o Public Health Nurse is strategically

OVERVIEW OF THE COMMUNITY HEALTH positioned to make a difference in the

NURSING health outcomes of individuals, families and
communities cared for.
WEEK 3
➢ Characteristics of a PUBLIC HEALTH
➢ WHAT IS A COMMUNITY? NURSE

o A group of people with common o Has a good understanding of the current

characteristics and interest living together health system and political infrastructure.
within a territory or geographical boundary. o Sensitive to the political and social
implications of the dynamics of health.
o Place where people under usual conditions o Adept in public relations.
are found. o Can relate with anybody across the social,
political, religious and economic spectrum.
➢ WHAT IS COMMUNITY HEALTH? o With comprehensive grasp of current
situations that impact on the health of the
o Part of paramedical and medical people.
intervention which is concerned on the
health of the whole population. ➢ Community Health Nursing
Definition
o AIMS: ❖ "The utilization of the nursing process in
the different levels of clientele-individuals,
1. Health promotion families, population groups and
communities, concerned with the
2. Health prevention promotion of health, prevention of disease
and disability and rehabilitation."- Maglaya,
3. Management of factors affecting health et al
❖ “Synthesis of nursing knowledge and
➢ practice and the science and practice of
PUBLIC HEALTH NURSING public health, implemented via a
The term used before for Community Health systematic use of the nursing process and
Nursing. other processes to promote health and
o According to DR. C.E. WILSON, Public prevent illness in population groups.”-
Health is a Science and part of 3 P’s.. Clark, et.al.
❖ “A service rendered by a professional
1. Prevention of disease nurse to individuals, families, communities
and population groups in health centers,
2. Prolonging of life clinics, schools, and the workplace in order
to promote health, prevent illness, provide
3. Promotion of health through organized care for the sick at their respective homes,
community effort provide care for the sick at their respective
homes, provide effective rehabilitation” -
o Public health nursing in the Philippines Freeman.
evolved along side the institutional ❖ The synthesis of nursing practice and
development of the Department of Health public health practice applied to promoting
(DOH). and preserving the health of the
o DOH- is the government agency mandated populations.” - ANA, 1986
to protect and promote people’s health and
the biggest employer of health workers
including public health nurse.

o In the light of changing national and global

health situation and that nursing is a
significant contributor to health, the
➢ The following statements ➢ ROLES AND FUNCTIONS
characterize CHN:
✓ The roles and functions of nurses are
1. Promotion of health and prevention of defined by the nursing law (RA 9173) and
disease are the goals of professional standards that are developed by
practice. professional associations such as:

2. CHN practice is comprehensive, general, 1. Philippine Nurses Association (PNA)

continual and not episodic.
2. Occupational Health Nurses Association of
3. There are different level of clientele- the Philippines (OHNAP)
individuals, families, population groups and
community. 3. National League of Philippine Government
Nurses (NLPGN)
4. The nurse and the client have greater
control in making decisions related on 4. Department of Education (DepEd)
health care.
➢ What is RA 9173 all about?
5. The nurse recognizes the impact of different
factors on health and has a greater This Act shall be known as the “Philippine
awareness of his clients’ lives and Nursing Act of 2002.” The State hereby
situations. guarantees the delivery of quality basic health
services through an adequate nursing
➢ 2 Major Fields of Nursing in the personnel system throughout the country.
Philippines • The Philippine Nurses Association
o Community Health Nursing
(PNA)
- School health nursing Is a professional organization in the
Philippines established to promote the holistic
- Occupational health nursing
welfare of nurses and to prepare them to be
globally-competitive.
- Public health nursing
• It used to be known as Filipino Nurses
o Hospital Nursing or Institutional
Association (FNA). It was founded by
Nursing Anastacia Giron-Tupas in 1922. It is located
➢ COMMUNITY HEALTH NURSING IN at 1663 F.T. Benitez Street, in Malate,
THE PHLIPPINES Manila.

