Community Health NursingCommunity Health Nursing

Joy Colindres,Joy Colindres,RN,MANRN,MAN

Overview of Community Overview of Community Health NursingHealth Nursing

Community Health Nursing as a Community Health Nursing as a Field of Nursing PracticeField of Nursing Practice

Historical PerspectiveHistorical Perspective

Nursing has Nursing has been directed for been directed for a need to reduce a need to reduce pain with comfort pain with comfort measuresmeasures

Influence of Ancient Cultures Influence of Ancient Cultures on Public Healthon Public Health

Egyptians, Hebrew, Greeks, Egyptians, Hebrew, Greeks, RomanRoman

Egyptians CivilizationsEgyptians Civilizations

Built irrigations and granaries for proper Built irrigations and granaries for proper storage of foodsstorage of foods

Practice of prophylaxis by the medicine Practice of prophylaxis by the medicine man and high priestman and high priest

Emphasize on personal hygieneEmphasize on personal hygieneSanitation measures (removal of refuse Sanitation measures (removal of refuse

and fumigation esp. during epidemic)and fumigation esp. during epidemic)

HebrewsHebrews

Founders of public hygieneFounders of public hygieneMoses – Father of SanitationMoses – Father of SanitationMosaic Health Code – focus on individual, Mosaic Health Code – focus on individual,

family and community hygienefamily and community hygienePrinciple of personal hygienePrinciple of personal hygieneEnvironmental sanitationEnvironmental sanitation

Personal Hygiene (rest, hours of Personal Hygiene (rest, hours of work, cleanliness)work, cleanliness)

Environmental HygieneEnvironmental HygieneInspection of foodInspection of foodMethods of disposal of excretaMethods of disposal of excretaDetecting and reporting of diseaseDetecting and reporting of diseasePractice of isolation, quarantine, Practice of isolation, quarantine,

fumigations and disinfectionsfumigations and disinfectionsHandwashingHandwashing

GreeksGreeks

Hippocrates – Father of MedicineHippocrates – Father of MedicineScience of preventive medicinesScience of preventive medicinesIntroduce principles of Introduce principles of

interrelationship physicians and interrelationship physicians and mental healthmental health

“ “ A healthy mind dwells in a A healthy mind dwells in a healthy body.”healthy body.”

RomansRomans

Contributed to the field of sanitationsContributed to the field of sanitationsAppointing public health medicine Appointing public health medicine

officerofficerEstablish hospitals which emphasize Establish hospitals which emphasize

on preventive and curative aspects of on preventive and curative aspects of care care

Development of Public Health Development of Public Health Nursing as a World MovementNursing as a World Movement

Early Christian Period (1Early Christian Period (1stst Century)Century)

Middle AgesMiddle AgesRenaissanceRenaissance

Early 19Early 19thth Century Century

Early Christian Period Early Christian Period (1(1stst Century) Century)

Order of Deaconesses Order of Deaconesses Visiting nurseVisiting nurseForerunners of community health Forerunners of community health

nursesnursesEndeavored to practice the corporal Endeavored to practice the corporal

works of Mercyworks of Mercy

(feeding the hungry, caring for the sick, (feeding the hungry, caring for the sick, burying the dead)burying the dead)

Middle AgesMiddle AgesBeguines of Flanders Beguines of Flanders

worked as nursing sister in the worked as nursing sister in the hospitalhospital

gives care to the sick in their gives care to the sick in their homeshomes

staying with the dying and consoles staying with the dying and consoles the familythe family

RenaissanceRenaissance

St. Vincent the Paul – introduce modern St. Vincent the Paul – introduce modern principles of visiting nursing and social principles of visiting nursing and social servicesservicesTaught that discrimination is harmfulTaught that discrimination is harmfulEmphasized the concept of helping people Emphasized the concept of helping people

help themselveshelp themselvesOrganized Daughters of CharityOrganized Daughters of CharityFamily is the basic unit of serviceFamily is the basic unit of serviceRecognized the importance of supervision of Recognized the importance of supervision of

those who render services of the sickthose who render services of the sick

Early 19Early 19thth Century Century

Pastor Theodor Fliedner – a German Pastor Theodor Fliedner – a German pastor, went on tour to raise fund for a pastor, went on tour to raise fund for a program on social work.program on social work.

Frederika Munster Fliedner – organized Frederika Munster Fliedner – organized Women’s Society for visiting and nursing Women’s Society for visiting and nursing the sick poor in their homesthe sick poor in their homes

Development of Modern Development of Modern Public Health NursingPublic Health Nursing

Period of Empirical Environmental Period of Empirical Environmental Sanitation (1840-1890)Sanitation (1840-1890)

Emphasized measures to control Emphasized measures to control communicable diseases:communicable diseases:Removal of refuse wasteRemoval of refuse wasteClean-up campaigns of prisons and Clean-up campaigns of prisons and

asylumasylumImprovement of working conditions of Improvement of working conditions of

women and childrenwomen and children

Florence Nightingale – “Mother of Florence Nightingale – “Mother of Nursing” - (1873) developed a Nursing” - (1873) developed a model for independent nursing model for independent nursing schools to teach critical thinking, schools to teach critical thinking, attention to patients individual attention to patients individual needs and respect for patient’s needs and respect for patient’s rights.rights.

William Rathborne – Father of William Rathborne – Father of modern district nursing – modern district nursing – organized training school for organized training school for nurses, hospital, private duty, nurses, hospital, private duty, and district nurseand district nurse

Period of Scientific control of Period of Scientific control of communicable diseases (1890-1910)communicable diseases (1890-1910)

Application of Application of bacteriology bacteriology and and immunologyimmunology

Period of Health Education (1910 to Period of Health Education (1910 to present)present)

Emphasized on Emphasized on education for education for prevention of prevention of diseases with diseases with active cooperation active cooperation of individual in of individual in health actionhealth action

Public Health Nursing in the Public Health Nursing in the PhilippinesPhilippines

Pre-Spanish Era – no recordsPre-Spanish Era – no recordsSpanish Regime (1591-1898) Spanish Regime (1591-1898)

Bro. Juan Clemente (1577) – started public Bro. Juan Clemente (1577) – started public health serviceshealth services

Introduction of water sanitationIntroduction of water sanitation Introduction of small pox vaccineIntroduction of small pox vaccineCreation of position of district, provincial and Creation of position of district, provincial and

national health officersnational health officers

American Regime (1898-1946)American Regime (1898-1946)1898 – creation of Board of Health for 1898 – creation of Board of Health for

physiciansphysicians1899 – appointment of the 11899 – appointment of the 1stst

commissioner of healthcommissioner of health1901 – Act No. 157 created Board of 1901 – Act No. 157 created Board of

Health for the City of Manila; Act No. 309 Health for the City of Manila; Act No. 309 created Provincial and Municipal Boards of created Provincial and Municipal Boards of HealthHealth

1905 – Act No. 1407 (reorganization act) 1905 – Act No. 1407 (reorganization act) abolish Board of Health and was taken abolish Board of Health and was taken over by the Bureau of Health under the over by the Bureau of Health under the Department of InteriorDepartment of Interior

1906 – creation of Bureau of Health1906 – creation of Bureau of Health1912 – Fajardo Act (Act No. 2156) created 1912 – Fajardo Act (Act No. 2156) created

Sanitary Division. In the same year public Sanitary Division. In the same year public health nursing in the Philippines started.health nursing in the Philippines started.

1915 – Bureau of Health was renamed 1915 – Bureau of Health was renamed Philippine Health Service; Reorganization Act Philippine Health Service; Reorganization Act No. 2462 – created the office of General No. 2462 – created the office of General Inspection, headed by nurse-physician Dr. Inspection, headed by nurse-physician Dr. Rosario Pastor.Rosario Pastor.

1916 to 1918 – Ms. Perlita Clark took charge of 1916 to 1918 – Ms. Perlita Clark took charge of the public health nursingthe public health nursing

1917 – 4 nursing graduates from Manila were 1917 – 4 nursing graduates from Manila were employed to worked in the city schoolemployed to worked in the city school

1919 1919 Public health nursing was inaugurated in Tondo, Public health nursing was inaugurated in Tondo,

Manila when visiting nurse Ms. Balbina Basa was Manila when visiting nurse Ms. Balbina Basa was assigned to make a house to house visit, hold clinic assigned to make a house to house visit, hold clinic and dispensary work with special emphasis on and dispensary work with special emphasis on maternal and child care. maternal and child care.

Philippine National Red Cross introduced the Philippine National Red Cross introduced the operation of puericulture.operation of puericulture.

The program was later extended to the province The program was later extended to the province incorporation with Bureau of Public Welfareincorporation with Bureau of Public Welfare

Ms. Carmen del Rosario was appointed as Ms. Carmen del Rosario was appointed as the first Filipino nurse under the Bureau of the first Filipino nurse under the Bureau of HealthHealth

1923 – established 2 government schools 1923 – established 2 government schools of nursing: Zamboanga General Hospital of nursing: Zamboanga General Hospital School of Nursing and Baguio General School of Nursing and Baguio General Hospital in Northern Luzon. In later year 4 Hospital in Northern Luzon. In later year 4 more school were establishmore school were establish

1928 – Fist convention of nurses were 1928 – Fist convention of nurses were heldheld

1933 – Reorganization Act No. 4007, the 1933 – Reorganization Act No. 4007, the Division of Maternal and Child Health of Division of Maternal and Child Health of the Public Welfare Commission was the Public Welfare Commission was transferred to the Bureau of Healthtransferred to the Bureau of Health

1940 – The Department of Health and 1940 – The Department of Health and Welfare was createdWelfare was created

Japanese Regime (1942-1945) – Public health Japanese Regime (1942-1945) – Public health nursing were interruptednursing were interrupted

1946 – after world war, the Bureau of Health 1946 – after world war, the Bureau of Health increased the number of public health nurse. increased the number of public health nurse. Mrs. Genara de Guzman, technical assistant in Mrs. Genara de Guzman, technical assistant in nursing of the Ministry of Health and concurrent nursing of the Ministry of Health and concurrent president of Filipino Nurses Association president of Filipino Nurses Association recommended the creation of a nursing office in recommended the creation of a nursing office in the Ministry of Health.the Ministry of Health.

Era of Republic of the Philippines (1949 to Era of Republic of the Philippines (1949 to present)present)

1947 – Reorganization of government 1947 – Reorganization of government offices under EO No. 94: Bureau of Public offices under EO No. 94: Bureau of Public Welfare to the office of the president and Welfare to the office of the president and renamed as Department of Healthrenamed as Department of Health

1953 – the office of Health Education and 1953 – the office of Health Education and Personnel Training was createdPersonnel Training was created

May 18, 1954 – Republic Act 1082 was May 18, 1954 – Republic Act 1082 was passed creating Rural Health Unitspassed creating Rural Health Units

June 1957 – Republic Act 1891 – an act June 1957 – Republic Act 1891 – an act that strengthen health and dental services that strengthen health and dental services in the rural health areain the rural health area

1975 – Formulation of National Health 1975 – Formulation of National Health Plan and the restructured Health Care Plan and the restructured Health Care Delivery SystemDelivery System

1982 – Executive Order No. 851, the health 1982 – Executive Order No. 851, the health education and manpower development service education and manpower development service was created, and Bureau of Food and Drugwas created, and Bureau of Food and Drug

1986 – The Ministry of Health became 1986 – The Ministry of Health became Department of Health againDepartment of Health again

1991 – RA 7160 (Local Government Code). 1991 – RA 7160 (Local Government Code). Devolution – transfer of power from the national Devolution – transfer of power from the national to local government which aimed to built their to local government which aimed to built their capabilities for self-government and developed a capabilities for self-government and developed a self-reliant communities.self-reliant communities.

1993 to 1998 – National League of 1993 to 1998 – National League of Philippine Government Nurses was Philippine Government Nurses was organized organized

1996 – Primary Health Care as a 1996 – Primary Health Care as a strategies to attain Health for all by the strategies to attain Health for all by the year 2000year 2000

1999 – Creation of National Health 1999 – Creation of National Health Planning Committee and Inter-Local Planning Committee and Inter-Local Health Zones through EO 205Health Zones through EO 205

May 24,1994 – EO 102 signed by Pres. Estrada, May 24,1994 – EO 102 signed by Pres. Estrada, redirecting the function and operations of the redirecting the function and operations of the DOH, nursing positions were devolvedDOH, nursing positions were devolved

1999 to 2004 – Health Sector Reform Agenda of 1999 to 2004 – Health Sector Reform Agenda of the Philippines was launchedthe Philippines was launched

2005 – Fourmula One for Health to ensure 2005 – Fourmula One for Health to ensure speed, precision and effective coordination speed, precision and effective coordination towards improving the efficiency, effectiveness towards improving the efficiency, effectiveness and equity of health care deliveryand equity of health care delivery

Definitions and Focus: PHN/CHNDefinitions and Focus: PHN/CHN

Both term are often interchange but Both term are often interchange but synonymoussynonymous

PHN is a synthesis of public and PHN is a synthesis of public and nursing practice. (Freeman)nursing practice. (Freeman)

PHN is a field of professional practice PHN is a field of professional practice in nursing and in public health in in nursing and in public health in which technical nursing, which technical nursing, interpersonal, analytical and interpersonal, analytical and organizational skills are applied to organizational skills are applied to problems of health as they affect problems of health as they affect community. community.

These skills are applied in concert with These skills are applied in concert with those of other persons engaged in those of other persons engaged in health care, through comprehensive health care, through comprehensive nursing care of families and other nursing care of families and other groups and through measures for groups and through measures for evaluation or control of threats to evaluation or control of threats to health, for health education of the health, for health education of the public and for mobilization of the public public and for mobilization of the public for health action.for health action.

Public HealthPublic Health

According to Dr. C.E. WINSLOWAccording to Dr. C.E. WINSLOWPUBLIC HEALTH – is the science and art PUBLIC HEALTH – is the science and art

of preventing disease, prolonging life, of preventing disease, prolonging life, promoting health and efficiency through promoting health and efficiency through organized community effort for the organized community effort for the sanitations of the environment, control of sanitations of the environment, control of communicable diseases, education of communicable diseases, education of individuals in personal hygiene….individuals in personal hygiene….

… … the organization of medical and nursing the organization of medical and nursing services for early diagnosis and preventive services for early diagnosis and preventive treatment of disease, and the development treatment of disease, and the development of the social machinery to ensure of the social machinery to ensure everyone a standard of leaving adequate everyone a standard of leaving adequate for the maintenance of health, so for the maintenance of health, so organizing these benefits as to enable organizing these benefits as to enable every citizen to realize his birthright of every citizen to realize his birthright of health and longevity.health and longevity.

