PUBLIC HEALTH NURSING I

(PHN-013).
POLICIES, TRENDS AND ACTS OF PHN

MR. H. BANDA
 COURSE OBJECTIVES

At the end of the course, the student should be

able to:
[Link] public health trends in Zambia, the
region and at international level.
[Link] the organization of public health
services in Zambia.
 Key terms used in PHN
DEFINITION:

• Health: this is a state of complete physical, mental, social

and spiritual well being and not merely the absence of

disease or infirmity(WHO, 1947)

• Public health: It is a field of medicine that is concerned

with safe guarding and improving the physical, mental,

social, and spiritual well being of the community.

 PHN trend, acts & policies cont’
- The science of protecting and improving the
health of communities through education,
promotion of healthy lifestyles, and research for
disease and injury prevention.
• A Nurse: is a person who is trained in the
scientific bases of nursing and meets certain
prescribed standards of education and clinical
competence that enables him/her to provide
services that are essential to promote, maintain,
and restore health.
 Public health trends, acts & polices
Nursing

• It is a profession of health services that is

directed towards the provision of maintenace

health, the prevention and detection of diseases,

the restoration of optimal health of individuals,

families and communities.

 Public health trends, acts & polices

What is Health?

• The World Health Organization (WHO) defined

Health as the state of complete physical,

mental, and social wellbeing and not merely

the absence of disease or infirmity.

 Public health trends, acts & polices

Public health
• Public health can be defined as the science and art of
preventing diseases, prolonging life, promoting health,
restoration of health through use of minimum organized
community efforts for the sanitation of the environment, the
control of communicable diseases and ensure that everyone
has a standard of living adequate for the maintenance of
health.
 Public health trends, acts & polices
• Public Health Nurse: is a professional

who is qualified as a member of the

health care team responsible for the

efficiency of all nursing services in the

area.
 Public health trends, acts & polices

• Public health nursing: it is a branch of nursing

concerned with providing care and health guidance

to individuals in their homes, it combines social

assistance and programs of promotion of health and

improving of the conditions in the physical and

social environment.
 Public health trends, acts and policies

Community: it is a group of individuals and

families living in an area that has boundaries
having common interests. They may have
values and norms shared and they feel they
belong to the same organisation.
 Public health trends, acts and policies

Community health nursing: is a field that is a

blend of primary health care and the nursing
practice with public health nursing. A
community health nurse conducts a
continuing and comprehensive practice that is
preventive, curative and rehabilitative.
 THE COMPONENTS OF PUBLIC HEALTH

There are 4 (Four) main components of public health

These are:
• Health promotion
• Health prevention
• Curative
• Rehabilitation
 A. Health promotion
• According to WHO (2005), Health promotion is the
process of enabling people to increase control over
their health and its determinants, and thereby
improve their health. OR
•According to the American Journal of Health
Promotion (1986), is "the science and art of helping
people change their lifestyle to move toward a state of
optimal health”
 Ottawa Charter for Health
Promotion 1986
The 1st International Conference on Health

Promotion was held in Ottawa in 1986. This

conference resulted in the "Ottawa Charter for

Health Promotion”.
Ottawa Charter for Health Promotion 1986
cont’

•According to this charter, health promotion:

i. "is not just the responsibility of the health sector,
but goes beyond healthy life-styles to well-being"
ii. "aims at making... [political, economic, social,
cultural, environmental, behavioural and biological
factors] favourable through advocacy for health"
iii. "focuses on achieving equity in health"
 Charter 1986 cont’
Iv. "demands coordinated action by all concerned: by
governments, by health and other social and economic
sectors, by nongovernmental and voluntary
organization, by local authorities, by industry and by the
media"

v. "should be adapted to the local needs and possibilities of

individual countries and regions to take into account
 Common health promotion
special areas
Common areas which are addressed by health promotion
specialists:

1. smoking

2. alcohol

3. diet/obesity/exercise

4. sexual health - including STIs, family planning

5. mental health - including suicide prevention

 Health promotion methods
•Many of the health promotion activities are lifestyle campaigns

aimed at dissuading individuals from taking part in behaviour

likely to damage their health. This is done through health
education.

•Health education, health promotion attempts influence local or

national policies relating to health or environmental factors

impinging on the disease, such as introducing legislation to ban
smoking in public places, or discourage under-age drinking.
 Work site health promotion

•Health promotion can be performed in various locations.

