COLLEGE OF NURSING

MODULE 5: DEVELOPMENT CONCEPTS, PRINCIPLES AND STRATEGIES

OVERVIEW OF THE MODULE:

This lesson further discusses primary health care and its link to development –
the international and local basis of health and development in the context of CHN
practice and primary health care. Related policies and principles linked to
community health nursing and an example of community health practice in other
setting are presented. This will also further the discussion of recent trends to
improve the global and local state, and the development of Sustainable
Development Goals and the FOURMula Plus as strategies towards health and
wellness.

LEARNING OUTCOMES:
At the end of the lesson, student is expected to:
 Utilize the primary health care approach to provide holistic care to clients
 Identify the legal basis of primary health care in the Philippines
 Draw inspiration from CHN principles to develop interest in lifelong
learning

OBJECTIVES:
 Recognize the role of community health nurse in achieving sustainable
development
 Develop community health nursing possible interventions in achieving
health and development
 Identify barriers to solving health problems and achieving health goals
DISCUSSION:

The World Health Organization (WHO) defines health inequity as

“avoidable inequalities in health between groups of people within and between
countries.” These inequities arise from inequalities within and between societies.
Social and economic conditions and their effects on people’s lives determine
their risk of illness and the actions taken to prevent them becoming ill or treat
illness when it occurs (WHO 2005). To address these health inequities,
strategies to advance health evolved, particularly during the introduction of
primary health care derived from 1978 Alma-Ata declaration.

As public health and community health nursing continued to evolve,

nurses shaped themselves important roles in primary health care. Ideally, nurses
provide care to the sick and provide health education to the healthy to promote
health and prevent diseases. In practice, nurses are involved in policymaking,
disaster risks management, industrial safety, sanitation and environment, gender
equality initiatives, peace and order, and population and development among
others.

In 2000, a health goal was set by 189 United Nation member states, the
Millennium Development Goals, which was set and agreed upon to be achieved
by the year 2015. Moving forward, to continue the global development efforts, 17
Sustainable Development Goals (SDG) were adopted by governments in 2015.
 The 17 goals are presented thematically, but all of these goals are
interconnected. Imagine a community with peace issues and huge gender
inequality, would they achieve education and health goals (or vice-versa)?
Hence, in the context of development and community health nursing practice, we
promote health and prevent diseases by developing strategy which touches all
possible factors which may have direct or indirect impact to people’s health.

Among the 17 SGDs, one has special focus on health is the SDG 3 -
“Ensure healthy lives and promote wellbeing for all at all ages”.

This goal is translated into 13 targets: three relate to reproductive and

child health; three to communicable diseases, non-communicable diseases, and
addiction; two to environmental health; and one to achieving universal health
coverage (UHC). Four further targets relate to tobacco control, vaccines and
medicines, health financing and workforce, and global health risk preparedness
(Pettigrew, Maeseneer, Anderson, Essuman, Kidd, and Haines 2015).

🔎 SDG 3: Ensure healthy lives and promote wellbeing for all at all ages
Learning is progressive and it happens in several domains: cognitive, affective
and psychomotor:
3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100
000 live births.

3.2 By 2030, end preventable deaths of newborns and children under 5 years
of age, with all countries aiming to reduce neonatal mortality to at least as low
as 12 per 1000 live births and under-5 mortality to at least as low as 25 per
1000 live births.

3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected
tropical diseases and combat hepatitis, water-borne diseases and other
communicable diseases.

3.4 By 2030, reduce by one third premature mortality from non-communicable

diseases through prevention and treatment and promote mental health and
well-being.

3.5 Strengthen the prevention and treatment of substance abuse, including

narcotic drug abuse and harmful use of alcohol.
3.6 By 2020, halve the number of global deaths and injuries from road traffic
accidents.

3.7 By 2030, ensure universal access to sexual and reproductive health-care

services, including for family planning, information and education, and the
integration of reproductive health into national strategies and programs.

3.8 Achieve universal health coverage, including financial risk protection,

access to quality essential health-care services and access to safe, effective,
quality and affordable essential medicines and vaccines for all.

3.9 By 2030, substantially reduce the number of deaths and illnesses from
hazardous chemicals and air, water and soil pollution and contamination.
3.a Strengthen the implementation of the WHO Framework Convention on
 Tobacco Control in all countries, as appropriate.
3.b Support the research and development of vaccines and medicines for the
communicable and non-communicable diseases that primarily affect
developing countries, provide access to affordable essential medicines and
vaccines, in accordance with the Doha Declaration on the TRIPS Agreement
and Public Health, which affirms the right of developing countries to use to the
full the provisions in the Agreement on Trade-Related Aspects of Intellectual
Property Rights regarding flexibilities to protect public health, and, in particular,
provide access to medicines for all.