According to WHOAccording to WHOPUBLIC HEALTH – is the art of applying PUBLIC HEALTH – is the art of applying

science in the context of politics so as to science in the context of politics so as to reduce inequalities in health while reduce inequalities in health while ensuring the best health for the greater ensuring the best health for the greater number.number.

Therefore, the core element of Therefore, the core element of governments’ attempts to improve and governments’ attempts to improve and promote the health and welfare of their promote the health and welfare of their citizens.citizens.

Core business of PUBLIC HEALTHCore business of PUBLIC HEALTHDisease controlDisease control Injury preventionInjury preventionHealth promotionHealth promotionHealthy public policy, in relation to Healthy public policy, in relation to

environmental hazardsenvironmental hazardsPromotion of health and equitable health gainPromotion of health and equitable health gain

Essential Public Health FunctionsEssential Public Health Functions

Health situation monitoring and analysisHealth situation monitoring and analysisEpidemiological surveillance/disease Epidemiological surveillance/disease

prevention and controlprevention and controlDevelopment of policies and planning in Development of policies and planning in

public healthpublic healthStrategic management of health systems Strategic management of health systems

and services for population health gainand services for population health gainRegulation and enforcement to protect Regulation and enforcement to protect

public healthpublic health

Human resources development and Human resources development and planning in public healthplanning in public health

Health promotion, social participation and Health promotion, social participation and empowermentempowerment

Ensuring the quality of personal and Ensuring the quality of personal and population based health servicespopulation based health services

Research, development and Research, development and implementation of innovative public health implementation of innovative public health solutionssolutions

Public Health Nursing Public Health Nursing

Made great contributions to the Made great contributions to the improvement of the health of the people improvement of the health of the people

Leaders in providing quality health care Leaders in providing quality health care services to communities.services to communities.

First level of health workers to be First level of health workers to be knowledgeable about new public health knowledgeable about new public health technologies and methodologies.technologies and methodologies.

Usually the first to be trained to implement Usually the first to be trained to implement new programs and apply new technology.new programs and apply new technology.

NURSING UNDER W.H.ONURSING UNDER W.H.O

Demarcates the line of nursing actionDemarcates the line of nursing actionTo serve both well and ill in the communityTo serve both well and ill in the communityRight to medical care and right to nursing care Right to medical care and right to nursing care

are implied in the fundamental human rightsare implied in the fundamental human rightsA changing trend in community care gave A changing trend in community care gave

birth to COMMUNITY HEALTH NURSINGbirth to COMMUNITY HEALTH NURSING

Community Health NursingCommunity Health Nursing

Maglaya, Jacobson, FreemanMaglaya, Jacobson, FreemanUtilization of nursing process for clientele Utilization of nursing process for clientele Concerned with the promotion of health Concerned with the promotion of health

(optimal level of functioning), prevention (optimal level of functioning), prevention disease and disability and rehabilitationdisease and disability and rehabilitation

Achieved through teaching and delivery of Achieved through teaching and delivery of health carehealth care

GOAL: raise the level of health of the GOAL: raise the level of health of the citizenrycitizenry

Philosophy (Dr. Margaret Philosophy (Dr. Margaret Shetland)Shetland)Base on the worth and dignity of Base on the worth and dignity of

humanhuman

Historical background (refer to pp 8-Historical background (refer to pp 8-16)16)

Basic Concept of CHNBasic Concept of CHN

Primary focus on health promotion and Primary focus on health promotion and disease preventiondisease prevention

Extend the benefits not only to individual Extend the benefits not only to individual but the whole family and community and but the whole family and community and special populationspecial population

CH nurse are generalist in terms of their CH nurse are generalist in terms of their practice from womb to tombpractice from womb to tomb

Contact with clients is a long term at all levels of Contact with clients is a long term at all levels of health carehealth care PHC (community)PHC (community) SHC (regional/provincial/district municipal/local hosp.)SHC (regional/provincial/district municipal/local hosp.) THC (sophisticated medical centers)THC (sophisticated medical centers)

CHN practice requires knowledge from CHN practice requires knowledge from biological, social and other related sciencesbiological, social and other related sciences

Continuous nursing process is appliedContinuous nursing process is applied

Basic Principles of CHNBasic Principles of CHN

Recognized needs of communities, Recognized needs of communities, families, groups and individualsfamilies, groups and individuals

CHN nurses has full knowledge of the CHN nurses has full knowledge of the objective and policies of the agency she objective and policies of the agency she represent (facilities goal achievements)represent (facilities goal achievements)Set prioritiesSet prioritiesGoal settingGoal settingObjective should be client centered and Objective should be client centered and

SMARTSMARTAction Action EvaluationEvaluation

Focus care on the familyFocus care on the familyAvailable to all race, creed and socio-Available to all race, creed and socio-

economic status and respect values, economic status and respect values, customs and beliefs of clientcustoms and beliefs of client

Health education and counseling are vital Health education and counseling are vital role of CHNrole of CHN

Collaborative work relationship- Collaborative work relationship- coordinator of health servicecoordinator of health service

Monitoring or periodic evaluation of health Monitoring or periodic evaluation of health services (accurate recording and reporting services (accurate recording and reporting for evaluation purposes)for evaluation purposes)

Opportunities of continuous education Opportunities of continuous education program to upgrade nursing practiceprogram to upgrade nursing practice

Make use of available community health Make use of available community health resources or the indigenous and existing resources or the indigenous and existing community resource appropriate community resource appropriate technologytechnology

CH nurse has active participation in the CH nurse has active participation in the communitycommunity

Role of Public Health NurseRole of Public Health Nurse

The roles are varied and dynamic.The roles are varied and dynamic.It is influenced by the nature of health It is influenced by the nature of health

needs of the population, specific needs of the population, specific goals of the health care system and goals of the health care system and the attitudes and practices of the the attitudes and practices of the nurse in providing care.nurse in providing care.

Clinician (health care provider) – Clinician (health care provider) – takes care of sick people at home or takes care of sick people at home or in the RHU.in the RHU.Home visit Home visit PHN BagPHN Bag

Home visitHome visit

PURPOSEPURPOSEGive nursing care to sick, mothers, and Give nursing care to sick, mothers, and

childrenchildrenAssess living conditionAssess living conditionProvide health educationProvide health educationPromote health and use of referral for Promote health and use of referral for

utilization of community healthutilization of community health

PRINCIPLEPRINCIPLEState purpose and objectiveState purpose and objectiveUse records and reports Use records and reports Give priority to essential needsGive priority to essential needsPlanning and delivery of care involves clientsPlanning and delivery of care involves clientsPlan should be flexiblePlan should be flexible

PHN BagPHN Bag

Essential and indispensable equipment Essential and indispensable equipment which contains basic medication and which contains basic medication and articles necessary for giving care.articles necessary for giving care.Should observe proper bag technique Should observe proper bag technique

principleprinciplePrevent spread of microorganismPrevent spread of microorganismSave time and efforts for nursing procedureSave time and efforts for nursing procedureShould show effectiveness of total care given to Should show effectiveness of total care given to

clientsclients

Case ManagerCase ManagerAssist clients to make decisions Assist clients to make decisions

about appropriate health care about appropriate health care services and to achieve service services and to achieve service delivery integration and delivery integration and coordination coordination

AdvocateAdvocateSeek to promote an understanding of Seek to promote an understanding of

health problems, lobby for beneficial health problems, lobby for beneficial public policy and stimulate supportive public policy and stimulate supportive community action for healthcommunity action for health

Teacher/Health EducatorTeacher/Health EducatorApplication of teaching – learning Application of teaching – learning

principles to facilitate behavioral principles to facilitate behavioral changes among clients changes among clients

Partner/ CollaboratorPartner/ CollaboratorTo get people together in order to To get people together in order to

address problems or concerns address problems or concerns Works with people’s and health Works with people’s and health

organizations educational institutions, organizations educational institutions, socio-civic organizations and sectoral socio-civic organizations and sectoral groupsgroups

Health Planner/ProgrammerHealth Planner/Programmer Identifies needs, priority and problems of Identifies needs, priority and problems of

individual, families and communitiesindividual, families and communitiesFormulates nursing component of health Formulates nursing component of health

plansplans Interprets and implements nursing plans, Interprets and implements nursing plans,

program policies, memoranda and circulars program policies, memoranda and circulars for the concerned staff/personnel and provide for the concerned staff/personnel and provide technical assistancetechnical assistance

Community Organizer/LeaderCommunity Organizer/LeaderResponsible for motivating and Responsible for motivating and

enhancing community participations in enhancing community participations in terms of planning, organizing, terms of planning, organizing, implementing and evaluating health implementing and evaluating health programs and servicesprograms and services

Case Finder/EpidemiologistCase Finder/EpidemiologistLooks for actual or risk problems or Looks for actual or risk problems or

concerns and followed periodically as concerns and followed periodically as they developthey develop

Recorder and ReporterRecorder and ReporterPrepares and submit required records Prepares and submit required records

and reportand reportReview, validates, consolidates, Review, validates, consolidates,

analyzes and interprets all records and analyzes and interprets all records and reportsreports

Maintains adequate, accurate and Maintains adequate, accurate and complete recording and reportingcomplete recording and reporting

Responsibility of CHNResponsibility of CHN

Be a part in developing and overall health Be a part in developing and overall health plan, its implementation and evaluation for plan, its implementation and evaluation for communities.communities.

Provide quality nursing service to all level Provide quality nursing service to all level of clienteleof clientele

Maintain coordination/ linkages with other Maintain coordination/ linkages with other health team members in the provision of health team members in the provision of public health servicepublic health service

Conduct researches relevant to CHN Conduct researches relevant to CHN services to improve provision of HCservices to improve provision of HC

Provide opportunities for professional Provide opportunities for professional growth and continuing education for staff growth and continuing education for staff developmentdevelopment

COMMUNITY HEALTH AND COMMUNITY HEALTH AND DEVELOPMENT CONCEPTS, DEVELOPMENT CONCEPTS,

PRINCIPLES AND STRATEGIESPRINCIPLES AND STRATEGIES

CONCEPTS AND DEFINITIONSCONCEPTS AND DEFINITIONS

HealthHealth is a state of complete is a state of complete physical, mental and social well-physical, mental and social well-being and not merely the absence being and not merely the absence of disease or infirmity of disease or infirmity (WHO,1946)(WHO,1946)

A fundamental human right (Ottawa A fundamental human right (Ottawa Charter – 1986).Charter – 1986).

All people should have access to basic All people should have access to basic resources for health:resources for health:Peace, adequate resources, food and shelter, Peace, adequate resources, food and shelter,

and a stable ecosystem and sustainable and a stable ecosystem and sustainable resources use.resources use.

MODELS OF HEALTHMODELS OF HEALTH

Medical ModelMedical Model Health is the state of being free of signs or Health is the state of being free of signs or

symptoms of disease and illness. symptoms of disease and illness. The absence of one or more of the “five D’s”The absence of one or more of the “five D’s”

DeathDeathDiscomfortDiscomfortDiseaseDiseaseDisabilityDisabilityDissatisfactionDissatisfaction

* If you are not sick or dying, you are considered * If you are not sick or dying, you are considered to be in the best attainable state of health.to be in the best attainable state of health.

Health Belief ModelHealth Belief Model

Health and illness is affected by Health and illness is affected by genetic characteristics and the genetic characteristics and the cultural values and beliefs learned cultural values and beliefs learned and practice by the families and and practice by the families and communities.communities.

Beliefs – Feeling – Behavior Beliefs – Feeling – Behavior

Agent – Host – Environment ModelAgent – Host – Environment Model

The agent- host- The agent- host- environment model of environment model of health and illness for health and illness for community health community health (Leavell and Clark –(Leavell and Clark –1965)., is useful for 1965)., is useful for examining the cause of examining the cause of disease in an individual. disease in an individual.

““health is an ever changing state.”health is an ever changing state.”

ENVIRONMENT(factors external to the host)

HOST(living organism capable

of being infected by the agent)

AGENT(microorganism or

chemical substance)

Health- Illness ContinuumHealth- Illness Continuum

Health is a constantly changing state, with Health is a constantly changing state, with high level wellness and death being on high level wellness and death being on opposite ends of a graduated scale, or opposite ends of a graduated scale, or continuum.continuum.

High Level WellnessHigh Level Wellness

High level wellness High level wellness refers to refers to functioning to one’s functioning to one’s maximum potential maximum potential while maintaining while maintaining balance of balance of purposeful purposeful direction in the direction in the environment(1977, environment(1977, Rodale). Rodale).

Needs Fulfillment ModelNeeds Fulfillment Model

Health is a state in Health is a state in which needs are which needs are being sufficiently being sufficiently met to allow an met to allow an individual to individual to function function successfully in life successfully in life with the ability to with the ability to achieve the highest achieve the highest possible potentialpossible potential

Role Performance ModelRole Performance Model

Health is the ability Health is the ability to perform all those to perform all those roles for which on roles for which on has been has been socialized.socialized.

PRIMARY HEALTH PRIMARY HEALTH CARECARE

30 years ago, the Declaration of Alma-Ata 30 years ago, the Declaration of Alma-Ata articulated primary health care as a set of articulated primary health care as a set of guiding values for health development, a guiding values for health development, a set of principles for the organization of set of principles for the organization of health services, and a range of health services, and a range of approaches for addressing priority health approaches for addressing priority health needs and the fundamental determinants needs and the fundamental determinants of health.of health.

The The Declaration of Alma-AtaDeclaration of Alma-Ata was was adopted at the International Conference adopted at the International Conference on Primary Health Care, Almaty on Primary Health Care, Almaty (formerly (formerly Alma-Ata)Alma-Ata), presently in Kazakhstan, , presently in Kazakhstan, September 6-12, 1978. September 6-12, 1978.

It expressed the need for urgent action by It expressed the need for urgent action by all governments, all health and all governments, all health and development workers, and the world development workers, and the world community to protect and promote the community to protect and promote the health of all the people of the world. health of all the people of the world.

It was the first international declaration It was the first international declaration underlining the importance of primary underlining the importance of primary health care. The primary health care health care. The primary health care approach has since then been accepted approach has since then been accepted by member countries of WHO as the key by member countries of WHO as the key to achieving the goal of "Health for All".to achieving the goal of "Health for All".

