COMMUNITY HEALTH DEVELOPMENT

By: ROSECHELLE SIUPAN ELARCO,RN,MAN

Community a group of people with common characteristics or interests living together within a territory or geographical boundary place where people under usual conditions are found (WHO) defined a community as a social structure, exhibits and creates norms and values, and establishes social institutions (BlackWells Nsg. Dictionary)- a group of people in a same geographical area with a same government. Health (WHO) a complete state of physical, mental, emotional, psychological and spiritual well being in absence of disease or infirmary. Development Growth in one or more sectors of society plus associated changes in attitudes, social institutions and knowledge, resulting in desired changes in peoples standard of living Defined as a multi dimentional process involving major changes in social structures, population, attitudes as well as acceleration of economic growth, reduction of inequality and eradication of absolute poverty. (National Economic Development Authority NEDA)- includes consumption of basic goods and services like health, education, etc., and a generation of more productive employment and reduction of inequalities in income and access. According to Teodoro, 1978- Goal of development is to have a better life Community Development Organized effort of people to improve the conditions of the community life and the capacity of the people for participation, self-direction, and integrated efforts in community affairs in which development is accomplished by the people. Community Health Development (CHD) Process of putting in the hands of community members the power to make effective health decisions and to influence the management of available health resources so that they can start to address their own health concerns Active players: community leaders, barangay health workers, community volunteer health workers,and people in the community Mission: Cooperation Self help Voluntary participation Community development assumptions 1. Provides opportunity and means for the individuals worth may revealed. 2. Everyone has something to contribute to the life of the community. 3. Peoples ability to learn and grow.

4. Everyones worth and dignity are the basic values in a democratic society. CHARACTERISTIS OF COMMUNITY DEVELOPMENT 1. CD is concerned with all the people in the community. 2. CD is concerned with community life as a whole. 3. CD is concerned about social change as an outcome. 4. CD is concerned with the problem solving of social issues and conflicts 5. CD is based upon the philosophy of self help and participation by as many members of the community as possible. 6. CD involves technical assistance, personnel, equipment, supplies, money or consultation from the government or voluntary private organization both domestic and foreign 7. CD is essentially inter disciplinay. 8. CD is both a concern with task goals and process goals. 9. CD involves educational process. 10. CD continues over a substantial period of time. 11. CD program should be based on felt needs, and desires as well as the aspirations of the people in the community. 12. CD involves a direct participation and is open to any community resident who wishes to participate CHD AIMs Development of a healthy Community Effective PHC delivery system Developed trained health workers Empowerment of the people Community Health Nursing (WHO) Special field of nursing that combines the skills of nursing, public health, and some phases of social assistance & functions as part of the total public health program for the: promotion of health improvement of the conditions in the social and physical environment rehabilitation of illness and disability 1. COMMUNITY HEALTH NURSING (ANA 1980) A synthesis of nursing practice and public health practice in promoting and preserving the health of populations. The practice is general & comprehensive. Not limited to a particular age group or diagnosis. Continuing not episodic Dominant responsibility is the population as a whole Nursing is directed to individuals, families or groups contributes to the health of the total population. 2. COMMUNITY HEALTH NURSING (Jacobson) Learned practice discipline with the ultimate goal of contributing as individual and in collaboration with others, to the promotion of the clients optimum level of functioning through teaching & delivery of care. Major roles: 1. Health educator 2. Provider of nursing care

3. Community Health Nursing (Freeman) - is service rendered by a professional nurse with the community, groups, family, and individual at home, in health centers, in clinics, in school, in places of work for the ff: promotion of health prevention of illness care of the sick at home and rehabilitation 4. Community Health Nursing (Maglaya) The utilization of the nursing process in the different levels of clientele - individual, families, population groups, and community concerned with: promotion of health prevention of diseases disability and rehabilitation Goal: to raise the level of health of the citizenry by helping community & families to cope with the discontinuities in & threats to health in such a way as to maximize their potential for highlevel wellness. Community Health Nursing A specialized field of nursing practice. 1. Utilitarianism: greatest good for the greatest number. 2. Nursing Process. 3. Priority of health-promotive and disease-preventive strategies over curative interventions. 4. Tools for measuring and analyzing Community Health problems. 5. Application of principles of management and organization in the delivery of health services to the community

Basic Principles of CHN 1. The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual, family, population group (those who share common characteristics, developmental stages and common exposure to health problems e.g. children, elderly), and the community. 2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care 3. CHN practice is affected by developments in health technology, in particular, changes in society, in general 4. The goal of CHN is achieved through multi-sectoral efforts 5. CHN is a part of health care system and the larger human services system. The two most commonly identified subspecialties of CHN are occupational health nursing and school health nursing.

