“a group of people who share

COMMUNITY HEALTH something in common and

NURSING 1 interact with one another, who
may exhibit a commitment with
one another and may share a
geographic boundary”
Nurses constitute a large (Lundy and Janes, 2009, p.16)
group of health care workers
They are in a position to create a health – care “a group of people who share
delivery system that will common interests, who interact
meet the health oriented needs of the people with each other, and who
function collectively within a
Public / Community Health Nursing is the defined social structure to
synthesis of NURSING PRACTICE and address common concerns”
PUBLIC (Clark, 2008, p.27)
HEALTH PRACTICE
Maurer and Smith (2009) identified four
Public Health Nurse main attributes:
• Trained and educated to •People
assess the overall population •Place
•Interaction
Community Health Nurse •Common characteristics, interests or
• Assess the needs of the goals
individual and families within
a population. Maurer and Smith (2009) two
main types of communities:
The major goal of COMMUNITY HEALTH
NURSING is to preserve 1. Geopolitical Communities
the health of the community and the surrounding • Defined or formed by both
population natural and man made
by focusing on HEALTH PROMOTION and boundaries and include
HEALTH MAINTENANCE barangays, municipalities,
of individuals, families and groups within the cities, provinces, regions and
community. nations.
• COMMUNITY / PUBLIC HEALTH
NURSING is associated with 2. Phenomenological Communities
health and the identification of populations at • Relational, interactive
risk rather than groups, the place or setting is
with an episodic response to patient demand. more abstract, and people
share a group perspective or
identity based on culture,
HEALTH values, history, interests, and
“A state of complete physical, goals
mental, and social well-being
and not merely the absence of Community of Solution - a
disease or infirmity” collection of people who form
WHO (1958, P.1) a group specifically to address
a common need or concern.
Population – a group of
COMMUNITY people having common
personal or environmental
“A collection of people who characteristics. It can also be
interact with one another and referred to all the people in
whose common interests or the defined community.
characteristics form the basis for (Maurer and Smith, 2009)
a sense of unity or belonging”
(Allender et al., 2009, p.6) • Aggregate(s) – subgroups or
sub populations that have
common characteristics or
concerns (Clark, 2008)
DETERMINANTS OF HEALTH Community Health Nursing
AND DISEASE • “the synthesis of nursing
practice and public health
The health status of a community is associated practice applied to promoting
with a number and preserving the health
of factors such as health care access, economic populations” (p.2) American
conditions, Nurses Association (ANA) in
social and environmental issues and cultural 1980:
practices.
• “it is essential for the community health nurse Public Health Nursing
to understand • Defined as a field of
the determinants of health and recognize the professional practice in nursing
interaction of and public health in which
the factors that lead to disease, death and technical nursing,
disability.” interpersonal, analytical and
organization skills are applied
to problems of health as they
“WHO states that the health or lack of affect the community. These
health of individuals depends on the context skills are applied in concert
of their lives.” with those of other persons
engaged in health care.
 Income and Status
 Education • Community and public health nurses
 Physical Environment practice disease
 Employment and working condition prevention and health promotion.
• Community health nursing practice is
DEFINITION AND FOCUS OF collaborative and is
PUBLIC HEALTH AND based in research and theory.
COMMUNITY HEALTH
Community – based nursing
“Public health is the science and art of...
• Preventing disease • “application of the nursing process in caring
• Prolonging life for individuals,
• Promoting health and efficiency through families and groups where they live, work or go
organized community to school as
effort for: they move through the health care system
• Sanitation of the environment (McEwewn and
• Control of communicable infections Pullis, 2008, p.6)
• Education of the individual in personal hygiene
• Organization of medical and nursing services Philosophy of Community Health
for the early diagnosis and Nursing:
preventive treatment of disease • According to Margarette Shetland, the
• Development of the social machinery to ensure philosophy of CHN is
everyone a standard of living based on the worth and dignity of man.
adequate for the maintenance of health, so
organizing these benefits as to Goal of Community Health Nursing:
enable every citizen to realize his birthright of
health and longevity” • To assist the individual, family and community
in attaining
“The term PUBLIC HEALTH connotes their highest level of holistic health which is
organized, legislated, and tax – supported attained through
efforts that serve all people through health multidisciplinary effort and to promote
departments or related governmental reciprocally supportive
agencies,” relationship between people and their physical
and social
development.
 developmental stage or common exposure to
particular
Concepts and Principles: environmental factors and consequently
common health
• Family: problems.
• Primary unit of care or basic unit of service of
Community
Health care where primary prevention is given OBJECTIVES OF PUBLIC
priority. HEALTH (CODES)
• Individual client or patient is a member of the
family
• The family may be a part of a population group C – CONTROL OF
like being COMMUNICABLE DISEASES
members of a regional group (Visayan, Lumad,
etc) which in
turn is part of the bigger group which is the O – ORGANZIATION OF
community. MEDICAL AND NURSING
Partnership: SERVICES
• The community health nurse works WITH, not
FOR, the
individual patient, family, group or community D- DEVELOPMENT OF SOCIAL
as active MACHINERIES
partners and not passive recipients of care.
• Activily involved in the organizing, planning,
implementation E – EDUCATION OF IEC ON
management and evaluation phases of their care. PERSONAL HYGIENE -
• Change: HEALTH EDUCATION IS THE ESENTAIL
• The practice of community health nursing is TASK OF EVERY HEALTH WORKER
affected by
change in the society in general and by
developments in the THREE ELEMENTS IN HEALTH
health field in particular EDUCATION
• The environment and socio economic status
have been shown • INFORMATION – To share ideas to keep
to affect the health of the community population group
• Health care delivery system: knowledgeable and aware
• CHN is part of a community health system and • EDUCATION – Change within the individual
of the larger • COMMUNICATION – interaction involving
human services system two or more persons or
• CHN shares with other members of health team agencies
and other
sectors in the community the responsibility of
delivering FUNCTIONS OF THE
health care services COMMUNITY HEALTH NURSE

