Community Health Nursing I

(Individual And Family)

Prepared by:
Mrs. Lavinia T. Malabuyoc, MAN,R.N
Healthcare Delivery System
“the totality of all policies, facilities, equipment, products,
human resources and services which address the health
needs, problems and concerns of the people. It is large,
complex, multi-level and multi-disciplinary.”
rendering of health care services to the people
A health care delivery system is an organization of people,
institutions, and resources to deliver health care services to
meet the health needs of a target population.
Healthcare Delivery System
The healthcare delivery system in the Philippines is
dominated by the public sector (regional, provincial,
municipal, and barangay level) while being supported by
private healthcare service providers. The implementation of
Universal Health Care (UHC) is already driving the demand
across all sectors of healthcare.
Private hospitals tend to be rated higher in terms of facilities
and technologies offered; they are also more expensive because
government hospitals don't charge any fees.
Types Of Healthcare Delivery System
Exclusive Provider Organization (EPO) EPO's have a
network of providers who have agreed to provide care
for the members at a discounted rate.
Health Maintenance Organization (HMO) ...
Integrated delivery system (IDS) ...
Preferred Provider Organization (PPO) ...
Point-of-Service (POS) Plan.
 OBJECTIVES Of Healthcare Delivery System
The primary objectives of any health delivery
system are to enable all citizens to receive health
care services whenever needed, and to
deliver health services that are cost-effective and meet
pre-established standards of quality.
 In the Philippines the components of the health care delivery system as
The Philippine Health Care Delivery
mandate of the Department of Health (DOH) is to be responsible for
the following: 
 formulation and development of national health policies, guidelines,
standards and manual of operations for health services and programs
issuance of rules and regulations, licenses and accreditations; 
promulgation of national health standards goals, priorities and
indicators;
development of special health programs and projects and advocacy
for legislation on health policies and programs.
PRIMARY FUNCTION OF DOH
is the promotion, protection, preservation or
restoration of the health of the people through the
provision and delivery of health services and through
the regulation and encouragement of providers of
health goods and services (E.O. No. 119, Sec. 3).
BASIC HEALTH SERVICES UNDER OPHS OF DOH
E ducation regarding Health
L ocal Endemic Diseases
E xpanded Program on Immunization
M aternal & Child Health Services
E ssential drugs and Herbal plants
N utritional Health Services (PD 491): Creation of Nutrition Council
of the Phils.
T reatment of Communicable & Non communicable Diseases
S anitation of the environment (PD 856): Sanitary Code of the
Philippines
D ental Health Promotion
A ccess to and use of hospitals as Centers of Wellness
M ental Health Promotion
VISION BY 2030 (DREAM OF DOH)
A Global Leader for attaining
better health outcomes,
competitive and responsive
health care systems, and
equitable health financing
 MISSION of DOH
To guarantee EQUITABLE,
SUSTAINABLE and QUALITY
health for all Filipinos, especially
the poor and to lead the quest for
excellence in health
Principles to attain the vision of DOH
Equity: equal health services for all-no discrimination
Quality: DOH is after the quality of service not the
quantity
Philosophy of DOH: “Quality is above quantity”
Accessibility: DOH utilize strategies for delivery of
health services
THREE STRATEGIES IN DELIVERING HEALTH SERVICES
(ELEMENTS)
" Creation of Restructured Health Care Delivery
System (RHCDS) regulated by PD 568 (1976) "
Management Information Systems regulated by
R.A. 3753: Vital Health Statistics Law
 " Primary Health Care (PHC) regulated by LOI
949 (1984): Legalization of Implementation of
PHC in the Philippines
CREATION OF RHCDS RHO
(National Health Agency) or existing national
agencies like PGH or specialized agencies like Heart
Center for Asia, NKI MHO & PHO
(Municipal/Provincial Health Office)
BHS & RHU (Barangay Health Station/Rural Health
Unit)
3 LEVELS OF HEALTH CARE PROMOTION
. Primary-prevention of illness or
1

