MODULE 1:

1st Semester │S.Y. 2022-2023

LECTURER: HAZEL S. INZO

WEEK 1 - It carries the mandate that health is a

basic human right.
Community Health Nursing: The 3 Broad
Concepts - It is seen as a spectrum or a continuum.
1.) What is a community? - The modern concept of health refers to
the Optimum Level of Functioning
- A group of people with common
(OLOF) of individuals, families, and
characteristics or interests living together
communities, which is influenced by the
within a territory or geographical
ecosystem through a myriad of factors.
boundary.
- Places where people under usual
conditions are found. What influences OLOF?
- The community is the object or form of - Behavioral (Culture, habits, moves,
care in CHN, with the family as the unit of ethnic customs)
service.
- Socio-economic (employment,
FACTS of CHN education, housing)
Focus: Promotion and preservation of health ● People with low educational
levels will really follow what we,
Area of Content: Skills and knowledge relevant to
nurses, say. Hence, be specific
both nursing and public health.
and go down to their level of
Clients: General populations (individuals, understanding
families, populations, communities) - Political (Safety, oppression, people,
empowerment)
● populations are also known as
“aggregates” or “groups” - Hereditary (genetic endowment,
● Ex. Aggregates of lactating mothers familial, racial)
Time: Continual, not limited to episodic care - Health Care Delivery System (promotive,
preventive, curative, rehabilitative)
Scope: Comprehensive and general, not limited
to a particular age or group. Promotion and prevention
“Health center”
Concepts of Community Health Nursing: ↓
- Clients of Community Health Nurse Curative
“Hospital”
- Composed of different levels of clients, ↓
individuals, families, population groups, and Rehabilitative
community. “Home”
- Community as setting _____ CHN PRACTICE - Environment (air, food, water, wastes,
- School Health Nursing – School noise, radiation, pollution, congestion)

- Occupational Health Nursing – Workspace 1.) What is Nursing?

- Public Health Nursing - Home - The diagnosis and treatment of

human responses to actual or
●
Public health - limited; local potential health problems (ANA,
●
Community health - broad; scope is main 1980).
area and sub-areas
2.) What is Health? - Nursing, together with public health,
is one of the helping professions in
- A state of complete physical, mental, the health care system which
and social well-being and not merely the operates at three levels of clientele -
absence of disease and infirmity (WHO, individuals, families, or groups, and
1995) communities.

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 MODULE 1:
1st Semester │S.Y. 2022-2023
LECTURER: HAZEL S. INZO
Community Health nsg - By Dr. Araceli Maglaya
- The Utilization of the nsg process in the
different levels of clientele individual
families, pop groups, and comm.
- Concerned with the promotion of health
- prevention of diseases
- disability and rehabilitation
According to Maglaya, et al CHN
- Composed of 3 major concepts
- Community (Client)
- health (Goal)
- Nursing (the means)
Is a service rendered by a professional nurse with
the community groups, families, and individuals
at home, in health centers, in clinics, in school, in
place of work for the promotion of Health,
prevention of illness, care of the sick at home
and rehabilitation (Ruth B. Freeman)
- A synthesis of nursing knowledge and
practice and the science and practice of
public health implemented via a
systematic use of the nursing process
and other processes to promote health
and prevent illness in population groups
(Clark, 2008)
The PHILOSOPHY of CHN
- Is based on the worth and dignity of man
(Margaret Shetland) it is population-
focused - “the greatest good for the
greatest number”
- 1 nurse = 10 - 15,000 clients
- Community Diagnosis
- Vital statistics
● Hypertension, diabetes, fever,
colds, cough, etc are common
illnesses in the community that
we should know
- Priority Setting
- It is a promotive-preventive service
o Adheres to Primary Health
Care
o Promotive Service: Health
Education
o Preventive treatment
▪ Best example is
health center
because this is the
first place that
people go to for
healthcare
- It is a generalist practice - deals with
all cases
Goal:
- To raise the level of health of the
citizenry by helping comm. & families to
cope with the discontinuities in &
threats to health in such a way as to
maximize their potential for high-level
wellness.
The PRIMARY FOCUS of CHN
- Health Promotion wherein Health
Teaching is the primary responsibility of
the community health nurse, who is a
generalist in terms of practice.
PRINCIPLES of CHN
E - education as a primary tool and responsibility
M - ade available to all regardless of race, creed,
and socio-economic status
P - olicies and objectives of the agency is fully
understood by the nurse
O - rganizing for health, with the family as the
unit of service
Works as a member of the health team (PHN)
Existing active organizations are utilized
Recording, and reporting are accurate
Monitoring and evaluation of services is
periodically done
Existing indigenous resources of the community
is used (Ex: BABALUNYTS)
Needs of clienteles are recognized and serves as
basis for CHN
Training and development as opportunities for
continuing staff educational programs.
BASIC CONCEPTS AND PRINCIPLES OF CHN
1.) The family is the unit of care, the
community is the patient and there are
four levels of clientele in CHN.
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 MODULE 1:
1st Semester │S.Y. 2022-2023
LECTURER: HAZEL S. INZO

