4) Strategic management of health systems and
services for population health gain
Public Health Nursing in the Philippines
Introduction
Nursing in the Philippines has a deep and enigmatic
history. This article illustrates the considerable weight
and influence of nursing history while at the same time
disclosing the challenges of applying the past to the
present.
What is Public Health?
Public Health
● Is a “science and art of preventing disease,
prolonging life, promoting health and efficiency
through organized community efforts for the
sanitation of the environment, control of
communicable disease, education of
individuals in personal hygiene, organization of
the medical and nursing service and the
development of the social machinery, which
will ensure to every individual in the
community a standard of living adequate for
the maintenance of health”.. (C.E. Winslow,
1920)
● Refers to the health status of the members of
the community, to the problems affecting their
health and to the totality of health care
provided for the community (WHO)
Core Business of Public Health
1. Disease control
2. Injury prevention
3. Health protection
4. Healthy public policy
5. Promotion of health and equitable health gain
Essential Public Health Functions
1) Health situation monitoring and analysis
2) Epidemiological surveillance/disease
prevention and control
3) Development of policies and planning in public
health
5) Regulation and enforcement to protect public
health
6) Health promotion, social participation and
empowerment
7) Ensuring the quality of personal and
population based health services
8) Research, development and implementation of
innovative public health solutions
Community health - (WHO) defines community health
as: environmental , social and economical resources to
sustain emotional and physical well being among
people in a way that advances their aspirations and
satisfies their needs in their unique environment.
Public health - focuses on the scientific process of
preventing infectious diseases, Community health -
focuses more on the overall contributors to a
population’s physical and mental health
Public Health Nursing - The American Public Health
Association defines public health nursing as. “The
practice of promoting and protecting the health of
populations using knowledge from nursing, social and
public health sciences”.
Community Health Nursing
Community Health Nursing
Community
● Derived from a latin word “ comunicas” which
means a group of people.
● A social group determined by geographical
boundaries and/or common values and
interests (WHO)
● Local areas over which people are using the
same language, conforming to the same
feeling, more or less the same sentiments and
acting upon the same attitudes. (Sutherland)
can be viewed
Three Ways: 4. The goal of CHN is achieved through
➢ Geographical location multi-sectoral efforts
➢ Social system 5. CHN is part of health care system and the
➢ Collection of people larger human services system

Standards of Public Health Nursing Practice

● A service rendered by professional nurse with
the community, groups, families, and
individuals at home, in health center, in clinics, STANDARDS OF CARE
in schools, and in places of work for the
promotion of health, prevention of illness, care STANDARD 1 - The public health nurse
of the sick at home and rehabilitation (Ruth B. Assessment collects comprehensive
Freeman) data pertinent to the
● The utilization of the nursing process in the health status of the
population
different levels of clientele-individuals, families,
population groups and communities, STANDARD 2 - The PHN analyzes the
concerned with the promotion of health, Population Diagnosis assessment date to
prevention of disease and disability and and Priorities determine the population
rehabilitation.” (Araceli Maglaya, et al). diagnosis and priorities

STANDARD 3 - The PHN identifies the

Goal
Outcome Identification expected outcome for a
”to raise the level of citizen by helping communities plan that is based on
and families to cope with the discontinuities in such a population diagnoses
way as to maximize their potential for high-level and priorities.
wellness” (Nisce, et al)
STANDARD 4 - The PHN develops a
Mission of CHN Planning plan that reflects best
practices by identifying
● Health promotion
strategies- action plans,
● Health protection and alternatives to attain
● Health balance expected outcomes.
● Disease prevention
● Social justice STANDARD 5 - The PHN implements
Implementation the identified plan by
partnering with others
Philosophy
● “The philosophy of CHN is based on the worth a. coordination Coordinates programs,
and dignity of man”. (Dr. M. Shetland) services, and other
activities to implement
Basic Principles of CHN the identified plan
1. The community is the patient in CHN, the
family is the unit of care, and there are four b. Health Employs multiple
education and strategies to promote
levels of clientele:
health health , prevent disease,
- Individual, family, population group promotion and ensure a safe
(those who share common environment for
characteristics, developmental stages, populations.
and common exposure to health
problems – e.g. children, elderly), and c. consultation Provides consultation to
various community
the community
groups and officials to
2. In CHN, the client is considered as an ACTIVE facilitate the
partner, NOT PASSIVE recipient of care implementation of
3. CHN practice is affected by developments in programs and services
health technology, in particular, changes in
society in general d. Regulatory Identifies, interprets, and
 activities implements public health Research research findings in
law , regulation, and practice
policies
STANDARD 14 - The PHN considers
STANDARD 6 - The PHN evaluates the Resource Utilization, factors related to safety,
Evaluation health status of the Population effectiveness, cost, and
population impact on practice and
in planning and delivery
STANDARDS OF PROFESSIONAL of nursing and public
PERFORMANCE health programs,
policies, and services
STANDARD 7 - Quality The PHN systematically
of Practice enhances the quality STANDARD 15 - The pHN provides
and effectiveness of Leadership leadership in nursing
nursing practice and public health.

