Community Health Nursing 101 By Jhun

HEALTH

1.

•

“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 2.

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

•

3.

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 status

2.

Education

3.

Physical environment

4.

Employment and Working conditions

5.

Social support networks

6.

Culture

7.

Genetics

8.

Personal behavior and coping skills

9.

Health services

10.

Gender

4.

5.

Political a.

safety

b.

oppression

c.

people empowerment

Socio-economic a.

employment

b.

education

c.

housing

Environment a.

air

b.

food

c.

water

d.

urban/rural

e.

noise

f.

radiation

g.

pollution

Behavior a.

culture

b.

habits

c.

mores

d.

ethnic customs

Heredity a.

genetic endowment i.

defects

ii.

strengths

iii.

risks

iv.

familial ethnic racial

PUBLIC HEALTH 6. •

“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”.

Health Care Delivery System a.

Promotive

b.

Preventive

c.

Curative

d.

Rehabilitative

Core business of Public Health FACTORS:

1 | Page

1.

disease control

2.

injury prevention

3.

health protection

4.

Reduce child mortality

4.

health public policy

5.

Improve maternal health

5.

promotion of health and equitable health gain

6.

Combat HIV/AIDS, malaria and other diseases

7.

Ensure environmental sustainability

8.

Develop a global partnership for development

ESSENTIAL PUBLIC HEALTH FUNCTIONS Needed to achieve the core business of public health

Following are essential health functions:

OVERVIEW OF THE PUBLIC HEALTH NURSING

1.

Health situation monitoring and analysis

2.

Epidemiological surveillance/disease prevention and control

3.

Development of policies and planning in public health

4.

Strategic management of health systems and services for population health gain

5.

Regulation and enforcement to protect public health

6.

Human resources development and planning in public health

7.

Health promotion, social participation and empowerment

8.

Ensuring the quality of personal and population based health services

CHN defined by Freeman:

9.

Research, development and implementation of innovative public health solutions

“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”

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”

GLOBAL AND COUNTRY HEALTH IMPERATIVES CHN defined by Jacobson Ongoing changes which exert a number of pressures on the public health system “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”

1.

Shifts in demographic and epidemiological trends in diseases

2.

New technologies for health care, communication and information

3.

Existing and emerging environmental hazards some associated with globalization

The original thrust of Public Health Nursing:

4.

Health reforms

“Nursing for the health of the entire public/community versus nursing only for the public who are poor”

United Nations General Assembly Standards of Public Health Nursing: Common vision Poverty reduction and sustainable development in September 2000 Public Health Nursing

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 hunger

2.

Achieve universal primary education

3.

Promote gender equality and empower women

2 | Page

•

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

•

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

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

Philippine General Hospital •

Part of national level which provide health care services

Local level (Local Health System) THE PHILIPINE HEALTH CARE DELIVERY SYSTEM Major players of the HCDS 1.

Run by LGU

Provincial government

Private sector

•

a.

Largely market oriented

b.

Health care is paid through user fees at the point of service

c.

Includes profit and non-profit health providers

d.

Includes providing health services in

e.

2.

•

i.

Clinics

ii.

Hospitals

iii.

Health insurance

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

Manufacture of i.

Medicines

ii.

Vaccines

iii.

Medical supplies

iv.

Medical equipment

v.

Other health and nutrition products

vi.

Research and development

vii.

Human resource development

Provincial and District hospitals

PHILIPPINE DEPARTMENT OF HEALTH HISTORICAL BACKGROUND PRE-SPANISH and SPANISH PERIOD

1888

Public sector a.

largely financed through a tax-based budgeting system at both national and local levels

b.

health care is generally given free at the point of service

c.

consist of the national and local government agencies

•

Superior board of health and charity was created by the Spaniards which established a hospital system and a board of vaccination

June 23, 1898 •

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

September 29, 1898 • NATIONAL LEVEL Department of Health

3 | Page

July 1, 1901

General Orders No. 15 established the Board of Health for the City of Manila

•

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

April 13, 987 •

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

October 10, 1991 •

Board of Health for the Philippine Islands became Insular Board of Health

October 26, 1905

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

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

•

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

•

EO No. 102 (Redirecting the Functions and Operations of the DOH) granted the DOH to proceed with its Rationalization and Streamlining Plan.

