COMMUNITY HEALTH NURSING (LECTURE)

PRELIMS
CHNN 211 | 1st SEM (Second Year)

W1: OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES GLOBAL HEALTH SITUATION
A. GLOBAL AND NATIONAL HEALTH SITUATIONS
IMPACT OF COVID-19 ON POPULATION HEALTH
GLOBAL: WHO (WORLD HEALTH ORGANIZATION) ● COVID-19 poses major challenges to population health and
well-being globally and hinders progress in meeting the SDGs
We are building a better, healthier future for people all over the world. and WHO’s Triple Billion targets.
Together we strive to combat diseases – communicable diseases like Cases Deaths

influenza and HIV, and noncommunicable diseases like cancer and heart As of May 2021 153 Million 3.2 Million

disease. confirmed COVID

cases
48% Regions of 34% European
America Region

Who We Are?
Cases
● Established in April 7, 1948 – A date we celebrate every
year as “World Health Day” South East Asia Region 23.1 Million

● Headquarters: Geneva, Switzerland *over 86% are attributed to India

What We Do?
● Primary Role: Is to direct and coordinate International
Health within the United Nations system
● Our main areas of work are Health Systems
➔ Health through the life-course
➔ Noncommunicable and communicable diseases
➔ Preparedness
➔ Surveillance and response
➔ Corporate Services
Where We Work?
● We support countries as they coordinate the efforts of
governments and partners including bi- and multilaterals,
funds and foundations, civil society organizations and
private sector.
How We Are Governed?
● The world Health Assembly is attended by delegations from
all states, and determines the policies of the Organization
Who We Work With?
● Our core function is to direct and coordinate International
health work through collaboration.
● Despite the extensive spread of the virus, COVID-19 cases to
date appear to be concentrated predominantly in high-income
countries (HICs).
● The 20 most impacted HICs account for almost half (45%) of
the world’s cumulative COVID-19 cases, yet they represent
only one eighth (12.4%) of the global population.
○ inequalities across income groups
○ disrupted access to essential medicines and health
services
○ stretched the capacity of the global health workforce
○ revealed significant gaps in country health information
system
● While high-resource settings have faced challenges related to
overload in the capacity of health services, the pandemic poses
critical challenges to weak health systems in low- resource
settings and is jeopardizing hard-won health and development
gains made in recent decades.
● Data from 35 high-income countries shows that preventive
behaviors decrease as household overcrowding (a measure of
socioeconomic status) increases.
Uncrowded Household Crowded Household
Physically Distance from 79% 65%
others

● WHO partners with countries: Regular Daily Handwashing 93% 82%

➔ United Nations system
➔ International organizations Mask-wearing in Public 87% 74%

➔ Civil society
➔ Foundations
➔ Academia LIFE EXPECTANCY AND HEALTHY LIFE EXPECTANCY
➔ Research Institutions

TRIPLE BILLION TARGETS

A shared vision among WHO and Member States, which help

countries to accelerate the delivery of the SDGs

LE HALE

Between 2000 and 2019 66.8 years to 73.3 years 58.3 years to 63.7 years

LE – Life Expectancy
HALE – Healthy Life Expectancy
● LE and HALE also rise with national income levels, however the
fastest improvements were observed in low-income countries
MDG Millennium Development Goals (LICs), gaining over 11 years in LE and nearly 10 years in
● Reduce Child Mortality HALE in 2000-2019, predominantly reflecting the remarkable
● Improve Maternal Health progress made in reducing mortality among children under 5
● Combat HIV/AIDS years of age in the past 20 years.
 BURDEN OF DISEASE
The global share of NCD deaths among all deaths increased from
60.8% in 2000 to 73.6% in 2019.
Decrease in the following:
● Reducing the number of deaths caused by communicable,
maternal, perinatal and nutritional conditions
● Progress in preventing and treating these diseases (especially
those that tend to kill children under 5 years of age) has seen
them decline significantly relative to noncommunicable
diseases and injuries
● Disability Adjusted Life Years (DALYs) and Years Lived with
Disability (YLD)
At the global level, this means seven of the top 10 causes of
death in 2019 were non-communicable diseases.
1. HIV/AIDS
➢ 1998, a reduce by 40% infections
➢ In 2019, 1.7 Million were infected with HIV, more than a
million fewer than 1998.
➢ This is far from the 2020 global milestone of below
500,000 new infections.
2. TUBERCULOSIS (TB)
➢ World’s Leading cause of Death from a single infectious
agent.
➢ 10 Million (range, 8.9–11 million) people fell ill with TB in
2019, a number that has been declining very slowly in
recent years but not fast enough to reach the 2020
milestone of a 20% reduction between 2015 and 2020.
3. MALARIA
➢ Mortality rate has been more than halved: from 25
deaths per 100,000 population at risk in 2000 to just 10
per 100,000 population at risk in 2019.
➢ The total number of malaria deaths worldwide fell from
736,000 in 2000 to 409,000 in 2019.
NOTE: The first two diseases dropped out of the Top 10
Global causes of death in 2019.
UNIVERSAL HEALTH COVERAGE
All individuals and communities receive the health services they need
without suffering financial hardship.
2000 2017
UHC Service Coverage Index
(SCI)
45 of 100 66 of 100
*many inequalities persist
Progress has slowed since 2010- poorest of countries and conflicted
countries lag furthest behind
● The proportion of the population with out-of-pocket spending
exceeding 10% of their household budget rose from 9% to 13%
and those exceeding 25% rose from 1.7% to 2.9%, over the
period 2000-2015.
● Continued progress requires considerable strengthening of
health systems, particularly in lower income settings, along with
a recognition of the crucial role of healthcare workers in public
health capacity with adequate protection for their safety and
wellbeing.
HEALTH WORKFORCE
● 2021 designated ”International Year of Health and Care
Workers” in appreciation of their unwavering dedication in the
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fight against COVID-19.
● There are dramatic disparities in the number of people for each
health worker across different WHO regions. This reveals just
how varied the distribution is throughout the world and
highlights the unacceptable scarcity of health workers in some
regions.
2014-2020 2000-2006
Global births were assisted by 83% 53%
skilled birth attendants,
including medical doctors,
nurses and midwives
Investments in better infrastructure for health facilities, continuous
education and capacity-building and better working conditions for
health and care workers – all relevant to universal health coverage –
will be crucial.
● Regionally, health workers who deliver essential services are at
their lowest density in the places where the highest burden of
disease was measured. Even when national densities are
sizable, inequalities persist between rural, remote and
hard-to-reach areas compared to capital cities and urban
centers. According to the latest available data from 2014-2019,
the density of health workers is the lowest in the WHO African
Region, with just three doctors per 10 000 population and 10
nursing/midwifery personnel per 10 000 population.
NATIONAL: DOH (DEPARTMENT OF HEALTH)
“a national health policy-maker and regulatory institution.”
The Department of Health (DOH) holds the overall technical authority on
health as it is a national health policy-maker and regulatory institution.
Mission To lead the country in the development of a productive, resilient, equitable and
people-centered health system
Vision Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by
2040
Roles in the Health (1) leadership in health; (2) enabler and capacity builder; and (3) administrator of
Sector specific services
Mandate To develop national plans, technical standards, and guidelines on health
NATIONAL HEALTH SITUATION
HEALTH SYSTEM
1. Health Service Delivery
➢ The Philippines has a mixed public-private healthcare
system that operates within a fragmented environment.
➢ Private sector caters to only about 30 percent of the
population but is far larger than the public system in
terms of financial resources and staff
➢ Provides healthcare that is generally paid through user
fees at point of service.
➢ About 65 percent of the 1,224 hospitals in the country in
2016 were private
2. Health Financing
➢ The National Health Insurance Act of 1995 created the
Philippine Health Insurance Corporation (PhilHealth) to
provide health insurance coverage for all Filipinos but
enrollment was not made compulsory.In 2013, it was
amended, expanding the contribution based national
health insurance program (NHIP) beyond formal
employment to include the underprivileged, sick, elderly,
persons with disabilities (PWDs) and women and
children. It strengthened the roles of the LGUs and health
providers in NHIP enrolment
3. Health Governance and Regulation
DOH governs national level LGU at the subnational Level
• over-all steward and technical
authority on health being the national
health policy-maker and regulatory
•
institution
develop national plans
•
•
technical standards
guidelines on health
pg. 2
 • in charge of licensing hospitals,
laboratories and other health facilities
through the Health Facilities and
Service Regulatory Bureau (HFSRB),
and health products through the Food
and Drug Administration (FDA).
• coordinates government, private sector
and development partner assistance on
health and leverages funds for
improved health performance.

The Insurance Commission (IC) regulates and supervises the

operations of private insurance companies, and since 2015, of health
maintenance organizations as well, except PhilHealth. The DOH also
coordinates government, private sector and development partner
3. MORBIDITY
assistance on health and leverages funds for improved health
➢ morbidity in 2016 was caused mainly by acute
performance.
respiratory infection, followed by hypertension, acute
lower respiratory tract infection (ALRTI) and pneumonia.
HEALTH TRENDS These were the same top three causes of morbidity in
2012, except that the second and third top diseases
2000-2005 2015-2020
AVERAGE LIFE EXPECTANCY 61.7 YEARS 71.6 YEARS interchanged ranks
RURAL
STUNTING
POOREST QUINTILES 33.1 33.4
➢ Leading causes of morbidity were all communicable
38.1% 49.7% diseases, except for hypertension.
● Based on PSA 2000 Census-based projections, the average
life expectancy improved from 67.1 years in 2000-2005 to 71.6
years in 2015-2020. Modest gains were also achieved in infant
and under-five mortalities as shown by mortality data from five
demographic surveys conducted from 1993 to 2013.
● Infant mortality rate decreased from 34 per 1,000 live births to
23 per 1,000 live births and under-five mortality rate went down
from 54 per 1,000 live births to 31 per 1,000 live births.
● The rates of decline, however, slowed down over the period.
Meanwhile, the MMR has minimal progress from 126 per
100,000 live births in 2012 to 114 per 100,000 live births in
2015. ● Despite living longer than in previous years, Filipinos now
● In terms of nutrition, the 8th National Nutrition Survey bear a triple burden of disease with the high prevalence of
showed that stunting remained almost unchanged from 33.1 communicable diseases and NCDs.
percent in 2005 to 33.4 percent in 2015. Stunting was ● Filipinos are also susceptible to risks brought by the
observed to be high among those residing in rural areas (38.1 increasing impact of globalization and climate change, with
percent) and those belonging to the poorest quintiles (49.7 the Philippines ranking third in the world in terms of
percent) exposure to disaster risks
● Thousands have died from previous rapid onset disasters
that struck the country, commonly owing to trauma,
1. TUBERCULOSIS (TB) drowning or crush-related injuries.
➢ TB case detection rate and treatment success rate both ● looding can increase transmission of certain diseases such
exceeded the national targets of 93.6 and 90 percent as leptospirosis and dengue, while power cuts may disrupt
➢ The Philippines remained to be one of the 30 high TB water treatment and supply, exposing the population to the
burden countries in the world, with an estimated risk of water-borne diseases (WHO, 2018b).
incidence of 554 per 100,000 population in 2016 (WHO,
2017)
➢ The National TB Prevalence Survey (NTPS) 2016
estimated prevalence of smear-positive TB at 434 per
B. DEFINITION OF FOCUS
100,000 population, and of bacteriologically confirmed
TB at 1,159 per 100,000 population. PUBLIC HEALTH

