COMMUNITY HEALTH NURSING 2

LECTURE | WEEK 1

SIX GLOBAL HEALTH ISSUES

Pandemics
● Global disease outbreaks
● Example: Covid, influenza
Environmental factors
● Climate change is thought by many global health
experts to be the greatest threat to human health
● Climate change led to more extreme weather
● According to World Meteorological Organization
(WMO)
- 11, 000 reported disasters (1970-2019)
- 2 million deaths, more than 91% of deaths
occurred in developing countries
- US$ 3.64 trillion
- Droughts, storms, floods, extreme temperature
● Storms, flooding, droughts, and air pollution make
it easier for diseases to spread across large
groups of people.
● Ex. Typhoon Odette (2021) – 6 regions affected
(Dinagat islands, Surigao del Norte, Bohol, Cebu,
Palawan), 9.9 million affected, 2.4 million were
need of assistance, 28 billion damage, 405
deaths, 66 missing
Animal Health, Food Sourcing and Supply
● Based on the leader, if the person with power
cares about health care, the leader will give
importance to health
Note: The ever-growing list of global health issues
can be overwhelming, but there are so many ways
individuals can make a positive impact
COMMUNITY HEALTH NURSING
Health
● WHO defines health as a “state of complete,
mental, and social well-being, not merely the
absence of disease or infirmity.”
Determinants of Health
Income and Higher income and social status is
social status linked to better health
Low levels of education are linked
Education to poor health, more stress and
lower self-confidence

Economic Disparities and Access to Safe water, clean air, healthy

Physical workplaces, safe houses,
Healthcare
environment communities and roads all
● Communities across the world still lack access to contribute to good health
basic health education and health care
Employment People in employment are healthier,
and working particularly those who have more
conditions control over their working conditions

Social Greater support from families,

support friends, and communities is linked
networks to better health

● Measured thru health Indicators Customs, belief, traditions affect

Culture
1. Data infrastructure health
2. Process and outcome measures stratified by Inheritance plays a part in
subpopulations Genetics determining life span, healthiness
3. Process and outcomes measures targeted at and developing certain illness
specific subpopulations
4. Process and outcome measures targeted at Personal Balanced eating, keeping active,
strategies intended to reduce inequities behavior and smoking, drinking and how we deal
coping skills with life’s stresses affect health
Political factors
Access and use of services that
● Based on the leader, if the person with power Health
prevent and treat illness influence
cares about health care, the leader will give Services
health
importance to health
Men and women suffer from
Non-Communicable Diseases Gender different types of diseases at
● Hypertension, heart diseases, cancer, diabetes, different ages
respiratory diseases
COMMUNITY HEALTH NURSING 2
LECTURE | WEEK 1

