NCM 104: Community Health Nursing PDF

The department of health (DOH) is the principal health agency in the PH. - It is responsible for ensuring access to basic public health service to all filipinos through the provision of quality health care and regulation of providers of health good and service. **Vision** - Filipinos...

The department of health (DOH) is the principal health agency in the PH. - It is responsible for ensuring access to basic public health service to all filipinos through the provision of quality health care and regulation of providers of health good and service. **Vision** - Filipinos are among in the healthiest people in the 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. **Mandate** - the DOH shall provide assistance to local government units (LGUs) people's organization (PO) and other members of civic society in effective implementing programs, projects, ad service that will: a. promote the heath and well-being of every filipino b. prevent and control diseases among population at risks c. protect individuals, families and communities exposed to hazards and risks that could affect their health and d. treat, manage, and rehabilitate individuals affected by disease and disability (E.O 102 Sec. 1) **Brief history primary health care** **September 6-12 1978** - health leaders of 200 countries attended international conference for primary health care at alma ata, USSR - iniated by WHO and UN children's fund **The conference 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 heath of their people - PHC strategy was adopted in the philippines virtue of LOI (letter of instruction) 949 of 1979 **Common view** - **Health** is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity **People's right to health** - Government is driven to increase investment on health care - WHO recommends government to allocate 5% of the gross national product (GNP) to health services. - Philippine scenario: Average allocation from 2005-2007 was only 3.3% of the gross national product (GNP). **Primary health care** - Is the essential health care based on practical scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. (Alma Ata Declaration) **Universal goal of PHC:** "health for all by the year 2000" Global strategy to attain 3 main objectives 1. Promotion of health lifestyles 2. Prevention of diseases 3. Therapy for existing condition President Marcos signed LOI 949 with an underlying theme - "health in the hands of the people by 2020" 5 key elements to achieve the goal "health for all" (as identified by WHO) 1. Reducing exclusion and social disparities in health (universal coverage) 2. Organizing health services around people's needs and expectations (health service reforms) 3. Integrating health into all sectors (public policy reforms) 4. Pursuing collaborative models of policy dialogue (leadership reforms) 5. Increasing stakeholder participation **8 essential health services** **E --** education for health **L --** Locally endemic disease control **E --** Expanded program for immunization **M --** maternal and child health nursing including responsible parenthood **E --** essential drugs **N --** Nutrition **T --** treatment of communicable and non communicable diseases **S --** safe and water sanitation Key principles of PHC 1. Accessibility, affordability, acceptability and availability 2. Support mechanisms 3. Multisectoral approach 4. Community participation 5. Equitable distribution of health resources 6. Appropriate technology 4 A's of PHC - **Accessibility** -- refers to the physical distance of health facility or travel time required to get to the health services - Health care facilitates must be within 30 mins from the communities - **Affordability --** individual or family's capacity to pay - Whether community or government can afford the public health services - **Acceptability --** health care offered is in consonance with the prevailing culture and traditions of the population - **Availability --** 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 **Health Programs:** a. Botika ng bayan or botika ng barangay b. "ligtas ng tigdas ang pinas" **Support mechanism** Resources for essential health services come from: a. **The people** b. **The government** c. **The private sector like NGOs, socio-civic and faith groups** **Multisectoral approach** - PHC requires communication, cooperation and collaboration within and among the sectors through: a. **Intrasectoral linkages --** communication, cooperation and collaboration within the health sector (eg. Two-way referral system) b. **Intersectoral linkages --** encompass the communication, cooperation and collaborations - Collaborative effort (eg. Rabies prevention and control program) **Community participation** - PHC emphasis: health is achieved through self-reliance and self-determination - Clintele are not considered as recipients of care but active participants in achieving their **Equitable distribution of health resources** - DOH in spearheading 2 programs to ensure equitable distribution of manpower a. **Doctor to the barrios (DTTB) program --** deployment of doctors to municipalities to manage RHU or health centers in unserved, economically depressed 5^th^ or 6^th^ class municipalities for 12 years b. **Registered nurses health enhancement and local service (RN HEALS) --** training and deployment program for unemployed nurses - Deployed the unserved, economically depressed municipalities for 1 year **Appropriate technology** **Technology --** "applied science'' **Health technology --** includes tools, drugs, methods, procedures and techniques **Appropriate technology --** refers to the technology that is suitable to the community that will use it. - "People's technology" "indigenous technology" Appropriate technology (criteria): a. **Safety --** technology results minimal risk to the user of that positive outcome b. **Effectiveness --** technology should accomplish what is meant to accomplish (medicinal herbs) c. **Affordability --** measures for health promotion and disease prevention are cost effective d. **Simplicity --** technology that requires readily available simple materials and involves simpler process in its use e. **Acceptability --** it is used by those who need it f. **Feasibility and reliability --** technology must be easy to apply considering the people's natural settings g. **Ecological effects --** effects on ecology are important consideration in choosing or rejecting a particular technology h. **Potential to contribute to individual and community development --** appropriate technology promotes self-sufficiency on the part of those using it **1992 local government code (RA 7160)** - All structures, personnel and budgetary allocations from provincial health level down to the barangays were devolved to LGU to facilitate health services delivery **Objectives for local health system** - Establish local health systems for effective and efficient delivery of health care services - Upgrade the