GOOD MORNING EVERYONE

WELCOME TO NCM 113

COMMUNITY HEALTH NURSING 2
Population Groups and Community as client
NCM 113: CHN 2 LECTURE COURSE CONTENTS

Unit 1: Assessing The Health Needs of The Community

Unit 2: Planning for Community Health Nursing Program
&
Services Unit 3: The CHN and Community Health
Development Unit 4: Nursing care of clients with
communicable
diseases Unit 5: Care of Patients with Non-
Communicable Diseases Unit 6: Evaluation in Community
Health Nursing Practice
 Dates to Remember: 1st Sem AY, 2022-2023
▪ Start of Classes: August 15, 2022
▪ Ninoy Aquino Day: August 21, 2022
▪ National Heroes Day: August 29, 2022 (No Classes)
▪ Baguio Foundation Day: September 1, 2022 (No Classes)
▪ Preliminary Examinations: September 22-24, 26-27, 2022
▪ Academic Break: October 29 & 31, 2022
▪ All Saints Day: November 1, 2022 (No Classes)
▪ All Souls’ Day: November 2, 2022 ( No Classes)
▪ Midterm Examinations: November 3-5, 7-9, 2022
 Dates to Remember: 1st Sem AY, 2022-2023
▪ SLU Foundation Week: November 28-December 3, 2022
▪ CICM Day: November 28, 2022
▪ Bonifacio Day: November 30, 2022 (No Classes)
▪ Immaculate Conception: December 8, 2022 (No Classes)
▪ Final Examinations: December 14-17, 19-20, 2022
▪ Baccalaureate Mass & Graduation Exercises: January 26-27,
2023 ( If Face-to-Face is allowed)
UNIT 1: ASSESSING THE HEALTH NEEDS OF
THE COMMUNITY
 UNIT 1 DESCRIPTION
▪ Revisits concepts on Community Health Nursing relative to
the community as a primary client along with the expanded
roles and responsibilities of a Community Health Nurse;
▪ Review the basic principles in Community Health Nursing
including Primary Health Care.
▪ Identify and discuss the Public Health Tools in identifying,
measuring and analyzing community health problems such as
epidemiology, demography and vital statistics
 What is Community Health Nursing?
▪ Community Health Nursing – the utilization of the Nursing
Process in the different levels of clientele - Individual, Family,
Population Groups and Community, concerned with the
promotion of health, prevention of disease and disability and
rehabilitation. (Maglaya)
▪ Service rendered by a professional nurse with communities,
groups, families, individuals at home, in clinics, in schools, in
places of work for the promotion of health, prevention of illness,
care of the sick at home and rehabilitation (Ruth B. Freeman)
• The definition components are further elaborated in the
principles and aims of CHN which are:
● Community is the patient, and the family is the unit of
care;
● Client is considered as an active partner and not a
passive recipient of care
● Nature of the community health nurses job is
continuous not episodic; generalist; and collaborative
 WHAT IS THE PRIMARY GOAL OF COMMUNITY HEALTH
NURSING?

The primary goal of community Health Nursing is to enhance

the capacity of individuals, families and communities to cope
with their health needs. To assist a community protect and
preserve the health status of its members.
 Community Health Nursing and Primary Health
Care are Interlinked in that:
▪ Both incorporate community-based practice,
▪ Involvement of the community in health care decisions,
▪ A focus on disease prevention and health promotion and
▪ Use of an interdisciplinary approach in planning and
implementing appropriate solutions to health problems
▪ Primary health care emphasizes the development of
universally acceptable, affordable and accessible essential
health services that are community-based and emphasizes
health promotion and maintenance, self-reliance and
community participation in decision making about health
 PHILOSOPHY OF CHN
CHN is guided by the following beliefs:
▪ Humanistic values of the nursing profession upheld
▪ Unique and distinct component of health care
▪ Multiple factors of health considered
▪ Active participation of clients encouraged
▪ Nurse considers availability of resources
▪ Interdependence among health team members practiced
▪ Scientific and up-to-date
▪ Tasks of CHN vary with time and place
▪ Independence or self-reliance of the people is the end goal
▪ Connectedness of health and development regarded
 BASIC PRINCIPLES of CHN
1. The community is the patient in CHN; the family is the unit of care;
there are four (4) levels of clientele; the individual, the family, the
population group (sub-units of the population who share common
characteristics, developmental stage, 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 a passive
recipient of care. 3. CHN practice is affected by developments in
health technology, in
particular and 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.
 Two important reasons why the community is considered as
the primary client in CHNng (Maglaya):
a. the community has a direct influence on the health of the
individual, families and sub-groups; b.It is at the
community level that most health services are
provided. It is thus imperative that the CHN knows the
defining characteristics of a particular community and use it as a basis
for understanding the various direct as well as indirect variables that has
a bearing on the health status of the community. Further, these same
characteristics serve as the foundation in the planning and development
of specific and relevant health programs appropriate for a particular
community.
 What is a

Anyway?