Primary health carePrimary health care, often , often abbreviated as PHC, isabbreviated as PHC, is

"essential health care based on practical, "essential health care based on practical, scientifically sound and socially acceptable scientifically sound and socially acceptable methods and technology made universally methods and technology made universally accessible to individuals and families in the accessible to individuals and families in the community through their full participation community through their full participation and at a cost that the community and the and at a cost that the community and the country can afford to maintain at every country can afford to maintain at every stage of their development in the spirit of stage of their development in the spirit of self-determination"self-determination"

In the Philippines, primary health care was In the Philippines, primary health care was implemented under Letter Of Instruction implemented under Letter Of Instruction 949 , which was signed by former 949 , which was signed by former President Marcos on October 19, 1979.President Marcos on October 19, 1979.

MISSIONMISSION

To strengthen the health care system by To strengthen the health care system by increasing opportunities and supporting increasing opportunities and supporting the conditions wherein people will manage the conditions wherein people will manage their own health caretheir own health care

GOALGOALHealth for AllHealth for AllSELF-RELIANCE SELF-RELIANCE

ability to stand on their own self-sufficiency ability to stand on their own self-sufficiency In accordance with the goal of the Department of In accordance with the goal of the Department of

Health which is, Health which is,

FrameworkFrameworkPeople’s empowerment and partnership is the People’s empowerment and partnership is the

key strategy to achieve the goal “Health for all key strategy to achieve the goal “Health for all Filipinos and Health in the hands of the Filipinos and Health in the hands of the people by the year 2020”.people by the year 2020”.

GENERAL PRINCIPLES AND GENERAL PRINCIPLES AND STRATEGIESSTRATEGIES

HEALTH AND DEVELOPMENT ARE HEALTH AND DEVELOPMENT ARE INTERRELATED INTERRELATED

ESSENTIAL HEALTH SERVICES MUST ESSENTIAL HEALTH SERVICES MUST BE ACCESSIBLE, AVAILABLE, BE ACCESSIBLE, AVAILABLE, ACCEPTABLE AND AFFORDABLE.ACCEPTABLE AND AFFORDABLE.

GENUINE PEOPLE’S PARTICIPATION GENUINE PEOPLE’S PARTICIPATION IS ESSENTIAL – Community IS ESSENTIAL – Community ParticipationParticipation

SELF-RELIANCE SELF-RELIANCE SOCIAL MOBILIZATIONSOCIAL MOBILIZATION DECENTRALIZATIONDECENTRALIZATION PROVISION OF QUALITY, BASIC AND PROVISION OF QUALITY, BASIC AND

ESSENTIAL HEALTH SERVICESESSENTIAL HEALTH SERVICES

HEALTH AND DEVELOPMENT HEALTH AND DEVELOPMENT ARE INTERRELATEDARE INTERRELATED

Convergence (meeting) of health, food, Convergence (meeting) of health, food, nutrition, water, sanitation, and nutrition, water, sanitation, and population services.population services.

Integration of PHC into national, Integration of PHC into national, regional, provincial, municipal and regional, provincial, municipal and barangay development plans.barangay development plans.

Coordination of activities with economic Coordination of activities with economic planning, education, agriculture, planning, education, agriculture, industry, housing, public works, industry, housing, public works, communication and social services.communication and social services.

Establishment of effective health referral Establishment of effective health referral systemsystem

ESSENTIAL HEALTH SERVICES ESSENTIAL HEALTH SERVICES MUST BE ACCESSIBLE, AVAILABLEMUST BE ACCESSIBLE, AVAILABLE

Health services delivered where the people Health services delivered where the people areare

Use of indigenous volunteer health worker Use of indigenous volunteer health worker as a health provider with a ratio of one as a health provider with a ratio of one community health worker per 10-20 community health worker per 10-20 householdshouseholds

Use of traditional medicines with essential Use of traditional medicines with essential drugsdrugs

GENUINE PEOPLE’S GENUINE PEOPLE’S PARTICIPATION IS ESSENTIALPARTICIPATION IS ESSENTIAL Awareness building and consciousness Awareness building and consciousness

rising on health- related issues.rising on health- related issues. Planning, implementations, monitoring and Planning, implementations, monitoring and

evaluation done through small group evaluation done through small group meeting (10-20 household cluster)meeting (10-20 household cluster)

Selection of community health workers by the Selection of community health workers by the community.community.

Formation of health committees.Formation of health committees.Establishment of community health Establishment of community health

organization at the parish or municipal level.organization at the parish or municipal level.Mass health campaigns and mobilization to Mass health campaigns and mobilization to

combat health problemscombat health problems

SELF-RELIANCE SELF-RELIANCE

Use of local resourcesUse of local resources Training of community in leadership Training of community in leadership

and management skillsand management skills Incorporation of income generating Incorporation of income generating

projects, cooperatives and small scale projects, cooperatives and small scale industries.industries.

SOCIAL MOBILIZATIONSOCIAL MOBILIZATION

Establishment of an effective health referral Establishment of an effective health referral systemsystem

Multi-sectoral and interdisciplinary linkageMulti-sectoral and interdisciplinary linkage Information, education, communication Information, education, communication

support using multi-mediasupport using multi-media Collaboration between government and non-Collaboration between government and non-

government organizationsgovernment organizations

DECENTRALIZATIONDECENTRALIZATION

Devolution (RA 7160)Devolution (RA 7160) Transfer of power from the national Transfer of power from the national

government to local government unitgovernment to local government unit Reallocation of budgetary resourcesReallocation of budgetary resources Reorientation of health professionals on Reorientation of health professionals on

Primary Health CarePrimary Health Care Advocacy for political will and support from Advocacy for political will and support from

the national leadership down to the the national leadership down to the barangay level.barangay level.

PROVISION OF QUALITY, BASIC PROVISION OF QUALITY, BASIC AND ESSENTIAL HEALTH SERVICESAND ESSENTIAL HEALTH SERVICES

Training design and curriculum based on Training design and curriculum based on community needs and prioritiescommunity needs and priorities

Attitude, knowledge and skills developed are Attitude, knowledge and skills developed are on promotive, preventive, curative and on promotive, preventive, curative and rehabilitative health carerehabilitative health care

Regular monitoring and periodic evaluation Regular monitoring and periodic evaluation of community health worker performance by of community health worker performance by the community and health staff.the community and health staff.

MAJOR ELEMENTSMAJOR ELEMENTS

1. Use of Appropriate Technology1. Use of Appropriate TechnologyThis emphasizes equity and justice, that This emphasizes equity and justice, that

health is a basic right of every individual and health is a basic right of every individual and not just to those who can afford to pay their not just to those who can afford to pay their own health careown health care

Criteria in determining use of appropriate Criteria in determining use of appropriate technologytechnology

Effectiveness and safety Effectiveness and safety Complexity – simple and easy to applyComplexity – simple and easy to apply CostCost Scope of technology – effective, appropriateScope of technology – effective, appropriate AcceptabilityAcceptability Feasibility – compatible with the local settingFeasibility – compatible with the local setting

2. Multi-Sectoral Approach to Health2. Multi-Sectoral Approach to Health

Other health related systems(private/government)

Ways of the Community HeathHealth CarePeople System

(knowledge and values)

Environmental (social,economic, physical conditions)

Intersectional LinkagesIntersectional Linkages

Primary Health Care forms an integral part Primary Health Care forms an integral part of the health system and the over all social of the health system and the over all social and economic development of the and economic development of the community. As such, it is necessary to community. As such, it is necessary to unify health efforts within the health unify health efforts within the health organization it self and with other sectors organization it self and with other sectors concerned. It implies the integration of concerned. It implies the integration of health plans with the plan for the total health plans with the plan for the total community development.community development.

Sectors most closely related to health Sectors most closely related to health includes those concerned with:includes those concerned with:AgriculturalAgriculturalEducationEducationPublic worksPublic worksLocal governmentLocal governmentSocial welfareSocial welfarePopulation controlPopulation controlPrivate sectorsPrivate sectors

Intrasectoral LinkageIntrasectoral Linkage

In the health sector, the acceptance or primary In the health sector, the acceptance or primary health care necessitates the restructuring of the health care necessitates the restructuring of the health system to broaden health coverage and health system to broaden health coverage and make health service available to all. There is make health service available to all. There is now widely accepted pyramidal organization that now widely accepted pyramidal organization that provides level of services starting with primary provides level of services starting with primary health and progressing to specialty care. health and progressing to specialty care. Primary care is the hub of the health system.Primary care is the hub of the health system.

Rural Health Units, Community Hosp./Health CentersPrivate Practitioners, Barangay Health Station

Provincial/City Health services and Hospitals

Emergency and District Hospitals

National & RegionalHealth Services, Medical

Centers, Teaching & TrainingHospitals

HEALTH CARE FACILITIESHEALTH CARE FACILITIES

1. Primary Level of Health Care Facilities1. Primary Level of Health Care Facilities This are the rural health units, their sub-centers, chest This are the rural health units, their sub-centers, chest

clinics, malaria eradication units operated by the DOHclinics, malaria eradication units operated by the DOH Private clinics operated by Philippine medical Private clinics operated by Philippine medical

Association; large industrial firms for their employeesAssociation; large industrial firms for their employees Community hospitals and health centers operated by Community hospitals and health centers operated by

Philippine Medical care Commission and other health Philippine Medical care Commission and other health facilities operated by voluntary religious and civic facilities operated by voluntary religious and civic groupsgroups

Health services offered:Health services offered: caters to individuals in fair caters to individuals in fair health and to patients with disease in the early health and to patients with disease in the early symptomatic stages.symptomatic stages.

HEALTH CARE FACILITIESHEALTH CARE FACILITIES

2. Secondary Level of Health Care 2. Secondary Level of Health Care FacilitiesFacilitiesThese are smaller, non-departmentalized These are smaller, non-departmentalized

hospitals including emergency and hospitals including emergency and regional hospitals.regional hospitals.

Health services offered:Health services offered: care for care for patients with symptomatic stage of patients with symptomatic stage of disease with requires moderately disease with requires moderately specialized knowledge and technical specialized knowledge and technical resources for adequate treatment.resources for adequate treatment.

3. Tertiary Level of health Care Facilities3. Tertiary Level of health Care FacilitiesThese are highly technological and These are highly technological and

sophisticated services offered by medical sophisticated services offered by medical centers and large hospitals. These are centers and large hospitals. These are specialized national hospital.specialized national hospital.

Health services offered: Health services offered: for clients afflicted for clients afflicted with diseases which seriously threaten their with diseases which seriously threaten their health and which requires highly technical and health and which requires highly technical and specialized knowledge, facilities and personnel specialized knowledge, facilities and personnel to treat effectively.to treat effectively.

Two way referral systemTwo way referral system

Barangay Health Worker

Barangay Health Stations

Barangay Health Midwifes

Public Health Nurse

Rural Health Unit Midwifes

Sanitary Inspector

Physician

2

HEALTH FACILITIES

3

HEALTH FACILITIES

PRIMARY HEALTH WORKERPRIMARY HEALTH WORKER

Village/GrassrootsVillage/GrassrootsTrain community health workers, health Train community health workers, health

auxiliary volunteers, TBAauxiliary volunteers, TBA11stst contact of the community (initial link) contact of the community (initial link)Work in liaison with local health service Work in liaison with local health service

workerworkerProvide elementary, curative preventive Provide elementary, curative preventive

health care measureshealth care measures

Intermediate levelIntermediate levelGeneral Medical Practitioners, PHN, General Medical Practitioners, PHN,

MidwifesMidwifes11stst source of professional health care source of professional health careAttend to health problems beyond the Attend to health problems beyond the

competencies of the village workerscompetencies of the village workersProvides support to the front line health Provides support to the front line health

workers in term of supervision, training, workers in term of supervision, training, referral services and supplies through referral services and supplies through linkages with other sectorslinkages with other sectors

Health Personnel of first line hospitalsHealth Personnel of first line hospitalsPhysicians with specialty area, nurses and Physicians with specialty area, nurses and

dentistsdentistsEstablish close contact with the village and Establish close contact with the village and

intermediate level health workers to promote intermediate level health workers to promote the continuity of care from hospital to the continuity of care from hospital to community to home.community to home.

Provide back-up health services for cases Provide back-up health services for cases requiring hospital or diagnostic facilities not requiring hospital or diagnostic facilities not available in health care available in health care

3. Community participation3. Community participationDefining their health and health related needs Defining their health and health related needs

and problemsand problems Identifying realistic solutionIdentifying realistic solutionOrganizing community health actionOrganizing community health actionMobilizing local resourcesMobilizing local resourcesProviding essential health servicesProviding essential health servicesEvaluating the results of health actionsEvaluating the results of health actions

ELEMENTS OF PRIMARY ELEMENTS OF PRIMARY HEALTH CAREHEALTH CARE

H H – Hospital as a Center of – Hospital as a Center of WellnessWellness

O O – Oral and Dental Health– Oral and Dental HealthM M – Mental Health– Mental HealthE E – Elderly Care– Elderly Care

E E – Education for Health– Education for Health L L – Locally Endemic Disease Control– Locally Endemic Disease Control E E – Expanded program on Immunization– Expanded program on Immunization M M – Maternal and Child Health– Maternal and Child Health E E – Essential Drugs– Essential Drugs NN – Nutrition– Nutrition T T – Treatment of Communicable Diseases– Treatment of Communicable Diseases S S – Safe water and Sanitation– Safe water and Sanitation

HEALTH PROMOTIONHEALTH PROMOTION

Health promotion is a process of enabling Health promotion is a process of enabling people to increase control over the people to increase control over the determinants of health and thereby determinants of health and thereby improve their health. WHO (1986) Ottawa improve their health. WHO (1986) Ottawa CharterCharter

Participation is essential to sustain health Participation is essential to sustain health promotion actionpromotion action

STRATEGIES FOR HEALTH STRATEGIES FOR HEALTH PROMOTIONPROMOTION

AdvocacyAdvocacy for health to create the for health to create the essential conditions for health,essential conditions for health,

EnablingEnabling all people to achieve their full all people to achieve their full health potentials, andhealth potentials, and

MediatingMediating between the different interests between the different interests in society in the pursuit of healthin society in the pursuit of health

Health Promotion ModelHealth Promotion Model(Nola Pender,1996)(Nola Pender,1996)

Individual characteristics and experiences Individual characteristics and experiences can be useful in predicting if an individual can be useful in predicting if an individual will incorporate and use health related will incorporate and use health related behaviors. behaviors.

“ “ If a behavior has been used before and If a behavior has been used before and becomes a habit, it is more likely to used becomes a habit, it is more likely to used again.”again.”

Behavior- specific knowledge, beliefs and Behavior- specific knowledge, beliefs and relationships – major motivators for relationships – major motivators for engaging in health behaviors.engaging in health behaviors.

