HISTORY OF CHN

1901 - Act # 157 (Board of Health of the Philippines);

Act # 309 (Provincial and Municipal Boards of Health) were created.
1905 - Board of Health was abolished; functions were transferred to the Bureau
of Health.
1912 Act # 2156 or Fajardo Act created the Sanitary Divisions, the forerunners
of present MHOs; male nurses performs the functions of doctors
1919 Act # 2808 (Nurses Law was created)- Carmen del Rosario , 1st Filipino.
Nurse supervisor under Bureau of Health
Oct. 22, 1922 Filipino Nurses Organization (Philippine Nurses Organization)
was organized.
1923- Zamboanga General Hospital School of Nursing & Baguio General Hospital
School of Nursing were established; other government schools of nursing were
organized several years after.
1928- 1st Nursing convention was held
1940 Manila Health Department was created.
1941 Dr. Mariano Icasiano became the first city health officer; Office of Nursing
was created through the effort of Vicenta Ponce (chief nurse) and Rosario Ordiz
(assistant chief nurse)
Dec. 8, 1941 Victims of World War II were treated by the nurses of Manila.
July 1942 Nursing Office was created; Dr. Eusebio Aguilar helped in the release
of 31 Filipino nurses in Bilibid Prison as prisoners of war by the Japanese.
Feb. 1946 Number of nurses decreased from 556 308.
1948 First training center of the Bureau of Health was organized by the Pasay
City Health Department. Trinidad Gomez, Marcela Gabatin, Costancia Tuazon,
Ms. Bugarin, Ms. Ramos, and Zenaida Nisce composed the training staff.
1950- Rural Health Demonstration and Training Center was created.
1953 The first 81 rural health units were organized.
1957 RA 1891 amended some sections of RA 1082 and created the eight
categories of rural health unit causing an increase in the demand for the
community health personnel.
1958-1965 Division of Nursing was abolished (RA 977) and Reorganization Act
(EO 288)
1961 Annie Sand organized the National League of Nurses of DOH.
1967 Zenaida Nisce became the nursing program supervisor and consultant on
the six special diseases (TB, leprosy, V.D., cancer, filariasis, and mental health
illness).
1975 Scope of responsibility of nurses and midwives became wider due to
restructuring of the health care delivery system.
1976-1986 The need for Rural Health Practice Program was implemented.
1990- 1992- Local Government Code of 1991 (RA 7160)
1993- 1998 Office of Nursing did not materialize in spite of persistent
recommendation of the officers, board members, and advisers of the National
League of Nurses Inc.
Jan. 1999 Nelia Hizon was positioned as the nursing adviser at the Office of
Public Health Services through Department Order # 29.
May 24, 1999 EO # 102, which redirects the functions and operations of DOH,
was signed by former President Joseph Estrada.

Public Health
- science and art of preventing disease, prolonging life, promoting health and
efficiency thru 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 diseases 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 off
birth and longevity ( DR. C.E. Winslow)

- The 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. (WHO)

Public Health Nursing

- The practice of nursing in national and local government health departments
(which include health centers and local health units), and public schools.

- A community health nursing practiced in the public sector. (Standard of Public

Health Nursing in the Philippines, 2005)

- 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 conditions in the
social and physical environment, rehabilitation, and the prevention of illness and
disability. (WHO Expert Committee on Nursing)

Community 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 ( WHO
Expert Committee of Nursing )

- a learned practice discipline with the ultimate goal of contributing as

individuals and in collaboration with others to the promotion of the clients
optimum level of functioning thru teaching and delivery of care. (Jacobson)
 - a service rendered by a professional nurse to individual, family, community,
and, population groups in health centers, clinics, schools , workplace for the
promotion of health, prevention of illness, care of the sick at home and
rehabilitation (DR. Ruth B. Freeman)

- 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, et al.)

A service rendered by a professional nurse.

WHO community, groups, family, individual at home
WHERE in health centers, clinics, schools and places of work.
FOR the promotion of health, prevention of illness and rehabilitation of
the sick.
The hallmark of community health nursing is that it is population- or
aggregate-focused.
CHN is a synthesis of nursing and public health practice.
1. Emphasis on the importance of the greatest good for the greatest
number
2. Assessing health needs planning, implementing and evaluating the
impact of health services on population groups.
3. Priority of health - promotive and disease preventive strategies over
curative interventions.

Basic Principles
1. 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.
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE
recipient of care.
3. CHN practice is affected by developments in health technology, in
particular, changes in society, in general.
4. The goal of CHN is achieved through multi-sectoral efforts.
5. CHN is a part of health care system and the larger human services
system.

Concepts
The primary focus of community health nursing is health promotion.
Community health nurses provide care necessary to meet the
requirements of an individual all throughout the life cycle.
Knowledge on different fields (biological and social sciences, clinical
nursing, and community health organizations) is used.
 Nursing process in community health nursing changes based on the needs
of the community.

Goal
To raise the level of health of the citizenry by helping communities and families
cope with the discontinuities in and threats to health in such a way as to
maximize the potential for high-level wellness. (Nisce, Reyala, et al.)

ROLES OF THE NURSE IN COMMUNITY HEALTH NURSING

Clinician focus on the health of the individuals on the larger context of the
community
Advocate promote self-care and self-determination
Collaborator brings together strengths and weaknesses of people involved
toward a common goal
Researcher utilizes data to predict future phenomenon and modify
interventions
Counselor key tasks include listening and providing feedback and information
Case Manager oversees all aspects of care to facilitate delivery of cost-
efficient care; to individualize and coordinate care
Educator provide knowledge, skills and attitudes that people need to make
appropriate choices or decision
Hospice Care providing care skills in a home and other settings and balancing
clients needs

Roles of the PUBLIC HEALTH NURSE

Clinician- a health care provider, taking care of the sick people at home or in the
RHU.
Health Educator- who aims towards health promotion and illness prevention
through dissemination of correct information; educating people.
Facilitator- who establishes multi-sectoral linkages by referral system.
Supervisor- who monitors and supervises the performance of midwives and
barangay health workers.
Leader and Change Agent- influences people to participate in the overall
process of community development.
Manager- organizes the nursing service component of the local health agency or
local government unit.
Researcher- participates in the conduct of research and utilizes research finding
in the practice.
Others.

In the event that the Municipal Health Officer (MHO) is unable to perform
his Duties/functions or is not available, the Public Health Nurse will take
charge of the MHOs responsibilities.
Other Specific Responsibilities of a Nurse, spelled by the implementing rules and
Regulations of RA 7164 (Philippine Nursing Act of 1991) includes:
Supervision and care of women during pregnancy, labor and puerperium
Performance of internal examination and delivery of babies
Suturing lacerations in the absence of a physician
Provision of first aid measures and emergency care
Recommending herbal and symptomatic medicine.

In the care of the families:

Provision of primary health care services
Developmental/Utilization of family nursing care plan in the provision of
care.

In the care of the communities:

Community organizing mobilization, community development and people
empowerment
Case finding and epidemiological investigation
Program planning, implementation and evaluation
Influencing executive and legislative individuals or bodies concerning
health and development.

Responsibilities of CHN
Be a part in developing an overall health plan, its implementation
and evaluation for communities.
Provide quality nursing services to the three 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 development.

Specialized Fields:
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 in conserving the health of
workers in all occupations
School Health Nursing
The application of nursing theories and principles in the care of the school
population.

