COMMUNITY HEALTH NURSING

- MR. GERARDO “DYERI” P. ANDAMO R.N.

Unit 1
COMMUNITY HEALTH NURSING: AN OVERVIEW

 Defining Community Health Nursing

• What is a community?
- a group of people with common characteristics or interests living together
within a territory or geographical boundary

- place where people under usual conditions are found

• What is health?
1. Health-illness continuum
2. High-level wellness
3. Agent-host-environment
4. Health belief
5. Evolutionary-based
6. Health promotion
7. WHO definition

• What is community health?

- part of paramedical and medical intervention/approach which is concerned

on the health of the whole population

- aims:
1. health promotion
2. disease prevention
3. management of factors affecting health

• What is nursing?

- assisting sick individuals to become healthy and healthy individuals achieve

optimum wellness

• What is Community Health Nursing?

“The utilization of the nursing process in the different levels of

clientele-individuals, families, population groups and communities,
concerned with the promotion of health, prevention of disease and
disability and rehabilitation.”

- Maglaya, et al

Goal: “To raise the level of citizenry by helping communities and families
to cope with the discontinuities in and threats to health in such a way as to
maximize their potential for high-level wellness”
 - Nisce, et al
 Basic Principles of CHN

1. The community is the patient in CHN, the family is the unit of care and there
are four levels of clientele: individual, family, population group (those who
share common characteristics, developmental stages and common exposure
to health problems – e.g. children, elderly), and the community.

2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE

recipient of care

3. CHN practice is affected by developments in health technology, in particular,

changes in society, in general

4. The goal of CHN is achieved through multi-sectoral efforts

5. CHN is a part of health care system and the larger human services system.

 Roles of the PUBLIC HEALTH NURSE

• Clinician, who is a health care provider, taking care of the sick people at
home or in the RHU

• Health Educator, who aims towards health promotion and illness prevention
through dissemination of correct information; educating people

• Facilitator, who establishes multi-sectoral linkages by referral system

• Supervisor, who monitors and supervises the performance of midwives

In the event that the Municipal Health Officer (MHO) is unable to perform his
duties/functions or is not available, the Public Health Nurse will take charge of
the MHO’s responsibilities.

Other Specific Responsibilities of a Nurse, spelled by the implementing rules and

Regulations of RA 7164 (Philippine Nursing Act of 1991) includes:

• Supervision and care of women during pregnancy, labor and puerperium

• Performance of internal examination and delivery of babies
• Suturing lacerations in the absence of a physician
• Provision of first aid measures and emergency care
• Recommending herbal and symptomatic meds…etc.

In the care of the families:

• Provision of primary health care services

• Developmental/Utilization of family nursing care plan in the provision of
care

In the care of the communities:

• Community organizing mobilization, community development and people

empowerment
• Case finding and epidemiological investigation
• Program planning, implementation and evaluation
 • Influencing executive and legislative individuals or bodies concerning
health and development

 Responsibilities of CHN

• be a part in developing an overall health plan, its implementation and

evaluation for communities

• provide quality nursing services to the three levels of clientele

• maintain coordination/linkages with other health team members,

NGO/government agencies in the provision of public health services

• conduct researches relevant to CHN services to improve provision of health

care

• provide opportunities for professional growth and continuing education for

staff development

Unit 2
LEVELS OF CLIENTELE IN CHN

 Individual

Basic approaches in looking at the individual:

1. Atomistic

2. Holistic

Perspectives in understanding the individual:

1. Biological

a. unified whole

b. holon

c. dimorphism

2. Anthropological

a. essentialism

b. social constructionism

c. culture

3. Psychological

a. psychosexual

b. psychosocial
 c. behaviorism

d. social learning

4. Sociological

a. family and kinship

b. social groups

 Family

Models:
1. Developmental

Stages of Family Development

Stage 1 – The Beginning Family

Stage 2 – The Early Child-bearing Family

Stage 3 – The Family with Preschool Children

Stage 4 – The Family with School Age Children

Stage 5 – The Family with Teen-agers

Stage 6 – The Family as Launching Center

Stage 7 – The Middle-aged Family

Stage 8 – The Aging Family

2. Structural-Functional

Initial Data Base

• Family structure and Characteristics

• Socio-economic and Cultural Factors

• Environmental Factors

• Health Assessment of Each Member

 • Value Placed on Prevention of Disease
First Level Assessment

• Health threats:
conditions that are conducive to disease, accident or failure to realize
one’s health potential

• Health deficits:
instances of failure in health maintenance (disease, disability,
developmental lag)

• Stress points/ Foreseeable crisis situation:

anticipated periods of unusual demand on the individual or family in
terms of adjustment or family resources

Second Level Assessment:

• Recognition of the problem

• Decision on appropriate health action
• Care to affected family member
• Provision of healthy home environment
• Utilization of community resources for health care

Problem Prioritization:

• Nature of the problem

Health deficit
Health threat
Foreseeable Crisis

• Preventive potential
High
Moderate
Low

• Modifiability
Easily modifiable
Partially modifiable
Not modifiable

• Salience
High
Moderate
Low

Family Service and Progress Record

 Population Group

Vulnerable Groups:

• Infants and Young Children

• School age
• Adolescents
• Mothers
 • Males
• Old People

Specialized Fields:

• Community Mental Health Nursing

A unique clinical process which includes an integration of concepts
from nursing, mental health, social psychology, psychology,
community networks, and the basic sciences

• Occupational Health Nursing

The application of nursing principles and procedures in conserving
the health of workers in all occupations

• School Health Nursing

The application of nursing theories and principles in the care of the
school population

Components:

Unit 3
ASSESSMENT OF COMMUNITY HEALTH NEEDS

 Community Diagnosis

- A process by which the nurse collects data about the community in order
to identify factors which may influence the deaths and illnesses of the
population, to formulate a community health nursing diagnosis and
develop and implement community health nursing interventions and
strategies

2 Types of Community Diagnosis

Comprehensive Community Problem-Oriented Community

Diagnosis Diagnosis

- aims to obtain general information - type of assessment responds to a

about the community particular need

STEPS:

• Preparatory Phase

1. site selection
2. preparation of the community
3. statement of the objectives
4. determine the data to be collected
5. identify methods and instruments for data collection
6. finalize sampling design and methods
7. make a timetable

• Implementation Phase
 1. data collection
2. data organization/collation
3. data presentation
4. data analysis
5. identification of health problems
6. priority zation of health problems
7. development of a health plan
8. validation and feedback

• Evaluation Phase
 Biostatistics
A. Demography

-study of population size, composition and spatial distribution as affected

by births, deaths and migration.

* Sources:
Census – complete enumeration of the population

2 Ways of Assigning People

De jure De facto
People were assigned to the place where People were assigned to the place
they usually live regardless of where they where they are physically present at
are at the time of census. the time of census, regardless, of
their usual place of residence.

COMPONENTS:
Population size

Population composition
* Age Distribution
* Sex Ratio
* Population Pyramid
* Median age
age below which 50% of the population fall and above which 50% of the
population fall. The lower the median age, the younger the population
(high fertility, high death rates).
* Age – Dependency Ratio
used as an index of age-induced economic drain on human resources

* Other characteristics:
- occupational groups
- economic groups
- educational attainment
- ethnic groups

Population Distribution

* Urban-Rural
shows the proportion of people living in urban compared to the rural areas
* Crowding Index
 indicates the ease by which a communicable disease can be transmitted
from 1 host to another susceptible host.
* Population Density
determines congestion of the place
B. Vital Statistics
the application of statistical measures to vital events (births, deaths and
common illnesses) that is utilized to gauge the levels of health, illness and
health services of a community.

