NLE Community Health Nursing — Philippine Health Care Delivery System & DOH ProgramsCheat Sheet
One-page cheat sheet for NLE Community Health Nursing — Philippine Health Care Delivery System & DOH Programs. Every formula, definition, and key fact you need for this chapter, condensed to a single printable page. Designed for the final review session before the NLE 2026.
Exam context
For the Philippine Nurse Licensure Examination (PNLE), Professional Regulation Commission (PRC) — Board of Nursing tests Community Health Nursing under a "Core" label, with Philippine Health Care Delivery System & DOH Programs in the 1st slot across 6 chapters. NLE candidates must clear the 75% weighted average with no sub-test below 60% cut on the 2026 paper, which draws about 50 Community Health Nursing questions. Date to watch: Bi-annual.
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.
Sections
Section Title
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
Term
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.
Definition
Transfer of basic health service delivery from national DOH to Local Government Units (LGUs); provinces run hospitals, municipalities/cities run RHUs and BHS.
Term
Public Sector
Example
Government-owned Rural Health Unit, provincial hospital, city health center.
Definition
Government-financed health services (via taxation and social insurance) delivered through national and local government facilities; primary provider for majority of Filipinos, especially poor.
Term
Private Sector
Example
Private clinics, privately-owned hospitals, non-profit faith-based hospitals.
Definition
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)
Section Title
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
Term
Primary Level (First Contact Care)
Example
Blood pressure screening, vaccination, treatment of simple cough and colds, prenatal visits.
Definition
Entry point to health system; provides preventive, promotive, and treatment services for common conditions; includes BHS, RHU, health centers, private clinics.
Term
Secondary Level (First Referral)
Example
A patient with complicated pregnancy from RHU is referred to provincial hospital for operative delivery.
Definition
General medicine, surgery, OB-GYN, pediatrics; emergency, district, and provincial hospitals; receives referrals from primary level.
Term
Tertiary Level (Specialist Care)
Example
Philippine General Hospital, National Kidney and Transplant Institute, National Institutes of Health.
Definition
Highly specialized medical-center and regional/national hospital care; receives referrals from secondary level; research and advanced training.
Term
Two-Way Referral System
Example
Patient with TB treated at tertiary center is back-referred to RHU for ongoing directly observed therapy (DOT).
Definition
Upward referral (primary → secondary → tertiary) and back-referral (tertiary → secondary → primary); ensures appropriate care level and continuity.
Term
Upward Referral
Example
RHU nurse refers a child with severe pneumonia to district hospital with detailed assessment and vital signs documented.
Definition
Client whose needs exceed facility capacity is referred to a higher-level facility with accompanying referral form documenting findings, interventions, and reason.
Term
Back-Referral (Downward Referral)
Example
After specialized cardiac catheterization at tertiary center, patient returns to RHU for regular BP monitoring and medication compliance counseling.
Definition
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)
Section Title
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
Term
Department of Health (DOH)
Example
DOH sets national immunization schedule; DOH runs FDA and PhilHealth; DOH monitors disease surveillance.
Definition
Lead agency in health; national policy-maker, technical authority, and regulator; role is policy/standards/regulation, not direct service delivery.
Term
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.
Definition
Regional offices of DOH that coordinate with LGUs, provide technical support, and implement national programs at regional level.
Term
DOH-Retained Hospitals and Services
Example
Philippine General Hospital, National Kidney and Transplant Institute, Philippine Heart Center, National Institute of Health.
Definition
Specialty hospitals and services that DOH still operates directly (not devolved); include emergency services, disaster response, and national programs.
Term
Sentrong Sigla (SS) Movement
Example
An RHU that meets Sentrong Sigla criteria receives certification, technical support, incentives, and public recognition for quality service delivery.
Definition
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
Section Title
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
Term
Primary Health Care (PHC)
Example
Community-based immunization campaigns, barangay health worker prenatal counseling, health education on sanitation, affordable TB treatment.
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.