▪ A group of people living in the same place or having a

particular characteristics in common.
▪ A feeling of fellowship with others, as a result of sharing,
common attitudes, interests and goals.
▪ It is a social group determined by geographical boundaries and
or common values and interest.
TYPES OF COMMUNITY
1. URBAN COMMUNITY – It has a higher density population & a
complex structure, non-agricultural occupations.
2. Rural community - A community that is usually small and the
occupation of the people is usually farming, fishing and food
gathering.
 3 FEATURES OF A COMMUNITY
1. Location: every physical community carries out its daily
existence in a specific geographical location. The health of the
community is affected by this location, including the placement
of the service, the geographical features…
2. Population: consists of specialized aggregates, but all of the
diverse people who live within the boundary of the community.
3. Social system: the various parts of communities’ social
system that interact and include the heath system, family
system, economic system and educational system.
 WHAT ARE THE ROLES
COMMUNITY HEALTH NURSE?
 ROLES OF THE CHN
1. Clinician or Health Care Provider
2. Health Educator
3. Coordinator and collaborator
4. Supervisor
5. Leader/Manager and Change Agent
6. Manager
6. Researcher
7. Health Advocate
8. Community Organizer
9. Epidemiologist
10. Informaticist
 Responsibilities of Community Health Nurse
1.Report existence of communicable disease
2.Find out what family knows about preventive/control measure
3.Teach/demonstrate/supervise good nursing care
4.Assist/guide family in seeking prompt medical attention
5.Health Education
6.Actively participate in the training component of the service like
in Food Handler’s Class, and attend training/workshops related
to environmental health.
7.Assist in deworming activities for the school children and
targeted groups
 Responsibilities of Community Health Nurse
8. Effectively and efficiently coordinate programs, projects and
activities with other government and government agencies
9. Acts as advocate or facilitator to families in the community in
matters of program/projects/activities on environmental health in
coordination with other members of RHU especially the Rural
Sanitary Inspector
10. Actively participate in environmental sanitation campaigns
and projects in the community
11. Be a role model for others in the community to emulate in
terms of cleanliness in the home and surrounding.
 Responsibilities of Community Health Nurse
12. Participate in the research/studies to be conducted in their
respective areas of assignment
13. Help in the interpretation and implementation of PD 856
commonly known as Sanitation Code of the Philippines
14. Assist in the Disaster Management, which will be
implemented in all levels.
15. Provide quality nursing services to the four levels of clientele
 LEVELS OF CLIENTELE IN
COMMUNITY HEALTH NURSING

1. Individual
2. Family
3. Population Group
4. Community
1. INDIVIDUAL

Basic approach in looking at the individual

▪ Ensure privacy and there are no distractions, be friendly, calm
and relaxed with a smile and begin conversation by identifying
yourself and calling the person by name.
▪ Provides support that looks at the whole person, support
should also consider their physical, emotional, social and
spiritual wellbeing.
▪ Encourages feelings of independence and dignity
2. FAMILY
▪ Defined my Murray and Zentner is a small social system and
primary reference group made up of two or more persons
living together who are related by blood, marriage or adoption
or who are living together by arrangement over a period of
time.
3. POPULATION GROUP – A group of people sharing
the same characteristics, developmental stage or common
exposure to particular environmental factors thus resulting in
common health problems.
Components
1. The very young and very old
2. Childbearing women
3. Homeless/street children/factory workers/prostitution
4. Population groups suffering for Communicable Diseases
5. Population groups suffering for Non-communicable Diseases
6. Physically and physically disabled
COMMUNITY DIAGNOSIS: is a process of: A. DATA
COLLECTION - collecting data about a community for the
purpose of finding out the various factors that may have a direct
or indirect influence on the health of a population; B. DATA
ANALYSIS - collected data are analyzed to find explanations
for the occurrence of health needs and problems of the
community; C. CHNng DIAGNOSIS - are formulated from the
analysis and serve as bases for the next step in the process;
D. NURSING INTERVENTION PLANNING - intended actions
are developed along with the strategies for implementation;
COMMUNITY HEALTH STATUS
- is a product of the various interacting factors in the
community. The interrelationship of these same factors explain
the health and wellness patterns existing in the community.
Examples of these factors are: 1. Population 2. Physical and
topographical characteristics 3. Socio-economic and cultural
factors 4. Health and basic social services 5. Power structure
within
 Types of community Diagnosis:

1. Comprehensive Community Diagnosis - aims to obtain

a general information about the community.

2. Problem Oriented Community Diagnosis - assessing the

community in response to a particular need.
Elements of Comprehensive Community Diagnosis:
A. Demographic Variables - total population & geographical
distribution like urban-rural index and density;Age & Sex
Composition; Selected vital stats; migration patterns; population
projections.
B. Socio- Economic & Cultural Variables - social, economic,
environment, cultural indicators
C. Health & Illness Patterns - Leading causes of: morbidity,
mortality, infant mortality, maternal mortality, hospital admission
D. Health resources - manpower, material
E. Political/Leadership Patterns
Community Diagnosis Process:
- collecting,organizing, synthesizing, analyzing, &
interpreting health data.
Steps in the CDX Development