• Fertility Rate

Crude Birth Rate

General Fertility Rate

• Mortality Rates

Crude Death Rate

Specific Mortality Rate
Infant Mortality Rate
Neonatal Mortality Rate
Post-neonatal Mortality Rate
Maternal Mortality Rate
Proportionate Mortality Rate
Swaroop’s Index
Case Fatality Rate
Cause-of- Death Rate

• Morbidity Rates

Prevalence Rate
Incidence Rate

C. Epidemiology
- the study of distribution of disease or physiologic condition among
human population s and the factors affecting such distribution
- the study of the occurrence and distribution of health conditions
such as disease, death, deformities or disabilities on human
populations

Basic Concepts:
1. Epidemiologic Triad
2. transmission
3. incubation period
4. herd immunity

Factors affecting distribution:

1. PERSON
- intrinsic characteristics
2. PLACE
- extrinsic factors
3. TIME
- temporal patterns

Patterns of Disease Occurrence:

Epidemic
 a situation when there is a high incidence of new cases of a specific
-
disease in excess of the expected.
- when the proportion of the susceptibles are high compared to the
proportion of the immunes
Epidemic potential
- an area becomes vulnerable to a disease upsurge due to causal
factors such as climatic changes, ecologic changes, or socio-
economic changes
Endemic
- habitual presence of a disease in a given geographic location
accounting for the low number of both immunes and susceptibles
e.g. Malaria is a disease endemic at Palawan.
- the causative factor of the disease is constantly available or present
to the area.
Sporadic
- disease occurs every now and then affecting only a small number
of people relative to the total population
- intermittent
Pandemic
- global occurrence of a disease

Types of Epidemiological Study Designs

Descriptive VS Analytical

Provides information on patterns of

disease in terms of person, place and Test hypothesis about
causes characteristics of disease

Intervention
* Correlational * Case Reports Observational (Experimental)
studies
*Case Series * Case control * Trials
* Ecologic *Cross-sectional * Cohort
surveys

Experimental VS. Non-Experimental

With manipulation Mere observation of study conditions

* Clinical Trials * Cohort

* Field Trials * Case Control
* Community Intervention Trials * Proportional-Mortality Studies
* Cross-sectional
* Ecologic

Common Epidemiologic Studies:

Retrospective Cross-sectional Prospective Cohort

Steps in EPIDEMIOLOGICAL IVESTIGATION:

1. Establish fact of presence of epidemic
 2. Establish time and space relationship of the disease
3. Relate to characteristics of the group in the community
4. Correlate all data obtained

Unit 4:
NATIONAL HEALTH SITUATION

 Health Indices
I. Basic Health Indicators
A. Nutrition
B. Disease Patterns
Leading Causes of Morbidity
Leading Causes of Mortality

II. Other Indicators

A. Infant Mortality Rate

B. Maternal Mortality Rate
C. Life Expectancy at Birth
D. Median Age
E. Crude Rates
1. Crude birth rate
2. Crude death rate

 Health Care Delivery System

Health Care Delivery System is

“the totality of all policies, facilities, equipments, products, human
resources and services which address the health needs, problems and
concerns of the people. It is large, complex, multi-level and multi-
disciplinary.”

Categories:

According to Increasing Complexity of According to the Type of Service

the Services Provided

Type Service Type Example

Health Promotion, Health Information

Preventive Care, Promotion and Dissemination
Primary Continuing Care for illness
common health Prevention
problems, attention to
psychological and
social care, referrals

Surgery, Medical Diagnosis and Screening

Secondary services by Specialists Treatment
 Advanced, specialized,
Tertiary diagnostic, therapeutic Rehabilitation PT/OT
& rehabilitative care

 The Health Sector

Department of Health

Vision: Health for all by year 2000 ands Health in the Hands of the
People by 2020

Mission: In partnership with the people, provide equity, quality and access
to health care esp. the marginalized

5 Major Functions:
1. Ensure equal access to basic health services
2. Ensure formulation of national policies for proper division of labor and
proper coordination of operations among the government agency
jurisdictions
3. Ensure a minimum level of implementation nationwide of services
regarded as public health goods
4. Plan and establish arrangements for the public health systems to
achieve economies of scale
5. maintain a medium of regulations and standards to protect consumers
and guide providers

Local Government Units

Private Sector
-Composed of both commercial and business organizations, non-business
organizations

Commercial / Business Non-commercial

Profit – oriented Orientation to social development, relief
and rehabilitation, community organizing
► Manufacturing companies ► Socio-civic groups
► Advertising agencies ► Religious organizations/foundations
► Private practitioners
► Private institutions

NGOs
assumes the following roles:
- Policy and Legislative Advocates
- Organizers, Human Rights Advocates
- Research and Documentation
- Health Resource Development Personnel
- Relief and Disaster Management
- Networking

FOUR QUESTIONS:

Who are served?

Who provides the services?

Where are the services given?

What is the focus of care?

Unit 5
THE NATIONAL HEALTH PLAN

National Health Plan is a long-term directional plan for health; the

blueprint defining the country’s health –

PROBLEMS
POLICY THRUSTS
STRATEGIES
THRUSTS
(Acronym: PPST)

GOAL :

to enable the Filipino population to achieve a level of health which will allow
Filipino to lead a socially and economically-productive life, with longer life
expectancy, low infant mortality, low maternal mortality and less disability through
measures that will guarantee access of everyone to essential health care

 Broad Objectives:

• promote equity in health status among all segments of society

• address specific health problems of the population
• upgrade the status and transform the HCDS into a responsive, dynamic
and highly efficient, and effective one in the provision of solutions to
changing the health needs of the population
• promote active and sustained people’s participation in health care

 MAJOR HEALTH PLANS TOWARDS “HEALTH IN THE HANDS OF THE

PEOPLE IN THE YEAR 2020”

“23 IN 1993”

■ refers to the 23 programs, projects, activities of the DOH for the year
1993, which marks the beginning of its journey towards DOH vision

“Health for more in ‘94”

- activities in 1994 focused on Cancer prevention, Reproductive health,

Mental health and maintenance of a safe environment
“Health Focus in 1995”… “Think Health, Health Link”

National

a health promotion strategy

Multi-sectoral

Conveying health messages to people wherever they are

advocacy
aimed at
Building supportive environments thru -- community action

networking

5 Thrusts and Strategies

Multi-sectoral action & Consensus Building

Linkages & Networking
Community Organizing
Risk Assessment & Management
Capacity Building

In lieu of “Five in ‘95”, DOH characterized what a…

Healthy __________________ should be:

BARRIO
► Residents actively participate in attaining good health; they are
PARTNERS in health care

Highlight Project: BOTIKA SA PASO CAMPAIGN

Goal : to maintain herbal plants in pots for family use

CITY
► The physical environment in the workplace, streets, and public
places promotes health, safety, order, and cleanliness through
structural manpower support

Health-related Strategies: Construction of well-maintained, income-generating

public toilets; designation of a “Pook-Sakayan, Pook-Babaan”

EATING PLACE
Safe properly - Prepared
An eating place where Stored
Nutritious Transported
foods & drinks are served.