2. MORTALITY Definition of Public Health according to: C. E. Winslow- “Public

➢ The leading causes of mortality in the Philippines in
2016 consisted of non-communicable diseases (NCDs)
like ischemic heart disease, neoplasms or cancer,
cerebrovascular diseases or stroke, hypertensive
diseases, diabetes and other heart diseases, and
communicable diseases like pneumonia, respiratory
tuberculosis and chronic lower respiratory infections.
➢ Several NCDs share common lifestyle-related risk
factors: cigarette smoking, hypertension, hyperglycemia,
dyslipidemia, obesity, physical inactivity and poor
nutrition (Asena et al., 2015)
➢ Ischemic heart disease remained to be the top leading
cause of death in the country, followed by cancer and
pneumonia. While assault did not appear on this table, it
was included in the top 10 leading causes of death for
males in 2016.
➢ In the previous years, accident figured prominently in the
list, ranking as the fifth highest among the leading
causes of mortality from 2012-2014 (DOH, 2016a).
health is the science and art of (1) preventing disease, (2) prolonging
life, and (3) promoting health and efficiency through organized
community effort for:
1. sanitation of the environment,
2. control communicable infections,
3. education of the individual in personal hygiene,
4. organization of medical and nursing services for the early
diagnosis and preventive treatment of disease, and
5. development of the social machinery to ensure everyone a
standard of living adequate for the maintenance of health, so
organizing these benefits is to enable every citizen to realize his
birthright of health and longevity.” (Hanlon)
COMMUNITY HEALTH
Community Health is a term used to describe the “state of health
and how easy or difficult it is to be healthy where people live,
learn, work and play.”

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 ● The health of a community, including ease of access to medical
care and community resources available for exercise and
encouraging healthy habits, is an important part of emergency
planning that can have a positive impact on a community
before, during, and after a public health emergency. (Centers
for Disease Control and Prevention)
PUBLIC HEALTH NURSING
● A component or subset of CHN
● The synthesis of public health and nursing practice
● Defined as the field of professional practice in nursing and in
public health in which technical nursing, interpersonal,
analytical, and organizational skills are applied to problems of
health as they affect the community. These skills are applied in
concert with those of other persons engaged in health care,
through comprehensive nursing care of families and other
groups and through measures for evaluation or control of
threats to health, for health education of the public and for the
mobilization of the public for health action. (Freeman, 1963)
● The practice of promoting and protecting the health of
populations using knowledge from nursing, social and public
health sciences (ANA; American Public Health Association,
1996)
● Population-focused, with the goals of promoting health and
preventing disease and disability for all people through the
creation of conditions in which people can be healthy.(ANA,
2007)
COMMUNITY HEALTH NURSING
Definition of Community Health Nursing according to ANA, 1980
● synthesis of nursing practice and public health practice applied
to promoting and preserving health of the populations
● broader and more general specialty area that encompasses
subspecialties that include public health nursing, school
nursing, occupational health nursing, and other developing
fields of practice, such as home health, hospice care, and
independent nurse practice”
STANDARDS OF PUBLIC HEALTH NURSING IN THE
PHILIPPINES
1. SAFE AND QUALITY NURSING CARE – knowledge of
health/illness status of the client, sound decision making;
safety, comfort, privacy, administration of meds and health
therapeutics and nursing process.
2. MANAGEMENT OF RESOURCES AND ENVIRONMENT –
organization of workload; use of financial resources for client
care; mechanism to ensure proper functioning of equipment
and maintenance of a safe environment
3. MANAGEMENT OF RESOURCES AND ENVIRONMENT –
organization of workload; use of financial resources for client
care; mechanism to ensure proper functioning of equipment
and maintenance of a safe environment
4. HEALTH EDUCATION – assessment of client’s learning
needs; development of health education plan and learning
materials and implementation and evaluation of health
education plan
5. LEGAL RESPONSIBILITY – adherence to the nursing laws
as well as to national, local and organizational policies
including documentation of care given to clients
6. ETHICO MORAL RESPONSIBILITY – respect for the rights
of the client; responsibility and accountability for own
decisions and actions; and adherence to the international
and national codes of ethics for nurses
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7. PERSONAL AND PROFESSIONAL DEVELOPMENT –
identification of own learning needs, pursuit of continuing
education; involvement in professional image; positive
attitude towards change and criticism
8. QUALITY IMPROVEMENT – data gathering for quality
improvement; participation in nursing rounds; identification
and reporting of solutions to identify problems related to
client care.
9. RESEARCH – research-based formulation of solutions to
problems in client care and dissemination and application of
research findings
10. RECORDS MANAGEMENT – accurate and updated
documentation of client care while observing legal
imperatives and record keeping
11. COMMUNICATION – uses therapeutic communication
techniques, identifies verbal and nonverbal cues, responds
to client needs, while using formal and informal channels of
communication and appropriate information technology
12. COLLABORATION AND TEAMWORK – establishment of
collaborative relationship with colleagues and other
members of health team
EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES
1577 Franciscan Friar Juan Clemente opened a medical dispensary in Intramuros
(the old walled city of Manila) for the indigent.
1690 Dominican Father Juan de Pergero worked toward installing a water system
in San Juan del Monte and Manila
1805 smallpox vaccination was introduced by Francisco de Balmis, the personal
physician of King Charles IV of Spain
1876 first medicos titulares were appointed by the Spanish government
1888 2-year courses consisting of fundamental medical and dental subjects was
first offered in the University of Santo Tomas. Graduated were known as
“cirujanosministrantes” and serve as male nurses and sanitation inspectors
1901 United States Philippines Commission, through Act 157, created the Board of
Health of the Philippine Islands with a Commissioner of the Public Health, as its
chief executive officer (now the Department of Health)
Association Lagota de Leche was the first center dedicated to the service of the mothers and
Feminista Filipina babies
(1905)
Fajardo Act of 1912 created sanitary divisions made up of one to four municipalities. Each sanitary
division had a president who had to be a physician
1915 The Philippine General hospital began to extend public health nursing services
in the homes of patients by organizing a unit called Social and Home Care
services
1947 The Department of Health was reorganized into bureaus: quarantine, hospitals
that took charge of the municipal and charity clinics and health with the sanitary
divisions under it.
1954 Congress passed RA 1082 or the Rural Health Act that provided the creation of
RHU in every municipality
RA 1891 enacted in 1957 amend certain provisions in the Rural Health ActCreated 8
categories of rural health units corresponding to the population size of the
municipalities
RA 7160 (Local enacted in 1991, amended that devolution of basic health services including
Government Code) health services, to local government units and the establishment of a local
health board in every province and city of municipality
Millennium adopted during the world summit in September 2000
Development Goals
FOURmula One (F1) agenda launched in 1999
for health, 2005 and
Universal Health
Care in 2010
pg. 4
 Universal Health aims to achieve the health system goals of better health outcomes, sustained
Care health financing, and responsive health system that will provide equitable
HEALTH MONITOR
access to health care ● Monitors and detects the presence of health concerns
in the community through contacts or home visits.
● Utilizes various effective data gathering techniques in
keeping an eye on the health status of all recipients of
ROLES AND RESPONSIBILITIES OF A COMMUNITY HEALTH care.
NURSE ● Records and reports health status and presence of
1. The main focus of community health nurses is health health problems in the community
promotion.
5. The nature of nursing practice in the community needs
PROGRAMMER/PLANNER the knowledge of biological and social sciences, ecology,
● Identifies the needs and concerns of individuals, clinical nursing, and community organizing, for it to be
groups, families, and the community effective.
● Formulates health plans, especially in the absence of a
community physician RESEARCHER
● Interprets and implements nursing plans and programs ● Follows a systematic process of monitoring the health
● Assists other health team members in implementing status of the community through the conduct of surveys
health programs in the setting and home visits
● Conducts researches concerning the health of the
HEALTH EDUCATOR/TRAINER/ COUNSELLOR community
● Acts as resource speaker on health and health-related ● Coordinates with government and non- government
services organizations in the conduct and implementation of
● Advocates health programs in the community through studies
dissemination of IEC or Information Education and
Communication materials STATISTICIAN
● Conducts advocacy educations concerning premarital, ● Records data systematically and ensures its validity
breastfeeding, and immunization counsellings through accurate and complete data gathering
● Organizes orientation/ training of concerned groups like ● Reports prepared reports to concerned organizations
pregnant mothers i.e. government organization for immediate necessary
● Identifies and interprets training needs of health team plans or programs
members and formulate appropriate training program ● Consolidates and reviews reports efficiently.
for them ● Analyzes and interprets consolidated data for
● Conducts and facilitates necessary training or monitoring the development in the health matters of the
educational orientation to other health team members whole community
in the community
6. This field of nursing practice utilizes a dynamic process
2. The recipient of care of community public health nursing (assessment, planning, implementation, and evaluation)
practice is extended not only to the individual but also to in the provision of continuous care until termination is
benefit the whole family and community. implicit.

COMMUNITY ORGANIZER CHANGE AGENT

● Promotes self- reliance of community and emphasizes ● Promotes and motivates change in the community in
their involvement and participation in planning, their health practices and lifestyle behaviors for them to
organizing, implementing and evaluating of health promote and maintain good health, be knowledgeable
services and has the initiative in accessing health services
● Initiates and implements community development ● Inculcates self- reliance to brought about development
activities and improvement in the community

COORDINATOR OF SERVICES
● Coordinates health services with concerned individuals
and families through the community health team W2: THE HEALTH CARE DELIVERY SYSTEM
members, government organizations and non-
government organizations The Health Care Delivery System was restructured that brought about a
● Coordinates nursing plans and programs with other major change in terms of health care in the Philippines
health programs
1. Expansion of the roles of the public health nurse and midwives in
3. Community health nurses are generalists in terms of their the health centers and rural health units
practice through life’s continuum. 2. There's a strong involvement of the private sectors comprising
50% of the health system
PROVIDER OF NURSING CARE 3. DOH serves as the main governing body of the health services in
● Renders direct care to various clients with different the country. The DOH provides the guidance and technical
needs, may it be at home, in school, clinics or work assistance to LGU’s through the center for health development in
settings each of the 17 regions.
● Involves the family in the care of the sick or dependent 4. Provincial gov’t is responsible for the administration of provincial
individual, i.e., sick child and district hosp.
5. Municipal and city gov’t are in charge of the primary care through
4. Continuity of care with the client, family or and the rural health units (RHU) or health centers.
community extends for a longer time involving 6. Satellite outpost known as barangay health stations (BHS) Provide
individuals of all ages and health needs. health services in the periphery of the municipality or city.

