NCM102 - COL - SG - WK6

REAL WORLD READY PROGRAM

SUPLEMENTAL STUDY GUIDE

Subject Community Health Nursing
The Health Care Delivery System (part 1) Primary
Topic
Health Care (PHC)

Course/Year BSN 2

Week Week 6

School Year 1st Semester/SY 2020-2021

I. Objectives

• Define primary health care (PHC)

• Explain definition of health by the World Health Organization
• Outline the historical background of PHC
• Enumerate the key principles of PHC
• Relate the application of the PHC key principles in the implementation
of public health programs
• Describe traditional and alternative health care modalities that maybe
applied in communities
• Cite the difference between the PHC approach and primary care

II. Discussion

In the age of globalization, health and health problems too have become
global. Cardiovascular diseases and cancer are no longer identified as
diseases of just affluent countries; even developing countries like the
Philippines are seeing continuous like the Philippines are seeing a continuous
upward trend of these diseases in the past decade. Note that health care is
not just a problem of poor developing countries, even the wealthiest
countries are coping with the situation where they have ageing population
with chronic illness that need long term care.

An overall approach in delivery of health services is necessary- a strategy that

engages both the health worker and the people themselves as partners, and
a strategy that is affordable to the government yet still effective and
acceptable to the communities, a strategy that ensures access to health care
regardless of economic class. The world health organization (WHO) has long
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championed a strategy that it believes is the key to most of the health

problems. And for more than 30 years, the WHO has not wavered in its
promotion for the global implementation of primary health care.

Brief History of Primary Health Care

September 6-12, 1978 – Health leader from around 200 countries attended the
international conference for primary health care held at Alma Ata USSR a call for an
urgent action by all government, all health and development workers, and the world
community to protect and promote the health for all the people of the world

The conference was initiated by the World health organization (WHO) and United
Nations Children’s Fund (UNICEF)

The Alma Ata declaration

1. Health is the Basic fundamental right
2. There exists global burden of health inequalities among populations
3. Economic and social development is of basic importance for the full attainment of
Health for all
4. Governments have a responsibility for the health of their people
Legal Basis of PHC
The strategy was later adopted in the Philippines by the virtue of LOI 949 of 1979,
making the Philippines was the first country in Asia to embark on meeting the
challenge of PHC (Bautista 2001) even before the adoption there is community based
health program in the rural areas of Visayas and Mindanao, applying the spirit of PHC
even before it was formally adopted by the government

Definition of Primary Health Care

According to the Alma Ata declaration, PHC is;
• Practical, scientifically sound and socially acceptable methods, and technology
made universally accessible to individuals and families in the community
through their full participation and at a cost that the community and the country
can afford to maintain at every stage of their development in the spirit of self-
reliance and
self determination
Universal GOAL of PHC
As stated in the Alma Ata declaration is “Health for all” by the year 2000. Health for all
means an acceptable level of health for all the people of the world through community
and individual self-reliance

Policy agenda for Health for all has 3 main Objective:

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1. Promotion of healthy lifestyles

2. Prevention of diseases
3. Therapy of existing conditions
To put further emphasis on PHC in the Philippines, President Ferdinand E. Marcos
signed the LOI 949 that has underlying theme “ Health in the Hands of the people by
2020”

Five elements to achieve the goal

1. Reducing exclusion and social disparities in health (Universal coverage)
2. Organizing health services around people’s needs and expectations (health
service reform)
3. Integrating health to all sectors (Public policy reform)
4. Pursuing collaborative models of policy dialogue (leadership reforms)
5. Increasing stakeholder’s participation

The Alma Ata Declaration listed eight essential health services, using the acronyms
ELEMENTS as memory aid;
E – Education for Health
L – Locally endemic disease control
E – Expanded program for immunization
M – Maternal and Child Health including responsible parenthood
E – Essential Drugs
N – Nutrition
T – Treatment of communicable and non-communicable diseases
S – Safe water and sanitation

Key principles of Primary Health Care

1. 4A’s of PHC accessibility, affordability, acceptability and availability
2. Support mechanism
3. Multisectoral approach
4. Community participation
5. Equitable distribution of health resources
6. Appropriate technology

The 4As of PHC: Accessibility, Affordability, Acceptability and Availability

• Accessibility usually refers to the physical distance of a health facility or the

travel time required for people to get needed or desired health services.

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According to WHO to be considered accessible it must be within 30 minutes from

the communities, Barangay health stations (BHSs) are facilities intended to
provide accessible health services at the community level
• Affordability is not only inconsideration of individual or family’s capacity to pay
for basic health services, WHO considers in determining affordability of health
care, is the out-of-pocket expenses for health care. In the Philippines, the
government health insurance is covered through Philhealth. There are other
health insurance policies offered by private companies or health management
organizations.
• Acceptability means that the health care offered is in consonance with the
prevailing culture and traditions of the population.
• Availability is a question whether the basic health services required by the
people offered are offered in the health care facilities or is provided on a regular
and organized manner
Consider the following health program under 4As:
1. Botika ng bayan and botika ng barangay- drugstores established by the
Philippine government ensuring the availability, affordability, safe and
effective quality essential drugs to all
2. “Ligtas sa tigdas ang pinas” door to door immunization campaign
mass measles immunization to a children 9 months to below 8 years
old

Support mechanisms
The resources for essential health services come from 3 major entities; the people
themselves, the government and the private sector like NGOs and socio-civic and faith
groups. Health programs and projects provide better outputs when these three entities
are involved. For efficient utilization of resources from these three major sectors, a
Multisectoral approach is necessary

Multisectoral approach
As health and disease are outcomes of multiple interrelated factors, PHC requires
communication, cooperation, and collaboration within and among various sectors; this
is exemplified through intersectoral and intrasectoral linkages.

