https://www.pcp.org.

ph/files/PJIM%20Vol5 assure patients of higher quality service than

4%20No2/The_Philippine_Health_Agenda_ public hospitals can provide.
2016_to_2022.pdf Human resources management, however,
leaves much to be desired. Health care
https://www.icnvoicetolead.com/wp- providers and health educators are
content/uploads/2017/04/ICN_AVoiceToLe concentrated in urban areas, like Metro
ad_guidancePack- Manila. Thus there is a dearth of health care
9.pdf?fbclid=IwAR0yCyndq9HoUngdoj__u manpower in the rural areas.
4r5ZMlwiTgBXdA6L1P4vWZQbdxAG5rT Emergency services
JFDBzns In the Philippines, a few institutions
https://www.slideshare.net/csteve21/updated-
measure up to the high international
community-health-nursing standards for emergency services.
Some facilities, however, are not capable of
https://www.prc.gov.ph/uploaded/documents/ handling complex trauma and major medical
Nursing%20Core%20Competency%20Standards emergencies.
%202012.pdf The intensive care unit in some tertiary
public facilities and in a number of private
http://intranet.tdmu.edu.ua/data/kafedra/inter hospitals meet international standards.
nal/i_nurse/lectures_stud/RN- Blood products in the country are also
BSN%20Program/Full%20time%20study/Second generally regarded as safe.
%20year/Community%20and%20Public%20Heal Medicines
th%20Nursing/Lect.%209%20Roles%20and%20 Most pharmacies in the Philippines provide
Functions%20of%20the%20Community%20Heal
medicines approved by the Bureau of Food
th%20Nurse.htm
and Drugs.
------ Professional pharmacists who studied in top
medical schools in the country run most of
AT A GLANCE: THE PHILIPPINE the standard pharmacies and they follow
HEALTH CARE SYSTEM strict guidelines in drug prescription. While
THE health care system in the Philippines pharmacists in some countries provide
has undergone dramatic changes in the last drugsto patients even without a doctor’s
20 years as the government has instituted prescription, pharmacists in the Philippines
various reforms and policies to provide easy have to follow strict directives on the sale of
access to health benefits for every Filipino. drugs.
The Department of Health (DoH) lists 1,071 Universal health care coverage
licensed private hospitals, and 721 public Today, the government continues to make
hospitals. The Department takes care of 70 progress towards developing a universal
of the public hospitals while local health care system to ensure that every
government units and other state-run Filipino will have easy access to every type
agencies manage the rest. of medical procedure. The health insurance
Most hospitals provide efficient and scheme is funded through subsidies and
affordable health services. Facilities, contributions from employers and
however, pale in comparison with those in employees.
high-end health institutions abroad. On a In September 2017, Congress passed into
positive note, private hospitals in the law the Universal Health Coverage (UHC)
country have better technical facilities than program, which aims to provide
the public hospitals. Private hospitals thus
comprehensive health care and insurance for private sector to make the Philippines the
all Filipinos. country of choice for health care.
The UHC is expected to give citizens all With the program, the local health care
health services they need—disease industry can generate substantial income to
prevention, treatment, and rehabilitation. boost the Philippine economy.
The law mandates that the Philippine Health 10 FACTS ABOUT
Insurance System (PhilHealth) will be HEALTHCARE IN THE
reorganized as the Philippine Health PHILIPP INES
Security Corporation (PHSC). The PHSC
will then serve as the “national purchaser of The World Health Organization
health services.” (WHO) labels a healthcare system as “well-
The government’s National Health functioning” if it provides impartial access
Insurance Program (NHIP) outlines the to quality healthcare regardless of pay
government’s Millennium Development dimensions while protecting them from
Goals (MDGs) to attain the Universal Health financial consequences of poor health.
Coverage. Healthcare in the Philippines does not
meet these set standards.
The program aims to let Filipinos know their
entitlements and responsibilities so that they Top 10 Facts on Healthcare in the
may availthemselves of effective health Philippines
services. They may reimburse their health 1. The WHO refers to the Filipino
care expenses through PhilHealth. Healthcare System as “fragmented.”
The health care program redirects There is a history of unfair and unequal
PhilHealth operations to widen coverage of access to health services that
the insurance system. The DoH also pushes significantly affects the poor. The
for the use of information technology to government spends little money on the
speed up processing of PhilHealth payments. program which causes high out of
The Department of Health also has pocket spending and further widens the
developed the Health Facility Enhancement gap between rich and poor.
