COMHEN (LEC) - PRELIM.docx

***LESSON ONE!*** ***OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES*** *GLOBAL HEALTH* **-**The current global health situation is complex and challenging, with numerous threats to public health. **-**The COVID-19 pandemic has had a devastating impact on the world, with over 300 million re...

***LESSON ONE!*** ***OVERVIEW OF PUBLIC HEALTH NURSING IN THE PHILIPPINES*** *GLOBAL HEALTH* **-**The current global health situation is complex and challenging, with numerous threats to public health. **-**The COVID-19 pandemic has had a devastating impact on the world, with over 300 million reported cases and six million deaths worldwide. **-**Other significant health concerns include the ongoing Ebola outbreak in the Democratic Republic of Congo, the rise of antimicrobial resistance, and the growing of non-communicable diseases such as diabetes, cancer, and heart disease. **-**Additionally, the world is also facing with mental health issues, such as depression and anxiety, which are often exacerbated by social and economic factors. 1. **INFECTIOUS DISEASE:** 2. **NON-COMMUNICABLE DISEASES:** 3. **MATERNAL AND CHILD HEALTH:** 4. **VACCINE-PREVENTABLE DISEASES:** 5. **MENTAL HEALTH:** 6. **HEALTH INEQUITIES:** 7. **ENVIRONMENTAL HEALTH:** 8. **NUTRITION:** *NATIONAL HEALTH* **-**The Philippines faces various health situations, including a high burden of infectious diseases. **-**The country is also susceptible to natural disasters, which can lead to outbreaks of waterborne and vector-borne diseases. **-**Philippines has a high incidence of non-communicable diseases such as hypertension, diabetes, and heart disease, which are often linked to lifestyle factors and environmental factors. **-**Mental health issues, including depression and anxiety, are also prevalent in the country. **-**The country's healthcare system is facing challenges in addressing these health situations, including a shortage of healthcare workers, inadequate infrastructure, and limited access to healthcare services, particularly in rural areas. ***PUBLIC HEALTH*** +-----------------------------------------------------------------------+ | *"science and art of preventing disease, prolonging life, promoting | | health and efficiency through organized community effort for the | | sanitation of the environment, control of communicable diseases, the | | education of individuals in personal hygiene, the organization of | | medical and nursing services for the early diagnosis and preventive | | treatment of disease, and the development of social machinery to | | ensure everyone a standard of living adequate for the maintenance of | | health, so organizing these benefits as to enable every citizen to | | realize his birthing of health and longevity"* | | | | *-Dr. C.E Winslow* | +-----------------------------------------------------------------------+ *CORE BUSINESS OF PUBLIC HEALTH* - Disease control - Injury prevention - Health protection - Health public policy including those in relation to environmental hazards such as in the workplace, housing, food, water and others. - Promotion of health and equitable health gain *ESSENTIAL PUBLIC HEALTH FUNCTIONS* - Health situation monitoring and analysis - Epidemiological surveillance/disease prevention and control - Development of policies and planning in public health - Strategic management of health systems and services for population health gain - Regulation and enforcement to protect public health - Human resources development and planning in public health - Health promotion, social participation and empowerment - Ensuring the quality of personal and population based health services - Research development and implementation of innovative public health solutions ***COMMUNITY HEALTH*** Community Health refers to the health and well-being of individuals and groups within a specific geographic area, such as a neighborhood, town, or city. -It encompasses the social, economic, and environmental factors that affect the health of a community, as well as the collective efforts to promote health, prevent disease, and provide healthcare services to the population. Community health is often characterized by: *A.FOCUS ON PREVENTION* -Emphasis on preventing disease and promoting health through education, advocacy, and community-based initiatives. *B.COMMUNITY ENGAGEMENT* -Involvement of community members in the planning, implementation, and evaluation of health programs. *C.HOLISTIC APPROACH* -Addressing the physical, emotional, social, and environmental factors that impact health. *D.COLLABORATION* -Working with local organizations, governments, and other stakeholders to achieve common health goals. *E.EMPOWERMENT* -Building capacity and empowering individuals and communities to take ownership of their health and well-being. ***PUBLIC HEALTH NURSING*** +-----------------------------------------------------------------------+ | *The practice of promoting and protecting the health of populations | | using knowledge from nursing, social, and public health sciences* | | | | *(American Public Health Association, Public Health Nursing Section, | | 1996).