Primary Health Care Day 1

Levels of Prevention

Primary= healthy = promotion of health,= achieve the highest level of wellness

Nutrition, exercise , rest
prevention of illness- Identify the different risk factors
Specific disease
Immunization/vaccination

Secondary= sick =restore health, cure,

early detection = early treatment; limit the disease process, to shorten illness, to
prevent complication
Identify the early signs and symptoms
Test--- ID presences
restore health, cure, === Doctors and Nurses

tertiary= recovered= remnant of diseases ( optimum level of functioning

Health Care Delivery System

Health care system is an organized plan of health services. === Job the DOH
- The rendering of health care services to the people is called health care
delivery system.
- The health care delivery system is the network of health facilities and
personnel which carries out the task of rendering health care to the people.

Levels of Health Facilities

Primary= BHS, MHC/RHU = clinics, Emergency hospitals,
B(Basic)EMONC= Lying-in
Suction machine, Oxygen

Secondary=, District hospitals ( Inter- Local Health Zone), Provincial hospitals,

C(comprehensive)EMONC= District hospitals Provincial,
C/S. Blood Transfusion

tertiary= regional Hospitals, PGH, specialized hospitals

Levels of Health Care Workers

Primary= MWs--- first health professional - deals the clients

Secondary= Nurses
tertiary= Doctor

X-ray Technician, Medical Technologists= back ups in the diagnosis

RHCDS===== 2 -way referral system

Health Team

RHP 1:20000

PHN RHD, RSI, BNS1: 20000

RHM- first health professional 1Mw: 5000 pop

BHW--- 1:20 households
Restructured Health care Delivery System

2- way Referral system

Inter Local Health Zone

Devolution
 - Local Health Board
=Municipal Level
● Mayor---- chairman
● Rural Health Physician----C0-chairman

= Provincial Level
● Governor---- chairman
● Provincial Health Officer

DOH

Regional, PGH, Specialized

Basically, the DOH has three major roles in the health

}

sector:
} (1) leadership in health;

} (2) enabler and capacity builder; and

} (3) administrator of specific services.

DOH programs based of the health problems/

indicators

Leading causes of Morbidity ( sickness)

Mortality (deaths)
Before pandemic ( COVID 19)
Heart
Ds of the vascular system
Cancer
Pneumonia
Accidents
TB

After pandemic 2021

Dm
Hpn ds
Pneumonia
Covid
Heart

}Its mandate is to develop national plans, technical

standards, and guidelines on health.

Aside from being the regulator of all health services

and products, the
DOH is the provider of special tertiary health care
services and technical assistance to health providers
and stakeholders.
VISION
“Filipinos are among the healthiest people in Southeast Asia by 2022. Asia by
2040”

MISSION
“To lead the country in the development of a Productive, Resilient, Equitable
and People Centered health system.”

GOALS

“Better Health Outcomes,

More Responsive Health System,

More Equitable Health Care Financing”

STRATEGIC PILLARS

Financing,

Service Delivery,

Governance and

Regulation

“PLUS”

Performance Accountability

VALUES==

Integrity, Excellence and Compassion

NATIONAL OBJECTIVES ON HEALTH:
Improve the general health status of the
}

population
Reduce morbidity and mortality from certain
}

diseases
Eliminate certain diseases as public health
}

problems
Promote healthy lifestyle and environmental
}

health
Protect vulnerable groups with special health and
}

nutrition needs

Strengthen national and local health systems to

}

ensure better health service delivery

Pursue public health and hospital reform

Reduce the cost and ensure the quality of

}

essential drugs

Generic law=
Institute health regulatory reforms to ensure
}

quality and safety of health goods and services

Strengthen health governance and management

}

support systems
Institute safety nets for the vulnerable and
}

marginalized groups
} Expand the coverage of social health insurance

} Mobilize more resources for health

Improve efficiency in the allocation, production
}

and utilization of resources for health

All for health towards health for all.

This is the vision of the
Philippine Health Agenda 2016–2022.

UHC Law= to ensure Filipinos has equitable access to

quality Health Services and avoid high out of the pocket
health expenses
universal health coverage. = all Filipinos in automatically
member of the National Health Insurance
Program(PHILHEALTH)

LOI 949= PHC to be used as the approach in the delivery of the essential services

Primary Health Care (PHC) is an essential health care made universally

available 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 and can afford at every stage of development.

Definitions

World Health Organization (WHO)

The WHO defines Primary Health Care an essential health care made
universally acceptable 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 and afford at every stage of development.

Alma Ata Declaration

The Declaration of Alma-Ata was adopted at the International Conference

on Primary Health Care (PHC), Almaty (formerly Alma-Ata), Kazakhstan
(formerly Kazakh Soviet Socialist Republic), 6-12 September 1978

Eight essential elements based on the Alma Ata on PHC: An essential

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

1. Health Education
 2. Treatment of Locally Endemic Diseases( Malaria, Filiariasis<
schistosomiasis)

3. Expanded Program on Immunization

4. Maternal and Child Health

5. Provision of Essential Drugs

6. Nutrition

7. Treatment of communicable and non-communicable diseases

Triple jeopardy: CD; NCD, emerging diseases

8. Safe water and good waste disposal

Goals

The ultimate goal of primary health care is better health for all. WHO has
identified five key elements to achieving that goal:

Health for all in the year 2000 and Health in the Hands in the year 2020

Self- Reliance

● Reducing exclusion and social disparities in health (universal

coverage reforms);
● Organizing health services around people’s needs and expectations
(service delivery reforms);
● Integrating health into all sectors (public policy reforms);

● Pursuing collaborative models of policy dialogue (leadership reforms);

and
 ● Increasing stakeholder participation.

