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COMMUNITY HEALTH NURSING
04/18/2023 1
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04/18/2023 2
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Community Health Nursing: The 3 Broad Concepts
1. What is a community?– a group of people with
common characteristics or interests living together within a territory or geographical boundary
– place where people under usual conditions are found
– The community is the object or focus of care in CHN, with the family as the unit of service.
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FACTS of CHN
Focus : promotion and preservation of health
Area of Content: skills and knowledge relevant to both nursing and public health
Clients : general populations (individuals, families, communities)
Time : continual, not limited to episodic care
Scope : comprehensive and general, not limited to a particular age or group
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Concepts on Community Health Nursing:
CLIENTS of Community Health NurseComposed of different levels
of clientele: Individual, family, population group, and community
• Community as a SETTING for CHN PRACTICE School Health Nursing-
School Occupational Health
Nursing- Workplace Public Health Nursing-Home
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2. What Is Health?
A state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity (WHO, 1995).
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What is Health?
It carries the mandate that health is a basic human right.
It is seen as a spectrum or a continuum
• The modern concept of health refers to Optimum Level of Functioning (OLOF) of individuals, families, and communities, which is influenced by the ecosystem through a myriad of factors.
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What influences OLOF?
• Behavioral (culture, habits, mores, ethnic customs)
• Socio-economic (employment, education, housing)
• Political (safety, oppression, people, empowerment)
• Hereditary (genetic endowment, familial, racial)
• Health Care Delivery System (promotive, preventive, curative, rehabilitative)
• Environment (air, food, water, wastes, noise, radiation, pollution, congestion)
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3. What is Nursing?
The diagnosis and treatment of human responses to actual or potential health problems (ANA, 1980).
Nursing, together with public health, is one of the helping professions in the health care system which operates at three levels of clientele – individuals, families or groups, and communities
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It operates within the realm of health care both independently and interdependently.
The objective of nursing is to assist clients to achieve, maintain, or recover a high level of functioning.
Assisting sick individuals to become healthy and healthy individuals achieve optimum wellness (Henderson)
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The PHILOSOPHY of CHN
• is based on the worth
and dignity of man
(Shetland)
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•Concepts and Principles
pertaining to CHN
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Knowledge-base of CHN• Biological and social sciences
• Ecology
• Clinical Nursing
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•Utilizes COMMUNITY HEALTH ORGANIZATIONS
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it is population-focused – “the greatest good for the greatest number” > Community diagnosis
> Vital statistics
> Priority setting
it is a promotive-preventive service
– adheres to Primary Health Care > Health education
> Preventive treatment
• It is a generalist practice – deals with all cases
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The ULTIMATE GOAL of CHN
RAISE the level
of health
of citizenry
…
04/18/2023 16
• By: help communities and
families cope with discontinuities in health and threats
Maximize their potential for high level wellness
Promote reciprocally supportive relationship between people and their physical and social environment
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The PRIMARY FOCUS of CHN
health promotion wherein health teaching is the
primary responsibility of the community health nurse,
who is a generalist in terms of practice
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Principles of CHNE – ducation as primary tool and responsibilityM – ade available to all regardless of race, creed and socio-economic
statusP – olicies and objectives of the agency is fully understood by the nurseO – rganizing for health, with the family as the unit of serviceW – orks as a member of the health team (PHN)E – xisting active organizations are utilizedR – ecording and reporting are accurateM – onitoring and evaluation of services is periodically doneE – xisting indigenous resources of the community is usedN – eeds of clienteles is recognized and serves as basis for CHNT – raining and development as opportunities for continuing staff education
programs
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REMEMBER that in CHN:
1. The patient in CHN is the Community which is composed of different population groups and several families (the basic unit of care), and In turn compose of individuals.
2. Client is ACTIVE and NOT PASSIVE recipient of care
3. CHN practice is affected by any changes in society and environment
4. Multi-sectoral effort is the key to goal achievement
5. CHN is a part of health care system and the larger human services system.
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Quick Review Exercises
(QRX)
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QRX
In terms of CHN practice, the nurse in the community is trained as
a. Certified in public healthb. Specialist in CHNc. 4-year BSN graduated. Generalist in nursing
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Ans: d. Generalist in nursing
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QRX
The thrusts of CHN must be embodied in the hearts of health care providers. Which one strengthens the health care system?
a. Supporting conditions for healthy habits
b. Increasing opportunities to be healthy
c. Letting the people manage their own health
d. Financing health care program
Ans: c.Letting the people manage their own health
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Ans: c.Letting the people
manage their own health
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QRX
As a Public Health Nurse, what is your primary function or responsibility?
a. Reporting of casesb. Health Promotionc. Community Diagnosisd. Health Teaching
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• Ans:
d. Health
Teaching
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QRX
The philosophy of CHN practice is based on the belief that the family is the smallest unit in a democratic society. Which age group should be the priority of the nurses in the community?
a. Older persons and terminally ill
b. Adolescents and adultsc. Infants and childrend. All ages regardless of status 04/18/2023 27
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Ans:
d. All ages regardless
of status
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HIGHLIGHTS in CHN Concepts
CHN is based on the recognized needs of communities, families,
groups, ands individuals.