STANDARD 8 - The PHN attains

Education knowledge and
competency that reflects Roles and Responsibilities of a
current nursing and
Community Health Nurse
public health practice

STANDARD 9 - The PHN evaluates Roles

Professional Practice one’s own nursing
Evaluation practice in relation to 1. Clinician
professional practice
2. Health Educator
standards and
guidelines, relevant 3. Facilitator
statutes, rules, and 4. Supervisor
regulations 5. Health Advocator
6. Collaboration
STANDARD 10 - The PHN establishes
Collegiality and collegial partnerships
professional knowledge while interacting with
representatives of the Other Specific Responsibilities of a Nurse
population, organization,
and health and human
services professionals Spelled by the implementing rules and regulations of
and contributes to the RA 7164 (Philippine Nursing Act of 1991) includes:
professional
development of peers, ● Supervision and care of women during
students, colleagues, pregnancy, labor, and puerperium
and others. ● Performance of internal examination and
delivery of babies
STANDARD 11 - The PHN collaborates
● Suturing lacerations in the absence of a
Collaboration with the representatives
of the population, physician
organizations, and ● Provision of first aid measures and emergency
health and human care
services professionals in ● Recommending herbal and symptomatic
providing for and meds…etc.
promoting the health of
the population In the care of the families:
STANDARD 12 - Ethics The PHN integrates 1. Provision of primary health care services
ethical provision in all
areas of practice 2. Developmental/ Utilization of family nursing
care plan in the provision of care
STANDARD 13 - The PHN integrates
In the care of the communities: ● Health Care Delivery System is the totality of
all policies, infrastructures, facilities,
1. Community organizing mobilization, equipment, product, human resources, and
community development, and people services that address the health needs,
empowerment problems and concerns of the people
● Composed of 2 sectors
2. Case finding and epidemiological investigation a. Public sector - largely financed
3. Program planning, implementation, and through tax-based budgeting system
evaluation at both national and local levels and
where health care is generally given
4. Influencing executive and legislative
free at the point of service
individuals or bodies concerning health and b. Private sector - largely
development market-oriented and where health care
is paid through user fees at the point
of service

World Health Organization

Responsibilities of CHN ● WHO - a specialized agency of the United

Nations that provides global leadership on
health matters
1. Be a part in developing an overall health plan, ● The WHO constitution states that its objective
its implementation and evaluation for is the attainment by all people’s highest
communities possible level of health
2. Provide quality nursing services to the three ● It came into force on April 7, 1948
levels of clientele
3. Maintain coordination/ linkages with other
health team members, NGO/ government
agencies in the provision of public health
services
4. Conduct researches relevant to CHN services
to improve provision of health care
5. Provide opportunities for professional growth
and continuing education for staff development

