COMMUNITY HEALTH NURSING (CHN)

Public Health Nursing

Health - State of complete physical, mental and social well-being, not merely the absence of
disease or infirmity

Determinants of Health

Public Health
 science and art of preventing disease, prolonging life, promoting health and efficiency
through organized community effort to enable every citizen to realize his birthright of
health and longevity (Winslow)
 Organized community efforts aimed at the prevention of disease and promotion of health
(Institute of Medicine)
 Art of applying science in the context of politics so as to reduce inequalities in health
while ensuring the best health for the greatest number (WHO) → utilitarianism
 special field of nursing that combines the skills of nursing, public health and some phase
of social assistance and functions as part of total public health programme for promotion
of health, the improvement of conditions in the social and physical environment,
rehabilitation of illness and disability (WHO Expert Committee of Nursing)
 a term coined to denote a service that was available to all people (Lillian Wald)

Community Health Nursing

 Service rendered by a professional nurse with communities, groups, families, individuals
at home, in health centers, in clinics, in schools, in places of work for the promotion of
health, prevention of illness, care of the sick at home and rehabilitation (Ruth B.
Freeman)

Which is broader- CHN “for everyone” (PHN is for public only)

Public Health Nursing
Practice of nursing in national and local government health departments (which includes health
centers and rural health units), and public schools.
It is CHN practiced in the public sector.

SHETLAND - worth dignity of man

General Characteristics of a Community

Community
 A social group determined by geographic boundaries and/or common values and
interests
 It is made up of institutions organized into social system with the institutions and
organizations linked in a complex network having a formal and informal power structure
and a communication system
 A common or shared interest that binds the members together exists
 Its has an area with fluid boundaries within which a problem can be identified and solved
 It has a population aggregate concept

Overview of Philippine Healthcare Delivery System (PHCDS)

Public Sector - tax-based services, free or affordable

DOH secretary - Harry Ruque
Private Sector - profit oriented, paid

Primary Health Care

 An approach to delivery of health care services
 A strategy which focuses responsibility for health on the IFC
 Alma Ata, USSR in 1978
 Health for all by the year 2000
 Health in the Hands of the People by 2020
 Primary health is the responsibility of an individual
Primary Health Care
Essential health care made universally accessible to individual and families in the community by
means acceptable to the through their full participation and at cost that the community and
country can afford at every stage of development

Elements of PHC
Hospital as center of wellness
Oral & Dental Health
Mental Health
Elderly care

Education for health

Local disease P&C
EPI (Expanded program on immunization)
Maternal & child/family health
Essential drugs
Nutrition
Treatment of CD
Safe water & sanitation

4 Cornerstones or Pillars
 Active community participation
 Intra- and inter-sectoral linkages
 Use of appropriate technology (not HIGH technology)
 Support mechanism made available

2 Levels of PHC Workers

 Village/Barangay HW - intermediate
 Intermediate Level HW - licensed

RHU TEAM (100k divided 10/5/20 depends to the given population )

Physician → ideally physician should be 1:20k
Dentist → 1:50k
PHN → 1:20k
Midwife → 1:5k
Sanitarian → 1:20k
Other health workers → 1:20k
100,000 population, how many nurses should there be? 20k

1. Primary - Barangay health station, Barangay health centers, rural health units- primary
(first contact) - ideally, people should go here first
2. Secondary - District and municipal hospital - secondary (minor surgeries)
3. Tertiary - Provincial, Regional, National hospitals, medical centers, training centers,
specialized hospitals (heart) - tertiary
  Primordial - achieved through public health policies
 Primary - with existing risk factors, without disease (immunization, vitamins,
isolation of child with chickenpox) not all health teaching falls on primary
 Secondary - with disease, treat at early stage of disease (screening procedure -
operation timbang, breast self examination)
 Tertiary - late stage of disease (rehabilitation, treatment, prevention of
complications) → teaching patients for post op

Universal Health Care

 Kalusugan pangkalahatan
 Republic Act 11223

General Objective
Ensure all filipinos are guaranteed equitable access to quality and affordable healthcare
goods and services, the protected against financial risk
Financial Health protection - PhilHealth

Public Health Nurse

 Practice of nursing in national and local government health departments (which includes
health centers and rural health units), and public schools.

