COMMUNITY HEALTH NURSING

Content Outline

Part 1 Definition of TermsPart 2 Basic Principles of CHNPart 3 Roles and Functions of the PHNPart 4 Levels of CarePart 5 Levels of ClientelePart 6 Health Care Delivery SystemPart 7 Primary Health CarePart 8 Ten Herbal Plants Recommended by

the DOHPart 9 Family Nursing ProcessPart 10 Community DiagnosisPart 11 COPARPart 12 Selected Public Health SituationPart 13 Vital StatisticsPart 14 EpidemiologyPart 15 DemographyPart 16 Target SettingPart 17 Environmental SanitationPart 18 DOH National Events

PART 1 DEFINITION OF TERMSA. Public Health

Science and Art of Preventing Disease, Prolonging Life, Promoting Health and efficiency through organized community effort for the sanitation of the environment, control of communicable diseases, the education of individuals in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to Enable Every Citizen to Realize His Birthright to Health and Longevity

- Dr. C.E. Winslow Art of applying Science in the Context of Politics so as to Reduce

Inequalities in Health while ensuring the best health for the greatest number

- WHOB. Public Health Nursing

Special Field of Nursing that combines the skills of nursing, public health, and some phases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability.

- WHOC. Community Health Nursing

Service rendered by a professional nurse with communities, groups, families, individuals at home, in health centers, in clinics, in schools, in places of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation.

- Ruth B. Freeman Nursing Practice in a wide variety of community services and

consumer advocate areas, and in a variety of roles, at times including independent practice… community nursing is certainly not confined to public health nursing agencies.

- Jacobson The utilization of the Nursing Process in the Different Levels of

Clientele-Individuals, Families, Population Groups and Communities, concerned with the Promotion of Health, Prevention of Disease and Disability and Rehabilitation

- Dr. Araceli Maglaya

Part 2 Basic Principles of CHNA. Brief History of Nursing

The Community is the patient in CHN; The Family is the Unit of Care; and there are four levels of clientele: Individual, Family, Population Group (those who share common characteristics, developmental stages, and common exposure to health problems—e.g. children, elderly), and the Community

In CHN, the client is considered as an Active Partner, not a passive recipient of care.

CHN Practice is affected by developments in Health Technology, in Particular, Changes in Society, in General.

The goal of CHN is achieved through Multi-Sectoral Efforts CHN is a part of the Health Care System and the larger Human

Services System

B. Philosophy of CHN A philosophy is defined as a system of beliefs that provides a

basis for a guides action. A philosophy provides the direction and describes the whats, the whys, and the hows of activities within a profession.

CHN Practice is guided by the following beliefs:

Humanistic values of the nursing profession upheld

Unique and distinct component of health care

Multiple factors of health considered

Active participation of clients encouraged

Nurse considers availability of resources

Interdependence among health team members practiced

Scientific and up-to-date

Tasks of CHN vary with time and place

Independence or self-reliance of the people is the end goal

Connectedness of health and development regarded

Part 3 Roles and Functions of the Public Health NurseA. Roles of the CHN

Clinician or Health Care Provider: utilizes the nursing process in the care of the client in the home setting through home visits and in public health care facilities; conducts referral of patients to appropriate levels of care when necessary

Health Educator: utilizes teaching skills to improve the health knowledge, skills and attitude of the individual, family and the community and conducts health information campaigns to various groups for the purpose of health promotion and disease prevention

Coordinator and collaborator: establishes linkages and collaborative relationships with other health professionals, government agencies, the private sector, non-government organizations and people’s organizations to address health problems

Supervisor: monitors and supervises the performance of midwives and other auxiliary health workers; also initiates the formulation of staff development and training programs for midwives and other auxiliary health workers as part of their training function as supervisors

Leader and Change Agent: influences people to participate in the overall process of community development

Manager: organizes the nursing service component of the local health agency or local government unit; also, as program manager, the PHN is responsible for the delivery of the package of services provided by the health program to target clientele

Researcher: participates in the conduct of research and utilizes research findings in practice

B. Responsibilities of the CHN Be a part in developing an overall health plan, its implementation and

evaluation for communities. Provide quality nursing services to the four levels of clientele Maintain coordination/linkages with other health team members, NGO/

government agencies in the provision of public health services Conduct researches relevant to CHN services to improve provision of

health care Provide opportunities for professional growth and continuing education

for staff developmentC. Specialized Fields of CHN

Community Mental Health Nursing: a unique clinical process which includes an integration of concepts from nursing, mental health, social psychology, psychology, community networks, and the basic sciences

Occupational Health Nursing: the application of nursing principles and procedures conserving the health of workers in all occupation

School Health Nursing: the application of nursing theories and principles in the care of the school population

Part 4 Levels of CareA. The Three Levels of Health Care Services

Primary Level of Care: devolved to the cities and municipalities and is the first contact between the community people and the different levels of health facility; refers to health care provided by the health center staff

Secondary Level of Care: rendered by physicians with basic health training in district hospitals, provincial hospitals, and city hospitals; these facilities are capable of basic surgical procedures and simple laboratory examinations; serves as referral center of primary health facilities

Tertiary Level of Care: rendered by specialists in medical centers, regional hospitals and specialized hospitals like the Lung Center of the Philippines; serves as the referral center of secondary health facilities

B. Three levels of Health Care Services and the Two-Way Referral System

Barangay Health Station

National HealthServices, Medical Centers, Tertiary

Teaching and Training Hospitals

Rural Health Units, Community Hospitals and Health Centers,

Puericulture centers

Emergency / District Hospitals

Provincial/City Health Services, Provincial /CityHospitals

Regional Health Services,Regional Medical Centers

and Training Hospital

PRIMARY

TERTIARY

SECONDARY

REFERRAL from the COMMUNITY

*There are TWO LEVELS OF PRIMARY HEALTH CARE WORKERS, namely:1. Village or Barangay Health Workers: refers to trained community health workers or health auxiliary volunteers or traditional birth attendants or healers2. Intermediate Level Health Workers: refers to general medical practitioners or their assistants, public health nurse, rural sanitary inspectors, and midwives.