LEVELS OF CLIENTELE OF THE PLANNER / PROGRAMMER

COMMUNITY HEALTH NURSE
• Provide technical assistance to rural health
Individual midwives in health
matters like target setting and etc.
• Deal with the sick and well on a daily basis • Identify needs, priorities and problems of
• Consult at health center (prenatal, well child individuals, families
follow up, and communities
morbidity services) • Formulate nursing component of health plans.
In doctorless
Population Group / Aggregate areas, the nurse is responsible for formulation of
municipal /
• A group of people who share common city health plan.
characteristics,
• Interprets and implements the nursing plan researches on nursing and health related subjects
program policies, • Coordinates with government and non –
memoranda and circulars for the concerned staff government
/ personnel organization in the implementation of studies /
research

CARE PROVIDER
ROLES OF A COMMUNITY
• Provides direct nursing care to the sick, HEALTH NURSE
disabled in the home,
clinic, school or place of work HEALTH PROMOTION

SUPERVISOR • “the process of enabling people to increase

control over their
• Interprets and implements program policies health and its determinants, and thereby improve
memoranda and their
circulars health” , WHO
• Engages and empowers individuals and
COMMUNITY ORGANIZER communities to engage
in healthy behaviors and make changes that
• Responsible for motivating and enhancing reduce the risk of
community developing chronic diseases and other
participation in terms of planning organizing and morbidities.
implementing • Nurses role in health promotion:
and evaluating health program services. • Ambassadors of wellness
• Initiates and participates in community • Caring for the well is more important than
development. caring for the sick
• If we can preserve wellness, we reduce the
COORDINATOR OF SERVICES number of times a person
needs to enter the health – care system, thus
• Coordinates with individuals, families and reducing costs.
groups for health
services provided by various members of the DISEASE PREVENTION
health team and
other Government Organizations / National • Focuses on prevention strategies to reduce the
Government risk of
Agencies, and Non government organizations developing chronic diseases and other
(NGOs) morbidities.
• Coordinates nursing program with other health • Includes a wide range of activities known as
programs “interventions”
which are aimed at reducing risks or threats to
DISEASE SURVEILLANCE health

• Detects deviation from health of individuals, Health Promotion vs Disease Prevention:

families, groups
of the community through contact / visits • Health promotion activities enhance resources
• Use symptomatic and objective observation directed at
and other forms of improving well being.
data gathering • Disease Prevention Activities protect people
from disease and
ROLE MODEL the effects of disease.

• Provides good example / model of healthful Levels of Prevention

living to the
public / community. • Leavell and Clark (1958) identified three (3)
levels of
RESEARCHER prevention commonly described in nursing as
PRIMARY
• Participates / assists in the conduct of surveys, PREVENTION, SECONDARY PREVENTION
studies and and TERTIARY
PREVENTION. • Governments have responsibility for the health
of their
Primary Prevention: people.