• CHN is a unique blend of nursing and public health practice, and is oftentimes used interchangeably
with the term “Public Health Nursing”. 04/18/2023 29
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Philosophy of Public HealthHealth and longevity as birthrights
Longevity – average lifespan or life expectancy• 50 years – Swaroop’s Index• Untimely death – person died without reaching
the average lifespan
Combined (M/F) – 69.6 y/o Male – 66.74 y/o Female – 72.61 y/o
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Objectives of Public Health
3 P’s:
Promote health
Prevent Disease
Prolong Life
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Basic Public Health Services
• Environmental Sanitation• Health Education• Prevention of Communicable Diseases• Medical Services• Nursing Services• Vital Statistics• Public Health Laboratories• Maternal and Child Health Services
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Basic Competencies Needed by the Public Health Nurse
• Teaching• Management• Critical Thinking• Physical Caregiving• Application of the Nursing Process• Application of the Epidemiological
Process• Documentation04/18/2023 33
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Functions of the PHN
Manager> Planner, Programmer, Supervisor, Coordinator of services
Health Care Provider> Direct nursing care
Researcher> Epidemiologist, Health Monitor, Recorder, Statistician
Community Organizer> Change Agent
Trainer> Health Educator, Counselor
Role Model
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In the care of the families:
Provision of primary health care services Developmental/Utilization of family
nursing care plan in the provision of care
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In the care of the communities: • Community organizing mobilization, community development
and people empowerment
• Case finding and epidemiological investigation
• Program planning, implementation and evaluation
• Influencing executive and legislative individuals or bodies concerning health and development
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Responsibilities of CHN:
– be a part in developing an overall health plan, its implementation and evaluation for communities
– provide quality nursing services to the three levels of clientele, the standards ser for CHN practice
– maintain coordination/linkages with other health team members, NGO/government agencies in the provision of public health services
– conduct researches relevant to CHN services to improve provision of health care
– provide opportunities for professional growth and continuing education for personal growth thru staff development
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CHN Process
1.Establishing a working relationship with the client• Initiating contact• Communicating interest in the
client’s welfare• Showing willingness to help with
expressed need of the client• Maintaining a two-way
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CHN Process
2. Assessment of needs, taking into consideration personal, environmental and psycho-socio- cultural factors influencing health
• Situation and trends revealed in personal, socio- economic and environmental history
• Physical, emotional, intellectual ability to perform a function
• Attitudes, knowledge and perceptions of health and illness
• Health behavior and patterns of health care• Resources available to meet own needs• Other factors affecting health
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A. Collection of DataA. Community
Demographic data Vital statistics Community Dynamics Disease surveillance Economic, cultural , and environmental characteristics Health service utilization
B. Family and Individual
- Health status/ education Socio-cultural factors Occupation Family dynamics Environment Patterns of coping
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B. Categories of Health ProblemA. Wellness State
B. Health Deficit
C. Health Threat
D. Foreseeable Crisis
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CHN Process
3. Planning of care
• Summarizing problems and needs
• Establishing priorities of care• Setting objectives of care• Determining approaches or
strategies to meet identified objectives04/18/2023 42
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CHN Process
4. Implementation of care
• Actual delivery of care• Institution of planned
interventions• Application of coordination,
supervision, social mobilization, health education,
therapeutic communication04/18/2023 43
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CHN Process
5. Evaluation of care
• Monitoring of status• Systematic documentation of
results• Analysis of effectiveness of
care provided(Structural elements, Process
Elements, and Outcome elements)04/18/2023 44
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Levels of Clientele
Individual • Basic approaches in
looking at the individual:
– Atomistic
– Holistic
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Family
Models:
Developmental
Stages of Family Development
Stage 1 – The Beginning Family
Stage 2 – The Early Child-bearing Family
Stage 3 – The Family with Preschool Children
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Stage 4 – The Family with School Age Children
Stage 5 – The Family with Teen-agers
Stage 6 – The Family as Launching Center
Stage 7 – The Middle-aged Family
Stage 8 – The Aging Family
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Structural-Functional
Initial Data Base
Family structure and Characteristics
Socio-economic and Cultural Factors
Environmental Factors
Health Assessment of Each Member
Value Placed on Prevention of Disease
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First Level Assessment
Health threats: conditions that are conducive to disease, accident or failure to realize
one’s health potential
Health deficits: instances of failure in health maintenance (disease, disability,
developmental lag)
Stress points/ Foreseeable crisis situation: anticipated periods of unusual demand on the individual or family in terms
of adjustment or family resources
Wellness State/ Potential
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Second Level Assessment: • Recognition of the problem• Decision on appropriate health action• Care to affected family member• Provision of healthy home environment• Utilization of community resources for
health care
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Problem Prioritization:
Nature of the problem
Wellness State
Health deficit
Health threat
Foreseeable Crisis
Preventive potential
High
Moderate
Low
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• Modifiability
