NLE Community Health Nursing — Philippine Health Care Delivery System & DOH ProgramsConcept Map

Concept

Structure of the Philippine Health Care System

Sub Concepts

• Public (Government) Sector
• Private Sector (For-profit and Non-profit)
• Devolution under RA 7160 (Local Government Code 1991)
• Role of Local Government Units (LGUs)

Relationship To Central

Foundational framework defining how health services are organized and delivered

Concept

Department of Health (DOH)

Sub Concepts

• Central Office Structure
• Centers for Health Development (CHDs)
• DOH-Retained Hospitals and Specialty Centers
• Attached Agencies (PhilHealth, FDA, PITAHC)
• Sentrong Sigla Movement (Quality Assurance Program)

Relationship To Central

Lead agency responsible for policy-making, technical authority, and regulation of health system

Concept

Levels of Health Care and Referral System

Sub Concepts

• Primary Level (BHS, RHU, Health Centers)
• Secondary Level (District and Provincial Hospitals)
• Tertiary Level (Medical Centers, Specialty Hospitals)
• Upward Referral Process
• Downward/Back-Referral Process
• Two-Way Referral Documentation

Relationship To Central

Organizational structure determining where clients enter care and how services are coordinated

Concept

Primary Health Care (PHC)

Sub Concepts

• Alma-Ata Declaration (1978) and LOI 949 (1979)
• PHC Principles (4 As: Accessibility, Availability, Affordability, Acceptability)
• Community Participation as Core Cornerstone
• Intersectoral Coordination
• Appropriate Technology
• Essential Elements of PHC (ELEMENTS Mnemonic)
• PHC Worker Levels (BHWs, Intermediate-level Workers)

Relationship To Central

Cornerstone philosophy guiding community health nursing practice and service delivery

Concept

Universal Health Care Law (RA 11223)

Sub Concepts

• Automatic PhilHealth Enrollment
• Direct and Indirect Contributor Categories
• Population-Based vs Individual-Based Health Services
• Health Care Provider Networks
• Primary Care as Gateway
• Health Technology Assessment (HTA)
• Integration into Province/City-Wide Health Systems

Relationship To Central

Landmark legislation reshaping health financing and ensuring equitable access to care

Concept

PhilHealth (National Health Insurance Program)

Sub Concepts

• RA 7875 (National Health Insurance Act of 1995)
• Inpatient and Outpatient Benefit Packages
• Z-Benefits for Catastrophic Conditions
• Konsulta (Primary Care Benefit Package)
• Maternity Care Packages
• Client Eligibility and Access Navigation

Relationship To Central

Social health insurance mechanism providing financial protection and benefit coverage

Concept

Field Health Services Information System (FHSIS)

Sub Concepts

• Individual Treatment Record (ITR) as Basic Building Block
• Target Client Lists (TCLs) for Program Tracking
• Summary and Monthly Consolidation Tables
• Quarterly and Annual Reports
• Data Utilization for Local and National Planning

Relationship To Central

Official DOH recording and reporting system providing data for planning and program management

Concept

Roles of the Community Health Nurse

Sub Concepts

• Care Provider (Clinical and Community-Based)
• Health Educator (Core PHC Function)
• Manager/Supervisor (RHU Nursing Service, BHWs, Midwives)
• Coordinator/Collaborator (Inter-facility and Intersectoral)
• Recorder/Reporter (FHSIS and Program Records)
• Advocate and Community Organizer (Community Mobilization)

Relationship To Central

Specific functions nurses perform within the health care delivery system to operationalize it

To

Department of Health Role Transformation

From

Local Government Code RA 7160

Strength

strong

Relationship

Devolution shifted DOH from direct service provider to technical and regulatory authority

To

Centers for Health Development

From

Department of Health

Strength

strong

Relationship

CHDs serve as DOH's regional offices coordinating with LGUs on technical matters and standards

To

Community Participation

From

Primary Health Care

Strength

strong

Relationship

Community participation is the underlying cornerstone and core principle of PHC implementation

To

Philippine PHC Adoption LOI 949 1979

From

Alma-Ata Declaration 1978

Strength

strong

Relationship

Philippines adopted Alma-Ata principles through Letter of Instruction 949, making PHC official policy

