MODULE 01: OVERVIEW
respiratory infections (3.7 million),
OF PUBLIC HEALTH
NURSING IN THE
PHILIPPINES
LESSON 1 Global and National Health Situations
Global and Country Health Imperatives
Public health systems are operating within a
context of ongoing changes, which exert a number
of pressures on the public health system.
These changes include: (Reyala, 2007)
1. Shifts in demographic and
epidemiological trends in diseases,
including the emergence and re-
emergence of new diseases and in
the prevalence of risk and protective
factors;
2. New technologies for health care,
communication and information;
3. Existing and emerging
environmental hazards some
associated with globalization;
4. Health reforms.
Global Health Situation (World Health
Organization, 2018)
 The global population was 2.8
billion in 1955 and is 5.8 billion now. It
will increase by nearly 80 million
people a year to reach about 8 billion
by the year 2025.
 The proportion of older people
requiring support from adults of
working age will increase from 10.5%
in 1955 and 12.3% in 1995 to 17.2%
in2025.
 The proportion of young people
under 20 years will fall from 40% now
to 32% of the total population by 2025,
despite reaching 2.6 billion - an actual
increase of 252million.
 The number of people aged over 65
will rise from 390 million now to 800
million by 2025 - reaching 10% of the
totalpopulation.
 By 2025, increases of up to 300% of
the older population are expected in
many developing countries, especially
in Latin America andAsia.
 Globally, the population of children
under 5 will grow by just 0.25%
annually between 1995-2025, while the
population over 65 years will grow
by2.6%.
 Average life expectancy at birth in
1955 was just 48 years; in 1995 it was
65 years; in 2025 it will reach 73 years.
 By the year 2025, it is expected that
no country will have a life expectancy
of less than 50 years.
 By 2025, 8% of all deaths will be in
the under-5s, 3% among 5-19-year-
olds, 27% among 20-64-year-olds and
63% among theover-65s.
 Leading causes of death from
infectious diseases were acute lower
tuberculosis (2.9 million), diarrhea (2.5
million), HIV/AIDS (2.3 million) and
malaria (1.5-2.7 million).
 By 2025 there will still be 5 million
deaths among children under five -
97% of them in the developing world,
and most of them due to infectious
diseases such as pneumonia and
diarrhea, combined with malnutrition.
 The number of young women aged
15-19 will increase from 251 million in
1995 to 307 million in2025.
 Infectious diseases will still
dominate in developing countries. As
the economies of these countries grow,
non-communicable diseases will
become more prevalent. This will be
due largely to the adoption of "western"
lifestyles and their accompanying risk
factors - smoking, high-fat diet, obesity
and lack ofexercise.
 Diabetes cases in adults will more
than double globally from 143 million
in 1997 to 300 million by 2025 largely
because of dietary and other
lifestylefactors.
 By 2025 the risk of cancer will
continue to increase in developing
countries, with stable if not declining
rates in industrializedcountries.
The Philippine Public Healthcare Scenario
(Famorca, 2013)
• The national budget allocation for health
care is relativelysmall.
• Local government units augment the
national budget to an
undeterminedextent.
• This scenario requires strategies that will
allow maximization of limitedresources:
– Healthpromotion
– Diseaseprevention
Glasco (2019) published in
Inquirer that 2019 has been very
eventful for public health in the
Philippines. In February, amid much
fanfare and anticipation, the Universal
Health Care Act (Republic Act No.
11223) was passed — a culmination of a
series of health-related legislative
measures over the past several years,
from the sin tax law (RA 10351) to the
new HIV/AIDS law (RA 11166), that
many hope would transform the health
care system. We also saw health figure
in the 2019 elections as part of several
candidates’ campaign platforms, with
varying degrees of depth and substance
Yet if 2019 saw a lot of
attention toward health, it also served to
illustrate the serious challenges that need
to be hurdled if “health for all Filipinos”
— and not just universal insurance
coverage—is to be achieved.
 Read more:
https://opinion.inquirer.net/125981/public-
health-challenges-for-2020-part-
i#ixzz6UWtk6v3k
LESSON 2 Definitions and Focus
Concept s of Health
• The variety of characterizations of
the word illustrates the difficulty
instandardizing the
conceptualization ofhealth.
• Common concepts in various
definitionsinclude:
– Goal-directed/ purposeful
actions, processes, responses
orbehaviors.
