Philippine Health Care Delivery System & DOH Programs - Cheat Sheet
Your last-minute rapid-fire reference for the Philippine health care system, DOH structure, PHC principles, RA 11223, PhilHealth, and the referral system. Master these 10 core concepts and ace the CHN section.
Structure of the Philippine Health Care Delivery System
Important facts
- DOH is now primarily a policy-maker, technical authority, and regulator—NOT a direct service provider (except DOH-retained hospitals and national programs).
- LGUs have devolved responsibility for basic health services since 1991.
- Provinces manage secondary and tertiary care (district and provincial hospitals).
- Municipalities and cities manage primary care (RHUs, BHS).
- Most community health nurses work within the devolved LGU structure at RHU or BHS level.
- The three major roles of DOH: (1) Leadership in health, (2) Enabler and capacity-builder, (3) Administrator of specific services.
Key definitions
Devolution (RA 7160, Local Government Code 1991)
Example
A pregnant woman attends the Municipal RHU for prenatal care (not DOH facility); the RHU is managed by the municipal LGU, not DOH.
Transfer of basic health service delivery from national DOH to Local Government Units (LGUs); provinces run hospitals, municipalities/cities run RHUs and BHS.
Public Sector
Example
Government-owned Rural Health Unit, provincial hospital, city health center.
Government-financed health services (via taxation and social insurance) delivered through national and local government facilities; primary provider for majority of Filipinos, especially poor.
Private Sector
Example
Private clinics, privately-owned hospitals, non-profit faith-based hospitals.
For-profit and non-profit (NGO, faith-based) health providers financed largely out-of-pocket and through PhilHealth/private HMOs.
Diagrams to know
- Philippine health system hierarchy: DOH → CHDs (Centers for Health Development, regional) → LGU (province/municipality) → RHU/BHS
- Three-level care system: Primary (BHS/RHU) → Secondary (district/provincial hospital) → Tertiary (specialty center/national hospital)
Levels of Health Care and the Referral System
Important facts
- Referral is two-way, not one-way; clients return to primary level for continuity.
- Upward referral requires a completed referral form/slip with nursing assessment and reason for referral.
- Back-referral ensures continuity of care and community re-integration.
- RHU/health center is the gateway and primary care provider for every registered client.
- Movement between levels is guided by client need and facility capacity, not client choice alone.
- Effective referral requires accurate documentation, inter-facility communication, and follow-through by community nurse.
- Referral form documents: client identifying info, diagnosis/findings, interventions given, reason for referral, and receiving facility.
- Community nurse tracks back-referrals to ensure clients comply with recommended follow-up.
Key definitions
Primary Level (First Contact Care)
Example
Blood pressure screening, vaccination, treatment of simple cough and colds, prenatal visits.
Entry point to health system; provides preventive, promotive, and treatment services for common conditions; includes BHS, RHU, health centers, private clinics.
Secondary Level (First Referral)
Example
A patient with complicated pregnancy from RHU is referred to provincial hospital for operative delivery.
General medicine, surgery, OB-GYN, pediatrics; emergency, district, and provincial hospitals; receives referrals from primary level.
Tertiary Level (Specialist Care)
Example
Philippine General Hospital, National Kidney and Transplant Institute, National Institutes of Health.
Highly specialized medical-center and regional/national hospital care; receives referrals from secondary level; research and advanced training.
Two-Way Referral System
Example
Patient with TB treated at tertiary center is back-referred to RHU for ongoing directly observed therapy (DOT).
Upward referral (primary → secondary → tertiary) and back-referral (tertiary → secondary → primary); ensures appropriate care level and continuity.
Upward Referral
Example
RHU nurse refers a child with severe pneumonia to district hospital with detailed assessment and vital signs documented.
Client whose needs exceed facility capacity is referred to a higher-level facility with accompanying referral form documenting findings, interventions, and reason.
Back-Referral (Downward Referral)
Example
After specialized cardiac catheterization at tertiary center, patient returns to RHU for regular BP monitoring and medication compliance counseling.
After specialist care, client is returned to primary facility for continuing care, follow-up, and community-level management.
Diagrams to know
- Referral flow diagram: BHS ↔ RHU ↔ District Hospital ↔ Provincial Hospital ↔ Regional/Tertiary Hospital (with arrows showing upward and downward movement)
Department of Health (DOH): Structure, Function, and Quality Assurance
Important facts
- DOH Central Office houses Secretary, Undersecretaries, and technical bureaus (Disease Prevention and Control, Epidemiology, Health Promotion).
- DOH has attached agencies: PhilHealth (PHIC), FDA, PITAHC (Philippine Institute of Traditional and Alternative Health Care).
- DOH's three major roles: (1) Leadership in health (policy and standards), (2) Enabler and capacity-builder (support to LGUs), (3) Administrator of specific services (retained hospitals, disaster management, national programs).
- Sentrong Sigla certifies facilities meeting quality standards; provides grants, technical assistance, and awards.