1. Public health nursing- Public health • The Occupational Health Nurses

nurses together with the other members Association of the Philippines (OHNAP),
of the health team are the implementers Inc. is a non-stock, non- profit professional
of the local government units in organization of nurses working in the
promoting and protecting the health of industrial, agricultural, commercial,
their constituents. educational, service (hotel & restaurant),
government and non government
2. Occupational health nursing- aimed at institutions.
assisting workers in all occupations to
cope with actual and potential stresses • The National League of Philippine
in relation to their work and work Government Nurses (NLPGN)
environment.
• The National
3. School nursing- aims to promote the League for Nursing promotes excellence
health of school personnel and students. in nursing education to build a strong and
diverse nursing workforce to advance the
health of our nation and the global
community.
• Promote the preparation of a E – ducation as primary tool and
diverse nurse workforce that contributes to responsibility
health care quality and safety.
M – ade available to all regardless of race,
➢ The PHILOSOPHY of CHN creed and socio-

• is based on the worth and dignity of man economic status

(Dr. Margaret Shetland) P – olicies and objectives of the agency is

fully understood by
➢ Goal of CHN
the nurse
- To assist the individual, family and
community in attaining their highest level
O – rganizing for health, with the family as
of holistic health which is attained
the unit of service
through multidisciplinary effort
- To promote mutual and supportive W – orks as a member of the health team
relationship between people and their
(PHN)
physical and social environment
➢ The ULTIMATE GOAL of CHN E – xisting active organizations are utilized
RAISE the level of health of citizenry… By: R – ecording and reporting are accurate
❑ Helping communities and families cope M – onitoring and evaluation of services is
with health threats periodically done
❑ Maximizing their potential for high level E – xisting indigenous resources of the
wellness community is used
❑ Promoting relationship between people and N – eed of clientele is recognized and serves
environment as basis for CHN
➢ BASIC PRINCIPLES OF CHN T – raining and development as
opportunities for continuing staff education
• The community is the patient in CHN. programs
• The family is the unit of care
➢ Missions of CHN
➢ 4 LEVELS OF CLIENTELE: ◾ Health Promotion
1. Individual- sick or well ▪ Actions related to lifestyles and
choices that maintains/enhances a
2. Family- a collection of people who are
population health
integrated, interacting and interdependent.
◾ Health Protection
3. Population group- those who share common
characteristics, development stages and ▪ Includes activities designed to
common exposure to health problems. e.g. detect or prevent illness or alter
children, elderly disease processes
4. Community- a group of people sharing ◾ Health Balance
common geographic
boundaries/values/interests within a specific ▪ State of well being that results from
social system. a healthy interaction between a
person’s body, mind, spirit and
➢ Principles of CHN environment
◾ Disease Prevention 8. Maternal and Child Health Services

▪ Activities designed to protect people Roles of the Healthcare Provider in Caring of

from disease and its consequence the Community and Population Groups

◾ Social Justice ➢ Basic Competencies Needed by the

Community Health Nurse
▪ All the people have the right to a
certain “basics” of life and health • Teaching
protection
• Management
➢ HIGHLIGHTS in CHN Concepts
• Critical Thinking
• CHN is based on the recognized needs of
communities, families, groups, and • Physical Caregiving
individuals.
• Application of the Nursing Process
• CHN is a unique blend of nursing and public
health practice, and is often times used • Application of the Epidemiological Process
interchangeably with the term “Public Health
• Documentation
Nursing”.

➢ REMEMBER that in CHN: ➢ ROLES OF THE HEALTH CARE

PROVIDER
1. The patient in CHN is the Community which
is composed of different population groups 1. Client oriented role
and several families (the basic unit of care),
and In turn compose of individuals. - Involve direct provision of services to
individuals, families, and occasionally
2. Client is ACTIVE and NOT PASSIVE groups of people.
recipient of care - Care Giver, Counselor, Educator, Referral
Source, Role Model, Case Manager
3. CHN practice is affected by any changes in
society and environment

4. Multi-sectoral effort is the key to goal 2. Delivery oriented role

achievement
- Are those designed to enhance the
5. CHN is a part of health care system and the operation of the health care delivery system,
larger human services system. - Resulting in better care for clients.
- Roles in this category include coordinator or
➢ Basic Public Health Services care manager, collaborator and liason.