promotion of health
2. Secondary-curative
3. Tertiary-rehabilitative
Primary prevention
those preventive measures that
prevent the onset of illness or injury
before the disease process begins.
Examples include immunization and
taking regular exercise.
Secondary prevention
those preventive measures that lead to early diagnosis
and prompt treatment of a disease, illness or injury to
prevent more severe problems developing.
 Here health educators such as Health Extension
Practitioners can help individuals acquire the skills of
detecting diseases in their early stages.
Examples include screening for high blood pressure and
breast self-examination.
Tertiary prevention
those preventive measures aimed at
rehabilitation following significant illness.
At this level health services workers can
work to retrain, re-educate and rehabilitate
people who have already developed an
impairment or disability.
According to Increasing Complexity According to the Type of
of the Services Provided Service
Type Service Type Example
Primary Health Promotion, Preventive Health Promotion Information
Care, Continuing Care for and illness Dissemination
common health problems, Prevention
attention to psychological and
social care, referrals
Secondary Surgery, Medical services by Diagnosis and Screening
Specialists Treatment
Tertiary Advanced, specialized, Rehabilitation PT/OT
diagnostic, therapeutic &
rehabilitative care
 PRIMARY LEVEL SECONDARY TERTIARY
Health Promotion and
Illness Prevention LEVEL LEVEL
Prevention of Prevention of Disability
Complications Early Dx
and Tx
. Provided at – •When hospitalization is •When highly-specialized
•Health care/RHU ! Brgy. deemed necessary and medical care is necessary
Health Stations referral is made to • referrals are made to
•Main Health Center emergency (now district), hospitals and medical
•Community Hospital and provincial or regional or center such as PGH, PHC,
Health Center private hospitals POC, National Center for
• Private and Semi-private Mental Health, and other
agencies gov’t private hospitals at
the municipal level
Referral System in Levels of the Health Care:
" Barangay Health Station (BHS) is under the
management of Rural Health Midwife (RHM) "
Rural Health Unit (RHU) is under the management or
supervision of PHN "
Public Health Nurse (PHN) caters to 1:10,000
population, acts as managers in the implementation of
the policies and activities of RHU, directly under the
supervision of MHO (who acts as administrator)
REFERRAL SYSTEM:
BHS→ RHU→ MHO→
PHO→ RHO→ National
Agencies→ Specialized
Agencies
CHARACTERISTICS OF PHC
Acceptable
Accessible
Affordable
Available
Sustainable
Attainable
UTILIZES APPROPRIATE TECHNOLOGIES USED BY PHC:
ACCEFS
A ffordable, accessible, acceptable, available
C ost wise=economical in nature
C omplex procedures which provide a simple outcome
 E ffective
F easibility of use=possibility of use at all times
S cope of technology is safe & secure
SENTRONG SIGLA MOVEMENT (SSM)
was established by DOH with LGUs having a logo of a
Sun with 8 Rays and composed of
4 Pillars:
1. Health Promotion
2. Granted Facilities
3. Technical Assistance
4. Awards: Cash, plaque, certificate
4 CONTRIBUTIONS OF PHC TO DOH & ECONOMY:
Training of Health Workers
Creation of Botika sa Baryo & Botika sa
Health Center
Herbal Plants
Oresol
A. TRAINING OF HEALTH WORKERS
3 Levels of Training:
Grassroot/Village
Includes Barangay Health Volunteers (BHV) and Barangay Health
Workers (BHW)
Non professionals, didn’t undergo formal training, receive no salary
but are given incentive in the form of honorarium from the local
government since 1993