– Soundness, wholeness, and/
orwell-being
Concepts of Community
• Before 1996: definitions of
community focused on geographical
boundaries,combined with social
attributes of people.
• Later part of the decade:
geographical location became a
secondary characteristic in the
discussion of what defines a
community (Baldwin, et.al,1998)
• a group of people with common
characteristics or interests living
together within a territory or
geographical boundary
• place where people under usual
conditions arefound
• Derived from a latin word
“comunicas” which means a group
ofpeople.
Defining Attributes of Communities (Maurer
& Smith, 2009)
1. People
2. Place
3. Interaction
4. Common characteristics, interests or
goals
Types of Community (Maurer & Smith,
2009)
1. Geopolitical / Territorialcommunity
2. Phenomenological / Functional
community
Determinants of Health and Disease
• Income and socialstatus
• Education
• Physical environment
• Employment and workconditions
• Social supportnetworks
• Culture
• Genetics
• Personal behavior and copingskills
• Healthservices
• Gender
Community Health
 Part of paramedical and
medical intervention/approach
which is concerned on the health of
the wholepopulation
Aims:
1. Healthpromotion
2. Diseaseprevention
3. Management of factors affecting
health
Health Promotion and Disease Prevention
• Health promotion activities
enhance resources directed at
improving well-being, whereas
disease prevention activities
protect people from disease and
theeffects ofdisease.
Levels of Prevention (Leavell & Clark, 1958)
• Primary: general health promotion
and specificprotection
• Secondary: early detection and
prompt intervention
• Tertiary: reduce the effects of
disease and injury, and restore
individuals to their optimal level
offunctioning
Community Health Nursing
 “The utilization of the nursing
process in the different levels of
clientele- individuals, families,
population groups and communities,
concerned with the promotion of
health, prevention of disease and
disability and rehabilitation.”
(Maglaya, et al, 2009)
 Goal: “To raise the level of citizenry
by helping communities and families to
cope with the discontinuities in and
threats to health in such a way as to
maximize their potential for high-level
wellness” (Nisce, et al,2009)
 Special field of nursing that
combines the skills of nursing, public
health and some phases of social
assistance and functions as part of the
total public health
programforthepromotionofhealth,theim
provementoftheconditionsinthe social
and physical environment,
rehabilitation of illness and disability
(WHO Expert Committee ofNursing)
 A learned practice discipline with
the ultimate goal of contributing as
individuals and in collaboration with
others to the promotion of the client’s
optimum level of functioning thru’
teaching and delivery of care(Jacobson)
 A service rendered by a
professional nurse to IFCs, population
groups in health centers, clinics,
schools, workplace for the promotion
of health, prevention of illness, care of
the sick at home and rehabilitation
(DR. Ruth B.Freeman)
Public Health
 “Public Health is directed towards
assisting every citizen to realize his
birth rights and longevity.” The science
and art of preventing disease,
 prolonging life and efficiency through
organized community effortfor:
1. The sanitation of theenvironment
2. The control of communicable
infections
3. The education of the individual in
personalhygiene
4. The organization of medical and
nursing services for the early
diagnosis and preventive treatment
ofdisease
5. The development of a social
machinery to ensure everyone a
standard of living, adequate for
maintenance of health to enable
every citizen to realize his birth
right of health and longevity (Dr.
C.EWinslow)
Public Health Nursing
• 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 (Freeman,1963).
• The practice of promoting and
protecting the health of populations
using knowledge from nursing,
social, and public health sciences
(ANA/APHA,1996).
Mission of CHN
 HealthPromotion
 HealthProtection
 HealthBalance
 Diseaseprevention
 SocialJustice
Philosophy of CHN
 “The philosophy of CHN is
based on the worth and dignity on
the worth and dignity of man.”
(Dr. M.Shetland)
Basic Principles of CHN
1. The community is the patient in
CHN, the family is the unit of care and
there are four levels of clientele:
individual, family, population group
(those who share common
characteristics, developmental stages
and common exposure to health
problems – e.g. children, elderly), and
thecommunity.
2. In CHN, the client is considered as
an ACTIVE partner NOT PASSIVE
recipient of care
3. CHN practice is affected by
developments in health technology, in
particular, changes in society, ingeneral
4. The goal of CHN is achieved through
multi-sectoralefforts
5. CHN is a part of health care system and
the larger human servicessystem.