The Health Care Delivery System

● Health System - consist of all organizations,

people, and actions whose primary intent is to
promote, restore, or maintain health
● It has 6 building blocks:
1. Service delivery
2. Health workforce
3. Information Millennium Development Goals (MDGs)
4. Medical products (vaccines and
technologies)
5. Financing ● There were goals that all 19 UN Member
6. Leadership and governance States have agreed to try to achieve by the
stewardship year 2015.
● The united Nations Millennium Declaration,
signed in September 2000, committed world
 leaders to combat poverty, hunger, disease,
illiteracy, environmental degradation, and
discrimination against women.
● The MDSs were derived from this Declaration,
and had specific targets and indicators.
● A common vision of poverty reduction and
sustainable development in response to the
global and country health trends.
● Imperatives:
- Shifts in demographic and
epidemiological trends in disease
- New technologies for healthcare,
communication and information
- Existing and emerging environmental
hazards
- Health norms
Millenium Development Goals (MDGs)
- 2005 - 2015 is based on the fundamental
values of freedom, equality, solidarity,
tolerance, health, respect for nature and
shared responsibility.
underpinned by 13 targets that cover a wide spectrum
of WHO’s work.
1. No poverty
2. Zero hunger
3. Good health and well being
4. Quality education
5. Gender equality
6. Clean water and sanitation
7. Affordable and clean energy
8. Decent work and economic growth
9. Industry, innovation and infrastructure
10. Reduced inequality
11. Sustainable cities and communities
12. Responsible consumption and production
13. Climate action
14. Life below water
15. Life on land
16. Peace and justice, strong institutions
17. Partnership to achieve the goal
Note: It has 15 years lifespan; 2016 marks the 1st year
of its implementation

● 8 MDGs
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/ AIDS, malaria, and other
diseases
7. Ensure environmental sustainability
8. Develop a global partnership for development

Sustainable Development Goals (SDG)

● Also known as the “Global Goals”

● Are the blueprint to achieve a better and more
sustainable future for all.
● They address the global challenges we face,
including those related to poverty, inequality,
climate change, environmental degradation,
peace and justice.
● The 17 goals are all interconnected, and in
order to leave no one behind, it is important
that we achieve them all by 2030.

17 SDG’s
Health has a central place in SDG 3 “Ensure healthy
lives and promote well-being for all at all ages”,
 Summary

● The Global Challenge for Government

Transparency: The Sustainable Development
Goals (SDG) 2030 Agenda
● In 2015, nations agreed with the United Nation
that they can change the world for the better
● This will be accomplished by bringing together
their respective governments, businesses,
media, institutions of higher education, and
local NGOs to improve the lives of the people
in their country by the year 2030

Standards of Public Health Nursing Practice

Standards of Care

▪ STANDARD 1 Assessment
The public health nurse collects
comprehensive data pertinent to the health
status of the population.
▪ STANDARD 2 Population Diagnosis and
Priorities
The PHN analyzes the assessment data to
determine the population diagnosis and
priorities
▪ STANDARD 3 Outcome Identification
The PHN identifies the expected outcome for
a plan that is based on population diagnoses
and priorities
▪ STANDARD 4 Planning
The PHN develops a plan that reflects best
practices by identifying strategies ., action
plans , and alternative to attain expected
outcomes Planning
▪ STANDARD 5 Implementation
The PHN implements the identified plan by
partnering with others
1. Coordination – Coordinates programs,
services, and other activities to
implement the identified plan
2. Health education and health promotion
– Employs multiple strategies to
promote health , prevent disease, and
ensure a safe environment for
populations.
3. Consultation – Provides consultation
to various community groups and
officials to facilitate the implementation
of programs and services
4. Regulatory activities – Identifies,
interprets, and implements public
health laws , regulations, and policies
▪ STANDARD 6 Evaluation
The PHN evaluates the health status of the
population
▪ STANDARD 7 Quality of Practice
The PHN systematically enhances the quality
and effectiveness of nursing practice
▪ STANDARD 8 Education
The PHN attains knowledge and competency
that reflects current nursing and public health
practice
▪ STANDARD 9 Professional Practice Evaluation
The PHN evaluates one’s own nursing
practice in relation to professional practice
standards and guidelines, relevant statutes,
rules, and regulations
▪ STANDARD 11 Collaboration
The PHN collaborates with the
representatives of the population ,
organizations, and health and human
services professionals in providing for and
promoting the health of the population
▪ STANDARD 10 Collegiality and professional
relationships
The PHN establishes collegial partnerships
while interacting with representatives of the
population, organization, and health and
human services professionals and contributes
to the professional development of peers,
students, colleagues, and others
▪ STANDARD 12 Ethics
The PHN integrates ethical provisions in all
areas of practice
▪ STANDARD 13 Research
The PHN integrates research findings in
practice
▪ STANDARD 14 Resource Utilization
population
The PHN considers factors related to safety ,
effectiveness, cost, and impact on practice
and in planning and delivery of nursing and
public health programs , policies, and services
STANDARD 15 Leadership
The PHN provides leadership in nursing and
public health
Health Care Delivery System
 Philippine Department of Health