Complies with the following sanitation standards:

► safe, environment-friendly
 ► with clean restrooms
► food handlers are medically-fit and observes proper personal hygiene
► clean with adequate, well-maintained facilities

MARKET
► adequate water supply
► proper drainage
► well-maintained toilet facilities
► proper garbage and waste disposal is observed by vendors
► cleanliness maintained
► affordable quality foods
► has a well-organized and honest market system

WORKPLACE
► Physical Environment: clean, orderly, well-ventilated, adequately-lighted,
smoke-free and adequately-secured which promotes and protects the safety
and health of the family members
► Psychosocial Environment: its management encourages professional,
personal and spiritual growth, which promotes harmonious relationships and
productive work

HOSPITAL
► A “CENTER OF WELLNESS”
► Promotes preventive care
► provides clean and adequate resources, affordable and accessible services
► Patient-centered
► Governed by competent health team members and personnel

HOME
► A safe, sanitary, peaceful place where God-fearing household members are
provided with the basic physical, social, economic, emotional, mental, moral
and spiritual needs by their responsible parents/guardians

SCHOOL
► Health instructions provided through classroom/extra-curricular activities
► Maintains adequate, basic health services to both pupils, teachers, and other
personnel
Sample School Initiative : Little Doctor Program
- outstanding students are chosen yearly on the bases of their healthy
conditions and lifestyles

PRISON
► Physical Environment: clean, safe detention place with adequate facilities
► Psychosocial Environment: services address the mental, spiritual, physical,
social and economic needs of inmates; has an atmosphere that actively
promotes JUSTICE, PEACE, REHABILITATION and a HEALTHY LIFESTYLE

PORT
► Physical Environment: clean, spacious, and secure, with public waiting
areas, passenger terminals, safe drinking water, sanitary food shops and public
toilets; conveniently and economically-accessible
► NOT a FRONT for gambling, smuggling, prostitution, and other vices

HOTEL/MOTEL
► Physical Environment: clean, safe, pleasant place; conforms with a set of
guidelines and standards; provides comfort and security
RESORT
► Clean, safe, affordable resort
► Provides recreation, rest, relaxation and wholesome entertainment
► Promotes and maintains favorable environmental and health conditions
STREET
► Well-maintained roads and public waiting areas
► Well-marked traffic signs and pedestrian crossing lane and visible street
names
► Clean and obstruction-free sidewalks
► With minimal traffic problems
► With adequate strict law enforcement
Project: Pook-Tawiran (Kapag ikaw ay nahuli, walang sisihan)
Goal : To promote and reorient people especially erring pedestrians on the use
of pedestrian crossings

VEHICLE
► Clean, safe, comfortable, smoke-free, well-ventilated, in good running
condition
► Manned by a reliable and dependable licensed operators
► With posters on health promotion and illness prevention

MOVIE HOUSE
► Provides rest, recreation, and wholesome entertainment
► Has sanitary toilets and adequate communication facilities

Unit 6
STRATEGIES AND METHODOLOGIES IN CHN:

 Strategies and Health Status Targets to Achieve Objectives

Strategies to promote equity in health

► priority for the vulnerable and marginalized

Marginalized people are those who live geographically and culturally isolated
areas; are victims of poverty, armed-conflict, man-made and natural disasters
and poor environmental conditions. Vulnerable sector of the population is
composed of infants (0 mo-1 yr) and children (1-4 y/o), women or reproductive
age (15-44 y/o), youth and adolescents and the elderly (65 and above).

► primary Health Care as the Key Approach

1. Health Promotion

Levels of Health Promotion:

1. individual wellness

2. family wellness

3. community wellness

4. environmental wellness

5. societal wellness
2. Disease Prevention

Primary Level of Disease Prevention

Through people
Environmental control

Secondary Level of Disease Prevention

Screening Methods:
* mass screening
* case-finding
* contact-tracing
* multi-phasic screening
* surveillance

Characteristics of an ideal screening test:

• sensitivity
• specificity

Tertiary Level of Disease Prevention

3 Levels of Prevention

PRIMARY LEVEL SECONDARY LEVEL TERTIARY LEVEL

Health Promotion Prevention of Prevention of Disability,
and Illness Complications thru Early etc.
Prevention Dx and Tx

Provided at – ► When hospitalization ► When highly-

► Health care/RHU is deemed specialized medical
► Brgy. Health necessary and care is necessary
Stations referral is made to ► referrals are made to
►Main Health emergency (now hospitals and
Center district), provincial or medical center such
►Community regional or private as PGH, PHC,
Hospital and hospitals POC, National
Health Center Center for Mental
►Private and Semi- Health, and other
private agencies gov’t private
hospitals at the
municipal level

3. Community Organizing

Levels of Awareness:

Political socialization

Political mobilization
 Interest aggregation

Interest articulation

Culture of silence/passivity

4. Primary Health Care

PHC was declared in the ALMA ATA CONFERENCE in 1978, as a strategy to
community health development. It is a strategy aimed to provide essential
health care that is:
Community-based
Accessible
Part and parcel of the total socio-economic development effort of the nation
Acceptable
Sustainable at an affordable cost.

Framework
People’s Empowerment and Partnership is the
Key Strategy to achieve the goal, “Health For all Filipinos by the year 2000
And Health in the Hands of the People by the year 2020”

WHAT DOES ESSENTIAL HEALTH CARE IN PHC MEANS?

It stands for: Education of prevailing Health Problems

Locally-endemic Disease Prevention and Control
Expanded Program of Immunization
Maternal and Child Health and Family Planning
Environmental Sanitation and Safe Water Supply
Nutrition and Food Supply
Treatment of Communicable & Non-communicable Diseases/
Conditions
Supply and Proper use of Essential Drugs and Herbal Medicine
Dental Health Promotion
Access to and use of hospitals as Centers of Wellness
Mental Health Promotion

Acronym: ELEMENTS + DAM

Pillars (major elements):

A. Multi-sectoral approach
Intersectoral linkages
Intrasectoral linkages
B. Community Participation
C. Appropriate Technology
- method used to provide a socially and environmentally acceptable level
of service or quality product at the least economic cost.

Criteria: Feasible
Acceptable, Affordable
Complex
Effective
Safe
Scope-wise

Herbal Medicine:
 • aromatic
• astringent –tasting
• bitter-tasting
• seeds
• grass family
10 MEDICINAL PLANTS:

Lagundi Sambong
Olasimang-Bato Ampalaya
Bawang Niyog-niyogan
Bayabas Tsaang gubat
Yerba-buena Akapulko
(Acronym: LOBBY SANTA)

In “23 in ‘93”, the utilization of the 10 Herbal Plants was aggressively prescribed
through community wide implementation of projects such as herbal garden in
communities

RA 8423: utilization of medicinal plants as alternative for high cost

medications.
Policies:
1. The indications/uses of plants
2. The part of the plant to be used
3. Preparation of
a. Decoction e. oils
b. Poultice f. ointment
c. Infusion g. tincture
d. Syrup h. Elixir

D. Support mechanism made available

TYPES OF PRIMARY HEALTH WORKERS

Village/Grassroots Health Intermediate Level Health Personnel of

Workers First-Line Hospitals
Trained Community General Medical Physicians with
E Health worker; health Practitioners specialty area
X auxiliary volunteer; Public Health Nurses Nurses
Traditional Birth Midwives Dentists
Attendant
C ► Initial link, 1st ► 1st source of ► Establish close
H contact of the professional contact with the
A community health care village and
R ► Work in liaison w/ ► Attend to health intermediate level
A the local health problems beyond health workers to
C service workers the competence of promote the continuity
T ►Provide village health of acre from hospital
E elementary workers to community to home
R curative preventive ► Provide support to ► Provide back-up
I health care the frontline health health services for
S measures workers in terms of cases requiring
T supervision, hospital or diagnostic
I training, referral facilities not available
C services and in health care
S supplies thru
 linkages with other
sectors

Unit 7
STRATEGIES AND METHODOLOGIES IN CHN
Strategies/Programs to Promote Health of the Vulnerable Sectors of the
Population

 Maternal Care Program

Strategies:
A. Provision of Regular and Quality Maternal Care Services
► regular and quality pre-natal care
- hx-taking, utilization of HBMR (Home-Based Mother’s Record)
as a guide in the identification of risk factors
- PE: weight, height, BP-taking
- Perform head-to-toe assessment, abdominal exam
- Tetanus Toxoid Immunization
- Fe supplementation: given from 5th mo. of pregnancy to two
months postpartum (100-120 mg orally/day for 210 days)
- Laboratory exam: Heat-acetic acid test. Benedict’s test
- Oral/Dental exam

► Pre-natal counseling

► Provision of safe, delivery care

- all birth attendants shall ensure clean and safe deliveries at
home or at the faciltiies (RHUs/hospitals)
- at-risk pregnancies and mothers must be immediately referred
to the nearest institution
- untrained TBA’s who actively practice must be identified, trained
and supervised by a personnel of the nearest BHS/RHU trained
on maternal care.

