COMMUNITY HEALTH NURSING I

(INDIVIDUALS AND FAMILY AS CLIENTS)

PREPARED BY:
RIKKA KLAIRE V. GALINGANA,RN,MSN
ROMELLA M. TUPPAL,RN,MSN
 OVERVIEW OF PUBLIC
HEALTH NURSING IN THE
PHILIPPINES

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NATIONAL HEALTH SITUATIONS
 The national health situation gives us an idea of the
health situations in the communities where nurses work.

 Because of the different conditions prevailing in these

communities, their health picture expectedly varies.

 For example, goiter is highly prevalent in Mountain

Province while schistosomiasis is endemic in Leyte. The
local health situation, therefore, needs to be established
for each province, city, and municipality.
 Determinants of Health
 Demographic profile
 The total population of the Philippines as of 2010 is
92,097,978.
 Life expectancy as of 2010 is 66.10 for male and 71.6
for female, and for the year 2020 is 68.8 and female
74.3.
 The leading causes of death are disease of the heart,
diseases of the vascular system, pneumonias,
malignant neoplasms/cancer, all forms of tuberculosis,
accidents COPD and allied conditions, diabetes
mellitus, nephritis/nephritic syndrome, and other
diseases of respiratory system.
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Determinants of Health
 Poverty is the major reason for the
health problems of our people.
 Most of the leading causes of morbidity
and mortality are associated with
factors that could be attributed to
poverty. Poverty incidence among
Filipino families in 2018 was estimated
at 16.1 percent. This is defined as the
proportion of families whose income is
below poverty line to the total number
of families. 5
Cultural Influence on Health/Hereditary
 Culture is a way of life it is stable, which is the reason why it endures time and is passed on to
the next generation, it is obviously important in the influence when we are talking of health.

 It includes, belief, values and customs or practices, the food we eat, our lifestyle how we take
care of ourselves, how we cope up with problems and how we seek help.

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 Environmental Influence
 The environment plays a major role in
the health of the community a dirty or
unsanitary environment could lead to
different disease in the community.
 an example of this are the unsafe waste
disposal which leads to diarrheal
disease, and could also be the harbor
place for animals and insects that could
bring different diseases.

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Political Influence
 The political influence can be a major player when it comes to health
provision because they are considered the governing body in the policy
making regarding the delivery of health in the country.

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Political Influence

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 The health budget is the most concrete expression of the political influence
of the governing bodies of the country, the different law regarding health is
also influence by the different politician in the country.
 There are different laws which embodies health care in the country, and this
has major impact in the health situation of the Philippines

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COMMUNITY HEALTH NURSING:
AN OVERVIEW

 What is a community?

 a group of people with

common characteristics or
interests living together
within a territory or
geographical boundary
5 MAIN FUNCTIONS OF A COMMUNITY
1. PRODUCTION, DISTRIBUTION AND
CONSUMPTION OF GOODS AND SERVICES
- the community provides for the economic needs of its
members.
- includes not only supplying of foods and clothing but also
provision of water, electricity and police and fire protection and
the disposal of refuse

2. SOCIALIZATION
-refers to the process of transmitting values, knowledge, culture
and skills to others.
- established institution of socialization : families, churches,
schools, media, voluntary, and social organization
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5 MAIN FUNCTIONS OF A COMMUNITY
3. SOCIAL CONTROL
- refers to the way in which order is maintained in a
community
- Laws are enforced
4. SOCIAL INTERPARTICIPATION
-refers to the community activities that are designed to
meet people’s needs for companionship.
-e.g. families, churches, organizations
5. MUTUAL SUPPORT
- refers to community’s ability to provide resources at
a time of illness or disaster.
- assistance
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 TEN CHARACTERISTICS OF A HEALTHY
COMMUNITY
1. Is one in which members have a high degree of awareness of
being a community.
2. Uses its natural resources while taking steps to conserve them
for future generations.
3. Openly recognizes the existence of subgroups and welcomes
their participation in community affairs.
4. Is prepared to meet crises.
5. Is a problem-solving community; it identifies, analyzes, and
organizes to meet its own needs.
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 TEN CHARACTERISTICS OF A HEALTHY
COMMUNITY
6. Possesses open channels of communication that allow
information to flow among all subgroups of citizens in all
directions.
7. Seeks to make each of its systems’ resources available to all
members.
8. Has legitimate and effective ways to settle disputes that arise
within the community.
9. Encourages maximum citizen participation in decision making
10. Promotes high level of wellness among all its members.
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What is health?

 Health is a state of
complete physical,
mental and social
well-being and not
merely the absence
of disease or
infirmity.

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Personal definition of health

 HEALTH is a highly individual perception.

 Being free from symptoms of disease ans pain as much as
possible
 Being able to be active and to do what they want
 Being in good spirit most of the time

❖ Health is not something that a person achieve suddenly at a

specific time. It is an ongoing process– a way of life– through
which a person develops and encourages every aspect of body,
mind and feelings to interrelate harmoniously as much as
possible. 17
 WELLNESS- a state of well-being
 Deals with the whole being of an individual.
SEVEN COMPONENTS OF WELLNESS( ANSPAUGH, HAMRICK
AND ROSATO, 2003)
1. PHYSICAL – the ability to carry out daily tasks, active fitness,
maintain adequate nutrition and proper body fat, avoid abusing
drugs and alcohol or using tobacco products, and generally to
practice positive lifestyle habits
2. SOCIAL – the ability to interact successfully with people and
within the environment of which each person is a part, to
develop and maintain intimacy with SO, to develop respect and
tolerance for those with different opinions and beliefs
3. EMOTIONAL- the ability to manage stress and express emotions
appropriately.
4. INTELLECTUAL- the ability to learn and use information
effectively for personal, family and career development.
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 WELLNESS- a state of well-being
SEVEN COMPONENTS OF WELLNESS( ANSPAUGH, HAMRICK
AND ROSATO, 2003)
5. SPIRITUAL- the belief in some force ( nature, science,
religion, or a higher power) that serves to unite human
beings and provide meaning and purpose in life. It
includes person’s own values, morals, and ethics
6. OCCUPATIONAL- the ability to achieve a balance between
work and leisure time.
7. ENVIRONMENTAL- the ability to promote health measure
that improve the standard of living and quality of life in
the community.

WELL-BEING- is a subjective perception of

vitality and feeling well.
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 1. HEALTH AND ILLNESS CONTINUUM

MODELS ❑ first proposed by John W.Travis in 1972.

OF ❑ It describes how wellbeing is more than simply an

absence of illness , but also incorporates the individuals
HEALTH mental and emotional health.
Composed of two arrows pointing in opposite direction
AND 
and joined at a neutral point.

WELLNESS

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2. HIGH- LEVEL WELLNESS GRID

❑ Dunn (1959) describes a health grid in which a health axis

and environmental axis intersect.
 HEALTH AXIS extends from PEAK WELLNESS TO DEATH
 ENVIRONMENTAL AXIS extends from very favorable to very
unfavorable.
 The intersection of the 2 axes forms 4 quadrants of
health and wellness:
1. HIGH-LEVEL WELLNESS IN A FAVORABLE ENVIRONMENT
2. EMERGENT HIGH-LEVEL WELLNESS IN AN UNFAVORABLE
ENVIRONMENT
3. PROTECTED POOR HEALTH IN A FAVORABLE ENVIRONMENT
4. POOR HEALTH IN AN UNFAVORABLE ENVIRONMENT

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3. Agent-Host-Environment
Model ( ECOLOGIC MODEL )
❑ Used primarily in predicting illness
rather than in promoting health. AGENT- any environmental factor or stressor
(biochemical, mechanical, physical, or
❑ Identification of risk factors that result psychosocial) that by its presence or absence can
from the interaction of agent, host and lead to illness of disease
environment are helpful in promoting
and maintaining health. HOST- PERSON who may or may not be at risk of
acquiring the disease. Family hx, age, lifestyle
❑ Constant interaction of the 3→ health is habits influence the host’s reaction
an ever changing state.
ENVIRONMENT- all factors external to the host
❑ Variables are balance → health is
that may or may not predispose the person to the
maintained
devt of disease.
❑ Imbalanced→ disease occurs PHYSICAL ENVT- climate, living conditions, sound (noise
levels) and economic level.22 Social envt- interaction with
others and life events (death of spouse)
4. HEALTH BELIEF MODELS BY
ROSENSTOCK AND BECKER
is a theoretical model that can be
used to guide health promotion
and disease prevention programs.
It is used to explain and predict
individual changes in health
behaviors. It is one of the most
widely used models for
understanding health behaviors.

