1.
HEALTH
“State of complete physical, mental and social well-being, not merely the absence of disease or infirmity”
•
Political a.
safety
b.
oppression
c.
peo people ple empo empow werm erment ent
Major contributor to the overarching goal of poverty reduction
•
2.
Determinants of Health •
Affected by a combination of many factors
•
Determined his circumstances and environment
3.
It is inappropriate therefore to blame or credit the persons state of health to himself himself alone because because he is unlikely able to directly control control many of these factors
•
Knowledge of these factors is important in order to effectively promote health and prevent illnesses
•
Factors that make people healthy or not: 1.
Inco Income me and and soc socia iall stat status us
2.
Education
3.
Phy Physica sicall envi enviro ronnment ment
4.
Emplo Employm ymen entt and and Wor Worki king ng con condi diti tion onss
5.
Soci Social al supp suppor ortt netw networ orks ks
6.
Culture
7.
Genetics
8.
Pers Person onal al beha behavi vior or and and copi coping ng skill skillss
9.
Health s er ervi ce ces
10.
Gender
4.
5.
S oc ocio-economi c a.
employment
b.
education
c.
housing
Environment a.
air
b.
food
c.
water
d.
urban/rural
e.
noise
f.
radiation
g.
pollution
Behavior a.
culture
b.
habits
c.
mores
d.
ethnic cu customs
Heredity a.
genetic e nd ndowment i.
defects
ii .
str en engths
i ii .
risks
iv. iv.
fami famili lial al eth ethni nicc raci racial al
PUBLIC HEALTH
6.
•
“Science “Science and Art of preventing preventing disease, prolonging prolonging life, promoting promoting health and efficiency through organized community effort for the sanitation of environment, control of communicable diseases, education of individuals in personal hygiene, organization of medical and nursing services for the early diagnosis and preventive treatment of disease and the development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity”.
Heal Health th Car Caree Del Deliv iver eryy Syst System em a.
Promotive
b.
Preventive
c.
Curative
d.
R eh ehabilita titive
Core business of Public Health FACTORS:
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1.
dis ea ease control
2.
inju injury ry prev reventi entioon
3.
health p ro rotecti on on
4.
Redu Reduce ce chil childd mort mortal alit ityy
4.
heal health th publ public ic poli policy cy
5.
Impr Improv ovee mat mater erna nall heal health th
5.
promot promotion ion of health health and equitab equitable le health health gain gain
6.
Combat Combat HIV/AI HIV/AIDS, DS, malari malariaa and and other other diseas diseases es
7.
Ensu Ensure re envi enviro ronm nmen enta tall sustai sustaina nabil bility ity
8.
Develo Developp a global global partner partnershi shipp for for develo developme pment nt
ESSENTIAL PUBLIC HEALTH FUNCTIONS
Needed to achieve the core business of public health
Following are essential health functions:
OVERVIEW OF THE PUBLIC HEALTH NURSING
1.
Heal Health th situ situat atio ionn monito monitori ring ng and and analy analysi siss
2.
Epidem Epidemiol iologic ogical al surveil surveillan lance/ ce/dise disease ase preve preventi ntion on and control control
3.
Develo Developme pment nt of polici policies es and and planni planning ng in public public heal health th
4.
Strateg Strategic ic manage managemen mentt of health health systems systems and servic services es for popula populatio tionn health health gain
5.
Regula Regulatio tionn and and enforc enforceme ement nt to protec protectt publi publicc health health
6.
Human Human resou resource rcess develo developme pment nt and and planni planning ng in publ public ic health health
7.
Health Health prom promotio otion, n, socia sociall particip participati ation on and and empowe empowerme rment nt
8.
Ensurin Ensuringg the quality quality of of persona personall and popula populatio tionn based based health health servic services es
CHN defined by Freeman:
9.
Resear Research, ch, develo developme pment nt and impleme implementa ntation tion of innova innovativ tivee public public health health solutions
“Service rendered by a professional nurse with communities, groups, families and individuals at home, in health centers, in clinics, in schools and in places of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation”
Public Health Nursing and Community Health Nursing often used interchangeably
PHN defined by WHO: “Special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of total public health programme for the promotion of health, improvement of the conditions in the social and physical environment, rehabilitation of illness and disability”
GLOBAL AND COUNTRY HEALTH IMPERATIVES CHN defined by Jacobson Ongoing changes which exert a number of pressures on the public health system “Nursing practice in a wide variety of community services and consumer advocate areas and in a variety of roles at times including independent practice… community nursing is certainly not confined to public health nursing agencies”
1.
Shifts Shifts in demo demogra graphi phicc and epide epidemio miolog logical ical tren trends ds in disea diseases ses
2.
New techn technolo ologie giess for health health care, care, comm communi unicat cation ion and and informa informatio tionn
3.
Exist Existin ingg and and emer emergin gingg envi enviro ronm nmen ental tal hazard hazardss some some asso associ ciat ated ed with with globalization
The original thrust of Public Health Nursing:
4.
Health re reforms
“Nursing for the health of the entire public/community versus nursing only for the public who are poor”
United Nations General Assembly Standards of Public Health Nursing:
Common vision Poverty reduction and sustainable development in September 2000 Public Health Nursing •
Exemplified by Millennium Development Goals which are based on the fundamental values of freedom, equality, solidarity, tolerance, health, respect for nature and shared responsibility: 1.
Erad Eradica icate te extr extrem emee pove poverty rty and and hung hunger er
2.
Achi Achiev evee unive univers rsal al pri prima mary ry edu educa catio tionn
3.
Promot Promotee gend gender er equalit equalityy and and empowe empowerr wome womenn
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•
Refers to the practice of nursing in national and local government health departments and public schools It is a community health nursing practice in the public sector
Public Health Nurses
•
Refers to the nurses in the local/national health departments or public schools whether their official position title is public health nurse or nurse or school nurse
•
Mandated as the lead agency in health
•
Maintains specialty hospitals, regional hospitals and medical centers
•
PUBLIC HEALTH NURSES •
•
Leaders in providing quality health services to the communities First level of health workers to be knowledgeable about new public health technologies and methodologies
Philippine General Hospital •
•
Maintains provincial health teams made up of DOH representatives to the local health boards and personnel involved in CDC, specifically for malaria and schistosomiasis
Part of national level which provide health care services
Usually the first ones to be trained to implement new programs and apply new technologies Local level (Local Health System)
THE PHILIPINE HEALTH CARE DELIVERY SYSTEM
Major players of the HCDS 1.
•
Provincial government
Private se sector
•
a.
Larg Largel elyy mark market et orie orient nted ed
b.
Health Health care care is is paid paid throug throughh user user fees fees at at the poin pointt of serv service ice
c.
Includ Includes es profit profit and non-pro non-profit fit health health provid providers ers
d.
•
Health centers/RHU
•
Barangay health stations
Incl Includ udes es pro provi vidi ding ng hea health lth servi service cess in i.
Clinics
ii.
Hospitals
iii. iii.
Local Chief Executive Chaired the local health board
Heal Health th ins insur uran ance ce •
2.
Provincial and District hospitals
City/Municipal government
•
e.
Run by LGU
Manufacture of i.
Medicines
ii.
Vaccines
iii. iii.
Medi Medica call supp suppli lies es
iv. iv.
Medica Medicall equi equipm pmen entt
v.
Other Other health health and and nutri nutritio tionn produc products ts
vi. vi.
Resea Research rch and and deve develo lopm pmen entt
vii. vii.
Human Human resourc resourcee develo developme pment nt
Function is mainly to serve as advisory body to the local executive and the sanggunian or local legislative council on health-related matters
PHILIPPINE DEPARTMENT OF HEALTH HISTORICAL BACKGROUND PRE-SPANISH and SPANISH PERIOD
1888
Public sector a.
largel largelyy financ financed ed throu through gh a tax-b tax-based ased budget budgeting ing syst system em at both both national and local levels
b.
health health care care is is genera generally lly give givenn free free at the the point point of of servic servicee
c.
consist consist of the the natio national nal and local local gover governme nment nt agen agencies cies
•
Superior board of health and charity was created by the Spaniards which established a hospital system and a board of vaccination
June 23, 1898 •
Department of Public Works, Education and Hygiene was created by virtue of decree signed by President Emilio Aguinaldo
September 29, 1898 •
NATIONAL LEVEL
Department of Health
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July 1, 1901
General Orders No. 15 established the Board of Health for the City of Manila
•
Act No. 157 created Board of Health for the Philippine Islands, also functioned as the Local Health Board of Manila
April 13, 987 •
December 2, 1901 •
•
Act Nos. 307, 308 established the Provincial and Municipal Boards completing the health organization in accordance with the territorial division of the islands
•
•
October 10, 1991 •
Board of Health for the Philippine Islands became Insular Board of Health
October 26, 1905
EO No. 119 transformed the Ministry of Health back to the Department of Health
RA 7160 (Local Government Code) provided for the decentralization of the entire government; DOH changed its role from one of implementation to one of governance
May 24, 1999
Act No. 1407 abolished the Insular Board of Health and replaced by the Bureau of Health under the Department of Interior
•
Act No. 1487 (1906) replaced the provincial boards of health with district health officers
•
EO No. 102 (Redirecting the Functions and Operations of the DOH) granted the DOH to proceed with its Rationalization and Streamlining Plan. Mandates the DOH to provide assistance to LGU, LGU, people’s organization and other members of civic society in effectively implementing programs, projects and services that will
1915 •
Act No. 2468 transformed the BOH into a commissioned service called the Philippine Health Service
1932
o
Promote the health and well being of every Filipino;
o
Prevent and control diseases among population at risk;
o
•
Act No. 4007 (Reorganization Act of 1932) reverted back the Philippine Health Service into the Bureau of Health and combined the Bureau of Public Welfare under the Office of the Commissioner of Health and Public Welfare
o
Protect individuals, families and communities exposed to hazards and risks; Treat, manage and rehabilitate individuals affected by diseases and disability
1999-2004 PHILIPPINE COMMONWEALTH AND THE JAPANESE OCCUPATION (1935-1945)
Development of Health Sector Reform Agenda
May 31, 1939
ROLES AND AND FUNCTIONS OF DOH (Mandated by the EO No. 102)
•
Commonwealth Act No. 430 created the Department of Public Health and Welfare
ROLE Providing technical and other resource assistance
January 7, 1941 GENERAL FUNCTIONS UNDER THREE SPECIFIC ROLES •
EO No. 317 fully implemented Commonwealth Act No. 430
January 1, 1951 •
Office of the President of the Sanitary District was converted into RHU carrying out 7 basic health services; Maternal and Child Health, environmental Health, CDC, Vital Statistics, Medical Care, Health Education and Public Health Nursing
February 20 1958 •
EO No. 288 effort to decentralize governance of health service. An office of the regional health director was created in 8 regions and all health services were decentralized to the regional, provincial and municipal levels
1970
1.
Lead Leader ersh ship ip in Healt ealthh
2.
Enab Enable lerr and and Capa Capaci city ty Bui Build lder er
3.
Admi Admini nistr strat ator or of of Spec Specifi ificc Serv Servic ices es
VISION The DOH is the leader, staunch advocate and model in promoting Health for All in the Philippines
MISSION •
Restructured Health Care Delivery System was conceptualized, classified health services into Primary, Secondary and Tertiary Tertiary
Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor and shall lead the quest for excellence in health
June 2, 1978 •
PD 1397 renamed the Department of Health to the Ministry of Health
December 2, 1982 •
EO No. 851 created Integrated Provincial Health Office
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GOAL: Health Sector Reform Agenda (HSRA) Health Sector Reform is the overriding goal of the DOH. Support mechanisms will be through sound organizational development, strong policies, systems and procedures, capable of human resources and adequate financial resources
Rationale for Health Sector Reform 1.
Slowin Slowingg down down in the the reduc reductio tionn in the IMR and the MMR
2.
Persistence Persistence of large large variations variations in health health status status across across populatio populationn groups groups and geographic areas
3.
High High bur burde denn from from infec infecti tiou ouss dise diseas ases es
4.
