Community Health Nursing 101 by Jhun

HEALTH

“State of complete physical, mental and social well-being, not merely the absence of disease or infirmity”

Major contributor to the overarching goal of poverty reduction

Determinants of Health Affected by a combination of many factors Determined his circumstances and environment It is inappropriate therefore to blame or credit the persons state of health to

himself alone because he is unlikely able to directly control many of these factors

Knowledge of these factors is important in order to effectively promote health and prevent illnesses

Factors that make people healthy or not:1. Income and social status2. Education3. Physical environment4. Employment and Working conditions5. Social support networks6. Culture7. Genetics8. Personal behavior and coping skills9. Health services10. Gender

PUBLIC HEALTH

“Science and Art of preventing disease, prolonging life, promoting health and efficiency through organized community effort for the sanitation of environment, control of communicable diseases, education of individuals in personal hygiene, organization of medical and nursing services for the early diagnosis and preventive treatment of disease and the development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity”.

FACTORS:

1. Politicala. safetyb. oppressionc. people empowerment

2. Socio-economica. employmentb. educationc. housing

3. Environmenta. airb. foodc. waterd. urban/rurale. noisef. radiationg. pollution

4. Behaviora. cultureb. habitsc. moresd. ethnic customs

5. Hereditya. genetic endowment

i. defectsii. strengths

iii. risksiv. familial ethnic racial

6. Health Care Delivery Systema. Promotiveb. Preventivec. Curatived. Rehabilitative

Core business of Public Health1. disease control2. injury prevention3. health protection4. health public policy5. promotion of health and equitable health gain

ESSENTIAL PUBLIC HEALTH FUNCTIONSNeeded to achieve the core business of public health

Following are essential health functions:1. Health situation monitoring and analysis2. Epidemiological surveillance/disease prevention and control3. Development of policies and planning in public health4. Strategic management of health systems and services for population health

gain5. Regulation and enforcement to protect public health6. Human resources development and planning in public health7. Health promotion, social participation and empowerment8. Ensuring the quality of personal and population based health services9. Research, development and implementation of innovative public health

solutions

GLOBAL AND COUNTRY HEALTH IMPERATIVESOngoing changes which exert a number of pressures on the public health system

1. Shifts in demographic and epidemiological trends in diseases2. New technologies for health care, communication and information3. Existing and emerging environmental hazards some associated with

globalization4. Health reforms

United Nations General AssemblyCommon visionPoverty reduction and sustainable development in September 2000

Exemplified by Millennium Development Goals which are based on the fundamental values of freedom, equality, solidarity, tolerance, health, respect for nature and shared responsibility:

1. Eradicate extreme poverty and hunger2. Achieve universal primary education3. Promote gender equality and empower women4. Reduce child mortality5. Improve maternal health6. Combat HIV/AIDS, malaria and other diseases7. Ensure environmental sustainability8. Develop a global partnership for development

OVERVIEW OF THE PUBLIC HEALTH NURSING

Public Health Nursing and Community Health Nursing often used interchangeably

PHN defined by WHO:“Special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of total public health programme for the promotion of health, improvement of the conditions in the social and physical environment, rehabilitation of illness and disability”

CHN defined by Freeman:“Service rendered by a professional nurse with communities, groups, families and individuals at home, in health centers, in clinics, in schools and in places of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation”

CHN defined by Jacobson“Nursing practice in a wide variety of community services and consumer advocate areas and in a variety of roles at times including independent practice… community nursing is certainly not confined to public health nursing agencies”

The original thrust of Public Health Nursing:“Nursing for the health of the entire public/community versus nursing only for the public who are poor”

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Standards of Public Health Nursing:

Public Health Nursing Refers to the practice of nursing in national and local government health

departments and public schools It is a community health nursing practice in the public sector

Public Health Nurses Refers to the nurses in the local/national health departments or public

schools whether their official position title is public health nurse or nurse or school nurse

PUBLIC HEALTH NURSES

Leaders in providing quality health services to the communities First level of health workers to be knowledgeable about new public health

technologies and methodologies Usually the first ones to be trained to implement new programs and apply

new technologies

THE PHILIPINE HEALTH CARE DELIVERY SYSTEMMajor players of the HCDS

1. Private sectora. Largely market orientedb. Health care is paid through user fees at the point of servicec. Includes profit and non-profit health providersd. Includes providing health services in

i. Clinicsii. Hospitals

iii. Health insurancee. Manufacture of

i. Medicinesii. Vaccines

iii. Medical suppliesiv. Medical equipmentv. Other health and nutrition products

vi. Research and developmentvii. Human resource development

2. Public sector a. largely financed through a tax-based budgeting system at both

national and local levelsb. health care is generally given free at the point of servicec. consist of the national and local government agencies

NATIONAL LEVELDepartment of Health

Mandated as the lead agency in health Maintains specialty hospitals, regional hospitals and medical centers Maintains provincial health teams made up of DOH representatives to the

local health boards and personnel involved in CDC, specifically for malaria and schistosomiasis

Philippine General Hospital Part of national level which provide health care services

Local level (Local Health System) Run by LGU

Provincial government Provincial and District hospitals

City/Municipal government Health centers/RHU Barangay health stations

Local Chief Executive Chaired the local health board Function is mainly to serve as advisory body to the local executive and the

sanggunian or local legislative council on health-related matters

PHILIPPINE DEPARTMENT OF HEALTH

HISTORICAL BACKGROUNDPRE-SPANISH and SPANISH PERIOD

1888 Superior board of health and charity was created by the Spaniards which

established a hospital system and a board of vaccinationJune 23, 1898

Department of Public Works, Education and Hygiene was created by virtue of decree signed by President Emilio Aguinaldo

September 29, 1898 General Orders No. 15 established the Board of Health for the City of

ManilaJuly 1, 1901

Act No. 157 created Board of Health for the Philippine Islands, also functioned as the Local Health Board of Manila

December 2, 1901 Act Nos. 307, 308 established the Provincial and Municipal Boards

completing the health organization in accordance with the territorial division of the islands

Board of Health for the Philippine Islands became Insular Board of HealthOctober 26, 1905

Act No. 1407 abolished the Insular Board of Health and replaced by the Bureau of Health under the Department of Interior

Act No. 1487 (1906) replaced the provincial boards of health with district health officers

1915 Act No. 2468 transformed the BOH into a commissioned service called the

Philippine Health Service1932

Act No. 4007 (Reorganization Act of 1932) reverted back the Philippine Health Service into the Bureau of Health and combined the Bureau of Public Welfare under the Office of the Commissioner of Health and Public Welfare

PHILIPPINE COMMONWEALTH AND THE JAPANESE OCCUPATION (1935-1945)

May 31, 1939 Commonwealth Act No. 430 created the Department of Public Health and

WelfareJanuary 7, 1941

EO No. 317 fully implemented Commonwealth Act No. 430January 1, 1951

Office of the President of the Sanitary District was converted into RHU carrying out 7 basic health services; Maternal and Child Health, environmental Health, CDC, Vital Statistics, Medical Care, Health Education and Public Health Nursing

February 20 1958 EO No. 288 effort to decentralize governance of health service. An office of

the regional health director was created in 8 regions and all health services were decentralized to the regional, provincial and municipal levels

1970 Restructured Health Care Delivery System was conceptualized, classified

health services into Primary, Secondary and TertiaryJune 2, 1978

PD 1397 renamed the Department of Health to the Ministry of HealthDecember 2, 1982

EO No. 851 created Integrated Provincial Health OfficeApril 13, 987

EO No. 119 transformed the Ministry of Health back to the Department of Health

October 10, 1991 RA 7160 (Local Government Code) provided for the decentralization of the

entire government; DOH changed its role from one of implementation to one of governance

May 24, 1999 EO No. 102 (Redirecting the Functions and Operations of the DOH) granted

the DOH to proceed with its Rationalization and Streamlining Plan. Mandates the DOH to provide assistance to LGU, people’s organization and

other members of civic society in effectively implementing programs, projects and services that will

o Promote the health and well being of every Filipino;

o Prevent and control diseases among population at risk;

o Protect individuals, families and communities exposed to

hazards and risks;

