1

FAR EASTERN UNIVERSITY Institute of Nursing

Nursing Care Management 107A: Nursing Leadership and Management Leadership in Community De e!opment

C"URSE #AND$"UTS

C"RE C"NCE%TS AND %RINCI%LES "F C"&&UNITY DEVEL"%&ENT

Community a social group determined by geographical boundaries and/or common values and interests !"#$% "ealth a complete state o& physical and mental 'ell being and not merely the absence o& disease% "ealth is also seen as being a&&ected by the social( educational( economic( and political environment !"#$% )evelopment a multi*dimensional process involving ma+or changes in social structures( population( attitudes and national institutions( as 'ell as the acceleration o& economic gro'th( reduction o& ine,uality and eradication o& absolute poverty% -he goal o& development is to have a better li&e -eodoro( 1.7/$% Community )evelopment is an organi0ed e&&ort o& people to improve the economic conditions o& community li&e and the capacity o& the people &or participation( sel& direction and integrated e&&orts in community a&&airs% 1t advocates the principle o& sel& help( and the voluntary participation and cooperation o& the people in the community% 2sually couples 'ith technical assistance &rom the government and voluntary organi0ations% Community development rests upon certain assumptions: 1% -he 'orth and dignity o& the individual are the basic values in democratic society 3% 4veryone has something to contribute to the li&e o& the community% 5% 6eople have the ability to learn and gro'% 7% Community development provides the opportunity and the means by 'hich the 'orth o& an individual is revealed( his/her contributions can be made and learning can ta8e place% Characteristics o& Community )evelopment: 1% Community development is concerned 'ith all the people o& the community( rather than +ust a particular group or segment o& the population% 3% Community development is concerned 'ith the 'hole community li&e the total need o& the community%

5% Community development is concerned 'ith bringing about social change in the community%

7% Community development is concerned 'ith &inding solutions to social problems and con&licts% 9% Community development is based on the philosophy o& sel& help and participation by as many members o& the community as possible% :% Community development usually involves technical assistance &rom the government( or voluntary or private organi0ations( 'hether domestic or &oreign% 7% Community development is essentially interdisciplinary% 1t must involve pro&essional s8ills and resources &or the service o& the communities various specialties% /% Community development is concerned 'ith both tas8 goals and process goals% 4;% 1t is concerned 'ith achieving ob+ectives( as 'ell as strengthening the ,ualities o& participation( sel& direction and cooperation% .% Community development involves the educational process% 1t is al'ays concerned 'ith teaching and learning &rom the people% 10% Community development continues over a substantial period o& time% 1t is not an ad hoc or crash program rather( it is a process% 11% Community development program should be based on &elt needs and desires as 'ell as the aspirations o& the people in the community% 13% Community development is open to any community resident 'ho 'ishes to participate direct participation$% Community )iagnosis Community )iagnosis Community assessment$ * is a systematic process o& collecting( collating( synthesi0ing and analy0ing data to dra' a clear picture o& the community( particularly its problems% -he community diagnosis is then derived and 'ill become the bases &or developing and implementing community health nursing interventions and strategies% -ypes o& Community )iagnosis: 1% Comprehensive Community )iagnosis aims to obtain a general in&ormation about the community% 3% 6roblem #riented Community )iagnosis a type o& community assessment that responds to &or a particular need% 4lements o& a comprehensive community diagnosis: A% )emographic variables 1% -otal population( geographical distribution and population density% 3% Age and se; composition 5% <ro'th rate( crude birth rate( crude death rate( and li&e e;pectancy at birth 7% 6atterns o& migration 9% 6opulation pro+ections =% >ocio*economic and Cultural variables

1% >ocial 1ndicators a% Communication net'or8s b% -ransportation system c% 4ducational level

d% "ousing conditions 3% 4conomic 1ndicators a% 6overty level income b% 2nemployment and underemployment rate c% 6roportion o& salary and 'age earners to active population

d% #ccupation common in the community 5% 4nvironmental 1ndicators a% 6hysical( geographical( topographical characteristics o& the community b% !ater supply c% !aste disposal

d% Air( 'ater and land pollution 7% Cultural &actors a% 4thnicity( social class( language( religion( race( political orientation b% Cultural belie&s and practices that a&&ects health c% Concepts about health and illness

C% "ealth and illness pattern 1% Leading cause o& mortality 3% Leading cause o& morbidity 5% Leading cause o& in&ant mortality 7% Leading cause o& maternal mortality 9% Leading cause o& hospital admission )% "ealth ?esources 1% Manpo'er resources 3% Material resources 4% 6olitical/Leadership patterns 1% 6o'er structures

3% Attitudes o& the people to'ards authority 5% Conditions/events that cause social con&lict 7% 6ractices/approaches e&&ective in setting issues and concerns Steps in Condu'ting Community Diagnosis( 1% )etermine the ob+ectives 3% )e&ining the study population 5% )etermining the data to be collected 7% Collecting the data 9% )eveloping the instrument survey ,uestionnaire( intervie' guide( observation chec8list$ :% Actual data gathering 7% )ata collation /% )ata presentation .% )ata analysis 10% 1denti&ying the community health nursing problems a% "ealth status problem mortality( morbidity( &ertility$ b% "ealth resource problem manpo'er( money( material$ c% "ealth*related problem social( economic( environmental and political$

11% 6riority setting a% Nature o& the problem presented health status( health resource and health related problem$ b% Magnitude o& the problem re&ers to the severity o& the problems 'hich can be measured in terms o& the proportion o& the population a&&ected by the problem% c% Modi&iability o& the problem the probability o& reducing( controlling( or eradicating the problem

d% 6reventive potential the probability o& controlling or reducing the e&&ects posed by the problem% e% >ocial concern perception o& the population or the community as they are a&&ected by the problem%

"ealth 6roblem is a situation 'hich inter&eres 'ith the promotion and/or maintenance o& health and recovery &rom illness or in+ury% -ypology o& Nursing 6roblems in @amily Nursing 6ractice @irst Level Assessment

1%

6resence o& !ellness Condition stated as 6otential or ?eadiness a clinical nursing +udgment about a client in transition &rom a speci&ic level o& 'ellness or capability to higher level NAN)A 3001$% 6resence o& "ealth -hreats conditions that are conducive to disease( accident or &ailure to reali0e oneAs health potential% 6resence o& "ealth )e&icits instances o& &ailure in health maintenance% 6resence o& >tress 6oints/@oreseeable Crisis >ituations anticipated period o& unusual demand on the individual or &amily in terms o& ad+ustment/&amily resources%

11% 111% 1B%

@amily Nursing 6roblem stated as the &amilyAs &ailure to per&orm ade,uately speci&ic health tas8s to enhance the 'ellness state or manage the health problem% -ypes o& @amily Nursing 6roblems: 1% 1nability to recogni0e the presence o& the condition/problem 3% 1nability to ma8e decisions 'ith respect to ta8ing appropriate action 5% 1nability to provide nursing care to the sic8( disabled or dependent member o& the &amily 7% 1nability to provide a home environment 'hich is conducive to health maintenance and personal development 9% @ailure to utili0e community resources &or health care 6rioriti0ing "ealth 6roblems: >cale &or ?an8ing @amily "ealth Conditions and 6roblems According to 6riorities =aylon and Maglaya( 1..0$% -his tool aim to ob+ectively set priorities among the problems identi&ied% @our criteria &or determining priorities among health conditions: 1% Nature o& the condition/problem categori0ed into 'ellness state/potential( health threats( health de&icit and &oreseeable crisis% 3% Modi&iability o& the condition/problem re&ers to the probability o& success in enhancing the 'ellness state( improving the condition( minimi0ing( alleviating or totally eradicating the problem through intervention% 5% 6reventive potential * re&ers to the nature and magnitude o& &uture problems that can be minimi0ed or totally prevented i& intervention is done on the problem under consideration% 7% >alience re&ers to the &amilyAs perception and evaluation o& the problem in terms o& seriousness and urgency o& attention needed or &amily readiness%

>trategies in 6eople 6articipation: 1% A'areness*building and consciousness*raising on health and health related issues

3% 6lanning( implementation( monitoring and evaluation through small group meetings household clusters$ 5% >election o& community health 'or8ers by the community 7% Community*building and community organi0ing 9% @ormation o& health committees :% 4stablishment o& community health 'or8er organi0ation at the parish or municipal level 7% Mass health campaign and mobili0ation to combat health problems% 6rograms &or basic "ealth >ervices:

10*13

%RI&ARY #EALT# CARE 6rimary "ealth Care is a practical approach to the e&&ective provision o& health services that are community based, accessible, acceptable and sustainable at cost 'hich the community and the government can a&&ord%

?ationale &or the need &or 6"C in the 6hilippines 1% 3% 5% 7% Magnitude o& health problems 1nade,uate and une,ual distribution o& health services 1ncreasing cost o& medical care 1solation o& health care activities &rom other development activities Characteristics o& 6"C 1% 3% 5% 7% 9% :% Community based Accessible <eographical @inancial Cultural >ustainable Acceptable >el& reliance 1nterrelated to socio*economic <oal o& 6"C ALL @1L161N#> A?4 "4AL-"C An improved state o& health and ,uality o& li&e &or all people attained through sel&*reliance%

%#C has T)o$ Fo!d *oa!