Easily modifiable
Partially modifiable
Not modifiable
• Salience
High
Moderate
Low
*Family Service and Progress Record04/18/2023 52
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Population Group
• Vulnerable Groups:
Infants and Young Children
School age
Adolescents
Mothers
Males
Old People
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CHN Process
Community Diagnosis
• Determining the health status of the populations in the community as
well as the factors that directly or indirectly affect their health status
• It is an integral part of the assessment phase of the CHN Process
• It is also known as community assessment or situational analysis
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• A process by which the people in the community and the health team assess the community’s health problems and needs as bases for health program development.
• A learning process for the community to identify their own health problems and needs.
• A profile that depicts the health problems and potentials of the community.
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2 types of Community Diagnosis:
1. Comprehensive- provides general health profile of the community
2. Specific or Problem-Oriented- yields a comprehensive profile of a particular health problem
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STEPS:Preparatory Phase
1. site selection2. preparation of the community3. statement of the objectives4. determine the data to be collected5. identify methods and instruments for data
collection6. finalize sampling design and methods7. make a timetable
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Implementation Phase
1. data collection
2. data organization/collation
3. data presentation
4. data analysis
5. identification of health problems
6. prioritization of health problems
7. development of a health plan
8. validation and feedback
Evaluation Phase04/18/2023 58
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CHN Process
Parts of Community Diagnosis:
A. Demographic Variables
• Total population and population density
• Age and sex composition, Population Pyramid
• Sex Ratio
• Civil Status
• Population movement/patterns of migration
• Growth Rate, Life Expectancy
• Crude Birth Rate, Crude Death Rate04/18/2023 59
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CHN Process
Parts of Community Diagnosis:
B. Social Indicators
• Literacy Rate
• Educational attainment
• Communication network
• Transportation system
• Housing conditions (types, ownership, lighting, ventilation, crowding/congestion)
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CHN Process
Parts of Community Diagnosis:
C. Economic Indicators• Dependency Ratio
• Occupation
• Income
• Poverty index
• Unemployment Rate
• Underemployment Rate
• Types of industry present in the community04/18/2023 61
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CHN Process
Parts of Community Diagnosis:
D. Cultural Factors• Ethnicity
• Race
• Language
• Religion
• Beliefs (superstitions and traditions)
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CHN Process
Parts of Community Diagnosis:
E. Environmental Indicators• Topographical characteristics
• Water supply
• Garbage disposal/collection system
• Excreta disposal
• General sanitary condition
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CHN Process
Parts of Community Diagnosis:
F. Health Patterns• Food storage
• Infant feeding practice
• Immunization status
• Health seeking behavior
• Source of health information
• Leading causes of mortality, morbidity, infant mortality, infant morbidity, maternal mortality
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CHN Process
Parts of Community Diagnosis:
G. Health Resources• manpower-population ratio
• manpower distribution
• manpower policies
• health budget and policies
• sources of health funding
• categories of health institutions available
• categories of health services available04/18/2023 65
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CHN Process
Parts of Community Diagnosis:
H. Political and Leadership Patterns• Power structures in the community
• Confidence of people to authority
• Conditions that cause developmental conflicts
• Prevailing issues
• Practices that are usually utilized in settling concerns of the community
• Stakeholder Analysis04/18/2023 66
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CHN ProcessSteps in Conducting Community Diagnosis:
1. Determining the objectives
2. Defining the study population
3. Determining the data to be collected
4. Developing an instrument
• survey questionnaire
• interview schedule04/18/2023 67
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CHN ProcessSteps in Conducting Community Diagnosis:
5. Data gathering
• Records review
• Observation
• Surveys
• Interviews
6. Data collation04/18/2023 68
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CHN Process
Steps in Conducting Community Diagnosis:
7. Data presentation
8. Data analysis
9. Identification of CHN Problems
• Health status
• Health resources
• Health-related04/18/2023 69
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CHN Process
Steps in Conducting Community Diagnosis:
10. Prioritization of CHN Problems
• Nature
• Magnitude
• Modifiability
• Preventive potential
• Social concern 04/18/2023 70
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Biostatistics
A. Demography
A study of population size, composition, and spatial distribution as affected by births, deaths, and migration
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SOURCES OF DEMOGRAPHIC DATA:
1. Survey1. Census- De jure or De facto
2. Sample Survey
2. Continuing Population Registers
3. Other Records and Registration Systems
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COMPONENTS:Population Size
1. Natural increase2. Net migration3. Rate of natural increase
Population Composition4. Age Distribution5. Median Age6. Dependency Ratio7. Sex Ratio8. Population Pyramid9. Others: occupational groups, economic groups,
educational attainment, and ethnic groups
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Population Distribution1. Urban-Rural
• Shows the proportion of people living in urban compared to the rural areas
2. Crowding Index• Indicates the ease by which a communicable
disease can be transmitted from 1 host to another susceptible host
3. Population Density• Determines the congestion of the place
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B. VITAL STATISTICS The application of statistical measures to
vital events (births, deaths and common illnesses) that is utilized to gauge the levels of health, illness and health services of a community.
