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5. Identify 10 community problems presented in the film and categorize them using the Typology of Community Problems.

Compute the score of each problem and indicate the reason for rating each criterion. 1. Geographical characteristics of the community and housing condition that contributes to vector problems and other diseases (e.g TB, scabies) CRITERIA Nature of the problem -Health status -Health resources -Health related Magnitude of the Problem -75%-100% affected -50%-74% affected -25%-49% affected -<25% affected Modifiability of the problem -High -Moderate -Low -Non-modifiable 3 2 1 WEIGHT REASON The nature of the problem is health related since the geographical characteristic of the community places the residents at risk of having dengue, malaria, etc. Also, noting the housing of the resident places them more at risk to health hazards. Most of the residents are affected since a majority lives in that certain place and most has the same type of housing conditions.

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Due to low income by the community, it has low modifiability since it needs a large amount of money to fix or renovate their houses. Moreover, one cannot simply ask the residents to migrate to a place which is safer and accessible to health resources needed. There is high preventive potential to vector problems by teaching the residents ways to prevent such diseases and any health hazards especially if the residents are willing to cooperate.

Preventive Potential -High -Moderate -Low Social Concern -Urgent community concern;expressed readiness -Recognized as problem but not needing urgent attention -Not a community concern 2. Low economic level/income CRITERIA Nature of the problem -Health status -Health resources -Health related

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As observed in the film, they recognized it as a problem but they are contented on what their community has.

WEIGHT 3 2 1

REASON Having a low income status is health related since residents are not able to provide their family the proper kind and amount of food, clean water, appropriate clothing and a nice house to live in and health expenditures when needed.

Magnitude of the Problem -75%-100% affected -50%-74% affected -25%-49% affected -<25% affected Modifiability of the problem -High -Moderate -Low -Non-modifiable Preventive Potential -High -Moderate -Low Social Concern -Urgent community concern;expressed readiness -Recognized as problem but not needing urgent attention -Not a community concern 3. Low educational level CRITERIA Nature of the problem -Health status -Health resources -Health related Magnitude of the Problem -75%-100% affected -50%-74% affected -25%-49% affected -<25% affected Modifiability of the problem -High -Moderate -Low -Non-modifiable Preventive Potential -High -Moderate -Low

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Since the community belongs to the poorest community in the Philippines, everyone is deeply affected by it.

There is moderate modifiability of the problem since it needs government attention and financial assistance to provide the residents a stable job and to uplift the community. There is moderate preventive potential if we could teach these community ways in where they could gain income. The community seems not consider this as a community concern, they are contended on the life they have, even contented of not seeking medical help when needed.

WEIGHT 3 2 1

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REASON Having low educational level can affect the perception of the community when it comes to health matters. Their low educational level could affect on how they understand health teachings being given to them Most of the community is affected since the community itself lacks on infrastructures and manpower to provide such needs like providing a good education. It has a moderate modifiability of the problem if the local government unit is willing to provide these small community infrastructures, educational paraphernalia and teachers to teach or provide basic education the community especially the youth. There is moderate preventive potential if the local government unit responds immediately to these problems which the community faces and if the residents are willing to learn then it would not be a problem at all. The community could also organize and coordinate to invite volunteers for now to help them in providing basic education to

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Social Concern -Urgent community concern;expressed readiness -Recognized as problem but not needing urgent attention -Not a community concern 4. Inadequate nutritional intake CRITERIA Nature of the problem -Health status -Health resources -Health related

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the youth. The community seems not consider this as a community concern, they are contended on the life they have, even contented of not seeking medical help when needed.

WEIGHT 3 2 1 3

Magnitude of the Problem -75%-100% affected -50%-74% affected -25%-49% affected -<25% affected Modifiability of the problem -High -Moderate -Low -Non-modifiable Preventive Potential -High -Moderate -Low Social Concern -Urgent community concern;expressed readiness -Recognized as problem but not needing urgent attention -Not a community concern

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REASON The nature of the problem affects the health status of the residents. Lack of quantity and quality of food being taken daily could lead to malnutrition and can affect the growth and development of an individual. As seen in the film, children were deprived of nutritional requirements that the body needs that is why they suffer from mental and growth retardation. Most of the community is affected since everyone does not have a decent job to provide such basic needs, and the community is poor in itself.