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 4. HEALTH BELIEF MODELS BY
ROSENSTOCK AND BECKER
INDIVIDUAL PERCEPTIONS

1. PERCEIVED SUSCEPTIBILITY – A family hx

of a certain disorder that may make the
individual feel at high risk. Ex: cancer, DM

2. PERCEIVED SERIOUSNESS- subjective

assessment of the severity of a health
problem and its potential consequences

3. PERCEIVED THREATS- perceived

susceptibility and perceived seriousness
combine to determine the total perceived 24

threat of an illness to a individual

 4. HEALTH BELIEF MODELS BY
ROSENSTOCK AND BECKER
MODIFYING FACTORS

1. DEMOGRAPHIC VARIABLE- age, sex,

race, ethnicity)

2. SOCIOPSYCHOLOGIC VARIABLES-
social pressure or influence from
peers or other reference groups

3. STRUCTURAL VARIABLES- knowledge

about the target disease
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 4. HEALTH BELIEF MODELS BY
ROSENSTOCK AND BECKER
LIKELIHOOD OF ACTION

1. PERCEIVED BENEFITS OF THE

ACTION – refrain from smoking to
prevent lung cancer

2. PERCEIVED BARRIERS TO ACTION-

cost, unpleasantness, lifestyle
changes

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What is community health?

 A part of paramedical and medical intervention/

approach which is concerned on the health of the
whole population
 AIM:
1. health promotion
2. disease prevention
3. management of factors affecting health

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 28

What is nursing?

 assisting sick
individuals to become
healthy and healthy
individuals achieve
optimum wellness
PUBLIC HEALTH

 According to Dr. C.E. Winslow, Public Health is a

science & art of 3 P’s:
1. Prevention of Disease
2. Prolonging life
3. Promotion of health and efficiency through organized community
effort
✓ 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 development of social
machinery to ensure everyone a standard of living adequate 29

for the maintenance of health

Public Health Nursing

 The practice of nursing in national and local

government health departments ( which include
health centers, and rural health units), and
public schools. It is COMMUNITY HEALTH
NURSING PRACTICED IN THE PUBLIC SECTOR.
-Standards of Public Health Nursing in the
Philippines, 2005

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What is Community
Health Nursing?
 “The utilization of the nursing
process in the different levels of
clientele---individuals, families,
population groups and
communities, concerned with
the promotion of health,
prevention of disease and
disability and rehabilitation.”
- Maglaya, et al

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GOAL OF COMMUNITY HEALTH NURSING

 TO RAISE THE LEVEL OF HEALTH OF THE CITIZENRY by helping communities

and families cope with the discontinuities in and threats to health in such a
way as to maximize their potential for high-level wellness
-Nisce, Reyala, et al

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CHN practice is guided by the ff beliefs:
H-U-M-A-N-I-S-T-I-C
 Humanistic values of the nursing profession upheld
 Unique and distinct component of health care
 Multiple factors of health considered
 Active participation of clients encouraged
 Nurse considers availability of resources
 Interdependence among health team members practiced
 Scientific and up-to-date
 Tasks of CHN nurse vary with time and place
 Independence or self-reliance of the people is the end
goal
 Connectedness of health and development regarded
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 BASIC PRINCIPLES
OF CHN
 " The community is the
patient in CHN, the family is
the unit of care and there are
four levels of clientele:
individual, family, population
group (those who share
common characteristics,
developmental stages and
common exposure to health
problems – e.g. children,
elderly), and the community.
"
 In CHN, the client is
considered as an ACTIVE
partner NOT PASSIVE recipient
of care
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 BASIC PRINCIPLES
OF CHN
 " CHN practice is affected
by developments in health
technology, in particular,
changes in society, in
general "
 The goal of CHN is
achieved through multi-
sectoral efforts " HEALTH CARE DELIVERY SYSTEM
“the totality of all policies, facilities, equipment,
 CHN is a part of health products, human resources and services which
address the health needs, problems and concerns of
care system and the larger the people. It is large, complex, multi-level and
human services system. multi-disciplinary.” 35
ROLES OF THE PUBLIC HEALTH NURSE

 CLINICIAN OR HEALTH
CARE PROVIDER- utilizes
the nursing process in the
care of the client in the home
setting through home visits
and in public health care
facilities; conducts referral of
patients to appropriate level
of care when necessary

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ROLES OF THE PUBLIC HEALTH NURSE

 Health Educator-
aims towards health
promotion and illness
prevention through
dissemination of
correct information;
educating people

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ROLES OF THE PUBLIC HEALTH NURSE

 COORDINATOR AND COLLABORATOR – establishes linkages and

collaborative relationships with the other health professionals, government
agencies, the private sector, non-government organizations and people’s
organizations to address health problems.
 SUPERVISOR- who monitors and supervises the performance of midwives
and other auxiliary health workers.; also initiates the formulation of staff
development and training programs for midwives and other auxiliary health
workers .
 LEADER AND CHANGE AGENT- influences people to participate in the
overall process of community development.

 MANAGER- organizes the nursing service component of the local health

agency

 RESEARCHER- participates in the conduct of research and utilizes

research findings In the conduct
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 RESPONSIBILITIES OF THE COMMUNITY
HEALTH NURSE
1. Participates in the development of an overall health plan,
its implementation and evaluation for communities
2. Provides quality nursing services to the four levels of
clientele
3. Maintains coordination/linkages with other health team
members, NGO/government agencies in the provision of
public health services
4. Initiates and conducts researches relevant to CHN services
to improve provision of health care
5. Initiates and provides opportunities for professional
growth and continuing education for staff development 39
 RESPONSIBILITIES OF THE COMMUNITY
HEALTH NURSE
 In the care of families:
 Provision of primary health care services
 Development/utilization of family nursing care plan in the provision of care

 In the care of the communities:

- Community organizing, mobilization, community dev’t, and people
empowerment
- Case finding and epidemiological investigation
- Program planning., implementation and evaluation
- influencing executive and legislative individuals or bodies concerning health
and development 40
SPECIALIZED FIELDS OF CHN

 COMMUNITY MENTAL HEALTH NURSING

 OCCUPATIONAL HEALTH NURSING
 SCHOOL HEALTH NURSING

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 LEVELS OF CLIENTELE

DIFFERENCES BETWEEN PATIENT AND CLIENT

CLIENT PATIENT

May or may not be sick Sick

Collaborates with the HCP when comes Dependent on HCP for decisions and
to his/her care health care

Assumes an active role in health care Passive receiver of health services

HP perform health promotion and HP generally perform disease prevention

disease prevention activities actrivities

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 LEVELS OF CLIENTELE
1. THE INDIVIDUAL AS A CLIENT
- receive health services in different forms
-Individuals are also seen as both clients and patients during home visits,
school clinic consultation, workplace clinic visits
- can be used as an entry point in working with the whole family

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Atomistic Approach According to Byrne
and Thompson
 They view Man with the different levels of
organization that influence body structure and
function.
 1.Chemical Level 2.Organelle level 3.Cellular
level 4.Tissue level 5.Organ Level 6.System Level
 This view sees the whole, which is a man, as
equal to the sum of its parts, and sub parts, the
different physical structure of man.
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 Holistic Approach
 traces the pattern of Man relationship with other beings in
the suprasystem of society. It is how Man reacts in a given
situational stimuli.
 Views Man as a whole organism which interrelated and
interdependent parts functioning to produce behavior
unacceptable or acceptable to the society
 Man as a whole is different from and is more than the sum of
its component parts

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46
 Five Dimensions of Man
 Man as a PHYSICAL BEING -Characteristics of a individual as genetic
endowment, sex and physical attributes such as structure (anatomy)
and functions (physiology)

 Man a PSYCHOLOGICAL BEING -Individual as a psychological BEING is

capable of feeling, rationality and all conscious and unconscious mental
states. His rational side makes him merciful, kind and compassionate

 Man as a SOCIAL BEING- Man is capable of relating to others. His first

agent of socialization is the family where he is nurtured, where he
learns his first language and where he first learns to socialize

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 Five Dimensions of Man
 Man as a SPIRITUAL BEING- Man is capable of virtues such as faith, hope and
charity
-Faith is the unquestioning belief in someone or something
-Hope is looking forward to something positive
-Charity is the outward expression of the love of man for his fellowmen
 Man as a THINKING or INTELLECTUAL BEING- Man capable of perception,
cognition and communication Intelligence is simply defined as the “capacity
to learn from experience and adapt successfully to one’s environment .
Perception includes selecting, organizing and interpreting sensory
information

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2. THE FAMILY AS A CLIENT
 FAMILY- a small social system and primary reference group
made up of two or more persons living together who are
related by blood, marriage, or adoption or who are living
together by arrangement over a period of time. (MURRAY
AND ZENTHER, 1997)

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3. THE POPULATION GROUP AS A CLIENT

A group of people sharing the same

characteristics, developmental stage
or common exposure to a particular
environmental factors.
 Children, women, farmers, cultural
minorities, elderly
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4. The COMMUNITY AS A CLIENT

 A group of people sharing common interest within a geographic boundaries

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STANDARDS OF PUBLIC HEALTH NURSING
PRACTICE
 focus on providing quality, ethical, and effective care to populations.

