Concept of Community Health : Universal Health Care

• Public Health

  • The science and art of preventing disease, prolonging life and promoting health and efficiency through organized community effort
  • An organized community effort to address the public interest in health by applying scientific and technical knowledge to prevent disease and promote health
  • Institute of Medicine, 1988 “The Future of Public Health”
  • Mission of PH – ensure conditions that promote the health of the community
• Difference of Public Health vs. Clinical Medicine

  • Focuses on prevention rather than cure
  • Utilizes broad measures to protect large populations and communities not just individual patients
  • Does not rely on specific body of knowledge or expertise but on a combination of science and social approaches
  • Novick and Morrow (www.jblearning.com)
• Primary Prevention

  Preventing the development of a disease
• Primary Prevention


  • Immunization
  • Reducing exposure to a risk factor
• Secondary Prevention


  Early detection of existing disease to reduce severity and complications
• Secondary Prevention


  • Screening for cancer
• Tertiary Prevention


  Reducing the impact of the disease (Physical)
• Tertiary Prevention


  • Rehabilitation for stroke
• Clinical/Hospital Health


  • Setting/place of practice and activities: Hospital wards, special clinic units in hospital
  • Types of patients seen: Mostly sick people; maybe limited to one group of patients
  • Source of concern/range of services provided: Mostly curative and rehabilitative
  • Priority concern: Comfort and care during illness, recovery from disease
  • Unit or focus of care: Individual patient
  • Ultimate goal: Maximum comfort, patient independence (self care), recovery from disease, peaceful/dignified death for terminal cases
• Community Health

  • Setting/place of practice and activities: Outside of the hospital – home, school, RHU, place of work
  • Types of patients seen: Varied patients, representing the total heath spectrum
  • Source of concern/range of services provided: Total care, whole range of services
  • Priority concern: Promotion and maintenance of health; prevention of disease
  • Unit or focus of care: The family, population groups, the whole community
  • Ultimate goal: Effective coping and self-reliance for families and the whole community
• Four Pillars of PHC

  • community participation
  • inter-sectoral coordination (multi-sectoral linkages)
  • appropriate technology
  • support mechanism made available
• Community participation.

  • "in a given community as many people as possible determine a common aim and work together, pooling their resources to achieve it"
  • "a process whereby social groups are supported to crystallize their needs and are assisted to translate them into action"
  • "a committed, community-driven initiative, which leads to a common goal identified by that community and broader empowerment of that community"
  • "Community participation is a planned process whereby local groups are clarifying and expressing their own needs and objectives and taking collective action to meet them."
•  Inter-sectoral coordination. (Multi-sectoral Linkages) 

  • Relationships and interactions between
  • Tasks
  • Functions
  • Departments
  • Organizations
  • That promote flow of information, ideas and integration in achievement of shared objectives
• Appropriate technology.

  • practical, scientifically sound and socially acceptable methods and technology
  • practical, effective and socially acceptable technologies that are accessible, affordable by community and national health systems, encourage self-reliance, and result from participatory processes.
  • Methods, Procedures, Techniques and Equipment that are:
  • Scientifically valid
  • Adapted to local needs
  • Acceptable to users and recipients Maintainable with local resources
• Support mechanism made available.

  1. Training and HR development
  2. Health education and promotion
  3. Supervision and guidance 
  4. Monitoring and evaluation
  5. Logistics/financial support
  6. Restructuring of infrastructure and organization
• Population coverage: All Filipinos are automatically included in the National Health Insurance Program (NHIP)
• Service coverage: Health care packages (population-based / individual based)
• Three major dimensions of coverage:

  1. Population coverage
  2. Service coverage
  3. Financial Coverage
• Direct contributors : Members with capacity to pay premiums, or those gainfully employed or self-earning professionals or workers. 
• Indirect contributors : Those whose PhilHealth premiums are subsidized by the government. 
• • Revenue Generation : Raising and collecting resources to pay for health services 
• • Pooling of Funds : Redistributing risk and resources across population groups
• • Purchasing of Services : Leveraging resources towards high-value services and desired provider performance
• Primary Health Care

  • 1977 – WHO members, International Conference on Primary Health Care in Alma Ata, Kazakhstan, Resolution - 20th Word Health Assembly
  • “the main social targets of governments and WHO in the coming decades should be the attainment by all citizens of the world by year 2000 of a level of health that will permit them to lead a socially and economically productive life”
• • Alma Ata Declaration of 1978 - “Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost the community or the country can afford to maintain at every stage of their development in the spirit of self-reliance and self determination”
• • PHC forms part of:
  • a country’s health care system
  • Overall socioeconomic development of a community
  • First level of contact with the national health system health care as close as possible to where people live and work
• Primary Health Care Facilities


  • rural health units
  • sub-centers
  • chest clinics
  • malaria eradication units
  • schistosomiasis control units
  • puericulture centers
  • tuberculosis clinics
  • private clinics
  • clinics operated by large industrial firms
  • community hospitals
  • health centers
  • other health facilities
• Secondary Health Care Facilities

  • non-departmentalized hospitals
  • emergency hospitals
  • regional hospitals
• Tertiary Health Care Facilities

  • medical centers
  • large hospitals
• Village of Grassroot Health Workers


  • Community health worker
  • Volunteers
  • Traditional birth attendants
• Village of Grassroot Health Workers

  • First contacts
  • Curative and preventive
• Intermediate Level Health Workers


  • Medical practitioners
  • Nurses
  • Midwives
• Intermediate Level Health Workers


  • First source
  • Provide support
  • Attends to health problems
• First Line Hospital Personnel


  • Physician with specialty
  • Nurses
  • Dentists
  • Pharmacists
  • Other health professionals
• First Line Hospital Personnel


  • Establish close contact
  • Back up health services