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The Public Health Nurse

Public Health Nurses- Are found in various health settings and occupying various positions in the hierarchy.- Are assigned in rural health units, city health centers, provincial health offices,

regional health offices, and evening the national office of the Department of Health.- Are also assigned in public schools and in the offices of government agencies

providing health care services.- Occupy a range of positions from Public Health Nurse to Nurse Program

!upervisors to "hief Nurse in public health settings.- #ses various tools and procedures necessary for her to properly practice her

profession and deliver basic health service.- #ses nursing process in her practice and is adept in documenting and reporting

accomplishments through records and reports.- Technically competent in various nursing procedures conducted in settings $here she

is assigned

%ualifications and &unctionsThe standards of Public Health Nursing in the Philippines developed by the National

'eague of Philippine government Nurses in ())* described the +ualification and functions of aPublic Health Nurse.

Public health nurse- must be professionally +ualified and licensed to practice in the area of public health

nursing.- ust possess personal +ualities and people s ills/ that $ould allo$ her practice to

ma e a difference in the lives of these people.- &unctions in accordance $ith the dominant values of public health nurses, $ithin the

ethico-legal frame$or of the nursing profession, and in accordance $ith the needsof the clients and available resources for health care.

- &unctions of PHN are consistent $ith the Nursing 'a$ ())( and program policiesformulated by the DOH and local government health agencies. They are related tomanagement, supervision, provision of nursing care, collaboration and coordination,

health promotion and education training and research.

• anagement &unction- the management function of the public health nurse is inherent in her practice.- The nurse, in $hatever setting and role has been trained to lead and manage.- Ob0ectives set for $or being done can only be achieved through the e1ecution of the

five management functions of planning, organi2ing, staffing, directing and controlling.- This function is performed $hen she organi2es the nursing service/ of the local

health agency.- anaging the nurses and their activities- Program management. This is a function $here the PHN actually e1cels in.- A program manager is responsible for the delivery of the pac age of services

provided by the program to the target clientele.

- 3eports on program accomplishments is a documentation of her management s ills.• !upervisory &unction

- PHN is the supervisor of the mid$ives and other au1illary health $or ers in thecatchment area.

- &ormulates a supervisory plan and conducts supervisory visits to implement plan.- "onducts supervisory visits using a supervisory chec list- During the visit the PHN identifies together $ith the supervisee any issue or problem

encountered and addresses them accordingly.- "oaching



- 4nhancement of training for the supervisee- 3eport of the encounter is given to the supervisee and ept in her personal file for

future reference.

• Nursing &unction- An inherent function of the nurse

- Her practice as a nurse is based on the science and art of caring- Public health nursing is caring for individuals, families and communities to$ard healthpromotion and disease prevention

- PHN are e1pected to provide nursing care- PHN uses her no$ledge and s ill in the nursing process. !he does assessment,

plans, and implements care, and evaluates outcomes.- 4stablishes rapport $ith her client5 individual, family or community- Home visits- 3eferral of patients to appropriate levels of care

• "ollaborating and coordinating &unction- 6rings activities or group activities systematically into proper relation or harmony $ith

each other.- "are coordinators for communities and their members- Actively involved both socially and politically to empo$er individuals, families and

communities as an entity to initiate and maintain health promoting environments.- 4stablishes lin ages and collaborative relationships $ith other health professionals,

government agencies, the private sector, N7Os, people8s organi2ations to addresshealth problems.

- dentifies persons, groups, organi2ations, other agencies and communities $hoseresources are available $ithin and outside the community and $hich can be tappedin the implementation of individuals, family and community health care.

• Health Promotion and 4ducation &unction- Activities goes beyond health teachings and health information campaigns.- #nderstands that health is determined by various factors such as physical and

political environment, socio-economic status, personal coping s ills and many other circumstances, and it is inappropriate to blame or credit a person8s health to himself alone because he is unli ely to control many of these factors.

- #nderstanding the multidimensional nature of health $ill enable her to plan andimplement health promoting interventions for individuals and communities.

- #ses her s ills in advocacy for the creating of a supportive environment throughpolicies and reengineering of the physical environment for healthier actions.

- As an educator, the nurse provides clients $ith information that allo$s them to ma ehealthier choices and practices.

- Health education is a ma0or component of any public health program.- PHN are e1pected to teach on a daily basis as part of their practices.

• Training &unction- nitiates the formulation of staff development and training programs for mid$ives and

other au1illary $or ers- Does training needs assessment for these health $or ers, designs the training

program and conducts them in collaboration $ith other resource persons.- Also does evaluation of training.- PHN participates in the training of nursing and mid$ifery affiliates in coordination $ith

the faculty of colleges of nursing and mid$ifery.- Participates in teaching, guidance and supervision of student affiliates for their 3'4s

in the community setting.- Health promotion calls for the active participation of the community.



- obili2e communities for health actions.- "ommunity organi2ing is a means of mobili2ing people to solve their o$n problems.

Through this, people learn that their problems have social causes and fighting bac isa more reasonable, dignified approach than passive acceptance and personalalienation.

•

3esearch &unction- Participates in the conduct of research and utili2es research findings.- PHN function is disease surveillance. Purposes of disease surveillance5

o To measure the magnitude of the problemo To measure the effect of the control program

- t is important in monitoring the progress of the disease reduction initiatives5Poliomyelitis, Neonatal Tetanus 4limination, easles "ontrol, N"D ris factors, etc.