So'ia! because it is directed to the improvement o& the ,uality o& li&e and the e;tension o& ma;imum health bene&its to all( particularly to the underserved segment o& the population%

De e!opment + because it vie's the community as moving progressively to'ards socio*economic prosperity 'ith the ultimate goal o& sel&*reliance%

D-he healthier the population( the more productive the community becomes and the more improvements in the living conditions and the ,uality o& li&e en+oyed by the people% 6rinciples #@ 6"C 1% 3% 5% 7% 9% 4,uitable distribution @ocus on prevention Multisectoral approach >cope o& technology @easibility

)1M4N>1#N <#AL @#C2> #@ CA?4 >4--1N< >4?B1C4> 64#6L4 >-?2C-2?4 @#?

-?A)1-1#NAL Absence o& disease -he sic8 2rban based in hospital( clinics( and homes% Accessible only to &e' 6assive recipients o& health care "ealth isolated other sectors &rom

6"C )evelopment health care and preventive

-he 'ell and the early sic8 ?ural based in satellite clinics% Community health centers are accessible to all Active participants in health development and preventive health% "ealth is an integral part o& the socio economic development system )ecision ma8ing &rom bottom*top 6romotive and preventive services blending traditional medicines 'ith modern medicines Acceptance o& indigenous practitioner Approtech &or &ront*line care Local sel& reliance >ocial and economically productive >el& help

6?#C4>> -4C"N#L#<C

)ecision ma8ing &rom top*do'n Curative services based on modern medicines/ sophisticated technology )octor dominated ?eliance on pro&essionals health

"UTC"&E

4lements o& 6rimary "ealth Care 4 4ducation &or "ealth L Locally 4ndemic )isease Control 4 4;panded program on 1mmuni0ation M Maternal E Child "ealth 4 4ssential )rugs N Nutrition - -reatment o& Communicable )iseases > >a&e !ater and >anitation

@unctions o& the Nurse in the 6rimary "ealth Care 1% 3% 5% 7% 9% "ealth Care 6rovider 6romotion o& health and prevention o& disease% 6rogram 6lanner Assess problems( plan action &or community development >upervisor/ -rainer Conducts training needs analysis Community #rgani0er 4stablishes mechanism &or ma;imum participation o& community &or health action% >chool Nurse 4ducation &or "ealth%

1ntersectoral Lin8age )ep4) )1L< )#>- )#L4 N4)A

)6!" 66Com N"A

)>!)

1ntrasectoral Lin8age

5rd )" 3nd M" 1st M)( 6"N/Mid'i&e( ="!

Maternal and Child "ealth <oal o& MC": 1% -o ensure that every e;pectant and nursing mother maintains good health( learns the art o& child care( has a normal delivery and bears healthy children% 3% -o ensure that every child lives and gro's up in a &amily unit 'ith love and security( in healthy surroundings( receives ade,uate nutrition( e&&icient medical attention and is taught the elements o& healthy living% 6hilosophy o& MC": 6regnancy labor and delivery are part o& the continuum o& the total li&e cycle% 6ersonal( cultural and religious attitudes and belie&s in&luence the meaning o& pregnancy &or individuals and ma8e each e;perience uni,ue% Maternal*child nursing is &amily centered% -he &ather o& the child is as important as the mother( 6re*natal Care: #b+ectives: -o reach all pregnant 'omen( to give su&&icient care to ensure a healthy pregnancy and the birth o& a &ull term healthy baby% Classi&ication o& 6regnant !omen: 1% Normal 6atients -hey 'ill be given healthy instructions and counseling prompt pre*natal care$

3% 6atients 'ith serious or potentially serious complications

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6atients should be re&erred to medical/hospital care( #r should be &ollo'ed up care&ully by the rural health unit city health clinic or puericulture center 'here they should be seen &re,uently by the physician%

5% 6atients 'ith mild complications 6atients should be evaluated thoroughly to evaluate the needs &or &ollo' ups% Nursing Care during 6regnancy: All ?"2 should have a masterlist o& pregnant 'omen in their respective areas% All pregnant 'omen must be motivated to submit themselves &or pre*natal visits% -he "ome =ased MotherAs ?ecord "=M?$ used in prenatal care as guide in the identi&ication o& ris8 &actors( danger signs( and to be able to do appropriate measures%

-here should be at least 5 pre*natal visits during pregnancy:

@irst prenatal should be made as early as possible( during the &irst trimester% >econd visit during the second trimester% -he third and the subse,uent visit during the third trimester More &re,uent visits should be done &or those at ris8/'ith complications >tandard prenatal physical e;amination per visit shall include the &ollo'ing:

!eight( height and blood pressure 4;amination o& the con+unctiva( palms o& the hands &or pallor Abdominal e;amination &undic height( &etal position( &etal presentation and &etal heart tones% @ace( hands and lo'er e;tremities &or edema =reast e;amination -hyroid gland enlargement goiter$

-he basic prenatal service delivery at the hospitals/?"2 should include the &ollo'ing:

"istory ta8ing 6hysical e;amination -reatment o& disease -etanus to;oid immuni0ation accdg to !"#$

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1ron supplementation 9th month o& pregnancy up to 3 months postpartum$ 100*300mg p%o%( #) &or 310 days% Laboratory e;amination #ral/dental e;amination "ealth education Ante %artum Ris, Fa'tors( a% Age less than 1/ or above 59 b% !ith 7 babies or more multi*gravida$ c% =elo' 179 cm or 7A.AA tall

d% "aving one or more o& the &ollo'ing 6revious C> 5 consecutive miscarriage or stillbirth 6ost*partum hemorrhage

e% Medical conditions -= "eart disease )M <oiter =ronchial asthma Care of the Ne)-orn =C< immuni0ation should be given to the ne'born anytime a&ter birth% 4;clusive breast&eeding o& in&ants recommended &or the &irst si; months o& their lives% =ene&its o& =reast&eeding = bonding bet'een mother and child ? rich in antibodies 4 easy and hustle &ree A * a&&ordable > * sa&e - to help mother loose 'eight @ &ull o& bene&it both to the mother and child

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4 enhances &eeling o& rela;ation 4 environmentally sa&e ) does not your babyAs stool &oul smelling 1 increase bone density N * natural < good nutrition &or your baby is assured

Ne) .orn S'reening is the process o& testing ne'born babies &or treatable genetic( endocrinologic( metabolic and hematologic diseases% Ne'born screening has been adopted by most countries around the 'orld( though the lists o& screened diseases vary 'idely( any'here &rom 1 disorder to more than 100 disorders% )isease ,uali&ication Common considerations in determining 'hether to screen &or disorders: 1% A disease that can be missed clinically at birth 3% A high enough &re,uency in the population 5% A delay in diagnosis 'ill induce irreversible damages to the baby 7% A simple and reasonably reliable test e;ists 9% A treatment or intervention that ma8es a di&&erence i& the disease is detected early

