This chapter provides an overview of community health nursing in the Philippines by discussing the global and national health situations, standards of public health nursing, evolution of public health nursing, and roles of community health nurses. It notes that while health has improved due to factors like economic growth and health insurance coverage, many Filipinos still suffer from preventable diseases. It outlines the roles of community health nurses in areas like health promotion, education, monitoring, and care coordination. The chapter also describes the evolution of public health nursing from the 1500s to present day, noting milestones like the establishment of nursing schools and expansion of maternal and child health services.

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CHAPTER 1. Overview of Public Health Nursing in the Philippines
Introduction of the Lesson:
This chapter gives you an overview of community health nursing practice. It discusses
the global as well as the Philippine health situation as the context of the practice. It provides
you an idea of the standards of public health nursing in the Philippines, the evolution of public
health nursing and the roles and functions of the community health nurse.
Learning Outcomes:
Upon completion of this chapter, you should have:
1. Explained global and national health situation
2. Described all related terms
3. Recognized the standards of Public Health Nursing in the Philippines
4. Stated the evolution of Public Health Nursing in the Philippines
5. Distinguished the roles and responsibilities of a Community Health Nurse
Warm-up Activity:
Learning Inputs:
A. Global and National Health Situation
Global Health Situations
-Despite of the advent in technology like MRI, CT scan, electronic medical
recording, teletherapy, and advance drug therapy, the world is still facing
multiple health challenges
-Global health concerns arise from the spread of infectious diseases, latest of
which is the COVID 19 disease
-The outbreaks of vaccine-preventable diseases like measles, pulmonary
tuberculosis
and polio especially from underdeveloped countries are still a problem
The World Health Organization enumerated ten (10) threats to global health and these
are the following:
1. COVID-19 virus, Ebola and other high-threat pathogens
-emergence of Ebola, COVID 19, MERS-CoV, SARS represent the need to prepare
for an unknown pathogen that could cause a severe epidemic
To start with, try to look at your surroundings, what distinct changes have you noticed in relation to
health? What is the present condition of the world in general and of the Philippines in particular? Can
you site some of these?

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2. Air pollution and climate change
-9 out of 10 people breathe polluted air everyday
-WHO (2019) considered air pollution as the greatest environmental risk
to health
- microscopic pollutants in the air can penetrate respiratory and
circulatory systems, damaging the heart and brain killing 7 million people
prematurely every year from diseases such as cancer, stroke, heart and lung
disease
-around 90% of these deaths are in low and middle income countries, with
high volumes of emissions from industry, transport and agriculture
-the primary cause of air pollution(burning fossil fuels) is also a major
contributor to climate change, which impacts people’s health in different
ways
-between 2030 and 2050, climate change is expected to cause 250,000
additional deaths per year from malnutrition, malaria, diarrhea and heat
stress
3. Non-communicable diseases
-over 70% of all deaths globally (41M people) is due to DM, Cancer and heart
disease
-this includes 15M people dying prematurely, aged between 30 and 69
-over 85% of premature deaths are in low- and middle-income countries
-the rise of these diseases has been driven by 5 major risk factors----tobacco
use, physical inactivity, harmful use of alcohol, unhealthy diets and air
-half of all mental illness begins by the age of 14, but most cases go undetected
and untreated
-suicide is the second leading cause of death among 15-19 years of age
4. Global influenza pandemic
-circulation of influenza viruses and occurrence of potential pandemic strains
5. Fragile and vulnerable settings
-more than 1.6B people (22% of the global population) live in places where
protracted crises and weak health services leave them without access to basic
care (through a combination of challenges such as drought, famine, conflict
and population displacement)
6. Antimicrobial resistance
-the ability of bacteria, parasites, viruses and fungi to resist antibiotics resulting
to inability to prevent infections (pneumonia, TB, gonorrhea, salmonellosis)
-it could seriously compromise surgery and procedures such as chemotherapy
-drug resistance is driven by overuse or imprudent use of antimicrobials,
decreased awareness and knowledge and increasing infection