* | +-----------------------------------------------------------------------+ -Public health nursing practice focuses on population health, with the goal of promoting health, and preventing disease and disability. ***LESSON TWO!*** ***COMMUNITY HEALTH NURSING*** **-** The synthesis of nursing and public health practice applied to promote and protect the health of population. **-** Combines all the basic elements of professional, clinical nursing with public health and community practice. *BASIC CONCEPT* -Promote healthy lifestyle -Prevent disease and health problems -Provide direct care **PRIMARY GOAL OF COMMUNITY HEALTH NURSING:** To help a community protect and preserve the health of its members **SECONDARY GOAL:** To promote self-care among individuals and families ***STANDARDS OF PUBLIC HEALTH NURSING IN THE PHILIPPINES*** 1. **Philippine Nursing Association (PNA):** The PNA's Code of Ethics for Nurses emphasizes the importance of public health nursing in promoting and protecting the health of the population. 2. **Department of Health (DOH):** The DOH has established the National Health Policy and the Philippine Health Strategy 2017-2022, which focuses on *[universal health care, health promotion, and disease prevention.]* -Public health nurses in the Philippines are expected to adhere to these standards, *[providing preventive and curative services, conducting community outreach programs, and advocating for health equity and social determinants of health.]* -PH Nurses play a crucial role in disease surveillance, outbreak response, and implementation of health policies and programs at the local level. ***EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES*** **-** Public Health Nursing in the Philippines has undergone significant evolution since its inception in the early 20th century. **-** Initially, it was introduced by American nurses who were trained in the public health nursing model of Lillian Wald and Mary Breckinridge. ***1930s:*** Philippine Nurses Association (PNA) established the first public health nursing program, which focused on maternal and child health care. ***1960s:*** Public health nursing expanded to include community health education and family planning ***70s:*** The introduction of primary health care, which emphasized community-based health care and community involvement. ***80s:*** Public health nursing became more decentralized, with increased focus on rural and remote areas. ***TODAY:*** Public health nursing in the Philippines emphasizes community-based care, health promotion, and disease prevention, with a strong emphasis on interprofessional collaboration and partnership with local communities. ***ROLES, FUNCTIONS, AND RESPONSIBILITIES OF THE COMMUNITY HEALTH NURSE*** In the Philippines, a community health nurse plays a crucial role in promoting and protecting the health of individuals and communities. The roles and responsibilities of a community health nurse include: **-** Conducting community assessments to identify health needs and develop plans to address them. **-** Implementing health education and promotion programs to empower individuals and communities to take care of their health. **-** Providing primary health care services, including preventive and curative care, to individuals and families. **-** Collaborating with other healthcare professionals, community organizations, and government agencies to achieve health goals. **-** Developing and implementing health programs for specific populations, such as children, pregnant women, and older adults. **-** Providing guidance and support to community-based health workers, such as midwives and health workers in rural areas. **-** Advocating for policies and programs that promote health equity and address social determinants of health. **-** Monitoring and evaluating the effectiveness of health programs and making data-driven decisions to improve them. ***CLINICIAN OR HEALTH CARE PROVIDER:*** Utilizes the nursing process in the care of the client in the home setting through home visits and in public health care facilities; conducts referral of patients to appropriate levels of care when necessary. ***HEALTH EDUCATOR:*** Utilizes teaching skills to improve the health knowledge, skills and attitude of the individual, family and the community and conducts health information campaigns to various groups for the purpose of health promotion and disease prevention. ***COORDINATOR AND COLLABORATOR:*** Establishes linkages and collaborative relationships with other health professionals, government agencies, the private sector, non-government organizations and people's organizations to address health problems. ***SUPERVISOR:*** Monitors and supervises the performance of midwives and other auxiliary health workers; also initiates the formulation of staff development and training programs for midwives and other auxiliary health workers as part of their training function as supervisors. ***LEADER AND