1. Environmental Sanitation

2. Health Education 3. Population oriented role

3. Prevention of Communicable Diseases - Those directed toward promoting,

maintaining, and restoring the health of the
4. Medical Services population and include those of case finder,
leader and change agent
5. Nursing Services - Case finder, Change agent, Leader,
Community Mobilizer, Coalition builder,
6. Vital Statistics Researcher, Policy advocate, Social
Marketer
7. Public Health Laboratories
 – 1928 first convention of nurses was
Brief history of CHN Week 4 held

➢ PHN in the Philippines – 1940- DOH and Welfare was

created/Manila Health Department
• Pre- Spanish Era- no records
– 1941 – Dr. Mariano Icasiano became
• Spanish Regime (1591-1898) the first City Health Officer of Manila

– Bro. Juan Climente (1577) – Started o Office of Nursing was created

Public Health Services though a through the effort of Vicenta
dispensary in Intramuros Ponce (chief nurse) and Rosario
Ordiz (assistant chief nurse)
– Started water sanitation
– 1942 – Dr. Eusebio Aguilar was the director
– Introduced small pox vaccine of Bureau of Health
– Creation of position of district,
• Japanese Regime (1942-1945)
provincial, national health officers
PHN services were interrupted
• American Regime (1898- 1942)
• Era of the Republic of the
– 1898 creation of board of the Health for
Philippines (1946 to present)
Physician
• 1947 DOH was divided into 3
– 1899 appointment of the first
bureaus
commissioner of health
a. Hospital
– 1901 Act # 157 (Board of Health of the
b. Quarantine
Philippines); Act # 309 (Provincial and
c. Health
Municipal Boards of Health) were
created. • 1948 – first training center (Tabon Health
Center later named as Doña Marta Health
– 1906 abolition of the board of health,
Center) of the BOH was organized with the
creation of bureau of health
Pasay City Health Department.
– 1912 PHN started in Cebu w/ 4
Training Staff:
graduate nurses who dealt primarily in
MCH services • Trinidad Gomez
• Marcela Gabatin
– 1915 PHN began in Manila with 2 • Costancia Tuazon
nurses who offered follow-up care of • Ms. Bugarin
OB patients and environmental • Ms. Ramos
sanitation services • Zenaida Nisce
– 1919 Carmen del Rosario was first • 1950 – Rural Health Demonstration and
Filipino Nurse Supervisor appointed Training Center was established by the
under the Bureau of Health DOH. The first supervising training nurse
was Ms. Marta Obaña
– 1923 Establishment of 2 government
Schools of Nursing (Zamboanga
General Hospital School of Nursing and
Baguio General Hospital)
• 1953 – Ms. Zenaida Panlilio and Ms. mayor. Material supplies of health center
Leonora Liwanag (first graduates of have to be provided by the LGUs.
BSNursing degree)
• 1996 – PHC was created
• Ms. Florida Ramos and Ms. Lydia Amurao
(first public health nurses) • Jan. 1999 - Nelia Hizon was positioned as
the nursing adviser at the Office of Public
• May 18, 1954 – RA 1082 (first RHU Act) Health Services through Department
was passed, implemented in July of the Order # 29.
same year, provided for the employment
of health personnel, including nurses, who • May 24, 1999 - EO # 102, which redirects
would man the RHUs and help raise the the functions and operations of DOH, was
health conditions of the rural population. signed by former President Joseph
Estrada.
• June 1957 – RA 1891 (2nd RHU Act - An Act
Strengthening Health and Dental Services • 1999-2004 – Health Sector Reform Agenda
in the Rural Areas and Providing Funds (HSRA) was launched
Thereof) was approved; created eight(8)
• 2005 – Fourmula One for Health (F1) was
categories of RHUs
launched
corresponding to 8 population groups to
be served. • 2005-2010 – National Objectives for
Health (NOH) on MDG, HSRA and F1
• 1961 - Annie Sand organized the National
League of Nurses of DOH.