•

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

•

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

•

Act No. 2468 transformed the BOH into a commissioned service called the Philippine Health Service

1915

1932 •

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

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;

o

Treat, manage and rehabilitate individuals affected by diseases and disability

1999-2004 PHILIPPINE COMMONWEALTH AND THE JAPANESE OCCUPATION (1935-1945)

Development of Health Sector Reform Agenda

May 31, 1939

ROLES AND FUNCTIONS OF DOH (Mandated by the EO No. 102)

•

Commonwealth Act No. 430 created the Department of Public Health and Welfare

ROLE Providing technical and other resource assistance

January 7, 1941 GENERAL FUNCTIONS UNDER THREE SPECIFIC ROLES •

EO No. 317 fully implemented Commonwealth Act No. 430

January 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

•

Restructured Health Care Delivery System was conceptualized, classified health services into Primary, Secondary and Tertiary

1970

1.

Leadership in Health

2.

Enabler and Capacity Builder

3.

Administrator of Specific Services

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

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

June 2, 1978 •

PD 1397 renamed the Department of Health to the Ministry of Health

December 2, 1982 •

EO No. 851 created Integrated Provincial Health Office

4 | Page

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 Reform 1.

Slowing down in the reduction in the IMR and the MMR

2.

Persistence of large variations in health status across population groups and geographic areas

3.

High burden from infectious diseases

4.

Rising burden from chronic and degenerative diseases

5.

Unattended emerging health risks from environmental and work related factors

6.

Burden of disease is heaviest on the poor

Reason for the existence of the above conditions 1.

2.

3.

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 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 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.

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:

Goals of FOURmula one for Health

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.

Starting the Race with the End in Mind: Fourmula One for Health Goals and Objectives

F1 Rule No. 4:

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:

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.

• • •

Better health outcomes More responsive health system More equitable healthcare financing.

5 | Page

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.

Governance in local health systems may be improved by undertaking the following strategies:

F1 Rule No. 6:

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.

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.

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

•

• • •

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.

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 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 ComponentSpecific Objectives

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”

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.

Concept of PHC is characterized by;

 F1 Component No.2: HEALTH REGULATION

Partnership and empowerment of the people 

PHC is a strategy

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

 

which focuses responsibility for health on the individual, his family and the community

PHC includes full participation and active involvement of the community

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



towards the development of self-reliant people, capable of achieving an acceptable level of health and well being

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.

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

Elements/Components of PHC

6 | Page

1.

Environmental Sanitation

a.

General medical practitioners

2.

Control of communicable diseases

b.

PHN

3.

Immunization

c.

RSI

4.

Health Education

d.

RHM

5.

Maternal and Child Health and Family Planning

6.

Adequate Food and Proper Nutrition

7.

Provision of Medical Care and Emergency Treatment

o

Devolved to the cities and municipalities

8.

Treatment of Locally Endemic Diseases

o

Health care provided by the center physicians, PHN, RHM, BHW, TBAs and others

9.

Provision of Essential Drugs o

Usually the first point of contact between the community members and other levels of health facility

LEVELS OF HEALTH CARE AND REFERRAL SYSTEM 

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



Primary Level of Care

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 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 facilities o

National and Regional Health Services

o

Medical centers

o

Teaching and Training hospitals

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 participation

2.

Intra and Inter-sectoral linkages

3.

Use of appropriate technology

4.

Support mechanisms made available



Secondary level care facilities o

Provincial / City health services and hospitals

o

Emergency and District hospitals

Primary level care facilities o

RHU

o

Community hospitals & health centers

o

Private practitioners, puericulture centers

o

BHS

Two levels of PHC workers 1.

Village or Barangay Health Workers

2.

