PRIMARY HEALTH CARE NOTES

WHAT IS ILLNESS AND CAUSES OF

HEALTH ILLNESS?
- Infectious Diseases are disorders
- “state of complete physical, caused by organisms- such as
mental and social well-being, not bacteria, viruses, fungi or
merely the absence of disease or parasites
infirmity.” – WHO 1947
- Health is a state of being that
COMMON ILLNESSES
people define in relation to their
 Allergies.
own values, personality, and
 Colds and Flu.
lifestyle. Each person has a  Conjunctivitis ("pink eye")
personal concept of health.  *Diarrhea.
Individual’s views health can vary  *Headaches.
among different age- groups,  Mononucleosis.
gender, race and culture.  Stomach Aches
- Pender, 1996. He explains that
all people free of disease are not EXAMPLES OF CHRONIC ILLNESSES
equally healthy. ARE:
- Pender, 1996. Suggest that many  Alzheimer disease and dementia
 Arthritis
people, conditions of life rather
 Asthma
than pathological states are what
 Cancer
define health. Life conditions can  COPD
have positive or negative effects  Crohn disease
on health long before an illness is  Cystic fibrosis
evident life conditions may  Diabetes
include:
o Socio-economic variables WHAT ARE THE FIVE STAGES OF
such as environment ILLNESS?
o Diet
o Lifestyle practices or The five periods of disease (sometimes
choices referred to as stages or phases) include
o Physiological and the:
psychological variables  Incubalion
- Health and illness must be  Prodromal
 Illness
defined in terms of the individual.
 Decline
Health can include conditions
 Convalescence
previously concerned to be
illness. DIMENSIONS OF WELLNESS

WHAT IS WELLNESS?
ILLNESS
- a disease or period of sickness - Wellness is being in good
affecting the body or mind physical and mental health.
 Because mental health and on eating a variety of healthy
physical health are linked, foods actually leads to enjoying
problems in one area can impact food more. And, Dr. Birkholz
the other. At the same time, says, you don’t need to eliminate
improving your physical health chocolate since dark chocolate is
can also benefit your mental good for you.
health, and vice versa. It is 2. BE ACTIVE: It’s about more than
important to make healthy exercise. It’s about being active
choices for both your physical in daily life – moving frequently
and mental wellbeing. and not sitting for extended
periods of time. Get up and move
WELLNESS
at least one to three minutes
- Wellness is an active process of
every half hour. In addition, your
becoming aware of and making
choices toward a healthy and daily exercise program should be
fulfilling life. moderate in intensity, frequency
- Wellness is more than being free and duration to ensure balance.
from illness, it is a dynamic The general rule of thumb is to
process of change and growth. get 30 mins of exercise 5 times a
week.
THE WELLNESS APPROACH focuses 3. AVOID TOXINS AND POISONS:
on capacity building, maintaining Not surprisingly, Dr. Birkholz sites
function and minimizing the impact of tobacco and excessive
functional loss. It identifies what a client consumption of alcohol as the
can and wants to do, rather than only two biggest culprits. More than
what they have difficulty with. It focuses one serving of alcohol a day for
on the balance between doing with women and two servings a day
versus 'doing for. for men is considered as
excessive.
6 CORE PRINCIPLES OF WELLNESS 4. SLEEP ENOUGH: People often
underestimate the value of
1. Eat healthy adequate sleep when it comes to
2. Be active long-term health and wellness.
3. Avoid toxins and poisons Beyond getting enough sleep, Dr.
4. Sleep enough Birkholz says it’s important to get
5. Manage stress quality sleep. Sleep is when your
6. Cultivate loving, supportive brain cleanses itself, giving the
relationship body a better chance to recover
and prepare for what’s to come.
Generally speaking, adults
1. EAT HEALTHY: Eat real whole should strive for seven to eight
foods, mostly plant-based. Avoid hours at night, teens should get
highly processed foods and steer eight to ten hours and children
clear of sugar and flour. Focusing should sleep eight ten to twelve
 hours. As a society, we fall far quality of our surroundings
short of these recommendations. (including protecting and
Preserving nature)
5. MANAGE STRESS: Stress is
unavoidable-it's a part of life that 3. Financial-Achieving satisfaction
gives you a chance to exercise with current and future financial
and build your emotional situations; handling finances
wisely
strength, Dr. Birkholz says. The
key is managing stress, eat well,
4. Intellectual-Recognizing creative
and sleep enough, be active and abilities and finding ways to
avoid toxins. Funny how these expand knowledge and skills;
things come full circle huh? being open-minded