Health Sector Reform Agenda

◼ DOH - Is the national agency mandated to lead
The five major reforms contained in the HSRA:
the health sectors toward assuring quality
health care for Filipinos
1. Provide fiscal autonomy to government
– national government’s biggest health care hospitals
provider
2. Secure funding for priority public health
– exercises regulatory powers of health programs
facilities and product
3. Promote the development of local health
– takes the lead in the formulation of systems and ensure its effective
policies and standards related to health performance
facilities, health products and health
human resource 4. Strengthen the capacities of health
regulatory agencies
◼ Major Role of DOH
5. Expand the coverage of the National
– Leader in health Health Insurance Program

– Enabler and capacity builder Framework for Implementation for of HSRA :

FOURmula ONE for Health - it is the strategy for
– Administrator of specific services
implementing health reforms
◼ Vision
▪ Spells out the program imperatives of the health
– The DOH is the leader, staunch advocate sector
and model in promoting HEALTH FOR ALL
in the Philippines ▪ Intends to implement critical interventions as a
single package backed by effective management
◼ Goal infrastructure and financing arrangements
following a sectoral approach
• Overriding goal of the DOH is the Health Sector
Reform Agenda. Goals of FOURmula ONE for Health

◼ Mission ▪ Better health outcomes

Guarantee equitable, sustainable, and ▪ More responsive health systems

quality health for all Filipinos, especially the
poor and shall lead the quest for excellence
▪ Equitable health care financing
in health.

✔ by making services available ▪ National Objectives for Health - provides the

road map for stakeholders in health and
health-related sectors to intensify and harmonize
✔ By arousing community awareness
their efforts to attain its vision and mission
✔ By mobilizing resources
Principles

✔ By promoting the means to better health

▪ Universal access to basic health services must
 be ensured.
▪ The health and nutrition of vulnerable groups
must be prioritized.
▪ The epidemiologic shift from infectious to
degenerative diseases must be managed.
practitioners, traditional/alternative providers,
caregivers, household
• Core referral hospital(s): District Hospital or
Provincial Hospital
• End referral hospital(s): Higher level hospitals

▪ The performance of the health sector must be Guiding Principles for ILHZs
enhanced
1. Voluntary actions for mutual benefits
Goals and Objectives
2. Flexible forms of organization
◼ Improve the general health status of the
population. 3. Results -oriented

◼ Reduce morbidity and mortality from 4. Sustained and evolutionary

certain diseases
5. Purposive and developmental
◼ Eliminate certain diseases as public health
problems 6. Universal and non –partisan

◼ Promote healthy lifestyle and environment

health
Devolution of Health Services

◼ Protect vulnerable groups with special
health and nutrition needs
Local Health System
◼ RA 7160 a.k.a. Local Government Code
• One of the significant laws that radically
changed the landscape of health care
delivery

◼ LHS - A health system at the sub-national level • Aims to transform local government units
into self-reliant communities and active
(Dorotan, et al) The core element of local or
partners in the attainment of national goals
district health system is the integrated primary
through more responsive and accountable
health care and the first referral hospital serving a
local government structure instituted
well-defined population (Segall, 2003).
through a system of decentralization
Inter-Local Health Zone
◼ 1993- Health services were devolved or
transferred from the DOH to the LGU - all
∙ Any form of organized arrangement for
provincial, district and municipal hospitals to the
coordinating the operations of an array and
provincial governments and the rural health units
hierarchy of health providers and facilities
(RHUs) and barangay health stations (BHSs) to
serving a common population within a local
the municipal governments
geographic area under the jurisdictions of more
than one local government (DOH, CY 2006)
∙ Composition of an ILHZ Levels of Health Care and Referral System