• Activities directed at preventing a problem • The PHC strategy was later adopted in the
BEFORE it occurs Philippines by
by altering susceptibility or reducing exposure virtue of Letter of Instruction (LOI) 949 in 1979,
for susceptible making PH
individuals. the first country in Asia to embark on meeting
• Consists of two elements: the challenge of
• General Health Promotion PHC. (Bautista, 2001)
• Specific Protection Health Promotion • Signed by President F. Marcos with an
• Examples: underlying theme:
• Good nutrition, adequate shelter, encouraging “Health in the Hands of the People by 2020”
regular exercise
• Specific: Immunization, water purification PHC Definition:
• Source: (Keller et.al., McEwen and Pullis,
2008) • According to the Alma Ata Declaration:
• PHC is “essential health care based on practical,
Secondary Prevention: scientifically
sound and socially acceptable methods and
• Early detection and prompt intervention during technology made
the period of universally accessible to individuals and families
early disease pathogenesis in the
• Implemented after a problem HAS BEGUN community through their full participation and at
but BEFORE SIGNS a cost that
AND SYMPTOMS appear and targets those the community and country can afford to
populations who have maintain at every
risk factors stage of their development in the spirit of self –
• Examples: reliance and
• Mammography, blood pressure screening, self – determination”.
newborn screening, and
mass sputum examination for pulmonary Universal Goal of PHC as stated by the
tuberculosis Alma Ata Declaration:

Tertiary Prevention: • “Health for All by the year 2000”

• Targets populations that have experienced

disease or injury WHOs Five Key Elements to achieving
and focuses on limitation of disability and “Health for All”:
rehabilitation.
• Aims to reduce the effects of disease and injury • Reducing exclusion and social disparities in
and to restore health (Universal
individuals to their optimal level of functioning. Coverage)
• Examples: • Organizing health services around people’s
• How to perform insulin injection techniques needs and
• Disease management to a patient with diabetes expectations (Health Service Reforms)
GJNS • Integrating Health into all sectors (Public
Policy Reforms)
PRIMARY HEALTH CARE • Pursuing collaborative models of policy
dialogue (Leadership
International Conference on Primary Health Reforms)
Care, Alma Ata, 1978: (Alma Ata Declaration) • Increasing stakeholder participation
• Health is a basic fundamental right
• There exists a global burden of health Essential Health Services by Alma Ata
inequalities among Declaration:
populations
• Economic and social development is of basic • E – Education for Health
importance for • L – Locally endemic disease control
the full attainment of health for all. • E – Expanded program for immunization
• M – Maternal and child health including Community Participation:
responsible parenthood
• E – Essential Drugs • An educational and empowering process in
• N – Nutrition which people, in
• T – Treatment of Communicable and Non partnership with those who are able to assist
communicable them, identify
Diseases the problems and the needs and increasingly
• S – Safe water and sanitation assume
responsibilities themselves to plan, manage,
control and assess
KEY PRINCIPLES OF PRIMARY the collective actions that are proved necessary.
HEALTH CARE
Equitable Distribution of Health
4As of PHC Resources

• Accessibility: Refers to the physical distance of • PHC advocates for care that is community -
a health facility or based and
the travel time required for people to get the preventive in orientation. It calls for an
needed or desired inventory and analysis
health services. (must be accessible within 30 of health resources, facilities and manpower.
minutes according to • Doctors to the Barrios (DTTB) Program
WHO) • Nurse Deployment Project (NDP)
• Affordability: consideration of the individual • Rural Health Midwife Placement Program
or family’s capacity to (RHMPP)
pay for basic health services. (Out of Pocket • Pharmacist Deployment Project (PDP)
Expenses: PhilHealth) • Public Health Associate Deployment Project
• Acceptability: health care offered is in (PHADP)
consonance with the
prevailing culture and traditions of the Appropriate Technology:
populations
• Availability: basic health services required by • Safety
the people are • Effectiveness
offered in health care facilities or is provided on • Affordability
a regular and • Simplicity
organized manner • Acceptability
• Feasibility and reliability
Support Mechanisms: • Ecological effects
• Potential to contribute to individual and
• People community
• NGAs Development
• NGOs

Multisectoral Approach:

• PHC requires communication, cooperation and

collaboration
within and among various sectors.
• INTRASECTORAL: communication,
cooperation and
collaboration within the health sector
• INTERSECTORAL: communication,
cooperation and
collaboration between the health sector and other
sectors of
society.
 1987, Book III, Chapter 2, Section 2.
LESSON 4: Health – ADMINISTRATIVE
ORDERS:
related Issuances
• “Acts of the President which relate to particular
(Public Health Law) aspects of governmental operations in
pursuance of his duties as administrative head
shall be promulgated in administrative orders.”
REPUBLIC ACTS: Administrative Code of 1987, Book III, Chapter
2, Section 3
• A Republic Act is a piece of legislation used to
create policy in order to carry out the principles RA No. 9288: “Newborn
of the Constitution. It is crafted and passed by Screening Act Of 2004”
the Congress of the Philippines and approved
by the President of Philippines. It can only be • An Act Promulgating A Comprehensive Policy
repealed by a similar act of Congress. and A National System For Ensuring Newborn
Screening
PROCLAMATION:
RA No. 9211: “Tobacco
• “Acts of the President fixing a date or Regulation Act of 2003”
declaring
a status or condition of public moment or • An act regulating the packaging, use, sale,
interest, upon the existence of which the distribution and advertisements of tobacco
operation of a specific law or regulation is products and for other purposes
made to depend, shall be promulgated in GJNS
proclamations which shall have the force of an
executive order. "Administrative Code of 1987, RA No. 9165: Dangerous Drugs
Book III, Chapter 2, Section 4 Act of 2002