6. CULTIVATE LOVING 5. Occupational-Personal

SUPPORTIVE fulfillment and enrichment from
RELATIONSHIPS: As a human ore's work and/or responsibilities
being you're a social creature.
You need loving healthy 6. Physical-Recognizing the need
relationships in order to thrive. for physical activity healthy foods,
Avoiding people sometimes even and adequate sleep; avoiding
family members – who are unhealthy habits
harmful to you can improve your
7. Social-Developing a sense of
emotional health and well-being
connection, belonging and
Dr. Birkholz suggests learning to
sustained support system; having
appreciate and value the positive, positive relationships
loving people in your life
8. Spiritual- Having a sense of
Learning about the EIGHT purpose and meaning in life;
DIMENSIONS OF WELLNESS can help establishing peace, harmnony,
you choose how to make wellness a and balance in our lives
part of your everyday life. Wellness
strategies are practical ways to start HISTORICAL BACKGROUND OF PHC
developing healthy habits that can have
a positive impact on your physical and - Started in September 6-12, 1978,
mental health. at an International Level. A
conference was held at ALMA
1. Emotional-Coping effectively ATA, RUSSIA. The conference
with life and expressing emotions was sponsored by the World
in appropriate manner Health Organization (WHO) and
the United Nation Children's Fund
2. Environmental- Occupying (UNICEF).
pleasant, healthy, and safe
environments that support well- - The purpose of the conference
being; positively impacting the was to develop an approach to
 health care delivery that would to - Is essential healthcare based on
health care delivery that would methods and technology made
make possible the global goal of universally accessible to
the WHO individuals and community by
means acceptable to them,
GOAL: Health for All the "Health for by through their active full
the year 2000 (1997)
participation and at an affordable
The output of the conference was
cost that the community and
entitled the "Alma Ata Declaration on
Primary Health Care " country can afford at every stage
of development.
 1977-20th World Assembly of the
WHO and HFA 2000 movement Elements of Primary Health Care
(Elements Dam) ,
 1978- Alma Ata Conference and E – ducation on prevailing health
Declaration problems
L – ocally endemic Disease Prevention
PHC identified as the key strategy in and Control
achieving the “HEALTH FOR ALL BY E – xpanded Program of immunization
THE YEAR 2000” goal M – aternal and Child Health and Family
 October 19, 1979 – the Planning
Philippines adopting PHC though E – nvironmental Sanitation and Safe
LOI 949 by President Ferdinand Water Supply
Marcos N – nutrition and Food Supply
 LOI 949 – legal basis of PHC in T – reatment of Communicable & Non-
the country communicable Diseases
S – supply and proper use of Essential
PRIMARY HEALTH CARE (PHC) Drugs and Herbal Medicine
- as defined by the World Health D – ental Health Promotion
Organization, is essential health A – ccess to and use of hospitals as
care made universally accessible centers of wellness
to individuals and families in the M – ental health promotion
community by means acceptable
to them, through their full
participation and at a cost that ASSESSMENT – first step of
the community and country can health provider
afford at every stage of - To be able to know the needs of
development. individual, community, and
- It is very important that the society
individual in the community can
- We get data collection by
manage their own health care,
applying the subjective and
and there is always a continuity
objective data
of all the activities or program. To
be able to strengthen the health
care system.
PHC ESSENTIAL HEALTH CARE
MADE UNIVERSALLY ACCEPTABLE Example:
TO THEM 5 A's o Safety
o Oppression and
 ACCESSIBLE o People empowerment.

GEOGRAPHIC ACCESSIBILITY – Increase of crimes and the lack of

location of the facility, as much as safety in streets and even in the homes
possible within 5 km or may be reach are major concerns of society.
within 30 minutes
Oppression especially of the poor,
CULTURAL ACCESSIBILITY – differential treatment in various classes
accessibility of health care services of society affects health.

FINANCIAL ACCESSIBILITY - 2. BEHAVIORAL

affordability of health care services - A person's level of functioning is
affected by certain habits that he/
 ACCEPTABLE she has. These may be in the
 AVAILABLE form of smoking, intake of alcohol
 APPROPRIATE drinks, substance abuse and lack
 AFFORDABLE of exercise. The people's lifestyle,
health care and child rearing
practices are shaped, to a large
extent, by their culture and ethnic
The modern concept of Health refers heritage.
to Optimum Level Of Individuals,
Families and Communities. These are 3. HEREDITARY
several factors in the eco-system which
- Understanding of genetically
affect this level of Functioning.
influenced diseases is increased
through knowledge about the
THESE FACTORS ARE:
nature of genetic materials and
 POLITICAL
about the process by which
 BEHAVIORAL
genetic traits are transmitted.
 HEREDITARY
New opportunities for preventive
 HEALTH CARE DELIVERY
health care are also produced.
SYSTEM
For example, more precise
 ENVIRONMENTAL
estimates of the risk of
INFLUENCES
transmitting undesirable traits
 SOCIO- ECONOMIC
make it possible to provide
INFLUENCE
prospective parents with
information that will enable them
1. POLITICAL
to make decisions about child
- Politics greatly influence the rearing. Early knowledge of the
social climate in which people live. genetic risks makes it possible to
Political jurisdictions have the anticipate and counteract genetic
power and authority to regulate outcomes, as when knowledge of
the environment.
 incompatible Rh factors in the 6. SOCIO- ECONOMIC
paternal genes enable the INFLUENCE
medical team to prepare for - Families from the lower income
necessary therapeutic groups are the one's mostly
intervention. served in public health services
and by the community health
4. HEALTH CARE DELIVERY midwife. This is because, people
SYSTEM from the lower income groups
- In the Philippines, Primary Health tend to have proportionately
Care is a partnership approach to greater number of illnesses and
the effective provision of health problems than those in the
essential health services that are higher income groups. However,
community based, accessible, the middle and upper income
acceptable Sustainable and group have also very pressing
affordable. Although Promotive health problems such as drug
and Preventive health measures abuse and life-style diseases
are emphasized in community
health the availability and
accessibility of Curative and
Rehabilative services also affect "All people free of disease are not
people’s health. equally healthy".