Q: When is a “trained hilot” allowed to attend to home deliveries?

A: when ---
At the time of delivery, no licensed health personnel trained on
maternal care, is available
A pregnant mother lives on an area where there is no licensed
health personnel trained on maternal care

► Provision of quality postpartum care

Proper schedule of follow-up must be followed:
- 1st postpartum visit for home deliveries must be done within
24 hours after delivery
- 2nd, done at least 1 week after delivery
- 3rd, done 2-4 weeks thereafter

Attendants must be aware of the early signs, symptoms and

complications. They should follow the 3 CLEANS:
CLEAN Hands
CLEAN Surface
 CLEAN Cord

B. Improvement of the health personnel’s capabilities on newborn care,

midwifery thru trainings. Trainings for “hilots” must also be conducted.

C. Improvement on the quality of care at the First Referral Level

► Orientation, training should be done on the use of proper filling-up
of HBMR card
► Proper referrals/endorsements must be done for future If-ups

D. Prevention of unwanted pregnancies through family planning services

E. Prevention and management of STDs

F. Promotion of Appropriate health practices

G. Upgrade reporting services

H. Mobilize political commitment and community involvement to provide

Support to basic health care delivery

 Family Planning Program

Methods of Family Planning:

I. Spacing
A. Hormonal - Oral Contraceptives
Injectables
Inplants
B. Barrier - IUD
Condom
Diaphragm, Cervical cap
C. Biologic - Lactation-Amenorrhea Method
D. Natural - Basal Body Temperature (BBT)
Sympto-thermal
Cervical Mucus
II. Permanent (surgical/irreversible)
A. Tubal Ligation - done in women; a 15 min. surgical procedure in which
the fallopian tubes are tied and cut to prevent
passage of sperms
B. Vasectomy - done in men, was deferens is tied and cut to block
passage of sperm

DOH Effort : National Family Planning Program in 23 in ‘93

EO 119 gave a legal mandate to the program from UN Declaration of

Human Rights, which considers Family Planning as a basic human right.
Goal: Universal access to family planning information and services
Policies:
- to improve family welfare with main focus on:
i. woman’s health
ii. safe motherhood
iii. child survival
- to promote family solidarity and responsible parenthood

In “Health for more in ‘94”

 DOH effort: Buwan ng Masayang Pamilya
National Focus: Alay sa Pamilya II
- an activity that promotes the National Family Planning Program
(Other Event: Pneumonia Prevention Week)

3 FACTORS CONTRIBUTING TO PREGNANCY RELATED ILLNESS AND

DEATH AMONG MOTHERS AND INFANTS

1. too early pregnancy

2. pregnancy before age 20 or after age 35
3. pregnancy after the 4th baby

 Expanded Program on Immunization

Goal: morbidity and mortality reduction of immunizable diseases

Schedule:
At birth: BCG
1 ½ months: First doses of DPT, Hep B, OPV
2 ½ months: Second doses of DPT, Hep B, OPV
3 ½ months: Third doses of DPT, Hep B, OPV

Tetanus Toxoid:
First Pregnancy: TT1- 5th to 6th mo of pregnancy, after 4 weeks TT2 (3 years
immunity)
Second Pregnancy: TT3 (1st booster dose) – 5th to 6th (5 years immunity)
Third Pregnancy: TT4 (2nd booster dose) – 5th to 6th (10 years immunity)
Fourth Pregnancy: TT5 (3rd booster dose) – 5th to 6th (life-long long immunity)

Administration:

BCG: (infants) 0.05 ml intradermal

(school entrants) 0.10 ml intradermal
DPT: 0.5 ml intramuscular
Hepa B: 0.5 ml intramuscular
OPV: 2 drops per orem
Measles: 0.5 ml subcutaneous

Tetanus toxoid: 0.5 ml intramuscular

Side Effects:

BCG: inflammation at the site (Koch’s phenomenon) – warm compress

Glandular enlargement, deep abscess, indolent ulceration: insicision and
drainage and powered INH
DPT: inflammation at site: warm compress; fever for a day; abscess: incision and
drainage and antiseptic(betadine
Measles: fever 3-5 days within a week after injection; mild rashes

Frequently Asked Questions (FAQs)

Q: What if the child failed to return after the first dose of the vaccine (D.O.H.),
can we still give it?
A: YES. It is a MUST to complete the doses

Q: Is it necessary to repeat the 1st dose?

A: NO. just give the REMAINING doses not given.
Remember the principle:
Even if the interval exceeded that of the expected interval, continue to give
the doses of the vaccine.

Q: What is the eligible age for giving immunization (up to what age can we give
the immunization)?
A: Before the child reaches 6 years old

Q: If there has been a reported epidemic of measles, is it okay to give measles

vaccine at an earlier age?
A: In case of measles epidemic, we can give MEASLES as early as 6 months of
age

* a booster dose of BCG shall also be given to all school entrants both in
private and public schools REGARDLESS of presence of BCG scar.

Q: What if the 2nd dose of Tetanus Toxoid was not given to the mother, when is
the best time to give the dose?
A: It has to be given after birth in order to protect the mother and the succeeding
pregnancies.

Q: Is there any contraindication to giving DPT, OPV, Hepa-B?

A: There is none, EXCEPT when the child had convulsions upon giving the 1st
dose of DPT. Mothers must be warned that the incident of CONVULSION
upon giving the 1st dose of DPT, MUST BE REPORTED

Q: What if the child has fever of <38.5 C, mild respiratory infections and
diarrhea, should the child be given the vaccine?
A: The abovementioned conditions are not to be considered as a
contraindication to immunization. Thus, vaccine can still be given.

Q: What if the child Is malnourished?

A: MALNUTRITION is not a contraindication, but RATHER an INDICATION for
immunization since common childhood diseases are often severe to
malnourished children.

COLD CHAIN
► A system used to maintain the potency of a vaccine from that of manufacture
to the time it is given to child or pregnant woman.

Principles:

I. Storage

Storage of vaccine should not exceed:

- 6 mos. @ the Regional Level

- 3 mos. @ the Provincial Level/District Level
- 1 mo. @ Main Health Centers (with refrigerators)
- not more than 5 days @ Health Centers (using transport boxes)

Important points to remember:

► Arranging of stored vaccine according to :

■ Type
 ■ Expiration date
■ Duration of Storage
■ # of times they have been brought out to the field

Storage Vaccine Form Dose/Containe Conditions

Temperature r when
exposed to
heat/freezing

Most - 15 C to – 25 C 20 dose/special Easily

Sensitive FREEZER OPV Liquid bottle or 25 damaged by
to Heat dose/special heat; not
bottle destroyed by
freezing

Measles Freez 10 dose/vial

e dried

BCG Freez 20 dose/amp Destroyed by

BODY OF THE e dried 50 dose/amp heat,
REFRIGERATOR sunlight; not
+ 2C TO + 18 C destroyed by
freezing
D
L Destroyed by
freezing; heat
I
P Damaged by
Q 20 dose/vial heat

U Damaged by
T heat and
I freezing

Hepa-B Liquid
Damaged by
Least Tetanus Liquid 20 dose/vial heat or
Sensitive Toxoid freezing
to heat

Most sensitive to heat:

Most sensitive to freezing:

► The vaccine stored the LONGEST AND THOSE THAT WILL EXPIRE
FIRST should be distributed or used 1st.
► It is MUST to mark ampules / vials with an “X” mark each time they are
carried to the field, because if a VACCINE IS NOT USED on the third trip,
it must already BE DISCARDED.

II. Transport

use cold dogs

III. Handling

Once opened or reconstituted, vaccines must be placed in a special cold

pack during immunization sessions.
Vaccine Half life
BCG 4 hours
DPT
Polio
Measles 8 hours
Tetanus Toxoid
Hepa-B

DOH STRATEGIES:

- “23 in ‘93”
National Immunization Day Slogan: “Ceasefire for Children: Support
National Immunization Day!
Concept: “No shooting of bullets, only shooting of vaccines”
Project included: Polio Eradication Project
Goal of the project to immunize 9m. children with OPV to completely
eradicate polio by 1995
Disease Eradication: Measles, Rabies, Polio, Neonatal Tetanus
Formalization of plans for an improved Biologic Production Service is done
to develop self-sufficiency in vaccine production decreasing
dependence on imported vaccines.