Rising Rising burd burden en from from chro chronic nic and dege degener nerativ ativee disea diseases ses
General Objective: FOURmula ONE for Health is aimed at achieving critical reforms with speed, precision and effective coordination directed at improving the quality, efficiency, effectiveness and equity of the Philippine health system in a manner that is felt and appreciated by
Filipinos, especially the poor.
Specific Objectives: mula One for Health will strive, within the medium term, to: Four mula
• •
5.
6.
Unattended Unattended emerging emerging health risks from environmen environmental tal and and work work related factors
2.
3.
•
Burd Burden en of of dise disease ase is hea heavi vies estt on the the poo poor r
Reason for the existence of the above conditions 1.
•
Secure more, better and sustained financing for health Assure the quality and affordability of health goods and services Ensure access to and availability of essential and basic health packages Improve performance of the health system
Inappropriat Inappropriatee health health delivery delivery system – shown shown by an an inefficient inefficient and poorly targeted hospital system ineffective mechanism for providing public health programs on top of health human resources maldistribution Inadequate Inadequate regulatory regulatory mechanisms mechanisms for health services services resulting resulting to poor poor quality of health care, high cost of privately provided health services, high cost of drugs and presence of low quality of drugs in the market Poor health care financing financing and ineffi inefficient cient sourcing sourcing or or generation generation of funds funds for healthcare
FOURmula ONE for ONE for Health Framework for the implementation of HSRA: FOURmula
Defining the Rules of Engagement: Seven (7) General Guidelines for Health Reform Implementation F1 Rule No.1:
FOURmula ONE for Health will organize the critical reform initiatives into four implementation components, namely, Financing, Regulation, Service Delivery and Governance. F1 Rule No. 2:
The implementation of FOURmula ONE for Health will focus on a few manageable and critical interventions. Such interventions will be identified using the following criteria:
•
Doable given available resources - Critical interventions identified for each
component must be deemed doable given the available time, human and financial resources. •
Sufficient groundwork and buy-in - The chosen interventions must be backed by suffici sufficient ent ground groundwor workk and buy-in buy-in from implem implement entatio ationn partne partners, rs, especially in the development of reform packages for local implementation.
•
Triggers a reform chain reaction - These critical interventions must be able
FOURmula FOURmula ONE for ONE for Health is the implementation framework for health sector reforms
in the Philippines for the medium term covering 2005-2010. It is designed to implement critical health interventions as a single package, backed by effective management infrastructure and financing arrangements.
to trigger a chain of reaction that will spur the implementation of other FOURmula ONE for Health Health interv intervent ention ions, s, within within and across across the four four
components. FOURmula FOURmula ONE for ONE for Health engages the entire health sector, including the public and
private sectors, national agencies and local government units, external development agencies, and civil society to get involved in the implementation of health reforms. It is an invitation to join the collective race against fragmentation of the health system of the country, against the inequity of healthcare and the impoverishing effects of ill-health. With a robust and united health sector, we can win the race towards better health and a brighter future for generations to come.
•
Produces Produces tangible results and generates generates public public support support - These critical
interventions must be able to show tangible results within the immediate and medium terms, which in turn generate support and cooperation from the public;
F1 Rule No. 3:
Goals of FOURmula one for Health Starting the Race with the End in Mind: Four mula mula One for Health Goals and Objectives Over-all Goals:
The implementation of FOUR FOURmula ONE for Health is directed towards achieving the following end goals, in consonance with the health system goals identified by the World Health Organization, the Millennium Development Goals, and the Medium Term Philippine Development Plan: • • •
Better health outcomes More responsive health system More equitable healthcare financing.
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The reforms will be implemented under a sector-wide approach, which encompasses a management perspective that covers the entire health sector and an investment portfolio that encompasses all sources. F1 Rule No. 4:
The National Health Insurance Program (NHIP) will serve as the main lever to effect desired changes and outcomes in each of the four implementation components, where the main functions of the NHIP including including enrollment, accreditation, accreditation, benefit delivery, provider payment and investment are employed to leverage the attainment of the targets for each of the reform components. F1 Rule No. 5:
The functional and financial management arrangements will be defined in terms of specific offices having clear mandates, performance targets and support systems,
within within well-de well-defin fined ed time time frames frames in the implem implement entatio ationn of reform reformss within within each each component.
Governance in local health systems may be improved by undertaking the following strategies:
F1 Rule No. 6:
FOUR-IN-ONE Convergence Sites have to be established. These convergence sites will undertake integrated implementation of FOURmula ONE for Health components in
The functional clustering of teams and assignment of specific Team Leaders shall facilitate implementation, monitoring and supervision in a coordinative manner and shall not, in any way, prejudice the corporate nature of the DOH-attached agencies nor the autonomy of Local Government Units.
appropriately delineated localities or inter-local health zones.
FOURmula ONE for Health LGU Scorecard will be developed and employed to A FOURmula track the progress and compare the performance of various localities or inter-local health zones. F1 Rule No. 7:
The selection of FOUR-in-ONE FOUR-in-ONE Convergence Sites will be governed by the following criteria:
•
•
Willingness of the LGU to participate in the FOURmula ONE for Health implem implement entati ation, on, in terms terms of willin willingne gness ss to provid providee the requisit requisitee counterpart counterpart resources, and willingness willingness to enter into formal national government to local government, inter-local government and government to private private sector sector networ networking king,, partne partnersh rship ip and resour resource ce sharing sharing arrangements; Presence of local initiatives or start-up activities relevant to FOURmula ONE strategies, to include, but not limited to: development of inter-local
•
•
A FOURmula will be FOURmula ONE for ONE for Health Professional Development and Career Track Track will institutionalized where competent and dedicated health personnel will provide quality health services and sound advice to local chief executives with regard to health reforms.
health zones, enrollment of indigents into the social health insurance system, improvement in drug management systems, among others; Relatively high feasibility of success and sustainability, to include factors such as capacity to enter into loans, capacity to absorb investments and sustain the reform process, etc.; and Availabi vailability lity of funds funds from GOP and external external sources sources for capital capital investment requirements.
Carrying out the Game Plan: Winning Strategies to Attain FOURmula FOURmula ONE for ONE for Health ComponentSpecific Objectives
PRIMARY HEALTH CARE AS AN APPROACH TO DELIVERY OF HEALTH CARE SERVICE
PRIMARY HEALTH CARE
Essential health care made universally accessible to individuals and families in the communi community ty by means means of acce accepta ptable ble to them them through through their full participation and at a cost that the community and country can afford at every stage of development
Primary health care was declared during the First International Conference on PHC held in Alma Ata USSR on September 6 – 12, 1978 by WHO with a goal of “Health for All by the year 2000”
Primary Health Care was adopted in the Philippines through LOI 949 signed by Pres. Marcos on October 19, 1979 and has an underlying theme of “Health in the hands of the People by 2020”
F1 Component No. 1: HEALTH FINANCING Objective: The objective of financing reforms under FOUR FOURmula ONE for Health is to
secure more, better and sustained investments investments in health to provide equity and improve improve health outcomes, especially for the poor.
Concept of PHC is characterized by;
F1 Component No.2: HEALTH REGULATION
Partnership and empowerment of the people
PHC is a strategy
Objective: The main objective of health regulation under FOUR FOURmula ONE for Health is
assuring access to quality and affordable health products, devices, facilities and services, especially those commonly used by the poor. F1 Component No. 3: HEALTH SERVICE DELIVERY
which which focuses focuses responsi responsibili bility ty for health health on the individual, his family and the community
PHC includes full participation and active involvement of the community
Objective: FOURmula ONE for Health interventions in service delivery are aimed at
improving the accessibility and availability of basic and essential health care for all, particularly the poor. This shall cover all public and private facilities and services
towards towards the developmen developmentt of self-reli self-reliant ant people, people, capable of achieving an acceptable level of health and well being
F1 Component No.4: GOOD GOVERNANCE IN HEALTH
Objective: The objective of good governance in health is to improve health systems performance at the national and local levels. FOURmula ONE for Health will introduce
interventions to improve governance in local health systems, improve coordination across local health systems, enhance effective private-public partnership, and improve national capacities to manage the health sector.
PHC recognizes the interrelationship between health and the overall political, socio-cultural and economic development of society
Elements/Components of PHC
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1.
Envi Enviro ronm nmen enta tall Sani Sanita tati tion on
a.
Gener General al medi medica call prac practit titio ione ners rs
2.
Cont Control rol of comm commun unic icab able le dise diseas ases es
b.
PHN
3.
Immunization
c.
RSI
4.
Health Ed Educat io ion
d.
RHM
5.
Matern Maternal al and and Child Child Heal Health th and and Fami Family ly Plannin Planningg
6.
Adeq Adequa uate te Foo Foodd and and Prop Proper er Nutri Nutritio tionn
7.
Provis Provision ion of of Medica Medicall Care Care and and Emerg Emergency ency Treat Treatmen mentt
o
8.
Trea Treatm tmen entt of Loca Locally lly End Endem emic ic Dise Diseas ases es
o
9.
Prov Provis isio ionn of Ess Essen enti tial al Dru Drugs gs
LEVELS OF HEALTH CARE AND REFERRAL SYSTEM
Primary Level of Care
o
Strategies
Reorientation and reorganization of the national health care system (RA 7160)
Effective preparation and enabling process for health action at all levels
Mobilization of the people
o
with the end view of providing appropriate solutions leading to self-reliance and self determination
o
Development and utilization of appropriate technology
focusi focusing ng on local local indige indigenou nouss resour resources ces availa available ble in and acceptable to the community
Organization of communities arising from their expressed needs
Increase opportunities for community participation
Development of intra-sectoral linkages with other government and private agencies
Emphasizing partnership
o
Health care provided by the center physicians, PHN, RHM, BHW, BHW, TBAs and others Usuall Usuallyy the first first point point of contact contact between between the commu community nity members and other levels of health facility
Secondary Level of Care o
Devolved to the cities and municipalities
Given by physicians with basic health training Usually given in health facilities either privately owned or government operated such as infirmaries, municipal and district hospitals, out-patient departments of provincial hospitals Serves as a referral center for the primary health facilities Capable Capable of performing performing minor surgeries and perform perform some simple laboratory examinations
Tertiary Level of Care o
o
Rendered by specialists in health facilities including medical centers centers as well well as region regional al and provincial provincial hospitals hospitals and specialized hospitals Referral center for the secondary care facilities
LEVELS OF HEALTH CARE SERVICES
Tertiary level care facilities o
National and Regional Health Services
Framework for meeting the goal of PHC
o
Medical centers
o
Teaching and Training hospitals
Organizational strategy
o
calls calls for active active and contin continuin uingg partne partnersh rship ip among among the commun communitie ities, s, private private and govern governmen mentt agencie agenciess in health health development
Secondary level care facilities o
Provincial / City health services and hospitals
o
Emergency and District hospitals
Four cornerstones/Pillars in PHC 1.
Activ Activee commu communi nity ty part partici icipa pati tion on
2.
Primary level care facilities
Intr Intraa and and Inte Interr-se sect ctor oral al linka linkage gess
3.
Use Use of appr approp opria riate te tech techno nolo logy gy
4.
Suppo Support rt mec mecha hani nism smss mad madee avai availa labl blee
o
RHU
o
Community hospitals & health centers
o
Private practitioners, puericulture centers
o
BHS
Two levels of PHC workers 1.
Villag illagee or Bar Baran anga gayy Heal Health th Wor Worke kers rs
2.