2.) The goal of improving community health is

realized through a multi-disciplinary effort.
a.) Multi-disciplinary Effort -
participation/involvement of every
member of health team
3.) The community health nurse works with
and not FOR the individual patient, family,
group, or community, The latter are active
partners, not passive recipients of care.
4.) The practice of CHN is affected by changes
in society in general and by developments
in the health field in particular.
5.) CHN is part of the community health
system which in turn is part of the larger
human services system.
BASIC CONCEPTS OF CHN
- PRIMARY FOCUS/EMPHASIS: HEALTH
PROMOTION AND DISEASE PREVENTION
- PRIMARY GOAL: SELF-RELIANCE IN
HEALTH OR ENHANCED CAPABILITIES
- ULTIMATE GOAL: RAISE THE LEVEL OF
HEALTH OF CITIZENRY
- PHILOSOPHY OF CHN: WORTH AND
DIGNITY AT MAN.

WEEK 2

Highlights in CHN

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 MODULE 1:
1st Semester │S.Y. 2022-2023
LECTURER: HAZEL S. INZO
● CHN is based on the recognized needs of
communities, families, groups, and
individuals
o Let people recognize and solve
their own problems to promote
people’s participation
● CHN is a unique blend of nursing and
public health practice and is oftentimes
used interchangeably with the term
● “Public Health Nursing”
Public Health Nursing
● The practice of nursing in national and
local government health departments
(which include health centers and rural
health units), and public schools
● Standards of Public Health Nursing in the
Philippines, 2005
● WHO defined PHN as a 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
According to WHO
● PUBLIC HEALTH
o The art of applying science in the
context of politics so as to
reduce inequalities in health
while ensuring the best health
for the greatest number
▪ Always involved or connected
with politics. Hence, think,
reflect, pray, and decide before
you vote
▪ They are the ones that have the
power to hold funds from our
taxes
Objectives of Public Health/ Major Concepts
● 4 P’s
● Promote Health
● Prevent Disease
● Prolong life
● People participation towards self-
reliance
Roles and Functions of PHN
1. Clinical/health care provider
2. Health advocator
3. Collaborator
4. Consultant
5. Counselor/Health educator
6. Researcher
7. Case manager
8. Community organizer
9. Role model
Responsibilities of CHN
● Participates in the development of an overall
health plan, its implementation, and
evaluation for communities
● Maintains coordination/linkages with other
health team members, NGO/government
agencies in the provision of PH services
● Example of linkages: In case of
emergency, call the barangay
captain to transport the patient to
the hospital using the van of
barangay hall
● Work with or connect with the
government
▪ Example: A certain barangay has
rocky roads and they have
difficulty transporting things. Work
with the barangay captain so that
they can connect with people
responsible for road-making and
the production of products
● Initiates and conducts research relevant to
CHN services to improve the provision of
health care
● Example: you need to know the
reason why an endemic of diarrhea
happened in Pasonanca
● Engages in such activities that require the
utilization of knowledge and decision-
making skills of a registered nurse;
● Note: PHN takes charge in the absence of
MHO (medical health officer or doctor)
● Since we are in the primary
health care (health center) we
should still cater clients even if
there are no doctors
● Give “unang lunas”
● This expands our roles
● In the care of the families:
● Provision of public health care
services
● Development/utilization of Family
Nursing Care Plan (FNCP) in the
provision of care
● In The care of the communities:
● Community organizing,
mobilization, community
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1st Semester │S.Y. 2022-2023
LECTURER: HAZEL S. INZO

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

REVIEW QUESTIONS
1. In terms of CHN practice, the nurse in
the community is trained as:
a. Certified in public health
b. Specialist in CHN
c. 4-year BSN graduate
d. Generalist in nursing