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7. Weak PHC
-PHC is the first point contact people have with their health care system
-ideally, it should provide comprehensive, affordable community-based care
throughout life
-many countries, do not have adequate PHC facilities or lack of resources
especially in low or middle-income countries
8. Vaccine hesitancy
-the reluctance or refusal to vaccinate despite the availability of vaccine
-reasons identified are complacency, inconvenience in accessing vaccines
and lack of confidence
9. Dengue
-an estimated 40% of the world is at risk of dengue fever and around 390 M
Infections a year
-it is a lethal disease that kill up to 20% of those with severe dengue
-a high number of cases occur during rainy seasons of countries such as
Bangladesh and India
10. HIV
-Since the beginning of the epidemic, more than 70 M people have acquired the
infection and about 35 M people have died
-today, around 37 M people worldwide live with HIV
-a group increasingly affected by HIV are young girls and women aged 15-24
A. Assignment/Research on Global and National Health Situations (Morbidity/Mortality)
National Health Situations
-The Philippines has made significant investments and advances in health in recent years
-Rapid economic growth have contributed to Filipinos living longer and healthier
-Health insurance now covers 92% of the population
-Maternal and child health services have improved with more children living beyond
infancy
-A higher number of women delivering at health facilities and more births
being attended by professional service providers than ever before
-Access to and provision of preventive, diagnostic and treatment services
for communicable diseases have improved
-Several initiatives to reduce illness and death due to non-communicable diseases had
been made
-Despite of these, many Filipinos continue to die or suffer from illness that have been
well-proven, cost-effective interventions (PTB, HIV, dengue and diseases affecting
mothers and children)

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-Covid 19 disease have affected at least 1.98M with 33,330 deaths in the country. With
this, it has pushed the health systems to the edge and pulled the economy down
-Many people lack sufficient knowledge to make informed decisions about their own
health
-Along with rapid economic development, urbanization, escalating climate change and
widening exposure to diseases and pathogens, there is an increase risks associated with
disasters, environmental threats and emerging and re-emerging infections
B. Roles and Responsibilities of a Community Health Nurse based from priority areas of
health promotion (WHO)
Roles and Responsibilities of a Community Health Nurse:
1. Change Agent
-Promotes and motivates change in the community in their health practices and lifestyle
behaviors for them to promote and maintain good health, be knowledgeable and has
initiative in accessing health services
-Inculcates self- reliance to bring about development and improvement in the
community
2. Community Organizer
-Promotes self- reliance of community and emphasizes their involvement and
participation in planning, organizing, implementing and evaluating of health services
-Initiates and implements community development activities
3. Coordinator of Services
-Coordinates health services with concerned individuals and families through the
community health team members, government organizations and non- government
organizations
-Coordinates nursing plans and programs with other health programs
4. Health Educator
-Acts as resource speaker on health and health related services
-Advocates health programs in the community through dissemination of IEC or
Information Education and Communication materials
-Conducts advocacy educations concerning premarital, breastfeeding, and immunization
counselling.
-Organizes orientation/ training of concerned groups like pregnant mothers
-Identifies and interprets training needs of health team members and formulate
appropriate training program for them
-Conducts and facilitates necessary training or educational orientation to other health
team members in the community

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5. Health Monitor
-Monitors and detects presence of health concerns in the community through contacts
or home visits.
-Utilizes various effective data gathering techniques in keeping an eye on the health
status of all recipients of care.
-Records and reports health status and presence of health problems in the community
6. Planner/Programmer
-Identifies the needs and concerns of individuals, groups, families, and the community
-Formulates health plans, especially in the absence of a community physician
-Interprets and implements nursing plans and programs
-Assists other health team members in implementing health programs in the setting
7. Provider of care
- Renders direct care to various clients with different needs, may it be at home, in
school, clinics or work settings
- Involves the family in the care of the sick or dependent individual, i.e. sick child
8. Researcher
-Follows a systematic process of monitoring the health status of the community through
the conduct of surveys and home visits
-Conducts researches concerning the health of the community
-Coordinates with government and non- government organizations in the conduct and
implementation of studies
9. Statistician
-Records data systematically and ensures its validity through accurate and complete
data gathering
-Reports prepared reports to concerned organizations i.e. government organization for
immediate necessary plans or programs
-Consolidates and reviews reports efficiently
-Analyzes and interprets consolidated data for monitoring the development in the
health matters of the whole community
Roles and Responsibilities of a Community Health Nurse based from priority areas of
health promotion (WHO)
1. Build Healthy Public Policy
- Health promotion place health on the agenda of policy makers in all sectors at all
levels, directing them to be aware of the health outcomes of their decisions and to accept their
responsibilities for health
2. Create Supportive Environments