Among the settings that have received special attention are
the community, health care facilities, schools, and worksite
health promotion. Workplace health promotion has been
defined as "the combined efforts of employers, employees
and society to improve the health and well-being of people at
work" (WHO, 2009)
 2. Health Prevention
•Prevention means anticipating and averting problems or discovering
them as early as possible to minimise possible disability and
impairment. It focuses on keeping the people healthy.

• Prevention of health problems constitutes a major part of

community health practice
• Health prevention activities often address social determinants of
health which influence modifiable risk behaviors.
 Health prevention cont’
• Modifiable risk behaviors include for example,
tobacco smoking, poor eating habits and lack of
physical activities which contribute to the
development of chronic diseases.
• Social determinants of health are the economic,
social, cultural and political conditions in which
people live that affect their health status
 Levels of prevention
1. Primary prevention:
 refers to interventions aimed at preventing the
occurrence of disease, injury, or disability
(Stanhope and Lancaster, 2007). Interventions at
this level of prevention are aimed at individuals
and groups who are susceptible to disease but are
not yet sick. At this level prevention includes
broad efforts such as health promotion,
environmental protection, and specific
protection. Immunization.
 Levels of prevention cont’
• E.g of primary prevention, growth monitoring
activities for children, fluoridation of water
supplies to prevent dental caries, and actions
taken to reduce exposure to agents that may
cause cancer.
•Primary prevention occurs in homes, in
community health centres, and rural health
clinics.
 Levels of prevention cont’

2. Secondary prevention:

strategies attempt to diagnose or treat an

existing disease in its early stages before it
results in significant morbidity. Health screening
is the main focus of secondary prevention.
 Goals of Secondary prevention
• to identify and detect disease in its earliest stages,
before noticeable symptoms develop, when it is most
likely to be treated successfully. With early detection
and diagnosis, it may be possible to cure a disease, slow
its progression, prevent or minimize complications, and
limit disability.
• to prevent the spread of communicable diseases.
 Levels of prevention cont’
3. Tertiary prevention:
generally consists of the prevention of disease progression and
attendant suffering after it is clinically obvious and a diagnosis
established.
• Tertiary prevention programs aim to improve the quality of
life for people with various diseases by limiting complications
and disabilities, reducing the severity and progression of
disease, and providing rehabilitation (therapy to restore
functionality and self-sufficiency).
 Tertiary prevention cont’
•Tertiary prevention involves actual treatment for the
disease and is conducted primarily by health care
practitioners, rather than public health agencies.

•E.g. Eliminating offending allergens from asthmatic

patients; routine screening for diabetic patients and
preventing reoccurrence of heart attack with anti
clotting medications and physical modalities to regain
function among stroke patients.
 C. Curative services
• These are activities that aim at eliminating the diseases.
Treatment facilities are placed as close to the family as
possible through community health workers and ensuring
that there is availability of essential drugs to treat common
diseases.

• Programs may be developed to correct and control health

conditions through regulations such as how to treat water for
drinking in order to reduce the occurrence of water borne
diseases.
 Curative services cont’

• People can also obtain treatment through referral

to higher level hospitals or more specialized
personnel such as to eye department.

• It focuses on the illness end of the continuum and is

the remedial aspect of community health practice.
 Curative services cont’
This occurs by three methods

1. Direct service to the people with health problems

2. Indirect service that helps people to obtain treatment
3. Development of programs to correct unhealthy
conditions. E g home based care team visiting a lonely
AIDS patient or a group of PHN visiting an old person
during their clinical experience
 D. REHABILITATION
Rehabilitation involves efforts to reduce disability and,
as much as possible, restore function. People whose
handicaps are congenital or acquired through illness or
accident, such as stroke, heart condition, amputation,
or mental illness, can be helped to regain some measure
of lost function or develop new compensating skills.
E.G a factory worker who lost his leg in an industrial
accident received good medical and nursing care,
prosthetic fittings, and physical and occupational
therapy then he assumes an office job.
 Public health trends in Zambia, the region and international

The development of public health in Zambia has been

influenced by the following trends:
1. Demographic trends
2. Social trends
3. Economic trends
4. Health workforce
5. Technological trends
 Public health trends in Zambia, the
region and international
Definition:-Trends
• A trend is a pattern of gradual change in a
condition, output, or process, or an average or
general tendency of a series of data points to move
in a certain direction overtime, represented by a
line or curve on a graph
 Trends influencing Public health in
Zambia
1. Demographic trends

•There has been an increase in the population growth due to the

increase in fertility and reducing mortality rates.