health care management and service capabilities of local health facilities - Promote inter-LGU linkages and cost sharing scheme including local health care financing systems for better utilization of local health resources - Foster participation of the private sector, non-government organizations (NGOs) and communities in local health systems development - Ensure the quality of health service delivery at the local level **Inter local health zone (ILHZ)** - Any form or organized arrangement for coordinating the operations of an array and hierarchy of health providers and facilitates, which typically includes primary health providers, core referral hospital and end-referral hospital, jointly serving a common population within a local geographic area under the jurisdictions of more than one local government - Inspired by district health systems (DHS) **The district health system is subdivided into three levels of referral:** - **Primary** -- barangay health stations and rural health units) - **Secondary --** district/provincial hospitals - **Tertiary --** provincial/regional hospitals **Composition of inter-local health zone** **People** - Vary from zone to zone - 100,000 and 500,000 for optimum efficiency and effectiveness (WHO, 1986) **Boundaries** - Clear boundaries determine the accountability and responsibility of health service providers **Health facilities** - A district or provincial hospital (referral hospital for secondary level of health care), a number of rural health units (RHU), barangay health stations (BHS) and other health services deciding to work together as an integrated health system **Health workers** - The right unit of health providers is needed to deliver comprehensive health services - DOH - District hospital - Rural health units - Barangay health stations - Private clinic - Volunteer health workers - Non government organization **Expression of ILHZ in the local setting:** - **STABAYABAS --** Sta. Catalina, Bayawan, Basay - **SIAZAM --** Siaton and Zamboanga - **METROPOLITAN --** Dauin, Bacong, Dumaguete City, Sibulan, San jose - **MAMABATA --** Mabinay, Manjuyod, Tanjay, Bais - **BINATA --** Bindoy, Ayungon, Tayasan **Devolution of health services** - the transfer of power and authority from national government to LGUs as the territorial and political subdivisions of the state enable them to perform specific functions and responsibilities - Section 17 of local government code of 1991 RA 7160 **Population based health manpower needs** **RHU Manpower** **Population Ratio** --------------------------- ------------------------ Physicians (MHO/RHP) **120,000 population** Nurses (PHN) **120,000 population** Midwives (RHM) **15,000 population** Sanitary inspectors (RSI) **120,000 population** Dentists **150,000 population** Medical Technicians **120,000 population** Classification of hospitals a. According to ownership 1. **Government --** created by law, a government health facility may be under the national defense (DND), Philippine National Police (PNP), Department of justice (DOJ), state universities and colleges (SUCs), government owned and controlled cooperation (GOCC) and others. 2. **Private --** owned, established and operated with funds through donation, principal, investments or other means by any individual, corporation, association or organization. A private health facility may be a single proprietorship, partnership, corporation, cooperative, foundation, religious, non-government organization and others. b. According to scope of services 3. General -- a hospital that provides services for all kinds of illnesses, diseases, injuries or deformities. A general hospital shall provide medical and surgical care to the 4. sick and injured, maternity, newborn, and child care. It shall be equipped with the service capabilities needed to support board certified/eligible medical specialties and other licensed physicians rendering services in, but not limited to: - **Category A (Primary care facility):** a first contact health care facility that offers basic services including emergency services and provision for normal deliveries - **Category B (Custodial care facility):** a health facility that provides long term care including basic services life food and shelter to patients with chronic conditions requiring ongoing health and nursing care due to impairment and reduced degree of independence in ADL patients in need of rehabilitation - **Category C (Diagnostic /therapeutic facility):** a facility for the examination of the human body specimens from the human body for the diagnosis sometimes treatment of disease or water for drinking water analysis. Ex. Laboratory -clinical lab radiologic facility - **Category D (Specialized outpatient facility):** a facility that performs highly specialized procedures on an outpatient basis. Ex. Dialysis clinic **Universal health care (Republic act 11223)** **Declaration of principles** - **Integrated and comprehensive approach** to ensure health literacy, and protection from hazards and risks - **Whole of system, whole of government, who of society approach** in the development of health policies - Health care model that provides **comprehensive health services without causing financial hardship** - **People oriented approach** centered on people's and well-being **General objectives** - To progressively realize universal health care through systematic approach and clear role definition of stakeholders - To ensure equitable access to quality and affordable health care and protection against financial risk **UHC Coverage** **Population coverage** - Automatic inclusion of every Filipino citizen into thee NHIP **Service coverage** - **Immediate eligibility and access** to population-based and individual-based health services - Comprehensive outpatient benefit package - Provision of primary care provider **Financial coverage** - **Population-based health services:** funded by national government through DOH and free at point of service - **Individual-based health services:** funded primarily through pre-payment mechanismss (SHI,PHI, HMO) - **Pooling funds to philhealth** for all individual-based health services - **Simplication of NHIP membership:** - **Direct contributors --** those who have the capacity to pay premiums - **Indirect contributors -** those whose premiums are subsidized by the national government **National health insurance program** **Entitlement to benefits** - Immediate eligibility - No co-payment in basic or ward accommodation - Co-payment/co-insurance policy - No reduction in current philhealth package - Additional benefits for direct contributors **Service delivery** **Population-based health services** - DOH to contract province-wide and city-wide health systems with the following minimum components: - Primary care provider network with accessible patient records - Health promotion programs and campaigns - Epidemiologic surveillance systems - Public health emergencies and disasters and preparedness and response