Program (HFEP) to provide funds for 2. Out of the 90 million people living in
improving facilities for trauma and other the Philippines, many do not get access
emergencies. HFEP aims to upgrade 20 to basic care. The country has a high
percent of DoH-retained hospitals, 46 maternal and newborn mortality rate,
percent of provincial hospitals, 46 percent of and a high fertility rate. This creates
district hospitals, and 51 percent of rural problems for those who have especially
health units. limited access to this basic care or for
Medical tourism those living in generally poor health
Another important DoHproject is the conditions.
Philippine Medical Tourism Program, which 3. Many Filipinos face diseases such as
aims to make the country a global leader in Tuberculosis, Dengue, Malaria and
“providing quality health care for all through HIV/AIDS. These diseases pair with
universal health care.” protein-energy malnutrition
The program will further improve the and micronutrient deficiencies that are
Philippines’ healthcare manpower becoming increasingly common.
capabilities and facilities in both public and 4. The population is affected by a high
prevalence of obesity along with heart
disease.
 5. Healthcare in the Philippines suffers UHC TO ADDRESS INEQUITY IN THE
from a shortage of human medical HEALTH SYSTEM
resources, especially doctors. This Universal Health Care and Its Aim
makes the system run slower and less
efficiently. Universal Health Care (UHC), also referred
6. Filipino families who can afford to as Kalusugan Pangkalahatan (KP), is the
private health facilities usually choose “provision to every Filipino of the highest
these as their primary option. Private possible quality of health care that is
facilities provide a better quality of care accessible, efficient, equitably distributed,
than the public facilities that lower adequately funded, fairly financed, and
income families usually go to. The appropriately used by an informed and
public facilities tend to be in rural areas empowered public”.1 The Aquino
that are more run down. These facilities administration puts it as the availability and
have less medical staff and inferior accessibility of health services and
supplies. necessities for all Filipinos.
7. Only 30 percent of health
professionals employed by the It is a government mandate aiming to ensure
government address the health needs of that every Filipino shall receive affordable
the majority. Healthcare in the and quality health benefits.This involves
Philippines suffers because the providing adequate resources – health
remaining 70 percent of health human resources, health facilities, and
professionals work in the more health financing.
expensive privately run sectors. UHC’s Three Thrusts
8. To compensate for the inequality, a
program called Doctors to the Barrios To attain UHC, three strategic thrusts are to
and its private sectors decided to build be pursued, namely: 1) Financial risk
nine cancer centers, eight heart centers protection through expansion in enrollment
and seven transplant centers in regional and benefit delivery of the National Health
medical centers. Insurance Program (NHIP); 2) Improved
9. The Doctors to the Barrios included access to quality hospitals and health care
Public-Private Partnerships in a plan to facilities; and 3) Attainment of health-
modernize the government-owned related Millennium Development Goals
hospitals and provide more up to date (MDGs).
medical supplies. Financial Risk Protection
10. More than 3,500 public
health facilities were updated across the Protection from the financial impacts of
country. health care is attained by making any
Filipino eligible to enroll, to know their
Although advances have been made to entitlements and responsibilities, to avail of
improve healthcare in the Philippines, there health services, and to be reimbursed by
are still many issues that the country has yet PhilHealth with regard to health care
to overcome to achieve a high quality, cost expenditures.
efficient healthcare system.
– Katelynn Kenworthy PhilHealth operations are to be redirected
https://borgenproject.org/healthcare-in-the- towards enhancing national and regional
philippines/ health insurance system. The NHIP
enrollment shall be rapidly expanded to
improve population coverage. The availment The organization of Community Health
of outpatient and inpatient services shall be Teams (CHTs) in each priority population
intensively promoted. Moreover, the use of area is one way to achieve health-related
information technology shall be maximized MDGs. CHTs are groups of volunteers, who
to speed up PhilHealth claims processing. will assist families with their health needs,
Improved Access to Quality Hospitals and provide health information, and facilitate
Health Care Facilities communication with other health providers.
RNheals nurses will be trained to become
Improved access to quality hospitals and trainers and supervisors to coordinate with
health facilities shall be achieved in a community-level workers and CHTs. By the
number of creative approaches. First, the end of 2011, it is targeted that there will be
quality of government-owned and operated 20,000 CHTs and 10,000 RNheals.
hospitals and health facilities is to be Another effort will be the provision of
upgraded to accommodate larger capacity, to necessary services using the life cycle
attend to all types of emergencies, and to approach. These services include family
handle non-communicable diseases. The planning, ante-natal care, delivery in health
Health Facility Enhancement Program facilities, newborn care, and the
(HFEP) shall provide funds to improve Garantisadong Pambata package.
facility preparedness for trauma and other
emergencies. The aim of HFEP was to Better coordination among government
upgrade 20% of DOH-retained hospitals, agencies, such as DOH, DepEd, DSWD, and
46% of provincial hospitals, 46% of district DILG, would also be essential for the
hospitals, and 51% of rural health units achievement of these MDGs.