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 STANDARDS OF PUBLIC HEALTH NURSING
PRACTICE
STANDARD 1: ASSESSMENT The public health nurse collects comprehensive data pertinent to
the health status of population

STANDARD 2: POPULATION The public health nurse analyzes the assessment data to determine
DIAGNOSIS PRIORITIES the population diagnosis and priorities

STANDARD 3: OUTCOMES The public health nurse identifies outcomes for a plan that is based
IDENTIFICATION on population diagnosis and priorities

STANDARD 4: PLANNING The public health nurse develops a plan that reflects best practices
by identifying strategies, action plans, and alternatives to attain
expected outcomes

STANDARD 5: IMPLEMENTATION The public health nurse implements the identified [plans by
partnering with others
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56
THE FAMILY

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 THE FAMILY AS A CLIENT
 The BASIC UNIT IN SOCIETY and is shaped
by all forces around it.
 Values, beliefs, and customs of society
influence the role and function of the
family
 It is a unit of interacting persons bound by
ties of blood, marriage or adoption.
 Constitute a single household, interact with
each other in their respective familial roles
and create and maintain a common culture.
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2. THE FAMILY AS A CLIENT
 Characterized by:
❖ Face-to-face contact
❖ Bonds of affection, love, loyalty,
❖ emotional and financial commitment
❖ Harmony
❖ Simultaneous competition and mutual concern
❖ A continuity of past, present and future, shared
goals and identity
❖ Behaviors and rituals common only to the specific
unit
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2. THE FAMILY AS A CLIENT

Family as a system:
 focus is on the family as client, and
the family is viewed as an interacting
system in which the whole is more
than the sum of its parts;
simultaneously focuses on individual
members and the family as a whole

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2. THE FAMILY AS A CLIENT
Family Health:

- a dynamic changing, relative state of well-

being that includes the biological,
psychological, sociological, cultural, and
spiritual factors or state of the family
system.
Family Nursing:

-means nurses and families working together

to ensure the success of the family and its
members in adapting to responses to health
and illness
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2. THE FAMILY AS A CLIENT
TYPES OF FAMILIES
 TRADITIONAL

❑Viewed as an autonomous unit

❑Father, mother and children live
together in one roof
❑MOTHER-assumes the nurturing
role/housewife
❑FATHER- breadwinner

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2. THE FAMILY AS A CLIENT
TYPES OF FAMILIES
 NON-TRADITIONAL

❑FATHER- household chores,

bringing up the children and
family life in general
❑MOTHER- employed/ contributes
in addressing the financial needs
of the family

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 TYPES OF FAMILIES BASED ON
COMPOSITION
❑ NUCLEAR FAMILY – a type of family
composed of a father, mother and
children
❑ EXTENDED FAMILY – a type of family
composed of nuclear family , plus the
relatives of one or both spouses, who
usually live with the nuclear family;
usually composed of members that
span 3 generations at the least .
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 TYPES OF FAMILIES BASED ON
COMPOSITION
❑ BEANPOLE FAMILY – a type of family
with four or more generations, long
and small; parent-child relationship
last longer
❑ Vertically
extended family; great grand
parents→ grandparents→parents→child
❑ SINGLE-PARENT FAMILY – composed of
either mother or father with his/her
biological/adopted children
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 TYPES OF FAMILIES BASED ON
COMPOSITION
❑ STEPFAMILY/BLENDED FAMILY/
RECONSTITUTED FAMILY -composed
of one widowed/divorced/ separated
adult with his/her children and a new
spouse with all or some of his/her
children and often also the children
born to this unison live together under
one household

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 TYPES OF FAMILIES BASED ON
COMPOSITION
❑ SINGLESTATE - the never-
marrieD, separated, divorced
or widowed individual
❑ Characterizedby privacy,
independence, job mobility,
opportunity to develop skills and
knowledge and geographical
mobility
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 TYPES OF FAMILIES BASED ON
COMPOSITION
❑ SAME-SEX OR HOMOSEXUAL
FAMILY- composed of gay or
lesbian partners living
together with or without
adopted children or a child
from previous relationship

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 TYPES OF FAMILIES BASED ON
COMPOSITION
❑ COHABITING OR COMMUNAL
FAMILY- consists of unrelated
individuals or families who live
together under one roof for the
purpose of companionship,
desiring to achieve a sense of
family, test commitment, and
share resources and household
management.
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 BASED ON LOCUS OF POWER
 PATRIFOCAL/PATRIARCHAL FAMILY- a
union in which the man has the main
authority and decision making power

 MATRIFOCAL/MATRIARCHAL FAMILY- a
union in which the woman has the main
authority and decision making power
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 BASED ON LOCUS OF POWER
 EGALITARIAN FAMILY- a union in which the
husband and wife exercise more or less an
equal amount of authority.
 MATRICENTRIC- the prolonged absence of
the father as in case of families of OFWs gives
the mother a dominant position in the family,
although the father may in a way also share
the decision making power with the mother.

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BASED ON PLACE OF RESIDENCE
 PATRILOCAL- requires the newlywed couple to live with or
near the residence of the parents/ family of the bridegroom
 MATRILOCAL- requires the newlywed couple to live with or
near the residence of the parents/ family of the bride
 BILOCAL- provides the newlywed couple the choice of
staying with either the groom’s or the bride’s parents,
depending on factors like the relative wealth and status of
the families, the wishes of the parents, or certain personal
preferences of the bride and the groom.

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BASED ON PLACE OF RESIDENCE
 NEOLOCAL – permits the couple to reside
independently from their parents. They
can decide on their own as far as their
residence is concerned.
 AVUNCULOCAL- prescribes the newlywed
couple to reside with or near the
maternal uncle of the groom
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 BASED ON DESCENT
 PATRILINEAL- affiliates a person with a group of relatives through his or her father
 MATRILINEAL- affiliates a person with a group of relatives through his or her
mother
 BILATERAL- affiliates a person with a group of relatives through BOTH his or her
parents

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 The Filipino Family
 Based on the Philippine Constitution, Family code with focus on religious, legal and
cultural aspects of the definition of family.
SECTION1. it recognizes the Filipino family as the foundation of nation. Accordingly, it shall
strengthen its solidarity and actively promote its total development.
SECTION2. Marriage is inviolable social institution, is the foundation of family and shall be
protected by the state.

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 The Filipino Family
 SECTION 3. The state shall defend:
1. The right of spouses to found a family in accordance with their religious
convictions and demands of responsible parenthood.
2. The right of children to assistance including proper care and nutrition and
special protection from all forms of neglect, abuse, cruelty, exploitation,
and other conditions prejudicial to their development.

76
 The Filipino Family
3. The right of the family to a family living wage income.
4. The right of families or family associations to participate in the planning and
implementation of policies and programs of that affect them.
SECTION 4. The family has the duty to care for its elderly members but the state may also
do so through just programs of social security.

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The Filipino Family and its characteristics
 Although the basic unity is the nuclear family, the influence of kinship is felt in the
social organizations.
 Extensions of relationships and descent pattern are bilateral.
 Kinship circles is considerably greater because effective range often includes the third
cousin.
 Kin group is further enlarged by finial, spiritual or ceremonial ties. Filipino marriage is
not an individual but a family affair.