Occupational Health Nursing 1. Nursing in the workplace. 2. Research-based with an emphasis on optimizing health, preventing illness and injury, and reducing health hazards.

School Health Nursing 1. Nursing in an educational environment (school)

2. Aims at promoting the health of school children & preventing health problems that would hinder their learning and performance of their developmental tasks. Public Health (Dr. Winslow) the science & art of preventing disease prolonging life promoting health and efficiency through organized community effort for the sanitation of the environment control of communicable diseases the education of individuals in personal hygiene the organization of medical and nursing services for the early diagnosis and preventive treatment of disease development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health

PUBLIC HEALTH (WINSLOW) organizing these benefits as to enable every citizen to realize his birthright of health and longevity. SETTINGS OF CHN Community - town, city or municipality with spatial boundaries, with population ranging from 10,000 to 50,000 people. Health Center work base/office where she provides services like pre-natal, well-baby or general clinic for sick cases Clients Home house-to-house visits, home deliveries, case findings, follow-up visits Schools conducts mass immunization Workplace factories/industrial establishments Marketplace/rice fields emergency/accidents COMMON PROCEDURE IN CHN: HOME VISIT BAG TECHNIQUE STERILIZATION SPECIMEN COLLECTION - URINE - FECES - SPUTUM 4 Levels of Clientele in CHN Individual focus of care is the person/patient objective of nursing care is promotion or maintenance of health, disease prevention, early diagnosis & treatment of a suspected ailment, recovery or rehabilitation of illness, eventual self-reliance in personal care, or a peaceful, dignified death Scope of service varies from first aid, to basic & to comprehensive nursing care.

2. Family unit of care Unit of living, is also a unit of illness Illness in one member affects other family members and the whole family as a unit Alterations in health alter relationships between members (physiologically, psychosocially, and economically) Affects the functions & effectiveness of the family as a whole Dynamic interplay between health & family characteristics

Vehicle for preventive & therapeutic health interventions 8 Family tasks or Basic Tasks: physical maintenance allocation of resources- income given to wife division of labor joint parenting socialization of family members reproduction, recruitment & release maintenance of order & discipline apply sanctions placement of members in larger society- indication familys success (school, church, social, political, economic orgs.) maintenance of motivation and morale

3. Group Certain population group with common unique health needs or risk groups whom the nurse delivers health promotive, preventive, curative or rehabilitative nursing services CHN utilizes group approaches in identifying the common health needs of the members, and addressing them for the whole group. 4. Community Refers to a group of people who share common needs, interests, ethnic or cultural ties, and are committed to their groups well-being. Functions within a particular social and political system & structure, creates & exhibits certain norms, values and social institutions, and its members interact and socialize with each other Emphasis on the importance of the greatest good for the greatest number. Mortality & morbidity statistics are broad indicators of a communitys state of health. Interventions for community-wide health problems come in the form of specific programs or special projects implemented with the participation of the comm & health care teams. 3 Major Concepts of CHN Community - client Health - goal Nursing - the means Development - progress-sustainable development or an increase of quality of life

Community Health Nursing Principles: affected by the changes in technology. In general, it is affected by changes in society. goals are achieved through multi-sectoral efforts. - HOLISTIC part of the health system and the larger human service system.

Roles of Public/ Community Health Nurse 1. 2. 3. 4. Clinician Health Educator Facilitator Supervisor

RESPONSIBILITIES OF THE CH NURSE (as per Republic Act 7164: Philippine Nursing Act of 1991) Supervision and care of women during pregnancy, labor and puerperium. Performance of internal examination and the delivery of babies. Suturing lacerations in the absence of a physician. Provision of First Aid measures and emergency care. Recommending herbal and symptomatic care. RESPONSIBILITIES OF THE CH NURSE (as per Republic Act 7164: Philippine Nursing Act of 1991) Participate in the development of an overall plan, its implementation, and evaluation. Provide quality nursing service. Maintain networking / links with other health team members and agencies in the provision of health care services. Provide opportunities for professional growth and continuing education.