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- Health cannot be separated from other goals. The inseparable links between people and their
environment constitute the basis for a socioecological approach to health
3. Strengthen Community Actions
- Health promotion works through tangible and effective community actions in setting
priorities, making decisions, planning strategies, and implementing them to achieve an
improved health.
4. Develop Personal Skill
- Health promotion favors personal and social development through providing information,
education for health, and enhancing life skills.
5. Reorient Health Service
- The individuals, community groups, health professionals, health service institutions, and
government do all have the shared responsibility for health promotion in health
services.
6. Moving into the future
- Health is created and lived by people within the settings of their everyday life. Settings
wherein they learn, work, play, and love.
C. Definition and Focus:
1. Community Health Nursing-a unique blend of nursing and public health practice woven into
a human service that is properly developed and applied, which has a tremendous impact on
human well being
2. Community Development-a process designed to create conditions of economic and social
progress for the whole community with its active participation and the fullest possible reliance
upon the community’s initiative.
3. Community health-meeting the needs of a community by identifying their health problems
and managing the well-being of members of the community.
5. Epidemic-an outbreak of disease that spreads quickly and affects many individuals at the
same time
6. Endemic-restricted or peculiar to a locality or region
7. Pandemic-an outbreak of a disease that occurs over a wide geographic area and affects an
exceptionally high proportion of the population

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8. Public health-connotes organized, legislated and tax-supported efforts that serve all people
through health departments or related governmental agencies to improve the health of the
public by promoting healthy lifestyles, preventing disease and injury and protecting the health
of communities
9. Sporadic-a disease that occurs infrequently and irregularly
• Framework for Community Health Nursing Practice
As a blend of nursing and public health CHN utilizes and applies the concepts, principles,
methods and tools of these two sciences to realize the goal of health for individual
clients/patients, families, specific population groups and the community as a whole.
Theoretical Framework for CHN Practice
Nursing Process:
• Assessment
• Intervention
• Evaluation
Levels of Prevention:
• Health Promotion
• Specific protection
• Early diagnosis
• Prompt treatment
• Rehabilitation
Levels of Clientele
• Individual
• Family
• Specific Population Group
• Community
Approach to Nursing Care Delivery
• Risk Approach
• Team Approach
Approaches to Community Nursing Care Delivery
1. Risk Approach to Health Care
-refers to the early recognition of risk factors associated with adverse or undesirable
unwanted outcomes in individuals, families, specific population groups or communities.

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Examples:
1. genetic
2. Biological
3. Psychosocial
4. Environmental
5. Behavioral
Steps in the application of the risk approach
1. Study and analyze the prevalent health-related problems
2. Decide on the priority problems that should and will be given attention.
3. Identify the risk factors associated with each of the priority problems identified
4. Identify and apply the appropriate anticipator actions to modify the risk factors and
reduce and eliminate the risk of occurrence of the problem
5. Evaluate the results of the intervention measures.
2. Teamwork Approach
- A complex process that requires participation, cooperation and collaboration among
members of the health team as well as with relevant intersectoral teams
Essential Elements of Teamwork
1. An attitude of mutual trust, confidence, and respect among the various members of the
team.
2. Commonly agreed and understood goals and plan of action
3. Effective Leadership.
4. A clear division of labor and appropriate allocation of responsibilities among members
5. Supportive, collaborative, and cooperative relationship among the members of the team
6. Open and honest communication among the members of the team
7. Recognition of the responsibility of each professional group represented in the team to
safeguard its own practice
8. Appropriate use of available resources so as to achieve the goals of the team.
9. Provision for periodic evaluation of the team’s functioning.
10. Training, retraining, and continuing education for team members
D. Evolution of Public Health Nursing in the Philippines
1577-Franciscan Juan Clemente opened a medical dispensary in Intramuros, Manila for
the indigents
1620-Dominican Father Juan de Pergero worked towards installing a water system in
San Juan
1805-Dr. Francisco de Balmis, the personal physician of King Charles IV of Spain
introduced smallpox vaccination