- “Health for more in ‘94”

Buwan ng Oplan Alis Disease II
Goals: to completely eradicate or control childhood killer diseases that are
immunizable
To promote a healthy lifestyle that will decrease every Filipino’s risk of
having a heart disease, most especially those belonging to 35
years and above.

LEGAL MILESTONES:
PD 996 – Compulsary, Basic Immunization for children 8 years old
and below (0-8 y/o), thus covers 2 age groups - infants
School entrants
PP # 6 – “Universal Law on Immunization” strengthens the EPI
PP # 147 – “National Immunization Day”; every organized Patak Center
will cater to 1,000 population (1:1000 population). The team will be
composed of:
◊ 1 organizer
◊ 1 vaccinator
◊ 1 recorder
◊ 1 health educator
◊ 1 sanitary inspector
PP # 46 – Launched the POLIO CONTROL PROGRAM OF THE
PHILIPPINES
Polio Eradication Knock-out Polio Zero-Polio Philippines
Project (PEP) (KOP) (’95-’00)

AC # 63-A – included Hepa-B as an immunizable disease (EPI Program

of the DOH)
AC # 242 – Hepa –B must be given with DPT, OPV (3 doses)
TARGET-SETTING
- involves the calculation of the eligible population. “Eligible population
consists of any group of people targeted for specific immunizations due to
their susceptibility to one or several of the EPI diseases.”

3 Population with which the EPI is concerned.

Infants
School Entrants
Pregnant Women

For infants, target-setting should be based on the 3% of the total

population, while for pregnant women, it must be based on the 3.5% of
the total population.

infants

Eligible Population = total population x 0.03

school entrants

x 0.035 pregnant women

To compute for the vaccines

I. Determine Annual Dose-doses required in a year for complete coverage

AD = EP x # of doses to consider that immunization is complete

II. Determine Wastage Allowance

Wastage Dose = Annual Dose x % wastage allowance

III. Combine complete coverage needs with wastage allowance

Annual doses = annual doses (no wastage) + wastage doses with
wastage

IV. Determine # of ampules or vials needed per year

Amp: vials = annual doses/doses per ampule (per year)

V. Determine 3 of ampules/vials needed per month

Amp: vials = annual amp: vials/12 months (per month)

Solve: Total population = 6000, determine DPT vaccine to be used for infants.

SURVEILLANCE

 Under Fives Care Program

UFC Program (Under Five Care Program)

A package of child health-related services focused to the 0-59 months old
children to assure their wellness and survival
 A. Growth and Health Monitoring
Growth Monitoring Chart (GMC)
A standard tool used in health centers to record vital information
related to child growth and development, to assess signs of malnutrition.
• Sallen “Ming Scale”, Bar and Detect type scales are being used
• All newborns must be enrolled for UFCP

B. Oresol Therapy

Diarrhea (Unusual frequency of bowel movements more than 3x/day)

(Marked change in the amount of stool)
(Increase in stool liquidity)

3 CLASSIFICATIONS:
Mild - 5 - 10 unformed stools/24 hours
Moderate - 10 - 15 unformed stools/24 hours
Severe - > 15 unformed stools/24 hours with associated
signs/symptoms

Dehydration
ORS, assess after 4 – 6 hours

Management of Moderate and Severe Dehydration

Intravenous fluids
If NOT possible, assess if the child can drink (give ORS and refer for IV)
If cannot drink ( give fluids via NGT)
If no NGT, refer immediately!

Diarrhea Management at Home

3 F’s
Fluids Frequent Feeding Fast Referral
► Oresol ► Continue If child doesn’t get
Rehydration breastfeeding better in 3 days, or if
Therapy ► With children over danger signs develop
►Encourage/ensure 6 mos.: – refer patient
intake of any fruit Cereals/ starchy Danger Signs:
juices, “am lugaw” foods mixed with ► Fever
homemade soup meat or fish and ► Sunken fontanel
vegetables ► Sunken eyeball
► Mashed banana ► Frequent watery
or any fresh fruit stool
► Feed the child at ► Repeated vomiting
least 6x/day ► Blood in stool
► After diarrhea ► Poor intake of
episode, feed 1 meals
extra meal/day for ► Weakness
2 weeks

ORS :
1 pack
1 L of water
Contains:
glucose for Na absorption
NaCI for fluid retention
NaHCO3 to serve as a buffer system
KCL for smooth muscle contraction

Home-made Oresol:
1 L of water: or 1 glass of water
8 tsp. of sugar: 2 tsp. of sugar
1 tsp. of salt 1 pinch of salt
Remember:
Infant must be given ¼ - ½ cup every after LBM
Child must be given ½ - 1 cup every after LBM
Adult must be given 1 or more cup every after LBM

Measures on Diarrhea Prevention:

- Breastfeed infants
- Provide appropriate supplemental feeding
- Handwashing
- Utilize clean and potable water
- Clean toilet and observe proper feces disposal
- Immunize the child with measles

* No antibiotics must be given to a diarrheic patient except in infectious

diarrhea (e.g. cholera)

C. Breastfeeding

Unique Characteristics of Breast milk:

B Fresh
Reduced allergic reaction Emotional bonding
Economical Easily established
Always available Digestible
Safe/maintains the stool soft Immunity
Temperature always right Nutritious
GIT disorders are decreased

Difference of breast milk from formula milk

BREASTMILK VS FORMULA*
CHO > CHO
CHON (LACTALBUMIN) < CHON (CASEIN)
FATS = FATS
Linoleic acid content (3x) > Linoleic acid content
MINERALS < MINERALS

* the high CHON and mineral content of cow’s milk may overwhelm the
newborn’s kidney, thus it still needs to be diluted. Casein is more difficult
to digest.

LEGAL MILESTONES:
EO 51 MILK CODE OF THE PHILIPPINES
RA 7600 MOTHER-CHILD FRIENDLY HOSPITAL
- part of “23 in ’93 which aims to sustain breastfeeding
efforts immediately after delivery
 D. Immunization (see EPI)

E. Care of Acute Respiratory Tract Infections (CARI)

Goal: treatment of pneumonia

Assessment:
History:
Age, cough (since when), fever (since when), stop feeding?, convulsions?

Physical Examination:
Assess for fast breathing:
RR of 60/min (below 2 months)
50/min (2months to 1 year)
40/min (1 to 5 years)
stridor, wheeze
level of consciousness
stop feeding
malnutrition

Standard ARI / PNEUMONIA Case Management (EO 110-E s, 1991)

○ Cotrimoxazole adult tabs

Injectable penicillin should be regularly available in
IM gentamycin DOH facilities
IM chloramphenicol

○ No DOH fund shall be used to regularly provide cough medicines

except only for the following emergency conditions.
- Single ingredient cough suppressant for severe pertussis
- Single antihistamine fro confirmed allergic conditions such as
allergic rhinitis

○ O2 and flow meters must be regularly available in all government

hospitals, with O2 delivered properly according to Standard
ARI/Pneumonia Case Management

○ Children found to have Severe Pneumonia, Very Severe Pneumonia,

wheezing, otitis media, streptococcal sore throat should be referred to
Municipal Health Officer (MHO) or hospital physicians for proper
management according to the referral scheme

Unit 8
STRATEGIES TO ADDRESS SPECIFIC HEALTH PROBLEMS
 Communicable Disease Prevention and Control

Communicable Diseases

Chronic Communicable Vector-borne

Communicable
 Diseases
► Tuberculosis ► Malaria (MCP)
Schistosomiasis (SCP)
► Leprosy (LCP) ► Filariasis (FCP)
► H-Fever (Dengue)

1. National Tuberculosis Control Program (NTBCP)

“Tuberculosis is a highly infectious, chronic respiratory disease caused by TB

Bacilli. It is one of the 10 leading causes of morbidity and mortality in the
Philippines, which is also known as “Koch’s Disease.”