 It is CHN practiced in the public sector

WHO is a Public Health Nurse?

Refers to the nurses in the local /national health departments or public schools whether their
official position title is Public Health Nurse or Nurse or school nurse
Roles of a CHN
1. Nurse Manager
2. Community Organizer
3. Trainer
4. Health Planner
5. Researcher
6. Health Monitor
7. Care Manager
8. Advocate
9. Educator

Questions:
1. A community health nurse has several roles and responsibilities that she needs to
perform to provide the best service to the people. Which of the following pertains to a
nurse acting as a manager?

A. Formulation of individual, family, group and community centered care plan.

B. Initiation and participation in community development activities. (Community Organizer)
C. Training of Barangay Health Workers (Trainer)
D. Identifies needs, priorities and problems of individuals, families and community (health
planner)

community organizer - motivates to mobilize people

health planner - creates programs specific to community
health monitor - detects anomalies in health status (increasing rate of disease)

2. Barbara, a community health nurse in Bgy. Mariano, recently conducted a survey and
interview to identify the presence of risk factors and prevalence of endemic diseases in the said
area. In this situation, which of the following roles is the nurse predominantly performing?
A. Health Planner- Programmer
B. Researcher
C. Health Monitor- Deviation
D. Community Organizer

3. Nurse Lester supports Brgy. Malikot’s program on planting herbal plants at the backyard of
each house. In this scenario, which of the following roles is the CHN assuming?
A. Program coordinator
B. Care manager → Decisions
C. Health Planner
D. Advocate

4. The community health nurse is an important personality in the whole mechanism of

community health development. He/she assumes different roles in the process of community
development. What is the goal if one is acting as an educator?
A. Promote an understanding of health problems
B. Provide health programs for the community
C. Facilitate changes in behavior among clients
D. Identify clients at risk among the population served
5.Which of the following statements is true about the concepts encompassing the practice of
community health nursing?

1. The primary focus of CHN practice is on health promotion

2. A community health nurse must be a generalist.
3. The contact with the client and / or the family may continue over a long period of time.
4. CHN practice benefits individuals only.

A. 1,2
B. 1,3
C. All except 2
D. All except 4

Different Positions in PHN

POSITION YEARS OF EXPERIENCE INCLUSION

Provincial/City Nurse Supervisor 5

Nurse Instructor II 3

Regional Training Nurse 6 3 years at academe

Regional Nurse Supervisor 5 2 years supervisor

Nurse Program Supervisor 7

PHN II - frontliner
PHN III - nurse in charge (for frontliners)
Nurse V - supervising PHN (in charge of all of the staff, only 1 health center)
Nurse VI - nurse program supervisor (handles multiple health centers)
CHN Process (APIE)

Assessment
 Initiate contact
 Demonstrate caring attitudes
 Mutual trust & confidence
 Collect data
 Identify health problems (per family)
 Assess coping ability
 Analyze and interpret data
 Assessment-identify health problems ,establish relationships with the family

Categories of Health Problems

1. Health Deficit - there is already a disease
2. Health Threat - existing risk factor (stagnant water, improper waste disposal, epidemic)
3. Foreseeable crisis - events causing stress to family (death of loved one)

Planning Phase
 Prioritize needs
 Establish goals
 Construct actions & operation plan
 Develop evaluation parameters
 Revise plan as needed
Modifiability - present problem (more severe, high priority)
Preventive Potential - future problem
Salience of Problem - level of prevention (do they see it as a problem?, do they see it as an
urgent problem?) → family will identify

Total score = 5

Implementation
 Put nursing plan into action
 Coordinate care/services
 Utilize community resources
 Delegate
 Supervise
 Provide health education & training
 Document responses to nursing actions