"ommunity Health Nursing Process"ommunity health purposes and goals are reali2ed through the application of a series

that lead to desired results. The nursing process is central to all nursing actions9 it is the veryessence of nursing, applicable in any setting, in any frame of reference, and $ithin anyphilosophy. ts uni+ueness $ill depend on the best application of nursing and public health s illsto family and community problems.

The nursing process is a systematic, scientific, dynamic, on-going interpersonal processin $hich the nurses and the clients are vie$ed as a system $ith each affecting the other and bothbeing affected by the factors $ithin the behavior. The process is a series of actions that leadto$ard a particular result. This process of decision-ma ing results in the optimal health care for the clients to $hom the nurse applies the process.

Goal of Care

:Nursing Audit :"areOutcomes:Performance Appraisal:4stimate cost benefitratio :Assessment ofproblems : dentifyneeded alterations:3evise plans asnecessary

:Prioriti2e Needs:4stablish goal basedon needs ; capabilitiesof staff :"onstructaction and Operationplan :Developevaluation parameters:3evise plan as needed

: nitiate "ontact :Demonstratecaring attitudes : utual trust ;

confidence :"ollect data from allpossible sources : dentify healthproblems :Assess coping ability

:Analy2e and interpret data

:Put Nursing Plan to action:"oordinate care<!ervices :#tili2ecommunity resources :Delegate

:!upervise<monitor healthservices provided :Provide healtheducation and training :Document

responses to Nursing action



1. Assessment- provides an estimate of the degree to $hich a family, group or community is

achieving the level of health possible for them- identifies specific deficiencies or guidance needed and estimates the possible effects

of the nursing interventions.

Assessment process involves the follo$ing steps5a. "ollection of Data

- 3elevant data are collected on the health status of the family, groups and community5demographic data, vital health statistics, community dynamics including po$erstructure, studies of disease surveillance, economic, cultural and environmentalcharacteristics, utili2ation of health services by the population5 and on individuals andfamilies5 health status, education, socio-cultural, religious and occupationalbac ground, family dynamics, environment and patterns of coping.o =arious methods to collect data5

"ommunity surveysntervie$ of individuals, family, groups and significant others

Observation of health-related behaviors of individuals, family groups and

environmental factors3evie$ of statistics, epidemiological and relevant studiesndividual and family health records

'aboratory and screening tests and physical e1aminations of individuals.b. "ategories of Health Problems

- Health deficits, health threats and foreseeable crises or stress points arecategories of health problems. The public health nurse analy2es the data inaccordance $ith the nurse8s conception of the source of the client8s problems andneeds that can be met through nursing intervention. The nursing diagnoses areinterpreted and validated $ith individuals, members of the community and familygroups concerned.

"apabilities and limitations to are identified5a. A health deficit occurs $hen there is a gap bet$een actual and achievable health

status. No regular chec -up is e1ample.b. Health threats are conditions that promote disease or in0ury and prevent people from

reali2ing their health potential.c. &oreseeable crises includes stressful occurrencesd. A health need e1ists $hen there is a health problem that can be alleviated $ith

medical or social technologye. A health problem is a situation in $hich there is a demonstrated health need

combined $ith actual or potential resources to apply remedial measures and acommitment to act on the part of the provider or the client.

2. Planning Nursing Actions/Care- plan for nursing action or care is based on the actual and potential problems that

$ere identified and prioriti2ed. Planning nursing actions include the follo$ingsteps5

a. 7oal !etting- A goal is a declaration of purpose that gives essential direction to action.- !pecific ob0ectives of care are made. These ob0ectives are stated in

behavioral terms5 !pecific, easurable, Attainable, 3ealistic and Timebounded >! A3T?.

- The nurse prioriti2es these ob0ectives.b. "onstructing a Plan of Action



- Planning phase of community health nursing process is concerned $ithchoosing from among the possible courses of action, selecting theappropriate types of nursing intervention, identifying appropriate andavailable resources for care and developing an operational plan.

- "ourse of action may have positive<negative effects.- Ability of the family to cope or solve its o$n problems and ma e decisions on

health matters should be considered.- mprove the capacity of the clients to act in their behalf.

c. Developing an Operational Plan- PHN must establish priorities, phase and coordinate activities.- Plans of care are prioriti2ed in order of urgency to determine those that need

the earliest action or attention.- These plans are bro en do$n to manageable units and properly se+uenced.- Development of evaluation parameters is don in the planning stage and

based on standards set by the nursing services

3. Implementation of Planned Carea. PHN carry out nursing procedures $hich are consistent $ith the N"P,

are adopted to present situations $hich promote a safe and therapeuticsenvironment.

b. The role of the community health nurse shifts from direct care giver tothat of a teacher.

c. "lients need the support of his o$n no$ledge to maintain his optimumlevel of functioning.

d. #tili2ation of a support system provides a harmonious, orderly care toenable client to function optimally.

e. "lient is offered planned assistance.f. PHN monitor the health services provided, ma e proper referrals as

necessary.g. Documentations are legal records to protect the agency and the health

care providers or the client himself.

4. Evaluation of Care and ervices Provided

a. 4valuation is inter$oven in every nursing activity and every step of the publichealth nurses.

b. Process elements include the steps of the nursing process itself-assessing,planning, implementing and evaluating, ma ing a nursing diagnosis, determiningnursing goals, $riting an N"P, performing the necessary nursing interventionsand coordination of services and measuring success of nursing actions.

c. %uality assurance efforts no$ recommend that evaluation of structure, processand outcomes criteria be made. This $ill evaluate the effectiveness of nursingcare done, or changes in behavior, condition or compliance.

d. 4valuation based on professional practicee. 4valuation of structure include cost-benefit ration, +ualifications and number of

members of the heath team in proportion to the populations served and thematerial resources in terms of +uantity and +uality.

f. 4valuation based on information gathered is utili2ed to improved communityhealth nursing services as part of the total community health services.



