EVOLUTION OF PUBLIC

HEALTH NURSING
Prepared by:
Dr. Joycelyn P. Reyes, RN, RM
Community Health Nursing

• Community health nursing is the product of centuries of responsiveness and

growth.
• Its practice was adapted to accommodate the needs of a changing society,
yet it has always maintained its initial goal of improved community health.
• Community health nursing development has beeninfluenced by changes in
nursing, public health and society that is traced through several stages.
• In tracing the development of public health nursing, now it is clear that
leadership role has been evident throughout its history. Nurses in this
specialty have provided leadership in: planning and developing programs;
shaping policy; administration; and the application of research to the
community health
Four general stages mark the development of
public health or community health nursing

1. The early home care stage

2. The district nursing stage
3. The public health nursing stage
4. The community health nursing stage
Early Home Care Stage (Before Mid 1800s)

• For many centuries female family members and friends attended the sick at home.
• The focus of this care was to reduce suffering and promote healing (Kalish and Kalish,
1986).
• The early roots of home care nursing began with religious and charitable group
• The set back of these services were:
1. Social approval following the reformation caused a decline in the number of religious
orders with subsequent curtailing of nursing care for the sick and poor.
2. High maternal mortality rates prompted efforts to better prepare midwives and
medical students.
3. Industrial revolution created additional problems; among them were epidemics, high
infant mortality, occupational diseases, injuries and increasing mental illness both in
Europe and America.
• This stage was in the midst of these deplorable conditions and
response to them that Florence Nightingale (1820 - 1910) began
her work. Much of the foundation for modern community health
nursing practice was laid through Florence Nightingale's
remarkable accomplishments. Nightingale’s concern for population
at risk as well as her vision and successful efforts at health reform
provided a model for community health nursing today
 The District Nursing Stage

• 1. District Nursing (Mid-1800s to 1900) Nightingale’s Continued Influence - The

development of community health nursing was the formal organization of
visiting nursing,or district nursing.
• District nurses primarily care for the sick, they also thought cleanliness and
wholesome living to their patients, even in that early period.
• Nightingale referred to them as “health nurse”. This early emphasis on
prevention and health nursing became one of the distinguishing features of
district nursing and later of public health nursing as a specialty.
• The work of district nurses focused almost exclusively on the care of
individuals. District nurses recorded temperatures and pulse rates and gave
simple treatments to the sick poor under the immediate direction of a
physician. They also instructed family members in personal hygiene, diet and
healthful living habits and the care of the sick.
• Problems of district nursing:
1. Increased number of immigrants
2. Increased crowded city slums
3. Inadequate sanitation practices
4. Unsafe and unhealthy working conditions

• Nevertheless, nursing educational programs at that time did not

truly prepare district nurses to cope with their patients, multiple
health, and social problems
EVOLUTION OF PUBLIC HEALTH NURSING IN
THE PHILIPPINES

• The public health nursing in the Philippines comes from the

caregiving provided by women, priest and herb doctors during the
pre-colonial Philippines. In this timewomen didn’t have much
opportunity to be formally educated in schools, this trend continued
during the Spanish colonial era. During the American period in the
Philippines they were given the chance to become educated as
nurses, guided by their American nurse and missionary mentors,
until nursing became a full-pledged profession in the Philippines, a
professional career not only for modern-day women in the country
but also formen in the Philippinesasmale nurses
Pre-Spanish Era Before 1565

• Ancient Filipinos regarded health as a harmonious relationship

with the environment, both natural and supernatural. Early
Filipinos were good physicians who used medical herbs. When the
first Spanish explorers reached our shores, what they discovered
was far more than such mysticism and superstition. The Spanish
historian Miguel de Loarca report that the natives were “good
physicians and had a remedy for every poison.”
Public Health Nursing Training (1900-1970