Objective of the Program:

To control TB by reducing the annual risk of infection (prevalence and mortality
rates)

Key Policies:
Prevention
○ BCG vaccination under the EPI Program
○ Annual identification of at least 45% of its prevalence
○ Public health education re: PTB mode of transmission, methods of control,
and importance of early diagnosis
○ Provide outreach services for home supervision of patients in Multi-Drug
Therapy and also for preventive treatment of contacts

Case Finding
○ Direct sputum microscopy for identified TB symptomatics
○ X-ray exam of TB symptomatics who are (-) after 2 or more sputum exam
○ Establishment of passive and active collection points for sputum samples
of all identified TB symptomatics, as well as validation centers to ensure
the standard and quality of sputum exam
○ Case finding and treatment services shall be made available in the
BHS/RHUs

Treatment
○ All TB cases must be treated for free, on ambulatory and domiciliary
(home) basis, except those with acute complications and emergencies
○ All sputum positive and cavitary cases shall be given priority for short
course chemotherapy or SCC for 6 mos.
○ Standard Regimen or SR for a year or intermittent SCC for 6 mos. shall be
given to all infiltrative but sputum negative.

SR: isoniazid and streptomycin sulfate

SCC: Combo pack, Multi Drug Therapy

PTB TREATMENT REGIMEN

Categories:
6 SCC
Patient will be:

Rifampicin Rifampicin
2 mos. on Isoniazid + 4 mos.
Pyrazinamide Isoniazid

Indicated for patients who are

 - (+) sputum smear
- seriously ill ---
- (-) sputum smear, (+) extensive lung lesion
- (+) radiographic lung lesion
- extrapulmonary cases

8 SCC
Patient will be:

Rifampicin Rifampicin Rifampicin

2 mos. on Isoniazid + 4 mos. Isoniazid + 5 mos Isoniazid
Pyrazinamide Ethabutol Ethambulol
Ethambulol
Streptomycin

Indicated for those with relapse

- failures
- others

4 SCC
Patient will be:

Rifampicin Rifampicin
2 mos. on Isoniazid + 2 mos.
Pyrazinamide Isoniazid

Indicated for PTB minimal

(-) sputum smear

3 Phases of Treating a PTB patient:

Rifampicin
1 - Intensive Phase 2 mos. on Isoniazid
Pyrazinamide
Diagnostic: Sputum Exam
if (+), proceed to
Rifampicin
2 - Maintenance Phase + 4 mos. on
Isoniazid
if still (+) TB Colonies proceed to

Rifampicin
3 - Extensive Phase up to 12 mos. on
Isoniazid

What is the purpose of SCC-MDT?

- prevent developing resistance against the three drug combinations
- shorten duration of treatment usually treatment lasts from 5-10 years.
With SCC-MDT. tx can be reduced to a minimum of 6 mos.
- eradicate and completely prevent the relapse of the disease

Direct Observation Treatment of Short-Course Chemotherapy (DOTS)

“Tutok-Gamutan”

DOH Activities on NTBCP:

 Part of the “23 in ‘93” is the integrated disease control of TB together with
schistosomiasis and malaria through the formulation of a strategic plan for
infectious disease control by specific DOH units.

“Health for More in ‘94” had “Malakas na Baga, Malinaw na Mata” as its
strategy National Focus: TB Control Month
► laboratory and drug supplies were available to local governments in
1994 aimed to accelerate case finding and treatment

Strategies done:
Ensure that every microscopy and treatment center has the ff:
 Exnal microscope
 Microscopist trained within the last 3 years
 A 90% agreement rate in microscopy reading
between the microscopist and validator
 Available NTP manual of procedures
 Drugs for at least 6 months supply
 Reagents, sputum cups for at least 6 months
 Utilization of an itinerant team composing of at
least 2 microscopists, nurse, midwife, and a
medical officer who will stay for 2 – 3 days in
far flung communities to identify TB and start
treatment

2. Leprosy Control Program

LEPROSY is a chronic disease of the skin and peripheral nerves caused by

Myobacterium Leprae

WHO CLASSIFICATION OF LEPROSY:

Paucibacillary (tuberculoid and indeterminate) – non-infectious

Duration of Treatment: 6-9 months
Multibacillary (lepromatous and borderline) – infectious
Duration of treatment: 24-30 months

Objectives of the Program:

- provide MDT to all leprosy cases within 3 years and complete the
treatment of 90% of all cases out on MDT within the prescribed period
- identify all correctible deformities and institution of appropriate
intervention
- reduce the stigma attached to the disease thru IEC
- formulate research proposals on topics associated with leprosy

Key Policies:
- MDT as the core strategy for the National Leprosy Control Program
- Procurement and supply of MDT Drugs, IEC and Training Materials by
CDCS
- Health education
- Supervision and Control of leprosy Control Activities

Strategies:
Prevention
- Health Education
- BCG vaccination
- Case Finding
 - Validate old registered cases
- Early referral of suspected leprosy patients
- Epidemiologic investigation
Treatment
- Ambulatory
- Domiciliary chemotherapy through the use of MDT as embodied in RA
4073 which advocates home treatment
MDT Treatment Regimen
Paucibacillary Multibacillary
Supervised dose: Supervised dose:
Rifampicin 600 mg Rifampicin 600 mg
Dapsone 100 mg Lamprene 300 mg
Taken once/month in the clinic Dapsone 100 mg
Self-administered Taken once/month in the
clinic
Dapsone 100 mg Self-administered dose
Taken OD, daily by the patient at home Lamprene 50 mg
Dapsone 100 mg
Take OD, daily at home
• Leprosy Patients must be taught ways to prevent secondary injury
caused by burns and rough sharp objects
• Emphasize importance of sustained therapy, correct dosage,
effects of drugs and the need for medical check-up from time to
time
• Provide mental and emotional support to the families of leprosy
patients
• Refer patients as needed

Rehabilitation:
• Imbibe patient’s participation in occupational activities
• Family and community health (PD 304)
o non-segregation of leprosy patients
o counseling and guidance

 Locally-endemic Disease Prevention and Control

1. Malaria Control Program

Malaria a vector-borne disease caused by female Anopheles mosquito causing
symptoms such a fever, sweating, intermittent chills, anemia, and splenomegaly.

2 Major Strategies of the Program

I - Vector-Control
Highlight
In “24 in ‘94”
Project: “Kalusugan ng Kalikasan, Kalusugan ng Mamamayan”
National Focus: Awareness and prevention of mosquito borne disease day
Community Action Campaign Acronym CLEAN
Chemically treated mosquito nets
Larva-eating fish
Environmental clean-up of stagnant water
Anti-mosquito soap
Neem trees
● Chemoprophylaxis – Chloroquine 1-2 weeks before entering an area
then continuous until 4-6 weeks after leaving the area
2 - Detection and Early Treatment of Cases
 ● Early Recognition, Prevention, and Control of Malaria epidemics
• a system which will recognize impending malaria epidemics
● Early diagnosis and prompt Treatment
• identification of a patient with malaria as soon as he is
examined.

