PREVENTIVE COMMUNITY HEALTH II

COMPREHENSIVE EXAMINATION NOTES

Core Sciences of Public Health

• Prevention Effectiveness
• Epidemiology
• Laboratory
• Informatics
• Surveillance
Core Functions of Public Health
• Assessment
o Systematically collect, analyze, and make available information on healthy
communities
• Policy
o Promote the use of a scientific knowledge base in policy and decision
making
• Assurance
o Ensure the provision of services to those in need

Stakeholders in the Public Health System

• Ensuring the Conditions for Population Health
o Community
o Clinical Care Delivery System
o Government Public Health Infrastructure
o Employers and Businesses
o Academia
o The Media
§ Vehicle for public discourse
§ Health education and promotion
§ Health communication
§ Social media as a catalyst
o Employers and Businesses
§ Employer-sponsored health insurance programs
§ Wellness Initiatives and Benefits
§ Healthy Workplaces and Communities
o Government Agencies
§ City planning
§ Education
§ Health in all policies
o Academia
§ Education
§ Training
§ Research
§ Public Service
Health Determinants that Affect the Population Health
• Socio-Cultural
 • Physical Determinant
• Community Organization
• Behavioral Determinant
• Genes and Biology
• Health Behaviors
• Social or societal characteristics
• Health Services or Medical Care
• Good-To-Know:
o Socioeconomic Factors: Socioeconomic factors play a crucial role in
determining community health. These include income level, poverty,
education, employment opportunities, and social support systems.
Communities with higher levels of poverty and limited access to education
and employment opportunities often face greater health disparities and
poorer health outcomes.
o Environmental Factors: The environment in which a community exists
can greatly influence health. This includes aspects such as air and water
quality, access to green spaces and recreational facilities, exposure to
toxins and pollutants, and the availability of healthy food options. Poor
environmental conditions can lead to increased rates of respiratory
diseases, waterborne illnesses, and other health issues.
o Health Behaviors: Individual behaviors within a community also impact
overall health. Health behaviors include lifestyle choices such as diet,
physical activity, substance abuse, and tobacco use. Communities that
promote healthy behaviors through education, access to resources, and
supportive environments tend to have better health outcomes.
o Access to Healthcare: The availability and accessibility of healthcare
services are crucial for community health. Factors such as proximity to
healthcare facilities, affordability of care, health insurance coverage, and
the presence of healthcare professionals can significantly impact health
outcomes. Communities with limited access to healthcare services often
face barriers to receiving timely and appropriate care.
o Social Determinants of Health: Social determinants of health refer to the
social, economic, and political factors that influence health inequities.
These include factors such as race, ethnicity, gender, age, and social
capital. Health disparities can arise when certain groups within a
community experience discrimination, marginalization, or lack of
resources.

Health Impact Pyramid

Concepts and Principles of Disaster Risk Reduction
• Community-Based Approach: DRR in the Philippines adopts a community-based
approach, recognizing that communities play a crucial role in disaster
preparedness, response, and recovery. The principle emphasizes the active
participation and engagement of local communities in identifying and addressing
their specific risks and vulnerabilities, as well as promoting community resilience.
• Localization: The principle of localization highlights the importance of tailoring
DRR efforts to the local context, considering the specific characteristics, hazards,
vulnerabilities, and capacities of each region, province, municipality, or barangay
(village). It encourages the active involvement of local government units,
community organizations, and stakeholders in decision-making and
implementation processes.
• Risk Assessment and Mapping: Risk assessment is a key concept in DRR,
involving the systematic analysis and evaluation of hazards, vulnerabilities, and
capacities to understand and quantify the level of risk. In the Philippines, risk
assessment and mapping initiatives, such as the Nationwide Operational
Assessment of Hazards (Project NOAH) and the GeoRisk Philippines project,
aim to provide accurate and up-to-date information on hazards and vulnerabilities
for informed decision-making.
• Early Warning Systems: Early warning systems are crucial in a disaster-prone
country like the Philippines. The principles of timely and effective warning
systems involve the development and implementation of systems that can detect
and disseminate warnings for various hazards, including typhoons, earthquakes,
and volcanic eruptions. These systems enable individuals, communities, and
authorities to take appropriate actions and evacuate if necessary.
 • Building Back Better: The concept of building back better emphasizes the
opportunity to enhance resilience during post-disaster reconstruction and
recovery. It involves incorporating DRR principles into the reconstruction process,
such as applying resilient building codes, integrating risk reduction measures in
infrastructure development, and ensuring that communities are more prepared
and resilient for future disasters.
• Multi-Stakeholder Collaboration: DRR in the Philippines recognizes the
importance of multi-stakeholder collaboration and partnership. This involves
close coordination and cooperation among government agencies, local
authorities, civil society organizations, private sector entities, and communities to
share knowledge, resources, and expertise, and work together to reduce disaster
risks.
• Mainstreaming DRR: The principle of mainstreaming DRR emphasizes
integrating DRR considerations into policies, plans, programs, and development
processes at various levels. It involves incorporating DRR in land-use planning,
infrastructure development, education curricula, health systems, and other
sectors to ensure that disaster risk reduction becomes an integral part of
sustainable development.

Key terms: Disaster, Risk, Hazard, Vulnerability

• Disaster: A disaster refers to a sudden or prolonged event that causes significant
disruption, damage, and destruction, often resulting in human suffering, loss of life,
and extensive damage to infrastructure, environment, and livelihoods. Disasters
can be triggered by natural events (such as earthquakes, floods, hurricanes) or
human-made incidents (such as industrial accidents, conflicts).
• Risk: Risk is the probability of an event occurring and the potential negative
consequences or impacts that may result from that event. In the context of disaster
risk reduction, risk is the combination of hazards, vulnerabilities, and exposure. It
assesses the likelihood and potential severity of the adverse effects of a hazard
on vulnerable elements, such as people, assets, or the environment.
• Hazard: A hazard refers to a natural or human-made phenomenon or process that
has the potential to cause harm, damage, or loss. Hazards can include geological
events (earthquakes, volcanic eruptions), hydrological events (floods, tsunamis),
meteorological events (storms, hurricanes), biological events (disease outbreaks),
technological events (industrial accidents, chemical spills), and socio-political
events (conflicts, terrorism).
• Vulnerability: Vulnerability refers to the characteristics and conditions of
individuals, communities, systems, or assets that make them susceptible to the
impacts of hazards. It represents the weaknesses, limitations, or lack of resilience
in socio-economic, physical, environmental, and institutional dimensions.
Vulnerability can be influenced by factors such as poverty, inadequate
infrastructure, social inequalities, limited access to resources or services, and
weak governance.
Economic Evaluation Methods
• The choice of economic evaluations used is dependent on:
o Audience
o Study Question
o Data

• Economic evaluations of a prevention effectiveness study involve four common

methods:
o Cost-Analysis identifies the total cost for a program or intervention. It is
typically reported as the cost per patient or cost per service rendered.
§ Achieves cost minimization for the program under
consideration
o Cost-Effectiveness is used to estimate the dollars per life saved. It
measures dollars expended per health outcome attained.
§ Most common economic analysis in public health, is useful
when comparing one or more interventions for the same
disease or condition among a common population
o Cost-Utility Study looks at outcomes measured in quality-adjusted life
years. The standard formula is used to determine—for example is 1 year
of perfect health = 1 QALY, but if the quality of health is reduced during
that year, the QALY is proportionally reduced.
o The Cost-Benefit method converts health outcomes into dollars on the
basis of willingness to pay for the health outcomes, and the results are
provided as net costs or net savings.
§ Controversial and difficult because the cost of a life is being
referenced.