• By the turn of the century, district nursing had broadened its focus to include the
health and welfare of the general public, not just the poor. This new emphasis
was part of a broader consciousness about public health. Specialized programs
such as infant welfare that brought health care and health teaching to the public
and gave nurses an opportunity for more independent work, and helped to
improve nursing education (Bullough and Bullough 1978)
• Lillian D. Wald’s (1867-1940) contributions to public health nursing were
enormous. Her driving commitment was to serve needy populations. Wald’s
emphasis on illness prevention and health promotion through health teaching and
nursing intervention as well as her use of epidemiological methodology
established these actions as hallmarks of public health nursing practice .The
public health nursing stage was characterized by service to the public with the
family targeted as a primary unit of care.
Community Health Nursing (1970 to present)
• The emergence of the term community health nursing heralded a new era while public
health nurses continued their work in public health by the late 1960s and early 1970s.
• Many other nurses, not necessarily practicing public health, were based in the
community. Their practice settings included community based clinics, doctor’s office,
work sites, schools, etc, to provide a label that encompassed all nurses in the
community. The confusion was laid in distinguishing between public health nursing and
community health nursing.
• The terms were being used interchangeably and yet, had different meanings for many
in the field in 1984 the division of nursing convened a consensus conference on the
essentials of Public Health Nursing practice and education in Washington DC (1985).
• This group concluded that community health nursing was the broader term referring to
all nurses practicing in the community regardless of their educational preparation.
• Public health nursing, viewed as a part of community health
nursing, was described as generalist practice for nurses prepared
with basic public health content at the baccalaureate level and a
specialized practice for nurses prepared in the public health at the
masters level or beyond
 Influence of Ancient
Cultures on Public Health
Egyptian Ancient Cultures on Public Health
Egyptian Ancient Cultures on Public
Health

• Ancient Egypt was a civilization that lasted from 3300 to 525 B.C.E. This is probably where the
concept of health started. Some of the earliest records of medical care come from ancient Egypt.
• The ancient Egyptians believed in prayer as a solution to health problems, but they also had
natural, or practical, remedies, such as herbs.
• It was a structured society with tools such as written language and mathematics, which enabled
them to record and develop ideas, and it meant that others could learn from them
• The ancient Egyptians thought that gods, demons, and spirits played a key role in causing
diseases.
• Doctors believed that spirits blocked channels in the body and that this affected the way the
body worked. They looked for ways to unblock these channels. They used a combination of
prayer and natural — or non-spiritual — remedies.
• Most healers were also priests, but, in time, the profession of a “doctor of medicine” emerged.
• The fact that ancient Egyptians had systems of letters and numbers meant they were
able to record and develop ideas and make calculations. Documented ancient Egyptian
medical literature is among the oldest in existence today.
• The ancient Egyptians had an organized economy and system of government, a settled
population, social conventions, and properly enforced laws. Before this, the local
people mainly lived a nomadic life.
• This stability allowed medical research to develop.
• In addition, there were also relatively wealthy individuals in ancient Egyptian society.
They could afford some health care and also had time to ponder and study.
• The ancient Egyptians were also traders. They traveled long distances, coming back
with herbs and spices from faraway lands.
• The ancient Egyptians’ practice of preserving deceased people as mummies
meant that they learned something about how the human body works.
• In one process, the priest-doctor inserted a long, hooked implement through
the nostril and broke the thin bone of the brain case to remove the brain.
• Kings and queens from faraway lands sought Egyptian doctors because of
their reputation for excellence.
• Archaeologists have found a number of written records that describe ancient
Egyptian medical practice, including the Ebers papyrus.
• This document contains over 700 remedies and magical formulas and
scores of incantations aimed at repelling demons that cause disease.
• The authors probably wrote them around 1500 B.C.E., but the document
may contain copies of material dating back to 3400 B.C.E. They are
among the oldest preserved medical documents in existence.
• The scroll provides evidence of some sound scientific procedures.
• Medical advice, Dentistry, Family Planning, Mental Illness, Surgery
Mental Illness -The ancient Egyptians appear to have seen mental diseases as a
combination of blocked channels and the influence of evil spirits and angry Gods.
Family Planning - The ancient Egyptians used a variety of methods for birth control,
including natural remedies, medicinal solutions, and mechanical barriers.
• Natural remedies for birth control in ancient Egypt included herbs, such as acacia and
honey, which were believed to have spermicidal properties.
• Medicinal solutions for birth control in ancient Egypt included potions and suppositories
made from plant-based ingredients, such as dates, honey, and sodium carbonate.
• Mechanical barriers, such as condoms made from animal intestine or linen, were also
used for birth control in ancient Egypt and Putting a plug of crocodile dung into the
entrance of the vagina, for example, was a method of birth control. People also used
dung to disperse evil spirits.
• The ancient Egyptians had a strong understanding of reproductive biology and were
willing to experiment with different methods of birth control in order to shape the
future of their society.
China’s”Ancient Cultures on Public Health
China’s”Ancient Cultures on Public Health

