Pamantasan ng Lungsod ng Maynila

Intramuros, Manila
College of Nursing

In partial fulfillment of the requirements in

NRS 2107 Community Health Nursing

WRITTEN REPORT

Submitted by:

Arciaga, John Stephen

Gonzales, Zarah
Habacon, Gabrielle Anne
Katada, Jermaine Faye B.
Romero, Cristine
Santiago, Toni Arstelle

BSN 2-4

Submitted to:
Prof. Lynnette G. Cleto, RN, MAN

August 13, 2019

Overview of the Public Health Nursing in the Philippines
(Arciaga, John Stephen)

A. Global and National Health Situations

Global Health Situation
It is estimated that the current world population (2006) is close to 6.5 billion and will reach
9 billion in the year 2050. Each person on earth has his own culture that is deeply ingrained with
beliefs and practices, which guides his daily behaviors, including those for health and illness. The
vast number of cultural diversity that exists both within and between groups of people is influenced
by genetics, psychological and environmental factors, such as geography, politics, economics, and
religion.
Hence, health care providers must be competent in observing the cultural practices of a
family or population groups and how it affects their health. They should have a working knowledge
of definitions and basic concepts, as briefly discussed in the next section, before performing field
activities and educating a particular community.

Ten Threats to Global Health in 2019

1. Air pollution and climate change

In 2019, air pollution is considered by WHO as the greatest environmental risk to

health. Microscopic pollutants in the air can penetrate respiratory and circulatory systems,
damaging the lungs, heart and brain, killing 7 million people prematurely every year from
diseases such as cancer, stroke, heart and lung disease. Around 90% of these deaths are in
low- and middle-income countries, with high volumes of emissions from industry,
transport and agriculture, as well as dirty cookstoves and fuels in homes.
The primary cause of air pollution (burning fossil fuels) is also a major contributor
to climate change, which impacts people’s health in different ways. Between 2030 and
2050, climate change is expected to cause 250 000 additional deaths per year, from
malnutrition, malaria, diarrhea and heat stress.
2. Non-communicable disease
Noncommunicable diseases, such as diabetes, cancer and heart disease, are
collectively responsible for over 70% of all deaths worldwide, or 41 million people. This
includes 15 million people dying prematurely, aged between 30 and 69.

Over 85% of these premature deaths are in low- and middle-income countries. The
rise of these diseases has been driven by five major risk factors: tobacco use, physical
inactivity, the harmful use of alcohol, unhealthy diets and air pollution. These risk factors
also exacerbate mental health issues, that may originate from an early age: half of all mental
illness begins by the age of 14, but most cases go undetected and untreated – suicide is the
second leading cause of death among 15-19 year-olds.

3. Global influenza pandemic

The world will face another influenza pandemic – the only thing we don’t know is
when it will hit and how severe it will be. WHO is constantly monitoring the circulation of
influenza viruses to detect potential pandemic strains: 153 institutions in 114 countries are
involved in global surveillance and response.
Every year, WHO recommends which strains should be included in the flu vaccine
to protect people from seasonal flu. In the event that a new flu strain develops pandemic
potential, WHO has set up a unique partnership with all the major players to ensure
effective and equitable access to diagnostics, vaccines and antiviral (treatments), especially
in developing countries.

4. Fragile and vulnerable settings

More than 1.6 billion people (22% of the global population) live in places where
protracted crises (through a combination of challenges such as drought, famine, conflict,
and population displacement) and weak health services leave them without access to basic
care.
Fragile settings exist in almost all regions of the world, and these are where half of
the key targets in the sustainable development goals, including on child and maternal
health, remains unmet.
 WHO will continue to work in these countries to strengthen health systems so that they are
better prepared to detect and respond to outbreaks, as well as able to deliver high quality
health services, including immunization.

5. Antimicrobial resistance
The development of antibiotics, antivirals and antimalarials are some of modern
medicine’s greatest successes. Antimicrobial resistance – the ability of bacteria, parasites,
viruses and fungi to resist these medicines – threatens to send us back to a time when we
were unable to easily treat infections such as pneumonia, tuberculosis, gonorrhoea, and
salmonellosis. The inability to prevent infections could seriously compromise surgery and
procedures such as chemotherapy.
Resistance to tuberculosis drugs is a formidable obstacle to fighting a disease that
causes around 10 million people to fall ill, and 1.6 million to die, every year. In 2017,
around 600 000 cases of tuberculosis were resistant to rifampicin – the most effective first-
line drug – and 82% of these people had multidrug-resistant tuberculosis.

6. Ebola and other high-threat pathogens

In 2018, the Democratic Republic of the Congo saw two separate Ebola outbreaks,
both of which spread to cities of more than 1 million people. One of the affected provinces
is also in an active conflict zone.
At a conference on Preparedness for Public Health Emergencies held last
December, participants from the public health, animal health, transport and tourism sectors
focussed on the growing challenges of tackling outbreaks and health emergencies in urban
areas. They called for WHO and partners to designate 2019 as a “Year of action on
preparedness for health emergencies”.

