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 Provides information on patterns of disease in terms of person, place and causes characteristics * Correlational studies * Ecologic * Case Reports *Case Series *Cross-sectional surveys VS. VS Test Analytical hypothesis of disease about

Observational * Case control * Cohort

Intervention (Experimental) * Trials

Experimental With manipulation * Clinical Trials * Field Trials * Community Intervention Trials

Non-Experimental

Mere observation of study conditions * Cohort * Case Control * Proportional-Mortality Studies * Cross-sectional * Ecologic

Common Epidemiologic Studies:

Retrospective

Cross-sectional

Prospective Cohort

Steps in EPIDEMIOLOGICAL IVESTIGATION: 1. Establish fact of presence of epidemic

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

Unit 4: NATIONAL HEALTH SITUATION

I.

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

II.

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 Service Health Promotion, Preventive Care, Continuing Care for common health problems, attention to psychological and social care, referrals According to the Type of Service

Type Health Promotion illness Prevention

Example Information and Dissemination

Primary

Secondary

Surgery, Medical Diagnosis services by Specialists Treatment

and Screening

Tertiary

Advanced, specialized, diagnostic, therapeutic Rehabilitation & rehabilitative care

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

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 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 health promotion strategy

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: Feasible Acceptable, Affordable Complex Effective Safe Scope-wise

Herbal Medicine:

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

(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 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 plants as alternative for high cost

aromatic astringent tasting bitter-tasting seeds grass family

Sambong Ampalaya Niyog-niyogan Tsaang gubat Akapulko

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

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. C. Improvement of the health personnels capabilities on newborn care, midwifery thru trainings. Trainings for hilots must also be conducted. 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 Prevention of unwanted pregnancies through family planning services Prevention and management of STDs Promotion of Appropriate health practices Upgrade reporting services Mobilize political commitment and community involvement to provide Support to basic health care delivery

D. E. F. G. H.

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 Vaccine Form Dose/Containe r Conditions when exposed to heat/freezing Easily damaged by heat; not destroyed by freezing

Most - 15 C to 25 C Sensitive FREEZER to Heat

OPV

Liquid

20 dose/special bottle or 25 dose/special bottle

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 20 dose/vial Damaged by heat Damaged by heat and freezing

L I

Q U

I D

Hepa-B Least Sensitive to heat Tetanus Toxoid

Liquid 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. Transport use cold dogs Handling

II. III.

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 To compute for the vaccines I. II. III. Determine Annual Dose-doses required in a year for complete coverage AD = EP x # of doses to consider that immunization is complete Determine Wastage Allowance Wastage Dose = Annual Dose x % wastage allowance Combine complete coverage needs with wastage allowance Annual doses = annual doses (no wastage) + wastage doses with wastage Determine # of ampules or vials needed per year Amp: vials = annual doses/doses per ampule (per year) Determine 3 of ampules/vials needed per month Amp: vials = annual amp: vials/12 months (per month) pregnant women

IV. V.

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

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

ORS : 1 pack 1 L of water

Contains: glucose for Na absorption NaCI for fluid retention NaHCO3 to serve as a buffer system KCL for smooth muscle contraction Home-made Oresol: 1 L of water: or 1 glass of water 8 tsp. of sugar: 2 tsp. of sugar 1 tsp. of salt 1 pinch of salt Remember: Infant must be given - 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 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 Fresh Emotional bonding Easily established Digestible Immunity Nutritious GIT disorders are decreased

* 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

 Tuberculosis Leprosy (LCP)

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

1. National Tuberculosis Control Program (NTBCP) Tuberculosis is a highly infectious, chronic respiratory disease caused by TB Bacilli. It is one of the 10 leading causes of morbidity and mortality in the Philippines, which is also known as 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. Isoniazid

Indicated for patients who are

8 SCC Patient will be: 2 mos. on Rifampicin Isoniazid Pyrazinamide Ethambulol Streptomycin

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

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

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

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

 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 Every hospital must have a Nurse ward, where an adequately trained nutritionist were assigned (RA 422) Akbayan sa Kalusugan (ASK Project) 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 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

- 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) 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 = _________________ Ideal Body Weight Thus; a. Degree of Malnutrition = Actual Body Weight (115) ____________________ x 100% Ideal Body Weight (135) = 85-18% 1st degree Malnutrition

x 100%

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

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.

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.