Medical advise - They advised people to wash and shave their bodies to
prevent infections, to eat carefully, and to avoid unclean animals and raw
fish

Dentistry – carries and tooth decay are common during ancient times and
they treated them with
• cumin, incense, and onion to treat swollen gums
• opium, possibly, to treat pain pain
• drilling holes into the jaw to drain an absces
 China’s Ancient Cultures on Public Health

• The Chines System of Medicine is of great antiquity and is independent of any recorded
external influences.
• Traditional Chinese medicine (TCM) is thousands of years old and has changed little over
the centuries. Its basic concept is that a vital force of life, called Qi, surges through the
body. Any imbalance to Qi can cause disease and illness. This imbalance is most
commonly thought to be caused by an alteration in the opposite and complementary
forces that make up the Qi. These are called yin and yang.
• Ancient Chinese believed that humans are microcosms of the larger surrounding universe,
and are interconnected with nature and subject to its forces. Balance between health and
disease is a key concept. TCM treatment seeks to restore this balance through treatment
specific to the individual.
• It is believed that to regain balance, you must achieve the balance between the internal
body organs and the external elements of earth, fire, water, wood, and metal.
• Like most aspects of traditional Chinese culture, Chinese medicine has a long history.
Originally said to have been invented by the legendary Yellow Emperor and the
Emperor Shennong, there is oracle bone evidence of traditional Chinese medical
practices dating back to the Shang Dynasty (c. 1600-1046 BC). Shang Dynasty people’s
understanding of disease was limited, however. Illnesses were thought to be caused
by curses from one’s ancestors and treatments involved some magical aspects.
• China’s first systematic medical texts appeared during the Han Dynasty (202 BC–220
AD). The four great classics of Chinese medicine ( 中医四大经典 or zhōngyī
sìdàjīngdiǎn) were written during this time.
• The first is The Inner Canon of the Yellow Emperor ( 黄帝内经 or Huángdì Nèijīng).
This text describes treatments still used in TCM today such as acupuncture, drugs and
dietary changes. It also lays out the theories about anatomy and physiology that form
the philosophical basis for TCM.
• Treatment to regain balance may involve:
• Acupuncture
• Moxibustion (the burning of herbal leaves on or near the body)
• Cupping (the use of warmed glass jars to create suction on
certain points of the body)
• Massage
• Herbal remedies
• Movement and concentration exercises (such as tai chi)
• Today, TCM enjoys a great deal of popular and political support in China. China’s President
Xi Jinping is an extremely influential promoter of TCM, which he
refers to as a national treasure. Since 2017, local governments have been required by law
to support and expand the development of TCM services, which are considered equal to
Western medical services by China’s official state insurance plan
• China runs government-sponsored training programs for foreign students interested in
studying TCM and supports TCM tourism, which draws patients from around the world to
China. It has also opened TCM medical centers in many global cities including Dubai and
Barcelona and is planning to open more as part of the Belt and Road Initiative. TCM doctors
and medicines were even sent as part of the aid China supplied to countries affected by
COVID-19.
• In 2019, China successfully lobbied for TCM to be included in the World Health
Organization’s
International Statistical Classification of Diseases and Related Health Problems (ICD). The
ICD is influential, serving as a standard reference for doctors, epidemiologists, health
officials and insurance companies in over 100 countries. Inclusion in this document is likely
to accelerate the global spread of TCM practices and eventually help them become an
integral part of healthcare around the world.
America’s Ancient Cultures on Public Health
• The arrival of European colonizers created a new world of health and disease for the Indigenous
peoples of North America. Most prominently, epidemic disease devastated populations.
• The disastrous effects of the first-contact epidemics are well known. Wherever European settlers
went, Indigenous people fell ill and died.
• From Mexico to New England, smallpox, influenza, measles, typhus, and other diseases took a
terrible toll. The toll they took was not only physical.
• The dead took with them generations’ worth of knowledge, tradition, and skill, including
knowledge of healing
• Herbal remedies were also universal among indigenous peoples. This aspect of Indigenous
practice has been particularly well documented, since European observers took a deep interest in
local plants for curing their own diseases as well as for potential commercial exports. Indigenous
women practitioners were honored by some Europeans for their deep knowledge of local plants.
Among peoples with specialized practitioners, herbalists were most likely to be women
America’s Ancient Cultures on Public Health
• There are many descriptions of the uses of plants and herbs among
indigenous practitioners. The Choctaw placed powdered roots on wounds to
stop bleeding; the Seneca (as well as many others) used a plant Europeans
called snakeroot to cure snakebite; the people of Quebec used the inner
bark of spruce trees to cure what we now know as scurvy. Plants had
important physical properties, but they also had spiritual power. A Jesuit
observer described (with much scoffing) a ceremony in which the Miami
people blessed medicinal plants and asked them for help. Among the
Cherokee, medicinal plants were chosen for symbolic and spiritual value.
For instance, bark and roots from plants that did not die over the winter
(such as pine trees) had particularly potent healing powers. For individual
maladies, plants were chosen to counteract the source of the illness.
Pre-Industrial America