A health related behavior is initiated by A health related behavior is initiated by committing to a plan of action, committing to a plan of action, accompanied by developing associated accompanied by developing associated strategies to perform the value behavior.strategies to perform the value behavior.

HEALTH PROMOTION MODEL (HPM) – HEALTH PROMOTION MODEL (HPM) – NOLA PENDERNOLA PENDER

Conceptualized that motivation to Conceptualized that motivation to participate in health promoting behavior is participate in health promoting behavior is influenced by cognitive-perceptual factors influenced by cognitive-perceptual factors and modifying factorsand modifying factors

COGNITIVE-PERCEPTUAL COGNITIVE-PERCEPTUAL FACTORS INCLUDES:FACTORS INCLUDES:

Importance of healthImportance of health Perceived control of healthPerceived control of health Self efficacySelf efficacy Definition of healthDefinition of health Perceived health statusPerceived health status Perceived benefits of health promoting Perceived benefits of health promoting

behaviorsbehaviors Perceived barriers to health promoting behaviorsPerceived barriers to health promoting behaviors

HEALTH PROMOTION HEALTH PROMOTION THEORYTHEORY

Self-efficacySelf-efficacy

It is a belief that one has the capabilities to It is a belief that one has the capabilities to execute the courses of actions required to execute the courses of actions required to manage prospective situations. manage prospective situations.

Example:Example:A person with high self-efficacy may engage A person with high self-efficacy may engage

in a more health related activity when an in a more health related activity when an illness occurs, whereas a person with low illness occurs, whereas a person with low self-efficacy would harbor feelings of self-efficacy would harbor feelings of hopelessness.hopelessness.

Therefore:Therefore:

Self efficacy is Self efficacy is the ability or the the ability or the power to power to produce an produce an effect/ change. effect/ change.

Psychologist Albert Bandura has defined Psychologist Albert Bandura has defined self-efficacy as one's belief in one's ability self-efficacy as one's belief in one's ability to succeed in specific situations. to succeed in specific situations.

One's sense of self-efficacy can play a One's sense of self-efficacy can play a major role in how one approaches goals, major role in how one approaches goals, tasks, and challenges. tasks, and challenges.

According to Bandura's theory, people According to Bandura's theory, people with high self-efficacy:with high self-efficacy:are those who believe they can perform wellare those who believe they can perform wellare more likely to view difficult tasks as are more likely to view difficult tasks as

something to be mastered rather than something to be mastered rather than something to be avoided.something to be avoided.

How self-efficacy affects human How self-efficacy affects human functionfunction

Choices regarding behaviorChoices regarding behavior People will be more inclined to take on a task People will be more inclined to take on a task

if they believe they can succeed. People if they believe they can succeed. People generally avoid tasks where their self-efficacy generally avoid tasks where their self-efficacy is low, but will engage in tasks where their is low, but will engage in tasks where their self-efficacy is high. self-efficacy is high.

Motivation People with high self-efficacy in a task are People with high self-efficacy in a task are

more likely to make more of an effort, and more likely to make more of an effort, and persist longer, than those with low efficacy.persist longer, than those with low efficacy.

Thought patterns & responses Thought patterns & responses Low self-efficacy can lead people to believe Low self-efficacy can lead people to believe

tasks are harder than they actually are. tasks are harder than they actually are. People with high self-efficacy often take a People with high self-efficacy often take a

wider overview of a task in order to take the wider overview of a task in order to take the best route of action. best route of action.

People with high self-efficacy are shown to be People with high self-efficacy are shown to be encouraged by obstacles to make a greater encouraged by obstacles to make a greater effort. effort.

Self-efficacy also affects how people respond Self-efficacy also affects how people respond to failure. to failure.

A person with a high self-efficacy will attribute A person with a high self-efficacy will attribute the failure to external factors, where a person the failure to external factors, where a person with low self-efficacy will attribute failure to with low self-efficacy will attribute failure to low ability. low ability.

Health Behaviors Health Behaviors Health behaviors such as non-smoking, Health behaviors such as non-smoking,

physical exercise, dieting, condom use, dental physical exercise, dieting, condom use, dental hygiene, seat belt use, or breast self-hygiene, seat belt use, or breast self-examination are, among others, dependent on examination are, among others, dependent on one’s level of perceived self-efficacy (Conner one’s level of perceived self-efficacy (Conner & Norman, 2005). & Norman, 2005).

Self-efficacy beliefs are cognitions that Self-efficacy beliefs are cognitions that determine whether health behavior change determine whether health behavior change will be initiated, how much effort will be will be initiated, how much effort will be expended, and how long it will be sustained in expended, and how long it will be sustained in the face of obstacles and failures. the face of obstacles and failures.

Self-efficacy influences the effort one puts Self-efficacy influences the effort one puts forth to change risk behavior and the forth to change risk behavior and the persistence to continue striving despite persistence to continue striving despite barriers and setbacks that may undermine barriers and setbacks that may undermine motivation. motivation.

Self-efficacy is directly related to health behavior, but Self-efficacy is directly related to health behavior, but it also affects health behaviors indirectly through its it also affects health behaviors indirectly through its impact on goals. impact on goals.

Self-efficacy influences the challenges that people Self-efficacy influences the challenges that people take on as well as how high they set their goals (e.g., take on as well as how high they set their goals (e.g., "I intend to reduce my smoking," or "I intend to quit "I intend to reduce my smoking," or "I intend to quit smoking altogether"). A number of studies on the smoking altogether"). A number of studies on the adoption of health practices have measured self-adoption of health practices have measured self-efficacy to assess its potential influences in initiating efficacy to assess its potential influences in initiating behavior change (Luszczynska, & Schwarzer, 2005). behavior change (Luszczynska, & Schwarzer, 2005).

TYPES OF HEALTH TYPES OF HEALTH PROMOTIONAL ACTIVITIESPROMOTIONAL ACTIVITIES

HEALTH EDUCATION (information HEALTH EDUCATION (information dissemination)dissemination)Use of variety of media to offer information to Use of variety of media to offer information to

the public about the particular lifestyle choices the public about the particular lifestyle choices and personal behavior, the benefits of and personal behavior, the benefits of changing that behavior and the improvement changing that behavior and the improvement of quality of lifeof quality of life

FIVE PRIORITY ACTIONS AREAFIVE PRIORITY ACTIONS AREA

Build healthy public policy;Build healthy public policy;Create supportive environments for health;Create supportive environments for health;Strengthen community action for health;Strengthen community action for health;Developed personal skills;Developed personal skills;Re-orient health servicesRe-orient health services

Jakarta Declaration on Leading Jakarta Declaration on Leading Health Promotion into the 21Health Promotion into the 21stst

Century (1997)Century (1997)

Strategies and action areas are Strategies and action areas are relevant for all countriesrelevant for all countries

Comprehensive approaches to health Comprehensive approaches to health development are most effective.development are most effective.

Setting for health offer practical Setting for health offer practical opportunities for the implementation of opportunities for the implementation of comprehensive strategies.comprehensive strategies.

Participation is essential to sustain efforts.Participation is essential to sustain efforts.Health literacy fosters participations.Health literacy fosters participations.

Five PrioritiesFive Priorities

Promote Promote social responsibility for healthsocial responsibility for health;; Increase Increase investments for health investments for health

developmentdevelopment;;Expand Expand partnerships for health partnerships for health

promotionpromotion;; Increase Increase community capacity and community capacity and

empower the individualsempower the individuals;;Secure an Secure an infrastructures for health infrastructures for health

promotionpromotion

ACTIVITIES FOR HEALTH ACTIVITIES FOR HEALTH PROMOTIONPROMOTION

HEALTH APPRAISAL WELLNESS HEALTH APPRAISAL WELLNESS ASSESSMENT PROGRAMASSESSMENT PROGRAMAppraise individuals of their risk factors that Appraise individuals of their risk factors that

are inherited in their lives/family in order to are inherited in their lives/family in order to motivate them to reduce specific risk and motivate them to reduce specific risk and develop positive health habitsdevelop positive health habits

Wellness assessment programs are focused Wellness assessment programs are focused on more positive methods of enhancementon more positive methods of enhancement

LIFE-STYLE AND BEHAVIOR CHANGE LIFE-STYLE AND BEHAVIOR CHANGE PROGRAMPROGRAMBasis for changing behaviorBasis for changing behaviorGeared towards enhancing the quality of life Geared towards enhancing the quality of life

and extending the life spanand extending the life span

WORKSITE WORKSITE WELLNESS WELLNESS PROGRAMPROGRAM Includes programs that Includes programs that

serve the needs of the serve the needs of the persons in their work persons in their work placesplaces

ENVIRONMENTAL ENVIRONMENTAL CONTROL CONTROL PROGRAMPROGRAM Developed to address Developed to address

the growing problem of the growing problem of environment pollution environment pollution such as air, land, such as air, land, water etc.water etc.

DISEASE PREVENTIONDISEASE PREVENTION

Disease prevention covers measures not Disease prevention covers measures not only to prevent the occurrence of only to prevent the occurrence of diseases, such as risk factor reduction, but diseases, such as risk factor reduction, but also to arrest it progress and reduce its also to arrest it progress and reduce its consequences once established. WHO consequences once established. WHO (1984)(1984)

Disease prevention is sometimes used as Disease prevention is sometimes used as a complementary term alongside health a complementary term alongside health promotion.promotion.

Although there is frequent overlap Although there is frequent overlap between the content and strategies, between the content and strategies, disease prevention is defined saparetly.disease prevention is defined saparetly.

Disease prevention is considered to be Disease prevention is considered to be actions which usually emanates from actions which usually emanates from health sector, dealing with individuals and health sector, dealing with individuals and populations identified as exhibiting populations identified as exhibiting identifiable risk factors, often associated identifiable risk factors, often associated with different risk behaviors.with different risk behaviors.

LEVELS OF DISEASE LEVELS OF DISEASE PREVENTIONPREVENTION

PRIMARY LEVELPRIMARY LEVELDirected towards preventing the initial Directed towards preventing the initial

occurrence of disease.occurrence of disease.Decreases the risk or exposure of Decreases the risk or exposure of

individual and community to disease.individual and community to disease.Example:Example:

Health education about accident and poisoningHealth education about accident and poisoning

Health education about standards of nutrition and Health education about standards of nutrition and growth and development, exercise requirements, growth and development, exercise requirements, stress management, protection against stress management, protection against occupational hazard.occupational hazard.

ImmunizationImmunizationRisk assessments for specific diseaseRisk assessments for specific diseaseFamily planning services and family counselingFamily planning services and family counselingEnvironmental sanitation and provision of Environmental sanitation and provision of

adequate housing, recreation and work conditionsadequate housing, recreation and work conditions

SECONDARY LEVELSECONDARY LEVELFocus on early identification of health Focus on early identification of health

problem and prompt intervention to problem and prompt intervention to alleviate health problems.alleviate health problems.

Includes prevention of complications and Includes prevention of complications and disabilities.disabilities.ExampleExample

Screening surveysScreening surveys

Encouraging regular medical and dental Encouraging regular medical and dental examinationexamination

Teaching self-examination for breast and testicular Teaching self-examination for breast and testicular cancercancer

Assessing growth and development of childrenAssessing growth and development of childrenMaintaining skin integrity, turning, positioning, Maintaining skin integrity, turning, positioning,

exercising client, ensuring adequate rest and exercising client, ensuring adequate rest and sleep, food and fluid intake, elimination, sleep, food and fluid intake, elimination, administering medical therapies such as administering medical therapies such as medicationsmedications

TERTIARY LEVELTERTIARY LEVELBegins after illness, when defect or Begins after illness, when defect or

disability is fixed or determined to be disability is fixed or determined to be irreversibleirreversible

Focus to help rehabilitate individuals and Focus to help rehabilitate individuals and restore hem to an optimal level of restore hem to an optimal level of functioning within the constraints of the functioning within the constraints of the disabilitydisability

Example:Example:Referring client to a support groupReferring client to a support groupTeaching diabetic client to prevent complicationsTeaching diabetic client to prevent complicationsReferring client to rehabilitation centerReferring client to rehabilitation center

BAHAVIOR ASSOCIATED WITH BAHAVIOR ASSOCIATED WITH LEVELS OF PREVENTIONLEVELS OF PREVENTION

PRIMARYPRIMARYQuit smoking and avoid alcohol intakeQuit smoking and avoid alcohol intakeRegular exercise and eat well balance dietRegular exercise and eat well balance dietReduce fat and increase fiber intakeReduce fat and increase fiber intakeTake adequate fluid intakeTake adequate fluid intakeMaintain ideal body weightMaintain ideal body weightComplete immunization programComplete immunization programAvoid over exposure to sunlight and wear Avoid over exposure to sunlight and wear

protective gear at work placeprotective gear at work place

SECONDARYSECONDARYHave annual health examinationHave annual health examinationRegular pap’s test for womenRegular pap’s test for womenMonthly BSE for women (20 and up)Monthly BSE for women (20 and up)Sputum examination for tuberculosisSputum examination for tuberculosisAnal stool guaiac test and rectal examination Anal stool guaiac test and rectal examination

for client 50 y.o. and abovefor client 50 y.o. and above

TERTIARYTERTIARYSelf monitoring of blood glucose among Self monitoring of blood glucose among

diabetic clientdiabetic clientPhysical therapy after CVAPhysical therapy after CVAParticipate in cardiac rehabilitation after MIParticipate in cardiac rehabilitation after MI

COMMUNITY ORGANIZING COMMUNITY ORGANIZING TOWARDS COMMUNITY TOWARDS COMMUNITY

PARTICIPATION IN HEALTHPARTICIPATION IN HEALTH

COMMUNITYCOMMUNITY

Comunitas – latin word for group of Comunitas – latin word for group of individualsindividuals

A community is a group of people sharing A community is a group of people sharing common geographical boundaries and/or common geographical boundaries and/or common values and interest/ its functions common values and interest/ its functions within a particular socio-cultural context. within a particular socio-cultural context. (Maglaya, 2004)(Maglaya, 2004)

A community is a collection of people who A community is a collection of people who interact with each other and whose interact with each other and whose common interest or characteristics give common interest or characteristics give them a sense of unity and belonging. them a sense of unity and belonging. (Spradley & Allender, 1996)(Spradley & Allender, 1996)

Dimensions of a CommunityDimensions of a Community

LOCATIONLOCATION POPULATIONPOPULATIONSOCIAL SYSTEMSOCIAL SYSTEM

LOCATIONLOCATION

1.1. boundary of the communityboundary of the community

2.2. placement of health servicesplacement of health services

3.3. geographical featuresgeographical features

4.4. climateclimate

5.5. plants and animal (ecosystem)plants and animal (ecosystem)