Evaluation
 Nursing audit - focuses on patient care provided by nurses
 Care outcomes
  Performance appraisal -evaluate the performance of the employees or the nurse
 Estimate cost- benefit ratio - compare expenditure and benefit to the community
 Assessment of problems
 Identify needed alterations
 Revise plan as necessary

Performance appraisal - peer evaluation or different rank evaluation

Quality assurance - hospital services

Criteria for Evaluation

1. Structure - physical (building, facilities, instruments) and philosophy (mission, vision,
objectives), financial resources, man power
2. Process - standards and protocols followed
3. Outcome - improvements in condition and effect
.
Health deficit has the highest priority

QUESTIONS:
1. The nursing process is central to all nursing actions - It is the very essence of nursing,
applicable in any setting, in any frame of reference, and within any philosophy. Which of
the following activities belong to the planning process?
A. Data collection, Identification of health problems, Analysis and interpretation of data
B. Nursing audit , performance appraisal, Estimating cost-benefit ratio
C. Coordinating service, delegation, documentation
D. Prioritizing needs, goal setting, development of evaluation parameters.

2. An important dimension in the definition of quality is that the delivery of health services is in
accordance with standards. Which of the following are considered as structural elements?

A. Philosophy, budget, nursing care plan

B. Nursing goals, staff, instrumentalities
C. Objectives, resources, hierarchy in the organization
D. Nursing care plan, modification of symptoms, compliance with treatment

3. Nurse Marlon went to visit the Leonel Family for initial assessment. With the interview he did
with the members of the family, he found out that 3 out of their 5 children have scabies. The
family also stores water in their backyard for immediate and future use. The mother has just
also got unexpectedly pregnant with their 6th child. Based on the health category, which of the
following should be the priority?

A. Scabies
B. Stored water as. possible reservoir
C. Mother’s pregnancy
D. Both A & B

4.Amanda, a community health nurse, has started conducting assessments for the Velesco
Family. She has already completed identifying their existing health problems. Which of the
following is the next nursing action for her to take.
 A. Formulate nursing diagnoses based on the data she gathered.
B. Analyze all the data she has collected
C. Determine if the family recognizes the existence of the problem.
D. Develop a family nursing care plan

Nursing Procedures in the Community

Clinic Visit Standard Procedures
1. Registration/Admission
2. Waiting Time
3. Triaging
a. Program-based - example is under IMCI chart, then provide package treatment
(cough), do not refer to physician
b. Non-program based - refer to physician
c. Emergency - provide first aid treatment
4. Clinical Evaluation - doctor examine physically with history, inform client nature of treatment
5. Laboratory and other diagnostic examinations
6. Referral system
7. Prescription/Dispensing
8. Health education

BP Measurement
Phases
1. Preparatory
2. Applying the BP cuff and stethoscope
3. Obtaining the BP
4. Recording the BP

BP MEASUREMENT NURSING CONSIDERATIONS

Rested for at least 5 minutes
Should not have smoked or ingested caffeine within 30 minutes before BP measurement
Apply cuff around the upper arm 2-3 cm above the brachial artery
Take the mean of 2 readings, obtained at least 2 minutes apart
If the first 2 readings differ by 5mmHg or more, obtain a 3rd reading and include this in the
average

Diagnostic Tests at Home

1. Benedict’s Test - test for sugar in the urine; test for diabetes burner
Remember “BGYOR”
Blue (-) No Glucose
Green +1 Traces of reducing sugar
Yellow +2 Traces of reducing sugar
Orange +3 Moderate
Red +4 Large amount of reducing sugar

2. Acetic Acid Test - test for Pregnancy induced hypertension

2. Tourniquet Test or Rumpel-Leed’s test (RL) - sign of severe DHS under IMCI
  The tourniquet test is part of the new WHO case definition for dengue. The test is
a marker of capillary fragility and it can be used as a triage tool to differentiate
patients with acute gastroenteritis, for example. from those with dengue. Even if
a tourniquet test was previously done, it should be repeated if
 It was previously negative
 There was no bleeding manifestation

How to do a tourniquet Test

1. Take the patient’s blood pressure and record it, for example, 100/ 70.
2. Inflate the cuff to a point midway between SBP and DBP and maintain for minutes. (100
+ 70) divided 2 = 85 mmHg
3. Reduce and wait 2 minutes
4. Count petechiae below antecubital fossa. See image at right
5. A positive test is 10 or more petechiae per 1 square inch.