• The Industrial Revolution (1700 – 1800s) medical advances included the discovery of the smallpox
vaccine (1796), the invention of the stethoscope (1819), the ability to view microorganisms, and
the discovery of capillaries. By 1885, French chemist Louis Pasteur identified microorganisms as
the cause of disease, developed pasteurization of milk and produced the rabies vaccine. British
surgeon Joseph Lister introduced antiseptics and disinfectants to reduce infection in surgery.
Florence Nightingale, the British social reformer, known as the founder of modern nursing, trained
and managed nursing care of soldiers during the Crimean War (1853-1856). German physicist,
Robert Koch established the science of pathology in the late 1800s with the discovery of
pathogens. Anesthesia was first demonstrated dentist William Morton at Massachusetts General
Hospital in 1846.
• But from the birth of the nation to the end of the nineteenth century, health care in the United states
lagged behind Europe. Medical training was not scientific and health care was very primitive.
Family members were more likely to care for their own sick, women served as midwives to family
and friends, and only occasionally was there a “physician” in the community.
• Hospitals that were situated in cities only, had poor sanitation and hygienic practices. Staff were
untrained and unskilled.
• Asylums were the early state run institutions that preceded today’s inpatient mental health
facilities. Staff were often abusive, with no medical or psychiatric training.
• Pest houses were set up more or less as quarantine facilities to serve people with infectious
diseases such as cholera, typhoid, yellow fever and smallpox.
• Dispensaries were the precursor to outpatient clinics and pharmacies, where free care and
drugs were dispensed to people who could not pay.
• Medical training was more of an apprenticeship than any form of university training. There
were only about 42 inadequate medical schools in the US in 1850, about six months training
with apprenticeship over 2 years. In 1849, Elizabeth Blackwell became the first female
physician.
• Medical practice was primitive and unregulated, often a local barber or other town
professional. Care was not based on science and were very unsanitary. By the mid 1800s,
surgery and the use of ether as anesthesia became more widely practiced.
• After the Civil War (1861-1865) the US population started to shift to cities. By 1900, the
population in urban areas increased from 11% (1840) to 40%. Medical care began to be
driven by science and technology.
Post-Industrial America