5. ENVIRONMENTAL To help clients identify and reach

INFLUENCES health goals, the midwife must discover
- The menace of pollution has and used information about their
been growing over the years and concepts of health to set individual goals.
has greatly affected the health of Pender suggests that for many people,
the people. The disease today conditions of life rather than pathological
are largely manmade. Examples states are what define health. Life
of these are communicable conditions can have positive or negative
diseases due to poor sanitation, effects on health long before an illness
poor garbage collection, smoking, is evident
air pollution and utilization of (PENDER, 1996)
chemicals such as pesticides.
Cutting of trees has brought LIFE CONDITION MAY INCLUDE
about floods and drought. If the SOCIOECONOMIC VARIABLES SUCH
quality of air that we breathe AS:
continues to deteriorate, life o Environment
cannot be sustained. o Diet
Uncontrolled dumping of organic o Lifestyles practices, as well as
waste, detergents, and pesticides many other
including industrial wastes, o Physiological
continue to threaten man's supply o Psychological variables
of food, his drinking water and his
health in general.
HEALTH AND ILLNESS
 - Must defined in terms of the
individual. Health can include
conditions previously considered  Positive health behaviors are
to be illness. activities related to:
o Maintaining
For example; o Attaining
A person with epilepsy who has o Regaining good health
learned who has learned to o Preventing illness
control seizures with medication
and who functions at home and COMMON POSITIVE HEALTH
at work may no longer consider BEHAVIORS
himself or herself ill. Midwife  Immunization
attitudes toward health and  Proper sleep patterns
illness should consider the total  Adequate exercise
person, as well as the  Nutrition
environment in which the person
lives, to individualize midwives
NEGATIVE HEALTH BEHAVIORS
care and enhance
meaningfulness of the client's
Include practices actually or potentially
future health status.
harmful to health, such as:
 Smoking
MODELS OF HEALTH AND ILLNESS  Drug or alcohol abuse
 Poor diet
A model is a theoretical way of  Refusal to take necessary
understanding a concept or idea. medications
Models represent different ways of
approaching complex issues. Because HEALTH-ILLNESs CONTINUUM
Health and Illness are complex concepts, MODEL
models are used to understand the
relationships between these concepts According to a Health- illness
and the client's attitudes toward health Continuum Model, Health is a dynamic
and health behaviors. state that fluctuates as a person adapts
to changes in the Internal and External
Health beliefs are a person’s ideas, environments to maintain a state of ;
convictions and attitudes about health  Physical
and illness. They may be based on:  Emotional
 Intellectual
- Factual information or
 Social Development
misinformation
 Spiritual being
- Common sense or myths
- Reality or false expectations
ILLNESSS
Health belief usually influence health Is a process in which the functioning of
behavior, they can positively or a person is diminished or impaired in
negatively affect a client’s level of one or more dimensions when
compared with person's previous
health.
condition. Because Health and Illness For example, is man with broken leg
are relative qualities, existing in varying who has adapted to limited mobility
degrees, it may be more useful to more or less healthy than a physically
consider Health and Illness in terms of a healthy man experiencing severe
point on a scale or continuum rather depression after the death of his spouse?
than as an absolute state. The health-illness continuum is most
effective when used to compare a
client's present level of health with the
HIGH -LEVEL WELLNESS AND client's own previous level of health.
SEVERE LLLNESS (premature death) Subsequently it is useful as a midwife
are opposite ends of the continuum. helps the client set goals to attain a
According to Neuman (1990), “Health on future level of health.
a continuum is a the degree of client
wellness that exist at any point in time, Risk factors to functioning in all
ranging from an optimal wellness
dimensions
condition, with available energy at its
maximum, to Death, which represents - Health
total energy depletion. Central to the - Severe illness
Health-illness continuum model are - Illness
risk factors include; - High level wellness
 Genetic and Physiological
variables such as:
o Age
HEALTH BELIEF MODEL
o Lifestyles
ROSENSTOCH'S (1974) and Becker
o environment
and Maiman's (1975