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o Treat, manage and rehabilitate individuals affected by diseases

and disability1999-2004Development of Health Sector Reform Agenda

ROLES AND FUNCTIONS OF DOH (Mandated by the EO No. 102)ROLEProviding technical and other resource assistanceGENERAL FUNCTIONS UNDER THREE SPECIFIC ROLES

1. Leadership in Health2. Enabler and Capacity Builder3. Administrator of Specific Services

VISIONThe DOH is the leader, staunch advocate and model in promoting Health for All in the Philippines

MISSIONGuarantee equitable, sustainable and quality health for all Filipinos, especially the poor and shall lead the quest for excellence in health

GOAL: Health Sector Reform Agenda (HSRA)Health Sector Reform is the overriding goal of the DOH. Support mechanisms will be through sound organizational development, strong policies, systems and procedures, capable of human resources and adequate financial resources

Rationale for Health Sector Reform1. Slowing down in the reduction in the IMR and the MMR2. Persistence of large variations in health status across population groups and

geographic areas3. High burden from infectious diseases4. Rising burden from chronic and degenerative diseases5. Unattended emerging health risks from environmental and work related

factors6. Burden of disease is heaviest on the poor

Reason for the existence of the above conditions1. Inappropriate health delivery system – shown by an inefficient and poorly

targeted hospital system ineffective mechanism for providing public health programs on top of health human resources maldistribution

2. Inadequate regulatory mechanisms for health services resulting to poor quality of health care, high cost of privately provided health services, high cost of drugs and presence of low quality of drugs in the market

3. Poor health care financing and inefficient sourcing or generation of funds for healthcare

Framework for the implementation of HSRA: FOURmula ONE for Health

FOURmula ONE for Health is the implementation framework for health sector reforms in the Philippines for the medium term covering 2005-2010. It is designed to implement critical health interventions as a single package, backed by effective management infrastructure and financing arrangements.

FOURmula ONE for Health engages the entire health sector, including the public and private sectors, national agencies and local government units, external development agencies, and civil society to get involved in the implementation of health reforms. It is an invitation to join the collective race against fragmentation of the health system of the country, against the inequity of healthcare and the impoverishing effects of ill-health. With a robust and united health sector, we can win the race towards better health and a brighter future for generations to come.

Goals of FOURmula one for Health

Starting the Race with the End in Mind: Fourmula One for Health Goals and Objectives Over-all Goals:The implementation of FOURmula ONE for Health is directed towards achieving the following end goals, in consonance with the health system goals identified by the World Health Organization, the Millennium Development Goals, and the Medium Term Philippine Development Plan:

Better health outcomes More responsive health system

More equitable healthcare financing.

General Objective: FOURmula ONE for Health is aimed at achieving critical reforms with speed, precision and effective coordination directed at improving the quality, efficiency, effectiveness and equity of the Philippine health system in a manner that is felt and appreciated by Filipinos, especially the poor.

Specific Objectives: Fourmula One for Health will strive, within the medium term, to:

Secure more, better and sustained financing for health Assure the quality and affordability of health goods and services

Ensure access to and availability of essential and basic health packages

Improve performance of the health system

Defining the Rules of Engagement: Seven (7) General Guidelines for Health Reform Implementation F1 Rule No.1:

FOURmula ONE for Health will organize the critical reform initiatives into four implementation components, namely, Financing, Regulation, Service Delivery and Governance. F1 Rule No. 2:

The implementation of FOURmula ONE for Health will focus on a few manageable and critical interventions. Such interventions will be identified using the following criteria:

Doable given available resources - Critical interventions identified for each component must be deemed doable given the available time, human and financial resources.

Sufficient groundwork and buy-in - The chosen interventions must be backed by sufficient groundwork and buy-in from implementation partners, especially in the development of reform packages for local implementation.

Triggers a reform chain reaction - These critical interventions must be able to trigger a chain of reaction that will spur the implementation of other FOURmula ONE for Health interventions, within and across the four components.

Produces tangible results and generates public support - These critical interventions must be able to show tangible results within the immediate and medium terms, which in turn generate support and cooperation from the public;

F1 Rule No. 3:The reforms will be implemented under a sector-wide approach, which

encompasses a management perspective that covers the entire health sector and an investment portfolio that encompasses all sources. F1 Rule No. 4:

The National Health Insurance Program (NHIP) will serve as the main lever to effect desired changes and outcomes in each of the four implementation components, where the main functions of the NHIP including enrollment, accreditation, benefit delivery, provider payment and investment are employed to leverage the attainment of the targets for each of the reform components. F1 Rule No. 5:

The functional and financial management arrangements will be defined in terms of specific offices having clear mandates, performance targets and support systems, within well-defined time frames in the implementation of reforms within each component. F1 Rule No. 6:

The functional clustering of teams and assignment of specific Team Leaders shall facilitate implementation, monitoring and supervision in a coordinative manner and shall not, in any way, prejudice the corporate nature of the DOH-attached agencies nor the autonomy of Local Government Units.

F1 Rule No. 7:The selection of FOUR-in-ONE Convergence Sites will be governed by the following criteria:

Willingness of the LGU to participate in the FOURmula ONE for Health implementation, in terms of willingness to provide the requisite counterpart resources, and willingness to enter into formal national government to local government, inter-local government and government to private sector networking, partnership and resource sharing arrangements;

Presence of local initiatives or start-up activities relevant to FOURmula ONE strategies, to include, but not limited to: development of inter-local health zones, enrollment of indigents into the social health insurance system, improvement in drug management systems, among others;

Relatively high feasibility of success and sustainability, to include factors such as capacity to enter into loans, capacity to absorb investments and sustain the reform process, etc.; and

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Availability of funds from GOP and external sources for capital investment requirements.

Carrying out the Game Plan: Winning Strategies to Attain FOURmula ONE for Health Component-Specific Objectives

F1 Component No. 1: HEALTH FINANCING

Objective: The objective of financing reforms under FOURmula ONE for Health is to secure more, better and sustained investments in health to provide equity and improve health outcomes, especially for the poor.

F1 Component No.2: HEALTH REGULATION

Objective: The main objective of health regulation under FOURmula ONE for Health is assuring access to quality and affordable health products, devices, facilities and services, especially those commonly used by the poor.

F1 Component No. 3: HEALTH SERVICE DELIVERY

Objective: FOURmula ONE for Health interventions in service delivery are aimed at improving the accessibility and availability of basic and essential health care for all, particularly the poor. This shall cover all public and private facilities and services

F1 Component No.4: GOOD GOVERNANCE IN HEALTH

Objective: The objective of good governance in health is to improve health systems performance at the national and local levels. FOURmula ONE for Health will introduce interventions to improve governance in local health systems, improve coordination across local health systems, enhance effective private-public partnership, and improve national capacities to manage the health sector.

Governance in local health systems may be improved by undertaking the following strategies: FOUR-IN-ONE Convergence Sites have to be established. These convergence sites will undertake integrated implementation of FOURmula ONE for Health components in appropriately delineated localities or inter-local health zones.

A FOURmula ONE for Health LGU Scorecard will be developed and employed to track the progress and compare the performance of various localities or inter-local health zones.

A FOURmula ONE for Health Professional Development and Career Track will be institutionalized where competent and dedicated health personnel will provide quality health services and sound advice to local chief executives with regard to health reforms.