PUBLIC HEALTH NURSING AND COMMUNITY community, and the actions and conditions that
HEALTH NURSING protect and improve the health of the community
Community Health Nursing
Public Health
● The utilization of the nursing process in the
● Science and art of preventing diseases,
different levels of clientele-individuals, families,
prolonging life, promoting health and
population groups and communities, concerned
efficiency through organized community effort for
with the promotion of health, prevention of disease
the sanitation of environment, control of
and disability and rehabilitation
communicable diseases, the education of
individuals in personal hygiene, organization of Concept on Community Health Nursing
medical and nursing services for early diagnosis
1. CHN identifies the need for a holistic care
and preventing treatment of disease and the
approach
development of social machinery to ensure
2. CHN supports that community-based efforts and
everyone a standard of living adequate for the
involvement is essential for risk reduction
maintenance of health, so organizing these
3. It realizes that health promotion and primary
benefits as to enable every citizen to realize his
prevention are major activities in CHN practice
bright right of health and longevity
4. It supports the entire community as well as
Essential Public Health Functions individual, families and aggregates as a focus for
1. Health Situation Monitoring and analysis CHN
2. Epidemiological surveillance/ disease prevention 5. It believes in over-all development and well-being
and control of individuals, families and communities
3. Development of policies and planning in public
Clients pf CHNs
health
1. Individual
4. Strategic management of health systems and
2. Family
services for population health gain
3. Population group
5. Regulation and enforcement to protect public
4. Community
health
6. Human resources development and planning in
public health Public Health Community Health
7. Ensuring quality of personnel and Nursing Nursing
population-based health services
8. Health promotion, social participation and social ● Whatever the local ● Has the same goals
empowerment department of health and employs the same
9. Research, development and implementation of takes under its strategies (health
innovative public health purview – infectious promotion, prevention
disease prevention etc), but is primarily
Public Health Nursing and eradication, organized around a
● Special field of nursing that combines the skills of policymaking etc. geographic area.
nursing, public health and some phases of social ● Sets safety standards ● Focuses more on
assistance and function as part of total public to protect workers and advocating for
health program for the promotion of health, the develops school healthcare and medical
improvement of the condition in social and nutrition programs to services to local
physical environment, rehabilitation of illness and ensure kids have communities but can
disability access to healthy be broader as it
foods encompasses nursing
Community
● The practice of practice in a variety of
● Group of people who might have different nursing in roles, which at times
characteristics but share geographical location, local/national health include independent
setting goals or social interests departments (which nursing practice
● Characteristics of a Community includes health
1. Determined by geographical boundaries centers and rural
2. Common values and interests health units and public
3. Its members know and interact with each schools
other ● Implementers of the
4. It functions within a particular social structures local government
and exhibits and creates certain norms, units’ mandate in
values, and social institutions promoting and
Community Health protecting the health
● The health status of a defined group of people, or
of their constituents.
COMMUNITY HEALTH NURSING 2
LECTURE | WEEK 1
STANDARDS OF PUBLIC HEALTH NURSING IN
PHILIPPINES (2005)
Nursing Service
● Separate and distinct unit of the local health
agency/unit which is composed of nurses,
midwives and auxiliaries such as barangay health
workers nursing aides and volunteers.
I. ORGANIZATION AND MANAGEMENT
● A nursing service is organized in a local health
agency to ensure the effective delivery of nursing
services and nursing component of public health
programs
● Nursing service is headed by a qualified Chief
Nurse (RA 9173)
1. Has a bachelor’s degree in nursing and a
registered nurse in the Philippines
2. Has at least 5 yrs. experience in general
nursing service administration
3. Has master’s degree in nursing
4. Member of a good standing of the accredited
professional organization of nurses
● The Supervising PHN who heads a nursing unit
should have following qualification:
1. BSN, RN
2. 5 yrs. Supervisory experience in public health
3. Master’s degree in public health or nursing
4. Member of good standing of the accredited
professional org. of nurses
● The nursing service has a written vision, mission,
philosophy, goals and objectives.
● Formulates/reviews and implements the nursing
service plan, manual of policies and nursing
standards.
● Participates in the health agency’s physical
facilities, equipment and supplies and in
monitoring their use.
● Participates in the official recruitment, selection,
promotion, and discharge process at all levels
involving nursing personnel and in making
decisions involving nurses and midwives and
nursing practice.
● Initiates/strengthens mechanisms within the
agency that enhance nursing and midwifery
contribution to the overall community health goals.
II. QUALIFICATION AND FUNCTION OF PHN
● Graduate of BSN and a RN
● Personal and professional competencies:
1. Good physical and mental health
2. Interest and willingness to work in the
community
3. Leadership potentials
4. Resourcefulness and creativity
5. Honesty and integrity
6. Active membership to professional nursing
organizations
● The PHN performs functions and activities in
accordance with the dominant values of public
health nurses
1. Management training, supervision, provision
of nursing care, health promotion and
education and coordination are consistent
with RA 9173 and program policies formulated
by DOH
2. Considers the needs of her/his clients and
their available resources for heath and health
care
● PHN, in coordination with the faculty of colleges of
nursing, participates in teaching, guidance and
supervision of students in nursing and midwifery
for their RLE in the community setting
● Participates in the conduct of research and utilizes
research findings in his/her nursing practice
III. OTHER COMPONENTS
● Supervision
● Interdisciplinary and intersectoral collaboration
● Nursing process
● Health promotion and health education
● Demonstrating Professional, Responsibility and
Accountability
EVOLUTION OF PUBLIC HEALTH NURSING IN
THE PHILIPPINES
1898
● The history of public health nursing in the
Philippines is embedded in the history of the
Department of Health which was first established
as Department of Public Works, Education and
Hygiene
2006 – Present
● The Philippine Nursing Act of 2002 was enacted
under the Republic Act No. 9173 which entails
changes on existing policies under Republic Act
No. 7164
UNIVERSAL HEALTH CARE LAW
RA 11223: The Universal Health Care Law
● Signed by Rodrigo Duterte
● Expansion of population, service, and financial
coverage
● Shift to primary care
COMMUNITY HEALTH NURSING 2
LECTURE | WEEK 1
● All Filipinos guaranteed “equitable access to
quality and affordable health care goods and
services and protected against financial risk
● Ensure every Filipino is healthy, protected from
health hazards and risks, and has access to
affordable, quality and readily available health
service that is suitable to their need
General Objectives
● To progressively realize universal health care
through systemic approach and clear role
delineation of stakeholders
● To ensure equitable access to quality and
affordable health care and protection against
financial risk
Declaration of Principles
● Integrated and comprehensive approach
● Whole of system, whole of government, whole of
society approach
● Comprehensive health services without causing
financial hardship
● People oriented approach
Universal Health Care
● Healthy living, schooling and working
environments
● Primary care provider team for every family
● Healthy spending is predictable not “lahat libre”
SALIENT FEATURES OF UHC LAW
Financing
● All Filipinos automatically be member of Philhealth
● Families not registered – assisted by their
healthcare provider
● Philhealth ID will not require availing services
● Direct and Indirect Contributors
● Private Sector Financing Agents – offer
complementary or supplementary benefit
packages
● Service Coverage - “Preventive, promotive,
curative, rehabilitative and palliative care for
medical, dental mental and emergency health
services delivered either as population-based or
individual-based health services.
Service Delivery
● Health care provider network (HCPN) - group of
primary to tertiary care providers (public or
private), offering people-centered
comprehensive care in an integrated manner with
the primary care provider acting as the navigator
and coordinator.
● Primary Care Provider Network refers to a group
of public, private or mixed primary care providers
as the foundation of HCPN.
● Organization of Local Health Systems:
- Province-wide and City-wide Health systems
- Provincial/ City Health Board
- Provincial/ City health office
- Incentives for improving competitiveness
Human Resources for Health
● National Health Human Resource Master Plan
● National Health Workforce support system
Regulation
● Safety and quality
● Affordability
● Equity
Governance and Accountability
● Health Promotion
● Evidence-Informed sectoral; policy and planning
for UHC
● Monitoring and Evaluation
● Health Impact Assessment
● Health Technology Assessment
● Ethics in public health policy and practice
● Health information system
● Appropriation
PHILIPPINE HEALTHCARE DELIVERY
SYSTEM
Health System
● Interrelated system in which a country organizes
available resources for the maintenance an
improvement of the health of its citizens and
communities
● Comprises all organizations, institutions and
resources devoted to producing actions whose
primary intent is to improve health
Healthcare Organized plan of health
System service
Healthcare Rendering health services to
Delivery people
network of health facilities and
Healthcare personnel which carries out
Delivery System the task of rendering health
care to the people
and
Philippine Healthcare system Context
● Health basic human right
● DOH lead agency
COMMUNITY HEALTH NURSING 2
LECTURE | WEEK 1