- DOH is regulatory and policy body, not direct provider of routine primary care (exception: DOH-retained hospitals).
- CHDs serve as regional intermediary between DOH central office and LGUs.
- Sentrong Sigla promotes continuous improvement, accountability, and evidence-based standards for local health services.
Key definitions
Department of Health (DOH)
Example
DOH sets national immunization schedule; DOH runs FDA and PhilHealth; DOH monitors disease surveillance.
Lead agency in health; national policy-maker, technical authority, and regulator; role is policy/standards/regulation, not direct service delivery.
Centers for Health Development (CHDs)
Example
CHD Region IV-A coordinates with provincial, city, and municipal health offices in CALABARZON area; provides capacity-building and monitoring.
Regional offices of DOH that coordinate with LGUs, provide technical support, and implement national programs at regional level.
DOH-Retained Hospitals and Services
Example
Philippine General Hospital, National Kidney and Transplant Institute, Philippine Heart Center, National Institute of Health.
Specialty hospitals and services that DOH still operates directly (not devolved); include emergency services, disaster response, and national programs.
Sentrong Sigla (SS) Movement
Example
An RHU that meets Sentrong Sigla criteria receives certification, technical support, incentives, and public recognition for quality service delivery.
DOH quality-assurance and certification program for health facilities; uses seal-of-approval to recognize RHUs and health centers meeting quality standards.
Diagrams to know
- DOH organizational chart: Secretary → Undersecretaries → Technical Bureaus; Attached Agencies (PhilHealth, FDA, PITAHC); CHDs (regional); DOH-Retained Hospitals
- Sentrong Sigla process: Standard setting → RHU/Health Center application → Assessment → Certification → Technical support → Incentives
Primary Health Care (PHC): Principles, Elements, and Alma-Ata Declaration
Important facts
- PHC is the cornerstone of community health nursing practice.
- PHC emphasizes accessibility, availability, affordability, acceptability (the 4 As) of health services.
- Community participation is the underlying theme and cornerstone of PHC.
- PHC includes intersectoral coordination (health + education + water/sanitation + agriculture + housing).
- PHC uses appropriate technology suited to local context and resources.
- PHC requires support mechanisms (policies, financing, capacity-building).
- Essential elements of PHC (mnemonic ELEMENTS): E = Education for health L = Locally endemic disease control E = Expanded Program on Immunization (EPI) M = Maternal and child health + family planning E = Essential drugs N = Nutrition T = Treatment of communicable and non-communicable diseases S = Safe water and sanitation
- PHC workers include village/barangay health workers (BHWs), midwives, nurses, physicians, and traditional healers recognized as community resource.
- BHWs are volunteers trained in basic health care; serve as bridge between community and formal health system.
- PHC goal: universal health coverage and health equity.
Key definitions
Primary Health Care (PHC)
Example
Community-based immunization campaigns, barangay health worker prenatal counseling, health education on sanitation, affordable TB treatment.
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.
Alma-Ata Declaration (1978)
Example
Landmark event that shaped community health nursing practice worldwide; Philippines adopted it via LOI 949 in 1979.
International Conference on Primary Health Care in Almaty (then USSR); launched PHC globally with goal 'Health for All by the Year 2000'; endorsed community participation.
Letter of Instruction (LOI) 949 (1979)
Example
Basis for Philippine PHC implementation; emphasizes BHWs, community involvement, and local ownership of health programs.
Philippine presidential issuance adopting PHC principles; underlying theme: community participation and partnership in health.
Community Participation (PHC Cornerstone)
Example
Barangay residents participate in identifying health priorities, planning vaccination campaign, and monitoring community health outcomes.
Active involvement of community members as partners in planning, decision-making, implementation, and evaluation of health programs; not passive recipients.
Intersectoral Coordination (PHC Pillar)
Example
DOH coordinates with DEPTM (education) for school health programs, with DENR for clean water, with PNP for community safety—all affect health.
Health sector works with agriculture, education, water/sanitation, housing, social services to address determinants of health; health cannot be achieved by health sector alone.
Appropriate Technology (PHC Principle)
Example
Use of oral rehydration solution (ORS) instead of IV therapy for mild dehydration; simple BP cuff instead of electronic monitor in remote RHU.
Health technology suited to local conditions, resources, and needs; effective, acceptable, affordable, and sustainable.
Diagrams to know
- PHC essential elements: Education, Locally endemic disease control, EPI, MCH + FP, Essential drugs, Nutrition, Treatment, Safe water
- PHC support structure: Community (BHWs) ← → RHU/Health center ← → District Hospital; with intersectoral partners (education, water, agriculture, housing)
Universal Health Care Law (RA 11223, 2019): Key Provisions
Important facts
- RA 11223 provides automatic enrollment of all Filipinos—membership is mandatory, not voluntary.
- Two membership categories: direct contributors (those who pay) and indirect contributors (government subsidizes premiums).
- RA 11223 reinforces primary care–led, referral-based system: every Filipino registered with primary care provider who coordinates care.
