Health Care Delivery Systems & PHC PDF

HEALTH CARE DELIVERY SYSTEMS & PRIMARY HEALTH CARE COMMUNITY HEALTH NURSING BLAISE B. NIEVE, RN, MAN LEARNING OUTCOMES Discuss how the World Health Organization (WHO) affects health issues in the Philippines; List the Millennium Development Goals (MDGs) and the targets of the healt...

HEALTH CARE DELIVERY SYSTEMS & PRIMARY HEALTH CARE COMMUNITY HEALTH NURSING BLAISE B. NIEVE, RN, MAN LEARNING OUTCOMES Discuss how the World Health Organization (WHO) affects health issues in the Philippines; List the Millennium Development Goals (MDGs) and the targets of the health-related MDGs; Describe the Philippine health care delivery system in terms of different levels of services; Explain how the Department of Health (DOH) provides health leadership in the Philippines; Elucidate on the functions of the members of the health team in the RHU/health center LEARNING OUTCOMES State a definition of a family; Identify the characteristics of the family that have implications for community health nursing practice; Define family nursing; Utilize the nursing process in the care of individuals within the family and the care of the family as a whole; Describe the different types of family-nurse contacts. REFERENCES Famorca, Z., et al. (2013). Nursing care of the community. Elsevier Mosby: Singapore Pte Ltd. HEALTH SYSTEM Consists of all organizations, people, and actions whose primary intent is to promote, restore, or maintain health. BUILDING BLOCKS OF A HEALTH SYSTEM (WHO, 2007A) 1. Service delivery 2. Health workforce 3. Information 4. Medical products, vaccines, and technologies 5. Financing 6. Leadership and governance or stewardship THE WORLD HEALTH ORGANIZATION (WHO) History: ▪Creation: April 7, 1948 ▪April 7: World Health Day ▪HQ: Geneva, Switzerland ▪Coverage: 147 country offices, 6 world regional offices for Africa, the Americas, Eastern Mediterranean, Europe, Southeast Asia, and Western Pacific THE WORLD HEALTH ORGANIZATION (WHO) Objective: Attainment by all peoples of the highest possible level of health Core Functions: ▪ Providing leadership on matters critical to health and engaging in partnerships where joint action is needed. ▪ Shaping the research agenda and stimulating the generation, translation, and disseminating valuable knowledge. THE WORLD HEALTH ORGANIZATION (WHO) Core Functions: ▪ Setting norms and standards and promoting and monitoring their implementation. ▪ Articulating ethical and evidence-based policy options. ▪ Providing technical support, catalyzing change, and building sustainable institutional capacity.  United Nations Millennium Declaration ▪ Collective responsibility to uphold the principles of human dignity, equality, and equity at the global level. ▪ Duty to all the people of the world, especially the most MILLENNIUM vulnerable and, in particular, the DEVELOPMENT GOALS children MILLENNIUM DEVELOPMENT GOALS 4. Reduce child mortality. Target: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate. 5. Improve maternal health. Targets: 1. Reduce by three quarters the maternal mortality ratio; and 2. Achieve universal access to reproductive health. MILLENNIUM DEVELOPMENT GOALS 6. Combat HIV/AIDS, malaria, and other diseases. Targets: 1. Have halted by 2015 and begun to reverse the spread of HIV/AIDS; 2. Achieve, by 2010, universal access to treatment for HIV/AIDS for all those who need it; and 3. Have halted by 2015 and begun to reverse the incidence of malaria and other major disease.  The 2030 Agenda for Sustainable Development, adopted by all United Nations Member States in 2015, provides a shared blueprint for peace and prosperity for people and the planet, now and into the future. They recognize that ending poverty and other deprivations must go hand-in-hand with strategies that improve health and education, reduce inequality, and spur economic growth – all while tackling climate change and working to preserve our oceans and forests.  THE PHILIPPINE HEALTHCARE DELIVERY COMMUNITY HEALTH NURSING SYSTEM ▪ The national agency mandated to lead the health sector towards assuring quality health care for all Filipinos. ▪Vision by 2030: A global leader for attaining better health outcomes, competitive and responsive health care system, and equitable health financing. ▪Mission: To guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health. Major Roles: 1. Leader in health; 2. Enabler and capacity builder; and 3. Administrator of specific services. Core Values: 1. Integrity 2. Excellence 3. Compassion and respect for human dignity 4. Commitment 5. Professionalism 6. Teamwork 7. Stewardship of the health of the people Health care delivery system: ▪ Provincial governments: Administration of provincial & district hospitals ▪ Municipal and city governments: In charge of primary care thru RHUs ▪ RA 7160: Local Government Code ▪ RA 7875: National Health Insurance Act of 1995 LEVELS OF HEALTH CARE DELIVERY Hospitals Other health facilities General A. Primary care facility ▪ Level 1 B. Custodial care facility ▪ Level 2 C. Diagnostic/ Therapeutic facility ▪ Level 3 (teaching/ training) Specialty D. Specialized Outpatient Facility [A.O. 2012-0012: Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines] CATEGORY A. PRIMARY CARE FACILITY A first-contact health care facility that offers basic services, including emergency services and provision for normal deliveries. 