CHN 1 – Community Health Nursing 1 Module PDF

CHN 1 – COMMUNITY HEALTH NURSING 1 MODULE PREPARED BY: MELISSA D. SARMIENTO, RN, RM, MSN ROLES & RESPONSIBILITIES OF A COMMUNITY HEALTH NURSE ROLES OF A COMMUNITY HEALTH NURSE  Case Manager  assist clients to make decisions about approp...

CHN 1 – COMMUNITY HEALTH NURSING 1 MODULE PREPARED BY: MELISSA D. SARMIENTO, RN, RM, MSN ROLES & RESPONSIBILITIES OF A COMMUNITY HEALTH NURSE ROLES OF A COMMUNITY HEALTH NURSE  Case Manager  assist clients to make decisions about appropriate health care services and to achieve service delivery integration and coordination  Advocate  seeks to promote an understanding of health problems  Teacher  apply teaching-learning principles to facilitate behavioral changes among clients assistance to rural health midwives in health matters  Partner & Collaborator - establishes and maintains valuable working relationships with people  Health Planner/Programmer  identify needs, priorities and problems/ formulate nursing health plan.  Component of health plans: responsible for formulating municipal health plan in doctorless areas interprets and implements the nursing health plan Plan, program policies, memoranda and circulars provides technical support  Community Organizer  motivate and enhance community participation in terms of planning, organizing, implementing and evaluating health programs/services  Health Educator/Trainer  identifies and interprets training needs of RHMs, BHWs/BHVs and hilots  Casefinder  identifies and follow-up periodically cases especially to at risk  Epidemiologist  collect data on health problem  Recorder/Reporter/Statistician  prepares and submits required records and reports  review, validates, consolidates, analyzes and interprets all records and reports  maintains adequate, accurate and complete recording and reporting  Community Leader  being a leader, role model and respected in the community is in better position to empower others RESPONSIBILITIES OF THE CHN  Be a part in developing an overall health plan  Provide quality nursing services  Maintain coordination/linkages in the provision of public health services.  Conduct researches relevant to CHN services to improve provision of health care.  Provide opportunities for professional growth and continuing education for staff development. WORLD HEALTH ORGANIZATION (WHO)  a global health organization   creation was discussed when diplomats formed the UN in 1945  WHO constitution came into force on April 7, 1948  April 7 is “World Health Day” declared since then  Headquarters - Geneva, Switzerland  Has 147 country offices  6 World Regional offices  Africa,  the Americas,  Eastern Mediterranean,  Europe,  Southeast Asia and  the Western Pacific  Philippines, a member of the Western Pacific Region, holds office in Manila (WHO, 2007)  Objective: Attainment by all people of the highest possible level of health (WHO, 2006) THE MILLENNIUM DEVELOPMENT GOALS (MDG)  September 6 – 8, 2000 - World leaders in the UN General Assembly participated in the Millennium Summit  United Nations Millennium Declaration (UN, 2013) - resolution result of the summit  the world leaders recognized collective responsibility to uphold the principles of human dignity, equality, and equity at the global level  expressed the commitment of the 191 member states  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 derived from this Declaration.  Each MDG has targets set for 2015 and indicators to monitor progress from 1990 levels. Several of these relate directly to health. SUSTAINABLE DEVELOPMENT GOALS (SDG)  adopted by the United Nations General Assembly in September 2015 and look to 2030  far broader in scope than the Millennium Development Goals (MDGs)  focused on a narrow set of disease-specific health targets for 2015  also known as the Global Goals   adopted by all United Nations Member States in 2015 as a universal call to action to:  end poverty,  protect the planet and  ensure that all people enjoy peace and prosperity by 2030  blueprint to achieve a better and more sustainable future for all  address the global challenges we face  related to poverty,  inequality,  climate,  environmental degradation,  prosperity, and  peace and justice  Newly implemented 2030 Agenda for Sustainable Development - holds a deep promise for persons with disabilities everywhere.  