Community Health
Nursing
Lectured by: Z. Famorca, PhD, RN
DOTS
-
♥ Under the office of the president
Many are from Mindanao
Hospice home care
Parish Community Nursing
Faith community nursing
Treatment partner – follows up medication
“Public health is supposed to be given for free” FALSE
♥ PHN appoints a treatment partner
Financing of health services
♥ Another health worker that is accessible
- Out of pocket
– BHW
- Health maintenance organization (Phil Health)
3. Population/aggregate—focused
- Free at the point of care
- “The greater good of the majority”
♥ Government—Taxes are paid
- Community Diagnosis
Test taking technique
♥ Vital Statistics
- When choosing numbers choose the middle
ground
♥ Demography
- Do not choose the extreme numbers
- Magnitude (prevalence) of a problem
CHN: Definition
♥ A criterion for priority setting
1. Developmental Services
4. Promotive and preventive
- Development of health capability of Individual,
- Preventive treatment, e.g. DOTS
Family, Group, Community
- Health Education
♥ Groups with common susceptibility
♥ Same working group
5. Pre-paid service
- Enabling service self- reliance
- Taxation (public and school health)
- Health education—done for health promotion
- Passed on to consumer (occupational)
♥ Patient Education—Done when person
is sick
Transfer of Technology
6. Generalist Practice
- Community organizing
Labor Code: Health, Safety and Welfare Benefits
2. Community-based
- Book 4: Health, safety and welfare benefits
- Catchment
Number of workers
OH services
- Natural environment of people
10-50
Graduate first aider who may be
one of the workers
Home PHN
50-200
Non-hazardous: full-time first
School  SHN
aider
Workplace OHN
Hazardous workplace: OHN
3 fields of CHN Practice
- Case-finding of CHN practice
♥ Direct Sputum Smear Microscopy (TB)
♥ Weighing Scale or tape measure for
mid-upper arm circumference
(Malnourishment)
2 types of community:
- Geo political community
♥ Barangay
♥ City
♥ Province
- Phenomenological
GIDA- Geographically Isolated and Deprived Areas
- Cooperative Development Authority
200-300
>300
OHN, Part-time physician and
dentist (at least 2hrs a day),
emergency clinic (1 bed: 100
workers) or hospital within 5 km
Full time DMD and MD
RA 124—mandates all schools to have a school clinic for
the treatment of minor ailments and attendance to
emergency cases (1947)
- School health physician reports to the board of
health (DOH)
Functions of OHN and SHN
1. Health care provider
- Promotive and preventive services
♥ Health advocacy
♥ Health education and counseling
♥ Immunization, prenatal care
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-
Treatment of common ailments and emergency
nursing care
♥ CD control
- Screening for health problems:
♥ School health and nutrition survey—
done on the 1st visit by the nurse and
every 3 years thereafter
♥ Random/rapid classroom inspection
♥ Annual individual health inspection
o Interview
o Height and weight
measurement
♥ Head to foot examination for
cleanliness, skin disease and other
obvious abnormalities
♥ Visual acuity test: a child with visual
acuity of 20/40 or poorer to be referred
♥ Ear exam and hearing acuity test:
otoscopy, whisper test, ballpen click
test or with the use of tuning fork
(ototoxicity for Streptomycin)
2. Environmental Manager
- Monitoring environmental conditions
- Recognizing and reporting accident and health
hazards in workplace/school
- Healthful school living
- Application of ergonomic principles (physical
environment)
3. Health coordinator
- Making referrals to other agencies and health
personnel
- Coordination with public health nurse, e.g. for
immunization of school children
- Private sector
Philosophy of public health nursing (Margaret Shetland)
- PHN is based on the worth and dignity of man
♥ Contribute to the integrity of the
Individual, Family and Community
- The family is the basic unit of service in PHN
- Physical and emotional health are inseparable
♥ Consider physical and emotional
aspects of the needs of all the members
of the family
Public Health Nursing (WHO expert committee on
nursing)
- PHN is a special field of nursing that combines
the skills of:
♥ Public health
♥ Nursing
♥ Some phases of social assistance –
feeding program
4P’s Pantawid pamilyang Pilipino Program
(CCT- conditional cash transfer)
- Poverty alleviation
♥ MDG1: Eliminate hunger and poverty
th
- 5 Quintile and instrument to identify “True
Poor”
Benefits:
1. P500/month
2. For every qualified child (max of 4 up to 15yrs)
- P300/month for 10 mos.