History

A brief history of Primary Health Care is outlined below:

● May 1977. The 30th World Health Assembly adopted resolution

which decided that the main social target of governments and of
WHO should be the attainment by all the people of the world by the
year 2000 a level of health that will permit them to lead a socially and
economically productive life.
● September 6-12, 1978. International Conference in PHC was held in
this year at Alma Ata, USSR (Russia)
● October 19, 1979. The President of the Philippines (Ferdinand
Marcos) issued Letter of Instruction (LOI) 949 which mandated the
then Ministry of Health to adopt PHC as an approach towards
design, development, and implementation of programs which focus
health development at the community level.

Rationale

Adopting primary health care has the following rationales:

● Magnitude of Health Problems

● Inadequate and unequal distribution of health resources
● Increasing cost of medical care
● Isolation of health care activities from other development activities

Objectives

1. Improvement in the level of health care of the community

2. Favorable population growth structure

 3. Reduction in the prevalence of preventable, communicable and
other disease.

4. Reduction in morbidity and mortality rates especially among

infants and children.

Target : Infants= birth to < 12 months

Children = under five ( 12 months to 59 months

5. Extension of essential health services with priority given to the

underserved sectors.--

6. Improvement in basic sanitation

7. Development of the capability of the community aimed at self-

reliance.

8. Maximizing the contribution of the other sectors for the social and
economic development of the community.

Appropriate Technology
Acupressure/ acupuncture

SANTA LUBBY

Infusion vs. Decoction

Elements

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

1. Education for Health

This is one of the potent methodologies for information dissemination. It

promotes the partnership of both the family members and health workers in
the promotion of health as well as prevention of illness.

2. Locally Endemic Disease Control

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

3. Expanded Program on Immunization

This program exists to control the occurrence of preventable illnesses

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

4. Maternal and Child Health and Family Planning

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

5. Environmental Sanitation and Promotion of Safe Water Supply

Environmental Sanitation is defined as the study of all factors in the man’s

environment, which exercise or may exercise deleterious effect on his well-
being and survival. Water is a basic need for life and one factor in man’s
environment. Water is necessary for the maintenance of healthy lifestyle.
Safe Water and Sanitation is necessary for basic promotion of health.

6. Nutrition and Promotion of Adequate Food Supply

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

7. Treatment of Communicable Diseases and Common Illness

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

8. Supply of Essential Drugs

This focuses on the information campaign on the utilization and acquisition

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

Principles

Primary health care is run with the following principles:

1. 4 A’s = Accessibility, Availability, Affordability and Acceptability,

Appropriateness of health services.

The health services should be present where the supposed recipients are.
They should make use of the available resources within the community,
wherein the focus would be more on health promotion and prevention of
illness.

2. Community Participation

Community participation is the heart and soul of primary health care.

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

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

Barriers of Community Involvement

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

4. Self-reliance

Through community participation and cohesiveness of people’s

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

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

provision of quality of life.

Providing linkages between the government and the non-government

organization and people’s organization.

6. Recognition of interrelationship between the health and

development

● Health is defined as not merely the absence of disease. Neither is it

only a state of physical and mental well-being. Health being a social
phenomenon recognizes the interplay of political, socio-cultural and
economic factors as its determinant. Good Health therefore, is
manifested by the progressive improvements in the living conditions
and quality of life enjoyed by the community residents
 ● Development is the quest for an improved quality of life for all.
Development is multidimensional. It has political, social, cultural,
institutional and environmental dimensions (Gonzales 1994).
Therefore, it is measured by the ability of people to satisfy their basic
needs.
● Multisectoral approach

= Intersectoral--- CHED, DEPED, DSWD, DTI, LGU, DA

= Intrasectoral --- within the health sector

7. Social Mobilization

It enhances people’s participation or governance, support system provided

by the government, networking and developing secondary leaders.

8. Decentralization

This ensures empowerment and that empowerment can only be facilitated

if the administrative structure provides local level political structures with
more substantive responsibilities for development initiators. This also
facilities proper allocation of budgetary resources.