Roles of the PUBLIC HEALTH NURSE
 Clinician, who is a health care
provider, taking care of the sick people
at homeor in theRHU
 Health Educator, who aims
towards health promotion and
illnessprevention through
dissemination of correct
information; educatingpeople
 Facilitator, who establishes multi-
sectoral linkages by referralsystem
 Supervisor, who monitors and
supervises the performance
ofmidwives
 Health Advocator, who speaks on
behalf of theclient
 Advocator, who act on behalf of
theclient
 Collaborator, who working with other
health team member
*In the event that the Municipal Health
Officer (MHO) is unable to perform his
duties/functions or is not available, the
Public Health Nurse will take charge of the
MHO’s responsibilities.
Nurses in Public Healthcare
• Community/public health nursing is
the synthesis of nursing practice and
public health practice.
• The major goal of community
health nursing is to preserve the
health of the community and
surrounding populations by
focusing on health promotion and
health maintenance of individuals,
families, and groups within
thecommunity.
• The mission of public health is
SOCIAL JUSTICE, which entitles
all people to basic necessities such
as adequate income and health
protection and accepts
collectiveburdens to make
thispossible.
Community-Based Nursing
• Application of the nursing process
in caring for individuals, families
and groups where they live, work or
go to school or as they move
through the health care system
(McEwen & Pullis, 2008).
Population-Focused Approach
• Focuses on the entirepopulation
• Isbased on assessment of the
populations' healthstatus
• Considers the broad determinants
ofhealth
• Emphasizes all levels ofprevention
• Intervenes with communities,
systems, individuals, and
families(Minnesota
Department of Health,2003)
Levels of Clientele
• Individual
 • Family
• Group/Aggregate
• Community
Emerging Fields of Community Health
Nursing in the Philippines
• Home health care: This practice
involves providing nursing care to
individuals and families in their
own places of residence mainly to
minimize the effects ofillness
anddisability.
• Hospice home care: This is home care
specifically rendered to
terminallyill.
• EntrepreNurse: This is a project
initiated by the Department of
Labor and Employment (DOLE), in
collaboration with the Board of
Nursing of the Philippines,
Department of Health, Philippine
Nurses Association, and
otherstakeholders to promote
nurseentrepreneurship.
• Faith community nursing or parish
nursing: This is the practice of
nursing combined with spiritual
care. They may work in either paid
or unpaid positions in a variety of
religiousfaiths
Standards in Community Health Nursing
1. Theory
a. Applies theoretical concepts as
basis for decisions inpractice
2. Data Collection
a. Gathers comprehensive, accurate
datasystematically
3. Diagnosis
a. Analyzes collected data to
determine the needs/ health
problems ofIFC
4. Planning
a. At each level of
prevention, develops plans
that specify nursingactions
unique to needs of clients
5. Intervention
a. Guided by the plan,
intervenes to promote,
maintain or restore health,
prevent illness and
instituterehabilitation
6. Evaluation
a. Evaluates responses of
clients to interventions to
note progress toward goal
achievement, revise data
base, diagnoses andplan
7. Quality Assurance and
ProfessionalDevelopment
a. Participates in
peer review and other
means of evaluation to
assure quality of
nursingpractice
b. Assumes professional development
c. Contributes to development
ofothers
8. InterdisciplinaryCollaboration
i. Collaborates with other
members of the health
team, professionals and
community
representatives in
assessing, planning,
implementing and
evaluating programs for
community health
9. Research
a. Indulges in research to
the
contribute to theory and
practice in community
healthnursing
b. History of Public Health Nursing
in the Philippines
10. 1577:Friar Juan Clemente opened a
medical dispensary in Intramuros for the
indigent.
• 1690:Dominican Father Juan de
Pergero worked towards installing a
watersystem in San Juan del Monte
(now San Juan City, Metro Manila)
andManila.
• 1805: Dr. Francisco de Balmis
introduced Smallpoxvaccination.
• 1876:The first medicos titulares
were appointed and worked as
provincial healthofficers.
• 1888:TheUniversityofSantoTomasope
nsatwo-year,cirujanosministrantes
course to produce male nurses and
sanitary inspectors.
• 1901:The Board of Health of the
Philippine Islands was created
through Act157, which eventually
evolved into the Department of
Health(DOH)
• 1912: The Fajardo Act law created
sanitary divisions made up one to
four municipalities.