Conditions:
1. 85% of class days, students should be present
2. Immunization up to the age of 4
3. Children will be in the garantisadong pambata
program
-
Public Health (C.E.Winslow)
Philosophy of public heatlh
- “Health and longevity” as “birth rights”
- Premature death (*untimely death)
Objectives of public health
- To prevent disease
- To prolong life
- To promote health and efficiency
Organized community efforts
- People
Primary Health Care
RHU
PHN functions as part of a total public health
program
♥ Health team
♥ 1 municipal health plan
- Objectives of PHN
♥ Promotion of health
♥ Improvement of conditions in the
physical and social environment
♥ Rehabilitation
♥ Prevention of illness and disability
Basic competencies of the Public Health Nurse
- Patient care competencies
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♥
♥
CHN process
Nursing procedures during clinic and
home visits
♥ Surveillance
- Health promotion and education
- Communication
- Collaboration: community organizing
- Empowering competencies
♥ Legal responsibility
♥ Ethico-moral responsibilities
♥ Personal and professional development
- Enabling competencies
♥ Management of resources and
environment
♥ Record management
- Enhancing competencies
♥ Research
♥ Quality improvement
Level of Prevention
- Target population:
♥ Beneficiaries (For whom?)
♥ Purpose of the nursing action: aspect of
prevention (for what?)
Primary level
- Target population: well individuals, families,
groups and communities
- Aspects of prevention
♥ General health promotion
♥ Specific disease prevention
o Prevent from a single person
♥ Specific protection
o Groups of people
o ASIN Law- “An Act for Salt
Iodization Nationwide”
Secondary Level
- Target Population: Early sick + subclinical cases
(asymptomatic)
- Aspects of prevention
♥ Early diagnosis and prompt treatment
♥ Prevention of complications
Tertiary Level
- Target population: Late sick: convalescent,
disabled, complicated case, terminal ill
Natural hx of disease
PrePathogenesis
Pathogenesis
Interaction
Millennium Summit: September 6-8, 2000
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce by2/3 the under 5 mortality rate
(1990:80/1000 live births 2015: 26.7/1000)
5. Reduce by ¾ the maternal mortality rate (1990:
2.09/1000 live births 2015: 52/1000 live
births)
6. Combat HIV/AIDS, malaria and other disease
1993: eradication of
1. Polio
2. Neonatal Tetanus
3. Measles
4. Rabies
7. Ensure environmental sustainability
8. Develop a global partnership for development
World Health Organization (MDG4-6)
The Department of Health
Vision- Mission
Vision
To staunch advocate, model and leader of health for all
in the Philippines
“A global leader for attaining better health
outcomes, competitive and responsive health
care system, and equitable health financing.”
Mission
“To guarantee equitable, sustainable and quality health
for all Filipinos, especially the poor, and to lead the
quest for excellence in health.”
Roles and functions of the DOH
1. Leader
a. Planner and policy-maker
b. Regulator of health services
c. Advocate in the adoption of health policies,
plans and programs
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2. Enabler and capacity builder
a. Develop new strategies in health
b. Initiate public discussion on health issues
and disseminate info on research outputs
c. Ensure standards of health promotion,
protection and care (training)
3. Administrator of specific services
a. Manage selected national health facilities
b. Administer direct services for emergent
health concerns that require new
complicated technologies
c. Administer health emergency responses
Universal Health Care
(2010-2016)
FOURmula One for
Health (2005-2010)
Health Sector Reform
Agenda (1999-2004)
Goals
Better Health
outcomes
Responsive
health system
Equitable health
financing
Health care delivery system of the Philippines
Primary Level
- Promotion and prevention
- Management of prevalent conditions
- Out-patient services
Secondary
- Hospitalization
Tertiary
- Specialized care
♥ Specially trained personnel
♥ Highly departmentalized
♥ Sophisticated equipment
National hospitals/DOH national office/ medical
centers/ university hospitals/ special hospitals
Center for health development
Provincial hospital (PHO)
Priority Health Policy Directions of the Aquino
Administration
Prove Health Board
Chair: Governor
Vice-chair: IPHO
District hospital (DHO)
RHU/CHC/CHO
Financial Risk
Protection
BHS
Municipal/city Health Board
Chair: Mayor
Vice-chair: Municipal Health Officer
RA 7160—devolution code
Achieving
MDGmax
Health
facilities
enhancement
Universal Health Care
Strategies
1
2
Health Financing Service Delivery
6
Health Human
Resource
5
Health
information
3
Policy and
regulation
4
Governance for
Health
Inter Local Health System
- To ensure quality of health care service at the
local level integrate hospital and public
health services  holistic health care
- Inter Local Health Zone (ILHZ)
♥ Clustered municipalities (defined
population within a defined area)
♥ Primary level facilities (RHU’s and
BHS’s)
♥ Central referral hospital
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Components of the ILHZ
- People—may vary, according to WHO, between
100, 000 to 500, 000
- Boundaries—to determine accountability of
health service providers
- Health facilities- secondary level hospital
(district of provincial), RHU’s BHS’s and other
health facilities
- Health workers—both government and nongovernment
Two-way referral system
- Communication among facilities
The RHU team
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