LEVELS OF CLIENTELE IN THE

COMMUNITY 2. FAMILY
- basic unit of society
1. Individual
refers to 2 or more individuals joined or
● nurses provide care to specific related by ties of blood, marriage or
clients/patients adoption and who constitute a single
● from being healthy/well - dying household.
● considered as “Entry Point” in
working with families/community\ interact with each other in their
● FOCUS of Care = the respective familial roles & who create
"person" and maintain a common culture.

2 Approaches ( Ways of Looking at

the Individual) 3. POPULATION GROUP
/AGGREGATES
a. Atomistic Approach
views man as an organism composed of A group of people sharing the same
characteristics, developmental stage or
different organs systems (parts) which in
common exposure to particular
order to function properly, they have to
environmental factors (Clark, 1999 as cited
be properly organized at different levels. in Maglaya)

- common health problems

b. Holistic Approach
views man a whole organism with - examples: children, women, farmers,
interrelated and interdependent parts elderly
functioning to produce behavior
(acceptable or unacceptable) to the
society 4. COMMUNITY
Objectives of nursing care : A group or collection of individuals
interacting in social units sharing
1. Promotion & maintenance of common interests, characteristics,
health values and goals.
2. Prevention of disease, early Community as a whole is the client to
diagnosis and treatment of a whom the nurse delivers nursing
suspected ailment services addressed to the community-
3. Recovery and/or rehabilitation wide health problems.
from illness
4. Self reliance in personal care, or
peaceful, dignified death.
 World Health Organization - Promote and monitor their
implementation
(WHO)

- 193 member countries

Ethics
- WHO is directed towards
providing technical collaborations - Articulate ethical and evidence-based
with member states in policy options
accordance with each country's
needs and capacities.
- The Philippines is a member of Technical Support
the Western Pacific Region
which holds office in Manila - Provide technical support and training
(WHO, 2007 as cited by to its member countries
Famorca) - Monitor health situations and assess
health trends
OBJECTIVE: The attainment by all - Develop guidelines and tools on
people of the highest possible level of measurement, monitoring and
health evaluation

CORE FUNCTIONS OF WHO

Public Health in the Philippines
Leadership

- Provide leadership on matters critical Public Health: The science and art of
to health and engage in partnerships preventing disease prolonging life and
where joint action is needed. promoting health and efficiency through:

- organized community effort for

Research
sanitation.
- Shape the research agenda and - control of communicable diseases.
facilitate translation and disseminate - education of individuals in personal
valuable knowledge hygiene.
- organization of medical and nursing
services for the early diagnosis and
Quality Assurance preventive treatment of disease.
- development of social machinery to
- Set norms and standards for health ensure everyone a standard of living
and health related issues adequate for the maintenance of health,
so organizing these benefits as to
enable every citizen to realize his - Assure a competent public health and
birthright to health and longevity. personal health care workforce.

- Inform, educate, and empower

people about health issues.
Core Functions of Public Health
Mobilize community partnerships to
identify and solve health problems
1. Assessment
- Monitor health status to identify
community health problems Public Health Interventions

- Diagnose and investigate health INTERVENTION DEFINITION

problems and health hazards in the
community
Surveillance Describes and monitors health
events through systemic
- Evaluate effectiveness, accessibility,
collection
and quality of personal and
population-based health services
Case Finding Locates individuals and
families with identified risk
factors and connects them with
2. Policy Development resources

- Develop policies and plans that Health Communicates facts, ideas, and
support individual and community health Teaching
skills that change knowledge,
efforts attitudes, values, beliefs and
- Enforce laws and regulations that practices of I, F, P and C

protect health and ensure safety.