7. Weak primary health care

Primary health care is usually the first point of contact people have with their
health care system, and ideally should provide comprehensive, affordable, community-
based care throughout life.
 Primary health care can meet the majority of a person’s health needs of the course
of their life. Health systems with strong primary health care are needed to achieve
universal health coverage.

8. Vaccine hesitancy
Vaccine hesitancy – the reluctance or refusal to vaccinate despite the availability
of vaccines – threatens to reverse progress made in tackling vaccine-preventable diseases.
Vaccination is one of the most cost-effective ways of avoiding disease – it currently
prevents 2-3 million deaths a year, and a further 1.5 million could be avoided if global
coverage of vaccinations improved.

The reasons why people choose not to vaccinate are complex; a vaccines advisory
group to WHO identified complacency, inconvenience in accessing vaccines, and lack of
confidence are key reasons underlying hesitancy. Health workers, especially those in
communities, remain the most trusted advisor and influencer of vaccination decisions,
and they must be supported to provide trusted, credible information on vaccines.

9. Dengue

Dengue, a mosquito-borne disease that causes flu-like symptoms and can be lethal
and kill up to 20% of those with severe dengue, has been a growing threat for decades.
A high number of cases occur in the rainy seasons of countries such as
Bangladesh and India. Now, its season in these countries is lengthening significantly (in
2018, Bangladesh saw the highest number of deaths in almost two decades), and the
disease is spreading to less tropical and more temperate countries such as Nepal, that
have not traditionally seen the disease.
An estimated 40% of the world is at risk of dengue fever, and there are around
390 million infections a year. WHO’s Dengue control strategy aims to reduce deaths by
50% by 2020.
 10. HIV

The progress made against HIV has been enormous in terms of getting people
tested, providing them with antiretrovirals (22 million are on treatment), and providing
access to preventive measures such as a pre-exposure prophylaxis (PrEP, which is when
people at risk of HIV take antiretrovirals to prevent infection).
The epidemic continues to rage with nearly a million people every year dying of
HIV/AIDS. Since the beginning of the epidemic, more than 70 million people have
acquired the infection, and about 35 million people have died. Today, around 37 million
worldwide live with HIV.
This year, WHO will work with countries to support the introduction of self-
testing so that more people living with HIV know their status and can receive treatment
(or preventive measures in the case of a negative test result).

National Health Situation

Rapid economic growth and strong country capacity have contributed to Filipinos living
longer and healthier. However, not all the benefits of this growth have reached the most vulnerable
groups, and the health system remains fragmented.
Health insurance now covers 92% of the population. Maternal and child health services
have improved, with more children living beyond infancy, a higher number of women delivering
at health facilities and more births being attended by professional service providers than ever
before. Access to and provision of preventive, diagnostic and treatment services for communicable
diseases have improved, while there are several initiatives to reduce illness and death due to
noncommunicable diseases (NCDs). Despite substantial progress in improving the lives and health
of people in the Philippines, achievements have not been uniform and challenges remain. Deep
inequities persist between regions, rich and the poor, and different population groups.
Many Filipinos continue to die or suffer from illnesses that have well-proven, cost-effective
interventions, such tuberculosis, HIV and dengue, or diseases affecting mothers and children.
Many people lack sufficient knowledge to make informed decisions about their own health. Rapid
economic development, urbanization, escalating climate change, and widening exposure to
diseases and pathogens in an increasingly global world increase the risks associated with disasters,
environmental threats, and emerging and re-emerging infections.
10 Facts on Healthcare in the Philippines

1. The WHO refers to the Filipino Healthcare System as “fragmented.” There is a history of
unfair and unequal access to health services that significantly affects the poor. The
government spends little money on the program which causes high out of pocket spending
and further widens the gap between rich and poor.
2. Out of the 90 million people living in the Philippines, many do not get access to basic care.
The country has a high maternal and newborn mortality rate, and a high fertility rate. This
creates problems for those who have especially limited access to this basic care or for those
living in generally poor health conditions.
3. Many Filipinos face diseases such as Tuberculosis, Dengue, Malaria and HIV/AIDS. These
diseases pair with protein-energy malnutrition and micronutrient deficiencies that are
becoming increasingly common.
4. The population is affected by a high prevalence of obesity along with heart disease.
5. Healthcare in the Philippines suffers from a shortage of human medical resources,
especially doctors. This makes the system run slower and less efficiently,
6. Filipino families who can afford private health facilities usually choose these as their
primary option. Private facilities provide a better quality of care than the public facilities
that lower income families usually go to. The public facilities tend to be in rural areas that
are more run down. These facilities have less medical staff and inferior supplies.
7. Only 30 percent of health professionals employed by the government address the health
needs of the majority. Healthcare in the Philippines suffers because the remaining 70
percent of health professionals work in the more expensive privately run sectors.
8. To compensate for the inequality, a program called Doctors to the Barrios and its private
sectors decided to build nine cancer centers, eight heart centers and seven transplant centers
in regional medical centers.
9. The Doctors to the Barrios included Public-Private Partnerships in a plan to modernize the
government-owned hospitals and provide more up to date medical supplies.
10. More than 3,500 public health facilities were updated across the country.
B. Definition and Focus
(Katada, Jermaine Faye B.)
1. Public Health
Public Health according to Charles-Edward Amory Winslow (1920) – “...the science and art
of preventing disease, prolonging life and promoting health and efficiency through organized
community effort for:
 the sanitation of the environment
 the control of communicable infections
 the education of the individual in personal hygiene
 the organization of medical and nursing services for the early diagnosis and
preventive treatment of disease;
 and for the development of the social machinery to insure everyone a standard of
living adequate for the maintenance of health, so organizing these benefits as to
enable every citizen to realize his birthright of health and longevity.” (Association
of Accredited Public Health Programs, 2015)