CHN (Freeman) - involves intelligent application of nursing and public health measures within the framework of the total community health efforts. Roles/Functions of CHN : Provider - personal care to the sick esp. the poor Advocate liaison between family & health provider Adviser - sister/brother/teacher/collaborator to the families & co-worker Worker sensitive to the deviation from normal to abnormal conditions of people & environment in the family & community 5. Catalyst/Change Agent influences decisions & produces changes by helping influences decisions & produces changes by helping families make good decisions about health, avoid illness, death or disability - acts as a potentiator who makes others effective - enhances the family & community capacity to cope with their problem as well as to provide care 6. Organizer & Manager engaged in all nursing & management process like planning,organizing, leading and evaluating 7. Participant engaged in planning with health-care groups 1. 2. 3. 4.

RESPONSIBILITIES OF THE COMMUNITY HEALTH NURSE IN : THE CARE OF FAMILIES Provision of health care services. Development and utilization of family nursing care plan.

THE CARE OF THE COMMUNITIES Community organizing mobilization, community development and people empowerment Case finding and epidemiological investigation Program planning, implementation and evaluation Influencing executive and legislative individuals or bodies concerning health and development

Health - A state of complete physical, mental, and social well being and not merely the absence of disease and infirmity. World Health Organization - 1947 A dynamic state or condition which is multidimensional in nature and results from the adaptation to his/her environment.

Community - Group of people who have common characteristics; can be defined geographically or administratively Community Health The health status of a defined group of people and the actions and conditions, both private and public, to promote, protect, and preserve their health. Population Health - The health status of people who are not organized and have no identity as a group or locality and the actions and conditions to promote, protect and preserve their health Public Health - Health status of a defined group of people and governmental actions and conditions to promote, protect, and preserve the peoples health Community Health vs Personal Health - Personal o Individual actions and decision making that affect the health of an individual or their immediate family - Community o Activities aimed at protecting or improving the health of a population or community Development - growth in one or more sectors of society plus associated changes in attitudes, social institutions and knowledge, resulting in desired changes in peoples standard of living Community Health Development (CHD) - Process of putting in the hands of community members the power to make effective health decisions and to influence the management of available health resources so that they can start to address their own health concerns - Active players: community leaders, barangay health workers, community volunteer health workers,and people in the community

II. THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM HEALTH CARE SYSTEM - an organized plan of health services (Miller-Keane, 1987) HEALTH CARE DELIVERY - rendering health care services to the people (Williams-Tungpalan, 1981). HEALTH CARE DELIVERY SYSTEM (Williams-Tungpalan, 1981) - the network of health facilities and personnel which carries out the task of rendering health care to the people. PHILIPPINE HEALTH CARE SYSTEM - is a complex set of organizations interacting to provide an array of health services (Dizon, 1977).

COMPONENTS OF THE HEALTH DELIVERY SYSTEM The Department of Health Mandate: The Department of Health shall be responsible for the following: formulation and development of national health policies, guidelines, standards and manual of operations for health services and programs; issuance of rules and regulations, licenses and accreditations; promulgation of national health standards, goals, priorities and indicators; development of special health programs and projects and advocacy for legislation on health policies and programs. The primary function of the Department of Health is the promotion, protection, preservation or restoration of the health of the people through the provision and delivery of health services and through the regulation and encouragement of providers of health goods and services (E.O. No. 119, Sec. 3). Vision: Health as a right. Health for All Filipinos by the year 2000 and Health in the Hands of the People by the year 2020.

Mission: The mission of the DOH, in partnership with the people to ensure equity, quality and access to health care: - by making services available - by arousing community awareness - by mobilizing resources - by promoting the means to better health LEVELS OF HEALTH CARE FACILITIES 1. PRIMARY LEVEL OF HEALTH CARE FACILITIES - are the rural health units, their sub-centers, chest clinics, malaria eradication units, and schistosomiasis control units operated by the DOH; puericulture centers operated by League of Puericulture Centers; tuberculosis clinics and hospitals of the Philippine Tuberculosis Society; private clinics, clinics operated by the Philippine Medical Association; clinics operated by large industrial firms for their employees; community hospitals and health centers operated by the Philippine Medicare Care Commission and other health facilities operated by voluntary religious and civic groups (Williams-Tungpalan, 1981). 2. SECONDARY LEVEL OF HEALTH CARE FACILITIES - are the smaller, non-departmentalized hospitals including emergency and regional hospitals.