To

Community Health Nurse Functions

From

Primary Health Care Essential Elements

Strength

strong

Relationship

The eight PHC elements (ELEMENTS mnemonic) guide and structure all CHN interventions in the community

To

Automatic PhilHealth Enrollment

From

Universal Health Care Law RA 11223

Strength

strong

Relationship

RA 11223 mandates automatic enrollment of all Filipinos, eliminating voluntary enrollment and employment-based coverage

To

Primary Care-Led Referral System

From

RA 11223 Universal Health Care

Strength

strong

Relationship

UHC Act reinforces the primary care gateway model where RHU/health center coordinates client care

To

Universal Health Care Implementation

From

PhilHealth National Health Insurance Program

Strength

strong

Relationship

PhilHealth is the social health insurance mechanism that operationalizes and finances UHC benefits

To

Rural Health Unit Quality

From

Sentrong Sigla Movement

Strength

moderate

Relationship

Sentrong Sigla is DOH's quality assurance program that certifies and improves RHU and health center standards

To

Two-Way Referral System

From

Levels of Care Primary Secondary Tertiary

Strength

strong

Relationship

The three levels are connected and integrated through upward referral and back-referral mechanisms

To

Community Health Nurse Coordination Role

From

Referral System

Strength

strong

Relationship

CHNs prepare referral forms, facilitate upward referral, and ensure back-referral follow-up and continuity

To

Individual Treatment Record ITR

From

Field Health Services Information System FHSIS

Strength

strong

Relationship

ITR is the basic building block of FHSIS; every client encounter is documented on an ITR

To

Program Coverage and No-Miss Strategy

From

Target Client Lists TCL

Strength

strong

Relationship

TCLs track program-specific clients (prenatal, EPI, TB, FP) ensuring comprehensive program coverage

To

FHSIS Quality and Accuracy

From

Community Health Nurse Data Recorder Role

Strength

strong

Relationship

CHNs are primary recorders responsible for accurate, complete, timely FHSIS data at the point of service

To

DOH Planning and Program Development

From

FHSIS Data

Strength

strong

Relationship

FHSIS data flows upward through municipal, city, and regional levels to inform DOH policy and program decisions

To

Community Health Nurse Multiple Roles

From

Rural Health Unit Primary Care Gateway

Strength

strong

Relationship

RHU is where CHNs operate as care providers, educators, managers, coordinators, and recorders simultaneously

To

RA 11223 Automatic Enrollment

From

PHC Accessibility Affordability Availability Acceptability

Strength

strong

Relationship

UHC automatic enrollment directly addresses PHC principles by removing financial and eligibility barriers

To

Community Health Nurse Supervision

From

Barangay Health Worker BHW

Strength

strong

Relationship

CHNs at RHU manage, train, and supervise BHWs who are the first community-level health resource

To

Community Participation and Mobilization

From

Health Education

Strength

strong

Relationship

Health education facilitates community understanding and engagement, enabling true participation in PHC

To

PHC Implementation

From

Intersectoral Coordination

Strength

moderate

Relationship

PHC recognizes health requires coordination beyond health sector (agriculture, education, water, housing, sanitation)

To

Primary Health Care Sustainability

From

Appropriate Technology

Strength

moderate

Relationship

PHC uses technology suited to local conditions and resources, ensuring sustainability and community ownership

To

Indirect Contributors PhilHealth

From

Direct Contributors PhilHealth

Strength

moderate

Relationship

RA 11223 classifies Filipinos into two membership categories with different premium arrangements but equal benefits

To

Government Financing

From

Population-Based Health Services

Strength

strong

Relationship

Population-based services like surveillance and promotion are government-financed, not PhilHealth-financed

To

PhilHealth Benefit Packages

From

Individual-Based Health Services

Strength

strong

Relationship

Individual services like consultations, tests, and medications are covered under PhilHealth benefit packages

To

PhilHealth Coverage Decisions

From

Health Technology Assessment HTA

Strength

moderate

Relationship

HTA is a mechanism to guide which services and technologies PhilHealth funds based on evidence and feasibility