Public health is the science and art of preventing disease, prolonging life, and promoting health through the organized efforts of society (the classic definition by C.-E. A. Winslow). It focuses on populations rather than single patients.

Community health nursing (CHN) applies nursing and public health knowledge to promote and preserve the health of individuals, families, population groups, and whole communities where they live, learn, and work. Its overall goal is to raise the level of health of the community by helping people and groups manage their own health problems.

Public health nursing is the part of CHN that focuses on whole populations, usually in government public health services. In the Philippines, the public health nurse (PHN) is typically employed by the local government unit (LGU) and works in the rural health unit (RHU) or city health center.

Levels of prevention

• Primary — before disease: health education, immunization, nutrition, environmental sanitation
• Secondary — early detection and prompt treatment: screening, case finding, early treatment
• Tertiary — after disease or disability: rehabilitation, limiting complications, restoring function

Principles of CHN

• The community is the client; the family is the unit of service
• Services are based on recognized needs of communities, families, and groups
• Health programs are planned with the people (community participation), using existing resources and intersectoral collaboration
• Emphasis on health promotion and prevention, with care of the sick at home as needed
• Health teaching is a primary responsibility
• The nurse works as part of the health team and within the policies of the agency
• Services are evaluated regularly, and records and reports are kept accurately

Historical roots tested in exams

Where the PHN works in the Philippine public health system

• Under the Local Government Code of 1991 (RA 7160), municipalities provide primary health care, maternal and child care, and communicable and non-communicable disease control; barangays maintain barangay health centers; provinces run hospitals and other tertiary services; cities provide both municipal and provincial services.
• The RHU / city health center is headed by the municipal or city health officer (a physician). The team typically includes public health nurses, rural health midwives, a sanitary inspector, medical technologist, and dentist, supported by barangay health workers (BHWs).
• Barangay health stations (BHS) are the most peripheral facilities; they are commonly staffed by a midwife with BHWs and supervised from the RHU.
• Barangay health workers are volunteers trained through accredited programs who render primary health care services in the community after accreditation by the local health board (RA 7883).

Roles of the PHN

1. Clinician / care provider — provides nursing care to individuals and families at home, in clinics, and in health centers
2. Health educator — teaches individuals, families, and groups to adopt healthy practices
3. Manager / supervisor — plans, organizes, and supervises program implementation; supervises midwives and BHWs; manages supplies and records
4. Community organizer — mobilizes people to identify and act on their own health needs (see COPAR, Topic 10)
5. Coordinator / collaborator — links clients to services and works with other sectors (schools, social welfare, agriculture, local officials)
6. Advocate — speaks for vulnerable groups and for health-promoting local policies
7. Researcher — collects and analyzes data, takes part in surveys and program evaluation
8. Case finder and surveillance officer — detects cases early and reports notifiable diseases
9. Trainer — trains BHWs and other community volunteers

Typical PHN activities

• Implementing DOH programs at the local level: immunization, maternal and newborn care, family planning, nutrition, tuberculosis, and noncommunicable disease control (Unit 5)
• Home visits using the bag technique (Topic 14)
• Family and community assessment and nursing care plans (Topics 11–13)
• Keeping target client lists and program records; reporting through the Field Health Services Information System (FHSIS)
• Disaster preparedness and response with the local health office

• Know the community: population, vital statistics, resources, leaders, and health problems
• Plan services with the community and the health team based on identified needs and priorities
• Deliver services across all levels of prevention, giving priority to vulnerable groups (mothers, infants, older persons, the poor, geographically isolated areas)
• Supervise and support midwives and BHWs; provide training and technical guidance
• Refer clients to appropriate higher-level facilities and follow up after referral
• Keep accurate records and submit timely reports
• Work within the Philippine Nursing Act of 2002 (RA 9173), local health office policies, and DOH program guidelines

• Magna Carta of Public Health Workers (RA 7305, 1992) covers persons engaged in health work in government facilities, including rural health units and barangay health stations. Its benefits include a normal work schedule of 8 hours a day or 40 hours a week, hazard allowance, and security of tenure.
• Barangay Health Workers' Benefits and Incentives Act of 1995 (RA 7883) defines BHWs and requires training and accreditation by the local health board. A proposed Magna Carta for BHWs has passed the Senate but is not yet law; check its status.
• Local Government Code (RA 7160) devolved basic health services to LGUs and created local health boards chaired by the governor or mayor, with the provincial, city, or municipal health officer as vice-chair.
• Confidentiality: family and household records are protected under the Data Privacy Act (RA 10173).
• Ethical principles in community work: respect for autonomy and culture, justice (equitable distribution of services), beneficence, and the common good; community decisions should be made with, not for, the people.

Case 1 — First task in a new barangay. A newly assigned PHN wants to start a hypertension program immediately.

• Correct first action: assess the community (data, leaders, resources, perceived needs) and involve residents in identifying priorities.
• Why: CHN services are based on recognized needs and community participation.

Case 2 — Supervising a BHW. A BHW reports that several children in one sitio missed their vaccinations.

• Correct action: verify with the target client list, plan catch-up immunization with the midwife and BHW, and explore reasons for missed doses with families.
• Why: the PHN supervises, coordinates, and addresses causes, not just the numbers.

Case 3 — Level of prevention. A PHN organizes blood pressure screening at the barangay hall.

• Classification: secondary prevention (early detection).
• Why: screening detects existing but unrecognized disease.

• Treating the individual patient as the main client; in CHN, the family is the unit of service and the community is the client.
• Calling screening primary prevention; it is secondary.
• Assuming the PHN in a devolved system is employed by the DOH; most are LGU employees.
• Confusing the RHU (municipal level) with the BHS (barangay level).
• Assuming BHWs are licensed professionals; they are trained, accredited community volunteers.
• Mixing up Rathbone (district nursing, Liverpool) and Wald (Henry Street, "public health nurse").

• Public health = organized community efforts to prevent disease, prolong life, promote health.
• CHN: community is the client, family is the unit of service; focus on promotion and prevention.
• Primary prevention = before disease; secondary = early detection; tertiary = rehabilitation.
• RHU (municipality) led by the municipal health officer; PHN, midwives, sanitary inspector, and BHWs form the team.
• BHS is the most peripheral facility, commonly run by a midwife with BHWs.
• RA 7160 devolved health services to LGUs; local health boards chaired by the local chief executive.
• RA 7305: Magna Carta of Public Health Workers (8 h/day or 40 h/week, hazard allowance, security of tenure).
• RA 7883: BHWs are trained volunteers accredited by the local health board.
• PHN roles: clinician, educator, manager/supervisor, community organizer, coordinator, advocate, researcher.
• Wald coined "public health nurse" (Henry Street, 1893); Rathbone started district nursing (1859).