Intrasectoral linkages
Intrasectoral linkages refer to communication, cooperation and collaboration within the
health sector: among the members of the health team and among health agencies. This
is exemplified by the team approach utilized by the personnel of a health center in
dealing with health conditions and problems. The two-way referral system, another
illustration of intrasectoral linkages, is necessary so that clients get the needed and
desired care. For example, a pregnant woman who had prenatal checkups in the BHS or
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rural health unit (RHU) has been identified as high risk. She would referred to the
appropriate hospital for child birth

In this case, competent care is ensured and available health resources are utilized
properly. In the spirit of the two ways referral system, the same mother once
discharged from hospital is referred back to RHU for follow up and home care a service
that most hospitals obviously do not provide

Given the above scenario, the two-way referral system ensures competent care,
maximum use of availability of resources, and community care
Intersectoral linkages

One of the major criticisms against traditional perspective in development is that the
tools for analysis and strategies used are primarily economic in orientation. The idea
that the population is sick because they are poor implies that illness or health is a result
of economic gains or the lack thereof. PHC seeks this paradigm, advocating a more
comprehensive view of the synergy between health and economic development. Health
is a Multisectoral concern. Therefore, primary health and public health programs should
not and cannot be taken in isolation from the overall development agenda of society

Intersectoral linkages encompass the communication, cooperation and collaboration

between the health sector and other sectors of society like education, public works,
agriculture, and local government officials.

Examples of Intersectoral linkages

1. Rabies prevention and control program – requires collaborative effort among
the Department of Health (DOH), Department of Agriculture (DA, Department
of Education (DepEd), and Local government units (LGU)
▪ The DOH provides immunization for victims of animal bites. The
DA provides outreach rabies immunization for dogs, while the
Deped and the LGus are in charge of information campaign in
schools and communities

Community Participation

A key to understand the concept of PHC puts emphasis on how it is defined: that health
is achieved through self-reliance and self-determination, and those individuals, families,
and communities are not considered as recipients of care but active participant in
achieving their health goals. Community participation is an educational and empowering
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process in which people, in partnership with those who are able to assist them, identify
the problems and the needs and increasingly assume responsibilities themselves to
plan, manage, control and assess the collective actions that are proved necessary

Equitable distribution of health resources

PHC advocates for care that is community based and preventive in orientation. It calls
for an inventory and analysis of health resources, facilities, and manpower.

There is a general impression that graduates of health related college programs prefer
to work abroad rather than to stay in the Philippines. To reverse this trend, the DOH is
spearheading two programs to ensure equitable distribution of manpower to the rural
areas. These programs are;
1. Doctor to the barrios (DTTB) program. The DTTB program is the
deployment of doctors to municipalities that are without doctors. DTTB
volunteers are fielded to manage the RHU or health centers in unserved,
economically depressed fifth or sixth class municipalities for 2 years, they also
have the option of being permanently absorbed by the municipality, and the
volunteers are offered competitive compensation by the DOH and the LGU.
2. Registered Nurses Health Enhancement and Local service (RN
HEALS) is a training deployment program for unemployed nurses. RN HEALS
volunteers are deployed to unserved, economically depressed municipalities for
one year to address the inadequate nursing work forces in rural communities
and Health facilities.
Appropriate technology
According to the dictionary, technology is an “applied science” health technology
includes tools, drugs, methods, and procedures and technique. Appropriate technology
refers to the technology that is suitable to the community that will use it to better
capture its essence, the terms “people’s technology” and “indigenous technology” are
also used in reference to appropriate technology

Criteria for Appropriate Health technology

• Safety. this means that the technology results in minimal risk to the user and
that the intended positive outcomes of the use of technology far outweigh its
unintended negative effect
❖ Example, the pertussis vaccine (a component of DPT which is administered in
the expanded program of immunization) it is not recommended to be given