Communit! "ealt# $evelopment %C"$&

Public Health Nursing @ >Philippine !etting? According to &rancis T Du+ue , uplift the valuablerole of public health nurses as innovators, leaders, health providers and members of the healthcare team.

nspite of increasing demands of nurses abroad they >PHN!? choose to study and serveand nurse the health of the people8s health needs.

Public health nurses provide evidence that service truly has no limits.

Public Health Nurses• ade great contributing to the improvement of the health of the people• 3eaders in providing +uality health services to communities• &irst level health $or ers no$ledgeable about ne$ public health technologies and

methodologies.•

&irst to be trained to implement ne$ programs and apply ne$ technologies.• 'eaders in health promotion and advocacy• a e a difference in the health outcomes of individuals, families and communities cared

for.7lobal and "ountry Health mperatives/ >ongoing changes?

. !hifts in demographic and epidemiological trends in diseases, including theemergence and re-emergence of ne$ diseases and in the prevalence of ris andprotective factors.

(. Ne$ technologies for health care, communication and information.B. 41isting and emerging environmental ha2ards some associated $ith

globali2ation.C. Health reforms

illenium Development 7oals > D7s? ())*-() * based on the fundamental values of freedom

e+uality, solidarity, tolerance, health, respect for nature and shared responsibility.

illenium Development 7oals. 4radicate e1treme poverty and hunger

(. Achieve universal primary educationB. Promote gender e+uality and empo$er $omenC. 3educe child mortality*. mprove maternal healthE. "ombat H =<A D!, alaria and other desireF. 4nsure 4nvironmental !ustainability

. Develop a global partnership for development

H!3A @ Health !ector 3eform Agenda @ implemented through &O#3mula ON4 from ())*-() )=accination=itamin ADental "hec -#p"hild !afety Tips

"ritical "omponents to !tart &ourmula One mplementation. Health "are &inancing

(. Health 3egulationB. Health !ervice DeliveryC. 7overnance



Health (WHO) @ state of complete, physical, mental and social $ell being, not merely the absenceof disease or infirmity.

&actors or things that ma e people healthy or not, no$ as determinants of health are listed bythe GHO5

. ncome and social status. Higher income and social status are lin ed to better health.(. 4ducation @ 'o$ education levels are lin ed $ith poor health, more stress and lo$er self

confidence.B. Physical environment. !afe $ater and clean air, healthy $or places, safe houses,

communities and roads all contribute to good health.C. 4mployment and $or ing conditions. People in employment are healthier, particularly

those $ho have more control over their $or ing conditions.*. !ocial support net$or s. 7reater support from families, friends and communities is lin ed

to better health.E. "ulture "ustoms and traditions are the beliefs of the family and community all affect

health.F. 7enetics. nheritance plays part in determining life span, healthiness and the li elihood of

developing certain illnesses. Personal behaviors and coping s ills. 6alanced eating, eeping active, smo ing, drin ing

and ho$ $e deal $ith life8s stresses and challenges all affect health.. Health services. Access and use of services that prevent and treat disease influence

health.). 7ender. en and $omen suffer from different types of diseases at different ages.

Public Health (Accdg. To Dr. C.E. Winslow) @ science and art of preventing disease, prolonginglife, promoting health and efficiency through organi2ed community effort for the sanitation of theenvironment, control of communicable diseases, the education of individuals in personal hygiene,the organi2ation of medical and nursing services for the early diagnosis and preventive treatmentof disease and the development of the social machinery to ensure everyone a standards of livingade+uate for the maintenance of health and longevity.



4"O @ !I!T4 N&'#4N"4! ON OPT # '4=4' O& &#N"T ON N7 >O'O&?odified from 6lum by "HN "ommittee, ()))

Public Health (WHO) @ art of applying science in the conte1t of policies so as to reduceine+ualities in health $hile ensuring the best health for the greatest number. Public health is acore element of governments8 attempt to improve and promote the health and $elfare of their citi2ens.

"ore 6usiness of Public health. Disease "ontrol

(. n0ury preventionB. Health protectionC. Health public policy including those in relation to environmental ha2ards such as in the

$or place, housing, food, $ater etc.*. Promotion of health and e+uitable health gain.

The core of business of public health cannot be achieved $ithout proper delivering of essential public health functions.

According to YACH @ a set of fundamental activities that address the determinants of health,protect a population8s health and treat disease.

O'O&ndividuals

&amily 7roups"ommunitiesPopulations

PO' T "A'!afety

OppressionPeople 4mpo$erment

H4A'TH "A34D4' =43I !I!T4

PromotivePreventive

"urative3ehabilative

4N= 3ON 4NT Air

&oodGater Gaste#rban<3ural

Noise3adiationPollution

H434D TI7eneric4ndo$ment -Defects -!trengths -3is s &amilial 4thnic 3acial

64HA= O3"ultureHabits

ores4thnic "ustoms

!O" O 4"ONO "4mployment

4ducationHousing



4ssential public health functions. Health situation monitoring and analysis

(. 4pidemiological surveillance<disease prevention and controlB. Development of policies and planning in public healthC. !trategic management of health systems and services for population health gain.*. 3egulation and enforcement and planning in public healthE. Human resources development and planning in public healthF. Health promotion, social participation and empo$erment

. 4nsuring the +uality of personal and population based health services.

. 3esearch, development and implementation of innovative public health solutions.