2016 marks the first year of the implementation of the SDGs GOAL 1: NO POVERTY  Economic growth must be inclusive to provide sustainable jobs and promote equality. GOAL 2: ZERO HUNGER  The food and agriculture sector offers key solutions for development, and is central for hunger and poverty eradication. GOAL 3: GOOD HEALTH AND WELL-BEING  Ensuring healthy lives and promoting the well-being for all at all ages is essential to sustainable development. GOAL 4: QUALITY EDUCATION  Obtaining a quality education is the foundation to improving people’s lives and sustainable development. GOAL 5: GENDER EQUALITY  Gender equality is not only a fundamental human right, but a necessary foundation for a peaceful, prosperous and sustainable world. GOAL 6: CLEAN WATER AND SANITATION  Clean, accessible water for all is an essential part of the world we want to live in. GOAL 7: AFFORDABLE AND CLEAN ENERGY  Energy is central to nearly every major challenge and opportunity. GOAL 8: DECENT WORK AND ECONOMIC GROWTH   Sustainable economic growth will require societies to create the conditions that allow people to have quality jobs. GOAL 9: INDUSTRY, INNOVATION, AND INFRASTRUCTURE  Investments in infrastructure are crucial to achieving sustainable development. GOAL 10: REDUCED INEQUALITIES  To reduce inequalities, policies should be universal in principle, paying attention to the needs of disadvantaged and marginalized populations. GOAL 11: SUSTAINABLE CITIES AND COMMUNITIES  There needs to be a future in which cities provide opportunities for all, with access to basic services, energy, housing, transportation and more. GOAL 12: RESPONSIBLE CONSUMPTION AND PRODUCTION  Responsible Production and Consumption GOAL 13: CLIMATE ACTION  Climate change is a global challenge that affects everyone, everywhere. GOAL 14: LIFE BELOW WATER  Careful management of this essential global resource is a key feature of a sustainable future. GOAL 15: LIFE ON LAND  Sustainably manage forests, combat desertification, halt and reverse land degradation, halt biodiversity loss GOAL 16: PEACE, JUSTICE AND STRONG INSTITUTIONS  Access to justice for all, and building effective, accountable institutions at all levels. GOAL 17: PARTNERSHIPS  Revitalize the global partnership for sustainable development. PHILIPPINE DEPARTMENT OF HEALTH THE HEALTH CARE DELIVERY SYSTEM  Is the totality of all policies, infrastructures, facilities, equipment, products, human resources and services that address the health needs, problems and concerns of all people. Department of Health (DOH)  main governing body of health services in the Philippines  national agency mandated to lead the health sectors towards assuring quality health care to all Filipinos  provides guidance and technical assistance to LGUs through the Center for Health Development in each of the 17 regions.  Provincial governments – responsible for administration of provincial and district hospitals  Municipal and city governments – in-charge primary care (RHUs or health centers, BHSs)  Private sector – composed of for-profit and non-profit agencies  About 30% of Filipinos utilize private health facilities  An estimated 60% of the national health expenditure goes to the private sector  Private sector employs more than 70% of the health professionals in the Philippines  Financing of health services:  Government (national and local)  Private sources   Social health insurance  Philippine Health Insurance Corporation (PhilHealth) – created by the National Health Insurance Act (R.A. 7875)  A tax-exempt government corporation attached to the DOH for policy coordination and guidance  aims for universal health coverage of all Filipino citizens (Congress of the Republic of the Philippines, 1995) Philippine Department of Health VISION  “To make Filipinos among the healthiest in Southeast Asia by 2022 and in Asia by 2040.” Philippine Department of Health MISSION  “To lead the country in the development of a productive, resilient, equitable, and people- centered health system” (DOH, 2019). Major Roles of DOH  Leader in health. (EO 102, series of 1999)  planning and formulating policies of health programs and services  monitoring and evaluating the implementation of health programs, projects, research, trainings , and services  advocating for health promotion and healthy lifestyles  serving as a technical authority in disease control and prevention, and  providing administrative and technical leadership in health care financing and implementing