Public Health Workers: Are members of the health team who are professionals
namely
 Medical Health Officer (MHO)- Physician
Public Health Nurse (PHN)- Registered Nurse
Rural Health Midwife (RHM)- Registered Midwife
Dentist
Nutritionist
Medical Technologies
Pharmacist
Rural Sanitary Inspector- must be a sanitary engineer

Health Care Ratio:

1 MHO : 20,000
1 PHN : 10,000
1 PHM : 5,000
2 BHW/Barangay minimum

LEVELS OF CLIENTELE:

PATIENT
Comes from Greek word pathein which means to suffer
- Commonly referred to as the person who is waiting for or is undergoing
medical treatment and care.
- Implies that the person is ill or has a disease
- Person passively accepts the decision and care of health professionals.

CLIENT
A person who may or may not be sick but who engages the advice or
services of a health professional.
Presents the client as a collaborator in his/ her care and not as a passive
receiver of health services.
Assumes an active role in health care

CLIENTS OF CHN

1. INDIVIDUAL
Sick or well on a daily basis
2. FAMILY
- VERY important social institution that performs two major functions
reproduction and socialization.
- It is generally considered as the basic unit of care in community health
nursing for many reasons.
- A small social system and primary reference group made up of two or more
persons living together who are related by blood, marriage or adoption or who
are living together by arrangement over a period of time. (Murray and
Zentner.1997)

Types of Families
 Based on Composition
1. Nuclear Family
2. Extended Family
3. Single- Parent Family
4. Step / Blended / Reconstituted Family
5. Same- Sex or Homosexual Family
6. Cohabiting or Communal Family
Based on locus of power
7. Patrifocal or Patriarchal Family
8. Matrifocal or Matriarchal Family
9. Egalitarian
10. Matricentric
Based on place of residence
11. Patrilocal
12. Matrilocal
13. Bilocal
14. Neolocal
15. Avuncolocal
Based on Descent
16. Patrilineal
17. Matrilineal
18. Bilateral
FUNCTIONAL TYPE:
1. Family of Procreation- refers to the family you yourself created.
2. Family of Orientation- refers to the family where you came from.

Stages and Developmental Tasks in the Family Life Cycle Stage

Stage 1. Beginning Family: The married couples establish their home but do
not yet have children.
Developmental Tasks: Establishing a satisfying home and marriage
relationship and preparing for childbirth.
Stage 2. Childbearing Family: From the birth of the first child until that child
is 2 1/2 years old.
Developmental Tasks: Adjusting to increased family size; caring for an
infant; providing a positive developmental environment.
Stage 3. Family with Preschoolers: When the oldest child is between the
ages of 2 1/2 and 6.
Developmental Tasks: Satisfying the needs and interests of preschool
children; coping with demands on energy and attention with less privacy at
home.
Stage 4. Family with School Children: When the oldest child is between the
ages of 6 and 13.
Developmental Tasks: Promoting educational achievement and fitting in
with the community of families with school-age children.
Stage 5. Family with Teenagers: When the oldest child is between the ages
of 13 and 20.
 Developmental Tasks: Allowing and helping children to become more
independent; coping with their independence; developing new interests
beyond child care.
Stage 6. Launching Center: From the time the oldest child leaves the family
for independent adult life till the time the last child leaves. Option 2 & 3
Teacher Info Page 2
Developmental Tasks: Releasing young adults and accepting new ways
of relating to them; maintaining a supportive home base; adapting to new
living circumstances.
Stage 7. Empty Nest: From the time the children are gone till the marital
couple retires from employment.
Developmental Tasks: Renewing and redefining the marriage
relationship; maintaining ties with children and their families; preparing for
retirement years.
Stage 8: Aging Family: From retirement till the death of the surviving
marriage partner.
Developmental Tasks: Adjusting to retirement; coping with the death of
the marriage partner and life alone.

STAGES OF FAMILY DEVELOPMENT

1. INITIAL OR ESTABLISHEMENT STAGE

Courtship and engagement precede the establishment of the family
unit.
Developmental tasks:
Contending w/ partner selection pressure from parents
Giving over autonomy while retaining some independence
Preparing for marriage
Becoming free of parental domination.

2. EXPECTANT STAGE
Pregnancy
Couple is expected to learn to assume new roles father/ mother
Couple expected to think as a family and not just as a pair.

3. PARENTHOOD OR EXPANSION STAGE

Characterized by birth or adoption of a child.

4. DISENGAGEMENT OR CONTRACTION STAGE

Occurs when the children leave and the couple must rework their
separateness
Retirement planning
Preparation for the spouses death
Eventual bereavement - loneliness

3. POPULATION GROUP
 - aggregate (clark, 1999:5) is a group of people who share common
characteristics, developmental stage or common who exposure to particular
environmental factors, and consequently common health problems.
- Vulnerable Groups:
Infants and Young Children
School age
Adolescents
Mothers
Males
Old People

4. COMMUNITY
- Group of people sharing common geographic boundaries and/ or common
values and interests.
- It functions w/in a particular socio cultural context, which means that no two
communities are alike.
- The dynamics in one community is different from another due to the varying
biological characteristics, interests, and socio-economic status of the people.
- According to Maglaya, a community has the following characteristics:
1. It is defined by its geographic boundaries within certain identifiable
characteristics.
2. It is made up of institutions organized into a social system, with the
institutions and organizations linked in a complex network having
formal and informal power structures and a communication system.
3. It has a common or shared interest that binds the members together.
4. It has an area with fluid boundaries within which a problem can be
identified and solved.
5. It has a population aggregate concept.

FAMILY HEALTH NURSING

- that level of CHN practice directed to the FAMILY as the unit of care with
HEALTH as the goal and NURSING as the medium, channel or provider of care

Family Nursing Problem

Arises when the family cannot effectively perform its health tasks.

Nurses Roles in Family Health Nursing

1. HEALTH MONITOR
2. PROVIDER OF CARE TO A SICK FAMILY MEMBER
3. COORDINATOR OF FAMILY SERVICES
4. FACILITATOR
5. TEACHER
6. COUNSELOR
INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

Family structure, Characteristics, and Dynamics

Members of the household and relationship to the head of the family
Demographic data age, sex, civil status, position in the family
Place of residence of each member whether living with the family or
elsewhere

Type of family structure e.g. matriarchal or patriarchal, nuclear or

extended

Dominant family members in terms of decision-making, especially in

matters of health care
General family relationship/dynamics presence of any readily observable
conflict between members; characteristics communication patterns among
members
Socio-economic and Cultural Characteristics
Income and Expenses
Occupation, place of work and income of each working members
Adequacy to meet basic necessities
Who makes decisions about money and how it is spent
Educational attainment of each other
Ethnic background and religious affiliation
Significant Others role(s) they play in familys life
Relationship of the family to larger community Nature and extent of
participation of the family in community activities
Home and Environment
Housing
Adequacy of living space
Sleeping arrangement
Presence of breeding or resting sites of vectors of diseases
Presence of accidents hazards
Food storage and cooking facilities
Water supply source, ownership, potability
Toilet facility type, ownership, sanitary condition
Drainage system type, sanitary condition
Kind of neighborhood, e.g. congested, slum, etc.
 Social and health facilities available
Communication and transportation facilities available
Health Status of each Family Member
Medical and nursing history indicating current or past significant illnesses
or beliefs and practices conducive to health illness

Nutritional assessment

Anthropometric data: Measures of nutritional status of children, weight,

height, mid-upper arm circumference: Risk assessment measures of
obesity: body mass index, waist circumference, waist hip ratio
Dietary history specifying quality and quantity of food/nutrient intake per
day
Eating/ feeding habits/ practices

Developmental assessments of infants, toddlers, and preschoolers e.g., Metro

Manila Developmental Screening Test.
Risk factor assessment indicating presence of major and contributing modifiable
risk factors for specific lifestyles, cigarette smoking, elevated blood lipids, obesity,
diabetes mellitus, inadequate fiber intake, stress, alcohol drinking and other
substance abuse
Physical assessment indicating presence of illness state/s
Results of laboratory/ diagnostic and other screening procedures supportive of
assessment findings

Values, Habits, Practices on Health Promotion, Maintenance and Disease

Prevention.