CHANGE AGENT:*** influences people to participate in the overall process of community development. ***MANAGER:*** Organizes the nursing service component of the local health agency or local government unit; also, as program manager, the PHN is responsible for the delivery of the package of services provided by the health program to target clientele. ***RESEARCHER:*** Participates in the conduct of research and utilizes research findings in practice. ***MILLENNIUM DEVELOPMENT GOALS*** 1. ERADICATE EXTREME POVERTY AND HUNGER 2. ACHIEVE UNIVERSAL PRIMARY EDUCATION 3. PROMOTE GENDER EQUALITY AND EMPOWER WOMEN 4. REDUCE CHILD MORTALITY 5. IMPROVE MATERNAL HEALTH 6. COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES 7. ENSURE ENVIRONMENTAL SUSTAINABILITY 8. A GLOBAL PARTNERSHIP FOR DEVELOPMENT **-**The Millennium Development Goals (MDGs) are eight goals with measurable targets and clear deadlines for improving the lives of the world's poorest people. *WHAT IS THE EXPLANATION OF* *MILLENNIUM DEVELOPMENT GOALS?* **-**The eight Millennium Development Goals (MDGs) - which range from having extreme poverty rates to halting the spread of HIV/AIDS and providing universal primary education, all by the target date of 2015 -- form a blueprint agreed by all the world's countries and all the world's leading development institutions. *WHAT* *ARE THE IMPORTANCE OF MILLENNIUM DEVELOPMENT GOALS?* **-**It invests in poor communities in least-developed countries by providing economic and social infrastructure, credit for both agricultural and small-scale entrepreneurial activities, and local development funds which encourage people's participation as well as that of local governments in the planning and implementation. *VISION* **-**The Millennium Development Goals (MDGs) commit the international community to an expanded vision of poverty reduction and pro-poor growth, one that vigorously places human development at the center of social and economic progress in all countries. ***SEPTEMBER 2000:*** The MDGs were developed out of several commitments set forth in the Millennium Declaration, signed in *September 2000.* There are *[eight]* *[goals with 21 targets]*, and a series of measurable health indicators for each target. **-**The United Nations Millennium Declaration, signed in September 2000, commits world leaders to combat poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. - The MDGs are inter-dependent; all the MDG influence health, and health influences all the MDGs. - For example, better health enables children to learn and adults to earn. - Gender equality is essential to the achievement of better health. - Reducing poverty, hunger and environmental degradation positively influences, but also depends on, better health. *WHAT ARE THE ISSUES AND CHALLENGES IN THE MDG IMPLEMENTATION IN THE PHILIPPINES?* **-**According to Alba and Leal (2009) the main challenges when implementing MDG in the Philippines are lack of financial resources, high poverty rate, slow economic growth, the rule of law and bureaucratic red tape. ***SUSTAINABLE DEVELOPMENT GOALS*** **-** The *[17 Sustainable Development Goals and 169 targets]* today demonstrate the scale and ambition of this new Universal Agenda. **-** They seek to build on the Millennium Development Goals and complete what they did not achieve. **-** They seek to realize the human rights of all and to achieve gender equality and the empowerment of all women and girls. **-** They are integrated and indivisible and balance the three dimensions of sustainable development: *[The economic, social and environmental.]* **-**The Goals and targets will stimulate action over the *[next 15 years in areas of critical importance]* for humanity and the planet. 1. End poverty in all its forms everywhere 2. End hunger, achieve food security and improved nutrition and promote sustainable agriculture 3. Ensure healthy lives and promote well-being for all at all ages 4. Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all 5. Achieve gender equality and empower all women and girls 6. Ensure availability and sustainable management of water and sanitation for all 7. Ensure access to affordable, reliable, sustainable and modern energy for all 8. Promote sustained, inclusive and sustainable economic growth, full and productive employment and decent work for all 9. Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation 10. Reduce inequality within and among countries 11. Make cities and human settlements inclusive, safe, resilient and sustainable 12. Ensure sustainable consumption and production patterns 13. Take urgent action to combat climate change and its impacts 14. Conserve and sustainably use the oceans, seas and marine resources for sustainable development 15. Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss 16. Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels 17. Strengthen the means of implementation and revitalize the Global Partnership for Sustainable Development -- -- ***LESSON THREE!