Intermediate Level Health Workers THE PUBLIC HEALTH NURSE

7 | Page

 Qualifications and Functions



The PHN visits the patient

Bag technique

Must be professionally qualified and licensed to practice in the arena of public health nursing



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

Consistent 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

•



Contain all necessary articles Cleaned very often

Supervisor of the midwives and other health workers

Well protected

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

Arrangement-most convenient

ASSESSING COMMUNITY HEALTH NEEDS

COMMUNITY HEALTH NURSING •

COMMUNITY –

• •

Primary client

HEALTH

Health promotion and education function – –

•

Important points to consider in the use of the bag

Supervisory function –

•

Minimize if not prevent the spread of any infection

Activities goes beyond health teachings and health information campaigns

•

NURSING –

Training function –

Goal

Means

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

•

Research function –

•

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

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

•

–

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

NURSING PROCEDURES – 



Patient visits the health center Most common is BP measurement



Matures through time

Clinic visit

COMMUNITY DIAGNOSIS

•

Done to come up with a profile of local health situation

Home visit – 

8 | Page

Family-nurse contact

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 •

–

Analyzing & interpreting health data •

–

In order to identify the different factors that may directly or indirectly influence the health of the population

–

Seek explanations for the occurrence of health needs and problems of the community

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

Types of Community Diagnosis

•

–

Comprehensive community diagnosis –

Transportation system

•

Educational level

•

Housing conditions

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

Formulation of Community Health Nursing Diagnoses •

•

•

Cultural factors •

Aims to obtain general information about the community

Variables that may break up people into groups within the community e.q.

Problem Oriented community diagnosis –

Responds to a particular need

ELEMENTS OF COMPREHENSIVE COMMUNITY DIAGNOSIS 1.

•

DEMOGRAPHIC VARIABLES –

Total population & Geographical distribution including UrbanRural index & Population Density

–

Age & Sex composition

–

Selected vital indicators e.q. Growth rate, CBR, CDR & Life expectancy rate

–

Patterns of migration

–

Population projection

–

Population groups that need special attentions:

3.

Note:

•

Indigenous people

•

Internal refugees

•

Socially dislocated groups as a result of disasters, calamities & development programs 4.

2.

SOCIO-ECONOMIC & CULTURAL VARIABLES –

Social indicators •

9 | Page

Communication network

–

Ethnicity

–

Social class

–

Language

–

Religion

–

Race

–

Political orientation

•

Cultural beliefs and practices that affect health

•

Concepts about Health and Illness

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

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

DEMOGRAPHY •

IDENTIFYING COMMUNITY HEALTH NURSING PROBLEMS 

Science which deals with the study of the human population’s –

Size

–

Composition

–

Distribution in space

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

SOURCES OF DEMOGRAPHIC DATA -Can be obtained from a variety of sources



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

•

Censuses

•

Sample surveys

•

Registration systems

Two ways of assigning people when the census is being taken De jure •

PRIORITY-SETTING •

Nature of the condition/problem presented –

•

•

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

Probability of controlling or reducing the effects posed by the problem

Social concern –

•

Probability of reducing, controlling or eradicating the problem

Preventive potential –

•

Severity of the problem which can be measured in terms of the proportion of the population affected by the problem

Modifiability of the problem –

•

De facto

Magnitude of the problem –

•

Classified as health status, health resources or health related problems

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

Perception of the population or the community as they are affected by the problem and their readiness to act on the problem

TWO METHODS IN DETERMINING POPULATION SIZE Method 1 •

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

Application of Public Health Tools NATURAL INCREASE •

COMMUNITY HEALTH NURSING •

Nat. increase = no. births – no. of deaths / specified year

Three important tools

The health disciplines of •

Demography

•

Vital statistics

•

Epidemiology

10 | P a g e

Difference between the number of births and the number of deaths occurring in a population in a specified period of time

RATE OF NATURAL INCREASE •

Difference between the CBR and the CDR occurring in a population in a specified period of time Rate of Nat. increase = CBR – CDR / specified year

The sex ratio represents the number of males for every 100 females in the population 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

AGE COMPOSITION •

Two ways to describe the age composition of the population

MEDIAN AGE ABSOLUTE INCREASE PER YEAR • •

Divides the population into two equal parts.