Services offered to patients with symptomatic stages of disease, which require moderately specialized knowledge and technical resources for adequate treatment.

3. TERTIARY LEVEL OF HEALTH CARE FACILITIES - are the highly technological and sophisticated services offered by medical centers and large hospitals. These are the specialized national hospitals. - Services rendered at this level are for clients afflicted with diseases which seriously threaten their health and which require highly technical and specialized knowledge, facilities and personnel to treat effectively (Williams-Tungpalan, 1981)

FACTORS ON THE VARIOUS CATEGORIES OF HEALTH WORKERS AMONG COUNTRIES AND COMMUNITIES 1. available health manpower resources 2. local health needs and problems 3. political and financial feasibility THREE LEVELS OF PRIMARY HEALTH CARE WORKERS A. VILLAGE OR GRASSROOT HEALTH WORKERS - first contacts of the community and initial links of health care. - Provide simple curative and preventive health care measures promoting healthy environment. - Participate in activities geared towards the improvement of the socio-economic level of the community like food production program. - Community health worker, volunteers or traditional birth attendants. B. INTERMEDIATE LEVEL HEALTH WORKERS - represent the first source of professional health care - attends to health problems beyond the competence of village workers - provide support to front-line health workers in terms of supervision, training, supplies, and services. - Medical practitioners, nurses and midwives. C. FIRST LINE HOSPITAL PERSONNEL - provide back up health services for cases that require hospitalization - establish close contact with intermediate level health workers or village health workers. - Physicians with specialty, nurses, dentist, pharmacists, other health professionals.

TWO-WAY REFERRAL SYSTEM (Niace, et. al. 8th edition 1995) A two-way referral system need to be established between each level of health facility e.g. barangay health workers refer cases to the rural health team, who in turn refer more serious cases to either the district hospital, then to the provincial, regional or the whole health care system. Public P Barangay Health O Health Worker Nurse 2nd 3rd P HF HF U EA EA L Barangay RHU AC AC A Health Midwife Physician LI LI T Stations TL TL I HI HI O T T N RHS Sanitary Y Y Midwife Inspector MULTISECTORAL APPROACH TO HEALTH (NLGNI, 8th edition, 1995) The level of health of a community is largely the result of a combination of factors. Other health-related Systems (government/ private

Ways of The People (Cultural)

Community Health

Health Care System

Environment (Social, Economic, physical, Etc.

Health, therefore, cannot work in isolation. Neither can one sector or discipline claim monopoly to the solution of community health problems. Health has now become a multisectoral concern. For instance, it is unrealistic to expect a malnourished child to substantially gain in weight unless the familys poverty is alleviated In other words, improvement of social and economic conditions need to be attended to first or tackled hand in hand with health problems. 1. Intersectoral Linkages - Primary Health Care forms an integral part of the health system and the over-all social and economic development of the community. As such, it is necessary to unify health efforts within the health organization itself and with other sectors concerned. It implies the integration of health plans with the plan for the total community development. - Sectors most closely related to health include those concerned with: a. Agricultural b. Education c. Public works d. Local governments e. Social Welfare f. Population Control g. Private Sectors The agricultural sector can contribute much to the social and economic upliftment of the people. Demonstration to mothers of better techniques and procedures for food preparation and preservation can preserve the nutritive value of local foods. Through joint efforts, agricultural technology that produces side effects unsafe to health (for instance, insecticide poisoning) can be minimized or prevented. The school has long been recognized as an effective venue for transmission of basic knowledge to the community. Every pupil or student can be tapped for primary health care activities such as sanitation and food production activities..

Construction of safe water supply facilities and better roads can be jointly undertaken by the community with public works. Community organization (e.g. establishing a barangay network for health) can be worked through the local government or community structure. Likewise, better housing through social welfare agencies, promotion of responsible parenthood through family planning services and increased employment through the private sectors can be joint undertakings for healthWe have to recognize that oftentimes health actions undertaken outside the health sector can have health effects much greater than those possible within it. 2. Intrasectoral Linkages - In the health sector, the acceptance of primary health care necessitates the restructuring of the health system to broaden health coverage and make health service available to all. There is now a widely accepted pyramidal organization that provides levels of services starting with primary health and progressing to specialty care. Primary health care is the hub of the health system.