Inte Interm rmed edia iate te Lev Level el Hea Healt lthh Work Worker erss THE PUBLIC HEALTH NURSE
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Qualifications and Functions
The PHN visits the patient
Bag technique
Must be professionally qualified and licensed to practice in the arena of public health nursing
Tool by which the nurse during her visit will enable her to perform a nursing procedure with ease and deftness, save time and effort
Consistent with the nursing law of 2002 (RA 9173)
•
•
–
Inhe Inhere rent nt in the the pra pract ctic icee of of PHN PHN
–
Organi Organizes zes the nursin nursingg servi service ce of of the the local local healt healthh agenc agencyy
•
Minimize if not prevent the spread of any infection
Contain all necessary articles Cleaned very often
Superv Superviso isorr of the midwiv midwives es and and other other healt healthh work workers ers
Well protected
Nursing care function
–
Inhe Inhere rent nt func functi tion on of the the nur nurse se
–
Base Basedd on on the the scien science ce of art art and and cari caring ng
–
Caring Caring for all all level levelss of clie clientel ntelee towar towardd health health prom promoti otion on and and disease prevention
Collaborating and coordinating function
–
Care Care coord coordina inator torss for for commu communiti nities es and and their their mem member berss
–
Establ Establishe ishess linkage linkagess and coll collabo aborati rative ve relati relations onship hipss with with other other health professionals, government agencies, private sectors, NGO’s people’s people’s organizations to address health problems
Arrangement-most convenient
ASSESSING COMMUNITY HEALTH NEEDS
COMMUNITY HEALTH NURSING •
COMMUNITY –
• •
Primary cl client
HEALTH
Health promotion and education function
– –
•
Important points to consider in the use of the bag
Supervisory function
– •
Most important principle
Management function
Activi Activities ties goes goes beyo beyond nd healt healthh teachi teachings ngs and and healt healthh informa informatio tionn campaigns
•
NURSING –
Training function
–
Goal
Means
Initiat Initiates es the the form formula ulatio tionn of staff staff devel developm opment ent and trainin trainingg programs for midwives and other auxiliary workers COMMUNITY
•
Research function
–
•
Group Group of peop people le sharin sharingg common common geogra geographi phicc bounda boundarie ries, s, comm common on value valuess and interest
•
Functi Functions ons with within in a partic particula ularr sociosocio-cul cultur tural al conte context, xt, whic whichh means means that that no two communities are alike
•
Pri ma mary c lilient of CHN
Partici Participat pates es in the cond conduct uct of resea research rch and and utili utilizes zes rese researc archh findings in her practice •
Dis ea ease surveillanc e –
Meas Measur uree the the mag magni nitu tude de of the the problem
–
Meas Measur uree the the eff effec ectt of of the the cont contro roll program
•
–
Has a direct direct influ influenc encee on the the heal health th of the indi individ vidual, ual, familie familiess and sub-populations
–
It is at this this level level that that most most heal health th servi service ce prov provisio isionn occur occurss
Regarde Regardedd as as an organi organism sm with with its its own own stages stages of dev develo elopme pment nt
NURSING PROCEDURES
–
Patient visits the health center Most common is BP measurement
Ma tu tures th through titi me me
Clinic visit
COMMUNITY DIAGNOSIS
•
Done to come up with a profile of local health situation
Home visit –
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Family-nurse contact
Will Will serve serve as a basis basis of health health prog program ramss and and servi services ces to be delivered to the community
•
Starts with determining the health status of the community
PROCESS OF COMMUNITY DIAGNOSIS •
–
Consists of; –
Coll Collec ectin ting, g, org organ aniz izin ingg & synt synthe hesi sizin zingg data data •
–
Analy Analyzi zing ng & inte interp rpret retin ingg hea healt lthh dat dataa •
–
In ord order er to to iden identif tifyy the the diff differ eren entt facto factors rs tha thatt may may directly or indirectly influence the health of the population
–
Seek Seek expl explan anat atio ions ns for for the occu occurr rren ence ce of heal health th needs and problems of the community
Wi llll b ec ecome the bases for developin g a nd nd impl implem emen enti ting ng comm commun unity ity heal health th nursi nursing ng interventions and strategies
Types of Community Diagnosis
•
–
Comp Compre rehe hens nsiv ivee commu communi nity ty dia diagn gnos osis is –
Transport at ati on on s ys ystem
•
Educational level
•
Housing co conditions
Ec on onomi c in indicators •
Povert y l ev evel i nc ncome
•
Employment rate
•
Types ypes of indu industr stryy pre prese sent nt in the the com commu muni nity ty
•
Occu Occupa pati tion on com common mon in the the comm commun unit ityy
Envi Enviro ronm nmen enta tall indi indica cato tors rs •
Phys Physica ical/g l/geo eogr grap aphi hica cal/ l/top topog ogra raph phic ical al characteristics
•
Water supply
•
Waste di disposal
•
Air Air, Wat Water er and and Lan Landd poll pollut utio ionn
Formul Formulatio ationn of of Comm Communi unity ty Health Health Nursin Nursingg Diag Diagnos noses es •
•
•
Cultural fa factors •
Aims Aims to obtain obtain general general informa informatio tionn about about the commun community ity
Variab ariable less that that may may brea breakk up peo people ple into into gro group upss within the community e.q.
Prob Proble lem m Orie Oriente ntedd comm commun unity ity diag diagno nosis sis –
Resp Respon onds ds to a par parti ticu cula larr nee needd
ELEMENTS OF COMPREHENSIVE COMMUNITY DIAGNOSIS 1.
•
DEMO DEMOGR GRAP APHI HIC C VAR VARIA IABL BLES ES –
Total otal popula populatio tionn & Geogr Geograph aphical ical dist distribu ribution tion includi including ng Urba UrbannRural index & Population Density
–
Age Age & Sex Sex com composi positi tion on
–
Select Selected ed vital vital indicat indicators ors e.q. e.q. Grow Growth th rate, rate, CBR, CBR, CDR CDR & Life Life expectancy rate
–
Patt Patteerns rns of migr igratio ationn
–
Popu Popula lati tioon proj rojecti ection on
3.
Note: –
Popu Popula latio tionn group groupss that that need need speci special al atte attent ntio ions: ns: •
Indigenous people
•
Internal refugees
•
Socia Socially lly dislo disloca cated ted group groupss as a resu result lt of of disa disaste sters rs,, calamities & development programs 4.
2.
SOCIO SOCIO-EC -ECON ONOMI OMIC C & CUL CULTU TURAL RAL VARIABL ARIABLES ES –
S oc oci al al indicat or ors •
9 | Pa ge
Communication n et etwork
–
Ethnicity
–
Social class
–
Language
–
Religion
–
Race
–
Poli Politi tica call orie rientat ntatio ionn
•
Cult Cultura urall beli belief efss and and prac practic tices es tha thatt affec affectt heal health th
•
Conc Concep epts ts abou aboutt Hea Healt lthh and and Illn Illnes esss
HEAL HEALTH TH & ILL ILLNE NESS SS PA PATTER TTERNS NS –
Lead Leadin ingg caus causee of mort mortal alit ityy
–
Lead Leadin ingg caus causee of morb morbid idit ityy
–
Lead Leadin ingg caus causee of inf infan antt mort mortal alit ityy
–
Lead Leadin ingg cause cause of mate matern rnal al morta mortali lity ty
–
Lead Leadin ingg cause cause of hosp hospita itall admi admiss ssion ion
HEAL EALTH RESO ESOURCES RCES –
Manpower re resources
–
Ma te terial re res ou our ce ces
5.
POLITI POLITICA CAL/L L/LEAD EADERS ERSHIP HIP PATTERNS TTERNS –
Refl Reflec ects ts the acti action on pote potent ntia iall of the stat statee and and its its peop people le to address the health needs and problems of the community
–
Mirr Mirror orss the the sens sensit itiv ivit ityy of the gover governm nmen entt to the peopl people’ e’ss struggle for better lives
DEMOGRAPHY •
IDENTIFYING COMMUNITY HEALTH NURSING PROBLEMS
Science Science which which deal dealss with with the the stud studyy of the human human popu populati lation’ on’ss –
Size
–
Composition
–
Dist Distri ribu buti tioon in spac spacee
Health Status Problems Increased/de Increased/decrease creasedd morbidity morbidity,, mortality mortality fertility fertility or reduced reduced capability for wellness
SOURCES OF DEMOGRAPHIC DATA -Can be obtained from a variety of sources
Health Resources Problems Lack Lack of or absenc absencee of manpow manpower er,, money money,, materi materials als or institutions necessary to solve health problems
Health Related Problems Existence Existence of social, social, economic, economic, environmen environmental tal and political political factors factors that aggravate the illness-induc illness-inducing ing situations in the community
•
Censuses
•
Sample su surveys
•
R eg egi st str at at io ion sy syst em ems
Two Two ways of assigning people when the census is being taken
De jure •
PRIORITY-SETTING •
Nature of the condition/problem condition/problem presented
–
•
Severit Severityy of the problem problem which which can can be meas measured ured in terms terms of the the proportion of the population affected by the problem
Modifiability Modifiability of the problem
– •
•
People People are are assign assigned ed to the the place place wher wheree they they are phys physica ically lly pres present ent at at the time time of the census regardless of their usual place or residence
POPULATION SIZE
•
Refers Refers to to the number number of of people people in a give givenn place place or or area area at a given given time time
•
Allows Allows the the nurse nurse to to make make compar comparison isonss about about popul populatio ationn change changess over over time
•
Helps Helps ration rationali alize ze the the types types of of health health prog program ramss or interv intervent ention ionss which which are are going to be provided for the community
Probab Probabili ility ty of contro controllin llingg or redu reducin cingg the the effec effects ts posed posed by the the problem
Social concern
–
•
Probab Probabili ility ty of redu reducin cing, g, contr controll olling ing or or eradica eradicatin tingg the prob problem lem
Preventive potential
–
•
De facto
Magnitude of the problem
–
•
Class Classifi ified ed as healt healthh status status,, health health resou resourc rces es or healt healthh relate relatedd problems
Done Done when when peop people le are are assi assign gned ed to the place place wher wheree they they usual usually ly live live regardless of where they are at the time of the census
Perc Percep eptio tionn of the pop popul ulat atio ionn or the com commu muni nity ty as they they are are affected by the problem and their readiness to act on the problem
TWO METHODS IN DETERMINING POPULATION SIZE Method 1
•
Determ Determinin iningg the incr increas easee in the the popula populatio tionn resultin resultingg from from exces excesss of births births compared to deaths
Application of Public Health Tools NATURAL INCREASE
• COMMUNITY HEALTH NURSING •
Nat. increase = no. births – no. of deaths / specified year
Thr ee ee i mp mpor ta tant tools
The health disciplines of
•
Demography
•
Vital st statistics
•
Epidemiology
Differe Difference nce betw between een the the numbe numberr of birth birthss and the numb number er of deat deaths hs occu occurrin rringg in a population in a specified period of time
RATE OF NATURAL INCREASE
•
Diff Differe erenc ncee betwe between en the CBR CBR and and the CDR CDR occur occurrin ringg in a popu popula lati tion on in a specified period of time Rate of Nat. increase = CBR – CDR / specified year
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The sex ratio represents the number of males for every 100 females in the population Method 2
•
Dete Determ rmin inee the increa increase se in the popul populat atio ionn using using data obtai obtaine nedd during during two census periods. This implies that the increase in the size of the population is not merely attributed to excess in births but also the effect of migration
AGE COMPOSITION •
Two ways ways to desc describ ribee the the age age comp composi osition tion of the the popu populat lation ion
MEDIAN AGE ABSOLUTE INCREASE PER YEAR
• •
Divid Divides es the the pop popul ulat ation ion into into two two equa equall parts parts..
Measur Measures es the the number number of of people people that that are are added added to to the popu populat lation ion per per year year.. DEPENDENCY RATIO Abs. Increase/year = Pt – Po / t
•
•
•
Compar Compares es the the number number of of econom economica ically lly depe dependen ndentt with with the econo economic mically ally productive group in the population.
•
Econ Econoomical ically ly depe depend nden entt
where: –
Pt = pop pop.. Size Size at a lat later er time time
–
Po = pop pop.. Siz Sizee at at an an ear earli lier er time time
–
0 – 14
–
t = no. no. of year yearss betw betwee eenn 0 and and time time t.
–
65 and above
Method 2
•
Econ Econoomical ically ly prod produc ucti tive ve –
Withi ithinn 15 – 64 64 age age grou groupp
RELATIVE INCREASE
•
Actu Actual al differ differen ence ce betwe between en the two two census census coun counts ts expre expresse ssedd in percen percentt relative to the population size made during an earlier census
POPULATION DISTRIBUTION
•
The meas measure uress help help the nurs nursee decide decide how how meag meager er resour resources ces can can be justi justifia fiably bly allocated based on concentration of population in a certain place
1.