Examples include:
Immunization status of family members
Healthy lifestyle practices. Specify.
o Adequacy of:
rest and sleep
exercise
use of protective measures- e.g. adequate footwear in parasite-
infested areas;
relaxation and other stress management activities
Use of promotive-preventive health services.

Methods of Data Gathering

1. Health assessment of each family member
2. Observation
3. Interview
4. Review of records/reports & laboratory results
5. Assessment of home & environment
6. Tools used in family assessment: genogram, ecomap, initial database,
family assessment guide

A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

FIRST-LEVEL ASSESSMENT

1. Presence of 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 level.
Wellness potential is a nursing judgment on wellness state or condition
based on clients performance, current competencies or clinical data but no
explicit expression of client desire.
Readiness for enhanced wellness state is a nursing judgment on
wellness state or condition based on clients current competencies or
performance, clinical data explicit expression of desire to achieve a higher level
of state or function in specific area on health promotion and maintenance.

Examples of these are the following:

Potential for Enhanced Capability for:
Healthy lifestyle e.g. nutrition/diet, exercise/ activity
Health Maintenance
Parenting
Breastfeeding
Spiritual Well-being process of a clients unfolding of mystery through
harmonious interconnectedness that comes from inner strength/sacred
source/GOD (NANDA 2001)
Others,

Readiness for Enhanced Capability for:

Healthy Lifestyle
Health Maintenance
Parenting
Breastfeeding
Spiritual Well-being
Others,

2. Presence of Health Threats conditions that are conducive to disease,

accident or failure top realize ones health potential.

Examples of these are the following:

A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic
syndrome, smoking)
B. Threat of cross infection from communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident hazards specify.
Broken chairs
Pointed /sharp objects, poisons and medicines improperly kept
Fire hazards
Fall hazards
Others specify.
E. Faulty/unhealthful nutritional/eating habits or feeding techniques/practices.
Specify.
Inadequate food intake both in quality and quantity
Excessive intake of certain nutrients
Faulty eating habits
Ineffective breastfeeding
Faulty feeding techniques
F. Stress Provoking Factors. Specify.
Strained marital relationship
Strained parent-sibling relationship
Interpersonal conflicts between family members
Care-giving burden
G. Poor Home/Environmental Condition/Sanitation. Specify.
Inadequate living space
Lack of food storage facilities
Polluted water supply
Presence of breeding or resting sights of vectors of diseases
Improper garbage/refuse disposal
Unsanitary waste disposal
Improper drainage system
Poor lightning and ventilation
Noise pollution
Air pollution
H. Unsanitary Food Handling and Preparation
I. Unhealthy Lifestyle and Personal Habits/Practices. Specify.
Alcohol drinking
Cigarette/tobacco smoking
Walking barefooted or inadequate footwear
Eating raw meat or fish
Poor personal hygiene
Self medication/substance abuse
Sexual promiscuity
Engaging in dangerous sports
Inadequate rest or sleep
Lack of /inadequate exercise/physical activity
Lack of/relaxation activities
 Non use of self-protection measures (e.g. non use of bed nets in malaria
and filariasis endemic areas).
J. Inherent Personal Characteristics e.g. poor impulse control
K. Health History, which may Participate/Induce the Occurrence of Health Deficit
e.g. previous history of difficult labor.
L. Inappropriate Role Assumption e.g. child assuming mothers role, father not
assuming his role.
M. Lack of Immunization/Inadequate Immunization Status Especially of Children
N. Family Disunity
Self-oriented behavior of member(s)
Unresolved conflicts of member(s)
Intolerable disagreement
O. Others. Specify._________

III. Presence of health deficits- instances of failure in health maintenance.

Examples include:
A. Illness states, regardless of whether it is diagnosed or undiagnosed by
medical practitioner.
B. Failure to thrive/develop according to normal rate
C. Disability- Whether congenital or arising from illness; transient/temporary (e.g.
aphasia or temporary paralysis after a CVA) or permanent (e.g. leg amputation,
blindness from measles, lameness from polio)

IV. Presence of stress points/foreseeable crisis situations- are anticipated

periods of unusual demand on the individual or family in terms of
adjustment/family resources.

Examples of this include:

A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e. g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of job
K. Hospitalization of a family member
L. Death of a member
M. Resettlement in a new community
N. Illegitimacy
O. Others, specify.___________
SECOND-LEVEL ASSESSMENT

Second level assessment identifies the nature or type of nursing problems the
family experiences in the performance of their health tasks with respect to a
certain health condition or health problem.

I. Inability to recognize the presence of the condition or problem due to:

A. Lack of or inadequate knowledge
B. Denial about its existence or severity as a result of fear of consequences of
diagnosis of problem, specifically:
Social-stigma, loss of respect of peer/significant others
Economic/cost implications
Physical consequences
Emotional/psychological issues/concerns
C. Attitude/Philosophy in life, which hinders recognition/acceptance of a problem
D. Others. Specify _________
II. Inability to make decisions with respect to taking appropriate health
action due to:
A. Failure to comprehend the nature/magnitude of the problem/condition
B. Low salience of the problem/condition
C. Feeling of confusion, helplessness and/or resignation brought about by
perceive magnitude/severity of the situation or problem, i.e. failure to break
down problems into manageable units of attack.
D. Lack of/inadequate knowledge/insight as to alternative courses of action open
to them
E. Inability to decide which action to take from among a list of alternatives
F. Conflicting opinions among family members/significant others regarding action
to take.
G. Lack of/inadequate knowledge of community resources for care
H. Fear of consequences of action, specifically:
Social consequences
Economic consequences
Physical consequences
Emotional/psychological consequences
I. Negative attitude towards the health condition or problem-by negative attitude
is meant one that interferes with rational decision-making.
J. In accessibility of appropriate resources for care, specifically:
Physical Inaccessibility
Costs constraints or economic/financial inaccessibility
K. Lack of trust/confidence in the health personnel/agency
L. Misconceptions or erroneous information about proposed course(s) of action
M. Others specify._________
III. Inability to provide adequate nursing care to the sick, disabled,
dependent or vulnerable/at risk member of the family due to:
A. Lack of/inadequate knowledge about the disease/health condition (nature,
severity, complications, prognosis and management)
B. Lack of/inadequate knowledge about child development and care
C. Lack of/inadequate knowledge of the nature or extent of nursing care needed
D. Lack of the necessary facilities, equipment and supplies of care
E. Lack of/inadequate knowledge or skill in carrying out the necessary
intervention or treatment/procedure of care (i.e. complex therapeutic regimen or
healthy lifestyle program).
F. Inadequate family resources of care specifically:
Absence of responsible member
Financial constraints
Limitation of luck/lack of physical resources
G. Significant persons unexpressed feelings (e.g. hostility/anger, guilt,
fear/anxiety, despair, rejection) which his/her capacities to provide care.
H. Philosophy in life which negates/hinder caring for the sick, disabled,
dependent, vulnerable/at risk member
I. Members preoccupation with on concerns/interests
J. Prolonged disease or disabilities, which exhaust supportive capacity of family
members.
K. Altered role performance, specify.
Role denials or ambivalence
Role strain
Role dissatisfaction
Role conflict
Role confusion
Role overload
L. Others. Specify._________
IV. Inability to provide a home environment conducive to health
maintenance and personal development due to:
A. Inadequate family resources specifically:
Financial constraints/limited financial resources
Limited physical resources-e.i. lack of space to construct facility
B. Failure to see benefits (specifically long term ones) of investments in home
environment improvement
C. Lack of/inadequate knowledge of importance of hygiene and sanitation
D. Lack of/inadequate knowledge of preventive measures
E. Lack of skill in carrying out measures to improve home environment
F. Ineffective communication pattern within the family
G. Lack of supportive relationship among family members
H. Negative attitudes/philosophy in life which is not conducive to health
maintenance and personal development
I. Lack of adequate competencies in relating to each other for mutual growth and
maturation
Example: reduced ability to meet the physical and psychological needs of other
members as a result of familys preoccupation with current problem or condition.
J. Others specify._________
V. Failure to utilize community resources for health care due to:
A. Lack of/inadequate knowledge of community resources for health care
B. Failure to perceive the benefits of health care/services
C. Lack of trust/confidence in the agency/personnel
D. Previous unpleasant experience with health worker
E. Fear of consequences of action (preventive, diagnostic, therapeutic,
rehabilitative) specifically:
Physical/psychological consequences
Financial consequences
Social consequences
F. Unavailability of required care/services
G. Inaccessibility of required services due to:
Cost constraints
Physical inaccessibility
H. Lack of or inadequate family resources, specifically
Manpower resources, e.g. baby sitter
Financial resources, cost of medicines prescribe
I. Feeling of alienation to/lack of support from the community e.g. stigma due to
mental illness, AIDS, etc.
J. Negative attitude/ philosophy in life which hinders effective/maximum utilization
of community resources for health care
K. Others, specify __________