The way clients view their levels of Health Belief Model addresses
health depends on their: the relationship between person's belief
 Attitudes toward Health and behaviors a way of understanding
 Values and predicting how clients will behave in
 Beliefs relation to their health and how they
 Perception of their comply with health therapies.
o Physical
o Social - Unique personalities, common
o Emotional sense
o Developmental
o Spiritual well being Variables influencing health beliefs
o Intellectual and practices – positively or negatively
affect, plan individualized care due to
The drawback of the Health- Illness different beliefs
continuum is that it is not always easy to  Internal variables
describe a client's level of health in - Developmental stages: thought,
terms of one point between two thinking patterns changes
extremes. throughout life,
 COP: must consider level of The health belief model helps
growth as basis of planning care, midwife to understand factors
use different teaching technique influencing client's perceptions, beliefs
- fear and anxiety about illness, and behavior in order to plan care that
hospitalization due to lack of will most effectively assist clients in
information or clarification maintaining or restoring health and
(experiences) preventing illness.
- Intellectual background: ability
to understand about illness HEALTH PROMOTION MODEL
- Perception of functioning: way The Health Promotion Model
people perceive physical proposed by Pender 1982, 1993, 1996)
functioning; level of fatigue was designed to be "Complementary
- Emotional functioning: counterpart to models of Health
- Social categories: single parents, protection". It defines Health as positive,
children, unemployed, senior dynamic state, not merely the absence
citizen of disease (Pender 1993, 1996). Health
promotion is directed at increasing a
 External variables client's level wellbeing (Pender 1993,
Cultural practices – deals with suffering, 1996).
pain
The Health Promotion Model
describes the multidimensional nature of
The first component on this persons as they interact within their
model involves the individual's environment to pursue health (Pender,
perception of susceptibility to an illness 1996).The model focuses on the
following three areas:
The second component is the
individual's perception of the 1. Client's cognitive perceptual
seriousness of the illness. This factors (individual perceptions).
perception is influenced a modified by 2. Modifying factors (demographic
demographic and socio-psychological and social)
variable perceived threats of the illness, 3. Participation in Health- promoting
and cues to action (e.g, mass media behaviors(likelihood of action )
campaigns and advice from family,
friends, and medical professionals).
EMERGING MODELS OF HEALTH
The third component- the
likelihood that a person will take Wellness-llIness Model. Jensen and
preventive action- results from the Allen (1993)- propose a wellness-illness
person perception of the benefits and model that describes the relationship
barriers of taking action. Preventive between health, disease, wellness, and
action may include lifestyle changes, illness as distinct parts of a process
increased adherence to medical involving the changing person in the
therapies, or a search for medical
changing world. In this model, health is
advice or treatment.
viewed as an objective process
characterized by stability, balance, and
integrity of functioning. Disease, also an individual is affected by adict the client's
objective process, is viewed as a response to the present illness or the
dysfunction or alteration in functioning. threat of future illness. The planning of
Disease is measured by laboratory tests nursing care is then adapted to these
and direct observation. In contrast, expectations, as well as to the client's
wellness is the subjective experience of abilities to participate in self-care.
health (Benner and Wrubel, 1989).
Illness, then, is the human experience Intellectual Background. A person's
of disease and may be perceived as beliefs about health are shaped in part
loss, challenge, threat, punishment, or by the person's knowledge (or
gain (Lipowski,1969, 1983) misinformation) about body functions
and illnesses, educational background,
The HEALTH-Healing/Disordering and past experiences. These variables
Model. Mcabe (1995) constructed a influence how a client thinks about
model of healing based on current health. In addition, cognitive abilities
literature on the phenomenon of healing shape the way a person thinks,
and the lived experiences of nurses who including the ability to understand
use holistic and complementary factors involved in illness and to apply
therapies in their practice of nursing. knowledge of health and illness to
The proposed model may have personal health practices. Cognitive
significance for any health care abilities also relate to a person's
practitioner as a means to understand developmental stage. A nurse considers
the health care provider's role in the intellectual background so that these
process of healing. In the model (Figure variables can be incorporated into
1-5, p. 8), health is a dynamic process nursing care (Edelman and Mandle,
conceptualized as a functional state. 1998).
Illness is deviation from a normal state
in which disordering processes occur. Perception of Functioning. The way
people perceive their physical
functioning affects health beliefs and
practices. When nurses assess a client's
A Model Within a Model. A model of level of health, they gather subjective
health called “a model within a model" data about the way the client perceives
(Collins, 1995) addresses the physical functioning, such as level of
determinants of health on an individual fatigue, shortness of breath, or pain.
and community level. The "nested" They also obtain objective data about
model links the determinants of health actual functioning, such as blood
for the individual and the community and pressure, height measurements, and
suggests that they are interdependent. lung sound assessment. This
In this model, the individual consists of information allows nurses to more
five "environments" of health
determinants. The health of the
successfully plan and implement External variables influencing a
individualized care. person's health beliefs and practices
include family practices, socioeconomic
Emotional Factors. The client's degree factors, and cultural background.
of calm or stress can influence health
beliefs and practices. The manner in Family Practices. The way that clients'
which a person handles stress families use health care services
throughout each phase of life will generally affects their health practices.
influence the way the person reacts to Their perceptions of the seriousness of
illness. A person who generally is very diseases and their history of preventive
calm may have little emotional response care behaviors (or lack of them) can
during illness, whereas an individual influence how clients will think about
unable to cope emotionally with the health.
threat of illness nm either overreact to
illness and assume it is life threatening Socioeconomic Factors. Social and
or deny the presence of symptoms and psychosocial factors can increase the
not take therapeutic action. risk for illness and influence the way that
a person defines and reacts to illness.
Spiritual Factors. Spirituality is Psychosocial variables include the
reflected in a person lives his or her life, stability of the person's marital or
including the value and beliefs exercised, intimate relationship, lifestyle habits, and
the relationships established with family occupational environment. A person
and friends, and the ability to find hope generally seeks approval and support
and meaning in life spirituality serves as from social networks (neighbors, peers,
an integrating theme in peoples’ Iives. and co-workers), and this desire for
Religious practices are one way that approval and support affects health
people exercise spirituality. There are beliefs and practices. Najman (1993)
some religions that restrict the use of suggests that the five social categories
certain forms of medical treatment. that constitute the majority of those in
Nurses must understand clients' spiritual poverty are single parents and their
dimensions to involve them effectively in children, older adults, the unemployed,
nursing care. Ross (1995) suggests that members of racial and ethnic minorities,
hospitalization can precipitate spiritual and the disabled. In addition, data point
distress; therefore clients' spiritual to a consistent pattern of higher
needs should be addressed, since the mortality rates tor the economically most
spiritual dimension is important for the disadvantaged.
attainment of an overall sense of health,
well-being, and quality of life. Social variables partly determine how
the health care system provides medical
care. Because the health care system is
organized in certain ways, it determines
EXTERNAL VARIABLES how clients can obtain care, the
treatment method, the economic cost to - Emotional and spiritual well being
the client, and potential reimbursement and other dimension
to the health care agency or client. - Physical wellness
- Create a condition to promote the
Like social variables, economic optimal health
variables may affect a client's level of - Uses midwife’s process
health by increasing the risk for disease - Subjective experience – relevant
and influencing how or at what point the - Readiness of Clients involved in
healing process
client enters the health care system.
- Personal control over health and
A person's compliance with the illness – learning/teaching to be
independent
treatment that is designed to maintain or
- Music therapy as an intervention
improve health is also affected by – subjective experience
economic status. A person who has high - Relaxation therapy – deep
utility bills, a large family, and a low breathing
income tends to give a higher priority to - Therapeutic touch
food and shelter than to costly drugs or - massage therapy
treatment, or expensive foods for - augment standard treatment
special diets. - easy to learn and apply to health
care setting