• Primary Health Care Providers (Barangay ◼ PRIMARY HEALTH CARE

Health Station, Rural Health Unit, health
centers, community hosp., private ✔ Health services offered at this level are to
 individuals in fair health and to patients with
diseases in the early symptomatic stage
✔ Primary care is devolved to the cities and
the municipalities.
✔ It is the health care provided by center
physicians, public health nurses, rural
health midwives, BHWs, traditional healers.
◼ SECONDARY LEVEL OF CARE
✔ Service offered to patients with
symptomatic stages of disease which
require moderately specialized knowledge
and technical resources for adequate
treatment
✔ Is given by physicians with basic health
training.
✔ This is usually given in health facilities
either owned or government operated such
as infirmaries, municipal, and district
hospitals, OPD of provincial hospitals.
✔ Capable of performing minor surgeries and
perform some simple laboratory
examinations.
◼ TERTIARY LEVEL OF CARE
✔ Are the highly technological and
sophisticated services offered by medical
centers and large hospitals. These are
specialized national hospitals.
✔ Services are for clients afflicted with
diseases which seriously threaten their
health & which require highly technical and
specialized knowledge, facilities and
personnel to treat effectively.
✔ Note: Advances in health sciences and
services have brought about the
development of different types of health
facilities . DOH Administrative Order
2012-0012 ( Rules and Regulation
Governing the new Classification of
Hospital and other Health Facilities in the
Philippines )
◼ Classification of Hospitals
◼ General Hospital - provides services
for all kinds of illnesses and injuries,
or deformities.
◼ Specialized Hospital – offers services
for a specific disease or condition or
type of patient.
Classification of other Health Facilities :
1. Category A Primary Health Care Facility- a first
contact health care facility that offers basic
services including emergency services and
provisions to normal deliveries .
A. Without in patient beds like health
centers, clinics, and dental facilities
B. Within patients beds- a short stay
facility where the patients on the
average one or two days before
discharge . ex. Lying –in , birthing
homes
2. Category B Custodial Care Facility – health
facility that provides long term care including the
basic services like food, shelter, to patients with
chronic conditions . ex. Custodial psychiatric
facilities, substance/ drug abuse treatment and
rehabilitation . sanitaria/ leprosaria, nursing
homes
3. Category C. Diagnostic/ Therapeutic Facility – a
facility for the examination of the human body,
specimens from human body for the diagnosis,
sometimes treatment of disease, or water
drinking analysis. Ex. A patient needs to give a
sputum specimen to check for TB.
FURTHER CLASSIFICATION:
o Laboratory Facility - such as, but no
limited to the ff.
a) Clinical Laboratory
b) HIV Testing Center
c) Blood Service Facility
d) Drug Testing Laboratory
e) Newborn Screening Laboratory
 f) Laboratory for drinking water
analysis
o Radiologic Facility - such as X-ray , CT scan ,
Mammography, MRI, ultrasonography
o Nuclear Medicine facility - a facility regulated by
the Philippine Nuclear Research
Institute utilizing radioactive materials in
diagnosis, treatment , or medical research.
4. Category D Specialized Out patient Facility - a
facility that performs highly specialized
procedures on an out patient basis . ex dialysis,
cancer radiation facility, rehabilitation centers
PRIMARY HEALTH CARE
● Sept. 6-12, 1978 - health workers from around
200 countries attended the INTERNATIONAL
CONFERENCE FOR PRIMARY HEALTH
CARE @ Alma Ata, USSR
● INITIATED by WHO and United Nations
Children’s Fund
● Altogether the partici[ants expressed the need
for concerted efforts by all government and
health and development workers for the
protection and promotion by health of all
people
● The Alma Ata declaration on Primary Health
Care emerged from the said conference
ALMA ATA DECLARATIONS
1. Health is a basic fundamental right
2. There exist global burden of health inequalities
among population
3. Economic and social development is of basic
importance for the attainment of health for all
4. Government have a responsibility for the
health of their people
Legal Basis
- PHC was adopted in the Philippines by Virtue
of letter if Instruction (LOI) 949 of 1979
- Philip[pines the 1st country in asia to meet the
challenge of PHC
Definition
- Primary Health care an essential health care
made universally acceptable to individuals and
families in the community by means
acceptable to them through their full
participation and at a cost that the community