the National Health Insurance Law  Enabler and capacity builder. (Office of the President, 1999)  providing logistical support to LGUs, the private sector, and other agencies in implementing health programs and services,  serving as the lead agency in health and medical research, and  protecting standards of excellence in the training and education of health care providers at all levels of the health care system  Administrator of specific services. (Office of the President, 1999)  serve as administrator of selected health facilities at subnational levels that act as referral centers for local health system (tertiary and secondary hospitals, reference laboratories, training centers, centers for health promotion, centers for disease control and prevention, and regulatory offices  provide specific program components for conditions that affect large segments of the population (tuberculosis, malaria, schistosomiasis, HIV/AIDS, and micronutrient deficiencies  develop strategies for responding to emerging health needs; and  provide leadership in health emergency preparedness and response services, including referral and networking systems for trauma, injuries, and catastrophic events LOCAL HEALTH SYSTEM & DEVOLUTION THE RURAL HEALTH UNIT (RHU)  Commonly known as “health center”  Primary level health facility in the municipality  Focus:  Preventive and promotive health services   Supervision of BHS (DOH, 2001) Ratio of RHU to catchment population = 1 RHU : 20,000 population (DOH,2009) BARANGAY HEALTH STATION (BHS)  First contact health care facility that offers basic services at barangay level  Satellite station of the RHU (DOH, 2009)  Manned by volunteer BHWs under the supervision of the RHM (DOH, 2001) THE RURAL HEALTH UNIT PERSONNEL I. THE MUNICIPAL HEALTH OFFICER (MHO)  RURAL HEALTH PHYSICIAN - Heads the health services at the municipal level Roles and Functions 1. Administrator of the RHU  Prepares municipal health plan and budget  Monitors the implementation of basic health services  Management of the RHU staff 2. Community physician  Conducts epidemiological studies  Formulates health education campaigns on disease prevention  Prepares and implements control measures or rehabilitation plans 3. Medico-legal officer of the municipality (DOH, 2001) Ratio of MHO to population = 1 MHO : 20,000 population (Magna Carta of Public Health Workers (R.A. 7305) implementing rules and regulations (IRRs), (DOH, 1999) II. THE PUBLIC HEALTH NURSE (PHN) Roles and Functions 1. Supervise and guides all RHMs in the municipality (DOH, 2001) 2. Prepares the FHSIS (Field Health Service Information System) quarterly and annual reports of the municipality for submission to the Provincial Health Office (DOH, 2011) 3. Utilizes the nursing process in responding to health care needs (needs for health education and promotions of individuals, families and catchment community) 4. 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.  Nurse Deployment Project (NDP)  launched to augment efforts of PHNs in their areas of jurisdiction Nurse – population ratio (R.A.7305) = 1 : 10,000 III. THE RURAL HEALTH MIDWIFE (RHM)/PUBLIC HEALTH MIDWIFE Roles and Functions 1. Manages the BHS and supervises and trains the BHWs 2. Provides midwifery services and execute health care programs and activities for women of reproductive age, including family planning counseling and services 3. Conducts patient assessment and diagnosis for referral or further management 4. Performs health information, education, and communication activities 5. Organizes the community 6. Facilitates barangay health planning and other community health services Ratio of RHM to Population (DOH, 2009) = 1 : 5,000 population IV. RURAL SANITATION INSPECTOR  Ensures a healthy physical environment in the municipality which entails:  Ensuring a healthy physical environment in the municipality which entails: Advocacy, Monitoring, and Regulatory activities e.g. inspection of water supply inspection of unhygienic household conditions V. BARANGAY HEALTH WORKERS (BHWs)  Interface between the community and the RHU  Accredited by the Local Health Board 1. Trained in preventive health care  Maternal and child care  Family planning  Reproductive health  Nutrition  Sanitation 2. Equipped with basic skills  Prevention and management of common diseases 3. Assist in providing basic health services at the BHS and the RHU Ratio of BHW to catchment