Cultural Background. Cultural EMERGING MODELS OF HEALTH

background influences beliefs, values, - wellness illness model
and customs. It influences the approach - Relationship between health,
to the health care system, personal disease, wellness, illness
- Objective process stability,
health practices, and the nurse-client
balance, integrity of functioning
relationship. Cultural background may - disease as dysfunction
also influence an individual's beliefs disease measurement: direct
about causes of observation (physical assessment) ,
laboratory test
BASIC HUMAN NEEDS MODEL - wellness subjective experience of
- Elements necessary for human health
survival and health (e.g. food, illness human experience loss,
water, safety, love) challenge, threat, gait
- Shared health - affected by inter and
- Provide basis in clients intrapersonal disease related and
- Provide most effective care in extra personal factors
clients needs (different valid intrapersonal – personality, past
approach) experience, emo state
- flexible in clients needs interpersonal social support, relationship
health dse factors – health promotion,
orientation, visibility of dse health,
HOLISTIC HEALTH MODELS prognosis
extrapersonal – sociocultural and Health promotion is an emerging field
economic with proactive attempts to prevent
- human experience of actual or illness or disease. Health promotion
perceived factors activities can be passive or active. With
passive strategies of health promotion,
individuals gain from the activities of
others without acting themselves. The
fluoridation of municipal drinking water
Health Promotion, Wellness, and and the fortification of homogenized milk
Illness Prevention with vitamin D are examples of passive
Health care has become increasingly health promotion strategies. With active
focused on health promotion, wellness, strategies of health promotion,
and illness prevention. The rapid rise of individuals are motivated to adopt
health care costs has motivated people specific health programs. Weight
to seek ways of decreasing the reduction and smoking cessation
incidence and minimizing the results of programs require clients to be actively
illness or disability. involved in measures to improve their
present and future levels of wellness
The concepts of health promotion, while decreasing the risk of disease.
wellness, and illness prevention are
closely related and, in practice, overlap Health is acquired and maintained by
to some extent. All are focused on the engaging in activities that promote and
future; the difference between them maintain wellness (Plawecki,1997). An
involves motivations and goals. Health individual takes responsibility for health
promotion activities such as routine and
exercise and good nutrition, help clients
maintain or enhance their present levels
of health. Primary Prevention. Primary
prevention is true prevention; it
Wellness education teaches people how precedes disease or dysfunction and is
to care for themselves in a healthy way applied to clients considered physically
and includes topics such as physical and emotionally healthy. Primary
awareness, stress management, and prevention aimed at health promotion
self-responsibility. Wellness has been includes health education programs,
described as the ongoing and dynamic immunization, and physical and
process of striving to achieve optimum nutritional fitness activities. It can be
health (Plawecki, 1997). Illness provided to an individual or to a general
prevention activities such as population, or it can focus on individuals
immunization programs protect clients at risk for developing specific diseases.
from actual or potential threats to health. Wellness activities (Edelman and
Mandle, 1998) are synonymous with the
activities identified for primary level aims to help clients achieve as
prevention by Leavell and Clark (1965) high a level of functioning as possible,
in Figure 1-7. Primary prevention despite the limitations caused by illness
includes all health promotion efforts, as or impairment. This level
well as wellness activities that focus on
maintaining or improving the general
health of individuals, families, and Primary Prevention
communities (Edelman and Mandle,
1998). Health Promotion