(RHUs) by end of 2011. https://www.doh.gov.ph/kalusugang-
pangkalahatan?fbclid=IwAR2rSZ6t5nRhrV31kn4
Financial efforts shall be provided to allow 0Lw_yafeCp1SoO20eXYBPVBM4LvOwE6qPMsE
immediate rehabilitation and construction of Uz7Q
critical health facilities. In addition to that,
treatment packs for hypertension and PH vs CH
diabetes shall be obtained and distributed to
RHUs. Public Health includes community health.
Public health is "the science and art of
preventing disease, prolonging life and
The DOH licensure and PhilHealth promoting health through the organized efforts
accreditation for hospitals and health and informed choices of society,
facilities shall be streamlined and unified. organizations, public and private, communities
Attainment of Health-related MDGs and individuals”. It is concerned with threats to
health based on population health analysis.
Further efforts and additional resources are Public health incorporates the interdisciplinary
to be applied on public health programs to approaches of epidemiology, biostatistics and
health services, environmentak health,
reduce maternal and child mortality, community health, behavioral health, health
morbidity and mortality from Tuberculosis economics, public policy, insurance medicine
and Malaria, and incidence of HIV/AIDS. and occupational health (respectively
Localities shall be prepared for the emerging occupational medicine) are other important
disease trends, as well as the prevention and subfields. Community Health is a discipline
control of non-communicable diseases. concerned with the study and improvement of
the health characteristics of different
communities. Community health tends to
focus on geographical areas, and includes -Diagnosis is based on the needs of
primary, secondary and tertiary healthcare. individuals, family, or group

-Work to promote health and prevent illness

What is the difference between in groups and families with the main goal
community health nursing and public being to increase community health. For
health nursing? example, meeting with a group of young
mothers to provide information on
I learned about their differences in the
immunizations.
context of scope. Public health is broad
and is described as " the science and art
-Implementation is based on individual
of preventing disease, prolonging life
and promoting health through the needs. For example, a new diabetic who is a
organized efforts and informed choices kinesthetic learner would be taught how to
of society, organizations, public and give insulin injections by practicing with an
private, communities and individuals” orange.
Community Health, is a subcomponent
or discipline of that. The Institutes of -Evaluate whether health needs were met on
Health for instance & the WHO, that’s the individual, family or group level.
public health and a much broader scope **-Assessing the populations health needs
or lens that they are looking at our
wellbeing from. Where as your -Diagnose and develop policy in relation to
community health department is community health needs.
focused on disseminating “public
health” information like vaccinations & -Plan for the community as a whole in order
preventive fronts that apply to your to prevent disease and disability and
region. preserve the health of the community. For
example, after an illness outbreak, the public
I was bummed when I missed out on a health nurse will assess the need and
position to work as the community develop a program for an immunization
health nurse / director for Minneapolis clinic.
St. Paul a few years back. It’s a gorgeous
area. The theories on pay-it-forward -Implementing the plan means the nurse
have always resonated with me and I ensures the resources are available to all
cannot imagine a better way to give back who need them within the community.
to a community then by looking-out
after those who may not have the -Evaluate the health status of the whole
resources or capacity to do it for community and whether planned goals and
themselves.
objectives were met.
Role of the Public Health Nurse How do they relate?
Public health nursing is an umbrella term
Community vs Public that encompasses community health nursing.
Health Nursing Both have the main goal of promoting,
preserving, and maintaining the
-Deliver health services to individuals, community’s health.
groups, and families What boundaries exist?
Boundaries between these two concepts ○ Record management
exist in relation to the level of assessment. ○ Communication
Public health nurses are trained and ○ Collaboration & teamwork
educated to assess the population overall.
Whereas the community health nurse's LEGAL BASES
knowledge lies within assessing the needs of
individuals and families within the
Article 3 Sec.9 (c) of R.A. 9173/ “Philippine
population that they work.