- Increase in the size of the population

• There has been an increase in the population in the country to

about 13,046,508 million. This has resulted from the continued

high fertility rate (5.63 children born per woman) and birth

rates (41.5births/1000 people).

 Trends influencing Public health in Zambia cont’
Characteristics of a population
• There has been an increase in the lifespan of many
Zambians which has been attributed to improved
access to health care with the introduction of free
ARVs which entails that the younger
generation( 52.9%) which was dying at an early age
have now a longer life span and reduced mortality
rate.
• Non communicable disease are becoming more
common than the infectious diseases.
 Trends influencing Public health in
Zambia cont’
2. Social trends

There has been a change in the life styles with

people appreciating more the quality of life they
live through behavioural change and increased
households. Most people are taking
responsibility of their health and preferring to
spend more money on their health.
 Trends influencing Public health in
Zambia cont’
3. Economic trends

There has been a steady increase in household

income which could be attributed to both husband

and wife being engaged in income generating

activities. However the uneven distribution of the

economy resulting in a big gap between those who

get a lot of money and those who hardly get any.

• This has resulted in straining the government
income (Social cash transfers) and also failing
the minimum requirements in the provision of
quality health care. Currently there are more
children below 15 years (46% of the
population) which means more increased
demand on the working force for support and
service provision.
 Trends influencing Public health in Zambia
4. Health work force
cont’
 Due to the increasing need for public health nurses, the government of

Zambia through the Ministry of Health in 2017, planned to train 5000 new

public health workers, (daily mail newspaper, august 10, 2017). To this

effect, more nursing schools are training public health nurses such as at

LUCON

• There is an increase in research studies in nursing which are helping in the

identification of diseases and other problems affecting our communities

and how they can be alleviated.

.
 Trends influencing Public health in
Zambia cont’
5. Technological Trends
•There has been improved technology which provides
positive outcomes and challenges as well. The advancement
in technology has led to improved quality of care through
advanced medical diagnostic test and treatment options,
there is also improved communication which leads to
improved referral system, as you advance there will also be
increased costs to meet these developmental activities.
•The new technology also demand for specialized personnel
to use it and hence nurses need to be re oriented with
certain program in order too function properly.
 Factors Influencing Trends In
Public Health Nursing
• Advanced technology such as use of computers
• Increased literacy levels; more people are educated
and enlightened about their rights.
• Changing roles of women
• Demands of the society
• Changes in medicines
• Increased disease burden
• Environmental degradation
• Globalization
• Rural urban migration.
 NATIONAL HEALTH POLICIES AND STRATEGIES

•Zambia remains a country with a high disease burden which is

under significant pressure to improve health status of the people.
The plan focuses on PHC as a main vehicle of service delivery,
resolving the human resource crises, addressing PH problems and
ensuring that priority systems and services receive the necessary
support.
•National health strategic plan support the national vision 2030,
which expresses the Zambian peoples aspiration to become a
prosperous middle income nation by 2030
National Health Policies And Strategies

• The NHSP 2017-2021 has a transformative agenda

which focuses on building robust and resilient health
systems.
• The plan focuses on delivering quality health services
across the continuum of care which includes,
promotion, prevention, curative, rehabilitation and
palliative care.
 National Public Health Priorities
The National Health Priority Areas (NHPAs) are diseases

and conditions that Zambian governments have chosen

for focused attention because they contribute

significantly to the burden of illness and injury in the

Zambian community (Australian Institute of health and

welfare, 2005). The ministry of health has identified the

following public health priorities for its people:

 National Public Health Priorities cont’

Primary health care services.

• Maternal, neonatal and child health.

• Communicable diseases, especially malaria, HIV and AIDS, STIs and

TB.
• Non-Communicable Diseases (NCDs)

Epidemics control and public health surveillance.

• Environmental health and food safety.

• Health service referral systems.