• At the start of the 20th century, populations began to organize into multi-level societies. State and county levels of
government began to provide regulation of medical training and medical services.
• Medical professionals began to become licensed. The health care organization, the American Medical Association,
formed and lobbied to keep physician control of prescription authorization, health insurance to pay only if physician
monitored
• With the accidental discovery of Xrays in 1895 Germany, the use of diagnostic technology would lead to CT scans and
MRIs in the 1970s. In 1920, the discovery of penicillin radically changed the treatment of infectious diseases. Radium
was discovered as a treatment for cancer. Prior to the first successful kidney transplant in 1954, eye and skin
transplants had been performed. The first successful in vitro fertilization occurred in 1978. More recent advances in
laser, micro and computerizes (robotic) surgeries were among the avalanche of emerging technologies in medical
treatment. Life expectancy for an American born in 1900 was 50 years of age, by 1925 it was 63 years, by 1950 it was
78 years and has remained fairly constant up to 2010.
• With the advances in technology that came with the industrial revolution, physicians could no longer afford equipment
or facilities. Hospitals and physicians began to form alliances to keep patients in hospital and policy began to inform
patient care. While physicians were not employed by the hospitals they did have considerable input into the operations
and policies.
• In addition to urbanization, scientific advancement led to increased health care costs and a new shift to specialization
versus general practice. Medical education reform elevated the power and prestige of the medical community. This led
to the organization of a medical political interest group (AMA) who would control medical education, support
licensing laws and oppose national health insurance proposals to pursue entrepreneurship of physicians.
 EVOLUTION OF PUBLIC
HEALTH NURSING IN THE
PHILIPPINES
Spanish Regime (1565-1898)

1565 : Hospital Real De Manila-The very first hospital in the Philippines

(established mainly to care for the Spanish King’s soldiers, but also
admitted Spanish civilians; founded by Gov. Francisco de Sande).
1577-1578 : The first Franciscan missionary, Bro. Juan Clemente took pity
on the numerous beggars who flocked to the gates of the convent; he
concocted medications and salves to apply to their wounds. It started
public health services through dispensary in Intramuros for the indigent.
• In 1578, two wards of nipa and bamboo were constructed by Clemente
called Hospital de los Indios Naturales, more popularly known as Hospital
de Naturales.The friars cared for the sick while also tending to their
spiritual needs
1603

• Hospital de la Misericordia- after the firethe original site of the

Hospital de Naturales is turned over to the Brotherhood of Santa
Misericordia. It was built for the care of the sick servants and slaves of
the Spaniards. Hospital of San Gabriel-the priests built a modest-sized
building behind the convent and called it the Hospital de San Pedro
Martir to accommodate the growing number of sick it was created for
the Chinese whom fell sick and died in poverty and abandonment
• San Lazaro Hospital- The reconstruction of the Hospital de Naturales
(founded by Brother Juan Clemente and was administered for many
years by the Hospitalliers of San Juan De Dios; built exclusively for
patient with leprosy)
1690