Family – basic unit of Care

1.Community Health Care Process applied to
the family – Family Health Care

Assessment=
Initial Data Base

1.Health threats - at risk

Incomplete immunization

Poor environmental sanitation

Diet- is not complete( high carbo)

2.Health deficit

- Primary complex, marasmus

3.Foreseeable crises/ stress points

=mother is pregnant, entrance at school,
=death the breadwinner

4.Wellness state
 Mother ready breastfeed, practice healthy
lifestyle

2nd level assessment

Planning
Priority Setting--- several problems

Criteria:
Nature Of the condition
deficit/ well state-----3
Threat ------------------2
Crisis---------------------1
Divide score with the highest score X weight
3/3 X 1 ------ 1
preventive potential,
3,2,1 ------------- 1
modifiability of the problem and
2,1,0
0/2 =0 x2 ------0

Salience
2,1,0
½== .5x 1--------.5
Total score 2.5

Highest total 5 given the highest priority

Setting of goals and Objectives

Program of Activities ( Specific)

Activity.. What, When. who

Evaluate:

2.Health Problem – Health threat=== 1st level

3.HealthNeed – Health problem that family
cannot cope= 2nd level

4.Characteristics of Healthy Family

•Aware and interested in life
•Energetic and active
•Pleasant disposition
•Guides family members
•Healthy physically and mentally

5.High risk family – classification

•Young couple, many children
•Large family (5 children )
•Low socio-economic status
•Living in congested housing
•Low education
•Poor home sanitation

6.Major functions of the family:

•Physical

•Economic

•Reproductive
•Socialization

7.Family Structure
Traditional
Nuclear vs. Extended
Single parent
Alternative Family Structure
Cohabiting – living together
Homosexual / lesbian

MIDWIFE-PATIENT(Family) CONTACTS

I. Clinic Visits
Pre-consultation

Envelope (Family)---- Clinic records

Home based records vs. Clinic based records

PINK CARD--- pregnant

Yellow Card---- infants

Advantages of H0me Based Record

- Less loses
- Consultation done as soon as the family comes in
- Transfers to another locality no need referral record
Consultation

- Assessment,
- treatment,

Post Consultation

- For follow up….

- Evaluate the Health Education
- Shech for next visit

II. HOME VISIT

A nursing home visit is a family-Midwife contact which allows

the health worker to assess the home and family situations in order to
provide the necessary nursing care and health related activities.

In performing home visits, it is essential to prepare a plan of

visit to meet the needs of the client and achieve the best results of
desired outcomes.

Purposes

1. To give care to the sick, to a postpartum mother and her

newborn with the view to teach a responsible family member to
give the subsequent care.

Postpartum

First post partum ===3rd day

2nd ==============1 week

6th week------ clinic visit

2. To assess the living condition of the patient and his family

and their health practices in order to provide the appropriate
health teaching.
 3. To give health teachings regarding the prevention and
control of diseases.

4. To establish close relationship between the health agencies

and the public for the promotion of health.

5. To make use of the inter-referral system and to promote the

utilization of community services

Family to be visited:

1. Postpartum day 3
2. Pregnant mother missed scheduled visit
3. 3-year old with measles
4. Father with TB failed to return for Strep injection

1 2 4 3

Principles

The following principles are involved when performing a home visit:

1. A home visit must have a purpose or objective.

2. Planning for a home visit should make use of all available

information about the patient and his family through family
records.

3. In planning for a home visit, we should consider and give

priority to the essential needs of the individual and his family.

4. Planning and delivery of care should involve the individual

and family.

5. The plan should be flexible.

Guidelines
The following guidelines are to be considered regarding the
frequency of home visits:

1. The physical needs, psychological needs and educational

needs of the individual and family.

2. The acceptance of the family for the services to be rendered,

their interest and the willingness to cooperate.

3. The policy of a specific agency and the emphasis given

towards their health programs.

4. Take into account other health agencies and the number of

health personnel already involved in the care of a specific
family.

5. Careful evaluation of past services given to the family and

how the family avails of the nursing services.

6. The ability of the patient and his family to recognize their

own needs, their knowledge of available resources and their
ability to make use of their resources for their benefits.

Steps

1. Greet the patient and introduce yourself.

2. State the purpose of the visit

3. Observe the patient and determine the health needs.

4. Put the bag in a convenient place and then proceed to

perform the bag technique.

5. Perform the nursing care needed and give health teachings.

6. Record all important date, observation and care rendered.

7. Make appointment for a return visit.

Bag Technique
The public health bag is an essential and indispensable equipment of a
public health Midwife which she has to carry along during her home visits. It
contains basic medication and articles which are necessary for giving care.

Principles

● Performing the bag technique will minimize, if not, prevent the spread
of any infection.
● It saves time and effort in the performance of nursing procedures.
● The bag technique can be performed in a variety of ways depending
on the agency’s policy, the home situation, or as long as principles of
avoiding transfer of infection are always observed.

Contents

The following are the contents of a Public Health Midwife bag:

● Paper lining
● Extra paper for making waste bag
● Plastic/linen lining
● Apron
● Hand towel
● Soap in a soap dish
● Thermometers (oral and rectal)
● 2 pairs of scissors (surgical and bandage)
● 2 pairs of forceps (curved and straight)
● Disposable syringes with needles (g. 23 & 25)
● Hypodermic needles (g. 19, 22, 23, 25)
● Sterile dressing
● Cotton balls
 ● Cord clamp
● Micropore plaster
● Tape measure
● 1 pair of sterile gloves
● Baby’s scale
● Alcohol lamp
● 2 test tubes
● Test tube holders
● Solutions of:
○ Betadine
○ 70% alcohol
○ Zephiran solution
○ Hydrogen peroxide
○ Spirit of ammnonia
○ Ophthalmic ointment
○ Acetic acid
○ Benedict’s solution

*BP apparatus and stethoscope are carried separately and are never
placed in the bag.