MEMORANDUM ORDERS: • An Act Instituting the Comprehensive

Dangerous Drugs Act of 2002, repealing
• “Acts of the President on matters relating to republic act no. 6425, otherwise known as the
internal administration, which the President Dangerous Drugs Act of 1972, as amended,
desires to bring to the attention of all or some providing funds therefore and for other
of the departments, agencies, bureaus or purposes
offices of the Government, for information or
compliance, shall be embodied in
memorandum circulars. ”Administrative Code RA No. 9994: “Expanded
of 1987, Book III, Chapter 2, Section 6 Senior Citizens Act of 2010”

MEMORANDUM • An act granting additional benefits and

CIRCULARS: privileges to senior citizens, further amending,
as amended, otherwise Republic Act No.
• “Acts of the President on matters relating to 7432 known as “An Act To Maximize The
internal administration, which the President Contribution Of Senior Citizens To Nation
desires to bring to the attention of all or some Building, Grant Benefits And Special
of the departments, agencies, bureaus or Privileges And For Other Purposes”
offices of the Government, for information or
compliance, shall be embodied in
memorandum circulars. ”Administrative Code Republic Act 7883 - Barangay
of 1987, Book III, Chapter 2, Section 6 Health Workers Benefits and
Incentives Acts of 1995
EXECUTIVE ORDERS • An Act Granting Benefits and Incentives to
Accredit Barangay Health Workers and for
• “Acts of the President providing for rules of a Other Purposes.
general or permanent character in
implementation or execution of constitutional or
statutory powers shall be promulgated in
executive orders.” Administrative Code of
 Act No. 8293 or the Intellectual Property Code,
Republic Act 4226 - Republic Act No. 6675 Or The Generics Act
Hospital Licensure Act Of 1988, and Republic Act No. 5921 or The
• An Act Requiring the Licensure of all Pharmacy Law, and for other purposes
Hospitals
in the Philippines and Authorizing the Bureau
of Medical Services to Serve as the Licensing Republic Act 8423 - Traditional
Agency and Alternative Medicine Act
(TAMA of 1997)
RA No. 3573: Law on • An Act creating the PHILIPPINE INSTITUTE
Reporting of Communicable OF TRADITIONAL AND ALTERNATIVE
Diseases HEALTH CARE (PITAHC) to accelerate the
• Requires all individuals and health facilities to development of traditional and alternative
report notifiable diseases to national and local health care in the Philippines, providing for a
health authorities TRADITIONAL AND ALTERNATIVE
HEALTH
CARE DEVELOPMENT FUND and for other
RA No. 11332: Mandatory Reporting Of purposes
Notifiable Disease And Health Events
Of Public Health Concern Act RA No. 7875 - National Health
Insurance Act of 1995
• An act providing policies and prescribing
procedures on surveillance and response to • An Act Instituting A National Health Insurance
notifiable diseases, epidemics, and health Program For All Filipinos And Establishing The
events of public health concern, and Philippine Health Insurance Corporation For
appropriating funds therefor, repealing for the The Purpose
purpose Act No. 3573, otherwise known as the
“Law On Reporting Of Communicable RA 10606: “National Health
Diseases” Insurance Act of 2013”

RA No. 7719 - National Blood • An act amending Republic Act No. 7875,
Services Act of 1994 otherwise known as the “National Health
Insurance Act Of 1995′′, as amended, and for
• An Act Promoting Voluntary Blood Donation, other purposes
Providing For An Adequate Supply Of Safe
Blood Regulating Blood Banks And Providing RA No. 8504: “Prevention and
Penalties For Violation Thereof Control of HIV / AIDS”