$efinitions of Pu'lic "ealt# Nursing According to

GHO @ a special field of nursing, public health and some phases of social assistance andfunctions as part of the total public health programme for the promotion of health, theimprovement of the condition in the social and physical environment, rehabilitation of illness anddisability.

3uth 6. &reeman @ a service rendered by a professional nurse $ith communities, groups,families, individuals at home, in health centers, in clinics, in schools, in places of $or for thepromotion of health, prevention of illness, care of the sic at home and rehabilitation.

Jacobson @ it encompasses nursing practice in a $ide variety of community services andconsumer advocate areas, and in a variety of roles, at times including independent practiceKcommunity nursing is certainly not confined to public health nursing agencies./

'illian Gald @ a director of the Henry !treet !ettlement in Ne$ Ior "ity to denote a service that$as available to all people. The term, public health nursing became associated $ith public/ or government agencies and in turn $ith the care of the poor people.

The National 'eague of Philippine 7overnment came up $ith !tandards of Public Health Nursingin the Philippines ())*. The !tandards differentiated public health nursing and community health

nursing only in one area5 setting of $or as dictated by funding.

Public Health Nurses @ refer to the nurses in the local<national health departments or publicschools $hether their official position title is Public Health Nurse or Nurse or school nurse.Public Health Nursing @ refers to the practice of nursing in national and local government healthdepartments >$hich includes health centers and rural health units?, and public schools. t iscommunity health nursing practiced in the public sector.

"istorical (ac)ground

- Department of Health $as first established as Department of Public Gor s,4ducation and Hygiene.

( - The &a0ardo Act >Act No. ( *E? created !anitary Divisions.- The President of !anitary Division too charge of t$o or three municipalities. Ghere

there are no physicians available, male nurses $ere assigned to perform the dutiesof the President, !anitary Division.

- Philippine 7eneral Hospital >P7H?, then under the 6ureau of Health sent four nursesto "ebu to ta e of mothers and their babies.

- !t. Paul8s Hospital !chool of Nursing in ntramuros, also assigned t$o nurses to dohome visiting in anila and gave nursing care to mothers and ne$born babies fromthe outpatient obstetrical service of the P7H.



C- !chool nursing $as rendered by a nurse employed by the 6ureau of Health in

Tacloban, 'eyte.- 3eorgani2ation Act No. (CE( created the Office of 7eneral nspection.- Dr. 3osario Pastor a lady physician $as headed the Office of District Nursing.- T$o graduate &ilipino nurses, rs. "asilang 4usta+uia and rs. atilde A2urin $ere

employed for aternal and "hild Health and !anitation in anila under an Americannurse, rs. 7.D. !chudder.

- The first &ilipino nurse !upervisor under the 6ureau of Health, iss "armen del3osario $as appointed. !he succeeded iss abel Dabbs.

(B- T$o government !chools of Nursing $ere established5 Lamboanga 7eneral Hospital

!chool of Nursing in indanao and 6aguio 7eneral Hospital in Northern 'u2on.These schools $ere primarily intended to train non-"hristian $omen and preparethem to render service among their people.

- &our more government !chool of Nursing $ere establish5 one in !outhern 'u2on>%ue2on Province? and three in the =isayan slands of "ebu, 6ohol and 'eyte.

(F- The Office of District Nursing under the Office of 7eneral nspection, Philippine

Health !ervice $as abolished and supplanted by the !ection of Public HealthNursing. rs. 7enara de 7u2man acted as consultant to the Director of Health onnursing matters.

(- &irst convention of nurses $as held follo$ed by yearly conventions until the advent of

Gorld Gar . Pre-service training $as initiated as a pre-re+uisite for appointment.B)

- The !ection of Public Health Nursing $as converted into !ection of Nursing. The!ection of Nursing $as transferred from the Office of 7eneral !ervices to the Divisionof Administration. This Office covered the supervision and guidance of nurses in theprovincial hospitals and the government schools of nursing.

BB- 3eorgani2ation Act No. C))F transferred the Division of aternal and "hild Health of

the Office of Public Gelfare "ommission to the 6ureau of Health.- rs. !oledad A. 6uenafe, former Assistant !uperintendent of Nurses of the Public

Gelfare "ommission $as appointed as Assistant !hief Nurse of the !ection of Nursing, 6ureau of Health.

C- 6ureau of Health $ere transferred to the ne$ department.- Dr. ariano casiano became the first "ity Health Officer of anila.- An office of Nursing $as organi2ed $ith rs. =icenta ". Pnce. As "hief Nurse and

rs. 3osario A. Ordi2 as Assistant "hief Nurse.

Dec . C

- Gorld Gar bro e out, public health nurses in anila $ere assigned to devastatedareas to attend to the sic and the $ounded.

C(- A group of public health nurses, physicians and administrators from the anila Health

Department $ent to the internet camp in "apas, Tarlac to receive sic prisoners of $ar repleased by the Japanese Army.

- They $ere confined at !an 'a2aro Hospital and E Public Health Nurses $ereassigned to help the hospital staff ta e care of them.



July C(- B nurses $ho $ere ta en prisoners of $ar by the Japanese army and confined at

the 6ilibid Prison in anila $ere released to the Director of the 6ureau of Health, Dr.4usebio Aguilar $ho acted as their guarantor.

- any public health nurses 0oined the guerillas or $ent to hide in the mountains duringGorld Gar .

&ebruary CE- Post $ar records of the 6ureau of Health sho$ed that there $ere B) public health

nurses and B supervisors compared to pre-$ar $hen there $ere **E public healthnurses and B supervisors.