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1876-The Spanish government appointed the first “medicos titulares who worked as
provincial health officers
1888-The UST offered a 2-year course medical and dental subjects in which graduates of
this course known as “cirujanosministrantes” served as male nurses and sanitation
inspectors
1901-Creation of the Board of Health in the Phils. by the Phil. Commission-Act No. 157
Act No. 309 created Provincial and Municipal Boards of Health
1905-The Board of Health had been abolished and taken over by the Bureau of Health
thru Act No. 1407 (Reorganized Act)
1906-Creation of District Health Offices
1912-Creation of Sanitary Divisions thru the Fajardo Act (A.N. 2156)
PGH sent 4 nurses to Cebu to take care of mothers while St. Paul’s Hosp. sch. of
nursing assigned 2 nurses to do home visit in Manila to give nursing care to
mothers and newborns
The focus was on Maternal and Child Health due to high infant-maternal
mortality rate
Public Health Nursing started in the Phils.
1914-School Nursing started and was rendered by a Filipino nurse employed by the
Bureau of Health in Tacloban, Leyte
1915-Social and Home Care Service was started by PGH to extend public health nursing
services in the homes of patients
1919-The first Filipino nurse supervisor was appointed under the Bureau of Health-Miss
Carmen del Rosario
The Red Cross introduced the operation of Puericulture Centers focusing on
maternal and infant care
1923-Establishment of 2 government schools of nursing (Zamboanga Gen. Hosp. Sch. Of
Nursing in Mindanao and Baguio Gen. Hosp. in Northern Luzon followed by 4 more: 1
each in Quezon province, Cebu, Bohol and Leyte
1928-First convention of nurses was held followed by yearly conventions until the
advent of World War II
1933-The Reorganization Act no. 4470 created more positions for nurses

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1935-133 positions of public health nurses were created to work in communities with
high infant mortality rates
1940-Creation of Manila Health Department by virtue of the new charter of the city of
Manila
Dept. of Health and Welfare was also created
1941-Public Health Nurses in Manila were assigned to devastated areas to attend to
the sick and wounded civilians during the WW II
1942-31 PHN who were taken as prisoners were released by Japanese Army
1946-Post war records show a decrease in the number of PHNs from 556 to 308
1947-reorganization of government offices under EO 94 which created a division-1st
chief in the person of Mrs. Genera de Guzman
1954-passage of RA1082-Rural Health Unit Act providing employment for health
personnel
1957-passage of RA 1891 which strengthened health and dental service in the rural
areas, creating 8 categories of RHU
1958-creation of regional health offices as a result of decentralization
1970-PHCDS was restructured into primary, secondary, tertiary levels
1971-creation of other health agencies (FDA, NCMCH, FPP, NNP, Bureau of Disease
Center, Malaria Eradication Service, Bureau of Dental Health Service)
1972-issuance of LOI 8 pursuant to PD 1 renaming DOH to Min. of Health dividing the
country into 12 regions
1979-issuance of LOI 949 adopting PHC as an approach to community development
1982-issuance of EO 851 reorganizing the MOH creating the Health Education and
Manpower Development Services
1986-1987-renaming the MOH to DOH again adding NCR, CAR, and ARMM were added
to the 12 regions
1991-passage and full implementation of RA 7160(Local Government Code)
1999-issuance of EO 102-redirecting the functions and operations of the DOH

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Three important programs were launched:
1. HSRA
2. Natl Objectives for Health
3. Natl Health Planning Committee
2000-formulation 8 MDGs (Millenium Development Goals)
2005-formulation of the implementation framework of DOH known as FOURmula One
2008-4 P’s (Pantawid Pamilyang Pilipino Program) was implemented as a flagship
poverty alleviation program of the administration of former Pres. Gloria Aroyo
2010-launching of Universal Health Care that aims to provide equitable access to health
care
2015-adoption of the 17 Sustainable Development Goals (SDGs)
Activity 3
Discuss one (1) significant event in the history of Public Health Nursing in
the Philippines.
Related Learning Experience Activities
Activity 1.
Relate one (1) role of the Community Health Nurse to three other members of the health team.
Conceptualize this output in not more than 5 sentences in each of the three members.
Eq. 1. Health Educator to Rural Health Midwife
2. Health Educator to Municipal Health Officer
3. Health Educator to clientele

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Wrap-up Activity
Community Health Nursing involves a holistic approach to patient care.
Interventions are aimed at individuals, families and groups within a geographic area.
Nursing care focuses on managing and preventing diseases as well as educating a
community about maintaining well-being.
To determine how to educate and treat a community, nurses should consider its
environment, cultural beliefs, interests, lifestyle and socioeconomic aspects. That is
why, it is vital for you future nurses to know the global as well as the Philippines’ health
situations. It is equally important to know the Standards of Public Health Nursing for you
to be guided in the care of your clienteles---the community. The history of Public Health
Nursing gave you an idea on how this special field of our profession have evolved.
Community health nurses wear many hats while conducting day-to-day practice.
The focus of nursing includes not only the individual, but also the family and the
community and meeting these multiple needs of our clienteles requires multiple roles.
The nurses’ actions acknowledge the need to comprehensive health planning, recognize
the influences of social and ecological issues, give attention to populations at risk and
utilize dynamic faces which influence change. Therefore, nursing directed to individuals,
families or groups contributes to the health of the total population.
Assessment (Post-assessment)