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HEALTH ORGANIZATIONS

pg. 5
 INTERNATIONAL: WORLD HEALTH ORGANIZATION (WHO) ➢ Have halted by 2015, and begun to reverse the
● WHO is our international partner in health. As they provide incidence of malaria and other major diseases.
leadership on matters critical to health and engaging in 7. Ensure environmental sustainability
partnership where joint action is needed, WHO objective is the 8. Develop a global partnership for development
attainment by all people of the highest possible of health
(WHO,2006)
● WHO was established on April 7, 1948. Since then, April 7 has
been celebrated each year as ”WORLD HEALTH DAY”. With
its Headquarters in GENEVA, SWITZERLAND.
● WHO has 150 member states and offices and six regional
offices for, Africa, the America, eastern Mediterranean, Europe,
Southeast Asia and Western Pacific. Phil is a member of the
Millennium Development Goals (MDGs)
Western Pacific, which holds office in Manila.
● MDG 4 reduce child mortality
NATIONAL: DEPARTMENT OF HEALTH (DOH) ● Garantisadong pambata, nutrition program, EPI, DOH under 5
● DOH is a national agency mandated to lead the health sector programs, EINC, IMCI
towards assuring quality health care for all Filipinos ● MDG 5 improve maternal health
● Maternal and child care e.g., Free prenatal check-up, Maternal
immunization of tetanus toxoid, laboratory / diagnostic test e.g.
A. WORLD HEALTH ORGANIZATION (WHO) U/S, Nutrition program for mother, Family planning’ child care,
Who We Are? ● WHO is the directing and coordinating authority for health within the United pre/post-partum care, Mental health, Health teaching
Nations system. It is responsible for providing leadership on global health
matters, shaping the health research agenda, setting norms and standards,
● MDG 6 combats HIV/ AIDS, MALARIA and other diseases. Free
articulating evidence-based testing HIV
● Established in April 7, 1948 – A date we celebrate every year as “World
Health Day”
● Headquarters: Geneva, Switzerland
SUSTAINABLE DEVELOPMENT GOALS (SDGs)
What We Do? ● WHO works worldwide to promote health, keep the world safe, and serve ● The United Nations Sustainable Development Goals (UN SDGs,
the vulnerable.
● Our goal is to ensure that a billion more people have universal health also known as the Global Goals) are 17 goals with 169 targets that
coverage, to protect a billion more people from health emergencies, and
provide a further billion people with better health and well-being.
all UN Member States have agreed to work towards achieving by
the year 2030.
Where We Work? ● We support Member States as they coordinate the efforts of multiple ● They set out a vision for a world free from poverty, hunger and
sectors of the government and partners – including bi- and multilaterals,
funds and foundations, civil society organizations and private sector – to
disease.
attain their health objectives and support their national health policies and ● Health has a central place in SDG 3 “Ensure healthy lives and
strategies.
promote well-being for all at all ages”, underpinned by 13 targets
How We Are ● The World Health Assembly is attended by delegations from all Member
that cover a wide spectrum of WHO’s work.
Governed? States, and determines the policies of the Organization ● Almost all of the other 16 goals are related to health or their
achievement will contribute to health indirectly.
Who We Work With? ● Our core function is to direct and coordinate international health work
through collaboration.
● The SDGs aim to be relevant to all countries – poor, rich and
● WHO partners with countries, the United Nations system, international middle-income – to promote prosperity while protecting the
organizations, civil society, foundations, academia, and research
institutions. environment and tackling climate change. They have a strong
focus on improving equity to meet the needs of women, children
and disadvantaged populations in particular so that “no one is left
MILLENIUM DEVELOPMENT GOALS (MDGs) behind”.
● On September 6 to 8, 2000, world leaders in the UN General ● This agenda builds on the Millennium Development Goals (MDGs)
Assembly participated in the Millennium Summit. The result of the which were 8 goals that UN Member States signed in September
summit was a resolution entitled the United Nations Millennium 2000 to achieve targets to combat poverty, hunger, disease,
Declaration. In this declaration, the world leaders recognized their illiteracy, environmental degradation and discrimination against
collective responsibility to uphold the principles of human dignity, women by 2015.
equality and equity at the global level
● The declaration expressed the commitment of the 191 member
states, including the Philippines, to reduce extreme poverty and
achieve seven other targets - now called the Millennium
Development Goals (MDGs) by the year 2015.
● The following are the eight MDG’s and the targets corresponding
to health- related MDG’s 4,5, and 6:
1. Eradicate extreme poverty and hunger.
2. Achieve universal primary education.
3. Promote gender equality and empower women.
4. Reduce child mortality.
○ Target:
➢ reduce by 2/3, between 1990 and 2015, the
under-five mortality rate.
5. Improve maternal health
○ Target:
➢ Reduce by three quarters the maternal mortality ratio
➢ Achieve universal access to reproductive health
6. Combat HIV/AIDS, malaria and other diseases.
○ Target:
➢ Have halted by 2015 and begun to reverse the
spread of HIV/AIDS Sustainable Development Goals (SDGs)
➢ Achieve by 2010, universal access to treatment for all
B. PHILIPPINE DEPARTMENT OF HEALTH (DOH)

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those who need it
“a national health policy-maker and regulatory institution.”

pg. 6
The Department of Health (DOH) holds the overall technical authority on
health as it is a national health policy-maker and regulatory institution.
MISSION-VISION
Mission To lead the country in the development of a productive, resilient, equitable and
people-centered health system
Vision Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by
2040
Roles in the (1) leadership in health; (2) enabler and capacity builder; and (3) administrator of
Health Sector specific services
Mandate To develop national plans, technical standards, and guidelines on health
HISTORICAL BACKGROUND
LOCAL HEALTH SYSTEM AND DEVOLUTION OF HEALTH
SERVICES
● The implementation of the local government code of 1991
resulted in the devolution of health services to local government
units (LGU's) which included among others the provision,
management and maintenance of health services at different
levels of LGUs.
● In 1992, the Philippines Government devolved the management
and delivery of health services from the National Department of
Health to the Locally elected provincial, city and municipal
government.
● Devolution is one administrative category of decentralization
and typically involves legal transfer of administrative powers to
political units. In this situation, health providers then come
under the management of non- health managers. this is
essentially a public administration conceptualization of
decentralization.
1987 PHILIPPINE CONSTITUTION
🐶🦉🦊🐙
● Mandated the Congress to “enact a local government code
which shall provide for a more responsive and accountable
local government structure instituted through a system of
decentralization with effective mechanisms of recall, initiative
and referendum, allocate among the different local
government units their powers, responsibilities, and
resources, and provide for the qualifications, election,
appointment and removal, term, salaries, powers and
functions and duties of local officials, and all other matters
relating to the organization and operation of the local units
(Section 3, Article X).”
● To enable the local gov’t to attain their fullest development as
self-reliant communities and make them more effective
partners in the attainment of national goals RA 7160 or the
LOCAL GOVERNMENT CODE was enacted in 1991.
● The law mandated devolution of basic services to the local
government units and the establishment of a local health
board in every province or municipality.
REPUBLIC ACT NO. 7160
● AKA the Local Government Code of 1991 (hereafter Code),
which was signed into law on October 10, 1991 and took
effect on January 1, 1992
● From a highly centralized system of health service delivery
with the Department of Health (DOH) as the sole provider, the
Code mandated the devolution1 to local government units
(LGUs)2 of many of the functions previously discharged by
DOH. Health devolution or decentralization of health services
was initially geared towards efficiency and effectiveness of
health service delivery by reallocating decision-making
capability and resources to LGUs (Grundy et al. 2003;
Galvez-Tan et al. 2010)
PRIMARY HEALTH CARE (PHC)
● Decentralization is a core element of the implementation of
the Primary Health Care (PHC).
● ensures that essential health care is “made universally
accessible to individuals and families in the community”
PHILIPPINE LOCAL HEALTH SYSTEM
● The Philippine’s local health systems were established on
PHC principles, which is basically “Health in the Hands of
the People”
● Health devolution has empowered LGUs and people by
allowing them to participate in policy and decision-making that
concerns delivery and quality of health care.
● LGUs take great responsibility in the delivery of basic
services and in the operation of facilities in areas that
include primary health care and hospital care/services.
● DOH assumed the role as the “national technical authority
on health.” It is expected to “ensure the highest
achievable standards of quality health care, health
promotion and health protection” that LGUs, NGOs,
private organizations, and civil society should uphold.
● Primary Health Services are otherwise known as basic
health services, which are delivered at health centers or
rural health units (RHUs) and barangay health stations
(BHS). These services include health education; control of
locally endemic diseases such as malaria, dengue,
pg. 7
 Blood Station Blood Station Blood Bank
schistosomiasis; expanded program of immunization (against
tuberculosis, polio, measles, diphtheria, whooping cough, and 1st Level X-ray 2nd Level X-ray with 3rd Level X-ray
mobile unit
tetanus); maternal and child health and family planning;
environmental sanitation and provision of safe water supply; Pharmacy
nutrition; treatment of common diseases; and supply of
essential drugs (DOH-LGAMS 1993).
B. SPECIALTY HOSPITAL
● Secondary Health Services are medical services that are
- Specializes in a particular disease or condition or in one
accessible in some rural health units, infirmaries, district
type of patient.
hospitals, and out-patient departments of provincial hospitals.
- Advances in health sciences and services have brought
● Tertiary Health Services include medical and surgical
about the development of the dfferent types of health
diagnostics, treatment, and rehabilitative care that are
facilities.
usually provided by medical specialists in a hospital setting
(DOH Task Force on Decentralization 1992).
EXAMPLES OF SPECIALTY HOSPITALS
● Devolved functions of the LGU has brought basic services
closer to the people, but it has also caused fragmentation and Particular Disease Particular Organ/s Particular Group of Patients
segregation of the health care delivery system in the country.
National Orthopedic Hospital Lung Center Philippine Children’s Medical
● Not all DOH powers, functions, and responsibilities have been Center
devolved. The DOH takes on the residual powers and
National Center for Mental Philippine Heart Center National Children’s Hospital
functions that include oversight or general supervision of the Health
health sector, monitoring and evaluation functions, formulation
San Lazaro Hospital National Kidney and Dr. Jose Fabella Memorial
of standards and regulation, and provision of technical and Transplant Institute Hospital
other forms of assistance (DOH-LGAMS 1993).