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The Filipino Family and its characteristics
 Obligation goes with this kinship system
 Extended family has a profound effect on daily decisions.
 There is a great degree of equality between husband and wife
 Children not only have to respect their parents and obey them, but also have to
repress their repressive tendencies
 The older siblings have something of authority of their parents

79
 The family as a unit of care
Rationale:
 The family is considered the natural and fundamental unit of
society
 The family as a group generates, prevents and tolerates and
corrects health problems within its membership
 The health problems of the family members is interlocking.
 The family is the most frequent focus of health decisions and
action in personal care
 The family is an effective and available channel for much of
the effort of the health worker

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 The family as a client :
Characteristics of a family as a client
1. The family is a product of time and place
-a family is different from other family who lives in another location
in many ways
- a family who lives in the past is different from another family who
lives in the present in many ways
2. The family develops its own lifestyle
- develops its own patterns or behaviour and its own style in life
-develops their own power system which either be balance or
strongly bias

81
3. The family operates as a group
-a family is a unit in which the action of any member may set a
whole series of reaction within the group.
4. The family accommodates the needs of the individual members
like
 the need for self expression
 Equality of Power
 Independence
5. The family relates to the community
6. The family has a growth cycle

82
12 BEHAVIORS INDICATING A WELL FAMILY
1. Able to provide for physical, emotional and spiritual
needs of the family members
2. Able to be sensitive on the needs of the family members
3. Able to communicate thoughts and feelings effectively
4. Able to provide support, security and encouragement
5. Able to initiate and maintain growth producing
relationship
6. Maintain and create constructive and responsible
community relationships

83
12 BEHAVIORS INDICATING A WELL FAMILY
7. Able to grow with and through children
8. Able to perform family roles flexibly
9. Able to help oneself and to accept help when
appropriate
10. Demonstrate mutual respect for the individuality
of family members
11. Ability to use crisis experience as means of growth
12. Demonstrate concern of family unity, loyalty, and
interfamily cooperation
84
 FUNCTIONS OF THE FAMILY

The family fulfils 2 important purposes:

(FRIEDMAN ET AL, 2003)

 To meet the needs of the society

 To meet the needs of individual family members

85
TO MEET THE NEEDS OF THE SOCIETY
THROUGH:
1. PROCREATION – family is an institution for reproductive
function and child rearing
2. SOCIALIZATION OF FAMILY MEMBERS – socialization is the
process of learning how to become productive members of
the society.it involves transmission of the culture of a
social group.
3. STATUS REPLACEMENT- society is cha. By a hierarchy of its
members into social class
4. ECONOMIC FUNCTION- family serves as a unit of
production – participate in business, farming, fishing etc
TO MEET THE NEEDS OF INDIVIDUALS
THROUGH:
1. PHYSICAL MAINTENANCE – provides for the survival
needs of its dependent members like children and the
aged.
2. WELFARE AND PROTECTION- the family support spouses
or partners by providing for companionship and
meeting affective, sexual and socioeconomic needs
- by developing love and belonging→children
have emotional gratification and psychological security
 THEORETICAL FRAMEWORKS
APPLICABLE TO FAMILIES
 KALISH HIERARCHY OF NEEDS
- Proposed by Richard Kalish.
- he adopted the Maslow’s hierarchy of needs in order to come up with a
NEEDS THEORY FOR THE FAMILY.
-he added STIMULATION NEEDS as an additional category between physiologic
needs and satefy and measure needs.

88
89
 Emphasized the importance of exploring and manipulating the environment so
that the children could have achieve optimum growth and development.
 Adults should seek novelty adventures or stimulating experience before
considering their safety and security needs

90
The FAMILY AS A CHANGING SYSTEM

 FAMILY THEORIST EVERLYN DUVALL, outlined the 8 stages of the family cycle
to depict a series of changes in family composition, roles and relationship
from the time people marry until they die.
 In each stage, family members play a distinctive roles and carry out
distinctive developmental tasks.

91
 STAGES OF THE FAMILY LIFE CYCLE
ACCORDING TO DUVALL
Stage Available Roles
1. Married couple (without children Husband and wife
2. Childbearing family Wife/mother
(oldest child at birth up to 30 months) Husband/father
Infant daughter or son
3. Family with preschool children Wife/mother
(oldest child at over 30 months up to 6 Husband/father
years) Daughter/sister
Son/ brother
4. Family with school-age children Wife/mother
(oldest child up to 12 y/0) Husband/father
Daughter/sister
Son/ brother
5. Family with teenagers Wife/mother
(oldest child at 13 up to 20 y/0) Husband/father
Daughter/sister
92
Son/ brother
 STAGES OF THE FAMILY LIFE CYCLE
ACCORDING TO DUVALL
Stage Available Roles
6. Family with launching young adults Wife/mother/ grandmother
(first child to last child gone) Husband/father/ grandfather
Daughter/sister/ aunt
Son/ brother/ uncle
7. Family without children Wife/mother/ grandmother
(empty nest to retirement) Husband/father/ grandfather
8. Aging family Wife/mother/ grandmother
(retirement to death) Husband/father/ grandfather
Widow/widower

93
 STAGES OF FAMILY DEVELOPMENT
INITIAL OR ESTABLISHMENT STAGE

 COURTSHIP AND ENGAGEMENT precede the establishment of

the family unit.
 The developmental tasks of both the male and female during
the courtship period includes:
▪ contending with partner selection pressure from parents
▪ Giving over autonomy while retaining some independence
▪ Preparing for marriage
▪ Becoming free of parental domination.

94
 STAGES OF FAMILY DEVELOPMENT
EXPECTANT STAGE/ PREGNANCY

- Domestic and social adjustments should be made by the

couple
- Pregnancy is developmental crisis –they are expected to
assume new roles (father and mother)
- expected to think as a family not just as a pair.
- Both explore knowledge and practices regarding childrearing
and plan for a family in terms of daily tasks, a home setting,
budget and necessary supplies

95
 STAGES OF FAMILY DEVELOPMENT
EXPECTANT STAGE/ PREGNANCY
- Both need extra mothering from each other during pregnancy in order to prepare them
emotionally and psychologically for childbirth.
- HEALTH TEACHINGS on the progress of pregnancy and labor and delivery would prepare
both fir childbirth

96
 STAGES OF FAMILY DEVELOPMENT
PARENTHOOD OR EXPANSION STAGE
- Characterized by birth or adoption of a child
Stages:
 Anticipatory stage- the couple is learning new roles and
perceptions associated with pregnancy
 Honeymoon stage – immediately after childbirth when both
parents are uncertain about the meaning of parental love.
This period parent-child attachment is being formed.
-both parents lose sleep because they need to attend to
their child’s needs.
-husband-wife intimacy diminishes;less freedom for the
couple to pursue their interests
97
 Plateau or consolidation stage – entire period od child
dev’t when both parents are actively assuming their
parenting roles. - Both are concerned with family
planning, socialization, the education of the child and
even active participation in community organizations
 Disengagement or contraction stage –occurs when the
children leave and the couple must rework their
separateness.
-middle-aged woman may return to work after
childrearing
-retirement planning- older couple
-preparation for the spouse death may also be necessary
esp when chronic or terminal illness sets in.
-eventual bereavement, loneliness, and further role
changes and losses will eventually occur.
98
 DIFFERENT FUNCTIONS FULFILLED BY
THE FAMILY
 PHYSICAL FUNCTIONS- met by parents as they provide food,
clothing, and shelter, protection against danger, reproduction
and provision for bodily repairs in cases of fatigue or illness
 AFFECTIONAL FUNCTIONS- meeting emotional needs and
promoting adaptation and adjustment
 SOCIAL FUNCTIONS- providing social together; fostering self-
esteem and personal identity tied to a family identity;
providing opportunities for learning social and sexual roles;
accepting responsibility for behaviours, and supporting
individual creativity and initiative.