Scale for Ranking Health Conditions and Problems according to priorities

Criteria:
a. Nature of the condition or problem presented as Wellness state, health
deficit, health threat, foreseeable crisis.
b. Modifiability of the condition or problem- easily, partially, not
modifiable.
c. Preventive Potential (high, moderate, low)
d. Salience (needs immediate attention, not immediate, not perceived as a
problem)

PRIORITIZING HEALTH PROBLEMS

NATURE OF THE PROBLEM categorized into health deficit, health threat and
foreseeable crisis Weight
Health deficit 3 1
Health threat 2
Foreseeable crisis 1

MODIFIABILITY OF THE PROBLEM refers to the probability of success in

minimizing, alleviating or totally eradicating the problem through intervention
Easily modifiable 2 Weight
Partially modifiable 1 2
Not modifiable 0
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 Weight
High 3 1
Moderate 2
Low 1
SALIENCE refers to the familys perception and evaluation of the problem in
terms of seriousness and urgency of attention needed Weight
A serious problem, immediate attention needed 2 1
A problem, but not needing immediate attention 1
Not a felt need / problem 0

Cues/Data Family Nursing Problem

6 months old male infant with cough A. Measles as a Health Deficit
and rashes all over his body. 1. Inability to provide adequate
Nilagnat siya ng tatlong (3) araw bago nursing care to the dependent
lumabas ang mga pula pula niya sa member of the family with
katawan. measles and cough due to:
2. Lack of knowledge on the nature
and management of the health
condition.
Ang daming ipis ditto pag umaga, B. Presence of vectors and rodents as
yung pag binuksan mo yung ilaw, Health Threat
kanya- kanyang takbo na sila. Minsan 1. Inability to recognize the health
din malangaw at may mangilan- threat due to lack of knowledge
ngilang daga na naghaharutan sa may about the condition
kisame. 2. Inability to make decision with
regards to the management of
the condition due to the failure in
identifying what measures are
appropriate.
3. Inability to provide home
conducive to health
maintenance and personal
development due to ignorance in
preventive measures.
Nakakatakot lang dito yung bukas na C. Open drainage as Health Threat
kanal dyan sa may labas. Lalo kapag 1. Inability to make decisions with
umuulan at bumabaha, baka kasi di respect to taking appropriate
mapansin malusot dun. health action due to lack of
knowledge about alternative
solutions.
1. Measles with Cough.

Criteria Computation Score Justification

Nature of the Problem
Modifiability of the Problem
Preventive Potential
Salience
Total
3/3 X 1 1 It is a Health Deficit that
requires immediate
attention.
2/2 X 2 2 Resources needed are
available.
3/3 X 1 1 With the compliance in
the given instruction of
appropriate health
providers, disease will be
manageable.
2/2 X 1 1 The family considers this
is a problem that needs
immediate attention.
5

2. Presence of Vectors and Rodents

Criteria Computation Score Justification

Nature of the Problem
Modifiability of the Problem
Preventive Potential
Salience
Total
2/3 X 1 2/3 It is a Health Threat that
needs an immediate
attention.
1/2 X 2 1 The family has the
necessary resources but
does not utilize them
properly.
2/3 X 1 2/3 The susceptibility in
acquiring other infections
can be prevented if the
problem will be solved.
1/2 X 1 1/2 The problem was
recognized by the family
but they do not think it
needs an immediate
attention.
2 5/6

3. Open Drainage

Criteria Computation Score Justification

Nature of the Problem 2/3 X 1 2/3 It is a Health Threat for it
could damage the health
 of the family.
Modifiability of the Problem 1/2 X 2 1 It is partially modifiable for
the family alone cant
solve the issue, referral to
higher officials were still
needed.
Preventive Potential 2/3 X 1 2/3 Solving the problem
lessen the risk of the
family on acquiring
infections brought about
by an unpleasant
environment.
Salience 1/2 X 1 1/2 The family recognizes the
problem but does not
think it needs an
immediate action.
Total 2 5/6

The genograms and ecomaps are essential components of family assessment,

and they should be used concurrently with any of the assessment approaches.

The genogram displays family information in family tree that shows family
members and their relationship over at least three generations. It enhance
nurses abilities to make clinical judgment and connect them to family structure
and history

Ecomap is a visual diagram of the family unit in relation to other units or systems
in the community.

The ecomap serves as a tool to organize and present factual information and
thus allows the nurse to have a more holistic and integrated perception of the
family situation.
PRIMARY HEALTH CARE (PHC)

DEFINITION:
It is an essential health care made universally accessible to individuals and
families in the community by means acceptable to them, through their full
participation and at cost that the community can afford at every stage of
development.

A practical approach to making health benefits within the reach of all people.

An approach to health development, which is carried out through a set of

activities and whose ultimate aim is the continuous improvement and
maintenance of health status of the community.

May 1977 -30th World Health Assembly decided that the main health target of
the government and WHO is the attainment of a level of health that would
permit them to lead a socially and economically productive life by the year
2000.

September 6-12, 1978 - First International Conference on PHC in Alma Ata,

Russia (USSR) The Alma Ata Declaration stated that PHC was the key to attain
the health for all goal.

October 19, 1979 - Letter of Instruction (LOI) 949, the legal basis of PHC was
signed by Pres. Ferdinand E. Marcos, which adopted PHC as an approach
towards the design, development and implementation of programs focusing on
health development at community level.
o Magnitude of Health Problems
o Inadequate and unequal distribution of health resources
o Increasing cost of medical care
 o Isolation of health care activities from other development activities

GOAL:
HEALTH FOR ALL FILIPINOS by the year 2000 and HEALTH IN THE
HANDS OF THE PEOPLE by the year 2020.

