Community Health Nursing (NCM 104 LEC) Notes PDF

COMMUNITY HEALTH NURSING PUBLIC HEALTH NURSING PUBLIC HEALTH 3. NURSING FUNCTION – An inherent function of the nurse – According to Dr. C...

COMMUNITY HEALTH NURSING PUBLIC HEALTH NURSING PUBLIC HEALTH 3. NURSING FUNCTION – An inherent function of the nurse – According to Dr. C.E. Winslow, he defines public – Her practice as a nurse is based on the science and health as the “science and art of preventing disease, art of caring prolonging life, promoting health and efficiency.” – Public health nursing is caring for individuals, families – GOAL: To enable every citizen to realize his and communities toward health promotion and birthright of health and longevity. disease prevention – Achieved through community effort – PHN are expected to provide nursing care – PHN uses her knowledge and skill in the nursing PUBLIC HEALTH NURSING process. She does assessment, plans, and implements care, and evaluates outcomes. – According to WHO Expert Committee of Nursing, – Establishes rapport with her client: individual, family or PHN is a “special field of nursing that combines the community skills of nursing public health and some phases of – Home visits social assistance and functions as part of the total – Referral of patients to appropriate levels of care public health program for the promotion of health, the o Should be done when it is indicated improvement of the conditions in the social and physical environment, rehabilitation of illness and 4. COLLABORATING AND COORDINATING disability.” FUNCTION – Brings activities or group activities systematically into STANDARDS OF PUBLIC HEALTH NURSING IN THE proper relation or harmony with each other. PHILIPPINES – Care coordinators for communities and their members – National League of Philippine Government Nurses – Actively involved both socially and politically to (2005) came up with the standard of public health empower individuals, families and communities as an nursing in the Philippines entity to initiate and maintain health promoting environments. PUBLIC HEALTH NURSES MUST BE/HAVE: 5. HEALTH PROMOTION AND EDUCATION 1. BSN graduate FUNCTION 2. Registered Nurse – Activities goes beyond health teachings and health 3. Member of PNA information campaigns. 4. Good moral character – Understanding the multidimensional nature of health will enable her to plan and implement health 1. MANAGEMENT FUNCTION promoting interventions for individuals and – The management function of the public health nurse communities. is inherent in her practice. – Uses her skills in advocacy for the creating of a – This function is performed when she organizes the supportive environment through policies and “nursing service” of the local health agency reengineering of the physical environment for – A program manager healthier actions. o As a program manager, they are responsible for the delivery of the package of services 6. TRAINING FUNCTION provided by the program to target client. – Initiates the formulation of staff development and o Example: She plans activities and sets targets, training programs for midwives and other auxiliary organizes, directs, and controls activities and workers outputs, deploys needed manpower and – Does training needs assessment for these health budget resources accordingly. workers, designs the training program and conducts o Reports on program accomplishments is a them in collaboration with other resource persons. documentation of her management skills. – Also does evaluation of training – In areas where there are more nurses like in big – PHN participates in the training of nursing and municipalities and cities, the management function of midwifery affiliates in coordination with the faculty of the nurse is more apparent and managing the nurses colleges of nursing and midwifery in their activities. 7. RESEARCH FUNCTION 2. SUPERVISORY FUNCTION – Participates in the conduct of research and utilizes – PHN is the supervisor of the midwives and other research findings. auxiliary health workers in the catchment area. – PHN function is disease surveillance. Purposes of – Formulates a supervisory plan and conducts disease surveillance: supervisory visits to implement plan. o To measure the magnitude of the problem – Conducts supervisory visits using a supervisory o To measure the effect of the control program checklist It is important in monitoring the progress of – During the visit the PHN identifies together with the the disease reduction initiatives: supervisee any issue or problem encountered and Poliomyelitis, Neonatal Tetanus Elimination, addresses them accordingly. Measles Control, NCD risk factors, etc.  COMMUNITY HEALTH NURSING COMMUNITY HEALTH NURSING COMMUNITY HEALTH NURSING 7. Periodic and continuing evaluation provides the – Is a service rendered by professional nurse with the means for assessing the degree to which CHN goals Community, Groups, Families, and Individuals at and objectives are being attained. home, in health centers, clinics, schools, place of – Clients are involved in the appraisal of their work for the promotion of health, prevention of illness, health program through consultations, care of the sick at home and rehabilitation. observations, and accurate recording OBJECTIVES 8. Continuing staff education program quality services to To participate in the development of an overall health client and are essential to upgrade and maintain plan for the community. sound nursing practices in their setting. To provide quality nursing services to individuals, – Professional interest and needs of Community families & communities. Health Nurses are considered in planning staff To coordinate nursing services with various members development programs of the agency. of health team. To participate in and/or conduct researches relevant 9. Utilization of indigenous and existing community to community health and community health nursing resources maximizing the success of the efforts of the services and disseminate their results for Community Health Nurses. improvement of health. – The use of local available ailments linkages with existing community resources both public Basic CHN Concepts and private increase the awareness of what care they need and what are entitled. PHILOSOPHY – Worth and dignity of man 10. Active participation of the individual, family and community in planning and making decisions for their Ultimate Goal: To raise the level of health of the citizenry. health care needs, determine, to a large extent, the Primary Focus: Health promotion and disease prevention success of the CHN programs. Primary Goal: Self-reliance in health – Organized community groups are encouraged – Help the client to be dependent on to participate in the activities that will meet their selves and knowing what are community needs and interests. their needs and resources which they can use. 11. Supervision of nursing services by qualified by CHN personnel provides guidance and direction to the work PRINCIPLES to be done. – Potentials of employees for effective and 1. Is based on recognized needs of communities, efficient work are developed families, groups and individuals. 12. Accurate recording and reporting serve as the basis 2. Knowledge and understanding of the objectives and for evaluation of the progress of planned programs policies of the agency facilities goal achievement. and activities and as a guide for the future actions. – Maintenance of accurate record is a vital 3. CHN considers the family as the unit of service. responsibility of community as these are – Its level of functioning influence by the degree utilized in studies and researches and as a to which it can build its own problem legal documents. – Therefore, the family is an effective and available channel for the most of the CHN MISSION OF COMMUNITY HEALTH NURSING efforts. 