PRIMARY HEALTH CARE AS AN APPROACH TO DELIVERY OF HEALTH CARE SERVICE

PRIMARY HEALTH CARE Essential health care made universally accessible to individuals and families

in the community by means of acceptable to them through their full participation and at a cost that the community and country can afford at every stage of development

Primary health care was declared during the First International Conference on PHC held in Alma Ata USSR on September 6 – 12, 1978 by WHO with a goal of “Health for All by the year 2000”

Primary Health Care was adopted in the Philippines through LOI 949 signed by Pres. Marcos on October 19, 1979 and has an underlying theme of “Health in the hands of the People by 2020”

Concept of PHC is characterized by; Partnership and empowerment of the people

PHC is a strategy which focuses responsibility for health on the

individual, his family and the community PHC includes full participation and active involvement of the

community towards the development of self-reliant people,

capable of achieving an acceptable level of health and well being

PHC recognizes the interrelationship between health and the overall political, socio-cultural and economic development of society

Elements/Components of PHC

1. Environmental Sanitation2. Control of communicable diseases3. Immunization4. Health Education5. Maternal and Child Health and Family Planning6. Adequate Food and Proper Nutrition7. Provision of Medical Care and Emergency Treatment8. Treatment of Locally Endemic Diseases9. Provision of Essential Drugs

Strategies Reorientation and reorganization of the national health care system (RA

7160) Effective preparation and enabling process for health action at all levels Mobilization of the people

with the end view of providing appropriate solutions leading to self-reliance and self determination

Development and utilization of appropriate technology focusing on local indigenous resources available in and

acceptable to the community Organization of communities arising from their expressed needs Increase opportunities for community participation Development of intra-sectoral linkages with other government and private

agencies Emphasizing partnership

Framework for meeting the goal of PHC

Organizational strategy o calls for active and continuing partnership among the

communities, private and government agencies in health development

Four cornerstones/Pillars in PHC

1. Active community participation2. Intra and Inter-sectoral linkages3. Use of appropriate technology4. Support mechanisms made available

Two levels of PHC workers

1. Village or Barangay Health Workers2. Intermediate Level Health Workers

a. General medical practitionersb. PHNc. RSId. RHM

LEVELS OF HEALTH CARE AND REFERRAL SYSTEM

Primary Level of Careo Devolved to the cities and municipalities

o Health care provided by the center physicians, PHN, RHM,

BHW, TBAs and otherso Usually the first point of contact between the community

members and other levels of health facility Secondary Level of Care

o Given by physicians with basic health training

o Usually given in health facilities either privately owned or

government operated such as infirmaries, municipal and district hospitals, out-patient departments of provincial hospitals

o Serves as a referral center for the primary health facilities

o Capable of performing minor surgeries and perform some

simple laboratory examinations Tertiary Level of Care

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o Rendered by specialists in health facilities including medical

centers as well as regional and provincial hospitals and specialized hospitals

o Referral center for the secondary care facilities

LEVELS OF HEALTH CARE SERVICES

Tertiary level care facilitieso National and Regional Health Services

o Medical centers

o Teaching and Training hospitals

Secondary level care facilitieso Provincial / City health services and hospitals

o Emergency and District hospitals

Primary level care facilitieso RHU

o Community hospitals & health centers

o Private practitioners, puericulture centers

o BHS

THE PUBLIC HEALTH NURSE

Qualifications and FunctionsMust be professionally qualified and licensed to practice in the arena of public health nursingConsistent with the nursing law of 2002 (RA 9173)

• Management function– Inherent in the practice of PHN– Organizes the nursing service of the local health agency

• Supervisory function– Supervisor of the midwives and other health workers

• Nursing care function– Inherent function of the nurse– Based on the science of art and caring– Caring for all levels of clientele toward health promotion and

disease prevention• Collaborating and coordinating function

– Care coordinators for communities and their members– Establishes linkages and collaborative relationships with other

health professionals, government agencies, private sectors, NGO’s people’s organizations to address health problems

• Health promotion and education function– Activities goes beyond health teachings and health information

campaigns• Training function

– Initiates the formulation of staff development and training programs for midwives and other auxiliary workers

• Research function– Participates in the conduct of research and utilizes research

findings in her practice• Disease surveillance

– Measure the magnitude of the problem

– Measure the effect of the control program

NURSING PROCEDURES Clinic visit

Patient visits the health center Most common is BP measurement

Home visit Family-nurse contact The PHN visits the patient

Bag technique Tool by which the nurse during her visit will enable her to

perform a nursing procedure with ease and deftness, save time and effort

Most important principle Minimize if not prevent the spread of any infection

Important points to consider in the use of the bag Contain all necessary articles Cleaned very often

Well protected Arrangement-most convenient

ASSESSING COMMUNITY HEALTH NEEDS

COMMUNITY HEALTH NURSING• COMMUNITY

– Primary client• HEALTH

– Goal• NURSING

– Means

COMMUNITY• Group of people sharing common geographic boundaries, common values

and interest• Functions within a particular socio-cultural context, which means that no

two communities are alike• Primary client of CHN

– Has a direct influence on the health of the individual, families and sub-populations

– It is at this level that most health service provision occurs• Regarded as an organism with its own stages of development

– Matures through time

COMMUNITY DIAGNOSIS• Done to come up with a profile of local health situation

– Will serve as a basis of health programs and services to be delivered to the community

• Starts with determining the health status of the community

PROCESS OF COMMUNITY DIAGNOSIS• Consists of;

– Collecting, organizing & synthesizing data• In order to identify the different factors that may

directly or indirectly influence the health of the population

– Analyzing & interpreting health data• Seek explanations for the occurrence of health

needs and problems of the community– Formulation of Community Health Nursing Diagnoses

• Will become the bases for developing and implementing community health nursing interventions and strategies

Types of Community Diagnosis• Comprehensive community diagnosis

– Aims to obtain general information about the community• Problem Oriented community diagnosis

– Responds to a particular need

ELEMENTS OF COMPREHENSIVE COMMUNITY DIAGNOSIS1. DEMOGRAPHIC VARIABLES

– Total population & Geographical distribution including Urban-Rural index & Population Density

– Age & Sex composition– Selected vital indicators e.q. Growth rate, CBR, CDR & Life

expectancy rate– Patterns of migration– Population projection

• Note:– Population groups that need special attentions:

• Indigenous people• Internal refugees• Socially dislocated groups as a result of disasters,

calamities & development programs

2. SOCIO-ECONOMIC & CULTURAL VARIABLES

– Social indicators• Communication network• Transportation system• Educational level• Housing conditions

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– Economic indicators• Poverty level income• Employment rate• Types of industry present in the community• Occupation common in the community

– Environmental indicators• Physical/geographical/topographical

characteristics• Water supply• Waste disposal• Air, Water and Land pollution

– Cultural factors• Variables that may break up people into groups

within the community e.q.– Ethnicity– Social class– Language– Religion– Race– Political orientation

• Cultural beliefs and practices that affect health• Concepts about Health and Illness

3. HEALTH & ILLNESS PATTERNS– Leading cause of mortality– Leading cause of morbidity– Leading cause of infant mortality– Leading cause of maternal mortality– Leading cause of hospital admission

4. HEALTH RESOURCES– Manpower resources– Material resources

5. POLITICAL/LEADERSHIP PATTERNS– Reflects the action potential of the state and its people to

address the health needs and problems of the community– Mirrors the sensitivity of the government to the people’s

struggle for better lives

IDENTIFYING COMMUNITY HEALTH NURSING PROBLEMS Health Status Problems

Increased/decreased morbidity, mortality fertility or reduced capability for wellness

Health Resources Problems Lack of or absence of manpower, money, materials or

institutions necessary to solve health problems Health Related Problems

Existence of social, economic, environmental and political factors that aggravate the illness-inducing situations in the community

PRIORITY-SETTING • Nature of the condition/problem presented

– Classified as health status, health resources or health related problems

• Magnitude of the problem– Severity of the problem which can be measured in terms of the

proportion of the population affected by the problem• Modifiability of the problem

– Probability of reducing, controlling or eradicating the problem• Preventive potential

– Probability of controlling or reducing the effects posed by the problem

• Social concern– Perception of the population or the community as they are

affected by the problem and their readiness to act on the problem

• Application of Public Health Tools

COMMUNITY HEALTH NURSING• Three important tools

The health disciplines of • Demography

• Vital statistics• Epidemiology

DEMOGRAPHY• Science which deals with the study of the human population’s

– Size– Composition– Distribution in space

SOURCES OF DEMOGRAPHIC DATA-Can be obtained from a variety of sources• Censuses• Sample surveys• Registration systems

Two ways of assigning people when the census is being takenDe jure

• Done when people are assigned to the place where they usually live regardless of where they are at the time of the census

De facto• People are assigned to the place where they are physically present at the time

of the census regardless of their usual place or residence

POPULATION SIZE• Refers to the number of people in a given place or area at a given time• Allows the nurse to make comparisons about population changes over time• Helps rationalize the types of health programs or interventions which are

going to be provided for the community

TWO METHODS IN DETERMINING POPULATION SIZEMethod 1

• Determining the increase in the population resulting from excess of births compared to deaths

NATURAL INCREASE• Difference between the number of births and the number of deaths occurring

in a population in a specified period of timeNat. increase = no. births – no. of deaths / specified year

RATE OF NATURAL INCREASE• Difference between the CBR and the CDR occurring in a population in a

specified period of timeRate of Nat. increase = CBR – CDR / specified year

Method 2• Determine the increase in the population using data obtained during two

census periods. This implies that the increase in the size of the population is not merely attributed to excess in births but also the effect of migration

ABSOLUTE INCREASE PER YEAR• Measures the number of people that are added to the population per year.