The key phrase in Winslow’s definition is ‘through organized community effort’. Public
health associated with systematic, legislated, and tax-supported efforts that serves the people
through health agencies or related government departments and it strives to improve the
health of the public by promoting a healthy lifestyle, preventing diseases, and protecting the
health of the public.
According to Institute of Medicine of the United States (IOM) (1988) assessment,
assurance, and policy development are the three primary functions of public health.
 Assessment: regular collection, analysis, and data sharing of health conditions, risk,
and resources in a community.
 Policy development: use of data gathered during assessment to construct local and
state health policies and concentrate resources to those policies.
 Assurance: focuses on the availability of needed health services throughout the
community. This includes the service of both public and private health agencies to
maneuver day-to-day assignments and having the ability to respond to critical
situations and emergencies
 All nurses who works in the community setting is expected to develop knowledge and
skills in line with these primary functions.
While the public health identification of the IOM was widely accepted by the
profession, it did not resonate with the policy makers and public in an understandable and
meaningful way. In the spring of 1994 a group worked on the core functions of public
health developed a consensus list of “essential services of public health” that would make
it easier for the public and policy makers to understand along with the public health
professionals.

10 Essential Services of Public Health are:

1. Monitor health status to identify and solve community health problems
2. Diagnose and investigate health problems and health hazards in the
community
3. Inform, educate, and empower people about health issues
4. Mobilize community partnerships and action to identify and solve health
problems
5. Develop policies and plans that support individual and community health
efforts
6. Enforce laws and regulations that protect health and ensure safety
7. Link people to needed personal health services and assure the provision of
health care when otherwise unavailable
8. Assure a competent public and personal health care workforce
9. Evaluate effectiveness, accessibility, and quality of personal and population-
based health services
10. Research for new insights and innovative solutions to health problems.

(Association of Accredited Public Health Programs, 2015)

Public health focuses on preventing and promoting of population health at the national and
local level; national level concentrates on providing advisory and support services to the
public at local level; local level gives direct services to communities thru environmental
health services that protects the public from hazards like polluted water and air; also thru
 personal health care services like immunization and family planning, or treatment-prevalent
health condition, both communicable and non-communicable.

2. Community Health
Community Health extends public health to add organized health efforts in community
level through both government and private efforts.
In the expanding field of community health in public health practice the definition was not
positioned to frame the importance of community engagement. According to Green and
Ottoson (1999)“… the health status of a community and to the organized responsibilities of
public health, school health, transportation safety, and other tax-supported functions, with
voluntary and private actions, to promote and protect the health of local populations identified
as communities.” A community was defined as “a group of inhabitants living in a somewhat
localized area under the same general regulations and having common norms, values, and
organizations”
In 2005, McKenzie and colleagues proposed the definition: “Community Health refers to
the health status of a defined group of people and the actions and conditions, both private and
public (governmental), to promote, protect, and preserve their health” (McKenzie et al., 2005).
In general, earlier programs and descriptions tended to look at communities as mutually
exclusive and as having minimal within-community variation. Although this approach may
be useful in simplifying study design and program implementation, it typically does not reflect
the reality of the situation. Community health should show the diversity of the community and
its values, how they make decisions whilst providing a small amount of order that assists the
organized generation of evidence, these are critical to the maturation of the field.
There are four focuses on community health:
 “community” – include population groups and the locus (e.g., place, venue, or other
unit) of programs, interventions, and other actions. For example, people with diverse
characteristics but are linked by social ties and share common perspectives.
(MacQueen et. al.,2001)
 “health” – may differ as the function of a community's experience and expectations
varies. The definition of health in a given community may further define the
organization of the community health and how community health is put into action.
  “interventions” – cover the scope of the intervention(s) being given within the
community, and shows the input, needs, perspectives, and goals of communities as
they work to enrich their health. Interventions include creating safe and healthful
environments; ensuring health equity for all members of the community (Centers for
Disease Control, Prevention — Division of Community Health, 2013);
 “science of community health” – encompasses the methods that are used by the field
to develop and evaluate the evidence base that support the conception, design,
implementation, evaluation, and dissemination of interventions. Community health
draws upon many applied and theoretical public health, medical, and other scientific
disciplines in terms of methods (e.g., surveillance and surveillance systems,
epidemiology, evaluation), and expertise (e.g., prevention effectiveness, health
economics, anthropology, demography, policy, health education, behavioral
sciences, and law).