Classification of Hospitals According to Trauma Capability:

Guidelines formulated by PCS
CLASSIFICATION OF HEALTH CARE FACILITIES A. TRAUMA-CAPABLE FACILITY
- A DOH licensed hospital designated as a trauma center.
The DOH issued administrative order (A.O.) 2012-0012 (Rules and B. TRAUMA-RECEIVING FACILITY
Regulations Governing the new Classification of Hospitals and - A DOH licensed hospital within the trauma service area
Other Health Facilities in the Philippines) that provides for a new which receives trauma patients for transport to the point
classification scheme of health facilities. of care or a trauma center.
HOSPITALS OTHER HEALTH FACILITIES
EXAMPLE OF TRAUMA CAPABILITY HOSPITALS
GENERAL A. Primary Care Facility
• Level 1 1. Las Piñas Hospital and Satellite Trauma Center
• Level 2 B. Custodial Care Facility 2. San Jose Hospital and Trauma Center in Cavite
• Level 3 (Teaching/Training)

C. Diagnostic / Therapeutic Facility

DOH administrative Order 2012-0012 classifies other health
SPECIALTY D. Specialized Out-Patient Facility
facilities as follows:
1. CATEGORY A. PRIMARY HEALTH CARE FACILITY – a first
Classification of Hospitals According to Functional Capacity: contact health care facility that offers basic service including
A. GENERAL HOSPITAL emergency services and provision for normal deliveries.
- Provides medical and surgical care to the sick and ● Without in-patient beds like health centers, out- patient
injured and maternity care and shall have as minimum, clinics, and dental clinics.
the following clinical services: medicine, pediatrics, ● With in-patient beds – a short-stay facility where the
obstetrics and gynecology, surgery and anesthesia, patient spends on the average of one to two days before
emergency services, out-patient and ancillary services. discharge.
OLD NEW ● Ex: Infirmaries and birthing (Lying-in) facilities.
LEVEL 1 RE-CLASSIFY TO OTHER HEALTH FACILITIES
2. CATEGORY B. CUSTODIAL CARE FACILITY – a health
LEVEL 2 LEVEL 1 facility that provides long-term care, including basic services
like food and shelter, to patients with chronic conditions
LEVEL 3 LEVEL 2
requiring ongoing health and nursing care due to impairment
LEVEL 4 LEVEL 3 and a reduced degree of independence in activities of daily
living, and patients in need of rehabilitation.
● Ex: Custodial health care facilities, substance/drug abuse
General Level 1 Level 2 Level 3
treatment and rehabilitation centers, sanitaria, leprosaria,
Clinical Services and Consulting Level 1 plus all: Level 2 plus all: and nursing homes.
Facilities for Specialists in:
In-Patients Medicine Pediatrics Departmentalized Teaching/ training
OB-GYNE Surgery Clinical Services with accredited 3. CATEGORY C. DIAGNOSTIC/THERAPEUTIC FACILITY – a
residency training
program in the 4
facility for the examination of the human body, specimens from
major clinical services the human body for the diagnosis, sometimes treatment of
Emergency and Out- Respiratory Unit Physical Medicine
disease or water for drinking analysis. The test covers the
patient Services and Rehabilitation preanalytical, analytical and post analytical phases of
Unit
examination.
Isolation Facilities General ICU

Ancillary Services
Surgical/ Maternity High Risk Pregnancy Ambulatory Surgical 4. CATEGORY D. SPECIALIZED OUTPATIENT FACILITY – a
Facilities Unit Clinic
facility that performs highly specialized procedures on an
Dental Clinic NICU Dialysis Clinic outpatient basis.
● Ex: Dialysis clinic, ambulatory surgical clinic, cancer
Secondary Clinical Tertiary Clinical Tertiary lab with
Laboratory Laboratory histopathology chemotherapeutic center/clinic, cancer radiation facility,
and physical medicine and rehabilitation center/clinic.

🐶🦉🦊🐙 pg. 8
 NEW CLASSIFICATION OF OTHER HEALTH FACILITIES ● During the last 30 years of Health Sector Reform, e have
undertaken key structural reforms and continuously built on
A B C D
programs that take us a step closer to our aspiration
Primary Care Custodial Care Diagnostic/ Specialized Out-
Facility Facility Therapeutic Facility Patient Facility

With In-patient Beds: Psychiatric Care Laboratories: Dialysis Clinic (DC)

• Infirmary/ Facility • Clinical
Dispensary Lab/ HIV Ambulatory Surgical
• Birthing • Blood Clinic (ASC)
Home Service
Facilities
• Drug Test
Lab
• NB
Screening
Lab
• Water Lab

Without Beds: Drug Abuse Ionizing Machines as In-Vitro Fertilization

• Medical Treatment and X-ray, CT scan, (IVF) Centers
Out- patient Rehabilitation Center mammography and
Clinics (DATRC) others
• OFW
Clinics
• Dental
Clinics

Sanitarium/ Non-Ionizing Radiation Oncology

Persistent Inequities in Health Outcomes
Leprosarium Machines as Facility
ultrasound, MRI and
others

Nursing Home Nuclear Medicine Oncology Center/

Clinic

THE RURAL HEALTH UNIT

● The RHU, commonly known as health center, is a primary
level health facility in the municipality. The focus of RHU is Restrictive and Improvising Healthcare Costs
preventive and promotive health services and the
supervision of BHSs under its jurisdiction. The
recommended ratio of RHU to catchment population is 1
RHU: 20,000 populations.
● The BHS is the first contact health care facility that offers
basic services at the barangay level. It is a satellite station of
the RHU. It is manned by Volunteer Barangay Health
Workers (BHW’s) under the supervision of Rural Health
Midwife (RHM). Poor quality and undignified care synonymous with public
clinics and hospital
THE RURAL HEALTH UNIT PERSONNEL
● The Municipal Health Officer (MHO) or Rural Health
Physician heads the health services at the municipal level
and carries out the following roles and functions:
1. Administrator of the RHU
2. Prepares the municipal health plan and budget
3. Monitors the implementation of basic health services
4. Management of the RHU staff
5. Community physician
6. Conducts epidemiological studies
7. Formulates health education campaigns on disease
prevention
8. Prepares and implements control measures or
rehabilitation plan
9. Medico-legal officer of the municipality. I. GUARANTEE #1: ALL LIFE STAGES & TRIPLE BURDEN
OF DISEASE (Service for Both the Well and the Sick)
● The revised implementing rules and regulations (IRRSs) of
R.A. 7305 or the Magna Carta of Public Health Workers
stipulate that there be one rural health physician to a
population of 20,000. ● First 1000 days | Reproductive and Sexual health |
maternal, newborn, and child health | exclusive
breastfeeding | food & micronutrient supplementation |
ALL FOR HEALTH TOWARDS HEALTH FOR ALL: PHILIPPINE immunization | Adolescent health | Geriatric Health |
Health screening, promotion & information
HEALTH AGENDA 2016 - 2022

🐶🦉🦊🐙 pg. 9
II. GUARANTEE #2: SERVICE DELIVERY NETWORK H Harness the power of strategic HRH development
(Functional Network of Health Facilities)
1. Revise health professions curriculum to be more primary care-
oriented and responsive to local and global needs
2. Streamline HRH compensation package to incentivize service
in high-risk or GIDA areas
3. Update frontline staffing complement standards from
profession-based to competency-based
4. Make available fully-funded scholarships for HRH hailing from
GIDA areas or IP groups
5. Formulate mechanisms for mandatory return of service
schemes for all health graduates

III. GUARANTEE #3: UNIVERSAL HEALTH INSURANCE ● HRH – Human Resource for Health
(Financial Health Freedom when Accessing Services) ● GIDA – Geographically Isolated Disadvantaged Area
● IP – Indigenous People

I Invest in eHealth and data for decision-making

1. Mandate the use of electronic medical records in all health

facilities
2. Make online submission of clinical, drug dispensing,
administrative and financial records a prerequisite for
registration, licensing and contracting
3. Commission nationwide surveys, streamline information
systems, and support efforts to improve local civil registration
and vital statistics
4. Automate major business processes and invest in
OUR STRATEGY ware-housing and business intelligence tools
5. Facilitate ease of access of researchers to available data
A Advance quality, health promotion and primary care

C Cover all Filipinos against health-related financial risk E Enforce standards, accountability and transparency

H Harness the power of strategic HRH development

1. Publish health information that can trigger better performance
and accountability
I Invest in eHealth and data for decision-making 2. Set up dedicated performance monitoring unit to track
performance or progress of reforms
E Enforce standards, accountability and transparency

V Value all clients and patients, especially poor, marginalized, and vulnerable
V Value all clients and patients, especially poor, marginalized, and vulnerable

1. Prioritize the poorest 20 million Filipinos in all health programs

E Elicit multi-sectoral and multi- stakeholder support for health
and support them in non-direct health expenditures
2. Make all health entitlements simple, explicit and widely
published to facilitate understanding, & generate demand
A Advance quality, health promotion and primary care
3. Set up participation and redness mechanisms
1. Conduct annual health visits for all poor families and special 4. Reduce turnaround time and improve transparency of
populations (NHT, IP, PWD, Senior Citizen) processes at all DOH health facilities
2. Develop an explicit list of primary care entitlements that will 5. Eliminate queuing, guarantee decent accommodation and clean
become the basis for licensing and contracting arrangements restrooms in all government hospitals
3. Transform select DOH hospitals into mega-hospitals with
capabilities for multi- specialty training and teaching and E Elicit multi-sectoral and multi- stakeholder support for health
reference laboratory
4. Support LGUs in advancing pro-health resolutions or 1. Harness and align the private sector in planning supply side
ordinances (e.g., city-wide smoke-free or speed limit investments
ordinances) 2. Work with other national government agencies to address
5. Establish expert bodies for health promotion and surveillance social determinants of health
and response 3. Make health impact assessment and public health management
plan a prerequisite for initiating large- scale, high-risk
infrastructure projects
C Cover all Filipinos against health-related financial risk
4. Collaborate with CSOs and other stakeholders on budget
1. Raise more revenues for health, e.g., impose health- promoting development, monitoring and evaluation
taxes, increases NHIP premium rates, improve premium
collection efficiency
2. Align GSIS, MAP, PCSO, PAGCOR and minimize overlaps with
PhilHealth
3. Expand PhilHealth benefits to cover outpatient diagnostics,
medicines, blood and blood products aided by health
technology assessment
4. Update costing of current PhilHealth case rates to ensure that it
covers full cost of care and link payment to service quality
5. Enhance and enforce PhilHealth contracting policies for better
viability and sustainability