Prevention Effectiveness Costs

• Good to Know: Economic Costs
o Cost is a component in most prevention effectiveness studies, particularly
economic evaluations
 • Direct Costs
o Medications
o Medical Devices
o Computer Software and Equipment
o Research and Development
o Inpatient Care
• Indirect Costs
o Change in productivity
o Costs of absenteeism
o Foregone leisure time
o Time spent caring for the patient
o Includes time or productivity
§ Example: patient is not working because of a scheduled
appointment at the doctor’s office, time, and productivity are lost at
the job.
• Intangible Costs
o Physical pain and suffering
o Emotional Anxiety
• Opportunity Costs
o Monetary and Non-Monetary
o Costs and Charges
o Limited Resources = Not all interventions can be implemented
o The cost of a prevention strategy must reflect what might be gained by
alternative strategies
§ Can be monetary or non-monetary
o Social Stigmatization
o Often difficult to measure with a monetary value, yet they affect decision-
making. They include what the patient perceives as a risk.
Scope of Prevention Effectiveness
• Examine costs and benefits
• Evaluation and allocation of healthcare resources
• Assessment of the Impact of Different Policies, Programs, and Practices
The Health Systems Definition
• Referred to as health care system; is the organization of people, institutions, and
resources that deliver healthcare services to meet the health needs of target
populations
• Includes efforts to influence determinants of health as well as more direct health-
improving activities
• Goal
o Providing a route from inputs to health outcomes is through achieving
greater access to and coverage for effective health interventions, without
compromising the efforts to ensure and provide quality and safety.
Building Blocks of Health System
• Health Services: those which deliver effective, safe, quality personal and non-
personal health interventions to those that need them, when and where needed,
with minimum waste of resources.
 • Health Workforce: one that works in ways that are responsive, fair, and efficient
to achieve the best health outcomes possible, given available resources and
circumstances
• Health Information System: one that ensures the production, analysis,
dissemination, and use of reliable and timely information on health determinants,
health system performance, and health status.
• Access to Essential Medical Products, Vaccines, and Technologies: assured
quality, safety, efficacy, and cost-effectiveness, and their scientifically sound and
cost-effective use.
• Health Financing: system raises adequate funds for health, in ways that ensure
people can use needed services and are protected from financial catastrophe, or
impoverishment associated with having to pay for them. It provides incentives for
providers and users to be efficient.
• Leadership and Governance involve ensuring strategic policy frameworks exist
and are combined with effective oversight, coalition-building, regulation, attention
to system design, and accountability.

The Indicators of the Health System (Not Sure, Can’t Find PPT)
• Access to Healthcare: This indicator measures the extent to which individuals
can obtain timely and affordable healthcare services. It includes metrics such as
the availability of healthcare facilities, healthcare workforce density, geographic
accessibility, waiting times for services, and financial barriers to access.
• Health Expenditure: Health expenditure indicators assess the financial resources
allocated to the healthcare system. This includes total health expenditure as a
percentage of gross domestic product (GDP), per capita health expenditure,
public and private health spending, and the allocation of funds to different
healthcare sectors (e.g., primary care, hospitals, public health).
• Health Workforce: Health workforce indicators focus on the availability,
distribution, and capacity of healthcare professionals. It includes metrics such as
physician-to-population ratio, nurse-to-population ratio, healthcare worker
retention rates, and the skill mix of healthcare providers.
• Quality of Care: Quality of care indicators assess the safety, effectiveness,
efficiency, patient-centeredness, and equity of healthcare services. This can
include measures such as patient satisfaction surveys, adherence to clinical
guidelines, hospital-acquired infection rates, avoidable hospital readmissions,
and mortality/morbidity rates for specific conditions or procedures.
• Health Outcomes: Health outcome indicators measure the overall impact of the
healthcare system on population health. This includes metrics such as life
expectancy, infant mortality rate, under-five mortality rate, maternal mortality rate,
disease-specific mortality rates, and disability-adjusted life years (DALYs).
• Health Information Systems: Indicators related to health information systems
evaluate the availability, accessibility, and quality of health data and information.
This includes metrics such as electronic health record adoption, data
completeness and accuracy, disease surveillance systems, and health
information exchange capabilities.
 • Equity: Equity indicators focus on measuring the fairness and distribution of
healthcare services across different population groups. This includes assessing
disparities in access to care, health outcomes, and healthcare utilization based
on socio-economic status, ethnicity, gender, and geographic location.
• Patient Safety: Patient safety indicators assess the occurrence of adverse
events, medical errors, and healthcare-associated infections. This includes
metrics such as hospital-acquired infection rates, medication errors, surgical
complications, and near misses.

The Outcomes of the Health System (Not Sure, Can’t Find PPT)
• Improved Population Health: The ultimate goal of a health system is to improve
the overall health of the population it serves. Positive outcomes include
increased life expectancy, reduced mortality rates, decreased disease burden,
improved health-related quality of life, and better management of chronic
conditions.
• Reduced Morbidity and Mortality: A well-functioning health system aims to
minimize the occurrence and impact of diseases and injuries. Outcomes related
to reduced morbidity and mortality include decreased rates of infectious
diseases, lower incidence of preventable conditions, fewer complications from
medical procedures, and improved survival rates for serious illnesses.
• Enhanced Access to Care: Access to timely and appropriate healthcare services
is a crucial outcome of a health system. Positive outcomes in this area include
increased availability of healthcare facilities, reduced waiting times for services,
improved geographical accessibility, decreased financial barriers, and equitable
distribution of services across population groups.
• Improved Patient Experience and Satisfaction: Patient-centered care is an
important aspect of a high-quality health system. Positive outcomes in this area
include higher patient satisfaction levels, improved communication and shared
decision-making between patients and healthcare providers, respect for patient
preferences, and better overall patient experience.
• Quality and Safety of Care: High-quality care that is safe and effective is a key
outcome of a well-performing health system. Positive outcomes in this domain
include adherence to clinical guidelines and best practices, reduced medical
errors and adverse events, lower rates of healthcare-associated infections,
improved patient safety culture, and effective coordination of care across different
healthcare settings.
• Efficient and Effective Resource Allocation: A health system should strive for
efficient use of resources to maximize health outcomes. Positive outcomes
include optimal allocation of financial resources, reducing waste and
inefficiencies, appropriate utilization of healthcare services, the cost-effectiveness
of interventions, and sustainable financing mechanisms.
• Health Equity and Reduced Disparities: A desirable outcome of a health system
is the reduction of health disparities and the achievement of health equity.
Positive outcomes include decreased inequalities in access to care and health
outcomes among different population groups, improved health outcomes for
 marginalized and vulnerable populations, and fair distribution of resources and
services.

Prevention Strategies in Prevention Effectiveness

• Prevention effectiveness is the systematic assessment of the impact of public
health policies, programs, and practices on health outcomes by determining their
effectiveness, safety, and costs

Design Approaches in Prevention Effectiveness

• Problem Identification
o Any health-related situation in which a policy solution or management
decision can be applied
• Audience Identification
o Policy and Program Decision Makers
o Healthcare Organizations
o Researchers
o Clinical Workers
o The General Public
 o The Media
• Perspective Identification

Difference Between Public Health and Clinical Medicine

• Public Health
o Population Focus
o Public Health Ethic
o Prevention or Public Health Emphasis
o Joint Laboratory and Field Involvement
o Clinical Sciences Peripheral to Professional Training
o Public Sector Basis
• Clinical Medicine
o Individual Patient Focus
o Personal Service Ethics
o Diagnosis and Treatment Emphasis
o Joint Laboratory and Patient Involvement
o Clinical Sciences Essential to Professional Training
o Private Sector Basis

Austin Bradford Hill’s Criteria: Temporality, Specificity, Experiment, Coherence,

Strength of Association
• Used to evaluate the evidence supporting a causal relationship between an
exposure and an outcome in observational studies:
 o Strength: A strong association between exposure and the outcome
increases the likelihood of a causal relationship. A large effect size
suggests a more probable causal relationship.
o Consistency: The relationship between exposure and the outcome
should be consistently observed in different studies, populations, and
settings. Replication of findings adds weight to the evidence.
o Specificity: A specific association between a particular exposure and a
distinct outcome supports a causal relationship. However, specificity is not
necessary for causation, as many exposures can lead to multiple
outcomes.
o Temporality: The exposure should precede the outcome in time.
Establishing a temporal relationship is crucial for inferring causation.
o Biological gradient (Dose-response relationship): A dose-response
relationship implies that increasing exposure to a factor leads to a
corresponding increase in the risk or severity of the outcome. This
provides additional evidence for causation.
o Plausibility: The proposed causal relationship should be biologically
plausible and supported by existing knowledge of the subject. Mechanistic
explanations and coherence with established theories enhance plausibility.
o Coherence: The causal relationship should be consistent with known
facts and other established causal associations.
o Experiment: Evidence from experimental studies, such as randomized
controlled trials, can provide stronger support for causation as they allow
for greater control over confounding factors.
o Analogy: If similar relationships have been established between other
exposures and outcomes, it adds weight to the evidence for causation.