C. Types of Primary Health Workers

Village / Grassroots Health Workers

Intermediate Level Health Personnel of First-Line Hospitals

EXAMPLE

- trained community-health worker-auxiliary health volunteer-traditional birth attendant

-general medical practitioners-public health nurses-midwives

-physicians-nurses-dentists

CHARACTERISTICS

-initial link, first contact of the community

-works in liaison with the local health service workers

-provides elementary curative and preventive health care measures

-first source of professional health care

-attends to health problems beyond the competence of village health workers

-provides support to the frontline health workers in terms of supervision, training, referral services and supplies thru linkages with other sectors

-establishes close contact with the village and intermediate level health workers to promote the continuity of care from hospital to community to home

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

care

Part 5 Levels of Clientele*Four Levels of Clientele in the Community Setting

A. IndividualB. FamilyC. CommunityD. Population Groups

A. Individual-basic approaches in looking at the individual

Atomistic: the whole is equal to the sum of its parts Holistic: the whole is NOT equal to the sum of its parts; traces

man’s relationship in the suprasystem of society

B. Family-defined by Murray and Zentner is a small social system and

primary reference group made up of two or more persons living together who are related by blood, marriage or adoption or who are living together by arrangement over a period of time.

C. Population Groups- a group of people sharing the same characteristics,

developmental stage or common exposure to particular environmental factors thus resulting in common health problems* Vulnerable groups:

Infants and young children School age Adolescents Mothers Males Older People

D. Community-a group of people sharing common geographic boundaries

and/or common values and interests

Part 6 Health Care Delivery System

HEALTH CARE DELIVERY SYSTEM-the totality of all policies, facilities, equipment, products, human

resources and services which addresses the health need, problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary

MAJOR PLAYERS Public Sector- largely financed thru tax-based budgeting system at

both the national and local levels and where health care is generally given free at the point of servicea. National Level – Department of Health as lead agencyb. Local Health system run by local government units

Private Sector- largely market-oriented and where health care is paid through user fees at the point of service

A. THE PUBLIC SECTOR1. Department of Health

Vision: The DOH is the leader, staunch advocate and model in promoting Health for all in the Philippines

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

Roles and Functions: Executive Order 102 has identified the DOH as the national health authority providing technical and other resource assistance to concerned groups. It has three specific roles in the health sector and several functions under each role. LEADERSHIP IN HEALTH

Functions:

a. LEADER in the formulation, monitoring and evaluation of national health policies, plans and programs

b. ADVOCATE in the adoption of health policies, plans and programs to address national and sectoral concerns

c. NATIONAL POLICY AND REGULATORY INSTITUTION where local government units, nongovernmental organizations and other members of the health sector involved in social welfare and development anchor their thrusts and directions for health.

ADMINISTRATOR OF SPECIFIC SERVICESFunctions:a. MANAGE selected health facilities and hospitalsb. ADMINISTER direct services for emergent health

concerns that require new complicated technologiesc. PROVIDE emergency health response services including

referral and networking system for trauma, injuries and catastrophic events, and, in cases of epidemic widespread public danger upon the direction of the President and in consultation with the concerned LGU

d. ADMINISTER special components of specific programs like tuberculosis, HIV-AIDS, etc.

CAPACITY BUILDER AND ENABLERFunctions:a. ENSURE highest achievable standards of quality health

care, health promotion and health protectionb. INNOVATE new strategies in health to improve the

effectiveness of health programsc. INITIATE public discussion on health issues and

disseminate policy research outputs to ensure informed public participation in policy decision-making

d. OVERSEE implementation, monitoring and evaluation of national health plans, programs and policies

Goal of the DOH: Implementation of Health Sector Reform Agenda (HSRA)

Framework for the implementation of the HSRA: FOURmula ONE for Health

a. FOURmula ONE for health intends to implement critical interventions as a single package backed by effective management infrastructure and financing arrangements thru a sector-wide approach

b. This is directed towards ensuring accessible, affordable quality health care especially for the more disadvantaged and vulnerable sectors of the population

c. This strategy has FOUR ELEMENTS1. Good Governance – to enhance health system

performance at the national and local levels.2. Health Financing – to foster greater, better and

sustained investments in health3. Health Regulation – to ensure the quality and

affordability of health goods and services4. Health Service Delivery – to improve and ensure

the accessibility and availability of basic and essential health care in both public and private facilities and services

Objectives of the Health Sector- to facilitate understanding the objectives of the health sector could be divided into 4 general objectives, namely:

Improve Health Status of the Populationa. Improve the general health status of the

populationb. Reduce morbidity and mortality from certain

diseasesc. Eliminate certain diseases as public health

problemsd. Promote health lifestyle and environmental

health e. Protect vulnerable groups with special

health and nutritional needs

Ensure Quality Service Deliverya. Strengthen national and local health

systems to ensure better health service delivery

b. Pursue public health and hospital reforms

c. Reduce the cost and ensure the quality and safety of health goods and services

d. Strengthen health governance and management support systems

Improve Support system for the Vulnerable and Marginalized Groupsa. Institute safety nets for the vulnerable and

marginalized groups

Implement Proper Resource Managementa. Expand the coverage of social health

insuranceb. Mobilize more resources for healthc. Improve efficiency in the allocation,

production and utilization of resources for health

Major Health Plans towards “Health in the Hands of the People in the Year 2020”

A Healthy BARRIO should be:a. Residents actively participate in attaining

good health; they are PARTNERS in health care.

b. Highlight Project: BOTIKA SA PASO CAMPAIGN

c. Goal: to maintain herbal plants in pots for family use

A Healthy CITY should be:a. The physical environment in the workplace,

streets, and public places promote health, safety, order and cleanliness through structural manpower support

b. Health- Related Strategies: Construction of well-maintained, income generating public toilets; designation of a “pook-sakayan, pook-babaan”

A Healthy EATING PLACE should be:a. Eating place where:

-safe and properly prepared, stored and transferred foods

-nutritious foods and drinks are served.b. Complies with the following sanitation

standards: -safe, environment-friendly -with clean restrooms

-food handlers are medically fitA Healthy MARKET should be:a. Adequate water supplyb. Proper drainagec. Well-maintained toilet facilitiesd. Proper garbage and waste disposale. Cleanliness maintainedf. Affordable quality foodsA Healthy HOSPITAL should be:a. A “Center of Wellness”b. Promotes Preventive carec. Patient-centeredA Healthy STREET should be:a. Well-maintained roads and public waiting

areasb. Clean and obstruction free sidewalksc. With minimal traffic problemsd. With adequate strict law enforcemente. Project: Pook Tawiranf. Goal: to promote and reorient people

especially erring pedestrians on the use of pedestrian crossings

2. Local Government Units-the Local Government Code of 1991 or RA 7160 transformed local government units into self-reliant communities and active partners in the attainment of national goals through a more responsive an accountable government structure instituted through a system of decentralization

GOVERNOR

Provincial Health Office

Provincial Hospital District Hospital Other health and medical facilities

MAYOR

Municipal Health Board

Municipal Health Office

Rural Health Unit/ Health Center

Barangay Health Station

Provincial Health Board

Municipal Level

Provincial Level

B. The Private Sector- composed of both commercial and business organizations with its market or profit orientation and non-business organizations with its service orientation

Part 7 Primary Health Care

Primary Health Care – is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community and country can afford at every stage of development

Conceptual Framework:a. Health is a fundamental human rightb. Health is both an individual and collective responsibilityc. Health should be an equal opportunity to alld. Health is an essential element of socio-economic

development

Translated into action, the PHC APPROACH focuses on:

Partnership with the community

Equitable distribution of health resources

Organized and appropriate health system infrastructure

Prevention of disease and promotion of health as focus

Linked multisectorally

Emphasis on appropriate technology

PHC GOAL (1978): Health for all by the year 2000

PHC was declared in Alma-Ata, USSR during the First International Conference on PHC held on September 6-12, 1978 through the sponsorship of WHO and UNICEF

LEGAL BASIS OF PHC IN THE PHILIPPINES- Letter of Instruction(LOI) 949 signed in October 19, 1979 by former President Ferdinand E. Marcos

UNDERLYING THEME of the Philippine implementation of PHC: Health in the Hands of the People by 2020

5A’s of Health Care according to PHCa. Availableb. Accessiblec. Affordabled. Acceptablee. Attainable

*PHC as a service delivery policy of the DOH permeates all strategies and thrusts of government health programs from the national to the local and community levels

Dimension Commercialized Health Care

Primary Health Care

Goal Absence of disease for the individual

Prevention of diseaseSocio-economic development

Focus of Care Sick Sick and well individualsSetting for Services

Hospital-basedUrban-Centered

Satellite Health CentersCommunity Health Centers

Accessible only to a few people

Rural-Based Accessible to all

People Passive recipients of health care

Active participants in health care

Structure Health is isolated from other sectors of society

Inter- and intra- sectoral linkaging allows health to be integrated with over-all socio-economic development efforts

Process Decision-making from top-down

Decision-making from bottom-top

Technology Curative services based on modern medicine and sophisticated technologyPhysician dominated

Promotive and preventive services blend traditional medicine with modern medicineAppropriate technology for frontline health care

Outcome Reliance on health professionals

People empowerment or self-reliance

Four Cornerstones or Pillars of PHC

Use of appropriate technology

Support mechanism made available

Active community participation

Intra- and inter-sectoral linkage

a. APPROPRIATE TECHNOLOGY implies the use of methods, procedures, techniques, equipment or materials that are not only scientifically sound but also provides a socially and environmentally acceptable service or product at the least economic costCRITERIA used in determining the appropriateness of technology:Acceptability: measured in terms of the degree of utilization of the peopleComplexity: should be simple and easy to apply under local conditionsCost: should be affordableEffectiveness: should produce the desired effect

Safety: effect of utilization should produce no harmScope of Technology: serves a variety of purposesFeasibility: compatible with local conditions

b. MULTISECTORAL APPROACH recognizes intersectoral and intrasectoral linkages in health. With intersectoral linkages, PHC recognizes the integration of health plans with other sectors for TOTAL community development.