1. Determining the objectives 7. Data Collection

2. Defining the study population 8. Data Presentation

3. Determining data to be collected 9. Data Analysis

4. Collecting the data 10. Identifying the CHNsg Problems

5. Developing the instrument 11. Priority setting

6. Actual Data Gathering

Sources of data
• PRIMARY DATA- community people through surveys, interviews, focused
group discussions, observations, and through actual minutes of community
meetings
• SECONDARY DATA- organizational records of the program, health center
records, and other public records
Three levels of data gathering
1) Community people- household heads, traditional, and non-traditional
leaders; 30% of the total households for the surveys ample spread out
proportionally would be ideal
2) Community health workers- ideally, 20% of all enlisted community health
workers as of the previous year
3) Program staff
Instruments
• Survey questionnaire
• Observation checklist
• Interview guides (CHW, leaders, program staff)
Identification of the community health
nursing problems
• HEALTH STATUS PROBLEMS
- may be described in terms of increased or decreased morbidity, mortality,
or fertility e.g., 40% of the school age children have ascariasis
• HEALTH RESOURCES PROBLEMS
- described in terms of lack of or absence of manpower, money, materials,
or institutions necessary to solve health problems e.g., 25% of the BHWs
lack skills in vital signs taking
• HEALTH-RELATED PROBLEMS
- described in terms of existence of social, economic, environmental, and
political factors that aggravate the illness-inducing situations of the
community e.g., 30% of the households dump their garbage in the river
Priority setting of community health
nursing problems
• NATURE OF THE PROBLEM PRESENTED
- the problems are classified by the nurse as health status, health resources,
or health-related problems
• MAGNITUDE OF THE PROBLEM
- the severity of the problem, which can be measured in terms of the
proportion of the population affected by the problem
• MODIFIABILITY OF THE PROBLEM
- probability of reducing, controlling, or eradicating the problem
• PREVENTIVE POTENTIAL
- probability of controlling or reducing the effects posed by the problem
• SOCIAL CONCERN
- perception of the population or the community as they are affected by the
problem
problems
CRITERIA (scores) WEIGHT

1
A. NATURE OF THE PROBLEM
Health status (3)
Health resources (2)
Health-related (1)

3
B. MAGNITUDE OF THE PROBLEM
75%-100% affected (4)
50%-74% affected (3)
25%-49% affected (2)
<25% affected (1)

4
C. MODIFIABILITY OF THE PROBLEM
High (3)
Moderate (2)
Low (1)
Not modifiable (0)

1
D. PREVENTIVE POTENTIAL
High (3)
Moderate (2)
Low (1)

1
E. SOCIAL CONCERN
Urgent community concern (2)
Recognized as problem but not needing immediate attention (1)
Not a community concern(1)
Steps in prioritizing community problems
1. Score each item according to each criteria
2. Divide the score by the highest possible score
3. Multiply the answer by each weight of the criteria
4. Add the final score for each criterion to get the total score for the problem.
The highest possible score is 10, while the lowest possible score is 1 5/12
5. The problem with the highest total score is given high priority by the nurse.
Given the situation
After collating the data in the community diagnosis, the nurse learned that
one of the community health problems is that 40% of the school aged children
have ascariasis. The mother recognize this and are willing to have their
children undergo deworming. Majority of the mother are so concerned that
they asked the nurse about its cause and the ways on how to prevent it.

The other barangay health problem is the lack of skills of the BHWs in
Barangay, For example, 25% of the BHWs lacked skills in vital signs taking.
The BHWs expressed their concern that they cannot perform their tasks
because of this. All of them verbalized their desire to attend health skills
trainings in the future.
 problems

Problem A: 40% of the school age children have ascariasis Problem B: 25% of the BHWs lack skills in vital signs taking

PRIORITIZING (3÷3) x 1=1 PRIORITIZING (2÷3) x 1=0.66

A. NATURE OF THE PROBLEM A. NATURE OF THE PROBLEM
Health status (3) Health resources

B. MAGNITUDE OF THE PROBLEM (2÷4) x 3=1.5 B. MAGNITUDE OF THE PROBLEM (2÷4) x 3=1.5
25%-49% affected (2) 25%-49% affected (2)

C. MODIFIABILITY OF THE (3÷3) x 4=4 C. MODIFIABILITY OF THE (3÷3) x 4=4

PROBLEM PROBLEM
High (3) High (3)

D. PREVENTIVE POTENTIAL (3÷3) x 1=1 D. PREVENTIVE POTENTIAL (3÷3) x 1=1

High (3) High (3)

E. SOCIAL CONCERN (2÷2) x 1=1 E. SOCIAL CONCERN (2÷2) x 1=1

Urgent community concern (2) Urgent community concern (2)

TOTAL 8.16
TOTAL 8.5
 PUBLIC HEALTH TOOLS IN
COMMUNITY HEALTH NURSING
1. Demography
2. Vital Statistics
3. Epidemiology
 DEFINITION OF TERMS
▪ Fertility Rate (average number of babies born to females
during their reproductive years aged 15 to 49 years old.
▪ Birth rate is the number of live births per 1,000 women in the
total population. We usually calculate this figure on an annual
basis.
▪ Morbidity (Disease; any departure from a state of
physiological or psychological health and well-being)
▪ Mortality rate - The frequency of occurrence of death among a
defined population during a specified time interval.
▪ Endemic diseases (constant presence of a disease or
infectious agent within a given geographic area or population
group).
 1. DEMOGRAPHY
▪ Demography – is the science which deals with the study of
the human population’s size (number of people in a given place
or area at a given time), composition(age, sex, occupation or
educational level) and distribution in space (Geographic
location – Urban or Rural)
▪ Demography helps the nurse to find reasons or rationale why
or how a particular population or group is influenced by a
variety of factors resulting in vulnerability to diseases.
▪ Demographic information can be obtained from a variety of
sources but most common come from census, sample surveys
and registration system (Civil registrars).
 2. VITAL STATISTICS