OBJECTIVES OF PRIMARY HEALTH CARE:

o Improvement in the level of health care of the community
o Favorable population growth structure
o Reduction in the prevalence of preventable, communicable and
other disease.
o Reduction in morbidity and mortality rates especially among infants
and children.
o Extension of essential health services with priority given to the
underserved sectors.
o Improvement in Basic Sanitation
o Development of the capability of the community aimed at self-
reliance.
o Maximizing the contribution of the other sectors for the social and
economic development of the community.

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

FOUR CORNERSTONES/ PILLARS IN PRIMARY HEALTH CARE

1. Active Community Participation
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available

MAJOR STRATEGIES OF PRIMARY HEALTH CARE:

A. ELEVATING HEALTH TO A COMPREHENSIVE AND SUSTAINED NATIONAL

EFFORTS.

Attaining Health for all Filipino will require expanding participation in health and
health related programs whether as service provider or beneficiary.
Empowerment to parents, families and communities to make decisions of their
health is really the desired outcome.

Advocacy must be directed to National and Local policy making to elicit support
and commitment to major health concerns through legislations, budgetary and
logistical considerations.
B. PROMOTING AND SUPPORTING COMMUNITY MANAGED HEALTH CARE

The health in the hands of the people brings the government closest to the
people. It necessitates a process of capacity building of communities and
organization to plan, implement and evaluate health programs at their levels.

C. INCREASING EFFICIENCIES IN THE HEALTH SECTOR

Using appropriate technology will make services and resources required for their
delivery, effective, affordable, accessible and culturally acceptable. The
development of human resources must correspond to the actual needs of the
nation and the policies it upholds such as PHC. The DOH will continue to support
and assist both public and private institutions particularly in faculty development,
enhancement of relevant curricula and development of standard teaching
materials.

D. ADVANCING ESSENTIAL NATIONAL HEALTH RESEARCH

Essential National Health Research (ENHR) is an integrated strategy for

organizing and managing research using intersectoral, multi-disciplinary and
scientific approach to health programming and delivery.

TWO LEVELS OF PRIMARY HEALTH CARE WORKERS

Barangay Health Workers - trained community health workers or health
auxiliary volunteers or traditional birth attendants or healers.
Intermediate level health workers- that includes the Public Health
Nurse, Rural Sanitary Inspector and the midwives.

ELEMENTS OF PRIMARY HEALTH CARE:

The following are the eight (8) essential elements of primary health care:

1. Education for Health

This is one of the potent methodologies for information dissemination. It
promotes the partnership of both the family members and health workers in the
promotion of health as well as prevention of illness.

2. Locally Endemic Disease Control

The control of endemic disease focuses on the prevention of its occurrence to
reduce morbidity rate. Example: Malaria control and Schistosomiasis control.

3. Expanded Program on Immunization

This program exists to control the occurrence of preventable illnesses especially
of children below 6 years old. Immunizations on poliomyelitis, measles, tetanus,
diphtheria and other preventable disease are given for free by the government
and ongoing program of the DOH/

4. Maternal and Child Health and Family Planning

The mother and child are the most delicate members of the community. So the
protection of the mother and child to illness and other risks would ensure good
health for the community. The goal of Family Planning includes spacing of
children and responsible parenthood.

5. Environmental Sanitation and Promotion of Safe Water Supply

Environmental Sanitation is defined as the study of all factors in the mans
environment, which exercise or may exercise deleterious effect on his well-being
and survival. Water is a basic need for life and one factor in mans environment.
Water is necessary for the maintenance of healthy lifestyle. Safe Water and
Sanitation is necessary for basic promotion of health.

6. Nutrition and Promotion of Adequate Food Supply

One basic need of the family is food. And if food is properly prepared then one
may be assured healthy family. There are many food resources found in the
communities but because of faulty preparation and lack of knowledge regarding
proper food planning, Malnutrition is one of the problems that we have in the
country.

7. Treatment of Communicable Diseases and Common Illness

The diseases spread through direct contact pose a great risk to those who can
be infected. Tuberculosis is one of the communicable diseases continuously
occupies the top ten causes of death. Most communicable diseases are also
preventable. The Government focuses on the prevention, control and treatment
of these illnesses.

8. Supply of Essential Drugs

This focuses on the information campaign on the utilization and acquisition of
drugs. In response to this campaign, the GENERIC ACT of the Philippines is
enacted. It includes the following drugs: Cotrimoxazole, Paracetamol,
Amoxycillin, Oresol, Nifedipine, Rifampicin, INH (isoniazid)
and Pyrazinamide,Ethambutol, Streptomycin,Albendazole,Quinine

PRINCIPLES:
Primary health care is run with the following principles:
1. 4 As = Accessibility, Availability, Affordability and Acceptability,
Appropriateness of health services.
The health services should be present where the supposed recipients are. They
should make use of the available resources within the community, wherein the
focus would be more on health promotion and prevention of illness.
2. Community Participation
Community participation is the heart and soul of primary health care.

3. People are the center, object and subject of development.

Thus, the success of any undertaking that aims at serving the people is
dependent on peoples participation at all levels of decision-making;
planning, implementing, monitoring and evaluating. Any undertaking must
also be based on the peoples needs and problems (PCF, 1990)
Part of the peoples participation is the partnership between the
community and the agencies found in the community; social mobilization
and decentralization.
In general, health work should start from where the people are and
building on what they have. Example: Scheduling of Barangay Health
Workers in the health center.

Barriers of Community Involvement

Lack of motivation
Attitude
Resistance to change
Dependence on the part of community people
Lack of managerial skills

4. Self-reliance
Through community participation and cohesiveness of peoples organization they
can generate support for health care through social mobilization, networking and
mobilization of local resources. Leadership and management skills should be
develop among these people. Existence of sustained health care facilities
managed by the people is some of the major indicators that the community is
leading to self reliance.

5. Partnership between the community and the health agencies in the

provision of quality of life.
Providing linkages between the government and the non-government
organization and peoples organization.

6. Recognition of interrelationship between the health and development

Health is defined as not merely the absence of disease. Neither is it only a
state of physical and mental well-being. Health being a social phenomenon
recognizes the interplay of political, socio-cultural and economic factors as its
determinant. Good Health therefore, is manifested by the progressive
improvements in the living conditions and quality of life enjoyed by the
community residents
Development is the quest for an improved quality of life for all.
Development is multidimensional. It has political, social, cultural, institutional and
 environmental dimensions (Gonzales 1994). Therefore, it is measured by the
ability of people to satisfy their basic needs.

7. Social Mobilization
It enhances peoples participation or governance, support system provided by the
government, networking and developing secondary leaders.

8. Decentralization
This ensures empowerment and that empowerment can only be facilitated if the
administrative structure provides local level political structures with more
substantive responsibilities for development initiators. This also facilities proper
allocation of budgetary resources.

LEVELS OF CARE:

I. Health Promotion
To increase well- being and actualize human health potentials
Not disease oriented
Motivated by personal positive approach to wellness

II. Disease Prevention/ Health Prevention

Behavior motivated by desire to actively avoid illness, detect it early
or maintain functioning with constraints of illness.

III. Health Maintenance

To prevent relapse by integrating newly adopted behaviors into his of her
lifestyles. The person no longer experiences temptation to return to previous
unhealthy behavior.
IV. Curative
Define that care tends to overcome disease and to promote recovery.

V. Rehabilitative
Emphasizes the importance of assistance of patients.

LEVELS OF PREVENTION:

I. Primary Prevention
- To decrease rater of exposure of the individual or community. It consists of
activities which are undertaken before disease. It is also apply to generally
healthy person in order to keep them well.
 a. Health Promotion- Enable clients to maintain health
and realize their full potential for development.
- Consists of activities aimed at maintaining and
enhancing peoples physical, social well- being

b. Disease Prevention- protects patients or the other

member of the public from actual or potential health threats and their
harmful consequences.