2. The thrusts of CHN must be embodied in

the hearts of health care providers.
Which one strengthens the health care
system?
a. Supporting conditions for health
habits
b. Increasing opportunities to be
healthy
c. Letting the people manage their
own health
d. Financing health care program

3. As a PHN, what is your primary function

or responsibility
a. Reporting of cases
b. Health promotion
c. Community diagnosis
d. Health teaching

4. The philosophy of CHN practice is based

on the belief that the family is the
smallest unit in a democratic society,
Which age group should be the priority
of the nurses in the community?
a. Older persons and terminally ill
b. Adolescent and adults
c. Infants and childre
d. All ages regardless of status

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 MODULE 1:
1st Semester │S.Y. 2022-2023
LECTURER: HAZEL S. INZO
WEEK 3
Health Care Delivery System
● (Maglaya p.22)
● Public Health (Dr. C.E.A. Winslow/Charles
Edward Amory Winslow)
A. “Science and art of preventing disease,
prolonging life, promoting health and
efficiency through organized community
effort for the sanitation of the
environment, control of CD, the
education of medical and nursing
services for the early diagnosis and
preventive treatment of diseases, and
the development of the social machinery
to ensure 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”
3 Core Functions of HCDS
1. Assessment
● Is the regular collection and analysis of
health data
● These data are used for program planning
and policy development
● Assess first before comes policies
A. Ex: Threats to safety No ID no entry
in AdZU to maintain peace and order
2. Policy Development
● Involves advocacy and political action to
develop policies in various levels of decision
making
3. Assurance
● Is making sure that health services are
effective, available and accessible to the
people
Related to the core functions of public health
are the 10 essential health services:
1. Monitoring health status to identify
community health problems
2. Diagnosing and investigating health problems
and hazards in the community
● Ex. Dirty river = Diarrhea
● Hold community assembly to decide on
solutions
3. Informing educating and empowering people
about health issues
● Information, Communication, Education
(ICE)
● Inform people about illnesses and how to
prevent them, thus empowering them
4. Mobilizing community partnerships to identify
and solve health problems
● Work with the people and not for them;
mobilize them
● They should not be dependent on you
5. Developing policies and plans that support
individual, family, and community efforts
● The policies should be for the common good
and not for vested interests
6. Enforcing laws and regulations that protect
health and ensure safety
● Ex: Letting people go home if they are not
vaccinated
7. Linking people to needed personal health
services and ensuring the provision of health
care that is otherwise unavailable
● Ex: Sta. Maria does not have an ambulance
and there is a case of placenta accreta. The
nurse called the Barangay captain to use the
barangay vehicle
● Hypovolemic shock – low blood volume
8. Ensuring competent public health and
personal health and personal health care
workforce
● Public health includes licensed health team
members
● License should always be renewed, not
expired
9. Evaluating effectiveness, accessibility and
quality of personal and population-based health
services
● Ex: Check medications if they are not expired
before administering
10. Researching for new insights and innovative
solutions to health problems
● Investigate the needs of the community
● As much as possible, deliver the baby in side-
lying to prevent it from drowning in amniotic
fluid
● Suction Ambu Bag, suction machines
Health Care Delivery (White book by cuevas
p.19)
1. Private Sector
2. Public Sector
Private Sector (For profit and non-profit
providers)
● Is largely market-oriented and where health
care is paid through user fees at the point of
service.
A. Business oriented because you need to
pay for health services
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1st Semester │S.Y. 2022-2023
LECTURER: HAZEL S. INZO
● Their involvement in maintaining the
people’s health is enormous
● This includes providing health services in
clinics and hospitals, health insurance,
manufacture of medicines, vaccines, medical
supplies, equipment, and other health and
nutrition products, research and
development, human resource development
and other health-related services
A. SSS (private) and GSIS (public)
Public Sector
● Is largely financed through a tax-based
budgeting system at both national and local
levels and where health care is generally
given free at the point of service (although
socialized user fees have been introduced in
recent years for certain types of services)
A. Free check-ups, pay to enter roads
