Area informatics in community health policy & system

development to cope with changing health needs in South

East AsiaProf. Masami MATSUDA, Dr.H. Sc.,

Prof. of Public Health, Dep. of Health Nutrition,Tokyo Kasei-gakuin University

PNC 2103 ,Kyoto Univ. Japan,Dec.11th, 2013

The recent development process of community health policy & health system change in Thailand show the position as the leading case of the area informatics in health field in South East Asia. From the viewpoints of health status & policy reports on global health such as in WHO (World Health Organization: United Nations’ Technical Agency in Health established in 1948), the current innovative programmer of TCNAP/RECAP on community health, nursing & information system in Thailand will be overviewed in the framework of international trend to understand the meaning of those activities in world health. The overview of framework in international health include such as 1.Primary Health Care in 1978 (Alma-Ata Declaration) & Primary Health Care 2008 (The World Health Report 2008, PHC: Now more and ever, 1)universal coverage, 2)primary care,3)public policy, and 4)leadership & government), 2.Health Promotion in 1986 (Ottawa Charter), 3.NCDs (the Political Declaration on Noncommunicable Diseases adopted by the UN General Assembly in 2011), 4.SDH (Rio Political Declaration at the World Conference on Social Determinants of Health in October 2011 in Rio de Janeiro, Brazil & Conceptual framework on Social determinants of health inequities,2010:CSDH) ,5.Global health risks,2009(WHO) & GBD (Global Burden of Disease) 2010 (Institute for Health Metrics and Evaluation).

The position of Data analysis and informatics in current innovative health activities in South East Asia is on the frontline in community health planning & policy implementation from the health statistics in national level. The content of health data in community include not only quantitative data but also qualitative data and how to marge those data is the critical issue in the actual field to cope with changing health needs such as aging, lifestyle diseases, NCDs. The factors which affect health policy change are the emerging four changes in population structure & social environments, such as rapidly aging society, epidemiological transition, risk behaviors & economic crises. The current health activities of TCNAP in Thailand are ample examples of the five sectors (1.Community empowerment, 2.Health literacy and health behavior, 3.Strengthening health systems, 4.Partnerships and intersectoral action, 5.Building capacity for health promotion) of the 7th Global Conference on Health Promotion, Kenya, 2009.

Change of Community & health issue in 40 years

• Disease structure (DM, hypertension, cancer)

• Lifestyle(obesity)• Economic development• (4C: Car, Cooler, Calar TV,

Computer)• Autonomy in local

government • Information revolution-

personal computer• Educational level

• Globalization• Loan, increasing debt• Aging• Disabilities: ＩＣＦ（ International Classification

of Functioning, Disability and Health ） May,2001 （ＷＨＯ） ,1980 ＷＨＯ（ＩＣＩＤＨ） , ICD(International Statistical Classification of Diseases) to Health &

• Indicators from death rate to DALY

PHC in 1978-2000• Health: infectious diseases (Diarrhea, TB, AIDS)• Development: occupational training, water supply,

etc.• Information: IEC• Participation: to Care provision such as VHV(health

volunteer )• GIS: nothing• Equipment in community: few telephone, no

computer,• Manpower: PHC worker but no RN/NP

Started the bachelor degree program

Established the 1 year course for th 1st- formal Program to train nurses at the Department of Public Health Nursing, Faculty of Public Health, Mahidol University

Lacked of Community Nurse who could provide screening and treatment

Demanded on Neonatal NP

2002

19841980-1981

1977

Development of Nursing Practitioner and Community Nurse in Thailand

1970

Faculty members and nursing staff = 4 NPs

Produced 12 groups (apprx.10-15 nurses/gr.)

1979

Produced and entitled the ‘Public Health Nurse Practitioner Program”

Started the 6 M NP course under physician authorities at Ramathibodi School of Nursing, MahidolUniversity

Not enough doctor specialiststo meet the needs of the people and lacked of skill nurses to screen and provide basic Tx to eyes pts

Established th 2rd- formal program 6 m. eye-NP program, by a physician from the Dept. of Ophthal. in collaboration with Dept. of Nursing, Faculty of Medicine, Ramathibodi Hosp., Mahidol Uni.

Demanded on ER NP to be able to manage cases

Produced ER-NP

Established th 3rd- formal program 6 m for ER-NP for Faculty ofMedicine, Ramathibodi Hosp, Mahidol Uni.

Established th 4rd- formal program 4 m for Neonatal-NP to work on growth, development, overall healthof newbornsProduced Neonatal-NP

2007

MoPH released regulations for NPs to provide treatment legally.