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to a child who is 7 years or older because at this age, the vaccine is already
more hazardous than the disease itself
• Effectiveness. the technology should accomplish what it is meant to
accomplish
❖ Example, medicinal herbs endorsed by the DOH has been tested and have
been clinically proven to have a medical value to a relief and treatment of
ailments
• Affordability. Measures for health promotion and disease prevention are cost
effective in comparison to treatment of disease. Prevalent childhood conditions
such as cough and colds, diarrhea, and fever, often require home management
only. These cost effective interventions require an educated community
• Simplicity. The technology that requires readily available simple materials and
that involves a simpler process in its use can be more easily adopted by the
people in the community when and where applicable
❖ Example Oral rehydration for management of diarrhea is a simple technology
that can be administered at home
• Acceptability. Technology is effective only when it used by those who need in.
thus, culture is an important consideration in determining the appropriateness of
a technology. In addition, education regarding a particular technology is essential
for its adoption
• Feasibility and reliability. The technology must be easy to apply considering
the people’s natural settings like the home, school, workplace, and community.
Supplies must be constantly available.
❖ Example compared to chest-x-ray, sputum examination is feasible in more
areas
• Ecological effects. Effects on ecology are an important consideration in
choosing or rejecting a particular technology
❖ DOH administrative order no. 2, s. 208 mandated the gradual phase out of
mercury in all Philippine health care facilities and institutions.
• Potential to contribute individual and community development .
Appropriate technology promotes self-sufficiency on the part of those using it.
Traditional and alternative health care

• R.A. 8423 or the traditional and alternative medicine act of 1997 (Juan Flavier
sec. of health that time)
• Created by the Philippine institute of traditional and alternative health care,
which tasked to promote and advocate the use of traditional and alternative
health care modalities through scientific research and product development
• Defined as “Sum total of Knowledge, skills, and practice on health care, not
necessarily explicable context of modern scientific philosophical framework, but
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recognized by the people to help maintain and improve their health towards the
wholeness of their being, the community and society, and their interrelations
based on culture, history, heritage, and consciousness”

Ten Medicinal plant endorsed by the Department of health

Medicinal Plant Use/indication Preparation

Lagundi Asthma, cough, colds, fever, Decoction

dysentery, pain, skin diseases Wash affected site with
decoction
Yerba Buena Headache, stomachache Decoction
Cough and colds Infusion
Rheumatism and arthritis Massage sap
Sambong Antiedema/antiurolithiasis Decoction
Tsaang Gubat Diarrhea, stomachache Decoction
Niyog-niyogan Anthelminthic Seeds are use
Bayabas Washing wounds Decoction
Diarrhea, gargle, toothache
akapulko Antifungal Poultice
Ulasimang bato/ Lowers blood uric acid Decoction
Pansit-pansitan (rheumatism and gout) Eaten raw
Bawang Hypertension Eaten raw/fried Apply
Lowers blood cholesterol on part
Toothache
Ampalaya Diabetes mellitus (mild Decoction/steam
NIDDM)

Medicinal plant preparations

Decoction Boil the recommended part of the plant material in wate,

recommended boiling time is 20 minutes
Infusion Plant material is soak in hot water, much like making a tea,
recommended period of soaking is 10 to 15 minutes
Poultice
Directly apply the plant material on the part affected, usually used

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Tincture on bruise, wounds or rashes

Mix the plant material in alcohol
Preparation Procedure for preparation

III. Learning Rubric

Instruction: Please read carefully and check the corresponding box for your answer.
(Basahin ng mabuti ang bawat tanong at i-tsek ang kahon ng iyong sagot).

Note: Your honest answers will help us gather accurate data to understand and provide
appropriate interventions for the topic discussed.
(Ang matapat na pagsagot ay makapagbibigay ng tumpak na datos upang mas higit
na maunawaan at makapagbigay ng nararapat interbensiyon patungkol sa paksang
ito.)

CONTENT YE MAYB N
S E O
(3) (2) (1

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)
1. I have background knowledge about the topic.
(Mayroon na akong konting kaalaman tungkol sa paksa.)
2. I can analyze the content to deepen my understanding. ( Kaya
kong suriing mabuti ang paksa upang mapalawak pa ang aking
kaalaman.)
3. I can give my own examples.
(Kaya kong magbigay ng sarili kong halimbawa.)

4. I can summarize the content and information that I have

(Kaya kong lagumin ang paksa at ang kaalamang aking

learned.

natutunan.)
5. I clearly understood the topic.
(Lubos kong naunawaan ang paksa ng aralin.)
6. I understand the direction of each activity and answered it correctly.
(Nauunawan ko ang panuto ng bawat gawain at nasagutan ito ng
tama.)

7. I can enumerate the necessary steps and procedures related to the

lesson.
(Kaya kong hanayin ang mga hakbang at proseso na may kaugnayan
sa paksang tinalakay.)
8. I can independently perform the skill, strategy, or process. ( Kaya
kong i-apply ang aking natutunan upang magsagawa ng isang
kasanayan, pamamaraan, o proseso.)
9. I can relate the topic to real-life situations. (Kaya
kong iugnay ang paksa sa totoong buhay.)
10. I accomplished the task on time.
(Natapos ko ang mga gawain sa itinakdang oras.)

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IV. References
1. Zenaida U. Famorca, Mary A. Nieves, Melanie McEwen (2013).Nursing Care of the
Community. Elsevier Singapore
2. Araceli S. Maglaya (2004). Nursing Practice in the Community. 4thEdition.
Argonauta Corporation Philippines
3. Frances Prescilla l. Cuevas (2007). Public Health Nursing in the Philippines 10th
edition. National League of Philippine Government Nurses, Incorporated.
Philippines

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Page

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