1. Local Levels
● Local health system is now run by Local
Government Units (LGUs)
● The provincial and district hospitals are
under the provincial government
● The city/municipality government manages
the Health center/rural health units (RHUs)
and Barangay Health Stations (BHSs)
A) Ex: Canelar health center has certain
barangays under it
B) Ex: Sta. maria main health center (RHU) –
Pasonanca, Kilometer 7, Kabatangan, Dulian,
Shanty
C) RHUs distribute health supplies
● In every province, city or municipality, there
is a local health board chaired by the Local
Chief Executive (mayor)
A. Its function is mainly to serve as advisory
body to the local executive and the
sanggunian or local legislative council on
health-related matters
2. National Levels
● The DOH is mandated as the lead agency in
health (CBQ)
● It has a regional field office in every region
and maintains specialty hospitals, regional
hospitals and medical centers
● It also maintains provincial health teams
made up of DOH representatives to the local
health board and personnel involved in CD
control specifically malaria and
schistosomiasis
● We have different rooms for malaria,
schistosomiasis, and TB patients (for TB
DOTS)
● Involved in epidemiology
● Endemic – Constantly present in a certain
population or region, with relatively low
spread (or there may be periods when it
does not affect people at all, it is only
present in the environment
● Ex: Malaria and filariasis in
mountain province (Depends on
demography)
● Epidemic – When there is a sudden increase
in cases spreading through a large
population like a country (an outbreak is
similar, but usually covers a smaller
geographic area)
● Ex: Measles
● Pandemic – When there is a sudden increase
in cases spreading through several countries,
continents, or the whole world
● Ex: COVID-19
● Sporadic – disease that occurs infrequently
and irregularly
● Ex: Non-communicable diseases
(diabetes, cancer)
● Other national level agencies providing
healthcare services such as the Philippine
General Hospital (PGH) are also part of this
sector
● Major components of the Philippine
healthcare delivery system (PHCDS) that
constitute the context of CHN:
1. Department of Health (DOH)
2. Health Sector Reform Agenda (HSRA)
3. FOURmula 1 (F1)
4. Millenium Development Goals/
Sustainable Development Goals
(MDG/SDG)
5. Medium-Term Philippine
Development Plan (MTPDP)
Department of Health (DOH)
● DOH, in its new role as the national authority
on health providing technical and other
resource assistance to concerned groups as
mandated by Executive Order 102
● Functions:
A. Leadership in health
B. Enabler and capacity builder
C. Administrator of specific services
● Its mandate is to develop national plan,
technical standards and guidelines on health
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1st Semester │S.Y. 2022-2023
LECTURER: HAZEL S. INZO
A. Middle East Respiratory Syndrome
coronavirus (MERS-CoV): they
immediately make new policies and
protocols if this comes in the country
● Vision: The DOH is the leader, staunch
advocate and model in promoting health for
all in the Philippines
A. Staunch advocate – should be firm and
not bankrupt
● Mission: Guarantee equitable, sustainable
and quality health for all Filipinos, especially
the poor and shall lead the quest for
excellence in health
Health Sector Reform Agenda (HSRA)
● Goal: Health sector is the overriding goal of
the DOH (to ensure affordable access to
services of general interest). Support
mechanisms will be through sound
organizational development, strong policies,
systems, and procedures, capable human
resources and adequate financial resources
● The DOH has come up with the HSRA that
included the following reforms:
1. Provide fiscal autonomy to government
hospitals
A. Ex: Financing ZCMC to meet the
needs of the community
2. Secure funding for priority public health
programs
3. Promote the development of local
health systems and ensure its effective
performance
B. They should monitor needed
equipment to ensure that these are
readily accessible when needed
4. Strengthen the capacities of health
regulatory agencies
C. Ex. FDA, healthcare research
agencies, disease control and
prevention center)
D. BFAD (Bureau of Food and Drugs)
5. Expand the coverage of the National
Health Insurance Program
E. PhilHealth – 60 years and above
(senior citizens) are members
F. Your coverage will be bigger when
you are already a member before
being a senior citizen
FOURmula One for health (F1)
● Is the implementation framework for the
health sector reforms under the current
administration
● 3 Goals of F1:
A. Better health outcomes
B. More responsive health systems
C. Equitable health care financing
● The Four Elements of the strategy are:
A. Health financing – the goal of this
health reform is to foster greater,
better, and sustained investments in
health