RA No. 10821: “Children’s • Promulgating Policies And Prescribing

Emergency Relief And Protection Measures For The Prevention And Control Of
Act” Hiv/Aids In The Philippines, Instituting A
• An act mandating the provision of emergency Nationwide HIV/Aids Information And
relief and protection for children before, during, Educational Program, Establishing A
and after disasters and other emergency Comprehensive Hiv/Aids Monitoring System,
situations Strengthening The Philippine National Aids
Council, And For Other Purposes
Ra No. 6675 - Generics Act of
1988 Republic Act 8344 - An Act
Prohibiting the Demand of
• An Act to Promote, Require and Ensure the Deposits or Advance Payments
Production Of An Adequate Supply, • An Act Prohibiting The Demand Of Deposits
Distribution, Use And Acceptance Of Drugs Or
And Medicines Identified By Their Generic Advance Payments For The Confinement Or
Names Treatment Of Patients In Hospitals And Medical
Clinics In Certain Cases
RA No. 9502: “Universally
Accessible Cheaper and Quality Republic Act 8976: Philippine
Medicines Act of 2008” Food Fortification Act of 2000
• An act providing for cheaper and quality
medicines, amending for the purpose Republic • An Act Establishing The Philippine Food
Fortification Program And For Other Purposes. and management framework and
RA No. 8749 - Philippine Clean institutionalizing the national disaster risk
Air Act reduction and management plan, appropriating
funds therefor and
• An Act Providing For A Comprehensive Air for other purposes.
Pollution Control Policy And For Other
Purposes RA No. 7600: “The Rooming-in
And Breastfeeding Act Of
RA No. 6713: Code of conduct and 1992′′
Ethical Standards for Public • An act providing incentives to all government
Officials and Employees and private health institutions with rooming-in
• An act establishing a code of conduct and and breastfeeding practices and for other
ethical standards for public officials and purposes.
employees, to uphold the time-honored
principle of public office being a public trust, RA No. 10028: “THE
granting incentives and rewards for exemplary EXPANDED BREASTFEEDING
service, enumerating prohibited acts and PROMOTION ACT OF 2009”
transactions and providing penalties for • provides national policy to support
violations thereof breastfeeding in the workplace. It mandates
and for other purposes that breastfeeding mothers be provided with
lactation space, lactation breaks and access to
RA No. 7160: Local breastfeeding information at work. It also
Government Code of 1991 requires every workplace to have a lactation
policy and comply with the provisions of
• Responsibility for the delivery of basic services Executive Order 51
and facilities of the national government has
been transferred to the local government Provisions:

RA No. 7305: Magna Carta for • Lactation stations in every private enterprises,
Public Health Workers government agencies, government-owned and
controlled corporations
(a) to promote and improve the social and • “Lactation periods” for breastfeeding
economic well-being of the health workers, employees, in
their living and working conditions and terms addition to time-off for meals, to allow them
of employment; time to
(b) to develop their skills and capabilities in express their breast milk.
order • Breast milk banks in health institutions to store
that they will be more responsive and better pasteurized breast milk donated by breastfeeding
equipped to deliver health projects and mothers.
programs; and • Inclusion of breastfeeding in the curriculum of
(c) To encourage those with proper schools (under relevant subjects).
qualifications GJNS
and excellent abilities to join and remain in
government service Executive Order No. 102

RA No. 9262: Anti-Violence • Redirecting the Functions and Operations of

Against Women and Their the Department of Health.
Children Act of 2004
• An act defining violence against women and Executive Order No. 51
their children, providing for protective
measures for victims, prescribing penalties • Adopting a National Code of Marketing of
therefore, and for other purposes Breastmilk Supplements and related products,
GJNS penalizing violations thereof, and for other
purposes.
RA No. 10121: “Philippine
Disaster Risk Reduction and
Management Act of 2010".
• An act strengthening the Philippine disaster
risk reduction and management system,
providing for the national disaster risk reduction
LESSON 3 Financing
• Eliminating redundancies:
Universal Health • Population – based – DOH, LGU
• Individual – based – PHIC
Care • Simplifying membership into two types:
• Direct Contributory
Republic Act 11223: • Indirect Contributory
Universal Health Care Act Pooling of funds to PhilHealth
• For all individual – based health services (e.g.
• An act instituting UNIVERSAL HEALTH Sin Tax,
CARE PAGCOR, PCSO)
for ALL FILIPINOS, prescribing reforms in the • Improving current provider payment
health care system and appropriating funds mechanisms
Therefor
Financing
Republic Act 11223: • PhilHealth shall
Universal Health Care Act • Shift to performance-driven, close-end,
prospective
• General Objectives: payments based on DRGs, validated costing
• To ensure equitable access to quality and methods, and no differentiation between facility
affordable health care and protection against and
financial risk professional fees
• To progressively realize UNIVERSAL • Develop differential payment considering
HEALTH service
CARE through systemic approach and clear quality
role delineation
Service Delivery (1)
Republic Act 11223: • Contracting by network and designating
Universal Health Care Act primary car
providers as navigator
Declaration of Principles: • Consolidating public system into province –
• Integrated and comprehensive approach to wide and city –
• Ensure health literacy, healthy living and wide health systems
protection • Improving pool, presence, perspective of
from hazards and risks HCWs
• Provide comprehensive health services without • Securing resources and retaining income for
causing financial hardship health through
a special health fund
• Whole of system, whole of government, whole • PhilHealth to contract public, private or mixed
of society approach in the development of health care
health policies provider networks
• People – oriented approach: centered on • Service quality
people’s needs and well being • Co – payment / co – insurance
• Data submission
Universal Health Care • PhilHealth and DOH to incentivize health care
means... providers