• Young women carried water taken from various water sources and
stored in bamboo poles. An important development in public
health administration during the Spanish regime was the
introduction of safe water supply
HISTORICAL DEVELOPMENT OF COMMUNITY
HEALTH
• Before the nature of community health nursing can be fully grasped or its practice
• defined, it is necessary to understand its roots and the factors that shaped its growth over
• time. Community health nursing is the product of centuries of responsiveness and growth.
• Its practice has adapted to accommodate the needs of a changing society, yet it has
• always maintained its initial goal of improved community health. Community health
• nursing’s development, which has been influenced by changes in nursing, public health,
• and society, can be traced through several stages. Nurses in this specialty have provided
• leadership in planning and developing programs, in shaping policy, in administration, and
• in the application of research to community health
1577
• Franciscan Friar Juan Clemente (Priest) opened medical dispensary in Intramuros for the indigent. This medical
dispensary is now San Lazaro Hospital. Dispensary- giving of free medicines.
• 1690 -Dominican Father Juan de Pergero (Priest) worked toward installing water system in San Juan del Monte
and Manila. They adopted the idea of John Snow who find out that cholera contaminates water so they put up
water station.
• 1805 - Smallpox vaccination was introduced by Francisco de Balmis, a personal physician of King Charles IV of
Spain.
• 1876 - First medicos titulares (Certified doctor) were appointed by the Spanish government. They introduced a
2-year course in UST as there are a lot of spreading diseases in the Philippines.
• 1888 - 2-year courses consisting of fundamental medical and dental subjects - First offered UST. Graduates were
“cirujanos ministrantes”. Serve as male nurses and sanitation inspectors. They are the one who are given the
responsibility when it comes to sanitation of the community.
• 1901 United States Philippine Commission Act 157, created Board of Health of Philippine Islands with
Commissioner of the Public Health (like duque), as chief executive officer (now DOH).
• Fajardo Act of 1912 - Created Sanitary Divisions made up of one to four municipalities, Each sanitary division
had a president who had to be physician.
• 1915 Philippine General Hospital began to extend public health nursing services in homes by organizing unit
called social and home services.
• 1905 Asociacion Femenista Filipina La Gota de Leche was the first center dedicated to the service of mother
and babies
• Nursing During the Philippine Revolution
• In the late 1890’s, the war between Philippines and Spain emerges which resulted to
significant amount of casualties. With this, many women have assumed the role of
nurses in order to assist the wounded soldiers. The emergence of Filipina nurses
brought about the development of Philippines Red Cross.
• Josephine Bracken — wife of Jose Rizal, installed a field hospital in an estate
house in Tejeros. She provided nursing care to the wounded night and day.
• Rosa Sevilla de Alvero — converted their house into quarters for the Filipino
soldiers; during the Philippine-American War that broke out in 1899
• Dona Hilaria de Aguinaldo — wife of Emilio Aguinaldo who organized that
Filipino Red Cross under the inspiration of Mabini.
• Dona Maria Agoncillo de Aguinaldo — second wife of Emilio Aguinaldo;
provided nursing care to Filipino soldiers during the revolution, President of the
Filipino Red Cross branch in Batangas.
• Melchora Aquino a.k.a. “Tandang Sora” — nursed the wounded Filipino soldiers and
gave them shelter and food.
• Capitan Salome — a revolutionary leader in Nueva Ecija; provided nursing care to the
wounded when not in combat.
• Agueda Kahabagan — revolutionary leader in Laguna, also provided nursing services
to her troops
• Trinidad Tecson (“Ina ng Biak-na-Bato”) — stayed in the hospital at Biak na Bato to
care for wounded soldiers
Hospitals and Nursing Schools
• Americans began training the first Filipino nursing students in 1907. Nursing students in
the Philippines studied many of the same subjects as nursing students in the U.S.
However, it was believed that the curriculum in the Philippines “was never a mirror-
image reproduction of the American nursing curriculum” and involved more than a
simple transfer of knowledge from American nurses to Filipino nurses. The first Filipino
nursing students also studied subjects that were more relevant to their patients, such as
“the nursing of tropical diseases” and “industrial and living conditions in the islands,” as
described by Lavinia L. Dock’s 1912 book A History of Nursing: From the Earliest
Times to the Present Day with Special Reference to the Work of the Past Thirty Years.
Hospital School of Nursing’s Formal Training (1901 – 1911)