 Health education

Secondary Prevention. Secondary  Good standard of nutrition

adjusted to
prevention focuses on individuals who
are experiencing health problems or  developmental phases of lite
illnesses and who are at risk for
developing complications or worsening  Attention to personality
development
conditions. Activities are directed at
diagnosis and prompt intervention,  Provision of adequate housing
thereby reducing severity and enabling and recreation, as well as
the client to return to a normal level of agreeable working conditions
health as early as possible (Pender,
 Marriage counseling and sex
1993; Edelman and Mandle, 1998). A education
large portion of nursing care related to
secondary prevention is delivered in  Genetic screening
homes, hospitals, or skilled nursing
 Periodic selective examinations
facilities. It includes screening
techniques and treating early stages of Specific Protection
disease to limit disability by averting or
 Use of specific immunizations
delaying the consequences of advanced
disease  Attention to personal hygiene
Tertiary Prevention. Tertiary  Use of environmental sanitation
prevention occurs when a detect or
disability is permanent and irreversible.  Protection against occupational
It involves minimizing the effects of long- hazards
term disease or disability by
interventions directed at preventing  Protection from accidents
complications and deterioration  Use of specific nutrients
(Edelman and Mandle, 1998). Activities
are directed at rehabilitation rather than  Protection from carcinogens
diagnosis and treatment. Care at this
  Avoidance of allergens  Provision of hospital and
community facilities for retaining
and education to maximize use of
remaining capacities
 Education of public and industry
to use rehabilitated persons to
Secondary Prevention fullest possible extent
 Selective placement
Early Diagnosis and Prompt
 Work therapy in hospitals
Treatment
 Use of sheltered colony
 Case-finding measures: I . Levels of Health Care Services -
individual and mass Health problems that are beyond the
capability of PHC units and beyond the
 Screening surveys competence of the PHC workers are
referred to an intermediate health
 Selective examinations to facility or Rural health Units (RHU) -
The RHU team generally consists of the
 Cure and prevent disease
physician, dentist, public health nurse,
process midwife, sanitarian and other health
workers. - The higher the level the more
 Prevent spread of communicable qualified the health personnel and the
disease more sophisticated the health
equipment.
 Prevent complications and
sequelae

 Shorten period of disability 3 levels:

1. Primary level - Barangay Health
station, Private practitioners, Community
Disability Limitations Hospitals, Health Centers and Rural
Health Unit
 Adequate treatment to arrest
disease process and prevent 2. Secondary Level - Emergency/
further complications and District Hospitals, Provincial/ City
sequelae Hospitals and Provincial/ City Health
Services
 Provision of facilities to limit - services offered to px with
disability and prevent death symptomatic stages of dse, which
require moderately specialized
knowledge and technical resources for
adequate treatment.
Tertiary prevention
3. Tertiary Level - Teaching and
Restoration and Rehabilitation Training Hospitals, Medical Centers and
National Health Services
- services are for clients afflicted with
dses which seriously threaten their
health and which require highly
technical and specialized knowledge,
facilities, and personnel to treat
effectively.

b. Rural Health Unit

a primary referral center from
Types of services available in each BHS.
referral levels: promotive and secondary
level prevention.
a. Barangay Health Stations treatment of primary cases not
a satellite of the RHU where the needing inpatient services.
first contact of the patient occur. outpatient services (case
primary preventive and finding and treatment.)
promotive services such as health education, promotive and
health education preventive campaigns.
campaign for sanitation. normal delivery, pre-natal and
immunization. post natal.
normal delivery by midwife . minor surgery.
contact tracing.
liaison with the community c. District Hospitals
 the first level referral hospital in the enjoyed by the community
health district. residents (PCF,
it has a catchments of 75,000  Development- is the quest for an
population or more and is about 35 improved quality of life for all.
kilometers to next government facility. Development is multidimensional.
It has political, social, cultural,
it should have adequate capabilities institutional and environmental
as a secondary level hospital or should dimensions (Gonzales 1994).
provide surgical, radiological and routine Therefore, it is measured by the
laboratory services. ability of people to satisfy their
basic needs. Thus, the
d. Provincial Hospitals - the highest interrelationship of health and
referral level facility in the province. development.
cases not treated in the district
hospital are referred to the Interrelationship of Health and
Provincial hospital. Development

has tertiary level capabilities for Man as a factor of production – Production

providing medical cares to cases – Goods and services – Health and Quality
requiring the expertise of trained of Life
specialists, subspecialists and
The Poverty-Illness Cycle
other licensed physicians using
highly specialized ancillary
diagnostic and therapeutic
equipment Low Production