- rs. 7enera . de 7u2man, Technical Assistant in Nursing of the Department of Health and concurrent President of the &ilipino Nurses Association recommended thecreation of a Nursing Office in the Department of Health.

Oct. F, CF- 41ecutive Order No. C organi2ed government offices and created the Division of

Nursing under the Office of the !ecretary of Health. This $as implemented onDecember E, CF.

- rs. 7enara de 7u2man $as appointed as "hief of the Division, $ith three Assistant5iss Annie !and for Nursing 4ducationM rs. agdalena ". =alen2uela for Public

Health Nursing and rs. Patrocinio J. ontellano for !taff 4ducation.- At the 6ureau of Health, the !ection of Nursing !upervision too over the functions of

the former !ection of Nursing.- rs. !oledad 6uenafe $as appointed "hief and iss arcela 7abatin, Assistant

"hief.

C- The first training "enter of the 6ureau of Health $as organi2ed in cooperation $ith

the Pasay "ity Health Department. This $as housed at the Tabon Health "enter located in a marginali2ed part of the city. t $as later renamed as Do a arta Health"enter.

- Physicians and nurses undergoing pre-service and in-service training in public

health<public health nursing as $ell as nursing student on affiliation $ere assigned tothe above training center.

*)- The 3ural Health Demonstration and Training "enter >3HDT"? $as established by

the Department of Health through the initiative of Dr. Hilario 'ara, Dean, institute of Hygiene, no$ "ollege of Public Health, #niversity of the Philippines.

- The GHO<#N "4& assisted pro0ect used health centers of the %ue2on "ity HealthDepartment, $hich $ere located in the rural areas of the city.

- Dr. Amansia !. angay > rs. Andres Angara?, a Doctor of Public Health 7raduateform Harvard $as chosen tobe the "hief of the 3HDT".

- Dr. Antonio =. Acosta, former Physician of the anila Health Department $as edicalTraining Officer.

*B - The Office of Health 4ducation and Personnel Training $as established $ith Dr.Trinidad 7ome2 as "hief

- Philippine "ongress approved 3epublic Act No. ) ( or the 3ural Health 'a$. tcreated the first 3ural Health #nits.

*F- 3epublic Act $as approved amending !ections T$o, Three, &our, !even and

4ight of 3.A. ) ( 5!trengthening Health and Dental !ervices in the 3ural Areas andProviding &unds thereto./



* - E*- 3epublic Act FF passed by "ongress in *C $as implemented. This abolished the

Division of Nursing. Ho$ever, it created nursing positions at different levels in thehealth organi2ation. iss Annie !and $as appointed Nursing "onsultant under theOffice of the !ecretary of Health.

- The Department of Health National 'eague of Nurses, nc. $as founded by iss Annie !and in E . !he became its first President and Adviser.

- The 3eorgani2ation Act $ith implementing details embodied in 41ecutive Order ( ,series of * de-centrali2ed and integrated health services.

- The reorgani2ation of * also merged t$o 6ereaus in the Department of Health.The 6ureau of Health $as merged $ith the 6ureau of Hospitals to form the 6ureau of Health and edical !ervices.

EF- n the 6urea of Disease "ontrol, rs. Lenaida Panlilio @ Nisce $as appointed as

Nursing Program !upervisor and served as consultant on the nursing aspects of the* special diseases5 T6, 'eprosy, =enereal Disease, "ancer, &ilariasis, and entalHealth.

FC- The Pro0ect anagement !taff $as organi2ed as part of Population of the

Philippine 7overnment $ith Dr. &rancisco Aguilar as Pro0ect anager.



F*- The roles of the public health nurse and the mid$ife $ere e1panded. ())) mid$ives

$ere recruited and trained to serve in the rural areas.

F-- 41ecutive Order No. reorgani2ed the Department of Health and created several

offices and services $ithin the Depratment of Health.

)- (- Dpeartment Order No. ( designated rs. Neila &. Hi2on, Nurse = , then President of

the National 'eague of Philippine 7overnment Nurses, as Nursing Adviser. !he $as detailed atthe Office Public Health !ervices. As Nursing Adviser, matters affecting nurses and nursing arereferred to her.

ay (C, - 41ecutive Order No. )( $as signed by President Joseph 40ercito 4strada,

redirecting the functions and operations of the Department of Health.

())*-())E- The development of the 3ationali2ation Plan to streamline the bureaucracy further $as

started and is in the last stages of finali2ation.



The Philippine Health "are Delivery !ystem

Public Health Nurse >PHN?- a member of a team $or ing $ithin a system- has to understand the health care delivery system $herein she is $or ing because it

influences her status and functions.- needs to properly relate $ith the dynamics of the political, organi2ational structure

surrounding her position in the health care delivery system.

( sectors of Philippine health care delivery system5. The public sector, $hich is largely financed through a ta1-based budgeting system at both

national and local levels and $here health care is generally given free at the point of service.

(. The private sector, $hich is largely mar et-oriented and $here health care is paid throughuser fees at the point of service. ncludes for-profit and non-profit health providers. Thisincludes providing health services in clinics and hospitals, health insurance, manufactureof medicines, vaccines, medical supplies, e+uipment, and other health and nutritionproducts, research and development, human resource development and other health-related services.

'ocal 7overnment #nits >'7#s?- runs the local health system- provincial and district hospitals are under the provincial government $hile the

city<municipal government manages the health centers<rural health units >3H#s?, andbarangay health stations >6H!s?.

- ts function is mainly to serve as advisory body to the local e1ecutive and thesanggunian or local legislative council on health-related matters.