Definition of Health, Community Health, and Wellness

• Health: the state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity
• Wellness: a state in which the needs of each of the key aspects are met and all
aspects of your WHOLE SELF are able to work in harmony with each other.
Ecologic Concept of Disease
• Disease: a failure of the body’s defense mechanism to cope with forces tending
to disturb body equilibrium
• Ecologic Concept of Disease:
o Based on the three premises of the biological laws:
§ The disease is the result of the imbalance between the forces of the
agent and the host
§ The resulting imbalance depends on the nature of the agent and
the host
§ The nature of the agent and the host and their interaction depends
on the environment
Sustainable Development Goals
• The Sustainable Development Goals (SDGs) are a set of 17 global goals
adopted by the United Nations (UN) in 2015 as part of the 2030 Agenda for
Sustainable Development.
• These goals provide a blueprint for addressing global challenges and achieving a
more sustainable and equitable future for all.
• The SDGs encompass a wide range of interconnected issues, including social,
economic, and environmental dimensions.
• The Sustainable Development Goals:
a. No Poverty: End poverty in all its forms and dimensions, including extreme
poverty.
b. Zero Hunger: End hunger, achieve food security, improve nutrition, and
promote sustainable agriculture.
c. Good Health and Well-Being: Ensure healthy lives and promote well-being
for all at all ages, focusing on various health issues and access to
healthcare services.
d. Quality Education: Ensure inclusive and equitable quality education and
promote lifelong learning opportunities for all.
e. Gender Equality: Achieve gender equality and empower all women and
girls, addressing issues of discrimination and violence.
f. Clean Water and Sanitation: Ensure the availability and sustainable
management of water and sanitation for all.
g. Affordable and Clean Energy: Ensure access to affordable, reliable,
sustainable, and modern energy for all.
h. Decent Work and Economic Growth: Promote sustained, inclusive, and
sustainable economic growth, full and productive employment, and decent
work for all.
i. Industry, Innovation, and Infrastructure: Build resilient infrastructure,
promote inclusive and sustainable industrialization, and foster innovation.
j. Reduced Inequalities: Reduce inequality within and among countries,
addressing disparities based on income, gender, age, disability, and other
factors.
k. Sustainable Cities and Communities: Make cities and human settlements
inclusive, safe, resilient, and sustainable.
l. Responsible Consumption and Production: Ensure sustainable
consumption and production patterns, promoting resource efficiency and
sustainable lifestyles.
m. Climate Action: Take urgent action to combat climate change and its
impacts, including through mitigation, adaptation, and capacity-building.
n. Life Below Water: Conserve and sustainably use the oceans, seas, and
marine resources for sustainable development.
o. Life on Land: Protect, restore, and promote sustainable use of terrestrial
ecosystems, sustainably manage forests, combat desertification, halt and
reverse land degradation, and halt biodiversity loss.
p. Peace, Justice, and Strong Institutions: Promote peaceful and inclusive
societies, provide access to justice for all, and build effective, accountable,
and inclusive institutions at all levels.
 q. Partnerships for the Goals: Strengthen the means of implementation and
revitalize the global partnership for sustainable development.

Indicators of Community Health Status

• Vital Indices
o Crude Birth Rate: measures of fertility
o Crude Death Rate: risk of dying from any cause
• Disease Indices
o Morbidity:
§ Incidence rate- the risk of developing the disease
§ Prevalence rate- the proportion of the population suffering from a
disease at a given instant in time
o Mortality:
§ Cause-specific mortality rate- the risk of dying from a specific
disease
§ Age-specific mortality rate- the risk of dying for a specific age
group
§ Case- Fatality rate- killing power of a disease, also reflects care
given to patients
§ Proportionate Mortality Rate- Proportion of total deaths ascribed
to a specific disease
§ Maternal Mortality Rate- the risk of a woman dying associated
with pregnancy, delivery & puerperium
§ Stillbirth or Fetal Mortality Rate- the risk of losing the product of
conception before delivery
§ Infant Mortality Rate- risk of Dying during the first year of life
§ Neonatal Mortality rate- the risk of dying during the first 28 days of
life.
§ Perinatal Mortality Rate- the sum of stillbirth and neonatal death
rate
Preventive and Control Measures for Agent, Host, and Environment
• Agent
o Isolation and Quarantine
o Slaughter of Animals
• Environment: measure towards agent while in transit from the reservoir to
susceptible individuals consisting mostly of sanitary measures:
o Disinfection
o Disinfection: fumigation, delousing, etc.
o Provision of Safe and Adequate Water Supply
o Food and Milk Sanitation
o Insect Vector Control
o Control of Animals
o Building Sanitation Facilities
• Host: increasing resistance of host by specific or non-specific means
o Specific
§ Active immunization
§ Passive immunization
§ Chemoprophylaxis
o Non-Specific
§ Health education and motivation
§ Socio-economic improvement including the provision of adequate
nutrition

Strategy to Improve Host Resistance

• Achieved by general health promotion or personal hygiene and increasing
resistance to specific diseases by immunization, chemoprophylaxis, and
mechanical prophylaxis
• Personal Hygiene: include all activities to ensure body fitness which refers to
proper development and vitality of musculoskeletal, circulatory, respiratory,
digestive secretory, nervous, integumentary, and reproductive systems.
o Exercise, Posture, Rest, Relaxation, and Sleep
o Nutrition: adequate intake, eating habit
o Development of the Healthful Habits and Personal Cleanliness
o Genetic and Marriage Counseling
o Avoidance of Exposure
o Removal of Pre-Disease Conditions
o Proper Personality Development with Healthy Social Life and Sexual Life

Definition of community health needs assessment, Community health

improvement plan, Community development, Community engagement

• Community health is the intersection of healthcare, economics, and social

interaction. A medical specialty that focuses on the physical and mental well-being
of the people in a specific geographic region. This important subsection of public
 health includes initiatives to help community members maintain and improve their
health, prevent the spread of infectious diseases and prepare for natural disasters.
• Community Health Needs Assessment (CHNA) is a systematic process involving
the community to identify and analyze community health needs. The process
provides a way for communities to prioritize health needs, and to plan and act upon
unmet community health needs.
• Community Health Improvement Plan→ Health assessment activities and the
community health improvement process
• Community engagement is the process by which individuals from the community,
stakeholder organizations, and hospitals work collaboratively to identify the needs most
important to residents and pursue meaningful strategies to address those needs.

Step Processes in Conducting Community Health Needs Assessment

• Initial Communication
o Communication is the foundation for the community health needs
assessment and its success is contingent upon open and transparent
communication and developing a strong communication channel with
organizational leadership
• Develop a Steering Committee
o A strategy to help gain support in carrying out all of the tasks associated
with a CHNA and make the process collaborative in nature
o The steering committee provides continuity and local guidance to the
CHNA process, so it reflects your community
o The steering committee should consist of 1-2 other individuals who can
assist in providing oversight to the CHNA process and completing the
required tasks.
o The steering committee must include a public health staff and hospital
employee or board member, as well as other volunteers who will
spearhead the CHNA process.
• Survey Development
o The CHNA survey tool contains both open-ended and close-ended
questions and is a good way to gather honest, anonymous feedback.
o The survey will be available to all community members at locations
throughout the country.
o It includes a set of base questions, and the steering committee will have
the opportunity to select additional community questions from a list of
sample options
• Plan Community Meeting One
o Review the community's calendar, and venue availability to select three
potential dates for an on-site Community Meeting.
o Invite community members to participate in either of two forms of
facilitated discussions:
§ Key informant interviews, which are 45 minutes, one-on-one
meetings with people who are actively involved in the community
§ A community meeting, which is an hour-and-a-half discussion with
10 to 15 community stakeholders
• Launch Media Campaign and Distribute Survey
o Surveys are intended to be an additional tool for collecting qualitative
information about community perceptions, not a method of collecting
statistically valid data
o Distribute the surveys as widely as possible to area residents, taking care
to make them available to different demographic groups, including lower-
income residents, medically underserved residents, minority residents,
and residents with chronic health conditions.
• Hold the First Community
o On the Agenda for Community Meeting One:
§ Overview of the process
§ Share the hospital’s services, community benefits, and
demographic data.
§ Conduct a focus group session exploring the topics of the survey in
greater detail.
§ Explain the process for survey distribution to community members
§ Completion and distribution of surveys
• Finalize Survey Distribution and Plan Community Meeting Two
o As the survey window ends, monitor survey completion rates and ensure
surveys have been collected from distribution sites throughout the
community.
o Working with the Steering Committee, review the community’s calendar,
and venue availability to select three potential dates for Community
Meeting Two.
o Meeting participants will review survey results, findings from Community
Meeting One, and any key informant interviews, along with secondary
data about health conditions and indicators.
• Hold Community Meeting Two
o On the agenda for Community Meeting Two:
§ Presentation of secondary data about health conditions and
indicators
§ Presentation of results of a community survey
§ Presentation of findings of key informant interviews and Community
Meeting One
§ Presentation of a list of community health needs
§ Prioritize the identified health needs
• Closing the CHNA Process
o Based on the decisions and recommendations stemming from Community
Meeting Two, a Community Health Needs Assessment report will be
written.
o The draft will be sent to the liaison for review, then the CRH will send a
finalized report to the liaison.
o The report will then need to be approved by the hospital’s board of
directors. Distribute the CHNA report widely to the community.
o Ensure that the report is prominently displayed on the organization’s
website and at the front desk.
 o Thank the community for their effort, participation, and community
engagement
• Implementation Plan and Outcomes
o Following the receipt of your final report, you will create an implementation
plan.
o The implementation plan must be completed and approved by your board
within five months and fifteen days following your taxable year.

