Midwife Licensure Exam Community & Public Health — Health Promotion & Primary Health CareRevision Notes

Exam Tips

• NLE CLASSIC QUESTION TYPE: 'Who manages the Rural Health Unit?' — Answer: the municipality or city (LGU), not the DOH.
• NLE CLASSIC QUESTION TYPE: 'Under what law was health service delivery devolved to LGUs?' — Answer: RA 7160, Local Government Code of 1991.
• Remember: DOH = policy + standards + regulation + retained hospitals. LGU = frontline service delivery (RHU, BHS).
• Think of the DOH as the 'architect' of the health system and the LGU as the 'construction crew' that builds and delivers services on the ground.

Key Points

• The system has TWO broad sectors: the PUBLIC (government) sector and the PRIVATE sector.
• The PUBLIC sector is financed through taxation and PhilHealth social insurance; it is the dominant provider for low-income Filipinos.
• The PRIVATE sector includes for-profit hospitals, NGO/faith-based organizations, and is financed mainly out-of-pocket and through PhilHealth or private HMOs.
• DEVOLUTION under RA 7160 (Local Government Code of 1991) transferred basic health service delivery from the national DOH to Local Government Units (LGUs).
• PROVINCES manage provincial and district hospitals (secondary and tertiary level care).
• MUNICIPALITIES and CITIES manage Rural Health Units (RHUs) / health centers and Barangay Health Stations (BHS) — the primary care level.
• After devolution, the DOH shifted from being a direct service provider to a TECHNICAL, STANDARD-SETTING, AND REGULATORY BODY.
• The community health nurse most commonly works at the RHU or BHS, which are under LGU governance.
• RA 7160 is the legal basis for why your immediate supervisor in a municipal RHU is the local government, NOT the DOH.

Definitions

Section Title

1. Structure of the Philippine Health Care Delivery System

Common Mistakes

• Thinking the DOH directly manages all public health facilities — after RA 7160, the DOH only retains specific hospitals and specialty centers; LGUs run RHUs and BHS.
• Confusing devolution (transfer of authority) with deconcentration (only transferring administrative tasks while retaining central authority) — the Philippines underwent true devolution.
• Assuming the private sector is not part of the health delivery system — private providers are a significant part, especially for middle- and high-income groups.
• Forgetting that provinces manage district/provincial hospitals while municipalities/cities manage RHUs and BHS — the level of LGU determines the type of facility managed.

Exam Tips

• Memorize the three levels and their corresponding facility types — NLE questions frequently ask at which level a specific facility operates.
• Philippine General Hospital (PGH) = TERTIARY. Provincial Hospital = SECONDARY. RHU = PRIMARY.
• The nurse's role in the referral system: prepare the referral form, document findings and interventions given, communicate with the receiving facility, and follow up on back-referred clients.

Key Points

• LEVEL 1 — PRIMARY CARE: Barangay Health Stations, Rural Health Units, health centers, private clinics. This is the FIRST CONTACT and ENTRY POINT. Focuses on preventive, promotive, and treatment of simple/common conditions.
• LEVEL 2 — SECONDARY CARE: District hospitals, provincial hospitals, general hospitals. Provides general medicine, surgery, OB-GYN, and pediatrics. Serves as the FIRST REFERRAL LEVEL.
• LEVEL 3 — TERTIARY CARE: Medical centers, regional and national hospitals, DOH specialty hospitals. Provides highly specialized care (e.g., Philippine General Hospital, National Kidney and Transplant Institute, Lung Center of the Philippines).
• The two-way referral system connects all three levels — clients move UP when their needs exceed a facility's capacity and BACK DOWN for continuing care.
• DOH-retained specialty hospitals operate at the tertiary level and remain directly under the DOH even after devolution.
• Understanding the levels helps the nurse determine the APPROPRIATE REFERRAL when a client's condition exceeds the capacity of the primary care facility.