Urba Urbann-Ru Rura rall distr distrib ibut utio ion n
Relative increase = Pt – Po / Po
•
where: –
Pt = pop popul ulat atio ionn siz sizee at at a lat later er time time
2.
Crowding Index
–
Po = pop popul ulat atio ionn siz sizee at at an an earl earlie ierr tim timee
3.
P op opu lla a ttiio n De ns ns it it y
POPULATION COMPOSITION
Pertaining to population size’s variables such as:
VITAL STATISTICS
•
Refers Refers to to the system systematic atic study study of vital vital events events such such as births births,, illnes illnesses, ses, marriages, divorces/separations and deaths
•
Tool in in estimat estimating ing the the extent extent or or magnitu magnitude de of heal health th needs needs and and probl problem emss in the community
•
Age
•
Sex
•
Occupation
•
Com Common heal healtth ind indic icat atoors
•
Educational level
•
Fertility rates
•
Comm Common only ly des descr crib ibed ed in ter terms ms of its its age age and and sex sex
–
Crud Crudee birt birthh rate rate (CBR (CBR))
•
Nurse Nurse util utilize izess data on age age and sex sex compo composi sitio tionn to decide decide who who among among the the population groups merits attention in terms of health services and programs
–
Gene Genera rall fer ferti tili lity ty rate rate (GFR (GFR))
•
Mortality rates –
Crud Crudee deat deathh rate rate (CD (CDR)
–
Spec Specif ific ic mort mortal alit ityy rat ratee (SM (SMR) R)
–
Caus e of deat h rat e
–
Infa Infant nt mort mortal alit ityy rate rate (IMR (IMR))
–
Mate Matern rnal al mort mortal alit ityy rat ratee (MM (MMR) R)
–
Propo Proporti rtion onat atee morta mortali lity ty rate rate (PMR (PMR))
SEX COMPOSITION
•
To describe the sex composition of the population, the nurse computes for the “sex ratio”
•
Sex Sex rati ratioo comp compar ares es the the no. no. of fem femal ales es in in the the popu popula latio tionn Sex ratio = Number of males / Number of females
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•
–
Swaroops in index
•
Dise Diseas asee deve develo lopm pmen entt does does not not res restt on a sin singl glee caus causee
–
Case ase fa fatali tality ty rate rate (CFR (CFR))
•
Heal Health th cond conditi ition onss resul resultt from from a mult multitu itude de of of factor factorss
Morbidity rate –
Incidence ra rate
–
Prevalence rate
Model that explain the MCT –
Ecolo Ecologi gicc Tri Triad ad/E /Epi pide demi miol olog ogic ic tria triang ngle le
AGENT
• MORBIDITY
Any elem element ent,, substa substance nce or or force, force, eithe eitherr animat animatee or inani inanimat mate. e. The The presen presence ce or absence of which may serve as stimulus to initiate or perpetuate a disease process
•
TEN TEN LEA LEADI DING NG CAUS CAUSES ES OF MORB MORBID IDIT ITY Y No. & Rate/100,000 Population PHILIPPINES, 2002
–
Disease Disease proces processs happe happens ns only only when when the the agent agent comes comes in contact contact with with a suscep susceptibl tiblee host and under under proper proper environ environmen mental tal conditions
•
MORBIDITY (2002)
–
Intrins Intrinsic ic prope property rty of of microo microorga rganis nism m to surv survive ive and and mult multiply iply in the environment to produce disease
HOST
•
Any orga organis nism m that that harbor harborss and prov provide idess nouris nourishme hment nt for for anothe anotherr organi organism sm
•
Charac Characteri teristic sticss of the the host host will will affect affect his his or its its risk risk of expos exposure ure to source sourcess of infection and his or its susceptibility or resistance
•
Intr Intrin insi sicc fac facto tors rs of the the hos hostt –
Genetic
–
Age
MORTALITY
–
Sex
•
Ten Lead Leadin ingg Caus Causes es of Morta Mortali lity ty by Sex Sex Number, Rate/100,000 Population & Percentage Philippines, 2002
–
Ethnic group
–
Physiologic
MORTALITY
–
Immu Immuno nolo logi gicc expe experie rienc ncee (imm (immun uniz izati ation on))
–
Inter Inter-c -cur urre rent nt or prepre-ex exis istin tingg dise diseas asee
–
Human behavior
•
EPIDEMIOLOGY
•
EPIDEMIOLOGY
•
RESISTANCE
•
Study Study of the the occur occurren rence ce and and distrib distributi ution on of heal health th condi conditio tions ns such such as dise disease, ase, deformities or disabilities on human populations
•
Specific
•
Two main ain are areas as of conc concer ernn
–
•
–
Study Study of occurr occurrenc ences es and distrib distributio utionn of of disease diseasess
–
Search Search for the determi determinan nants ts (cau (causes ses)) of the disease disease and its observed distributions
•
Back Backbo bone ne of the the pre preve vent ntio ionn of dise diseas ases es
Epidemiology rests on two important concepts; •
Mult Multip iple le Cau Causati sation on Theor heoryy
•
Leve Levels ls of Preve Prevent ntio ionn of Healt Healthh Prob Proble lems ms
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Non-specific –
Resul Results ts from from an intact intact skin, skin, muco mucous us memb membra rane ne,, reflex reflexes es as lacrimation, coughing, diarrhea or vomiting
–
Can Can be main mainta tain ined ed thro throug ughh pers person onal al hygi hygien enic ic prac practi tice ces, s, enviro environme nmenta ntall sanita sanitation tion,, proper proper nutriti nutrition on and a health healthyy lifestyle
•
COMMUNITY
•
Community as a host –
• Multiple Causation Theory
Resul Results ts from from an an immun immunol olog ogic ic expe experi rien ence ce suc suchh as; immunization or vaccination
Protect Protectss its heal health th by the nurse nurse by incre increasi asing ng its its herd herd immu immunity nity
Herd Immunity –
Proba Probabi bili lity ty of a grou groupp or commu communi nity ty devel develop opin ingg an epidem epidemic ic introduction of an infectious agent
–
It is the the propo proporti rtion on of the the immu immune ness and the the susc suscep eptib tible le in the the group
•
Inte Interr rrup uptt the the chai chainn of of infe infect ctio ionn thro throug ughh environmental manipulation
•
Prev Preven entio tionn of spre spread ad to to huma humann reser reservo voirs irs and and othe other r susceptible human hosts
ENVIRONMENT
• •
•
Prim Primar aryy prev preven entio tionn can can be done done throu through gh;;
Sum total total of all all extern external al condi conditio tions ns and and influe influence ncess that that affect affect the the life life and and development of an organism
–
Pers Persoonal nal surv survei eill llan ance ce
Affect fectss the the agen agentt and and the the hos hostt
–
Quarantine
–
Seg Segrega regati tion on or iso isolati lation on
Three components of environment –
Phy Physica sicall env environ ironm ment •
–
Comp Compos osed ed of the the ina inani nima mate te sur surro roun undi ding ngss e.q e.q.. geophysical conditions or the climate
Heal Health th prom promot otio ionn activ activiti ities es incl includ ude; e; –
Prov Provis isio ionn of of pro prope perr nut nutri riti tion on
–
Safe Safe wate waterr suppl supplyy and and waste waste disp dispos osal al sys syste tem m
Biol Bioloogica gicall en enviro vironm nmen entt •
• –
•
–
Vector control
Make Makess up the the livi living ng thi thing ngss arou around nd us us e.q. e.q. pla plant nt and and animal life
–
Prom Promot otio ionn of of a hea healt lthy hy lif lifes esty tyle le
Human population
–
Good pe personal ha habi ts ts
Soci Socioo-ec econ onom omic ic envi enviro ronm nmen entt •
•
May May be be in in the the form form of leve levell of of eco econo nomi micc development of the community, presence of social disruptions
LEVELS OF PREVENTION OF HEALTH PROBLEM
•
Prom Promot otin ingg heal health th and and Prev Preven entin tingg heal health th pro probl blem emss
•
Make Make up up most most of the the nurs nurse’ e’ss activi activities ties in the the comm communi unity ty
Spec Specifi ificc meas measur ures es incl includ udee pro provi visio sionn of; of; –
Immunization
–
Proph Prophyl ylaxi axiss to vuln vulner erab able le or or at-ris at-riskk grou groups ps
SECONDARY PREVENTION
•
Aims Aims to ident identify ify and and treat treat exist existing ing heal health th probl problems ems at at the earl earliest iest poss possibl iblee time
•
Interve Interventio ntions ns can can still still lead lead to the the contro controll or eradi eradicat cation ion of of the healt healthh proble problem m –
Screening
–
Case finding
–
Dise Diseaase surv survei eill llan ance ce
–
Prom Prompt pt and and app appro ropr pria iate te tre treat atme ment nt
PREVENTION
•
Refer Referss to ident identif ific icati ation on of of pote potent ntial ial probl problem emss
•
Dire Direct cted ed to the the hea healt lthy hy popu popula lati tion on –
Prim Primoordia rdiall prev preven enti tioon • •
–
Focu Focusi sing ng on pre preve venti ntion on of eme emerg rgen ence ce of of risk risk factors
In Comm Commun unic icab able le dise diseas asee con contr trol ol;;
–
Health education on signs and symptoms will enable the client to identify illness and seek early care or treatment
–
Knowledge of risk behaviors that contribute to the spread of the disease may influence patients and the families t o modify this behavior and, thus, assist in the prevention of disease
Specif ic ic pr pr ot otecti on on •
Remov Removal al of of the the risk risk fac facto tors rs or or redu reduct ctio ionn of their their levels
PRIMARY PREVENTION TERTIARY PREVENTION
•
In Com Commu muni nica cabl blee dise diseas asee prev preven enti tion on • –
–
Activi Activities ties on prim primary ary preven preventio tionn are target targeted ed at at interve intervenin ningg before the agent enters the host and cause pathological changes
Limi Limits ts disa disabi bili lity ty prog progre ress ssio ionn –
The nurse nurse attempt attemptss to reduc reducee the magnitu magnitude de or severi severity ty of the residual effects of;
It aims to; • •
stre streng ngth then en the the host host resi resist stan ance ce
•
Inact Inactiv ivat atee the the agen agentt (sou (sourc rcee of of inf infec ectio tion) n)
Infecti ou ous diseases –
13 | P a g e
E.q E.q hea heari ring ng impa impairm irmen entt fro from m fre frequ quen entt ear infections
•
NonNon-co com mmunic unicaable ble dise diseas ases es –
–
Mental ilillness, CV CVD
Day care care cente centers rs and and shel sheltere teredd worksh workshops ops are exampl examples es of of opportunities to achieve the objective of tertiary prevention in mental illness and drug abuse
– •
PHASES
1.
Desc Descri ript ptiv ivee epid epidem emio iolo logy gy •
2.
ASPECT 1
•
SENSITIVITY
•
4.
•
Atte Attemp mpts ts to anal analyz yzee the the caus causes es or dete determ rmin inan ants ts of dise diseas asee through hypothesis testing
Interv Intervent ention ion or Experi Experimen mental tal epidem epidemiolo iology gy
•
Answer Answerss quest question ionss about about the effect effective ivenes nesss of new method methodss for for controlling diseases or for improving underlying conditions
Eval Evalua uati tion on epid epidem emio iolo logy gy •
Should Should cons conside iderr the the sensit sensitivi ivity ty and and spec specific ificity ity of the the tests tests
•
Anal Analyt ytic ical al epid epidem emio iolo logy gy •
3.
