A.

HEALTH SITUATION

A. 1. Global and National Health Situations

Global health situation

1. Population
2. Life expectancy
3. Age structure of deaths
4. Leading causes of global deaths
5. Health of infants and small children
6. Health of older children and adolescents
7. Health of adults
8. Health of older people
A. 2. National Health Situation:
• 6 out 10 Filipinos who die, die without health profession attendance
• 4 out of 10 families cannot buy the medicines they need.
• 70% of health professionals serve only 30% of the population, those who can pay
• Our health system is chronically underfunded
• 54% of our National Health expenditure comes from out of the pocket.
• In the past 20 years some infectious and degenerative diseases are on the rise.
• Many Filipinos are still living in remote and hard to reach areas where it is difficult to
deliver the health services they need
• The scarcity of doctors, nurses and midwives add to the poor health delivery system to
the poor
• Total population (2016) – 103,320,000
• Life Expectancy:
o Female – 73 yrs. old
o Male – 66 yrs. Old
• Leading Causes of Morbidity
o Most of the top ten leading causes of morbidity are communicable disease
o These include the diarrhea, pneumonia, bronchitis, influenza, TB, malaria and
varicella
o Leading non CD are heart problem, HPN, accidents and malignant neoplasms
• Leading Causes of Mortality
o The top 10 leading causes of mortality are due to non CD
o Diseases of the heart and vascular system are the 2 most common causes of
deaths.
o Pneumonia, PTB and diarrheal diseases consistently remain the 10 leading
causes of deaths.
• Probability of dying under five (per live births, 2018) – 28
• Probability of dying between 15 and 60 years for m/f – (per 1000 population) – 244/141

B. DEFINITION AND FOCUS

a. Public Health
• The science and art of preventing disease, prolonging life, and promoting health and
efficiency, to enable every citizen to realize his birth right to health and longevity. –
Dr. C. E. Winslow
• Art of applying science in the context of policies so as to reduce
inequalities in health while ensuring the best health for the greatest number. Public
health is a core element of governments’ attempt to improve and promote the
health and welfare of their citizens. WHO

• Essential public health functions

1. Health situation monitoring and analysis
2. Epidemiological surveillance/disease prevention and control
 3. Development of policies and planning in public health
4. Strategic management of health systems and services for population
health gain.
5. Regulation and enforcement and planning in public health
6. Human resources development and planning in public health
7. Health promotion, social participation and empowerment
8. Ensuring the quality of personal and population based health services.
9. Research, development and implementation of innovative public health
solutions.

b. Community Health
• Part of paramedical and medical intervention/approach which is concerned on
the health of the whole population that aims:
o Health promotion
o Disease prevention
o Management of factors affecting health
c. Public Health Nursing
• The practice of nursing in national and local government health departments, and
public schools. Or it is community health nursing practiced in public. Standards of
Public Health Nursing in the Philippines, 2005
• 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.
WHO Expert Committee on Nursing
d. Community Health Nursing (CHN)
• Service rendered by a professional nurse to communities, groups, families, and
individuals at home, in health centers, in clinics, schools, and in places of work for
the promotion, prevention of illness, care of the sick at home, and rehabilitation. –
Ruth B. Freeman
• Nursing practice in a wide variety of community services and consumer advocate
areas, and in variety of roles, at time including independent practice…. Community
nursing is certainly not confined to public health agencies. – Jacobson, 1975
• 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 diseases, disability and rehabilitation. – Dr. Araceli Maglaya, et
al.
e. Standards of Public Health Nursing in the Philippines
The standards of Public Health Nursing in the Philippines was developed
by the National League of Philippine government Nurses in 2005 that described the
qualifications and functions of a Public Health Nurse.

• Must be professionally qualified and licensed to practice in the area of public health
nursing.
• Must possess personal qualities and “people skills” that would allow her practice to
make a difference in the lives of these people.
• Functions in accordance with the dominant values of public health nurses, within the
ethico-legal framework of the nursing profession, and in accordance with the needs
of the clients and available resources for health care.
• Functions of PHN are consistent with the Nursing Law 2002 and program policies
formulated by the DOH and local government health agencies. They are related to
management, supervision, provision of nursing care, collaboration and coordination,
health promotion and education training and research.