Abs. Increase/year = Pt – Po / t• where:

– Pt = pop. Size at a later time– Po = pop. Size at an earlier time– t = no. of years between 0 and time t.

• Method 2

RELATIVE INCREASE• Actual difference between the two census counts expressed in percent

relative to the population size made during an earlier censusRelative increase = Pt – Po / Po

• where:– Pt = population size at a later time– Po = population size at an earlier time

POPULATION COMPOSITIONPertaining to population size’s variables such as:

• Age• Sex• Occupation• Educational level• Commonly described in terms of its age and sex• Nurse utilizes data on age and sex composition to decide who among the

population groups merits attention in terms of health services and programs

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SEX COMPOSITION• To describe the sex composition of the population, the nurse computes for

the “sex ratio” • Sex ratio compares the no. of females in the population

Sex ratio = Number of males / Number of femalesThe sex ratio represents the number of males for every 100 females in the population

AGE COMPOSITION• Two ways to describe the age composition of the population

MEDIAN AGE• Divides the population into two equal parts.

DEPENDENCY RATIO• Compares the number of economically dependent with the economically

productive group in the population.• Economically dependent

– 0 – 14– 65 and above

• Economically productive– Within 15 – 64 age group

POPULATION DISTRIBUTION• The measures help the nurse decide how meager resources can be justifiably

allocated based on concentration of population in a certain place1. Urban-Rural distribution2. Crowding Index3. Population Density

VITAL STATISTICS• Refers to the systematic study of vital events such as births, illnesses,

marriages, divorces/separations and deaths• Tool in estimating the extent or magnitude of health needs and problems in

the community• Common health indicators• Fertility rates

– Crude birth rate (CBR)– General fertility rate (GFR)

• Mortality rates– Crude death rate (CDR)– Specific mortality rate (SMR)– Cause of death rate– Infant mortality rate (IMR)– Maternal mortality rate (MMR)– Proportionate mortality rate (PMR)– Swaroops index– Case fatality rate (CFR)

• Morbidity rate– Incidence rate– Prevalence rate

MORBIDITY • TEN LEADING CAUSES OF MORBIDITY

No. & Rate/100,000 Population PHILIPPINES, 2002

• MORBIDITY (2002)

MORTALITY • Ten Leading Causes of Mortality by Sex

Number, Rate/100,000 Population & Percentage Philippines, 2002

• MORTALITY

EPIDEMIOLOGY• EPIDEMIOLOGY • Study of the occurrence and distribution of health conditions such as disease,

deformities or disabilities on human populations• Two main areas of concern

– Study of occurrences and distribution of diseases

– Search for the determinants (causes) of the disease and its observed distributions

• Backbone of the prevention of diseases

Epidemiology rests on two important concepts;• Multiple Causation Theory• Levels of Prevention of Health Problems

Multiple Causation Theory• Disease development does not rest on a single cause• Health conditions result from a multitude of factors

Model that explain the MCT– Ecologic Triad/Epidemiologic triangle

AGENT • Any element, substance or force, either animate or inanimate. The presence

or absence of which may serve as stimulus to initiate or perpetuate a disease process

– Disease process happens only when the agent comes in contact with a susceptible host and under proper environmental conditions

– Intrinsic property of microorganism to survive and multiply in the environment to produce disease

HOST• Any organism that harbors and provides nourishment for another organism• Characteristics of the host will affect his or its risk of exposure to sources of

infection and his or its susceptibility or resistance• Intrinsic factors of the host

– Genetic– Age– Sex– Ethnic group– Physiologic– Immunologic experience (immunization)– Inter-current or pre-existing disease– Human behavior

• RESISTANCE• Specific

– Results from an immunologic experience such as; immunization or vaccination

• Non-specific– Results from an intact skin, mucous membrane, reflexes as

lacrimation, coughing, diarrhea or vomiting– Can be maintained through personal hygienic practices,

environmental sanitation, proper nutrition and a healthy lifestyle

• COMMUNITY• Community as a host

– Protects its health by the nurse by increasing its herd immunity• Herd Immunity

– Probability of a group or community developing an epidemic introduction of an infectious agent

– It is the proportion of the immunes and the susceptible in the group

ENVIRONMENT• Sum total of all external conditions and influences that affect the life and

development of an organism• Affects the agent and the host

Three components of environment– Physical environment

• Composed of the inanimate surroundings e.q. geophysical conditions or the climate

– Biological environment• Makes up the living things around us e.q. plant and

animal life• Human population

– Socio-economic environment• May be in the form of level of economic

development of the community, presence of social disruptions

LEVELS OF PREVENTION OF HEALTH PROBLEM• Promoting health and Preventing health problems• Make up most of the nurse’s activities in the community

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PREVENTION• Refers to identification of potential problems• Directed to the healthy population

– Primordial prevention• Focusing on prevention of emergence of risk

factors– Specific protection

• Removal of the risk factors or reduction of their levels

PRIMARY PREVENTION• In Communicable disease prevention

– Activities on primary prevention are targeted at intervening before the agent enters the host and cause pathological changes

– It aims to;• strengthen the host resistance• Inactivate the agent (source of infection)• Interrupt the chain of infection through

environmental manipulation• Prevention of spread to human reservoirs and other

susceptible human hosts• Primary prevention can be done through;

– Personal surveillance– Quarantine– Segregation or isolation

• Health promotion activities include;– Provision of proper nutrition– Safe water supply and waste disposal system– Vector control– Promotion of a healthy lifestyle– Good personal habits

• Specific measures include provision of;– Immunization– Prophylaxis to vulnerable or at-risk groups

SECONDARY PREVENTION• Aims to identify and treat existing health problems at the earliest possible

time• Interventions can still lead to the control or eradication of the health problem

– Screening– Case finding– Disease surveillance– Prompt and appropriate treatment

• In Communicable disease control;– Health education on signs and symptoms will enable the client

to identify illness and seek early care or treatment– Knowledge of risk behaviors that contribute to the spread of the

disease may influence patients and the families to modify this behavior and, thus, assist in the prevention of disease

TERTIARY PREVENTION• Limits disability progression

– The nurse attempts to reduce the magnitude or severity of the residual effects of;

• Infectious diseases– E.q hearing impairment from frequent

ear infections• Non-communicable diseases

– Mental illness, CVD– Day care centers and sheltered workshops are examples of

opportunities to achieve the objective of tertiary prevention in mental illness and drug abuse

THE EPIDEMIOLOGICAL APPROACH• PHASES1. Descriptive epidemiology

• Concerned with disease distribution and frequency2. Analytical epidemiology

• Attempts to analyze the causes or determinants of disease through hypothesis testing

3. Intervention or Experimental epidemiology• Answers questions about the effectiveness of new methods for

controlling diseases or for improving underlying conditions

4. Evaluation epidemiology• Attempts to measure the effectiveness of different health

services and programs

DESCRIPTIVE EPIDEMIOLOGYAspects involved in descriptive epidemiology

1. Observation and recording of existing patterns of occurrence of the health condition under study

2. Description of the disease/condition as to person, place and time characteristics

3. Analysis of the general pattern of occurrence of the disease or condition• ASPECT 1

I. Observation and recording of existing patterns of occurrence of the health condition under study

In order to describe the occurrence of disease condition; the nurse needs to recognize or identify the disease with reasonable certainty

• Done by conducting– Screening– Case finding activities

• ASPECT 1 • SCREENING

– Presumptive identification of unrecognized diseases or defects through the application of diagnostic tests or laboratory examinations and clinical assessment

• CASE FINDING– Done to look for previously unidentified cases of diseases

• Screening & Case Finding– Should consider the sensitivity and specificity of the tests

• ASPECT 1 • SENSITIVITY

– Proportion of persons with a disease who test positive on a screening test

– Measures the probability of the test correctly identifying a positive case of a disease