• Healthy Living, Schooling and working Service Delivery (2)

environments • Province – wide and City – Wide Health
• Primary care provider team for every family Systems:
member • Provincial / City Health Board shall:
• Health spending is predictable, not “lahat libre” • Oversee integration of health services
• Manage the special health fund
• Exercise administrative and technical
A “Systemic” supervision
Approach to UHC over health facilities and HRH within their
Financing, Service Delivery, Regulation, jurisdiction
Governance • Municipalities and cities shall be represented in
the board • Mandatory use of IT systems and submission
of health and financial data by health care
Service Delivery (3) providers and suppliers
• Special health Fund: • Promoting fairness and transparency in
• Province – wide and City – Wide Health benefits expansion through Health Technology
System Assessment
shall pool and manage all resources in order to
finance population – based and individual – Health Promotion
based
health services • Transformation of HPCS to Health Promotion
• DOH, in consultation with DBM and LGUs Bureau
shall • At least one percent of total DOH budget
develop guidelines for Special Health Fund earmarked for health promotion
• PhilHealth payments shall accrue to the Special • Dep ed schools to be designated as healthy
Health Fund and credited as Annual Regular settings
Income (ARI) of the LGU • Incorporation of health promotion in school
curricula
Service Delivery (4) • LGU to enact stricter ordinances to promote
• Scholarship and Training Program health literacy and healthy lifestyles
• Expansion of existing and new health related
degree and training programs Health Information
• Regulation of the number of enrollees based on System
needs • Health service providers and insurers to
• Expansion of scholarship grants maintain a health information system to be
• Reorientation of health professional education, electronically uploaded on a regular basis
certification and regulation towards provision of through interoperable system
primary care services • Enterprise resource planning
• Human resource information
Service Delivery (5) • Electronic health records
Return Service Agreement • Electronic prescription pad
• At least three (3) years for recipients of
government – funded scholarship programs
National Health Workforce (NHW) Support
System
• Support to local public health systems in
addressing human health needs, especially for
GIDAs

Regulation (1)
• Transparent pricing of health goods and
services
• Benefit complementation between PhilHealth
and Private Health Insurance (PHIs) and
Health Maintenance Organizations (HMOs)
• Basic and non – basic accommodation bed
ratio
• 90:10 for government
• 70:30 for government specialty
• 10:90 for private hospitals

Regulation (2)
• Licensing for stand-alone health facilities,
ambulatory and PCP
• Registry of healthcare providers