Ne'born >creening 6rogram in the 6hilippines -he &ollo'ing tests are mandated in the ?%A% .3// or Ne'born >creening program o& 3007%Ne'born screening is available in practicing health institutions hospitals( lying*ins( ?ural "ealth 2nits and "ealth Centers$ 'ith cooperation 'ith )#"% 1& babies are delivered at home( babies may be brought to the nearest institution o&&ering ne'born screening% "o'ever( no' there is also a simple method by 'hich the Ne'born >creening can be made possible even at home% -he urine sample o& ne'born can be absorbed on &ilter paper and sent to laboratories 'hich may run the test% -he reports are simple enough to be understood by the parents% A negative screen mean that the result o& the test is normal and the baby is not su&&ering &rom any o& the disorders being screened% 1n case o& a positive screen( the N=> nurse coordinator 'ill immediately in&orm the coordinator o& the institution 'here the sample 'as collected &or recall o& patients &or con&irmatory testing% =abies 'ith positive results should be re&erred at once to the nearest hospital or specialist &or con&irmatory test and &urther management% >hould there be no specialist in the area( the N=> secretariat o&&ice 'ill assist its attending physician% )isorders >creened: "eel 6ric8 Method &or the ne'born screening FC" Congenital hypothyroidism$ * is a condition o& thyroid hormone de&iciency present at birth% Appro;imately 1 in 7000 ne'born in&ants has a severe de&iciency o& thyroid &unction( 'hile even

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more have mild or partial degrees% 1& untreated &or several months a&ter birth( severe congenital hypothyroidism can lead to gro'th &ailure and permanent mental retardation% -reatment consists o& a daily dose o& thyroid hormone thyro;ine$ by mouth% =ecause the treatment is simple( e&&ective( and ine;pensive( nearly all o& the developed 'orld practices ne'born screening to detect and treat congenital hypothyroidism in the &irst 'ee8s o& li&e%

CA" Congenital adrenal hyperplasia$ * re&ers to any o& several autosomalrecessive diseases resulting &rom mutations o& genes &or en0ymes mediating thebiochemical steps o& production o& cortisol &rom cholesterol by the adrenal glands steroidogenesis$% Most o& these conditions involve e;cessive or de&icientproduction o& se; steroids and can alter development o& primary or secondary se;characteristics in some a&&ected in&ants( children( or adults% Appro;imately .9Go& cases o& CA" are due to 31*hydro;ylase de&iciency%

<AL <alactosemia$ * is a rare genetic metabolic disorder 'hich a&&ects anindividualHs ability to properly metaboli0e the sugar galactose% Lactose in &ood such as dairy products$ is bro8en do'n by the body into glucose and galactose%1n individuals 'ith galactosemia( the en0ymes needed &or &urther metabolism o& galactose are severely diminished or missing entirely( leading to to;ic levels o& galactose to build up in the blood( resulting in hepatomegaly an enlarged liver$(cirrhosis( renal &ailure( cataracts( and brain damage% !ithout treatment( mortalityin in&ants 'ith galactosemia is about 79G%

6I2 6henyl8etonuria$ * is an autosomal recessive genetic disorder characteri0ed by a de&iciency in the en0yme phenylalanine hydro;ylase 6A"$% -his en0yme isnecessary to metaboli0e the amino acid phenylalanine to the amino acid tyrosine%!hen 6A" is de&icient( phenylalanine accumulates and is converted intophenylpyruvate also 8no'n as phenyl8etone$( 'hich is detected in the urine%6A" is &ound on chromosome number 13%Le&t untreated( this condition can cause problems 'ith brain development( leading to progressive mental retardation and sei0ures% "o'ever( 6I2 is one o& the &e' genetic diseases that can be controlled by diet% A diet lo' in phenylalanine and high in tyrosine can be a very e&&ective treatment% -here is no cure% )amage done is irreversible so early detection is crucial%

<:6) )e&iciency * is an J*lin8ed recessive hereditary disease characteri0ed by abnormally lo' levels o& the glucose*:*phosphate dehydrogenase en0yme abbreviated <:6) or <:6)"$% 1t is a metabolic en0yme involved in the pentose phosphate path'ay( especially important in red blood cell metabolism

?eproductive "ealth ?"$ * A state o& complete physical( mental and social 'ell being and not merely the absence o& disease or in&irmity in all matters relating to the reproductive system and its &unctions and process% Concepts: A married couple has the capability to reproduce/procreate ?eproductive health is the e;ercise o& reproductive right 'ith responsibility

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?" includes se;ual health &or the purpose o& enhancement o& li&e and personal relations% ?" mean sa&e pregnancy and delivery ?" includes protection &rom un'anted pregnancy by having access to appropriate health in&ormation and services to enable 'oman to go to through pregnancy and child birth sa&ely% ?" includes protection &rom un'anted pregnancy by having access to sa&e and acceptable methods o& &amily planning o& their choice ?" include protection &rom harm&ul reproductive practice and violence ?" assures access to in&ormation on se;uality to achieve se;ual en+oyment% 4lements o& ?"

Maternal and Child "ealth and Nutrition @amily 6lanning 6revention and Management o& Abortion Complications 6revention and -reatment o& ?eproductive -ract 1n&ections ?-1$including >-)( "1B and A1)> 4ducation and Counseling on >e;uality and >e;ual "ealth =reast and ?eproductive -ract Cancers and other <ynecological conditions MenAs ?eproductive "ealth Biolence Against !omen 6revention and -reatment o& 1n&ertility and >e;ual )isorders @amily 6lanning Method: Natural:

Cervical Mucus Method #vulation Method$ Lactational Amenorrhea Method LAM$ Arti&icial:

1n+ectables )M6A$ 12) Contraceptive 6ills Condom =ilateral -ubal Ligation Basectomy

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Integrated Management of Childhood Illness (IMCI) #b+ectives and <oals Components Content Current >ituation ?egional Accomplishments About the K"ealthy Children: <oal 3003K

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1nitiative .a',ground Integrated Management of Childhood Illness (IMCI) is a strategy &ormulated by the !orld "ealth #rgani0ation !"#$ and the 2nited Nations ChildrenHs @und 2N1C4@$( presented in 1..: as the principal strategy to improve child health% 1t &ocuses on the care o& children under &ive( not only in terms o& their overall health status but also on the diseases that may occasionally a&&ect them% -hus( it reduces missed opportunities &or early detection and treatment o& diseases that can escape the notice o& both parents and health 'or8ers( 'ith the conse,uent ris8 o& the illness becoming 'orse and complications arising% 1n addition( 1MC1 incorporates a strong component o& prevention and health promotion as an integral part o& care% -hus( among other bene&its( it helps increase vaccination coverage and improve 8no'ledge and home*care practices &or children under &ive( subse,uently contributing to gro'th and healthy development% 1MC1 implementation involves the participation o& the community( the health*service sector and the &amily% -his is carried out in three 'ays: 1% 1mproving the per&ormance o& health 'or8ers &or in the prevention and treatment o& childhood diseases% 3% 1mproving the organi0ation and operation o& health services so they provide ,uality care% 5% 1mproving &amily and community care practices% 1MC1 is a strategy that integrates all available measures &or disease prevention and health problems during childhood( &or their early detection and e&&ective treatment( and &or promoting healthy habits 'ithin the &amily and community% 1MC1 can be applied by both health 'or8ers and other people responsible &or the care o& boys and girls under &ive years o& age( i%e% their parents and those 'ho care &or them% 1MC1 o&&ers the 8no'ledge and abilities to se,uentially evaluate and integrate the status o& child health and( in this 'ay( detect the diseases or problems &re,uently a&&ecting it according to the epidemiological patterns o& the respective location% =ased on this evaluation( 1MC1 gives clear instructions on disease classi&ication and problems( establishing the treatment that should be administered &or each one% -he strategy also provides instructions on ho' to control the progress o& treatment( in order to identi&y the need &or applying prevention measures as 'ell as ho' to in&orm and educate parents on disease prevention and child health promotion% #n this basis( 1MC1 is currently regarded as the most e&&icient strategy &or reducing the burden o& disease and disability among the population in this age group% 1t main goal is to contribute to healthy gro'th and development during the &irst &ive years o& li&e% "-/e'ti es and *oa!s 01MC1 has three ob+ectives$ 1% 3% ?educing in&ant mortality% ?educing the incidence and seriousness o& illnesses and health problems that a&&ect boys and girls% 6ro+ects