- Population-based services (health promotion, surveillance) are government-financed.
- Individual-based services (clinical care) are largely PhilHealth-financed through benefit packages.
- RHU/health center is the primary care provider and gateway to higher-level care.
- Health Technology Assessment ensures PhilHealth funds evidence-based, cost-effective services.
- RA 11223 aims to eliminate financial barriers to health care and achieve health equity.
- Benefit packages include: inpatient, outpatient, Z-benefits (catastrophic care—certain cancers, dialysis), Konsulta (primary care), maternity packages.
- RA 11223 strengthens the two-way referral system and continuity of care.
Key definitions
Universal Health Care Act (RA 11223, 2019)
Example
All Filipinos automatically enrolled in PhilHealth; no Filipino denied health care due to inability to pay; benefits packages cover consultation, labs, hospitalization, maternity.
Landmark Philippine law guaranteeing every Filipino equitable access to quality and affordable health care goods and services, protected against financial hardship.
Automatic PhilHealth Membership
Example
Newborn babies, unemployed persons, overseas workers (OFWs), persons with disability—all automatically PhilHealth members.
All Filipino citizens are automatically enrolled in National Health Insurance Program; membership is mandatory, not voluntary; no longer contingent on employment.
Direct Contributors (PhilHealth)
Example
Private sector employee, self-employed vendor, OFW abroad—all contribute premiums directly to PhilHealth.
PhilHealth members who pay their own premiums; includes employed, self-earning, OFWs, and those with capacity to pay.
Indirect Contributors (PhilHealth)
Example
Poor family, senior citizen, person with severe disability—their PhilHealth premiums paid by national government.
PhilHealth members whose premiums are subsidized by national government; includes indigents, senior citizens, PWDs, and sponsored members.
Population-Based Health Services (RA 11223)
Example
Community health education campaign, dengue vector surveillance, immunization outreach—funded by DOH/LGU, not PhilHealth claims.
Public health services benefiting the entire population (health promotion, disease surveillance, vector control); financed by national/local government, not PhilHealth.
Individual-Based Health Services (RA 11223)
Example
Patient consults nurse at RHU → PhilHealth covers Konsulta benefit; blood test for TB → PhilHealth covers lab fee.
Clinical services for individual patients (consultations, lab tests, treatment, hospitalization); financed largely through PhilHealth benefit packages.
Province-Wide and City-Wide Health Systems
Example
In Laguna province, all RHUs link to district hospitals and Laguna Provincial Hospital; each resident registers with RHU in their municipality; RHU coordinates referrals.
Integrated networks of health facilities (RHU → district hospital → provincial hospital) organized to serve defined geographic area; RHU is primary care gateway.
Health Technology Assessment (HTA)
Example
HTA committee reviews data on new cancer drug; if cost-effective, PhilHealth includes in Z-benefit package; if not, not covered.
Mechanism to guide which health services and technologies PhilHealth funds based on evidence of effectiveness, safety, and affordability.
Diagrams to know
- RA 11223 financing model: Government (population-based services) + PhilHealth (individual-based services) + Out-of-pocket (co-payments) = Universal coverage
- Membership structure: All Filipinos → Direct Contributors (employed, self-earning, OFWs) OR Indirect Contributors (indigent, senior, PWD)
PhilHealth (National Health Insurance Program): RA 7875 and Benefit Packages
Important facts
- PhilHealth was created by RA 7875 (1995) and reformed by RA 11223 (2019).
- PhilHealth provides financial protection against health expenses through benefit packages.
- Benefit packages include: inpatient, outpatient, Konsulta (primary care), maternity, Z-benefits (catastrophic), and others.
- Konsulta benefit is free or minimal co-payment; integral to RA 11223 primary care–led system.
- Maternity package covers prenatal, delivery, and postnatal care—supports maternal health and institutional delivery targets.
- Z-benefits cover catastrophic conditions; prevent financial hardship from expensive treatment.
- Patient typically pays co-payment (percentage or fixed amount) + any balance exceeding PhilHealth benefit limit.
- Community nurse helps clients understand PhilHealth eligibility, benefits, and how to access services.
- PhilHealth benefit limits and packages are updated annually; nurse must stay current.
- RHU is key point of access to PhilHealth services; nurse verifies membership and processes claims.
Key definitions
PhilHealth (PHIC / National Health Insurance Program)
Example
Patient hospitalized for pneumonia; PhilHealth covers portion of hospital bill up to benefit limit; patient pays co-payment and additional balance if any.
Social health insurance mechanism created under RA 7875 (1995); provides financial protection through benefit packages; operates under RA 11223 (2019) UHC framework.
RA 7875 (National Health Insurance Act, 1995)
Example
Historical foundation of Philippine universal health insurance; RA 11223 expanded it to automatic, mandatory coverage.
Philippine law creating the National Health Insurance Program (PhilHealth); basis for social health insurance; reformed by RA 11223.