Points to consider

1. The bag should contain all the necessary articles, supplies and
equipment that will be used to answer the emergency needs

2. The bag and its contents should be cleaned very often, the
supplies replaced and ready for use anytime.

3. The bag and its contents should be well protected from contact
with any article in the patient’s home.

4. Consider the bag and its contents clean and sterile, while articles
that belong to the patients as dirty and contaminated.
 5. The arrangement of the contents of the bag should be the one
most convenient to the user, to facilitate efficiency and avoid
confusion.

Steps

The following are steps in performing bag technique and rationale for each
action:

Action Rationale

Upon arrival at the patient’s home, place To protect the bag from getting
the bag on the table lined with a clean contaminated.
paper. The clean side must be out and
the folded part, touching the table

Ask for a basin of water or a glass of To be used for hand washing.

drinking water if tap water is not
available.

Open the bag and take out the towel and To prepare for hand washing.
soap.

Wash hands using soap and water, wipe To prevent infection from the
to dry. care provider to the client.

Take out the apron from the bag and put To protect the nurse’s uniform.
it on with the right side

Put out all the necessary articles needed To have them readily
for the specific care. accessible

Close the bag and put it in one corner of To prevent contamination

the working area.

Proceed in performing the necessary To give comfort and security

nursing care treatment. and hasten recovery

After giving the treatment, clean all To protect the caregiver and
things that were used and perform hand prevent infection
washing.

Open the bag and return all things that

were used in their proper places after
cleaning them.

Remove apron, folding it away from the Remove apron, folding it away
person, the soiled side in and the clean from the person, the soiled
side out. side in and the clean side out.
Place it in the bag.

Fold the lining, place it inside the bag

and close the bag

Take the record and have a talk with the mother. Write down all the
necessary data that were gathered, observations, nursing care and
treatment rendered. Give instructions for care of patients in the absence
of the nurse.

Make appointment for the next visit For follow-up care

(either home or clinic) taking note of the
date and time.

Any flat surface

6 feet away from the PATIENT’S bed

- Droplet

Home visits

Several families to be visited

1. Pregnant who did go back for appointed prenatal

2. 3 day old post partum
3. A father with tuberculosis on DOTS
4. A 5 year with measles

2….1…..3….4

CHARACTERISTICS OF A COMMUNITY:

1. Environment- includes the physical, biological, socio-cultural,

educational and employment milieu

The physical environment of the community includes the geography,

climate, terrain, natural resources and structural entities (buildings such
as schools, workplaces and homes).

The biological environment of the community includes various flora,

fauna, bacteria, viruses, molds, fungi, toxic substances, and food and
water supplies.
The sociocultural environment of the community reflects the culture, values,
attitudes, and demographic characteristics of the people of the community.

2. Population behavior or lifestyle – This describes the self-

responsibility, the self-care competency of the people in the community.

3. Human biology – describes the genetic characteristics of population.

4. Systems of Health care – Describes whether available health care is

that of prevention, promotion, cure and rehabilitation.

Classification of Communities:

1. Urban- high density, a socially heterogeneous population and a

complex structure, non-agricultural occupations; something different
from an area characterized by complex interpersonal social relations.

2. Rural – usually small and the occupation is usually farming, fishing

and food gathering. It is peopled by simple folk characterized by primary
group relations, well-knit and having a high degree of group feeling.

3. Rurban – a combination of the first two.

COMPONENTS OF A COMMUNITY
 I. THE CORE – represents the people that make up the
community. Included in the community CORE are the demographics
of the population as well as the values, beliefs and the history of the
people.

Nature and Scope of Demography:

The word demography was derived from the Greek words: demos,
meaning people and graphos, meaning count. Very simply, it is the study
by statistical methods of human population.

More inclusively, it is the study of the size, composition and distribution of

human population and the changes over time brought about by births,
deaths and migration. The scope of demography thus includes the
following aspects, which are indicated by certain demographic measures:

¸ Population size – the size of the population simply refers to the

population or the number of people that is affected by births, deaths and
migration.

2020=== 109.6 million

October 22, 2022=== 112.934,928 ( UN data)

¸ Population composition – The composition of the population refers to

the arrangement of the people according to biologic, social, ecological
characteristics such as age, marital status, education, occupation, etc.
Three common that relate to population composition are the following:
a. Sex ratio – This is simply the number of males in a population
divided by the number of females. Since the quotient is usually just
below or above `1, it is multiplied by 100 (and expressed in
percentage) to give it meaning. Thus sex ratio = male/female x 100.

Example:

40 %

40 males for every 100 females

In a community with 400 males and 600 females, the sex ratio is 66%
or 66 males for every 100 females.

b. Age composition – There are two to describe the age

composition of the population

Median age – divides the population into two equal parts. So

if the median age is said to be 19 years old, it means half of
the population belongs to 19 years and above, while the
other half belongs to ages below 19 years old.

young= more people die of preventaBLE

Median age40

= old

= MORE people die of chronic degenerative diseases

Dependency Ratio – compares the number of economically

dependent with the economically productive group in the
population.
 - The economically dependent are those who belong to the
0-14 and 65 and above age groups.
- Considered to be economically productive are those
within the 15 to 64 age group.