National Health Situation Incapacity and shorter life expectancy

- Need to act on their own
- Use whatever resources within
reach to solve problems Less energy and Low
wages
General Principles of PHC higher in capacity More illness
1. Health and development are
interrelated
 Health- Is not merely the
absence of disease. Neither is it
only a state of physical and Low investment in sanitation
and prevention
mental well-being. Health being a
social phenomenon recognizes Malnutrition
the interplay of political, socio- poor education,
cultural and economic factors as housing, etc.
its determinant. Good Health High expense in curative activities
therefore, is manifested by the
progressive improvements in the
living conditions and quality of life
2. ESSENTIAL HEALTH SERVICES MUST on their health is really a desired
BE ACCESSIBLE, AVAILABLE, outcome.
ACCEPTABLE, AND AFFORDABLE - Advocacy must be directed to
national and local policy makers to
- The health services should be elicit support and commitment to
present where the supposed major health concerns through
recipients are. They should make us legislations, budgetary and logistical
of the available resources that is considerations.
found in the community, wherein the
focus would be more on promotive B. PROMOTING AND SUPPORTING
of health and prevention of illness. COMMUNITY-MANAGED HEALTH CARE

3. GENUINE PEOPLE’S PARTICIPATION - The vision of health in the hands of

IS ESSENTIAL. the people brings the government
closest to the people. It necessitates
- People are the center, object and a process of capacity-building of
subject of development. Thus, the communities and organizations to
success of any undertaking that plan, implement and evaluate health
aims at serving the people is programs at their levels. The DOH,
dependent on the people’s in promoting community-managed
participation at all levels of decision- care as a cornerstone to health,
making: planning, implementing, must manifest support to community
monitoring and evaluating. Any organizing and organizations,
undertaking must also be based on establish sustainable mechanisms
the people’s needs and problems. for community-managed financial
- Part of the people’s participation is schemes and identify and develop
the partnership between the indigenous health resources.
community and the agencies found
in the community; social mobilization; C. INCREASING EFFFICIENCIES IN THE
and decentralization. HEALTH SECTOR
- In general, health work should start
from where the people are and - The DOH will safeguard and
building on what they have. strengthen the integration of health
operations to maintain the quality of
MAJOR STRATEGIES OF PRIMARY health care…It will also evolve an
HEALTH CARE: appropriate organizational structure
(based on the visions, policies and responsive to devolution and
strategies of the department of health, decentralization… Using appropriate
Philippines) technology will make the services
and the resources required for their
A. ELEVATING HEALTH TO A delivery effective, affordable,
COMPREHENSIVE AND SUSTAINED accessible, and culturally acceptable.
NATIONAL EFFORT The development of health human
resources must correspond to the
- Attaining health for all Filipinos will actual needs of the nation and the
require expanding participation in policies it upholds such as PHC. The
health and health-related DOH will continue to provide support
programmes whether as service and assistance to both public and
provider or beneficiary. private institutions particularly in
Empowerment of parents, families faculty development, enhancement
and communities to make decisions of relevant curricula and
 development of standard teaching Immunizations on poliomyelitis,
materials. measles, tetanus, diphteria and
other deadly but preventable
D. ADVANCING ESSENTIAL NATIONAL diseases are given for free by the
HEALTH RESEARCH government and an on-going
program of the DOH.
- Essential national health research
(ENHR) is an integrated strategy for M- MATERNAL AND CHILD HEALTH
organizing and managing research
using intersectoral, multi-disciplinary - The mother and the child are the
and scientific approach to health most delicate members of the
programming and delivery community. Therefore, the maternal
and infant mortality and morbidity
rates are among the indications of
PHC ELEMENTS health of a particular community. So,
the protection of the mother and
E – EDUCATION FOR HEALTH child to illnesses and other risks
- Health education is one of the potent would ensure a good health for the
methodology for information community.
dissemination. It promotes the
partnership of both the family E – ESSENTIAL DRUGS
members and the health worker in
the promotion of health as well as - This focuses on the information
prevention of illness. It is a means of campaign on the proper utilization
improving the health of people by and acquisition of drugs. In response
employing various methods of to this campaign, is the Generic Act
scientific procedures to show the of the Philippines.
most healthful ways of living.
N – NUTRITION
L – LOCALLY ENDEMIC DISEASE
CONTROL - One of the basic needs of the family
Endemic disease – present dse all over the is food. And if food is properly
season prepared then one may be assured
of a healthy family. There are many
- The control for locally endemic food resources found in our
diseases focuses on the prevention communities, but because of faulty
of the occurrence of this disease. preparation and lack of knowledge
Endemic diseases may have a low regarding proper food planning,
morbidity rate but since it is malnutrition is one of the problems
continuously present in the that we have in the country.
community, prevention or control is
necessary. E.g malaria control T – TREATMENT OF COMMUNICABLE
DISEASES
E – EXPANDED PROGAM ON
IMMUNIZATION - The diseases spread by direct
contact pose a great risk to those
- This program exist to control the who can be infected. Tuberculosis,
occurrence of preventable illnesses which is one of the communicable
especially of children. The DOH’s diseases, continuously occupies the
araw ng sangkap pinoy is a top ten causes of death. Most
response to this particular program. communicable diseases that affects
 the country are also preventable. best in relation to resources, goals, risks
Thus, the government’s focus on the and the like, decide on plan of action with
prevention, control, and treatment of time table of implementation.
this illnesses.
IV. Implementation – take action; planned
S – SAFE WATER AND SANITATION activities are put into action, as you put your
plan into action, put the responses you will
- Environmental sanitation is still a think of the process again, results are
health problem in the country. And surprising, requires knowledge and skills to
environmental sanitation is defined specific alternatives.
as the study of all the factors in
man’s environment which exercise V. Evaluation – evaluate the result;
or may exercise a deleterious effort critically analyze data that is collecting
on his well-being and survival. evaluate responses, thinking about what
- Water is a basic need for life and you are doing, what results you are getting
one of the factors in man’s should be a continuous process so that you
environment. In our daily activities, can revise the plan where needed as you go
water plays a critical role. Water is along. Evaluation can be subjective as well
also necessary for the maintenance as objective, including not only the
of healthy lifestyle. Safe water and measurement results but also a feeling of
sanitation is necessary for the basic accomplishment or satisfaction having a
promotion of health. result form having results successful;
provide clues for future action.