• 1967 - Zenaida Nisce became the nursing

program supervisor and consultant on the
six special diseases (TB, leprosy, V.D.,
cancer, filariasis, and mental health
illness).

• 1975 – Formulation of the National Health

Plan and the restructured Health Care
Delivery System.

- Scope of responsibility of nurses

and midwives became wider

• 1976-1986 – Rural Health Practice

Program

• 1991 – The Local Government Code Code

of 1991 (R.A. 7160) was passed and
implemented.

• 1992- Devolution transferred authority to

LGU by virtue of the Local Government
Code. Appointments of RHU/City Health
Department personnel (including nursing
personnel) have to be approved by the
 Community Health and Development Concepts, Principles and Strategies

Primary Health Care Characteristics of PHC Essential Services

• May 1977 – 30th World Health Assembly

• Attainment of a level of health that would Community-

permit them to lead a socially and Based
economically productive life by the year 2000.

• WHO: PHC was declared in the ALMA ATA

• CONFERENCE(USSR) in September 6-12, Affordable Accessible

1978, as a strategy to community health
development.
PHC
• Philippines: Adopted through LOI 949 signed by
President Marcos on October 19, 1979 with the
theme-
o “Health for all Filipinos by the year
2000 and Health in The Hands of the Acceptable Sustainable
People by 2020”

Rationale for Adopting Primary Health Care

Objectives of Primary Health Care
• Magnitude of Health Problems
1. Improvement in the level of health care of the
• Inadequate and unequal distribution of health
community
resources
2. Favorable population growth structure
• Increasing cost of medical care
3. Reduction in the prevalence of preventable,
• Isolation of health care activities from other
communicable and other disease.
development activities
4. Reduction in morbidity and mortality rates
especially among infants and children.
Definition:
5. Extension of essential health services with
• Essential health care made universally priority given to the underserved sectors.
accessible to individuals and families in the
6. Improvement in Basic Sanitation
community by means acceptable to them
through their full participation and at a cost that 7. Development of the capability of the community
the community and country can afford at every aimed at self- reliance.
stage of development in the spirit of self-reliance
and self-determination (WHO). 8. Maximizing the contribution of the other sectors
for the social and economic development of the
community.
Key Strategy to Achieve the Goal: Mission

• Partnership with and Empowerment of the • To strengthen the health care system by
people increasing opportunities and supporting the
conditions wherein people will manage their own
health care.
TYPES OF PRIMARY HEALTH WORKERS Principles
1. 4 A's = Accessibility, Availability, Affordability &
Acceptability, Appropriateness of health
1. Village/Grassroots Health Workers services.
• Initial link, 1st contact of the community
2. Community Participation - heart and soul of
a. Trained Community Health worker PHC
b. health auxiliary volunteer
c. Traditional Birth Attendant 3. People are the center, object and subject of
development.
2. Intermediate Level
• 1st source of professional healthcare 4. Self-reliance

a. General Medical 5. Partnership between the community and the

b. Practitioners health agencies in the provision of quality of life.
c. Public Health Nurses
d. Midwives 6. Recognition of interrelationship between the
health and development

3. Health Personnel of First-Line Hospitals 7. Social Mobilization

• Establish close contact with the village
and intermediate level Health Worker 8. Decentralization