B. Health Regulation – the goal is to
ensure the quality and affordability of
health goods and services
● Affordable medicine but still good
quality
C. Health Service delivery – the goal is to
improve and ensure the accessibility
and availability of basic and essential
health care in both public and private
facilities and services
D. Good Governance – the goal is to
enhance health system performance at
the national and local levels
● According to Secretary of Health, F1 is the
guiding philosophy and strategic approach of
the DOH
Millenium Development Goal (MDG)
● The concern is to improve people’s health is
universal because there is a strong
correlation between health and
development
● Poor health is a consequence and cause of
poverty and underdevelopment
● Poverty also breeds despair and turmoil
● The United Nations spearheaded the
formulation of the MDGs. These 8 goals are:
A. Eradicate extreme poverty and hunger
B. Achieve universal primary education
C. Promote gender equality and empower
women
D. Reduce child mortality
E. Improve maternal health
F. Combat HIV/AIDS, malaria and other
diseases
G. Ensure developmental sustainability
H. Develop a global partnership for
development
● As of 2015, MDG ended
● January 2016 – an even more ambitious set
of goals to banish a whole host of social ills
by 2030
● “The 17 Sustainable Development Goals
(SDGs) are our shared vision of humanity and
a social contract between the world’s
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1st Semester │S.Y. 2022-2023
LECTURER: HAZEL S. INZO
leaders and the people,” UN Secretary-
General Ban Ki-moon (Korean diplomat) said
of the 2030 Agenda for Sustainable
Development adopted unanimously by 193
Heads of State and other top leaders at a
summit at UN Headquarters in New York in
September
● “They are a to-do list for people and planet,
and a blueprint for success,” he added of the
177 goals and 169 targets to wipe out
poverty, fight inequality, and tackle climate
change over the next 15 years
● The 2030 Agenda for Sustainable
Development calls on countries to begin
efforts to achieve the 17 SDGs over the next
15 years. The goals address the needs of
people in both developed and developing
countries, emphasizing that no one should
be left behind. Broad and ambitious in scope.
● Poverty and hunger are as one in MDG; these
are separate in SDG (CBQ)
● The agenda addresses the three dimensions
of sustainable development:
A. Social
B. Economic
C. Environmental
D. As well as important aspects related to
Peace, Justice, and Effective Institutions
Medium-Term Philippine Development Plan
(MTPDP) 2017-2022
● By President Rodrigo Duterte
● Spells out the priority strategies to meet the
basic needs of the poor
A. To empower the poor and marginalized
B. Marginalized – IPs, LGBTQ, people with
learning and physical disabilities, senior
citizens
C. Push for improved transparency and
accountability in governance
D. Fuel the economy
● Specifically, growth shall be more
inclusive by lowering poverty incidence in
the rural areas, more jobs shall be
created, making individuals and
communities more resilient, driving
innovation, and building greater trust in
the government and in society
NOH (National Objective for Health)
● Is an important document that reflects
the MDGs/SDG, MTPDP, HSRA, and F1 to
bring the health sector to its desired
outcome
● Objectives of Health Sector (NOH) By
Cuevas et. al p. 27
A. Improve general health status of the
population
B. Reduce morbidity and mortality from certain
diseases
● Ex: Homemade oral rehydration –
replace fluid and electrolyte balance
in the body. Does not cure diarrhea
but is still helpful
o 6 tsp sugar
o 1 tsp salt
C. Eliminate certain diseases as public health
problems
● Prevent Dengue
o Aedes Aegypti
o Dengue brigade
● 3 As
o Asin – cost-effective. Rock salt
o Alcohol – not cost-efficient
o Aseyte (oil) – used for cooking. Black
D. Promote healthy lifestyle and environmental
health
● Exercise
● Healthy diet
● Enough sleep
● 4 o’clock habit (AM) of cleaning
E. Protect vulnerable groups with special
health and nutrition needs
● Children – BCG for tuberculosis
● Seniors
● Pregnant women
Classification of Health Facilities
(DOH A.O 2012-0012) By Famorca, pp. 187-188
Category A. Primary Care Facility
● A first contact health care facility that
offers basic services including
emergency services and provision for
normal deliveries.
● Ex: Health centers, infirmaries, and
birthing lying-in facilities
Category B. Custodial Care Facility
● Provides long-term care including food
and shelter to clients. With chronic
conditions requiring ongoing health and
nursing care due to impairment or
reduced degree of independence in
activities of daily living and clients in
need of rehabilitation
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1st Semester │S.Y. 2022-2023
LECTURER: HAZEL S. INZO