Nursing Act 2002”
Public health looks at everyone from all Board shall monitor & enforce quality
over. We are concerned with things that standards of nursing practice necessary to
may be coming down the pike and hit all of ensure the maintenance of efficient, ethical
us (like bird flu, etc.). Community health
and technical, moral and professional
mostly involves nurses and other health care
professionals that tailor interventions to a standards in the practice of nursing taking into
particular community's needs, and they account the health needs of the nation.
generally don't plan out for "the bigger
picture", although they do a heck a job in SIGNIFICANCE OF CORE
their locales, since they know it better.
COMPETENCY STANDARDS
Unifying framework for nursing practice,
education, regulation
11 CORE Guide in nursing curriculum development
Framework in developing test syllabus for
COMPETENCIES nursing profession entrants
Tool for nurses’ performance evaluation
Basis for advanced nursing practice,
specialization
KEY AREAS OF RESPONSIBILITY:
Framework for developing nursing training
curriculum
Public protection from incompetent
practitioners
CORE COMPETENCY STANDARDS
Yardstick for unethical, unprofessional
FOR NURSING PRACTICE IN THE
nursing practice
PHILIPPINES
Phases of developing competency standards
(Click here to show the content of each core
○ 1st Phase
competency standards)
Competency identification through DACUM
○ Safe & quality nursing practice
○ Management of resources & environment
○ 2nd Phase
○ Health education
Verification of identified competencies
○ Legal responsibility
○ Ethico – moral responsibility
○ 3rd Phase
○ Personal & professional development
Pilot testing ( senior student in 8 nursing
○ Quality improvement
colleges)
○ Research
○ 4th Phase Community
Health Nurses’
Benchmarking with exiting standards from 3
countries + ICN

http://thenursingprofession.blogspot.com/2009
/09/11-core-competencies.html
Roles
Community health nurses, sometimes called
Working as a community nurse is unlike any
public health nurses, are registered nurses
(RNs) who are trained to work in public health other nursing position. By helping whole
communities, community nurses act as
settings such as county or state health
educators, disease and injury prevention
departments, schools, jails, and businesses.
specialists, research scientists, community
Because of their roles in the community as
advocates, emergency preparedness experts,
caregivers, they often form close bonds within
the communities they serve and form lasting public health liaison, and healthcare
professionals. In more detail, the roles of
relationships. They become area experts on
public health nurses are:
health and wellness.
On any given day, community nurses can be
found running wellness clinics, coordinating
1. Disease prevention
emergency preparedness for disaster relief, or
treating injuries and illnesses. specialist
Community nursing integrates evidence-
based research with community health needs Community health nurses focus on long- and
to provide care based on science and short-term care for disease prevention. Their
evidence. They must determine the cultural work includes averting or controlling the
and socioeconomic needs of the community spread of the flu and other communicable
and adjust care as needed. In this role, RNs diseases. They work with patients to support
may be required to have a baccalaureate diabetes self-management and improve
nursing education with studies in population- diabetes control. They also work with mothers
based health and community health of newborns to reduce the rate of infant
nursing. RN to BSN programs allow nurses to mortality and in schools to identify gaps in
study the theory and research behind public services.
health practices and apply them to everyday
practice. 2. Community
“They are educated to see each person for
whom they care in the context of his or her
life—all the factors that impact that person’s
educator
life and well-being,” the Robert Wood Johnson
Foundation, the nation’s largest healthcare As educators, community health nurses focus
philanthropic organization, said in a call to on presenting materials in a clear and
action for improved public health. “Indeed, understandable format. They provide
nurses have a responsibility and an information to individuals, families, and
obligation—by virtue of their education—to communities that create a framework for
promote population health no matter where healthy living and healthy choices. In schools
and how they practice.” they may teach sex education and HIV
education classes. In the public, they hold
classes and seminars on diabetes
management. Overall, they focus on
community health education as a step to
preventive healthcare.
 Florida Department of Health in Hernando
3. Leader County. She said working as a public health
nurse provides an opportunity to use skills not
Community health nurses use evidence to used in a hospital setting.
implement policy changes and quality-based
practices. They lead collaborative efforts to “Whether it is Ebola, Zika, budget challenges,
produce successful health outcomes and hurricanes, clinic operations, dog bites,
provide critical medical and social services in tuberculosis, sexually transmitted diseases or
communities. HIV, there is always a new challenge and a
new opportunity to make a positive
difference,” she said.
