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.
2.
3.
4.
5.
6.
7.

Health-illness continuum
High-level wellness
Agent-host-environment
Health belief
Evolutionary-based
Health promotion
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 MHOs 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 medsetc.

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
ones 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
Diagnosis

Problem-Oriented Community
Diagnosis

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

about the community
particular need
STEPS:

Preparatory Phase
1.
2.
3.
4.
5.
6.
7.

site selection
preparation of the community
statement of the objectives
determine the data to be collected
identify methods and instruments for data collection
finalize sampling design and methods
make a timetable

Implementation Phase

1.
2.
3.
4.
5.
6.
7.
8.

data collection
data organization/collation
data presentation
data analysis
identification of health problems
priority zation of health problems
development of a health plan
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
Swaroops 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 socioeconomic 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

Provides information on patterns of

disease in terms of person, place and
causes characteristics
* Correlational
studies
* Ecologic

Analytical
Test

hypothesis
of disease

* Case Reports

Observational

*Case Series
*Cross-sectional
surveys

* Case control
* Cohort

Experimental

VS.

about

Intervention
(Experimental)
* Trials

Non-Experimental

With manipulation

Mere observation of study conditions

* Clinical Trials
* Field Trials
* Community Intervention Trials

* Cohort
* Case Control
* Proportional-Mortality Studies
* Cross-sectional
* Ecologic

Common Epidemiologic Studies:

Retrospective

Cross-sectional

Steps in EPIDEMIOLOGICAL IVESTIGATION:

1. Establish fact of presence of epidemic

Prospective Cohort

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

I.

II.

Health Indices
Basic Health Indicators
A. Nutrition
B. Disease Patterns
Leading Causes of Morbidity
Leading Causes of Mortality
Other Indicators
A.
B.
C.
D.
E.

Infant Mortality Rate

Maternal Mortality Rate
Life Expectancy at Birth
Median Age
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 multidisciplinary.

Categories:
According to Increasing Complexity of
the Services Provided
Type

Primary

Secondary

According to the Type of Service

Service

Type

Health
Promotion,
Preventive
Care,
Continuing Care for
common
health
problems, attention to
psychological
and
social care, referrals

Health
Promotion
illness
Prevention

Surgery,
Medical Diagnosis
services by Specialists
Treatment

Example
Information
and Dissemination

and Screening

Advanced, specialized,
diagnostic, therapeutic Rehabilitation
& rehabilitative care

Tertiary

PT/OT

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
Profit oriented
Manufacturing companies
Advertising agencies
Private practitioners
Private institutions

Non-commercial
Orientation to social development, relief
and rehabilitation, community organizing
Socio-civic groups
Religious organizations/foundations

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 countrys 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 peoples 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
An eating place where
Nutritious
Complies with the following sanitation standards:
safe, environment-friendly

properly -

Prepared
Stored
Transported
foods & drinks are served.

 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
Health Promotion
and Illness
Prevention

SECONDARY LEVEL
Prevention of
Complications thru Early
Dx and Tx

TERTIARY LEVEL
Prevention of Disability,
etc.

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 SemiHealth, and other
private agencies
govt
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
Peoples 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:

Herbal Medicine:

Feasible
Acceptable, Affordable
Complex
Effective
Safe
Scope-wise

aromatic
astringent tasting
bitter-tasting
seeds
grass family

10 MEDICINAL PLANTS:
Lagundi
Olasimang-Bato
Bawang
Bayabas
Yerba-buena

Sambong
Ampalaya
Niyog-niyogan
Tsaang gubat
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
medications.
Policies:
1. The indications/uses of plants
2. The part of the plant to be used
3. Preparation of
a. Decoction
b. Poultice
c. Infusion
d. Syrup

plants as alternative for high cost

e. oils
f. ointment
g. tincture
h. Elixir

D. Support mechanism made available

TYPES OF PRIMARY HEALTH WORKERS
Village/Grassroots Health
Workers
Trained Community
E
Health worker; health
X
auxiliary
volunteer;
Traditional
Birth
Attendant
C
Initial link, 1st
H
contact of the
A
community
R
Work in liaison w/
A
the local health
C
service workers
T
Provide
E
elementary
R
curative preventive
I
health
care
S
measures
T
I
C
S