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5%

1mproving gro'th and development during the &irst &ive years o& a childHs li&e% 1n the ?egion o& the Americas( 6A"# has proposed a speci&ic goal &or the implementation and strengthening o& the 1MC1 strategy% -he Healthy Children: Goal 2002 initiative 'as launched in 1...% 1t proposes to reduce the number o& deaths o& children under &ive in the American hemisphere by 100(000 during the period 1...*3003% Content 1n its initial version( the central &ocus o& the 1MC1 strategy 'as a basic set o& communicable diseases and the nutritional status o& children under &ive% 6rogressively( ho'ever( the strategy has been being e;panded and is currently &inali0ing the preparation o& complementary symptoms encompassing the ma+ority o& health problems and diseases that a&&ect children under &ive years o& age% -hus( 1MC1 includes the &ollo'ing: 1 months to 2 years o o o o o @ever: Malaria% Measlies% Malnutrition and anemia% Baccination status% Non*speci&ic signs o& serious illness% Cough or di&&iculty breathing% )iarrhea: )ehydration% 6ersistent diarrhea% )ysentery% o o o Nonspeci&ic >igns o& serious disease% )iarrea: )ehydration% 6ersistent diarrhea% )ysentery% @eeding 'eight% problems or lo' 3 )ee, to 1 months

Baccination status%

-he &ollo'ing constitute additional areas o& relevance during di&&erent implementation phases: 6erinatal/neonatal% Asthma and broncho*obstructive syndrome% Child development% #ral health% Neglect( child abuse( and accidents%

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)iabetes and obesity% Components:

1%

1mproving the per&ormance o& health 'or8ers 'hen tending to children under &ive and their &amilies health*'or8er component$% 3% 1mproving the organi0ation and overall &unctioning o& health*care services so that they o&&er e&&icient( good*,uality care health*service component$% 5% 1mproving 8no'ledge on best practices &or the care o& boys and girls at home and in the community community component$% !ith regard to impro ing the performance of health !or"ers ( 1MC1 o&&ers a number o& practical tools( including Modules &or the evaluation( classi&ication and treatment o& children under &ive( and training materials on these modules% <uides &or health*care 'or8ers to provide support in e&&ective 1MC1 application% -raining materials on ho' to improve communications 'ith parents during their childHs evaluation( diagnosis and treatment( telling them ho' to deal 'ith problems and promoting practices &or healthy gro'th and development% !ith regard to impro ing the organi#ation and o erall functioning of health ser ices ( 1MC1 also has made available practical tool8it including <uidelines &or evaluating the care provided to children under &ive in primary health*care services and in hospitals% -raining materials on ho' to develop local plans &or 1MC1 implementation( &ollo'*up and evaluation% -raining courses to improve the availability o& attention and medications needed &or 1MC1 application% 6rotocols &or operational and epidemiological research related to 1MC1% <uidelines to evaluation the results o& applying 1MC1% !ith regard to impro ing "no!ledge and practices on the part of parents and others !ho care for children under fi e( 1MC1 has made various practical tools available( including >i;teen 8ey &amily practices &or healthy gro'th and development% <uide &or developing community 1MC1 pro+ects% <uide on evaluating the care o& children under &ive in primary health*care &acilities and hospitals%

En ironmenta! Sanitation is de&ined as the study o& all &actors in manAs physical environment( 'hich may e;ercise a deleterious e&&ect on his health 'ell being and survival%

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@actors in 4nvironmental >anitation: !ater sanitation @ood sanitation ?e&use and garbage disposal 4;creta disposal 1nsect vector and rodent control "ousing Air pollution Noise ?adiological protection 1nstitutional sanitation >tream pollution -he 4nvironmental "ealth >ervices 4">$ o& )#" is responsible &or the promotion o& healthy environmental conditions and prevention o& environmental related diseases through appropriate sanitation strategies: !ater ,uality surveillance 4valuation o& &ood establishments 6roper solid and li,uid 'aste management >anitation o& public places >anitation management o& disaster areas 1mpact assessment o& environmentally critical pro+ects 4n&orcement o& sanitation la's( rules and regulations% Ma+or 4nvironmental >anitation 6rograms: 1% "ealth and >anitation 6)%/9: 1.7/$ >anitation code o& the 6hils% 3% !ater >upply >anitation 6rogram 5% 6roper e;creta and se'age disposal program 7% @ood sanitation program 9% "ospital 'aste management program :% 6rogram on health ris8 minimi0ation due to environmental pollution 7% "ealth 4ducation nursing responsibilities and activities

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Control o& Communicable )iseases 1% -= * N-6 3% Leprosy Control 6rogram 5% >chistosomiasis 7% @ilariasis 9% Malaria :% )engue "emorrhagic @ever 7% Measles /% Chic8en 6o; .% Mumps 10% )iphtheria 11% !hooping Cough 13% -etanus neonatorum 15% 1n&luen0a 17% 6neumonias 19% Cholera 1:% -yphoid &ever 17% Leptospirosis 1/% ?abies E4isting *o ernment %rograms -he @ourmula #ne &or "ealth: -he ?oad Map &or "ealth >ector ?e&orms in the 6hilippines 3009 * 3010 5hat is FOURmu!a ONE for #ea!th6 $%&'mula %() &or "ealth is the implementation &rame'or8 &or health sector re&orms in the 6hilippines &or the medium term covering 3009*3010% 1t is designed to implement critical health interventions as a single pac8age( bac8ed by e&&ective management in&rastructure and &inancing arrangements% -his document provides the road map to'ards achieving the strategic health sector re&orm goals and ob+ectives o& $%&'mula %() &or "ealth &rom the national do'n to the local levels%

<eneral #b+ective: $%&'mula %() &or "ealth is aimed at achieving critical re&orms 'ith speed, precision and

31

effecti e coordination directed at improving the ,uality( e&&iciency( e&&ectiveness and e,uity o& the 6hilippine health system in a manner that is &elt and appreciated by @ilipinos( especially the poor%

>peci&ic #b+ectives: *+ Health $inancing D >ecure more( better and sustained &inancing &or healthL 2+ Health 'egulation D Assure the ,uality and a&&ordability o& health goods and servicesL ,+ Health -er ice .eli ery D 4nsure access to and availability o& essential and basic health pac8agesL /+ Good Go ernance in Health D1mprove per&ormance o& the health system

Community "rgani7ing %ro'ess

I8 %RE$ENTRY %#ASE -he simplest phase in terms o& actual outputs activities and strategies% A8 activities% Activities: .8 Community consultations/dialogues 6reliminary social investigation initial data gathering in&ormal intervie' net'or8 'ith local government unit &or pro+ect endorsements Identifi'ation of #ost Fami!ies living 'ith host &amilies ensures round the cloc8 integration and e;periencing the li&e o& the community residence% 9A host family should be identified before the actual entry Criteria: Site Se!e'tion Criteria: )epressed( poor community 1naccessibility or inade,uacy o& health services 6oor health status o& community !ith no serious peace and order problem No strong resistance &rom the community &rom the model utili0ed No similar agencies or programs currently in the community to avoid duplication o&

33

enter%

"ouse should be strategically located in the barangay to enable communication% "ost &amily should not belong to the rich segment o& the community% -he &amily should be respected by the leaders o& the community% -he &amily should have a house 'here neighbors( especially the poor are not hesitant to

II 8 ENTRY %#ASE -he social preparation phase% Criteria: #rgani0ers should recogni0e local authorities through courtesy call to orient pro+ect ob+ectives% -he team memberAs speech( appearance( behavior and li&estyle should be in 8eeping o& those 'ith the community% -hey should adopt a lo' 8ey pro&ile and approach% Activities: 1% 3% 5% 7% 9% 38 1ntegration 'ith the community Conduct o& in&ormation campaign regarding the program Conduct o& deepening social investigation 6rovision o& health services 1denti&ication o& potential leaders Integration the process o& establishing rapport 'ith the people in a continuing e&&ort to imbibe community li&e% Methods o& 1ntegration: Living 'ith the community 6articipation in direct production activities o& the people li8e planting( harvesting( &ishing( etc% 5% 7% 9% :% 18 :8 1% 3% 5% 7% 9% :% 7% /% .% 10% 11% 28 Conducting house to house visit >ocial activities li8e birthdays( 'eddings( 'a8es( etc% Conversing 'here people usually gather such as stores( 'ash area( church yards )oing household chores% Condu't of Information 'ampaign a-out the program + disseminates in&ormation about the purpose and strategies that 'ould be underta8en &or development Community study and deepening so'ia! in estigation (!ata "athering) 6hysical geographical data )emographical data 4conomic conditions Mortality and morbidity data @ood supply and nutrition Cultural patterns( belie&s and health practices "ealth &acilities and services 4ducation Community leaders and organi0ation )evelopment agencies Community problem needs %ro ision of -asi' hea!th ser i'es initiate immediate interventions &or acute health problems o& the community% 4;% )engue @ever( measles( disasters and calamities%