Steps in the Community Health Assessment Process and Toolkit

Definition of Health Promotion and Disease Prevention

• Health promotion refers to the process of enabling individuals and communities

to take control of their health and make informed choices that lead to a healthy
lifestyle. It involves empowering people to enhance their health through
 education, awareness, and behavior change. Health promotion activities focus on
addressing the underlying determinants of health, such as socioeconomic
factors, environmental conditions, and individual behaviors, to promote positive
health outcomes. These activities may include health education campaigns,
community outreach programs, policy advocacy, and creating supportive
environments that foster healthy behaviors.

• On the other hand, disease prevention involves specific strategies and

interventions designed to prevent the onset of diseases or detect them at an
early stage to minimize their impact. It aims to reduce the incidence, prevalence,
and severity of diseases by implementing interventions targeted at high-risk
individuals or the entire population. Disease prevention strategies can be
categorized into three levels:

o Primary prevention: This level aims to prevent the occurrence of a disease

before it develops. It focuses on reducing risk factors and promoting
protective factors. Examples include immunizations, healthy eating
initiatives, regular physical activity, and smoking cessation programs.
o Secondary prevention: This level aims to detect and treat diseases in their
early stages, often before symptoms appear. It involves screening
programs and early detection efforts to identify individuals who may have
a disease but are not yet symptomatic. Examples include mammography
for breast cancer, Pap smears for cervical cancer, and blood pressure
screenings for hypertension.
o Tertiary prevention: This level focuses on managing and mitigating the
impact of established diseases to prevent complications, disability, and
further progression. It involves interventions to improve quality of life,
reduce disability, and prevent relapses or complications. Examples include
rehabilitation programs, chronic disease management, and support
groups.

Population Health Strategy

• Identifying the social determinants of health in the community
• Engaging the community
• Strengthening partnerships and collaboration
• Identifying strengths, assets, challenges, and barriers
• Coordinating and ensuring access to healthcare services through care
coordination strategies, networks and coalitions, integrated services, and
transportation.

Models of Behavioral change: Ecological, Health belief model, Stages of changes,

Social cognitive, Theory of reasoned action

• Ecological models recognize multiple levels of influence on health behaviors,

including:
 o Intrapersonal/individual factors, influence behavior such as knowledge,
attitudes, beliefs, and personality.
o Interpersonal factors, such as interactions with other people, can provide
social support or create barriers to interpersonal growth that promotes
healthy behavior.
o Institutional and organizational factors, including the rules, regulations,
policies, and informal structures constrain or promote healthy behaviors.
o Community factors, such as formal or informal social norms that exist
among individuals, groups, or organizations, can limit or enhance healthy
behaviors.
o Public policy factors, including local, state, and federal policies and laws
that regulate or support health actions and practices for disease
prevention including early detection, control, and management.
o Examples:
§ Project HEART (Health Education Awareness Research Team)
used an ecological model to design a health promotion and disease
prevention program to address cardiovascular disease risk factors.
The project uses a community health worker (CHW) promotora
model to provide services.
§ CDC's Colorectal Cancer Control Program (CRCCP) was designed
to address multiple factors of influence on colorectal cancer
prevention, using ecological model components.
§ Rural networks and coalitions often acknowledge multiple factors of
influence and may be designed using theoretical components of
ecological models. More information is available in the Rural Health
Networks and Coalitions Toolkit.
o a useful framework for understanding the range of factors that influence
health and well-being. It is a model that can assist in providing a complete
perspective of the factors that affect specific health behaviors, including
the social determinants of health.
• The Health Belief Model
o a theoretical model that can be used to guide health promotion and
disease prevention programs. It is used to explain and predict individual
changes in health behaviors. It is one of the most widely used models for
understanding health behaviors.
o The model defines the key factors that influence health behaviors as an
individual's perceived threat to sickness or disease (perceived
susceptibility), the belief of consequence (perceived severity), potential
positive benefits of action (perceived benefits), perceived barriers to
action, exposure to factors that prompt action (cues to action), and
confidence in the ability to succeed (self-efficacy).
o The first four constructs were developed as the original tenets of the HBM.
The last two were added as research about the HBM evolved.
§ Perceived susceptibility - This refers to a person's subjective
perception of the risk of acquiring an illness or disease. There is
 wide variation in a person's feelings of personal vulnerability to an
illness or disease.
§ Perceived severity - This refers to a person's feelings on the
seriousness of contracting an illness or disease (or leaving the
illness or disease untreated). There is wide variation in a person's
feelings of severity, and often a person considers the medical
consequences (e.g., death, disability) and social consequences
(e.g., family life, social relationships) when evaluating the severity.
§ Perceived benefits - This refers to a person's perception of the
effectiveness of various actions available to reduce the threat of
illness or disease (or to cure illness or disease). The course of
action a person takes in preventing (or curing) illness or disease
relies on consideration and evaluation of both perceived
susceptibility and perceived benefit, such that the person would
accept the recommended health action if it was perceived as
beneficial.
§ Perceived barriers - This refers to a person's feelings on the
obstacles to performing a recommended health action. There is
wide variation in a person's feelings of barriers, or impediments,
which lead to a cost/benefit analysis. The person weighs the
effectiveness of the actions against the perception that it may be
expensive, dangerous (e.g., side effects), unpleasant (e.g., painful),
time-consuming, or inconvenient.
§ Cue to action - This is the stimulus needed to trigger the decision-
making process to accept a recommended health action. These
cues can be internal (e.g., chest pains, wheezing, etc.) or external
(e.g., advice from others, illness of a family member, newspaper
article, etc.).
§ Self-efficacy - This refers to the level of a person's confidence in his
or her ability to successfully perform a behavior. This construct was
added to the model most recently in mid-1980. Self-efficacy is a
construct in many behavioral theories as it directly relates to
whether a person performs the desired behavior.
• Stages of Change Model
o Pre-contemplation: There is no intention of taking action.
o Contemplation: There are intentions to take action and a plan to do so in
the near future.
o Preparation: There is the intention to take action and some steps have
been taken.
o Action: Behavior has been changed for a short period of time.
o Maintenance: Behavior has been changed and continues to be maintained
for the long-term.
o Termination: There is no desire to return to prior negative behaviors.
• Social-Cognitive Theory
o describes the influence of individual experiences, the actions of others,
and environmental factors on individual health behaviors. SCT provides
 opportunities for social support through instilling expectations, and self-
efficacy, and using observational learning and other reinforcements to
achieve behavior change.
o Key components of the SCT related to individual behavior change include:
§ Self-efficacy: The belief that an individual has control over and is
able to execute a behavior.
§ Behavioral capability: Understanding and having the skill to perform
a behavior.
§ Expectations: Determining the outcomes of behavior change.
§ Expectancies: Assigning a value to the outcomes of behavior
change.
§ Self-control: Regulating and monitoring individual behavior.
§ Observational learning: Watching and observing outcomes of
others performing or modeling the desired behavior.
§ Reinforcements: Promoting incentives and rewards that encourage
behavior change.
• The Theory of Reasoned Action (TRA) is a social psychological theory that
explains and predicts human behavior based on individuals' attitudes, beliefs,
and subjective norms. Developed by Martin Fishbein and Icek Ajzen in the late
1960s, the TRA provides insights into how individuals make decisions and form
intentions to engage in specific behaviors. The central premise of the Theory of
Reasoned Action is that individuals' behavioral intentions are influenced by two
primary factors:
o Attitudes: Attitudes refer to an individual's overall evaluation or
assessment of a particular behavior. It involves their beliefs about the
positive or negative outcomes associated with performing the behavior
and the subjective value they place on those outcomes. Positive attitudes
toward a behavior are more likely to result in the intention to perform that
behavior, while negative attitudes are associated with the intention to
avoid it.
o Subjective norms: Subjective norms reflect the perceived social pressure
or expectations from significant others regarding a specific behavior.
These norms can come from family, friends, peers, or societal influences.
Subjective norms are determined by the individual's beliefs about whether
important others approve or disapprove of the behavior, as well as the
individual's motivation to comply with those beliefs. If an individual
perceives social pressure or a strong normative influence to perform or
avoid a behavior, it is more likely to affect their intention to engage in that
behavior.