▪ Is a tool in estimating the extent or magnitude of health needs

and problems in the community.
▪ The nurse is able to describe the health status of the people
which serves as a basis for developing, implementing and
evaluating programs and intervention strategies.
 DEFINITION OF TERMS
▪ Fertility Rate (average number of babies born to females
during their reproductive years aged 15 to 49 years old.
▪ Birth rate is the number of live births per 1,000 women in the
total population. We usually calculate this figure on an annual
basis.
▪ Morbidity (Disease; any departure from a state of
physiological or psychological health and well-being)
▪ Mortality rate - The frequency of occurrence of death among a
defined population during a specified time interval.
▪ Endemic diseases (constant presence of a disease or
infectious agent within a given geographic area or population
group).
 COMMON VITAL STATISTICS INDICATORS

1. Fertility rates
▪ Crude Birth Rate – A measure of one characteristics of the
natural growth or increase of population.
Formula:
Crude Birth Rate = Total number of live births X 1000
Midyear population
 Common Vital Statistics Indicator
2. Mortality rates
▪ Crude Death Rate = Number of Deaths X 1000
Midyear population
▪ Infant Mortality Rates = Death under 1 year of age X 1000
Number of live births
▪ Maternal Mortality Rate = No. of Deaths due to Pregnancy X 1000
Number of live births

▪ Swaroop’s Index = Number of deaths among those 50 years old and above X 100
Total deaths
 Common Vital Statistics Indicator
3. Morbidity Rates
▪ Incidence Rate – measures the frequency of occurrence of the
phenomenon during a given period of time.
IR=Number of new cases of a particular disease registered during a specified time X 1000

Estimated population as of July of same year

▪ Prevalence Rate – measures the proportion of population which exhibits a particular

disease at a particular time. Deals with total old and new cases
PR=No. of old & new cases of a certain disease registered at a given time X 1000
Total of persons examined at same given time
 Prevalence Rate

▪ Prevalence Rate – measures the proportion of population

which exhibits a particular disease at a particular time. Deals
with total old and new cases
PR=No. of old & new cases of a certain disease registered at a given time X 1000
Total of persons examined at same given time
WHAT IS DALY? (Disability Adjusted Life Years)
▪ Way to measure the burden of disease
▪ The life expectancy of Filipinos in 2002 has gone up to 72
years.
▪ The process of aging brings out myriad health problems that
are degenerative.
 WHAT IS YLL AND YLD?

▪ YLL = Years of life lost due to premature death (Life

expectancy – age during death)
YLD = Years of life lost due to disability (Age during death – age
when unable to work)
YLL + YLD = DALY
 Example

▪ if Pepito, a Filipino died of cancer at the age of 55. He was

diagnosed and was unable to work at 45 years old. The
average Filipino life span is 72 years old. Compute the DALY.
YLL= 72-55 = 17 years of life lost due to premature death
YLD = 55-45 – 10 years of life lost due to disability
ANSWER: 17 +10 = 27 DALY
 3. WHAT IS EPIDEMIOLOGY?

▪ Epidemiology - study of distribution and determinants of

health related states or events in specified populations and the
application of these study to control health problems (Last,
1988)
▪ Epidemiology is defined as the study of the occurrence and
distribution of health conditions such as diseases, death,
deformities or disabilities on human populations (Maglaya, et.al,
2004)
▪ Use by the nurse to explain probable causes of health
conditions as they occur to the community.
 4 PHASES OF EPIDEMIOLOGY
1. Descriptive epidemiology aims to describe the occurrence of a health
conditions in the community in terms of person, place and time
characteristics. The nurse will be able to formulate a hypothesis
regarding the relationship between the exposure factors and the
disease conditions under study.
2. Analytical epidemiology. To prove the association between factor and
disease, the hypothesis will undergo some frm of testing.
3. Intervention epidemiology – prevention and control to reduce the
occurrence of a disease.
4. Evaluation epidemiology -"surveillance" to collect information regarding
risks, benefits, and optimal use. This phase can be particularly
important for identifying rare, but potentially devastating side effects by
evaluating new treatments for existing disease.
FUNCTIONS OF THE NURSE IN EPIDEMIOLOGY
∙ Maintains surveillance of the occurrence of notifiable disease
∙ Coordinates with other members of the health team during a
disease outbreak
∙ Participates in case finding and collection of laboratory
specimens
∙ Isolates cases of communicable diseases
∙ Renders nursing care, teaches and supervises giving of care
∙ Performs and teach household members on concurrent and
terminal methods of disinfection
∙ Provide health teachings to prevent further spread of disease
and infection
 2 MAJOR CONCEPTS IN EPIDEMIOLOGY

1. MULTIPLE CAUSATION THEORY

2. LEVELS OF PREVENTION OF HEALTH PROBLEMS
 1. THE MULTIPLE CAUSATION THEORY

∙ Diseases development does not rest on a single cause.

∙ Health conditions result from a multiple factor.
∙ Disease is a condition of abnormal vital function involving
structure or system of an organism while health is a condition
of physical, mental, social-wellbeing and an absence of a
disease.
 MODELS THAT EXPLAIN THE MULTIPLE
CAUSATION THEORY
1. Agent is any element, substance or force, either animate or
inanimate, the presence or absence of which may serve as a
stimulus to initiate or perpetuate a disease process.