1% 3%

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;8

Identifi'ation of potentia! !eaders or Core group formation involving &uture organi0ers and possible partners% (Community leaders) III8 "R*ANI<IN* AND CA%A.ILITY .UILDIN* M 1nvolves 6lanning( 1mplementing( Monitoring and evaluating community 'ide activities% 1t signals the start o& community sel& management o& any development program% 2 &a/or A'ti ities( 1% 6reparing the community &or organi0ational building 3% #rgani0ing Committees 5% -raining and development o& committees &ormed 7% >etting up the community 'ide organi0ation community assembly Community Diagnosis M A systematic process o& collecting( collating( synthesi0ing and analy0ing data to dra' a clear picture o& the community( particularly its problems%

IV8 SUSTENANCE AND STREN*#TENIN* %#ASE -his occurs 'hen the community health organi0ation has already been established and the residents are already participating in the community 'ide underta8ings%

Strategies( 1% 3% 5% 7% 9% 4ducation and training Net'or8ing and lin8ages Conduct mobili0ation on health and development concerns 1mplementation o& livelihood program )eveloping secondary leaders V8 TURN$"VER AND %#ASE "UT %#ASE -he actual turn*over o& activities( programs that have been previously set to the 8ey person in the community involved in the organi0ing process to sustain program/pro+ect continuity and development%

Leadership -raining( 6rinciples and 6rocess -he organi0ing process must not revolve around the community organi0er( but on the indigenous leaders o& the community( 'ho 'ill eventually ta8e over the role o& the community organi0er% Community #rgani0ing promotes collective or shared leadership%

Leadership -raining must be based on the &ollo'ing principles and concepts:

37

a% Leadership as service as opposed to a leader as authority% Leadership is directed to'ards the 'el&are o& others% b% Corporate/collective leadership as opposed to a one*person &orm leadership% 1t means sharing o& leadership 'ith others% c% )elegation o& authority in implementing decisions( 'or8 and responsibility are decided by di&&erent leaders and members%

d% 4liciting participation Leaders encourage/motivate people to +oin the discussions and 'or8 to'ards a common goal% e% 6roblem solving means investigating all aspects o& a situation or a problem% All suggestions are considered and integrated into a viable theory that could be put into action%

6rograms and 6ro+ects o& )#" I8 FA&ILY #EALT# AND NUTRITI"N CLUSTER -he @amily "ealth and Nutrition 6rogram aims to improve the health and nutritional status o& the &amily( especially that o& the 'omen o& the reproductive age group and that o& the children belo' &ive years o& age( thereby promoting sa&e motherhood( reducing &emale morbidity and mortality( reducing in&ant morbidity and mortality and reducing under*&ive child morbidity and mortality%

%rograms and pro/e'ts under the Fami!y #ea!th and Nutrition C!uster( 1% 3% 5% 7% 9% :% 7% /% .% Maternal and Child "ealth( 2nder*@ive Clinic( 4;panded 6romotion o& =reast&eeding and the Mother and =aby @riendly "ospital 4;panded 6rogram on 1mmuni0ation >-)/"1B/A1)> Control 6rogram 6lanning/?eproductive "ealth 6rogram Comprehensive Nutrition 6rogram Comprehensive )ental 6rogram Control o& Acute ?espiratory 1n&ection Control o& )iarrheal )iseases

39

-he activities o& these di&&erent programs and pro+ects geared to'ards the improvement o& the health and nutritional status o& 'omen and children thereby reducing the mortalities and morbidities o& these groups%

MA#ERNA$ AN! C%I$! CARE&%EA$#% AN! UN!ER'FI(E C$INIC 6roviding ,uality health care &or 'omen and children is the utmost concern o& this department% An integrated pac8age o& services &or 'omen and children 'as provided( a component o& 'hich is the Maternal and Child Care/"ealth and the 2nder*@ive Clinic% 1ts ob+ective is to strengthen the maternal and child health program implementation at the regional and local levels( particularly by the L<2s% 6ro+ects/6rograms promoting sa&e motherhood ( ensuring the 'ell*being o& mothers and children and addressing to their needs 'ere conceptuali0ed and implemented to &ill in the gaps o& the Maternal and Child "ealth 6rogram% -hese are the !omenAs "ealth and >a&e Motherhood 6ro+ect( the 4arly Child )evelopment 6ro+ect( the L<2 6er&ormance 6rogram( the 2N@6A 6rogram o& Assistance and the 2N1C4@ 6rogram o& Assistance%

)ROMO#ION OF *REA+#FEE!IN" )RO"RAM&MO#%ER AN! *A*, FRIEN!$, %O+)I#A$ INI#IA#I(E ?eali0ing optimal maternal and child health nutrition is the ultimate concern o& the 6romotion o& =reast&eeding 6rogram% -hus( e;clusive breast&eeding in the &irst &our 7$ to si; :$ months a&ter birth is encouraged as 'ell as en&orcement o& legal mandates% -he Mother and =aby @riendly "ospital 1nitiative M=@"1$ is the main strategy to trans&orm all hospitals 'ith maternity and ne'born services into &acilities 'hich &ully protect( promote and support breast&eeding and rooming*in practices% -he legal mandate to this initiative are the ?A 7:00 -he ?ooming*1n and =reast&eeding Act o& 1..3$ and the 4;ecutive #rder 91 o& 1./: -he Mil8 Code$% National assistance in terms o& &inancial support &or this strategy ended year 3000( thus L<2s 'ere advocated to promote and sustain this initiative%

E-)AN!E! )RO"RAM ON IMMUNI.A#ION Children need not die young i& they receive complete and timely immuni0ation% Children 'ho are not &ully immuni0ed are more susceptible to common childhood diseases% -he 4;panded 6rogram on 1mmuni0ation is one o& the )#" 6rograms that has already been institutionali0ed and adopted by all L<2s in the region% 1ts ob+ective is to reduce in&ant mortality and morbidity through decreasing the prevalence o& si; :$ immuni0able diseases -=( diphtheria( pertussis( tetanus( polio and measles$% >pecial campaigns have been underta8en to improve &urther program implementation( notably the National 1mmuni0ation )ays N1)$( Inoc8 #ut 6olio I#6$ and <arantisadong 6ambata <6$ since 1..5 to 3000% -his is being supported by increasing/sustaining the routine immuni0ation and improved surveillance system%

3:

+#!& AI!+ CON#RO$ )RO"RAM >e;ually -ransmitted )iseases >-)s$( and particularly Ac,uired 1mmune )e&iciency >yndrome A1)>$ are among the ma+or global health concerns% !ith the spread o& these diseases( this 'ould a&&ect the economy &urther( creating more social problems% "uman 1mmunode&iciency Birus "1B$ is the virus that causes A1)>% Ninety*&ive .9G$ percent o& those in&ected 'ith A1)> are not even a'are that they are in&ected% 1n 1..7( it is estimated that about 30(000 have already been in&ected 'ith "1B throughout the country but ma+ority o& these cases are still undetected and unreported% -hus( "1B/A1)> is considered a priority program o& the )#"% -he most common mode o& transmission is se;ual transmission( primarily through heterose;ual contact% #ther modes are through blood and blood products( in+ection drug use( needle pric8 in+uries and perinatal during pregnancy%

FAMI$, )$ANNIN"&RE)RO!UC#I(E %EA$#% )RO"RAM -he @amily 6lanning 6rogram aims to assist couples to practice responsible planning and decision*ma8ing regarding reproductive health% 1t is geared to'ards promotion o& maternal and child health through universal access to program in&ormation( education and services% Li8e'ise( the program intends to strengthen the management and &ield implementation o& &amily planning/reproductive health initiatives/activities in order to reduce unmet needs( reduce high ris8 births( prevent abortions( improve sustainability and e;pand participation o& the private sector%

COM)RE%EN+I(E NU#RI#ION )RO"RAM #ne in three @ilipino children is malnourished% -his remains a threat to the @ilipino childAs survival% -he ob+ective o& the program is to reduce mortality and morbidity due to avitaminosis and other nutritional de&iciencies among in&ants( preschoolers( pregnant and lactating mothers by improving the health and nutrition status o& mothers and children% Assistance &rom di&&erent pro+ects to the program includes <arantisadong 6ambata Activities and 6rovision o& Micronutrients &rom the !omenAs "ealth and >a&e Motherhood 6ro+ect( >alt 1odi0ation under the 4arly Child )evelopment 6ro+ect and other assistance &rom 2N1C4@%