Levels of Community Engagement

• Community engagement can take many forms, and partners can include
organized groups, agencies, institutions, or individuals. Collaborators may be
engaged in health promotion, research, or policymaking.
Concepts of Community

1. Systems Perspective
a. From a systems perspective, a community is similar to a living creature,
comprising different parts that represent specialized functions, activities, or
interests, each operating within specific boundaries to meet community
needs. For example, schools focus on education, the transportation sector
focuses on moving people and products, economic entities focus on
enterprise and employment, faith organizations focus on the spiritual and
physical well-being of people, and healthcare agencies focus on the
prevention and treatment of diseases and injuries (Henry, 2011). For the
community to function well, each part has to effectively carry out its role in
relation to the whole organism. A healthy community has well-connected,
interdependent sectors that share responsibility for recognizing and
resolving problems and enhancing its well-being. Successfully addressing
a community’s complex problems requires integration, collaboration, and
coordination of resources from all parts (Thompson et al., 1990). From a
systems perspective, then, collaboration is a logical approach to health
improvement.
2. Social Perspective
a. A community can also be defined by describing the social and political
networks that link individuals, community organizations, and leaders.
Understanding these networks is critical to planning efforts in
engagement. For example, tracing social ties among individuals may help
engagement leaders to identify a community’s leadership, understand its
behavior patterns, identify its high-risk groups, and strengthen its networks
(Minkler et al., 1997).
 3. Virtual Perspective
a. Some communities map onto geographically defined areas, but today,
individuals rely more and more on computer-mediated communications to
access information, meet people, and make decisions that affect their lives
(Kozinets, 2002). Examples of computer-mediated forms of
communication include email, instant or text messaging, e-chat rooms,
and social networking sites such as Facebook, YouTube, and Twitter
(Flavian et al., 2005). Social groups or groups with a common interest that
interact in an organized fashion on the Internet are considered “virtual
communities” (Rheingold, 2000; Ridings et al., 2002). Without question,
these virtual communities are potential partners for community-engaged
health promotion and research.
4. Individual Perspective
a. Individuals have their own sense of community members that is beyond
the definitions of community applied by researchers and engagement
leaders. Moreover, they may have a sense of belonging to more than one
community. In addition, their sense of membership can change over time
and may affect their participation in community activities (Minkler et al.,
2004).
Definition of Community Development vs Community-Based Work
Community Organization
• The process where the community identifies its needs or objectives, orders these
needs or objectives, develops the confidence and will to work at these needs or
objectives, and finds the resources to deal with these needs.
 • Goal:
o To bring about the desire for community improvement
o Lead empowerment in the community

3 Models of Community Development

• Social Planning
o The process of People of a community defining their needs and working
out what has to happen in order to have them met, as well as how the
existing services and resources can be coordinated and utilized to best
effect.
o This method works with a large population.
o An Agency exists that will undertake an exercise of evaluating welfare
needs and existing services in the area and planning possible community
health plans for a more efficient delivery of services to the social problem
e.g. TESDA, DSWD, DepEd
o It is a responsive model to the needs and attitudes of the community like
housing, health insurance, education
o Emphasizes a technical process of problem-solving regarding substantive
social problems
o Deals with concrete deficiencies, defects, or illnesses
o Goal:
§ Address social issues/problems
o Focus:
§ Social Problems and social needs
o Indicators:
 § Coordination of services, initiation, and development of new
services and facilities
• Social Action
o A strategy used by groups or sub-communities or even national
organizations that feel that they have inadequate power and resources to
meet their needs, so they confront the power structure using conflict as a
method to solve their issues related to inequalities and deprivation
o Goal: Shifting power and resources to focus on an aggrieved or
disadvantaged segment of the population that needs to be organized in
order to make demands on the larger community for increased resources
or equal treatment.
o Indicators:
§ Change in the External environment
§ Change social practices and policies
§ Change legislation/laws and policies and practices of government
and other organizations
§ Focus
• Policies, power, and Decision-making
• help people acquire and exercise power
• Locality Development
o It is a method of working with community people.
o The process of community building
o Enhances the involvement of the people in the community through
planning and finding solution
o Goal:
§ Helping people to help themselves (Empowerment)
o Focus:
§ Process of educating people and nurturing personal development
§ Community Capacity to become integrated and to engage in
cooperative problem-solving.
o Indicator:
§ Participation by a variety of people at the local community level.
§ Leadership development and education of the participants are the
essential elements in the process
Community Participation, Community Building
• When developing a community, you build the community
• Building social capital
o Sense of belonging
o Networks
o Citizen power and participation
o Feelings of trust and safety
o Diversity
o Sharing of knowledge and resources
• Strengthening the social interactions
• Bringing people together
• Helping people communicate with each other
 • Capacity Building
o Can be assessed
through:
§ The willingness of the people to get involved
§ Skills, knowledge, and abilities
§ Wellness and Community Health
§ Ability to identify and access opportunities
§ Motivation to carry out initiatives
§ Infrastructure, supportive institutions, and physical resources
§ Leadership and the structure needed for Participation
§ Economic and financial resources
§ Enabling policies and local health system

Risk Factors for cardiovascular disease and community intervention

• In the context of the Philippines, where CVD is a leading cause of morbidity and
mortality, several risk factors contribute to the high burden of the disease.
Additionally, community interventions are vital in addressing these risk factors
and promoting cardiovascular health. Here are some common risk factors for
CVD in the Philippines and potential community interventions:
o Hypertension: High blood pressure is a significant risk factor for CVD.
Community interventions may include:
§ Conducting blood pressure screening campaigns in communities
and providing education on the importance of regular monitoring.
 § Promoting lifestyle modifications, such as adopting a healthy diet
low in salt and saturated fats, encouraging physical activity, and
reducing alcohol consumption.
§ Collaborating with local healthcare providers to ensure access to
affordable and effective hypertension management, including
medication adherence.
o Unhealthy Diet: Poor dietary habits, including high intake of processed
foods, unhealthy fats, and sugary beverages, contribute to CVD.
Community interventions may include:
§ Establishing community gardens and promoting local, nutritious
food production.
§ Conducting nutrition education programs that emphasize the
importance of a balanced diet rich in fruits, vegetables, whole
grains, and lean proteins.
§ Advocating for policies and regulations that promote healthier food
environments, such as limiting the marketing of unhealthy foods to
children.
o Physical Inactivity: Sedentary lifestyles increase the risk of CVD.
Community interventions may include:
§ Organizing community-wide physical activity initiatives, such as
group exercises, walking or biking campaigns, and sports events.
Creating safe and accessible recreational spaces in communities,
such as parks or walking paths.
Collaborating with schools to promote physical education programs
and active transportation options for students.
o Tobacco Use: Smoking is a significant risk factor for CVD. Community
interventions may include:
§ Implementing comprehensive tobacco control programs that
encompass awareness campaigns, tobacco cessation support, and
enforcement of smoke-free policies in public spaces.
§ Engaging youth organizations and schools to prevent tobacco use
initiation and educate on the harms of smoking.
§ Promoting community resources and counseling services to
support individuals in quitting smoking.
o Diabetes: Diabetes is a prevalent risk factor for CVD. Community
interventions may include:
§ Conducting diabetes awareness campaigns to promote early
detection and management.
§ Offering diabetes screening programs and providing education on
healthy lifestyle choices, including maintaining a healthy weight,
regular physical activity, and proper diet.
§ Collaborating with healthcare providers to ensure access to
diabetes management services and medications.
o Socioeconomic Factors: Socioeconomic factors, such as poverty and
limited access to healthcare, can contribute to CVD risk. Community
interventions may include:
 § Advocating for policies that address social determinants of health,
such as poverty reduction and improved access to education.
§ Establishing community health centers or mobile clinics to enhance
healthcare access in underserved areas.
§ Facilitating community-based health insurance schemes or
programs to improve financial protection for healthcare services.