Definitions

Section Title

2. Levels of Health Care Facilities and Services

Common Mistakes

• Thinking that 'primary care' means 'low-quality care' — it means FIRST-LEVEL, ESSENTIAL, and PREVENTIVE care, which is actually the most impactful level for population health.
• Forgetting that PROVINCIAL hospitals are at the SECONDARY level, not tertiary — only medical centers and highly specialized national hospitals qualify as tertiary.
• Assuming that the referral system only goes upward — it is explicitly TWO-WAY, meaning back-referral is equally important for continuity of care.

Exam Tips

• NLE CLASSIC: 'What is the primary role of the DOH after devolution?' — Answer: Policy-making, standard-setting, technical assistance, and regulation (NOT direct frontline service delivery).
• Sentrong Sigla = QUALITY CERTIFICATION for RHUs. Remember: 'Sigla' means vitality/energy — a vitalized, quality health center earns the seal.
• DOH attached agencies to memorize for NLE: PhilHealth, FDA, PITAHC. Know what each one does.

Key Points

• The DOH is the LEAD GOVERNMENT AGENCY for health in the Philippines — the national policy-maker, technical authority, and regulator.
• THREE MAJOR ROLES OF THE DOH: (1) Leadership in health — setting national policy, standards, and direction; (2) Enabler and capacity-builder — supporting LGUs technically and financially; (3) Administrator of specific services — running DOH-retained hospitals, emergency response, and national programs.
• The DOH Central Office houses the Secretary of Health, undersecretaries, and key technical bureaus including the Disease Prevention and Control Bureau (DPCB), Epidemiology Bureau (EB), and Health Promotion Bureau (HPB).
• CENTERS FOR HEALTH DEVELOPMENT (CHDs) are the DOH's REGIONAL OFFICES that coordinate with LGUs at the regional level.
• DOH ATTACHED AGENCIES include: PhilHealth (PHIC), Food and Drug Administration (FDA), Philippine Institute of Traditional and Alternative Health Care (PITAHC), and others.
• SENTRONG SIGLA (SS) MOVEMENT is the DOH's quality assurance and certification program for local health facilities — it awards a 'seal of quality' to RHUs and health centers that meet standards.
• The DOH does NOT manage day-to-day operations of RHUs and BHS — this is the LGU's responsibility.

Definitions

Section Title

3. The Department of Health (DOH)

Common Mistakes

• Confusing the DOH with PhilHealth — the DOH is a government department (executive branch); PhilHealth is an attached agency that handles HEALTH INSURANCE/FINANCING, not direct service delivery.
• Thinking that Sentrong Sigla is a financing program — it is a QUALITY ASSURANCE/CERTIFICATION program.
• Confusing Centers for Health Development (CHDs) with the central DOH office — CHDs are REGIONAL offices.

Exam Tips

• MEMORIZE: Alma-Ata = 1978. LOI 949 = 1979. Goal = 'Health for All by 2000.' Cornerstone = Community Participation.
• The 4 As of PHC: Accessible, Available, Affordable, Acceptable — like a good public health service must be all four.
• BHWs are the FIRST LINE of the PHC system. The nurse supervises and trains BHWs as part of the CHN role.
• Think of PHC as a 'people-powered' system — the community does not just receive care; they actively participate in achieving their own health.

Key Points

• PRIMARY HEALTH CARE was declared globally at the INTERNATIONAL CONFERENCE ON PRIMARY HEALTH CARE in ALMA-ATA (now Almaty), Kazakhstan (then USSR), in 1978.
• Goal of the Alma-Ata Declaration: 'HEALTH FOR ALL BY THE YEAR 2000.'
• The Philippines adopted PHC through LETTER OF INSTRUCTION (LOI) 949, signed in 1979 by President Ferdinand Marcos.
• PHC DEFINITION: Essential health care made universally accessible to individuals and families in the community, at a cost the community and country can afford, through their full participation and self-reliance.
• The UNDERLYING THEME / CORNERSTONE of PHC is COMMUNITY PARTICIPATION — people are active partners, not passive recipients of care.
• The four PRINCIPLES / 4 As of PHC: Accessibility, Availability, Affordability, and Acceptability.
• OTHER KEY PHC PRINCIPLES: Intersectoral coordination/linkages, appropriate technology, support mechanisms.
• LEVELS OF PHC WORKERS: (1) Village/Barangay Health Workers (BHWs) — first line; (2) Intermediate-level workers — midwife, nurse, physician at RHU, plus traditional healers (hilot, herbolario) recognized as community resources.