and country and afford at every stage of
development in the spirit of self-reliance and
self-determination (WHO)
GOALS
Universal goal of PHC = "HEALTH FOR ALL" by the
year 2000
● To have an acceptable level of health for all
people of the world through community and
individual self reliance.
The policy agenda of " health for all by the year 2000"
technically was a global strategy employed for
achieving 3 main objectives:
● Promotion of healthy lifestyle
● Prevention of diseases
● Therapy for existing conditions
President Ferdinand Marcos signed LOI 949 with the
theme " Health in the Hands of the People by 2020".
8 ESSENTIAL ELEMENTS OF FAMILY HEALTH
CARE
1. Education for health
- This 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. Locally endemic Disease Control
- The Control of endemic disease
focuses in the prevention of its
occurrence to reduce morbidity rate
(example Malaria control and
schistosomiasis control)
3. 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 on going
program of the DOH
4. 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. Environmental Sanitation and Promotion of
safe water supply
- Environmental sanitation is defined as
the study of all factors in the man’s
environment, which exercises
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 abacus promotion of health
6. Nutrition and Promotion of Adequate Food
Supply
- One basic need of the family is food.
And if food is properly prepared then
one may be assured of a healthy
family. There are many food resources
found in the communities but because
of faulty preparation and lack of
knowledge regarding proper food
planning, Malnutrition is one of the
problems that we have in the country.
7. Treatment of Communicable Diseases and
Common Illness
- The diseases spread through direct
contact pose a great risk to those who
can be infected.Tuberculosis is one of
the communicable diseases that
continuously occupies the top ten
causes of death. Most communicable
diseases are also preventable. The
Government focuses on the
prevention, control and treatment of
these illnesses.
8. 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
PRINCIPLES OF STRATEGIES
1. ACCESSIBILITY, AFFORDABILITY,
ACCEPTABILITY, AND AVAILABILITY (botika ng
bayan, Ligtas tigdas Pilipinas)
2. SUPPORT MECHANISM (Resources for essential
services comes from 3 entities:People, Government,
and Private sectors)
3. MULTISECTORAL APPROACH (exemplified
through intrasectoral and intersectoral linkages)
4. COMMUNITY PARTICIPATION (Individuals,
families, and communities are not recipients of care
but active participants in achieving their health goals)
5. EQUITABLE DISTRIBUTION OF RESOURCES –
(PHC advocates for care that is community based and
preventive in orientation)
6. APPROPRIATE TECHNOLOGY
4 A’S
Accessibility
- Refers to the physical distance of a health
facility or the travel time required for people to
get needed or desired services. This requires
the existence of a facility within reasonable
distance from the catchment population or the
people they serve
- WHO – health facilities should be accessible
within 30 mins from the communities.
- Barangay Health Stations (BHS) are facilities
intended to provide accessible health services
in a community level
Affordability
- Not only for consideration of the individual or
family’s capacity to pay for basic health
services. It is also the matter of whether the
community or government can afford these
services.
- WHO – to determine the affordability of
healthcare is the out-of-pocket expenses for
health care. This is the actual cost of the
family for health care services.
- Philippines health insurance is covered by
PhilHealth
Acceptability
- Health care offered is in consonance with the
prevailing culture and traditions of the
population
Availability
- Is a question of whether the basic health
services required by the people are offered in
the health care facilities or is provided on a
regular and organized manner
SUPPORT MECHANISM
● Resources for essential health services come
from three major entities:
○ The People, Government and the
Private sectors (NGO, socio-civic and
faith groups)
● Health programs and projects provide better
outputs when these three entities are involved
● Multisectoral approach is necessary to
efficiently utilize the resources from the three
major entities
MULTISECTORAL APPROACH
● Diseases are outcomes of multiple interrelated
factors, PHC requires Communication,
Cooperation, and Collaboration within and
among various sectors.
● This is exemplified through intersectoral and
intrasectoral linkages
Intrasectoral Linkages
● Refers to communication, cooperation and
collaboration within the health sector: among