🐶🦉🦊🐙 pg. 10
 W3: PRIMARY HEALTH CARE
● WHO (2008) Defines Primary Health Care as Essential health
care based on practical, scientifically sound, and socially
acceptable methods and technology made universally accessible
to individuals and families in the community through their full
participation and at cost that the community and country can afford
to maintain at every stage of their development in the spirit of
self-reliance and self- determination.
● Primary Health Care Is an overall approach to providing people
access to basic health care and ultimately improves the health of
the community.
● As a Goal, PHC seeks to ensure that all people regardless of age,
sex, creed, religion, ideology, and race are provided access to
basic health services.
BRIEF HISTORY AND LEGAL BASIS
May 1977 30th World Health Assembly decided that the main health target of the government
and WHO is the attainment of a level of health that would permit them to lead a
socially and economically productive life by the year 2000.
Sept. 6-12, 1978 First International Conference on PHC in Alma Ata, Russia (USSR) The Alma Ata
Declaration stated that PHC was the key to attain the “health for all” goal
Oct. 19, 1979 Letter of Instruction (LOI) 949, the legal basis of PHC was signed by Pres.
Ferdinand E. Marcos, which adopted PHC as an approach towards the design,
development and implementation of programs focusing on health development at
community level.
RATIONALE FOR ADOPTING PRIMARY HEALTH CARE
● Magnitude of Health Problems
● Inadequate and unequal distribution of health resources §
● Increasing cost of medical care
● Isolation of health care activities from other development activities
DEFINITION OF PRIMARY HEALTH CARE
● essential health care made universally accessible to individuals
and families in the community by means acceptable to them,
through their full participation and at cost that the community can
afford at every stage of development.
● a practical approach to making health benefits within the reach of
all people.
● an approach to health development, which is carried out through a
set of activities and whose ultimate aim is the continuous
improvement and maintenance of health status
GOAL OF PRIMARY HEALTH CARE
★ HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN
THE HANDS OF THE PEOPLE by the year 2020.
★ An improved state of health and quality of life for all people
attained through SELF RELIANCE.
KEY STRATEGY TO ACHIEVE THE GOAL:
Partnership with and Empowerment of the people – permeate as
the core strategy in the effective provision of essential health services
that are community based, accessible, acceptable, and sustainable,
at a cost, which the community and the government can afford.
OBJECTIVES OF PRIMARY HEALTH CARE
● Improvement in the level of health care of the community
● Favorable population growth structure
● Reduction in the prevalence of preventable, communicable and
other diseases.
● Reduction in morbidity and mortality rates especially among
infants and children.
● Extension of essential health services with priority given to the
underserved sectors.
● Improvement in Basic Sanitation
● Development of the capability of the community aimed at self-
reliance.
● Maximizing the contribution of the other sectors for the social and
economic development of the community.
🐶🦉🦊🐙
MISSION
To strengthen the health care system by increasing opportunities and
supporting the conditions wherein people will manage their own health
care.
TWO LEVELS OF PRIMARY HEALTH CARE WORKERS
1. Barangay Health Workers – trained community health workers
or health auxiliary volunteers or traditional birth attendants or
healers
2. Intermediate level health workers – include the Public Health
Nurse, Rural Sanitary Inspector and midwives.
PRINCIPLES OF PRIMARY HEALTH CARE
1. 4 A’s = Accessibility, Availability, Affordability & Acceptability,
Appropriateness of health services.
➢ The health services should be present where the supposed
recipients are. They should make use of the available
resources within the community, wherein the focus would
be more on health promotion and prevention of illness.
2. Community Participation
➢ heart and soul of PHC
3. People are the center, object and subject of development.
➢ Thus, the success of any undertaking that aims at serving
the people is dependent on people’s participation at all
levels of decision-making; planning, implementing,
monitoring and evaluating. Any undertaking must also be
based on the people’s needs and problems (PCF, 1990) §
➢ Part of the people’s participation is the partnership between
the community and the agencies found in the community;
social mobilization and decentralization.
➢ In general, health work should start from where the people
are and building on what they have. Example: Scheduling
of Barangay Health Workers in the health center
BARRIERS OF COMMUNITY INVOLVEMENT
● Lack of motivation
● Attitude
● Resistance to change
● Dependence on the part of community people
● Lack of managerial skills
4. Self-reliance
➢ Through community participation and cohesiveness of
people’s organization they can generate support for health
care through social mobilization, networking and
mobilization of local resources. Leadership and
management skills should be developed among these
people. Existence of sustained health care facilities
managed by the people is some of the major indicators that
the community is leading to self-reliance.
5. Partnership between the community and the health agencies
in the provision of quality of life.
➢ Providing linkages between the government and the non
government organization and people’s organization.
6. Recognition of interrelationship between the health and
development
➢ Health – Is not merely the absence of disease. Neither is it
only a state of physical and mental well-being. Health being
a social phenomenon recognizes the interplay of political,
socio-cultural and economic factors as its determinant.
Good Health therefore, is manifested by the progressive
improvements in the living conditions and quality of life
enjoyed by the community residents
pg. 11
 ➢ Development – is the quest for an improved quality of life
for all. Development is multidimensional. It has political,
social, cultural, institutional and environmental dimensions
(Gonzales 1994). Therefore, it is measured by the ability of
people to satisfy their basic needs.
7. Social Mobilization
➢ It enhances people participation or governance, support
system provided by the Government, networking and
developing secondary leaders.
8. Decentralization
➢ This ensures empowerment and that empowerment can
only be facilitated if the administrative structure provides
local level political structures with more substantive
responsibilities for development initiators. This also
facilitates proper allocation of budgetary resources.
ELEMENTS OF PRIMARY HEALTH CARE
1. E – Education for Health
● Is one of the potent methodologies for information
dissemination. It promotes the partnership of both the family
members and health workers in the promotion of health as
well as prevention of illness.
2. L – Locally Endemic Disease Control
● The control of endemic disease focuses on the prevention
of its occurrence to reduce morbidity rate. Example Malaria
Control and Schistosomiasis Control
3. E – Expanded Program on Immunization
● This program exists to control the occurrence of
preventable illnesses especially of children below 6 years
old. Immunizations on poliomyelitis, measles, tetanus,
diphtheria and other preventable disease are given for free
by the government and ongoing program of the DOH
4. M – Maternal and Child Health and Family Planning
● The mother and child are the most delicate members of the
community. So the protection of the mother and child to
illness and other risks would ensure good health for the
community. The goal of Family Planning includes spacing of
children and responsible parenthood.
5. E – Environmental Sanitation and Promotion of Safe Water
Supply
● Environmental Sanitation is defined as the study of all
factors in the man’s environment, which exercise or may
exercise deleterious effects on his well-being and survival.
Water is a basic need for life and one factor in man’s
environment. Water is necessary for the maintenance of a
healthy lifestyle. Safe Water and Sanitation is necessary for
basic promotion of health.
8. S – Supply of Essential Drugs
● This focuses on the information campaign on the utilization
and acquisition of drugs.
● In response to this campaign, the GENERIC ACT of the
Philippines is enacted. It includes the following drugs:
Cotrimoxazole, Paracetamol, Amoxycillin, Oresol,
Nifedipine, Rifampicin, INH (isoniazid) and
Pyrazinamide,Ethambutol,
Streptomycin,Albendazole,Quinine
MAJOR STRATEGIES OF PRIMARY HEALTH CARE
1. Elevating Health to a Comprehensive and Sustained
National Effort.
● Attaining Health for all Filipinos will require expanding
participation in health and health related programs
whether as service provider or beneficiary. Empowerment
to parents, families and communities to make decisions of
their health is really the desired outcome.
● Advocacy must be directed to National and Local policy
making to elicit support and commitment to major health
concerns through legislations, budgetary and logistical
considerations.
2. Promoting and Supporting Community Managed Health
Care
● The health in the hands of the people brings the
government closest to the people. It necessitates a
process of capacity building of communities and
organizations to plan, implement and evaluate health
programs at their levels.
3. Increasing Efficiencies in the Health Sector
● Using appropriate technology will make services and
resources required for their delivery, effective, affordable,
accessible and culturally acceptable. The development of
human resources must correspond to the actual needs of
the nation and the policies it upholds such as PHC. The
DOH will continue to support and assist both public and
private institutions particularly in faculty development,
enhancement of relevant curricula and development of
standard teaching materials
4. Advancing Essential National Health Research
● Essential National Health Research (ENHR) is an
integrated strategy for organizing and managing research
using an intersectoral, multidisciplinary and scientific
approach to health programming and delivery.
FOUR CORNERSTONES/PILLARS IN PRIMARY HEALTH CARE
1. Active Community Participation
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available

6. N – Nutrition and Promotion of Adequate Food Supply Support Mechanism Multisectoral Approach Community Participation
● One basic need of the family is food. And if food is properly
3 major resources: 1. Intrasectoral linkages (Two - a process in which people
prepared then, one may be assured of a healthy family. 1. People way referral sys.) – identify the problems and
There are many food resources found in the communities 2. Government communication, cooperation needs and assume
3. Private Sectors (e.g. and collaboration within the responsibilities themselves to
but because of faulty preparation and lack of knowledge NGO, church…) health sectors. plan, manage, and control.
2. Intersectoral Linkages –
regarding proper food planning, Malnutrition is one of the between the health sector
problems that we have in the country. and other sectors like
education, agriculture and
local gvn. officials.
7. T – Treatment of Communicable Diseases and Common
Illness
APPROPRIATE TECHNOLOGY
● The diseases spread through direct contact pose a great
risk to those who can be infected. Tuberculosis is one of the
Health technology includes: Criteria for Appropriate Health Technology
communicable diseases that continuously occupies the top ● Tools ● Safety
ten causes of death. Most communicable diseases are also ● drugs ● Effectiveness
● methods ● Affordability
preventable. The Government focuses on the prevention, ● procedures and technique ● Simplicity

🐶🦉🦊🐙
● people’s technology ● Acceptability
control and treatment of these illnesses. ● indigenous technology ● Feasibility and Reliability

pg. 12
 ● Ecological effects Aromatherapy combines essential aromatic oils to then applied to the body
● Potential to contribute to individual and
community development
Nutritional therapy “nutritional healing”, this improves health by enhancing the
nutritional value to reduce the risk of the disease
SAFE – It assures users that no harm will result from the use of the
technology or to the least, it minimizes risk of harm Pranic healing follows the principle of balancing energy
EFFECTIVE – it delivers the intended benefit or purpose of the
technology as proven through scientific processes. Reflexology application of pressure on the body’s reflex joints to enhance the
body's natural healing.
AFFORDABLE – the cost of technology will not be burden for both
individual consumers and organizations like the government to guarantee
its accessibility. HEALTH PROMOTION
ACCEPTABLE – use of technology is in harmony with the community
norms and culture. Health Promotion – activities enhance resources directed at improving
SUSTAINABLE – the technology is of utility to the population and can be well-being.
maintained, supplied to all and repaired as needed by users.
Disease Prevention – activities protect people from disease and effects
R.A. 8423 - TRADITIONAL AND ALTERNATIVE MEDICINE ACT OF of disease.
1997 (JUAN FLAVIER)
MEDICINAL PLANTS USE/INDICATION PREPARATION LEAVELL AND CLARK’S THREE LEVELS OF PREVENTION

Lagundi Asthma, cough and colds, Decoction

fever, dysentery, pain

Skin disease (scabies, ulcer, Wash affected site with

eczema), wounds decoction

Yerba Buena Headache, stomachache Decoction

Cough and colds Infusion

Rheumatism, Arthritis Massage sap

The Three Levels of Prevention
Sambong Antiedema/anti urolithiasis Decoction

1. PRIMARY PREVENTION – relates to activities directed at

Tsaang Gubat Diarrhea Decoction
Stomachache preventing a problem before it occurs by altering susceptibility or
reducing exposure for susceptible individuals.
Niyog-niyogan Antihelminthic Seeds are used
EX: Immunization, Promotion of nutrition, Encouraging regular
Bayabas Washing wounds Decoction exercise, Water purification, Mothers class on breastfeeding,
Diarrhea, gargle, toothache education / counseling regarding smoking, dental care.