Measures the number of people that are added to the population per year. DEPENDENCY RATIO Abs. Increase/year = Pt – Po / t •

•

•

Compares the number of economically dependent with the economically productive group in the population.

•

Economically dependent

where: –

Pt = pop. Size at a later time

–

Po = pop. Size at an earlier time

–

0 – 14

–

t = no. of years between 0 and time t.

–

65 and above

Method 2

•

Economically productive –

Within 15 – 64 age group

RELATIVE INCREASE •

Actual difference between the two census counts expressed in percent relative to the population size made during an earlier census

POPULATION DISTRIBUTION •

The measures help the nurse decide how meager resources can be justifiably allocated based on concentration of population in a certain place

1.

Urban-Rural distribution

Relative increase = Pt – Po / Po •

where: –

Pt = population size at a later time

2.

Crowding Index

–

Po = population size at an earlier time

3.

Population Density

POPULATION COMPOSITION Pertaining to population size’s variables such as:

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

•

Age

•

Sex

•

Occupation

•

Common health indicators

•

Educational level

•

Fertility rates

•

Commonly described in terms of its age and sex

–

Crude birth rate (CBR)

•

Nurse utilizes data on age and sex composition to decide who among the population groups merits attention in terms of health services and programs

–

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)

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 females

11 | P a g e

•

–

Swaroops index

•

Disease development does not rest on a single cause

–

Case fatality rate (CFR)

•

Health conditions result from a multitude of factors

Morbidity rate –

Incidence rate

–

Prevalence rate

Model that explain the MCT –

Ecologic Triad/Epidemiologic triangle

AGENT •

MORBIDITY

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

•

TEN LEADING CAUSES OF MORBIDITY No. & Rate/100,000 Population PHILIPPINES, 2002

–

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

•

MORBIDITY (2002)

–

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

MORTALITY

–

Sex

•

Ten Leading Causes of Mortality by Sex Number, Rate/100,000 Population & Percentage Philippines, 2002

–

Ethnic group

–

Physiologic

MORTALITY

–

Immunologic experience (immunization)

–

Inter-current or pre-existing disease

–

Human behavior

•

EPIDEMIOLOGY •

EPIDEMIOLOGY

•

RESISTANCE

•

Study of the occurrence and distribution of health conditions such as disease, deformities or disabilities on human populations

•

Specific

•

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

12 | P a g e

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 –

• Multiple Causation Theory

Results from an immunologic experience such as; immunization or vaccination

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

•

Interrupt the chain of infection through environmental manipulation

•

Prevention of spread to human reservoirs and other susceptible human hosts

ENVIRONMENT • •

•

Primary prevention can be done through;

Sum total of all external conditions and influences that affect the life and development of an organism

–

Personal surveillance

Affects the agent and the host

–

Quarantine

–

Segregation or isolation

Three components of environment –

Physical environment •

–

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

Health promotion activities include; –

Provision of proper nutrition

–

Safe water supply and waste disposal system

Biological environment •

• –

•

–

Vector control

Makes up the living things around us e.q. plant and animal life

–

Promotion of a healthy lifestyle

Human population

–

Good personal habits

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

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

PREVENTION •

Refers to identification of potential problems

•

Directed to the healthy population –

Primordial prevention • •

–

Focusing on prevention of emergence of risk factors

In Communicable disease control;

–

Specific protection •

–

Removal of the risk factors or reduction of their levels

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

PRIMARY PREVENTION TERTIARY PREVENTION •

In Communicable disease prevention • –

–

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

Limits disability progression –

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

It aims to; • •

strengthen the host resistance

•

Inactivate the agent (source of infection)

Infectious diseases –

13 | P a g e

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

Screening & Case Finding –

PHASES

1.

Descriptive epidemiology •

2.

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

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

Intervention or Experimental epidemiology •

4.

•

–

Analytical epidemiology •

3.