1. Without in-patient beds e.g., health centers, etc. 2. With in-patient beds – a short-stay facility, ave. stay of 1 to 2 days before discharge CATEGORY B. CUSTODIAL CARE FACILITY ▪ Provides long-term care, including basic services like food and shelter, to patients with chronic conditions requiring ongoing health and nursing care d/t impairment and a reduced degree of independence in ADL, and patients in need of rehab ▪ Example(s): Psychiatric Facilities, Substance/Drug Abuse Treatment & Rehab Centers CATEGORY C. DIAGNOSTIC/THERAPEUTIC FACILITY ▪ Facility for the examination of the human body, specimens from the human body for the diagnosis, sometimes treatment of disease, or water for drinking water analysis. ▪ Example(s): Laboratory facility, radiologic facility, nuclear medicine facility CATEGORY D. SPECIALIZED OUTPATIENT FACILITY ▪ Facility that performs highly specialized procedures on an outpatient basis ▪ Example(s): Dialysis clinic, ambulatory surgical clinic, cancer chemotherapeutic center, etc. RURAL HEALTH UNIT CO MMU N I T Y H E A L T H N URSIN G THE RURAL HEALTH UNIT (HEALTH CENTER) Primary level health facility in the municipality; Focus: 1. Preventive and promotive health services 2. Supervision of BHSs under its jurisdiction Recommended ratio: 1 RHU: 20 000 population BARANGAY HEALTH STATIONS ▪ First-contact health care facility that offers basic services at the barangay level; satellite stations of the RHU ▪ Manned by volunteer Barangay Health Workers (BHWs) under the supervision of the Rural Health Midwife (RHM) RHU PERSONNEL: MUNICIPAL HEALTH OFFICER ▪ Also known as rural health physician; ▪ Heads the health services at the municipal level 1. Administrator of the RHU a. Prepares the municipal health plan and budget b. Monitors the implementation of basic health services c. Management of the RHU staff  RHU PERSONNEL: MUNICIPAL HEALTH OFFICER 2. Community physician a. Conducts epidemiological studies b. Formulates health education campaigns on disease prevention c. Prepares and implements control measures or rehab plans 3. Medico-Legal Officer of the municipality NOTE: 1 RH PHYSICIAN: 20,000 (RA 7305: MAGNA CARTA OF PUBLIC HEALTH WORKERS RHU PERSONNEL: PUBLIC HEALTH NURSE ▪ Supervises and guides all RHMs in the municipality; ▪ Prepares the FHSIS quarterly and annual reports of the municipality for submission to the Provincial Health Office; * FHSIS - Field Health Services Information System  RHU PERSONNEL: PUBLIC HEALTH NURSE ▪Utilizes the nursing process in responding to health care needs, including needs for health education and promotions, of individuals, families, and catchment population community; and ▪Collaborates with the other members of the health team, government agencies, private businesses, NGOs, and people’s organizations to address the community’s health problems NOTE: 1 RH NURSE: 20,000 (RA 7305: MAGNA CARTA OF PUBLIC HEALTH WORKERS RHU PERSONNEL: RURAL HEALTH MIDWIFE ▪Manages the BHS and supervises and trains the BHW; ▪ Provide midwifery services and executes health care programs and activities for women of reproductive age, including family planning counseling and services; ▪Conducts patient assessment and diagnosis for referral or further management; RHU PERSONNEL: RURAL HEALTH MIDWIFE ▪Performs health information, education, and communication activities; ▪Organizes the community; and ▪Facilitates barangay health planning and other community health services. ▪NOTE: 1 RHM: 5000 population (DOH, 2009) RHU PERSONNEL: BARANGAY HEALTH WORKER ▪ Trained in preventive health care, with a strong emphasis on maternal and child care, family planning and reproductive health, nutrition, and sanitation ▪ Equipped with basic skills for prevention and management of common diseases; ▪ Assist in providing basic services at the BHS and RHU RHU PERSONNEL: BARANGAY HEALTH WORKER ▪ Accredited by the Local Health Board ▪ RA 7883: Barangay Health Workers’ Benefit and Incentives Act – entitles them to hazard and subsistence allowances and other benefits ▪ Note: 1 BHW: 20 households (DOH, 2009) RHU PERSONNEL: RURAL SANITATION