Akapulko Antifungal Poultice

2. SECONDARY PREVENTION – early detection and prompt
intervention during the period of early disease pathogenesis
Ulasimang Bato or Lowers blood uric acid Decoction
Pansit-pansitan (rheumatism and gout) Eaten raw
● implemented after a problem has begun but before signs
Bawang Hypertension, lowers blood Eaten raw or fried and symptoms appear and targets populations who have
cholesterol risk factors (Keller).
Toothache Apply on part
EX: Screening for STD, Mammography, BP screening, Newborn
screening, Mass sputum examination for PTB, HIV testing.
Ampalaya Diabetes mellitus (mild Decoction
non-insulin- dependent) Steamed
3. TERTIARY PREVENTION – targets populations that have
experienced disease or injury and focuses on limitations of
MEDICINAL PLANT PREPARATION disability and rehabilitation.
1. DECOCTION – boiling the plant material in water for 20 min.
● aims to reduce the effects of disease and injury and to
restore individuals to their optimum level of functioning.
2. INFUSION – plant material is soaked in hot water for 10 - 15
minutes.
EX: Exercise therapy after stroke, Mental health counseling, Referral
of pt. with spinal cord injury for PT/OT
3. POULTICE – directly apply plant material on the affected part,
usually in bruises, wounds and rashes.
HEALTH SECTOR REFORM: UNIVERSAL HEALTH CARE
4. TINCTURE – mix the plant material in alcohol. ● Universal Health Care (UHC), also referred to as “Kalusugan
Pangkalahatan (KP)”, is the “provision to every Filipino of the
highest possible quality of health care that is accessible, efficient,
ALTERNATIVE HEALTH CARE MODALITIES equitably distributed, adequately funded, fairly financed, and
TERM DEFINITION appropriately used by an informed and empowered public”
● The Aquino administration puts it as the availability and
Acupressure application of pressure on acupuncture pts. w/o puncturing the skin accessibility of health services and necessities for all Filipinos
● It is a government mandate aiming to ensure that every Filipino
Acupuncture uses special needles to puncture and stimulate specific part of the shall receive affordable and quality health benefits. This involves
body providing adequate resources – health human resources, health

🐶🦉🦊🐙
facilities, and health financing

pg. 13
 ● UHC was built upon strategies of two previous platforms of reform: W4: THE FAMILY
the initial Health Sector Reform Agenda and FOURmula One for Definition of family according to:
health

GOALS AND OBJECTIVES National Statistical Coordination Board, NSCB 2008 – “The family
1. Better health outcomes is a group of persons usually living together and composed of the
2. Sustained health financing, and head and other persons related to the head by blood, marriage, or
3. A responsive health system by ensuring that all Filipinos, adoption.”
especially the disadvantaged group, have equitable access to
affordable health care. Johnson, 2000 – “The family is a social unit interacting with the larger
society.

3 STRATEGIC 6 STRATEGIC Allen et al., 2000 – “A family is characterized by people together

THRUSTS INSTRUMENTS because of birth, marriage, adoption or choice.”

1. Financial risk 1. Health financing Freidman et al., 2003 – “A family is a two or more persons who are
protection through 2. Service delivery joined together by bonds of sharing and emotional closeness and who
expansion in NHIP ACHIEVED 3. Policy, standards, identify themselves as being part of the family.”
enrollment and THROUGH regulation
benefit delivery 4. Governance for health
2. Improved access to
quality hospitals and
health care facilities
3. attainment of the
➡ 5. Human resources for
health
6. Health information
TYPES OF FAMILY
Nuclear Family – husband, wife, and their immediate
children-natural, adopted or both
health-related MDGs
Dyad Family – husband and wife

To achieve the three strategic thrusts, six strategic instruments
shall be optimized:
1. HEALTH FINANCING – instrument to increase resources for health
that will be effectively allocated and utilized to improve the financial
protection of the poor and the vulnerable sectors.
2. SERVICE DELIVERY – instrument to transform the health service
delivery structure to address variations in health service utilization
and health outcomes across socioeconomic variables.
3. POLICY, STANDARDS, AND REGULATION – instrument to ensure
equitable access to health services, essential medicines, and
technologies of assured quality, availability and safety.
4. GOVERNANCE FOR HEALTH – instrument to establish the
mechanisms for efficiency, transparency, and accountability, and
prevent opportunities for fraud.
5. HUMAN RESOURCES FOR HEALTH – instrument to ensure that
all Filipinos have access to professional health care providers the
appropriate level of care.
6. HEALTH INFORMATION – instrument to establish a modern
information system that shall:
a. To achieve the three strategic thrusts, six strategic
instruments shall be optimized:Provide evidence for policy
and program development;
b. Support for immediate and efficient provision of health care
and management of province-wide health systems.
PUBLIC HEALTH PROGRAMS
1. Reproductive and maternal health: pre-pregnancy services and
care during pregnancy, delivery, and postpartum period
2. Expanded Garantisadong Pambata (child health): advocacy for
exclusive breastfeeding in the first 6 months of life, newborn
screening program, immunization, nutrition services, and
integrated management of childhood illness.
3. Control of communicable disease such as tuberculosis,
mosquito-borne diseases, rabies, schistosomiasis, and sexually
transmitted infections
4. Control of noncommunicable or lifestyle diseases
Extended Family – consist of three generations—married sibling, or
grandparents
Blended Family – one or both spouses brings a child or children from
previous marriage into one living arrangement
Compound Family – where a man has more than one spouse
Cohabiting Family – live-in arrangement between an unmarried
couple
Single Parent – results from a death of spouse, separation or
pregnancy outside of wedlock
The Gay or Lesbian Family – cohabiting couple of the same sex
FUNCTIONS OF THE FAMILY
PROCREATION – Despite the changing forms of the family, it has
remained the universally accepted institution for reproductive
functions and child rearing
SOCIALIZATION OF FAMILY MEMBERS – Socialization is the
process of learning how to become productive members of society. It
involves transmission of the culture of a social group
STATUS PLACEMENT – Society is characterized by a hierarchy of its
members into social classes. The family confers its societal rank on
the children. Depending on the degree of social mobility in a society,
the family and the children’s future families may move from one social
class to another
ECONOMIC FUNCTION – Observes that the Rural Family is a unit of
production where the whole family works as a team participating in
farming, fishing, or cottage industries
- -The Urban Family is more of a unit of consumption where
economically productive members work separately to earn
salaries or wages

5. Environmental health PHYSICAL MAINTENANCE- The family provides for the survival
need (food, shelter, and clothing) of its dependent members, like
young children and the aged.