4. Researcher
https://onlinenursing.duq.edu/blog/roles-
As researchers, community health nurses responsibilities-community-health-nurse/
collect and use evidence to execute positive Health devolution in the Philippines: Lessons
changes for better health. Research is used to and insights* Janet S. Cuenca** 1. Introduction
validate funding for public health programs, The 1987 Philippine Constitution mandated the
reduce inequalities in healthcare, and Congress to “enact a local government code
increase access to services. which shall provide for a more responsive and
accountable local government structure
5. Advocate instituted through a system of decentralization
with effective mechanisms of recall, initiative
and referendum, allocate among the different
Public health nurses advocate on the local,
state, and federal level to provide better local government units their powers,
access to healthcare, protect funding for responsibilities, and resources, and provide for
public health programs, and reduce or the qualifications, election, appointment and
eliminate health disparities. They help removal, term, salaries, powers and functions
families arrange assistance through social and duties of local officials, and all other
services programs such as the Special matters relating to the organization and
Supplemental Nutrition Program for Women, operation of the local units (Section 3, Article
Infants, and Children (WIC), which provides X).” In response to this Constitutional directive,
healthcare and nutritional services for low-
the Congress legislated the Republic Act No.
income pregnant women, breastfeeding
mothers, and children under age 5. 7160, otherwise known as the Local
Government Code of 1991 (hereafter Code),
6. Caregiver which was signed into law on October 10, 1991
and took effect on January 1, 1992. The Code’s
Community nurses cross cultural, language, Book I, Section 2 (i.e., Declaration of Policy)
and literacy boundaries to shape the health states that the Code aims to grant local
and well-being of children and adults. They autonomy to territorial and political
provide prenatal care and education for subdivisions of the State. In particular, DILG-
expectant mothers, including information LGA (2003, p. 4) specifies the objectives of the
about maternal nutrition, referrals for childbirth Code which include: • to provide local
classes, and postpartum assistance. They
government units the opportunity to tap their
also provide resources for parents to
understand proper childhood development fullest potentials as self-reliant communities
and discipline techniques. and as active partners of the national
government in the attainment of national goals
In addition, community nurses play other • to facilitate faster decision-making at the local
varied roles, said Virginia Crandall, Senior level • to enhance the participation of ordinary
Community Health Nursing Director for the citizens, organized groups, and the poorer
sectors in the conduct of public affairs and the Hands of the People,” thus signifying
business of government • to deliver basic empowerment of the people in managing their
services more efficiently The enactment of the health and health service delivery (Galvez-Tan
Code has changed the way basic government 2013). In the same vein, DOH-LGAMS (1993)
health services are delivered at the local level. explains that the Code ushered in participatory
From a highly centralized system of health local governance and placed health care in the
service delivery with the Department of Health hands of the people. In this sense, health
(DOH) as the sole provider, the Code mandated devolution has not empowered LGUs alone but
the devolution1 (i.e., involving all dimensions of also the people by allowing them to participate
decentralization of expenditure competencies in policy and decision-making that concerns
such as regulation, financing, and delivery of delivery and quality of health care (DOH-BLHD
public services (Martinez-Vazquez and Timofeev nd). As a result of health devolution, LGUs have
(2009)) to local government units (LGUs)2 of taken on the great responsibility in the delivery
many of the * This paper was lifted from of basic services and in the operation of
Chapter 2 of the author’s PhD Dissertation titled facilities in areas that include primary health
“Fiscal Decentralization and Health Service care and hospital care/services. On the other
Delivery: The Philippine Case.” The usual hand, the DOH5 has become the leader,
disclaimer applies. ** Supervising Research enabler, standard-setter (or regulatorenforcer
Specialist, Philippine Institute for Development of standards/regulation) for health services
Studies and PhD Candidate, Lee Kuan Yew planning and service provision and delivery,
School of Public Policy, National University of policy maker, health advocate, resource center,
Singapore 1 The Code defines devolution as the mobilizer, and technical adviser as well as
act by which the national government vests administrator of regional and special hospitals
power and authority upon local government (DOH-BLHD nd; Mercado et al. 1996;
units to perform specific functions and Romualdez et al. 2011; DOHBLHD 2013). In
responsibilities. 2 also referred to as other words, it has assumed the role of the
subnational governments 2 functions previously “national technical authority on health,” which
discharged by DOH. Health devolution or implies that it is expected to “ensure the
decentralization of health services was initially highest achievable standards of quality health
geared towards efficiency and effectiveness of care, health promotion and health protection”
health service delivery by reallocating that LGUs, non-government organizations
decisionmaking capability and resources to (NGOs), private organizations (POs), and civil
LGUs (Grundy et al. 2003; Galvez-Tan et al. society should uphold (DOH-BLHD 2013, p.7).