• Formal training in hospital school of nursing transpire. This began when American missionary doctors and
nurses realized that they manpower is insufficient. Thus it resulted to a decision of training Filipino nurses that
would be catering to the hospitals that Americans established in the 20th century.
• The first hospital in the Philippines which trained Filipino nurses in 1906 was Iloilo Mission Hospital,
established by the Baptist Missionaries. When this health institution was built, there were no strict requirements
for the applicants as long as they are all willing to work. This has been the beginning of development of more
nursing schools in the country. In this period, Pensionado Act of 1903 (or Act 854) was mandated, allowing
Filipino nursing student to study in United States. Among of the first wave of nurses who went to United States
• Iloilo Mission Hospital School of Nursing (Iloilo City, 1906)
• It was ran by the Baptist Foreign Mission Society of America. Miss Rose Nicolet, a graduate of New England
Hospital for Women and Children in Boston, Massachusetts was the first superintendent for nurses. It moved
from its present location to Jaro Road, Iloilo City in 1929. Miss Flora Ernst, an American nurse, took charge of
the school in 1942. In April 1944 graduate nurses took the first Nurses Board Examination at the Iloilo Mission
Hospital.
• Saint Paul’s Hospital School of Nursing (Manila, 1907)
• The hospital was established by the Archbishop of Manila, Jeremiah Harty under the supervision of the Sisters of
St. Paul de Chartres located in Intramuros. It provided general hospital services. It opened its training school for
nurses in 1908, with Mother Melanie as superintendent and Miss Chambers as Principal
• Philippine General Hospital School of Nursing (Manila, 1907) - PGH began in 1901 as a
small dispensary for Civil officers and Employees in the City of Manila and later grew as a
Civil Hospital. In 1906, Mary Coleman Masters, an educator advocated for the idea of training
Filipino girls for the profession of nursing with the approval of Government officials, she first
opened a dormitory for Girls enrolled at the Philippine Normal Hall and the University of the
Philippines.
• In 1907, with the support of Governor General Forbes and the Director of Health and among
others, she opened classes in nursing under the Auspices of the Bureau of Education.
Admission was based on an entrance examination. The applicant must have completed
elementary education to the seventh grade. Julia Nichols and Charlotte Clayton taught the
students nursing subjects. American physician also served as lecturers.
In 1910, the Act No. 1976 modified the organization of the school placing it under the
supervision of the Department of Health. The Civil Hospital was abolished and the Philippine
General Hospital was established.
• St. Luke’s Hospital School of Nursing (Quezon City, 1907) - The hospital is an Episcopalian
Institution. It began as a small dispensary in 1903. In 1907, the school opened with three girls
admitted. These three girls had their first year in combined classes with the PGH School of
Nursing and St. Paul’s Hospital School of Nursing. Miss Helen Hicks was the first principal.
Mrs. Vitaliana Beltran was the first Filipino superintendent of nurses and Dr. Jose Fores was
the first medical director of the hospital.
• Mary Johnston Hospital and School of Nursing (Manila, 1907) - It started as a
small dispensary on Calle Cervantes (now Avenida). It was called the Bethany
Dispensary and funded by the Methodist Mission for the relief of suffering among
women and children. In 1907, Sister Rebecca Parrish together with registered nurses
Rose Dudley and Gertude Dreisbach, organized the Mary Johnston School of
Nursing. The nurses’ training course began with three Filipino young girls fresh from
elementary as their first students.
• Philippine Christian Mission Institute Schools of Nursing -The United Christian
Missionary Society of Indianapolis, Indiana- a Protestant organization of the disciples
of Christ operated three schools of nursing.
• The Start of Nursing Practice (1911- 1921)
• Promulgation of Act No. 2493 which amends Medical Law (Act No. 310) allowing the regulation of nursing
practice transpired during this period. However, in 1919, the First True Nursing Law was enacted through
Act 2808. During this period the Board Examiners for Nursing was also created. The first nursing board
examination was given on 1920. The first executive officer of the Board Examiners for Nurses is a
physicians.
• Mary Chiles Hospital School of Nursing (Manila, 1911) -The hospital was established by Dr. WN Lemon
in a small house on Azcarraga, Sampaloc, Manila. In 1913, Miss Mary Chiles of Montana donated a large
sum of money with which the preset building at Gastambide was bought. The Tuason Annex was donated by
Miss Esperanza Tuason, a Filipino Philanthropist.
• Frank Dunn Memorial Hospital (Vigan Ilocos Sur, 1912)