Management Function
Supervisory Function
Nursing Function
Collaborating and coordinating Function
Health Promotion and Education Function
 Training Function
Research Function

f. Evolution of Public Health Nursing in the Philippines: Historical Background

1898
- Department of Health was first established as Department of Public Works,
Education and Hygiene.
1912
- The Fajardo Act (Act No. 2156) created Sanitary Divisions.
- The President of Sanitary Division took charge of two or three municipalities. Where
there are no physicians available, male nurses were assigned to perform the duties of
the President, Sanitary Division.
- Philippine General Hospital (PGH), then under the Bureau of Health sent four nurses to
Cebu to take of mothers and their babies.
- St. Paul’s Hospital School of Nursing in Intramuros, also assigned two nurses to do home
visiting in Manila and gave nursing care to mothers and newborn babies from the
outpatient obstetrical service of the PGH.
1914
- School nursing was rendered by a nurse employed by the Bureau of Health
inTacloban, Leyte.
- Reorganization Act No. 2462 created the Office of General Inspection.
- Dr. Rosario Pastor a lady physician was headed the Office of District Nursing.
- Two graduate Filipino nurses, Mrs. Casilang Eustaquia and Mrs. Matilde Azurin were
employed for Maternal and Child Health and Sanitation in Manila under an American
nurse, Mrs. G.D. Schudder.
1919
- The first Filipino nurse Supervisor under the Bureau of Health, Miss Carmen
del Rosario was appointed. She succeeded Miss Mabel Dabbs.
1923
- Two government Schools of Nursing were established: Zamboanga General Hospital
School of Nursing in Mindanao and Baguio General Hospital in Northern
Luzon. These schools were primarily intended to train non-Christian women
and prepare them to render service among their people.
- Four more government School of Nursing were establish: one in Southern
Luzon (Quezon Province) and three in the Visayan Islands of Cebu, Bohol and Leyte.
1927
- The Office of District Nursing under the Office of General Inspection,
Philippine
Health Service was abolished and supplanted by the Section of Public Health
Nursing. Mrs. Genara de Guzman acted as consultant to the Director of Health on
nursing matters.
1928
- First convention of nurses was held followed by yearly conventions until the advent of
World War II. Pre-service training was initiated as a pre-requisite for appointment.
1930
- The Section of Public Health Nursing was converted into Section of Nursing. The
Section of Nursing was transferred from the Office of General Services to the Division of
Administration. This Office covered the supervision and guidance of nurses in
theprovincial hospitals and the government schools of nursing.
1933
- Reorganization Act No. 4007 transferred the Division of Maternal and Child Health of the
Office of Public Welfare Commission to the Bureau of Health.
- Mrs. Soledad A. Buenafe, former Assistant Superintendent of Nurses of the Public
Welfare Commission was appointed as Assistant Shief Nurse of the Section
of Nursing, Bureau of Health.
1941
- Bureau of Health were transferred to the new department.
 - Dr. Mariano Icasiano became the first City Health Officer of Manila.
- An office of Nursing was organized with Mrs. Vicenta C. Pnce. As Chief Nurse and Mrs.
Rosario A. Ordiz as Assistant Chief Nurse.
Dec 8. 1941
- World War II broke out, public health nurses in Manila were assigned to devastated
areas to attend to the sick and the wounded.
1942
- A group of public health nurses, physicians and administrators from the Manila Health
Department went to the internet camp in Capas, Tarlac to receive sick prisoners of war
repleased by the Japanese Army.
- They were confined at San Lazaro Hospital and 68 Public Health Nurses
were assigned to help the hospital staff take care of them.
July 1942
- 31 nurses who were taken prisoners of war by the Japanese army and confined at the
Bilibid Prison in Manila were released to the Director of the Bureau of Health, Dr.
Eusebio Aguilar who acted as their guarantor.
- Many public health nurses joined the guerillas or went to hide in the mountains during
World War II.
February 1946
- Post war records of the Bureau of Health showed that there were 308 public health
nurses and 38 supervisors compared to pre-war when there were 556 public health
nurses and 38 supervisors.
- Mrs. Genera M. de Guzman, Technical Assistant in Nursing of the Department
of Health and concurrent President of the Filipino Nurses Association recommended the
creation of a Nursing Office in the Department of Health.
Oct. 7, 1947
- Executive Order No. 94 organized government offices and created the Division
of Nursing under the Office of the Secretary of Health. This was
implemented on December 16, 1947.
- Mrs. Genara de Guzman was appointed as Chief of the Division, with three Assistant:
Miss Annie Sand for Nursing Education; Mrs. Magdalena C. Valenzuela for Public
Health Nursing and Mrs. Patrocinio J. Montellano for Staff Education.
- At the Bureau of Health, the Section of Nursing Supervision took over the functions of
the former Section of Nursing.
- Mrs. Soledad Buenafe was appointed Chief and Miss Marcela Gabatin,
Assistant Chief.
1948
- The first training Center of the Bureau of Health was organized in cooperation with the
Pasay City Health Department. This was housed at the Tabon Health Center
located in a marginalized part of the city. It was later renamed as Doña Marta Health
Center.
- Physicians and nurses undergoing pre-service and in-service training in public
health/public health nursing as well as nursing student on affiliation were assigned to
the above training center.
1950
- The Rural Health Demonstration and Training Center (RHDTC) was established by the
Department of Health through the initiative of Dr. Hilario Lara, Dean, institute of
Hygiene, now College of Public Health, University of the Philippines.
- The WHO/UNICEF assisted project used health centers of the Quezon City Health
Department, which were located in the rural areas of the city.
- Dr. Amansia S. Mangay (Mrs. Andres Angara), a Doctor of Public Health Graduate form
Harvard was chosen tobe the Chief of the RHDTC.
- Dr. Antonio V. Acosta, former Physician of the Manila Health Department was Medical
Training Officer.
1953
- The Office of Health Education and Personnel Training was established with
Dr. Trinidad Gomez as Chief
 - Philippine Congress approved Republic Act No. 1082 or the Rural Health Law.
It created the first 81 Rural Health Units.