2010). It is noteworthy that decentralization is a https://pidswebs.pids.gov.ph/CDN/PUBLICATIO
core element of the implementation of the NS/pidsdps1836.pdf
Primary Health Care (PHC), which is a strategy
adopted by DOH in the late 1970s (DOH 1997;
Perez 1998a; Grundy et al. 2003; DOH-BLHD
2013; NCPAG-CPED 2014) in compliance with
the Declaration of Alma Ata on PHC3 to ensure
that essential health care4 is “made universally
accessible to individuals and families in the
community through their full participation and
at a cost that the community and country can
afford … (Alma-Ata Declaration 1978).” Perez
(1998a) mentions that the Philippine’s local
health systems were established on PHC
principles, which is basically “Health in the
  an approach to health development,
which is carried out through a set of
Primary Health Care (PHC) activities and whose ultimate aim is the
Overview continuous improvement and
maintenance of health status
 May 1977 -30th World Health Goal of Primary Health Care
Assembly decided that the main health
target of the government and WHO is  HEALTH FOR ALL FILIPINOS by the
the attainment of a level of health that year 2000 AND HEALTH IN THE
would permit them to lead a socially HANDS OF THE PEOPLE by the year
and economically productive life by the 2020.
year 2000.  An improved state of health and quality
 September 6-12, 1978 – First of life for all people attained
International Conference on PHC in through SELF RELIANCE.
Alma Ata, Russia (USSR) The Alma Key Strategy to Achieve the Goal:
Ata Declaration stated that PHC was  Partnership with and Empowerment of
the key to attain the “health for all” the people – permeate as the core
goal strategy in the effective provision of
 October 19, 1979 – Letter of Instruction essential health services that are
(LOI) 949, the legal basis of PHC was community based, accessible,
signed by Pres. Ferdinand E. Marcos, acceptable, and sustainable, at a cost,
which adopted PHC as an approach which the community and the
towards the design, development and government can afford.
implementation of programs focusing Objectives of Primary Health Care
on health development at community
level.  Improvement in the level of health care
Rationale for Adopting Primary Health of the community
 Favorable population growth structure
Care
 Reduction in the prevalence of
preventable, communicable and other
 Magnitude of Health Problems disease.
 Inadequate and unequal distribution of  Reduction in morbidity and mortality
health resources rates especially among infants and
 Increasing cost of medical care children.
 Isolation of health care activities from  Extension of essential health services
other development activities with priority given to the underserved
Definition of Primary Health Care sectors.
 Improvement in Basic Sanitation
 essential health care made universally
 Development of the capability of the
accessible to individuals and families in
community aimed at self- reliance.
the community by means acceptable to
 Maximizing the contribution of the
them, through their full participation
other sectors for the social and
and at cost that the community can
economic development of the
afford at every stage of development.
community.
 a practical approach to making health
benefits within the reach of all people.
Mission on what they have. Example:
Scheduling of Barangay Health
 To strengthen the health care system by Workers in the health center
increasing opportunities and supporting Barriers of Community Involvement
the conditions wherein people will 
manage their own health care.  Lack of motivation
Two Levels of Primary Health Care  Attitude
Workers  Resistance to change
 Dependence on the part of
1. Barangay Health Workers – trained community people
community health workers or health  Lack of managerial skills
auxiliary volunteers or traditional birth 4. Self-reliance
attendants or healers.  Through community participation and
2. Intermediate level health workers- cohesiveness of people’s organization
include the Public Health Nurse, Rural they can generate support for health
Sanitary Inspector and midwives. care through social mobilization,
Principles of Primary Health Care networking and mobilization of local
resources. Leadership and management
1. 4 A’s = Accessibility, Availability,
skills should be develop among these
Affordability & Acceptability,
people. Existence of sustained health
Appropriateness of health services.
care facilities managed by the people is
 The health services should be present
some of the major indicators that the
where the supposed recipients are. They
community is leading to self reliance.
should make use of the available
5. Partnership between the community and
resources within the community,
the health agencies in the provision of
wherein the focus would be more on
quality of life.
health promotion and prevention of
 Providing linkages between the
illness.
government and the nongovernment
2. Community Participation
organization and people’s organization.
 heart and soul of PHC
6. Recognition of interrelationship between
3.People are the center, object and subject of
the health and development
development.