- Research for new insights and Screening Identifies individuals with
unrecognized health risk
innovative solutions to health problems
factors and connects them with
resources

3. Assurance
Referral and Assist individuals, families,
Follow-up
- Link people to needed personal health groups, and communities to
services and assure the provision of identify necessary resources
to prevent/resolve concerns.
health care when otherwise
unavailable
 b. Regional and Provincial Level - Local
Counseling Established an interpersonal
health system run by LGU
relationship with a family,
community or system to c. Municipal or City Level - Local health
enhance capacity for
self-care and coping
system run by LGU

2. Private sector
Collaboration Commits 2 or more persons
or an organization to achieve - composed of both commercial and
a common goal business organization with its profit or
market orientation and non-business
Community
organizations with its service orientation
Helps community groups to
Organizing
identify common problems or (NGOs)
goals mobilize resources
and implement strategies

1. Public sector:
Advocacy Pleads someone’s cause or
acts on someone’s behalf to A. National level (Department
develop a community
of Health)
(Kagawaran ng Kalusugan)

- is the leader, staunch advocate and

model in promoting Health for All (HFA)
Health Care Delivery System
in the Philippines.

Health Care Delivery System (HCDS) - responsible for ensuring access to

basic public health services by all
- totality of all policies, facilities,
Filipinos through the provision of quality
equipment, products, human resources
health care and the regulation of all
and services which addresses the
health services and products
health needs, problems and concerns of
the people. - E.O. #102 (1999) – National Health
Authority
- multi-level and multidisciplinary
Vision

Major Players Filipinos are among the healthiest

people in Southeast Asia by 2022, and
1. Public sector Asia by 2040
a. National level - Department of Health
(DOH)
MISSION Functions and Responsibilities of
DOH: (National Level)
To lead the country in the development
of a productive, resilient, equitable and Leadership
people-centered health system.
- Policy making.
- Monitoring and evaluating
implementation of health
Dr. Maria Rosario Clarissa Singh
programs.
Vergeire - OIC of the Department of
- Advocating for health promotion
Health (Health Undersecretary)
activities.
- Serving as technical authority in
disease control.
- Provides administrative and
technical leadership in health
care financing (National Health
Insurance Law).

Administrator of Specific Services

- Serve as administrator of
selected health facilities at
subnational levels (referral
centers).
- Provide specific program
components for conditions that
affect large segments of the
population.
Major Roles of DOH:
- Develop strategies for responding
to emerging health needs.
- Provide leadership in health
emergency preparedness and
response services.
Capacity Builder and Enabler
- Provide logistical support to
LGUs, the private sector and
other agencies implementing
health programs and services.
- Serve as the lead agency in
health and medical research.
 - Protect standards of excellence C. Municipal or City Level
in the training and education of
Local health system run by LGU
health care providers at all levels.
Local Government Code or republic
Act No . 7160
B. Regional/Provincial Level
Devolution of powers, functions and
Functions and Responsibilities of responsibilities to LGUs in terms of
Regional and Provincial Level provision and delivery of basic health
services
Formulation of more detailed or specific
policies/ plans to suit local conditions Functions and Responsibilities of
the Municipal or City Level
- Translate plans into action
- Conduct of orientation program - implementation level of the CHN
for new staff program by the nursing team in the
- In service training for nursing health center.
personnel on the job
- Planning & implementation of
supervision program for CHN
personnel
- Assessment / evaluation of
performance of CHN personnel in
the health centers
- Implementation of standards for
CHN practice
- Quality control checks
- Preparation of reports

2 WAY REFERRAL SYSTEM

 1st Level 2nd Level 3rd Level X-ray
Levels of Health Care Facilities X-ray X-ray with
and Workers mobile Unit

Pharmacy
DOH Administrative Order
2012-0012A

“ Rules and Regulations Governing the

New Classifications of Hospital and
OTHER HEALTH FACILITIES
Other Health Facilities in the
Philippines” HOSPITALS OTHER HEALTH
FACILITIES

General Cat. A :Primary Care Facility

GENERAL HOSPITALS
Level 1 Cat B : Custodial Care
Hospitals Level 1 Level 2 Level 3 Facility

Level 2 Cat. C :
Clinical Consulting Level 1 + Level 2 + Diagnostic/Therapeutic
Services specialist in: Department Teaching/Training Facility
for alized with accredited
in-patients Medicine, Clinical residency training Level 3
Pediatrics, Services program in 4 (Teaching/Learni
OB-Gyne major clinical
Surgery ng)
services