1957
- Republic Act 1891 was approved amending Sections Two, Three, Four, Seven and Eight
of R.A. 1082 :Strengthening Health and Dental Services in the Rural Areas and Providing
Funds thereto.”
1958-1965
- Republic Act 977 passed by Congress in 1954 was implemented. This abolished the
Division of Nursing. However, it created nursing positions at different levels in the
health organization. Miss Annie Sand was appointed Nursing Consultant under the Office
of the Secretary of Health.
- The Department of Health National League of Nurses, Inc. was founded by
Miss Annie Sand in 1961. She became its first President and Adviser.
- The Reorganization Act with implementing details embodied in Executive Order 288,
series of 1959 de-centralized and integrated health services.
- The reorganization of 1959 also merged two Bereaus in the Department of Health. The
Bureau of Health was merged with the Bureau of Hospitals to form the Bureau of Health
and Medical Services.
1967
- In the Burea of Disease Control, Mrs. Zenaida Panlilio – Nisce was appointed as
Nursing Program Supervisor and served as consultant on the nursing aspects of the 5
special diseases: TB, Leprosy, Venereal Disease, Cancer, Filariasis, and Mental Health.
1974
- The Project Management Staff was organized as part of Population II of the
Philippine Government with Dr. Francisco Aguilar as Project Manager.
1975
- The roles of the public health nurse and the midwife were expanded. 2000 midwives
were recruited and trained to serve in the rural areas.
1987-1989
- Executive Order No. 119 reorganized the Department of Health and created several
offices and services within the Depratment of Health.
1990-1992
- Department Order No. 29 designated Mrs. Neila F. Hizon, Nurse VI, then President of the
National League of Philippine Government Nurses, as Nursing Adviser. She was detailed
at the Office Public Health Services. As Nursing Adviser, matters affecting nurses and
nursing are referred to her.
May 24, 1999
- Executive Order No. 102 was signed by President Joseph Ejercito Estrada,
redirecting the functions and operations of the Department of Health.
2005-2006

- The development of the Rationalization Plan to streamline the bureaucracy further was
started and is in the last stages of finalization.

g. Roles and Responsibilities of a Community Health Nurse

• Roles of a community health nurse:
o Clinician or health care provider
▪ Utilizes the nursing process in the care of the clients in the home
setting through home visits and in public health care facilities;
conducts referral of patients.
o Health educator
▪ Utilizes teaching skills to improve the health knowledge, skills, and
attitudes of the individual, family and the community, and conducts
health information campaigns to various groups for the purpose of
health promotion and disease prevention.
 o Coordinator and collaborator
▪ Establishes linkages and collaborate relationships with other health
professionals, government agencies, the private sector, non-
government organizations and people’s organizations to address
health problems
o Supervisor
▪ Monitors and supervises the performances of midwives and other
auxiliary health workers; also initiates the formulation of staff
development and training programs as part of their training function
as supervisors.
o Leader and change agent
▪ Influences people to participate in the overall process of community
development
o Manager
▪ Organizes the nursing service component of the local heath agency
or local government unit
▪ As a program manager, the PHN is responsible for the delivery of the
package of services provided by the health program to the target
clientele
o Researcher:
▪ Participates in the conduct of research and utilizes this findings in
practice.
• Responsibilities of the community health nurse:
o Participates in the development of an overall health plan, its
implementation, and evaluation for communities.
o Provides quality nursing services to the four levels of clientele
o Maintains coordination/linkages with other health team members,
NGO/Government agencies in the provision of public health services.
o Initiates and conducts researches relevant to CHN services to improve
provision of health care.
o Initiates and provides opportunities for professional growth and continuing
education for staff development.
o The PHN will take charge of the municipal health officer’s responsibilities in
the event that the MHO is unable to perform his duties/functions or is not
available.