Elements/ Components of Primary Health Care

Communicable disease control

Health education

Expanded program on immunization

Locally endemic disease treatment

Environmental Sanitation

Maternal and child health and family planning

Essential drugs provision

Nutrition and adequate food provision

Treatment of emergency cases and provision of medical care

Part 8 Ten Herbal Plants Recommended by DOH

10 Medicinal Plants (LUBBY SANTA)

Lagundi

Indications: cough, asthma, fever, muscle pain Preparation: decoction or syrup

Ulasimang Bato

Indications: lowers serum uric acid in cases of gouty arthritis

Preparation: Salad or decoction

Bawang

Indications: lowers serum cholesterol Preparations: may be roasted, soaked in vinegar or used

for sautéing

Bayabas

Indications: its antiseptic properties is best used for wound cleansing, as mouthwash in cases of oral cavity infections and gingivitis

Preparation: decoction

Yerba Buena

Indications: for muscle pain Preparation: decoction

Sambong

Indications: its diuretic effect is good for edema and against urolithiasis

Preparation: decoction

Ampalaya

Indications: for diabetes mellitus or non-insulin dependent diabetes

Preparation: decoction or steamed

Niyug-niyogan

Indications: for intestinal infestation with ascaris lumbricoides

Preparation: prepare dried, mature niyug-niyugan seeds

Tsaang gubat

Indications: stomachache Preparation: decoction

Akapulko

Indications: ringworm, tinea flava, athlete’s foot and other types of fungal infection

Preparation: poultice or Ointment

*GUIDELINES Chemical pesticides or insecticides may leave toxic

residues on plants. These should not be used on herbal plants

Use palayok or clay pots and wooden spoon when cooking herbal medicines, Remove the pot cover when the herbal preparation starts to boil

Use only the plant part recommended Use the appropriate herbal plant for each sign and

symptom observed Watch out for allergic reactions. STOP the use of herbal

plant preparation when allergic and untoward reactions are observed

Always keep the herbal medicine containers properly labeled

Always keep the herbal preparations out of reach of children

RA 8423: utilization of medicinal plants as alternative for high cost medicationsPolicies:

The indications/uses of plants The part of plant to be used Preparation of herbal medicines

Part 9 Family Nursing Process Initial Data base

a. Family structure and characteristicsb. Socio-economic and cultural factorsc. Environmental factorsd. Health assessment of each membere. Value placed on prevention of disease

First Level Assessmenta. Wellness condition – stated as POTENTIAL or READINESS – a

clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher one

b. Health Threats – conditions that are conducive to disease, accident or failure to realize one’s health potential

c. Health deficits – instances of failure in health maintenance (disease, disability or developmental lag)

d. Stress Points/ Foreseeable crisis situation – anticipated periods of unusual demand on the individual or family in terms of adjustment or family resources

Second Level Assessment (based on Freeman’s Family Health Tasks):a. Ability to recognize the existence of a problemb. Ability to make decisions with respect to taking appropriate

health actionsc. Ability to provide nursing care to the affected family memberd. Ability to provide a home environment that is conducive to

health maintenance and personal developmente. Ability to utilize community resources for health care

Problem Prioritizationa. Nature of the Problem

Wellness condition Health deficits Health threats Foreseeable crisis

b. Preventive Potential – refers to the nature and magnitude of future problems that can be minimized or totally prevented if intervention is done on the problem under consideration

c. Modifiability of the Condition – refers to the probability of success in enhancing the wellness state, improving the condition, minimizing, alleviating or totally eradicating the problem through intervention

d. Salience – refers to the family’s perception and evaluation of the problems in terms of seriousness and urgency of attention needed

Scale for Ranking Health Conditions and Problems according to Priorities

Criteria Score WeightNature of the ConditionWellness State 3

1Health Deficit 3Health Threat 2Foreseeable Crisis 1Modifiability of the ConditionEasily Modifiable 2

1Partially Modifiable 1Not Modifiable 0Preventive PotentialHigh 2

1Moderate 2Low 1SalienceA condition needing immediate attention

2

1A condition not needing immediate attention

1

Not perceived as a condition needing change

0

Part 10 Community DiagnosisA. What is Community Diagnosis?

As a profile, it is a description of the community’s state of health as determined by its physical, economic, political and social

factors. It defines the community and states community problems

As a process, it is a continuous learning experience for the nurse/program coordinator and the staff, as well as the community people.

B. Why undertake Community Diagnosis? To have a clear picture of the problems of the community and

to identify the resources available to the community people. Community diagnosis enables the nurse/program coordinator

to set priorities for planning and developing programs of health care for the community.