With all the given definition Goodman R. A. et. al. (2014) offer the following as a definition
to community that is in line with needs of U.S. public health practice: “Community health is
a multi-sector and multi-disciplinary collaborative enterprise that uses public health science,
evidence-based strategies, and other approaches to engage and work with communities, in a
culturally appropriate manner, to optimize the health and quality of life of all persons who
live, work, or are otherwise active in a defined community or communities.”
Public health and community health principles resemble each other but community health
should be more focused on the community's needs, the community's knowledge and
precedence for health, and the best way for documenting the evidence gathered from practice
in the community, as well as the data from the science of community health.
3. Public Health Nursing
Public Health Nursing described as the combination of public health and nursing practice.
Public health nursing is seen as a subspecialty in nursing that is generally given through
government agencies.
According to Freeman (1963) ‘public health nursing may be defined as a field of
professional practice in nursing and in public health in which technical nursing, interpersonal,
analytical, and organizational skills are applied to problems of health as they affect the
community. These skills are applied in concert with those of other persons engaged in health
 care, through nursing care of families and other groups and through measures for evaluation
or control of threats to health, for health education of the public, and for mobilization of the
public for health action.’

The ANA revised the standards for this area in 2007. They used the definition given by the
American Public Health Association’s Committee on Public Health Nursing (1996) stating
“the practice of promoting and protecting the health of populations using knowledge from
nursing, social, and public health sciences”. The ANA (2007) explained further that the
practice of public health nursing “is population-focused, with the goals of promoting health
and preventing disease and disability for all people through the creation of conditions in which
people can be healthy”. It is understandable that public health nursing along with community
health nursing is focused on preventing diseases and promoting health.

(Habacon, Gabrielle Ann)

4. Community Health Nursing
In the year 1980, Community Health Nursing was considered as a specialized field in the
nursing practice. According to the American Nurses Association (ANA), Community Health
Nursing is defined as the synthesis of nursing practice and public health practice applied to
promoting and preserving the health of populations. This field of nursing is broader and a
more general specialty area that has different subspecialties like public health nursing, school
nursing, occupational health nursing as well as other developing fields of practice.
Community health nursing is both a science of public health nursing skills together with
social assistance for which the goal of this specialized field is to raise the level of the health
of the people and to raise optimum level of functioning for everyone in that certain
community. Every community health nurse should understand and remember that community
health nursing practice is both collaborative as well as it is based on research and theory. A
community health nurse should always practice their critical thinking and applies the nursing
process in certain situations in the community such as upon the care of individuals, families
and aggregates.

5. Standards of Public Health Nursing in the Philippines

 The American Nurses Association has revised the STANDARDS OF PRACTICE for the
new specialty are called Public Health Nursing in 2007. The following are the Standards of
Public Health Nursing as formulated by ANA (2007):

(1) Assessment
(2) Population diagnosis and priorities
STANDARDS (3) Outcomes identification
OF (4) Planning
CARE (5) Implementation
5.1 Coordination
5.2 Health education and promotion
5.3 Consultation
5.4 Regulatory Activities
(6) Evaluation

(7) Quality of Practice

(8) Education
STANDARDS (9) Professional Practice evaluation
OF (10) Collegiality and professional relationships
PROFESSIONAL (11) Collaboration
PERFORMANCE (12) Ethics
(13) Research
(14) Resource Utilization Population
(15) Leadership

(Gonzales, Zarah)

6. History of Public Health in the Philippines

Spanish Regime (1591-1898)
 1577 – Franciscan Friar Juan Clemente – Opened a medical dispensary in Intramuros for
the indigent
 1690 – Dominic Father Juan de Pergero – worked toward installing a water system in San
Juan City and Manila
  1805 – Dr. Francisco de Balmis – came to the Philippines and introduced smallpox
vaccination
 1876 – First medicos titulares, who worked as provincial health officers, were appointed
by Spanish government
 1888 – a 2-year course consisting of fundamental medical and dental subjects were first
offered in University of Santo Tomas

American Regime (1898-1942)

 1901
- Through Act No. 157 of the Philippine Commission created a Board of Health
- Subsequently, Act No. 309 created Provincial and Municipal Boards of Health
 1905
- Act No. 1407 (Reorganization Act) abolished the Board of Health and its functions
and activities were taken over by the Bureau of Health under the Department of
Interior
- La Gota de Leche, found by the Association Feminista Filipina, was the first center
dedicated to the service of mothers and babies
 1906
- The District Health Offices headed by District Health Officers had jurisdiction over
health districts. Hence, the abolition of the Board of Health; creation of the Bureau
of Health
 1912
- Fajardo Act of 1912 (Act No. 2156) created Sanitary Divisions. The President,
Sanitary Division took charge of two or three municipalities, where there were no
physicians available. Male nurses were assigned to perform the duties of the
President Sanitary Division.
- Public health nursing in the Philippines started when the Bureau of Health
employed four graduate nurses from the Philippine General Hospital School of
Nursing. They were assigned in the province of Cebu and were engaged purely on
maternal and child health services.
 - St Paul’s Hospital School of Nursing in Intramuros, also assigned two nurses to do
home visiting in Manila and rendered maternal and child nursing care at the
outpatient obstetrical service of the Philippine General Hospital