A PYRAMIDAL HEALTH STRUCTURE

Tertiary National Health Services Regional Health Services District Health Services Rural (Local Hospital) Services Rural Health Units Barangay Health Stations Health Care

Secondary Health Care

Primary Health Care

THE NATIONAL HEALTH PLAN (Niace, et. al 8th edition 1995) The National Health Plan is the blue print which is followed by the Department of Health. It defines the countrys health problems, policy thrusts, strategies and targets. POLICY THRUSTS AND STRATEGIES There are policy thrusts and strategies which are commonly important. These are: 1. Information, education, and communication programs will be implemented to raise the awareness of the public, including policy makers, program planners and decision makers; 2. An update of the legislative agenda for health, nutrition and family planning (HNFP), and stronger advocacy for pending HNFP related legislations will be pursued; 3. Integration of efforts in the health, nutrition and family planning sector to maximize resources in the delivery of services through the establishment of coordinative mechanisms at both the national and local levels; 4. Partnership between the public and the private sectors will be strengthen and institutionalized to effectively utilize and monitor private resources for the sector; 5. Enhancement of the status and role of women as program beneficiaries and program implementers will be pursued to enable them to substantially participate in the development process.

Health Care Delivery System the totality of all policies, facilities, equipments, products, human resources and services which address the health needs, problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary. HEALTH SECTORS GOVERNMENT SECTORS Department of Health Vision: Health for all by year 2000 and Health in the Hands of the People by 2020 Mission: In partnership with the people, provide equity, quality and access to health care esp. the marginalized 5 Major Functions: 1. Ensure equal access to basic health services 2. Ensure formulation of national policies for proper division of labor and proper coordination of operations among the government agency jurisdictions 3. Ensure a minimum level of implementation nationwide of services regarded as public health goods 4. Plan and establish arrangements for the public health systems to achieve economies of scale 5. maintain a medium of regulations and standards to protect consumers and guide providers NON GOVERNMENT SECTORS PRIVATE SECTORS PRIMARY STRATEGIES TO ACHIEVE HEALTH GOALS Support for health goal Assurance of health care Increasing investment for PHC Development of National Standard MILESTONE IN HEALTH CARE DELIVRY SYSTEM RA 1082 - RHU Act RA 1891 - Strengthen Health Services PD 568 - Restructuring HCDS RA 7160 - LGU Code

National Health Plan National Health Plan is a long-term directional plan for health; the blueprint defining the countrys health PROBLEMS, POLICY THRUSTS STRATEGIES, THRUSTS GOAL : to enable the Filipino population to achieve a level of health which will allow Filipino to lead a socially and economically-productive life, with longer life expectancy, low infant mortality, low maternal mortality and less disability through measures that will guarantee access of everyone to essential health care OBJECTIVES: 36 promote equity in health status among all segments of society address specific health problems of the population upgrade the status and transform the HCDS into a responsive, dynamic and highly efficient, and effective one in the provision of solutions to changing the health needs of the population promote active and sustained peoples participation in health care MAJOR HEALTH PLANS TOWARDS HEALTH IN THE HANDS OF THE PEOPLE IN THE YEAR 2020 A. MAJOR HEALTH PLAN 23 IN 93 Health for more in 94 Think health Health Link 5 in 95 B. PRIORITY PROGRAM IN YEAR 2000 Plan 50 Plan 500 Womens health Childrens health Healthy Lifestyle Prevention & Control of Infectious Disease C. PRIORITY PROGRAM IN THE YEAR 2005 Ligtas Buntis Campaign Mag healthy Lifestlye tayo TB Network Blood Donation Program (RA 7719) DTOMIS Ligtas Tigdas Campaign Murang Gamot Anti Tobacco Signature Campaign Doctors to the Barrios Program Food Fortification Program

 Sentrong Sigla Movement D. NATIONAL HEALTH EVENTS FOR 2006 JANUARY National Cancer Consciousness Week - (16-22) FEBRUARY Heart Month Dental Health Month Responsible Parenthood Campaign National Health Insurance Program MARCH Women's Health Month Rabies Awareness Month Burn Injury Prevention Month Responsible Parenthood Campaign Colon and Rectal Cancer Awareness Month World TB Day - (24) APRIL Cancer in Children Awareness Month World Health Day - (7) Bright Child Week Phase I Garantisadong Pambata (11-17) MAY Natural Family Planning Month 37 Cervical Cancer Awareness Month AIDS Candlelight Memorial Day - (21) World No Tobacco Day - (31) JUNE Dengue Awareness Month No Smoking Month National Kidney Month Prostate Cancer Awareness Month JULY Nutrition Month National Blood Donation Month National Disaster Consciousness Month AUGUST National Lung Month National Tuberculosis Awareness Month Sight-Saving Month Family Planning Month Lung Cancer Awareness Month SEPTEMBER Generics Awareness Month

