Chapter 1 Overview of Public Health Nursing

in the Philippines

Learning Objectives
After this lesson, you should be able to:
1. Discuss the global and national health situations.
2. Compare the different fields of community health nursing practice.
3. Apply the competency standards of nursing practice in the Philippines in
community health nursing practice.
4. Outline the historical development of public health and public health nursing in
the Philippines.
5. Understand the role and responsibilities of a community health nurse.

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% in 2025.
 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
252 million.
 The number of people aged over 65 will rise from 390 million now to 800
million by 2025 - reaching 10% of the total population.
 By 2025, increases of up to 300% of the older population are expected in many
developing countries, especially in Latin America and Asia.
 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 by 2.6%.
 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 the over-65s.
 Leading causes of death from infectious diseases were acute lower respiratory
infections (3.7 million), 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 in 2025.
 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 of exercise.
 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 lifestyle factors.
 By 2025 the risk of cancer will continue to increase in developing countries, with
stable if not declining rates in industrialized countries.

The Philippine Public Healthcare Scenario (Famorca, 2013)

• The national budget allocation for health care is relatively small.

• Local government units augment the national budget to an undetermined extent.
• This scenario requires strategies that will allow maximization of limited resources:
– Health promotion
– Disease prevention

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
 Activity # 1
(Lecture)
Kahoot

Given a series of questions, active participation is required.

LESSON 2 Definitions and Focus

Concepts of Health
• The variety of characterizations of the word illustrates the difficulty in
standardizing the conceptualization of health.
• Common concepts in various definitions include:
– Goal-directed/ purposeful actions, processes, responses or behaviors.
– Soundness, wholeness, and/ or well-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 are found
• Derived from a latin word “comunicas” which means a group of people.
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 / Territorial community
2. Phenomenological / Functional community
Determinants of Health and Disease
• Income and social status
• Education
• Physical environment
• Employment and work conditions
• Social support networks
• Culture
• Genetics
• Personal behavior and coping skills
• Health services
• Gender
Community Health
 Part of paramedical and medical intervention/approach which is concerned on
the health of the whole population
Aims:
1. Health promotion
2. Disease prevention
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 the effects
of disease.
Levels of Prevention (Leavell & Clark, 1958)
• Primary: general health promotion and specific protection
• Secondary: early detection and prompt intervention
• Tertiary: reduce the effects of disease and injury, and restore individuals to their
optimal level of functioning
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
program for the promotion of health, the improvement of the conditions in the
 social and physical environment, rehabilitation of illness and disability
(WHO Expert Committee of Nursing)
 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 effort for:
1. The sanitation of the environment
2. The control of communicable infections
3. The education of the individual in personal hygiene
4. The organization of medical and nursing services for the early diagnosis and
preventive treatment of disease
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.E Winslow)

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
 Health Promotion
 Health Protection
 Health Balance
 Disease prevention
 Social Justice

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 the community.
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, in general
4. The goal of CHN is achieved through multi-sectoral efforts
5. CHN is a part of health care system and the larger human services system.

Roles of the PUBLIC HEALTH NURSE

 Clinician, who is a health care provider, taking care of the sick people at home or
in the RHU
 Health Educator, who aims towards health promotion and illness prevention
through dissemination of correct information; educating people
 Facilitator, who establishes multi-sectoral linkages by referral system
 Supervisor, who monitors and supervises the performance of midwives
 Health Advocator, who speaks on behalf of the client
 Advocator, who act on behalf of the client
 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 the community.
• The mission of public health is SOCIAL JUSTICE, which entitles all people to basic
necessities such as adequate income and health protection and accepts collective burdens
to make this possible.

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 entire population
 • Is based on assessment of the populations' health status
• Considers the broad determinants of health
• Emphasizes all levels of prevention
• 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 of
illness and disability.
• Hospice home care: This is home care specifically rendered to the terminally ill.
• 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 other
stakeholders to promote nurse entrepreneurship.
• 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 religious faiths
Standards in Community Health Nursing

1. Theory
 Applies theoretical concepts as basis for decisions in practice
2. Data Collection
 Gathers comprehensive, accurate data systematically
3. Diagnosis
 Analyzes collected data to determine the needs/ health problems of IFC
4. Planning
 At each level of prevention, develops plans that specify nursing actions
unique to needs of clients
5. Intervention
 Guided by the plan, intervenes to promote, maintain or restore health,
prevent illness and institute rehabilitation
6. Evaluation
 Evaluates responses of clients to interventions to note progress toward
goal achievement, revise data base, diagnoses and plan
7. Quality Assurance and Professional Development
 Participates in peer review and other means of evaluation to assure
quality of nursing practice
 Assumes professional development
 Contributes to development of others
8. Interdisciplinary Collaboration
  Collaborates with other members of the health team, professionals and
community representatives in assessing, planning, implementing and
evaluating programs for community health
9. Research
 Indulges in research to contribute to theory and practice in community
health nursing