6.6. human-made environmenthuman-made environment

POPULATIONPOPULATION

1.1. size size

2.2. densitydensity

3.3. composition\rate of growth and declinecomposition\rate of growth and decline

4.4. cultural characteristicscultural characteristics

5.5. social classsocial class

6.6. mobilitymobility

SOCIAL SYSTEMSOCIAL SYSTEM

healthhealth familyfamily economiceconomic educationeducation regionregion

welfarewelfare politicalpolitical recreationalrecreational legallegal communicationcommunication

Classifications of a communityClassifications of a community

URBANURBANRURALRURALSUB - URBANSUB - URBAN

URBANURBAN

citycity high density areahigh density area socially heterogeneous population socially heterogeneous population complex structurecomplex structure complex interpersonal social relationscomplex interpersonal social relations non-agricultural occupationnon-agricultural occupation

RURALRURAL

town - provincetown - province low density arealow density area having simple life having simple life close family tiesclose family ties people usually spend time in farming and people usually spend time in farming and

fishing for foodsfishing for foods

SUB - URBANSUB - URBAN

suburbssuburbs a combination of an urban and rural a combination of an urban and rural

communitycommunity thick population thick population heterogeneous with mixed family tiesheterogeneous with mixed family ties

Difference between Rural and Difference between Rural and Urban CommunityUrban Community

Criteria Rural Urban

1. Density of population Less dense Thick dense

2. Social relationship Strong and have close ties and interaction with the community

Face to face contact but usually very casual

3. Social mobility Lesser Greater

4. Social structure No significant difference of wealth, more or less there is even distribution of wealth

There is very wide range of income distribution; few are rich and majority of the people belong to a lower income

5. Social institution Not very specialized; less in membership; small scale institution

Highly specialized; wide scale institution; more membership

6. Activities Bayanihan is common Paid services

7. Cultural activities Many Few

8. Nature of occupation Agricultural/ non professional White color jobs, professionals

9. Domestic animals Many Few

10. Size Usually small Generally big

11. Choice Based on personal attachment Based on educational attainment, credentials, achievements, popularity

HEALTHY COMMUNITYHEALTHY COMMUNITY

A community which is able to: A community which is able to: collaborate effectively to identify the collaborate effectively to identify the

needs, concerns and problems of the needs, concerns and problems of the community, community,

achieve a working consensus on the achieve a working consensus on the agreed-on goals, agreed-on goals,

collaborate effectively in the required collaborate effectively in the required actionsactions

CHARACTERISTIC OF A CHARACTERISTIC OF A HEALTHY COMMUNITYHEALTHY COMMUNITY

prompts its members to a degree of prompts its members to a degree of awarenessawareness

uses its natural resources eg. air to breath, uses its natural resources eg. air to breath, cooperation, valuescooperation, values

openly recognize the existence of openly recognize the existence of subgroups and welcome their participationsubgroups and welcome their participation

prepared to meet crisesprepared to meet crises

able to solve problemsable to solve problems has an open channel of communicationhas an open channel of communication seek to make its system of communityseek to make its system of community resources are available for allresources are available for all encourage maximum participation in encourage maximum participation in

decision makingdecision making promotes high level of wellnesspromotes high level of wellness

Components of a CommunityComponents of a Community

CoreCoreSub systemSub system

CORECORE

represents the people that make up the represents the people that make up the communitycommunity Social classSocial classEthnicityEthnicityCultureCultureBeliefsBeliefsTraditionsTraditions

SUB - SYSTEMSUB - SYSTEM

HOUSINGHOUSING EDUCATIONEDUCATION FIRE AND SAFETYFIRE AND SAFETY POLITICS AND POLITICS AND

GOVERNANCEGOVERNANCE

HEALTHHEALTH COMMUNICATIONCOMMUNICATION ECONOMICSECONOMICS RECREATIONRECREATION

HOUSINGHOUSING

What type of housing facilities are there in What type of housing facilities are there in the community?the community?Structure, materials, arrangementStructure, materials, arrangement

Are there enough housing facilities Are there enough housing facilities available?available?

Are there housing laws/regulations Are there housing laws/regulations governing the people? governing the people?

EDUCATIONEDUCATION

These include laws, regulations, facilities, These include laws, regulations, facilities, and activities affecting educations.and activities affecting educations.

Ratio of health educators to learners, Ratio of health educators to learners, distribution of educational facilitiesdistribution of educational facilities

FIRE AND SAFETYFIRE AND SAFETY

Fire protection facilities and fire prevention Fire protection facilities and fire prevention activities, and the distribution of these in activities, and the distribution of these in the community.the community.

Peace and orderPeace and order

POLITICS AND GOVERNANCEPOLITICS AND GOVERNANCE

Political structure presents in the Political structure presents in the community, decision making process/ community, decision making process/ patterns leadership style observed etc.patterns leadership style observed etc.

HEALTHHEALTH

Health facilities and activities present, Health facilities and activities present, distribution, utilization, ratio of providers to distribution, utilization, ratio of providers to clientele served, and priorities in health clientele served, and priorities in health programs.programs.

COMMUNICATIONCOMMUNICATION

Systems, types of communication, Systems, types of communication, existing, forms of communication be it existing, forms of communication be it formal or informal etc.formal or informal etc.

ECONOMICSECONOMICS

Occupation, types of economic activities, Occupation, types of economic activities, and income, etc. and income, etc.

RECREATIONRECREATION

Recreational activities and facilitiesRecreational activities and facilitiesType of consumers.Type of consumers.

Elements of a Healthy Elements of a Healthy CommunityCommunity

People are partners in health care.People are partners in health care.People work together to attain goals.People work together to attain goals.Physical environments promote health, Physical environments promote health,

safety, order and cleanliness.safety, order and cleanliness.Safe water and nutritious foodSafe water and nutritious foodFamilies provide members with basic Families provide members with basic

needsneedsAvailable, affordable, accessible, Available, affordable, accessible,

acceptable health care servicesacceptable health care services

Community HealthCommunity Health

According to According to DeverDever : : fundamental to community health are peace, fundamental to community health are peace,

shelter, education, food, income, a stable shelter, education, food, income, a stable ecosystem, sustainable resources, social ecosystem, sustainable resources, social justice and equity.justice and equity.

According to According to FlynnFlynn:: responsibility for health is widely shared in responsibility for health is widely shared in

the community with collaborative decision-the community with collaborative decision-making about health issue. Informed political making about health issue. Informed political action and healthy pubic policies are essential action and healthy pubic policies are essential to healthy community. to healthy community.

According to According to GeoppingerGeoppinger: : community health have 3 dimensions that community health have 3 dimensions that

are currently assessed by multiple are currently assessed by multiple measures:measures:

1. STATUS DIMENSION - 1. STATUS DIMENSION - morbidity, mortality, life expectancy, risk morbidity, mortality, life expectancy, risk factors, consumer satisfaction, mental factors, consumer satisfaction, mental health, crime rates, functional levels, health, crime rates, functional levels, and infant mortality.and infant mortality.

2. STRUCTURAL DIMENSION - 2. STRUCTURAL DIMENSION - community resources measured by community resources measured by utilization patterns, treatment data and utilization patterns, treatment data and providers, population rates, social providers, population rates, social indicators measured by dependency indicators measured by dependency ratios, socio-economic and racial ratios, socio-economic and racial contribution and education.contribution and education.

3. PROCESS DIMENSION - effective 3. PROCESS DIMENSION - effective community functioning that results in community functioning that results in community competence as evidence by: community competence as evidence by: commitment, self-awareness and ability commitment, self-awareness and ability of situational definitions, articulateness, of situational definitions, articulateness, effective communication, conflict, and effective communication, conflict, and accommodation, participation and accommodation, participation and management of relations with large management of relations with large society.society.

FACTORS THAT AFFECT FACTORS THAT AFFECT COMMUNITY HEALTHCOMMUNITY HEALTH

OLOFIndividuals

FamilyCommunity

POLITICALSafety

OppressionPeople

Empowerment BEHAVIORCultureHabitsNorms

Ethnic Customs

HEREDITYGenetic-defects

-risks familial ethnic racial

HEALTH CARE DELIVERYSYSTEM

Promotive, PreventiveCurative, Rehabilitative

ENVIRONMENTAir

Food, waterNoise

Radiation

SOCIO ECONOMICEmploymentEducation,Housing

FACTOR AFFECTING HEALTH

POLITICALPOLITICAL

Politics greatly influence the social climate in Politics greatly influence the social climate in which people live. Political jurisdictions have the which people live. Political jurisdictions have the power and authority to regulate the environment. power and authority to regulate the environment. Examples are safety, oppression and people Examples are safety, oppression and people empowerment. Increase in crimes and the lack empowerment. Increase in crimes and the lack of safety in streets and even in homes are major of safety in streets and even in homes are major concerns of society. Oppression especially of concerns of society. Oppression especially of the poor, differential treatment in various classes the poor, differential treatment in various classes of society affects health.of society affects health.

SOCIO-ECONOMICSOCIO-ECONOMIC

Families from the lower income groups are the Families from the lower income groups are the ones mostly served in public health services and ones mostly served in public health services and by the community health workers. This is by the community health workers. This is because, people from the lower income groups because, people from the lower income groups tent to have proportionately greater number of tent to have proportionately greater number of illnesses and health problems than those in the illnesses and health problems than those in the higher income groups. However, the middle and higher income groups. However, the middle and upper income group have also very pressing upper income group have also very pressing health problems such as drug abuse and life-health problems such as drug abuse and life-style diseases.style diseases.

HEREDITARYHEREDITARY

Understanding of genetically influenced Understanding of genetically influenced diseases is increased through knowledge diseases is increased through knowledge about the nature of the genetic materials about the nature of the genetic materials and about the process by which genetic and about the process by which genetic traits are transmitted. Early knowledge of traits are transmitted. Early knowledge of the genetic risk makes it possible to the genetic risk makes it possible to anticipate and counteract genetic anticipate and counteract genetic outcomes thus enabling the medical team outcomes thus enabling the medical team to prepare for necessary therapeutic to prepare for necessary therapeutic intervention.intervention.

ENVIRONMENTENVIRONMENT

The menace of pollution has been growing The menace of pollution has been growing over the years and has greatly affected the over the years and has greatly affected the health of the people. The diseases today health of the people. The diseases today are largely man made.are largely man made.

BEHAVIORS/BEHAVIORS/ATTITUDE/LIFE-STYLEATTITUDE/LIFE-STYLE

A person’s level of functioning is affected A person’s level of functioning is affected by certain habits that he has. These may by certain habits that he has. These may be in form of smoking, intake of alcoholic be in form of smoking, intake of alcoholic drinks, substance abuse and lack of drinks, substance abuse and lack of exercise. The people’s lifestyle, health exercise. The people’s lifestyle, health care and child rearing practices are care and child rearing practices are shaped, to a large extent, by their culture shaped, to a large extent, by their culture and ethic heritage.and ethic heritage.

HEALTH CARE DELIVERY HEALTH CARE DELIVERY SYSTEMSYSTEM

HEALTH CARE DELIVERY SYSTEMHEALTH CARE DELIVERY SYSTEM. In the . In the Philippines, primary health care is a partnership Philippines, primary health care is a partnership approach to the effective provision of essential approach to the effective provision of essential health services that are community based, health services that are community based, accessible, acceptable, sustainable and accessible, acceptable, sustainable and affordable. Although promotive and preventive affordable. Although promotive and preventive health measures are emphasized in community health measures are emphasized in community health the availability and accessibility of health the availability and accessibility of curative and rehabilitative services also affect curative and rehabilitative services also affect people’s health.people’s health.

COMMUNITY HEALTH COMMUNITY HEALTH DEVELOPMENT PROCESSDEVELOPMENT PROCESS

COMMUNITY, HEALTH, COMMUNITY, HEALTH, DEVELOPMENTDEVELOPMENT

WHO defined community as “ A social WHO defined community as “ A social group determined by geographical group determined by geographical boundaries and/or common values and boundaries and/or common values and interests.”interests.”

WHO defined health as “A complete state WHO defined health as “A complete state of mental, physical, and social well-being of mental, physical, and social well-being and not merely the absence of disease or and not merely the absence of disease or infirmity.”infirmity.”

Development is defined as:Development is defined as:a change, a process of unfolding from an un-a change, a process of unfolding from an un-

manifested condition to more advance or manifested condition to more advance or effective condition. In these process the effective condition. In these process the qualities reveals possibilities, capabilities qualities reveals possibilities, capabilities emerge, and potentials are realized.emerge, and potentials are realized.

A multi-dimensional process involving major A multi-dimensional process involving major changes in social structures, population, changes in social structures, population, attitudes and national institutions, as well as attitudes and national institutions, as well as the acceleration of economic growth, the acceleration of economic growth, reduction of inequality and eradication of reduction of inequality and eradication of absolute poverty.absolute poverty.

The goal of development is to have a better The goal of development is to have a better life. (Teodoro, 1978)life. (Teodoro, 1978)

According to NEDA: According to NEDA: DevelopmentDevelopment includes consumption of basic goods and includes consumption of basic goods and services such as health and education and services such as health and education and the generation of more productive the generation of more productive employment and reduction of inequalities employment and reduction of inequalities in income and access.in income and access.

Community DevelopmentCommunity Development is a process designed to create a condition of is a process designed to create a condition of

economic and social progress for the whole economic and social progress for the whole community with its active participation and community with its active participation and fullest possible reliance on the community fullest possible reliance on the community initiatives. initiatives.

This is achieved through:This is achieved through:Democratic proceduresDemocratic proceduresVoluntary cooperationVoluntary cooperationSelf-helpSelf-helpDevelopment of indigenous leadershipDevelopment of indigenous leadershipEducationEducation

How can we say that the community is How can we say that the community is developed?developed? the people are working together the people are working together have the visionhave the visionknow howknow howcapabilities and experience to confront and capabilities and experience to confront and

solve problems of under developmentsolve problems of under development

Community development principle is committed Community development principle is committed to the services of the people to become to the services of the people to become self-self-reliancereliance..

Therefore, the health of the community depends Therefore, the health of the community depends on its ability to work toward common health on its ability to work toward common health goals and upon adequate distribution of health goals and upon adequate distribution of health resources to all members.resources to all members.

Furthermore, Organized community effort Furthermore, Organized community effort to prevent disease and promote health is to prevent disease and promote health is valuable and effective.valuable and effective.