COM)RE%EN+I(E !EN#A$ %EA$#% )RO"RAM -he Comprehensive )ental "ealth 6rogram aims to improve the ,uality o& li&e o& the people through the attainment o& the highest possible oral health% 1ts ob+ective is to prevent and control dental diseases and conditions li8e dental caries and periodontal diseases thus reducing their prevalence%

37

-argeted priorities are vulnerable groups such as the 9*13 year old children and pregnant 'omen% >trategies o& the program include social mobili0ation through advocacy meetings( partnership 'ith <#s and N<#s( orientation/updates and monitoring adherence to standards% -o attain orally &it children( the program &ocuses on the &ollo'ing pac8age o& activities: oral e;amination and prophyla;isL sodium &luoride mouth rinsingL supervised tooth brushing drillL pit and &issure sealant applicationL a*traumatic restorative treatment and 14C% -he 6rogram also integrates its activities 'ith the Maternal and Child "ealth 6rogram( the Nutrition 6rogram and the <6 activities o& the !">M6%

CON#RO$ OF ACU#E RE+)IRA#OR, INFEC#ION 6neumonia is consistently one o& the top leading causes o& in&ant and child mortality and morbidity% -he ob+ective o& the program is to reduce in&ant and child mortality &rom pneumonia% -he thrust o& the program is to'ards home management 'herein the child carer is able to recogni0e the disease at an early stage( provide treatment and re&er 'hen needed% Main strategies are training o& health personnelL health advocacy and promotion particularly among &amily members and child carers and provision o& logistical support% @or year 3000( 6neumonia is the leading cause o& in&ant mortality% 1MC1 through the 4arly Child )evelopment 6ro+ect and 2N1C4@ has been introduced to support the CA?1 program and to integrate its management 'ith other common childhood illnesses%

CON#RO$ OF !IARR%EA$ !I+EA+E+ -he Control o& )iarrheal )iseases program aims to e&&ectively reduce diarrheal morbidity through oral rehydration therapy% 4mphasis is on home therapy by continued &eeding and increased inta8e o& &luidsL rational use and dispensation o& drugsL public in&ormationL and education on correct and prompt management o& diarrhea at home% >trategies include tri*media campaigns( strengthening the essential drug and distribution system( capability building and provision o& #?>% -rainings on 1MC1 provides continuous support to the C)) 6rogram

II8 INFECTI"US DISEASE CLUSTER -he 10 leading causes o& morbidity &or the past 5 years are in&ectious in origin% >i; :$ out o& the 10 leading causes o& mortality are non*in&ectious/non*communicable but 5 are secondary to in&ectious or communicable diseases% -he goal o& the 1n&ectious )isease Cluster is to reduce mortality and morbidity brought about by in&ectious/communicable diseases% #b+ectives o& the 1n&ectious )isease Cluster: to signi&icantly reduce the burden o& priority diseases such as -=( ?abies and Baccine*preventable diseases and subse,uently eliminate them thru a public health programL prevent and control emerging and re* emerging disease% 1% 3% 5% NA-1#NAL -= C#N-?#L 6?#<?AM MALA?1A C#N-?#L 6?#<?AM )4N<24 C#N-?#L 6?#<?AM

3/

7% 9%

L46?#>C C#N-?#L 6?#<?AM ?A=14> C#N-?#L 6?#<?AM

NA#IONA$ #* CON#RO$ )RO"RAM According to the !orld "ealth #rgani0ation( the 6hilippines ran8s &ourth in the 'orld &or the number o& cases o& tuberculosis and has the highest number o& cases per head in >outheast Asia% Almost t'o thirds o& @ilipinos have tuberculosis( and up to &ive million people are in&ected yearly in our country% 1n 1..:( !"# introduced the )irectly #bserved -reatment >hort Course )#->$ to ensure completion o& treatment% -he )#-> strategy depends on &ive elements &or its success: Microscope( Medicines( Monitoring ( )irectly #bserved -reatment( and 6olitical Commitment$% 1& any o& these elements are missing( our ability to consistently cure -= patients slips through our &ingers%

MA$ARIA CON#RO$ )RO"RAM Malaria is endemic in :9 o& the 7/ provinces in the country( a&&ecting appro;imately 10%3 million @ilipino 'ho are at ris8 o& the disease% -he commonly a&&ected groups are the &armers( indigenous cultural groups( &orest product gatherers( agricultural 'or8ers( miners and soldiers% -he program 'as not a&&ected by devolution( thus direct services are still being provided by the C")*13 to these a&&ected areas% -he Malaria Control 6rogram provides support to active and passive case detection and treatment and simultaneous mos,uito vector control to eradicate malaria in the ?egion% Bector control and surveillance remain to be the ma+or strategies o& the program% Bector control measures include chemical control( environmental management( biological control and personal protection% >urveillance involved case &inding and treatment%

!EN"UE CON#RO$ )RO"RAM #ne o& the ma+or health problems during rainy season is the incidence o& )engue "emorrhagic @ever% 1t occurs in all age groups% -his disease transmitted by Aedes( a day*biting mos,uito$ is preventable but is prevalent in urban centers 'here population density is high( 'ater supply is inade,uate resulting to 'ater storage and a good breeding place &or the vector$( and solid 'aste collection and storing are also inade,uate% -he thrust o& the )engue Control 6rogram is directed to'ards community*based prevention and control in endemic areas% Ma+or strategy is advocacy and promotion( particularly the @our #Acloc8 "abit 'hich 'as adopted by most L<2s% -his is a nation'ide( continuous and concerted e&&ort to eliminate the breeding

3.

places o& Aedes aegypti% #ther initiatives are the dissemination o& 14C materials and tri*media coverage%

$E)RO+, CON#RO$ )RO"RAM -he Leprosy Control 6rogram envisions to eliminate Leprosy as a human disease by 3030 and is committed to eliminate leprosy as a public health problem by attaining a national prevalence rate 6?$ o& less than 1 per 10(000 population by year 3000% 1ts elimination goals are: reduce the national 6? o& N1 case per 10(000 population by year 1../ and reduce the sub*national 6? to N1 case per 10(000 population by year 3000% 6rogram thrust is to'ards &inding hidden cases o& leprosy and put them on Multi*)rug -herapy M)-$( emphasi0ing the completion o& treatment 'ithin the !"# prescribed duration% >trategies are case*&inding( treatment( advocacy( rehabilitation( manpo'er development and evaluation%

RA*IE+ CON#RO$ )RO"RAM ?abies( a &atal disease a&&ecting the nervous system( remains a public health problem in the country% -he disease is most commonly transmitted through a bite by an in&ected animal( 'ith dogs as the main carriers% -he 6hilippine annual incidence o& rabies &or year 1./7 to 1..7 ranged &rom 5 to . per million population or appro;imately 500*:00 @ilipinos die o& rabies every year% -he National ?abies 6revention and Control 6rogram is a program +ointly implemented by the )epartment o& "ealth )#"$ and the )epartment o& Agriculture )A$ in collaboration 'ith the )epartment o& 4ducation( Culture and >ports )4C>$( and the )epartment o& 1nternal and Local <overnment )1L<$% -he )#"( the lead agency( conducts and supervises dog immuni0ation activities and dog control measures% #ther partner agencies )4C>( )1L<( L<2$ assist in the promotion o& ?esponsible )og #'nership% =ecause o& the &atality o& the disease and the burden it incurs on the government in terms o& economic cost( the N?6C6 aims to eliminate the disease and declare a rabies*&ree 6hilippines by year 3030% III8 DE*ENERATIVE DISEASE CLUSTER -he goal o& the )egenerative )isease Cluster is to reduce mortality and morbidity brought about by chronic and degenerative diseases%

NA#IONA$ CAR!IO(A+CU$AR !I+EA+E )RO"RAM&+MO/IN" CE++A#ION )RO"RAM

)RE(EN#ION

AN!