Intermediate - these are professionals including the 8 members of
the PHWs
First Line Personnel - the specialist
B. CREATION OF “BOTIKA SA BARYO & BOTIKA SA HEALTH
CENTER”
RA 6675: Generics Act of 1988: Implementing
“Oplan Walang Reseta Program”-solution to the absence
of a medical officer who prescribed the medicines so
PHN are given the responsibility to prescribe generic
medicines and
 “Walong Wastong Gamot Program”- available generics
in “Botika sa Baryo” & Health Center
 Father of Generics Act: Dr. Alfredo Bengzon
8 COMMONLY AVAILABLE GENERICS (CARIPPON
. Co-Trimoxazole:
it’s a combination of 2 generics of drugs which is antibacterial
Trimethoprim(TMP)
Has a bacteriostatic action that stops/inhibits multiplication of
bacteria
For GUT, GIT & URTI (TMP combined with SMX)
 Sulfamethoxazole (SMX)
Has bactericidal action that kills bacteria
For GUT, GIT, URTI & Skin Infections
8 COMMONLY AVAILABLE GENERICS (CARIPPON
. Amoxicillin/Ampicillin
An antibacterial drug that comes from the Penicillin
family
Effect is generally bacteriostatic (when source of
infection is bacterial)
These 2 drugs provide the least sensitivity reaction
(rashes & GI) and the adverse effect of other
antibiotics is anaphylactic shock
8 COMMONLY AVAILABLE GENERICS (CARIPPON
. TBDRUGS:
Rifampicin (RIF)
Isoniazid (INH)
Pyrazinamide (PZA)
8 COMMONLY AVAILABLE GENERICS (CARIPPON
. Paracetamol
Has an analgesic & anti-pyretic effect
Acetyl Salicylic Acid (ASA) or Aspirin is never
kept in the “Botika” because of its effects:
Anticoagulant-highly dangerous to Dengue
patients that’s why it’s not available in “Botika”
& Health Center )
8 COMMONLY AVAILABLE GENERICS (CARIPPON
. Oresol:
a management for diarrhea to prevent
dehydration under the Control of Diarrheal
Diseases (CDD) Program
8 COMMONLY AVAILABLE GENERICS (CARIPPON
Nifedipine:
An anti-hypertensive drug
According to DOH, 16% of population
belonging to 25 years old & above in the
community are hypertensive
8 COMMONLY AVAILABLE GENERICS (CARIPPON
Nifedipine:
An anti-hypertensive drug
According to DOH, 16% of population
belonging to 25 years old & above in the
community are hypertensive
Health Indicators
Morbidity Refers to having a disease or a symptom of
disease, or to the amount of disease within a population. It
also refers to medical problems caused by a treatment.
Crude Birth Rate (CBR) - Overall total reported births
Morbidity-Illnesses affecting the population group
Incidence Rate (IR)-reported new cases affecting the
population group
Prevalence Rate (PR)-determine sum total of new + old
cases of diseases per percent population
Health Indicators
Mortality-Reports causes of deaths
Crude Death Rate (CDR)-overall total reported death
Maternal Mortality Rate (MMR)-maternal deaths due to
maternal causes !Infant Mortality Rate (IMR)-# of infant
deaths (0-12 months) or less than 1 year old
Neonatal Mortality Rate (NMR)-# of deaths among
neonates (newborn 0-28 days, < 1 month)
Swaroops Index (SI)-deaths among individual in the age
group of 50 and above
CRUDE BIRTH RATE (CBR)
CBR= Overall total reported births x 1000
Population
(number of births) divided by (total population) then
multiply by 1000
INCIDENCE RATE (IR)
IR= new cases of disease x 100
Population
PREVALENCE RATE (PR):
PR= new cases + old cases x 100
Population
CRUDE DEATH RATE (CDR)
CDR = overall total deaths x 1000
Population
MATERNAL MORTALITY RATE (MMR)
MMR= # of maternal deaths x 1000

RLB
INFANT MORTALITY RATE (IMR)
IMR = # of infant deaths x 1000

RLB
NEONATAL MORTALITY RATE (NMR)
NMR = # of neonatal deaths x
1000
RLB
SWAROOP’S INDEX (SI)
SI= # of deaths (individual >50 years old) x 100
Total Deaths