• SPECIFICITY– Proportion of a persons without a disease who have negative

results on a screening test– Measures the probability of correctly identifying non-cases

• ATTACK RATE– Used to calculate an identifiable population exposed to an

infectious agent– Represents the incidence of the illness among the exposed

population– Frequently used in surveillance and control of communicable

diseases– ASPECT 2

II. Description of the disease/condition as to person, place and time characteristics

– After the disease or condition has been identified with reasonable certainty; the number of persons who possess the disease are recorded noting down the;

• Characteristics of the afflicted persons• Time the disease was initially recognized• Characteristics of the place where the cases came

from• ASPECT 2 1. Herd Immunity

– Basis for determining the community’s reaction against disease invasion since it represents the immunity and susceptibility levels of individuals comprising the population

– The immunity level is inversely proportional to susceptibility level

2. EXPOSURE or CONTACT RATE– Represents opportunities for progressive opportunities for

progressive transfer or transmission of an infectious agent to a susceptible host and depends on the;

• Frequency of contact• Facility of transmission

3. CHANCE– Probability of contact between the

• Source of infection• Susceptible host

– Depends upon the

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• Number of sources of infection• Number of immunes• Location of the source of infection

Disease occurrence can be described by the following:A) Short time fluctuations common in epidemics

– Common source epidemic – characterized by simultaneous exposure of a large number of susceptible to a common infectious agent

– Propagated epidemic – caused by a person-to-person transmission of disease agent

B) Cyclic variation – refers to recurrent fluctuations of disease that may exhibit cycles lasting for certain periods

C) Secular variation – refers to changes in disease frequency over a period of many years

• ASPECT 33. Analysis of the general pattern of occurrence of the disease or condition

– Establishing the • Disease frequency• Disease distribution in a population

– Defining the characteristics of the disease or condition in relation to

• Time• Place• Person

– Correlating the data and formulate a causal association between the

• Disease under study• Probable factors surrounding it

• DISEASE DISTRIBUTION• Variables affecting disease distribution

– Time• Period during which the cases of the disease being

studied were exposed to the source of infection and the period during which the illness occurred

– Persons• Characteristics of the individual who were exposed

and who contacted the infection or the disease– Place

• Features, factor or conditions which existed in or described the environment in which the disease occurred

• Patterns of occurrence and distribution• Sporadic

– Intermittent occurrence (rabies)• Endemic occurrence

– Continuous occurrence throughout a period of time • Malaria – Palawan• Schistosomiasis – Leyte and Samar• Filariasis – Sorsogon • Tuberculosis – all specific areas of the country

• Epidemic occurrence– Unusually large number of cases in a relatively short period of

time• Pandemic occurrence

– Simultaneous occurrence of epidemic of the same disease in several countries

PUBLIC HEALTH PROGRAMS Sets of interventions put together to operationalize policies and

standards directed towards the prevention of certain public health problems

Family Health Non-communicable Disease Prevention and Control Communicable Disease Prevention and Control Environmental Health and Sanitation Other priority health programs

Sentrong Sigla Herbal Medicine Health Emergency Preparedness and Response Program National Voluntary Blood Services Program Botika ng Barangay

FAMILY HEALTH Basic unit of the community

Concerned with the health of the mother, unborn, newborn, infant, child, adolescent and youth, adult men and women and older persons

Aims to: Improve the survival, health and well being of mothers and the

unborn Pre-pregnancy Prenatal Natal Postnatal stages

Reduce morbidity and mortality rates: Children 0-9 years old Among Filipino adults and older persons and improve

quality life Mortality from preventable causes among adolescents

and young peopleMATERNAL HEALTH PROGRAMTasked to reduce MMR by three quarters by 2015 to achieve MDG

Maternal Mortality Rate (2003) CAUSE Other Complications related to pregnancy occurring in the course of

labor, delivery and puerperium Hypertension complicating pregnancy, childbirth and puerperium

(25%) Postpartum hemorrhage (20.3%) Pregnancy with abortive outcome (9%) Hemorrhage related to pregnancy Strategic thrusts for 2005-2010 Launch and implement Basic Emergency and Obstetric Care

(BEMOC) strategy in coordination with DOH Entails establishment of facilities that provide emergency

obstetric care for every 125,000 population and which are located strategically

Improve quality of prenatal and postnatal care Pregnant women should have at least four (4) prenatal

visits Reduce women’s exposure to health risks

Institutionalization of responsible parenthood Stakeholders must advocate for health

Resource generation and allocation for health services

ANTENATAL REGISTRATION

Prenatal visits

Period of pregnancy

1st visit As early in pregnancy as possible before four months or during the first trimester

2nd visit During the 2nd trimester

3rd visit During the 3rd trimester

Every two

weeks

After 8th month of pregnancy till delivery

MICRONUTRIENT SUPPLEMENTATION

Vitamins Dose Schedule Remarks

Vitamin A 10,000 IU 2x a week starting on the 4th month of pregnancy

Do not give Vitamin A before 4th month of pregnancy. It might cause congenital problems in the baby

Iron 60mg/400 Daily

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ug tablet

Recommended Schedule for Post Partum Care Visits

1st visit 1st week post partum preferably 3-5 days

2nd visit 6 weeks post partum

FAMILY PLANNING PROGRAM Annual Population Growth

2.36% Population expected to double in 29 years Total fertility rate

3.5 children/woman 3 to 4 million getting pregnant/year 85% expected to progress full term

National Demographic and Health Survey (2003) 44% women got pregnant with 1st child ages 20-24 6.1% Ages 15-19 35-39 – highest percentage of using contraceptives 15-19 – lowest percentage

Married women 48.8% - use any form of contraceptive method

33.4% - modern method 15.5% - traditional method

51.1% - do not use any form of contraceptive method

FAMILY PLANNING METHODS Female sterilization

Cutting or blocking two fallopian tubes (BTL) Male sterilization

Vas deferens is tied and cut or blocked through a small opening on the scrotal skin (Vasectomy)

Effective 3 months after the procedure Pill

Hormones – estrogen and progesterone Taken daily PO

Male condom Thin sheath of latex Dual protection from STIs including HIV

Injectables Synthetic hormone – progestin which suppresses

ovulation, thickens cervical mucus LAM

Postpartum method of postponing pregnancy based on physiological infertility experienced by breast feeding women

Effective only for a maximum of 6 months postpartum Mucus/Billings/Ovulation

Abstaining from SI during fertile days Can not be used by woman with unusual disease or

condition that results in extraordinary vaginal discharge that makes observation difficult

BBT Identifying the fertile and infertile period by daily taking

and recording rise in BT during and after ovulation Temp is taken 3 hours of undisturbed rest (usually

morning) Sympto-thermal method

Combination of BBT and Billing/Mucus method Two day method

Simple fertility awareness based method Cervical secretions as an indicator of fertility Checking the presence of secretions daily

Standard days method

Users with menstrual cycle between 26 and 32 days are counseled to abstain from SI on days 8-19 to avoid pregnancy

CHILD HEALTH PROGRAMSMain goal is to reduce morbidity and mortality rates for children 0-9 years old

Strategic thrusts for 2005-2010 Pursuing the sentrong sigla initiative Apply REB strategy for immunization Intensify health education and information campaign IMCI and BEMOC strategy Implementation of laws and policies for the protection of newborns

Early Childhood Development Act of 2000 Newborn Screening Act of 2004 EO 286, Bright Child Program EO 51, Milk Code Rooming-in and Breastfeeding Act

Infant and Young Child Feeding (IYCF) Global Strategy for IYCF issued jointly by the WHO and UNICEF in

2002 as endorsed by the World Health Assembly in May 2002 and the UNICEF Executive Board in September 2002

Strategy calls for the: Promotion of breastmilk as the ideal food for the healthy

growth and development of infants Exclusive breastfeeding for the first 6 months of life

Overall objective: Improve the survival of infants and young children by

improving their nutritional status, G & D through optimal feeding

National Plan of Action for 2005 – 2010 for IYCF

GOAL Reduce Child Mortality Rate by 2/3 by 2015

OBJECTIVE Improve health and nutrition status of infants and young

childrenOUTCOME

Improve exclusive and extended breast feeding and complementary feeding

Specific Objectives 70% of newborns are initiated to breastfeeding within one

hour after birth 60% of infants are exclusively breastfed up to 6 months 90% of infants are started on complementary feeding by 6

months of age Median duration of breastfeeding is 18 months

Key messages on IYCF Initiate breastfeeding within 1 hour after birth Exclusive for the first 6 months of life Complemented at 6 months, excluding milk supplements Extend breastfeeding up to 2 years and beyond