II. Secondary Prevention

- This applies to those who have symptoms and with diagnosed disease. This
includes halting disease progress, minimizing and shortening disease duration,
prevent or reduce complications and bring about cure.

a. Early Diagnosis
b. Prompt Treatment

III. Tertiary Prevention

- To restore patient to an optimum level of functioning. This consists of activities
which are done when disease process an injury or a calamity has already
exacted its damage and ill effects with consequent disability or loss of function in
verifying degrees.
- Referrals; PT, OT, therapies

a. Rehabilitation

CONCEPT OF HEALTH PROMOTION:

The first International Conference on Health Promotion was held in Ottawa

, Canada in November 1986.
The aim of the conference was action to achieve Health for all by the year
2000 and beyond.
The Ottawa Conference is one of five International Health Promotion Conf
erences, exploring key health promotion strategies or issues.

Health Promotion is the process of enabling people to increase control over and
improve their health. Health is seen as a resource for everyday life, not the
objective of living. Health promotion is not just the responsibility of the health
sector, but goes beyond healthy lifestyle to well- being. The fundamental
conditions and resources needed for good health are:

I. Peace
II. Shelter
III. Education
 IV. Food
V. Income
VI. A stable ecosystem
VII. Sustainable Resources
VIII. Social Justice and Equity

THREE BASIC STRATEGIES FOR HEALTH PROMOTION:

1. Advocate- good health is a major resource for social,

economic and personal development, and an important dimension of quality of
life. Political, economic, social and cultural, environmental behavioral and
biological factors can all favor or harm health. Health promotion aims to make
these conditions favorable through advocacy for health.

2. Enable- health promotion focuses on achieving

equity in health. Health promotion action aims to reduce differences in current
health status and to ensure the availability of equal opportunities and resources
to enable all people to achieve their full health potential. This includes a secure
foundation in a supportive environment, access to information, life skills and
opportunities to make healthy choices.

3. Mediate- the prerequisites and prospects for health

cannot be ensured by the health sector alone. Health promotion demands
coordinated action by all concerned, including government and voluntary
organizations, local authorities, industry and the media.

Health promotion priority action areas identified in the Ottawa Charter are:

Build Healthy Public Policy

Create Supportive Environments
Strengthen Community Actions
Develop Personal Skills
Reorient Health Services
Moving into the Future

THEORIES/ MODEL OF HEALTH PROMOTION:

HEALTH PROMOTION THEORY BY NOLA PENDER

The theory explains that each person has unique personal characteristics and
experiences that affect subsequent actions. The set of variables for behavioral
specific knowledge and affect have important motivational significance. These
variables can be modified through nursing actions. Health promoting behavior is
the desired behavioral outcome and is the end point in the HPM. Health
promoting behaviors should result in improved health, enhanced functional ability
and better quality of life at all stages of development. The final behavioral
demand is also influenced by the immediate competing demand and
preferences, which can derail an intended health promoting actions.

SOCIAL COGNITIVE THEORY BY ALBERT BANDURA

Social Cognitive Theory (SCT) is also known as Social Learning Theory.

According to the theory is based on vicarious learning. According to the theory
behavior is learned by observation, imitation, and positive reinforcement. Role
model facilitates learning in that individuals reenact behaviors that they have
observed directly or seen in the media. The theory also suggests people learned
by noticing the benefits of action that they observed other people performing.

Standards in CHN
I. Theory
Applies theoretical concepts as basis for decisions in practice
II. Data Collection
Gathers comprehensive, accurate data systematically
Standards
III. Diagnosis
Analyzes collected data to determine the needs/ health problems of IFC
IV. Planning
At each level of prevention, develops plans that specify nursing actions unique to
needs of clients
Standards
V. Intervention
Guided by the plan, intervenes to promote, maintain or restore health, prevent
illness and institute rehabilitation
VI. Evaluation
Evaluates responses of clients to interventions to note progress toward goal
achievement, revise data base, diagnoses and plan
Standards
VII. Quality Assurance and Professional Development
Participates in peer review and other means of evaluation to assure quality of
nursing practice
Assumes professional development
Contributes to development of others
Standards
VIII. Interdisciplinary Collaboration
Collaborates with other members of the health team, professionals and
community representatives in assessing, planning, implementing and evaluating
programs for community health
Standards
Research
Indulges in research to contribute to theory and practice in community health
nursing

COMMUNITY HEALTH CARE PROCESS

Assessment
Purpose : To identify the health needs of the people
Planning of nursing actions
Purpose : To act on the determined needs of the community people
Implementation
Purpose : To achieve the optimum level of health of the community people
Evaluation
Purpose : To determine the effectiveness of health care programs

COMMUNITY HEALTH NURSING THEORIES

The theories enable community nurse to use already developed ideas to guide &
strength their work with programs.

1) META THEORY

It provides broad description & explanation of general happening in the world.

These theory help the nurse understand & transform the underlying ideas &
responses that support the social construction of inequities.

a) Caring Theory

Listening, caring, authenticity, respect & imagination comprise caring practice.

This theory is relevant in community program as in individual & family care.
Community health nurses are commissioned to provide care in the ways that
maintain dignity & respect, knowing the way that will vary for different people.

b) Phenomenological Theory

Enables nurses to understand the people lived experience within context of

culture, time & place.
.
c) Feminist Theory

This theory is intended to create knowledge to improve womens lives.

d) Critical Theory

Aims to provide a full understanding of social & philosophical contexts

surrounding mental health issues.

2) TRANSTHEORETICAL & RELAPSE PREVENTION

The nurse will encounter many programs aimed towards individual change. In
transtheoretical change model-the individual moves from not thinking about the
change in the near future to seriously thinking about the change. In relapse
prevention model, relapse is common in health behavior change programmer
needs to prepare individuals for the possibility of relapse.

3) DIFFUSION THEORY

It theory explains the way that information & change spread through population
unevenly. Diffusion processes are enhanced when people are aware of the
advances of the change

NEUMANS THEORY (1972)

Stress reduction is goal of systems model of nursing practice. nursing actions are
in primary, secondary & tertiary level of prevention.

NURSING PROCEDURES

CLINIC VISIT
- Process of checking the clients health condition in a medical clinic

HOME VISIT
- a professional face to face contact made by the nurse with a patient or the
family to provide necessary health care activities and to further attain the
objectives of the agency.

BAG TECHNIQUE
-a tool making of the public health bag through which the nurse during the home
visit can perform nursing procedures with ease and deftness saving time and
effort with the end in view of rendering effective nursing care.