AGENT EXAMPLE
Biological Virus, bacteria, fungus, parasites
Chemical Lead, Mercury, Insecticide
Physical Humidity, Atmosphere, Radiation
Mechanical Stab, Trauma
Nutritive Iodine Deficiency, Cholesterol
 MODELS THAT EXPLAIN THE MULTIPLE
CAUSATION THEORY

2. Host is any organism that harbours and provides nourishment

for another organism. Since the community considers as a host,
the nurse must protect the community by increasing its herd
immunity. Herd Immunity is the probability of a group of
community developing epidemic upon introduction of an
infectious agents.
 MODELS THAT EXPLAIN THE MULTIPLE
CAUSATION THEORY
3. ENVIRONMENT is the sum total of all external conditions and
influences that affects the life and development of an organism.
The environment affects the agent and the host. There are three
components of the environment.
∙ Physical environment is composed of the inanimate
surroundings such as the geophysical conditions or climate.
∙ Biological environment makes up the living things around us
such as plant and animals.
∙ Socio-economic environment which may be in the form of
level of economic development of the community, presence of
disruption and the like (landslides, Drowning, floods)
FIELD HEALTH SERVICE
INFORMATION SYSTEM
(FHSIS)
What is Field Health Service Information System?

∙ Official information system of the DOH, operational since 1989

∙ Provides health services data to monitor health care activities
and data on notifiable diseases, leading causes of morbidity
and mortality, births, immunization, dental health care, family
planning methods, maternal and child nutrition, health facilities,
and health care personnel.
∙ Done monthly, quarterly and annually
∙ Reports come from the Barangay Health Stations, MHO. PHO,
City Health Office, Regional Health
 Field Health Service Information System

▪ Republic Act No. 11332- An act providing policies and

prescribing procedures on surveillance and mandatory
reporting of notifiable diseases, epidemics and health events
of public health concern.
▪ Republic Act N. 3573 – The Law of reporting of communicable
diseases.
 Objectives of Field Health Service Information
System

∙ Provides summary of data on health service delivery and

accomplished programs at the barangay stations up to the
regional levels
∙ Provides data for program monitoring and evaluation
∙ Provides a standardized data base
∙ Minimizes the recording and reporting burden
 IMPORTANCE OF FHSIS
∙ Helps local government determine public health priorities
∙ Basis for monitoring and evaluating health program
implementation
∙ Basis for planning, budgeting, logistics and decision making at
all levels
∙ Source of data to detect any unusual occurrence of a disease
∙ Needed to monitor the health status of the community
∙ Helps midwives/nurses in following up clients / patients
∙ Documentation of the midwives / nurses’ day to day activities
 COMPONENTS OF FHSIS
1. RECORDING TOOLS
A. Individual Treatment Record (ITR)
B. Target Client List (TCL)
C. Summary Table
D. Monthly Consolidation Table
2. REPORTING TOOLS
2.1.Monthly Form
A. Program Report (M1)
B. Morbidity Report (M2)
2.2. Quarterly for Program Reports
A. Program Report (Q1)
B. Morbidity Report (Q2)
2.3. Annual Forms
1. RECORDING TOOLS
∙ Facility based documents.
∙ Gathers detailed data and contains day to day activities of the
health workers.
∙ Source of data- services delivered to patients/clients.
A. Individual Treatment Record (ITR)
⮚ Contains date, name, address of patient, presenting symptoms
or complaint on consultation, diagnosis (if available), treatment
and date of treatment is recorded.
⮚ Should be maintained as part of the system of records at each
health facility on all patients seen.
B. Target Client List (TCL)
Purposes:
1. Enables the midwife or nurse to plan and carry out patient
care and service delivery especially to “targets” or “eligibles”
for a particular health program.
2. Facilitates monitoring and supervision of service delivery
activities
3. Report services delivered.
4. May provide a clinic-level data base which can be accessed
for further studies. Target client lists, examples are: TCL for
Prenatal care, TCL for Post-Partum Care and TCL for
Nutrition and EPI
C. Summary table (ST)
∙ Monthly data record of all data from the TCL or registries.
∙ Easy source of data for reports being prepared by the midwife.
∙ Must be always updated
∙ Serve as proof of accomplishments to LGU officials
∙ Serves as the data source for survey, special study, or
research
∙ Serves as a tool for the midwife to assess her own
accomplishments
D. Monthly Consolidation Table (MCT)
∙ Form where the Public Health Nurse (PHN) records data from
all barangays she covers
 2. REPORTING TOOLS
▪ Summary data transmitted or submitted on a monthly, quarterly
and on annual basis to a higher-level facility
∙ Source of data in reporting is from the Summary Table and the
Monthly Consolidation table
1. Monthly Form
a. Program Report (M1)
▪ Contains selected indicators categorized as maternal care, child care,
family planning and disease control. It helps the midwife capture the
monthly data so that it would be easier for the nurse to consolidate and
prepare the quarterly report
b. Morbidity Report (M2)
▪ Contains a list of all diseases by age and sex. Monthly consolidation
report by midwife and is submitted to the PHN for quarterly
 2. Quarterly Form for Program Reports
⮚ Official health report of the municipality/city for the quarter.
⮚ Contains the consolidated three-month reports of all the BHS’s
and the Rural Health Unit/ Municipal Health Center
(RHU/MHC)
A. Program Report (Q1)
∙ The Quarterly Form contains 3-month total of indicators
categorized under maternal care, child care, dental care, family
planning and disease control. ** There should only be one
Quarterly Form per municipality/city.
B. Morbidity Report (Q2)
∙ The PHN uses the Quarterly Report of Morbidity diseases to
 3. ANNUAL FORMS