It is computed by dividing the number of economically

dependent age group by the number of economically
productive age group and multiplied by 100.

Example:

In a community of 400 economically dependent and 600

economically productive, the dependency ratio is

66% or 66 dependents for every 100 working pop.

c. Age and sex composition – This can be described at the same time
using a population pyramid. It is a graphical presentation of the age
and sex composition of the population. . This is usually expressed in
terms of proportion (or percentage) of people in various age groups of
different sex in a population.

infants=== Estimated number is 3% or 2.7 % Of the total population

5000 X .03= 150 infants=== measles immunization

Pregnant women==== 3.5% of the total population

5000 X 0.035= 175 pregnant women TT immunization

1-4 years==== 11.5%== Feeding program

5000 x .115 ====575 young children

¸ Population Distribution- The distribution of the population in space

can be described in terms of urban-rural distribution, population
density and crowding index. These measures helps the community
health care worker decide how meager resources can be justifiably
allocated based on concentration of population in a certain place.

a. Urban-rural distribution simply illustrates the proportion of

the people living in urban compared to the rural areas.

b. Crowding index will describe the ease by which a

communicable disease will be transmitted from one host to
another susceptible host.

This is described by dividing the number of persons in a

household with the number of rooms used by the family for
sleeping.

10 people

2 rooms used

10/2===== 5

c. Population density will determine how congested a place is

and has implications in terms of adequacy of basic health
services present in the community.

It can be computed by dividing the number of people living in a

given land area.

¸ Population Dynamics – This refers to the changes in size,

composition or distribution of the population over time. Changes in
the population can be reflected by measures of migration and
population growth. However, measures of migration are not being
used very much because of incomplete data.

a. Rate of Annual Increase – This refers to the difference

between birth and death rates per 1000 population. Thus,

RNI = CBR (Crude birth rate) – CDR (Crude death rate)

CBR-10; CDR- 5

5==== 5 people added to the population 1000pop

b. Average Annual Increase – This refers to the change in

population size with reference to the base population
(population at an earlier date) expressed either in absolute
or relative terms,

1. Absolute change: measures the number of people that are

added to the population per year; expressed in numerical increase;
obtained by the formula:

Pt - P o where : Pt = population at a later date--5500

T Po = population at an earlier date

5000

T = number of years between time

0 and time t---- 5years
 100/year

2. Relative increase = is the actual difference between the two

census counts expressed in per cent relative to the population size
made during at an earlier census.

Relative increase = Pt - Po

Po

SIGNIFICANCE OF DEMOGRAPHY TO COMMUNITY

HEALTH

1. Anticipate health problems. For example, age structure gives an idea

of the nature of health problems in a community. In a young population,
one may expect a predominance of certain childhood and communicable
diseases while in the old population, there maybe a high prevalence of
chronic, degenerative diseases.

2. Determine availability and need for resources. In the planning of

public health programs, population data are used in determining the
need for and allocating resources in terms of manpower and materials.

EPI Infants =

Pregnant women

3. Serve as a tool and basis for evaluation.

SOURCES OF DEMOGRAPHIC DATA

1. National Census. A census is a complete enumeration of population

taken at specified points in time.

If the count considers all persons wherever they maybe on census day,
it is called de facto census.

However, if it considers persons only in their places of residence, it is

termed as de jure census.

2. National Registration of vital events. Most nations have laws that

make it compulsory to register each birth (within 30 days in the Phils.)
after they occur.

RA3753

PD651 birth reporting must be done within 30 days after occurrence of

birth

3. Sample surveys. The sample survey is the study of a sub-group of

population that is a representative sample of the total population to
obtain more detailed information about the population.

Death

Age= Age as of last birth

58 as of day Jan 22, 2023

Birthday ====Feb 1. 2023=== 59

I. The eight (8) subsystems of the community

1. Housing – What type of housing facilities are there in the

community; are there enough housing facilities available; are
there housing laws/regulations governing the people? What are
these?

2. Education – These includes laws, regulations, facilities,

activities affecting education, ratio of health educators to
learners, distribution of educational facilities, who utilizes these;
what informal educational facilities and activities exist in the
community?

3. Fire and Safety – Fire protection facilities and fire prevention

activities, distribution of these.

4. Politics and government – Political structures present in the

community, decision-making process/pattern, leadership style
observed, etc…

5. Health – Health facilities and activities; distribution, utilization,

ratio of providers to clientele served; priorities in health,
programs developed, etc.

6. Communication – Systems, types of community existing, forms

of communication, be it formal or informal, vertical or horizontal;
etc.
 7. Economics – Occupation, types of economic activities, income,
etc….

8. Recreation–Recreational activities/facilities: types, consumers,

appropriateness to consumers, etc…

A HEALTHY COMMUNITY…..

M … prompts its members to have a high degree of awareness that “we

are community”

M … uses its natural resources while taking steps to conserve them for
future generations.