Concerned with disease distribution and frequency

•

ATTACK RATE

Answers questions about the effectiveness of new methods for controlling diseases or for improving underlying conditions

–

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

Evaluation epidemiology •

Should consider the sensitivity and specificity of the tests

•

THE EPIDEMIOLOGICAL APPROACH •

Done to look for previously unidentified cases of diseases

Attempts to measure the effectiveness of different health services and programs

DESCRIPTIVE EPIDEMIOLOGY II.

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

Aspects involved in descriptive epidemiology

–

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

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

•

Characteristics of the afflicted persons

3.

Analysis of the general pattern of occurrence of the disease or condition

•

Time the disease was initially recognized

•

ASPECT 1

•

Characteristics of the place where the cases came from

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 •

•

ASPECT 1

•

SCREENING –

•

14 | P a g e

ASPECT 2

1.

Herd Immunity

–

Done by conducting –

Screening

–

Case finding activities

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

CASE FINDING

•

–

2.

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

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 –

Characteristics of the individual who were exposed and who contacted the infection or the disease

•

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

Probability of contact between the –

–

•

•

Source of infection

•

Susceptible host

Place

Depends upon the •

Number of sources of infection

•

Number of immunes

•

Location of the source of infection

•

Patterns of occurrence and distribution

•

Sporadic –

•

Intermittent occurrence (rabies)

Endemic occurrence

Disease occurrence can be described by the following: – A)

Continuous occurrence throughout a period of time

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 transmission of disease agent

by

a

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 3

3.

Analysis of the general pattern of occurrence of the disease or condition

•

•

•

Disease frequency

•

Disease distribution in a population

•

Time

•

Place

•

Person

Correlating the data and formulate a causal association between the •

Disease under study

•

Probable factors surrounding it

•

Variables affecting disease distribution

•

Tuberculosis – all specific areas of the country

Unusually large number of cases in a relatively short period of time

Simultaneous occurrence of epidemic of the same disease in several countries



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

Time •

15 | P a g e

Filariasis – Sorsogon

PUBLIC HEALTH PROGRAMS

Defining the characteristics of the disease or condition in relation to

DISEASE DISTRIBUTION

–

•

Establishing the

•

–

Schistosomiasis – Leyte and Samar

Pandemic occurrence –

–

•

Epidemic occurrence –

–

Malaria – Palawan

person-to-person

B)

–

•

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



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

Persons



Aims to:



Improve the survival, health and well being of mothers and the unborn





Prenatal visits



Period of pregnancy



1st visit



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



Pre-pregnancy



Prenatal



2nd visit



During the 2nd trimester



Natal



3rd visit



During the 3rd trimester



Postnatal stages



Every two weeks



After 8th month of pregnancy till delivery

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 people

MICRONUTRIENT SUPPLEMENTATION Vitamins Dose

Schedule

Vitamin A 10,000 IU

2x a week starting on the 4th Do not give Vitamin A month of pregnancy before 4th month of pregnancy. It might cause congenital problems in the baby

MATERNAL HEALTH PROGRAM Tasked 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%)

Iron



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 





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 

Population expected to double in 29 years



Total fertility rate

Pregnant women should have at least four (4) prenatal visits

Institutionalization of responsible parenthood



Resource generation and allocation for health services

ANTENATAL REGISTRATION Married women

16 | P a g e



3.5 children/woman



3 to 4 million getting pregnant/year



85% expected to progress full term

National Demographic and Health Survey (2003)

Stakeholders must advocate for health 

2.36%



Reduce women’s exposure to health risks 



60mg/400 ug Daily tablet

Improve quality of prenatal and postnatal care 



Entails establishment of facilities that provide emergency obstetric care for every 125,000 population and which are located strategically

Remarks



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





48.8% - use any form of contraceptive method





33.4% - modern method

Cervical secretions as an indicator of fertility



15.5% - traditional method

Checking the presence of secretions daily

51.1% - do not use any form of contraceptive method



Standard days method 

FAMILY PLANNING METHODS 









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



Effective 3 months after the procedure

CHILD HEALTH PROGRAMS Main 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

Pill 

Hormones – estrogen and progesterone



Taken daily PO

Male condom 

Thin sheath of latex



Dual protection from STIs including HIV

Early Childhood Development Act of 2000



Newborn Screening Act of 2004



EO 286, Bright Child Program

Synthetic hormone – progestin which suppresses ovulation, thickens cervical mucus



