Unit 2:

Community and Development Concepts,

Theories, and Strategies
(6 hours)

Introduction

Learning Outcomes

Upon the completion of this unit, the student will be able to:

 Discuss how theory-based practice achieves the goals of

community/public health by protecting and promoting the health of the
public.
 Relate the application of the PHC key principles in the implementation of
Public health programs.
 Demonstrate an understanding of the difference between health promotion
and health protection.
 Discuss the relationship of risk to health and health promotion activities.
 Demonstrate teamwork and coordination among members of the
community and others sectors

Topic 1: Community and Development Concepts, Theories, and Strategies

Activating Prior Learning

 Theories help us see overall themes across many specific types of behaviors or decisions
that influence community development. Create an illustration that depicts the relationship
of a theory to community development.

Presentation of Contents
THEORETICAL APPROACHES

A. General Systems Theory

- Is applicable to the different levels of the community health clientele
- Viewed as an OPEN SYSTEM, the client is considered as a set of interacting elements
that exchange energy, matter, or information with the external environment to exist (Katz
and Kahn, 1966; von Bertalannfy, 1968)
- The individual is a set of several dimensions- physical, psychological, social, and
spiritual-that are interdependent and interrelated.
- Family and the group or aggregate are sets of interrelated individuals.
- A geographic community is composed of a set of families.
 Family has the basic structures that all open system have:
o Boundaries- separate it from its environment as well as regulates its exchange
of matter, energy and information with its environment
o Culture and the Family Code dictate the boundaries of a Filipino
family
o Family Environment- constitutes everything outside its boundaries that may
affect it
 Immediate environment: Home and community
 Family gets inputs of matter, energy and information- resources taken
from its environment
 Output- material products, energy and information that result from
family’s processing(throughputs) of inputs.
 Examples: Health practices and Health status
 Feedback- information from the environment directed back to the system,
allows the system to make necessary adjustment for better functioning
o Subsystems- components of a system, interact to accomplish their own purpose
ant the purpose for which the system exists
e.g., family members
o Suprasystem- bigger system composed of families who interrelate with and affect
one another, whether purposely or unknowingly, making community problems
complex and multifaceted
e.g., community

B. Social Learning Theory

- Is based on the belief that learning takes place in a social context, that is, people learn
from one another and that learning is promoted by modeling or observing other people.
- Persons are thinking beings with self-regulatory capacities, capable of making decisions
and acting according to expected consequences of their behavior.
- The environment affects learning, but learning outcomes depend on the learner’s
individual characteristics (Bandura, 1977)

C. Health Belief Model

- Provides the basis for much of the practice of health education and health promotion
today
each indiv has each own perception
-
- Developed by a group of social psychologists t explain why the public failed to
participate in screening for TB
- Found that information alone is rarely enough to motivate one to act
- Individuals must know what to do and how to do it before they can take action
- The information must be related in some way to the individual’s needs
- One of the most widely used conceptual frameworks in health behaviour
- Used to explain behaviour change and maintenance of behaviour change and to guide
health promotion interventions
- The HBM is based on the assumption that the major determinant of preventive health is
disease avoidance.
- A major limitation of HBM is that it places the burden of action exclusively on the client.
It assumes that only those clients who have distorted or negative perceptions of the
specified disease or recommended health action will fail to act.
- has the significance in cph
- aligned to national level policy making
D. Milio’s Framework for Prevention - best way to favorably impact people b/c it's a policy
- this policy are driving factors that affects more people
- Nancy Milio (1976) -
- National-level policy making was the best way to favorably impact the health of most
people rather than concentrating efforts on imparting information in an effort to change
individual patterns of behavior.
- Proposed that health deficits often result from an imbalance between a population’s
health needs and its health-sustaining resources.
- Personal and societal resources affect the range of health-promoting or health-damaging
choices
- Personal resources: individual’s awareness, knowledge and beliefs and the beliefs of the
individual’s family and friends; money, time and the urgency of other priorities
- Societal resources: community and national conditions; availability and cost of health
services, environmental protection, safe shelter and penalties or regards for failure to
select the given options
- Health promoting choices must be more readily available and less costly than health
damaging options for individuals to gain health and for society to improve health status.