Intermediate Level
General Medical
Practitioners
Public Health Nurses
Midwives

Health Personnel of
First-Line Hospitals
Physicians with
specialty area
Nurses
Dentists

1st source of

Establish
close
professional
contact
with
the
health care
village
and
Attend to health
intermediate
level
problems beyond
health workers to
the competence of
promote the continuity
village
health
of acre from hospital
workers
to community to home
Provide support to
Provide
back-up
the frontline health
health services for
workers in terms of
cases
requiring
supervision,
hospital or diagnostic
training,
referral
facilities not available
services
and
in health care
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 Mothers 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. Benedicts 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 TBAs 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 personnels 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. womans 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 months: First doses of DPT, Hep B, OPV
2 months: Second doses of DPT, Hep B, OPV
3 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 (Kochs 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
Temperature

Most
- 15 C to 25 C
Sensitive FREEZER
to Heat

Vaccine Form

OPV

Liquid

Dose/Containe
r

Conditions
when
exposed to
heat/freezing

20 dose/special
bottle or 25
dose/special
bottle

Easily
damaged by
heat;
not
destroyed by
freezing

Measles Freez 10 dose/vial

e dried
BODY OF THE
REFRIGERATOR
+ 2C TO + 18 C

BCG

Freez 20 dose/amp
e dried 50 dose/amp

Destroyed by
heat,
sunlight; not
destroyed by
freezing

Destroyed by
freezing; heat

I
P

20 dose/vial

U
T

Damaged by
heat
Damaged by
heat
and
freezing

I
D

Least
Sensitive
to heat

Hepa-B

Liquid

Tetanus
Toxoid

Liquid

20 dose/vial

Damaged by
heat
or
freezing

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

III.

use cold dogs

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 Filipinos 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
Project (PEP)

Knock-out Polio
(KOP)

Zero-Polio Philippines
(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 Fs
Fluids
Frequent Feeding
Oresol
Continue
Rehydration
breastfeeding
Therapy
With children over
Encourage/ensure
6 mos.:
intake of any fruit
Cereals/ starchy
juices, am lugaw
foods mixed with
homemade soup
meat or fish and
vegetables
Mashed banana
or any fresh fruit
Feed the child at
least 6x/day
After diarrhea
episode, feed 1
extra meal/day for
2 weeks

ORS :
1 pack
1 L of water

Fast Referral
If child doesnt get
better in 3 days, or if
danger signs develop
refer patient
Danger Signs:
Fever
Sunken fontanel
Sunken eyeball
Frequent watery
stool
Repeated vomiting
Blood in stool
Poor intake of
meals
Weakness

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 - cup every after LBM
Child must be given - 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
Reduced allergic reaction
Economical
Always available
Safe/maintains the stool soft
Temperature always right

Fresh
Emotional bonding
Easily established
Digestible
Immunity
Nutritious
GIT disorders are decreased

Difference of breast milk from formula milk

BREASTMILK
CHO
CHON (LACTALBUMIN)
FATS
Linoleic acid content (3x)
MINERALS

VS
>
<
=
>
<

FORMULA*
CHO
CHON (CASEIN)
FATS
Linoleic acid content
MINERALS

* the high CHON and mineral content of cows milk may overwhelm the
newborns 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
IM gentamycin
IM chloramphenicol

should be regularly available in

DOH facilities

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
Communicable

Vector-borne

Diseases
Malaria (MCP)
Schistosomiasis (SCP)
Filariasis (FCP)
H-Fever (Dengue)

Tuberculosis
Leprosy (LCP)

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 Kochs 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:
2 mos. on

Rifampicin
Isoniazid
Pyrazinamide

Rifampicin
+ 4 mos.

Indicated for patients who are

Isoniazid

(+) sputum smear

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

8 SCC
Patient will be:
2 mos. on

Rifampicin
Isoniazid
Pyrazinamide
Ethambulol
Streptomycin

Rifampicin
+ 4 mos. Isoniazid
Ethabutol

+ 5 mos

Rifampicin
Isoniazid
Ethambulol

Indicated for those with relapse

- failures
- others
4 SCC
Patient will be:
2 mos. on

Rifampicin
Isoniazid
Pyrazinamide

Rifampicin
+ 2 mos.
Isoniazid

Indicated for PTB minimal

(-) sputum smear
3 Phases of Treating a PTB patient:
1 - Intensive Phase

2 mos. on

Rifampicin
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 patients 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
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.