● Ex: Custodial psychiatric facilities, drug

abuse treatment and rehab centers,
leprosia/sanitaria and nursing homes

Category C. Diagnostic/Therapeutic Facility

● Facility for the examination of human
body specimens from the human body
for the diagnosis, sometimes treatment
of disease, or water for drinking water
analysis. Test covers analysis of
specimens
● Ex: Laboratories, Radiologic Facility
(Xray, CT Scan, mammography, MRI,
Ultrasound, etc.)

Nuclear Medicine Facility (Nuclear radioactive

materials in diagnosis, treatment or research)

Category D. Specialized Outpatient Facility

● Performs highly specialized procedures
on an outpatient basis
● Ex: Dialysis clinic, ambulatory surgical
clinic, chemotherapeutic clinics/center,
cancer radiation facility, Physical and
Rehabilitation Clinic (PT)
● Other examples: Circumcision clinics,
vasectomy clinics for family planning
o Vasectomy will only be effective
after 40-60 ejaculations (within
3 months)
● Situation:
o There is a fire in an ambulatory
clinic
o First help ambulating patients
go out for more efficient
evacuation of patients

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LECTURER: HAZEL S. INZO

reliant people, capable of achieving an

acceptable level of health and well-being.
-It also recognizes the interrelationship between
health and the overall political, socio-cultural,
Week 4 and economic development of society.
Primary Health Care ● Ex. Tetanus in a neonate because of
practice of using ashes to dry up
WHO defines PHC as essential health care made umbilical cord
universally accessible to individuals and families
in the community by means acceptable to them Elements/Components of PHC
through their full participation at a cost that the
1. Environmental Sanitation
community and country can afford at every stage
2. Control of Communicable Diseases
of development.
3. Immunization against major infectious
- Cost-effective - best example: health diseases
center a. Bacillus Calmette–Guérin (BCG)
and Hepatitis B for newborn
PHC was declared during the First International babies
Conference of PHC held in Alma Alta, USSR on b. Vitamin K before Hepa B to
September 6-12, 1978, by WHO. prevent bleeding of umbilicus
The Goal was adopted in the Philippines through c. BCG against TB
Letter of Instruction 949 signed by Pres. Marcos d. Primary complex – TB of
on October 19, 1979 and has an underlying newborns
theme of “Health in the Hands of the People by 4. Health Education
2020.” 5. Maternal and Child Health (MCH) and
Family Planning (FP)
DOH 6. Adequate food and proper nutrition
a. There are a lot of malnourished
A global leader for attaining better outcomes, a
children
competitive and responsive health care system,
b. PEM – Protein Energy
and equitable health financing.
Malnutrition (Marasmus and
Vision Kwashiorkor)
7. Provision of Medical Care and
Health for all in the Philippines Emergency treatment
Mission a. BEMONC – Basic Emergency
Obstetric Newborn Care
To guarantee equitable, sustainable, and quality 8. Treatment of locally endemic diseases
health for all Filipinos, especially the poor, and to a. Local sicknesses
lead the quest for excellence in health. b. Non-communicable diseases
Concept of PHC (e.g. cancer, diabetes)
9. Provision of essential drugs
Characterized by Partnership and Empowerment
of the people (core strategy) a. Maintenance drugs - diabetes,
● Work with and not for the client leprosy, hypertension
● “Client” instead of “patient”
4 As of essential health services that are
Strategies of PHC
community-based: accessible, acceptable,
available, affordable, and sustainable for both 1. Reorientation and reorganization of the
the community and government. national health care system with the
establishment of a functional support
PHC focuses on the responsibility for the health
mechanism is the support of the
of the individual, his family, and the community.
mandate of devolution under the Local
-includes full participation and active Government Code of 1991.
involvement of the community towards self- a. Devolution - decentralization or
delegation of powers from