3 C’s
Problem solving- series of steps to 1. Client
organize with best possible solution 2. Communication
Sort out complexity and organize to resolve 3. Culture
problem
4 levels of Clientele
Steps in problem solving 1. Individual
I. Assessment – collecting data; list 2. Family
concerning the problem; state objectively; 3. Community – with common health
describe, observe behavior instead of the needs
interpretation of that behavior. 4. Population group/Special population
II. Diagnosis – define the problem; data is – elderly, PWD
analyzed according to its pattern as well as
clues to the underlying problem; prepare a
summarizing statement of the situation in Philosophy – every human being has worth
which you define the problem as specifically and dignity
and objectively as possible. The summary
should not include the solution to the Health as a right – Article 2 section 15
problem. states the protection and promotion of
health of people
III. Plan – select strategies; break the
problem down into components and Article 13 sec. 11 – state shall adopt
establish priorities set goals and integrated and comprehensive approach to
measurable objectives and plan appropriate help development species provided
action; determine probable outcomes for throughout life span according to needs.
each alternative, decide which course is
Health Care Delivery System – sum of all 2. Personnel
agencies, personnel, services directed to
provide heath care in the population Categories of health workers
1. BHW/Village health workers – healers,
Components of Health Care Delivery grass root healers, traditional healers
System 2. Intermediate health workers –
1. Agencies – DOH, lead agency for health professional workers, physician, registered
in the country nurse, registered midwife, rural health
- develop, initiate, monitor health programs sanitary inspector, rural health dentist
at national level
- mandate is anchored in Philippine Basic Primary health Team
Constitution 1. Primary – midwife
- Local government code (RA 7160) or 2. Secondary – nurse
devolution code implement health 3. Tertiary – physician
programs at community level
Ratio of population to midwife, nurse,
Devolution – transfer power of national to physician, dentist
local
Aim – transfer LGU into SARAD 1:5,000 – midwife
S- self reliant communities 1:10,000 or 1:20,000 – nurse
A- active partnership with people 1:50,000 – dentist & physician
R- responsive to the needs of people 1:20,000 – sanitary inspector
A-accountable government representative
D- decentralization system of health Levels of Institution
decision making 1. Tertiary level – rehabilitation, specialized
care
Role of DOH – provide technical and - regional and national hospital, regional
financial assistance; develop standard institute for tropical medicine (RITM),
medical center, special hospital
Role of LGU – develop policies in
responsive development of DOH program 2. Secondary level – hospitalization
- provincial, district emergency hospital
Vision of DOH – to be the leader, staunch - provincial health board chairman (vice
advocate and model of health for all governor)
Filipinos
3. Primary level – prevention, management
Mission of DOH – guarantee equitable, of prevalent condition, outpatient
sustainable and quality health for all department
Filipinos especially the poor and to lead the - RHU, BHS, private clinics, lying-in
quest for excellence in health -municipal health board (mayor)

Strategies of DOH – SAID 5 A's = Accessibility, Availability,

S- support to the local government and Affordability & Acceptability,
frontline health workers Appropriateness of health services.
A- assurance of health for all
I- increase investment for PHC Four Cornerstone/Pillars in PHC
D- development of national standards for 1. active community participation
health 2. intra and inter –sectoral linkages
3. use of appropriate technology &
indigenous resources
4. support mechanism made available
Planning – 2 types (initial & on-going)
- Determine health status if changed
- Decide which problem to focus on
Priority setting in planning
- Client health values and beliefs
- Resources available

Establishing goals and expected outcomes

- Provide direction for health
development
- provide timespan for activities
- serve as criteria for client’s progress
to
- determine if problem is solved

Implementing – uses care plan into action

- cognitive, interpersonal, technical
skills (hands on skills, injecting,
repositioning)
- reassess client if needed
- determine need for midwifes care of
assistance
- communicating nursing midwife
action
-