⮚ Contains basic information about the municipality or city,

submitted only once a year.
⮚ It consists of data categorized under demographic,
environmental, natality and mortality.
⮚ The nurse in the Rural Health Unit/ Municipal Health Center fills
up the form and submits to the Provincial Health Office for
computer processing.
 3. ANNUAL REPORTS ALSO CONTAIN THE FF:

A. Morbidity Disease Report

⮚ This report is prepared by the PHN as the annual consolidation of the
monthly and quarterly morbidity disease reports from the BHSs and the
RHUs.
⮚ The report consists of all reported causes of morbidity diseases with age
and sex breakdown, and submitted to the PHO.
B. Mortality Report
⮚ This report is the annual consolidation of all deaths reported by the PHN,
categorized per disease, age and gender
 TABLE FOR REPORTING and RECORDING GUIDE
LOCUS OF RESPONSIBILITY
Office Person Frequency
Barangay Health Station Midwife Monthly forms
(BHS) and annual forms
Rural Health Unit Community Health Quarterly forms
(RHU) Nurse and annual form
Provincial Health Office Provincial/City Quarterly forms
(PHO) FHSIS and annual forms
City Health Office (CHO) Coordinator
Center for Health Regional FHSIS Quarterly forms
Development (CHD) Coordinator and annual forms
PRIMARY HEALTH CARE
USSR, ALMA ATA 1978
 HISTORY OF PRIMARY HEALTH CARE
▪ Before 1978, globally, existing health services were failing to
provide quality health care to the people.
▪ Different alternatives and ideas failed to establish a well-
functioning health care system.
▪ Considering these issues, a joint WHO-UNICEF international
conference was held in 1978 in Alma Ata (USSR), commonly
known as Alma-Ata conference.
▪ The conference included participation from government from
134 countries and other different agencies.
▪ The conference jointly called for a revolutionary approach to
the health care.
 HISTORY OF PRIMARY HEALTH CARE
▪ The conference declared ‘The existing gross inequality in the
health status of people particularly between developed and
developing countries as well as within countries is politically,
socially and economically unacceptable'. Thus, the Alma-Ata
conference called for acceptance of WHO goal of ‘Health for
All’ by 2000 AD.
▪ Furthermore, it proclaimed Primary Health Care (PHC) as a
way to achieve ‘Health for All’.
▪ In this way, the concept of Primary Health Care (PHC) came
into existence globally in 1978 from the Alma-Ata Conference.
 WHAT IS PRIMARY HEALTH CARE?
▪ The Department of Health (DOH) defines PHC as an approach
to health development which is carried through a set of
activities and whose ultimate aim is continuous improvement
and maintenance of the health status of the community.
▪ With the definition, 3 components can be gleaned:
1. meeting people’s health needs throughout their lives;
2. addressing the broader determinants of health through multi-
sectoral policy and action
3. Empowering individuals, families and communities to take
charge of their own health.
 PRIMARY HEALTH CARE

▪ Primary Health Care (PHC) is the health care that is available

to all the people at the first level of health care.
▪ According to World Health Organization (WHO), ‘Primary
Health Care is a basic health care and is a whole of society
approach to healthy well-being, focused on needs and
priorities of individuals, families and communities.
▪ Primary Health Care (PHC) is a new approach to health care
which integrates at the community level all the factors required
for improving the health status of the population.
 GOAL OF PRIMARY HEALTH CARE
▪ The International Conference on Primary Health Care, meeting
in Alma-Ata, USSR on September 12, 1978 expressing the
need for urgent action by all governments, all health and
development workers, and the world community to protect and
promote the health of all the people of the world. Health for all
people by 2020)
▪ However, the Philippine communities are still in state of poor
health to date perhaps due to poor implementation of health
policies.
 PRIMARY HEALTH CARE
Mission:
▪ Strengthen the health care system by increasing opportunities
and supporting the conditions wherein people will manage their
own health care
Goal:
▪ Health for all by the year 2000
Theme:
▪ Health for all and health in the hands of the people by the year
2020.
▪ For a more detailed discussion on the declarations made at
Astana, you may visit https://web-prod.who.int/primary-
health/conference-phc
 WHY PHC?
• Primary health care is key to solving the health challenges
facing countries in Asia and the Pacific, according to the World
Health Organization (WHO).
• Magnitude of health problems
• Lack of investment in primary health care (isolation of health
care from other areas of development)
• Lack of access to health services (inadequate and unequal
distribution of health resources)
• Increasing cost of medical care
5 As of PRIMARY HEALTH CARE PRINCIPLES

Available

Attainable
 PRINCIPLE OF PRIMARY HEALTH CARE
▪ Partnership between the community and the health agencies
▪ Recognition of interrelationship between the health and
development
▪ Social Mobilization
▪ Decentralization
 CHALLENGES PRIMARY HEALTH CARE
▪ Poor staffing and shortage of health personnel
▪ Inadequate technology and equipment
▪ Poor condition of infrastructure/infrastructure gap, especially in the rural
areas
▪ Concentrated focus on curative health services rather than preventive
and promotive health care services.
▪ Challenging geographic distribution
▪ Poor quality of health care services
▪ Lack of financial support in health care programs
▪ Lack of community participation
▪ Poor distribution of health workers/health workers concentrated on the
urban areas.
▪ Lack of intersectoral collaboration
 1. Active