 1915
- The Bureau of Health was renamed Philippine Health Service with a Director of
Health as its head. The Service was placed under the Department of Public
Instruction with the Vice Governor General as the Department Secretary.
- Reorganization Act No. 2462 created the Office of General Inspection. The Office
of District Nursing was organized under this Office which was headed by a nurse-
physician, Dr. Rosario Pastor. This office was created due to increasing demands
of nurses to work outside the hospital, in the homes and the need for direction,
supervision and guidance of public health nurses.
- The Philippine General Hospital began to extend public health services in the
homes of patients through a unit called Social and Home Care Service with two
nurses as staff.
 From 1916 – 1918, Ms. Perlita Clark took charge of the public health nursing work. Her
staff was composed of one American nurse supervisor, one American dietician, 36 Filipino
nurses working in the provinces and one nurse and one dietician assigned in two Sanitary
Divisions. However, in 1918, the office of Ms. Clark was abolished due to lack of funds.
 1917 – Four graduate nurses paid by the City of Manila were employed to work in City
Schools. Provinces that could afford to carry out school health services were encouraged
to employ a district nurses
 1919
- Public health nursing inaugurated its pioneer work in Tondo, Manila when a
visiting nurse Ms. Balbina Basa was assigned to make a house to house visit hold
clinic and dispensary work with special emphasis on maternal and child care.
- At the time, the high maternal and infant mortality posed a serious problem. To
remedy the situation, the Philippine National Red Cross introduced the operation
of puericulture centers in the crowded districts of Manila, primarily to take care of
 infants and mothers. The program was later extended to the provinces in
cooperation with the Bureau of Public Welfare.
- In response to the gradual increase of public health nurses and expansion of services
in 1919, the first Filipino supervisor, Ms. Carmen del Rosario was appointed under
the Bureau of Health.
 1928 – First convention of nurses was held followed by yearly conventions until the advent
of World War II. Pre-service training was initiated as a pre-requisite for appointment.
 1930
- Section of Public Health Nursing was converted into Section of Nursing due to
pressing need for guidance not only in public nursing services but also in hospital
nursing and nursing education. The Section of Nursing was transferred from the
Office of General Services to the Division of Administration, which covered the
supervision and guidance of nurses in the provincial hospitals and two government
Schools of Nursing.
 1933
- By virtue of the Reorganization Act No. 4007, the Division of Maternal and Child
Health of the Office of Public Welfare Commission was transferred to the Bureau
of Health. Mrs. Soledad Buenafe became the assistant chief nurse of the Section of
Nursing, Bureau of Health.
- 176 puericulture nurses assigned in Manila and the provinces since 1919 were
included in this transfer. Puericulture centers are semi-government agencies partly
financed by private funds and aided by the government. They carried a specialized
service, maternal and child health, and were under the supervision of the Office of
the Public Welfare Commission until the effect of Reorganization Act of 1933.
 1935 – through the efforts of Major George Dunham, the medical advisor the Governor
General, the Philippine Legislature appropriated funds for 133 positions of the public
health nurses for assignment in the communities with high infant mortality rate and 23
nurse supervisors to supervise the work in the provinces and 60 nurses including four chief
nurses for the four newly created community health and social centers
  The Department of Health and Welfare was created in 1940 where six of the public health
nurses of the Bureau of Health were transferred in 1941. This formed the nucleus of the
present Division of Nursing of the Manila Health Department created by virtue of the new
charter of the city of Manila.
Japanese Regime (1942-1945)
The effects of World War II on December 8, 1941 called for assignment of public health
nurses to devastated areas to attend to the sick and wounded civilians caused by bombing.

 June 1942, a group of public health nurses with physicians and administrators of the
Manila Health Department went to the internment camp in Capas, Tarlac to receive
sick prisoners of war released by the Japanese Army. They were confined at San Lazaro
Hospital and sixty eight national public health services were assigned to help the
hospital staff take care of them.
 July 22, 1942 – 31 nurses who were taken prisoners of war at the Bilibid Prisons in
Azcarraga were released to the Director of the Bureau of Health, Dr. Eusebio Aguilar.
 Many public health nurses joined the guerillas or went to hide in the mountains during
WWII. During the early liberation period of 1945, the public health nurses were
recalled to the Bureau of Health Services
 February 1946. After the world war, Bureau of Health showed the increase in public
health nurses as compared to the records during pre-war. In the same year, Mrs. Genara
de Guzman, technical assistant in nursing of the Ministry of Health and concurrent
president of the Filipino Nurses Association recommended the creation of a nursing
office in the Ministry of Health.