EO 51, Milk Code



Rooming-in and Breastfeeding Act

LAM



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

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:

Effective only for a maximum of 6 months postpartum

Mucus/Billings/Ovulation 

Abstaining from SI during fertile days



Promotion of breastmilk as the ideal food for the healthy growth and development of infants



Can not be used by woman with unusual disease or condition that results in extraordinary vaginal discharge that makes observation difficult



Exclusive breastfeeding for the first 6 months of life

 



Injectables





Cutting or blocking two fallopian tubes (BTL)

Male sterilization





Overall objective:

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 



GOAL

Combination of BBT and Billing/Mucus method

Two day method

17 | P a g e

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

 

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

Female sterilization 



Simple fertility awareness based method

OBJECTIVE

Reduce Child Mortality Rate by 2/3 by 2015



Improve health and nutrition status of infants and young children



Schools 

Introducing the “breastfeeding culture”

OUTCOME Laws that protects IYCF 



Improve exclusive and extended breast feeding and complementary feeding

Specific Objectives



EO 51, Milk Code



Rooming-in and Breastfeeding Act of 1992



RA 8976, Food Fortification Law of 2000



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



General principles which apply in vaccinating children

Median duration of breastfeeding is 18 months



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

EXPANDED PROGRAM IMMUNIZATION

 

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



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:

National IYCF strategy 

Health Facilities 

Mother-baby friendly hospitals



Health workers 

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

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





Maternity leave



Lactation/Breastfeeding room



Breastfeeding breaks

Industry 

18 | P a g e

Comply with the “Code”

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

Working places 

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

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



Occupational Health Program



Health Development Program for Older Persons (Elderly Health)



Tetanus Toxoid Immunization Schedule for Women



Persons with Disabilities Program



EPI vaccines and characteristics



Prevention of Blindness Program



Rabies Control Program



Safe Motherhood and Women's Health



OTHER HEALTH PROGRAMS 

Adolescent and Youth Health and Development Program



Schistosomiasis Control Program



Botika Ng Barangay



Smoking Cessation Program



Breastfeeding Program / Mother and Baby Friendly Hospital Initiative



Soil Transmitted Helmenthiasis



Blood Donation Program



TB Control Program



Child Health



Diabetes Mellitus Prevention Program

LAWS AFFECTING PUBLIC HEALTH



Dengue Control Program

REPUBLIC ACT



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



Republic Act 9288 - Newborn Screening –

 

Republic Act 9165 - Dangerous Drugs Act of 2002 -





19 | P a g e

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

Republic Act 6675 - Generics Act of 1988





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 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 Promulgating A Comprehensive Policy and A National System For Ensuring Newborn Screening

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





Magna Carta for Public Health Workers



Aims to promote and improve the social and economic well-being of health workers

EXECUTIVE ORDER 

An Act Instituting A National Health Insurance Program For All Filipinos And Establishing The Philippine Health Insurance Corporation For The Purpose

Executive Order No. 663



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



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













 







20 | P a g e

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

Transferring the National Nutrition Council from the Department of Agriculture to the Department of Health



Prescribing Sanitation Requirements for the Operation of Establishments and Facilities for the Protection and Convenience of the Travelling Public

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





Code on Sanitation of the Philippines

Presidential Decree No. 651



Code of conduct and Ethical Standards for Public Officials and Employees

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

the

Presidential Decree No. 522



Republic Act 7160 

of

Presidential Decree No. 856



Philippine Food Fortification Act of 2000

Republic Act 6713 



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

Republic Act 8976

Operations

PRESIDENTIAL DECREE

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

and

Executive Order No. 472

 

Redirecting the Functions Department of Health.