1. Health Promotion – actions related to lifestyles and 4. Respect for the values, customs and beliefs choices that maintains / enhances a population’s – This contributes to the effectiveness of care to health. the client 2. Health Protection – includes activities designed to – CHN services must be available, sustainable, detect or prevent illness or alter disease processes. and affordable to all regardless of race, creed, 3. Health Balance – state of wellbeing that results from color or social economic status a healthy interaction between a person’s body, mind, spirit and environment. 5. CHN integrated health education and counseling as 4. Disease Prevention – activities designed to protect vital parts of functions people from disease and its consequence – This encourage and support community efforts 5. Social Justice – all people have a right to certain in the discussion of issues to improve the “basics” of life and health protection. people’s health. CLIENTS OF THE NURSE 6. Collaborative work relationships with the co-workers and members of the health team facilities INDIVIDUAL (sick or well) accomplishments of goals. – Can be considered as entry point in working – Each member is helped to see how his/her with the whole family work benefits the whole enterprise – Least important client in the community health nursing – Most important client in the hospital  FAMILY – Basic unit of care – It is composed of two or more persons usually related to blood, marriage, and adoption. – Second important client Health task: o Recognizing interruptions of health or development o Seeking health care o Managing health & non health crises o Providing care to the sick, disabled & dependent member of the family o Maintaining a home environment conducive to good health & development o Maintaining good relationship with community & health institution. POPULATION GROUP – A group of people who share common characteristics, developmental stage or common exposure to particular environmental factors & consequently common health problems:(Children, Elderly) – Typically used to denote a group of people having common personal or environmental characteristics – It can also refer to all of the people in a defined communities COMMUNITY – Group of people sharing common geographic boundaries, values & interests – Most important client – Two main types: o Geo-political Community § Most traditionally recognized or imagined when considering the term “community” § Formed by both natural and man-made boundaries and include barangays, municipalities, cities, provinces, regions, and nations § May also be called territorial communities o Phenomenological Community § It refers to the relational interactive groups in which the place or setting is more abstract and people share a group perspective or identity based on culture, values, history, interests, and goals. § Example: schools, colleges, universities, churches, mosques, and various groups of organization § May also be described as functional communities. The hallmark of community health nursing is that it is population- or aggregate-focused. *Hallmark – a distinctive characteristics of something – It can mean a literal symbol of a certain topic *Aggregate – sub groups or sub population that has some common characteristics or concerns. So, these common characteristics or concerns may make members of aggregate vulnerable to similar health problems. – For example, groups with similar physiological processes (pregnancy and menopausal stages)  COMMUNITY HEALTH NURSING TYPES OF PUBLIC HEALTH NURSING CLINIC VISIT VII. Prescription/ Dispensing – It is a process of checking the client’s health condition VIII. Health Education in a medical clinic. – Conduct one on one counselling with the patient – The patient visits the health center/clinic to avail of the and then reinforce health education and services thereto offered by the facility primarily for counselling messages and nurses give consultation on matters that ailed them physically. appointments to the clients for the next visit. – Pre-consultation conference - A pre-clinic lecture is usually conducted prior to the admission of patients, HOME VISIT which is one way of providing health education. – Is a family- nurse contact which allow the health worker to assess the home and family situations in STANDARD PROCEDURES PERFORMED DURING order to provide the necessary nursing care and CLINIC VISIT health related activities. – In performing this activity, it is essential to prepare a I. Registration/Admission plan of visit to meet the needs of the client and 1. Greet the client upon entry and established achieve the best results of the desired outcomes. rapport. 2. Prepare the family record of new patients or PURPOSE OF HOME VISIT retrieve records of old clients. 3. Elicit and record the client’s chief complaint 1. To give nursing care to the sick, to a post-partum and clinical history. mother and her newborn with the view to teach a 4. Perform physical examination on the client and responsible family member to give the subsequent record it accordingly care. 2. To assess the living condition of the patient and his II. Waiting time family and their health practices in order to provide 1. Give priority numbers to clients. the appropriate health teaching. 2. Implement the “first come, first serve” policy 3. To give health teachings regarding the prevention and except for emergency/ urgent cases. control diseases. 4. To establish close relationship between the health III. Triaging agencies and the public for the promotion of health – Community and hospital set-ups have different 5. To make use of the inter- referral system and to triage promote the utilization of community services. – Nurses have to provide first a treatment to emergency cases and then to be referred PRINCIPLES INVOLVED IN PREPARING FOR A HOME necessarily to the next level care. VISIT 1. Manage program-based cases. 2. Refer all non-program based cases to the 1. A home visit must have a purpose or objective. physician. 2. Planning for a home visit should make use of all 3. Provide first-aid treatment to emergency cases available information about the patient and his family and refer when necessary to the next level through family records. care. 3. In planning for a visit, we should consider and give priority to the essential needs of the individual and his IV. Clinical Evaluation family. 1. Validate clinical history and physical 4. Planning and delivery of care should involve the examination individual and family. 2. The nurse arrives at evidence-based diagnosis 5. The plan should be flexible. and provides rational treatment based on DOH programs. GUIDELINES TO CONSIDER REGARDING THE a) Identify the patient’s problem FREQUENCY OF HOME VISITS b) formulate/ write the nursing diagnosis – The schedule of visit may vary according to the need and validate of the patient or family for nursing care but one has to c) give/ perform the nursing intervention consider the following factors: d) evaluate the intervention if it has enabled the patient to achieve this 1. The physical needs, psychological needs and desired outcome educational needs of the individual and family. 3. Inform the client on the nature of the illness, 2. The acceptance of the family for the services to be the appropriate treatment and prevention and rendered, their interest and the willingness to control measures. cooperate. 3. The policy of a specific agency and the emphasis V. Laboratory and other diagnostic examinations given towards their health programs. 