Specialty Cat. D : Specialized

Emergency Respiratory Physical
and OPD Unit Medicine and Outpatient Facility
Services rehabilitation Unit

Isolation General ICU

Facilities
Category A: Primary Care Facility
Surgical/Mater High Risk Ambulatory
nity Facilities Pregnancy surgical clinic - Are the rural health units/birthing
Unit
(lying-in) clinics
Dental Clinic NICU Dialysis Clinic
- first contact health care facility

- Health services offered at this level

Ancillary Secondary Tertiary Tertiary clinical
services clinical clinical laboratory with are to individuals in fair health and to
laboratory laboratory Histopathology patients with disease in the early
symptomatic stages.
Blood Station Blood Bank
 - with in-patient beds (short stay - a facility for the examination of the
facility) human body, specimens from the
human body for the diagnosis,
- manned by BHW (Barangay Health
Worker) under the supervision of a - Drinking water analysis and treatment
RHM (Rural Health Midwife
- Further classified into:

a. Laboratory facility (Clinical lab,

Ratio (DOH 2009) RA 7305 (Magna HIV testing, Newborn Screening, Blood
Carta Public Healthcare Workers) Services, Drug Testing, water analysis)

1 RHU : 20,000 Population b. Radiologic facility (Xray, MRI,

UTZ)
1 BHS : 5,000 population
c. Nuclear medicine facility
1 RH Physician : 20,000 Population
(application of radioactive materials for
1 PH Nurse : 10,000 Population diagnosis, treatment and medical
research
1 PHM : 5,000 population

1 Public Health Dentist : 50,000

population Category D: Specialized Outpatient
Facility
1 BHW : 20 households
- a facility that performs highly
specialized procedures on an
Category B: Custodial Facility outpatient basis

- a health facility that provides long-term - Dialysis clinics

care, including basic services like food - Ambulatory surgical clinics
and shelter to patients with chronic
conditions requiring ongoing health and - Cancer/Chemotherapeutic centers
nursing care due to impairment or in
- Rehabilitation centers
need of rehabilitation

- ex. Custodial psychiatric facilities,

drug rehab centers, leprosaria, nursing
homes

Category C: Diagnostic Facility

 “Health in the Hands of the People by
2020”

Definition of Primary Health

Care (Alma Ata Declaration)
Primary Health Care
PHC is essential health care based on
practical, scientifically sound and
“An Approach To Community Health”
socially acceptable methods and
technology made universally accessible
International Conference for Primary to individuals and families in the
Health Care (WHO and UN Children’s community through full participation and
Fund) at a cost that the community and
country can afford to maintain at every
● Sept. 6 – 12, 1978 in Alma Ata, stage of their development in the spirit
USSR
of self-reliance and
self-determination.

“Alma Ata Declaration on PHC”

Declarations: Goal of Primary Health

- Health is a basic fundamental right. Care
- There exists a global burden of
health inequalities among the
population.
- Economic and social development is "Health for All (HFA) by the year
a basic importance for the full 2000"
attainment of HFA.
- Government have a responsibility for
the health of their people. Objectives of Primary Health Care

- Promotion of healthy lifestyles

- Prevention of diseases
In the Philippines…
- Therapy for existing conditions
The PHC was established through Letter of
Instruction (LOI) 949 signed on Oct. 19,
1979 by then President Marcos one year 5 Key Elements in Achieving HFA
after the First International Conference.
1. Universal Coverage - reducing
Theme:
exclusion and social disparities
 2. Health Service Reforms - - (WHO) also considers
organizing health services around the out-of-the-pocket expenses for health
people’s need care.

Accessibility – refers to the physical

distance of a health facility or the travel
3. Public Policy Reforms –
time required for people to get the needed
integrating health into all sectors or desired health services.