Risk factors for Diabetes and prevention

• Unhealthy Diet: Poor dietary habits, including high consumption of sugary foods
and beverages, processed foods, and unhealthy fats, contribute to the
development of diabetes. Prevention strategies may include:
o Promoting healthy eating habits, such as consuming a balanced diet that
is rich in fruits, vegetables, whole grains, and lean proteins.
o Encouraging portion control and moderation in the consumption of high-
calorie and high-sugar foods.
o Conducting nutrition education programs in communities to increase
awareness of the importance of a healthy diet.
• Physical Inactivity: Sedentary lifestyles and lack of regular physical activity are
risk factors for diabetes. Prevention strategies may include:
o Encouraging regular physical activity through community-wide initiatives
such as group exercises, sports events, and walking or biking campaigns.
o Promoting the use of public spaces for recreational activities and
establishing safe walking or cycling paths.
o Collaborating with schools to incorporate physical education programs and
encourage active transportation options for students.
• Obesity and Overweight: Excess body weight, particularly obesity, significantly
increases the risk of developing diabetes. Prevention strategies may include:
o Promoting healthy weight management through education on portion
control, calorie balance, and healthy lifestyle choices
o Encouraging regular physical activity as a means of weight management.
o Collaborating with healthcare providers to offer weight management
programs and counseling services.
• Family History and Genetic Predisposition: Having a family history of diabetes
increases the risk of developing the disease. Prevention strategies may include:
o Conducting regular screenings and health assessments for individuals
with a family history of diabetes to detect early signs of the disease.
o Providing genetic counseling and education to individuals at higher risk
due to family history.
o Promoting awareness of the importance of early detection and regular
health check-ups.
• Socioeconomic Factors: Socioeconomic factors, such as poverty and limited
access to healthcare, can impact the risk of diabetes. Prevention strategies may
include:
o Implementing policies and programs that address social determinants of
health, such as poverty reduction and improved access to education and
healthcare services.
 o Establishing community health centers or mobile clinics to provide
affordable and accessible diabetes screening and management services.
o Promoting community-based health insurance schemes or programs to
improve financial protection for diabetes care.
• Tobacco and Alcohol Use: Smoking and excessive alcohol consumption are risk
factors for diabetes. Prevention strategies may include:
o Implementing comprehensive tobacco control programs that include
awareness campaigns, tobacco cessation support, and enforcement of
smoke-free policies.
o Promoting awareness of the harmful effects of alcohol abuse and
providing education on responsible alcohol consumption.

Water Sanitation Measures

• Good to know:
o 1.7 billion people still do not have basic sanitation services, such as
private toilets, or latrines
o 494 million still defecate in the open
o 45% of the household wastewater generated globally was discharged
without safe treatment.
o 10% of the world’s population consumes food irrigated by wastewater.
o Poor sanitation reduces human well-being, social, and economic
development due to impacts such as anxiety, risk of sexual assault, and
lost opportunities for education, and work.
§ Linked to the transmission of diarrheal diseases such as cholera
and dysentery as well as typhoid, intestinal worm infections, and
polio.
§ It exacerbates stunting and contributes to the spread of
antimicrobial resistance
Bodies of Water
Potable Water Standardization
1. Physical Standard
a. Water must be odorless, colorless, agreeable taste, and clear
b. The presence of organic materials can alter the physical characteristics
which makes it turbid and changes the odor
i. Geosmin: a natural bicyclic terpene with an earthy odor
ii. Methylisoborneol (MIB): organic compound synthesized in
cyanobacteria
iii. Other assessment: tubidity and Secchi disk depth
iv. Secchi disk is an 8-inch disk with alternating black and white
quadrants which measures the transparency of water
v. Transparency is an indicator of the impact of human activity on the
land surrounding the lake. If transparency is measured through the
season and from year to year, trends in transparency may be
observed. Transparency can serve as an early warning that
activities on the land are having an effect on a lake
2. Chemical Standard
a. PH must be neutral or slightly alkaline
b. With a moderate degree of hardness
c. Hardness is the presence of insoluble salts of calcium and magnesium or
bicarbonates, sulfates chlorides in water. It can cause GIT disturbance,
 lack of soap foam, and explosion of boilers. It can be removed by boiling,
the addition of lime, or precipitation. Permissible hardness is 20 degrees.
d. Safety limits for some chemicals are determined such as nitrate 1.0 ppm,
fluoride 1.5 ppm, iron 0.3 ppm, arsenic, and lead must be nil.
e. Assessment of water includes pH, temperature, dissolved oxygen,
conductivity, oxygen reduction potential, metals, and metalloids-lead,
mercury, and arsenic.
3. Bacteriological Standards
a. It concentrates on evidence of fecal pollution
b. Water is inoculated on special media
c. Coliform organisms are used as indicators for the presence of fecal
contamination
d. A high coliform count of >100 ml is regarded as being suspicious of fecal
pollution
e. Biological monitoring metrics have included aquatic insects such as
Ephemeroptera (mayfly), Plecoptera (stonefly), tricchoptera (caddisfly)
f. Viruses can be eliminated by free residual chlorine at 0.5 mg/L for 30
minutes with a pH 8.0 or ozone can be used.

Bacteriological Analysis of Water

• Coliforms
o Bacteria are always present in the digestive tracts of animals, including
humans, and are found in their wastes. They are also found in plant and
soil materials.
• Indicator Organisms
o Water pollution caused by fecal contamination is a serious problem due to
the potential for contracting diseases from pathogens
o Frequently, concentrations of pathogens from fecal contamination are
small, and the number of different possible pathogens is large.
o It is not practical to test for pathogens in every water sample collected.
o The presence of pathogens is determined with indirect evidence by testing
for an “indicator” organism such as coliform bacteria.
o The most basic test for bacterial contamination of a water supply is the
test for total coliform bacteria.

§ Total Coliform:
• Gives a general indication of the sanitary condition of a
water supply
• Include bacteria that are found in the soil, in water that has
been influenced by surface water, and in human or animal
waste (Escherichia, Citrobacter, Klebsiella, Enterobacter)
§ Fecal Coliform:
• Group of total coliforms that are considered to be present
specifically in the gut and feces of warm-blooded animals.
The origins of fecal coliforms are more specific than the
origins of the more general total coliform group of bacteria,
fecal coliforms are considered a more accurate indication of
animal or human waste than total coliforms.
§ E. coli
• Major species in the fecal coliform group.
• Only E. coli is not found growing and reproducing in the
environment.
 • E. coli is considered to be the species of coliform bacteria
that is the best indicator of fecal pollution and the possible
presence of pathogens.
• E. coli 0157:H7 generated much public concern about this
organism

Classification of Water-Related Diseases

Childhood immunization and route of administration: Diphtheria, Tetanus,
Pertussis; BCG, HPB, Pneumococcal, Polio, Measles, Mumps, Rubella
Classification of Malnutrition
• Undernutrition- defined as insufficient food intake combined with the repeated
occurrence of infectious disease.
• Moderate Acute Malnutrition (MAM)- defined by WHO/UNICEF as Weight for
Height Z-score <-2 but >-3.
• Severe Acute Malnutrition (SAM)- is defined by WHO/UNICEF as MUAC < 11.5
cm, weight for height Z-score < -3. with bilateral pitting edema.