M … openly recognizes the existence of sub-groups and welcomes their

participation in community affairs

M … is prepared to meet crises

M … is a problem-solving community; it identifies, analyzes and organizes

to meet its own needs

M … has open channels of communication that allows information to flow

among all sub-groups of its citizens in all directions
M … seeks to make each of its system’s resources available to all
members of the community

M … has legitimate and effective ways to settle disputes and meet needs
that arise within the community

M … encourages maximum citizen participation in decision-making

M … promotes a high level wellness among all its members.

ELEMENTS OF A HEALTHY COMMUNITY

B People are partners in health care

B People work together to attain goals

B Physical environment promotes health, safety, order and cleanliness

B Safe water and nutritious food

B Families provide members with basic needs

B Available, affordable health care

Primary Health Care approach

FACTORS THAT AFFECT COMMUNITY HEALTH

G Political

$ Socio-economic

Heredity

P Environment

Behavior

h Health Care Delivery System

EFFECTS OF A HEALTHY COMMUNITY

Development
 Vital statistics – is the application of statistical methods and techniques
to the study of vital facts, such as those concerning

births,

deaths and

illnesses.

- Statistical data, which relate the total number of various kinds of

biologic or vital events (like births, marriages, illnesses and deaths)
to the size and characteristics of the affected population.

Three categories of Vital Statistics:

A. Fertility or Birth rates

1. Crude Birth Rate – The Crude birth rate is only a rough measure of fertility in
the population since it makes use of the mid-year population (which ignores the
number of men and women incapable of child bearing) as its denominator.
However, it has its advantages. Used to compute for the rate of annual

For one, the data are easy to obtain, making the rate readily available.

Secondly, the rate can be used in determining population growth by subtracting

the crude death rate from it. This rate is obtained using the following formula:

CBR= Total live births in a calendar year x 1000

Mid-year population for that year

 5 live births / 1000 mid year population

2. General fertility Rate (GFR) – This rate is a more refined measure than crude
birth rate because the denominator makes use of the number of women of a child-
bearing age.

However, it is still limited in the sense that not all women of child-bearing age are
expected to give birth for various reasons. This rate is obtained by the following
formula:

GFR= Total live births in the calendar year x 1000

Mid-year population of women of

Child-bearing age (15-44 or 48 years) for that year

GFR= 10 births/ 1000 pop of women between 15-44 or 48

3. Age-Specific Fertility Rate – One of the most accurate refinements made in the
study of fertility is the age-specific fertility rate. This rate permits a more in-depth
study of the differences in fertility at specific ages throughout the reproductive period
and the impact of birth control measures on fertility.

The age-specific fertility rate is obtained by the following formula:

= total live births to women of X years x 1000

mid-year population of women of X years

B. Mortality/Death rates

1. Crude death rate (CDR). The crude death rate is a measure of the force of
mortality or the probability of dying in a population.

However, death rates are influenced to a large extent by the age and sex composition
of the population. For example, elderly people have higher death rates and males than
females in most causes at most ages. Therefore, comparisons of population groups
 that are radically different in age and sex composition may give misleading
conclusions if the crude death rate is used.

To overcome these difficulties, standardized death rates are estimated, whereby

adjustments are made for the age and sex compositions of populations.

Comparisons can thus be made between these standardized rates where age and sex
are held constant. The crude death rate is obtained by the following formula:

CDR= total deaths in a calendar year x 1000

mid-year population for that year

Lifespan of females is longer than that of males

Increasing life span 68-72

Developing countries== longer

65----- “new middle age”

2. Age-Specific Death Rate This rate gives a better picture of the force of mortality in
a given population than the Crude Death rate since the age factor (which affect death
rate to a large extent) is held constant. This rate is merely the crude death rate
calculated for each age group. The age-specific death rate is obtained by the
following formula:

= total deaths, specific age-group, calendar year x 1000

mid-year population, same age-group, same year

For ages 1-5---- 15

15 deaths aging 1-5 for every 1000 population aging 1-5 years old

3. Age and Sex-specific death rate. This rate is similar to the age-specific death rate
but specifies the sex as well. It is obtained by the following formula:

= total deaths, age group and sex, calendar year x 1000

mid-year population, same age-group and sex and year

 4. Cause-specific death rate. This rate specifies the cause rather than the age and
sex. It is obtained by the following formula:

= total deaths from a particular disease in a calendar year x 1000

mid –year population in a calendar year

This rate may also be refined as to age and sex, in which case it becomes the age,
sex and cause-specific death rate.

5. The proportional mortality rate. This rate denotes the percentage of all deaths
attributed to a certain disease. It is used in ranking the cause of death by magnitude
of frequency. The ten leading causes of mortality is a popular means of showing the
common health problems for a given geographic area, age and sex.

However, unlike the other mortality rates, it does not measure the probability of dying
in a given population because the denominator does not represent the population at
risk. The proportional mortality rate is obtained by the following formula:

=total deaths from a particular cause in a calendar year x 100

total deaths from all causes in the same year

Factor 100=== per cent

48 ---total

Cancer---10…. 10/48 x 100

Heart 15----------15/48 x 100

COVID 19 ---=

Note that it is always expressed in percentage since the factor used is 100.