National IYCF strategy Health Facilities

Mother-baby friendly hospitals Health workers

Advocates Protectors Promoters of IYCF Enforcers of laws, not violators

Family/Community Supportive family Milk Code “vigilantes” Lay/Peer counselors IYCF “bayanihan” spirit Mother-baby friendly public places

Working places Maternity leave Lactation/Breastfeeding room Breastfeeding breaks

Industry Comply with the “Code”

Schools Introducing the “breastfeeding culture”

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Laws that protects IYCF EO 51, Milk Code Rooming-in and Breastfeeding Act of 1992 RA 8976, Food Fortification Law of 2000

EXPANDED PROGRAM IMMUNIZATION General principles which apply in vaccinating children Safe and immunologically effective to administer all EPI vaccine on

the same day at different sites of the body Measles vaccine should be given as soon as the child is 9 months old

9 months – 85% protection 1 year above – 95% protection

Vaccination schedule should not be restarted from the beginning even if the interval between doses exceeded the recommended interval by months or years

Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindicated to vaccination; unless the child is so sick that he needs to be hospitalized

Absolute contraindications to immunizations are: DPT2 or DPT3 to a child who has had convulsions or

shock within 3 days the previous dose Vaccines containing the whole pertussis component

should not be given to children with an evolving neurological disease

Live vaccines like BCG must not be given to immunosuppressed due to malignant disease (child with clinical disease), therapy with immunosuppressive agents or irradiation

Safe and effective with mild side effects after vaccination. Local reaction, fever and systemic symptoms can result as part of the normal immune response

Giving doses of vaccine at less than the recommended 4 weeks interval may lessen the antibody response. Lengthening the interval between doses of vaccines leads to higher antibody levels

No extra doses must be given to children who missed a dose of DPT/HB/OPV/TT

Strictly follow the principle of never, ever reconstituting the freeze dried vaccines in anything other than the diluents supplied with them

Repeat BCG vaccination if the child does not develop a scar after the 1st injection

Use one syringe one needle per child during vaccination Routine Immunization Schedule for Infants A child is said to be “Fully Immunized Child” (FIC) when a child

receives 1 dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HB and 1 dose of measles before a child’s 1st birthday

Tetanus Toxoid Immunization Schedule for Women EPI vaccines and characteristics

OTHER HEALTH PROGRAMS Adolescent and Youth Health and Development Program Botika Ng Barangay Breastfeeding Program / Mother and Baby Friendly Hospital Initiative Blood Donation Program Child Health Diabetes Mellitus Prevention Program Dengue Control Program Dental Health Program Doctors to the Barrios (DttB) Program Emerging Disease Control Program Environmental Health Expanded Program on Immunization Family Planning Food and Waterborne Diseases Prevention and Control Program Food Fortification Program FOURmula One Garantisadong Pambata GMA 50 / Parallel Drug Importation (PDI) Healthy Lifestyle Program Knock-Out Tigdas Leprosy Control Program Malaria Control Program Measles Elimination Campaign (Ligtas Tigdas) National Cardiovascular Disease Prevention and Control Program

National Filariasis Elimination Program National Mental Health Program Natural Family Planning Newborn Screening Nutrition Occupational Health Program Health Development Program for Older Persons (Elderly Health) Persons with Disabilities Program Prevention of Blindness Program Rabies Control Program Safe Motherhood and Women's Health Schistosomiasis Control Program Smoking Cessation Program Soil Transmitted Helmenthiasis TB Control Program

LAWS AFFECTING PUBLIC HEALTHREPUBLIC ACT

Republic Act 9288 - Newborn Screening – An Act Promulgating A Comprehensive Policy and A

National System For Ensuring Newborn Screening Republic Act 9165 - Dangerous Drugs Act of 2002 -

An Act Instituting the Comprehensive Dangerous Drugs Act of 2002, repealing republic act no. 6425, otherwise known as the Dangerous Drugs Act of 1972, as amended, providing funds therefor and for other purposes

Republic Act 9257 - Expanded Senior Citizens Act of 2003 An Act Granting Additional Benefits and Privileges to

Senior Citizens Amending for the Purpose Republic Act No. 7432 Otherwise Known As "An Act To Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other Purposes"

Republic Act 7883 - Barangay Health Workers Benefits and Incentives Acts of 1995

An Act Granting Benefits and Incentives to Accredit Barangay Health Workers and for Other Purposes.

Republic Act 6675 - Generics Act of 1988 An Act to Promote, Require and Ensure the Production Of

An Adequate Supply, Distribution, Use And Acceptance Of Drugs And Medicines Identified By Their Generic Names

Republic Act 4226 - Hospital Licensure Act An Act Requiring the Licensure of all Hospitals in the

Philippines and Authorizing the Bureau of Medical Services to Serve as the Licensing Agency

Republic Act 3573 Declared that all communicable diseases should be

reportes to the nearest health station Republic Act 7719 - National Blood Services Act of 1994

An Act Promoting Voluntary Blood Donation, Providing For An Adequate Supply Of Safe Blood Regulating Blood Banks And Providing Penal Ties For Violation Thereof

Republic Act 7875 - National Health Insurance Act of 1995 An Act Instituting A National Health Insurance Program

For All Filipinos And Establishing The Philippine Health Insurance Corporation For The Purpose

Republic Act 8504 - Prevention and Control of 1988 Promulgating Policies And Prescribing Measures For The

Prevention And Control Of Hiv/Aids In The Philippines, Instituting A Nationwide HIV/Aids Information And Educational Program, Establishing A Comprehensive Hiv/Aids Monitoring System, Strengthening The Philippine National Aids Council, And For Other Purposes

Republic Act 8423 - Traditional and Alternative Medicine Act (TAMA of 1997)

An Act creating the PHILIPPINE INSTITUTE OF TRADITIONAL AND ALTERNATIVE HEALTH CARE (PITAHC) to accelerate the development of traditional and alternative health care in the Philippines, providing for a TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND and for other purposes

Republic Act 8749 - Philippine Clean Air Act of 1999

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An Act Providing For A Comprehensive Air Pollution Control Policy And For Other Purposes

Republic Act 8344 - An Act Prohibiting the Demand of Deposits or Advance Payments

An Act Prohibiting The Demand Of Deposits Or Advance Payments For The Confinement Or Treatment Of Patients In Hospitals And Medical Clinics In Certain Cases

Republic Act 5921 An Act Regulating The Practice Of Pharmacy And

Settings Standards Of Pharmaceutical Education In The Philippines And Other Purposes

Republic Act 8976 Philippine Food Fortification Act of 2000

Republic Act 6713 Code of conduct and Ethical Standards for Public Officials

and Employees Republic Act 7160

Responsibility for the delivery of basic services and facilities of the national government has been transferred to the local government

Republic Act 7305 Magna Carta for Public Health Workers Aims to promote and improve the social and economic

well-being of health workers

EXECUTIVE ORDER Executive Order No. 663

Implementing the the National Commitment for "Bakuna ang Una Sa Sanggol At Ina", Attaining World Health Organization's goals to Eliminate Measles and Neonatal Tetanus, Eradicate Polio, Control Hepatitis B and Other Vaccine-Preventable Diseases

Executive Order No. 102 Redirecting the Functions and Operations of the

Department of Health. Executive Order No. 51

Adopting a National Code of Marketing of Breastmilk Supplements and related products, penalizing violations thereof, and for other purposes.