Types and characteristics of Protein deficiency

• Marasmus
o is a form of severe protein malnutrition characterized by energy deficiency
which leads to extensive tissue and muscle wasting and edema (growth
retardation)
o < 60 % weight for age
• Kwashiorkor
o due to insufficient protein consumption, children ages 1-4 are mostly
affected, characterized by depigmentation of hair and skin.
o They are also deficient in micronutrients such as iron, folic, iodine, vit C.
o < 80 % weight for age + edema
• Marasmic kwashiorkor:
o wt/age < 60 % + edema

Mid-upper arm circumference and appropriate intervention

• Mid-upper arm circumference (MUAC) is a measurement commonly used to
assess nutritional status and identify individuals, particularly children, who may
be at risk of malnutrition. It is a simple and non-invasive measurement that
provides an indication of muscle and fat mass in the upper arm.
 • The appropriate intervention for individuals with a low MUAC depends on the
specific context and underlying causes of malnutrition. However, generally
speaking, there are several actions that can be taken:
o Nutritional Rehabilitation: Individuals with a low MUAC may require
immediate nutritional rehabilitation to address their malnutrition. This can
involve providing therapeutic foods, such as ready-to-use therapeutic
foods (RUTF), that are specially formulated to provide the necessary
nutrients and energy for rapid recovery. Nutritional rehabilitation may be
conducted in an outpatient setting or, in severe cases, in a hospital or
therapeutic feeding center.
o Nutritional Counseling and Education: Alongside nutritional rehabilitation, it
is important to provide individuals and their caregivers with education and
counseling on optimal feeding practices, including appropriate and diverse
food choices, meal frequency, and hygiene practices. This helps to
promote long-term nutritional well-being and prevent future episodes of
malnutrition.
o Micronutrient Supplementation: Malnutrition is often associated with
deficiencies in essential vitamins and minerals. Supplementation of key
nutrients, such as vitamin A, iron, zinc, and others, may be necessary to
address these deficiencies and support overall health and recovery.
o Health Monitoring and Follow-up: Regular monitoring of individuals with a
low MUAC is essential to assess their progress and ensure that the
interventions are effective. This includes regular weight and MUAC
measurements, as well as assessing other health indicators, such as
growth, development, and the presence of any medical complications.
Follow-up visits provide an opportunity to adjust interventions as needed
and provide ongoing support and guidance.
o Addressing Underlying Causes: Malnutrition is often influenced by multiple
factors, including inadequate food availability, poor feeding practices, lack
of access to healthcare, and socio-economic factors. Therefore,
addressing the underlying causes of malnutrition is crucial. This may
involve interventions such as improving agricultural practices, promoting
income generation activities, enhancing access to clean water and
sanitation, and strengthening healthcare systems.

STRATEGIES FOR EMERGING AND RE-EMERGING INFECTIOUS DISEASE

• Emerging infections
o Newly identified or previously unknown infections
§ Like the COVID-19
o New or drug-resistant infections whose incidence in humans has
increased within the past two decades or whose incidence threatens to
increase in the near future.
§ Like Ebola and Monkeypox
• Re-emerging infections
 o Secondary to the reappearance of a previously eliminated infection or an
unexpected increase in the number of previously known infectious
diseases.
§ Endemic diseases or sporadic cases
§ Eliminated infections like cowpox and smallpox; polio
• Emerging and Re-emerging Infectious Diseases are unpredictable and create a
gap between planning and concrete action.
• To address:
o need to come up with proactive systems that would ensure
preparedness and response in anticipation of negative consequences that
may result in pandemic proportions of diseases.
o Proactive and multi-disciplinary preparedness must be in place to
reduce the impact of the public the health threats
• Prevention
o Surveillance and Response
§ Detect, investigate, and monitor emerging pathogens, the diseases
they cause, and the factors influencing their emergence, and
respond to problems as they are identified.
o Applied Research
§ Integrate laboratory science and epidemiology to increase the
effectiveness of public health practice.
o Infrastructure and Training
§ Strengthen public health infrastructures to support surveillance,
response, and research and to implement prevention and control
programs.
o Prevention and Control
§ Ensure prompt implementation of prevention strategies and
enhance communication of public health information about
emerging diseases.
• Good to Know: Major Factors Contributing to Emerging Infections
o Human Demographics and Behavior
§ More people, more crowding
§ Changing sexual mores (HIV, STDs)
• This leads to an increased incidence and prevalence of
some STDs and HIV
§ Changing eating habits: out more, more produce (foodborne
infections)
• Eating raw than fully cooked meat
§ More populations with weakened immune systems like the elderly,
HIV/AIDS, cancer patients and survivors, and persons taking
antibiotics and other drugs.
o Technology and Industry
§ Mass food production (e.g., Campylobacter, E. coli, etc.)
• Campylobacter, E.coli, and jejuni have something to do
with food mass production—there has to be a policy to
ensure safe food production to prevent
 § Use of antibiotics in food animals (antibiotic-resistant bacteria)
• Has caused antibiotic resistance bacteria = practice of
antibacterial stewardship
§ More organ transplants and blood transfusions (Hepatitis C)
§ New drugs for humans (prolonging immunosuppression)
o Economic Development and Land Use
§ Changing ecology influencing waterborne, vector-borne disease
transmission (e.g., Dams, deforestation)
§ Contamination of watershed areas (Cryptosporidium)
§ More exposure to wild animals and vectors
• Increased zoonotic diseases
o International Travel and Commerce
§ Persons infected with an exotic disease anywhere in the world can
be in another country within hours (i.e., SARS)
§ Foods from other countries imported routinely (i.e., Cyclospora)
§ Vectors hitchhiking on imported products (i.e., Asian tiger
mosquitoes
o Microbial Adaptation and Change
§ Increased antibiotic resistance with increased use of antibiotics in
humans and food animals (VRE, VRSA, penicillin-and macrolide-
resistant strep pneumonia, multidrug-resistant i.e., Salmonella)
§ Increase virulence (Group A strep)
§ Jumping species from animals to humans (avian influenza, HIV.
SARS)
o Breakdown of Public Health Measures
§ Lack of basic hygienic infrastructure (safe water, safe food, etc)
§ Inadequate vaccinations (measles, diphtheria)
§ Discontinued mosquito control efforts (Dengue, malaria)
§ Lack of monitoring and reporting (SARS)
§ Human Vulnerability
§ Climate & weather
§ Changing ecosystems
§ Poverty & social inequality
§ War and Famine
§ Lack of Political will
§ Intent to harm (bioterrorism- anthrax, bio-crimes salmonella,
shigella, potential agents- smallpox, botulism toxin, plague,
tularemia
• The Emerging/Re-Emerging Infectious Disease Strategies
o Policy Development
o Resource Management and Mobilization
o Coordinated Networks of Facilities
o Building Health Human Resource Capacity
o Establishment of a Logistics Management System
o Managing Information to Enhance Disease Surveillance
o Improving Risk Communication and Advocacy
 o Goal: Prevention and control of emerging and re-emerging infectious
diseases from becoming public health problems, as indicated by the
EREID case fatality rate of less than one percent

GOOD TO KNOW: SARS-COVID 2 (COVID-19) Slide

• Acute Global Emergency
• High vaccination + Low Community Spread = Less need for masking and other
prevention strategies
• Emerging Infectious Disease

• Re-Emerging Infectious Disease

Food-Borne Diseases
Leprosy
• Leprosy is a chronic, mildly communicable disease that mainly affects the
skin, the peripheral nerves, the eyes, and the mucosa of the upper respiratory
tract caused by Mycobacterium leprae
• Transmission: droplet spread from nose and mouth, during close and
frequent contact.
• Cardinal Signs:
o Loss of Sensation
o Enlarged Peripheral Nerve
o Positive Slit-Skin Smear
• Goals and Component of the Program:
o Early Diagnosis and Treatment
o Integration of Leprosy Services
o Referral System
o Case Detection and Diagnosis
o Advocacy and IEC focusing on stigma discrimination and reduction
o Prevention of Deformity, Self-Care, and Rehabilitation
o Recording and Reporting
o Monitoring, Supervision, and Evaluation
• Strategies, Action Points, and Timeline
o Strengthen Local Government Ownership Coordination and
Partnership
§ Ensure political commitment and resources for leprosy
programs at all levels
§ Focus on the vulnerable population under UHC
§ Promote partnership with stakeholders
§ Operational research
§ Strengthening surveillance and health information system for
program monitoring and evaluation
o Stop Leprosy and It’s Complications
§ Strengthen patient education and community awareness on
leprosy
§ Promoting early case detection through active case-finding
§ Ensure prompt and manage disabilities
§ Strengthen surveillance for antimicrobial resistance
§ Promote training, referrals, and sustain expertise
§ Promote interventions for the prevention of infection and
disease-chemoprophylaxis
• Classification of Leprosy
o Paucibacillary Leprosy: Negative Skin Smears
o Multibacillary Leprosy: Positive Skin Smears
• Based on Morphological Characteristics of Lesions/Clinical
Manifestation:
o Tuberculoid Type: has limited disease and relatively few bacteria in
the skin and nerves.
§ Typically, pale or slightly red, dry, hairless, and numb to touch
 o Lepromatous Type:
§ Widespread disease and a large number of bacteria
§ Skin, thickening of many peripheral nerves, and at times
involvement of other organs such as eyes, nose, testicles, and
bone
• Treatment:
o Multi-Drug Therapy: Combination of rifampicin, clofazimine, and
dapsone à multibacillary
o Rifampicin and Dapsone à paucibillary
• The Ridley-Jopling Classification