Era of the Republic of the Philippines (1946-present)

 1947 – Reorganization of government offices under Executive Order No. 94 series of 1947
with the transfer of the Bureau of Public Welfare to the Office of the President and the
Department was renamed Department of Health.
 1953 – Office of Health Education and Personnel Training was created
 1954 – Republic Act 1082 (Rural Health Unit Act) was passed and implemented. It
provided for the employment of health personnel, including nurses, who would man the
RHU’s and help raise the health conditions of the rural population
 1957 – Republic Act 1891 – eight categories of rural health units corresponding to the
population size of municipalities were created. Regional health offices were created as a
result of decentralization
 1970s – Philippine healthcare system was restructured and brought about the expansion of
roles of the public health nurse and midwife in health centers and rural health units.
 1991 – Republic Act 7160 or the Local Government Code was enacted to enable local
governments to attain their fullest development as self-reliant communities and make them
more effective in attaining national goals.
 2005 – The Department of Health launched Formula One to ensure coordination toward
improving health care delivery
 From 1999-2004 – Health Sector Reform Agenda of the Philippines – The reforms are:
provide fiscal autonomy to government hospitals, secure funding for priority health
programs, promote the development of local health systems, strengthen the capacities of
health regulatory agencies, and expand coverage of National Health Insurance Programs.
 2010 – Universal Health Care – aims to achieve the health system goals of better health
outcomes, sustained financial health needs, and responsive health system that focuses on
economically disadvantaged Filipinos to ensure that they are given risk protection through
enrollment in Philippine Health Insurance Corporation (PhilHealth)

7. Roles and Responsibilities of a Community Health Nurse

1. Nursing Care Provider/Caregiver - direct nursing care of sick; provides patient

continuity of care

2. Advocate
 Seeks to promote an understanding of health problems, lobby for beneficial public
policy and stimulate supportive community action for health.
  Motivates changes in health behavior of individual, family, group and community
including lifestyle to promote and maintain health

3. Case Manager – assisting clients to make decisions about appropriate health care services
and to achieve service delivery integration and coordination.

4. Health Educator/Trainer
 Identifies and interprets training needs of Rural Health Midwives, Barangay Health
Workers/Volunteers and Hilots
 Formulates appropriate training program designs
 Provides and arranges training and learning experiences of nursing and midwife
affiliates
 Conducts trainings for health personnel
 Acts as resource speaker on health and health related services as the need arises
 Participates in the development and distribution of information Education and
Communication materials

5. Health Planner/Programmer
 Identifies needs, priorities and problems of individuals, families and communities
 Formulates nursing component of health plans
 Interprets and implements the nursing plan, program policies, memoranda and
circulars for the concerned staff/personnel
 Provides technical assistance to rural health midwives in health matters

6. Manager/Supervisor
 Formulates individual, family, and aggregates centered care plan
 Interprets and implements program policies, memoranda and circulars
 Organizes work force, resources, equipment and supplies and delivery of health
care at local levels
  Provides technical and administrative support to Rural Health Midwife (RHM).
Conducts regular supervisory visits and meetings to different RHMs and gives
feedback on accomplishments/performance.

7. Community Organizer
 Responsible for motivating and enhancing community participation in terms of
planning, organizing, implementing, and evaluating health programs/services
 Initiates and participates in community development activities

8. Casefinder – the nurse is responsible for detecting risk factors and deviation from health
of individual, family, group and community through contact visits with them; use of
systematic and objective assessment

9. Epidemiologist - the nurse studies the disease and health among population groups and
deals with community-wide health problems.

10. Recorder/Reporter/Statistician
 Prepares and submits required records and reports
 Review, validates, consolidates, analyzes, and interprets all records and reports
 Maintains adequate, accurate and complete recording and reporting
11. Community Leader – being a leader, a role model and respected in the community is in a
better position to empower others; provides good example/ model of healthful living to
public
The Health Care Delivery System

A. World Health Organization

(Santiago, Toni Arstelle C.)

1. Millenium Development Goals

The United Nations Millennium Development Goals are eight goals that all 191 UN member
states have agreed to try to achieve by the year 2015. The United Nations Millennium
Declaration, signed in September 2000 commits world leaders to combat poverty, hunger,
disease, illiteracy, environmental degradation, and discrimination against women. The MDGs
are derived from this Declaration, and all have specific targets and indicators.

The MDGs originated from the United Nations Millennium Declaration. The Declaration asserted
that every individual has dignity; and hence, the right to freedom, equality, a basic standard of
living that includes freedom from hunger and violence and encourages tolerance and solidarity.
The MDGs set concrete targets and indicators for poverty reduction in order to achieve the rights
set forth in the Declaration.
The MDGs emphasized three areas:

 Human capital (nutrition, healthcare including child

mortality, HIV/AIDS, tuberculosis and malaria, and reproductive health, and education)

 Infrastructure (access to safe drinking water, energy and modern

information/communication technology; increased farm outputs using sustainable
practices; transportation; and environment)

 Human rights (social, economic and political) include empowering women, reducing
violence, increasing political voice, ensuring equal access to public services and increasing
security of property rights.

The goals were intended to increase an individual’s human capabilities and "advance the means to
a productive life". The MDGs emphasize that each nation's policies should be tailored to that
country's needs; therefore most policy suggestions are general.

The MDGs are inter-dependent; all the MDG influence health, and health influences all the MDGs.
For example, better health enables children to learn and adults to earn. Gender equality is essential
to the achievement of better health. Reducing poverty, hunger and environmental degradation
positively influences, but also depends on, better health.