1. Identify a designated referral laboratory when 4. Take into account other health agencies and the needed. number of health personnel already involved in the care of a specific family. VI. Referral System 5. Careful evaluation of past services given to a family 1. Refer the patient if he needs further and how the family avail of the nursing services. management following the two- way referral 6. The ability of the patient and his family to recognize system (BHS to RHU, RHU to RHU, RHU to their own needs, their knowledge of available Hospital). resources and their ability to make use of their 2. Accompany the patient when an emergency resources for their benefits. referral is needed.  STEPS IN CONDUCTING HOME VISITS 1. Greet the patient and introduce yourself 2. State the purpose of the visit 3. Observe the patient and determine the health needs 4. Put the bag in a convenient place then proceed to perform the bag technique 5. Perform the nursing care needed and give health teachings 6. Record all important data, observation and care rendered 7. Make appointment for a return visit  COMMUNITY HEALTH NURSING EVOLUTION OF PUBLIC HEALTH NURSING IN THE PHILIPPINES PHN SPANISH REGIME SIGNIFANT CHANGED: – Bro. Juan Clemente started health services through a dispensary in Intramuros Branching out of the office of Public Health services to – Start of water sanitation form the office of special concern – Introduction of small pox vaccine National Immunization Day (Every Wednesday of the month) AMERICAN REGIME 1898 National Micronutrient Campaign (Araw ng Sangkap – Creation of the Board of Health for Physicians Pinoy) Disaster Management Urban Health and Nutrition 1901 Project – Creation of Board of Health for City of Manila, Traditional Medicine Doctors to the Barrios Provincial, and Municipal Boards of Health Program Let’s DOH it! Became a national battle cry 1996 1905 – Primary Health Care as strategy to attain – Abolished Board of Health Health for All by the year 2000 – Activities were taken over by the Bureau of Health 1999 under Department of Interior – Creation of the National Health Planning Committee (NHPC) 1906 – Establishment of Inter-Local Health Zone – Abolition of Board of Health 1999 – Creation of Bureau of Health 2004 1912 – Health Sector Reform Agenda of the – Creation of Sanitary Divisions Philippines was launched 2005 1915 – DOH launched Formula One of Health to – BOH was renamed Philippine Health Service with ensure speed, precision, and effective Director of Health as head communication toward improving the efficiency, effectiveness and equity of Health 1928 Care delivery. – First convention of Nurses was held 1930 – Section of PHN was converted to Section of Nursing 1933 – Reorganization act 4007 – Division of Maternal and Child Health of the office of Public Welfare Commission was transferred to Bureau of Health ERA OF THE REPUBLIC OF THE PHILIPPINES (1946 TO PRESENT) 1947 – Bureau of Public Welfare was renamed DOH June 1957 – Rep. Act 1891 (An act Strengthening Health and Dental Services in the Rural Area) 1975 – Formulation of the National Health Plan and the restricted Health Care delivery system 1982 – E.O 851 reorganized the DOH to synchronize health structure and operations with the shift to parliamentary form of government whence it became known as the Ministry of Health (Later, under the presidential form, as Department of Health).  COMMUNITY HEALTH NURSING PHILIPPINE HEALTH CARE DELIVERY SYSTEM PHILIPPINES AT A GLANCE NATIONAL NUTRITION COUNCIL Land Area: 300,00 sq. km. Population: 106, 512, 074 – Responsible for creating a conducive policy environment for national and local nutrition planning, HEALTH CARE DELIVERY SYSTEM implementation, monitoring and evaluation, and – Organization of people, institutions and resources that surveillance using state-of the art technology and deliver health care services to meet the needs of the approaches target population. COMMSSION ON POPULATION COMPONENTS OF HEALTH CARE DELIVERY SYSTEM – Is a government agency mandated as the over-all GOVERNMENT coordinating, monitoring and policy making body of the population program Department of Health Local Government Unit LEVEL OF HEALTH CARE FACILITIES PRIVATE Commercial and Business Organizations Non-commercial Organizations NON-GOVERNMENT Catalyst, advocates, facilitators, and enablers INTERPROFESSIONAL CARE IN THE COMMUNITY LEVELS OF PRIMARY HEALTH CARE WORKERS VILLAGE, GRASS ROOT Barangay Health Workers INTERMEDIATE Medical practitioners DEPARTMENT OF HEALTH Nurses, midwives Vision (2030) FIRST LINE HOSPITAL PERSONNEL A Global Leader in attaining better health outcomes, Physicians with specialty competitive and responsive health care system and Nurses, dentists, pharmacists equitable health financing. TWO-WAY HEALTH REFERRAL SCHEME Mission To guarantee equitable, sustainable and quality health for all Filipinos, especially the poor and to lead the quest for excellence in health PHILIPPINE HEALTH AGENDA GOALS Financial Protection o Filipinos, especially the poor are protected from high cost of health care Better Health Outcomes o Filipinos attain the best possible health outcomes with no disparity Responsiveness o Filipinos feel respected, valued, and empowered in all of their interaction with the health system DEPARTMENT OF SOCIAL WELFARE AND VALUES DEVELOPMENT Equitable and Inclusive to all – The Philippines' Department of Social Welfare and Uses resources efficiently Development is the executive department of the Transparent and accountable Philippine Government responsible for the protection Provides high quality services of the social welfare of rights of Filipinos and to promote social development – Main program: o Pantawid Pamilyang Pilipino Program (4P’s)  o Provision of fiscal autonomy to government o Cancer, Diabetes, Heart Diseases and their Risk hospitals Factors – obesity, smoking, diet, sedentary o Securing of funding for priority PH programs lifestyle o Strengthening the capacities of health regulatory o Malnutrition agencies o Expand coverage of NHIP Diseases of Rapid Urbanization and Industrialization o Promote development of local health systems and o Injuries ensure their effective performance o Substance abuse o Mental illness PhilHealth (1995) o Pandemics, travel medicine Good Governance Programs o Health consequences of climate change/disaster DOH resources to promote local health system development GUARANTEE #2 – SERVICE DELIVERY NETWORK Milestones Services are delivered by networks that are: Fiscal autonomy for government hospitals Devolution Fully Functionals Use of Generics – Complete equipment, medicine, health Funding for UHC professional Milk Code Every year, around 2000 mothers due to pregnancy- Compliant with Clinical Practice Guidelines related complication Available 24/7 and even during disasters Practicing gatekeeping Persistent Inequities in Health Outcomes Located close to the people Three out of 10 children are stunted Enhanced by telemedicine A Filipino child born to the poorest family is 3 times more likely to not reach his 5th birthday, compared to GUARANTEE #3 – UNIVERSAL HEALTH INSURANCE one born to the richest family. No balance billing for the poor/basic accommodation Restrictive and Impoverishing Healthcare Costs & Fixed co-payment for non-basic accommodation Expand benefits to cover comprehensive range of Every year, 1.5 million families are pushed to poverty services due to health care expenditures. Contracting networks of providers within SDNs. Filipinos forego or delay care due to prohibitive and unpredictable user fees or co-payments PHILHEALTH Php 4,000/month healthcare