Conc Concer erne nedd with with disea disease se distr distrib ibut utio ionn and and frequ frequen ency cy
Scre Screen enin ingg & Case Case Findi inding ng –
THE EPIDEMIOLOGICAL APPROACH
•
Done Done to look look for for previ previous ously ly unid unident entifie ifiedd cases cases of disea diseases ses
Atte Attemp mpts ts to measu measure re the the effe effect ctiv iven enes esss of diff differ eren entt heal health th services and programs
–
Proporti Proportion on of of perso persons ns with with a disea disease se who who test test posi positive tive on a screening test
–
Measure Measuress the probab probabili ility ty of of the the test test corre correctl ctlyy ident identify ifying ing a positive case of a disease
SPECIFICITY
–
Proporti Proportion on of of a pers persons ons withou withoutt a disea disease se who who have have negativ negativee results on a screening test
–
Measure Measuress the probab probabili ility ty of correc correctly tly iden identify tifying ing non-cas non-cases es
ATTACK RATE
–
Used to calc calculat ulatee an identif identifiab iable le popu populat lation ion expose exposedd to an infectious agent
–
Repres Represent entss the the incid incidenc encee of the illness illness among among the the expo exposed sed population
–
Freque Frequently ntly used used in surv surveill eillanc ancee and and contro controll of comm communi unicab cable le diseases
–
ASPECT 2
DESCRIPTIVE EPIDEMIOLOGY EPIDEMIOLOGY
II. Aspects involved in descriptive epidemiology
Descri Descriptio ptionn of of the the disea disease/ se/con condit dition ion as to pers person, on, place place and and time time characteristics –
After After the dise disease ase or con condi diti tion on has has bee beenn iden identi tifie fiedd with with reasonable certainty; the number of persons who possess the disease are recorded noting down the;
1.
Observation Observation and recording recording of of existing existing patterns patterns of occurrence occurrence of the the health health condition under study
2.
Descrip Descriptio tionn of the disea disease/ se/con conditi dition on as to perso person, n, place place and and time characteristics
•
Char Charac acte teri rist stic icss of the the affl afflic icte tedd per perso sons ns
3.
Analysis Analysis of of the general general pattern pattern of occurrenc occurrencee of the disease disease or conditio conditionn
•
Time ime the the dis disea ease se was was ini initi tial ally ly rec recog ogni nize zedd
•
ASPECT 1
•
Char Charac acte teris ristic ticss of of the the pla place ce wher wheree the the cases cases came came from
I.
Observ Observatio ationn and and record recording ing of exis existing ting patter patterns ns of of occur occurren rence ce of of the the healt healthh condition under study
In order to describe the occurrence of disease condition; the nurse needs to recognize or identify the disease with reasonable certainty •
•
ASPECT 1
•
SCREENING –
•
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ASPECT 2
1.
Herd Immunity
–
Basis for determining the community’s reaction against disease invasion since it represents the immunity and susceptibility levels of individuals comprising the population
–
The immu immunity nity level level is inve inverse rsely ly propo proportio rtional nal to susce susceptib ptibili ility ty level
Done by conducting –
Screening
–
Cas e finding acti vi vities
Presum Presumptiv ptivee identi identific ficatio ationn of unreco unrecogni gnized zed dise diseases ases or defec defects ts through the application of diagnostic tests or laboratory examinations and clinical assessment
CASE FINDING
•
2.
EXPO EXPOSU SURE RE or CONT CONTAC ACT T RATE RATE
–
Represents opportunities for progressive opportunities for progressive transfer or transmission of an infectious agent to a susceptible host and depends on the; •
Frequ en ency of c on ontact
•
Facil acilit ityy of tran transm smis issi sioon
3.
CHANCE –
Char Charac acte teris ristic ticss of the the indiv individ idua uall who were were expo expose sedd and who contacted the infection or the disease
•
Feat Feature ures, s, fac factor tor or or condi conditio tions ns whi which ch exi existe stedd in or or described the environment in which the disease occurred
Proba Probabi bili lity ty of cont contac actt betw betwee eenn the the –
–
•
•
Source of of in infection
•
Susceptible ho host
Place
Depends upon the •
Numb Number er of sour source cess of infe infect ctio ionn
•
Number of immunes
•
Loca Locati tion on of the the sou sourc rcee of of inf infec ecti tion on
•
Patterns of occurrence and distribution
•
Sporadic
– •
Inter Intermi mitt tten entt occu occurre rrenc ncee (rab (rabies ies))
Endemic occurrence
Disease occurrence can be described by the following: – A)
Contin Continuou uouss occu occurre rrence nce throug throughou houtt a period period of time time
Short Short time time fluct fluctuat uation ionss commo commonn in epid epidemi emics cs –
–
Comm Common on sourc sourcee epidem epidemic ic – char charac acte teriz rized ed by simul simulta tane neou ouss exposu exposure re of a large large number number of suscep susceptib tible le to a common common infectious agent Pro Propaga pagate tedd epide pidem mic – caus caused ed by a pers person on-t -too-pe pers rson on transmission of disease agent
B)
Cyclic Cyclic variation variation – refers to recurren recurrentt fluctuation fluctuationss of disease disease that may may exhibit exhibit cycles lasting for certain periods
C)
Secular Secular variation variation – refers refers to change changess in disease disease frequency frequency over over a period of many years
•
ASPECT 3
3.
Analysis Analysis of of the general general pattern pattern of occurrenc occurrencee of the disease disease or conditio conditionn
•
–
–
•
Disease frequency
•
Dise Diseas asee dist distri ribu buti tion on in in a popu popula lati tion on
•
Time
•
P l ac e
•
Person
Correl Correlatin atingg the data data and and formul formulate ate a causal causal asso associa ciation tion between between the •
Disease un under st study
•
Prob Probab able le fact factor orss sur surro roun undi ding ng it
•
Varia ariabl bles es aff affec ectin tingg dis disea ease se dist distri ribu butio tionn
Fi la lari as asis – Sors og ogon
•
Tuberc uberculo ulosi siss – all all spe speci cific fic area areass of the the cou count ntry ry
Unusual Unusually ly large large number number of of cases cases in a relativ relatively ely shor shortt period period of of time
Simult Simultane aneous ous occurr occurrenc encee of epidem epidemic ic of of the same same disea disease se in in several countries
Sets of interventi interventions ons put together to operationa operationalize lize policies policies and standards standards directed towards the prevention prevention of certain certain public public health health problems
Family Health
Non-communicable Non-communicable Disease Prevention and Control
Communicable Communicable Disease Prevention and Control
Environmental Health and Sanitation
Other priority health programs
Time
•
15 | P a g e
•
PUBLIC HEALTH PROGRAMS
Definin Definingg the the chara characte cterist ristics ics of the the dise disease ase or cond conditio itionn in relation to
DISEASE DISTRIBUTION
–
Schi Schist stos osom omia iasi siss – Ley Leyte te and and Sam Samar ar
Establishing th the
•
–
•
Pandemic occurrence
–
–
Malaria – Palawan
Epidemic occurrence
–
•
•
Perio Periodd durin duringg whic whichh the the cases cases of the the dise diseas asee bein beingg studied were exposed to the source of infection and the period during which the illness occurred
Sentrong Sigla
Herbal Medicine
Health Emergency Preparedness and Response Program
National Voluntary Blood Services Program
Botika ng Barangay
FAMILY HEALTH
Basic unit of the community
Concerned with the health of the mother, unborn, newborn, infant, child, adolescent and youth, adult men and women and older persons
Persons
Aims to:
Improve the survival, health and well being of mothers and the unborn
Prenatal visits
1st visit
Prenatal
2nd visit
During the 2nd trimester
Natal
3rd visit
During the 3rd trimester
Postnatal stages
Every two
After 8th month of pregnancy till delivery
weeks
Reduce morbidity and mortality rates:
Children 0-9 years old
Among Filipino adults and older persons and improve quality life
MICRONUTRIENT SUPPLEMENTATION Dose
Schedule
Tasked to reduce MMR by three quarters by 2015 to achieve MDG
CAUSE
Other Complications related to pregnancy occurring in the course of labor, delivery and puerperium Hypertension complicating pregnancy, childbirth and puerperium (25%)
60mg/400 ug Daily tablet
Recommended Schedule Schedule for Post Partum Care Visits
1st visit
2nd visit
1st week post partum preferably 3-5 days
6 weeks post partum
Postpartum hemorrhage (20.3%)
Pregnancy with abortive outcome (9%)
Hemorrhage related to pregnancy
Strategic thrusts for 2005-2010
Launch and implement Basic Emergency and Obstetric Care (BEMOC) strategy in coordination with DOH
Entails establishment of facilities that provide emergency obstetric care for every 125,000 population and which are located strategically
FAMILY PLANNING PROGRAM
Annual Population Growth
Population expected to double in 29 years
Total fertility rate
Pregnant women should have at least four (4) prenatal visits
Reduce women’s exposure to health risks
Institutionalization of responsible parenthood parenthood
Resource generation and allocation for health services
ANTENATAL ANTENATAL REGI STRATION Married women
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3.5 children/woman
3 to 4 million getting pregnant/year
85% expected to progress full term
National Demographic and Health Survey (2003)
Stakeholders must advocate for health
2.36%
Improve quality of prenatal and postnatal care
2x a week starting on the 4th Do not give Vitamin A month of pregnancy before 4th month of pregnancy. pregnancy. It might cause congenital problems in the baby
Maternal Mortality Rate (2003) Iron
Remarks
Mortality from preventable causes among adolescents and young people Vitamin A 10,000 IU
As early in pregnancy as possible before four months or during the first trimester
MATERNAL HEALTH PROGRAM
Pre-pregnancy
Period of pregnancy
Vitamins
44% women got pregnant with 1st child ages 20-24
6.1% Ages 15-19
35-39 – highest percentage of using contraceptives
15-19 – lowest percentage
48.8% - use any form of contraceptive method
33.4% - modern method
Cervical secretions as an indicator of fertility
15.5% - traditional method
Checking the presence of secretions daily
51.1% - do not use any form of contraceptive method
Standard days method
FAMILY PLANNING METHODS
Strategic thrusts for 2005-2010
Pursuing the sentrong sigla initiative
Apply REB strategy for immunization immunization
Intensify health education and information campaign
IMCI and BEMOC strategy
Implementation of laws and policies for the protection of newborns
Effective 3 months after the procedure
Hormones – estrogen and progesterone Taken daily PO
Thin sheath of latex
Dual protection from STIs including HIV
Early Childhood Development Act of 2000