Inpatient Benefit Package (PhilHealth)
Example
Patient admitted to district hospital for appendectomy; PhilHealth covers 80-90% of defined benefit; patient pays co-payment + excess if bill exceeds limit.
Covers hospitalization costs (room, board, diagnostics, procedures) up to defined benefit limits; patient pays co-payment and any excess.
Outpatient Benefit Package (PhilHealth)
Example
Patient visits RHU for hypertension follow-up; PhilHealth covers consultation fee; patient may pay small co-payment.
Covers clinic consultations, diagnostics, and outpatient procedures; typically limited to defined visit frequency and amount per year.
Konsulta Benefit Package (PhilHealth)
Example
Pregnant woman visits RHU for prenatal check-up; Konsulta benefit covers nurse assessment and counseling; patient pays minimal or no co-payment.
Primary care consultation benefit covering RHU/health center visits; integral to RA 11223 primary care–led system; free or minimal co-payment.
Maternity Care Package (PhilHealth)
Example
Pregnant woman receives prenatal care at RHU (Konsulta benefit) + delivers at hospital (maternity package covers delivery cost + newborn screening).
Covers prenatal care, normal/complicated delivery, and postnatal care; includes institutional delivery, attendant fees, and newborn care.
Z-Benefit Package (PhilHealth)
Example
Patient diagnosed with breast cancer; PhilHealth Z-benefit covers chemotherapy, radiation, and surgery costs up to defined limit.
Catastrophic care benefit covering expensive treatments (certain cancers, dialysis, cardiac procedures, organ transplant); aims to prevent financial ruin from catastrophic illness.
Diagrams to know
- PhilHealth benefit flow: Patient → RHU (Konsulta) or Hospital → Service provided → PhilHealth pays share → Patient pays co-payment + excess
Field Health Services Information System (FHSIS): Recording, Reporting, and Data Management
Important facts
- FHSIS is the official DOH recording and reporting system; all local health facilities required to report.
- Individual Treatment Record (ITR) is the basic building block; every client contact documented.
- Target Client Lists (TCLs) ensure systematic tracking of specific program clients (prenatal, EPI, TB, family planning, etc.).
- No client should be missed; TCL review is part of monthly program monitoring.
- Community nurse is heavily involved in accurate FHSIS recording and reporting.
- FHSIS data feeds local and national health statistics and program decisions.
- Data accuracy is critical; garbage in, garbage out—poor data leads to poor decisions.
- Consolidation tables summarize ITR data into meaningful program information.
- Quarterly and annual reports go to municipality/city and DOH/CHD.
- FHSIS data used to monitor: vaccination coverage, maternal health indicators, disease surveillance, program performance.
- Nurse must understand what data to collect, how to record accurately, and how to consolidate for reports.
Key definitions
Field Health Services Information System (FHSIS)
Example
RHU records every client consultation, vaccination, prenatal visit, and TB contact tracing; data entered into FHSIS for monthly, quarterly, and annual reports.
Official DOH recording and reporting system for health services at local level; provides data for planning, monitoring, and program management.
Individual Treatment Record (ITR)
Example
Nurse documents patient visit: date, BP, chief complaint, assessment, nursing intervention, referral (if any); ITR is filed and later consolidated into monthly FHSIS report.
Basic building block of FHSIS; records every client consultation—date, diagnosis, interventions, outcome; forms basis for all aggregate data.
Target Client List (TCL)
Example
Prenatal TCL lists all pregnant women registered with RHU; nurse checks list monthly to follow up missed clients, assess compliance with ANC schedule.
FHSIS tool tracking clients belonging to program groups (prenatal, under-1/EPI, family planning, TB, hypertension, diabetes); ensures no client missed.
Monthly Consolidation/Summary Table (FHSIS)
Example
RHU consolidation shows: 50 consultations (20 pediatric, 15 prenatal, 15 acute illness), 8 referrals, 95% vaccination coverage for under-1; used in municipal report.
Aggregates ITR data at RHU level; tallies consultations, diagnostics, interventions, referrals, outcomes by condition/service; basis for higher-level reporting.
Quarterly and Annual Reports (FHSIS)
Example
Municipal health office consolidates all RHU data into quarterly report showing immunization rates, maternal mortality ratio, TB cure rate; forwarded to CHD.
Summary data from RHUs compiled at municipality/city and province level; forwarded to DOH/CHD; used for program evaluation and national statistics.
Diagrams to know
- FHSIS recording flow: ITR (individual record) → Monthly consolidation (RHU) → Quarterly/Annual report (municipality) → DOH/CHD (national aggregation)
- TCL function: Target population identified → TCL created → Monthly review → Client follow-up → Compliance tracked → Report generated
Roles and Functions of the Community Health Nurse within the Philippine Health System
Important facts
- Community health nurse works primarily at RHU/BHS level within devolved LGU system.
- CHN's core role is health education (PHC cornerstone).
- CHN is provider, educator, manager, coordinator, recorder, and advocate—multifaceted role.