Term
Alma-Ata Declaration (1978)
Example
Landmark event that shaped community health nursing practice worldwide; Philippines adopted it via LOI 949 in 1979.
Definition
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.
Term
Letter of Instruction (LOI) 949 (1979)
Example
Basis for Philippine PHC implementation; emphasizes BHWs, community involvement, and local ownership of health programs.
Definition
Philippine presidential issuance adopting PHC principles; underlying theme: community participation and partnership in health.
Term
Community Participation (PHC Cornerstone)
Example
Barangay residents participate in identifying health priorities, planning vaccination campaign, and monitoring community health outcomes.
Definition
Active involvement of community members as partners in planning, decision-making, implementation, and evaluation of health programs; not passive recipients.
Term
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.
Definition
Health sector works with agriculture, education, water/sanitation, housing, social services to address determinants of health; health cannot be achieved by health sector alone.
Term
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.
Definition
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)
Section Title
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
Term
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.
Definition
Landmark Philippine law guaranteeing every Filipino equitable access to quality and affordable health care goods and services, protected against financial hardship.
Term
Automatic PhilHealth Membership
Example
Newborn babies, unemployed persons, overseas workers (OFWs), persons with disability—all automatically PhilHealth members.
Definition
All Filipino citizens are automatically enrolled in National Health Insurance Program; membership is mandatory, not voluntary; no longer contingent on employment.
Term
Direct Contributors (PhilHealth)
Example
Private sector employee, self-employed vendor, OFW abroad—all contribute premiums directly to PhilHealth.
Definition
PhilHealth members who pay their own premiums; includes employed, self-earning, OFWs, and those with capacity to pay.
Term
Indirect Contributors (PhilHealth)
Example
Poor family, senior citizen, person with severe disability—their PhilHealth premiums paid by national government.
Definition
PhilHealth members whose premiums are subsidized by national government; includes indigents, senior citizens, PWDs, and sponsored members.
Term
Population-Based Health Services (RA 11223)
Example
Community health education campaign, dengue vector surveillance, immunization outreach—funded by DOH/LGU, not PhilHealth claims.
Definition
Public health services benefiting the entire population (health promotion, disease surveillance, vector control); financed by national/local government, not PhilHealth.
Term
Individual-Based Health Services (RA 11223)
Example
Patient consults nurse at RHU → PhilHealth covers Konsulta benefit; blood test for TB → PhilHealth covers lab fee.
Definition
Clinical services for individual patients (consultations, lab tests, treatment, hospitalization); financed largely through PhilHealth benefit packages.
Term
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.
Definition
Integrated networks of health facilities (RHU → district hospital → provincial hospital) organized to serve defined geographic area; RHU is primary care gateway.
Term
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.
Definition
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)
Section Title
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
Term
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.
Definition
Social health insurance mechanism created under RA 7875 (1995); provides financial protection through benefit packages; operates under RA 11223 (2019) UHC framework.
Term
RA 7875 (National Health Insurance Act, 1995)
Example
Historical foundation of Philippine universal health insurance; RA 11223 expanded it to automatic, mandatory coverage.
Definition
Philippine law creating the National Health Insurance Program (PhilHealth); basis for social health insurance; reformed by RA 11223.
Term
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.
Definition
Covers hospitalization costs (room, board, diagnostics, procedures) up to defined benefit limits; patient pays co-payment and any excess.
Term
Outpatient Benefit Package (PhilHealth)
Example
Patient visits RHU for hypertension follow-up; PhilHealth covers consultation fee; patient may pay small co-payment.
Definition
Covers clinic consultations, diagnostics, and outpatient procedures; typically limited to defined visit frequency and amount per year.
Term
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.
Definition
Primary care consultation benefit covering RHU/health center visits; integral to RA 11223 primary care–led system; free or minimal co-payment.
Term
Maternity Care Package (PhilHealth)
Example
Pregnant woman receives prenatal care at RHU (Konsulta benefit) + delivers at hospital (maternity package covers delivery cost + newborn screening).