3.c Substantially increase health financing and the recruitment, development,

training and retention of the health workforce in developing countries,
especially in least developed countries and small island developing States.

3.d Strengthen the capacity of all countries, in particular developing countries,

for early warning, risk reduction and management of national and global health
risks.
Source: Sustainable Development Goals - WHO

Although different countries have different state of health and political

priorities, the SGD 3 still serve as a guide for health programming like in the
Philippines. It has already been acknowledged the community health nurses play
an important role in meeting the SDG 3, in particular, primary health care can
contribute to the achievement of other SDGs; like in addressing social
determinants of health which includes education, gender equality, poverty
alleviation, and reduction on inequalities among others.

Department of Health and Philippines’ National Objective for Health (2017

to 2022)

To respond to the challenges of improving the health of Filipinos, the

Department of Health pursues FOURmula One Plus (F1 Plus) for Health,
which is aimed to provide Universal Health Care (UHC) for all Filipinos. F1
Plus has three strategic goals:

Goal 1. Better Health Outcomes

The health sector will sustain gains and address new challenges especially in
maternal, newborn and child health, nutrition, communicable disease
elimination, and non-communicable disease (NCD) prevention and treatment.
Improvements in health outcomes will be measured through sentinel indicators
such as life expectancy, maternal and infant mortalities, NCD mortalities, TB
incidence, and stunting among under-five-year-olds.

Goal 2. More Responsive Health System

The quality of health goods and services as well as the manner in which they
are delivered to the population will be improved to ensure people-centered
healthcare provision. This may be done through instruments that routinely
monitor and evaluate client feedback on health goods used and services
received.

Goal 3. More Equitable Health Care Financing

Access of Filipinos, especially the poor and underserved, to affordable and
quality health goods and services will be expanded through mechanisms that
provide them with adequate financial risk protection from the high and
unpredictable cost of healthcare. These may include efforts to reduce
catastrophic out of pocket payments, such as through public subsidies targeted
towards the poor.

Vision: Filipinos are among the healthiest people in Southeast Asia by 2022
and Asia by 2040

Mission: To lead the country in the development of a Productive, Resilient,

Equitable and People-centered health system for Universal Health Care

Community health nurses have the potential to make significant contributions

to meet the F1 Plus goals and the health care needs of various population
groups in a variety of community settings.

Community health nurses as an important member of the public health team

are challenged to continue to develop along: educational preparation of nurses
and CHNs and strengthening advocacy and support for CHNs.

F1 Plus Strategy Map

 Source: DOH 2018 (National Objectives for Health)

Essential components of Community Health Nursing

Community health nurses providing community health services play key
roles in advancing primary health care of population groups in a variety of
community settings: this includes disease or injury prevention, disability
alleviation or rehabilitation and health promotion, as well as managing and
providing care and follow-up. Nursing interventions in community health practice
involves developing, planning, implementing and evaluating population-focused
and people-centered program and services, which are culturally and contextually
responsive.

Key elements of CHN Practice

 Assessment of entire population needs – the health and health care

needs of a population are assessed using systematic approaches aimed
at identifying sub-populations, families and individuals who might benefit
from health promotion programs, or who are at risk of illness, injury,
disability or premature death.
 Identification and articulation of the multiple determinants of health in
communities.
 CHNs often work to provide solutions that address biological, physical,
social and environmental causes of illness. Through the planning of
program and promotion of policy changes, interventions are developed
in collaboration with the community, helping to meet locally identified
needs, take into account available resources and consider other related
activities that might contribute to better health outcomes.
 Effective and equitable implementation of public health plans and
policies.
 Conduct of evaluations to determine the extent to which CHN programs
 impact the health status of individuals and populations.
 Use of evaluation results to inform further research, influence and direct
the delivery of care services, deployment of health resources, and
development of local, national and regional health policies to promote
health and prevent disease.
Source:
WHO – Enhancing the Role of
Community Health Nursing for UHC

Community Health Nursing Practice in the Philippines

The nursing practice in public and community health in the country is

anchored on nursing models and local policies. Policies ranges from national
laws, administrative orders, health guidelines, and local policies at the local
government unit level.
R.A. 9173 “Philippine Nursing Act of 2002”
Under the Philippine Nursing Law, the scope of nursing practice has been
defined. It described the nursing practice shall be performed by a registered
nurse singly or in collaboration with a team, to initiate and perform nursing
services to individuals, families, infancy, childhood, toddler, preschool, school
age, adolescence, adulthood, and old age.