 Liver Cancer Awareness Month OCTOBER National Children's Month Breast Cancer Awareness Month National Newborn Screening Week (3-9) Bright Child Week Phase II Garantisadong Pambata (10-16) NOVEMBER Filariasis Awareness Month Cancer Pain Management Awareness Month Traditional and Alternative Health Care Month Campaign on Violence Against Women and Children DECEMBER Firecracker Injury Prevention Campaign: OPLAN IWAS PAPUTOK
National Health Plan Is a long-term directional plan/blueprint for health covering the period 1995 to 2020. Country Plan general directions & broad strategies for an effective & efficient health care delivery system in the country

Concepts : Health is a basic human right Health is both a means & an end of development

Vision The societal image envisioned by the plan by the year 2020 is that of a socially and economically productive population with longer life expectancy, low infant and maternal mortality, less disability, with adequate shelter, education and means of livelihood.

Strategies: 1. Actively participating community 2. Intersectoral coordination 3. Equitable distribution of health and other resources 4. Use of effective technology that is affordable and that respects the sensibilities of the people

5. Practice of sound management 6. Development of the requisite health human resources

Indicators of Success - well nourished population - safe drinking water for all - sanitary disposal of human and animal waste - minimal environmental pollution & hazards - communicable disease no longer a problem - chronic diseases are under control - psychosocial well-being and lifestyle which is conducive to health - absence of pockets of illness - regulation of fertility to ensure better health and social well-being - access to appropriate health care for all Policy Thrusts & Strategies of NHP IEC programs to raise awareness of the public including policymakers, program planners & decision makers. An updated legislative agenda for Health, Nutrition and Family Planning (HNFP) Integration of efforts in the HNFP sector to maximize resources in the delivery of services. Strengthen and institutionalize partnership between the public and the private sectors. Enhancement of the status & role of women as program beneficiaries & program implementers to enable them to participate in the development process. Health Care Delivery System (HCDS) Is the totality of all policies, infrastructures, facilities, equipment, products, human resources and services that address the health needs, problems & concerns of all people Health facilities are maintained by public & private sectors Preventive health care major concern of govt-owned health centers Curative care provided by government & private hospitals Restructured Health Care Delivery System - 1975 (RHCDS)

The combination of main health center and satellite barrio health stations (BHS) which is essentially the basis for the implementation of the new system.

Objective : To strengthen the rural health services and to effect a more efficient and effective delivery care of health services in the country. Main Health Center Located in the municipality and has its own catchments area of 5,000 populations more or less Staff by a complete health team of MHO, Rural Health Physician, PHN, Rural Sanitary Inspector & RHM In RHU some headed by a PHN based on RA 1891, an amendment of RA 1082 Barrio Health Stations (BHS) Located is a strategic area beyond a 3-5 kilometer-radius from the main health center and each serves a catchments area of 5,000 populations more or less Staffed by RHM whose service are available 24 hours a day as she provides primary level of health care within their competence as defined in the Operational Manual for Nursing Personnel.

Referral System an integral part of the RHCDS Client cared for by family --- barrio health station ---- main health center or private agencies within the poblacion --- district/provincial/regional hospital and central referral system Population-Based Rural Manpower Needs

2 Major Sector of PHCDS Public Sector - financed through tax-based system both at National and Local level where health care is generally given free at the point of service.

2 agencies providing health services in public sector : 1. National agencies the DOH is the one as the lead agency in health. It has regional field office in every region and maintains specialty, regional hospital and medical center. - maintain provincial health team made up of DOH representative to the local health board and personnel involve in CD control specifically for malaria and schistosomiasis.