Newborn Screening Act of 2004
EO 286, Bright Child Program
Synthetic hormone – progestin which suppresses ovulation, thickens cervical mucus
EO 51, Milk Code
Rooming-in and Breastfeeding Act
LAM
Postpartum method of postponing pregnancy based on physiolog physiological ical infertili infertility ty experience experienced d by breast breast feeding feeding women
Infant and Young Child Feeding (IYCF)
Global Strategy for IYCF issued jointly by the WHO and UNICEF in 2002 as endorsed by t he World Health Assembly in May 2002 and the UNICEF Executive Board in September 2002
Strategy calls for the:
Effective only for a maximum of 6 months postpartum
Mucus/Billings/Ovulation
Abstaining from SI during fertile days
Promotion of breastmilk as the ideal food for the healthy growth and development of infants
Can not be used used by woman woman with with unusua unusuall diseas disease e or condition that results in extraordinary vaginal discharge that makes observation difficult
Exclusive breastfeeding for the first 6 months of life
Injectables
Main goal is to reduce morbidity and mortality rates for children 0-9 years old
Male condom
Vas Vas deferens is tied and cut or blocked through a small small opening on the scrotal skin (Vasectomy)
CHILD HEALTH PROGRAMS
Pill
Cutting or blocking two fallopian tubes (BTL)
Male sterilization
Overall objective:
BBT
Users with menstrual cycle between 26 and 32 days are counse counseled led to absta abstain in from from SI on days days 8-19 8-19 to avoid avoid pregnancy
Female sterilization
Simple fertility awareness based method
Identifying the fertile and infertile period by daily taking and recording rise in BT during and after ovulation
Temp is taken taken 3 hours hours of undist undisturb urbed ed rest rest (usual (usually ly morning)
Improve Improve the survival survival of infants infants and young children children by improving their nutritional status, G & D through optimal feeding
National Plan of Action for 2005 – 2010 for IYCF
Sympto-thermal method GOAL
Combination of BBT and Billing/Mucus method
Two day method
17 | P a g e
OBJECTIVE
Reduce Child Mortality Rate by 2/3 by 2015
Improve health and nutrition status of infants and young children
Schools
Introducing the “breastfeeding culture”
OUTCOME Laws that protects IYCF
Improve exclusive and extended breast feeding and complementary feeding
Specific Objectives
EO 51, Milk Code
Rooming-in and Breastfeeding Act of 1992
RA 8976, Food Fortification Law of 2000
70% of newborns are initiated to breastfeeding within one hour after birth
60% of infants are exclusively breastfed up to 6 months
90% of infants are started on complementary feeding by 6 months of age
General principles which apply in vaccinating children
Median duration of breastfeeding is 18 months
Safe and immunologically effective to administer all EPI vaccine on the same day at different sites of the body
Measles vaccine should be given as soon as the child is 9 months old
EXPANDED PROGRAM IMMUNIZATION
Key messages on IYCF
Initiate breastfeeding within 1 hour after birth
Exclusive for the first 6 months of life
Complemented at 6 months, excluding milk supplements
Extend breastfeeding up to 2 years and beyond
9 months – 85% protection
1 year above – 95% protection
Vaccin Vaccination ation schedule should not be restarted restarted from the beginning beginning even if the interval between doses exceeded the recommend recommended ed interval by months or years
Moderate Moderate fever, fever, malnutriti malnutrition, on, mild respiratory respiratory infection infection,, cough, cough, diarrhea and vomiting are not contraindicated to vaccination; unless the child is so sick that he needs to be hospitalized
Absolute contraindications to immunizations are:
National IYCF strategy
Health Facilities
Mother-baby friendly hospitals Health workers
DPT2 or DPT3 to a child who has had convulsions or shock within 3 days the previous dose
Vaccin Vaccines es containin containing g the whole whole pertussis pertussis component component shou should ld not not be give given n to chil childr dren en with with an evol evolvi ving ng neurological disease
Live Live vacc vaccin ines es like like BCG BCG must must not not be give given n to immunosuppressed due to malignant disease (child with clinical disease), therapy with immunosuppressive agents or irradiation
Advocates Protectors Promoters of IYCF Enforcers of laws, not violators
Family/Community
Supportive family
Milk Code “vigilantes”
Lay/Peer counselors
IYCF “bayanihan” spirit
Mother-baby friendly public places
Maternity leave
Lactation/Breastfeeding room
Breastfeeding breaks
Industry
18 | P a g e
Comply with the “Code”
Giving doses of vaccine at less than the recommended 4 weeks weeks interv interval al may lessen lessen the antibo antibody dy respon response. se. Lengthening the interval between doses of vaccines leads to higher antibody levels
No extra doses must be given to children who missed a dose of DPT/HB/OPV/TT
Strictly follow the principle of never, ever reconstituting the freeze dried vaccines in anything other t han the diluents supplied with them
Working places
Safe and effective effective with mild side effects after vaccinati vaccination. on. Local Local reaction, reaction, fever and systemic systemic symptoms symptoms can result as part of the normal immune response
Repeat BCG vaccination if the child does not develop a scar after the 1st injection
Use one syringe one needle per child during vaccination
Routine Immunization Schedule for Infants
A child is said to be “Fully Immunized Immunized Child” Child” (FIC) when a child child receives 1 dose of BCG, 3 doses of OPV, 3 doses of DPT, DPT, 3 doses of HB and 1 dose of measles before a child’s 1st birthday
Tetanus Toxoid Immunization Schedule for Women
EPI vaccines and characteristics
OTHER HEALTH PROGRAMS
Occupational Health Program
Health Development Program for Older Persons (Elderly Health)
Persons with Disabilities Program
Prevention of Blindness Program
Rabies Control Program
Safe Motherhood and Women's Health
Adolescent and Youth Health and Development Program
Schistosomiasis Control Program
Botika Ng Barangay
Smoking Cessation Program
Breastfeeding Program / Mother and Baby Friendly Hospital Initiative
Soil Transmitted Helmenthiasis Helmenthiasis
Blood Donation Program
TB Control Program
Child Health
Diabetes Mellitus Prevention Program
LAWS AFFECTING PUBLIC HEALTH
Dengue Control Program
REPUBLIC ACT
Dental Health Program
Doctors to the Barrios (DttB) Program
Emerging Disease Control Program
Environmental Health
Expanded Program on Immunization
Family Planning
Food and Waterborne Diseases Prevention and Control Program
Food Fortification Program
FOURmula One
Garantisadong Pambata
GMA 50 / Parallel Drug Importation (PDI)
Healthy Lifestyle Program
Knock-Out Tigdas
Leprosy Control Program
Malaria Control Program
Measles Elimination Campaign (Ligtas Tigdas)
Republic Act 9288 - Newborn Screening –
National System For Ensuring Newborn Screening
Republic Act 9165 - Danger ous Drugs Act of 2002 -
National Cardiovascular Disease Prevention and Control Program
National Filariasis Elimination Program National Mental Health Program
Natural Family Planning
Newborn Screening
Nutrition
Republic Act 9257 - Expanded Senior Citizens Act of 2003
An Act Granting Granting Additional Additional Benefits and Privileg Privileges es to Senior Citizens Amending for the Purpose Republic Act No. 7432 Otherwise Known As "An Act To Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other Purposes"
Republic Act 7883 - Barangay Health Workers Benefits and Incentives Acts of 1995
An Act Granti Granting ng Benefi Benefits ts and Incent Incentive ives s to Accred Accredit it Barangay Health Workers and for Other Purposes.
Republic Act 6675 - Generics Act of 1988
An Act to Promote, Require and Ensure the Production Of An Adequate Supply, Distribution, Use And Acceptance Of Drugs And Medicines Identified By Their Generic Names
Republic Act 4226 - Hospital Licensure Act
19 | P a g e
An Act Instituting the Comprehensive Dangerous Drugs Act of 2002, repealing republic act no. 6425, otherwise known as the Dangerous Drugs Act of 1972, as amended, providing funds therefor and for other purposes
An Act Promulgat Promulgating ing A Comprehen Comprehensive sive Policy Policy and A
An Act Requiring Requiring the Licensure of all Hospitals Hospitals in the Phili Philippi ppines nes and Autho Authoriz rizing ing the Bureau Bureau of Medica Medicall Services to Serve as the Licensing Agency
Republic Act 3573
Declar Declared ed that that all all commun communica icable ble diseas diseases es shoul should d be reportes to the nearest health station
Republic Act 7305
Magna Carta for Public Health Workers
Aims to promote and improve the social and economic well-being of health workers
Republic Act 7719 - National Blood Services Act of 1994
An Act Promoting Promoting Voluntary Voluntary Blood Blood Donation, Donation, Providing Providing For An Adequate Supply Of Safe Blood Regulating Blood Banks And Providing Penal Ties For Violation Thereof
Republic Act 7875 - National Health Insurance Act of 1995
EXECUTIVE ORDER
For All Filipinos And Establishing The Philippine Health Insurance Corporation For The Purpose
Promulgating Policies And Prescribing Measures For The Prevention Prevention And Control Of Hiv/Aids Hiv/Aids In The Philippines, Philippines, Instit Instituti uting ng A Natio Nationwi nwide de HIV/Ai HIV/Aids ds Inform Informati ation on And Educationa Educationall Program, Program, Establish Establishing ing A Comprehen Comprehensive sive Hiv/Aids Monitoring System, Strengthening The Philippine National Aids Council, And For Other Purposes
Republic Act 8423 - Traditional and Alternative Medicine Act ( TAMA of 1997)
An Act Act crea creati ting ng the the PHIL PHILIP IPPI PINE NE INST INSTIT ITUT UTE E OF TRADITION TRADITIONAL AL AND ALTERN ALTERNAT ATIVE IVE HEALT HEALTH H CARE CARE (PITAHC) (PITAHC) to accelerate the development of traditional and alternative health care in the Philippines, providing for a TRADITION TRADITIONAL AL AND ALTERN ALTERNAT ATIVE IVE HEALT HEALTH H CARE CARE DEVELOPMENT DEVELOPMENT FUND and for other purposes
Republic Act 8749 - Philippine Clean Air Act of 1999
An Act Providing Providing For A Comprehensiv Comprehensive e Air Pollution Pollution
Executive Order No. 102
Implementing the the National Commitment for "Bakuna ang Una Sa Sanggol At Ina", Attaining Attaining World World Health Health Organization's goals to Eliminate Measles and Neonatal Tetanus, Eradicate Polio, Control Hepatitis B and Other Vaccine-Preventable Vaccine-Preventable Diseases
Republic Act 8504 - Prevention and Control of 1988
Executive Order No. 663
An Act Instituting A National Health Insurance Program
Redi Redire rect ctin ing g the the Func Functi tion ons s Department of Health.
and and
Oper Operat atio ions ns
of
the the
Executive Order No. 51
Adopting Adopting a National National Code of Marketing Marketing of Breastmil Breastmilk k Supplements and related products, penalizing violations thereof, and for other purposes.