The SWAROOP’S INDEX is another proportional mortality indicator. It gives the

percentage of all deaths, which occur in persons 50 years and above as shown in the
following formula:
 = total deaths in persons 50 years and above x 100

total number of deaths for all ages=== 48

50 years and 1bove ==== 15

15/48 X 100=31%

31% dies after age 50

69 % dies before age 50

Good or bad

Die young===== poor health

The Swaroop’s index is directly proportional to the health status of a population.

For example a Swaroop’s index of 80% means that only 20% of the population are dying
before the age of 50 years, which is a good indication of the health of a population. A low
index, on the other hand, implies the life expectancy is short and people die more of
acute and communicable diseases.

6. Case Fatality Rate (CFR). This rate measures the lethality or the killing power of a
disease or injury as expressed in terms of percentage. For example, rabies and
meningitis are known to have a high CFR while measles or mumps are known to have
a low CFR.

Cancer =5/10= 50%

COVID=2/100 = 2%

To determine the case fatality rate of a disease, it is necessary to follow-up the

cases for a defined period such that deaths occurring beyond the period could

reasonably be directly related to the disease under study. Otherwise if the follow-

up period is indefinite, all cases will ultimately die. Thus, this rate is useful in

case of acute infectious diseases, assuming that all new cases are reported and
 most deaths occurred in a relatively short time after diagnosis.

The CFR maybe used to determine how well the treatment for a certain disease has
succeeded or is succeeding. The formula for obtaining this rate is as follows:

=total deaths from a particular cause during a specific time period x 100

total cases of the same cause followed-up during the same time period

5 cases rabies

4 died

CFR ===⅘ x 100==== 80%

20 cases

1 died

7. Infant Mortality Rate (IMR). This rate is considered one of the most sensitive
indices of the health conditions obtained in a population. Unlike the crude death rate,
which includes death rates from old age, degenerative diseases and other causes not
readily preventable by public measures, the IMR is closely linked with preventable or
environmental factors. Infant deaths are associated with acute communicable
diseases and such factors as poor environmental sanitation and poor hygiene; in
general inadequate health services. This rate is obtained by the following formula:

IMR= total deaths, less than 1 year of age in a calendar year x 1000

Total live births in the same year

Note that infant deaths are not actually divided by the actual population of that
age because the census data are obtained only for certain years and are likely to
fluctuate considerably between census years. Thus, the number of live births provides a
more reliable and readily available figure for the denominator.
 Because of the generally high mortality that occurs in the first year of life, further
division of the IMR into the neonatal (first month or 28 days of life) and post-neonatal
(after the first month to one year of age) mortality rates maybe made. Calculations of
these rates consist merely of substituting the age group less than 1 year of age to the
two age group mentioned.

NMR = total deaths, 28 days of life, calendar year x 1000

Total live births in the same year

PMR = total deaths after the 1st month to 1 year, calendar year x 1000

Total live births in the same year

8. Fetal Death Rate = Fetal deaths, which include abortions and still births, are
generally attributed to prenatal causes and are therefore influenced more by
endogenous than environmental factors. The term fetal death has been defined by
WHO as “ death prior to complete expulsion or extraction from the mother of a

product of conception, irrespective of the duration of pregnancy”. The death is indicated

by the fact that after such separation, the fetus does not breathe nor show any evidence
of life such as beating of the heart, pulsation of the umbilical cord or definite movement
of voluntary muscles. The accepted formula for the fetal heart rate is:

= total deaths, 28 weeks of gestation & over, calendar year x 1000

total live births in the same year

The appropriate denominator is the number of conceptions or pregnancies, which

maybe directly derived at by adding all fetal deaths and live births. Since fetal deaths (or
abortions) are seldom reported, the uses of live births is universally accepted. For the
same reason, better figures are obtained if the numerator is limited to late fetal deaths (or
still births).
10. Maternal Mortality Rate (MMR). This rate measures the risk of dying from causes with
childbirth. Maternal death is defined as the death of a mother directly due to pregnancy,
labor and puerperium within 90 days of delivery. Deaths of mother or pregnant women
are not due to causes previously mentioned are not included in maternal deaths. The
MMR is obtained from the following formula:

MMR = total maternal deaths in a calendar year x 1000

Total live births in the same year

Ideally, the denominator should be the number of pregnant women during the year
under review in the absence of the system of reporting pregnancies; the number of
live births is used as a convenient approximation of the number of pregnancies.

11. Perinatal Mortality Rate. (PMR). With the continuing improvement in maternal care
in general and the pre-natal in particular, the maternal mortality rate has declined
considerably especially in developed countries.

This situation has reduced the importance of this rate as an index of the quality of
health care available in a country. In view of this, increasing attention has been given to
peri-natal deaths (i.e., deaths of the fetus or neonate occurring around the time of birth).

The computation of perinatal mortality is now preferred over that of still birth and
neonatal death rates, as it has been realized that many fetal deaths in late pregnancy and
neonatal deaths in the first week of life maybe attributed to similar underlying
conditions/factors. To separate the two events gives incomplete information so that
certain factors maybe overlooked rather than identified.

It is now accepted that perinatal mortality rate is a good index of the quality of
maternity care available since maternity care is concerned both in improving the welfare
of the fetus and in insuring the birth of a healthy child.