● Local government code - devolved the ● 30% are in the public sector serving the majority
management and delivery of health services from ● Largest categories of HRH: nurses and midwives,
National DOH to the LGUs there is underproduction in other categories such
● Access to healthcare hampered by cost, physical as doctors, dentists, med techs etc.
and socio-cultural barriers and workforce crisis ● Less incentives – contractualization, low salary <
amount of work
The Pyramidal Health Structure: Levels of
Health Information System
Healthcare and Referral System
● E-Records
● E-surveillance
● E-medicine

Challenges:
● Computerized systems available but still highly
reliant on paper and pen systems in the frontline
● Telecom infrastructure mostly concentrated in
urban areas
● Lack of IT governance and structures

Major constraints Assessing Essential

Medicine
PHILIPPINE HEALTHCARE DELIVERY ● Limited availability
Classification of Hospitals ● Irrational use
According to ● High costs
Government / Private
ownership Note: As an effect of the devolution, LGUs are left to
budget for essential medicines which results in great
According to variability in access to such
General / Specific
scope of services
Philippine Health FInancing
According to General / Specialty / Trauma ● Main fund sources
functional capacity capability
Government - 18.5%
Private (OOP, HMOs, Life Insurance) - 69.6%
Service Delivery Public Sector
Social Health Insurance - 11.1%
● LGU
Others (Grants) - 0.9%
● DOH
● Financed through taxes making healthcare service
“free” at point of care
Service Delivery Private Sector
● Profit and non-profit providers
● Services are often not-free
● OOP schemes • Insurance
● External funding/grants

HEALTH WORKFORCE
DOH HRH Efforts:
● Doctors to the Barrios (DTTB)
● Nurses Deployment Program (NDP), formerly
RN-Heals)
● Rural Health Midwife Placement Program
(RHMPP) HRH Challenges:
● Brain Drain Phenomenon
● 70% of those who stay are in the private sector
catering to only 30% of the population