Definitions

Section Title

4. Primary Health Care (PHC) — Alma-Ata Declaration and Philippine Adoption

Common Mistakes

• Confusing the YEAR of Alma-Ata (1978) with the year the Philippines adopted PHC (1979 via LOI 949).
• Saying the cornerstone of PHC is 'intersectoral coordination' — while it IS a principle, the UNDERLYING THEME/CORNERSTONE is specifically COMMUNITY PARTICIPATION.
• Forgetting that traditional healers (hilot, herbolario) are RECOGNIZED as part of the PHC worker structure — this reflects the 'appropriate technology' and community resource utilization principle.
• Thinking LOI 949 is a Republic Act — it is a LETTER OF INSTRUCTION, not a law passed by Congress.

Exam Tips

• Practice writing out all 8 elements from the mnemonic until they become automatic — this is a guaranteed NLE topic.
• NLE SCENARIO: 'A nurse conducts a lecture on handwashing to community members' — this corresponds to which PHC element? Answer: E — Education for health AND S — Safe water and sanitation (handwashing connects both).
• NLE SCENARIO: 'A nurse distributes oral rehydration salts to a community during a cholera outbreak' — Answer: T — Treatment of communicable diseases.
• Remember: All 8 elements are essential. If an NLE question asks which is the MOST important, the correct answer is that all are equally essential — PHC is holistic.

Key Points

• There are EIGHT ESSENTIAL ELEMENTS of PHC, easily recalled using the mnemonic ELEMENTS.
• E — Education for health (health education for the community about common health problems and prevention)
• L — Locally endemic disease control (addressing diseases that are prevalent in the specific local area, e.g., schistosomiasis, malaria, filariasis)
• E — Expanded Program on Immunization / EPI (providing vaccines to protect children and other target groups)
• M — Maternal and child health, including family planning (MCH services for women, infants, and children)
• E — Essential drugs (ensuring availability and rational use of basic medicines)
• N — Nutrition (addressing malnutrition and promoting adequate nutritional status)
• T — Treatment of communicable and non-communicable diseases (basic curative care for common conditions)
• S — Safe water and sanitation (access to potable water and proper waste disposal — a shared responsibility with public works and environment sectors)
• All 8 elements are equally important and interdependent. No single element can fully address population health alone.
• These elements guide what services an RHU and BHS must provide as part of comprehensive PHC.

Definitions

Section Title

5. Essential Elements of PHC — The ELEMENTS Mnemonic

Common Mistakes

• Missing the SECOND 'E' (Essential Drugs) — students often only remember the first three letters and stop at EPI.
• Thinking 'T' stands for 'Tuberculosis' — it stands for TREATMENT of communicable AND non-communicable diseases (TB is just one example of communicable disease).
• Confusing 'S' for 'Social services' — it is specifically SAFE WATER and SANITATION.
• Forgetting that NUTRITION is included as a standalone essential element — it is not just part of MCH.

Exam Tips

• MEMORIZE: RA 11223 = UHC Act = signed 2019 = automatic PhilHealth enrollment for ALL Filipinos.
• MEMORIZE: RA 7875 (1995) = National Health Insurance Act = created PhilHealth originally.
• NLE QUESTION TYPE: 'A farmer with no formal employment asks if he is covered by PhilHealth under UHC' — Answer: YES, under RA 11223, all Filipinos are automatically enrolled; he may be classified as a direct or indirect contributor depending on his income.
• Population-based = government budget. Individual-based = PhilHealth. This distinction is NLE-testable.
• The nurse's UHC role: Educate clients about automatic coverage, help them understand direct vs. indirect contributor classification, and assist them in accessing PhilHealth benefits.