The standard formula for computing perinatal mortality rate is:

 fetal deaths, 28 weeks and over gestation + early

= neonatal deaths, 1 week of age in a calendar year x 1000

total live births in the same year

C. MORBIDITY/SICKNESS RATES

1. Incidence Rate. In times and in areas in which infectious diseases are the
predominant medical problems, reporting of new cases of specific diseases by
physicians to health authorities provides an important measure of disease risk—i.e.,
the probability of a healthy individual contracting a particular disease during the
specified time period. In reporting cases, one individual should be reported only
once; relapses or exacerbations are not included. However, reinfection with a disease
is another matter.

The incidence rate measures the rapidity of occurrence of new cases. It answers
the question, “how frequently does a disease occur within a given period of time, say a
year?” It is usually used in the study of acute diseases (when it is usually higher than
prevalence), in outbreaks or epidemics (study of causation) and secular trends (changes
in disease patterns over short periods of time). It can be made a specific for age, sex,
etc., in the same manner as age specific mortality rates.

Incidence rate is obtained by the following formula:

= No. of new cases during a specified time x Factor

POPULATION IN THE AREA DURING THAT TIME

 A refinement of the incidence rate is the ATTACK RATE (AR), which is used only
for a limited population group and time period, usually during an outbreak or epidemic. It
is obtained by the ff. Formula:

=no. of new cases of a disease in a time period

population at risk during that time period x100

2. Prevalence Rate. When chronic diseases constitute the major medical problem
incidence rates cannot easily be obtained since few such diseases are reportable.
Reporting can usually be demanded only if one case of disease involves exposure of
other persons and disease constitutes a danger to public health. Thus, the prevalence
rate is the more commonly used morbidity measure in chronic disease.

Prevalence rate is a measure of the status of a particular disease within a given

point or interval of time. It answers the question, “what proportion of the population are
actually ill with a particular disease or are infected with a particular agent?” Unlike the
incidence rate, therefore, the prevalence rate does not measure the probability of getting
a particularly disease in a specified time period.

Prevalence rate is usually used in the study of chronic diseases (when it is usually
higher than incidence) and in computing for carrier rates, antibody levels, etc. As such, it
is a valuable tool for administrative purposes.

Prevalence rate is obtained by the following formula:

Point prevalence= no. of cases existing (old and new) at a time

Population surveyed during that time x100

As of July, 2021=

Period prevalence = No. of cases existing (old and new) at a given interval of time

population surveyed during that interval of time x100

For the period January to July, 2021=

INTERPRETATION OF VITAL STATISTICS

A=SOURCES OF DATA

1. Vital registration records. The Civil Registry Law (Act No. 3753) requires the
registration of all births and deaths including fetal deaths.

2. Weekly reports from field Health Personnel. Data on notifiable diseases are based on
information gathered from field health personnel. The Law on Reporting Notifiable
Diseases I(Act No. 3573) provides that any case of notifiable disease shall be reported
weekly through the nearest provincial and city health officer to the Disease Intelligence
Center (DIC) of the Ministry of Health.

3. Population censuses

B. CLASSIFICATION OF DATA

Guidelines in the classification of data:

1. Classification of Vital Events. All vital events are registered and reported
by place of occurrence, not by place of residence. Classified into regions,
provinces, and cities.

2. Reckoning of age. Age should be recorded as of the last birthday.

Oct 30, 2022 ====31 years

3. Classification of disease and causes of deaths.

The following are factors that should be taken into consideration in the interpretation of
rates:

1. Definition/Classification of the event in either numerator or Denominator. This

refers to the definition of certain terms like cause of death or maternal death and to the
accuracy of diagnosis of certain diseases.

2. Accuracy of the Court of event or population concerned. This refers mainly to

the completeness or adequacy of coverage of the count. In the Philippines, although the
law provides for the compulsory registration of births and deaths and the reporting of
notifiable diseases, there are still deficiencies in the observance of the law.

Factors that may affect the reporting/registration of vital events:

a. Not all diseases are notifiable/reportable in the country, so that it is

very difficult to obtain data on these diseases, which are not reportable.

Diseases which will be monitored by the rural health Midwife at least weekly:

¸ Measles

¸ Acute poliomyelitis

¸ Severe acute diarrhea

¸ Neonatal tetanus

¸ AIDS

- COVID 19

Diseases which should be reported within 24 hours:

¸ Acute poliomyelitis
 ¸ Measles

- Covid 19

b. Certain diseases like venereal diseases carry a social stigma so that

they are often times not discovered/reported easily.

c. Usually, only frank cases tend to be reported so that the milder forms of
certain diseases remain unnoticed.

d. Ignorance of or plain disregard for registration result to under

registration of such events.

3.Use of correct numerator/denominator. If the computation of the statistical

indices for the Philippines, standard formulas are used.

4. Magnitude/nature of the rate. When comparing rates, one should be sure

that the rates cover the same time period and that the groups under study are
comparable with regard to important factors that may influence the magnitude
of the rate.

Importance of Vital statistics in public health:

Serve as indices to assess the health status of the community

To pinpoint particular health problems

Determine the cause and effect of health problems

Directs attention to particular health problems

Evaluates needs or failures of public health programs

Create administrative standards for public health activities

Serve as justification demanding support for public health programs