HOME VISIT
A family-nurse 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

Principles of Home Visit

1. A home visit must have purpose or objective:
 To give nursing care
 To assess living condition
 To give health teachings
 To establish close relationship
 To make use of the inter-referral system & promote utilization of community services
2. Planning for a home visit should make use of all available information about the patient
and his family through family records
2. The essential needs of the individual and his family is top priority
2. Planning and delivery of care should involve the individual and family
2. Plan should be flexible

Guidelines in Determining Frequency

1. The needs of the individual and family
2. The acceptance for services rendered
3. The ability to recognize their needs
4. The policy of a specific agency and the emphasis given towards their health programs
5. the number of health personnel already involved in the care of a specific family
6. Careful evaluation of past services given to a family.

Reminder!
If more than one member of the family is for health supervision and care, start the well
member to avoid transfer of infection. The one with the communicable disease goes last.

Bag Technique (Tool)

A tool by which the nurse, during her visit will enable her to perform nursing procedure with
ease and deftness, to save time and effort, with the end view of rendering effective nursing care
to clients
PHN Bag
An essential and indispensable equipment of a PHN which has to carry along during her home
visits

Contents of the Bag Technique

1. Paper lining
2. Extra paper for making waste bag
3. Plastic/linen lining
4. Apron
5. Hand towel
6. Soap in a soap dish
7. Thermometers (oral and Rectal)
8. 2 Pairs of scissors (surgical and bandage)
9. 2 Pairs of forceps (curved and straight)
10. Disposable syringes with needles (g.23 & 25)
11. Hypodermic needles (g. 19, 22, 23, 25)
12. Sterile dressing
13. Cotton balls
14. Cord clamp
15. Microscope plaster
16. Tape measure
17. 1 pair of sterile gloves
18. Baby’s scale
19. Alcohol lamp
20. 2 test tubes
21. Test tube holders
22. Solutions: Betadine, 70% alcohol, Zephiran solution, Hydrogen peroxide, Spirit of
ammonia, Ophthalmic ointment, Acetic acid, Benedict’s solution

Principles of Bag Technique

1. Performing the bag technique will minimize, if not, prevent the spread of any infection.
2. It saves time and effort in the performance of nursing procedures.
3. The bag technique should show the effectiveness of total care given to an individual or
family.
4. 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.

Important points to consider

1. The bag should contain all the necessary articles, supplies and equipment that be useful
to answer the emergency needs
2. The bag and its contents should be clean 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
patient’s 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.
Reminder!
Upon arrival at the patient’s home, place the bag on the table lined with a clean paper. The
clean side must be out and the folded part, touching the table.

Quarantine vs. Isolation

HOW? WHO?

Quarantine Limitation of freedom Expose person

Isolation Separation Sick person

Isolation Technique Nursing Considerations

1. Separate patient’s articles
2. Frequent washing and airing of beddings and other articles; Disinfection of room
3. The one caring for the sick member should have a protective gown used only within the
room of the sick
4. All discharge should be carefully discarded
5. Articles soiled with discharges should be boiled 30 minutes before laundering. Burn
those which could be burned.
Health Resources (7 M’s)

Nature of the Problem Criteria

Criteria Weight

1. Nature of the Problem 1

 Health Status 3

 Health Resources 2

 Health Related 1

2. Magnitude of the Problem 3

 75% - 100% affected 4

 50% - 74% affected 3

 25%-49% affected 2

 <25% affected 1

3. Modifiability of the Problem 4

 High 3

 Moderate 2

 Low 1
  Not Modifiable

 0

4. Preventive Potential 1

 High 3

 Moderate 2

 Low 1

5. Social Concern 1

 Urgent community concern with expressed readiness 2

 Recognized problem but not needing a urgent attention 1

 Not a common concern

 0

Total Score 10

Prioritization of Community Problems

Nature

Health Status (HS) 3

Health Resources 2

Health Related 1

Indicators of Health Status/Condition:

Fertility: increase CBR = community is overpopulated = HS
Morbidity: IR (new cases) & PR (old cases) = HS
Mortality: Deaths like children dying of pneumonia = HS

EPIDEMIOLOGY
Study of occurrences and distribution of diseases as well as the distribution and determinants of
the health statees or vents in specifies population, and the application of this stidy to the control
of health problems

Reminder!
Epidemiology is the backbone of disease prevention

Two Main Areas of Investigation

Distribution of health status in terms of age, gender, races, etc.
Explanation of patterns of disease distribution
Host - humans provide nutrition for adaptable organisms to multiply.
Intrinsic characteristics:
 Genes
 Age
 Sex
 Ethnicity
 Physiologic status (stress, puberty, pregnancy)
 Existence (Hypersensitivity, Personal Hygiene)
Agents - microorganisms
Environment - extrinsic factor influences the susceptibility

PATTERNS OF OCCURRENCE AND DISTRIBUTION

1. Sporadic - intermittent, not related, no season, no exact pattern (rabies)

2. Endemic - a certain disease has occurence to a particular people or country (Malaria,
Tuberculosis - Philippines) local areas (malaria); Schistosomiasis, Filariasis (Bicol
region)
3. Pandemic - simultaneous occurence a disease affecting several countries (AIDS, HIV)
4. Epidemic - an unusually large number of cases happen in relatively short period of time,
above what is normally expected in that population in that area.

Epidemic has more susceptible

Epidemic
1. Common source
 Point - everyone becomes ill at the same time
 Continuous - continuous exposure
2. Propagated - it can be transmitted from one person to another (syphilis); vector
born)
2. Mixed - propagate and common source (shigellosis)

Public Health Surveillance

 On - going systemic collection, analysis, interpretation and dissemination of health data
  it helps the government to make decisions that help reduce the incidence of certain
diseases.

Philippine Integrated Disease Surveillance and Response (PIDSR)

integrated approach to surveillance
1. NESS
2. Notifiable Disease Reporting System
3. EPI surveillance
4. HIV - AIDS Registry

PRIORITY DISEASES/SYNDROMES AND CONDITIONS TARGETED FOR SURVEILLANCE

Epidemic- Prone Disease Diseases Targeted For Other Diseases or
Eradication or Elimination Conditions of Public Health
Importance

1. Acute Viral Hepatitis 1. Poliomyelitis 1. Acute Bloody

2. Anthrax (Acute Flaccid Diarrhea
3. Bacterial Meningitis Paralysis) 2. Acute Hemorrhagic
4. Cholera 2. Measles Fever
5. Dengue 3. Neonatal Tetanus 3. Acute Encephalitis
6. Human Avian 4. Rabies Syndrome/Japanese
Influenza (Bird flu) 5. Malaria Encephalitis
7. Influenza-like Illness 4. Adverse Event
8. Leptospirosis following
9. Meningococcal Immunization (AEFI)
Disease 5. Diphtheria
10. Paralytic Shellfish 6. Hand Foot and Mouth
Poisoning Disease
11. Severe Acute 7. Non-Neonatal Tetanus
Respiratory Syndrome 8. Pertussis
(SARS)
12. Typhoid and
Paratyphoid Fever

National Epidemic Sentinel Surveillance System (NESS)

 Hospital-based information system that monitors the occurrence infectious diseases with
outbreak potential
Objectives:
1. To provide early warning
2. To provide accurate and timely information so that preventive and control measures
can be instituted

Diseases under Surveillance

Laboratory - confirmed Clinically - diagnosed

1. Cholera 1. Dengue
2. Hepatitis A 2. Diphtheria
 3. Hepatitis B 3. Leptospirosis
4. Malaria 4. Meningococcal disease
5. Measles 5. Non- neonatal tetanus
6. Typhoid Fever 6. Neonatal Tetanus
7. Pertussis
8. Rabies