- CHN supervises BHWs and midwives; responsible for their performance and compliance.
- CHN implements nursing process at community level (assess, diagnose, plan, implement, evaluate).
- CHN manages referral process: prepares referral form, communicates with higher level, follows up back-referral.
- CHN maintains FHSIS accuracy; responsible for recording and reporting data.
- CHN is advocate for vulnerable populations (poor, women, children, elderly).
- CHN mobilizes community participation; not a top-down service provider.
- CHN works within devolved structure under LGU; coordinates with CHD and DOH.
- CHN practices under RA 9173 (Nursing Act of 1991); subject to scope of practice, licensure, and ethical standards.
- CHN must be culturally sensitive and adapt care to local context and resources.
- CHN is bridge between community and formal health system.
Key definitions
Community Health Nurse (CHN)
Example
Nurse at rural health unit conducts prenatal clinics, gives health education, supervises BHWs, refers complicated cases, maintains FHSIS records.
Licensed nurse providing care, education, coordination, and advocacy in community and primary care settings (RHU, BHS, home, community) within the devolved health system.
Care Provider (CHN Role)
Example
Nurse assesses patient's blood pressure, identifies health problem, provides wound care, counsels on medication, evaluates outcome.
Direct nursing care at clinic, home, and community; assessment, diagnosis, intervention, evaluation using nursing process.
Health Educator (CHN Role - Core PHC Function)
Example
Nurse teaches pregnant woman about danger signs, hygiene, nutrition, importance of skilled delivery; educates community on dengue prevention.
Teaches individuals, families, and communities about health promotion, disease prevention, and management; most fundamental CHN role.
Manager/Supervisor (CHN Role)
Example
Nurse supervises BHW activities, plans monthly immunization schedule, assigns tasks, reviews BHW reports, provides coaching.
Directs RHU nursing service, supervises BHWs and midwives, plans and implements programs, manages resources and personnel.
Coordinator/Collaborator (CHN Role)
Example
Nurse coordinates with school for health programs, refers patient to hospital with complete documentation, partners with barangay officials for community mobilization.
Links clients with services, coordinates referrals, partners with other sectors (education, water, agriculture), and collaborates with community stakeholders.
Recorder/Reporter (CHN Role)
Example
Nurse documents every client visit, maintains prenatal and under-1 TCLs, completes monthly FHSIS consolidation, submits to municipality.
Maintains FHSIS records, Individual Treatment Records, target client lists, and consolidated reports; ensures data accuracy and timely submission.
Advocate and Community Organizer (CHN Role)
Example
Nurse advocates for adolescent sexual health services, mobilizes barangay for dengue prevention, facilitates community assembly to identify health priorities.
Champions client rights, mobilizes community participation, identifies community health priorities, advocates for health policies, empowers communities.
Diagrams to know
- CHN role framework: Care provider + Health educator + Manager + Coordinator + Recorder + Advocate = Multifaceted community health nursing practice
Nursing Process and NANDA Nursing Diagnoses in Community Health Context
Important facts
- Nursing process is the framework for CHN practice at individual, family, and community level.
- Assessment in CHN includes: individual health history, physical exam, family structure/dynamics, environmental/living conditions, community resources, cultural beliefs, risk factors.
- NANDA nursing diagnosis format: Problem + Related Factors + Evidence; examples relevant to CHN: ineffective health maintenance, risk for infection, deficient knowledge, inadequate housing, poor nutrition.
- Common CHN diagnoses include: health promotion, disease prevention, deficient knowledge, risk for communicable disease, inadequate housing, poor sanitation, nutritional deficiency.
- Planning uses Maslow's hierarchy: physiologic needs → safety → belonging → esteem → self-actualization.
- Prioritization rule: address life-threatening physiologic issues first (e.g., bleeding, severe infection), then safety risks (e.g., unsafe water), then health promotion.
- Community health nursing diagnoses address groups/populations, not just individuals; e.g., 'Ineffective health maintenance r/t lack of knowledge about vaccination AEB low immunization coverage."
- Interventions are nurse-driven and client-centered; include education, home visits, facilitation, referral, community mobilization.
- Evaluation is ongoing; nurse monitors outcomes, adjusts interventions, and documents progress.
- CHN uses collaborative diagnoses (working with physicians, midwives, BHWs).
- Documentation of nursing process feeds FHSIS (ITR, consolidation, reports).
Key definitions
Assessment (Nursing Process - CHN)
Example
Nurse visits home: observes water source, sanitation, living conditions; interviews family about health practices; takes vital signs; identifies strengths and risks.
Systematic data collection at individual, family, and community level; includes history, vital signs, physical exam, environmental observation, risk factors, health beliefs.
Nursing Diagnosis (NANDA Format in CHN)
Example
Ineffective health maintenance r/t lack of knowledge about dengue prevention AEB community ignorance of larval sources; or Risk for infection r/t unsafe water supply.
Clinical judgment statement identifying actual or potential health problem amenable to nursing intervention; structured as: Problem + Related Factors + Evidence (Evidence).