It also highlighted the primary role of nurses towards health promotion and
disease prevention, which includes curative, preventive, and rehabilitative
aspects of care, restoration of health, alleviation of suffering, and when
recovery is not possible, towards a peaceful death. Salient point of the law
along CHN practice is that it states that nurses have the duty to provide health
education to individuals, families and communities.
Source: (Official Gazette of the Philippines) R.A. 9173 Philippine Nursing Act

R.A. 1082 “Rural Health Unit Act”

This law mandates local government units to create rural health units: a senior
rural health unit with one municipal health officer as head of the unit, one public
health nurse, one mid-wife and one sanitary inspector; and a junior rural health
unit consisting of one physician or public health nurse as head of the unit and
one midwife or sanitary inspector.
Source: (R.A. 1082 - An Act Strengthening Health and Dental Services in The Rural Areas, And Providing Funds Therefor)

R.A. 7160 “Local Government Code”

In light with empowering local government units of becoming self-reliant
communities and more responsive and accountable local government, health
governance is decentralized through this law. This means that the health
governance is devolved, hence, the powers, functions and responsibilities in
health governance is owned by the local government both rural & urban.

Pursuant to this law, each province, city and municipality has a Local Health
Board which is mandated to propose annual budgetary allocations for the
operation and maintenance of their own health facilities. Nurses in the
community working in the rural health unit are directly involved in ensuring
health and health rights are equitably discussed and attended to by the local
health board and the local government unit.
Source: (R.A. 7160 – Local Government Code of 1991)

Other settings of CHN Practice: DepEd School Nursing

Schools are considered as a miniature community where young people are m
mostly found. This space enabled population-based programs such as
vaccination and nutrition program to happen, which is specific to an aggregate
young population.

Key functions include health nutrition and education, healthful school living,
health and nutrition services, school-community coordination for health and
nutrition and other related health and nutrition activities. With the increasing
prevalence of teenage pregnancy, substance abuse and violence, health
programs expanded and Oplan Kalusugan (OK sa DepEd) was established in
2018. This program aims to:
a) have efficient implementation of school-based health and nutrition
programs and services, through rational programming in terms of
resources and services to optimize the results of the five flagship
programs of OK sa DepEd,
b) provide all public-school learners with health and nutrition services to
allow them to attain their full educational potential,
c) ensure wellness of DepEd personnel through the provision of basic
medical care for better productivity,
d) generate information on the health and nutrition records of all learners
as a basis for planning and programming, and
e) maximize opportunities for better and wider coverage of health and
nutrition services delivery, through close collaboration with various
partners and stakeholders especially at the school level.
Source: (Llego 2019) Depart of Education - OK sa DepEd)

Grounded on these policies, the CHN practice in the Philippines involves

working with multi-sectoral and inter-disciplinary team, leadership and
management, program planning and implementation, monitoring and
evaluation, research, networking and linkage building, advocacy, and training
and education.
EVALUATION:

📝 Activity 1: Find the connection or interrelatedness of the SDGs and F1 Plus.

List down your findings. Using secondary information (by asking a public health
worker/nurse you know or researching through the internet), what can community
health nurses do to help achieve these goals?
📝 Activity 2: Barangay Burabod is an urban village in Sorsogon City. It has
2,900 population (Census 2015). According to the 2015 Census, the age group
with the highest population in Burabod is 15 to 19, with 279 individuals.
Conversely, the age group with the lowest population is 75 to 79, with 37
individuals. Although it is an urban village, a quarter of its geographic territory are
rice farms. Most of the families rely on farming as their main source of income.
Every harvest season, the local farmers burn the excess or waste of the rice
fields. It was documented that a number of absences in schools are being
reported during this season, and the village health station receives a spike of
difficulty of breathing, asthma, and pneumonia like symptoms. Same reports
were documented by adjacent villages.

1. As a community health nurse working in the City Health Unit, what are
your legal responsibilities in this situation? Support your answer.
2. List down possible actions or recommendations in order to address the
health problem.
3. Identify possible barriers or challenges you may encounter upon solving
the problem. How will you overcome these problems?
Activity 2.
REFERENCES:
WHO (2005), “Commission on Social Determinants of Health - Social
determinants of health; key concepts”, retrieved from
“https://www.who.int/social_determin
ants/thecommission/finalreport/key_concepts/en/”
WHO (2020), “Sustainable Development Goals - SDG 3: Ensure healthy lives
and promote wellbeing for all at all ages”, retrieved from
“https://www.who.int/sdg/targets/en/”?
Department of Health (2018), “National objectives for health: Philippines 2017-
2022”, Health Policy Development and Planning Bureau, Manila, Philippines
WHO (2017), “Enhancing the role of community health nursing for universal
health coverage: Human Resources for Health Observer Series No. 18”,
Geneva, Switzerland
Official Gazette, “R.A. 9173 Philippine Nursing Act of 2002”, “R.A. 1082 Rural
Health Unit Act”, and “R.A. 7160 – Local Government Code of 1991”
retrieved from “https://www.officialgazette.gov.ph/”
Llego (2019), “2019 Oplan Kalusugan (OK sa DepEd) Overview” retrieved from
“https://www.teacherph.com/oplan-kalusugan-ok-sa-deped/”