Philippine Department of Health >DOH?Historical 6ac ground

Pre-!panish and !panish Periods >before ?- traditional health care practices especially the use of herbs and rituals for healing

$ere $idely practiced during these periods.- The western conce!t of public health services in the country is traced to the first

dispensary for indigent patients of anila by a "ranciscan #riar that $as begun in*FF.

- n FE, $edicos Titulares% e+uivalent to provincial health officers $ere alreadye1isting.

- n , a !uperior 6oard of Health and "harity $as created by the &!aniards $hichestablished a hospital system and a board of vaccination.

June (B, - After the proclamation of the Philippine independence from !pain, the Department of

Public Gor s, education and Hygiene $as created by virtue of a decree signed byPresident E'ilio Aguinaldo.

!eptember ( , - General *rders No. 1+ established the 6oard of Health for the "ity of anila $ith

the primary ob ecti e o# !rotecting the health o# the A'erican soldiers.

July , )- a 6oard of Health for the Philippine slands $as created through Act No. 1+,

because it $as reali2ed that it $as impossible to protect the American soldiers$ithout protecting the natives.



- Act Nos. 3-, 3- dated $ecem'er 2 10-1 , established the Pro incial $unici!al *oards respectively completing the health organi2ation in accordance $ith theterritorial division of the islands.

October (E, )*- The nsular 6oard of Health proved to be inefficient operationally so it $as abolished

and $as replaced by the *ureau o# Health under the Department of nterior throughAct No. 14 , in +,- replaced the provincial boards of health $ith district healthofficers.

(- Act No. 21+ also no$n as the "a ardo Act% consolidated the municipalities into

sanity divisions and established $hat is no$n as the Health &und for travel andsalaries.

*- Act No. 24 transformed the 6ureau of Health into a commissioned service called

the Phili!!ine Health &er ice.- This introduced a systematic organi2ation of personnel $ith corresponding civil

service grades, and a secure system of civil service entrance and promotiondescribed as the semi-military system of public health administration/.

August (, E- The passage of the /ones 0aw also no$n as the P#ilippine Autonom! Act

provided the highlight in the struggle of the &ilipinos for independence from the American rule.

- The establishment of an elective Philippine !enate completed an all &ilipinoPhilippine Assembly that formed a bicameral system of government. This ushered ina ma0or reorgani2ation $hich culminated in the Administrative Code of 101, %Act2,11& , $hich included the Pu'lic "ealt# a of 101,.

B(- Act No. 4--, no$n as the eorgani5ation Act of 1032 reverted bac the

Philippine !ervice into the 6ureau of Health, and combined the 6ureau of PublicGelfare under the Office of the "ommissioner of Health and Public Gelfare.

The Philippine "ommon$ealth and the Japanese Occupation > B*- C*?

ay B , B- Common ealt# Act No. 43- created the Department of Public Health and Gelfare,

but the full implementation $as only completed through E6ecutive *rder No. 31,January F, C .

- Dr. /ose "abella became the first Department !ecretary of Health and Public Gelfarein C .

October C, CF

- E6ecutive *rder No. 04 provided the post $ar reorgani2ation of the Department of Health and Public Gelfare.- This resulted in the split of the Department $ith transfer of the 6ureau of Public

Gelfare and the Philippine 7eneral Hospital to the Office of the President.- Another split $as created bet$een the curati e and !re enti e ser ices through the

creation of the 6ureau of Hospitals $hich too over the curative services. Preventivecare services remained under the 6ureau of Health.

- This order also established the Nursing !ervice Division under the Office of the!ecretary.



January , *- The Office of the President of the !anitary District $as converted into a 3ural Health

#nit, carrying out F basic health services5 maternal and child health, environmentalhealth, communicable disease control, vital statistics, medical care, health educationand public health nursing.

- ural "ealt# Act of 10+4 % A 1- 2& created more rural health units and createdposts for municipal health officers, among other provisions.

&ebruary (), *- E6ecutive *rder No. 2 provided for $hat is described as the most s$eeping/

reorgani2ation in the history of the Department.- An office of the 3egional Health Director $as created in regions and all health

services $ere decentrali2ed to the regional, provincial ma ing and development of procedures. 3H#s $ere made an integral part of the public health care deliverysystem.

F)- the 3estructures Health "are Delivery !ystem $as conceptuali2edM under this

concept the public health nurse to population ratio $as 5(),))).

June (, F- $ith the proclamation of martial la$ in the country, Presidential $ecree 130,

renamed the Department of Health to the $inistr1 o# Health. &ecretar1 2at'aitanbecame the first inister of Health.

December (, (- E6ecutive *rder No. +1 signed by President "erdinand E. $arcos reorgani2ed the

inistry of Health as an integrated health care delivery system.

Aril B, F- E6ecutive *rder No. 110 3eorgani2ing the inistry of Health by President

Cora3on c. A4uino sa$ a ma0or change in the structure of the ministry. t transformedthe inistry of Health bac to the Department of Health.

- E* 110 clustered agencies and programs under the Office for !tandards andregulations and Office of anagement !ervices.

October ), - epu'lic Act ,1 - no$n as the 0ocal 2o ern'ent Code provided for the

decentrali2ation of the entire government.- #nder this la$, all structures, personnel and budgetary allocations from the provincial

health level do$n to the barangays $ere devolved to the local government units>'7#s? to facilitate health service delivery.

ay (C, - E6ecutive *rder No. 1-2 3edirecting the &unctions and Operations of the

Department of Health/ by President /ose!h E. Estrada granted the DOH to proceed

$ith its rationali2ation and !treamlining Plan $hich prescribed the currentorgani2ational, staffing and resource structure consistent $ith its ne$ mandate, rolesand functions post devolution.