E. Pender’s Health Promotion Model

- Explores many PSYCHOSOCIAL FACTORS that influence individuals to pursue health
- aligned model to that health belief model
promotion activities. - much specific than the HBM
- outcome is directed to health promoting behaviour
- Depicts the complex multidimensional factors which people interact as they work to
achieve optimum health
- Pender’s model does not include threat as a motivator, as threat may not be a motivating
factor for clients in all age groups.

F. The Transtheoretical Model - puts emphasis on the concept of change and combines several
theories and intervention
- Combines several theories of intervention - TTM can be used as an approach to community
- TTM is based on the assumption that behavior change takes place over time, progressing
through a sequence of stages.
- It also assumes that each of the stages is both stable and open to change.
- The TTM and Change
 - Change is difficult, even for the most motivated of individuals. People resist change for
many reasons. - preceede-to have a based line data or profile of the community before
intervining
- Proceed-implementation of programs (policies that are formed)
G. Precede-Proceed Model
- Developed by Dr. Lawrence W. Green and colleagues
- Provides a model for community assessment, health education planning, and evaluation.

- PRECEDE  stands for Predisposing, Reinforcing, and Enabling Constructs in

Educational Diagnosis and Evaluation
 used for community diagnosis

- PROCEED  stands for Policy, Regulatory, and Organizational Constructs in

Educational and Environmental Development
 a model for implementing and evaluating health programs based on PRECEDE
- impact assessment

Topic 2: Primary Health Care

Presentation of Contents

Declaration of Alma-Ata 1978

Section VII
Primary Health Care
1. Reflects and evolves from the economic conditions, socio-cultural and political
characteristics of the country, and its communities, and is based on the application of the
relevant results of social, biomedical and health services research and public health
expenditures
2. Address the main health problems in the community, providing promotive, preventive,
curative and rehabilitative services accordingly
3. Includes at least – education about prevailing health problems and the methods of
preventing and controlling them; promotion of food supply and proper nutrition; an
adequate supply of safe water and basic sanitation; maternal and child health care,
including family planning; immunization against major infectious diseases; prevention
and control of locally endemic diseases; appropriate treatment of common diseases and
injuries; and provision of essential drugs.
4. Involves in addition to the health sector, all related sectors and aspects of national and
community development in particular, agriculture, animal husbandry, food industry,
education housing, public works, communication and other sectors; and demands the
coordinated efforts of all those sectors
5. Requires and promotes maximum community and individual self-reliance and
participation in the planning, organization, operation and control of primary health care,
 making fullest use of local, national and other available resources; and to this end
develops through appropriate education the ability of communities to participate
6. Should be sustained by integrated, functional and mutually supportive referral system
leading to the progressive improvement of comprehensive health care for all, and giving
priority to those in need
7. Relies at the local and referral levels of health workers, including physicians, nurses,
midwives, auxiliaries and community workers as applicable, as well as traditional
practitioners as needed; who are suitably trained, socially and technically, to work as a
health team and to respond to the expressed health needs of the community.

All for Health towards Health for All - THE DUTERTE HEALTH AGENDA
Values
 Filipinos able to access services with least financial, cultural and geographical
barriers
 Preference for the underserved
 Filipinos able to demand quality and compassionate services at par with global
clinical and non-clinical standards
 Filipinos able to continuously get the most health from resources allocated (cost-
effective)
 Filipinos able to make informed choices with respect to their health/care and
participate in holding the government accountable to the people

Vision
 Financial Protection
o Filipinos protected from health-related impoverishment
 Better Health Status
o Filipinos attain best possible health outcomes with less disparity
 Responsiveness
o Filipinos feel respected and valued in all of their interaction with the health system

Strategy

Triple Burden of Disease

a. SERVICES THAT ADDRESS THE TRIPLE BURDEN OF DISEASE
o Communicable
o Non-communicable, including malnutrition
o Diseases of rapid urbanization and industrialization (e.g. Injuries, mental health
(including suicide prevention) and alcohol /drug use)
b. SERVICES THAT CORRESPOND TO THE FULL SPECTRUM OF CARE FOR ALL LIFE
STAGES (minimal exclusions)
o Promotive, preventive, curative, rehabilitative, palliative
o Emphasis on role of health promotion and primary care (annual health check)
c. INTERVENTIONS THAT MODIFY BUILT ENVIRONMENT AND MOBILIZE
COMMUNITIES
o Trigger behavioral shift towards healthy lifestyle/habits
o Adopt and scale-up community-based interventions
 o Create strategic partnerships to promote healthy homes, workplaces, schools and
transport