Key Points

• RA 11223, the UNIVERSAL HEALTH CARE ACT, was signed into law in 2019 — the most significant health reform in the Philippines in decades.
• CENTRAL AIM: Every Filipino is guaranteed equitable access to quality and affordable health care goods and services, protected against financial hardship.
• KEY PROVISION: AUTOMATIC PhilHealth MEMBERSHIP for ALL FILIPINO CITIZENS — no longer voluntary or contingent on employment.
• TWO MEMBERSHIP CATEGORIES: (1) DIRECT CONTRIBUTORS — those with capacity to pay premiums (employed, self-earning, OFWs); (2) INDIRECT CONTRIBUTORS — those whose premiums are subsidized by the government (indigents, senior citizens, persons with disability, and other sponsored members).
• POPULATION-BASED SERVICES (health promotion, disease surveillance, vector control) — financed by the national/local government budget.
• INDIVIDUAL-BASED SERVICES (consultations, laboratory tests, medicines, hospitalization) — financed primarily through PhilHealth.
• HEALTH CARE PROVIDER NETWORKS: Services are integrated into PROVINCE-WIDE and CITY-WIDE HEALTH SYSTEMS. The RHU/health center serves as the PRIMARY CARE PROVIDER and GATEWAY to higher levels.
• HEALTH TECHNOLOGY ASSESSMENT (HTA): A mechanism to evaluate and determine which health services and technologies PhilHealth should cover/fund.
• RA 11223 reinforces the PRIMARY CARE-LED, REFERRAL-BASED SYSTEM: every Filipino should be registered with a primary care provider who coordinates their care.

Definitions

Section Title

6. Universal Health Care Act — RA 11223 (2019)

Common Mistakes

• Thinking PhilHealth membership is still voluntary after RA 11223 — it is now AUTOMATIC for ALL Filipinos.
• Confusing direct and indirect contributors — the key difference is CAPACITY TO PAY premiums, NOT employment status alone (an OFW, for example, is a direct contributor even though they work abroad).
• Thinking population-based services (like disease surveillance or vector control) are financed by PhilHealth — they are NOT; these are funded by the government budget because they benefit entire populations, not individual clients.
• Forgetting that RA 11223 (2019) is a DIFFERENT law from RA 7875 (1995) which originally created PhilHealth — RA 11223 STRENGTHENED and EXPANDED PhilHealth under UHC.

Exam Tips

• RA 7875 (1995) = Created PhilHealth. RA 11223 (2019) = Expanded PhilHealth to universal/automatic coverage.
• PhilHealth = FINANCING (payer). DOH = POLICY + REGULATION. LGU = DELIVERY (frontline services). Keep these roles distinct.
• The nurse's PhilHealth role in the community: advocate, educator, and facilitator — helping clients claim their benefits, especially the Konsulta Package at the RHU.

Key Points

• PhilHealth (Philippine Health Insurance Corporation / PHIC) was created under RA 7875 (National Health Insurance Act of 1995) and is an ATTACHED AGENCY of the DOH.
• PhilHealth provides financial protection (NOT direct health services) through BENEFIT PACKAGES.
• KEY BENEFIT PACKAGES: (1) INPATIENT benefits (hospitalization); (2) OUTPATIENT benefits; (3) Z-BENEFITS — for catastrophic / high-cost conditions such as certain cancers, end-stage renal disease on dialysis; (4) KONSULTA PACKAGE — primary care benefit covering preventive services and consultations at registered primary care providers; (5) MATERNITY CARE PACKAGES — for prenatal, delivery (normal, cesarean), and postnatal care.
• The KONSULTA PACKAGE is particularly relevant for CHN — it allows clients to consult and receive preventive services at the RHU without out-of-pocket payment.
• The community health nurse plays a key advocacy role in informing clients about PhilHealth eligibility and how to access benefits.
• PhilHealth does NOT provide direct health services — it is a PAYER/INSURER, not a provider.