 Health- Is not merely the absence of
 Thus, the success of any undertaking
disease. Neither is it only a state of
that aims at serving the people is
physical and mental well-being. Health
dependent on people’s participation at
being a social phenomenon recognizes
all levels of decision-making; planning,
the interplay of political, socio-cultural
implementing, monitoring and
and economic factors as its
evaluating. Any undertaking must also
determinant. Good Health therefore, is
be based on the people’s needs and
manifested by the progressive
problems (PCF, 1990)
improvements in the living conditions
 Part of the people’s participation is the
and quality of life enjoyed by the
partnership between the community and
community residents (PCF,
the agencies found in the community;
 Development- is the quest for an
social mobilization and
improved quality of life for all.
decentralization.
Development is multidimensional. It
 In general, health work should start
has political, social, cultural,
from where the people are and building
 institutional and environmental good health for the community. The
dimensions (Gonzales 1994). goal of Family Planning includes
Therefore, it is measured by the ability spacing of children and responsible
of people to satisfy their basic needs. parenthood.
7. Social Mobilization 5. Environmental Sanitation and Promotion
 It enhances people participation or of Safe Water Supply
governance, support system provided  Environmental Sanitation is defined as
by the Government, networking and the study of all factors in the man’s
developing secondary leaders. environment, which exercise or may
8. Decentralization exercise deleterious effect on his well-
 This ensures empowerment and that being and survival. Water is a basic
empowerment can only be facilitated if need for life and one factor in man’s
the administrative structure provides environment. Water is necessary for the
local level political structures with maintenance of healthy lifestyle. Safe
more substantive responsibilities for Water and Sanitation is necessary for
development initiators. This also basic promotion of health.
facilities proper allocation of budgetary 6. Nutrition and Promotion of Adequate
resources. Food Supply
Elements of Primary Health Care  One basic need of the family is food.
And if food is properly prepared then
1. Education for Health one may be assured healthy family.
 Is one of the potent methodologies for There are many food resources found in
information dissemination. It promotes the communities but because of faulty
the partnership of both the family preparation and lack of knowledge
members and health workers in the regarding proper food planning,
promotion of health as well as Malnutrition is one of the problems that
prevention of illness. we have in the country.
2. Locally Endemic Disease Control 7. Treatment of Communicable Diseases and
 The control of endemic disease focuses Common Illness
on the prevention of its occurrence to  The diseases spread through direct
reduce morbidity rate. Example Malaria contact pose a great risk to those who
Control and Schistosomiasis Control can be infected. Tuberculosis is one of
3. Expanded Program on Immunization the communicable diseases
 This program exists to control the continuously occupies the top ten
occurrence of preventable illnesses causes of death. Most communicable
especially of children below 6 years diseases are also preventable. The
old. Immunizations on poliomyelitis, Government focuses on the prevention,
measles, tetanus, diphtheria and other control and treatment of these illnesses.
preventable disease are given for free 8. Supply of Essential Drugs
by the government and ongoing  This focuses on the information
program of the DOH campaign on the utilization and
4. Maternal and Child Health and Family acquisition of drugs.
Planning  In response to this campaign, the
 The mother and child are the most GENERIC ACT of the Philippines is
delicate members of the community. So enacted. It includes the following
the protection of the mother and child drugs: Cotrimoxazole, Paracetamol,
to illness and other risks would ensure
 Amoxycillin, Oresol, Nifedipine,  Essential National Health Research
Rifampicin, INH (isoniazid) and (ENHR) is an integrated strategy for
Pyrazinamide,Ethambutol, organizing and managing research
Streptomycin,Albendazole,Quinine using intersectoral, multi-disciplinary
Major Strategies of Primary Health Care and scientific approach to health
programming and delivery.
1. Elevating Health to a Comprehensive and Four Cornerstones/Pillars in Primary
Sustained National Effort. Health Care
 Attaining Health for all Filipino will
require expanding participation in
health and health related programs 1. Active Community Participation
whether as service provider or 2. Intra and Inter-sectoral Linkages
beneficiary. Empowerment to parents, 3. Use of Appropriate Technology
families and communities to make 4. Support mechanism made available
decisions of their health is really the https://www.rnpedia.com/nursing-
notes/community-health-nursing-
desired outcome.
notes/primary-health-care-
 Advocacy must be directed to National
phc/?fbclid=IwAR2rSZ6t5nRhrV31kn40Lw_yafe
and Local policy making to elicit
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support and commitment to major
health concerns through legislations,
budgetary and logistical considerations.
2. 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.
3. 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.
4. Advancing Essential National Health
Research
Primary prevention  suitably modified work so injured
or ill workers can return safely to
Primary prevention aims to prevent their jobs.
disease or injury before it ever occurs.