Service Delivery Network

a. NETWORKS AS CONTRACTED UNITS OF PHILHEALTH, ACCOUNTABLE FOR
ENSURING:
o Appropriate, ethical and at par with clinical and non-clinical standards
o Physical access
o Seamless continuum of services
o Patient/client-friendly and culturally-sensitive services
b. NETWORKS ENHANCED BY RELIABLE DATA & REGULAR FEEDBACK
o Mandate online submission/data sharing and reporting to disease registries
o Obtain accurate feedback: e.g. ghost patients, surprise field visits
o Streamline monitoring and evaluation systems and create dedicated performance unit
c. NETWORKS RESILIENT IN TIMES OF DISASTER
o Strengthen preparedness initiatives

Universal Health Insurance

 PHILHEALTH AS GATEWAY TO FINANCIAL ACCESS TO SERVICES and
PROTECTION FROM CATASTROPHIC SPENDING
 PHILHEALTH AS MEANS TO SUSTAINABLY FINANCE GOODS AND SERVICES

PRIMARY HEALTHCARE
 The WHO defines PHC as:
“Essential health care made universally, accessible to individuals & families in the
community by means of acceptable to them, through their full participation & at a
cost that community and country can afford to maintain at every stage of their
development in the spirit of self-reliance & self-determinations”

History of PHC:
 May 1977- The 30th World Health Assembly adopted resolution WHA 3043, which
decided that the main social target of the government & WHO should be the
attainment of a level of health that would lead people to a socially & economically
productive life by year 2000.
 “Health for all by year 2000
 September 6-12, 1978: First International Conference in PHC was held at Alma Ata,
USSR (Russia) on PHC
 PHC is the key to attain of “Health for All” goal
 October 19, 1979: LOI 949. Legal Basis of PHC in the Philippines.
o Issued by Pres. F. Marcos, which mandated the Ministry of Health to adopt
PHC as approach towards design, development, and implementation of
programs which focus health development at the community level.
 September 11, 1981: Launching of PHC by Sec. Azurin in the Philippines.
 1990: Health in the hands of the people by year 2020.
  AO No. 11 of 1993: Installed PHC as a course strategy in program thrusts of the
government at national and local community leaders to enable their people in active
participation for better health and self-reliance

The Alma Ata Conference on PHC made the following declarations:

 Health is a basic fundamental right.
 There exists global burden of health inequalities among populations.
 Economic and social development is of basic importance for the full attainment of health
for all.
 Governments have a responsibility for the health of their people.

Why adopt PHC?

 Magnitude of health problems
 Inadequate and unequal distribution of health resources
 Increasing cost of medical care
 4 Pillars or Cornerstone:
> Active community participation
> Intra & inter-sectoral linkages
> Use of appropriate technology
> Support mechanism made available

ESSENTIAL HEALTH SERVICES OF PHC:

 Education for Health
 Locally Endemic Disease Control
 Expanded Program on Immunization
 Maternal and Child Health and Family Planning
 Envi’l Sanitation and Promotion of Safe Water Supply
 Nutrition and Promotion of Adequate Food Supply
 Treatment of CD and Common Illness
 Supply of Essential Drugs

Primary Health Care Principles and Strategies

 ACCESSIBILITY
o physical distance of a health facility or the travel time required for people to get
the needed or desired health services.
o in order for these facilities to be accessible, they must be within 30 minutes from
the communities.
 AFFORDABILITY
o not only in the consideration of the individual or family’s capacity to pay for basic
health services.
o particularly for public health services, it is also a matter of whether the
community or government can afford these services.
 ACCEPTABILITY
o the health care offered is in consonance with the prevailing culture and traditions
of the population.
  AVAILABILITY
o a question of whether the basic health services required by the people are offered
in the health care facilities or is provided on a regular and organized manner.