Executive Order No. 472
Trans Transfer ferrin ring g the Nation National al Nutrit Nutrition ion Counc Council il from from the Department of Agriculture to the Department of Health
PRESIDENTIAL DECREE
Presidential Decree No. 856
Control Policy And For Other Purposes
Republic Act 8344 - An Act Prohibiting the Demand of Deposits or Advance Payments
Presidential Decree No. 522
An Act Prohibiting The Demand Of Deposits Or Advance Payments For The Confinement Or Treatment Of Patients In Hospitals And Medical Clinics In Certain Cases
Republic Act 5921
Code of conduct and Ethical Standards for Public Officials and Employees
20 | P a g e
Respon Responsib sibili ility ty for the delive delivery ry of basic basic servic services es and facilities of the national government has been transferred to the local government
Providing for Compulsory Basic Immunization for Infants and children below eight years of age
Presidential Decree No. 965
A Decree Decree Requirin Requiring g Applicant Applicant for Marriage Marriage License License to Receive Instructions on Family Planning and Responsible Parenthood
Republic Act 7160
Requiring Requiring the Registrati Registration on of Births Births and Deaths in the Philippin Philippines es which which occurred occurred from January 1, 1974 and thereafter
Presidential Decree No. 996
Philippine Food Fortification Act of 2000
Republic Act 6713
Prescribing Sanitation Requirements for the Operation of Establish Establishments ments and Facilitie Facilities s for the Protection Protection and Convenience of the Travelling Travelling Public
Presidential Decree No. 651
An Act Regula Regulatin ting g The Practi Practice ce Of Pharma Pharmacy cy And And Settings Standards Of Pharmaceutical Education In The Philippines And Other Purposes
Republic Act 8976
Code on Sanitation of the Philippines
Presidential Decree No. 384
Amending Republic Act Numbered 4073, entitled an An Act Further Liberaliz Liberalizing ing the Treatmen Treatmentt of Leprosy Leprosy by Amending and Repealing certain Sections of the Revised Administrative Code
Presidential Decree No. 893
Reconstitut Reconstituting ing the National National Schistoso Schistosomiasi miasis s Control Control Commission into the Schistosomiasis Control Council and for other Purposes
Presidential Decree •
Presidential Decree 881 January 30, 1976 Empowering the Secretary of Health to regulate the labeling, sale and distribution of hazardous substances
•
Presidential Decree No. 856 Code on Sanitation of the Philippines (with Implementing Rules and Regulations)
•
Presidential Decree No. 522 Prescribing Sanitation Requirements Requirements for the Operation of Establishments and Facilities for the Protection and Convenience of the Travelling Public
•
Presidential Decree No. 651 Requiring the Registration of Births and Deaths in the Philippines which occured from January 1, 1974 and thereafter
•
•
Presidential Decree No. 996 Providing for Compulsory Basic Immunization for Infants and children below eight years of age Presidential Decree No. 498 Amending sections two, three, four, seven, eight, eleven, thirteen, sixteen, seventeen, twenty-one and twenty-nine of Republic Act No. 5527, also known as the Philippine Medical Technology Technology Act of 1969
•
Presidential Decree No. 965 A Decree Requiring Applicant for Marriage License to Receive Instructions on Family Planning and Responsible Parenthood
•
Presidential Decree No. 1631 Creating the Lunsod ng Kabataan
•
Presidential Decree No. 1823 Creating the Lung Center of the Philippines
•
Presidential Decree No. 384 Amending Republic Act Numbered 4073, entitled an An Act Further LIberalizing the Treatment of Leprosy by Amending and Repealing certain Sections of the REvised Administrative Code
•
Presidential Decree No. 1832 Creating National Kidney Foundation of the Philippines
•
Presidential Decree No. 893 Reconstituting the National Schistosomiasis Control Commission into the Schistosomiasis Control Council and for other Purposes
•
Presidential Decree No. 79 Revising the Population Act of Nineteen Hundred and Seventy-one
for the Purpose Republic Act No. 7432 Otherwise Known As "An Act To Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other Purposes" Republic Act 9211 - Tobacco Regulation Act of 2003 An Act Regulating the Packaging, Use, Sale Distribution and Advertisements of Tobacco Products and for other Purposes Republic Act 7883 - Barangay Health Workers Benefits and Incentives Acts of 1995 An Act Granting Benefits and Incentives to Accredit Barangay Health Workers and for Other Purposes. Republic Act 8203 - Special Law on Counterfeit Drugs" An Act of Prohibiting Counterfeit drugs, Providing Penalties for Violations and Appropriating Funds Thereof Republic Act 6425 - Dangerous Drugs Act of 1972 This Act shall be known and cited as "The Dangerous Drugs Act of 1972." Republic Act 6675 - Generics Act of 1988 An Act to Promote, Require and Ensure the Production Of An Adequate Supply, Distribution, Use And Acceptance Of Drugs And Medicines Identified By Their Generic Names Republic Act 4226 - Hospital Licensure Act An Act Requiring the Licensure of all Hospitals in t he Philippines and Authorizing the Bureau of Medical Services to Serve as the Licensing Agency Republic Act No. 7876 - Senior Citizens Center Act of the Philippines An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges Republic Act 7305 - Magna Carta of Public Health Workers Magna Carta of Public Health W orkers (Republic Act No. 7305) Republic Act 7719 - National Blood Services Act of 1994 An Act Promoting Voluntary Blood Donation, Providing For An Adequate Supply Of Safe Blood Regulating Blood Banks And Providing Penal Ties For Violation Thereof Republic Act 7875 - National Health Insurance Act of 1995 An Act Instituting A National Health Insurance Program For All Filipinos And Establishing The Philippine Health Insurance Corporation For The Purpose Republic Act 7432 - Senior Citizen Act of 1992) An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges Amendment to RA 7170 - Organ Donation Act of 1991 An Act To Advance Corneal Transplantation In The Philippines, Amending Amending For The Purpose Republic Act Numbered Seven Thousand One Hundred And Seventy (R.A. N0. 7170) Otherwise Known As The Organ Donation Act Of 1991 Republic Act 8504 - Prevention and Control of 1988 Promulgating Policies And Prescribing Measures For The Prevention And Control Of Hiv/Aids In The Philippines, Instituting A Nationwide HIV/Aids Information And Educational Program, Establishing A Comprehensive Hiv/Aids Monitoring System, Strengthening The hilippine National Aids Council, And For Other Purposes
Republic Act Republic Act 9288 - Newborn Screening - An Act Promulgating A Comprehensive Policy and A National System For Ensuring Newborn Screening Republic Act 9165 - Dangerous Drugs Act of 2002 - An Act Instituting the Comprehensive Dangerous Drugs Act Act of 2002, repealing republic act no. 6425, otherwise known as the Dangerous Drugs Act of 1972, as amended, providing funds therefor and for other purposes Republic Act 9257 - Expanded Senior Citizens Act of 2003 An Act Granting Additional Benefits and Privileges to Senior Citizens Amending
21 | P a g e
Republic Act 8423 - Traditional and Alternative Medicine Act (TAMA of 1997) An Act creating the PHILIPPINE INSTITUTE OF TRADITIONAL AND AND ALTERNATIVE HEALTH CARE (PITAHC) to accelerate the development of traditional and alternative health care in the Philippines, providing for a TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND and for other purposes Republic Act 8749 - Philippine Clean Air Act of 1999 An Act Providing For A Comprehensive Air Pollution Control Policy And For Other Purposes
Republic Act 8344 - An Act Prohibiting the Demand of Deposits or Advance Payments An Act Prohibiting The Demand Of Deposits Or Advance Payments For The Confinement Or Treatment Of Patients I n Hospitals And Medical Clinics In Certain Cases Republic Act 5921 An Act Regulating The Practice Of Pharmacy And Settings Standards Of Pharmaceutical Education In The Philippines And Other Purposes Republic Act 9165 - An Act Instituting The Comprehensive Dangerous Drugs Act Of 2002, Repealing Republic Act No. 6425, Otherwise Known As The Dangerous Drugs Act Of 1972, As Amended, Providing Funds Thereof, And For Other Purposes Republic Act 7394 The Consumer Act Of The Philippines Philippines Republic Act 8976 Philippine Food Fortification Act of 2000 Republic Act 4688 - An Act Regulating Regulating the Operation and Maintenance Maintenance of Clinical Laboratories and Requiring the Registration of the same with the Department of Health, Providing Penalty for the Violation thereof, and for Other Purposes Republic Act Republic Act 9288 - Newborn Screening - An Act Promulgating A Comprehensive Policy and A National System For Ensuring Newborn Screening Republic Act 9165 - Dangerous Drugs Act of 2002 - An Act Instituting the Comprehensive Dangerous Drugs Act Act of 2002, repealing republic act no. 6425, otherwise known as the Dangerous Drugs Act of 1972, as amended, providing funds therefor and for other purposes Republic Act 9257 - Expanded Senior Citizens Act of 2003 An Act Granting Additional Benefits and Privileges to Senior Citizens Amending for the Purpose Republic Act No. 7432 Otherwise Known As "An Act To Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other Purposes" Republic Act 9211 - Tobacco Regulation Act of 2003 An Act Regulating the Packaging, Use, Sale Distribution and Advertisements of Tobacco Products and for other Purposes Republic Act 7883 - Barangay Health Workers Benefits and Incentives Acts of 1995 An Act Granting Benefits and Incentives to Accredit Barangay Health Workers and for Other Purposes. Republic Act 8203 - Special Law on Counterfeit Drugs" An Act of Prohibiting Counterfeit drugs, Providing Penalties for Violations and Appropriating Funds Thereof
Republic Act 7305 - Magna Carta of Public Health Workers Magna Carta of Public Health W orkers (Republic Act No. 7305) Republic Act 7719 - National Blood Services Act of 1994 An Act Promoting Voluntary Blood Donation, Providing For An Adequate Supply Of Safe Blood Regulating Blood Banks And Providing Penal Ties For Violation Thereof Republic Act 7875 - National Health Insurance Act of 1995 An Act Instituting A National Health Insurance Program For All Filipinos And Establishing The Philippine Health Insurance Corporation For The Purpose Republic Act 7432 - Senior Citizen Act of 1992) An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges Amendment to RA 7170 - Organ Donation Act of 1991 An Act To Advance Corneal Transplantation In The Philippines, Amending Amending For The Purpose Republic Act Numbered Seven Thousand One Hundred And Seventy (R.A. N0. 7170) Otherwise Known As The Organ Donation Act Of 1991 Republic Act 8504 - Prevention and Control of 1988 Promulgating Policies And Prescribing Measures For The Prevention And Control Of Hiv/Aids In The Philippines, Instituting A Nationwide HIV/Aids Information And Educational Program, Establishing A Comprehensive Hiv/Aids Monitoring System, Strengthening The hilippine National Aids Council, And For Other Purposes Republic Act 8423 - Traditional and Alternative Medicine Act (TAMA of 1997) An Act creating the PHILIPPINE INSTITUTE OF TRADITIONAL AND AND ALTERNATIVE HEALTH CARE (PITAHC) to accelerate the development of traditional and alternative health care in the Philippines, providing for a TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND and for other purposes Republic Act 8749 - Philippine Clean Air Act of 1999 An Act Providing For A Comprehensive Air Pollution Control Policy And For Other Purposes Republic Act 8344 - An Act Prohibiting the Demand of Deposits or Advance Payments An Act Prohibiting The Demand Of Deposits Or Advance Payments For The Confinement Or Treatment Of Patients In Hospitals And Medical Clinics In Certain Cases Republic Act 5921 An Act Regulating The Practice Of Pharmacy And Settings Standards Of Pharmaceutical Education In The Philippines And Other Purposes Republic Act 9165 - An Act Instituting The Comprehensive Dangerous Drugs Act Of 2002, Repealing Republic Act No. 6425, Otherwise Known As The Dangerous Drugs Act Of 1972, As Amended, Providing Funds Thereof, And For Other Purposes Republic Act 7394 The Consumer Act Of The Philippines
Republic Act 6425 - Dangerous Drugs Act of 1972 This Act shall be known and cited as "The Dangerous Drugs Act of 1972."
Republic Act 8976 Philippine Food Fortification Act of 2000
Republic Act 6675 - Generics Act of 1988 An Act to Promote, Require and Ensure the Production Of An Adequate Supply, Distribution, Use And Acceptance Of Drugs And Medicines Identified By Their Generic Names
Republic Act 4688 - An Act Regulating Regulating the Operation and Maintenance Maintenance of Clinical Laboratories and Requiring the Registration of the same with the Department of Health, Providing Penalty for t he Violation thereof, and for Other Purposes
Republic Act 4226 - Hospital Licensure Act An Act Requiring the Licensure of all Hospitals in the Philippines and Authorizing Authorizing the Bureau of Medical Services to Serve as the Licensing Agency
Republic Act
Republic Act No. 7876 - Senior Citizens Center Act of the Philippines An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges
22 | P a g e
Republic Act 9288 - Newborn Screening - An Act Promulgating A Comprehensive Comprehensive Policy and A National System For Ensuring Newborn Screening Republic Act 9165 - Dangerous Drugs Act of 2002 - An Act Instituting Instituting the Comprehensive Dangerous Drugs Act Act of 2002, repealing republic act no. 6425, otherwise known as the Dangerous Drugs Act of 1972, as amended, providing funds therefor and for other purposes
Republic Act 9257 - Expanded Senior Citizens Act of 2003 An Act Granting Additional Benefits and Privileges to Senior Citizens Amending for the Purpose Republic Act No. 7432 Otherwise Known As "An Act To Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other Purposes"
Republic Act 8344 - An Act Prohibiting the Demand of Deposits or Advance Payments An Act Prohibiting The Demand Of Deposits Or Advance Payments For The Confinement Or Treatment Of Patients In Hospitals And Medical Clinics In Certain Cases
Republic Act 9211 - Tobacco Regulation Act of 2003 An Act Regulating the Packaging, Use, Sale Distribution and Advertisements of Tobacco Products and for other Purposes
Republic Act 5921 An Act Regulating The Practice Of Pharmacy And Settings Standards Of Pharmaceutical Education In The Philippines And Other Purposes
Republic Act 7883 - Barangay Health Workers Benefits and Incentives Acts of 1995 An Act Granting Benefits and Incentives to Accredit Barangay Health Workers and for Other Purposes.