History of Public Health Nursing in the Philippines

• 1577: Friar Juan Clemente opened a medical dispensary in Intramuros for the
indigent.
• 1690: Dominican Father Juan de Pergero worked towards installing a water
system in San Juan del Monte (now San Juan City, Metro Manila) and Manila.
• 1805: Dr. Francisco de Balmis introduced Smallpox vaccination.
• 1876: The first medicos titulares were appointed and worked as provincial health
officers.
• 1888: The University of Santo Tomas opens a two-year, cirujanos ministrantes
course to produce male nurses and sanitary inspectors.
• 1901: The Board of Health of the Philippine Islands was created through Act
157, 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 first
center 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 bureau level.
• 1954: The congress passed R.A. 1082 or the Rural Health Unit Act which
provided an RHU in every municipality.
• 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 Health Officer.
• 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 tertiary levels.
• 1991: R.A.7160 or the Local Government Code mandated the devolution of
basic services, including health services, to local government units and the
establishment of a local health board in every province and city or municipality
• 1999: Health Sector Reform Agenda was launched to direct government efforts
towards comprehensive reforms.
• 2005: FOURmula One (F1) for health was launched to provide an
implementation framework to the reform agenda.
• 2010: Universal Health Care was launched to provide the necessary revisions to
the F1 framework.
Activity # 1
(Skills)
Interview Guide Questions
 In this activity you will create an interview guide questions that focus

on the roles and responsibilities of a community health nurse. Your

clinical instructor will facilitate to come up with one standard tool to be

use by the whole class.

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 and puerperium
 Performance of internal examination and delivery of babies
 Suturing lacerations in the absence of a physician
  Provision of first aid measures and emergency care
 Recommending herbal and symptomatic meds…etc.

In the care of the families:

 Provision of primary health care services

 Developmental/Utilization of family nursing care plan in the provision of care

In the care of the communities:

 Community organizing mobilization, community development and people

empowerment
 Case finding and epidemiological investigation
 Program planning, implementation and evaluation
 Influencing executive and legislative individuals or bodies concerning health and
development

Activity #2
(Skills)
Interview Guide
Roles and Responsibilities of a Community Health Nurse

Qualifications

1. Bachelor of Science in Nursing

2. Registered Nurse of the Philippines

Planner/Programmer

1. Identifies needs, priorities, and problems of individuals, families, and

communities
2. Formulates municipal health plan in the absence of a medical doctor
3. Interprets and implements nursing plan, program policies, memoranda, and
circular for the concerned staff personnel
4. Provides technical assistance to rural health midwives in health matters

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 development activities

Coordinator of Services
1. Coordinates with individuals, families, and groups for health-related services
provided by various members of the health team
2. Coordinates nursing program with other health programs like environmental
sanitation, health education, dental health, and mental health
Trainer/Health Educator
1. Identifies and interprets training needs of the RHMs, Barangay Health Workers
(BHW), and hilots
2. Conducts training for RHMs and hilots on promotion and disease prevention
3. Conducts pre and post-consultation conferences for clinic clients; acts as a
resource speaker on health and health related services
4. Initiates the use of tri-media (radio/TV, cinema plugs, and print ads) for health
education purposes
5. Conducts pre-marital counseling

Health Monitor
  Detects deviation from health of individuals, families, groups, and communities
through contacts/visits with them
Role Model
 Provides good example of healthful living to the members of the community

Change Agent
 Motivates changes in health behavior in individuals, families, groups, and
communities that also include lifestyle in order to promote and maintain health

Recorder/Reporter/Statistician
1. Prepares and submits required reports and records
2. Maintain adequate, accurate, and complete recording and reporting
3. Reviews, validates, consolidates, analyzes, and interprets all records and reports
4. Prepares statistical data/chart and other data presentation

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 the
implementation of studies/research

Activity #1
(Clinical)
Interview Community Health Nurse

Directions:
1. Using the formulated interview guide questionnaire, you are task to
interview a community health nurse (School Nurse, Public Health
Nurse, Company Nurse).
2. Share his/her insights to the whole group.
 Activity 2
(Clinical)
Reflective Essay