Definition
Covers prenatal care, normal/complicated delivery, and postnatal care; includes institutional delivery, attendant fees, and newborn care.
Term
Z-Benefit Package (PhilHealth)
Example
Patient diagnosed with breast cancer; PhilHealth Z-benefit covers chemotherapy, radiation, and surgery costs up to defined limit.
Definition
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
Section Title
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
Term
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.
Definition
Official DOH recording and reporting system for health services at local level; provides data for planning, monitoring, and program management.
Term
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.
Definition
Basic building block of FHSIS; records every client consultation—date, diagnosis, interventions, outcome; forms basis for all aggregate data.
Term
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.
Definition
FHSIS tool tracking clients belonging to program groups (prenatal, under-1/EPI, family planning, TB, hypertension, diabetes); ensures no client missed.
Term
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.
Definition
Aggregates ITR data at RHU level; tallies consultations, diagnostics, interventions, referrals, outcomes by condition/service; basis for higher-level reporting.
Term
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.
Definition
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
Section Title
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
Term
Community Health Nurse (CHN)
Example
Nurse at rural health unit conducts prenatal clinics, gives health education, supervises BHWs, refers complicated cases, maintains FHSIS records.
Definition
Licensed nurse providing care, education, coordination, and advocacy in community and primary care settings (RHU, BHS, home, community) within the devolved health system.
Term
Care Provider (CHN Role)
Example
Nurse assesses patient's blood pressure, identifies health problem, provides wound care, counsels on medication, evaluates outcome.
Definition
Direct nursing care at clinic, home, and community; assessment, diagnosis, intervention, evaluation using nursing process.
Term
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.
Definition
Teaches individuals, families, and communities about health promotion, disease prevention, and management; most fundamental CHN role.
Term
Manager/Supervisor (CHN Role)
Example
Nurse supervises BHW activities, plans monthly immunization schedule, assigns tasks, reviews BHW reports, provides coaching.
Definition
Directs RHU nursing service, supervises BHWs and midwives, plans and implements programs, manages resources and personnel.
Term
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.
Definition
Links clients with services, coordinates referrals, partners with other sectors (education, water, agriculture), and collaborates with community stakeholders.
Term
Recorder/Reporter (CHN Role)
Example
Nurse documents every client visit, maintains prenatal and under-1 TCLs, completes monthly FHSIS consolidation, submits to municipality.
Definition
Maintains FHSIS records, Individual Treatment Records, target client lists, and consolidated reports; ensures data accuracy and timely submission.
Term
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.
Definition
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
Section Title
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
Term
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.
Definition
Systematic data collection at individual, family, and community level; includes history, vital signs, physical exam, environmental observation, risk factors, health beliefs.
Term
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.
Definition
Clinical judgment statement identifying actual or potential health problem amenable to nursing intervention; structured as: Problem + Related Factors + Evidence (Evidence).
Term
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.
Definition
Develops client/community-centered goals, identifies nursing interventions, and sets priorities using Maslow's hierarchy; includes individual and community strategies.
Term
Implementation (Nursing Process - CHN)
Example
Nurse conducts prenatal class, demonstrates BP monitoring, refers hypertensive client to RHU physician, involves BHW for home follow-up.
Definition
Executes planned interventions; includes direct care, health teaching, facilitation, collaboration, referral; documented in ITR and FHSIS.
Term
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.
Definition
Assesses goal achievement, compares outcomes to expected results, revises plan as needed; continuous monitoring and adjustment.
Term
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.