C. What are the Types of Community Diagnosis?The types of a community diagnosis may vary according to:

The objectives or degree of detail or depth of the assessment;

The resources; and The time available for the nurse to conduct the

community diagnosisa. Comprehensive Community diagnosis – aims to

obtain general information about the community or a certain population

b. Problem-oriented Community diagnosis- type of assessment that responds to a particular need

D. What are the elements of a Comprehensive Community Diagnosis?1. Demographic Variables

-should show the size, composition and geographical distribution of the population

2. Socio-economic and Cultural Variablesa. Social indicatorsb. Economic indicatorsc. Environmental indicatorsd. Cultural factorse. Other factors that may directly or indirectly affect the health

status of the community3. Health and Illness Pattern

-if the nurse has access to recent and reliable secondary data, then those could be used

4. Health Resources-refer to manpower, institutional and material resources provided not only by the state but also those that are contributed by the private sector and other non-government organizations

5. Political/ Leadership Patterns-reflect the action potential of the state and it people to address the health needs and problems of the community; mirrors the sensitivity of the government to the people’s struggle for better lives

E. What are the sources of data in the conduct of the community diagnosis?1. Primary Data - source would be the community people through

survey, interview, focused group discussions, observation and through the actual minutes of community meetings

2. Secondary data – source would be organizational records of the program, health center records and other public records through review of records

F. What are the steps in Conducting a Community Diagnosis1. Planning

a. Determining the Objectives – nurse decides on the depth and scope of the data he/she needs to gather; regardless of the type of community diagnosis to be conducted, the nurse must determine the occurrence and distribution of selected environmental, socio-economic and behavioral conditions important to disease prevention and wellness promotion

b. Defining the Study Population – based on the objectives, the nurse identifies the population group to be included in the study

c. Preparation of the community – courtesy calls for meetings are a must to enable the nurse to formulate the

community diagnosis objectives with the key leaders of the community

d. Choosing the methodology and instrument of community diagnosis*Three Levels of Data Gathering1. Community People2. Community health workers3. Program staff

*INSTRUMENTS may be following: Survey questionnaire Observation checklist Interview guide

2. Implementationa. Actual data gatheringb. Collation/ organization of datac. Presentation of datad. Analysis of datae. Identifying the community health nursing problems

i. Health Status Problems – may be described in terms of increased or decreased morbidity, mortality or fertility

ii. Health Resources Problems - they may be described in terms of lack of or absence of manpower, money, materials or institutions necessary to solve health problems

iii. Health- Related Problems – they maybe described in terms of existence of social, economic, environmental and political factors aggravate the illness-inducing situations in the community

f. Priority- setting of the community Health Nursing Problems

g. Feedback to the Community – community meetings are held to inform the community people of the results of the community diagnosis

h. Action Planning – action programs are the activities necessitated by the results of the community diagnosis.

3. Evaluation – an evaluation scheme is necessary to measure the achievements of progress of the program based on the action plan made through the Community Diagnosis.

Part 11 COPARA. Definitions

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

A process by which a community identifies its needs and objectives, develops confidence to take action in respect to them and in doing so, extends and develops cooperative and collaborative attitudes and practices in the community

B. Importance of COPAR As important tool for community development and people

empowerment as this helps the community workers to generate community participation in development activities

Prepares people/clients to eventually take over the management of a development program/s in the future

Maximizes community participation and involvement; community resources are mobilized for community services

C. Principles of COPAR People, especially the most oppressed , exploited and deprived

sectors are open to change, have the capacity to change, and are able to bring about change

COPAR should be based on the interests of the poorest sectors of society

COPAR should lead to self-reliant community and society

D. Processes/ Methods Used A Progressive Cycle of Action- Reflection- Action which

begins with small, local, concrete issues, identified by the people

and the evaluation and reflection of and on the action taken by them

Consciousness – RAISING through experiential learning is central to COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action

COPAR is Participatory and Mass-Based because it is primarily directed towards and biased in favor of the poor, the powerless and the oppressed

COPAR is Group-centered and not Leader-oriented. Leaders are identified, emerge and are tested through action rather than appointed or selected by some external force or entity

E. Phases of the COPAR Process1. Pre-Entry Phase

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

Designing criteria for the selection of site Actually selecting the site for community care

2. Entry Phase Sometimes called the social preparation phase as the

activities done here include the sensitization of the people on the critical events in their life , motivating them to share their concerns and eventually mobilizing them to take collective action on these

3. Organization – Building Phase Entails the formation of more formal structures and the

inclusion of more formal procedures of planning, implementing, and evaluating community-wide activities

Conduct of trainings for the organized leaders or groups to develop their asks in managing their own concerns/programs

4. Sustenance and Strengthening Phase Occurs when the community organization has already been

established and the community members are already actively participating in community- wide undertakings

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

Strategies:*education and training*networking and linkages*developing secondary leaders

Part 12 Selected Public Health Programs

Part 13 Vital Statistics

VITAL STATISTICS – the application of statistical measures to vital events that is utilized to gauge the levels of health, illness and health services of a community

HEALTH INDICATORS – a list of information which would determine the health of a particular community like population, crude birth rate, crude death rate, infant and maternal death rates, neonatal death rates and tuberculosis death rate

Health Indicators Birth Death Marriages Migration

COMMON VITAL STATISTICAL INDICATORS Fertility Rates

Crude Birth Rate

Used often because of availability of dataa. Measures how fast people are added to the population

through birth

Number of livebirths in a year

Midyear Population, same year= X 1000

b. Crude since it is related to the total population including men, children and elderly who are not capable of giving birth

General Fertility Rate

a. More specific than CBR since births are related to the segment of the population deemed capable of giving birth

b. In some countries, reproductive age groups is 15-49 years of age

Age Specific Fertility Rate

a. Most accurate refinement in the study of fertility

Mortality Rates Crude Death Rate

a. Crude because death is affected by different factorsb. Widely used because of availability of data