4. 2. Intra

3. Use of
1. Community Participation
▪ Community participation is a process in which community
people are engaged and participated in making decisions
about their own health. It is a social approach to point out the
health care needs of the community people.
▪ Community participation involves participation of the
community people from identifying the health needs of the
community, planning, organizing, decision making and
implementation of health programs. It also ensures effective
and strategic planning and evaluation of health care services.
▪ In lack of community participation, the health programs cannot
run smoothly and universal achievement by primary health
care cannot be achieved.
2. Intra-Inter Sectoral Coordination
▪ Inter-sectoral coordination plays a vital role in performing
different functions in attaining health services.
▪ The involvement of specialized agency, private sectors, and
public sectors is important to achieve improved health facilities.
▪ Intersectoral coordination will ensure different sectors to
collaborate and function interdependently to meet the health
care needs of the people.
▪ It also refers to delivering health care services in an integrated
way. Therefore, the departments like agriculture, animal
husbandry, food, industry, education, housing, public works,
communication, and other sectors need to be involved in
achieving health for all.
3. Use of Appropriate Technology
• Appropriate healthcare technologies are an important strategy for
improving the availability and accessibility of healthcare services. It has
been defined as ‘’technology that is scientifically sound, adaptable to
local needs and acceptable to those who apply it and to whom it is
applied and that can be maintained by people themselves in keeping
with the principle of self-reliance with the resources the community and
country can afford.’’
▪ Appropriate technology refers to using cheaper, scientifically valid and
acceptable equipment and techniques.
▪ It is also necessary to ensure that the technology is:
- Scientifically reliable and valid
- Adapted to local needs
- Acceptable to the community people
- Accessible and affordable by the local resources
4. Support Mechanism Made Available

▪ Support Mechanism is vital to health and quality of life.

Support mechanism in primary health care is a well-known
process focused to develop the quality of life.
▪ Support mechanism includes that the people are getting
personal, physical, mental, spiritual and instrumental support
to meet goals of primary health care.
▪ Primary health care depends on adequate number and
distribution of trained physicians, nurses, community health
workers, allied health professions and others working as a
health team and supported at the local and referral levels.
 STRATEGIES TO ACCOMPLISH PHC GOALS

▪ Elevating health to a comprehensive and sustained national

effort.

▪ Promoting and supporting community managed health care.

▪ Increasing efficiency in health sector.

▪ Advancing essential national health research.

ELEMENTS OF PRIMARY HEALTH CARE
 ELEMENTS OF PHC
E Education about prevailing health problems and methods of
preventing and controlling them
L Prevention and control of locally endemic diseases
E Provision of essential drugs
M Maternal and child health care, including family planning
E Expanded immunization against major infectious diseases
N Promotion of food supply and proper nutrition
T Appropriate treatment of common diseases and injuries
S Adequate supply of safe water and basic sanitation
 EXPANDED ROLES OF THE NURSE IN PHC
▪ Assessing the health status of individual and communities
▪ Mobilizing community involvement
▪ Providing integrated health care including the treatment of
emergencies, and making referrals
▪ Maintaining epidemiological surveillance
▪ Training and supervising health workers
▪ Collaborating with other development sectors
▪ Monitoring progress in PHC
 BASIC HEALTH SERVICES OF PRIMARY
HEALTH CARE

1.Maternal and Child Health (MCH)

∙ Maternity Care (Prenatal, intra-natal and postnatal)
∙ Child Care – Neonatal, Under 5 (IMCI) NBS
∙ Family Planning
∙ Nutrition – Counselling
2. Epidemiology
3. Vital and Health Statistics
 BASIC HEALTH SERVICES OF PHC
4. Environmental Sanitation (PD 856- Sanitation Code of the
Philippines)
∙ Water sanitation (boiling time – 20 minutes
∙ Food sanitation
⮚ Inspection/approval of all food sources and transport vehicles
⮚ Compliance to sanitary permit requirement for all food
establishments
⮚ Provision of updated Health Certificate for Food Handlers,
cooks, and cook helpers which include monitoring as to
presence intestinal parasites and bacterial infection
⮚ Destruction or banning of food unfit for human consumption
 BASIC HEALTH SERVICES OF PHC

∙ Refuse and garbage disposal

⮚ Garbage – leftover foods
⮚ Refuse – basura
⮚ Hospital Waste Management (Green – nabubulok, Yellow –
Infectious and Black – General (dry)
∙ Excreta disposal
∙ Insect, Vector and Rodent control (Anti-rabies Act)
∙ Housing
 BASIC HEALTH SERVICES OF PHC