Approaches to community Approaches to community developmentdevelopment

1.1. WELFARE APPROACHWELFARE APPROACH

2.2. MODERNIZATION APPROACHMODERNIZATION APPROACH

3.3. TRANSFORMATORY/ TRANSFORMATORY/ PARTICIPATORY APPROACHPARTICIPATORY APPROACH

WELFARE APPROACHWELFARE APPROACH

This is an immediate and/or spontaneous This is an immediate and/or spontaneous response to ameliorate the manifestation of response to ameliorate the manifestation of poverty, especially on the personal level.poverty, especially on the personal level.

Assumes that poverty is caused by bad luck, Assumes that poverty is caused by bad luck, natural disasters and certain circumstances, natural disasters and certain circumstances, which are beyond the control of the people.which are beyond the control of the people.

MODERNIZATION MODERNIZATION APPROACHAPPROACH

This is also referred to as the project This is also referred to as the project development approach.development approach.

Introduces whatever resources are Introduces whatever resources are lacking in a given community.lacking in a given community.

Also considered a national strategy, Also considered a national strategy, which adopts the western mode of which adopts the western mode of technological development.technological development.

Assumes that development consists of Assumes that development consists of abandoning the traditional methods of doing abandoning the traditional methods of doing things and must adopt the technology of things and must adopt the technology of industrial countries.industrial countries.

Believes that poverty is due to lack of Believes that poverty is due to lack of education, lack of resources such as capital education, lack of resources such as capital and technology.and technology.

TRANSFORMATORY/ TRANSFORMATORY/ PARTICIPATORY APPROACHPARTICIPATORY APPROACH

This is the process of empowering/ This is the process of empowering/ transforming the poor and the oppressed transforming the poor and the oppressed sectors of society so that they can sectors of society so that they can pursue a more just and humane society.pursue a more just and humane society.

Believes that poverty is caused by prevalence Believes that poverty is caused by prevalence of exploitation, oppression, domination and of exploitation, oppression, domination and other unjust structure.other unjust structure.

COMMUNITY ORGANIZING COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH PARTICIPATORY ACTION RESEARCH (COPAR)(COPAR)

A A social development approachsocial development approach that aims that aims to transform the apathetic, individualistic, to transform the apathetic, individualistic, and voiceless poor into a dynamic, and voiceless poor into a dynamic, participatory and politically responsive participatory and politically responsive community.community.

A A collective, participatory, transformative, collective, participatory, transformative, liberated, sustained and systematic processliberated, sustained and systematic process of of building people organizations by mobilizing building people organizations by mobilizing and enhancing the capabilities and resources and enhancing the capabilities and resources of the people for the resolution of their issues of the people for the resolution of their issues and concerns towards affecting change in their and concerns towards affecting change in their existing oppressive and exploitative conditions.existing oppressive and exploitative conditions.

A A process by which community identifies process by which community identifies its need and objectiveits need and objective. Develops . Develops confidence to take action in respect to confidence to take action in respect to them and in doing so extends and them and in doing so extends and develops cooperative attitudes and develops cooperative attitudes and practices in the community.practices in the community.

A continuous and sustained process of educating the A continuous and sustained process of educating the people to understand and develop their critical people to understand and develop their critical awareness of their existing condition, working with the awareness of their existing condition, working with the people, collectively and efficiently on their immediate people, collectively and efficiently on their immediate and long term problems, and mobilizing the pursue to and long term problems, and mobilizing the pursue to develop their capability and readiness to respond and develop their capability and readiness to respond and take action on their immediate needs toward solving take action on their immediate needs toward solving their long term problems.their long term problems.

IMPORTANCE OF COPARIMPORTANCE OF COPAR

COPAR – is an important tool for COPAR – is an important tool for community development and people community development and people empowerment, as this helps the empowerment, as this helps the community workers to generate community workers to generate community participation and community participation and developmental activities.developmental activities.

COPAR – prepares people/clients to COPAR – prepares people/clients to actually takeover the management of actually takeover the management of development programs in the future.development programs in the future.

COPAR – maximizes community COPAR – maximizes community participation and involvement; community participation and involvement; community resources are mobilized for community resources are mobilized for community services.services.

PRICIPLES OF COPARPRICIPLES OF COPAR

People especially the most oppressed, exploited People especially the most oppressed, exploited and deprived sectors are open to change, have and deprived sectors are open to change, have the capacity to change, and able to bring about the capacity to change, and able to bring about change.change.

COPAR should be based on the interest of the COPAR should be based on the interest of the poorest sectors.poorest sectors.

COPAR should lead to self-reliant community COPAR should lead to self-reliant community and society.and society.

PROCESSES AND METHODS PROCESSES AND METHODS USEDUSED

A PROGRESSIVE CYCLE OF ACTION-A PROGRESSIVE CYCLE OF ACTION-REFLECTION-ACTIONREFLECTION-ACTION ( (ARAARA) – which ) – which begins with small, local, and concrete begins with small, local, and concrete issues identified by the people and the issues identified by the people and the evaluation and reflection of actions taken evaluation and reflection of actions taken by them.by them.

CONSCIOUSNESS RISINGCONSCIOUSNESS RISING – through – through experiential learning is centered to the experiential learning is centered to the COPAR process because it places COPAR process because it places emphasis on learning that emerges from emphasis on learning that emerges from concrete action and which enriches concrete action and which enriches succeeding action.succeeding action.

PARTICIPATORY AND MASS BASED PARTICIPATORY AND MASS BASED – it – it is primary directed towards and based in is primary directed towards and based in favor of the poor, the powerless and the favor of the poor, the powerless and the oppressed.oppressed.

GROUP CENTERED AND NOT LEADER GROUP CENTERED AND NOT LEADER ORIENTED ORIENTED – leaders are identified, – leaders are identified, emerged and are tested through action emerged and are tested through action rather than appointed or reelected by rather than appointed or reelected by some external force or entity.some external force or entity.

PHASES OF COPAR PHASES OF COPAR PROCESSPROCESS

PRE-ENTRY PHASE PRE-ENTRY PHASE ENTRY PHASE ENTRY PHASE CORE GROUP FORMATION PHASECORE GROUP FORMATION PHASE ORGANIZATION-BUILDING PHASEORGANIZATION-BUILDING PHASE SUSTENANCE AND STRENGTHENING SUSTENANCE AND STRENGTHENING

PHASEPHASE

PRE-ENTRY PHASEPRE-ENTRY PHASE

The The initial phaseinitial phase of the organizing of the organizing process where the community organizer process where the community organizer looks for communities to serve or help.looks for communities to serve or help.

It is considered the simplest phase in It is considered the simplest phase in terms of actual outputs, activities and terms of actual outputs, activities and strategies and time spent for it.strategies and time spent for it.

Activities included:Activities included:Designing a plan for community development, Designing a plan for community development,

including all its activities and strategies for care including all its activities and strategies for care and development. and development.

Preparing the health care worker.Preparing the health care worker.

Designing criteria for the selection of siteDesigning criteria for the selection of site DepressedDepressed OppressedOppressed PoorPoor ExploitedExploited

Actual selecting the site for community careActual selecting the site for community care

ENTRY PHASEENTRY PHASE

Sometimes called the Sometimes called the social preparation phasesocial preparation phase This includes the synthesis of the people on This includes the synthesis of the people on

the critical events in their life, motivating them the critical events in their life, motivating them to share their dreams and ideas on how to to share their dreams and ideas on how to manage their concerns and eventually manage their concerns and eventually mobilizing them to make collective action on mobilizing them to make collective action on these.these.

NOTE: NOTE: Recognize the role of local authorities by Recognize the role of local authorities by

paying them visits to inform them of their paying them visits to inform them of their presence and activities.presence and activities.

Health worker appearance, speech, behavior Health worker appearance, speech, behavior and lifestyle should be in kept in low profile and lifestyle should be in kept in low profile and health workers should always serves as and health workers should always serves as a role model.a role model.

Avoid raising the consciousness of the Avoid raising the consciousness of the community residentscommunity residents

Work always with community member to Work always with community member to identify potential leaders.identify potential leaders.

This phase This phase signals the actual entrysignals the actual entry of the of the community worker/organizer into the community. community worker/organizer into the community. She must be guided by the following:She must be guided by the following:

Integration with the communityIntegration with the community Conduct of courtesy callsConduct of courtesy calls Conduct of information campaigns about the community Conduct of information campaigns about the community

health development programshealth development programs Conduct of the community study and social investigationConduct of the community study and social investigation Provision of health and health related services, andProvision of health and health related services, and Identification of potential leadersIdentification of potential leaders

NOTE: NOTE: Recognize the role of local authorities by Recognize the role of local authorities by

paying them visits to inform them of their paying them visits to inform them of their presence and activities.presence and activities.

Health worker appearance, speech, Health worker appearance, speech, behavior and lifestyle should be in kept in behavior and lifestyle should be in kept in low profile and health workers should low profile and health workers should always serves as a role model.always serves as a role model.

Avoid raising the consciousness of the Avoid raising the consciousness of the community residentscommunity residents

Work always with community member to Work always with community member to identify potential leaders.identify potential leaders.

CORE GROUP FORMATION CORE GROUP FORMATION PHASEPHASE

Once the community health nurse identifies the Once the community health nurse identifies the potential leaders, they were formed into a core potential leaders, they were formed into a core group.group.

The core group will be given the role of The core group will be given the role of community organizer.community organizer.

Integration with the core group membersIntegration with the core group members Deepening social investigationDeepening social investigation Training and educationTraining and education Mobilizing the core groupMobilizing the core group

ORGANIZATION-BUILDING ORGANIZATION-BUILDING PHASEPHASE

Entails the formation of more formal Entails the formation of more formal structures and the inclusion of more structures and the inclusion of more formal procedures of planning, formal procedures of planning, implementing, and evaluating implementing, and evaluating community-wide activities. community-wide activities.

It is at this phase where the organized It is at this phase where the organized leaders or groups are being given trainings leaders or groups are being given trainings (formal, informal) to develop their ASK (formal, informal) to develop their ASK (attitude, knowledge and skills) in (attitude, knowledge and skills) in managing their own concerns/programs.managing their own concerns/programs.

Other community members are encourage Other community members are encourage to join and form a community organizationto join and form a community organization

Pre-organization building activitiesPre-organization building activitiesOrganizing the barrio health committeeOrganizing the barrio health committeeSetting up community organizationSetting up community organization

Training and education for the Training and education for the organization organization

SUSTENANCE AND SUSTENANCE AND STRENGTHENING PHASESTRENGTHENING PHASE

Occur when the community organization Occur when the community organization has already been established and the has already been established and the community-wide undertakings. community-wide undertakings.

At this point, the different committees set-At this point, the different committees set-up in the organization-building phase are up in the organization-building phase are already expected to be functioning by way already expected to be functioning by way of planning, implementing and evaluating of planning, implementing and evaluating their own programs, with the overall their own programs, with the overall guidance from the community-wide-guidance from the community-wide-organization.organization.

Strategies used:Strategies used:Education and trainingEducation and trainingNetworking and linkingNetworking and linkingConduct of mobilization on health and Conduct of mobilization on health and

development concernsdevelopment concernsImplementation of livelihood projectsImplementation of livelihood projectsDeveloping secondary leaders.Developing secondary leaders.

CRITICAL STEPS IN BUILDING CRITICAL STEPS IN BUILDING PEOPLE ORGANIZATION PEOPLE ORGANIZATION

INTEGRATION INTEGRATION SOCIAL INVESTIGATION SOCIAL INVESTIGATION TENTATIVE PROGRAM PLANNINGTENTATIVE PROGRAM PLANNING GROUNDWORKGROUNDWORK MEETINGMEETING ROLE PLAYINGROLE PLAYING MOBILIZATION OF ACTIONSMOBILIZATION OF ACTIONS EVALUATIONEVALUATION REFLECTIONREFLECTION ORGANIZATIONORGANIZATION

CRITICAL STEPS IN BUILDING CRITICAL STEPS IN BUILDING PEOPLE ORGANIZATION PEOPLE ORGANIZATION

INTEGRATION INTEGRATION – a community organizer – a community organizer becoming one with the people in order to:becoming one with the people in order to: immerse himself in the poor communityimmerse himself in the poor communityunderstand deeply the culture, economy, understand deeply the culture, economy,

leaders, history, rhythms and lifestyle of the leaders, history, rhythms and lifestyle of the community.community.

SOCIAL INVESTIGATION SOCIAL INVESTIGATION – A – A systematic process of collecting, systematic process of collecting, collating, analyzing data to draw a clear collating, analyzing data to draw a clear picture of the community. Also known as picture of the community. Also known as community studycommunity study

TENTATIVE PROGRAM PLANNING TENTATIVE PROGRAM PLANNING – – Community organizer to choose one issue Community organizer to choose one issue to work on in order to begin organizing the to work on in order to begin organizing the people.people.

GROUNDWORK GROUNDWORK – Going around and – Going around and motivating the people on something or an motivating the people on something or an issues. A time to spot and develop issues. A time to spot and develop potential leader. The entry phase or potential leader. The entry phase or sometimes called the social preparation sometimes called the social preparation phase.phase.

MEETING MEETING – Core group formation. People – Core group formation. People collectively ratifying what they have collectively ratifying what they have already decided individually. The meeting already decided individually. The meeting gives the people the collective power and gives the people the collective power and confidence. Problems and issues are confidence. Problems and issues are discussed.discussed.

ROLE PLAYING ROLE PLAYING – To act out the meeting – To act out the meeting that will take place between the leaders of that will take place between the leaders of the people and the government the people and the government representatives.representatives.

MOBILIZATION OF ACTIONS MOBILIZATION OF ACTIONS – Actual – Actual experience of the people in confronting the experience of the people in confronting the powerful and the actual exercise power.powerful and the actual exercise power.

EVALUATION EVALUATION – determines whether the – determines whether the goal is met or not.goal is met or not.

REFLECTION REFLECTION – dealing with deeper, on-– dealing with deeper, on-going concerns to look at the positive going concerns to look at the positive values compared to the ideal.values compared to the ideal.

ORGANIZATION ORGANIZATION – the result of many – the result of many successive and similar actions of the successive and similar actions of the people. Occurs when the community people. Occurs when the community organization has already been established organization has already been established and the community members are already and the community members are already participating in a community wide participating in a community wide undertaking.undertaking.

COMMUNITY HEALTH COMMUNITY HEALTH NURSING PROCESSNURSING PROCESS

Assessment of Assessment of Community Health NeedsCommunity Health Needs

Community DiagnosisCommunity DiagnosisA process by which the nurse collects A process by which the nurse collects

data about the community in order to data about the community in order to identify factors which may influence the identify factors which may influence the illness and deaths of the population.illness and deaths of the population.