*** ***DEPARTMENT OF HEALTH (DOH)*** **-**Is the principal health agency in the Philippines. It is responsible in ensuring access to basic public health services to all Filipinos through the provision of quality health care and regulation of providers of health goods and services. ***MISSION --*** The Department of Health (DOH) shall lead the country in the development of a People-centered, Resilient and Equitable health system. ***VISION --*** The Department of Health (DOH) envisions Filipinos are among the healthiest people in Southeast Asia by 2022, Asia by 2040. ***CORE VALUES --*** The Department of Health (DOH) shall embody at all times integrity, excellence, and compassion in carrying out its tasks and responsibilities. - ***1898 --*** Americans assembled a military Board of Health on *[September 10, 1898]*, with its formal organization on September 29. - *Dr. Frank S. Bourns is assigned as president while Dr. C. L. Mullins is assigned as assistant surgeon.* - ***1900 --*** 200,222 lives including 66,000 children were lost; three percent of the population was decimated in the worst epidemic in Philippine health history. - ***1905 --*** The Americans, led by *[Dean Worcester]* built the UP College of Medicine and Surgery and with Johns Hopkins University serving as the blueprint, at the time, one of the best medical schools in the world. - ***1909 --*** Nursing instruction was also begun at the Philippine Normal School. In terms of public health, the Americans improved on the sewer system and provided a safer water supply. - ***1915 --*** Bureau of Health was reorganized and renamed into the Philippine Health Service. During the succeeding years leadership and a number of health institutions were already being given to Filipinos, in accordance with the *[Organic Act of 1916.]* - ***January 1, 1919 --** [Dr. Vicente De Jesus]* [ ] became the first Filipino to head the Health portfolio. - ***1933 --*** Philippine Health Service reverted to being known as the *[Bureau of Health]*. It was during this time that it pursued its official journal, The Health Messenger and established Community Health and Social Centers, precursors to today's Barangay Health Centers. - ***1936 --** [Governor-General Frank Murphy]* was assuming the post of United States High Commissioner, he would remark that the Philippines led all oriental countries in terms of health status. - *When the Commonwealth of the Philippines was Inaugurated, [Dr. Jose F. Fabella] was named chief of the Bureau of Health. In 1936, Dr. Fabella reviewed the Bureau of Heath's organization and made an inventory of its existing facilities, which consisted of 11 community and social health centers, 38 hospitals, 215 puericulture centers, 374 sanitary divisions, 1,535 dispensaries and 72 laboratories.* - ***1940 --*** Bureau of Health was reorganized into the Department of Health and Public Welfare, still under Fabella. During this time, the major priorities of the agency were *[tuberculosis, malnutrition, malaria, leprosy, gastrointestinal disease, and the high infant mortality rate.]* - *When the Japanese occupied the Philippines, they dissolved the National Government and replaced it with the Central Administrative Organization of the Japanese Army. Health was relegated to the Department of Education, Health and Public Welfare under [Commissioner Claro M. Recto.]* - ***1944 --*** President Manuel Roxas signed *[Executive]* *[Order (E.O.) No. 94]* into law, calling *[creation of the]* *[Department of Health.]* Dr. Antonio C. Villarama as appointed Secretary. A new Bureau of Hospitals and a Bureau of Quarantine was created under DOH. Under E.O. 94, the Institute of Nutrition was created in 1948 to coordinate various nutrition activities of the different agencies. - - ***1975 -- MID 80s -*** The first three institutions were spearheaded by First Lady Imelda Marcos. *[The]* *[Philippine Heart Center]* was established on February 14, 1975, with Dr. Avelino Aventura as director. Second, the *[Philippine Children\'s]* *[Medical Center]* was built in 1979. Then in 1983, the *[National Kidney and Transplant Institute]* was set up. This was soon followed by the *[Lung Center]* *[of the Philippines]*, which was constructed under the guidance of Health Minister Dr. Enrique Garcia. - *With a shift to a parliamentary form of government, the Department of Health was transformed into the [Ministry of Health on June 2,] , with Dr. Clemente S. Gatmaitan as the first health minister. On April 13, 1987, the Department of Health was created* *from the previous Ministry of Health with Dr. Alfredo R. A. Bengzon as secretary of health.* - ***2016 -*** On *[December 17, 2016]*, Health Secretary Paulyn Jean Rossel-Ubial announced that in 2017 the government will start paying the hospital bills and medicines of poor Filipinos. She said that the Department of Health (DOH) is capable of taking care of the hospital bills and medicines of poor Filipinos owing to its bigger budget starting in 2017. - *A total of ₱96.336 billion was allocated to the DOH in the 2017 national budget, which includes funds for the construction of additional health facilities and drug rehabilitation centers. Ubial said poor patients in government hospitals do not even have to present PhilHealth cards when they* *avail of assistance. She added that poor patients will no longer be billed by government hospitals.