Executive Order No. 472 Transferring the National Nutrition Council from the

Department of Agriculture to the Department of Health PRESIDENTIAL DECREE

Presidential Decree No. 856 Code on Sanitation of the Philippines

Presidential Decree No. 522 Prescribing Sanitation Requirements for the Operation of

Establishments and Facilities for the Protection and Convenience of the Travelling Public

Presidential Decree No. 651 Requiring the Registration of Births and Deaths in the

Philippines which occurred from January 1, 1974 and thereafter

Presidential Decree No. 996 Providing for Compulsory Basic Immunization for Infants

and children below eight years of age Presidential Decree No. 965

A Decree Requiring Applicant for Marriage License to Receive Instructions on Family Planning and Responsible Parenthood

Presidential Decree No. 384 Amending Republic Act Numbered 4073, entitled an An

Act Further Liberalizing the Treatment of Leprosy by Amending and Repealing certain Sections of the Revised Administrative Code

Presidential Decree No. 893 Reconstituting the National Schistosomiasis Control

Commission into the Schistosomiasis Control Council and for other Purposes

Presidential Decree

Presidential Decree 881 January 30, 1976Empowering the Secretary of Health to regulate the labeling, sale and distribution of hazardous substances

Presidential Decree No. 856 Code on Sanitation of the Philippines(with Implementing Rules and Regulations)

Presidential Decree No. 522 Prescribing Sanitation Requirements for the Operation of Establishments and Facilities for the Protection and Convenience of the Travelling Public

Presidential Decree No. 651 Requiring the Registration of Births and Deaths in the Philippines which occured from January 1, 1974 and thereafter

Presidential Decree No. 996 Providing for Compulsory Basic Immunization for Infants and children below eight years of age

Presidential Decree No. 498 Amending sections two, three, four, seven, eight, eleven, thirteen, sixteen, seventeen, twenty-one and twenty-nine of Republic Act No. 5527, also known as the Philippine Medical Technology Act of 1969

Presidential Decree No. 965 A Decree Requiring Applicant for Marriage License to Receive Instructions on Family Planning and Responsible Parenthood

Presidential Decree No. 1631 Creating the Lunsod ng Kabataan

Presidential Decree No. 1823 Creating the Lung Center of the Philippines

Presidential Decree No. 384 Amending Republic Act Numbered 4073, entitled an An Act Further LIberalizing the Treatment of Leprosy by Amending and Repealing certain Sections of the REvised Administrative Code

Presidential Decree No. 1832 Creating National Kidney Foundation of the Philippines

Presidential Decree No. 893 Reconstituting the National Schistosomiasis Control Commission into the Schistosomiasis Control Council and for otherPurposes

Presidential Decree No. 79 Revising the Population Act of Nineteen Hundred and Seventy-one

Republic Act

Republic Act 9288 - Newborn Screening - An Act Promulgating A Comprehensive Policy and A National System For Ensuring Newborn Screening

Republic Act 9165 - Dangerous Drugs Act of 2002 - An Act Instituting the Comprehensive Dangerous Drugs Act of 2002, repealing republic act no. 6425, otherwise known as the Dangerous Drugs Act of 1972, as amended, providing funds therefor and for other purposes

Republic Act 9257 - Expanded Senior Citizens Act of 2003An Act Granting Additional Benefits and Privileges to Senior Citizens Amending for the Purpose Republic Act No. 7432 Otherwise Known As "An Act To Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other Purposes"

Republic Act 9211 - Tobacco Regulation Act of 2003 An Act Regulating the Packaging, Use, Sale Distribution and Advertisements of Tobacco Products and for other Purposes

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http://www.doh.gov.ph/ra/ra9211


http://www.doh.gov.ph/files/ra9165.pdf


http://www.lawphil.net/statutes/presdecs/pd1972/pd_79_1972.html











http://portal.doh.gov.ph/publications/manuals/code_on_sanitation



http://www.doh.gov.ph/pres_decree/pd881

http://www.doh.gov.ph/pres_decree/pd881

Republic Act 7883 - Barangay Health Workers Benefits and Incentives Acts of 1995An Act Granting Benefits and Incentives to Accredit Barangay Health Workers and for Other Purposes.

Republic Act 8203 - Special Law on Counterfeit Drugs"An Act of Prohibiting Counterfeit drugs, Providing Penalties for Violations and Appropriating Funds Thereof

Republic Act 6425 - Dangerous Drugs Act of 1972This Act shall be known and cited as "The Dangerous Drugs Act of 1972."

Republic Act 6675 - Generics Act of 1988An Act to Promote, Require and Ensure the Production Of An Adequate Supply, Distribution, Use And Acceptance Of DrugsAnd Medicines Identified By Their Generic Names

Republic Act 4226 - Hospital Licensure ActAn Act Requiring the Licensure of all Hospitals in the Philippines and Authorizing the Bureau of Medical Services to Serve as the Licensing Agency

Republic Act No. 7876 - Senior Citizens Center Act of the PhilippinesAn Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges

Republic Act 7305 - Magna Carta of Public Health WorkersMagna Carta of Public Health Workers (Republic Act No. 7305)

Republic Act 7719 - National Blood Services Act of 1994An Act Promoting Voluntary Blood Donation, Providing For An Adequate Supply Of Safe Blood Regulating Blood Banks And Providing Penal Ties For Violation Thereof

Republic Act 7875 - National Health Insurance Act of 1995An Act Instituting A National Health Insurance Program For All Filipinos And Establishing The Philippine Health Insurance Corporation For The Purpose

Republic Act 7432 - Senior Citizen Act of 1992)An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges

Amendment to RA 7170 - Organ Donation Act of 1991An Act To Advance Corneal Transplantation In The Philippines, Amending For The Purpose Republic Act Numbered Seven Thousand One Hundred And Seventy (R.A. N0. 7170) Otherwise Known As The Organ Donation Act Of 1991

Republic Act 8504 - Prevention and Control of 1988Promulgating Policies And Prescribing Measures For The Prevention And Control Of Hiv/Aids In The Philippines, Instituting A Nationwide HIV/Aids Information And Educational Program, Establishing A Comprehensive Hiv/Aids Monitoring System, Strengthening The hilippine National Aids Council, And For Other Purposes

Republic Act 8423 - Traditional and Alternative Medicine Act (TAMA of 1997)An Act creating the PHILIPPINE INSTITUTE OF TRADITIONAL AND ALTERNATIVE HEALTH CARE (PITAHC) to accelerate the development of traditional and alternative health care in the Philippines, providing for a TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND and for other purposes

Republic Act 8749 - Philippine Clean Air Act of 1999An Act Providing For A Comprehensive Air Pollution Control Policy And For Other Purposes

Republic Act 8344 - An Act Prohibiting the Demand of Deposits or Advance PaymentsAn Act Prohibiting The Demand Of Deposits Or Advance Payments For The Confinement Or Treatment Of Patients In Hospitals And Medical Clinics In Certain Cases

Republic Act 5921An Act Regulating The Practice Of Pharmacy And Settings Standards Of Pharmaceutical Education In The Philippines And Other Purposes

Republic Act 9165 - An Act Instituting The Comprehensive Dangerous Drugs Act Of 2002, Repealing Republic Act No. 6425, Otherwise Known As The Dangerous Drugs Act Of 1972, As Amended, Providing Funds Thereof, And For Other Purposes

Republic Act 7394The Consumer Act Of The Philippines

Republic Act 8976Philippine Food Fortification Act of 2000

Republic Act 4688 - An Act Regulating the Operation and Maintenance of Clinical Laboratories and Requiring the Registration of the same with the Department of Health, Providing Penalty for the Violation thereof, and for Other Purposes

Republic Act














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Republic Act





















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Executive Order 102

MALACAÑANG

MANILA

BY THE PRESIDENT OF THE PHILIPPINES

EXECUTIVE ORDER NO. 102

REDIRECTING THE FUNCTIONS AND OPERATIONS OF THE DEPARTMENT OF HEALTH

WHEREAS, the Department of Health, hereafter referred to as DOH, has been transformed from being the sole provider of health services, to being a provider of specific health services and technical assistance provider for health, as a result of the devolution of basic services to local government units;

WHEREAS, the DOH seeks to serve as the national technical authority on health, one that will ensure the highest achievable standards of quality health care, health promotion and health protection, from which local governments units, non-government organizations, other private organizations and individual members of civil society will anchor their health programs and strategies;

WHEREAS, to effectively fulfill its refocused mandate, the DOH is required to undergo changes in roles,: functions, organizational processes, corporate values, skills technology and structures;

WHEREAS, Section 20, Chapter 7, Title I Book III of Executive Order No. 292 series of 1987, otherwise known as the Administrative Code of 1987, empowers the President of the Philippines to exercise such powers and functions as are vested in him under the law:

WHEREAS, Section 78 of the General Provisions of RA 8522, otherwise known as the General Appropriations Act of 1998, empowers the President to direct changes in organization and key positions of any department, bureau or agency;

WHEREAS, Section 80 of the same General Provisions directs heads of departments, bureaus and agencies to scale down, phase out or abolish activities no longer essential in the delivery of health services;

NOW, THEREFORE, I, JOSEPH EJERCITO ESTRADA, President of the Republic of the Philippines, by virtue of the powers vested in me by law, do hereby order the following:

SECTION 1. Mandate. Consistent with the provisions of the Administrative Code of 1987 and RA 7160 (the Local Government Code), the DOH is hereby mandated to provide assistance to local government units (LGUs), people's organization (PO) and other members of civic society in effectively implementing programs, projects and services that will:

a) promote the health and well-being of every Filipino;

b) prevent and control diseases among populations at risks;

c) protect individuals, families and communities exposed to hazards and risks that could affect their health; and

d) treat, manage and rehabilitate individuals affected by disease and disability.