To formulate a community health To formulate a community health nursing diagnosis and develop and nursing diagnosis and develop and implement community health nursing implement community health nursing interventions and strategies.interventions and strategies.

Steps involved:Steps involved:

Site selectionSite selectionPreparation of the communityPreparation of the communityStatement of the objectivesStatement of the objectivesDetermine the data to be collectedDetermine the data to be collected Identify methods and instruments for data Identify methods and instruments for data

collectioncollectionFinalize sampling design and methodsFinalize sampling design and methodsMake time tableMake time table

Population groupPopulation group

Vulnerable groupsVulnerable groups Infants and young childrenInfants and young childrenSchool ageSchool ageAdolescentsAdolescentsMothersMothersMaleMaleOld peopleOld people

Implementation PhaseImplementation Phase

Data collectionData collectionData organization/collationData organization/collationData preparationData preparationData analysisData analysis Identification of health problemsIdentification of health problemsPrioritization of health problemsPrioritization of health problemsDevelopment of health care planDevelopment of health care planValidation and feedbackValidation and feedback

Community health problems are Community health problems are categorized as:categorized as:

A. Health status problemA. Health status problem – they may be – they may be described in terms of increased or described in terms of increased or decreased morbidity, mortality or fertilitydecreased morbidity, mortality or fertility

B. Health resources problemsB. Health resources problems – they may – they may be describe in terms of lack or absence be describe in terms of lack or absence of manpower, money, materials or of manpower, money, materials or institutions necessary to solve health institutions necessary to solve health problemproblem

c. Health related problemsc. Health related problems – they may be – they may be described in terms of existence of social, described in terms of existence of social, economic, environmental and political economic, environmental and political factors that aggravate the illness-factors that aggravate the illness-inducing situation in the communityinducing situation in the community

Priority SettingPriority Setting

Criteria:Criteria: nature of the problem presented nature of the problem presented –the problems are –the problems are

classified by the nurse as health status, health classified by the nurse as health status, health resources or health related problemsresources or health related problems

magnitude of the problemmagnitude of the problem – this refers to the severity – this refers to the severity of the problem which can be measured in terms of the of the problem which can be measured in terms of the proportion of the population affected by the problemproportion of the population affected by the problem

modifiability of the problemmodifiability of the problem – this refers to the – this refers to the probability of reducing, controlling or eradicating the probability of reducing, controlling or eradicating the problemproblem

preventive potentialpreventive potential – this refers to the probability of – this refers to the probability of controlling or reducing the effects posed by the problemcontrolling or reducing the effects posed by the problem

social concernsocial concern – this refers to the perception of the – this refers to the perception of the population or the community as they are affected by the population or the community as they are affected by the problemproblem

CriteriaCriteria WeightWeight

Nature of the problemNature of the problem Health status 3Health status 3 Health resources 2Health resources 2 Health related 1Health related 1

11

Magnitude of the problemMagnitude of the problem 75% - 100% affected 475% - 100% affected 4 50% - 74% affected 350% - 74% affected 3 25% - 49% affected 225% - 49% affected 2 < 25% affected 1< 25% affected 1

33

Modifiability of the problemModifiability of the problem High 3High 3 Moderate 2Moderate 2 Low 1Low 1 Not modifiable 0 Not modifiable 0

44

Preventive potentialPreventive potential High 3High 3 Moderate 2Moderate 2 Low 1Low 1

11

Social concernSocial concernUrgent community concern 2Urgent community concern 2Recognized as problem butRecognized as problem but not needing urgent attention 1not needing urgent attention 1Not a community concern 0Not a community concern 0

11

Individual, Family, CommunityIndividual, Family, CommunityGoal of CareGoal of Care

AssessmentAssessment Planning nursing Planning nursing actionaction

Implementation of Implementation of plan of careplan of care

Evaluation of care Evaluation of care and services and services

renderedrendered

Initiate contactInitiate contactDemonstrate caring Demonstrate caring attitudesattitudesmutual trust and mutual trust and confidenceconfidenceCollect data from all Collect data from all possible sourcespossible sourcesiIentify health problemsiIentify health problemsAssess coping abilityAssess coping abilityAnalyze and interpret Analyze and interpret datadata

Prioritize needsPrioritize needsEstablish goal base Establish goal base on needs and on needs and capabilities of staffcapabilities of staffConstruct action Construct action and operation planand operation planDevelop evaluation Develop evaluation parametersparametersRevise plan as Revise plan as necessarynecessary

Put nursing plan into Put nursing plan into actionactionCoordinate Coordinate care/servicescare/servicesUtilize community Utilize community resourcesresourcesDelegateDelegateSupervise/monitor Supervise/monitor health services health services providedprovidedProvide health Provide health education and education and trainingtrainingDocument Document responses to nursing responses to nursing carecare

Nursing auditNursing auditCare outcomesCare outcomesPerformance Performance appraisalappraisalEstimate cost Estimate cost benefit ratiobenefit ratioAssessment of Assessment of problemsproblemsIdentify needed Identify needed alterationsalterationsRevise plan as Revise plan as necessarynecessary

TOOLS USED IN COMMUNITY TOOLS USED IN COMMUNITY DIAGNOSIS: DEMOGRAPHY, DIAGNOSIS: DEMOGRAPHY,

VITAL AND HEALTH VITAL AND HEALTH STATISTICSSTATISTICS

EPIDEMIOLOGYEPIDEMIOLOGY

BiostatisticsBiostatistics

DemographyDemographyStudy of population size, Study of population size,

composition and spatial composition and spatial distribution as affected by births distribution as affected by births and deaths and migration.and deaths and migration.

SourcesSourcesCensus – complete enumeration of the Census – complete enumeration of the

populationpopulationDe jure –people were assigned to place where De jure –people were assigned to place where

they usually live regardless of where they are at they usually live regardless of where they are at the time of the censusthe time of the census

De facto –people were assigned to place where De facto –people were assigned to place where they physically present at the time of the censusthey physically present at the time of the census

ComponentsComponents

Population SizePopulation SizePopulation CompositionPopulation Composition

Age distributionAge distributionSex ratioSex ratioPopulation pyramidPopulation pyramid

Median ageMedian ageAge dependency ratioAge dependency ratioOther characteristicsOther characteristics

Occupational groups, Economic group, Occupational groups, Economic group, Educational attainment, Ethnic groupEducational attainment, Ethnic group

Population DistributionPopulation Distribution

Urban – RuralUrban – RuralCrowding Index – indicates the ease by Crowding Index – indicates the ease by

which a communicable disease can be which a communicable disease can be transmitted from one host to another transmitted from one host to another susceptible hostsusceptible host

Population Density – determine the Population Density – determine the congestion of the area/placecongestion of the area/place

Vital statisticsVital statistics

The application of statistical The application of statistical measurements to vital events such as measurements to vital events such as births, deaths and common illness that is births, deaths and common illness that is utilized to gauge the levels of health, utilized to gauge the levels of health, illness and health services of a illness and health services of a community.community.Fertility rateFertility rate

Crude birth rateCrude birth rateGeneral fertility rateGeneral fertility rate

Mortality ratesMortality rates CDRCDR Specific mortality ratesSpecific mortality rates Infant mortality rateInfant mortality rate Neonatal mortality rateNeonatal mortality rate Post-neonatal ratePost-neonatal rate Maternal mortality rateMaternal mortality rate

Morbidity ratesMorbidity rates Prevalence ratePrevalence rate Incidence rateIncidence rate

HEALTH INDICATORSHEALTH INDICATORS. . A list of information determined the A list of information determined the

health of a particular community health of a particular community particularly the population.particularly the population.

TYPES OF HEALTH INDICATORSTYPES OF HEALTH INDICATORSCBR – Crude Birth RateCBR – Crude Birth RateCDR – Crude Death RateCDR – Crude Death Rate IMR – Infant Mortality/Morbidity RateIMR – Infant Mortality/Morbidity RateMMR – Maternal Mortality/Morbidity RateMMR – Maternal Mortality/Morbidity RateNDR - Neonate Death RateNDR - Neonate Death Rate

IMPORTANCE/IMPLICATION OF IMPORTANCE/IMPLICATION OF HEALTH STATISTICSHEALTH STATISTICS

It is a tool in planning, implementation It is a tool in planning, implementation and evaluating health programs.and evaluating health programs.

Serves as indexes of the health Serves as indexes of the health condition obtaining in a community or condition obtaining in a community or population group.population group.

Provide variables due as to the nature Provide variables due as to the nature of health services or action needed.of health services or action needed.

Serves as basis for determining the Serves as basis for determining the success or failure of such services or success or failure of such services or actions.actions.

Crude Birth RateCrude Birth Rate (CBR ) (CBR )

Refers to the number of live birth/1000 Refers to the number of live birth/1000 population (fertility rate).population (fertility rate).

CBR =CBR = # of total registered live birth# of total registered live birth x 1,000 x 1,000

Estimated mid year populationEstimated mid year population

Crude Death RateCrude Death Rate (CDR) (CDR)

Refers to the deaths/1000 population. This Refers to the deaths/1000 population. This also measures the force of mortality in a 1 also measures the force of mortality in a 1 year calendar.year calendar.

CDR = CDR = # of total deaths# of total deaths x 1,000 x 1,000

Estimated mid year populationEstimated mid year population

Infant Mortality RInfant Mortality Rate (IMR)ate (IMR)

Pertains to the number of death under 1 Pertains to the number of death under 1 yr/ 1000 live birthsyr/ 1000 live births

IMR =IMR = # of deaths under1 yr. # of deaths under1 yr. X 1,000X 1,000

# of registered live births# of registered live births

Maternal Mortality RateMaternal Mortality Rate (MMR) (MMR)

Refers to the number of deaths related to Refers to the number of deaths related to pregnancy/ 1000 population.pregnancy/ 1000 population.

MMR = MMR = # of deaths related to pregnancy# of deaths related to pregnancy x 1,000 x 1,000

# of registered live births# of registered live births

Neonatal Death Rate Neonatal Death Rate (NDR)(NDR)

Refers to the total number of deaths Refers to the total number of deaths among individual below 28 days old. among individual below 28 days old.

NDR = NDR = # of deaths under 28 days# of deaths under 28 days x 1,000 x 1,000

# of registered live births# of registered live births

Barangay Wakat, Nagcarlan, Laguna has an Barangay Wakat, Nagcarlan, Laguna has an estimated mid year population of 550 for estimated mid year population of 550 for the year 2007. In the same year 250 live the year 2007. In the same year 250 live births are registered at the Municipal Hall. births are registered at the Municipal Hall. There are 75 deaths from any cause of There are 75 deaths from any cause of disease, which occurs, in the same year. disease, which occurs, in the same year. There are 7 mothers who died resulting There are 7 mothers who died resulting from pregnancy, labor and delivery at the from pregnancy, labor and delivery at the same year. 15 babies dies during prenatal same year. 15 babies dies during prenatal and post natal period. and post natal period.

Compute for the following: CBR, CDR, IMR, Compute for the following: CBR, CDR, IMR, MMRMMR

Given:Given:

population = 550population = 550

# of registered live births = 250# of registered live births = 250

# of registered deaths# of registered deaths = 75= 75

# of deaths resulting from pregnancy = 7# of deaths resulting from pregnancy = 7

# of babies deaths = 15# of babies deaths = 15

1. 1. CBR =CBR = # of total registered live birth# of total registered live birth x 1,000 x 1,000

Estimated mid year populationEstimated mid year population

== (250/550) x 1,000(250/550) x 1,000

== 454 / 1,000 population454 / 1,000 population

Interpretation: There are 454 live births per Interpretation: There are 454 live births per 1,000 population1,000 population

2. 2. CDR CDR = = # of total deaths# of total deaths x 1,000 x 1,000

Estimated mid year populationEstimated mid year population

== (75/550) x 1000(75/550) x 1000

== 136 / 1,000 population136 / 1,000 population

Interpretation: There are 136 deaths per Interpretation: There are 136 deaths per 1,000 population1,000 population

3. 3. IMR= IMR= # of deaths under1 yr. # of deaths under1 yr. X 1,000X 1,000

# of registered live births# of registered live births

= = (15/250) x 1,000(15/250) x 1,000

== 0.06/ 1,000 population0.06/ 1,000 population

Interpretation: There are 0.06 infant mortality Interpretation: There are 0.06 infant mortality rate per 1,000 populationrate per 1,000 population

4. MMR= 4. MMR= # of deaths related to pregnancy# of deaths related to pregnancy x 1,000 x 1,000

# of registered live births# of registered live births

== (7/250) x 1,000(7/250) x 1,000

== 0.028 / 1,000 population0.028 / 1,000 population

Interpretation: There are 0.028 maternal Interpretation: There are 0.028 maternal mortality rate per 1,000 populationmortality rate per 1,000 population

Incidence RateIncidence Rate

This measures the frequency of This measures the frequency of occurrence of the phenomenon during a occurrence of the phenomenon during a given period of time. Deals only with new given period of time. Deals only with new cases.cases.

No. of new cases of a particular disease No. of new cases of a particular disease

IR = IR = registered during a specific period of timeregistered during a specific period of time x 100,000 x 100,000

estimated population as of July of same yearestimated population as of July of same year

Prevalence RatePrevalence Rate

This measures the proportion of the This measures the proportion of the population which exhibits a particular population which exhibits a particular disease at a particular time. This can only disease at a particular time. This can only be determined following a survey of the be determined following a survey of the population concerned. Deals with the total population concerned. Deals with the total number of old and new cases.number of old and new cases.

No. of new and old cases of a certainNo. of new and old cases of a certain

PR = PR = disease registered at a given timedisease registered at a given time x 100 x 100

total number of person examined at total number of person examined at

same given timesame given time

EpidemiologyEpidemiology

The study of the distribution of disease or The study of the distribution of disease or physiological condition among human physiological condition among human populations and the factors affecting such populations and the factors affecting such distribution.distribution.

The study of the occurrence and The study of the occurrence and distribution of health conditions such as distribution of health conditions such as disease, death, deformities or disabilities disease, death, deformities or disabilities on human populations.on human populations.