expenses considered catastrophic for single Income families Services are financed predominantly by PhilHealth “Tiisin ko nalang ito..” PhilHealth As Main Revenue Source For Public Poor quality an undignified care synonymous with Health Care Providers public clinics and hospitals Simplify PhilHealth Rules PhilHealth As The Gateway To Free Long wait times Affordable Care Less than hygienic restrooms, Lacking amenities STRATEGY (ACHIEVE) Poor record-keeping Overcrowding & under-provision of care O Privacy A. Advance quality, health promotion and primary and confidentiality taken lightly care Limited autonomy to choose provider 1. Conduct annual health visits for all poor families Investing in People and special populations (NHTS, IP, PWD, Senior Citizens) UNIVERSAL HEALTH COVERAGE 2. Develop an explicit list of primary care entitlements that will become the basis for STRENGTHEN IMPLEMENTATION OF RPRH LAW licensing and contracting arrangements WAR AGAINST DRUGS 3. Transform select DOH hospitals into mega- ADDITIONAL FUNDS FROM PAGCOR hospitals with capabilities for multi-specialty Protection Against Instability training and teaching and reference laboratory 4. Support LGUs in advancing pro-health PHIILIPPINE HEALTH AGENDA FRAMEWORK resolutions or ordinances (e.g. city-wide smoke- free or speed limit ordinances) O 5. Establish 3 GUARANTEES expert bodies for health promotion and surveillance and response GUARANTEE #1 – ALL LIFE STAGES AND TRIPLE BURDEN OF DISEASE B. Cover all Filipinos against health-related financial risk Communicable o HIV/AIDS, TB, Malaria 1. Raise more revenues for health, e.g. impose o Diseases for Elimination health- promoting taxes, increase NHIP premium o Dengue, Leptospirosis, Ebola, Zika rates, improve premium collection efficiency. 2. Align GSIS, MAP, PCSO, PAGCOR and Non-communicable, Including Malnutrition minimize overlaps with PhilHealth  3. Expand Phil Health benefits to cover outpatient 4. Collaborate with CSOs and other stakeholders diagnostics, medicines, blood and blood on budget development, monitoring and products aided by health technology assessment evaluation 4. Update costing of current PhilHealth case rates to ensure that it covers full cost of care and link UNIVERSAL HEALTH CARE ACT payment to service quality 5. Enhance and enforce PhilHealth contracting Republic Act 11223 policies for better viability and sustainability Universal Health Care Act C. Harness the power of strategic HRH development – Automatically enrolls all Filipino citizens in the National Health Insurance Program and prescribes 1. Revise health professions curriculum to be more complementary reforms in the health system. primary care-oriented and responsive to local – MEMBERSHIP: and global needs o Direct contributors 2. Streamline HRH compensation package to o Indirect contributors incentivize service in high-risk or GIDA areas 3. Update frontline staffing complement standards a. Direct Contributors from profession-based to competency-based – Formal sectors 4. Make available fully-funded scholarships for o Employed HRH hailing from GIDA areas or IP groups o Migrant workers 5. Formulate mechanisms for mandatory return of o With own businesses service schemes for all heath graduates o Professional practitioners o Lifetime members( 60years old above) D. Invest in eHealth and data for decision-making including their dependents (21 years old below) 1. Mandate the use of electronic medical records in all health facilities b. Indirect Contributors 2. Make online submission of clinical, drug – Sponsored dispensing, administrative and financial records – Indigents (DDSWD; NHTS – Listahan) a prerequisite for registration, licensing and – Senior Citizen (RA 10645) contracting – Person with Disabilities/PWD (RA 11228) 3. Commission nationwide surveys, streamline information systems, and support efforts to Direct contributors depending on the category will improve local civil registration and vital statistics pay 200 php per month 4. Automate major business processes and invest A Member Data Record ( MDR) will be given to the in ware-housing and business intelligence tools members. An MDR contains the Basic information 5. Facilitate ease of access of researchers to about the member such as name, address, birthdate, available data age and PhilHealth number. It also includes the dependents of the member( below 21years old; 60 E. Enforce standards accountability and years old above) transparency Direct contributors have additional benefits if needed. 1. Publish health information that can trigger better performance and accountability Emergency cases are covered by UHC act 2. Set up dedicated performance monitoring unit to Outpatient drugs is also included such as track performance or progress of reforms medications for asthma, hypertension, gastroenteritis ( Expanded Primary Care Benefit) F. Value all clients and patients, especially the poor, 45 days allowance or single period of confinement marginalized, and vulnerable should be observed. Can be used in all Philhealth accredited facilities in 1. Prioritize the poorest 20 million Filipinos in all the country (Philippines) health programs and support them in non-direct Those who are in the private sectors can also benefit health expenditures or avail the services provided that the Philhealth, 2. Make all health entitlements simple, explicit and DOH and their private organization have a certain O widely published to facilitate understanding, & policy on this matter. generate demand Healthcare facilities who will successfully implement 3. Set up participation and redress mechanisms the UHC Act will be given incentives based on the 4. Reduce turnaround time and improve Special Health Fund (SHF) transparency of processes at all DOH health facilities Health facilities 5. Eliminate queuing, guarantee decent Public – 721 accommodation and clean restrooms in all Private – 1071 government hospitals Human Resource G. Elicit multi-sectoral and multi-stakeholder support Nurse – 488,000 for health Doctors – 70,000 1. Harness and align the private sector in planning Healthcare Financing supply side investments 4 main sources: 2. Work with other national government agencies Local (11%) and National Government (12%) to address social determinants of health Insurance (Government and Private – 9%)) 3. Make health impact assessment and public User fees/Out of Pockets (57%) health management plan a prerequisite for Donors (11%) initiating large-scale, high-risk infrastructure projects UNIVERSAL HEALTH CARE Lahat ng Pilipino Sagot ng PhilHealth Accessible kahit saang sulok ng bansa Mas maraming Health Professionals HEALTH STATUS OF THE PHILIPPINES Weakness Strengths Lack sufficient knowledge Health insurance now covers 92% of the population Rapid economic Maternal and child health development services have improved Urbanization Skilled birth attendants Climate Change Facility based deliveries Widening exposure to Access to and provision of diseases and pathogens – preventive diagnostic and emerging and re-emerging treatment services for infections NCD’s have improved TOP 10 LEADING CAUSES OF MORBIDITY AND MORTALITY  COMMUNITY HEALTH NURSING HEALTH CARE DELIVERY SYSTEM HEALTH CARE DELIVERY SYSTEM 3. Setting norms and standards and promoting and – A health system, also sometimes referred to as health monitoring their implementation; care system, is the organization of people, o The WHO develops norms and standards and institutions, and resources that deliver health care promoting and monitoring their implementation. services to meet the health needs of target o They develop norms and standard for various populations. health and health related