members of the health team and among health
agencies
● Team approach is utilized by the personnel of
a health center in dealing with health
conditions and problems.
● Two-way referral system – necessary for
clients to get the needed and desired care
Intersectoral linkages
● “the population is sick because they are poor”
–This statement implies that illness or health is
a result of economic gains or the lack thereof.
● Health is a multisectoral concern. Health
programs should not be taken in isolation from
the overall development agenda of society.
● Encompass the communication, cooperation
and collaboration between the health sector
and other sectors of society like education,
public works, agriculture and local govt
officials.
COMMUNITY PARTICIPATION
● Is an educational empowering process in
which people, in partnership with those who
are able to assist them, identify the problems
and the needs and increasingly assume
responsibilities themselves to plan, manage,
control and assess the collective actions that
are proved necessary.
True/ Active Participation
● people should be knowledgeable about their
own health problems
● should identify the needs for their solution or
reduction and
● draw out plans of actions according to the
priority and the resources available; organize
and implement the programs and monitor and
control their progress and periodically evaluate
for getting the feedback and do
reprogramming
EQUITABLE DISTRIBUTION OF HEALTH
RESOURCES
● PHC advocates for care that is community
based and preventive in orientation.
● Philippines has oversupply of medicine (due to
people not believing in medicine) and nursing
 graduates (other occupation, did not take or
want to take board exam)
● Govt health care employees (29% = Dr; 26%
= RN)
● Impression: graduates of health-related
college programs wants to work abroad
*NTP = National Tuberculosis Program
Two Programs of DOH to ensure distribution of
manpower to the rural areas:
● Doctor to the Barrios (DTTB) Program –
DTTB volunteers are fielded to manage the
RHU of 5 th o 6 th class municipalities for 2
years and have the option to be absorbed with
competitive compensation by the DOH and
LGU
● Registered Nurses Health Enhancement
and Local Service (RN HEALS ) –
deployment of nurses for 1 year to address the
inadequate nursing workforce in rural
communities
APPROPRIATE TECHNOLOGY
- refers to the technology that is suitable to the
community that will use it . To better capture its
essence, the terms “ people’s technology “ and
indigenous technology “ are also used in
reference to appropriate technology.
- Ex) to rehydrate pts in indigenous
communities, use Oresol
CRITERIA FOR APPROPRIATE TECHNOLOGY
1. Safety - technology results in minimal risks to the
users and that the intended positive outcome far
outweigh its unintended negative effects .
2. Effectiveness- technology should accomplish what
is meant to accomplish ex. medicinal plants
3. Affordability – measures for health promotion and
disease prevention are cost effective in comparison to
treatment of diseases.
4. Simplicity – technology that requires readily
available simple materials that involves a simple
process. Example ORS
5. Acceptability- technology is effective only when it is
used by those who need it ( culture is an important
consideration in determining appropriateness of
technology , education is essential for adoption.
6. Feasibility and Reliability- technology must be
easy to apply considering the peoples ’ natural settings
like the home ,school, workplace , and community
,supplies must be constantly available ex. DSSM
7. Ecological Effects – effects on ecology are RA
8423 Traditional and Alternative Medicine Act of 1997
– created the Philippine Institute of Traditional and
Alternative Health Care
MAJOR STRATEGIES
1. Elevating health to a comprehensive and
sustained national effort
2. Promoting and supporting community
managed health care
3. Increasing efficiency in health sector
4. Advancing essential national health research
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 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 organization to plan,
implement and evaluate health programs at
their levels

3. INCREASING EFFICIENCY IN HEALTH

SECTOR
Cd
● 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 Department of Health (DOH) 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 intersectoral,
multidisciplinary and scientific approach to
health programming and delivery.

LEVELS OF PREVENTION

● Primary Prevention—intervening
before health effects occur, through.
● Secondary Prevention—screening to
identify diseases in the earliest.
● Tertiary Prevention—managing
disease post diagnosis to slow or stop