The Eight Millennium Development Goals are:

1. to eradicate extreme poverty and hunger;

2. to achieve universal primary education;
3. to promote gender equality and empower women;
4. to reduce child mortality;
5. to improve maternal health;
6. to combat HIV/AIDS, malaria, and other diseases;
7. to ensure environmental sustainability; and
8. to develop a global partnership for development.
(Romero, Cristine)
2. Sustainable Development Goals

#ENVISION2030: 17 GOALS TO TRANSFORM THE WORLD FOR PERSONS WITH

DISABILITIES

Achieving sustainable development for all, a holistic approach based on the principle “leaving no
one behind”. In September 2015, the General Assembly adopted the 2030 Agenda for Sustainable
Development that includes 17 Sustainable Development Goals (SDGs) which includes disability
and persons with disability. Though not directly stated, all of the goals guarantees the inclusion
and development of person with disabilities.

#Envision2030 or the new 2030 agenda will work to promote the mainstreaming of disability and
the implementation of the SDGs throughout its 15-year lifespan with objectives to:

o Raise awareness of the 2030 Agenda and the achievement of the SDGs for persons with
disabilities;
o Promote an active dialogue among stakeholders on the SDGs with a view to create a better
world for persons with disabilities; and
o Establish an ongoing live web resource on each SDG and disability.

GOAL 1: No Poverty. End poverty in all its forms everywhere

 Ensure all the poor and vulnerable men and women have equal rights
to economic resources, and the continuous mobilization of resources in
order to provide means for developing countries
 Eradicate extreme poverty for all people everywhere and halved the
proportion of men, women, and children of all ages living in poverty.
 Reduce the vulnerability of the poor to climate-related extreme
events and undertake sound policies that are pro-poor and gender-sensitive
to aid in the eradication of poverty
GOAL 2: Zero Hunger. End hunger, achieve food security and improved
nutrition and promote sustainable agriculture
 End all forms of hunger and malnutrition.
 Increase investment to double agricultural productivity and find
sustainable ways of food production.
 Maintain the genetic diversity of seeds, cultivated plants and farmed
and domesticated animals and their related wild species
 Adopt measures to ensure the proper functioning of food commodity
markets

GOAL 3: Good Health and Well-being. Ensure healthy lives and promote
well-being for all at all ages.
 Reduce:

Global maternal mortality ratio to less than 70 per 100,000 live

births
Neonatal mortality to at least as low as 12 per 1,000 live births
By one third premature mortality from non-communicable disease
By half the no. of global deaths and injuries related to road traffic
 End:

Preventable deaths of newborns and children under 5 years old

Epidemics of AIDS, Tuberculosis, malaria and neglected tropical
diseases and combat hepatitis, water-borne diseases and other
communicable diseases
 Strengthen:
The prevention and treatment of substance abuse
The implementation of WHO’s framework on tobacco control
The capacity of all countries for early warning and risk reduction of
national and global health risks
 Ensure universal access to sexual and reproductive health-care
services and universal health coverage.
  Increase health financing, support research and development of
vaccines and medicines.

GOAL 4: Quality Education. Ensure inclusive and equitable quality

education and promote lifelong learning opportunities for all.
 All girls and boys should complete free, equitable and quality
primary and secondary education, they should also have access to quality
early childhood development, care and primary education.
 Ensure:

Equal access for technical, vocational, and tertiary education for all men
and women
A substantial proportion of adults and all youth should achieve literacy and
numeracy.
Skills and information that promote sustainable development must be
acquired by all learners.
A significant increase in the number of qualified teaches and scholarships
offered to developing countries
 Build and upgrade education facilities that are child, disability and
gender sensitive and provide safe, nonviolent, inclusive and effective
learning environments for all

GOAL 5: Gender Equality. Achieve gender equality and empower all

women and girls.
 Eliminate all forms of discrimination, harmful practices, and
violence against women and children.
 Ensure equal opportunities for women in all decision-making levels
and universal access to sexual and reproductive health and rights.
 Make reforms that gives women equal rights to economic resources.
 Improve the use of enabling technology and strengthen policies that
promotes gender equality and empowerment of all women and
children.
 GOAL 6: Clean Water and Sanitation. Ensure availability and sustainable
management of water and sanitation for all
 Safe and affordable drinking water should be easily accessible to all.
Implement water resources management which includes the protection
and restoration of water related ecosystems, and increase water-use
efficiency in all sectors.
 Achieve access to adequate and equitable sanitation and hygiene for all
and end open defecation, paying special attention to the needs of women
and girls and those in vulnerable situations.

GOAL 7: Affordable and Clean Energy. Ensure access to affordable,

reliable, sustainable and modern energy for all.
 Ensure universal access to affordable, reliable and modern energy
services. This includes access to clean energy research and technology
which can be enhance by heightened international cooperation.
 Technology providing modern and sustainable energy must be
upgraded especially in least developed countries, small island developing
states, and land-locked developing countries.