issues such as pharmaceutical products including vaccines and According to WHO: other biological products used in immunization, – The health system consists of all organizations, practices in maternal and child care and people and actions whose primary intent is to environmental conditions. promote, restore or maintain health. This includes efforts to influence determinants of health as well as 4. Articulating ethical and evidence-based policy more direct health-improving activities. options; o Through its department of ethics and social Health care delivery system identifies the different determinance, the WHO is involve in various institutions, organizations, and people who have the issues on health ethics in collaboration with responsibility to make sure that people are holistically other governmental and non-governmental healthy by promoting their health, preventing of having organizations WHO has work on bioethical diseases or illnesses and help them detect any disease concerns such as those related to human organ and help them recover or rehabilitate. and tissue transplantation, reproductive technology, and public health response to WORLD HEALTH ORGANIZATION (WHO) threats of infectious diseases such as AIDS, – The World Health Organization (WHO) is a influenza, and tuberculosis. specialized agency of the United Nations that is concerned with international public health 5. Providing technical support, catalyzing change, and – It was established by constitution on 7 April 1948 building sustainable institutional capacity; – Geneva, Switzerland (Headquarter) o The WHO offers technical support and training – There are 6 WHO regions, each with a regional office. to its member countries in the fields of maternal In addition, WHO has 149 field offices in countries, and child health, control of diseases and territories or areas. Countries without a WHO office environmental health services. are covered by nearby field officed or by the appropriate regional office. 6. Monitoring the health situation and addressing health trends Regional Office: o The WHO has develop guidance and tools on Africa measurement, monitoring, and evaluation. Americas South-East Asia MILLENIUM DEVELOPMENT GOALS Europe – The Millennium Development Goals (MDGs) were Eastern Mediterranean eight international development goals for the year Western Pacific 2015 that had been established following the Millennium Summit of the United Nations in Philippines: United Nations Ave, Ermita, Manila, 1000 September 6-8, 2000, following the adoption of the Metro Manila United Nations Millennium Declaration. ––––––––––––––––––––––––––––––––––––––––––––– o In this declaration, the United Nations Millennium Objective: Declaration, the world leaders recognize their The objective of WHO is the attainment by all peoples of collective responsibility to uphold the principles of the highest possible level of health. human dignity, equality, and equity at the global level. To attain this objectives, the WHO carries out the following – “To uphold these principles is their duty to all the core functions. people of the world, especially the most vulnerable and in particular, the children. The organization’s Eleventh General Programme of Work 2006-2015 details the six core functions it is focusing on 1. To eradicate extreme poverty and hunger between 2006 and 2015. These functions are: o 1 = thin = poverty 1. Providing leadership on matters critical to health and 2. To achieve universal primary education engaging in partnerships where joint action is needed; o 2 = etu = education 2. Shaping the research agenda and stimulating the generation, translation and dissemination of valuable 3. To promote gender equality and empower knowledge; women o 3 = looks like E = equality and empowerment 4. To reduce child mortality o 4 = looks like a child = child mortality 5. To improve maternal health o 5 = looks like pregnant = maternal health  6. To combat HIV/AIDS, malaria, and other DEPARTMENT OF HEALTH disease – The Department of Health (DOH) is the principal o 6 = six, sex = HIV/AIDS, malaria, and other health agency in the Philippines. It is responsible for disease ensuring access to basic public health services to all Filipinos through the provision of quality health care 7. To ensure environmental sustainability and regulation of providers of health goods and o 7 = seven, sevenvironment = environment services. 8. To develop a global partnership for Vision by 2030 development – A global leader for attaining better health outcomes, o 8 = looks like a link = global partnership competitive and responsive health care system, and equitable health financing. HEALTH RELATED MDG Mission GOAL 4: To reduce child mortality – To guarantee equitable, sustainable and quality Target: Reduce by two-thirds, between 1990 and 2015, the health for all Filipinos, especially the poor, and to lead under-five mortality rate the quest for excellence in health. GOAL 5. To improve maternal health MAJOR ROLES OF THE DEPARTMENT OF HEALTH Targets: – Reduce by three quarters, between 1990 and 2015, 1. LEADER IN HEALTH the maternal mortality ratio 2. ENABLER AND CAPACITY BUILDER – Achieve, by 2015, universal access to reproductive 3. ADMINISTRATOR OF SPECIFIC SERVICES health CORE VALUES OF THE DOH GOAL 6. To combat HIV/AIDS, malaria, and other diseases 1. INTEGRITY – The Department believes in upholding Targets: truth and pursuing honesty, accountability, and – Have halted by 2015 and begun to reverse the spread consistency in performing its functions. of HIV/AIDS – Achieve, by 2010. Universal access to treatment for 2. EXCELLENCE – The DOH continuously strive for the HIV/AIDS for all those who need it best by fostering innovation, effectiveness and – Have halted by 2015 and begun to reverse the efficiency, pro-action, dynamism, and openness to incidence of malaria and other major diseases change. SUSTANAIBLE DEVELOPMENT GOALS (SDGs) 3. COMPASSION AND RESPECT FOR HUMAN – The Sustainable Development Goals (SDGs) are a DIGNITY – Whilst DOH upholds the quality of life, collection of 17 global goals set by the United Nations respect for human dignity is encouraged by working General Assembly in 2015 for the year 2030. with sympathy and benevolence for the people in – Also known as The Global Goals need. – It is a call to action to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity 4. COMMITMENT – With all our hearts and minds, the by 2030. Department commits to achieve its vision for the – Unique and they take covers issues that affect health and development of future generations. people. They re-affirm the international commitment to end poverty, permanently everywhere. They are 5. PROFESSIONALISM – The DOH performs its ambitious in making sure that no one is left behind. functions in accordance with the highest ethical – More importantly, they involve all people to build a standards, principles of accountability, and full more sustainable, safer, more prosperous planet for responsibility. all human. 6. TEAMWORK – The DOH employees work together 1. No Poverty with a result-oriented mindset. 2. Zero Hunger 3. Good Health and Well-Being 7. STEWARDSHIP OF THE HEALTH OF THE PEOPLE 4. Quality Education – Being stewards of health for the people, the 5. Gender Equality Department shall pursue sustainable development 6. Clean Water and Sanitation and care for the environment since it impinges on the 7. Affordable and Clean Energy health of the Filipinos. 