This is done by preventing exposures to Tertiary prevention
hazards that cause disease or injury,
altering unhealthy or unsafe behaviours Tertiary prevention aims to soften the
that can lead to disease or injury, and impact of an ongoing illness or injury
increasing resistance to disease or injury that has lasting effects. This is done by
should exposure occur. Examples helping people manage long-term,
include: often-complex health problems and
injuries (e.g. chronic diseases,
 legislation and enforcement to permanent impairments) in order to
ban or control the use of improve as much as possible their ability
hazardous products (e.g. to function, their quality of life and their
asbestos) or to mandate safe and life expectancy. Examples include:
healthy practices (e.g. use of
seatbelts and bike helmets)  cardiac or stroke rehabilitation
 education about healthy and safe programs, chronic disease
habits (e.g. eating well, exercising management programs (e.g. for
regularly, not smoking) diabetes, arthritis, depression,
 immunization against infectious etc.)
diseases.  support groups that allow
members to share strategies for
Secondary prevention living well
 vocational rehabilitation
Secondary prevention aims to reduce programs to retrain workers for
the impact of a disease or injury that has new jobs when they have
already occurred. This is done by recovered as much as possible.
detecting and treating disease or injury
as soon as possible to halt or slow its Going “upstream”
progress, encouraging personal
strategies to prevent reinjury or To help explain the difference, take this
recurrence, and implementing programs example. Let’s say you are the mayor of
to return people to their original health a town near a swimming hole used by
and function to prevent long-term kids and adults alike. One summer, you
problems. Examples include: learn that citizens are developing serious
and persistent rashes after swimming as
 regular exams and screening tests a result of a chemical irritant in the
to detect disease in its earliest river. You decide to take action.
stages (e.g. mammograms to
detect breast cancer) If you approach the company upstream
 daily, low-dose aspirins and/or that is discharging the chemical into the
diet and exercise programs to river and make it stop, you are engaging
prevent further heart attacks or in primary prevention. You are
strokes removing the hazardous exposure and
preventing rashes in the first place.
If you ask lifeguards to check swimmers stages, before the onset of signs and symptoms,
as they get out of the river to look for through measures such as mammography and
signs of a rash that can then be treated regular blood pressure testing.10 3. Tertiary
right away, you are engaging in Prevention—managing disease post diagnosis
secondary prevention. You are not to slow or stop disease progression through
preventing rashes, but you are reducing measures such as chemotherapy, rehabilitation,
their impact by treating them early on so and screening for complications.11
swimmers can regain their health and go PREVENTION QUICK FACTS Actions such as the
about their everyday lives as soon as Clean Air Act as well as anti-smoking campaigns
possible. have had a significant preventive impact on
public health.1,2,3 States play a crucial role in
If you set up programs and support promoting both local and federal prevention
groups that teach people how to live efforts and also contribute to prevention
with their persistent rashes, you are through their own initiatives.2,3 Beyond
engaging in tertiary prevention. You are individual prevention efforts, local community
not preventing rashes or dealing with actions can be particularly effective in bringing
them right away, but you are softening about changes that prevent or reduce
their impact by helping people live with environmentally-related illness and disease.4 2
their rashes as best as possible. PREVENTION PICTURE OF AMERICA 3 Most
prevention suggestions are primary or
For many health problems, a secondary prevention efforts for individuals.
combination of primary, secondary and Yet, in the context of environmental health,
tertiary interventions are needed to prevention is much broader, because exposure
achieve a meaningful degree of to many contaminants is beyond the control of
prevention and protection. However, as individuals and historically has been most
this example shows, prevention experts effectively reduced by government programs
say that the further “upstream” one is and regulations12 (e.g., Pollution Prevention
from a negative health outcome, the Act13; Clean Air Act1 ). Traditionally,
likelier it is that any intervention will be environmental public health has focused on
effective. reducing exposure to environmental hazards
known to be related to disease. Increasing
Source: At Work, Issue 80, Spring emphasis is placed on upstream interventions—
2015: Institute for Work & Health, eliminating the source of the hazard rather than
Toronto [This column updates a just preventing or reducing exposure.14 This
previous column describing the same type of elimination has often required action by
term, originally published in 2006.] individuals as well as governments at the
federal, state, and local levels.
WHAT IS PREVENTION?

Prevention activities are typically categorized by

the following three definitions: 1. Primary
Prevention—intervening before health effects
occur, through measures such as vaccinations,
altering risky behaviors (poor eating habits,
tobacco use), and banning substances known to
be associated with a disease or health
condition.8,9 2. Secondary Prevention—
screening to identify diseases in the earliest