CON#RO$

)iseases o& the heart or the cardiovascular system are on the rise any'here around the 'orld and even here in our country( causing the most number o& deaths% -hey are li&e*style related diseases% -he rise in CB) mortality has been primarily due to mortality &rom hypertension( coronary artery

50

disease and cerebrovascular accident( all o& 'hich are more than doubled during the period 1.:7* 1./.% -he program envisions a nation o& @ilipinos 'ith healthy li&estyles and habits( living and 'or8ing in a clean and smo8e/tobacco*&ree environment( and 'ith access to ade,uate medical care &or cardiovascular diseases% 1t intends to reduce morbidity and morbidity &rom CB)L reduce the economic burden o& CB) to the individual( the &amily and the communityL and improve the productivity and ,uality o& li&e o& CB) cases%

)%I$I))INE CANCER CON#RO$ )RO"RAM -he most common are cancers o& the stomach( lungs( breast( colon/rectum( cervi; and mouth/pharyn;% -he 6hilippine Cancer Control 6rogram 6CC6$ 'as implemented in 1../( to reduce morbidity and mortality o& cancer cases( improve survival rate and ,uality o& li&e o& cancer patients and integrate hospital and public health interventions% >trategies are primary prevention eliminating conditions that cause cancer to develop$L secondary prevention early detection coupled 'ith e&&ective therapy$L de&initive diagnosis and managementL supportive care rehabilitation and pain relie&$L and research%

RENA$ !I+EA+E CON#RO$ )RO"RAM (RE!CO)) -he ?4)C#6 consists o& the &ollo'ing components: ?)? ?enal )isease ?egistry$L >tudy on <N and Iidney >tonesL @ollo'*up o& 6N6 casesL and #rgan )onation% -his is a relatively ne' program 'ith the ob+ective o& reducing the mortality and morbidity rates caused by renal diseases%

!IA*E#E+ )RE(EN#ION AN! CON#RO$ )RO"RAM Among the li&estyle diseases threatening the country today( the most daunting is )iabetes Mellitus% -he 1..7 !"# report states that there is an epidemic o& -ype 11 )iabetes in Asia% 1n order to reduce the impact o& )iabetes on the health and socioeconomic li&e o& the 1longgos( the 6rogram shall ensure that the &ollo'ing ob+ectives are met: to be able to develop health promotions and advocacy strategies and programs to prevent )M and its complicationsL to be able to adopt an appropriate community based screening methods &or early detection o& )ML to be able to establish coordinated health systems 'hich shall include clinicians( allied health personnel( researchers( lay 'or8ers &or the prevention o& )M and its complications% >trategies include strengthening o& health in&ormation and communication activities( development o& 14C materials( establishment o& diabetes clinics in peripheral hospitals( e;tension o& technical assistance and strong net'or8ing%

51

%EA$#% )RO"RAM FOR O$!ER )ER+ON+ (%)O)) -he program envisions a healthy productive older population% -his may be done 'ith the &amily( community and government 'or8ing together &or an improved ,uality o& li&e &or older persons% 1ts goal is to reduce morbidity and mortality due to chronic diseases among older persons% -he speci&ic ob+ectives o& the program are: establish a comprehensive cost e&&ective health program &or older personsL advocate a healthy li&estyleL prevent/minimi0e diseases( disability and handicapsL strengthen the &unctional capacity o& older persons to be productive and sel&*reliantL and build/enhance the competencies o& health care on the management o& older persons% 6rogram strategies are: advocacy/social mobili0ationL public in&ormation and health educationL human resource development/capability building L researchL and monitoring and evaluation%

NA#IONA$ A+#%MA E!UCA#ION0 )RE(EN#ION AN! CON#RO$ )RO"RAM (NAE))) -he ob+ective o& the program is to enhance the ,uality o& li&e &or patients 'ith asthma and decrease asthma related morbidity and mortality% >peci&ically( it aims to: increase a'areness o& patients( health pro&essionals and the public that asthma is a serious chronic diseaseL increase a'areness on the recognition o& the symptoms o& asthma by patients( &amilies and the public and increase the capability &or appropriate diagnosis by health pro&essionalsL and promote e&&ective control o& asthma by encouraging a partnership among patients support groups$( physicians and other health pro&essionals net'or8ing$ through modern treatment and education programs% 6rogram strategies are &ocused on advocacy/social mobili0ation( public in&ormation and health education( and technical assistance to L<2s%

NA#IONA$ O+#EO)ORO+I+ E!UCA#ION )RE(EN#ION )RO"RAM (NOE))) 6rogram strategies are: advocacy/social mobili0ationL public in&ormation and health educationL human resource development/capability buildingL researchL and monitoring and evaluation%

)RE(EN#ION OF *$IN!NE++ )RO"RAM -he 6revention o& =lindness 6rogram 6=6$ 'as launched in 1..1 'ith the ob+ective o& reducing the blindness prevalence rate% 1t has &our components: Cataract 6rogramL 6rimary 4ye Care 64C$L Bitamin A )e&iciency BA)$ 6revention and ControlL and other 4ye Care 6rogram%

53

-he Munting )o8tor 6ro+ect is adopted to intensi&y case &inding o& cataract cases% -his is an innovative approach using <rade B1 pupils as cataract case &inders 'ith the &inal screening and operations done by trained ophthalmologists in the region%

COMMUNI#,'*A+E! RE%A*I$I#A#ION )RO"RAM Launched in 1..0( the program is concerned 'ith the needs o& the disabled persons and hoped to reduce the prevalence o& physical( mental( sensory and motor disabilities at the community level% 1t is actually a creative application o& the 6rimary "ealth Care 6"C$ Approach in rehabilitation services% 6rimarily( it involves measures ta8en at the community level to use and build on the resources o& the community( including the impaired( disabled and handicapped persons themselves( their &amilies and their community as a 'hole% -he goal o& the program is to improve the ,uality o& li&e and productivity o& disabled and handicapped persons% 1ts ob+ective is to reduce the prevalence o& disability through prevention( early detection and provision o& rehabilitation services at the community level% IV8 ENVIR"N&ENTAL AND "CCU%ATI"NAL #EALT# CLUSTER

EN(IRONMEN#A$ %EA$#% )RO"RAM A ma+or problem con&ronting our country is the high incidence o& 'ater*borne and sanitation* related diseases a&&ecting most commonly those that belong to the in&ants and pre*school age group o& individuals% -his condition hinders the normal daily process o& human activities because o& poor health conditions% -he main ob+ective o& the program is to promote health and prevent environmental*related diseases% 1t also aims to overcome the e&&ects o& manAs activities on his environment%

OCCU)A#IONA$ %EA$#% )RO"RAM -he health needs o& the 'or8ers increase as the country moves to'ards industriali0ation% !or8ers in industrial establishments( agro*industrial( &ishing( mining/,uarry( &orestry and agricultural enterprises are e;posed to a variety o& occupational ha0ards or e;treme occupational conditions% Moreover( the increasing number o& 'omen o& reproductive age +oining the 'or8&orce and their e;posure to ha0ardous/to;ic chemicals brings about increased ris8 not only to mothers but also to the unborn &etus% -he #ccupational "ealth 6rogram #"6$ is directed to'ards the reduction o& the incidence o& occupation*related diseases( accidents and deaths% 6rogram strategies are: setting*up o& in&ormation center( net'or8ing( training( logistic support and technical assistance%

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MEN#A$ %EA$#% )RO"RAM -he Mental "ealth 6rogram aims to reduce the incidence o& mental illnesses% 1t has t'o ma+or aspects: promotive/preventive and curative/rehabilitative% -he promotive/preventive aspect includes advocacy and promotion to the di&&erent levels o& society and stress management% -he curative/rehabilitative aspect( on the other hand( covers outreach activities to the L<2>( logistic support and training o& 8ey health personnel in the L<2s% Con'epts and %rin'ip!es of Net)or,ing and Lin,age +-ui!ding -he aim o& partnership and collaboration is to get people to 'or8 together in order to address problems or concerns that a&&ect them% 1t gives people the opportunity to learn s8ills in group relationship% !or8ing together enables organi0ations to accomplish their goals much ,uic8er because resources( s8ills and vie's are pooled together%

A% Net'or8ing is a relationship among organi0ations that consists o& e;changing in&ormation about each otherAs goals and ob+ectives( services and &acilities% ?esults on ho' each organi0ation can contribute to the accomplishment o& the net'or8As goals and ob+ectives%

=% Coordination is a relationship 'here organi0ations modi&y their activities in order to provide better services to the target bene&iciary%