IMPORTANCE AND USES OF IMPORTANCE AND USES OF EPIDEMIOLOGY IN PUBLIC EPIDEMIOLOGY IN PUBLIC

HEALTHHEALTH

Serve as backbone of the prevention of Serve as backbone of the prevention of diseasesdiseases

Uses of Epidemiology: according to Uses of Epidemiology: according to MorrisMorrisTo study the history of the health To study the history of the health

population and the occurrences of diseasepopulation and the occurrences of diseaseTo diagnose the health of the community To diagnose the health of the community

and the condition of peopleand the condition of peopleTo study the working of health services To study the working of health services

with a view of improving themwith a view of improving themTo estimate the risks of disease, To estimate the risks of disease,

accidents, defects and the chances of accidents, defects and the chances of avoiding themavoiding them

Factors affecting distributionFactors affecting distribution

PersonPerson Intrinsic characteristicsIntrinsic characteristics

PlacePlaceExtrinsic factorsExtrinsic factors

TimeTimeTemporal patternsTemporal patterns

Patterns of Disease OccurrencePatterns of Disease Occurrence

ENDEMIC – places where diseases are ENDEMIC – places where diseases are regularly experience; occurrences of disease are regularly experience; occurrences of disease are constant. Example: malariaconstant. Example: malaria

EPIDEMIC – when disease occurs in short EPIDEMIC – when disease occurs in short duration of time or season. Example: measles, duration of time or season. Example: measles, chickenpox, dengue.chickenpox, dengue.

PANDEMIC – when disease occurs worldwide. PANDEMIC – when disease occurs worldwide. Example: SARS, AIDS, choleraExample: SARS, AIDS, cholera

SPORADIC - when disease occurs on and off. SPORADIC - when disease occurs on and off. Example: rabies, tetanusExample: rabies, tetanus

Steps in EPIDEMIOLOGICAL Steps in EPIDEMIOLOGICAL INVESTIGATIONINVESTIGATION

Establish fact of presence of epidemicEstablish fact of presence of epidemicEstablish time and space relationship of Establish time and space relationship of

the diseasethe diseaseRelate to characteristics of the group in Relate to characteristics of the group in

the communitythe communityCorrelate all data obtainedCorrelate all data obtained

Establish fact of presence of Establish fact of presence of epidemicepidemic

Verify diagnosisVerify diagnosisReportingReporting Is there an unusual prevalence of the Is there an unusual prevalence of the

diseasedisease

Establish time and space Establish time and space relationship of the diseaserelationship of the disease

Are the cases limited to or concentrated in Are the cases limited to or concentrated in a particular areaa particular area

Relation of cases by days of onset to Relation of cases by days of onset to onset of the first known cases (usually onset of the first known cases (usually done in weeks)done in weeks)

Relate to characteristics of the Relate to characteristics of the group in the communitygroup in the community

Relation of cases to age, groups, sex, Relation of cases to age, groups, sex, color, occupation, school attendance, past color, occupation, school attendance, past immunization.immunization.

Relation of sanitary facilitiesRelation of sanitary facilitiesRelation to milk and food supplyRelation to milk and food supplyRelation of cases to other cases and Relation of cases to other cases and

known carriers if anyknown carriers if any

Correlate all data obtainedCorrelate all data obtained

Summarize the dataSummarize the dataDraw final conclusionDraw final conclusionEstablish source of epidemic and the Establish source of epidemic and the

manner of the spreadmanner of the spreadMake suggestions as to the control and Make suggestions as to the control and

preventions of future outbreakspreventions of future outbreaks

Outline on the operational Outline on the operational procedure during a disease procedure during a disease

outbreakoutbreak Organization teamOrganization team Epidemiological investigationEpidemiological investigation Collection of laboratory specimensCollection of laboratory specimens Treatment of patients and contactsTreatment of patients and contacts Immunization campaignImmunization campaign Environmental sanitationEnvironmental sanitation Health educationHealth education Involvement of other agenciesInvolvement of other agencies ReportingReporting

Health Care Delivery SystemHealth Care Delivery System

the network of health facilities and the network of health facilities and personnel, which carry out the task of personnel, which carry out the task of rendering health care to the people.rendering health care to the people.

TypesTypes ServicesServices Types of Types of health health

servicesservices

ExamplesExamples

PrimaryPrimary Health promotion, Health promotion, preventive carepreventive care

Continuing care for Continuing care for common health common health

problems, attention problems, attention to psychological and to psychological and social care, referralssocial care, referrals

Health promotion Health promotion and illness and illness preventionprevention

Information Information disseminationdissemination

SecondarySecondary Surgery, medical Surgery, medical services by services by specialistspecialist

Diagnosis and Diagnosis and TreatmentTreatment

ScreeningScreening

TertiaryTertiary Advances, Advances, specialized, specialized, diagnostic, diagnostic,

therapeutic and therapeutic and rehabilitative carerehabilitative care

RehabilitationRehabilitation PT/OTPT/OT

Health SectorHealth Sector

groups of services or institutions in the groups of services or institutions in the community, which is concern with the community, which is concern with the protection of the population.protection of the population.NationalNationalLocalLocalPrivatePrivateNGONGO

DEPARTMENT OF HEALTHDEPARTMENT OF HEALTH

VISIONVISIONThe DOH is the leader, staunch, advocate The DOH is the leader, staunch, advocate

and model in promoting HEALTH FOR and model in promoting HEALTH FOR ALL in the PhilippinesALL in the Philippines

MISSIONMISSIONGuarantee equitable, sustainable, and Guarantee equitable, sustainable, and

quality health care for all Filipinos, quality health care for all Filipinos, especially the poor, and lead the quest for especially the poor, and lead the quest for excellence in health.excellence in health.

BASIC PRINCIPLES TO ACHIEVE BASIC PRINCIPLES TO ACHIEVE IMPROVEMENTS IN HEALTHIMPROVEMENTS IN HEALTH

Fostering a strong and healthy nationFostering a strong and healthy nationEnhancing the performance of the health Enhancing the performance of the health

sectorsectorEnsuring universal access to quality Ensuring universal access to quality

essential health careessential health care Improving macro-economic and social Improving macro-economic and social

conditions for better healthconditions for better health

FOURmula ONE FOR HEALTHFOURmula ONE FOR HEALTH

OVER-ALL GOALS:OVER-ALL GOALS:The implementation of FOURmula One for The implementation of FOURmula One for

Health is directed towards achieving the Health is directed towards achieving the following end goals, in consonance with following end goals, in consonance with the health system goals identified by the the health system goals identified by the WHO, the Millennium Development Goals, WHO, the Millennium Development Goals, and the Medium Term Philippine and the Medium Term Philippine Development Plan:Development Plan:

Better health outcomesBetter health outcomesMore responsive health systemMore responsive health systemMore equitable healthcare financingMore equitable healthcare financing

General Objective:General Objective:

FOURmula One for Health is aimed at FOURmula One for Health is aimed at achieving critical reforms with speed, achieving critical reforms with speed, precision and effective coordination precision and effective coordination directed at improving the quality, directed at improving the quality, efficiency, effectiveness and equality of efficiency, effectiveness and equality of the Philippine Health System in a manner the Philippine Health System in a manner that is felt and appreciated by Filipinos, that is felt and appreciated by Filipinos, especially the poor.especially the poor.

ComponentsComponents

Health FinancingHealth FinancingHealth RegulationHealth RegulationHealth Service DeliveryHealth Service DeliveryGood Governance in HealthGood Governance in Health

Health FinancingHealth Financing

ObjectiveObjectiveTo secure more, better, and sustained To secure more, better, and sustained

investments in health to provide equity and investments in health to provide equity and improved health outcomes, especially for improved health outcomes, especially for the poor.the poor.

StrategiesStrategies Mobilizing resources from extra budgetary Mobilizing resources from extra budgetary

sourcessources Adopting a performance based financing Adopting a performance based financing

systemsystem Coordinating local and national health Coordinating local and national health

spendingspending Focusing direct subsidies to priority programFocusing direct subsidies to priority program Expanding the national health insurance Expanding the national health insurance

programprogram

Health RegulationHealth Regulation

ObjectiveObjectiveAssuring access to quality and affordable Assuring access to quality and affordable

health products, devices, facilities and health products, devices, facilities and services, especially those commonly used services, especially those commonly used by the poor.by the poor.

StrategiesStrategiesHarmonizing licensing, accreditation and Harmonizing licensing, accreditation and

certificationcertification Issuance of quality sealsIssuance of quality sealsAssuring the availability of low-priced Assuring the availability of low-priced

quality essential medicines commonly quality essential medicines commonly used by the poorused by the poor

Health Service DeliveryHealth Service Delivery

ObjectiveObjective Improving the accessibility and availability Improving the accessibility and availability

of basic and essential health care for all, of basic and essential health care for all, particularly the poor. This shall cover all particularly the poor. This shall cover all public and private facilities and services.public and private facilities and services.

StrategiesStrategiesDesignating providers of specific and Designating providers of specific and

specialized services in localitiesspecialized services in localitiesEnsuring availability of providers of basic Ensuring availability of providers of basic

and essential health services in localitiesand essential health services in localities Intensifying public health programs in Intensifying public health programs in

targeted localitiestargeted localities

Good Governance in HealthGood Governance in Health

ObjectiveObjective Improve the health system both national and Improve the health system both national and

local levelslocal levels Improve coordination across local health Improve coordination across local health

systemsystem Enhance effective private-public partnershipEnhance effective private-public partnership Improve national capabilities to manage Improve national capabilities to manage

health sectorhealth sector

StrategiesStrategiesEstblishisng inter LGU coordination Estblishisng inter LGU coordination

mechanisms like interlocal health zones mechanisms like interlocal health zones and other model of appropriate local and other model of appropriate local health systems in the context of health systems in the context of devolution.devolution.

Developing performance assessment Developing performance assessment systems that cover local, regional and systems that cover local, regional and central health officescentral health offices

Institutionalizing a professional career Institutionalizing a professional career track mechanisms for human resources for track mechanisms for human resources for healthhealth

Improving management support systems Improving management support systems to enhance the delivery of health goods to enhance the delivery of health goods and services.and services.

Local Government UnitLocal Government Unit – with the – with the process of devolution (decentralization), process of devolution (decentralization), the responsibility for health promotion and the responsibility for health promotion and protection has become a shared effort protection has become a shared effort between the LGU’s and the DOH. between the LGU’s and the DOH.

Private SectorPrivate Sector - This consists of both - This consists of both commercial and business organizations and commercial and business organizations and non- commercial organizations.non- commercial organizations.

Their involvement includes:Their involvement includes: Inputs provision which covers supplies and Inputs provision which covers supplies and

equipments/treatment and facilitiesequipments/treatment and facilities Service delivery activities includes case findings/ Service delivery activities includes case findings/

treatment and follow-ups, counseling, environmental treatment and follow-ups, counseling, environmental sanitation and to manufacture goods.sanitation and to manufacture goods.

Support research, personnel training, project Support research, personnel training, project monitoring and evaluation and development of IEC monitoring and evaluation and development of IEC materials.materials.

Financing through financial assistance Financing through financial assistance

Non-Government OrganizationsNon-Government Organizations – plays – plays an important role in national and local an important role in national and local development. development.

They assumed the role of policy and They assumed the role of policy and legislative advocates, organizers, human legislative advocates, organizers, human rights advocates, research and rights advocates, research and documentation, health resources documentation, health resources development personnel, relief and disaster development personnel, relief and disaster management and networking.management and networking.

Communities, Families and IndividualsCommunities, Families and Individuals – the person who participates and – the person who participates and benefited the health care delivery systems.benefited the health care delivery systems.

Health FacilitiesHealth Facilities – infrastructures that – infrastructures that offers health services. This includes offers health services. This includes hospitals, health centers, health stations, hospitals, health centers, health stations, clinics and laboratories. The government, clinics and laboratories. The government, private sectors and NGO’s operates these private sectors and NGO’s operates these health facilities today.health facilities today.

The National Health Care PlanThe National Health Care Plan

A long term plan for healthA long term plan for healthThe blueprint defining the country’s healthThe blueprint defining the country’s health

GoalGoal

To enable the Filipino population to To enable the Filipino population to achieve a level of health which will allow achieve a level of health which will allow Filipino to lead a socially and Filipino to lead a socially and economically-productive life, with no economically-productive life, with no longer life expectancy, low infant mortality, longer life expectancy, low infant mortality, low maternal mortality and less disability low maternal mortality and less disability through measures that will guarantee through measures that will guarantee access of everyone to essential care.access of everyone to essential care.

Broad objectives:Broad objectives:

Promote equality in health status among Promote equality in health status among all segments of societyall segments of society

Address specific health problems of the Address specific health problems of the populationpopulation

PortsPortsPhysical environment: clean, spacious and Physical environment: clean, spacious and

secure, with public waiting areas, passengers secure, with public waiting areas, passengers terminals, safe drinking water, sanitary food terminals, safe drinking water, sanitary food shops and public toilets, conveniently and shops and public toilets, conveniently and economically accessible.economically accessible.

Hotels/MotelsHotels/MotelsPhysical Environment: clean, safe, pleasant Physical Environment: clean, safe, pleasant

place, conforms with set of guidelines and place, conforms with set of guidelines and standards, prove comfort and security.standards, prove comfort and security.

StreetStreetWell maintained roads and public waiting Well maintained roads and public waiting

areasareasWell mark traffic signs and pedestrian Well mark traffic signs and pedestrian

crossing line and visible street namescrossing line and visible street namesClean and obstruction-free sidewalksClean and obstruction-free sidewalksWith minimal traffic problemsWith minimal traffic problemsWith adequate strict law enforcementWith adequate strict law enforcement

VehiclesVehicles Clean, safe, comfortable, smoke free, well ventilated, Clean, safe, comfortable, smoke free, well ventilated,

in good running conditionin good running condition Manned by a reliable and dependable licensed Manned by a reliable and dependable licensed

operatorsoperators With posters on health promotion and illness With posters on health promotion and illness

preventionprevention Movie HouseMovie House

Provides rest, recreation and wholesome Provides rest, recreation and wholesome entertainmententertainment

Has sanitary toilets and adequate communication Has sanitary toilets and adequate communication facilitiesfacilities

Strategies and Methodologies in Strategies and Methodologies in CHNCHN

Priority for the vulnerable groupsPriority for the vulnerable groups Infants (0 – 1 year old)Infants (0 – 1 year old)Children (1 – 4 y.o.)Children (1 – 4 y.o.)Women of reproductive age (15 – 44 y.o.)Women of reproductive age (15 – 44 y.o.)AdolescentAdolescentElderlyElderly

Key ApproachKey ApproachPRIMARY HEALTH CAREPRIMARY HEALTH CARE

Levels of Health CareLevels of Health Care

Health PromotionHealth Promotion Individual wellnessIndividual wellness Family wellnessFamily wellness Community wellnessCommunity wellness Environmental Environmental

wellnesswellness Social wellnessSocial wellness

Disease PreventionDisease Prevention PrimaryPrimary SecondarySecondary TertiaryTertiary

Focus on screeningFocus on screening Case findingCase finding Contact tracingContact tracing Multi-phasing screeningMulti-phasing screening surveillancesurveillance