- PGH, San Lazaro, PHC, NCMH, Lung Center, POC 2. Local Health Agency run by the Local Govt composed of provincial and district hospitals under the provincial government; manages the health center and barangay health station. Private Sector a profit & non-profit provider where health care is paid through user fees at the service point of view. - maintain the peoples health which includes providing health services in clinic and hospital, health insurance, manufacturer of medicine, vaccine, medical supplies, equipment and other health and nutrition product. Levels of Care Tertiary - highly specialized - broad population base - regional/national provincial hospitals/medical centers - treatment of simple/specialized/complicated cases - maternal/child health & family palnning - Rehabilitative/intensive care - Minor/major surgery - simple & complicated diagnostic procedures

Secondary - Inpatient & diagnostic Care including surgery - Regional population district/province - RHU/infirmaries/municipal district Hosp - Private/govt./OPD - Health Education - Maternal/Child health & family planning - Nutrition Activities - Immunization - Minor surgery - Simple Laboratory exams - Essential Drugs Provision

Primary - Ambulatory & 1st entry level - Preventive care - Community/BHS/RHUs - Health Education - Control of Locally endemic diseases - Immunization - Maternal/Child Health & Family planning - Nutrition Activities - Treatment of Common Diseases - Essential drugs provision Primary Health Care An essential health care made universally accessible to individuals and families of the community by means acceptable to them through their full participation at the cost that the family and the country can afford at every stage of development. PHC: Conceptual Framework Goal: Health for all Filipinos and Health in the Hands of the People by the year 2020. PHC: Conceptual Framework Mission: To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care. PHC: Conceptual Framework Concept: Characterized by partnership and empowerment of the people. Includes the full participation and active involvement of the community towards the development of self-reliant people, capable of achieving an acceptable level of health and well-being. PHC: Legal Basis Letter of Instruction (LOI) 949 Signed on October 19, 1979 by President Ferdinand E. Marcos

Alma Ata (Russia) Conference First International Conference on PHC September 6-12, 1978 Sponsored by the WHO and UNICEF Primary Health Care Four (4) As: Characterisitics Accessibility Acceptability Affordability Availability Pillars of Primary Health Care S: SUPPORT MECHANISMS IN PLACE C: COMMUNITY PARTICIPATION A: APPROPRIATE TECHNOLOGY N: NETWORKING AND LINKAGES Elements of PHC ELEMENTS DAM!!! E: EDUCATION, INFORMATION, ADVOCACY L: LOCAL / ENDEMIC DISEASES E: EXPANDED PROGRAM ON IMMUNIZATION M: MATERNAL AND CHILD HEALTH E: ESSENTIAL DRUGS N: NUTRITION T: TREATMENT AND CONTROL OF DISEASES S: SANITATION AND ENVIRONMENT D: DENTAL HEALTH A: ACCESSIBLE HEALTH CARE / ACCESS TO APPROPRIATE HEALTH FACILITIES M: MENTAL HEALTH

Elements of PHC (Essential Services) HOME ELEMENTS H : ospital as a Center of wellness O : oral and dental Health M : ental health E : elderly Care E : education for health L : ocal endemic disease prevention & control E : xpanded program on immunization M : aternal and Child Health/Family Planning E : ssential drugs provision/herbal medicines N : utrition T : reatment of Communicable Disease & accidents S : afe water and Sanitation Role and function of DOH in the Health Sector Leadership in Health 1.1. Serves as a national policy and regulatory commission 1.2 Provide leadership in the formulation, monitoring & evaluation of National Health policies, plan and program 1.3 Serves as advocate in the adaptation of health policies, plans & program to address national & sectoral concerns. 2. Enabler & Capacity Builder 2.1 Innovate new strategies in health to improve the effectiveness of health program. 2.2 Exercise oversight function and monitoring the evaluation of National Health plans, programs and policies. 2.3 Ensure the highest achievable standard of quality health care, health promotion and health protection. 3. Administrator of Specific Services 3.1 Manage selected National Health Facilities and Hospitals with modern and advances facilities 3.2. Administer direct services of emergency health concern that require complicated technologies

3.3. Administer health emergency response services including referrals. Health Sector Reform Agenda - 1999 (HSRA) Goal: To improve the performance of the health sector by improving the way health services are being provided and financed. How: a. expanding effective coverage of local & national health programs b. increased access to personal health services delivered by both public & private providers c. reduction of financial burden on individual families through universal coverage of the National Health Insurance Program (NIHP) Rationale for Health Sector Reform Program Slowing down in the reduction in the Infant Mortality Rate (IMR) and Maternal Mortality Rate (MMR). Persistence of large variation in health status across population group and geographic. High burden from infectious diseases. Rising burden from chronic to degenerative diseases Unattended emerging health risks from environmental and work-related factors. Burden disease is heaviest in the poor Objectives of the Health Sector Improve the general health status of the population Reduce the mortality and morbidity of certain disease Eliminate certain disease as public health problem Promote healthy lifestyle and environmental health Protect vulnerable groups with special health and nutrition needs To ensure better health services delivery Reduce the cost and ensure the quality of essential health Pursue public health hospital reform To ensure quality & safety of health goods Expand the coverage of social health insurance. Interrelated Health Reform Areas

Local Health Systems Development promote the development of local health systems where networking among municipal & provincial health facilities are functional and sustained by cooperation and cost sharing among local govt units in the catchments area.