Governance (1)
• Allocating funding and scaling up Health
Promotion initiatives
• Mandating Health Impact Assessment for all
programs, policies and projects
LESSON 2 • The Summit led to the elaboration of eight
HEALTH CARE Millennium
Development Goals (MDGs) to reduce extreme
DELIVERY SYSTEM poverty
by 2015
WORLD HEALT ORGANIZATION 1. Eradicate extreme poverty and hunger
- international health agency of 2. Achieve universal primary education
United nation 3. Promote gender equality and empower women
- founded on April 7, 1948 (celebrated Worlds 4. Reduce child mortality.
Health Day) 5. Improve maternal health
6. Combat HIV / AIDS, malaria and other
6 REGIONAL OFFICES diseases
1. United States 7. Ensure environmental sustainability
2. Congo 8. Develop a global partnership for development
3. Denmark
4. Egypt
5. India 3 ROLES IN HEALTH SECTOR
6. Philippines 1. Leadership in Health
2. Enabler and Capacity Builder
3. Administrator of Specific Services
Sustainable Development
Goals (SDGs)
DOH HIGHEST VALUES OF WORK
Agenda 21  Integrity
In June 1992, at the Earth Summit in Rio de  Excellence
Janeiro, Brazil, more  Compassion and Respect for Human
than 178 countries adopted Agenda 21, a Dignity
comprehensive plan of  Commitment
action to build a global partnership for  Professionalism
sustainable development to  Teamwork
improve human lives and protect the  Stewardship of the Health of People
environment.
GJNS.09.01
•VISION:
Millennium Development Goals Filipinos are among the healthiest people
in SEA by 2022, and Asia by 2040.
• September 6 to 8, 2000 – world leaders in the •MISSION:
UN To lead the country in the development of
General Assembly participated in the a productive, resilient, equitable and
Millennium people – centered health system.
Summit
• The result of the summit was a resolution Private sector:
entitled: • Composed of “for profit” and “non-profit”
“United Nations Millennium Declaration” agencies
• In this declaration, the world leaders • It provides healthcare that is generally paid
recognized their through
collective responsibility to uphold the principles user fees at point of service.
of human, • About 65 percent of the 1,224 hospitals in the
dignity, equality, and equity at the global level. country in 2016 were private (DOH-HFSRB,
To uphold 2016).
these principles is their duty to all the people of
the world,
especially the most vulnerable people and in
particular, the
children (UN General Assembly, 2000)
 payment (52.2 percent) still dwarfed the share of
government subsidies (18.9 percent) and
PhilHealth
Health Financing social insurance (16.7 percent) to total health
expenditures, undermining financial protection.
• The National Health Insurance Act of 1995 (DOH
created the NOH 2017-2022)
Philippine Health Insurance Corporation
(PhilHealth) to Levels Of Health Care
provide health insurance coverage for all Delivery
Filipinos but Advances in health sciences and services have
enrolment was not made compulsory. brought about
• In 2013, it was amended, expanding the the development of different types of health
contribution- facilities.
based national health insurance program (NHIP)
beyond formal employment to include the PRIMARY:
underprivileged, sick, elderly, persons with • Usually the first contact between the
disabilities community
(PWDs) and women and children. members and other levels of health facility.
• It strengthened the roles of the LGUs and • Rural Health Physicians, Public Health Nurse,
health Rural
providers in NHIP enrolment. Health Midwives, Community Volunteer Health
• Government budget also flows through the Workers, Traditional Healers.
health
contributions of other central institutions such as SECONDARY:
DND, • Given by physicians with basic health training.
the Philippine National Police (PNP), the • Usually given in health facilities either private
University of owned or government operated.
the Philippines (all of which manage large • Infirmaries, municipal, district hospital,
hospitals), out-patient
the Philippine Charity Sweepstakes Office departments.
(PCSO), and • Rendered by specialists in health facilities.
the Philippine Amusement and Gaming
Corporation TERTIARY:
(PAGCOR). • Referral system for the secondary care
• PhilHealth administers the National Health facilities.
Insurance • Provided complicated cases and intensive care.
Program (NHIP) to provide all Filipinos with • Medical centers, regional and provincial
financial hospitals
risk protection. The government fully subsidizes and specialized hospitals.
the
PhilHealth premiums of the poor identified
through the Classification Of Hospitals
National Household Targeting Survey for
Poverty General Hospitals
Reduction (NHTS-PR). • Provides all kinds of
• Total health expenditure in the Philippines services for all kinds of
grew by 39 illnesses, injuries or
percent to PhP655.1 billion from 2012 to 2016. deformities
Government expenditures likewise increased • Level 1
owing to • Level 2
incremental revenues from sin taxes allocated • Level 3
for
health, which led to a dramatic increase in Specialty Hospitals
PhilHealth • Offers services for a
coverage from 84 percent in 2012 to 91 percent specific disease,
in condition or type of
2016. patient, such as the
• Nonetheless, the huge share of out-of-pocket children, the elderly or
(OOP)
 • Recommended ratio of RHU to catchment
population is 1 RHU:20,000 population
(DOH,2009)

Category A: Primary Care Facility Barangay Health Station

• A first contact health care facility that offers • The first contact health care facility that offers
basic basic
services including emergency services and services at the barangay level. It is a satellite
provision for normal deliveries: station
• Without inpatient beds like health centers, out of the RHU (DOH, 2009).
– patient • It is manned by volunteers called Barangay
clinics and dental clinics Health
• With inpatient beds – short stay facility where Workers(BHWs) / Community Volunteer Health
the Workers (CVHWs) under the supervision of the
patient spends on average of one to two days Rural Health Midwife (RHM), (DOH,2001)
before
discharge e.g. infirmaries / lying – in clinics.
Rural Health Unit Personnel
Category B: Custodial Care Facility
City / Municipal Health Officer
• A health facility that provides long – term care,
including basic services like food and shelter to • Heads the health services at the city /
patients with chronic conditions requiring on – municipal
going health and nursing care due to impairment level and carries out the following roles and
and a reduced degree of independence in functions:
activities
of daily living and patients in need of Administrator of the RHU:
rehabilitation.
• E.g. Custodial Psychiatric Facilities, Substance • Prepares City / Municipal Health Plan Budget
Drug –Abuse Treatment and rehabilitation • Monitors the implementation of basic health
Centers, services
Nursing Homes • Management of the RHU staff