99
 FAMILY HEALTH TASKS
 To achieve wellness among family members and to reduce, eliminate and prevent
health problems, the family should have the ability to perform the ff. health
tasks;
1. Recognize the presence of a wellness state and health condition problem
2. Make decisions about taking an appropriate health action to maintain wellness
or manage the health problem
3. Provide nursing care to the sick, disabled, dependent, or at risk member
4. Maintain a home environment conducive to health maintenance and personal
development
5. Utilize community resources for health care
*it is the nurse’s responsibility to assess if the family is able to attend to these tasks
or not. Failure to attend to these family health tasks constitutes the family
nursing problems.
100
HEALTH CARE DELIVERY
SYSTEM

101
 WORLD HEALTH ORGANIZATION
 Diplomats formed the UN in 1945→ creation of global
health organization→ WHO
 Head quarters – GENEVA, SWITZERLAND
 147 country offices and 6 world regional offices for
Africa, America, Eastern mediterranean, Europe,
Southeast Asia, the West Pacific.
 The PHILIPPINES is a member of West Pacific region
which holds the office in Manila

102
 OBEJECTIVE: attainment by all peoples of the highest
possible level of health (WHO,2006)
 CORE FUNCTIONS:

1. Provide leadership on matters critical to health and

engaging partnerships where joint action is needed.
2. Shaping the research agenda and stimulating the
generation, translation and disseminating valuable
knowledge
3. Setting norms and standards and promoting and monitoring
their implementation
4. Articulating ethical and evidence-based policy options
5. Providing technical support, catalysing change and building
sustainable institutional capacity. 103
 THE MILLENNIUM
DEVELOPMENTAL GOAL
 THE MILLENIUM DEVELOPMENT GOALS
 SEPTEMBER 6-8, 2000- world leaders of UN
General Assembly participated in Millennium
Summit→ resolution→ UNITED NATIONS
MILLENNIUM DECLARATION (UN,2013)
 191members expressed their commitment
to reduce the extreme poverty and achieve
seven other targets

105
 THE MILLENIUM DEVELOPMENT GOALS
GOAL 1 : ERADICATE EXTREME POVERTY AND HUNGER
Target : Halve, between 1990 and 2015, the proportion of people whose income
is less than one dollar a day
Target : Halve, between 1990 and 2015, the proportion of people who suffer
from hunger

106
GOAL 2: ACHIEVE UNIVERSAL PRIMARY
EDUCATION

 Target : Ensure that, by 2015, children everywhere, boys and girls alike, will be
able to complete a full course of primary schooling
GOAL 3: PROMOTE GENDER EQUALITY
AND EMPOWER WOMEN

 Target: Eliminate gender disparity in

primary and secondary education
preferably by 2005 and to all levels of
education no later than 2015
GOAL 4: REDUCE CHILD MORTALITY

 Target: Reduce by two-thirds,

between 1990 and 2015, the under-
five mortality rate
GOAL 5: IMPROVE MATERNAL HEALTH
 Target : Reduce by three-quarters, between 1990 and 2015, the maternal mortality
ratio
6. COMBAT HIV/AIDS , MALARIA AND OTHER
DISEASES.
Targets:
a. halted by 2015 and begun to reverse the spread of HIV/AIDS
b. achieve, by 2010, universal access to tx of HIV/AIDS for all those who need it.
c. Have halted by 2015 and begun to reverse the spread the incidence of malaria and
other major disease

111
 GOAL 7: ENSURE ENVIRONMENTAL
SUSTAINABILITY
Target :
A. Integrate the principles of sustainable
development into country policies and
programmes and reverse the loss of
environmental resources
B. Halve, by 2015, the proportion of people
without sustainable access to safe drinking
water
C. By 2020, to have achieved a significant
improvement in the lives of at least 100
million slum dwellers 112
GOAL 8: DEVELOP A GLOBAL
PARTNERSHIP FOR DEVELOPMENT
Target :
A. Develop further an open, rule-based, predictable,
nondiscriminatory trading and financial system
B. Address the special needs of the least developed
countries
C. Address the special needs of landlocked countries
and small island developing States
D. Deal comprehensively with the debt problems of
developing countries through national and
international measures in order to make debt
sustainable in the long term
*five are not considered as strictly
health issues (1,2,3,7,8)- goals toward
upgrading socioeconomic conditions
(health determinants )
 THE MILLENNIUM
DEVELOPMENTAL GOAL
 THE MILLENIUM DEVELOPMENT GOALS
 SEPTEMBER 6-8, 2000- world leaders of UN
General Assembly participated in Millennium
Summit→ resolution→ UNITED NATIONS
MILLENNIUM DECLARATION (UN,2013)
 191members expressed their commitment
to reduce the extreme poverty and achieve
seven other targets

116
 THE MILLENIUM DEVELOPMENT GOALS
GOAL 1 : ERADICATE EXTREME POVERTY AND HUNGER
Target : Halve, between 1990 and 2015, the proportion of people whose income
is less than one dollar a day
Target : Halve, between 1990 and 2015, the proportion of people who suffer
from hunger

117
GOAL 2: ACHIEVE UNIVERSAL PRIMARY
EDUCATION

 Target : Ensure that, by 2015, children everywhere, boys and girls alike, will be
able to complete a full course of primary schooling
GOAL 3: PROMOTE GENDER EQUALITY
AND EMPOWER WOMEN

 Target: Eliminate gender disparity in

primary and secondary education
preferably by 2005 and to all levels of
education no later than 2015
GOAL 4: REDUCE CHILD MORTALITY

 Target: Reduce by two-thirds,

between 1990 and 2015, the under-
five mortality rate
GOAL 5: IMPROVE MATERNAL HEALTH
 Target : Reduce by three-quarters, between 1990 and 2015, the maternal mortality
ratio
6. COMBAT HIV/AIDS , MALARIA AND OTHER
DISEASES.
Targets:
a. halted by 2015 and begun to reverse the spread of HIV/AIDS
b. achieve, by 2010, universal access to tx of HIV/AIDS for all those who need it.
c. Have halted by 2015 and begun to reverse the spread the incidence of malaria and
other major disease

122
 GOAL 7: ENSURE ENVIRONMENTAL
SUSTAINABILITY
Target :
A. Integrate the principles of sustainable
development into country policies and
programmes and reverse the loss of
environmental resources
B. Halve, by 2015, the proportion of people
without sustainable access to safe drinking
water
C. By 2020, to have achieved a significant
improvement in the lives of at least 100
million slum dwellers 123
GOAL 8: DEVELOP A GLOBAL
PARTNERSHIP FOR DEVELOPMENT
Target :
A. Develop further an open, rule-based, predictable,
nondiscriminatory trading and financial system
B. Address the special needs of the least developed
countries
C. Address the special needs of landlocked countries
and small island developing States
D. Deal comprehensively with the debt problems of
developing countries through national and
international measures in order to make debt
sustainable in the long term
*five are not considered as strictly health issues (1,2,3,7,8)- goals toward
upgrading socioeconomic conditions (health determinants )
126
The 2030 Agenda for Sustainable
Development, adopted by all United Nations
Member States in 2015, provides a shared
blueprint for peace and prosperity for people
and the planet, now and into the future. At its
heart are the 17 Sustainable Development Goals
(SDGs), which are an urgent call for action by all
countries - developed and developing - in a
global partnership.

127
 They recognize that ending poverty and other
deprivations must go hand-in-hand with
strategies that improve health and education,
reduce inequality, and spur economic growth –
all while tackling climate change and working
to preserve our oceans and forests.
 The SDGs build on decades of work by
countries and the UN, including the UN
Department of Economic and Social Affairs

128
 Everyyear, the UN Secretary General
presents an annual SDG Progress report,
which is developed in cooperation with the
UN System, and based on the global
indicator framework and data produced by
national statistical systems and
information collected at the regional level.

129
The 17 SDGs and their meanings:
1. No Poverty: Eradicate poverty in all its forms everywhere.
2. Zero Hunger: End hunger, achieve food security, improve nutrition,
and promote sustainable agriculture.
3. Good Health and Well-being: Ensure healthy lives and promote
well-being for all at all ages.
4. Quality Education: Ensure inclusive and equitable quality education
and promote lifelong learning opportunities for all.
5. Gender Equality: Achieve gender equality and empower all women
and girls.

130
6. Clean Water and Sanitation: Ensure availability and
sustainable management of water and sanitation for
all.
7. Affordable and Clean Energy: Ensure access to
affordable, reliable, sustainable, and modern energy for
all.
8. Decent Work and Economic Growth: Promote
sustained, inclusive, and sustainable economic growth,
full and productive employment, and decent work for
all.

131
9. Industry, Innovation, and Infrastructure: Build resilient
infrastructure, promote inclusive and sustainable
industrialization, and foster innovation.
10.Reduced Inequalities: Reduce inequality within and among
countries.
11.Sustainable Cities and Communities: Make cities and
human settlements inclusive, safe, resilient, and
sustainable.
12.Responsible Consumption and Production: Ensure
sustainable consumption and production patterns.