- (WHO) health care facilities should be

4. Leadership Reforms – pursuing within 30 minutes from the community
collaborative models of policy
Acceptability – means the health care
dialogue
offered is in consonance with the prevailing
culture and traditions of the population.
5. Increasing stakeholders Availability – is a question of whether the
participation basic health services required by the people
are offered in the health care facilities or are
8 Essential Health Services provided in a regular and organized manner.
(ELEMENTS)

2. Support mechanism

Health programs and projects have better

outputs when there is collaboration

A multi-sectoral approach is needed for an

efficient utilization of resources.

3. Multi-sectoral approach

- Health and diseases are outcomes of

inter-related factors, PHC requires 3C’s
Key Principles of PHC within and among various sectors
1. 4 A’s of health services 3 C's:
Affordability – refers to the individual or Communication
family’s capacity to pay for basic health
Cooperation
services.
Collaboration
- also involves the capacity of the
government or the community can afford - Requires intra-sectoral and inter-sectoral
the basic health services linkages
4. Community participation

- An educational and empowering process

in which people identify the problems, their
needs and assume responsibilities to
assess, plan, manage, and control actions
that are proven to be necessary. Strategies of PHC
- Clients are not recipient of care but active 1. Utilization of the 4As of Health
participants Services

- Health services must be delivered

5. Equitable distribution of health where the people are
resources - Indigenous/ resident volunteer
workers must be tapped as health
- PHC advocates for care that is care providers
community-based and preventive in - Use of traditional medicine must be
orientation used together with essential drugs

- There should be an inventory of health 2. Partnership between the community &

resources, facilities and manpower health agencies

- Trainings provided are based on

community needs
6. Appropriate Technology
- Tasks assigned to Community
- Refers to the technology that is suitable to Health Workers (CHW) are
the community that will use it and includes competency based
tools drugs, methods, procedures and - Regular monitoring and evaluation of
techniques CHWs performance by health center
staff
Criteria:
3. Community Participation
1. Safety
2. Effectiveness - Small group meetings
3. Affordability - Community building & community
4. Simplicity organizing
5. Acceptability - Formation of health committees
6. Feasibility and Reliability
4. Self-Reliance
7. Ecological effects
8. Potential to contribute to individual - community gives support ( cash,
and community development kind or labor) to the health program)
- use of local resources ( human,
financial or material)
- training of the community in
leadership and management skill
 I. Primary Prevention 1. Health
Promotion
2. Specific
Prevention

5. Recognition of inter-relationship II. Secondary Prevention 3. Early

Diagnosis
between health & development
(Early
detection)
- regional, provincial, municipal &
4. Prompt
barangay development plans Treatment
- coordination of activities with (Prompt
economic planning, education, Intervention)
agriculture, industry, housing, public
III. Tertiary Prevention 5. Rehabilitatio
works, communication & social n
services

6. Social Mobilization

- Establishment of an effective health I. Primary Prevention

referral system
- Information, education and - Relates to activities directed at
communication support using preventing a problem before it occurs by
multimedia altering susceptibility or reducing
- Collaboration between govt and exposure for susceptible individuals.
NGO
Focus of Activities:
7. Decentralization
1. General health promotion
- Re-allocation of budgetary resources
- Re-orientation of health 2. Specific protection
professionals on PHC
- Advocacy for political will & support, - The process of enabling people to
from the national leadership down to increase control over, and to improve their
the barangay level. health (Ottawa Charter of Health Promotion,
1986)

- Refers to behaviors in which one engages

with the specific intent to prevent disease,
Levels of Prevention in to detect disease in the early stages or to
Public Health maximize health within the constraints of
disease (Parse, 1990).

Levels of Prevention II. Secondary Prevention

Objectives and Focus of
Activities
- Refers to early detection and prompt
intervention during the period of early
 disease pathogenesis to prevent
complications

- Before signs and symptoms appear

Focus of Activities:

1. Early diagnosis

2. Prompt treatment

III. Tertiary Prevention (Rehabilitation)

-Targets populations that have experienced

disease or injury and focuses on limitation
of disability and rehabilitation

Aims:

1. Reduce the effects of disease and injury

2. Restore individuals to their optimal level

of functioning