Definition
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
Rows
Values
- 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
Property
Primary
Values
- 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
Property
Secondary
Values
- 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
Property
Tertiary
Columns
- Level
- Setting/Type
- Care Focus
- Services
- Referral
- Examples (Philippines)
Table Title
Three Levels of Health Care: Features and Functions
Rows
Values
- Local, community-based, easy access
- Regional/national, specialized center, often requires travel/referral
Property
Accessibility
Values
- Low-cost, affordable, subsidized
- High-cost, expensive, primarily for referred complex cases
Property
Cost
Values
- Preventive, promotive, treatment of common conditions
- Highly specialized, rare/complex conditions, advanced procedures
Property
Scope
Values
- High; community is active partner in planning and implementation
- Low; community is patient/consumer of service
Property
Community Participation
Values
- First contact/entry point for most health needs
- Referred from primary/secondary level, not entry point
Property
Entry Point
Values
- Simple, appropriate, sustainable
- Complex, advanced, technology-intensive
Property
Technology
Values
- BHW, nurse, midwife, doctor at RHU/BHS
- Specialists, super-specialists, advanced training
Property
Provider
Columns
- Feature
- Primary Health Care (PHC)
- Tertiary Care
Table Title
Primary Health Care vs. Tertiary Care: Core Differences
Rows
Values
- Voluntary or employment-based; not mandatory
- Automatic and mandatory for all Filipinos; not contingent on employment
Property
Membership
Values
- Individual must apply/register; coverage gaps for unemployed, informal sector
- All citizens automatically enrolled; no gaps; removes barriers to enrollment
Property
Enrollment
Values
- Individual, employer, or government subsidy; many uninsured
- Direct contributors pay own premiums; indirect contributors subsidized by government; universal coverage
Property
Premium Payment
Values
- Individual can choose provider; multiple entry points
- Primary care–led system; RHU/health center is gateway; referral-based; coordinated care
Property
Health Service Organization
Values
- Basic benefit packages; limited coverage for catastrophic illness
- Comprehensive benefit packages including Z-benefits; better protection against financial hardship
Property
Financial Protection
Values
- Not explicitly distinguished
- Clearly delineates: population-based (DOH/LGU-funded) and individual-based (PhilHealth-funded)
Property
Population vs. Individual-Based Services
Values
- Health insurance for those who register; reduce out-of-pocket spending
- Universal health coverage for all; health equity; financial protection for vulnerable populations
Property
Goal
Columns
- Aspect
- RA 7875 (1995)
- RA 11223 (2019)
Table Title
RA 11223 (UHC Law) vs. RA 7875 (National Health Insurance Act): Key Distinctions
Rows
Values
- Primary → Secondary → Tertiary (moving up the care ladder)
- Tertiary → Secondary → Primary (returning to source/lower level)
Property
Direction
Values
- Client needs exceed capacity/expertise of current facility; requires higher-level care
- Acute phase resolved; client stable; ready for continuing/maintenance care in community
Property
Reason
Values
- Complication, complex diagnosis, need for specialist care, diagnostic uncertainty
- Specialist care completed; improvement achieved; need for follow-up and medication compliance
Property
Trigger
Values
- 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
Property
Referral Form Content
Values
- 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
Property
CHN Responsibility
Values
- Ensure client receives appropriate specialist/higher-level care
- Ensure continuity of care, prevent rehospitalization, support community reintegration
Property
Goal
Columns
- Element
- Upward Referral
- Back-Referral (Downward)
Table Title
Upward Referral vs. Back-Referral: Process and Purpose
Rows
Values
- 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
Property
Konsulta (Primary Care)
Values
- 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
Property
Inpatient
Values
- 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
Property
Outpatient
Values
- 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
Property
Maternity
Values
- 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
Property
Z-Benefit (Catastrophic)
Columns
- Benefit Package
- What It Covers
- Client Example
- CHN Role
Table Title
PhilHealth Benefit Categories: Coverage and Focus
Rows
Values
- 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
Property
Care Provider
Values
- 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
Property
Health Educator
Values
- 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
Property
Manager/Supervisor
Values
- 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
Property
Coordinator/Collaborator
Values
- 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
Property
Recorder/Reporter
Values
- 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
Property
Advocate/Community Organizer
Columns
- CHN Role
- Core Functions
- Practical Example
Table Title
Roles of Community Health Nurse: Functions and Examples in Practice
Ready to practise for the NLE 2026?
Super Tutor's AI review plan adapts to your weak areas and builds a weekly practice schedule around your target NLE exam date.