SECTION 2. Roles. To fulfill its responsibilities under this mandate, the DOH shall serve as the:

a) lead agency in articulating national objectives for health to guide the development of local health systems, programs and services;

b) direct service provider for specific programs that affect large segments of the population, such as tuberculosis, malaria, schistosomiasis, HIV-AIDS and other emerging infections, and micronutrient deficiencies;

c) lead agency in health emergency response services, including referral and networking systems for trauma, injuries and catastrophic events;

d) technical authority in disease control and prevention;

e) lead agency in ensuring equity, access and quality of health care services through policy formulation, standards development and regulations;

f) technical oversight agency in charge of monitoring and evaluating the implementation of health programs, projects, research, training and services;

g) administrator of selected health facilities at sub national levels that act as referral centers for local health systems i.e. tertiary and special hospitals, reference laboratories, training centers, centers for health promotion; centers for disease control and prevention, regulatory offices among others;

h) innovator of new strategies for responding to emerging health needs;

i) advocate for health promotion and healthy life styles for the general population;

j) capacity-builder of local government units, the private sector, non-government organizations, people's organizations, national government agencies, in implementing health programs and services through technical collaborations, logistical support, provision of grant and allocations and other partnership mechanisms;

k) lead agency in health and medical research;

l) facilitator of the development of health industrial complex in partnership with the private sector to ensure self-sufficiency in the production of biologicals, vaccines and drugs and medicines;

m) lead agency in health emergency preparedness and response;

n) protector of standards of excellence in the training and education of health care providers at all levels of the health care system; and

o) implementor of the National Health Insurance Law; providing administrative and technical leadership in health care financing.

SECTION 3. Powers and Functions. To accomplish its mandate and roles the Department shall:

a) Formulate national policies and standards for health;

b) Prevent and control leading causes of health and disability; c) Develop disease surveillance and health information systems;

d) Maintain national health facilities and hospitals with modern and advanced capabilities to support local services;

e) Promote health and well-being through public information and to provide the public with timely and relevant information on health risks and hazards;

d) the resource allocation shift, specifying the effects of the streamlined set-up on the agency budgetary allocation and indicating where possible savings have been generated;

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f) Develop and implement strategies to achieve appropriate expenditure patterns in health as recommended by international agencies;

g) Development of sub-national centers and facilities for health promotion. disease control and prevention, standards. regulations and technical assistance;

h) Promote and maintain international linkages for technical collaboration;

i) Create the environment for development of a health industrial complex;

j) Assume leadership in health in times of emergencies, calamities and disasters; system fails;

k) Ensure quality of training and health human resource development at all levels or the health care system;

l) Oversee financing or the health sector and ensure equity and accessibility to health services; and

m) Articulate the national hea1th research agenda and ensure the provision of sufficient resources and logistics to attain excellence in evidenced-based interventions for health.

SECTION 4. Preparation of a Rationalization and Streamlining Plan In view of the functional and operational redirection in the DOH and to effect efficiency and effectiveness in its activities, the Department shall prepare a Rationalization and Streamlining Plan (RSP) which shall be the basis of the intended changes. The RSP Plan shall contain the following:

a) the specific shift in policy directions. functions, programs and activities/ strategies;

b) the structural and organizational shift stating the specific functions and activities by organizational unit and the relationship of each units;

c) the staffing shift, highlighting and itemizing the existing filled and unfilled positions; and

d) the resource allocation shift, specifying the effects of the streamlined set-up on the agency budgetary allocation and indicating where possible, savings have been generated.

The RSP shall submitted to the, Department of Budget and Management for approval before the corresponding shifts shall be affected by the DOH Secretary.

SECTION 5. Redeployment of Personnel. The redeployment of officials and other personnel on the basis of the approved RSP shall not result in diminution in rank and compensation of existing personnel. It shall take into account all pertinent Civil Service laws and rules.

SECTION 6. Funding. The financial resources needed to implement the Rationalization and Streamlining Plan shall be taken from funds available in the DOH, provided that the total requirements for the implementation of the revised staffing pattern shall not exceed available funds for Personnel Services.

SECTION 7. Separation Benefits. Personnel who opt to be separated from the service as a consequence of the implementation of this Executive Order shall be entitled to the benefits under existing laws. In the case of those who are not covered by existing laws, they shall be entitled to separation benefits equivalent to one month basic salary for every year of service or proportionate share thereof in addition to the terminal fee benefits to which he/she is entitled under existing laws,

SECTION 8. Implementing Authority. Following the approved RSP, the DOH Secretary, in addition to his authority to implement the RSP is hereby authorized to determine the type of agencies and facilities necessary to carry out the Department's mandate and roles, including the pilot testing of programs and such-pre corporization of hospitals following strictly the principles of efficiency and effectiveness.

SECTION 9. Effectivity. This Executive Order shall take effect immediately

DONE in the City of Manila this 24th day of May in the year of Our Lord, Nineteen Hundred and Ninety-Nine.

By the President:

RONALDO B. ZAMORAExecutive Secretary

THE PUBLIC HEALTH NURSE

Qualifications and FunctionsMust be professionally qualified and licensed to practice in the arena of public health nursingConsistent with the nursing law of 2002 (RA 9173)

I. Management functiona. Inherent in the practice of PHNb. Organizes the nursing service of the local health agency

II. Supervisory functiona. Supervisor of the midwives and other health workers

III. Nursing care functiona. Inherent function of the nurseb. Based on the science of art and caringc. Caring for all levels of clientele toward health promotion and

disease preventionIV. Collaborating and coordinating function

a. Care coordinators for communities and their membersb. Establishes linkages and collaborative relationships with other

health professionals, government agencies, private sectors, NGO’s people’s organizations to address health problems

V. Health promotion and education functiona. Activities goes beyond health teachings and health information

campaignsVI. Training function

a. Initiates the formulation of staff development and training programs for midwives and other auxiliary workers

VII. Research functiona. Participates in the conduct of research and utilizes research

findings in her practicei. Disease surveillance

1. Measure the magnitude of the problem2. Measure the effect of the control

program

OVERVIEW OF THE PUBLIC HEALTH NURSING

Public Health Nursing and Community Health Nursing often used interchangeably

PHN defined by WHO:“Special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of total public health programme for the promotion of health, improvement of the conditions in the social and physical environment, rehabilitation of illness and disability”

CHN defined by Freeman:“Service rendered by a professional nurse with communities, groups, families and individuals at home, in health centers, in clinics, in schools and in places of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation”

CHN defined by Jacobson“Nursing practice in a wide variety of community services and consumer advocate areas and in a variety of roles at times including independent practice… community nursing is certainly not confined to public health nursing agencies”

The original thrust of Public Health Nursing:“Nursing for the health of the entire public/community versus nursing only for the public who are poor”

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Standards of Public Health Nursing:Public Health Nursing

Refers to the practice of nursing in national and local government health departments and public schools

It is a community health nursing practice in the public sector

Public Health Nurses Refers to the nurses in the local/national health departments or public

schools whether their official position title is public health nurse or nurse or school nurse

PUBLIC HEALTH NURSES

Leaders in providing quality health services to the communities First level of health workers to be knowledgeable about new public

health technologies and methodologies Usually the first ones to be trained to implement new programs and

apply new technologies

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By Jhun Echipare

Documents

Community Health Nursing 101 by Jhun