• San Juan de Dios Hospital School of Nursing (Manila, 1913)

• In 1913, through the initiative of Dr. Benito Valdez, the board of inspectors and the executive board of the
hospital passed a resolution to open school of nursing. The school has been run by the Daughters of Charity
since then. Sister Taciana Tinanes was the first Directress of the School
• Emmanuel Hospital School of Nursing (Capiz, 1913) - In 1913, the American Baptist Foreign Mission
Society sent Dr. PH Lerrigo to Capiz for the purpose of opening a hospital. Miss Rose Nicolet assisted him.
The school offered a 3-year training course for an annual fee of Php 100.00. Miss Clara Pedroso was the first
principal
• Southern Islands Hospital School of Nursing (Cebu, 1918) -The hospital was established in 1911 under
the Bureau of Health. The school opened in 1918 with Anastacia Giron-Tupas as the organizer. Miss
Visitacion Perez was the first principal
• A Much Established Professional Organization: 1921 – 1931
• During this period, the precursor to the accredited professional organization in the Philippines was
created. The Filipino Nurses Association was established on October 15, and the organization initiated the
publication of Filipino Nurse Journal. Later, this journal was changed to The Philippine Journal of
Nursing. Amendment of certain sections of the Act 2008 was conducted in 1922 under Act 3025 passed
by the 5th Legislature. This policy is entitled An Act Regulating the Practice of Nursing Profession in the
Philippine Islands, which necessitates all nurses who are practicing the profession to register yearly. In
1929, the organization also became a member of the International Council of Nurses.
• Through the 1930s, Philippine schools of nursing continued to adopt those aspects of American
professional nursing they deemed relevant and appropriate, such as higher admission standards and the
specialization of public health nursing.
Public Health Nursing Development: 1931 – 1941
• In 1933, the nursing institution have increased their requirement. During this period, they have
implemented that to enter nursing education an applicant must be able to complete secondary education.
The first collegiate nursing graduates of the Philippines graduated from University of the Philippines
School of Public Health Nursing in 1938.
• Commonwealth Act No. 430 Philippine government Under Philippine government they put up Department of
Health and called it Department of Public Health and Welfare. Modern times: DOH and DSWD DSWD- chooses
indigent, children.
• EO No. 317 (1941) Full implementation of Commonwealth Act No. 430.
• Dr. Jose Fabella 1st Department Secretary of Health and Public Welfare.
• 1947- Post War The Department of Health was reorganized into bureaus: Bureau of Hospitals and a Bureau of
Quarantine were created under DOH. Took charge of municipal and charity clinics.
• Creation of Nursing Service Division
• Bureau of Health with the sanitary divisions under it. Originally male nurses handle sanitation during the time of
Spain. The doctors became their boss when there are sanitary divisions already. The sanitary division became under
the DOH. DOH was the one responsible for health prevention and health promotion.
• Bureau of public welfare
• Became the Social Welfare Administration, just like the DSWD). 3. Bureau of hospitals- curative 4. Bureau of
hospitals- preventive care services.
• 1951  Sanitary district was converted into a Rural Health Unit. 81 selected provinces , Vital statistics
• 7 Basic Health Services: 1. Maternal and Child Health 2. Environmental Health 3. Communicable Disease Control 4.
Vital Statistics 5. Medical Care 6. Health Education 7. Public Health Nursing
• 1954- R. A. 1082 or Rural Health Act -Initially known as sanitary district/division. Creation of RHU in every
municipality. Created post for Municipal Health Officer. Originally 81 provinces have this now
• 1957- R. A. 1891 Amend certain provisions in Rural Health Act. Created 8 categories of rural health units corresponding
to the population size of the municipalities. Barangay Health Station- branch RHU; no dentist; main stay midwife;
barangay health worker.  Rural Sanitary Inspector- inspector of sanitation.
• 1970 Classification of health services into: Primary, Secondary and Tertiary Levels of Care. PHN population ratio is 1:
20,000. (1- nurse) Primary Level of Care- for health promotion and disease prevention (Rural Health Center).
Secondary Level of Care- moderate specialized care. District hospital.
• Tertiary Level of Care- highly specialized care.
• RA 1891 In 1957 amend certain provisions in rural health act. Created 8 categories of rural health units corresponding
to the population size of the municipalities. Those places who are hard to be reached, they established Barangay
Health Stations- branch of rural health unit. Barangay Health Station- no dental chair, nurses, and doctors available
unlike in RHU. Rural sanitary inspector- inspects environment if it can cause sickness.
• 1991 October, R. A. 7160 or Local Government Code Decentralization of entire government- all structures, personnel,
and budgetary allocations from the provincial health level down to the barangays were devolved to the local
government unit (LGU) to facilitate health service delivery. What happened in the health system in PH because of the
local government code? -Decentralized Delivery health services- is now the responsibility of the LGU. DOH changes its
role from one of implementation to one of governance.
•  2000 Millennium Development Goals Adopted during world summit in September. Created 8 goals. 1- connected to
poverty 4, 5, 6-connected with health.

•  2005 FOURmula One (F1) for health and Universal Health Care in 2010 - agenda launched in 1999. Health Service
Delivery- both the national government and LGUs manage the delivery of promotive, preventive, curative and
rehabilitative health services. Health Financing- The National Health Insurance Act of 1995 created the Philippine
Health Insurance Corporation (PhilHealth)