Planning (Nursing Process - CHN)
Example
Goal: Client will demonstrate 3 dengue prevention practices within 2 weeks. Interventions: health education session, household observation, follow-up visit.
Develops client/community-centered goals, identifies nursing interventions, and sets priorities using Maslow's hierarchy; includes individual and community strategies.
Implementation (Nursing Process - CHN)
Example
Nurse conducts prenatal class, demonstrates BP monitoring, refers hypertensive client to RHU physician, involves BHW for home follow-up.
Executes planned interventions; includes direct care, health teaching, facilitation, collaboration, referral; documented in ITR and FHSIS.
Evaluation (Nursing Process - CHN)
Example
After 2 weeks, client demonstrates 2 of 3 dengue prevention practices; goal partially met. Nurse revises plan: more teaching needed on vector breeding sites.
Assesses goal achievement, compares outcomes to expected results, revises plan as needed; continuous monitoring and adjustment.
Maslow's Hierarchy in CHN Priority-Setting
Example
In acute phase: prioritize nutrition, shelter, infection prevention. As stabilized: address emotional support, health education, community participation.
Framework prioritizing nursing diagnoses/interventions: (1) physiologic safety, (2) safety, (3) belonging/love, (4) esteem, (5) self-actualization; addresses lower needs before higher.
Diagrams to know
- Nursing process cycle: Assessment → Diagnosis → Planning → Implementation → Evaluation → (back to assessment for revised planning)
- Maslow priority pyramid: Physiologic (food, water, rest) → Safety (shelter, protection, disease prevention) → Belonging (family, community) → Esteem (recognition, respect) → Self-actualization (growth, purpose)
Must remember
- RA 7160 (Local Government Code, 1991) devolved basic health services to LGUs: Provinces run hospitals; municipalities/cities run RHUs and BHS. DOH shifted from service provider to policy-maker and regulator.
- Alma-Ata Declaration (1978) launched PHC globally with goal 'Health for All by 2000'; Philippines adopted via LOI 949 (1979). Community participation is the cornerstone/underlying theme of PHC.
- RA 11223 (Universal Health Care Act, 2019): All Filipinos automatically enrolled in PhilHealth (mandatory, not voluntary). Two categories: direct contributors (those who pay) and indirect contributors (government subsidizes).
- Primary care–led, referral-based system: RHU/health center is the primary care provider and gateway; clients registered and follow two-way referral (upward for specialist care, back-referral for continuing care in community).
- PHC Essential Elements mnemonic ELEMENTS: Education for health, Locally endemic disease control, Expanded Program on Immunization, Maternal and child health + family planning, Essential drugs, Nutrition, Treatment of communicable and non-communicable diseases, Safe water and sanitation.
- FHSIS is the official DOH recording/reporting system; Individual Treatment Record (ITR) is the basic building block; Target Client Lists (TCLs) track program clients; data consolidated monthly and reported quarterly/annually.
- Community Health Nurse roles: care provider, health educator (core PHC function), manager/supervisor of BHWs, coordinator/collaborator, recorder/reporter, and advocate/community organizer. Works at RHU/BHS within devolved LGU system.
- DOH is policy-maker, standard-setter, and regulator (not direct service provider except DOH-retained hospitals). Centers for Health Development (CHDs) are regional DOH offices coordinating with LGUs. Sentrong Sigla is DOH quality-assurance and certification program for local health facilities.
- Two-way referral system: Upward referral (primary → secondary → tertiary) when needs exceed facility capacity; back-referral (tertiary → secondary → primary) after specialist care for continuing community-based care. Referral requires completed form documenting assessment, interventions, reason.
- RA 7875 (1995) created PhilHealth (National Health Insurance Program); RA 11223 expanded it to automatic universal enrollment. Benefit packages: Konsulta (primary care, free/minimal co-pay), inpatient, outpatient, maternity, Z-benefits (catastrophic illness). Population-based services (health promotion, surveillance) financed by government; individual-based services (clinical care) financed by PhilHealth.
Last minute tips
- Remember DEVOLUTION and LGU RESPONSIBILITY: The exam loves testing your understanding that RA 7160 shifted basic health services to LGUs. If a question asks 'Who manages the RHU?'—answer is LGU (municipality/city), NOT DOH. DOH now focuses on policy, standards, and regulation.
- PHC = Community Participation + Education: Don't just memorize PHC elements. The exam wants you to understand that PHC's cornerstone is COMMUNITY PARTICIPATION (not government-only top-down service). Health education is the CORE nursing function in PHC. If a CHN question asks about primary responsibility, think education first.
- RA 11223 = AUTOMATIC ENROLLMENT: This is newer content; exam will test it heavily. Key point: RA 11223 made PhilHealth membership mandatory and automatic for all Filipinos (not voluntary like RA 7875). Everyone is enrolled—direct or indirect contributor. This is a paradigm shift; expect 1-2 questions on this.