C% Cooperation is a relationship 'here organi0ations share in&ormation and resources and ma8e ad+ustments in oneAs o'n agenda to accommodate the other organi0ationAs agenda% #rgani0ation shares o'nership o& success( re'ards as 'ell as problems that go 'ith 'or8ing together%

)% Collaboration is the level o& organi0ational relationship 'here organi0ations help each other enhance their capacities in per&orming their tas8s as 'ell as the provision o& services% 6eople becomes partners rather than competitors%

4% Coalition or Multi*sector Collaboration organi0ations and citi0ens &orm partnership% All parties give priority to the good o& the community% ?e,uires great investment in terms o& e&&orts( time( trust and 'ill to ma8e a change

E a!uation of %rograms and Ser i'es #b+ectives o& 6rogram 4valuation: 1% Beri&y the value o& health interventions and outcomes 3% Appraise the e&&ect o& health intervention to the community

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#utput re&ers to the products or services 'hich an activity is e;pected to produce% 4;% O o& children 'eighed( O o& patients treated( O o& p; 'omen given --

4&&ect re&ers to outcome o& the utili0ed pro+ect outputs% 4;% 1ncidence o& tetanus neonatorum( O o& malnourished children( incidence o& communicable diseases%

1mpact re&ers to the outcome o& program/pro+ect e&&ects% 1t sho's actual long range results produced%

1mpact 4valuation assesses the impact o& care administered or the impact o& implemented program on the client by comparing the conditions o& the a&&ected groups be&ore and a&ter program/pro+ect implementation

Cost e&&ectiveness analysis compares alternative pro+ects/care interventions in terms o& the cost o& producing a given output%

?ecording and ?eporting >ystem

@ield "ealth >ervices and 1n&ormation >ystem @">1>$ #b+ectives: -o provide summary data on health service delivery and selected program accomplished indicators at the barangay( municipality/city( district( provincial( regional( and national levels% -o provide data 'hich 'hen combined 'ith data &rom other sources( can be used &or program monitoring and evaluation process% -o provide a standardi0ed( &acility level data base 'hich can be accessed &or more in*depth studies% -o ensure that the data reported to the @">1> are use&ul and accurate and are disseminated in a timely and easy to use &ashion% -o minimi0e the recording and reporting burden at the service delivery level in order to allo' more time &or patient care and promotive activities% Components:

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@amily -reatment ?ecord -arget Client List ?eporting @orms #utput ?eports

1% -reatment ?ecord -he &undamental Pbuilding bloc8Q and &oundation o& the @"1>% -his is the document( &orm( or piece o& paper upon 'hich recorded the presenting symptoms or complaints o& the patient on consultation and the diagnosis( treatment( and date o& treatment%

4;% 6atient ?ecord )ate Name Address Complaint ?; )iagnosis i& available$

3% -arget/client lists constitute the second Pbuilding bloc8Q o& the @">1> and are intended to serve &our purposes: a% -o plan and carry out patient care and services delivery% b% -o &acilitate the monitoring and supervision o& services c% -o report service delivered%

d% -o provide a clinic*level database * 'hich can be accessed &or &urther studies t 5% -ally/?eporting @orms it constitute he only mechanism through 'hich data are routinely transmitted &rom one &acility to another in the revised @">1>% Ma+ority o& the @">1> reports are prepared and submitted either monthly or ,uarterly% @">1> reports are prepared and submitted by the unit/person responsible &or the service or activity and sent directly to 6rovincial "ealth #&&ice%

7% #utput ?eports output reports or tables 'ill be a produced at the 6rovincial "ealth o&&ice or alternate data processing site in the province$ &rom the data reported in @">1> ?eporting @orms% Computer*generated output reports 'ill then be disseminated do'n to the ?"2/M"C and up through the )#" system to the ?egional "ealth #&&ice% Vita! Statisti's Bital >tatistics re&ers to the systematic study o& vital events such as births( illnesses( marriages( divorces/separations and deaths% >tatistics o& disease morbidity$ and death mortality$ indicate the health o& a community and the success or &ailure o& the health 'or8% 6opulation statistics such as age and se; can be obtained &rom N>#

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=irths and deaths are registered in the #&&ice o& the Local Civil ?egistry city or municipality >ources o& data: 6opulation Census ?egistration o& vital data "ealth surveys >tudies and research

1% Crude =irth ?ate * A measure o& one characteristic o& the natural gro'th or increase o& a population%

C=? M -otal no% o& live births registered in a given calendar year 4stimated population as o& Ruly 1 o& the same year

J 1(000

3% Crude )eath ?ate A measure o& one mortality &rom all causes 'hich may result in a decrease o& population% C)? M -otal no% o& deaths registered in a given calendar year J 1(000 4stimated population as o& Ruly 1 o& the same year

5% 1n&ant Mortality ?ate Measures the ris8 o& dying during the 1st year o& li&e%

1M? M -otal no% o& deaths under 1 year o& age registered in a given calendar year -otal no% o& registered live births o& same calendar year

J 1(000

7% Maternal Mortality ?ate Measures the ris8 o& dying &rom causes related to pregnancy( childbirth and puerperium%

MM? M -otal no% o& deaths &rom maternal causes registered &or a given year -otal no% o& live births registered o& same year

J 1(000

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9% @etal )eath ?ate Measures pregnancy 'astage% )eath o& the product o& conception occurs prior to its complete e;pulsion( irrespective o& duration o& pregnancy%

@)? M -otal no% o& &etal deaths registered in a given calendar year -otal no% o& live births registered o& same year

J 1(000

:+ Neonatal )eath ?ate Measures the ris8 o& dying the 1st month o& li&e%

N)? M No% o& deaths under 3/ days o& age registered in a given calendar year -otal no% o& live births registered o& same year

J 1(000

7+ >peci&ic )eath ?ate )escribes more accurately the ris8 o& e;posure o& certain classes or groups to a particular disease%

>peci&ic )? M )eaths in speci&ic class or group registered in a given calendar year

J 100(000

4stimated population as o& Ruly 1 in the same speci&ied class or group o& said year

/% 1ncidence ?ate Measures the &re,uency o& occurrence o& the phenomenon during a given period o& time% )eals only 'ith ne' cases

1? M No% o& ne' cases o& a particular disease registered during a speci&ied period o& time 4stimated population as o& Ruly o& same year

J 100(000

.% 6revalence ?ate Measures the proportion o& the population 'hich e;hibits a particular disease at a particular time% 6? M No% o& ne' and old cases o& a certain disease registered at a given time -otal no% o& person e;amined at same given time J 100

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10% Attac8 ?ate A more accurate measure o& the ris8 o& e;posure% A? M No% o& persons ac,uiring a disease registered in a given year No% e;posed to same disease in same year J 100

10% >'aroo&As 1nde; >1 M -otal deaths 90 years and above -otal deaths J 100

Noti&iable )iseases )iarrheas 6neumonias =ronchitis/=ronchiolitis 1n&luen0a Measles -= ?espiratory -= meningitis -= other &orms )iseases o& the heart Malignant Neoplasms Chic8enpo; )engue @ever Malaria Cholera -yphoid and 6aratyphoid &ever Biral "epatitis ?abies )iphtheria -etanus Neonatorum

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-etanus 6oliomyelitis !hooping Cough <onorrhea >yphilis A1)>/"1B in&ection Leprosy >chistosomiasis @ilariasis Meningitis/4ncephalitis Leptospirosis @ood/chemical 6oisoning Meningococcemia "ypertension

Ser i'es %ro ided to Fami!y and Community C#N pro ides mu!tip!e dire't and indire't '!ient ser i'es8 1% )irect client services: "ealth teaching "ands on bedside care "ealth ris8 appraisal Counseling "ealth planning Clinic services

3% 1ndirect client services: ?ecord 8eeping Coordinating 'ith agencies

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>upervising health center sta&& ?e&erences:

1% Community #rgani0ing 6articipatory Action ?esearch &or Community "ealth )evelopment by: >r% Carmen 4% Rimene0% 3% Nursing 6ractice in the Community by: Araceli >% Maglaya 5% Community "ealth Nursing >ervices in )epartment o& "ealth 6hilippines by: Rean 6% ?eyala% et%al% 7% Community 4;posure Community "ealth Management Manual &or Nursing >tudents by: Lydia C% Biet% 9% 1ntegrated Management o& Childhood 1llness ?esource Manual and !or8boo8