The Public Health Nurse

•
- Are found in various health settings and occupying various positions in the hierarchy.
- Are assigned in rural health units, city health centers, provincial health offices,
regional health offices, and evening the national office of the Department of Health.
• Are also assigned in public schools and in the offices of government agencies
providing health care services.
• Occupy a range of positions from Public Health Nurse I to Nurse Program
Supervisors to Chief Nurse in public health settings.
• Uses various tools and procedures necessary for her to properly practice her
profession and deliver basic health service.
• Uses nursing process in her practice and is adept in documenting and reporting
accomplishments through records and reports.
• Technically competent in various nursing procedures conducted in settings where she
is assigned.

Qualifications and Functions

The standards of Public Health Nursing in the Philippines developed by the National
League of Philippine government Nurses in 2005 described the qualification and functions of a
Public Health Nurse.

• must be professionally qualified and licensed to practice in the area of public health
nursing.
• Must possess personal qualities and “people skills” that would allow her practice to
make a difference in the lives of these people.
• Functions in accordance with the dominant values of public health nurses, within the
ethico-legal framework of the nursing profession, and in accordance with the needs
of the clients and available resources for health care.
• Functions of PHN are consistent with the Nursing Law 2002 and program policies
formulated by the DOH and local government health agencies. They are related to
Management, Supervision, Provision of Nursing Care, Collaboration and Coordination,
Health Promotion and Education Training and Research.

∙ Management Function
• The nurse, in whatever setting and role has been trained to lead and manage.
• Objectives set for work being done can only be achieved through the execution of the
five management functions of planning, organizing, staffing, directing and controlling.
• This function is performed when she organizes the “nursing service” of the
local health agency.
• Managing the nurses and their activities
• Program management. This is a function where the PHN actually excels in.
• A program manager is responsible for the delivery of the pac
kage of services provided by the program to the target clientele.
• Reports on program accomplishments is a documentation of her
management skills.

• Supervisory Function

• PHN is the supervisor of the midwives and other auxillary health workers in th
e catchment area.
• Formulates a supervisory plan and conducts supervisory visits to implement plan.
• Conducts supervisory visits using a supervisory checklist.
• During the visit the PHN identifies together with the supervisee any issue or problem
encountered and addresses them accordingly.
• Coaching
• Enhancement of training for the supervisee
• Report of the encounter is given to the supervisee and kept in her personal file for future
reference.

• Nursing Function

• Her practice as a nurse is based on the science and art of caring

• Public health nursing is caring for individuals, families and communities toward health
promotion and disease prevention
• PHN are expected to provide nursing care
• PHN uses her knowledge and skill in the nursing process. She does assessment,
plans, and implements care, and evaluates outcomes.
• Establishes rapport with her client: individual, family or community
• Home visits
 • Referral of patients to appropriate levels of care

• Collaborating and coordinating Function

• Brings activities or group activities systematically into proper relation or harmony with
each other.
• Care coordinators for communities and their members
• Actively involved both socially and politically to empower individuals, families and
communities as an entity to initiate and maintain health promoting environments.
• Establishes linkages and collaborative relationships with other health professionals,
government agencies, the private sector, NGOs, people’s organizations to address
health problems.
• Identifies persons, groups, organizations, other agencies and communities whose
resources are available within and outside the community and which can be tapped
in the implementation of individuals, family and community health care.

• Health Promotion and Education Function

• Activities goes beyond health teachings and health information campaigns.

• Understands that health is a multifactorial phenomenon, and is inappropriate to blame
or credit a person’s health to himself alone because he is unlikely to control many of these
factors.
• Understanding the multidimensional nature of health will enable her to plan
and implement health promoting interventions for individuals and communities.
• Uses her skills in advocacy for the creating of a supportive environment throug
h Policies and reengineering of the physical environment for healthier actions.
• As an educator, the nurse provides clients with information that allows them to make
healthier choices and practices.
• Health education is a major component of any public health program.
• PHN are expected to teach on a daily basis as part of their practices.

• Training Function

• Initiates the formulation of staff development and training programs for midwives and
other auxiliary workers
• Does training needs assessment for these health workers, designs the training
program and conducts them in collaboration with other resource persons.
• Also does evaluation of training.
• PHN participates in the training of nursing and midwifery affiliates in coordination with
the faculty of colleges of nursing and midwifery.
• Participates in teaching, guidance and supervision of student affiliates for their RLEs in the
community setting.
• Health promotion calls for the active participation of the community.
• Mobilize communities for health actions.
• Community organizing is a means of mobilizing people to solve their own problems.Through
this, people learn that their problems have social causes and fighting back is
a more reasonable, dignified approach than passive acceptance and personal
alienation.

• Research Function
• Participates in the conduct of research and utilizes research findings.
• PHN function is disease surveillance. Purposes of disease surveillance:
• To measure the magnitude of the problem
• To measure the effect of the control program
• It is important in monitoring the progress of the disease reduction initiatives:
• Poliomyelitis
• Neonatal Tetanus Elimination
• Measles Control
• NCD risk factors, etc.