- andates the department of Health to provide assistance to '7#s, people8sorgani2ation, and other members of civic society in effectively implementingprograms, pro0ects and services that $ill promote the health and $ell being of every&ilipinoM prevent and control diseases among population at ris sM protect individuals,families and communities e1posed to ha2ards and ris s that could affect their healthMand treat, manage and rehabilitate individuals affected by diseased and disability.



())* ongoing- Development of a plan to rationali2e the bureaucracy in an attempt to scale do$n

including the DOH.

oles and 7unctions4O )( has identified the follo$ing general functions under its three specific roles in the

health sector.

. 'eadership in Healtha. !erve as the national policy and regulatory institution from $hich the '7#s, non-

government organi2ations and other members of the health sector involved insocial $elfare and development $ill anchor their thrusts and directions for health.

b. Provide leadership in the formulation, monitoring and evaluation of nationalhealth policies, plans and programs.

c. !erve as advocate in the adoption of health policies, plans and programs toaddress national and sectoral concerns.

(. 4nabler and "apacity 6uilder a. nnovate ne$ strategies in health to improve the effectiveness of health

programs, initiate public discussion on health issues and underta ing anddisseminate policy research outputs to ensure informed public participation inpolicy decision-ma ing.

b. 41ercise oversight functions and monitoring and evaluation of national healthplans, programs and policies.

c. 4nsure the highest achievable standards of +uality health care, health promotionand health protection.

B. Administrator of !pecific !ervicesa. anage selected national health facilities and hospitals $ith modern and

advanced facilities that shall serve as national referral centers and selectedhealth facilities at sub-national levels that are referral centers for local healthsystems.

b. Administer direct services for emergent health concerns that re+uire ne$complicated technologies that it deems necessary for public $elfareM administer special components of specific programs li e tuberculosis, schistosomiasis, H =-

A D!, in as much as it $ill benefit and affect large segments of the population.c. Administer health emergency response services, including referral and

net$or ing system for trauma, in0uries and catastrophic events in cases of epidemic and other $idespread public danger, upon the direction of the Presidentand in consultation $ith concerned '7#.

=isionThe DOH is the leader, staunch advocate and model in promoting Health for All in the

Philippines.

ission7uarantee e+uitable, sustainable and +uality health for all &ilipinos, especially the poor

and shall lead the +uest for e1cellence in health.

The DOH shall do this by see ing all $ays to establish performance standards for healthhuman resourcesM health facilities and institutionsM health products and health services that $illproduce the best health systems for the country. This, in pursuit of its constitutional mandate tosafeguard and promote health for all &ilipinos regardless of creed, status or gender $ith specialconsideration for the poor and the vulnerable $ho $ill re+uire more assistance.

7oal5 Health !ector 3eform Agenda >H!3A?Health !ector reform is the overriding goal of the DOH. !upport mechanisms $ill be

through sound organi2ational development, strong policies, systems and procedures, capablehuman resources and ade+uate financial resources.



3ationale for Health !ector 3eform

"onditions still seen among the population5• !lo$ing do$n in the reduction in the nfant ortality 3ate > 3? and the aternal

ortality 3ate > 3?• Persistence of large variations in health status across population groups and geographic

areas.• High burden from infectious diseases.• 3ising burden from chronic and degenerative diseases.• #nattended emerging health ris s from environmental and $or related factors.• 6urden of disease is heaviest on the poor.

3easons $hy the above conditions are still seen among the population can be e1plained by thefollo$ing factors5

• nappropriate health delivery system as sho$n by an inefficient and poorly targetedhospital system, ineffective mechanism for providing public health programs on top of health human resources maldistribution.

• nade+uate regulatory mechanisms for health services resulting to poor +uality of healthcare, high cost of privately provided health services, high cost of drugs and presence of lo$ +uality drugs in the mar et.

• Poor health care financing and inefficient sourcing or generation of funds for healthcare.

mplications of the above situation5• There is poor coverage of public health and primary care services.• There is ine+uitable access >physical and financial? to personal health care services.• There is lo$ +uality and high cost of both public and personal health care.

Ob0ectives of the Health !ector5a. mprove the general health status of the populationb. 3educe morbidity and mortality from certain diseasesc. 4liminate certain diseases as public health problems

d. Promote healthy lifestyle and environmental healthe. Protect vulnerable groups $ith special health and nutrition needsf. !trengthen national and local health systems to ensure better health service deliveryg. Pursue public health and hospital reformsh. 3educe the cost and ensure the +uality of essential drugsi. nstitute health regulatory reforms to ensure +uality and safety of health goods and

services 0. !trengthen health governance and management support systems

. nstitute safety nets for the vulnerable and marginali2ed groupsl. 41pand the coverage of social health insurancem. obili2e more resources for healthn. mprove efficiency in the allocation, production and utili2ation of resources for health

'ocal Health !ystemHistorical 6ac ground

- The Philippine health care system $as administered by a central agency based inanila. This control agency provided the singular sources of resources, policy

direction, technical and administrative supervision to all health facilities nation$ide.- 'ocal 7overnment "ode also no$n as epu'lic Act ,1 - under this la$, all

structures, personnel and budgetary allocations from the provincial health level do$nto the barangays $ere devolved to the local government units to facilitate healthservice delivery.



- Provincial governments operate the hospital system, Provincial District Hospitals,$hile city<municipal governments operate the health "enters<3H#s and 6H!s.

Ob0ective for local health systems5. 4stablish local health systems for effective and efficient delivery of health care services.