1990

Program of Nursing of Community students started at FON/KKU

NP’s performances were unacceptabilityby the physicians.

Stopped th 1st- formal program training activitiesApprx. 700 people produced totally

Thailand Economic crisis/IMF

Needed students to diagnosed and screening to work in rural but no competent teacher

Th 3rd- formal program reduced to 4 m for ER-NP

4 m for ER-NP course

The Thailand Nursing and Midwifery Council (TNMC) took the lead in responding to this need.

First group of selected students by community learned at FON/KKUBe a NOC model.Other 26 NU institutes apply this idea.

Needed more institutes to produce NP

Nursing institues in Thailand provided 4 m. NP course and 2 Yrs. for Advance nursing practice (APN) -a master degreeAble to

produce NP 1000 prs/ yr and APN of community 250 prs/ yr

Needed more CN belonging to community

Able to produce the undergrade CN apporx .20prs./yrs. To return to their communities

Expanded to Local Admin. Org.+ private sector for funded selected students

National Health Security office , Thailand signed MOU with TNMC to produce NP 10 yrs to response the needs at PC level

2004

To comply with the regulations of government.

Asean Economic

Community

Demographic impact of the HIV/AIDS epidemic

20151997

2001

Sources of Fund

1988

Universal coverage scheme (2001-2007)

2005 2008-2014

Primary Health Care (Until 2000)

The National HealthCare Reform and the Universal Health CareCoverage System was implemented , demanded NP in PCU = 15,000 prs.

?? Merging of Health Funds

Sources: Khanitta Nuntaboot, 2007; Somchit Hanucharunkul,2007

Health Security(2007-2013)

20092001

ユニーバル・ヘルス（国民皆保険）制度の開始 タイヘルス・プロモーション財団の設立

国民保健法

20072005

HealthyThailand’

policy

2008

Health Risk /Health demands

参考　 Khanitta 　Nuntaboot

タイの保健システム発展の外的・内的要因

School Health Policy

Public Health

Ministry Policy

Oral Health Promotion

Saiyairak project

Ministry of Social Development and Human Security Policy

Millennium Development Goal

Constitution of Kingdom of

Thailand

2010 2012

Her Royal highness Princess Sirasm, Royal Consort of His Royal highness Crown Prince Mahavagiralongkorn

19991986

Bangkok charter for health promotion

• Economic crisis• Thai Royal

election/political party’s interest

• Demanded on decentralized

地方分権化の開始（市町の自治権）

The Nairobi charter for health promotion

The Ottawa charter for Health Promotion

20092001

ユニーバル・ヘルス（国民皆保険）制度の開始

タイヘルス・プロモーション財団の設立

国民保健法

20072005

健康タイ政策

2008

参考　 Khanitta 　Nuntaboot

タイの保健システム発展の外的（図上）・内的（図下）要因（ 1986-2013 ）

公衆衛生省政策の革新

社会保障省の新政策

憲法改正

2010 2012

王立健康増進プロジェクト

19991986

バンコク憲章 HP 経済危機

地方分権化の開始 :市町の自治権

ナイロビ憲章 HP

オタワ憲章・ヘルス・プロモーション (HP)

ミレニアム開発目標

学部の看護教育開始

2002

19841980-1981

1977

タイの Nursing Practitioner と地域看護師の発展過程

1970

眼科NP

1979

保健師 NP

NPの養成開始

救急 ER-NPの養成

新生児NPの養成

2007

公衆衛生省NPの治療を許可

1990

NP の質が問題化

NPの養成700名で停止

IMF経済危機

ｺﾝｹﾝ大で地域NP　　養成

年間 1000 人のNP と 250 人の地域APN Advance nursing practice

学部の地域看護強化

2004

HIV/AIDS の広がり

1997

20011988

Universal coverage scheme (2001-2007)

2005 2008-2014

Primary Health Care (Until 2000)

NP / PCU が 15,000名必要

参照 : Khanitta Nuntaboot, 2007; Somchit Hanucharunkul,2007

Health Security(2007-2013)

TCNAP in 2009-2012• Health: lifestyle diseases (DM ,hypertension, cancer),Aging,

disability• Development: economic development (from bicycle to car

in local area) etc.• Information: information system• Participation: in all revel of decision making (from data

collection, analysis, policy) • GIS: challenging• Equipment in community: mobile telephone, computer,

camera,PHC unit(curative care & preventive care)• Manpower: RN,NP

Comparison of TCNAP with PHC

PHC in 1978-2000• Health: infectious disease• Development: occupational

training, water supply, etc.• Information: IEC• Participation: to Care provision

such as VHV(health volunteer )• GIS: nothing• Equipment in community: few

telephone, no computer• Manpower: PHC worker but

no RN/NP

TCNAP in 2009-2012• Health: lifestyle diseases

(DM ,hypertension, cancer), Aging, disability

• Development: economic development (from bicycle to car in local area) etc.