8. Decent Work and Economic Growth 9. Industry, Innovation, and Infrastructure The following agencies are attached to the DOH: 10. Reducing Inequality 11. Sustainable Cities and Communities 1. Philippine Institute of Traditional and Alternative 12. Responsible Consumption and Production Health Care 13. Climate Action 2. Philippine Health Insurance Corporation 14. Life Below Water 3. Philippine National AIDS Council 15. Life On Land 4. Commission on Population 16. Peace, Justice, and Strong Institutions 5. National Nutrition Council 17. Partnerships for the Goals 1. PHILIPPINE INSTITUTE OF A TRADITIONAL AND HEALTH RELATED SDG ALTERNATIVE HEALTH CARE (PITAHC) – Republic Act 8423 (R.A. 8423) mandates the SDG 3: “Ensure healthy lives and promote well-being for all Philippine Institute of Traditional and Alternative at all ages.” Health Care (PITAHC) “to improve the quality and o Strictly health related SDG but all SDG are health delivery of health care services to the Filipino people related  through the development of traditional and alternative – The act will automatically enroll Filipino citizens into health care and its integration into the national health the National Health Insurance Program and expand care delivery system“. PhilHealth coverage to include free medical consultations and laboratory tests. 2. PHILIPPINE HEALTH INSURANCE CORPORATION (PHILHEALTH) WHAT MIGHT CITIZENS BE ABLE TO EXPECT? – It was created in 1995 to implement universal health 1. All Filipinos are covered coverage in the Philippines. It is a tax-exempt, – Every single Filipino citizen is automatically government-owned and controlled corporation enrolled into the newly-created National Health (GOCC) of the Philippines, and is attached to the Insurance Program (NHIP) Department of Health. – Its stated goal is to "ensure a sustainable national The program classified membership into two types: health insurance program for all", according to the company. DIRECT CONTRIBUTORS – those who pay PhilHealth premiums, are employed and bound by an 3. PHILIPPINE NATIONAL AIDS COUNCIL (PNAC) "employer-employee relationship," self-earning, professional practitioners, and migrant workers. – The PNAC is a national advisory body which reviews Members’ qualified dependents and lifetime members and recommends policies on HIV/AIDS to the are also included. President and directs national approaches against HIV/AIDS domestically. INDIRECT CONTRIBUTORS – those not considered – President Fidel Ramos signed Executive Order 39, as direct contributors, along with their qualified creating the Philippine National AIDS Council (PNAC) dependents, whose health premiums are subsidized on December 3, 1992. by the government. 4. COMMISSION ON POPULATION – All Filipinos will be granted “immediate eligibility” and access to the full spectrum of health care which – The Commission on Population (POPCOM) is the includes preventive, promotive, curative, central policymaking, planning, coordinating, and rehabilitative, and palliative care. This can be monitoring body of the population program. expected for medical, dental, mental, and emergency health services. 5. NATIONAL NUTRITION COUNCIL (NNC) – Filipinos will also be enrolled with a primary health care provider of their choice. The primary care – Abbreviated as NNC, is an agency of the Philippine provider is the health worker they can go and seek government under the Department of Health treatment from for health concerns. They will also responsible for creating a conducive policy serve as the person in charge of referring and environment for national and local nutrition planning, coordinating with other health centers if patients need implementation, monitoring and evaluation, and further treatment. surveillance using state-of the art technology and – Citizens will not need to present any PhilHealth ID approaches. present any PhilHealth ID to avail of these benefits. Meanwhile, poor Filipinos or those who are located in LOCAL GOVERNMENT CODE geographically isolated areas will also be given Republic Act 7160 priority when ensuring access to health services. – REPUBLIC ACT 7160 otherwise known as the Local Government Code was enacted into law, transferring 2. It is not completely free control and responsibility of delivering basic services – UHC (Universal Health Care) does not mean to the hands of local government units (LGU). It every single health expense will be made free, aimed to enhance provision of services in the grass – The law outlines that basic services roots level as well as improve the efficiency in accommodations will be covered by resource allocation. PhilHealth o 1991, the Philippine Government introduce a major a. Regular meals, devolution of National Government Service b. Bed in a shared room with fan ventilation o Devolution c. Shared toilet and bath – pinababa na d. Essential health benefit package (primary care, – the responsibility was given to the people below medicines, diagnostic, and laboratory tests. It or the LGUs which included the first wave of also includes preventive, curative, and health sector reform through the introduction of rehabilitative services) the local government code of 1991 o The code devolved basic services for agriculture As long as a patient avails of these basic accommodations, extension, forest management, health services, it will be covered by PhilHealth whether in a public or barangay roads, and social welfare for the local private hospital. government units. o 1992, the Philippine Government devolved the According to the law, hospitals should allocate certain management and delivery of health services from the portion of their beds as basic accommodations. National Department of Health to Locally elected provincial, City and Municipal governments. Hospital Allocations: o General Hospital – 90% UNIVERSAL HEALTHCARE ACT o Specialty Hospital – 70% Republic Act 11223 o Private Hospital – 10% – UNIVERSAL HEALTHCARE ACT or RA 11223 was signed into law by President Duterte on February 20, – The law also states that if patients need to pay 2019 for extra expenses, their “CO-PAYMENT” or  what is paid on top of basic services – should Better Health Outcomes be regulated by the DOH in public hospitals. o Filipinos attain the best possible health outcomes with no disparity 3. PhilHealth will become the “National Purchaser” Responsiveness of Health Goods and Services o Filipinos feel respected, valued, and empowered – This means that PhilHealth will be in charge of in all of their interaction with the health system paying health care providers like hospitals and clinics for services given to Filipinos. VALUES Funds for PhilHealth will be sourced from the Equitable and Inclusive to all following: Uses resources efficiently Transparent and accountable a. Philippine Amusement and Gaming Provides high quality services Corporation – 50% national government’s share THE RURAL HEALTH UNIT b. Philippine Charity Sweepstakes Office – It is commonly known as the Health Center. (PCSO) – 40% of its charity fund, net of – It is a primary level health facility in the municipality document stamp tax payments, and mandatory that focuses on preventive and promotive health PCSO contributions services and the supervision of Barangay Health c. Premium contributions of direct Stations under its jurisdiction. contributory members – Recommended ratio of RHU to catchment population d. PhilHealth annual budget is 1 RHU: 20,000 population (DOH, 2009) 4. DOH will still be in charge of “Population-Based” BARANGAY HEALTH STATION Health Services – On the other hand, a Barangay Health Station – While PhilHealth, along with other private health (BHS) is the first contact health care facility that insurance companies, is expected to cover offers basic services at the barangay level. services for individuals, the DOH is still in charge – It is a satellite station of the RHU. of delivering health services that cover entire – It is manned by a volunteer Barangay Health populations. Worker (BHW) under the supervision of a Rural Health Midwife 5. Health Systems will become city-wide and province-wide THE RHU PERSONNEL – Provinces and highly urbanized cities will now be in charge of overseeing health services in areas THE MUNICIPAL HEALTH OFFICER (MHO) as opposed to the current set-up where – He is also called as the Rural Health Physician who municipalities are tasked with managing their heads the health services at the municipality level. own health centers. – Recommended ration of Rural Health Physician to catchment population is 1 MHO: 20,000 population 6. Return service in the public health sector o Implementing Rules and Regulations (IRR) of – Graduates of health and health-related courses RA 7305 of the Magna Carta of Public Health who received government-funded scholarships Workers will be required to work in the public health sector for at least 3 full years. This will address FUNCTIONS OF THE RHU: the need for health workers across the country. 