Specific Mortality Rate

a. Made specific according to: Age Sex Occupation Education Exposure to risk factors Combination of the above

Number of livebirths in a year

Midyear Population of women15-44 years of age

= X 1000

Total Births to women age X years

Midyear Population of women age X years= X 1000

Number of deaths in a year

Midyear Population, same year= X 1000

Number of deaths in specified group

Midyear Population, same year= X 1000

b. More valid than CDR when comparing mortality experiences between group

Cause-of-Death Rate

a. Crude rate since the denominator includes the whole population

b. Could be made specific by relating the deaths from a specific cause and group to the mid-year population of that specific group

Infant Mortality Rate

a. SENSITIVE INDEX of level of health in a communityb. HIGH IMR means LOW LEVELS of health standards secondary

to poor maternal and child health care, malnutrition, poor environmental sanitation or deficient health service delivery

c. May be artificially lowered by improving the registration of births

Neonatal Mortality Rate

Post-neonatal Mortality Rate

Maternal Mortality Rate

a. Measures risk of dying from causes associated with childbirth

Number of deaths in specified cause

Midyear Population, same year= X 1000

No. of deaths under 1 yr of age

No. of Live births, same year= X 1000

No. of deaths among those under 28 days of age

No. of Livebirths, same year= X 1000

No. of deaths due to pregnancy, delivery and puerperium

Number of Live Births= X 1000

No. of deaths due to pregnancy, delivery and puerperium

Number of Live Births= X 1000

b. Affected by: Maternal health practices Diagnostic ascertainment of maternal condition or

cause of death Completeness of registration of birth

Perinatal Mortality Rate

Proportionate Mortality Rate

a. Used in ranking cause of death by magnitude of frequencyb. Expressed in PERCENTAGE

Swaroop’s Index

a. LOW INDEX implies that life expectancy is shortb. Directly proportional to the health status of a population,

where developed countries have higher Swaroop’s Index than developing countries

Case Fatality Rate

a. Measures the killing power of a disease or injuryb. A HIGH CFR means a more fatal diseasec. Rate depends on:

Nature of the disease Diagnostic ascertainment Level of reporting in the population

d. CFR from hospitals HIGHER than from the community

Fetal Deaths, 28 weeks & over of gestation + early neonatal deaths, 1 week of age in calendar year

Number of Live Births

= X 1000

No. of deaths from particular cause

Total deaths from all cause, same year= X 100

No. of deaths among those 50 years & over

Total Deaths, Same year= X 100

No. of deaths from a specified cause

No. of cases of the same disease= X 100

Morbidity Rates Incidence Rate

a. Measures the development of a disease in a group exposed to the risk of the disease in a period of time

b. Can be made specific for age and sex

Attack Rate

a. Used for a limited population group and time period, usually during an outbreak or epidemic

Prevalence Ratea. Useful in describing the occurrence of chronic conditions and

as basis for making decisions in the administration of health services

b. Useful also in computing for carrier rates and antibody levelsA. Point Prevalence

B. Period Prevalence

INTERPRETATION OF VITAL STATISTICSSources of Data

Vital Registration Recordsa. Civil Registry Law or Republic Act No. 3753 requires the

registration of all births and death – c/o National Census and Statistics Office

No. of NEW CASES of disease developing from a period of time

Population in the area during the same period of time= X 100,000

No. of NEW CASES of disease developing from a period of time

Population at risk of developing the disease during the same period of time

= X 100

No. of existing (Old and New Cases) of a disease at a given time

Population examined during that time= X 100

No. of existing (Old and New Cases) of a disease at a given interval time

Population examined during that interval time

= X 100

b. PD 651 – requires all health workers to register births within 30 days following delivery

Weekly Reports from Field Health Personnel Population Censuses – done every 5 years c/o the National Census

and Statistics Office

GUIDELINES IN THE CLASSIFICATION OF DATA1. Reckoning of Vital Events – all vital events are registered and

reported by place of occurrence, NOT by place of residence2. Reckoning of Age – age is recorded as of Last Birthday3. Classification of Disease and Causes of Death

a. Definition/ Classification of the event in either numerator or denominator for consistency

b. Accuracy of the count of event or population concernedc. Use of correct numeratord. Magnitude / Nature of the rate

Part 14 Epidemiology

EPIDEMIOLOGY – the study of distribution of disease or physiologic conditions such as deformities or disabilities and even death among human populations, and the factors affecting such distribution

AIM: to identify factors of causation as basis for determining preventive and control measures

DESCRIPTIVE PHASE – deals with the collection, organization, and analysis of data regarding the occurrence of disease other health conditions

A. VERIFICATION OF A DIAGNOSIS-stating one’s definition of a disease/ diagnosis based on the presenting signs and symptoms

Consider Two Factors:1. Sensitivity – indicates the strength of association between a

sign/ symptom and the disease; picks up most cases and avoids FALSE NEGATIVES

2. Specificity – shows the uniqueness of the association between a sign/ symptom and the disease; excludes non cases or avoids FALSE POSITIVES

B. DESCRIPTION OF THE DISEASE/ CONDITION Factors affecting distribution:

1. Place – extrinsic factors2. Person – intrinsic characteristics such as age, sex, genetic

endowment and other factors such as occupation, place of residence, income are analyzed to identify susceptible groups in a certain locality