• Information: information system• Participation: in all revel of decision

making (from data collection, analysis, policy)

• GIS: challenging• Equipment in community: mobile

telephone, computer, camera, PHC unit(curative care & preventive care)

• Manpower: RN,NP

Change the health & welfare system with rapidly

aging society What is the factor to change the role of PHNs & health system ?

1. Population structure(Aging)2. Disease structure (cause of death,

communicable diseases, NCDs)3. Risk factors(life style )4. Economic conditions

Community data base in health promotion policy making with Multi-sectoral Collaboration &

Multi-stakeholders Partnership

量 Quantity Data(work place, public health insurance, community, school)

質 Quality Data

個Individual

Health Risks(smoking)

Meaning of Life, Mental Health, Terminal Care(Clinical)

集団 / 地域Population/Community

Utilize the Epidemiological Indicators in Community level (Death Rate, Prevalence Rate …)Integrate Individual & Community in Healthy Life Expectancy

Community Assessment(People, PHNs, Nutritionists, MD)Social Capital

Leading causes of attributable global mortality and burden of disease, 2004 (WHO)

%

1. High blood pressure 12.82. Tobacco use 8.73. High blood glucose 5.84. Physical inactivity 5.55. Overweight and obesity 4.86. High cholesterol 4.57. Unsafe sex 4.08. Alcohol use 3.89. Childhood underweight 3.810. Indoor smoke from solid fuels 3.3

59 million total global deaths in 2004

%

1. Childhood underweight 5.92. Unsafe sex 4.63. Alcohol use 4.54. Unsafe water, sanitation, hygiene

4.25. High blood pressure 3.76. Tobacco use 3.77. Suboptimal breastfeeding 2.98. High blood glucose 2.79. Indoor smoke from solid fuels 2.710. Overweight and obesity 2.3

1.5 billion total global DALYs in 2004

Attributable Mortality Attributable DALYs

GBD2010

Nature of Change

• Quantitative change (such as 10 % to 15% increase, 50 % to 35 % decrease)

• Qualitative change(epidemiological transition, health transition, population transition)

• Speed( low, high, very high)• Aging (Slow Speed: Quantity, Quality: Europe)• (High Speed: Japan, Asia, other countries)• Age: 0,5,10,15,20,30,40,50,60,70• : 0,5,20,40

Globalization of unstable- welfare state such as Japan which is rapidly Aging society with family

collapseThere are four types of welfare states in sociology.Japanese health & welfare system is a mixture of four welfare states.

1.Libertarian type(Market system) : US, Canada, Australia 　　　　　　 In Japan; Fee- for Service in medical care mixed with social insurance 　　　　

2.Beveridge-libertarian type (National minimum) : UK In Japan; Welfare system for child care, elderly care, disability care

3.Social insurance type : Germany, France, Italy In Japan; National Medical Care Insurance from 1965 National Care Insurance for aged from 2000

4.Scandinavian type (De-commercialization of labour with maternity leave, parental leave & educational leave) : Sweden, Denmark, Finland, Norway In Japan; ???(Esping-Andersen, The three worlds of welfare capitalism, Polity press, 1990)(Kenichi Tominaga, Welfare state in social change, p156-157, Chuokouron-shinsha, 2001 in Japanese)

1947; Social Right (Beveridge-libertarian ) in the new constitution of article 251950’; Priority is recovery of economy (Libertarian )1961 ; National health insurance and pension system 　 (toward Beveridge-libertarian type)

1973 ; Starting point of welfare state (strengthen Beveridge-libertarian type) (Matsuda in Tokyo University)

1982 ; budget cut(Libertarian) (Matsuda in Graduate school of Tokyo Univ. & in Mahidol U.,Thailand)1989-2000; Gold plan for the Aged and care insurance

scheme for the Aged requiring nursing care (Scandinavian type or Social insurance type) (Matsuda in RITB & U.Shizuoka)

2001-2013; Libertarian with budget cut (Matsuda in U.Shizuoka, Care of my mother, in U. Kasei-gakuin)(K. Tominaga, Welfare state in social change, p182-196, Chuokouron-

shinsha,2001 in Japanese)