Executive Order No. 51





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

 





Republic Act 8504 - Prevention and Control of 1988





Republic Act 7305

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







Republic Act 7719 - National Blood Services Act of 1994





Declared that all communicable diseases should be reportes to the nearest health station

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, 1976 Empowering 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 other Purposes Presidential Decree No. 79 Revising the Population Act of Nineteen Hundred and Seventy-one

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 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 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 1972 This Act shall be known and cited as "The Dangerous Drugs Act of 1972." 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 No. 7876 - Senior Citizens Center Act of the Philippines An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges Republic Act 7305 - Magna Carta of Public Health Workers Magna Carta of Public Health Workers (Republic Act No. 7305) 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 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 1991 An 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 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 hilippine National Aids Council, And For Other Purposes

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 2003 An Act Granting Additional Benefits and Privileges to Senior Citizens Amending

21 | P a g e

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 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 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 7394 The Consumer Act Of The Philippines Republic Act 8976 Philippine 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 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 9211 - Tobacco Regulation Act of 2003 An Act Regulating the Packaging, Use, Sale Distribution and Advertisements of Tobacco Products 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 8203 - Special Law on Counterfeit Drugs" An Act of Prohibiting Counterfeit drugs, Providing Penalties for Violations and Appropriating Funds Thereof

Republic Act 7305 - Magna Carta of Public Health Workers Magna Carta of Public Health Workers (Republic Act No. 7305) 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 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 1991 An 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 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 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 1999 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 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 7394 The Consumer Act Of The Philippines

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

Republic Act 8976 Philippine Food Fortification Act of 2000

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 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 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

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

22 | P a g e

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

Republic Act 5921 An Act Regulating The Practice Of Pharmacy And Settings Standards Of Pharmaceutical Education In The Philippines And 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 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 8203 - Special Law on Counterfeit Drugs" An Act of Prohibiting Counterfeit drugs, Providing Penalties for Violations and Appropriating Funds Thereof

Republic Act 7394 The Consumer Act Of The Philippines

Republic Act 6425 - Dangerous Drugs Act of 1972 This Act shall be known and cited as "The Dangerous Drugs Act of 1972." 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 No. 7876 - Senior Citizens Center Act of the Philippines An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges Republic Act 7305 - Magna Carta of Public Health Workers Magna Carta of Public Health Workers (Republic Act No. 7305) 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 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 1991 An 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 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 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 1999 An Act Providing For A Comprehensive Air Pollution Control Policy And For Other Purposes

23 | P a g e

Republic Act 8976 Philippine 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 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:

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

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

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

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;

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; 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;

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;

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

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

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

d) technical authority in disease control and prevention;

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

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;

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;

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;

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.

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;

24 | P a g e

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,

i.

including the pilot testing of programs and such-pre corporization of hospitals following strictly the principles of efficiency and effectiveness.

Disease surveillance 1.

Measure the magnitude of the problem

2.

Measure the effect of the control program

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: OVERVIEW OF THE PUBLIC HEALTH NURSING RONALDO B. ZAMORA Executive Secretary THE PUBLIC HEALTH NURSE

Qualifications and Functions Must be professionally qualified and licensed to practice in the arena of public health nursing Consistent with the nursing law of 2002 (RA 9173) I.

II.

IV.

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”

Management function a.

Inherent in the practice of PHN

b.

Organizes the nursing service of the local health agency

Supervisory function a.

III.

Public Health Nursing and Community Health Nursing often used interchangeably

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”

Supervisor of the midwives and other health workers

Nursing care function

CHN defined by Jacobson

a.

Inherent function of the nurse

b.

Based on the science of art and caring

“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”

c.

Caring for all levels of clientele toward health promotion and disease prevention

Collaborating and coordinating function

The original thrust of Public Health Nursing:

a.

Care coordinators for communities and their members

“Nursing for the health of the entire public/community versus nursing only for the public who are poor”

b.

Establishes linkages and collaborative relationships with other health professionals, government agencies, private sectors, NGO’s people’s organizations to address health problems Standards of Public Health Nursing:

V.

Health promotion and education function Public Health Nursing a.

VI.

•

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

Training function a.

VII.

Activities goes beyond health teachings and health information campaigns

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

Research function a.

Participates in the conduct of research and utilizes research findings in her practice

25 | P a g e

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

By Jhun Echipare

26 | P a g e