132
13.Climate Action: Take urgent action to combat
climate change and its impacts.
14.Life Below Water: Conserve and sustainably use the
oceans, seas, and marine resources for sustainable
development.
15.Life on Land: Protect, restore, and promote
sustainable use of terrestrial ecosystems, sustainably
manage forests, combat desertification, and halt and
reverse land degradation and halt biodiversity loss.

133
16.Peace, Justice, and Strong Institutions: Promote
peaceful and inclusive societies for sustainable
development, provide access to justice for all,
and build effective, accountable, and inclusive
institutions at all levels.
17.Partnerships for the Goals: Strengthen the
means of implementation and revitalize the
global partnership for sustainable development.

134
THE PHILIPPINE HEALTH
CARE DELIVERY SYSTEM

135
136
 MAJOR PLAYERS
A. PUBLIC SECTOR
- largely financed through a tax-based budgeting system at both the
national and local levels and where health care is generally given for
free at the point of service
 NATIONAL LEVEL- Department of Health as lead agency
 LOCAL LEVEL- health system run by LGUs

B. PRIVATE SECTOR
- Largely market oriented and where health care is paid for through
user fees at the point of service
137
 The
Health
Sector DOH
LGU

NGO/PS

Self-Reliant, Healthy Filipino

8/25/2025 138
 The PUBLIC Sector
1. DEPARTMENT OF HEALTH- holds the overall technical
authority on health as it is a national health policy-maker and
regulatory institution
-Hold the main governing body of health services in the
country
Vision: Filipinos are among the healthiest people in Southeast
Asia by 2022, and Asia by 2040.
Mission: To Lead the country in the development of a
productive, resilient, equitable and people-centered health
system.
139
 PRINCIPLES TO ATTAIN THE VISION
OF DOH
 Equity: equal health services for all-no discrimination
 Quality: DOH is after the quality of service not the quantity
 Philosophy of DOH: “Quality is above quantity”
 Accessibility: DOH utilize strategies for delivery of health services

140
 3 MAJOR FUNCTIONS/ROLES OF DOH
IN THE HEALTH SECTOR

 LEADERSHIP IN HEALTH
❑ National
health policy/Plans and programs – formulation,
monitoring and evaluation
❑ Regulatory institution and national policy – social welfare

❑ Advocates adoption of health policies, plans and programs

8/25/2025 141
2. ENABLER AND CAPACITY BUILDER

❑ INNOVATE new strategies to improve the effectiveness of health

programs
❑ ENSURE highest achievable standards of quality health care
❑ INITIATE public discussion on health issues and disseminate
policy research outputs to ensure informed public participation
in policy decision making
❑ OVERSEE implementation, monitoring and evaluation of
national health plans, programs and policies
142
3. ADMINISTRATOR OF SPECIFIC SERVICES

❑ Manage selected national health facilities and hospitals:

a. National referral centers like special or tertiary
hospital
b. Referal centers for local health system like special or
tertiary hospital, CDC, training centers
❑ Administer direct services for emergent health concerns
that require new complicated technologies.

143
❑ Provide emergency health response services: referral and networking system for trauma,
injuries, epidemics, and widespread public danger, upon the direction of the president
and in consultation with the concerned LGU
❑ Administer special components of specific programs like:
a. Tuberculosis
b. Schistosomiasis
c. HIV-AIDS

144
 DOH CORE VALUES
 INTEGRITY
 EXCELLENCE
 COMPASSION AND RESPECT TO HUMAN DIGNITY
 COMMITMENT
 PROFESSIONALISM
 TEAMWORK
 STEWARDSHIP OF THE HEALTH OF THE PEOPLE

145
 DOH Programs
D – ental Health
O – perations for Environmental Sanitation
H – ealth Education and Community Organizing
P – revention and Control of Communicable Diseases
R – eproductive Health
O – lder Persons Health Services
G – uidelines for Nutrition
R – ehabilitation and Management of Non-communicable Dse.
A – lternative Health Care Practices (HerbalMeds/Acupressure)
M – aternal and Child Health and IMCI (Integrated Management of Childhood Illness)
S – entrong Sigla Movement
LOCAL ENDEMIC DISEASE
EXPANDED PROGRAM OF IMMUNIZATION
MENTAL HEALTH PROMOTION 8/25/2025 146

ACCESS TO AND USE OF HOSPITALS

 LEVELS OF HEALTH CARE DELIVERY
 DOH administrative order 2012-0012→
CLASSIFICATION OF HOSPITALS AND OTHER HEALTH
FACILITIES IN HE PHILIPPINES
 HOSPITALS:
 GENERAL OTHER FACILITIES :
 LEVEL 1 A. Primary Care facility
B. Custodial care facility
 LEVEL 2 C. Diagnostic/ therapeutic facility
 LEVEL 3 D. Specialized outpatient facility
 SPECIALTY

147
148
OTHER FACILITIES:
DOH administrative order 2012-0012
CATEGORY A: PRIMARY CARE FACILITY
- first contact health care facility that offers the basic
services including emergency services and provision of normal
deliveries
1. Without in patient beds like health centers, out-
patient clinics and dental clinics
2. With in-patient beds- patient can spend 1 to 2 days
before discharge—infirmaries and birthing center
(lying-in facilities)
149
CATEGORY B: CUSTODIAL CARE
FACILITY
-provides long term care including
basic services like food and shelter, to
pts with chronic conditions requiring
ongoing health and nursing care.
- Custodial psychiatric facilities,
substance abuse tx and rehab centers,
sanitaria, leprosaria, nursing homes
150
CATEGORY C: DIAGNOSTIC/THERAPEUTIC FACILITY
- Facility for the exam of human body,
specimens for diagnosis, txo f disease,or for water
drinking water analysis.
-CLASSIFICATIONS:
1. LABORATORY FACILITY – Clinical, HIV testing, blood service,
drug testing, newborn screening, drinking water analysis
2. RADIOLOGIC FACILITY –XRAY, CT scan, mammography, MRI,
UTZ
3. NUCLEAR MEDICINE FACILITY- utilizing application of
radioactive materials in diagnosis, tx and medical research
with the exception of the use of sealed radiation sources in
radiothearapy
151
CATEGORY D: SPECIALIZED OUTPATIENT
FACILITY
- Facility that performs highly
specialized procedures on an outpatient
basis.
- Dialysis clinic, ambulatory surgical clinic,
cancer chemotherapy center, cancer
radiation facility, rehab center

152
2. LOCAL GOVERNMENT UNITS (LGU)
- RA 7160 Local Government Code of 1991 (Decentralization
from NGO to LGU)
Amended by:
Setion 41(b) Amended by RA 8553
Setion 43 Amended by RA 8553
-the devolution of powers, functions and responsibilities to the
local government, both provincial and municipal as well as an
autonomous regional government and a metropolitan authority
DEVOLUTION- the act by which the National Government confers power
and authority upon the various LGUs to perform specific functions and
responsibilities, including provision and delivery of basic health services.

8/25/2025 153
 THE ORGANIZATIONAL STRUCTURE
PROVINCIAL GOVERNOR OF THE DOH AND LGUs AFTER DEVOLUTION
LEVEL
PROVINCIAL HEALTH
BOARD
PROVINCIAL HEALTH
OFFICE

PROVINCIAL DISTRICT OTHER HEALTH AND

HOSPITALS HOSPITALS MEDICAL FACILITIES

MUNICIPAL HEALTH
MUNICIPAL OFFICE
LEVEL
OFFICE OF THE MAYOR

MUNICIPAL HEALTH BOARD

MUNICIPAL HEALTH
OFFICE 154
RHU/HEATH CENTER BRGY HEALTH STATION
 Decentralization of health services –
 Local health boards- proposes annual budgetary
allocations for the operations of health services
within the locality

155
 COMPOSITION OF LOCAL HEALTH BOARDS
PROVINCIAL MUNICIPAL
GOVERNOR- Chairperson of the MAYOR- Chairperson of the Local
Local Health Board Health Board

PROVINCIAL HEALTH OFFICER- MUNICIPAL HEALTH OFFICER-

Vice-Person Vice-Person

Chairman of the committee on Chairman of the committee on

health of the Sanguniang health of the Sanguniang
Panlalawigan Panlalawigan

DOH Representative DOH representative

156
NGO Representative NGO Representative
 THREE STRATEGIES IN DELIVERING HEALTH SERVICES
(ELEMENTS)
 Creation of Restructured Health Care Delivery
System (RHCDS) regulated by PD 568 (1976)
 Management Information Systems regulated by R.A.
3753: Vital Health Statistics Law
 Primary Health Care (PHC) regulated by LOI 949
(1984): Legalization of Implementation of PHC in the
Philippines
158
OBJECTIVES OF LOCAL HEALTH SYSTEM

 Establish local health systems for effective and efficient

delivery of health care services
 Upgrade the health care management and service capabilities
of local health facilities
 Promote inter-LGU linkages and cost-sharing schemes,
including health care financing system for better utilization
of local health resources
 Foster participation of the private sector, NGOs and
communities in LHSs devt
 Ensure the quality of health service delivery at the local level
159
DISTRICT HEALTH SYSTEM

 Defined by WHO as the smallest manageable unit.