GOAL 8: Decent Work and Economic Growth. Promote sustained,

inclusive and sustainable economic growth, full and productive
employment and decent work for all
 Protect labor rights, eradicate modern slavery and forced labor, and
promote safe working environments. Implement policies that promotes
sustainable tourism which can result into new job opportunities and at
the same time promote locally crafted products.
 Economic productivity should be elevated into higher levels through
diversification, technological upgrading and innovation, including
through a focus on high-value added and labor-intensive sectors.
GOAL 9: Industry, Innovation and Infrastructure. Build resilient
infrastructure, promote inclusive and sustainable industrialization and
foster innovation.
 Ensure easy access of small scale enterprises to financial services
specially the ones on developing countries.
 Encourage innovation and facilitate sustainable and resilient
infrastructure development.
 Develop quality, reliable, sustainable and resilient infrastructure to
support economic development and human well-being, with a focus on
affordable and equitable access for all

GOAL 10: Reduce Inequalities. Reduce inequality within and among

countries.
 Empower and promote the social, economic and political inclusion
of all starting with the removal of laws or policies that discriminate ones
age, sex, disability, race, or other economic status. Enhance
representation of developing countries in order to deliver more
effective, credible, accountable and legitimate institutions.

GOAL 11: Sustainable Cities and Communities. Make cities and human
settlements inclusive, safe, resilient and sustainable.
 Enhance inclusive and sustainable urbanization by ensuring access
to all housing, basic services, and transport system with the women,
children, and older citizens and marginalized people as the focus.
Lessen the harmful environmental impacts of communities by effective
implementation of waste management practices emphasizing on air
quality.
 Lessen the death rates related to disasters with the people in vulnerable
situations in mind.
 Protect the world’s cultural and natural heritage.
GOAL 12: Responsible Consumption and Production. Ensure
sustainable consumption and production patterns.
 Practice the sustainable management and use of resources.
Companies should initiate and adapt sustainable practices which can
be done through prevention, reduction, recycling and reuse.
Developed countries should take the lead in implementing
sustainable consumption and production. Individuals should have
easy access to information that can aid a sustainable way of living.

GOAL 13: Climate Action. Take urgent action to combat climate

change and its impacts.
 Improve the dissemination of information concerning climate
change mitigation, adaptation, impact reduction and early warning;
with a special focus on women, youth and local and marginalized
communities.

GOAL 14: Life below Water. Conserve and sustainably use the oceans,
seas and marine resources for sustainable development.
 Enhance scientific cooperation in all levels, such as developing
marine research and technology in order to improve the overall health
of the ocean and produce sustainable ways of increasing the yield of
fish stocks and also for the resources efficiently contribute to the
demands of developing countries.
 Effectively regulate the harvest of different marine resources and
prevent harmful ways of fishing or eliminate the use of subsidies that
can aid in doing such activities.
 Conserve at least 10% of coastal and marine areas, protect coastal
and marine ecosystems – land-based activities degrading marine
resources should be lessened.
 GOAL 15: Life on Land. Protect, restore and promote sustainable use
of terrestrial ecosystems, sustainably manage forests, combat
desertification, and halt and reverse land degradation and halt
biodiversity loss
 Take urgent action to diminish the destruction of natural habits,
illegal poaching or trafficking of different species or wildlife products.
Strongly implement the conservation, restoration, and preservation of
natural resources and integrate its values into local and national
planning, development processes, and poverty reduction strategies.

GOAL 16: Peace, Justice and Strong Institutions. Promote peaceful and
inclusive societies for sustainable development, provide access to
justice for all and build effective, accountable and inclusive institutions
at all levels.
 Provide equal justice for all by the strictly implementing the rule of
law. Have a significant reduction in violence and death related rates
everywhere. Develop effective, accountable and transparent institutions
at all levels; this includes reducing the incidences of corruption and
bribery on all their forms. Protection of the fundamental freedoms and
ensuring public access to information in accordance with national
legislation and international agreements.

GOAL 17: Partnerships for the Goals. Strengthen the means of

implementation and revitalize the global partnership for sustainable
development.
 Finance:

Reinforce resource mobilization. Strengthening of financial sources

from domestic countries to increase their domestic capacity for tax and
other revenue collection. This also includes the assistance that should
be offered to developing countries in order to address any concerns with
debt, such as highly indebted poor countries, reduce debt distress, debt
relief and etc.
 Technology:

Enhance the overall access to science, technology, and innovation.

Information and Communications Technology, such as technology
bank and science should be fully operationalize for least developed
countries. Developing countries should also be the focus when
disseminating environmentally sound technologies.
 Capacity Building:

Improve international support for implementing effective and targeted

capacity-building in developing countries to support national plans to
implement all the sustainable development goals.
 Trade:

Doubling the shares of global exports by the least developed countries

and significantly increasing the shares of developing countries by the
year 2020. Promote a non-biased and equitable trading system under
the world trade organization.
 Systemic Issues:

Enhance global macroeconomic stability, policy coherence, global

partnership for sustainable development, and capacity-building support
to developing countries.

Respect each country’s policy space and leadership to establish and

implement policies for poverty eradication and sustainable
development
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