Community Physician
Category C: Diagnostic /
Therapeutic Facility • Conducts epidemiological studies
• A facility for the examination of the human • Formulates health education campaigns on
body, disease
specimens from the human body for the prevention
diagnosis, • Prepares and implements control measures or
sometimes treatment of disease or water for rehabilitation plans
drinking water analysis.
• The test covers the pre-analytical, analytical
and Medico – Legal officer of the City /
post-analytical phases of examination. Municipality
• Laboratory facility
• Radiologic facility • Attends to medico-legal cases and issues
• Nuclear medicine facility medico-
legal reports to the chief of police, fiscal or
Rural Health Unit judge.

• Commonly known as a health center, is a • Performs autopsies upon the request of the
primary above
level of health facility in the city / municipality. mentioned officials.
• The focus of the RHU is preventive and
promotive Public Health Nurse
health services and the supervision of BHSs
under • Supervises all RHMs in the City / Municipality
its jurisdiction (DOH,2001)
• Prepares the FHSIS quarterly and annual • It is comprehensive encompassing promotive,
reports of the preventive, curative and rehabilitative care. It
city / municipality for submission to the engages all health facilities from the lowest to
Provincial the
Health Officer (PHO) highest level.
• Utilizes the nursing process in responding to Local Health Board
health • Enacted to bring about genuine and meaningful
care needs, including needs for health education local
and autonomy
promotions, of individuals, families, and • Enable LGUs to attain their fullest
catchment development as self-
community reliant communities and make them more
• Collaborates with the other members of the effective
health partners in the attainment of national goals
team, government agencies, private agencies, • Mandates the DEVOLUTION of basic services
NGOs from the
• Under RA7305: nurse – population ratio= national government to the LGUs.
1:20,000 • Devolution – refers to the act by which the
national
Rural Health Midwife government confers power and authority upon
• Manages the BHS supervises and trains the the various
BHWs LGUs to perform specific functions and
• Provides midwifery services and executes responsibilities
health care (Congress of the Republic of the Philippines
programs and activities for women of 1991)
reproductive age,
including family counselling and services. • Provided the creation of the Provincial Health
• Conducts patient assessment and diagnosis for Board /
referral City / Municipal Health Board / Local Health
/ further management Board
• Organizes community RA 7160: Local Government Code
• Facilitates barangay health planning and other
community health services.
• 1 RHM = 5,000 population • Chairman of the board – local executive:
• Provincial Governor / Mayor
• Vice – Chairman:
Community Volunteer Health • Provincial / City / Municipal Health Officer
Workers (Formerly BHW) • Members:
• Considered as the interface between the • Chairman on Committee on Health of the
community and the RHU Sanggunian
• They are trained in preventive health care with • A representative from the private sector or
a NGO
strong emphasis in maternal and child care, involved in health services
family • Representative of the DOH
planning and reproductive health. • (Congress of the Republic of the Philippines,
• The recommended ratio of BHW to catchment 1991)
population = 1 BHW : 20 households (DOH,
2009) Functions:

Health Referral System • Proposing to the Saggunian annual budgetary

allocations for the operation and maintenance of
Referral health facilities and services within the province
• A referral is a set of activities undertaken by a /
health care provider or facility in response to its city / municipality;
inability to provide the necessary health • Serving as an advisory committee to the
intervention to satisfy a patient’s need. Sanggunian on health matters; and
• A functional referral system is one that ensures • Creating committees that shall advise local
the health
continuity and complementation of health and agencies on various matters related to health
medical services. service operations.
Inter-local health zones (ILHZ)

• based on the concept of the District Health

System,
a generic term used by WHO to describe an
integrated health management and delivery
system
based on a defined administrative and
geographical
area.

An ILHZ:

• Has a defined catchment population within a

defined geographical area
• It has a central core referral hospital and a
number
of primary level facilities such as RHUs and
BHSs.
• Does not only cover government health
services
but includes all other sectors involved in the
delivery of health services.

An ILHZ has the following

components:
• People: between 100,000 – 500,000 (from
WHO)
• Boundaries: clear boundaries between ILHZ
(establishes accountability and responsibility)
• Health facilities: RHU, BHSs and other health
facilties
• Health Workers: DOH personnel, staff of
district
provincial hospitals, RHUs, and BHS