Population = 1 BHW : 20 households  R.A. 7883 (Barangay Health Workers’ Benefit and Incentives Acts  Entitles the BHWs to hazard and subsistence allowances and other benefits. LOCAL HEALTH BOARDS  R.A. 7160 (Local Government Code) 1. Mandates devolution of basic services from the national government to LGUs  Enables LGUs to attain their fullest development as self-reliant communities and make them more effective partners in the attainment of national goals 2. Provided for the creation of Provincial Health Board and the City/Municipal Health Board or Local Health Boards  Chairman – Local Executive (Provincial Governor/Mayor)  Vice Chairman – Provincial/City/Municipal Health Officer  Members – Chairman of the Committee on Health of the Sanggunian, a representative from the private sector or NGO involved in health services and a DOH representative Functions of the Local Health Boards 1. Proposing to the Sanggunian annual budgetary allocations for the operation and maintenance of health facilities and services within the province/city/municipality. 2. Serving as an advisory committee to the Sanggunian on health matters, and 3. Creating committees that shall advise local health agencies on various matters related to health  service operations. THE HEALTH REFERRAL SYSTEM - Implemented since 1992  Two-Way Referral System  Involves movement of patient from the health center of first contact and the hospital at first referral level  When hospital intervention has been completed, the patient is referred back to the health center Two types of referral  Internal Referrals  Within the health facility, from one health personnel to the another  Made to request for an opinion or suggestion, co-management or further management or specialty care  External Referrals  Movement of patient from one facility to the another  Vertical : from lower to a higher level  Horizontal : between similar facilities in different catchment area THE INTER-LOCAL HEALTH ZONE (ILHZ)  A generic term used by the WHO to describe an integrated health management and delivery system based on a defined administrative and geographical area. COMPONENTS OF ILHZ (DOH, 2002)  People  Boundaries  Health facilities  Health workers People  WHO ideal population size of a health district = between 100,000 and 500,000  The number of people may vary from zone to zone  Taking consideration the number of LGU that will decide to cooperate and cluster Boundaries  Clear boundaries between ILHZs establish accountability and responsibility of health service providers Health facilities  RHUs, BHSs and other health facilities that decide to work together as a health system and a district or provincial hospital, serving as the referral hospital Health workers  Include DOH personnel, district or provincial hospitals, RHUs, BHSs, private clinics, volunteer health workers from NGOs and community-based organizations Levels of Public Health Care Delivery  Tertiary  National Hospitals  National Medical Centers and National Specialized Hospitals  Regional Hospitals/Regional Medical Centers  Teaching and training Hospitals  Secondary  Provincial Health Office   District Hospitals  Emergency Hospitals  Provincial Hospitals/Provincial Medical Centers  Primary  Municipal Health Office  Rural Health Units  Health Centers  Barangay Health Stations NEW CLASSIFICATION OF GENERAL HOSPITALS (DOH, Republic of the Philippine, 2012) Hospitals Level 1 Level 2 Level 3 Clinical services for Consulting specialists in: Level 1 plus: Level 2 plus: inpatients  Medicine Departmentalized Teaching/training with  Pediatrics clinical services accredited residency  Obstetrics and training program in gynecology four major clinical  surgery services Emergency and Respiratory unit Physical medicine and outpatient services rehabilitation unit Isolation facilities General ICU Surgical/Maternity High-risk pregnancy Ambulatory surgical facilities unit clinic Dental clinic NICU Dialysis clinic Ancillary Services Secondary clinical Tertiary clinical Tertiary clinical laboratory laboratory laboratory with histopathology Blood station Blood bank First level X - ray Second level X – ray Third level X - ray with mobile unit Pharmacy https://issuu.com/jakekho/docs/pha_ezine#:~:text=GOALS%20Ensure%20the%20best%20health,especi ally%20the%20poor%2C%20marginalized%2C%20and (Open this link for the copy of Philippine Health Agenda 2016 – 2022) MELISSA D. SARMIENTO, MSN Instructor