Socio-economic condition and population aging

Rapidly Aging Society-speed of Aging 　2-4 times ( 7%→14% 　 Japan 25 years 、 Europe, US 45 ～ 115 years 10%→20% 　 Japan 21 years 、 Europe, US 43 ～ 86 years) 7% to 14% 10% to 20%

canada

Japan

USAItaly

France

Rapidly Aging Society-Japan as a Model of Countries in Asia, Latin America & Eastern Europe in future

JapanJapan

USA,EU

Thailand,Korea,Singapore,China,Indonesia

How to cope with Rapidly Aging Society like Japan

1. Do not rely on the western model of aging society but try to create own activities based on each community settings.

2. Change the target of health & welfare services from the longevity of life to healthy life expectancy plus QOL(Quality of Life).(Development of New data system)

3. Putting together the experiences of PHC (TB control, MCH) into NCDs prevention with emphasis on health promotion with academic society: JAHWP.(Reform Health & Welfare System and Society)

2009

• Breast feeding policy• Baby friendly hospital• Mother-Child policy• Child care center/ Kindergarten• Teenage health promotion (

Pregnant, Youth council from school-to-University)

• Healthy working place• Woman Health (Violence, CA

screening)• Health promotion• The "3 Generations Weave

Family Love” Center • Elderly people club• Accident and Emergency

prevention• National institute of Emergency

medicine/Disaster management

2001

Cost USD 2 billion for health promotion

activities a year

Launching of the Universal Health

Coverage Scheme

• Draws upon a 2 percent surcharge levied on alcohol and tobacco excise tax, approximately USD 50-60 million a year

• ThaiHealth funds programs health risks/issues such as alcohol, tobacco, accidents, exercise, as well as area or setting based programs, for example, school, work place, community, and programs that target specific population groups such as the youth, the elderly, Muslim community

• Open grants program invites proposals from all kinds of organizations/groups interested in launching HP initiatives

Establishment of the ThaiHealth Promotion Foundation as a HP funding mechanism

National Health Act

20072005

HealthyThailand’

policy

Embraces the principle of human rights and key principles of the Ottawa Charter in 2005. It is a result of five years of extensive public dialogues on important health issues that enhanced public awareness and nation wide networking on health promotion

2008

Health Risk /Health demands

• Largest aerobic display

• Against drunk driving and controls on tobacco

• Thailand is committed to reducing substance

Policies influencing health promotion scheme in Thailand

Thai Royal Government Policy Statement

School Health Policy

Public Health

Ministry Policy

Oral Health Promotion

Saiyairak project

Ministry of Social Development and Human Security Policy

Millennium Development Goal

Constitution of Kingdom of

Thailand

2010 2012

Her Royal highness Princess Sirasm, Royal Consort of His Royal highness Crown Prince Mahavagiralongkorn

19991986

• Increasing prevalence of chronic illness

• Changing demographics of aging adults

• Risk Behavior i.e. smoking Alc. Drinking, Changing diet habit and unsafe sex practices

Bangkok charter for health promotion

• Economic crisis• Thai Royal

election/political party’s interest

• Demanded on decentralized

Decentralization started

Decentralization to LAO (Authorities and fund)• Sub- district fund

allocation• Control social

determinants to health

• Welfare to population

The Nairobi charter for health promotion

The Ottawa charter for Health Promotion

Embraces the principle and

direction of health promotion

GBD2010

GBD2010

GBD2010

GBD2010

Role of public health

• Policy, quality assurance, evaluation(ABM)• traditional public health practitioners and

institutions are reaching out (or could reach out) to the public through social media. "Public Health 2.0" is used to describe public health research that uses data gathered from social networking sites, search engine queries, cell phones, or other technologies.(Wiki)

Brief History; PHN Role(3) • Contemporary roles

– Community Developer– Facilitator of self-health promoter/self-help– Resource Manager– Policy Formulator

• Remarkable topics today : lifestyle disease, frail elderly– Community level activities– Health problems of the growing elderly population, so on– PHNs are using a variety of health promotion strategies

• The role of PHN has become bigger and bigger in Japan.

Feb. 5th 2009Katsumasa Ota

New role of head PHN in Shizuoka government for the policy in health promotion (Eguchi A.)

Several key health promotion concepts were identified in various health promotion initiatives.

The mindsets in PHNs’ activities became the driving force behind the initiatives. 　　　