 It refers to the first referral level; it should be close
enough to the community
 Includes:
 PHC facilities in the community
 Referral hospital
 Laboratory facilities
 Health office with full time health officer

160
RURAL HEALTH UNIT (HEALTH CENTER )
 PRIMARY HEALTH LEVEL FACILITY IN THE MUNICIPALITY
 Focus on preventive and promotive
 pop’n ratio catchment : 1RHU : 20,000 POPULATION
 The BHS- First contact health care facility that offers basic health services at the
brgy. Level→ mannered by BHW under the supervision of RURAL HEALTH MIDWIFE

161
 TWO WAY REFERRAL
SYSTEM

MIDWIFE
DISTRICT
HOSPITAL

HEALTH CENTER

REFERRAL SUPERVISION
FAMILY COMMUNITY

162
3. THE PRIVATE SECTOR
- COMMERCIAL AND BUSINESS ORGANIZATIONS
- Have a market orientation, and non business
organizations, which have a service orientation
- SOCIO-CIVIC GROUPS, ASSUMES THE
FOLLOWING ROLES:
 Policy and Legislative Advocates
 Community Organizers, Human Rights Advocates
 Researchers and Documentators of impt health
issues
 Health Resource Development Personnel
 Relief and Disaster Management volunteers 163
 FINANCING HEALTH SERVICES

 THE GOVERNMENT ( NATIONAL AND

LOCAL )
 PRIVATE SOURCES
 SOCIAL HEALTH INSURANCE

164
 PHILIPINE HEALTH INSURANCE
CORPORATION (PHILHEALTH) -
 National Health Insurance Act of 1995
(R.A.7875)
 A tax-exempt corporation attached to DOH
for policy coordination and guidance
 Aims for universal health coverage for all
Filipino citizen. (Congress of the RP, 1995a)
165
 Private sector as a major player in the
HCDS
TYPE ORIENTATION EXAMPLES
COMMERCIAL/ PROFIT-ORIENTED Private
BUSINESS practitioners,
private clinics, and
laboratories
NON-COMMERCIAL SERVICE-ORIENTED Socio-civic groups,
religious
organizations, or
foundations
166
 PRIMARY HEALTH CARE AS STRATEGY
WHO defined PHC as an essential health care made
universally accessible to individuals and families in the
community by means acceptable to them through their full
participation and at a cost that the community and country
can afford at every stage of development.
CONCEPTUAL FRAMEWORK
 Everyone should be given equal access to health and
health services and that socio-economic devt will
not be realized without the health of the people as
one of the primary considerations for development
programs 8/25/2025
167
167
Framework

eHealth Vision
By 2020 eHealth will enable
People widespread access to health care
Empowerment
services, health information, and
“Health for All securely share and exchange
Filipinos by the patients’ information in support to a
Year 2000 and safer, quality health care, more
Health in the equitable and responsive health
Hands of the system for all the Filipino people by
People by transforming the way information is
2020” used to plan, manage, deliver and
monitor
Partnership

8/25/2025 168
PHC goal (in 1978):Health for all by the 2000
- This goal was declared in the ALMA ATA
CONFERENCE(USSR) during the 1st
international conference on phc held on
September 6-12, 1978, through the sponsorship
of WHO and UNICEF as a strategy to community
health development.
Philippines: Adopted through LOI 949 signed by President
Marcos on October 19, 1979 with the theme-
“Health in The Hands of the People by 2020”
169
5 KEY ELEMENTS TO ACHIEVE THE GOAL
OF “HEALTH FOR ALL”
1. Reducing exclusion and social disparities in health
(UNIVERSAL COVERAGE)
2. Organizing health services around people’s needs
and expectations (HEALTH SERVICE REFORM)
3. Integrating health into all sectors (PUBLIC POLICY
REFORMS)
4. Pursuing collaborative models of policy dialogue
(LEADERSHIP REFORMS)
Increasing stakeholders participation
170
5.
 FOCUS OF THE PHC APPROACH

Partnership with the community

Equitable distribution of health resources
Organized and appropriate health system infrastructure
Prevention of disease and promotion of health as focus
Linked multisectorally
Emphasis on appropriate technology

171
 ESSENTIAL HEALTH SERVICES
LISTED BY ALMA ATA DECLARATION
Education for Health
Locally Endemic disease control
Expanded program for immunization
Maternal and Child health including responsible parenthood
Essential Drugs
Nutrition
Treatment of communicable and non communicable diseases
Safe water and sanitation
D ental Health Promotion
A ccess to and use of hospitals as Centers of Wellness
M ental Health Promotion
 KEY PRINCIPLES OF
PRIMARY HEALTH CARE
1. Accessibility, Affordability, Acceptability, and Availability (4 A’s of PHC)
2. Support mechanisms
3. Multisectoral approach
4. Community participation
5. Equitable distribution of health resources
6. Appropriate technology

173
 ACCESIBILITY- refers to the physical distance of
the health facility or the travel time required for
the people to get the needed or desired health
services.
-facilities must be within 30 minutes from the
communities
 AFFORDABILITY- The individual, family,
community and the government can afford to pay
for basic health services
- “out-of-pocket expenses
- government health insurance -PhilHealth
174
 ACCEPTABILITY- the health care offered is in consonance with the prevailing
culture and traditions of the pop’n
 AVAILABILITY- the basic health services required by the people are offered in the
health care facilities or provided on a regular and organized manner

 BOTIKA SA BRGY -4as to drugs

 LIGTAS SA TIGDAS ANG PINAS –Mass measles 9immunization campaign (9mos to
below 8yo)

175
2. SUPPORT MECHANISMS
 The sources for essential health services come from 3 entities:
 The people themselves
 The government
 The private sector ( NGOs AND SOCIOCIVIC AND
FAITH GROUPS)

- Health programs and projects provide better

output when these 3 entities are involved

176
 3. MULTISECTORAL EFFORTS
 PHC requires communication, collaboration and cooperation within and among
various sectors
 INTRASECTORAL LINKAGES- refers to the communication, collaboration and
cooperation within the health sector: among the members of health team and
among health agencies
- 2 way referral system

177
 INTERSECTORAL LINKAGES- refers to
the communication, collaboration and
cooperation between the health sector
and other sectors in society like
education, public works, agriculture,
and local government officials.
 E.g RABIES PREVENTION AND CONTROL
PROGRAM
-DOH,DA, DepEd, LGUs
178
4. COMMUNITY PARTICIPATION
 Is an educational and empowering process in which people, in partnership with
those who Are able to assist them, identify the problems and needs and increasing
assume responsibilities themselves to plan, manage, control, and assess collective
actions that are proved necessary.
 Community organizing

179
5. EQUITABLE DISTRIBUTION OF HEALTH
RESOURCES
 PHC advocates for care that community-based and
preventive in orientation. It calls for an inventory and
analysis of HEALTH RESOURCES, FACILITIES and MANPOWER
 the DOH spearheading 2 programs to equitable distribution
of manpower to rural areas:
DOCTOR TO THE BARRIOS (DTTB)
PROGRAM -2 YEARS
NURSE DEPLOYMENT PROGRAM (NDP) – 1
YR
180
 6. APPROPRIATE TECHNOLOGY
 Refers to the technology that is suitable to the community
that will use it.
 People’s technology, Indigenous technology
CRITERIA FOR APPROPRIATE TECHNOLOGY
1. SAFETY – minimal risk to the user and positive outcomes
outweighs unintended negative effects.
2. EFFECTIVENESS- should accomplish what it is meant to
accomplish
3. AFFORDABIITY – cost effective – health promotion and dse
prevention versus treatment of disease

181
 CRITERIA FOR APPROPRIATE TECHNOLOGY
4. SIMPLICITY- readily available simple materials and involves simpler process that
can easily adopt by the community people.
5. ACCEPTABILITY- effective only when it is used by those who need it.
6. FEASIBILITY AND RELIABILITY –must be easy to apply considering the people’s
natural setting like home, school, workplace and community.