THERMOMETER TECHNIQUE
-to assess the clients health condition through body temperature reading
NURSING CARE IN THE HOME
- giving to the individual patient the nursing care required by his/her specific
illness or trauma to help him/her reach a level of functioning at which he/she can
maintain himself/herself or die peacefully in dignity

ISOLATION TECHNIQUE IN THE HOME

-done by:
1. Separating the articles used by a client with communicable disease to prevent
the spread of infection:
2. Frequent washing and airing of beddings and other articles and disinfections of
room
3. Wearing a protective gown, to be used only within the room of the sick
member
4. Discarding properly all nasal and throat discharges of any member sick with
communicable disease
5. Burning all soiled articles if could be or contaminated articles be boiled first in
water 30 minutes before laundering

INTRAVENOUS THERAPY
Insertion of a needle or catheter into a vein to provide medication and fluids
based on physicians written prescription
- can be done only by nurses accredited by ANSAP

PRINCIPLES OF HEALTH EDUCATION

It considers the health status of the people, which is determined by the

economic and social conscience of the country.
It is a process whereby people learn to improve their personal habits and
attitudes, to work responsibly for the improvement of health conditions of the
family, community, and nation.
It involves motivation, experience, and change in conduct and thinking, while
stimulating active interest. It develops and provides experience for change in
peoples attitudes, customs, and habits in relation to health and everyday living.
It should be recognized as the basic function of all health workers.
It takes place in the home, in the school, and in the community.
It is a cooperative effort requiring all categories of health personnel to work
together in close teamwork with families, groups, and the community.
It meets the needs, interests, and problems of the people affected.
It finds means and ways of carrying out plans by encouraging individual and
community participation.
It is a slow, continuous process that involves constant changes and revisions
until objectives are achieved.
Makes use of supplementary aids and devices to help with the verbal
instructions.
 It utilizes community resources by careful evaluation of the different services
and resources found in the community.
It is a creative process requiring methods and techniques with various
characteristics, not following a rigid and flexible pattern.
It aims to help people make use of their own efforts and education to improve
their conditions of living,
It makes careful evaluation of the planning, organization, and implementation
of all health education programs and activities.

COMMUNITY ORGANIZING
A process whereby the community members develop the capability to
assess their health needs and problems, plan and implement actions to
solve these problems, put up sustain organizational structures which will
support and monitor implementation of health initiatives by the people.

Purpose:
Empowerment or building the capability of people for future

community action
Approaches to community development:
a. Social changes
Building up social organizations (relationships, structure and
resources)
b. Change in ideology
Knowledge, beliefs and attitude
c. Change agents
Capacity to influence others by setting a good example.

Principles of CO:
1. Welfare approach
People especially the oppressed, exploited and deprived sectors are most
open to change, have the capacity to change and are able to bring about
change. Hence , CO is based on the ff:
a. Power must reside in the people
b. Development is from the people to the people
c. People participation

2. Technological approach
Must be based on the poorest sectors of society. The solutions of
problems commonly shared by these sectors must be focused on
collective organizations, planning and action.

3. Transformatory approach
should lead to self-reliant communities
 Five stages
1. Community analysis
2. Design and initiation
3. Implementation
4. Program maintenance consolidation
5. Dissemination reassessment

1. Community analysis
The process of assessing and defining needs, opportunities and resources
involved in initiating community health action.
Maybe referred to as community diagnosis, community needs
assessment, health education planning and mapping.

Components of community analysis:

1. Demographic, social and economic profile of the community derived from

secondary data.
2. Health risk profile (social, behavioural and environmental risks)
Behavioural- dietary habits and other life style concerns like
alcohol, tobacco and drugs
Social indicators- exposure to long term unemployment, low
education and isolation.
3. Health/wellness out comes profile (morbidity/mortality data)
4. Survey of current health promotion programs.
5. Studies conducted in certain target groups

Steps in community analysis

Steps in community analysis

i. Defining the community

a. Determining the geographic boundaries of the target community
ii. Collecting data
iii. Assessing community capacity
a. Entails an evaluation of the driving forces which may facilitate or impede
the advocated change
iv. Assessing community barriers
v. Assessing readiness to change
a. Community interest
b. Perception on the importance of the problem
vi. Synthesis data and set priorities
a. Provide a community profile of the needs and resources and will become
the basis for designing prospective community interventions for health
promotion

2. Design and initiation

STEPS:
1. Establish a core planning group and select a local organizer.
Requirements:
Select 5-8 member in charge for core planning and management of
the program
With management skills, good listener and conflict resolution skills.

2. Choose an organizational structure.

This activates the community participation.

Types:
a. Leadership board council- existing local leaders working for a
common cause
b. Coalition- linking organizations and groups to work on community
issues.
c. Lead or official agency- a single agency takes the primary
responsibility of a liaison for health promotion activities in the
community.
d. Grass-roots- informal structures in the community like the
neighbourhood residents.
e. Citizens panels- a group of citizens (5-10) emerge to form a
partnership with the government agency.
f. Networks and consortia- network develop because of a certain
concerns

3. Identify, select and recruit organizational members.

As much as possible different groups, organizations sectors should
be represented.
Chosen representative have power for the group they represents

4. Define the organization mission and goals.

This will specify the what, who, where, when and extent of the
organizational objectives.

5. Clarify roles and responsibilities of people involved in the organization.

This is done to establish a smooth working relationship and avoid
overlapping of responsibilities.

6. Provide training and recognition.

Active involvement in planning and management of programs may
require skills development training.
Recognition of the programs accomplishment and individuals
contribution to the success of the program and boost morale of the
members.
 3. Implementation
-put the design plan into action.

a. Generate broad citizen participation

How?
Organizing task force, who, with appropriate guidance can
provide the necessary support.

b. Develop a sequential work plan

Activities should be planned sequentially. Often, times have to be
modified as events unfold. Community members may have to
constantly monitor implementation steps.

c. Use comprehensive, integrated strategies

Generally the programs utilize more than one strategy that must
complement each other.

d. Integrate community values into the programs, materials and

messages.
The community language, values and norms have to be
incorporated into the program.

4. Program maintenance consolidation

The program at this point has experienced some degree of success and
has weathered through implementation problems, the organization and
program is gaining acceptance in the community.

Maintenance:
a. Integrate intervention activities into community networks
This can be affected through implementation problems.
The organization and program is gaining acceptance in the
community.

b. Establish a positive organizational culture.

A positive environment is a critical element in maintaining
cooperation and preventing fast turnover of members.
This is a result of good group process based on trust, respect, and
openness.

c. Establish an ongoing recruitment plan.

It should be expected that volunteers may leave the organization.
This requires a built in mechanisms for continuous recruitment and
training of new members.

d. Disseminate results.
 Continuous feedback to the community on results of activities
enhances visibility and acceptance of the organization.
Dissemination of information is vital to gain and maintain
community support.

5. Dissemination-Reassessment
Continuous assessment is part of the monitoring aspect in the
management of the program

a. Update the community analysis.

Is there a change in leadership, resources and participation?
This may necessitate reorganization and new collaboration with
other organizations.

b. Assess effectiveness of interventions/programs.

Quantitative and qualitative methods of evaluation can be used to
determine participation, support and behavior change level of
decision making and other factors deemed important to the
program.

c. Chart future directories and modifications.

This may mean revision of goals and objectives and development
of new strategies.
Revitalization of collaboration and networking may be vital in
support of new ventures.

d. Summarize and disseminate results.

Some organizations die because of the lack of visibility.
Thus, a dissemination plan may be helpful in diffusion of
information to further boost support to the organizations
endeavour.