INSPECTOR ▪ Functions are directed towards ensuring a healthy physical environment in the municipality (e.g., advocacy, monitoring, and regulatory activities such as inspection of water supply and unhygienic household conditions, etc.) LOCAL HEALTH BOARDS ▪ RA 7160: Local Government Code ▪ Devolution: act by which the national government confers power and authority upon the various LGUs to perform specific functions and responsibilities. LOCAL HEALTH BOARDS: PROVINCIAL/CITY/MUNICIPAL ▪ Chairman: Local executive (Provincial Governor/ Mayor ▪ Vice Chairman: Provincial/ City/ Municipal Health Officer ▪ Members: 1. Chairman of the Committee on Health, Sanggunian 2. Representative from the private sector involved in health services 3. Representative of DOH PRIMARY HEALTH CARE ▪ PRACTICAL APPROACH TO EFFECTIVE PROVISION OF HEALTH SERVICES ▪UNIVERSAL GOAL / POLICY AGENDA: HEALTH FOR ALL BY YEAR 2000 OBJECTIVES: ▪PROMOTION OF HEALTHY LIFESTYLE ▪PREVENTION OF DISEASES ▪THERAPY FOR EXISTING CONDITIONS HISTORY & LEGAL BASIS: PRIMARY HEALTH CARE ▪WHAT: ALMA ATA DECLARATION ON PRIAMRY HEALTH CARE ▪WHERE: ALMA ATA, USSR (RUSSIA) – UNION OF SOVIET SOCIALIST REPUBLICS (USSR) ▪WHEN: SEPT 6-12, 1978 ▪WHO: WHO / UNICEF (UNITED NATIONS CHILDREN’S FUND HISTORY & LEGAL BASIS: PRIMARY HEALTH CARE ▪WHO: DR. DIZON / DR. VILLAR ▪LEGAL BASIS: LOI 949 ▪UNDERLYING THEME: HEALTH IN THE HANDS OF PEOPLE BY 2020 ▪FATHER OF PHC: DR. JESUS AZURIN (SEC OF MINISTRY OF HEALTH) ELEMENTS: PRIMARY HEALTH CARE 1. EDUCATION FOR HEALTH 2. LOCALLY ENDEMIC DISEASE CONTROL (E.G. MALARIA, SCHISTOSOMIASIS) 3. EPI 4. MCH, INCLUDING REPRODUCTIVE HEALTH 5. ESSENTIAL DRUGS 6. NUTRITION 7. TREATMENT OF CD AND NCD 8. SAFE WATER AND SANITATION KEY PRINCIPLES: PRIMARY HEALTH CARE 1. 4A’S: ACCESSIBILITY, AFFORDABILITY, ACCEPTABILITY, AND AVAILABILITY 2. SUPPORT MECHANISMS 3. MULTISECTORAL APPROACH 4. COMMUNITY PARTICIPATION 5. EQUITABLE DISTRIBUTION OF HEALTH RESOURCES 6. APPROPRIATE TECHNOLOGY 4A’S OF PHC: ACCESSIBILITY ▪Refers to the physical distance of a health facility or the travel time required for people to get the needed or desired health services. ▪Facilities must be within 30 minutes from the communities. ▪BHS are facilities intended to provide accessible health services at the community level. 4A’S OF PHC: AFFORDABILITY ▪Refers to the individual or family’s capacity to pay for basic health services and on whether the community or government can afford these services. ▪Determinant: Out-of-pocket expenses for health care 4A’S OF PHC: ACCEPTABILITY ▪Means that the healthcare offered is in consonance with the prevailing culture and traditions of the population 4A’S OF PHC: AVAILABILITY ▪A question of whether the basic health services required by the people are offered in the health care facilities or is provided on a regular and organized manner SUPPORT MECHANISMS Resources for essential health services come from three major entities: 1. The people themselves 2. The government 3. The private sector like NGOs and socio- civic and faith groups 3 working = better health outcomes! MULTISECTORAL APPROACH Intrasectoral linkages – communication, cooperation, and collaboration within the health sector: among members of the health team and among health agencies. E.g., two- way referral system example: high risk pregnant woman: hospital = BHS MULTISECTORAL APPROACH Intersectoral linkages – encompass the CCC between the health sector and other sectors of society like education, public works, agriculture, and local government officials. e.g., Rabies Prevention and Control Program COMMUNITY PARTICIPATION Based on the understanding that health is achieved through self-reliance and self- determination, and that IFCs are not considered as recipients of care but active participants in achieving their health goals. EQUITABLE DISTRIBUTION OF HEALTH SERVICES 1. Doctor to the Barrios (DTTB) Program. ▪The deployment of doctors to municipalities that are without doctors. ▪Fielded to manage the RHU or health centers in unserved, economically depressed fifth- or sixth-class municipalities for 2 years ▪Also have the option to be permanently absorbed by the municipality EQUITABLE DISTRIBUTION OF HEALTH SERVICES 2. Registered Nurses Health Enhancement and Local Service (RN Heals)* ▪A training and deployment program for unemployed nurses. ▪Volunteers are deployed to unserved, economically depressed municipalities for 1 year to address the inadequate nursing workforce in rural communities and health facilities. Note (*): Now termed as Nurse Deployment Project APPROPRIATE TECHNOLOGY The technology that is suitable to the community that will use it; aka “people’s technology” or “indigenous technology” END OF DISCUSSION COMMUNITY HEALTH NURSING