Definitions

Section Title

7. PhilHealth and Key Benefit Packages

Common Mistakes

• Thinking PhilHealth provides actual health services — PhilHealth is a HEALTH INSURER/PAYER that reimburses facilities and providers for services rendered.
• Confusing Z-benefits with regular inpatient benefits — Z-benefits are specifically for CATASTROPHIC CONDITIONS with potentially zero co-payment.
• Forgetting that the Konsulta Package is the primary care package — it is the PhilHealth benefit that supports the 'primary care first' approach of RA 11223.

Exam Tips

• NLE SCENARIO: 'A client at the BHS has severe dehydration beyond the midwife's management capacity. What should the nurse do?' — Answer: Initiate upward referral; stabilize the client (e.g., oral rehydration if still conscious), prepare the referral slip, and arrange transport.
• The REFERRAL FORM mnemonic: PIAR — Patient info, Interventions given, Assessment findings, Reason for referral.
• RA 9173 defines the scope of nursing practice, which includes initiating referrals — this is part of the nurse's independent and collaborative functions in CHN.

Key Points

• The REFERRAL SYSTEM links the three levels of care to ensure clients receive appropriate services and continuity of care.
• UPWARD REFERRAL: A client whose needs EXCEED the capacity of the BHS/RHU is referred to a higher-level facility (secondary or tertiary hospital).
• DOWNWARD / BACK-REFERRAL: After specialist care, the client is referred BACK to the primary facility for continuing/follow-up care — this is equally important for continuity.
• The nurse's role in upward referral: (1) Assess the client and identify the need for referral; (2) Stabilize the client (initial care/first aid); (3) Prepare the REFERRAL FORM/SLIP with documented findings, interventions given, and reason for referral; (4) Communicate with the receiving facility; (5) Arrange transport if needed.
• The nurse's role in back-referral: Follow up on referred clients, receive discharge summaries, continue care plans at the community level.
• Effective referral requires ACCURATE DOCUMENTATION, COMMUNICATION between facilities, and consistent FOLLOW-THROUGH by the community nurse.
• The REFERRAL FORM is the key document — it must contain: patient identification, presenting condition, assessment findings, interventions already given, reason for referral, and the referring nurse/doctor's contact information.

Definitions

Section Title

8. The Two-Way Referral System

Common Mistakes

• Thinking referral is a one-way process — the system is explicitly TWO-WAY; back-referral is equally part of the standard.
• Forgetting that the nurse should STABILIZE the client (provide first aid or initial care) BEFORE referral — do not send an unstable client without first intervening.
• Omitting key information in the referral form — especially interventions already given, which can prevent duplication or overdose at the receiving facility.
• Thinking that only physicians can refer patients — nurses can and do initiate referrals within their scope of practice under RA 9173.

Exam Tips

• NLE CLASSIC: 'What is the basic building block / unit of the FHSIS?' — Answer: Individual Treatment Record (ITR).
• NLE CLASSIC: 'What FHSIS tool ensures that no program client is missed?' — Answer: Target Client Lists (TCLs).
• Remember: ITR = individual client encounter record. TCL = program group tracking list. Monthly Table = aggregated summary. Reports = sent upward to DOH.
• Connect FHSIS to the nursing process: ITR = Assessment and Documentation. TCL = Planning (who needs services?). Summary/Reports = Evaluation.