• Fertility Rate
– Crude Birth Rate– General Fertility Rate
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Mortality RatesCrude Death RateSpecific Mortality RateInfant Mortality RateNeonatal Mortality RatePost-neonatal Mortality RateMaternal Mortality RateProportionate Mortality RateSwaroop’s IndexCase Fatality RateCause-of- Death Rate
Morbidity RatePrevalence Incidence Rate
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C. EPIDEMIOLOGY
– The study of distribution of disease or physiologic condition among human population s and the factors affecting such distribution
– The study of the occurrence and distribution of health conditions such as disease, death, deformities or disabilities on human populations
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Basic Concepts:
–Epidemiologic Triad–Transmission – Incubation period–Herd immunity
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Factors affecting distribution:
• PERSON– intrinsic characteristics
• PLACE– extrinsic factors
• TIME– temporal patterns
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Patterns of Disease Occurrence:• Epidemic
– a situation when there is a high incidence of new cases of a specific disease in excess of the expected.
– when the proportion of the susceptible are high compared to the proportion of the immunes
• Epidemic potential – an area becomes vulnerable to a disease upsurge due to causal
factors such as climatic changes, ecologic changes, or socio-economic changes
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• Endemic – habitual presence of a disease in a given geographic location
accounting for the low number of both immunes and susceptible
e.g. Malaria is a disease endemic at Palawan. – the causative factor of the disease is constantly available or
present to the area.
• Sporadic – disease occurs every now and then affecting only a small
number of people relative to the total population– intermittent
• Pandemic – global occurrence of a disease
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THE NATIONAL HEALTH SITUATION
Health Care Delivery System
Health Care Delivery System is
“the totality of all policies, facilities, equipments, products, human resources and services which address the health needs, problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary.”
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According to Increasing Complexity of the Services
Provided
According to the Type of Service
Type Service Type ExamplePrimary Health Promotion,
Preventive Care, Continuing Care for common health problems, attention to psychological and social care, referrals
Health Promotion and illness Prevention
Information Dissemination
Secondary
Surgery, Medical services by Specialists
Diagnosis and Treatment
Screening
Tertiary Advanced, specialized, diagnostic, therapeutic & rehabilitative care
Rehabilitation
PT/OT
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Self-Reliant, Healthy Filipino
NGO/PS
LGU
DOH
The Healt
h Secto
r
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The Health Sector
Department of HealthVision: Leader and staunch advocate and model in promoting Health for ALL in the Philippines
Mission: Guarantee equitable, sustainable, and quality health for all Filipinos, specially the poor and shall lead the quest for excellence in health
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3 Major Functions:
1. LEADERSHIP in healthNational policy – formulation, monitoring and evaluationRegulatory institutionAdvocates adoption of health policies, plans and programs
2. Enabler and Capacity BuilderInnovate new strategies to improve health programsExercise oversight functionEnsure highest achievable standards
3. Administrator of Specific ServicesManage selected national health facilities and hospitalsAdminister direct services for emergent health concernsAdminister health emergency response services04/18/2023 86
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DOH ProgramsD – ental Health
O – perations for Environmental Sanitation
H – ealth Education and Community Organizing
P – revention and Control of Communicable Diseases
R – eproductive Health
O – lder Persons Health Services
G – uidelines for Nutrition
R – ehabilitation and Management of Non-communicable Dse.