Republic Act 9165 - An Act Instituting The Comprehensive Dangerous Drugs Act Of 2002, Repealing Republic Act No. 6425, Otherwise Known As The Dangerous Drugs Act Of 1972, As Amended, Providing Funds Thereof, And For Other Purposes
Republic Act 8203 - Special Law on Counterfeit Drugs" An Act of Prohibiting Counterfeit drugs, Providing Penalties for Violations and Appropriating Funds Thereof
Republic Act 7394 The Consumer Act Of The Philippines
Republic Act 6425 - Dangerous Drugs Act of 1972 This Act shall be known and cited as "The Dangerous Drugs Act of 1972." Republic Act 6675 - Generics Act of 1988 An Act to Promote, Require and Ensure the Production Of An Adequate Supply, Distribution, Use And Acceptance Of Drugs And Medicines Identified By Their Generic Names Republic Act 4226 - Hospital Licensure Act An Act Requiring the Licensure of all Hospitals in the Philippines and Authorizing Authorizing the Bureau of Medical Services to Serve as the Licensing Agency Republic Act No. 7876 - Senior Citizens Center Act of the Philippines An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges
Republic Act 8976 Philippine Food Fortification Act of 2000 Republic Act 4688 - An Act Regulating Regulating the Operation and Maintenance Maintenance of Clinical Laboratories and Requiring the Registration of the same with the Department of Health, Providing Penalty for t he Violation thereof, and for Other Purposes Executive Order 102
MALACAÑANG MANILA BY THE PRESIDENT OF THE PHILIPPINES EXECUTIVE ORDER NO. 102
Republic Act 7305 - Magna Carta of Public Health Workers Magna Carta of Public Health Workers (Republic Act No. 7305)
REDIRECTING THE FUNCTIONS AND OPERATIONS OF THE DEPARTMENT OF HEALTH
Republic Act 7719 - National Blood Services Act of 1994 An Act Promoting Voluntary Blood Donation, Providing For An Adequate Supply Of Safe Blood Regulating Blood Banks And Providing Penal Ties For Violation Thereof
WHEREAS, the Department of Health, hereafter referred to as DOH, has been transformed from being the sole provider of health services, to being a provider of specific health services and technical assistance provider for health, as a result of the devolution of basic services to local government units;
Republic Act 7875 - National Health Insurance Act of 1995 An Act Instituting A National Health Insurance Program For All Filipinos And Establishing The Philippine Health Insurance Corporation For The Purpose
WHEREAS, the DOH seeks to serve as the national technical authority on health, one that will ensure the highest achievable standards of quality health care, health promotion and health protection, from which local governments units, non-government organizations, other private organizations and individual members of civil society will anchor their health programs and strategies;
Republic Act 7432 - Senior Citizen Act of 1992) An Act to Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges Amendment to RA 7170 - Organ Donation Act of 1991 An Act To Advance Corneal Transplantation In The Philippines, Amending Amending For The Purpose Republic Act Numbered Seven Thousand One Hundred And Seventy (R.A. N0. 7170) Otherwise Known As The Organ Donation Act Of 1991 Republic Act 8504 - Prevention and Control of 1988 Promulgating Policies And Prescribing Measures For The Prevention And Control Of Hiv/Aids In The Philippines, Instituting A Nationwide HIV/Aids Information And Educational Program, Establishing A Comprehensive Hiv/Aids Monitoring System, Strengthening The hilippine National Aids Council, And For Other Purposes
WHEREAS, to effectively fulfill its refocused mandate, the DOH is required to undergo changes in roles,: functions, organizational processes, corporate values, skills technology and structures; WHEREAS, Section 20, Chapter 7, Title I Book III of Executive Order No. 292 series of 1987, otherwise known as the Administrative Code of 1987, empowers the President of the Philippines to exercise such powers and functions as are vested in him under the law: WHEREAS, Section 78 of the General Provisions of RA 8522, otherwise known as the General Appropriations Act of 1998, empowers the President to direct changes in organization and key positions of any department, bureau or agency; WHEREAS, Section 80 of the same General Provisions directs heads of departments, bureaus and agencies to scale down, phase out or abolish activities no longer essential in the delivery of health services;
Republic Act 8423 - Traditional and Alternative Medicine Act (TAMA of 1997) An Act creating the PHILIPPINE INSTITUTE OF TRADITIONAL AND AND ALTERNATIVE HEALTH CARE (PITAHC) to accelerate the development of traditional and alternative health care in t he Philippines, providing for a TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND and for other purposes
NOW, NOW, THEREFORE, I, JOSEPH EJERCITO ESTRADA, President of the Republic of the Philippines, by virtue of the powers vested in me by law, do hereby order the following:
Republic Act 8749 - Philippine Clean Air Act of 1999 An Act Providing For A Comprehensive Air Pollution Control Policy And For Other Purposes
SECTION 1. Mandate. Consistent with the provisions of the Administrative Code of 1987 and RA 7160 (the Local Government Code), th e DOH is hereby mandated to provide assistance to local government units (LGUs), people's organization (PO) and
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other members of civic society in effectively implementing programs, projects and services that will:
d) Maintain national health facilities and hospitals with modern and advanced capabilities to support local services;
a) promote the health and well-being of every Filipino;
e) Promote health and well-being through public information and to provide the public with timely and relevant information on health risks and hazards;
b) prevent and control diseases among populations at risks; c) protect individuals, families and communities exposed to hazards and risks that could affect their health; and d) treat, manage and rehabilitate individuals affected by disease and disability. SECTION 2. Roles. To fulfill its responsibilities under this mandate, the DOH shall serve as the: a) lead agency in articulating national objectives for health to guide the development of local health systems, programs and services;
d) the resource allocation shift, specifying the effects of the streamlined set-up on the agency budgetary allocation and indicating where possible savings have been generated; f) Develop and implement strategies to achieve appropriate expenditure patterns in health as recommended by international agencies; g) Development of sub-national centers and facilities for health promotion. disease control and prevention, standards. regulations and technical assistance; h) Promote and maintain international linkages for technical collaboration; i) Create the environment for development of a health industrial complex;
b) direct service provider for specific programs that affect large segments of the population, such as tuberculosis, malaria, schistosomiasis, HIV-AIDS and other emerging infections, and micronutrient deficiencies;
j) Assume leadership in health in times of emergencies, calamities and disasters; system fails;
c) lead agency in health emergency response services, including referral and networking systems for trauma, injuries and catastrophic events;
k) Ensure quality of training and health human resource development at all levels or the health care system;
d) technical authority in disease control and prevention;
l) Oversee financing or the health sector and ensure equity and accessibility to health services; and
e) lead agency in ensuring equity, access and quality of health care services through policy formulation, standards development and regulations; f) technical oversight agency in charge of monitoring and evaluating the implementation of health programs, projects, research, training and services; g) administrator of selected health facilities at sub national levels that act as referral centers for local health systems i.e. tertiary and special hospitals, reference laboratories, training centers, centers for health promotion; centers for disease control and prevention, regulatory offices among others;
m) Articulate the national hea1th research agenda and ensure the provision of sufficient resources and logistics to attain excellence in evidenced-based interventions for health. SECTION 4. Preparation of a Rationalization and Streamlining Plan In view of the functional and operational redirection in the DOH and to effect efficiency and effectiveness in its activities, the Department shall prepare a Rationalization and Streamlining Plan (RSP) which shall be the basis of the intended changes. The RSP Plan shall contain the following: a) the specific shift in policy directions. functions, programs and activities/ strategies;
h) innovator of new strategies for responding to emerging health needs; i) advocate for health promotion and healthy life styles for the general population; j) capacity-builder of local government units, the private sector, non-government organizations, people's organizations, national government agencies, in implementing health programs and services through technical collaborations, logistical support, provision of grant and allocations and other partnership mechanisms;
b) the structural and organizational shift stating the specific functions and activities by organizational unit and the relationship of each units; c) the staffing shift, highlighting and itemizing the existing filled and unfilled positions; and d) the resource allocation shift, specifying the effects of the streamlined set-up on the agency budgetary allocation and indicating where possible, savings have been generated.
k) lead agency in health and medical research; l) facilitator of the development of health industrial complex in partnership with the private sector to ensure self-sufficiency in the production of biologicals, vaccines and drugs and medicines; m) lead agency in health emergency preparedness and response; n) protector of standards of excellence in the training and education of health care providers at all levels of the health care system; and o) implementor of the National Health Insurance Law; providing administrative and technical leadership in health care financing. SECTION 3. Powers and Functions. To accomplish its mandate and roles the Department shall: a) Formulate national policies and standards for health; b) Prevent and control leading causes of health and disability; c) Develop disease surveillance and health information systems;
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The RSP shall submitted to the, Department of Budget and Management for approval before the corresponding shifts shall be affected by the DOH Secretary. SECTION 5. Redeployment of Personnel. The redeployment of officials and other personnel on the basis of the approved RSP shall not result in diminution in rank and compensation of existing personnel. It shall take into account all pertinent Civil Service laws and rules. SECTION 6. Funding. The financial resources needed to implement the Rationalization and Streamlining Plan shall be taken from funds available in the DOH, provided that the total requirements for the implementation of the revised staffing pattern shall not exceed available funds for Personnel Services. SECTION 7. Separation Benefits. Personnel who opt to be separated from the service as a consequence of the implementation of this Executive Order shall be entitled to the benefits under existing laws. In the case of those who are not covered by existing laws, they shall be entitled to separation benefits equivalent to one month basic salary for every year of service or proportionate share thereof in addition to the terminal fee benefits to which he/she is entitled under existing laws, SECTION 8. Implementing Authority. Following the approved RSP, RSP, the DOH Secretary, in addition to his authority to implement the RSP is hereby authorized to determine the type of agencies and facilities necessary to carry out the Department's mandate and roles,
including the pilot testing of programs and such-pre corporization of hospitals following strictly the principles of efficiency and effectiveness.
i.
Dise Diseas ase e sur surve veil illa lanc nce e 1.
Meas Measur ure e the mag magni nitu tude de of of the the prob proble lem m
2.
Meas Measur ure e the the eff effec ectt of of the the con contr trol ol program
SECTION 9. Effectivity. This Executive Order shall take effect immediately DONE in the City of Manila this 24th day of May in the year of Our Lord, Nineteen Hundred and Ninety-Nine.
By the President: OVERVIEW OF THE PUBLIC HEALTH NURSING
RONALDO B. ZAMORA Executive Secretary THE PUBLIC HEALTH NURSE
Qualifications and Functions Must be professionally qualified and licensed to practice in the arena of public health nursing Consistent with the nursing law of 2002 (RA 9173) I.
II.
I V.
PHN defined by WHO: “Special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of total public health programme for the promotion of health, improvement of the conditions in the social and physical environment, rehabilitation of illness and disability”
Management function a.
Inhe Inhere rent nt in the the pra practi ctice ce of PHN PHN
b.
Organ Organize izes s the nursin nursing g servic service e of the local local heal health th agency agency
Supervisory function a.
III.
Public Health Nursing and Community Health Nursing often used interchangeably
CHN defined by Freeman: “Service rendered by a professional nurse with communities, groups, families and individuals at home, in health centers, in clinics, in schools and in places of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation”
Superv Superviso isorr of the midw midwive ives s and othe otherr health health work workers ers
Nursing care function
CHN defined by Jacobson
a.
Inhe Inhere rent nt func functi tion on of the the nur nurse se
b.
Base Based d on the the sci scien ence ce of of art and and cari caring ng
“Nursing practice in a wide variety of community services and consumer advocate areas and in a variety of roles at times including independent practice… community nursing is certainly not confined to public health nursing agencies”
c.
Caring Caring for for all all level levels s of clientele clientele toward health health promo promotion tion and disease prevention
Col la la bo bor at at in in g an d c oo oo rd rd in in at at in ing f un unc titi on on
The original thrust of Public Health Nursing:
a.
Care Care coordi coordinat nators ors for for commu communit nities ies and and their their memb members ers
“Nursing for the health of the entire public/community versus nursing only for the public who are poor”
b.
Establish Establishes es linkag linkages es and and colla collaborati borative ve relatio relationshi nships ps with with other other health professionals, government agencies, private sectors, NGO’s people’s organizations to address health problems Standards of Public Health Nursing:
V.
Health pr pr om omotion an and ed educat io ion fu function Public Health Nursing a.
VI.
Activitie Activities s goes goes beyond health health teachin teachings gs and and health health informati information on campaigns
•
Training function •
a.
VII.
Refers to the practice of nursing in national and local government health departments and public schools
Initiates Initiates the formulatio formulation n of of staff staff developme development nt and and training training programs for midwives and other auxiliary workers
Research fu function a.
Participat Participates es in in the the conduct conduct of researc research h and and utili utilizes zes resear research ch findings in her practice
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It is a community health nursing practice in the public sector
Public Health Nurses •
Refers to the nurses in the local/national health departments or public schools whether their official position title is public health nurse or nurse or school nurse
PUBLIC HEALTH NURSES •
•
•
Leaders in providing quality health services to the communities First level of health workers to be knowledgeable about new public health technologies and methodologies Usually the first ones to be trained to implement new programs and apply new technologies
By Jhun Echipare
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