WELFARE AND PROTECTION- The family supports spouses or

🐶🦉🦊🐙 pg. 14
partners by providing for companionship and meeting affective,
sexual, and socioeconomic needs. By developing a sense of love and
belonging, the family gives the children emotional gratification and
psychological security
FAMILY AS A CLIENT
Community health nursing has long viewed the family as an important
unit of health care, with awareness that the individual can be best
understood within the social context of the family.
Reasons it is important for the nurses to work with families:
1. The family is a critical resource.
➔ The importance of family is giving care to its members.
2. In a family unit, and dysfunctions (like illness, injury,
separation) that affects one or more family members will affect
the members and unit as a whole. Also known as “ripple effect”
3. “Case finding” is another reason to work with families.
➔ The nurse may identify a health problem that necessitates
identifying risks for the entire family.
4. Improving nursing care.
➔ The nurse can provide a better and more holistic care by
understanding the family and it’s members
FAMILY AS A SYSTEM
General System Theory- It is way to explain how the family as a unit
interacts with larger units outside the family and with smaller units
inside the family
Three subsystem of the family (Parke 2002)
● Parent-Child Subsystem
● Marital Subsystem
● Sibling-sibling Subsystem
DEVELOPMENTAL STAGES OF THE FAMILY
Family life cycle:
1. Beginning family through marriage or commitment as a
couple relationship
2. Parenting the first child
3. Living with adolescent(s)
4. Launching family (youngest child leaves home)
5. Middle-aged family (remaining marital dyad to retirement)
6. Aging family (from retirement to death of both spouses)
Stages and tasks of the family life cycle:
1. Marriage: joining of families
➔ Formation of identity as a couple
➔ Inclusion of spouse in realignment of relationships with
extended families
➔ Parenthood: making decisions
2. Families with young children
➔ Integration of children into family unit
➔ Adjustment of tasks: child rearing, financial and household
➔ Accommodation of new parenting and grandparenting roles
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3. Families with adolescents
➔ Development of increasing autonomy for adolescents
➔ Midlife reexamination of marital and career issues
➔ Initial shift towards concern for the older generation
4. Families as launching centers
➔ Establishment of independent identities for parents and
grown children
➔ Renegotiations of marital relationship
➔ Readjustment of relationships to include in-laws and
grandchildren
➔ Dealing with disabilities and death of older generation
5. Aging Families
➔ Maintaining couple and individual functioning while adapting
to the aging process
➔ Support role of middle generation
➔ Support and autonomy of older generation Preparation for
own death and dealing with loss of spouse and/or siblings
and other peers
FAMILY HEALTH TASKS
The first family health task is providing its members with means for health
promotion and disease prevention. Breastfeeding an infant, a healthy diet
for older family members, bringing a young child to the health center for
immunizations, and teaching a child about proper handwashing are a few
examples of family health tasks.
Health tasks according to Freeman and Heinrich 1981:
● Recognizing interruptions of health or development.
● Seeking health care.
● Managing health and nonhealthy crisis.
➔ The family’s ability to cope with crisis and develop from its
experience is an indicator of a healthy family.
● Providing nursing care to sick, disabled or dependent family members
of the family
● Maintaining a home environment conducive to good health and
personal development.
➔ The home should also have an atmosphere of security and
comfort to allow for psychosocial development.
● Maintaining a reciprocal relationship with the community and its health
institutions.
CHARACTERISTICS OF A HEALTHY FAMILY
1. Members interact with each other; they communicate and
listen repeatedly in many contexts
2. Healthy families can establish priorities. Members understand
that family needs are priority
3. Healthy Families affirm, support, and respect each other.
4. The members engage in flexible role relationships, share
power, respond to change, support the growth and autonomy
of others and engage in decision making that affects them.
5. The family teaches family and societal values and beliefs and
shares a spiritual core
6. Healthy Families foster responsibility and value service to
others
7. Healthy families have a sense of play and humor and share
leisure time.
8. Healthy families have the ability to cope with stress and crisis
and grow from problems
TRADITIONAL FILIPINO FAMILY VALUES AND TRAITS
1. Paggalang (Respect)
● The English translation of paggalang means to be
respectful or to give respect to a person.
● Filipinos are accustomed to using the words “po,” “opo,”
and “ho” when they are conversing with older people or,
sometimes, with those who are in a high role or a
prestigious member of society. Using these words is
pg. 15
 customary in the Philippines, and it shows a sign of respect
if you do so.
● Paggalangcan also be shown toward your elders by kissing
their hands before leaving/to say goodbye and upon
arrival/to greet them.
● The younger members of the family can show respect
toward older siblings by calling them kuya (older brother) or
ate(older sister).
2. Pakikisama (Helping Others)
● Pakikisama has the connotation of getting along with
people in general.
● There is a general yearning to be accepted and well-liked
among Filipinos. This applies to one and his or her friends,
colleagues, boss, and even relatives. This desire is what
steers one to perform pakikisama.
● The word pakikisamaliterally translates to "helping others."
Therefore, this trait usually fosters general cooperation and
performing good or helpful deeds, which can lead to others
viewing you in a favorable light.
3. Utang na Loob (Debt or Gratitude)
● Utang na Loob means to pay your debt with gratitude.
● With utang na loob, there is usually a system of obligation.
When this value is applied, it imparts a sense of duty and
responsibility on the younger siblings to serve and repay
the favors done to them by their elders.
4. Pagpapahalaga sa Pamilya (Prioritizing Family)
● Pagpapahalaga sa Pamilya. In other words: putting
importance on your family.
● This implies that a person will place a high regard on their
family and prioritize that before anything else.
● For example, this is why it's not uncommon for a father or a
mother in a Filipino family from the Philippines to seek
employment abroad or a job they don't want just to earn a
decent wage for their family. They've placed the utmost
priority on meeting the family’s basic needs and toward
practicing pagpapahalaga sa pamilya
5. Hiya (Shame)
● Hiya means shame.
● This controls the social behaviors and interactions of a
Filipino. It is the value that drives a Filipino be obedient and
respectful to their parents, older siblings, and other
authorities.
● This is also a key ingredient in the loyalty of one’s family.
TRADITIONAL HEALTH CARE PRACTICES IN THE PHILIPPINES:
Hilot – one of the practices of Filipino traditional medicine, thought of
as ‘healing’. Hilot or massage makes use of the most popular and
useful herbs: tanglad, lagundi, sambong and more native plants that
have healing and therapeutic properties.
Three different types of manghihilot:
1. Comadrona – expert in post-natal massage.
2. Acupressurist – aligns nerves and balances electrical
energy.
3. Reflexologist – drains excess energy.
4. Herbalist – uses herbal in healing
Cupping Therapy – a form of alternative medication that uses “cups”
on the skin to create suction. This suction is trusted to help in
mobilizing blood flow and promote the healing of a broad range of
medical ailments. Cupping is used in treating various
diseases/conditions such as acne and facial paralysis, however,
🐶🦉🦊🐙
cupping can cause mild side effects, such as mild discomfort, burns,
bruises, and skin infection.
W5: FAMILY NURSING AND NURSING PROCESS
Family Nursing Process – Is the blueprint of the care that the nurse
designs to systematically minimize or eliminate the identified health and
family nursing problems through explicitly formulated outcomes of care
(goals and objectives) and deliberately chosen set of interventions,
resources and evaluation criteria, standards, methods and tools.
Nursing Process – is a problem-solving approach that enables the
nurse to provide care in an organized and scientific manner. It is
applicable to individuals, families and community groups at any level of
health. It is adaptable to any practice setting or specialization and the
components may be used sequentially or concurrently
Phases of Nursing Process:
1. Assessment
2. Diagnosis
3. Planning
4. Implementation
5. Evaluation
THE NURSING ASSESSMENT PHASE
1. Collection of data
2. Comparison of data against the standard or norm
Family Nursing Assessment:
Data Collection:
Three sources of data:
1. First source - Health status of the family
2. Second Source - Family’s status as a functioning unit
3. Third Source - Family's environment
Methods of Gathering data:
1. Direct observation
● A method of data collection which is done through the use of all
sensory capacities
● The nurse gathers information about the family’s state of being
and behavioral responses.
● Presence of S/S
➔ Physical makeup of each member
➔ Communication or language patterns expected and tolerated.
➔ Role perception/task assumption by each member, including
decision-making patterns.
➔ Conditions in home and environment
2. Interviewing
● Productivity of the interview process depends upon the use of
effective communication techniques to elicit needed responses.
● Encourage verbalization of thought and feelings and offer
needed support or reassurance.
3. Physical Examination – Done through inspection, palpation,
percussion, auscultation measurement of specific body parts and
reviewing the body systems
● Review of Records – Reviewing existing records and reports
pertinent to the client
● Laboratory/Diagnostic Tests – Performing laboratory tests,
diagnostic procedures or other test of integrity and function
carried out by the nurse herself and /or health workers
5 Types of Data use as Initial Data Base for family nursing
practice:
1. Family structure and characteristics:
pg. 16
 ● Members of the household and relationship to the head of
the family.
● Demographic data- age,sex, civil status, position in the
family
● Place of residence of each member - whether living with or
elsewhere.
● Type of family structure - matriarchal, patriarchal, nuclear or
extended.
● Dominant family members in terms of decision making in
matters of health care.
● General family relationship - presence of any obvious/ready
observable conflict between members; communication
patterns among members
Example:
2. Socio-economic and cultural factors
● Income and expense
➔ Occupation, place of work and income of each working member
➔ Adequacy to meet basic necessities (food, clothing and shelter)
➔ Who makes decision about money and how it is spent
● Educational attainment of its members
● Ethnic background and religious affiliation
● Significant others - roles they play in the family
● Relationship of the family to the larger community
➔ what is the participation of the family in community activities?
Example:
3. Environmental factors
Typology of Nursing Practice:
● Housing
➢ a. Adequacy of living space
➢ b. Sleeping arrangement.
➢ c. Presence of insects and rodents.
Health problems and Family nursing diagnosis:
➢ d. Adequacy of the furniture
➢ e. Food storage and cooking facilities
➢ f. Presence of accidents hazards
➢ g. Water supply-source, ownership, potability
➢ h. Toilet facility-type, ownership, sanitary condition
➢ i. Garbage/refuse disposal- type, sanitary condition
➢ j. Drainage system- type and sanitary condition
● Kind of neighborhood- congested, slum, etc.
● Social and health facilities available
● Communication and transportation
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Example:
4. Health Assessment of Each Member
● Medical and Nursing History indicating past significant illness,
beliefs and practices conducive to illness.
● Nutritional assessment (specifically for vulnerable or at risk
members)
➢ a. Anthropometric data- weight, height.
➢ b. Dietary history indicating quality and quantity of food
intake per day
➢ c. Eating/feeding habits and practices
● Current health status indicating presence of illness states
(diagnosed/undiagnosed by medical practitioner)
5. Value Placed on Preventive Disease 1. Immunization status of
children 2. Use of other preventive services
Data Analysis:
Comparison of the gathered DATA to the STANDARDS OR NORMS
Three Types:
1. Normal health of individual members
2. Home and environment conditions conducive to health
development
3. Family characteristics, dynamics or level of functioning conducive
to family development
Health Problem
● Is defined as a situation or condition which interferes with
the promotion and/ or maintenance of health and recovery
from illness and injury.
● A health problem becomes a nursing problem when it can
be modified through nursing interventions.
Health Need
Exist when there is a health problem that can be alleviated with
medical or social technology.
THE NURSING DIAGNOSIS PHASE
● the study or systematic classification of types.
● A tool or classification of a family nursing problem that reflects
the family status and capabilities as a functioning unit.
Typology of Nursing Problems in Family Nursing Practice
First level of assessment
● Presence of health deficit, health threats, and foreseeable crisis/
stress points in the family
● inability to recognize presence of problem
● Inability to make decisions with respect to taking appropriate health
action
● Inability to provide adequate nursing care to the sick, disabled,
dependent or vulnerable/at risk member of the family.
● Inability to provide a home which is conducive to health
pg. 17
 maintenance and personal development due to: ➢ Noise pollution
○ Failure to utilize community resources for health care ➢ Air pollution
● Unsanitary Food Handling and Preparation
1. Health Deficits: ● Personal Habits/ Practices
- Instances of failure in health maintenance and development ➢ Frequent drinking of alcohol
- Occurs when there is a gap between actual and achievable ➢ Excessive smoking
health status. ➢ Walking barefooted
- diagnosed/suspected illness states of family members ➢ Eating raw meat/fish
- Sudden or premature or untimely death illness or disability and ➢ Poor personal hygiene
failures to adapt reality of life emotional control and stability ➢ self-medication
- Deviations in growth and development ➢ Use of dangerous drugs or narcotics
- Personality disorders ➢ Sexual promiscuity
➢ Engaging in dangerous sports
Example: ● Inherent personal characteristics- short temper
● Illness regardless whether it is diagnosed ● Health history which may precipitate the occurrence of health
● Failure to thrive or inability to develop according to normal deficit-previous history of difficult labor.
rate. ● Improper role assumption-child assuming mother’s role, father not
● Disability arising from illness, whether transient/temporary assuming his role.
● Lack of/ inadequate immunization status of children
Example: ● Family disunity
● TEMPORARY: Aphasia or temporary paralysis after CVA ➢ Self-oriented behaviour of members
● PERMANENT: Leg amputation secondary to DM, blindness ➢ Unresolved conflicts among members
from measles, paralysis from polio. ➢ Intolerable disagreements

2. Stress points/Foreseeable crisis situation

- Anticipated periods of unusual demand on the individual or family in Nursing Diagnosis Two parts:
terms of adjustments/family resources.
1. General - the statement of the unhealthful response
Example: 2. Specific - the statement of factors which are maintaining the
● Marriage undesirable response and preventing the desired change
● Pregnancy, labor, puerperium
● Parenthood Example:
● Additional member-newborn, lodger.
● Abortion ● GENERAL: Inability to utilize the community resources for
● Entrance at school health care due to
● Adolescence ● SPECIFIC: Lack of adequate family resources, specifically,
● Loss of job ➔ Financial
● Death of a member ➔ Manpower
● Resettlement in new community ➔ Time
● Illegitimacy

3. Health Threats THE NURSING PLANNING PHASE

- Condition that are conducive to diseases, accidents or failure to Family Nursing Care Plan
realize one’s health potential.
A Family Nursing Care Plan is the set of actions the nurse decides to
Example: implement to be able to resolve identified family health and nursing
● Health history of specific condition/diseasea. problems.
➢ family history of DM
● Threat of cross infection of CD case
Characteristics Family Nursing Care Plan
● Family size beyond what resources can adequately provide
1. The nursing care plan focuses on actions which are designed to
● Accident Hazards
solve or minimize existing problem.
➢ Broken stairs
2. The nursing care plan is a product of deliberate systematic
➢ Pointed sharp objects, poison and medicine improperly kept
process.
➢ Fire hazards
3. The nursing care plan, as with all other plans, relates to the future.
➢ Fall hazards.
4. The nursing care plan is based upon identified health and nursing
● Nutritional
problems.
➢ Inadequate food intake both in quantity and quality
5. The nursing care is a means to an end, not an end in itself.
➢ Excessive intake of certain nutrients
6. Nursing care plan is a continuous process not a one-shot deal.
➢ Faulty eating habits
● Stress Provoking Factors
➢ Strained marital relationship Desirable Qualities a Nursing Care Plan
➢ Strain parent-sibling relationship 1. It should be based on a clear definition of the problems.
➢ Interpersonal conflicts between family members. 2. A good plan is realistic.
● Poor Environmental Sanitation 3. The nursing care plan should be consistent with the goals and
➢ Inadequate living space philosophy of the health agency.
➢ Inadequate personal belongings/utensils 4. The nursing care plan is drawn with the family.
➢ Lack of food storage facilities 5. The nursing care plan is best kept in a written form.
➢ Polluted water supply
➢ Presence of breeding places of insects and rodents Importance of Planning Care
➢ Improper garbage/refuse disposal 1. They individualized care to clients
➢ Unsanitary waste disposal 2. The nursing care plan helps in setting priorities by providing
➢ Improper drainage system information about the client as well as the nature if his problem.