7. A “Healthy technology and assessment council” 1. Administrator of the RHU (HTAC) will be created a. Prepares the municipal health plan and budget – Another important feature of the law is the b. Monitors the implementation of basic health creation of the HTAC – a group of health experts services who will be responsible for evaluating latest c. Management of the RHU staff health developments and recommending their use to DOH and PhilHealth. 2. Community Physician – The HTAC will be attached DOH to the 5 years a. Conducts epidemiological studies after the law is implemented. After this, it will b. Formulates health education campaigns on become an independent body attached to the disease prevention Department of Science and Technology. c. Prepares and implements control measures or rehabilitation plans 8. Health information will be collected – Both public and private hospitals and health 3. Medico-legal officer of the municipality insurers will be required to maintain a health information system that will contain electronic THE PUBLIC HEALTH NURSE (PHN) health records, prescription logs, and “human – Recommended ratio of Public Health Nurse to resource information.” catchment population is 1 PHN: 20,000 population o Implementing Rules and Regulations (IRR) of ALL FOR HEALTH TOWARDS HEALTH FOR ALL RA 7305 of the Magna Carta of Public Health Philippine Health Agenda 2016-2022 Workers Healthy Philippines 2022 FUNCTIONS OF THE PHN: GOALS 1. Supervises and guides all Rural Health Midwives Financial Protection (RHM) in the municipality. o Filipinos, especially the poor are protected from 2. Prepares the FHSIS quarterly and annual reports of high cost of health care the municipality for submission to the Provincial Health Office. 3. Utilizes the nursing process in responding to health THE LOCAL HEALTH BOARD care needs of IFC. – The chairman is then local executive with the vice 4. Collaborates with other members of the healthcare chairman in the person of the team, government agencies, private businesses, Provincial/City/Municipal NGOs and people organizations to address the Health Officer. community’s health problems. – Members of the board are composed of the chairman of the committee on health of the Sanggunian, a THE RURAL HEALTH MIDWIFE (RHM) representative from the private sector or NGO – Recommended ratio of Rural Health Midwife to involved in health services and a representative from catchment population is 1 RHM: 5,000 population DOH. o Implementing Rules and Regulations (IRR) of RA 7305 of the Magna Carta of Public Health FUNCTIONS OF THE LHB: Workers 1. Proposing to the Sanggunian annual budgetary FUNCTIONS OF THE RHM: allocations for the operation and maintenance of health facilities and services within the province, city 1. Manages the BHS and supervises and trains BHW. or municipality. 2. Provides midwifery services and executes health care 2. Serving as advisory committee to the Sanggunian on programs and activities for women of reproductive health matters. age, including family planning counseling and service. 3. Creating committees that shall advise local health 3. Conducts patient assessment and diagnosis for agencies on various matters related to health service referral or further management. operation. 4. Performs health information, education, and communication activities. THE HEALTH REFERRAL SYSTEM 5. Organizes the community. 6. Facilitates barangay health planning and other REFERRAL community health services. – It is a set of activities undertaken by a healthcare facility in response to its inability to provide the THE RURAL SANITATION INSPECTOR (RSI) necessary health interventions to satisfy a patient’s need. FUNCTIONS OF THE RSI: TYPES OF REFERRAL: 1. Ensure a healthy environment in the municipality by advocating, monitoring and regulating activities such 1. Internal Referral as inspection of water supply and unhygienic – Occurs within the health facility household conditions. – It is made to request for an opinion or suggestions, co-management, or further THE BARANGAY HEALTH WORKER (BHW) management of specialty care. – The barangay health workers are considered as the 2. External interface between the community and the RHU. – It is a movement of a patient from one health – They are trained in preventive health care with facility to another emphasis on maternal and child care, family planning – It may be vertical or horizontal and reproductive health, nutrition and sanitation. – They are equipped with basic skills for prevention and management of common illness. – They assist in providing basic services at the BHS and RHU. – Recommended ratio of Barangay Health Worker to catchment population is 1 BHW: 20 households o Implementing Rules and Regulations (IRR) of RA 7305 of the Magna Carta of Public Health Workers BARANGAY HEALTH WORKERS’ BENEFIT AND INCENTIVE ACT (RA 7883) – Entitles BHW to hazard and subsistence allowances and other benefits. LOCAL GOVERNEMENT CODE RA 7160 – This law is enacted to bring about genuine and meaningful local autonomy. – This will enable LGU to attain their fullest development as self-reliant communities and make them more effective partners in the attainment of national goals. – It mandates the devolution of services, including health services. DEVOLUTION – It refers to the act by which the national government confers power and authority upon the various LGU to perform specific functions and responsibilities.  COMMUNITY HEALTH NURSING TYPES OF FAMILY NURSE CONTACT TYPES OF PUBLIC HEALTH NURSING XIV. Referral System 3. Refer the patient if he needs further CLINIC VISIT management following the two- way referral – It is a process of checking the client’s health condition system (BHS to RHU, RHU to RHU, RHU to in a medical clinic. Hospital). – The patient visits the health center/clinic to avail of the 4. Accompany the patient when an emergency services thereto offered by the facility primarily for referral is needed. consultation on matters that ailed them physically. – Pre-consultation conference - A pre-clinic lecture is XV. Prescription/ Dispensing usually conducted prior to the admission of patients, XVI. Health Education which is one way of providing health education. – Conduct one on one counselling with the patient and then reinforce health education and STANDARD PROCEDURES PERFORMED DURING counselling messages and nurses give CLINIC VISIT appointments to the clients for the next visit. IX. Registration/Admission HOME VISIT 5. Greet the client upon entry and established – Is a family- nurse contact which allow the health rapport. worker to assess the home and family situations in 6. Prepare the family record of new patients or order to provide the necessary nursing care and retrieve records of old clients. health related activities. 