• This may be done thru:

► Clinical ► Microscopic
- Signs and symptoms - Mass Blood Smear Exam
- history of visit to an endemic area
In the event that an imminent epidemic occurs, the following should be done:
• Mass Blood Smear Collection
• Immediate confirmation and follow-up of cases
• Insecticide-treatment of mosquito nets

2. Schistosomiasis, H-fever and Filariasis Control Programs

DOH measures to prevent and control in “24 in ‘94”

Project: “Kalusugan ng Kalikasan, Kalusugan ng Mamamayan”
National focus: Awareness and prevention of mosquito borne diseases day
Community Action Campaign Acronym: CLEAN

SCHISTOSOMIASIS H-FEVER (DENGUE) FILARIASIS CONTROL

CONTROL PROGRAM
Schistosomiasis – a
parasitic infection caused
by blood flukes inhabiting
the veins of their vertebral
victims transmitted thru
skin penetration causing
diarrhea, ascites,
hepatosplenomegaly.
PROGRAM
Dengue – acute febrile ►A mosquito borne
infection of sudden onset, disease caused by a
caused by Aedes tissue nematode
Aegypti, vector mosquito attacking the
lymphatic system of
humans thereby
causing
elephanthiasis,
lymphedema, and
hydrocele
►started in 1957 as an
operational research
of the malaria.
Eradication Service
Three Filaria Control
were established and
later on integrated
with the Regional
Health Offices

Activities: Activities: Activities:

Case Fx: Surveillance of Case Fx Case fx
the disease Early reporting of any Early reporting of any
Health Education – known case or outbreak known case of
encourage use of rubber outbreak
boots for protection
Environmental sanitation
– proper disposal of feces
Snail Eradication – use of
moluscides
 Prevention, Control and Rehabilitation of Non-communicable Diseases
1. Philippine Cancer Control Program

AO 89-A s. 1990
provided the Guidelines for the Philippine Cancer Control
Program specifying its program policy, components, implementing
guidelines and timetable.
6 Pillars:
• Public Information and Health Education
• Cancer Prevention and Early Detection
• Cancer Epidemiology and Research
• Cancer Treatment
• Cancer Pain Relief

In Cancer Nursing, the aim of management is to relieve physical, mental and

spiritual distress.
Vital Task of the nurse: To help the patient maintain his dignity and integrity

Cancer care is multidisciplinary.

Who are to be prioritized for health supervision?

• Newly diagnosed cases
• Post-op case/discharge
• Indigent cases needing continuity of hospital care
• Terminal cases

DOH Strategies:
In Health for More in ’94,
► “Kayang-kaya ang Cancer”
National Focus: Cancer Awareness and Prevention Day
“Araw ng Pag-iwas sa Kanser”
Cancer Project: Public information and health education on Cancer
Cancer information desk nationwide
► “Kalusugan ng Kababaihan, Kalusugan ng Bayan”
Women are encourage to undergo the following screening procedures
regularly
- Breast Self-Examination
- Regular Pap Smear
Nationwide demonstration on how to correctly do self breast-
examination
Information dissemination also on Urinary Tract Infection, Sexually
Transmitted Diseases, AIDS

2. Smoking Control Program

Health hazards of smoking:

• Lung Cancer
• Cardiovascular diseases
 • Chronic Obstructive Pulmonary Diseases
• Cancer of other body organs

Program objective:
decrease the prevalence of smoking-related diseases and subsequent premature
deaths

Program components:
• Information and Education on Campaign and Social Mobilization
• Policy Development and Legislation
• Training of Counselors in Smoking Cessation Clinics for Specialty
Hospitals
• Resource Management and Monitoring

Strategies:
• National Anti-Smoking Campaign
o World No Tobacco Day
o National No Smoking Month
o Yosi Kadiri Campaign

• Support comprehensive bill on Tobacco Advertising

“Warning labels be written on tobacco products and ads in compliance
with the consumer code of ‘92

3. Renal Disease

In “23 in ‘93”
Preventive Cardiology and Nephrology
► Enhance public awareness thru health education regarding healthy
lifestyles
► Improve access to basic health services

“Health for More in ‘94”

“Buwan ng Buhay na Bato”
► Requires urinalysis of ALL children entering Grade I so as to detect
childhood kidney infections, which may lead to Renal Failure
► Encourage adult Filipino to undergo urinalysis once a year

4. Cataract

In accordance with the Prevention of Blindness Program,

“Malakas na Baga, Malinaw na Mata”
National Focus: Cataracts Screening Week at DOH Centers
OPLAN: Sagip-Mata
► Eye Surgery for cataract and squint operations for cross-eyed
children

 Nutrition and Adequate Food Supply

Goal:

The improvement of nutritional status, productivity and quality of life of the

population through adoption of desirable dietary practices and healthy
lifestyle.

Coverage:
Philippine Food and Nutrition Programs

directed to the provision of nutrition services to the DOH’s identified priority

vulnerable groups: infants, pre-schoolers, schoolers, women of child bearing age
(also included are the pregnant and lactating mothers) and the elderly

Objectives: to decrease the morbidity and mortality rates secondary to

Avitaminoses and other nutritional deficiencies among the population mostly
composed of infants and children.

1. Malnutrition Rehabilitation Program

Targeted Food Task Nutrition Rehabilitation Akbayan sa Kalusugan

Force Assistance Ward (ASK Project)
Program (TFAP)
Provision of food rations Every hospital must have Aimed to provide rice and
of bulgur wheat and a Nurse ward, where an corn soya blend
green peas. adequately trained supplemented with local
Target population: nutritionist were assigned foods.
Preschoolers (RA 422) Target population:
Pregnant women 6 mos. – 2 yrs.
Lactating mothers moderately and severely
underweight
preschoolers not served
by the DSWD and DA in
Regions 2, 8, 9, 10, 11,
12.

2. Micronutrient Supplementation Program

“23 in ‘93” “Health for More in ‘94”

Fortified Vitamin Rice “Buwan ng Kabataan, Pag-asa ng
Bayan”
National Focus: National Micronutrient
Day or “Araw ng Sangkap Pinoy”
- a free enrichment program aimed to - aimed to distribute vitamin A
prevent deficiencies in vitamin A supplements, iodized oil for mothers
(blindness); iron (Anemia); Iodine and seedlings of plants rich in Fe and
(goiter, mental retardation and delayed other minerals
development)
(1 cavan of rice + fistful processed,
binilid enriched with essential
micronutrients)

3. Food Fortification Program

Fortification is the addition of a micronutrient deficient in the diet to a commonly

and widely consumed food or seasoning. It involves:
• Incorporation of Monosodium Glutamate (MSG) with Vitamin A to reduce
clinical signs of Xereopthalmia
• The use of FIDEL salt in lieu with the National Salt Iodization Program

Fortification for
Iodine
Deficiency
 ELimination

4. Nutrition Surveillance System

- a system of keeping close watch on the state of nutrition and the causes of
malnutrition within a locality, which involves periodic collection of data and
analysis and dissemination of analyzed information

Tools utilized are anthropometric measurements:

Weight for age

measures degree and presence of wasting or stunting

Height for age

measures the presence of stunting
< 90% of standard → stunting or past chronic malnutrition

Weight for height

determines the presence of muscle wasting

Male Rule Female

+ 6 For every increment of an +5
inch above 5 feet
105 – 110 lbs. For a height of 5 feet 100 – 105 lbs.
-6 For every decrement of -5
an inch below 5 feet

1. Compute for the Ideal Body Weight

if height = 5 feet and 6 inches

actual weight = 115 lbs.
sex = Female
5 feet = 105 lbs.
6 inches = 30 lbs.
IBW = 135 lbs.

2. Determine the degree of malnutrition

Actual Body Weight
a. Degree of Malnutrition = _________________ x 100%

Ideal Body Weight

Thus;

Actual Body Weight (115)

a. Degree of Malnutrition = ____________________ x 100%

Ideal Body Weight (135)

= 85-18%
► 1st degree Malnutrition

Degrees of Malnutrition

110% and above - obese

90 –109 % - normal
75 – 89 % - 1st degree
 60 – 75 % - 2nd
60% and below - 3rd

skinfold measurement
indicates amount of body fat with the use of fat-caliper
sites: triceps, biceps, subscapular, suprailiac

MUAC
estimates lean body mass or skeletal muscle reserves

Legal Milestones:
PD 491 – Nutrition Act of the Philippines

- declares Nutrition as a priority of the government

- creates the National Nutrition Council
- designates duly as the Nutrition Month

RA 832 – Rice Enrichment Law

“all milled rice have to be enriched with premix Rice”

government’s nutrition program

RA 8172 – FIDEL Salt

 Supply and Use of Essential Drugs

Essential drugs are medicinal preparations necessary to fill the basic health
needs of the population.