Classify the following Community Organizing activities as to phase of

COPAR each belong:

1. Conducts community meetings to draw up guidelines for the organization of

CHO
2. Trains BHWs
3. Sets up of linkages/network and referral systems
4. PIME of health services and or community devt. Projects
5. Provides continuing education to leaders or residents
6. Trains secondary leaders
7. Selects site for adoption
8. Identifies key leaders
9. Develops criteria for site selection
10. Forms the core group
11. Conducts SALT
12. Selects members of the research team
13. Assists the research team in presenting results during the general assembly
14. Helps the people identifying the community needs and health problems
15. Facilitates for the formulation and ratification of the constitution and by-laws
of the organization

The Health Resource Development Program

Community Health Organizing Utilizing COPAR
HRDP
Was developed and sponsored by the Philippine Center for
Population and Development (PCPD)
To make health services available and accessible to depressed and
underserved communities in the Philippines
PCPD is a non-stock, non-profit institution, which serves as a
resource center assisting institutions and agencies through
programs and projects geared toward the social human development
of rural and urban communities
Formerly known as The Population Center Foundation
HISTORY OF HRDP
HRDP I
Trained the faculty, medical/nursing students to provide health
care services to the far flung barrios because of lack of man
power for health services at the same time that similar
activities fulfilled the curricular requirements of the students
for public health
The PCPD provides seed money for the income generating
projects
The CO uses his/her own strategy or method in developing the
community
Short-term service
HISTORY OF HRDP
HRDP II
The 2nd cycle uses the same strategy but the program could
not be sustained by the schools or hospitals and the income-
generating projects eventually become the hindrance to the
goal of achieving the health program because the people tend
to be more interested in the income generated by the projects
Both HRDP I and HRDP II have brought about some changes in
the community life of the people
Established basic health infrastructure; basic health services
were increased; there were trained workers and organized
health groups to take care of the needs of the community
HISTORY OF HRDP
HRDP III
 PCPD refined the program and resulted to what is now called
HRDP III, which has these unique features:
Comprehensive training of the staff and faculty of the
participating agency in which the community work was
initiated
Periodic training program and regular assistance to the
participating agency were provided to strengthen the
health outreach program to become community oriented
PHC as the approach with which all nursing/medical
students, their CIs and indigenous health workers are
trained for community health work and around which all
other project inputs will revolve
HISTORY OF HRDP
Community organizing as the main strategy to be employed in
preparing the communities to develop their community health
care systems and the establishment of community health
organization to manage the community health programs
Organizing work in the communities were done in 3 phases
PAR as fascinating strategy for maximum community
involvement through collective identification and analysis of
community health problems and collective health action
Available funds to finance community initiated projects
COPAR?
Since Management Leadership and Jurisprudence are courses
taught in the classroom members of this group of students were
trained to manage and acts as leaders of the different levels of the
students who were involved in COPAR
Principles of management were applied in carrying out primary
health care
The community members, CHWs and leaders were empowered to
manage their own health projects
Conducted seminars and trainings as well as health education and
services needed by community(exposure and immersion 6-8 weeks)

THE HRDP-COPAR PROCESS

1. PRE-ENTRY PHASE
2. ENTRY PHASE
3. COMMUNITY STUDY/DIAGNOSIS PHASE/RESEARCH PHASE
4. COMMUNITY ORGANIZATION AND CAPABILITY-BUILDING PHASE
5. COMMUNITY ACTION PHASE
6. SUSTENANCE AND STRENGTHENING PHASE
1. Pre-Entry Phase
Preparation of the Institution
Train faculty and students in COPAR.
Formulate plans for institutionalizing COPAR.
Revise/enrich curriculum and immersion program.
 Coordinate participants of other departments.
Site Selection
Initial networking with local government.
Conduct preliminary special investigation.
Make long/short list of potential communities.
Do ocular survey of listed communities.
Criteria for Initial Site Selection
o Must have a population of 100-200 families.
o Economically depressed.
o No strong resistance from the community.
o No serious peace and order problem.
o No similar group or organization holding the same program.
Identifying Potential Barangay
o Do the same process as in selecting municipality.
o Consult key informants and residents.
o Coordinate with local government and NGOs for future activities.
Choosing Final Barangay
o Conduct informal interviews with community residents and key
informants.
o Determine the need of the program in the community.
o Take note of political development.
o Develop community profiles for secondary data.
o Develop survey tools.
o Pay courtesy call to community leaders.
o Choose foster families based on guidelines.
Identifying Host Family
o House is strategically located in the community.
o Should not belong to the rich segment.
o Respected by both formal and informal leaders.
o Neighbours are not hesitant to enter the house.
o No member of the host family should be moving out in the
community.
2. Entry Phase
Guidelines for Entry
o Recognize the role of local authorities by paying them visits to
inform their presence and activities.
o Her appearance, speech, behavior and lifestyle should be in
keeping with those of the community residents without disregard of
their being role model.
o Avoid raising the consciousness of the community residents;
adopt a low-key profile.
Activities in the Entry Phase
 Integration - establishing rapport with the people in continuing effort
to imbibe community life.
living with the community
seek out to converse with people where they usually
congregate
lend a hand in household chores
avoid gambling and drinking
Deepening social investigation/community study verification and
enrichment of data collected from initial survey
conduct baseline survey by students, results relayed through
community assembly
Leader Spotting Through Sociogram.
Key persons - approached by most people
Opinion leader - approach by key persons
Isolates - never or hardly consulted

Phil.Health Care Delivery System

1.PRIMARY LEVEL FACILITIES
2. SECONDARY LEVEL FACILITIES
3. TERTIARY LEVEL FACILITIES
Classify as to what level the ff. belong
1. Teaching and Training Hospitals
2. City Health Services
3. Emergency and District Hospitals
4. Private Practitioners
5. Heart Institutes
6. Puericulture Centers
7. RHU
THE DEPARTMENT OF HEALTH
VISION: Health for all Filipinos
MISSION: Ensure accessibility & quality of health care to improve the quality of
life of all Filipinos, especially the poor.
NATIONAL OBJECTIVES
Improve the general health status of the population (reduce infant mortality rate,
reduce child morality rate, reduce maternal mortality rate, reduce total fertility
rate, increase life expectancy & the quality of life years).
 Reduce morbidity, mortality, disability & complications from Diarrheas,
Pneumonias, Tuberculosis, Dengue, Intestinal Parasitism, Sexually Transmitted
Diseases, Hepatitis B, Accident & Injuries, Dental Caries & Periodontal Diseases,
Cardiovascular Diseases, Cancer, Diabetes, Asthma & Chronic Obstructive
Pulmonary Diseases, Nephritis & Chronic Kidney Diseases, Mental Disorders,
Protein Energy Malnutrition, Iron Deficiency Anemia & Obesity.
3.Eliminate the ff. diseases as public health problems:
Schistosomiasis
Malaria
Filariasis
Leprosy
Rabies
Measles
Tetanus
Diphtheria & Pertussis
Vitamin A Deficiency & Iodine Deficiency Disorders
4. Eradicate Poliomyelitis
5. Promote healthy lifestyle through healthy diet & nutrition, physical activity &
fitness, personal hygiene, mental health & less stressful life & prevent violent &
risk-taking behaviors.
6. Promote the health & nutrition of families & special populations through child,
adolescent & youth, adult health, womens health, health of older persons, health
of indigenous people, health of migrant workers and health of different disabled
persons and of the rural & urban poor.
7. Promote environmental health and sustainable development through the
promotion and maintenance of healthy homes, schools, workplaces,
establishments and communities towns and cities.
Basic Principles to Achieve Improvement in Health
Universal access to basic health services must be ensured.
The health and nutrition of vulnerable groups must be prioritized.
The epidemiological shift from infection to degenerative diseases must be
managed.
The performance of the health sector must be enhanced.
Primary Strategies to Achieve Goals
Increasing investment for Primary Health Care.
Development of national standards and objectives for health.
Assurance of health care.
Support to the local system development.
Support for frontline health workers.
PHC as a Strategy
An improved state of health and quality of life for all people attained through
SELF-RELIANCE.

KEY STRATEGY TO ACHIEVE THE GOAL:

Partnership with and Empowerment of the people - permeate as the core
strategy in the effective provision of essential health services that are community
based, accessible, acceptable, and sustainable, at a cost, which the community
and the government can afford.