- FHSIS = Data accuracy matters: Exam will test your understanding that FHSIS data feeds all program decisions and national statistics. The Individual Treatment Record (ITR) is the foundation; Target Client Lists ensure clients aren't missed. Nurses are responsible for accurate documentation—'garbage in, garbage out.' If you see a question about recording/reporting, think FHSIS.
- Prioritize using Maslow in CHN context: When you see a CHN case study with multiple problems, use Maslow to prioritize: physiologic needs (food, water, safety) FIRST, then safety (shelter, sanitation), then higher needs. Exam loves testing priority-setting. E.g., if a question asks what the nurse addresses first in a community with both poor nutrition AND lack of health education, answer nutrition (Maslow's lower need).
Comparison tables
Three Levels of Health Care: Features and Functions
| Level | Setting/Type | Care Focus | Services | Referral | Examples (Philippines) |
|---|---|---|---|---|---|
| Primary | BHS, RHU, Health Center, Clinic | First contact, preventive, promotive | Common conditions, health education, preventive screening | Upward → Secondary if needs exceed capacity | Barangay Health Station, Municipal RHU |
| Secondary | District, Provincial Hospital | General hospital medicine, surgery, OB-GYN, pediatrics | Complicated cases referred from primary; diagnostic confirmation, procedures | Upward → Tertiary if specialized care needed; Back-referral → Primary for follow-up | District Hospital of Laguna, Provincial Hospital of Bulacan |
| Tertiary | Regional, National Hospital, Medical Center | Highly specialized medicine, research, advanced training | Rare/complex conditions, specialty services, advanced procedures | Back-referral → Secondary/Primary for continuing care | Philippine General Hospital, National Kidney and Transplant Institute |
Primary Health Care vs. Tertiary Care: Core Differences
| Feature | Primary Health Care (PHC) | Tertiary Care |
|---|---|---|
| Accessibility | Local, community-based, easy access | Regional/national, specialized center, often requires travel/referral |
| Cost | Low-cost, affordable, subsidized | High-cost, expensive, primarily for referred complex cases |
| Scope | Preventive, promotive, treatment of common conditions | Highly specialized, rare/complex conditions, advanced procedures |
| Community Participation | High; community is active partner in planning and implementation | Low; community is patient/consumer of service |
| Entry Point | First contact/entry point for most health needs | Referred from primary/secondary level, not entry point |
| Technology | Simple, appropriate, sustainable | Complex, advanced, technology-intensive |
| Provider | BHW, nurse, midwife, doctor at RHU/BHS | Specialists, super-specialists, advanced training |
RA 11223 (UHC Law) vs. RA 7875 (National Health Insurance Act): Key Distinctions
| Aspect | RA 7875 (1995) | RA 11223 (2019) |
|---|---|---|
| Membership | Voluntary or employment-based; not mandatory | Automatic and mandatory for all Filipinos; not contingent on employment |
| Enrollment | Individual must apply/register; coverage gaps for unemployed, informal sector | All citizens automatically enrolled; no gaps; removes barriers to enrollment |
| Premium Payment | Individual, employer, or government subsidy; many uninsured | Direct contributors pay own premiums; indirect contributors subsidized by government; universal coverage |
| Health Service Organization | Individual can choose provider; multiple entry points | Primary care–led system; RHU/health center is gateway; referral-based; coordinated care |
| Financial Protection | Basic benefit packages; limited coverage for catastrophic illness | Comprehensive benefit packages including Z-benefits; better protection against financial hardship |
| Population vs. Individual-Based Services | Not explicitly distinguished | Clearly delineates: population-based (DOH/LGU-funded) and individual-based (PhilHealth-funded) |
| Goal | Health insurance for those who register; reduce out-of-pocket spending | Universal health coverage for all; health equity; financial protection for vulnerable populations |
Upward Referral vs. Back-Referral: Process and Purpose
| Element | Upward Referral | Back-Referral (Downward) |
|---|---|---|
| Direction | Primary → Secondary → Tertiary (moving up the care ladder) | Tertiary → Secondary → Primary (returning to source/lower level) |
| Reason | Client needs exceed capacity/expertise of current facility; requires higher-level care | Acute phase resolved; client stable; ready for continuing/maintenance care in community |
| Trigger | Complication, complex diagnosis, need for specialist care, diagnostic uncertainty | Specialist care completed; improvement achieved; need for follow-up and medication compliance |
| Referral Form Content | Assessment findings, vital signs, diagnosis/impression, interventions given, reason for referral, receiving facility name | Diagnosis, treatment received, current status, follow-up plan, medications prescribed, receiving provider/facility |
| CHN Responsibility | Complete assessment, prepare referral form, ensure safe transport, communicate with receiving facility, track if follow-up appointment made | Receive back-referred client, review specialist recommendations, ensure continued compliance, monitor for complications, provide community-based follow-up |
| Goal | Ensure client receives appropriate specialist/higher-level care | Ensure continuity of care, prevent rehospitalization, support community reintegration |
PhilHealth Benefit Categories: Coverage and Focus