PHC workers
In general, the PHC team may consist of:
 Physician
 Nurses
 Midwives
 Nurse auxiliaries
 Locally trained community health workers
 Traditional birth attendants and healers

Three Levels of PHC Workers

1. Village or Grassroot Health Workers
a. first contacts of the community and initial links of health care
b. provide simple curative and preventive health care measures promoting healthy
environment
c. trained community health workers, volunteers or traditional birth attendants or
healer
2. Intermediate level health workers
a. represent the first source of professional health care
b. attends to health problems beyond the competence of village workers
c. provide support to the front-line health workers in terms of supervision, training,
supplies, and services
d. General Medical practitioners, PH nurses
3. First Line Hospital Personnel
a. provide back up health services for cases that require hospitalization or diagnostic
facilities not available in the health center
b. establish close contacts with intermediate level health workers or village health
workers to promote community of care from hospital to community and home
c. Physicians with specialty, nurses, dentist, pharmacists, other health professionals
who are working in primary hospitals.

Levels of Health Care Facilities

1. Primary Level
• The “first” level of contact between the individual and the health
system.
• Serves as the foundation of health care based upon which
progressive levels of care are restructured.
• RHUs, their sub-centers, chest clinics, malaria eradication units, and
schistosomiasis control units, puericulture centers, TB clinics and
hospitals
• Provide basic curative, preventive, heath care measures
• First aid
2. Secondary Level
 • The 1st referral level
• Consists of a smaller , non-departmentalized hospitals including
emergency and regional hospitals.
• Services are offered to patients with symptomatic stage of disease,
which require moderately specialized knowledge and technical
resources for adequate treatment.
3. Tertiary Level
• Are highly technological and sophisticated services offered by
medical centers and large hospitals
• These are the specialized national hospitals.
• Services rendered at this level are for clients afflicted with diseases
which seriously threaten their health and which require highly
technical and specialized knowledge, facilities, and personnel to treat
effectively.
• Provide training programs

The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s)
Appropriateness
Availability
Adequacy
Accessibility
Acceptability
Affordability
Assessability
Accountability
Completeness
Comprehensiveness
Continuity
Appropriateness

TRADITIONAL AND ALTERNATIVE HEALTH CARE

RA 8423 or the TRADITIONAL & ALTERNATIVE MEDICINE ACT OF 1997

- this created the Philippine Institute of Traditional and Alternative Health Care, which is
tasked to promote and advocate the use of traditional and alternative health care
modalities through scientific research and product development.
RA 8423 defined TRADITIONAL MEDICINE as…
- “the sum total of knowledge, skills, and practice on health care, not necessarily explicable
in the context of modern, scientific, philosophical framework, but recognized by the
people to help maintain and improve their health towards the wholeness of their being,
the community and the society, and their interrelations based on culture, history, heritage,
and consciousness”
ALTERNATIVE HEALTH CARE
- Other forms of nonallopathic, occasionally nonindigenous or imported healing methods,
though not necessarily practiced for centuries nor handed down from one generation to
another.
  10 MEDICINAL PLANTS ENDORSED BY THE DOH
 ALTERNATIVE HEALTHCARE MODALITIES

Topic 3: The Health Care Delivery System

Activating Prior Learning

Create a diagram of the Health Care Delivery System in the Philippines.

Presentation of Contents

What is a HEALTH SYSTEM?

• Consist of all organizations, people, and actions whose primary intent is to promote,
restore, or maintain health
• Has 6 building blocks or components:
1. Service delivery
2. Health workforce
3. Information
4. Medical products, vaccines, and technologies
5. Financing
6. Leadership and governance or stewardship

Health Care System

• an organized plan of health services (Miller-Keane, 1987)

Health Care Delivery

• rendering health care services to the people (Williams-Tungpalan, 1981).

Health Care Delivery System

• the network of health facilities and personnel which carries out the task of rendering
health care to the people. (Williams-Tungpalan, 1981)

Philippine Health Care System

• is a complex set of organizations interacting to provide an array of health services
(Dizon, 1977).
The Department of Health
 serves as the main governing body of health services in the country
 responsible for ensuring access to basic public health services to all Filipinos through the
provision of quality care and regulation of providers of health goods and services

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