🐶🦉🦊🐙 pg. 18
3. The Nursing care plan promotes systematic communication among
those involve in the health care effort.
4. Continuity of care is facilitated through the use of nursing care
5. Nursing care plans facilitate the coordination of care by making
known to other members of the health team what the nurse is doing.
Four Criteria for Determining Priorities
1. Nature of condition or problem - Categorized into wellness state/
potential, health threat, health deficit of foreseeable crisis.
2. Modifiability of the Problem - refers to the probability of success in
minimizing, alleviation or totally eradicating the problem through
nursing intervention
3. Preventive Potential - refers to the nature and magnitude of future
problems that can be minimized or totally prevented if intervention is
done on the problem under consideration.
4. Salience - refers to the family’s perception and evaluation of the
problem in terms of seriousness and urgency attention needed.
Scoring:
a. Decide on a score for each of the criteria.
b. Divide the score by the highest possible score and multiply
by the weight. SCORE/HIGHEST SCORE X WEIGHT
Sum up the scores for all the criteria. The highest score is 5, which is
equivalent to the total weight.
🐶🦉🦊🐙
Summary:
The list of health problems ranked according to priorities is presented:
A. MALNUTRITION 5
B. SCABIES 4
C. IMPROPER REFUSE DISPOSAL 3.67
Formulation of Goals and Objective of Nursing Care
Establishment of Goals
Goals Is a general statement of condition or state to be brought about
by specific courses of action.
➔ It is the end towards which all efforts are directed.
Example: after nursing intervention, the family will be able to take
care of the premature infant competently
Goals relate to Health mater
➔ specifically the alleviation of disease conditions.
➔ And health problems that intertwined with other problems
like socioeconomic ones.
Example 1: at the end of nursing intervention, the family will be able
to start a piggery business
Example 2: at the end of nursing intervention, the family will be able
to start litigation proceedings against the landlord.
A cardinal principle in goal setting states that goals must be set
mutually with the family.
Basic to the establishment of mutually acceptable goals is the family’s
recognition and acceptance of existing health needs and problems.
Goals set by the nurse and the family should be realistic or attainable.
Goals are best stated in terms of client’s outcomes, whether at the
individual, family, or community levels.
pg. 19
Barriers to Joint Goal Setting between the Nurse and the Family
1. Failure on the part of the family to perceive the existence of the be able to feed the mentally
problem. challenged prescribed
2. The family may realize the existence of the health condition or quantity and quality of food.
problem but is too busy at the moment. ● They will be able to teach
3. Sometimes the family perceives the existence of the problem but the child simple skills related
does not see it as serious enough to warrant attention. to activities of daily living
and
4. The family may perceive the presence of the problem and the need ● The family will be able to
to take action. It may however refuse to face and do something apply measures taught to
about the situation. prevent infection in the
Reasons to this kind of behavior: mentally challenged child
a. Fear of consequences of taking actions.
b. Respect for tradition. OBJECTIVE TIME FRAME
c. Failure to perceive the benefits of action.
d. Failure to relate the proposed action to the family’s goals. Short-term or Medium-term or Long-term or
Immediate Intermediate Ultimate
5. A big barrier to collaborative goal setting between the nurse and Objectives objectives objectives
the family is the working relationship.
problem situations are those which are require several
Formulation Objectives of Nursing Care which require not immediately nurse family
immediate attention achieved and are encounters
Objectives: -refer to more specific statements of the desired results required to attain
or outcomes of care. It can either be nurse-oriented based on the long term ones.
activities of the nurse or client-oriented stated in terms of outcomes.
Results can be The nature of the
NURSE ORIENTED VS CLIENT ORIENTED observed in a outcomes sought
relatively short requires time to
Nurse Oriented Client Oriented period of time. demonstrate

Nurse-oriented objectives will Stating objectives in terms of They are Investment of more
not tell if the nurse’s activities client outcomes will indicate accomplished with resources
produced some beneficial during the evaluation phase few nurse-family
results; they only indicate what whether the desired changes in contacts and
the nurse did and in qualitative the problem situation resulted relatively less
evaluation, how well she from the nurse’s action. resources.
performed them.

Example: Example: Example of Nursing Goal/Objective:

● during the home visit, the
nurse will discuss the
importance of immunization.
● during the second
nurse-family contact, the
nurse will show the different
types of fertility regulating
methods.
● after the nursing intervention,
the malnourished pre-school
member of the family will
increase their weights by at
least one pound per month.
● after the nursing intervention,
there will be improved
relationship among family
members.
● after the nurse’s visit, the
family will bring the
pre-school members to the
well-baby clinic the following
day
The family will cope effectively with the threat of pulmonary
tuberculosis.
● Short Term -The infant and preschool members of the
family will be immunized with BCG.
● Medium Term-All members of the family will have a
complete physical check-up to rule out pulmonary
tuberculosis.
● Long Term-All members of the family will participate in the
care of the sick members and apply preventive measures
against the spread of infection.
THE NURSING IMPLEMENTATION PHASE
Selecting Appropriate Nursing Actions

The choice of nursing intervention is highly dependent on two major

GENERAL VS SPECIFIC OBJECTIVE
General Objective
After the nursing intervention,
the family will utilize community
resources for health care.
After the nursing intervention,
the family will be able to take
care of the mentally challenged
child competently.
variables:
1. The nature of the problem -resolve around the family’s assumption of
Specific Objective the health tasks.
2. Resource available to solve the problem -aimed at minimizing or
After the nursing intervention, eliminating the possible reasons for or causes of the family’s inability to
the family will bring the do these tasks.
pregnant member to the health
center regularly for check ups GOALS AND OBJECTIVES:
S – SPECIFIC
The family will also consult the M – MEASURABLE
health center on every episode A – ATTAINABLE
of illness among members. R – REALISTIC
T – TIME BOUND
Define the criteria for evaluation
Example: Principles of Nursing Actions:
● After the nursing ● To stimulate recognition and acceptance of health needs and problems
intervention, the family will ● The nurse can work on the family’s failure to decide on taking

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appropriate health actions

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● The nurse can increase the family’s confidence in providing nursing
care to its sick, disabled and dependent member through
demonstrations on nursing procedures utilizing supplies and
equipment available in the home.
● The nurse should involve the patient and family in order to motivate
them to assume responsibility for their own care
● The nurse also explains and clarifies doubts thus the role of the nurse
shifts direct care giver to that of a teacher.
● She can explore the ways to minimize or prevent threats to the
maintenance of health and personal development among family
members
● She can utilize intervention measures involving environmental
manipulations through improvements on the physical facilities in the
home either by construction of needed ones or modifying existing
ones.
● To minimize or eliminate psychological threats in the home
environment, the nurse can work closely with the family to improve its
communication patterns, role assumptions and relationships and
interaction patterns
Types of Resources:
1. FAMILY RESOURCES- physical and psycho-social strengths and
assets of individual members, financial capabilities, physical
facilities and the presence of support system provided by relatives
and significant others.
2. NURSE RESOURCES- knowledge about family health and her
skills in helping family manage them. These skills may range from
simple nursing procedures to complicated behavioural problems
such as marital disharmony. Availability of time and logistical
support are also part of resources of the nurse.
3. COMMUNITY RESOURCES- include existing agencies, programs
or activities for health and related needs/problems and community
organization for health actions.
Methods of Intervention:
Family nurse contact
● Home-Visit
➔ Home visit is a professional, purposeful interaction that
takes place in the family’s residence aimed at promoting,
maintaining and restoring the health of the family or its
members.
● Clinic- Visit
➔ takes place in a private clinic health center, barangay health
station.
➔ Major advantage is the fact that a family member takes the
initiative of visiting the professional health worker, usually
indicating the family readiness to participate in the health
care process.
➔ Because the nurse has greater control over the
environment, distractions are lessened and the family may
feel less confident to discuss family health concerns.
● Group Approach
➔ appropriate for developing cooperation, leadership,
self-reliance and or community awareness among group
members.
➔ The opportunity to share experiences and practical
solutions to common health concerns is a strength of this
type of family-nurse contact.
● Telephone Conference
● Written Communication - used to give specific information to
families, such as instructions given to parents through school
children.
● School Visit or Conference
● Industrial or Job Site Visit
The Nursing Bag
● Frequently called the PHN bag is a tool used by the nurse during
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home or community visits to be able to provide care safely and
efficiently.
● Serves as a reminder of the need for hand hygiene and other
measures to prevent the spread of infection.
● Nursing bag usually has the ff. contents:
➢ Articles for infection control
➢ Articles for assessment of family members
➢ Note that the stethoscope and sphygmomanometer are
carried separately.
➢ Articles for nursing care
➢ Sterile items
➢ Clean articles
➢ Pieces of paper
Uses of the Nursing Bag
● Bag technique helps the nurse in infection control.
● Bag technique allows the nurse to give care efficiently.
● It saves time and effort by ensuring that the articles needed for
nursing care are available.
● Bag technique should not take away the nurse’s focus on the
patient and the family.
● Bag technique may be performed in different ways, principles of
asepsis are of the essence and should be practiced at all times.
THE NURSING EVALUATION PHASE
● The determination of whether the objectives set were obtained or to
what degree they were attained.
● Evaluation is always related to objectives.
● Evaluation when addressed to the result or outcome of care answers
the question “did the intended results occur?”
● There is always an element of subjectivity in evaluation; the process
involves value judgment which is subjective
● Evaluation also involves decision-making
DIMENSION OF EVALUATION
● EFFECTIVENESS- focus is attainment of the objectives
● EFFICIENCY- relates to cost whether in terms of money, time,
effort, or materials
● APPROPRIATENESS- ability to solve or correct existing problem
situations, a question that involves professional judgment.
● ADEQUACY- pertains to its comprehensiveness whether all
necessary activities were performed in order to realize the intended
results.
CRITERIA AND STANDARD
● CRITERIA- refer to the signs or indicators that tell us if the
objective has been achieved. They are names and descriptions of
variables that are relevant indicators of having attained the
objectives. They are free from any value judgment and are
independent to time frame.
● STANDARD- once a value judgment is applied to a criterion; it
acquires the status of a standard. It refers to the desired level of
performance corresponding with a criterion against which actual
performance is compared. It tells us what the acceptable level of
performance or state of affairs should be for us to say that the
intervention was successful
ACTIVITY AND OUTCOME
● ACTIVITIES- are actions performed to accomplish an objective.
They are the things the nurse does in order to achieved a desired
result or outcome. Activities consume time and resources.
Examples are health teachings, demonstration and referrals.
● OUTCOME- is the results produced by activities. Where activity is
the cause, outcome is the effect. They can also be immediate,
immediate or ultimate outcomes. Patient care outcomes can be
measured along three broad lines:
● PHYSICAL CONDITION- decreased temperature or weight and
change in clinical manifestations
● PSYCHOLOGICAL OR ATTITUDINAL STATUS- decreased anxiety
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 and favorable attitude towards health care personnel.
● ¡ KNOWLEDGE ON LEARNING BEHAVIOR- compliance of the
patient with instructions given by the nurse.

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