* - *Ubial said President Rodrigo Duterte is keen on implementing the program to help poor Filipinos in all parts of the country. She said PhilHealth will remain a partner of government hospitals in serving the poor.* - *Senator Loren Legarda, chair of the Senate committee on finance said that the proposed ₱3.35-trillion national budget for 2017 will provide healthcare assistance to all Filipinos, said an additional ₱3 billion was allocated to the Philippine Health Insurance Corporation (PhilHealth) to ensure coverage for all Filipinos.* - *"The Department of Health (DOH) said there are some eight million Filipinos still not covered by PhilHealth. It is our duty, in serving the public, to extend basic healthcare protection to all our people. That is why we pushed for the augmentation of the PhilHealth's budget so that in 2017, we achieve universal healthcare coverage,"* - *Legarda said universal healthcare coverage means that [any non-member of PhilHealth will automatically be made a member upon availment of healthcare service in a public hospital.]* - ***2020 -*** In early January 2020, the Philippines confirmed its first case of Novel coronavirus disease. Two months later, the Philippines implemented national lockdowns, mask mandate, and social distancing. In February 2021, COVID-19 vaccines reached the Philippines and began to the administered. ***PHILIPPINES DOH LOCAL HEALTH SYSTEM*** *A - NATIONAL VOLUNTARY BLOOD SERVICES PROGRAM* *B - HEALTH LEADERSHIP AND GOVERNANCE PROGRAM* -- -- *C -- GEOGRAPHICALLY ISOLATED AND DISADVANTAGED AREAS (GIDA) INCLUDING INDIGENOUS POPULATION (IP) HEALTH PROGRAM CLUSTER/PROGRAM* - *Geographically Isolated and Disadvantaged Areas or GIDA, refers to communities with marginalized population, [PHYSICALLY] and [SOCIO-ECONOMICALLY] separated from* *the mainstream society.* ***PHYSICAL FACTOR -*** Isolated due to distance, weather conditions and places that are hard to reach such as being landlocked, lowland etc. ***SOCIO-ECONOMIC FACTOR -*** High poverty incidence, presence of vulnerable sector, communities recovering from a crisis or conflict -- -- *D - BARANGAY HEALTH WORKERS (BHW)* -- -- *E -- LGU HEALTH SCORECARD* - *A powerful tool to measure and monitor the performance of the health systems at the local level in terms of the implementation of health reforms and the achievement of desired results.* *F -- HEALTH CARE FINANCING* -- -- *G -- LOCAL INVESTMENT PLANNING FOR HEALTH* - *The three-year* *medium term plan, prepared by Provinces, Highly Urbanized Cities (HUCs) and Independent Component Cities (ICCs), and its yearly interpretation in the Annual Operational Plans (AOP), was initiated in 2005.* *H -- HEALTH FACILTY ENHANCEMENT PROGRAM* ***[HFEP GOALS]*** ----------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ Improving primary health facilities to "gatekeep" and deliver preventive health services and PhilHealth accredication Improving quality of LGU hospitals to comply with DOH licensing and PhilHealth accreditation Upgrading of DOH hospitals and other health care facilities to provide affordable quality tertiary care and specialized treatments ----------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ *I -- SERVICE DELIVERY NETWORK* ***BACKGROUND AND RATIONALE:*** Service Delivery Networks (SDN) refer to the network of health facilities and providers within the province or city-wide health systems, offering a core package of health care services in an integrated and coordinated manner similar to the district health system. ***THE GOALS OF SDNs ARE TO:*** - Improve service provision by providing equitable access to health services - Efficient provision of continuity of care - Service provision that is responsive to client's health needs or preferences. ***CLASSIFICATION OF HEALTH FACILITIES*** ***[Category A: Primary Health Care Facility -]*** A first contact health care facility that offers basic service including emergency services and provision for normal deliveries. ***[Category B: Custodial Care Facility -]*** A health facility that provides long-term care, including basic services like food and shelter, to patients with chronic conditions requiring ongoing health and nursing care due to impairment and a reduced degree of independence in activities of daily living, and 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 analysis. ***[Category D: Specialized Outpatient Facility -]*** A facility that performs highly specialized procedures on a outpatient basis. ***PHILIPPINE HEALTH AGENDA (2010-2022)*** ***GOAL:*** Improving the health and well-being of the Filipino people. ***FOCUS:** Noncommunicable Diseases, Maternal & Child Health, Infectious Diseases, Healthy Lifestyle, Disease Prevention, Access to Quality Care* ***THE AGENDA/TARGET:*** increasing