∙ Air pollution
⮚ Noise
⮚ Radiological protection
⮚ Institutional Sanitation
⮚ Stream Pollution
5. Health Education
6. Communicable Disease Control
 Types of Primary Health Workers
1. Village or Barangay Health Workers(BHWs)-This refers to the
trained community health worker or health auxiliary volunteer
or a traditional birth attendant or healer.
2. Intermediate Level Health Workers – Compose of general
practitioners or the assistants, Public Health Nurse,, Rural
Sanitary Inspectors and midwives. Below is the manpower
ratio to population.
1 Physician 20,000
1 Public Health Nurse 20,000
1 Medical Technologist 20,000
1 Sanitary Inspector 20,000
1 Dentist 50,000
1 Midwife 5,000
LEVELS OF HEALTH CARE and REFERRAL
SYSTEM
 LEVELS OF HEALTH CARE
Primary Level of Care
∙ Devolved to cities and municipalities
∙ Usually the first contact between the community members and other levels of the
health facility.
∙ Center physicians, public health nurses, rural health midwives, traditional healers.
Secondary Level of Care
∙ Given by physicians with basic health training.
∙ Usually given in health facilities either privately owned or government-operated.
∙ Infirmaries, municipal, district hospital, out-patient departments.
∙ Rendered by specialists in health facilities.
Tertiary Level of Care
∙ Referral system for the secondary care facilities.
∙ Provided complicated cases and intensive care.
∙ Medical centers, regional and provincial hospitals, and specialized hospitals.
 LEVELS OF CARE
▪ The higher the level, the more qualified the health team
personnel and the more sophisticated the health equipment.
▪ Under this structure, health care is provided by the suitable
health facility on the basis of health need. There is better
utilization of scarce health resources.
▪ Teamwork in primary health care entails joint planning,
implementation and evaluation of community activities by the
team members with the community health needs/problems as
a basis of action, joints effort in the implementation of health
programs is demonstrated by the health team in the EPI.
 REFERRAL SYSTEM
▪ Health problems that are beyond the capability of PHC units
and beyond the competence of PHC workers are referred to
an intermediate health facility, usually a Rural Health Unit
(RHU) located in a town or población. The RHU team
generally consist of the physician, dentist, public health nurse,
midwife, sanitarian and other health workers.
▪ The District Community Hospital attends to cases needing
hospitalization. Higher echelon of health services at the
provincial, regional and national levels, provide secondary or
tertiary care to complete the health care given at district and
peripheral levels.
 THE 3 LEVELS OF PREVENTION

▪ Prevention refers to the identification of potential

problems so that the nurse can minimize or
probably even eradicate possible disability or
deformity in a population at-risk to negative
exposure.
1. Primary Prevention
2. Secondary Prevention
3. Tertiary Prevention
 PRIMARY PREVENTION
▪ Primary prevention is directed to the healthy population. It aims
to strengthen the host resistance, inactivate the agent or
interrupt the chain of infection through environmental
manipulation and prevention of infection to human and other
susceptible hosts.
▪ Health promotion activities include provision of proper nutrition,
safe water supply and waste disposal system, vector control,
promotion of healthy lifestyle, good personal habits and
quarantine.
▪ Specific measures include immunization and prophylaxis to
vulnerable groups.
 SECONDARY PREVENTION
▪ Aims to identify and treat existing health problems at the
earlies possible time. The interventions include screening, case
finding, disease surveillance, prompt and appropriate treatment.
▪ In communicable disease control health education on the signs
and symptoms of the disease will enable the client to identify
illness.
▪ Knowledge and behavior will help prevent the spread of
communicable disease.
SECONDARY PREVENTION (SCREENING)
 TERTIARY PREVENTION
▪ Aims of tertiary prevention are to keep health problems from
getting worse, to reduce the effects of disease and injury, and
to restore individuals to their optimal level of functioning.
▪ Examples include teaching how to perform insulin injections
and disease management to a patient with diabetes, referral of
a patient with spinal cord injury for occupational and physical
therapy, and leading a support group for grieving parents.
Summary and Highlights
• Nurses roles in public health are expanding.
• FHSIS is the DOH-approved data analytics.
• Primary Health Care is the approach we use to promote health for all
• Three levels of prevention: primary, secondary, tertiary
 MAIN REFERENCES
▪ Cuevas, F et al. (Eds.) (2007). Public health nursing in the
Philippines. Manila: National League of Government Nurses,
Inc.
▪ David, E. et al. (2007). Community health nursing: An approach
to families and population groups, Manila, Phil: Merriam &
Webster Bookstore, Inc.
▪ Maglaya, A. et al. (4th Edition). Nursing practice in the
community. Marikina, Philippines: Argonauta Corp.
▪ Reyala, J et al. (9th Edition). Community Health Nursing in the
Philippines. National League of Government Nurses, Inc.
▪ Principles of Community Development (Michigan State
University).
 OTHER REFERENCES

Journals
▪ Cuevas, P. R. F., Calalang, C. F., Reyes, D. J. A. D., & Rosete, A. P. M.
A. L. (2017). The Impact of Decentralization of the Philippines’ Public
Health System on Health Outcomes.
Monograph
▪ Bolinto C. (2010) Community Organizing-Participatory Action Research
(CO-PAR): An alternative approach to community health development
Electronics
▪ Department of Health website: www.doh.gov.ph
▪ World Health Organization website: www.who.int
• Nursing care of the community (Niels &amp; McEwen,
2019) p.41-72 A community view and 49-96
Primary Health Care
• The Basics of Community Health Nursing (Gesmundo,
2010) p.361-369 Epidemiology and 391-397 Field
Health Services and Information System
• Health for All and Primary Health Care, 1978–2018:
A Historical Perspective on Policies and Programs over
40 Years by Rifkin (2018)
• Epidemiology (2018) p.147-163 Analytic Epidemiology
by Friis
END OF SLIDES