COMMUNITY HEALTH NURSING 2

LECTURE | WEEK 1

SIX GLOBAL HEALTH ISSUES

Pandemics Animal Health, Food Sourcing and Supply
● Global disease outbreaks ● Based on the leader, if the person with power
● Example: Covid, influenza cares about health care, the leader will give
importance to health
Environmental factors
● Climate change is thought by many global health Note: The ever-growing list of global health issues
experts to be the greatest threat to human health can be overwhelming, but there are so many ways
● Climate change led to more extreme weather individuals can make a positive impact
● According to World Meteorological Organization
(WMO)
- 11, 000 reported disasters (1970-2019) COMMUNITY HEALTH NURSING
- 2 million deaths, more than 91% of deaths Health
occurred in developing countries ● WHO defines health as a “state of complete,
- US$ 3.64 trillion mental, and social well-being, not merely the
- Droughts, storms, floods, extreme temperature absence of disease or infirmity.”
● Storms, flooding, droughts, and air pollution make
it easier for diseases to spread across large Determinants of Health
groups of people. Income and Higher income and social status is
● Ex. Typhoon Odette (2021) – 6 regions affected social status linked to better health
(Dinagat islands, Surigao del Norte, Bohol, Cebu,
Palawan), 9.9 million affected, 2.4 million were Low levels of education are linked
need of assistance, 28 billion damage, 405 Education to poor health, more stress and
deaths, 66 missing 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 4. Resourcefulness and creativity

PHILIPPINES (2005) 5. Honesty and integrity
Nursing Service 6. Active membership to professional nursing
● Separate and distinct unit of the local health organizations
agency/unit which is composed of nurses, ● The PHN performs functions and activities in
midwives and auxiliaries such as barangay health accordance with the dominant values of public
workers nursing aides and volunteers. health nurses
1. Management training, supervision, provision
I. ORGANIZATION AND MANAGEMENT of nursing care, health promotion and
● A nursing service is organized in a local health education and coordination are consistent
agency to ensure the effective delivery of nursing with RA 9173 and program policies formulated
services and nursing component of public health by DOH
programs 2. Considers the needs of her/his clients and
● Nursing service is headed by a qualified Chief their available resources for heath and health
Nurse (RA 9173) care
1. Has a bachelor’s degree in nursing and a ● PHN, in coordination with the faculty of colleges of
registered nurse in the Philippines nursing, participates in teaching, guidance and
2. Has at least 5 yrs. experience in general supervision of students in nursing and midwifery
nursing service administration for their RLE in the community setting
3. Has master’s degree in nursing ● Participates in the conduct of research and utilizes
4. Member of a good standing of the accredited research findings in his/her nursing practice
professional organization of nurses
● The Supervising PHN who heads a nursing unit III. OTHER COMPONENTS
should have following qualification: ● Supervision
1. BSN, RN ● Interdisciplinary and intersectoral collaboration
2. 5 yrs. Supervisory experience in public health ● Nursing process
3. Master’s degree in public health or nursing ● Health promotion and health education
4. Member of good standing of the accredited ● Demonstrating Professional, Responsibility and
professional org. of nurses Accountability
● The nursing service has a written vision, mission,
EVOLUTION OF PUBLIC HEALTH NURSING IN
philosophy, goals and objectives.
● Formulates/reviews and implements the nursing THE PHILIPPINES
service plan, manual of policies and nursing 1898
standards. ● The history of public health nursing in the
● Participates in the health agency’s physical Philippines is embedded in the history of the
facilities, equipment and supplies and in Department of Health which was first established
monitoring their use. as Department of Public Works, Education and
● Participates in the official recruitment, selection, Hygiene
promotion, and discharge process at all levels 2006 – Present
involving nursing personnel and in making ● The Philippine Nursing Act of 2002 was enacted
decisions involving nurses and midwives and under the Republic Act No. 9173 which entails
nursing practice. changes on existing policies under Republic Act
● Initiates/strengthens mechanisms within the No. 7164
agency that enhance nursing and midwifery
contribution to the overall community health goals. UNIVERSAL HEALTH CARE LAW
RA 11223: The Universal Health Care Law
II. QUALIFICATION AND FUNCTION OF PHN
● Signed by Rodrigo Duterte
● Graduate of BSN and a RN
● Expansion of population, service, and financial
● Personal and professional competencies:
coverage
1. Good physical and mental health
● Shift to primary care
2. Interest and willingness to work in the
community
3. Leadership potentials
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LECTURE | WEEK 1

● All Filipinos guaranteed “equitable access to ● Primary Care Provider Network refers to a group
quality and affordable health care goods and of public, private or mixed primary care providers
services and protected against financial risk as the foundation of HCPN.
● Ensure every Filipino is healthy, protected from ● Organization of Local Health Systems:
health hazards and risks, and has access to - Province-wide and City-wide Health systems
affordable, quality and readily available health - Provincial/ City Health Board
service that is suitable to their need - Provincial/ City health office
- Incentives for improving competitiveness
General Objectives Human Resources for Health
● To progressively realize universal health care ● National Health Human Resource Master Plan
through systemic approach and clear role ● National Health Workforce support system
delineation of stakeholders Regulation
● To ensure equitable access to quality and ● Safety and quality
affordable health care and protection against ● Affordability
financial risk ● Equity
Governance and Accountability
Declaration of Principles
● Health Promotion
● Integrated and comprehensive approach
● Evidence-Informed sectoral; policy and planning
● Whole of system, whole of government, whole of
for UHC
society approach
● Monitoring and Evaluation
● Comprehensive health services without causing
● Health Impact Assessment
financial hardship
● Health Technology Assessment
● People oriented approach
● Ethics in public health policy and practice
Universal Health Care ● Health information system
● Healthy living, schooling and working ● Appropriation
environments
● Primary care provider team for every family PHILIPPINE HEALTHCARE DELIVERY
● Healthy spending is predictable not “lahat libre” SYSTEM
Health System
SALIENT FEATURES OF UHC LAW ● Interrelated system in which a country organizes
Financing available resources for the maintenance an
● All Filipinos automatically be member of Philhealth improvement of the health of its citizens and
● Families not registered – assisted by their communities
healthcare provider ● Comprises all organizations, institutions and
● Philhealth ID will not require availing services resources devoted to producing actions whose
● Direct and Indirect Contributors primary intent is to improve health
● Private Sector Financing Agents – offer
complementary or supplementary benefit
Healthcare Organized plan of health
packages
System service
● Service Coverage - “Preventive, promotive,
curative, rehabilitative and palliative care for Healthcare Rendering health services to
medical, dental mental and emergency health Delivery people
services delivered either as population-based or
individual-based health services. network of health facilities and
Service Delivery Healthcare personnel which carries out
● Health care provider network (HCPN) - group of Delivery System the task of rendering health
primary to tertiary care providers (public or care to the people
private), offering people-centered and
comprehensive care in an integrated manner with
the primary care provider acting as the navigator Philippine Healthcare system Context
and coordinator. ● 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