• Health promotion and education

 Health System Priorities
A health system is the sum total of all the
organizations, institutions and resources whose
primary purpose is to improve health. A health
system needs staff, funds, information, supplies,
transport, communications and overall guidance
and direction. And it needs to provide services
that are responsive and financially fair, while
treating people decently (WHO, 2005).
 The health system priorities include

• Human Resources for Health (HRH).

• Essential drugs and medical supplies.
• Infrastructure and Equipment.
• Health information.
• Health care financing.
 STRATEGIC DIRECTIONS

•A strategic direction is a course of action that leads

to the achievement of the goals of an organization's
strategy. The government want to deliver quality
health service by following six (6) strategic directions
as follows:
1. Service delivery which is divided into three parts:
• i) Primary Care Service
• ii) Hospital Services
• iii) Specialised Support Service
 Strategic Direction cont’

For example:-
a. Health Management Information Systems
b. Health care Financing
c. Leadership and Governance
d. Human resources for health
e. Infrastructure, Equipment and commodities
 THE VISION

Zambians, by 2030, aspire to live as strong and dynamic

middle-income industrial nation that provides
opportunities for improving the well being of all,
embodying values of
• socio-economic justice, underpinned by the principles
of: (i) gender responsive sustainable
development; (ii) democracy; (iii) respect for human
rights; (iv) good traditional and family
values; (v) positive attitude towards work; (vi) peaceful
coexistence and; (vii) private-public partnerships.
 THE PUBLIC HEALTH ACT
•The Public Health Act cap 295 was enacted in 1996 and
has fifteen parts namely; Preliminary

[Link] of public health,

[Link] of infectious diseases,

[Link] and suppression of infectious diseases,

[Link] provision regarding formidable epidemic

disease,

[Link] of spread of small pox,

 CONT’
6. prevention of introduction of diseases,

7. genereal disease and leprosy,

8. sanitation and housing,

9. protection of foodstuffs,

10. water and food supplies,

11. prevention and destruction of mosquitoes,

12. cemeteries, general and finally miscellaneous provisions.

 Organization of public health services in Zambia
CENTRAL HOSPITALS (LEVEL THREE HOSPITALS)

These are: Kitwe, Ndola, UTH, and including

specialist hospitals i.e. Chainama, Kafue gorge
and Authur Davidson and Liteta, Levy
Mwanawasa Hospital. The functions of these
hospitals are;
 To teach and train health staff.
 To provide clinical services at national level
some of which are not provided elsewhere.
 ORGANIZATION OF PUBLIC HEALTH SERVICES
IN ZAMBIA cont’
GENERAL HOSPITALS (LEVEL TWO HOSPITALS)

These are situated in provincial headquarters

and serve as referral hospitals for neighbouring

districts. E.g. Kabwe, Kasama, Livingstone, etc.

they also provide training to health workers.

 ORGANIZATION OF PUBLIC HEALTH
SERVICES IN ZAMBIA cont’

DISTRICT HOSPITALS (LEVEL 1 HOSPITAL) These are

situated in all district of Zambia.

HEALTH CENTRES

Health centre have catchment areas of approximately

30,000 to 50,000 people in urban areas and

approximately 10,000 in rural areas.

 PRIVATE ORGANISATION
PRIVATE ORGANISATION
 Mine hospitals and clinics
 Private hospitals and clinics
 Nursing homes and hospice
 Mission hospitals
1. Specialized health service: Zambia flying doctor service- provides health
care to most in accessible rural areas of Zambia.
2. Occupational health board: takes care of miners.
3. Tropical disease research centre: does research on tropical disease.
4. Food and drug laboratory
5. Cancer centre
6. Blood bank
• THE END
 REFERENCES
• Howard, J. R. (1990). Community Health Nursing. Springhouse:
Springhouse Corporation.
• Gastrell, P. and Edwards, J. (1996). Community Health Nursing, London:
Bailliere Tindall.
• Sheila, T. and Andrews, B. (1996). Community Health Care Nursing:
Principles and Practice. Oxford: Butterworth Heinemann
• Becerra-Posada F. Health equity: the linchpin of sustainable development.
Pan American Journal of Public Health 2015;38(1):5 – 8.
• United Nations general Assembly. Transforming our world : the 2030
Agenda for Sustainable development, New York, 25 sept. 2015
(A/RES/70/1). New York: United Nations. Available from:
[Link]