the availability of healthcare services and improving access to care, especially in rural areas. ***PRIMARY HEALTH CARE*** **-** Primary health care (PHC) is a holistic approach to healthcare that emphasizes community-based and preventive care, focusing on the overall well-being of individuals and communities rather than just treating illnesses. **-** It involves a range of services, including health promotion, disease prevention, and treatment, as well as health education and community engagement. **-** PHC is often provided through local health centers, community clinics, or other grassroots organizations, and is intended to be accessible, affordable, and culturally sensitive to the needs of the community. **-** Primary health care is a key component of the country\'s healthcare system, aiming to reduce health disparities and improve health outcomes for all Filipinos. *HISTORY OF PRIMARY HEALTH CARE* ***1970 -*** international health experts recognized the need for a more comprehensive and community-based approach to healthcare. ***1978 -*** Alma-Ata Declaration, signed by 134 countries, including the Philippines, defined PHC as \"essential health care\" that is \"accessible, acceptable, and affordable\" to all people. This declaration emphasized the importance of community-based care, health education, and disease prevention, and encouraged countries to prioritize PHC in their healthcare systems. ***1980 -*** World Health Organization (WHO) further developed the concept of PHC, releasing guidelines and training programs to support its implementation. *LEGAL BASIS OF PRIMARY HEALTH CARE* The legal basis of Primary Health Care (PHC) in the Philippines is rooted in several laws and policies. Some of the key legal frameworks that support PHC include: 1. ***The 1987 Philippine Constitution - Article II,*** ***Section 11 -*** states that *\"the State shall promote the health of the people\" and \"the State shall establish and maintain an efficient and effective health system.\"* 2. ***National Health Policy (2001) -*** This policy sets the direction for the country\'s health care system, emphasizing the importance of PHC and community-based health care. 3. ***The Philippine Health Act of 2008 (RA 9710) -*** This law reorganized the country\'s health system, established a new health care framework, and emphasized the importance of PHC. 4. ***The Universal Health Care (UHC) Act of 2019 (RA 11223) -*** This law aims to provide universal access to quality health care services, including primary health care, to all Filipinos. 5. ***Executive Order No. 103 (2003) -*** This order established the National Health Care System and provided for the integration of PHC into the country\'s health care system. 6. ***Administrative Order No. 2009-0026 (2009) -*** This order provided guidelines for the implementation of PHC in the country. ***GOAL:*** HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE HANDS OF THE PEOPLE by the year 2020. ***OBJECTIVES:*** \- Improvement in the level of health care of the community \- Favorable population growth structure \- Reduction in the prevalence of preventable, communicable and other disease. \- Reduction in morbidity and mortality rates especially among infants and children. \- Extension of essential health services with priority given to the underserved sectors. \- Improvement in Basic Sanitation \- Development of the capability of the community aimed at self-reliance. \- Maximizing the contribution of the other sectors for the social and economic development of the community. ***MISSION:*** To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care. *2 LEVELS OF PRIMARY HEALTH CARE WORKERS* ***BARANGAY HEALTH WORKERS:*** trained community health workers or health auxiliary volunteers or traditional birth attendants or healers. ***INTERMEDIATE LEVEL HEALTH WORKERS:*** include the Public Health Nurse, Rural Sanitary Inspector and midwives. *PRINCIPLES OF PRIMARY HEALTH CARE WORKERS* 1. ***FOUR A's -*** The health services should be present where the supposed recipients are. They should make use of the available resources within the community, wherein the focus would be more on health promotion and prevention of illness. - *Accessibility, Affordability, Appropriateness, Availability* 2. ***COMMUNITY PARTICIPATION -*** The active involvement of individuals within their communities. 3. ***PEOPLE'S PARTICIPATION -*** People are the center, object and subject of development. **[Barriers of Community Involvement]** Lack of motivation Attitude Resistance to change Dependence on the part of community people Lack of managerial skills 4. ***SELF RELIANCE -*** Through community participation and cohesiveness of people's organization they can generate support for health care through social mobilization, networking and mobilization of local resources. 5. ***PARTNERSHIP BETWEEN THE COMMUNITY AND THE HEALTH AGENCIES IN THE PROVISION OF QUALITY OF LIFE -*** Providing linkages between the government and the nongovernment organization and people's organization. 