A – lternative Health Care Practices (HerbalMeds/Acupressure)
M – aternal and Child Health and IMCI
S – entrong Sigla Movement04/18/2023 87
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Local Government Units (LGU)
RA 7160 Local Government Code
Private Sector
Composed of both commercial and business organizations, non-business organizations
Non-Government Organizations
Assumes the following roles:Policy and Legislative AdvocatesOrganizers, Human Rights AdvocatesResearch and DocumentationHealth Resource Development PersonnelRelief and Disaster ManagementNetworking
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PRIMARY LEVELHealth Promotion and
Illness Prevention
SECONDARY LEVELPrevention of
Complications thru Early Dx and Tx
TERTIARY LEVELPrevention of Disability,
etc.
Provided at –► Health care/RHU► Brgy. Health Stations►Main Health Center►Community Hospital and Health Center►Private and Semi-private agencies
► When hospitalization is deemed necessary and referral is made to emergency (now district), provincial or regional or private hospitals
► When highly-specialized medical care is necessary► Referrals are made to hospitals and medical center such as PGH, PHC, POC, National Center for Mental Health, and other gov’t private hospitals at the municipal level
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Primary Health Care
WHO: PHC was declared in the ALMA ATA CONFERENCE(USSR) in September 6-12, 1978, as a strategy to community health development.
Philippines: Adopted through LOI 949 signed by President Marcos on October 19, 1979 with the theme-
“Health in The Hands of the People by 2020”
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Primary Health Care
PHC
Community- Based
AccessibleAffordable
Acceptable Sustainable
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Framework
People Empowerment
Partnership
“Health for All Filipinos by the Year
2000 and Health in the Hands of the People
by 2020”
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How can PHC be possible?Control of Communicable Diseases
Offers Health Education
Maternal and Child Care
Provision of Medical Care and Emergency Treatment
Offers “Immunization”
Nutrition and Food Supply
Environmental Sanitation
N “Family Planning”
Treatment of Locally Endemic Diseases
Supply and Proper Use of Essential Drugs
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COMM.
PARTIPATION
SECTORAL
LINKAGES
PROPER
TECHNOLOGY
SUPPORT
MECHANISM
P I L L A R S O F P H C04/18/2023 94
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PILLARS
A. Multi-sectoral approach
Intersectoral linkages (population control, private sectors, social welfare, public service, enrironmental, etc.)
Intrasectoral linkages (people’s empowerment; within own system)
B. Community Participation
e.g. Community Organizing
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C. Appropriate Technology
- method used to provide a socially and environmentally acceptable
level of service or quality product at the least economic cost.
Criteria:
Safe
Acceptable
Feasible
Effective
Scope-wise
Affordable
Complex
Example:
- ORS- - Herbal Meds
- -Botica sa Baryo- -Use of Indigenous Materials
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10 Medicinal Plants:
Bawang-anti cholesterol
Ulasimang-Bato-lowers uric acid
Bayabas- antiseptic; diarrhea
Lagundi-cough, asthma, and colds
Yerba Buena- toothache, pain, and arthritis
Sambong- renal calculi
Ampalaya- diabetes mellitus
Niyog-niyogan- anti-helminthic
Tsaang-Gubat- diarrhea
Akapulko- fungal infection RA 8423: utilization of medicinal plants as
alternative for high cost medications04/18/2023 97
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D. Support mechanism made available
Village/Grassroots Health Workers
Intermediate Level Health Personnel of First-Line Hospitals
Trained CommunityHealth worker; health auxiliary volunteer; Traditional Birth Attendant
General Medical PractitionersPublic Health NursesMidwives
Physicians withspecialty areaNursesDentists
TYPES OF PRIMARY HEALTH WORKERS
Initial link, 1st contact of the community
1st source of professional healthcare
Establish close contact with the village and
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D – ental Health
O – perations for Environmental Sanitation
H – ealth Education and Community Organizing
P – revention and Control of Communicable Diseases
R – eproductive Health
O – lder Persons Health Services
G – uidelines for Nutrition
R – ehabilitation and Management of Non-communicable Dse.
A – lternative Health Care Practices (Herbal Meds/Acupressure)
M – aternal and Child Health and IMCI
S – entrong Sigla Movement
Strategies and Programs:
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Reproductive Health• Exercise of reproductive right & responsibility
• Vision: RH practice as a way of life for every man and woman throughout life
• Goals: 4 E’s> Every pregnancy should be intended
> Every birth should be healthy
> Every sex act should be free of coercion
> Every family should achieve its desired size04/18/2023 100