• 1905:Asociacion de Feminista
Filipina founded La Gota de Leche:
the firstcenter dedicated to the
service of mothers and babies
• 1947: The DOH was reorganized
into bureaus and the administration
of city health departments was
placed at bureaulevel.
• 1954:The congress passed R.A.
1082 or the Rural Health Unit Act
whichprovided an RHU in
everymunicipality.
• 1957: R.A. 1891 was enacted to
have a more equitable distribution
of health personnel.
• 1958:Regional health offices were
created as a result of
decentralization efforts,thus creating
the position: Regional
HealthOfficer.
• 1970: the Philippine health care
delivery system was restructured,
paving the way for the health care
system that exists to this day where
health services are classified into
primary, secondary and
tertiarylevels.
• 1991:R.A.7160 or the Local
 Government Code mandated the
devolution of basic services,
including health services, to local
government units and
theestablishment of a local health
board in every province and city
ormunicipality
• 1999: Health Sector Reform
Agenda was launched to direct
government efforts towards
comprehensive reforms.
• 2005:FOURmula One (F1) for
health was launched to provide
animplementation framework to the
reformagenda.
• 2010: Universal Health Care was
launched to provide the necessary
revisions to the F1 framework.
Other Specific Responsibilities of a Nurse, spelled
by the implementing rules and Regulations of RA
7164 (Philippine Nursing Act of 1991) includes:
 Supervision and care of women
during pregnancy, labor
andpuerperium
 Performance of internal examination
and delivery ofbabies
 Suturing lacerations in the absence of
aphysician
 Provision of first aid measures and
emergencycare
 Recommending herbal and
symptomatic meds…etc.
In the care of the families:
 Provision of primary health
careservices
 Developmental/Utilization of family
nursing care plan in the provision
ofcare
In the care of the communities:
 Community organizing
mobilization, community development
and people empowerment
 Case finding and
epidemiologicalinvestigation
 Program planning, implementation
andevaluation
 Influencing executive and
legislative individuals or bodies
concerning health and development
Roles and Responsibilities
of a Community Health
NurseQualifications
1. Bachelor of Science inNursing
2. Registered Nurse of thePhilippines
Planner/Programmer
1. Identifies needs, priorities,
problems of individuals,
families, andcommunities
2. Formulates municipal health plan in the
absence of a medicaldoctor
3. Interprets and implements nursing
plan, program policies, memoranda,
and circular for the concerned
staffpersonnel
4. Provides technical assistance to rural
health midwives in healthmatters
Provider of Nursing Care
1. Provides direct nursing care to sick
or disabled in the home, clinic, school, or
workplace
2. Develops the family’s capability to
take care of the sick, disabled, or
dependent member
Community Organizer
1. Motivates and enhances community
participation in terms of planning,
organizing, implementing, and
evaluating health services
2. Initiates and participates in community
developmentactivities
Coordinator of Services
1. Coordinates with individuals,
families, and groups for health-related
services provided by various members
of the healthteam
2. Coordinates nursing program
with other health programs like
environmental sanitation, health
education, dental health, and
mentalhealth
Trainer/Health Educator
1. Identifies and interprets training
needs of the RHMs, Barangay
HealthWorkers (BHW), andhilots
2. Conducts training for RHMs and hilots
on promotion and diseaseprevention
3. Conducts pre and post-
consultation conferences for
clinic clients; acts asa resource
speaker on health and health
relatedservices
4. Initiates the use of tri-media
(radio/TV, cinema plugs, and print
ads) for health education purposes
5. Conducts pre-maritalcounseling
Health Monitor
 Detects deviation from health of
individuals, families, groups,
andcommunities through contacts/visits
withthem
Role Model
 Provides good example of healthful
living to the members of
thecommunity
Change Agent
 Motivates changes in health
behavior in individuals, families,
groups, and communities that
also include lifestyle in order to
promote and maintainhealth
Recorder/Reporter/Statistician
and 1. Prepares and submits required reports
and records
 2. Maintain adequate, accurate, and
complete recording andreporting
3. Reviews, validates, consolidates,
analyzes, and interprets all records
andreports
4. Prepares statistical data/chart and
other datapresentation

Researcher
1. Participates in the conduct of survey
studies and researches on nursing and
health-related subjects
2. Coordinates with government and
non-government organization in
implementation ofstudies/research