Factors Affecting the Community’s Reaction to Disease Agent Invasiona. Herd Immunity – state of resistance of a population group to

a particular disease at a given time; level of immunity of the group

b. Susceptibility Status – determined by the number of individuals with little or no immunity

Patterns of Disease Occurrencei. Epidemic - a situation when there is a high incidence of

new cases of a specific disease in excess of the expectedii. Endemic – habitual presence of a disease in a given geographic location accounting for the low number of both immunes and susceptibleiii. Sporadic – disease occurs every now and then affecting only a small number of people relative to the total populationiv. Pandemic – global occurrence of a disease

3. Time – temporal patterns; expressed on a daily, weekly, monthly or yearly basis

C. ANALYSIS OF DISEASE PATTERN-one tries to find out if there is a statistical relationship between a disease and biological or social factors

Causal – when there is evidence that shows that certain factors increase the probability of occurrence of a disease and a change in one or more of these factors produces a change in the occurrence of the disease

Non Causala. Spurious – due to chance or bias caused by certain

procedures/ aspects involved in studyb. Indirect – when a factor and disease are associated only

because both are related to some common underlying condition

Part 15 DemographyA. DEMOGRAPHY

The empirical, statistical and mathematical study of human population; derived from two Greek word snyos, which means people and ypagly which means to draw or write

Focuses on three common and observable human events:a. Population composition or structureb. Distribution of population in spacec. Population size

Sources of demographic dataa. Censusb. Sample surveysc. Registration system

Two ways of Assigning People1. De Jure – people are assigned to places where they

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

2. De Facto – people are assigned to the place where they are physically present at the time of the census, regardless of their usual place of residence

B. COMPONENTS1. Population Composition – pertains to all measurable

characteristics of the people who make up a given populationa. Sex Ratio

b. Age- dependency Ratio – used as an index of age-induced economic drain on human resources

c. Age and Sex Composition – graphical presentation of the age and sex composition of a population through the use of a POPULATION PYRAMID

d. Median Age – age below which 50% of the population fall and above which 50% of the population fall.

e. Life Expectancy at Birth – average number of years an infant is expected to live under the mortality conditions for a given year

2. Population Distributiona. Urban – Rural Distribution – shows the proportion of people

living in urban compared to the rural areas

b. Crowding Index – indicates the ease by which a communicable disease can be transmitted from one host to another susceptible host

c. Population Density – determines congestion of the place

Number of males

Number of females= X 100

No. of persons 0-14 years old + No. of persons aged 65 years and over

No. of persons 15-64 years old= X 1000

3. Population Sizea. Natural Increase – difference between the number of births

and the number of deaths that occurred in a specific population within a specified period of time

b. Rate of Natural Increase – difference between CBR and CDR of a specific population within a specified time

Part 16 Target – Setting

TARGET-SETTING -Involves the calculation of the eligible population for immunization services. Since the Universal Child Immunization goal of 80% was achieved in 1989, the target for immunizations since 1992 onwards has increased to 90%. The two most important goals are the following:

Sustainability of the high coverage and, Maintenance of quality immunization Services

A. Eligible Population 1. Infants – for EPI in a barangay, municipality, district, province/city

and region, target setting is based on 3% of the total population

ANNUAL DOSES NEEDED = Eligible population X No. of Doses

ANNUAL DOSES WITH WASTAGE ALLOWANCE

= Eligible population X No. of Doses X Wastage Multiplier

ANNUAL VACCINE NEEDS PER VIAL DOSE = Annual Vaccine / Dose per vial or ampule

MONTHLY VACCINE NEEDS

= Total Vials or ampules / 12 months

QUARTERLY VACCINE NEEDS

= Total Vials or ampules / 4 quarters

MONTHLY VACCINE NEEDS

= (Total Vials or ampoules / 12 months) X 1.25

2. BCG School Entrants – use 3% of the total population in calculating the number of children entering first grade in one year

3. Pregnant Women – All pregnant women are eligible for EPI. Target Setting must include the number of pregnancies that will terminate in live births (3% of the total population) plus the number of the pregnancies (0.5% of the total population); thus, the percentage of eligible women in the total population is 3.5%

B. Calculating Vaccine Needs*How to Calculate Vaccine Needs

Step One : Determine the eligible population Step Two: Determine the number of doses required in a year by

multiplying the eligible population with the number of doses for complete immunization

Step Three: Determine the wastage rate of antigen or use the wastage multiplier. From step two, multiply the product with the wastage multiplier to get the annual needs including the wastage allowance

Step Four: Determine the number of ampoules or vials needed by dividing the annual dose by the dose per vial or ampule

Step Five: Determine the vaccine need per month or quarter

Step Six: Determine the vaccine need per month or quarter with reserve stock

MONTHLY ELIGIBLE POPULATION = Annual eligible population / 12 months

MONTHLY INJECTIONS = Monthly eligible population X doses required per antigen

TOTAL REQUIRED SYRINGES = Monthly injections X 1.25 for syringes

TOTAL REQUIRED NEEDLES = Monthly injections X 1.50 for needles

C. Determining Needle and Syringe Requirements*How to Calculate Needle and Syringe Requirements

Step One: Determine the eligible population Step Two: Determine the monthly eligible population