| Benefit Package | What It Covers | Client Example | CHN Role |
|---|---|---|---|
| Konsulta (Primary Care) | RHU/health center consultation, assessment, counseling, basic diagnostics | Hypertensive client visits RHU for BP check and medication review | Verify PhilHealth membership, provide consultation, counsel on compliance, refer if needed |
| Inpatient | Hospital admission, room, board, procedures, diagnostics, surgery | Pregnant woman admitted to hospital for complicated delivery (cesarean section) | Prepare referral with complete assessment, follow up hospitalization, coordinate discharge and back-referral |
| Outpatient | Clinic visits, diagnostics, outpatient procedures, follow-up care | TB patient receives monthly DOT and sputum microscopy | Ensure clinic attendance, observe therapy, monitor adherence, record data |
| Maternity | Prenatal care, normal and complicated delivery, postnatal care, newborn screening | Pregnant woman receives ANC at RHU; delivers at hospital with PhilHealth coverage | Conduct prenatal classes, track ANC attendance, coordinate delivery referral, ensure postnatal follow-up |
| Z-Benefit (Catastrophic) | Expensive treatments for specified conditions (cancers, dialysis, cardiac procedures, organ transplant) | Patient diagnosed with breast cancer receives chemotherapy and surgery covered by Z-benefit | Help client understand Z-benefit eligibility, facilitate PhilHealth processing, provide psychosocial support |
Roles of Community Health Nurse: Functions and Examples in Practice
| CHN Role | Core Functions | Practical Example |
|---|---|---|
| Care Provider | Direct nursing care: assessment, intervention, evaluation; home/clinic care; wound dressing, vital signs, medication administration | Nurse conducts home visit: assesses wound healing post-delivery, teaches hygiene, refers to RHU if signs of infection |
| Health Educator | Health teaching at individual/family/community level; promotes health literacy; teaches disease prevention and management | Nurse conducts barangay health education: demonstrates proper handwashing to prevent diarrheal disease |
| Manager/Supervisor | Directs RHU nursing service; supervises BHWs/midwives; plans programs; manages resources; ensures accountability | Nurse reviews BHW activity reports, identifies training gaps, coaches on proper procedure, plans monthly immunization campaign |
| Coordinator/Collaborator | Links clients with services; coordinates referrals; partners with sectors (education, water, agriculture); multisectoral coordination | Nurse coordinates with school nurse for health programs, with barangay for community mobilization, with hospital for discharge planning |
| Recorder/Reporter | Maintains FHSIS records, ITR, Target Client Lists; ensures data accuracy; prepares consolidated reports for submission to municipality | Nurse documents client visit in ITR, updates prenatal TCL, consolidates monthly FHSIS data, submits to municipal health office |
| Advocate/Community Organizer | Advocates for client rights and vulnerable populations; mobilizes community participation; identifies health priorities; empowers community | Nurse advocates for adolescent sexual health program at municipal level; mobilizes barangay community assembly to identify priority health issues |
Diagrams
Philippine Health Care Delivery System Structure: From DOH to Community
This flowchart visualizes the hierarchical organization of the Philippine health system from national DOH through regional CHDs to LGUs managing primary and secondary care. It shows the devolved structure mandated by RA 7160, the referral pathways (upward and back), and how RA 11223 and PhilHealth integrate into the system.
Primary Health Care (PHC) Framework: Principles, Elements, and Implementation
This mind map organizes the PHC framework used in the Philippines since 1979 (LOI 949). It shows how community participation is the centerstone, the four As of accessibility, the support mechanisms (intersectoral coordination, appropriate technology), the eight essential elements (ELEMENTS mnemonic), and the implementation through BHWs and RHUs. Useful for rapid memorization of PHC concepts.
Nursing Process in Community Health: Assessment to Evaluation Cycle
This flowchart depicts the nursing process cycle as applied in community health nursing. It shows the five steps (Assessment, Diagnosis, Planning, Implementation, Evaluation) with decision points for goal achievement and revision. The cycle is continuous, emphasizing the dynamic nature of CHN practice. Maslow's hierarchy is integrated into the planning phase for priority-setting.
Referral Pathway: Patient Movement Through Levels of Care
This state diagram illustrates the two-way referral system in the Philippine health care system. Patients enter at primary level and move upward to secondary/tertiary if needs exceed capacity, then return downward for continuing and follow-up care at lower levels. The diagram shows that the primary level is the first contact and gateway, and emphasizes the importance of back-referral to ensure community-based continuity.
Field Health Services Information System FHSIS Recording and Reporting Flow
This flowchart visualizes the FHSIS recording and reporting pathway. Each client visit is documented in an Individual Treatment Record (ITR), which is the foundation. Data from ITRs are consolidated monthly at the RHU, reported to the municipality quarterly, then to DOH/CHD annually. Target Client Lists track specific program clients to ensure continuity. Accurate recording at the ITR level is critical because it feeds all higher-level reports and national statistics.