In the development of health promotion initiatives, PHNs work proactively in order to understand the opinions and concerns of both municipalities and residents through a variety of channels.

By observing both the overall picture and disparities in health status in different areas, prefectural PHNs supported the “visualization” of processes involved in and results produced by initiatives undertaken by its municipalities, while also promoting the “visualization” of reliable health information.

PHNs created an administrative system for ensuring the effectiveness of initiatives.

Advancing community development through win-win partnership that exceeds the boundaries of health sector appears to be linked to positive participation in

health promotion by both individuals and private corporations.

Box 1: Disability-adjusted life years (DALYs)DALYs are a common currency by which deaths at different ages and disability may be measured. One DALY can be thought of as one lost year of “healthy” life, and the burden of disease can be thought of as a measurement of the gap between current health status and an ideal situation where everyone lives into old age, free of disease and disability.DALYs for a disease or injury are calculated as the sum of the years of life lost due to premature mortality (YLL) in the population and the years lost due to disability (YLD) for incident cases of the disease or injury. YLL are calculated from the number of deaths at each age multiplied by a global standard life expectancy of the age at which death occurs. YLD for a particular cause in a particular time period are estimated as follows:YLD = number of incident cases in that period × average duration of the disease × disability weightThe disability weight reflects the severity of the disease on a scale from 0 (perfect health) to 1 (death). The disability weights used for global burden of disease DALY estimates are listed elsewhere (6).In the standard DALYs in recent WHO reports, calculations of YLD used an additional 3% time discounting and non-uniform age weights that give less weight to years lived at young and older ages (7). Using discounting and age weights, a death in infancy corresponds to 33 DALYs, and deaths at ages 5–20 years to around 36 DALYs.

Development of Healthy Japan 21st –National & Regional/Local Level(A.Eguchi)

Achievements of Healthy Japan 21st

(1st Stage :2000-2012)

1.National Level: Decrease the Smoking Rate of Male from 50 % to 35 % (still high)

2.National Level: Decrease the Suicide Population from over 30000 per year to under of it in 2012 (-1997 over 20000, increased during 1998-2011 over 30000)

3.Local Level: Average Prefecture of Shizuoka in any health & welfare outcomes became No.1 in healthy life expectancy in 2012(Male 71.68 years, Female 75.32 years)

Empower local city & town using area data on Smoking & heart disease-A Case of Shizuoka- (A.Eguchi)

JAHWP compare with TCNAP;Community Strengthening Actions

RECAP TCNAP (1)

HFA21Japan,9 HPP,130 Targets7 HPP

Healthy Public Policy(84 proposals)

Systems/Civil groups

(SOJO method; Iwanaga)

Outcomes &

Impacts of initiatives & actions

Multi-stakeholders Partnership

1. Alcohol Consumption 2. Smoking 3. Accident 4. Healthy Food (Shokuiku;eating education) 5. Physical Activity(100ys old Ikiiki; Horikawa) 6. Health Care (Economics, Politics) 7. Health Investment (Inequality & social divide) 8. Disaster management (Kobe,Fukushima) (Climate & Nuclear disasters)Etc.

Multi-sectoral Collaboration

1. Disaster management 2. Learning & Education3. Welfare4. Health Care5. Environment & natural resources management6. Food security & organic agriculture7. Governance in administration

of local government

Health : (1) Health care (2) Social Health Determinant

Evaluation of HFA21Japan

8+ Impacts of Health

Management of effective Initiatives & Actions

1. Te

chni

cal T

eam

2. M

anag

emen

t Tea

m3.

Com

mun

icati

on Te

am4.

May

or/A

dmin

istra

tor

Team

HP 10 Acts/law(Nishimoto)

Case;1.Shizuoka Prefecture (Eguchi,et al)2.Hachioji city (Noyama)

Shimane;GIS-Social capital (Shiwaku,Hamano)

Development of TCNAP

Development of community data base system

• community based research

• knowledge management for healthy tambons

• innovations for health care and services at primary level

• healthy tambons• community health system

development

Civil society groups

Local governmentChiefs &

chairs

Public sectors

RECAP

• students trainings •Trainings of students for nurses of the community project TCNAP

Knowledge from research findings

• social capitals• 4 groups of community data1. Baseline data2. Problems 3. Systems

strengthening4. Outputs, outcomes,

impacts•involving parties•assessment tools•supportive systems

TCNAP1

Nuntaboot, 2012

TCNAP2

TCNAP3

TCNAP4

• Community Problems• Target Population • Natural recourses management• Activities and problem solving process