RA 11332
Mandatory Reporting of Notifiable Diseases and Health Events of Public Health Concern
Act

Notifiable Disease
 A disease that, by legal requirements,, must be reported to the public health authorities

For the purpose of this IRR, following diseases/syndromes shall be categorized as

immediately notifiable (Category I):
a. acute flaccid paralysis
b. adverse event following immunization
c. Anthrax
d. COVID-19
e. Hand-Foot- and-Mouth Disease
f. Human Avian Influenza
g. Measles
h. Meningococcal Disease
i. Middle East Respiratory Syndrome (MERS)
j. Neonatal Tetanus
k. Paralytic Shellfish Poisoning
l. Rabies
m. Severe acute response syndrome (SARS)

Public Health Emergency

An occurrence or imminent threat of an illness or health condition that is caused by bioterrorism,
natural disaster, nuclear attach or that poses high probability of large number of deaths injuries,
widespread exposure to infectious agent, and travel restrictions

2 Kinds of Notifiable Diseases under RA 11332

Category 1 - immediately notifiable
Category 2 - weekly

Vital Statistics
 Systematic study of viral events such as births, illnesses, marriages, divorce, separation
and deaths

Ratio vs Rate
 Rate - measurement of a particular events in a population during a period of time (Crude
mortality rate)
 Ratio - indicate the relationship of one to another, one quantity to another of two random
quantities (Doctor patient ratio)
Crude vs Specific rates
Crude or General rates - refer to the total living population
example: Crude Birth Rate, Crude Death Rate

Specific Rates - refer to a specific population class group

Example:
 Age-specific
 Sex-specific
 Cause-specific

3 Leading Causes of Deaths in Philippines

1. Ischemic Heart Disease
2. Neoplasms
3. Stroke

Crude Birth Rate Formula:

Total Number of LIVE BIRTHS registered in a calendar year
ESTIMATED POPULATION as of July 1 of same year

Crude Death Rate Formula:

Total Number of DEATHS registered in a calendar year
ESTIMATED POPULATION as of July 1 of same year

Fetal Death Rate:

Total Number of FETAL DEATHS registered in a calendar year
Total number of REGISTERED LIVE BIRTHS of same Calendar year

 Age of gestation 7 mos and ups - ALIVE regardless how much time the child survive
 Less than 7 mos - if the child survives more than 24 hours, if he did BORN ALIVE, if
not NOT BORN ALIVE.

Neonatal Death Rate:

Total number of DEATHS UNDER 28 DAYS register in a Calendar year
Total number of REGISTERED LIVE BIRTHS of same Calendar year

Infant Mortality Rate: most sensitive index

Total number of DEATHS UNDER 1 YEAR OF AGE register in a Calendar year
Total number of REGISTERED LIVE BIRTHS of same Calendar year

Maternal Mortality Rate:

Total number of DEATHS FROM MATERNAL CAUSES register in a Calendar year
Total number of REGISTERED LIVE BIRTHS of same Calendar year

SWAROOP’S INDEX:
Total Number of DEATHS OF PEOPLE 50 Y/O & ABOVE registered for a given year
Total number of DEATHS of same Calendar year
→ increased swaroop’s index is GOOD
→ index for longevity
Attack Rate:
Total Number of PERSON ACQUIRING A DISEASE registered for a given year
Total number of EXPOSED TO SAME DISEASE of same Calendar year

Case Fatality Ratio:

Total Number of DEATHS FROM SPECIFIC DISEASE registered in a calendar
Total number of EXPOSED TO SAME DISEASE of same Calendar year

Incidence Rate:
Total # of NEW CASES OF A CERTAIN DISEASE registered during a specific period of time
Estimated Population as of July of same year

Prevalence Rate:
Total Number of NEW AND OLD CASES OF A CERTAIN DISEASE registered for a given year
ESTIMATED POPULATION as of July of same
year