Key Points

• The FHSIS is the DOH's OFFICIAL RECORDING AND REPORTING SYSTEM for health services at the local (primary care) level.
• Purpose: Provide data for health planning, program monitoring, evaluation, and management decisions at the local, regional, and national level.
• THE INDIVIDUAL TREATMENT RECORD (ITR) is the BASIC BUILDING BLOCK of FHSIS — records EVERY client consultation at the BHS or RHU. One ITR per client encounter.
• TARGET CLIENT LISTS (TCLs): Specific lists for program groups — prenatal clients, EPI/under-1 children, family planning clients, TB-DOTS clients, etc. TCLs ensure NO CLIENT IS MISSED.
• SUMMARY / MONTHLY CONSOLIDATION TABLE: Aggregates data from ITRs and TCLs at the RHU level every month.
• QUARTERLY AND ANNUAL REPORTS: Compiled at the municipality/city level and submitted upward to the CHD (DOH regional office) and national DOH.
• The community nurse is PRIMARILY RESPONSIBLE for accurate FHSIS recording and reporting — this is both a legal and professional responsibility.
• FHSIS data drives LOCAL AND NATIONAL HEALTH STATISTICS, program planning (e.g., determining vaccine targets), and budget allocation.

Definitions

Section Title

9. Field Health Services Information System (FHSIS)

Common Mistakes

• Thinking the ITR is the only FHSIS tool — it is the basic building block, but TCLs, summary tables, and reports are equally part of the system.
• Believing FHSIS reporting is only the responsibility of the physician — the community health NURSE is the primary FHSIS recorder and reporter at the RHU level.
• Thinking TCLs are only for immunization — TCLs exist for ALL program groups (prenatal, family planning, TB, etc.).
• Underestimating the importance of FHSIS — inaccurate recording leads to skewed national data, poor resource allocation, and missed health targets.

Exam Tips

• NLE SCENARIO: 'A community nurse organizes a meeting of barangay residents to discuss the high incidence of dengue in their area and plan a clean-up drive' — what role is the nurse playing? Answer: Community Organizer.
• NLE SCENARIO: 'The nurse prepares the FHSIS monthly report for submission to the CHD' — what role? Answer: Recorder/Reporter.
• RA 9173 defines the scope of professional nursing. In CHN, ALL the above roles are within the nurse's scope. The nurse is NOT just a bedside caregiver — in the community, she is a public health leader.

Key Points

• CARE PROVIDER: Delivers direct nursing care at the clinic, home, and community levels. Includes well-baby clinics, prenatal care, wound care, and health visits.
• HEALTH EDUCATOR: The core PHC function. Teaches individuals, families, and community groups about health promotion, disease prevention, and self-care.
• MANAGER / SUPERVISOR: Manages the nursing service at the RHU; supervises BHWs and midwives. Responsible for planning, organizing, directing, and evaluating community health services.
• COORDINATOR / COLLABORATOR: Links clients to referral facilities, coordinates with other health team members (physician, midwife, sanitary inspector), and collaborates with other sectors (barangay officials, schools, NGOs).
• RECORDER / REPORTER: Maintains FHSIS records (ITR, TCL, reports). Accuracy in documentation is a professional and legal duty under RA 9173.
• ADVOCATE: Speaks for clients' rights to access health services, especially marginalized populations (indigents, persons with disability, senior citizens).
• COMMUNITY ORGANIZER: Mobilizes community participation — a core PHC principle. Organizes BHWs, community health committees, and local health programs.
• EPIDEMIOLOGIST: Conducts community health assessments, identifies at-risk populations, monitors disease trends, and reports notifiable diseases.
• Under RA 9173 (Philippine Nursing Act of 2002), the nurse's scope of practice in CHN encompasses all these roles — the nurse is accountable for professional, ethical, and legal practice in the community setting.

Definitions

Section Title

10. Roles of the Community Health Nurse

Common Mistakes

• Thinking the nurse's primary role is only as a CARE PROVIDER — in CHN, the HEALTH EDUCATOR and COMMUNITY ORGANIZER roles are equally or more prominent.
• Forgetting the RECORDER/REPORTER role — documentation (FHSIS) is a core CHN nursing function, not just an administrative task.
• Confusing the COORDINATOR role with the MANAGER role — coordination involves linking and collaborating with others; management involves planning, directing, and supervising.
• Overlooking the ADVOCATE role — community health nurses frequently serve poor communities who may not know their rights to health services.