• Related organization•Community systems management• Model or guideline on mechanism for systems strengthening

• Health status• Outcomes of community systems strengthening• Impacts on human conditions that affect health and well being

Community problems & issues

Community systems management

Outcomesof community systems strengthening

2012-13

2012-13

2013-14

JAHWP compare with TCNAP;Community Strengthening Actions

RECAP TCNAP (1)

HFA21Japan,9 HPP,130 Targets7 HPP

Healthy Public Policy(84 proposals)

Systems/Civil groups

(SOJO method; Iwanaga)

Integrate into Platform

Outcomes &

Impacts of initiatives & actions

TCNAP (2)

TCNAP (4)

1. Alcohol Consumption 2. Smoking3. Accident 4. Healthy Food (Shokuiku;eating education) 5. Physical Activity(100ys old Ikiiki; Horikawa)6. Health Care 7. Health Investment 8. Disaster management (Kobe,Fukushima)Etc.

TCNAP (3)

1. Disaster management 2. Learning & Education3. Welfare4. Health Care5. Environment & natural

resources management6. Food security & organic

agriculture7. Governance in administration

of local government

Tambon Health : (1) Health care(2) Social Health Determinant

Evaluation of HFA21Japan

8+ Impacts of Health

Management of effective Initiatives & Actions

1. Te

chni

cal T

eam

2. M

anag

emen

t Tea

m3.

Com

mun

icati

on T

eam

4. M

ayor

/Adm

inis

trat

or

Team

HP 10 Acts/law(Nishimoto)

Case;1.Shizuoka Prefecture (Eguchi,et al)2.Hachioji city (Noyama)

Shimane;GIS-Social capital (Shiwaku,Hamano)

Pre-J AHWP projects of Health promotion in J apan (1978-1986-1997) 1. development of SOJ O(Prof.Iwanaga) with research

funds from MOHW and many local area practices.(national & over country)

2. Development of healthy city module/kit in Shimane Pref.(Prof.Yamane)(West)

3. Development of public health manpower (Prof.Arai) (North)

4. Development of GN model(Prof.Maruchi) (central) 5. Citizen participation in community health &

welfare of intractable diseases & mental health (Ishikawa,Tokinkyo)(Tokyo), (Yanak,Yadokari-no-sato)(Saitama)

1997 Creating the J apanese academic society of health & welfare policy (J AHWP)

PHN:Role in the past Health Systems in Transition Kozo Tatara, Etsuji Okamoto,WHO,2009

Health educationFor improvements in community involvement, it is essential to provideopportunities for residents to obtain information about health planningpromoted in their community. This has yet to be fully implemented in Japan,although residents may have had such opportunities in the various actions forhealth education organized by public health nurses in their community.

ReductionLong life expectancy in Japan is largely the result of a reduction in infant mortality and deaths from TB and cerebrovascular diseases. The recent decline in deaths from cerebrovascular diseases reflects the strong network of community activities, with an important role of public health nurses (Tatara et al., 1984).

Brief History; PHN Role(1) (truncated)• The first PHN activities started in 1920.

– Prevalence of Tuberculosis; prevalence rate 223.7– Main role; prevention and visiting care for TB

patients, school nursing, et. al• The systemized education of PHN began

– 1928 ; Japan Red-Cross– 1930 ; Japan Saint-luke’s Nursing School, so on.

• PHN Act was established in 1941.– To promote health condition of the candidate for

soldiers by the governmental request.

Feb. 5th 2009Katsumasa Ota

Brief History; PHN Role(2)• After WW-II

– Japanese health condition in general; so terrible– The American General Head Quarter GHQ re-organized

Japanese nursing system and unified the legislation of nurse, PHN and midwife into one ACT..

– The conventional role of the PHN:• cutting off vicious circle of poverty and disease• prevention of disease• supporting the effort of self-improvement by residents, et. al.

• An episode of the PHN in those days– PHNs completed successfully to give the poliomyelitis

vaccine to 13 million children within a month in 1955.– This resulted in big contribution for termination

of poliomyelitis in Japan, afterwards.

Feb. 5th 2009Katsumasa Ota

Education System for Nurses

Junior High

High School

4-year Univ/Col

BScN Program

3-year RNSchool

DiplomaProgram

MW

RN

1-year PHNCourse

1-year MWCourse

PHN

MW

2-year LPNSchool LPN

2-year RN School(JH grads need min. 3-year

clinical exp.)

RN PHN

Feb. 5th 2009Katsumasa Ota

GBD2010