(. #pgrade the health care management and service capabilities of local health facilities.B. Promote inter-'7# lin ages and cost sharing schemes including local health care

financing systems for better utili2ation of local health resources.C. &oster participation of the private sector, non-government organi2ations >N7Os? and

communities in local health systems development.*. 4nsure the +uality of health service delivery at the local level.

nter 'ocal Health !ystem- this system is being espoused by the Department of Health in order to ensure +uality

of health care service at the local level.- a system of health care similar to a district health system in $hich individuals,

communities and all other health care providers in a $ell-defined geographical areaparticipate together in providing +uality e+uitable and accessible health care as thebasic frame$or .

- dentify areas of sta eholders include5 '7#s at all level, DOH, Philippine Healthnsurance "ooperation >PH "?, communities, N7Os private sector and others.

41pected Achievement of the nter-local health !ystem5. #niversal coverage of health insurance

(. mproved +uality of hospital and 3ural Health #nits >3H#? serviceB. 4ffective referral systemC. ntegrated planning*. Appropriate health information systemE. mproved Drug anagement !ystemF. Developed human resources

. 4ffective leadership through nter-'7# corporation

. &inancially visible or self sustaining hospitals). ntegration of public health and curative hospital care

. !trengthened cooperation bet$een '7# and health sectors

7uiding Principles n Developing The nter 'ocal Health !ystem. &inancial and Administrative autonomy of the provincial and municipal administrations

>'7#s?(. !trong political supportB. !trategic synergies and partnershipsC. "ommunity participation*. 4+uity of access to health services by the population, especially the poor E. Affordability of health servicesF. Appropriateness of health programs

. Decentrali2ed management

. !ustainability of health initiatives

). #pholding of standards of +uality health service"omposition of the nter-'ocal Health Lone

. People(. 6oundariesB. Health &acilitiesC. Health Gor ers



Primary Health "are >PH"?- GHO defines PH" as 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 everystage of development.

- Gas declared during the &irst nternational "onference on PH" held in Alma Ata,#!!3 on &e!te'ber 5+6% +,78 by GHO. The goal $as Health for All by the year ()))/. This $as adopted in the Philippines through 0etter o# 9nstruction ,:, signed byPresident $arcos on October +,% +,7, and has an underlying theme of Health in theHands of the People by ()()./

- The concept of PH" is characteri2ed by partnership and empo$erment of the peoplethat shall permeate as the core strategy in the effective provision of essential healthservices that are community based, accessible, acceptable and sustainable at a cost$hich the community and the government can afford.

- A strategy, $hich focuses responsibility for health on the individual, his family and thecommunity. t includes the full participation and active involvement of the communityto$ards the development of self-reliant people, capable of achieving an acceptablelevel of health and $ell being. t also recogni2es the interrelationship bet$een healthand the overall political, socio-cultural and economic development of society.

- The recent PH" !ummit held on "ebruar1 6;56:% 6-- has sho$cased the variouscommunity managed health activities that has successfully placed health in thehands of the people in this country.

4lements<"omponents of PH"5. 4nvironmental sanitation

(. "ontrol of "ommunicable DiseasesB. mmuni2ationC. Health education*. aternal and "hild Health and &amily PlanningE. Ade+uate &ood and Proper NutritionF. Provision of edical "are and 4mergency Treatment

. Treatment of 'ocally 4ndemic Diseases

. Provision of 4ssential Drugs

!trategies5. 3eorientation and reorgani2ation of the national health care system $ith the

establishment of functional support mechanism in support of the mandate of devolutionunder the 'ocal 7overnment "ode of .

(. 4ffective preparation and enabling process for health action at all levels.B. obili2ation of the people to no$ their communities and identifying their basic health

needs $ith the end in vie$ of providing appropriate solutions leading to self-reliance andself-determination.

C. Development and utili2ation of appropriate technology focusing on local indigenousresources available in and acceptable to the community.

*. Organi2ation of communities arising from their e1pressed needs $hich they have decidedto address and that this is continually evolving in pursuit of their o$n development.

E. ncrease opportunities for community participation in local level planning, management,monitoring and evaluation $ithin the conte1t of regional and national ob0ectives.F. Development of intra-sectoral lin ages $ith other government and private agencies so

that programs of the health sector is closely lin ed $ith those of other socio-economicsectors at the national, intermediate and community levels.

. 4mphasi2ing partnership so that the health $or ers and the community leaders<membersvie$ each other as partners rather than merely providers and receiver of health carerespectively.



National HealthServices

Medical CentersTeaching and

Training Hospitals

Regional Health ServicesRegional Medical Centers

and Training Hospitals

Provincial / City Health ServicesProvincial / City Hospitals

Emergency / District Hospitals

Rural Health nitCommunity Hospitals and Health CentersPrivate Practitioners / Puericulture Centers

!arangay Health Stations

P3

A3I

4"ONDA3I

T43T

A3I

&our cornerstones<pillars in PH". Active community participation

(. ntra and inter-sectoral lin agesB. #se of appropriate technologyC. !upport mechanism made available

Types of PH" $or ers that vary in different communities depending upon5• Available health manpo$er resources• 'ocal health needs and problems• Political and financial feasibility

( 'evels of PH" $or ers5. =illage or 6arangay Health Gor ers

(. ntermediate level health $or ers

'evels of Health "are and referral !ystem5. Primary 'evel of "are

a. The first contact bet$een the community members and the other levels of healthfacility.

(. !econdary 'evel of "area. "apable of performing minor surgeries and perform some simple laboratorye1aminations.

B. Tertiary 'evel of "area. "omplicated cases and intensive care re+uires tertiary care and all these can be

provided.

Documents

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