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LECTURER: HAZEL S. INZO
central government to local
government
b. Central government
i. Executive, legislative
and judicial
ii. Law makers; their laws
should be delegated to
other local governments
iii. Ignorance of law
excuses no one
2. Effective preparation and enabling
process for health action at all levels.
a. Functional, available, and
accessible equipment
3. Mobilization of the people to know their
communities and identifying their basic
health needs with the end in view of
providing appropriate solutions
(including legal measures) leading to
self-reliance and self-determination.
a. Include local leaders (ex.
Barangay Captain)
b. Let them identify their own
problems and let them be the
ones to solve that problem
c. Be sure their solutions are legal
4. Development and utilization of
appropriate technology focusing on local
indigenous resources available in and
acceptable to the community.
a. Medicinal herbs
b. Promote visiting the health
center
5. Organization of the communities arising
from their expressed needs which they
have decided to address, and this is
continually evolving in pursuit of their
own development.
a. i. Leaders of groups (e.g.,
farmers, tricycle drivers)
6. Increase opportunities for community
participation in local-level planning,
management, monitoring, and
evaluation within the context of regional
and national objectives.
a. Always involve local leaders to
give them responsibility and so
that they know
b. Kagawad is in charge of health
7. Development of intersectoral linkages
with other government and private
agencies so that programs of the health
sector are closely linked with those of
other socio-economic sectors at the
national, intermediate and community
levels.
a. intra-sectoral
b. intersectoral
8. Emphasizing partnership so that the
health workers and the community
leaders/ members view each other as
partners rather than merely providers
and receiver of health respectively.
a. The community is our partner
b. However, there should be a
termination phase
The FRAMEWORK for meeting the goal of
Primary Health Care is Organizational
strategy, which calls for active and
continuing partnership among the
communities, private, and government
agencies in health development.
4 Cornerstone/ Pillars of PHC
1. Active community participation
2. Intra and Inter-sectoral Linkages
3. Use of appropriate technology
4. Support mechanism made available
a. Ex. Case of Placenta accreta in
the barangay: usage of barangay
vehicle as an ambulance
3 Levels of Health Care Services and the Two-
Way Referral System
A referral is a set of activities undertaken by a
healthcare provider or facility in response to its
inability to provide the necessary health
intervention for a patient.
● If midwife is incapable of handling a
case, refer to the nurse, physician, or
hospital
May be:
a. Internal – occurring within the facility
from one personnel to another.
b. External – movement from one health
facility to another; maybe vertical
(higher level of health facility) or
horizontal (different catchment).
c. Internal + External = Intra-sectoral
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LECTURER: HAZEL S. INZO

- ZCMC - training hospital

Internal Health Referral System A Pyramidal Health Structure

Individual/Family

Rural 1
Barangay BHW
Health
Station Health Station
Midwife 2
RHU Sanitary
PHN
Midwife Inspector 3

4
Rural Health
Physician
1. National Health Services, Medical
Centers, Tertiary teaching, and training
2nd Level hospital
Healthcare Facility 2. Regional health services and regional
medical centers and training hospitals
3. Provincial/ City health services or
3rd Level hospitals; Emergency/District hospitals
Healthcare Facility 4. Rural Health Unit (RHU), Community
Hospitals and HC, private practitioners/
Puericulture centers

3 Levels of Health Care External Health Referral

System
Primary Level of Care – devoted to the cities and
municipalities and is the first contact between
the community people and the different levels of
health facility.
- Health centers
- Include lying-in
Secondary Level of Care – rendered by
physicians with basic health training in district
provincial and city hospitals; capable of basic
surgical procedures and simple laboratory
examinations; serve as the referral center of
primary health facilities.
- All hospitals in ZC except ZCMC
Tertiary Level of Care – rendered by specialists
in medical centers, regional hospitals, and
specialized hospitals, like the Lung Center of the
Philippines; served as the referral center of
secondary health facilities.
Intra-sectoral Linkages – in the health sector,
the acceptance of PHC necessitated the
restructuring of the health system to broaden
health coverage and make services available to
all.
There is now a widely accepted pyramidal
organization that provides levels of services
starting with primary health and progressing to
specialty care. Primary Health Care is a
hub/center of the health system.
Intersectoral Linkages
PHC forms an integral part of the health system
and overall social and economic development of
the community. As such, it is necessary to unify
health efforts within the health organization
itself and with other sectors concerned. It
implies the integration of health plans with the
plan for the total community development.
Intersectoral linkages: sectors most closely
related to health includes those concerned with:

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LECTURER: HAZEL S. INZO
● Agricultural
● Education
● Public Works
● Social Welfare
● Population control
● Local government
● Private sectors
Two Levels of Primary Health Care Workers
1. Village or Grassroot Health Workers –
refers to trained community health
workers, BHW, health auxiliary
volunteer or a traditional birth attendant
or healer. (Non-licensed)
2. Intermediate Level Health Workers –
general medical practitioners or their
assistants. Public Health Nurse, rural
sanitary inspectors and midwives may
compose these groups. (Licensed)
Health Promotion and Concepts
A. 1ST International Conference
- Almost 10 years after the
declaration of PHC was signed, the
Ottawa Charter of Health Promotion
came out of the First International
Conference on Health Promotion in
November 1986.
- The Charter defines health
promotion as “the process of
enabling people to increase control
over, and to improve their health.”
- It identified 5 priority action areas:
(1) building healthy public policy (2)
creating supportive environment (3)
strengthening community action (4)
developing personal skills and (5)
reorienting health services.
B. 2nd International Conference
- Held in Adelaide, South Australia in
1988 focused on health public policy
- 4 priority areas were identified:
1. Supporting the health of
women
2. Improving food security
3. Safety and nutrition
4. Reducing tobacco and
alcohol use and creating
supportive environments
for health
C. 3rd International Conference
- Held in Sundsvall, Sweden in 1991
which centered on sustainable
development and equity in creating
supportive environments for health
at the community level with people
as the driving force of development.
D. 4th International Conference
- The Jakarta Declaration on Leading
Health promotion into the 21st
century which is the output of the 4th
international conference on health
promotion held in 1997.
- Identified 5 priorities for action:
1. Promoting social
responsibility for health
2. Increasing community
capacity and empowering
the individual
3. Expanding and
consolidating partnerships
for health
4. Increasing investments for
health development
5. Securing an infrastructure
for health promotion
E. 5th Global Conference on Health
Promotion (2000) June 5-9, Mexico City
- Examined the contributions made by
health promotion in improving the
health and quality of life of people
living in difficult circumstances.
- It called for the strengthening of the
science and art of health promotion
and strengthening political skills for
health promotion.
F. 6th International Conference
- The Bangkok Charter of Health
promotion in Globalized World
which was adopted in this
conference in 2005 focuses on the
need to address the determinants of
health through health promotion.
Determinants of Health
1. Income and social status
2. Education
3. Physical environment
4. Employment and working conditions
5. social support network
6. culture
7. genetics
8. personal behavior and coping skills
9. health services and
10. gender
Health Promotion is the process of
enabling people to increase control over
their health and determinants
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LECTURER: HAZEL S. INZO
This is done by strengthening individual
skills and capabilities and the capacity of
groups to change the social and
economic conditions that affect health.
The Charter recognizes that organized
and empowered communities are highly
effective in determining their own
health and are making governments and
the private sectors accountable for the
health consequences of their policies
and ill practices.
Directed towards healthy individuals or
populations, focusing on the prevention
of the emergence of risk factors such as
unhealthy lifestyle behavior. It is
applicable to the ff levels:
- Individuals – deals with increasing
the awareness of an individual on
the importance of a healthy lifestyle,
providing education and its
maintenance, and giving support for
him/her to sustain the change of
behavior towards a healthy lifestyle
and good personal habits.
- Family – deals with soliciting
support from the family for the
lifestyle changes in the individual
member by changing their beliefs
and practices as well
- Community – deals with making
healthy lifestyle behavior a norm in
the community.
- Society – a healthy society makes
sure that:
A. The basic needs of citizens
are met
a. Presence of
hospitals, markets,
and churches
B. The dignity and rights of
citizens are upheld and
protected
C. The talents and skills of its
citizens are utilized for
development
- Environment – deals with the
promotion of proper environmental
sanitation and the reduction of
population.
Examples: proper nutrition, regular
exercise, vector control, provision of
safe water supply and waste
disposal system
Levels of Disease Prevention
1. Primary Level Disease Prevention
(prevent disease and harm before it will
occur)
- Directed towards individuals who
are at RISK of developing a disease
or those who are in the pre-
pathogenic stage.
- Deals with the removal of risk
factors or using SPECIFIC
PROTECTION of individuals against
these risk factors.
- Examples: immunization, food
supplement, and malaria
chemoprophylaxis
2. Secondary Level Disease Prevention
(screening and detection)
- Directed towards individuals in the
subclinical stage, asymptomatic and
symptomatic stage of disease; aims
to diagnose and treat existing health
problems at the earliest possible
time.
- Examples: screening, case finding,
surveillance and treatment of early
diagnosed disease, blood screening,
testicular self-exam
3. Tertiary Level Disease Prevention
(treatment, disability, and
rehabilitation)
- Directed towards individuals in the
pathogenic stage of the disease;
deals with the reduction of the
magnitude and severity of the
residual effects of communicable
and non-communicable disease.
- Examples: rehabilitation of a post-
stroke patient, control of spread of
COVID-19 pandemic, rehabilitation
of patient with leg injury, alcohol
addiction support group
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