6. ***RECOGNITION OF INTERRELATIONSHIP BETWEEN THE HEALTH AND DEVELOPMENT -* Health-** Is not merely the absence of disease. Neither is it only a state of physical and mental well-being. Health being a social phenomenon recognizes the interplay of political, socio-cultural and economic factors as its determinant. Good Health, therefore, is manifested by the progressive improvements in the living conditions and quality of life enjoyed by the community residents (PCF) **Development-** is the quest for an improved quality of life for all. Development is multidimensional. It has political, social, cultural, institutional and environmental dimensions (Gonzales 1994). Therefore, it is measured by the ability of people to satisfy their basic needs. 7. ***SOCIAL MOBILIZATION -*** It enhances people participation or governance, support system provided by the Government, networking and developing secondary leaders. 8. ***DECENTRALIZATION -*** The process by which the activities of an organization, particularly those related to planning and decision-making, are distributed or delegated away from a central, authoritative location or group and given to smaller factions within it. *8 ELEMENTS OF PRIMARY HEALTH CARE* 1. ***Education for Health -*** Is one of the potent methodologies for information dissemination. It promotes the partnership of both the family members and health workers in the promotion of health as well as prevention of illness. 2. ***Locally Endemic Disease Control -*** The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate. *Example Malaria Control and Schistosomiasis Control.* 3. ***Expanded Program on Immunization -*** This program exists to control the occurrence of preventable illnesses especially of children below 6 years old. 4. ***Maternal and Child Health and Family Planning -*** The mother and child are the most delicate members of the community. So the protection of the mother and child to illness and other risks would ensure good health for the community. The goal of Family Planning includes spacing of children and responsible parenthood. 5. ***Clean Water & Sanitation / Environmental Sanitation and Promotion of Safe Water Supply -*** Environmental Sanitation is defined as the study of all factors in the man's environment, which exercise or may exercise deleterious effect on his well-being and survival. Water is a basic need for life and one factor in man's environment. Water is necessary for the maintenance of healthy lifestyle. Safe Water and Sanitation is necessary for basic promotion of health. 6. ***Nutrition and Promotion of Adequate Food Supply -*** One basic need of the family is food. And if food is properly prepared then one may be assured healthy family. There are many food resources found in the communities but because of faulty preparation and lack of knowledge regarding proper food planning, Malnutrition is one of the problems that we have in the country. 7. ***Treatment of Communicable Diseases and Common Illness -*** The diseases spread through direct contact pose a great risk to those who can be infected. Tuberculosis is one of the communicable diseases continuously occupies the top ten causes of death. Most communicable diseases are also preventable. The Government focuses on the prevention, control and treatment of these illnesses. 8. ***Supply of Essential Drugs -*** This focuses on the information campaign on the utilization and acquisition of drugs. In response to this campaign, the *[GENERIC ACT]* of the Philippines is enacted. *MAJOR STRATEGIES OF PRIMARY HEALTH CARE* 1. ***Elevating Health to a Comprehensive and Sustained National Effort*** - Attaining Health for all Filipino will require expanding participation in health and health related programs whether as service provider or beneficiary. - Empowerment to parents, families and communities to make decisions of their health is really the desired outcome. - Advocacy must be directed to National and Local policy making to elicit support and commitment to major health concerns through legislations, budgetary and logistical considerations. 2. ***Promoting and Supporting Community Managed Health Care*** - The health in the hands of the people brings the government closest to the people. It necessitates a process of capacity building of communities and organization to plan, implement and evaluate health programs at their levels. 3. ***Increasing Efficiencies in the Health Sector*** - Using appropriate technology will make services and resources required for their delivery, effective, affordable, accessible and culturally acceptable. - The DOH should continue to support and assist both public and private institutions particularly in faculty development, enhancement of relevant curricula and development of standard teaching materials. 4. ***Advancing Essential National Health Research*** - Essential National Health Research (ENHR) is an integrated strategy for organizing and managing research using intersectoral, multi-disciplinary and scientific approach to health programming and delivery.