7. Elicit and record the client’s chief complaint – In performing this activity, it is essential to prepare a and clinical history. plan of visit to meet the needs of the client and 8. Perform physical examination on the client and achieve the best results of the desired outcomes. record it accordingly PURPOSE OF HOME VISIT X. Waiting time 3. Give priority numbers to clients. 6. To give nursing care to the sick, to a post-partum 4. Implement the “first come, first serve” policy mother and her newborn with the view to teach a except for emergency/ urgent cases. responsible family member to give the subsequent care. XI. Triaging 7. To assess the living condition of the patient and his – Community and hospital set-ups have different family and their health practices in order to provide triage the appropriate health teaching. – Nurses have to provide first a treatment to 8. To give health teachings regarding the prevention and emergency cases and then to be referred control diseases. necessarily to the next level care. 9. To establish close relationship between the health 4. Manage program-based cases. agencies and the public for the promotion of health 5. Refer all non-program based cases to the 10. To make use of the inter- referral system and to physician. promote the utilization of community services. 6. Provide first-aid treatment to emergency cases and refer when necessary to the next level PRINCIPLES INVOLVED IN PREPARING FOR A HOME care. VISIT XII. Clinical Evaluation 6. A home visit must have a purpose or objective. 4. Validate clinical history and physical 7. Planning for a home visit should make use of all examination available information about the patient and his family 5. The nurse arrives at evidence-based diagnosis through family records. and provides rational treatment based on DOH 8. In planning for a visit, we should consider and give programs. priority to the essential needs of the individual and his e) Identify the patient’s problem family. f) formulate/ write the nursing diagnosis 9. Planning and delivery of care should involve the and validate individual and family. g) give/ perform the nursing intervention 10. The plan should be flexible. h) evaluate the intervention if it has enabled the patient to achieve this GUIDELINES TO CONSIDER REGARDING THE desired outcome FREQUENCY OF HOME VISITS 6. Inform the client on the nature of the illness, – The schedule of visit may vary according to the need the appropriate treatment and prevention and of the patient or family for nursing care but one has to control measures. consider the following factors: XIII. Laboratory and other diagnostic examinations 7. The physical needs, psychological needs and 2. Identify a designated referral laboratory when educational needs of the individual and family. needed. 8. The acceptance of the family for the services to be rendered, their interest and the willingness to cooperate. 9. The policy of a specific agency and the emphasis given towards their health programs. 10. Take into account other health agencies and the number of health personnel already involved in the care of a specific family. 11. Careful evaluation of past services given to a family and how the family avail of the nursing services. 12. The ability of the patient and his family to recognize their own needs, their knowledge of available resources and their ability to make use of their resources for their benefits. STEPS IN CONDUCTING HOME VISITS 8. Greet the patient and introduce yourself 9. State the purpose of the visit 10. Observe the patient and determine the health needs 11. Put the bag in a convenient place then proceed to perform the bag technique 12. Perform the nursing care needed and give health teachings 13. Record all important data, observation and care rendered 14. Make appointment for a return visit REFERENCES: Public Health Nursing in the Philippines, National League of Phillipine Government Nurses Nursing Care of the Community, Zenaida U. Famorca, Mary A. Nies, Melanie McEwen Nursing Practice in the Community, Araceli S. Maglaya  COMMUNITY HEALTH NURSING PRIMARY HEALTH CARE PRIMARY HEALTH CARE Community Participation – World Health Organization (WHO) defines PHC as an o An educational and empowering process in essential care made universally accessible to which people in partnership with those who are individuals and families in the community by means able to assist them identify the problems and the acceptable to them through their full participation and needs and decreasing the assume at a cost that the community and country can afford at responsibilities to plan, manage, control, and every stage of development. assess the collective action that are proof – According to Alma Ata declaration, PHC is essential necessary health care based on practical, scientifically sound, o Community participation is the heart and soul and socially acceptable methods and technology of primary health care. made universally accessible to individuals and families in the community through their full People are the center, object and subject of participation and at a cost that the community and development country can afford to maintain at every stage of their o Thus the success of any undertaking that aims development in the spirit of self-reliance and self- at serving other people is dependent on people’s determination. participation at all levels of decision making o In general, health work should start from where BACKGROUND the people are and building on the way they Primary Health Care (PHC) was declared during the have. First International Conference on Primary Health Care held in Alma Ata, Russia on September 6-12, 1978 by Self-reliance the World Health Organization (WHO). The goal was “ o Through community participation and Health for All by the Year 2000 ”. This was adopted in cohesiveness of people’s organization, they can the Philippines through: generate support for health care through o Legal basis: Letter of Instruction 949 signed socialization, networking, and mobilization of by President Marcos on October 19, 1979 and local resources has an underlying theme of “ Health in the o Leadership and management skills should be Hands of the People by 2020.” develop among these people o Existence of sustained health care facilities MISSION manage by the people is some of the major – To strengthen the health care system by increasing indicators that the community is leading to self- opportunities and supporting the conditions wherein reliance people will manage their own health care. Partnership between the community and the CONCEPT health agencies in the provision of quality of life. – Partnership and empowerment of the people towards o Providing linkages between the government and the development of Self -Reliance the non-government organizations and people’s organization. ELEMENTS/COMPONENTS OF PHC – The Alma Ata declaration listed 8 essential services Recognition of interrelationship between the using the acronym ELEMMENTS. health and development – New element: Mental Health o Health being a social phenomenon recognizes the interplay of political, socio-cultural, and Education for Health economic factors as its determinants. Locally endemic diseases control o Good health therefore is manifested by the EPI (Expounded Program for Immunization) progressive improvements in the living Maternal & Child Health & Family Planning conditions and quality of life enjoyed by the community residents. Mental Health