Characteristic of a Population Pyramid

 Population pyramid special type of histogram
 Male population shown at the left
 Females right
 Youngest at base
 Oldest at top
 Chronologically arranged
 1. Expansive - a sharp triangle meaning young population due high fertility rate, high
mortality rate. (Philippines)
2. Constrictive - the bottom is narrow, stable fertility rate due to low mortality rate (US)
3. Stationary - a pillar shape, wider in middle rather than a pyramid, stable populow
mortality and fertility rate (Austria)

VITAL OR CIVIL REGISTRATION

Vital or Civil Registration is the recording in the appropriate civil registers, vital acts and events
that affect the civil status of individuals
De facto- data is currently where you are located.

Vital acts and events

 Births
 Death
 Fetal deaths
 Marriages
 Change in civil status

QUESTIONS ON CIVIL REGISTRATION

1. Can a fetus with an intrauterine of less than 7 months be registered as live birth?
→ It depends on hours of survival (less than 24 hours - no need)
2. Who are responsible to report the occurrence of birth to the Local Civil Registry Office?
→ hospital administration = doctor or midwife or parents; if in house = parents; airplane
= captain, parents
2. What are the reglementary period and place of registration of births?
→ 30 days shall be registered in civil registry where the child born (arrival or origin)
4. Can an intrauterine life of less than 7 months be registered as Death?
→ depends, if the child born alive to have a death certificate. There will be no death if
there’s no birth.
5. What are the reglementary period and place of registration of death?
→ a report to health officer should be submitted within 24 hours then
 within 30 days, health officer will register the dead person
6. Who are responsible to report the event of death?
→ Hospital administration; Attending physician; Relative; Person who knows that cause
of death; Any member of sanggunian/LGU

Field Health Services Information System (FHSIS)

 It is a network of information
 It is intended to address the short-term needs of DOH and LGU staff with managerial or
supervisory functions in facilities and program areas.
 It monitors health service delivery nationwide.
 allows healthcare professionals to focus more in providing care rather than recording the
treatments due to requirements

Objectives
 To provide summary data on health service delivery and selected program
accomplishments indicators at the barangay municipality/city, and district, provincial,
regional and national levels
 To provide data which when combined with data from other sources, can be used for
program monitoring and evaluation purpose
 To provide a standardized facility-level data base that can be accessed for more in-
depth studies.
 To minimize the recording and reporting burden at the service delivery level in order
to allow more time for patient care and promote activities

Components:
1. Individual treatment record (ITR)
 Fundamental building block or foundation of FHSIS
 This is a document, form or piece of paper upon which is recorded the date,
name, address of patient presenting symptoms or complaint of the patient in
consultation and the diagnosis (if available) treatment and date of treatment.
2. Target Client List (TCL)
 masterlist, eligible person for health programs
 Second "building block" of the FHSIS and are intended to serve several
purposes:
 to plan and carry out patient care and service delivery (most valuable and
efficient)
 To facilitate the monitoring and supervision of service delivery activities.
 To report services delivered
 To provide a clinic-level database which can be accessed for further studies.
3. Summary Table/Tally or Reporting Forms
 only mechanism that transport from one area to another
 The reporting forms are routinely transmitted from barangay health station to
provincial health office (prepares) → disseminated form RHUs, Regional,
DOH
 Form with 12 month columns retained at the facility (BHS) where the midwife
records monthly all relevant data
 The summary table is composed of:
1. Health Program Accomplishment this can serve as proof of accomplishments to
show LGU officials whenever they visit the facility.
 2. Morbidity Diseases the source of ten leading causes of morbidity for the
municipality/city
 This summary table will help the nurse and MHO to get the monthly trend of
disease.
4. Monthly consolidation table (MCT) / Output Report
 Essential form in the FHSIS where the nurse at the RHU records the reported
data per indicator by each BHS or midwife.
 This is the source document of the nurse for the quarterly form.
 The consolidation table shall serve as the output table of the RHU as it already
contains a listing of BHS per indicator.

Nurses: 1:20K
Doctor: 1:20K
Midwife:1:5K
Dentist: 1:50K