HIV
Schistosomiasis

Classification of Tuberculosis Diagnosis

Diagnostic tests for TB and community intervention of TB
Dengue Diagnosis

National Rabies Programs

Categories of Animal Bite and Management
Universal Health Care Act
• It is about equity and fair access to health
• 50% of the population is still missing universal health coverage
• Half of the world’s population still does not have access to the full range of
essential health services
• 800 million: use at least 10% of their household budgets for out-ot-pocket
health expenditures
• Aim: all people having access to QUALITY health services without suffering
the financial hardship associated with the cost of care
• Health care for all à population coverage
• Access to quality health services à Service coverage
• Without suffering financial hardship associated with paying for care à
financial risk protection

Principles of UHC
• An integrated and comprehensive approach to ensure that every individual is
health literate, provided with healthy living conditions, and protected from
hazards and risks that affect their health.
• A health care model that provides access to a comprehensive set of quality and
cost-effective, promotive, preventive, curative, rehabilitative, and palliative health
services without causing financial hardship and prioritizes the needs of the
population.
• A framework that fosters a whole Health system, government, and society in the
development, implementation, monitoring, and evaluation of health policies,
programs, and plans.
• A people-oriented approach to the delivery of health services that are centered
on people’s needs and well-being, and cognizant of the differences in culture,
values, and beliefs.
Definition of terms: Health care provider network, Health technology assessment,
HMOs

• Health Care Provider Network: Refers to a group of primary to tertiary care

providers, whether public or private, offering people-centered and comprehensive
care in an integrated and coordinated manner with the primary care provider
acting as the navigator and coordinator of health care within the network.

Individual-Based Health Services vs Population-Based Services

• Individual-Based Health Services:
o Refers to services that can be accessed within a health care facility with
services such as ambulatory and in-patient care, medicine, and laboratory
tests.
• Population-Based Health Services:
o Refers to interventions such as health promotion, disease surveillance,
and vector control which have population groups as recipients.

Scopes and Practice of Primary Care Providers

• Primary Care- Refers to initial-contact, accessible, continuous, comprehensive,
and coordinated care that is accessible at the time of need including a range of
services for all presenting conditions, and the ability to coordinate referrals to
other healthcare providers in the healthcare delivery system when necessary.
• Primary Care Provider- Refers to a health care worker, with defined
competencies who has received certification in primary care as determined by
DOH or any health institution that is licensed and certified by the DOH.
Role of DepEd, CHED and LGUs, Phil. Statistics authority and DILG in the
implementation of UHC
1. Department of Education (DepEd):
a. DepEd plays a crucial role in promoting health education and integrating
health-related topics into the school curriculum. DepEd ensures that
students are equipped with knowledge and skills related to health
promotion, disease prevention, and responsible health behavior
2. Commission on Higher Education (CHED):
a. CHED is responsible for overseeing higher education institutions in the
Philippines. In the context of UHC, CHED plays a role in ensuring that
health-related courses and programs in universities and colleges align
with the goals and principles of UHC. CHED may also collaborate with
other agencies to develop healthcare-related curriculum standards and
guidelines.
3. Local Government Units (LGUs):
a. LGUs, including provincial, city, municipal, and barangay levels, are
instrumental in the implementation of UHC at the local level. They are
responsible for delivering health services, establishing, and managing
health facilities, and ensuring the accessibility of healthcare services to
their constituents. LGUs play a crucial role in coordinating with national
agencies, allocating resources, and implementing health programs and
initiatives based on local needs.
4. Philippine Statistics Authority (PSA):
a. PSA is responsible for the collection, analysis, and dissemination of
statistical data in the Philippines. In the context of UHC, PSA plays a role
in providing accurate and reliable health data and statistics, which are
crucial for evidence-based decision-making, monitoring health indicators,
and evaluating the impact of UHC implementation. PSA collaborates with
other agencies to collect health-related data and generate health statistics.
5. Department of the Interior and Local Government (DILG):
a. DILG is responsible for the supervision and oversight of LGUs. In the
implementation of UHC, DILG plays a role in providing guidance and
support to LGUs in aligning their policies, plans, and programs with the
principles and objectives of UHC. DILG may coordinate with other
agencies to ensure effective collaboration between national and local
governments in implementing UHC initiatives.

The Strategic Thrusts of UHC

• The Universal Health Care (UHC) Act in the Philippines encompasses several
strategic thrusts aimed at achieving its goals of providing universal health
coverage and improving the healthcare system. The strategic thrusts of UHC
include:
o Health Financing: This thrust focuses on ensuring sustainable and
equitable health financing mechanisms. It includes expanding the
 coverage and benefits of the National Health Insurance Program,
improving revenue generation, and exploring innovative financing
approaches. The goal is to reduce out-of-pocket expenses for healthcare
and promote financial risk protection for all Filipinos.
o Service Delivery: This thrust aims to enhance the delivery of health
services by strengthening the primary healthcare system and ensuring the
availability and accessibility of quality healthcare services. It includes
expanding the network of health facilities, improving health workforce
deployment, and promoting the use of evidence-based and cost-effective
interventions.
o Health Regulation and Quality Improvement: This strategic thrust
focuses on strengthening health regulation and quality assurance
mechanisms. It involves enhancing regulatory oversight of health facilities
and professionals, promoting patient safety, and ensuring adherence to
quality standards. This includes the establishment of a Health Facilities
and Services Regulatory Bureau and the implementation of quality
improvement programs.
o Governance and Health System Performance: This thrust aims to
improve the governance and performance of the health system. It involves
strengthening health sector governance and accountability, promoting
transparency and integrity, and optimizing the use of health resources.
This includes the establishment of a Health Technology Assessment
Council and the implementation of performance-based incentives for
health facilities and providers.
o Health Information and Digital Health: This strategic thrust focuses on
harnessing health information and technology to improve healthcare
delivery and decision-making. It involves the development of health
information systems, the promotion of interoperability and data sharing,
and the adoption of digital health solutions. This includes the
establishment of a National Health Data Center and the implementation of
electronic health records and telemedicine initiatives.
o These strategic thrusts work together to achieve the overarching goal of
universal health coverage and ensure that all Filipinos have access to
quality and affordable healthcare services. The implementation of these
thrusts requires collaboration between government agencies, healthcare
providers, and other stakeholders in the healthcare sector.
The Function of the National Health Insurance System in UHC
• The National Health Insurance Program (Phil health) is the preferred single
player for healthcare services for patients.
• Essential public health functions (e.g., Health promotion, disease surveillance,
quarantine) are funded by line-item government budgets.
• Service delivery is through a dual system composed of the public sector and a
strong private sector.
• The Special Health fund- is managed by the Provincial and City Health Board in
accordance with RA 7160 (Local government code of 1991).
o The local health board will set overall health policies, oversee, and
coordinate the integration and delivery of health services
o Exercise administrative and technical supervision over health facilities
Components of the Province-Wide and City-Wide Health System
• The Province-Wide and City-Wide Health System:
o ensures accountability and responsibilities to the Local Government Units
to provide Population-based health services including those that impact
the social determinants of health
o The province or city-wide health system, on the other hand, refers to the
organization of people, institutions, and resources accountable for the
delivery, management, and financing of health services to meet the health
and health-related needs of the population within the jurisdictional
boundaries of the province/city.
o Province-wide and city-wide health systems will pool and manage the
various sources of funding for health, such as DOH assistance, PhilHealth
payments, donations, etc., in a Special Health Fund (SHF).

Coverage of the UHC Act

• CARE: Consensus Oriented Accountability Responsiveness Equity
• UHC: coverage of healthcare to the people
• Communication
• Organized Community
• Values are shared
• Equitable
• Revitalized Primary Health Care
• Accountability
• Governed with Mutual Trust
• Effective and Efficient Service
• The UHC Act contains comprehensive and progressive reforms that will ensure
every Filipino is healthy, protected from health hazards and risks, and has access
to affordable, quality, and readily available health service that is suitable to their
needs.
o Who will benefit from UHC Act?
§ The government will ensure that the well-being and health needs of
all citizens, especially those of the vulnerable population, will be
addressed.
§ Every Citizen should be able to access preventive, promotive,
curative, rehabilitative, and palliative health services.
§ The UHC Act will improve and strengthen existing health sector
processes and systems by highlighting primary care close to
families and communities, supported by hospitals that are
contracted as part of a network, and making PhilHealth
membership automatic for every Filipino.
§ This will eventually lead to the establishment of better networks of
providers and facilities, making health accessible for all.