a. Physicians with
b. specialty area
c. Nurses
d. Dentists

Barriers of Community Involvement

1. Lack of motivation
2. Attitude
3. Resistance to change
4. Dependence on the part of community people
5. Lack of managerial skills
CHN Week 6: Obstacles and Framework Elements and support and commitment to major health concerns
Major Strategies of PHC through legislations, budgetary, and logistical
considerations
Obstacles for Primary Health Care 2. Promoting and Supporting Community Managed
Health Care- it necessitates a process of capacity
- Inequitable distribution of health care to lack of building of communities and organization to plan,
community participation and underdevelopment implement, and evaluate health programs at their
workforce and related resources levels
- inequitable distribution- major problem 3. Increasing Efficiencies in the Health Sector- the
- obstacles for PHC nursing: development of human resources must correspond
to the actual needs of the nation and the policies it
1. Role complexity uploads such as PHC (DOH)
2. Special responsibilities 4. Advancing Essential National Health Research-
3. Role confusion integrated strategy for organizing and managing
4. Lack of skills training research using intersectoral, multi-disciplinary, and
Framework of Primary Health Care scientific approach to health programming and
delivery (privacy)
- Promote a new approach, to work in partnership ,
to improve health outcomes that provides Pillars of PHC
mechanism for coordinated action among citizenry I. Sectoral Linkages “Multi-sectoral approach”-
and enable In more harmonize approach in primary deliberate collaborations among stakeholders
health care planning and service delivery • Intersectoral linkages- promotion and
- Framework: People Empowerment + Partnership = coordination of activities of different sectors
“Health for all Filipinos by the year 2000 and Health ✓ (population control, private sectors, social
in the Hands of the People by 2020 welfare, public service, environmental)
Elements of Primary Health Care • Intrasectoral lingkages- people’s
empowerment within own system
1. Education for Health- potent mythologist for
information dissemination Multisectoral approach: Examples of how non-health
2. Locally Endemic Disease Control- reduce morbidity sectors play a role in solution of common health
rate problems:
3. Expanded program on Immunization- control
o Agricultural sector- Malnutrition and Brucellosis
occurrence of preventable illnesses
o Municipality sector- Diarrhea, Hepatitis A, Typhoid
4. Maternal and Child Health and Family Planning-
o Social sector- Smoking, Divorce, Violence, Illiteracy,
mother and child as the delicate member of the
Unemployment
community and the spacing of children and
o Educational sector- Low IQ, Scabies, Retarded
responsible parenthood.
growth
5. Environmental Sanitation and Promotion of Safe
Water Supply- necessary for basic promotion of Levels of Governmental Health Care Services
health
6. Nutrition and adequate food supply- basic need of o Primary Health Care- Family Health Units & Family
the family Health Centers (1st contact between individuals and
7. Treatment of CD and common illness- TB has its health care system with out-patient & public health
program to give management on DOTS services)
8. Supply and Proper Use of Essential Drugs- o First referral-District Hospital & in-patient & out-
information campaign in utilization and acquisition patient services
of drugs (Generic Act) o Second referral- General Hospital
o Third referral- Teaching Hospital (major
Major Strategies of Primary Health Care contribution in moulding and upbringing different
medical professionals)
1. Elevating Health to a Comprehensive and
Sustained National Effort- advocacy must be
directed to National and Local policy making to elicit
II. Community Participation “Community Organizing”
• Financial participation
• Adopting healthful behaviors and avoiding harmful ones
• The population could be involved in defining health problems of the community and
setting up priorities
• Proper utilization of health services

III. Appropriate Technology

- method used to provide a socially and environmentally acceptable level of service or
quality product at the least economic cost
- Criteria:
• Safe (ORS)
• Acceptable (Herbal Meds)
• Feasible (Botica sa baryo)
• Effective (Growth Monitoring)
• Scope-wise (Breast Feeding)
• Affordable (Domiciliary treatment of TB)
• Complex

10 Herbal Medicine (DOH)- BUBLYSANTA

- Bawang (garlic)- anti cholesterol

- Ulasimang-bato (pansit-pansitan)- lowers uric acid, arthritis and cout
- Bayabas (guava)- anti-septic; diarrhea
- Lagundi (5-leved chaste tree)- cough, asthma, colds
- Yerba Buena (peppermint)- toothache, pain, arthritis
- Sambong (Bluemea Camphora)- renal calculi
- Ampalaya (Bitter Gourd)- diabetes mellitus
- Niyog-niyogan (Chinese Honey Sucke)- anti helminthic
- Tsaang Gubat- diarrhea
- Akapulko (bayabas-bayabasan/ringworm bush)- ringworm and skin fungal infection

RA 8423- utilization of medicinal plants as alternative for high cost medications

IV. Support mechanism made available

- Team- group of persons with different levels of knowledge, background, abilities,
qualifications, and or skills who share a common goal
- Team consist of:
• Personnel from other related sector
• Health Care Personnel
• Personnel from the community