Step Three: Multiply the monthly eligible population by the number of doses required for each antigen

Step Four: Determine the total requirement including additional allowance for syringes and needles

Part 17 Environmental Sanitation

ENVIRONMENTAL SANITATION -is defined as the study of all factors in man’s physical environment which may exercise a deleterious effect on his health, well-being and survival

GOAL: to eradicate and control environmental factors in disease transmission through the provision of basic services and facilities to all house holds

COMPONENTS: Water Supply Sanitation Program Proper Excreta and Sewage Disposal Program Insect and Rodent Control Food Sanitation Program Hospital Waste Management Program Strategies on Health Risk Minimization due to Environmental Pollution

A. Water Supply Sanitation ProgramThree Types of Approved Water Supply and Facilities

Level IPoint Source

Level IICommunal Faucet

System or Stand Posts

Level IIIWaterworks System or

Individual House Connections

A protected well or a developed spring with an outlet but without a distribution system for rural areas where houses are thinly scattered

A system composed of a source, a reservoir, a piped distribution network and communal faucets, located at not more than 25 meters from the farthest house in rural areas where houses are clustered densely

A system with a source, a reservoir, a piped distributor network and household taps that is suited for densely populated urban areas

B. Proper Excreta and Sewage Disposal ProgramThree Types of Approved Toilet Facilities

Level 1 Level 2 Level 3Non- water carriage toilet facility

On site toilet facilities of the water carriage type

Water carriage types of toilet facilities

with water sealed and flushed type with septic vault/ tank disposal facilities

connected to septic tanks and/or sewerage system to a treatment plant

C. Proper Solid Waste Management-refers to satisfactory methods of storage, collection and final disposal of solid wastesREFUSE is a general term applied to solid and semi-solid waste materials other than human excreta. Waste material in refuse may be divided into:1. Garbage refers to leftover vegetable, animal, and fish material

from kitchen and food establishments. These materials have the tendency to decay, thus, giving off foul odor and sometimes also serve as food for flies and rats

2. Rubbish refers to waste materials such as bottles, broken glass, tin cans, waste paper, discarded textile materials, porcelain wares, pieces of metal and other wrapping materials

3. Ashes are leftover from burning of wood and coal. Ashes may become a nuisance because of the dust associated with them

4. Stable Manure is animal manure collected from stables5. Dead Animals include dead dogs, cats, rats, pigs and chicken that

were killed by vehicles on streets and public highwaysTWO WAYS OF EXCRETA DISPOSAL

Household CommunityBurialOpen BurningAnimal FeedingCompostingGrinding and disposal sewer

Sanitary Landfill

D. Food Sanitation ProgramPolicies:

1. Food establishments are subject to inspection2. Comply with sanitary permit requirement for all food

establishments3. Comply with updated health certificates for food

handlers, helpers, cooksE. Hospital Waste Management Program

GOAL: to prevent the risk of contracting nosocomial infection and other diseases from the disposal of infectious, pathological and other hospital wastesPolicies:1. The use of appropriate technology and indigenous materials for

HWM system shall be adopted2. Training of all hospital personnel involved in waste management

shall be an essential part of the hospital training program3. Local ordinances regarding the collection and disposal techniques,

especially incinerators, shall be institutionalized

F. Strategies on Health Risk Minimization due to Environmental PollutionThese include the following:a. Anti-smoke belching campaign and air pollution campaignb. Zero solid waste managementc. Toxic, chemical and hazardous waste managementd. Red tide control and monitoringe. Integrated pest management and sustainable agriculturef. Pasig river rehabilitation Management

Part 18 DOH National EventsFIRST QUARTERJanuary

17-23

Cancer Consciousness Week

February

16-22

Leprosy control weekHeart MonthDental Health MonthCampaign on Family Planning

March

24 World TB dayWomen’s Health MonthBurn Injury Prevention MonthRabies Awareness MonthColon and Rectal Cancer Awareness Month

SECOND QUARTERApril

7 World Health DayCancer in Children Awareness Month

May

9-15 Safe Motherhood Week23-29

Health Workplace Week

31 World No Tobacco DayNatural Family Planning MonthCervical Cancer Awareness Month

June5 World Environment Day14 International Blood Donor’s

Day

23 DOH anniversaryKidney MonthNo Smoking MonthDengue Awareness MonthProstate Cancer Awareness Month

July

18-24

National Diabetes Awareness Week

Nutrition MonthNational Voluntary Blood Donation MonthNational Disaster Preparedness Month

THIRD QUARTERAugust

1 Family Planning Day1-17 Mother-Baby Friendly Week6-12 National Hospital Week8-14 Asthma Attack19 National TB Day

National Lung MonthSight-Saving MonthLung Cancer Awareness Month

September

26 World Heart DayLiver Cancer Awareness MonthGenerics Awareness Month

FOURTH QUARTEROctober

1-7 Elderly Filipino Week3-9 National Mental Health

Week3-9 National Newborn Screening

Week10-16

Health Education Week

17-23

Osteoporosis Awareness Week

17-23

Food Safety Awareness WeekBreast Cancer Awareness MonthNational Children’s Month

November

7 Food Fortification Day7-13 Substance Abuse Prevention

Week14 World Diabetes Day17 COPD Awareness Day

Traditional & Alternative Health Care Month

December

1 World AIDS Day10 National Youth health Day11 World Asthma Day