182
 CRITERIA FOR APPROPRIATE TECHNOLOGY
7. ECOLOGICAL EFFECTS –effects on ecology is considered
8. POTENTIAL TO CONTRIBUTE TO INDIVIDUAL AND COMMUNITY DEVELOPMENT –
promote self sufficiently on the part of using it

183
 APPROPRIATE TECHNOLOGY
 TRADITIONAL AND ALTERNATIVE HEALTH CARE
- R.A. 8423- TRADITIONAL AND ALTERNATIVE MEDICINE ACT OF 1997
- promote and advocate the use of traditional and alternative health
care modalities through scientific research and product devt
 10 MEDICINAL PLANTS endorsed by DOH
 ALTERNATIVE HEALTH CARE MODALITIES

184
 ASA SERVICE DELIVERY POLICY OF
THE DOH permeates all strategies
and thrusts of govt health programs
from the national to the local and
community levels

185
 DIMENSION COMMERCIALIZED HC PHC

GOAL Absence of disease for the Prevention of disease

individual Socio-economic development
FOCUS OF CARE Sick Sick and well individuals

SETTING FOR SERVICES Hospital-based Satellite health centers

Urban-centered Community health centers
Accessible to few people Rural based
Accessible to all
PEOPLE Passive recipients of health Active participants in the health care

STRUCTURE Health is isolated from the other Inter and intra- sectoral linkages
sectors of society allows health to be integrated with
overall socio-economic development
efforts

186
PROCESS Decision making Decision making from
from top to bottom bottom to top

TECHNOLOGY Curative services Promotive and

based on modern preventive services
medicine and blend with traditional
sophisticated medicine with modern
technology medicine
physician-dominated Appropriate
technology for
frontline health care
OUTCOME Reliance on health People empowerment
professionals or self reliance
187
 LEVELS OF PHC WORKERS
 VILLAGE/GRASSROOT/ BHWs
- trained community health workers, health
auxiliary volunteers or traditional birth attendants or
healers
 INTERMEDIATE LEVEL HEALTH WORKERS
- general medical practitioners or their assistants,
PH nurses, rural sanitary inspectors, and midwives

188
 THREE LEVELS OF HEALTH CARE SERVICES
and the 2 WAY REFERRAL SYSTEM

PRIMARY
-first contact between the community people and different
levels of health facility

-RHU,COMMUNITY HOSPITALS AND

HEALTH CENTERS, PRIVATE
PRACTITIONERS, BHS
 THREE LEVELS OF HEALTH CARE
SERVICES the 2 WAY REFERRAL SYSTEM
SECONDARY
-rendered by physicians with basic health trainings in district hospitals and city
hospitals.
- Capable of basic surgical procedures and simple laboratory examinations

-Provincial/city health services/

-Provincial/city hospitals
-Emergency/ district hospitals
- SERVES AS A REFERRAL CENTER OF PH facilities
 THREE LEVELS OF HEALTH CARE
SERVICES the 2 WAY REFERRAL SYSTEM

TERTIARY
-rendered by SPECIALISTS in medical centers, regional hospitals,
and specialized hospitals such as lung center of the phils.
- REGIONAL MEDICAL CENTERS AND TRAINING HOSPITALS
- -NATIONAL HEALTH SERVICES AND TRAINING AND TEACHING HOSPITALS
- -serves as a referral center of secondary health facilities
 HEALTH PROMOTION AND LEVELS
OF DISEASE PREVENTION
1. HEALTH PROMOTION- directed
towards healthy individuals or population,
focusing on the prevention of the emergence of risk factors.
-→ enhance resources directed at improving well being
 Applicable to the following levels:
 INDIVIDUAL – increasing the awareness on the importance of a healthy
lifestyle, providing health education on its maintenance and giving support to
sustain change of behaviour towards health lifestyle and good personal habit

 FAMILY- Soliciting support from the family for the lifestyle changes by changing their
beliefs and practices

 COMMUNITY- deals with making healthy lifestyle behaviour a norm in the community
 ENVIRONMENT- Promotion of proper environmental sanitation and the reduction
of pollution
EXAMPLES OF HEALTH PROMOTION:

PROPER NUTRITION, REGULAR

EXERCISE, VECTOR CONTROL,
PROVISION OF SAFE WATER
SUPPLY, AND WASTE DISPOSAL
SYSTEM
 PRIMARY LEVEL OF DISEASE
PREVENTION
 Prevention of problems before they occur
 Directed towards people who are at risk of developing disease
 PRIMARY LEVEL OF DISEASE
PREVENTION
 EXAMPLES:

IMMUNIZATION, FOOD
SUPPLEMENTATION, AND
MALARIA CHEMOPROPHYLAXIS
 SECONDARY LEVEL OF DISEASE
PREVENTION
 Directed towards individuals in the subclinical stage, asymptomatic stage of
disease
 Aims to diagnose and treat existing health problems at earliest possible time
and to limit disabilities attributed to it.
 Early detection and prevention
 SECONDARY LEVEL OF DISEASE
PREVENTION
 EXAMPLES:

Screening, casefinding,
surveillance, and treatment of
communicable diseases
 TERTIARY LEVEL OF DISEASE
PREVENTION
 Directed towards individuals in A PATHOGENIC stage of disease
 DEALS WITH THE REDUCTION OF THE MAGNITUDE AND SEVERITY OF RESIDUAL
EFFECTS OF COMMUNICABLE DISEASE AND NON COMMUNICABLE DISEASE
 Correction and prevention of deterioration of a disease state.
 TERTIARY LEVEL OF DISEASE
PREVENTION
 EXAMPLES:

REHABILITATION OF POST
STROKE PATIENT, CONTROL OF
SPREAD OF MEASLES/ DENGUE
DURING AN EPIDEMIC
UNIVERSAL HEALTH CARE
 UNIVERSAL HEALTH CARE (UHC), ALSO
REFERRED TO AS KALUSUGAN
PANGKALAHATAN (KP)
 is the “provision to every Filipino of
the highest possible quality of health
care that is accessible, efficient,
equitably distributed, adequately
funded, fairly financed, and
appropriately used by an informed and
empowered public”
 The Aquino administration puts it as the
availability and accessibility of health
services and necessities for all Filipinos.
 It is a government mandate aiming to
ensure that every Filipino shall receive
affordable and quality health
benefits.This involves providing adequate
resources – health human resources,
health facilities, and health financing.
UHC’S THREE THRUSTS
 1) Financial risk protection through expansion in enrollment and benefit
delivery of the National Health Insurance Program (NHIP);
 2) Improved access to quality hospitals and health care facilities; and
 3) Attainment of health-related Millennium Development Goals (MDGs).
1. FINANCIAL RISK PROTECTION

 Protection from the financial impacts of health care is attained by making any
Filipino eligible to enroll, to know their entitlements and responsibilities, to
avail of health services, and to be reimbursed by PhilHealth with regard to
health care expenditures.
2. IMPROVED ACCESS TO QUALITY
HOSPITALS AND HEALTH CARE FACILITIES
 Improved access to quality hospitals and health
facilities shall be achieved in a number of
creative approaches.
 First, the quality of government-owned and
operated hospitals and health facilities is to be
upgraded to accommodate larger capacity, to
attend to all types of emergencies, and to handle
non- communicable diseases.
 The Health Facility Enhancement Program (HFEP) shall provide funds to
improve facility preparedness for trauma and other emergencies. The aim of
HFEP was to upgrade 20% of DOH- retained hospitals, 46% of provincial
hospitals, 46% of district hospitals, and 51% of rural health units(RHUs) by end
of 2011.
3. ATTAINMENT OF HEALTH-RELATED
MDGS
 Further efforts and additional resources are to be applied on
public health programs to reduce maternal and child
mortality, morbidity and mortality from Tuberculosis and
Malaria, and incidence of HIV/AIDS. Localities shall be
prepared for the emerging disease trends, as well as the
prevention and control of non- communicable diseases.
 The organization of Community Health Teams (CHTs) in each
priority population area is one way to achieve health-related
MDGs. CHTs are groups of volunteers, who will assist families
with their health needs, provide health information, and