National Drug Formulary contains the list of essential drugs

“23 in ‘93” “Health for More in ‘94”

Philippine National Drug Policy
Objective: to promote access to –
High-quality
Effective
Essential
Low-cost
Safe Drugs and pharmaceuticals
ACRONYM HEELS
4 Pillars:
1. Assurance of safe, effective and
useful drugs
2. Rational drug use
- the practice of using only the
necessary, appropriate and effective
drugs in treating an illness
3. developing greater self-reliance in
basic production thru DOH herbal
processing plants
National Focus Generics information
Campaign Month
“Walong Wastong Gamot na Maabot”
- supports the Generics Act of 1998
through aggressive information
campaigns on rational drug use, to
provide consumers options for les
expensive drugs with the use of generic
labeling and prescribing.
Pilot Program OPLAN WALANG
RESETA
Several prescription drugs were made
available without a MD’s prescription
4. tailored drug procurement

Legal Milestones

Generics Act of 1998 Dangerous Drugs Act

RA 6675 RA 6425
“Formally proclaims the state policy of “The safe, administration and
promoting the use of generic transportation of prohibited drugs is
terminology in the importation, punishable by law”
manufacture, distribution, marketing, 2 Types of Drugs
promotion and advertising, labeling, Prohibited Regulated
prescribing and dispensing of drugs.” LSD Benzodazepines
“Reinforces the NDP with regards to Eucaine Barbiturates
the assurance of high-quality and Cocaine/codeine
rational drug use” Opiates

 Environmental Sanitation

Environmental Sanitation is defined as the study of all factors in man’s

physical environment, which may exercise a deleterious effect on his
health, well-being and survival.

Goal:
to eradicate and control environmental factors in disease transmission
through the provision of basic services and facilities to all households.

Components:

• Water Supply Sanitation Program

• Proper Excreta and Sewage Disposal Program
• Insect and Rodent Control
• Food and Sanitation Program
• Hospital Waste Management Program
• Strategies on Health risk immunization

1. Water Supply Sanitation Program

3 Types of Approved Water Supply and Facilities

Level I Level II Level III

Point Source Communal faucet system Waterworks system or
or stand posts individual house
connections
A protected well or a A system composed of a A system with a source, a
developed spring with an source, a reservoir, a reservoir, a piped
outlet but without a piped distribution network distributor network and
distribution system for and communal faucets, household taps that is
rural areas where houses located at not more than suited for densely
are thinly scattered. 25 meters from the populated urban areas.
farthest house in rural
areas where houses are
clustered densely.
Water must pass the National Standards for Drinking Water set by the DOH

2. Proper Excreta and Sewage Disposal System

3 Types of Approved Toilet Facilities

Level 1 Level 2 Level 3

Non-water carriage toilet On site toilet facilities of Water carriage types of
facility: the water carriage type toilet facilities connected
- Pit latrines with water sealed and to septic tanks an/or to
- Reed Odorless Earth flushed type with septic sewerage system to
Closet vault/tank disposal treatment plant.
- Bored-hole facilities.
- Compost
- Ventilated improved pit

Toilets requiring small

amount of water to wash
waste into receiving
space
- Pour flush
- Aqua privies

Rural Areas – “Blind drainage” type of wastewater collection and disposal

facilities shall be emphasized until such time that sewer facilities and off-site
treatment facilities are available.

3. Proper Solid Waste Management

- refers to satisfactory methods of storage, collection and final
disposal of solid wastes

2 Major Components:
Garbage
Those having a tendency to decay and give off foul odor
Rubbish
Broken glass, bottles, papers

Zero Solid Waste Management featured in “23 in ‘93”

2 Ways of Excreta Disposal

 Household
○ Burial
► Deposited in 1m x 1m deep pits
covered with soil, located 25 m.
away from water supply
Community
○ Sanitary landfill or controlled tipping
► Excavation of soil deposition of
refuse and compacting with a solid
cover of 2 feet

○ Open burning ○ Incineration

• Animal feeding
• Composting
• Grinding and disposal sewer

4. Food Sanitation Program

Policies:
• Food establishment are subject to inspection (approved of all food sources
containers and transport vehicles)
• Comply with sanitary permit requirement
• Comply with updated health certificates for food handlers, helpers, cooks
• All ambulant vendors must submit a health certificate to determine present
of intestinal parasite and bacterial infection

3 Points of Contamination
• Place of production processing and source of supply
• Transportation and storage
• Retail and distribution points

5. Hospital Waste Management

Goal:
To prevent the risk of contraction contracting nosocomial infection from
type disposal of infectious, pathological and other wastes from hospital

In 23 in ’93, hospitals were developed to be “Centers of Wellness”

addressing the need for preventive programs against smoking,
cancer and other communicable diseases. This is further pushed
through with the concept of “Ospital Pinoy Style: Sentro ng
Kalusugan” in Health for More in ’94 its major aim is to continue
upgrading the curative as well as basic services in hospitals, which
are available to all communities. One of its challenges is the
implementation of Hospital Waste Management program as a
requirement to operate

6. Programs related to health-risk minimization secondary to

environmental pollution

These include the following:

• Anti-smoke Beching Campaign and Air pollution Campaign
• Zero Solid Waste Management
• Toxic, Chemical and Hazardous Waste Management
• Red Tide Control and Monitoring
 • Integrated Pest Management and Sustainable Agriculture
• Pasig River Rehabilitation Management

7. Education of prevailing health problems

accepted activity at all levels of public health used as a means of

improving the health of the people through techniques which may
influence peoples thought motivation, judgment and action.

Three aspects of health education:

• Information – provision of knowledge

• Communication – exchange of information
• Education – change in knowledge, attitudes and skills

Sequence of steps in health education:

• Creating awareness
• Creating motivation
• Decision making action

 HIV/STI Prevention and Control

Operational Strategies:

• Promotion of health/health education

• Diseases detection
• Treatment program
• Contact tracing
• Clinical services

Program components:

• Case-finding
• Case management
• Training
• Monitoring
• Reporting system
• Operations research

Ministry circular #2 s. 1986 includes AIDS as a notifiable disease

AO#57 –As 1989 provides the policies for the prevention and
control of HIV/AIDS in the Philippines.

National AIDS Program, featured in 23 in ‘93

► Aimed to establish Surveillance program to determine
groups at increased risk of acquiring AIDS
► Create a Philippine National AIDS Council which
define policies advocacy, strategies, issues, and
public health education for AIDS prevention
 Mental Heath

- a state of well-being where a person can realize his or her own

abilities, to cope with the normal stresses of life and work
productively

- the emotional adjustment the person achieve in which he can

live with reasonable comfort, functioning acceptably in the
community where she lives

- involves the promotion of a healthy state of mind among the

whole population through
• developing positive outlook in life
• strengthening coping mechanisms

Vulnerable group to the development of Mental Illness:

• Streetchildren
• Victims of Torture or violence
• Internal refugees
• Victims of aimed conflict
• Victims of natural and man-made disasters

Components of Mental Health Program

A. Stress Management and Crisis Intervention

B. Drugs and Alcohol Abuse Rehabilitation
C. Treatment and Rehabilitation of Mentally-Ill Patients
D. Special Project for Vulnerable Groups

DOH Events:
“Buwan ng Kabataan, Pag-asa ng Bayan”,
featured in Health for More in ’94
National Focus: National Mental Health Week:
“Linggo ng Lusog-Isip”
Rationale:
Stresses in the environment of children such as times of disasters
and national calamities, disintegration of the values, structure and
functions of the family and urbanization, migration, drugs and
physical and sexual abuse and poverty have direct effects on
physical and mental health.