2. Hospital Reforms provide fiscal autonomy and managerial autonomy to govt hospitals; improving the way hospitals governed & financed so that quality of care is improved, hospital operations are cost efficient, revenues are enhanced & retained and dependence on direct budget subsidies are reduced.

3. Public health program reforms strengthen the capacity of the DOH to exercise technical leadership in disease prevention and control; enhance the effectiveness of local public health delivery systems; & sustain funding for priority health programs over a period required to remove then as public health threats. 4. Health Regulatory Reforms strengthen capacities of DOH to exercise its regulatory functions to ensure that health products, devices, & facilities are safe, affordable and of good quality. 5. Social health insurance reforms expand the coverage and enhance the benefit package of the NHIP to effectively reduce the financial burden to families.

The HSRA was designed to be gradually implemented as a reform package because the components are interrelated.

It is implemented in selected implementation or convergence sites - usually a province or a city where all the 5 reforms are implemented in an integrated fashion where the major stakeholders like DOH, Philhealth, the local govt, civil society groups, and the beneficiaries come together & pool their efforts and resources to make the health reforms succeed. - the convergence strategy aims to generate sufficient improvements in health delivery & financing in these local sites easily visible by the residents.

Tulong Sulong sa Kalusugan (TSK) slogan for implementing the convergence strategy of HSRA and to uplift the health status of every Fil., esp. the poor, through vital reforms in our health system.

Convergence Sites Pangasinan Nueva Viscaya Bulacan Pasay City Capiz

Negros Oriental Misamis Occidental South Cotabato 3 pillars of Tulong Sulong sa Kalusugan Pagtutulungan mutual assistance Pagsulong moving forward Kahulugan para sa lahat - health for all

Overall Goals & Objectives Medium Term Devt Plan (2005-2020) 1. Better Health Outcome 2. More responsive health system 3. More equitable health care financing

General Objective To undertake critical reforms with speed, precision and effective coordination directed at improving the efficiency, effectiveness & equity of the Phil. Health system in a manner that is felt & appreciated by Filipinos, esp. the poor. Specific Objectives 1. Secure more, better & sustained financing for health 2. Assure the quality and affordability of health goods and services 3. Ensure access to and availability of essential & basic health packages 4. Improve performance of the health system

FOURmula ONE Components Health Financing to secure more, better & sustained investment in health. Strategies Mobilizing resources for extra budgetary sources Coordinating local & natl health spending Adopting a performance based on financial system Expanding the national health insurance program

Health Regulation to assure access to quality and affordable health products, devices, facilities & services Strategies 1. Harmonizing & streamlining of systems, processes for licensing and accreditation and certification 2. Developing a seal of approval system 3. Pursuing cost recovery with income retention for health regulatory agencies & other revenue generating mechanisms 4. Ensuring access of the poor to essential health products > promoting high quality generic pharmaceutical products > expanding pharmaceutical distribution networks > identifying alternative local & foreign sources of low priced branded drugs > developing mechanisms for pooled procurement

Health Service Delivery to improve accessibility and availability of basic & essential health care for all Strategies 1. Making available basic & essential health service packages by designated providers in strategic locations 2. Assessing quality of both basic & specialized health services > Upgrade health facilities & strengthen human resource capabilities > Follow accepted standards of care > Provision of specialized diagnostic procedures & services

3. Intensifying current efforts to reduce public health threats > Undertake disease-free zone initiative > Intensify disease prevention & control strategies > Enhance health promotion & disease surveillance

Good Governance in Health to improve health systems performance at the national and local levels Strategies : 1. Improving governance in local health system thru : > FOUR-IN ONE convergence sites > FOURmula ONE for Health LGU Scoreboard > FOURmula One for Health Professional development & Career track 2. Improving national capacities to manage and steward the health sector 3. Develop a rationalized and more efficient national and local health systems thru strengthening : > networking mechanisms & referral systems > Sharing of resources > Organizational transformation & restructuring > Capacity building