H-FEVER (DENGUE)

FILARIASIS CONTROL
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:
Case Fx: Surveillance of
the disease
Health
Education

encourage use of rubber

boots for protection
Environmental sanitation
proper disposal of feces
Snail Eradication use of
moluscides

Activities:
Case Fx
Early reporting of any
known case or outbreak

Activities:
Case fx
Early reporting of any
known case of
outbreak

 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 breastexamination
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 DOHs 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
Force Assistance
Program (TFAP)
Provision of food rations
of bulgur wheat and
green peas.
Target population:
Preschoolers
Pregnant women
Lactating mothers

Nutrition Rehabilitation
Ward

Akbayan sa Kalusugan
(ASK Project)

Every hospital must have

a Nurse ward, where an
adequately
trained
nutritionist were assigned
(RA 422)

Aimed to provide rice and

corn
soya
blend
supplemented with local
foods.
Target population:
6 mos. 2 yrs.
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
Fortified Vitamin Rice

- a free enrichment program aimed to

prevent deficiencies in vitamin A
(blindness); iron (Anemia); Iodine
(goiter, mental retardation and delayed
development)
(1 cavan of rice + fistful processed,
binilid
enriched
with
essential
micronutrients)

Health for More in 94

Buwan ng Kabataan, Pag-asa ng
Bayan
National Focus: National Micronutrient
Day or Araw ng Sangkap Pinoy
- aimed to distribute vitamin A
supplements, iodized oil for mothers
and seedlings of plants rich in Fe and
other minerals

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
+ 6
105 110 lbs.
-6

Rule
For every increment of an
inch above 5 feet
For a height of 5 feet
For every decrement of
an inch below 5 feet

Female
+5
100 105 lbs.
-5

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;
a. Degree of Malnutrition

Actual Body Weight (115)

____________________ x 100%
Ideal Body Weight (135)

85-18%
1st degree Malnutrition

Degrees of Malnutrition
110% and above
90 109 %
75 89 %

obese
normal
1st degree

60 75 %
60% and below

2nd
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
governments 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
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

Health for More in 94

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 MDs prescription

4. tailored drug procurement

Legal Milestones
Generics Act of 1998
RA 6675
Formally proclaims the state policy of
promoting the use of generic
terminology
in
the
importation,
manufacture, distribution, marketing,
promotion and advertising, labeling,
prescribing and dispensing of drugs.
Reinforces the NDP with regards to
the assurance of high-quality and
rational drug use

Dangerous Drugs Act

RA 6425
The
safe,
administration
and
transportation of prohibited drugs is
punishable by law
2 Types of Drugs
Prohibited
Regulated
LSD
Benzodazepines
Eucaine
Barbiturates
Cocaine/codeine
Opiates

Environmental Sanitation
Environmental Sanitation is defined as the study of all factors in mans
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
Point Source
A protected well or a
developed spring with an
outlet but without a
distribution system for
rural areas where houses

Level II
Level III
Communal faucet system Waterworks system or
or stand posts
individual house
connections
A system composed of a A system with a source, a
source, a reservoir, a reservoir,
a
piped
piped distribution network distributor network and
and communal faucets, household taps that is
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
Non-water carriage toilet
facility:
- Pit latrines
- Reed Odorless Earth
Closet
- Bored-hole
- Compost
- Ventilated improved pit

Level 2
On site toilet facilities of
the water carriage type
with water sealed and
flushed type with septic
vault/tank disposal
facilities.

Level 3
Water carriage types of
toilet facilities connected
to septic tanks an/or to
sewerage system to
treatment plant.

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

Open burning
Animal feeding
Composting
Grinding and disposal sewer

Community
Sanitary landfill or controlled tipping
Excavation of soil deposition of
refuse and compacting with a solid
cover of 2 feet
Incineration

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.