There is modifiability of the problem since one can provide health teachings on proper diet and could provide the residents seeds to plant in their backyard to provide their nutritious meals. There is preventive potential of malnutrition if they are taught of the proper or balanced meal. Moreover, when they provided and taught to plant vegetables or fruits in their community to provide their nutritional needs. Not a community concern to them since they are not taught or aware on the consequences of not having a proper diet.

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5. Lack of communication network necessary for disseminating health information CRITERIA Nature of the problem -Health status -Health resources WEIGHT 3 2 REASON The nature of the problem is involved in health resources. The community lacks manpower with health care professionals and also health care

-Health related

Magnitude of the Problem -75%-100% affected -50%-74% affected -25%-49% affected -<25% affected

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Modifiability of the problem -High -Moderate -Low -Non-modifiable

3 2 1 0

Preventive Potential -High -Moderate -Low Social Concern -Urgent community concern;expressed readiness -Recognized as problem but not needing urgent attention -Not a community concern 6. 7. 8. 9. 10.

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centers and considering the distance of health centers to the community, there is lack of communication network for the residents to be informed of health care programs/health care benefits that they can avail. Most of the community is affected since, majority of them dies without even consulting a physician or visiting the health centers. As an example is the woman who suffered from TB, they lack information of the programs of the government regarding DOTS and health care institution also lack referrals. There is moderate modifiability of the problem. Since lack of manpower and health institutions is the main problem, the local government unit should find ways to assist the community when it comes to health expenditures. Meanwhile, available man power should provide time to visit and provide health teachings to this community. There is high preventive potential if available manpower is willing to provide time to visit and provide health teachings and promote awareness to this community on health programs provided by the health centers. The community perceived it as an urgent community concern and expresses readiness as seen in the film where they provide their own health centers in order to address health matters even with lack of resources.

Lack of transportation system and road networks necessary to access health care services. Lack and Inaccessible health institutions Lack of sources of health funding, health budget and expenditures Lack in the distribution of health manpower Low educational level

6. What public health programs are appropriate for the 10 identified problems? What are the policies involved in the implementation of each program? Are the standards followed in the implementation of the program?

PUBLIC HEALTH PROGRAMS A. CHILD HEALTH PROGRAM 1. Infant and Young Child Feeding 2. Newborn Screening 3. Expanded Program on Immunization 4. Management of Childhood Illnesses 5. Micronutrient Supplementation 6. Dental Health 7. Early Child Development 8. Child Health Injuries The Strategic Thrusts for 2005-2010 are as follows: - Develop local capacity to deliver the whole range of essential health packages for children. Pursue the SentrongSigla initiative to ensure quality of health services at the peripheral levels and identify priority areas of health systems development. - Implement programs and projects that favor disadvantaged populations. These programs should be able to address the needs of children with disabilities, children in areas of armed conflict, street children, children among indigenous people, among others - Apply the Reaching Every Barangay (REB) strategy for immunization to reach every child - Intensify health education and information campaigns at the ground level to increase the portion of mothers practicing behaviors that promote childrens health such as breastfeeding, ensuring childs immunization, ORS for sick children, knowledge of danger signs and control of child labor and other child abuse - Enhance medical, nursing and midwifery education with cost-effective life-saving strategies such as the Integrated Management of Childhood Illness and the Basic Emergency Obstetric Care - Pursue the implementation of laws and policies for the protection of newborns, infants such as Early Child Development Act of 2000, Newborn Screening Act of 2004, EO 286 for the Bright Child Program, EO 51 or the Milk Code, the Rooming In and Breastfeeding Act, etc. B. ESSENTIAL HEALTHCARE PACKAGE FOR THE OLDER PERSONS 1. Management of illness 2. Counseling on substance abuse, sexuality and reproductive tract infections 3. Nutrition and diet counseling 4. Mental health

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Family planning and responsible sexual behavior Dental care Screening and management of lifestyle related and other degenerative diseases Screening and management of chronic debilitating and infectious disease Post-productive care

STRATEGIC THRUST for 2005-2010 -redefine the minimum health care package for older persons. - Build capacity of human health resources toward preventive, medical and supportive care for older persons -integrate into current licensing and accreditation requirements, building facilities, equipment and personnel standards appropriate to care of older persons -develop community-based and institution-based models of health care for older person - pursue the implementation of laws and policies for the protection and improvement of the quality of life and older persons such as RA 9257 or the Expanded Senior Citizens Act of 2003 C. ESENTIAL HEALTH PACKAGE FOR THE ADULT MALE AND FEMALE 1. Management of illness 2. Counseling on substance abuse, sexuality and reproductive tract infections 3. Nutrition and diet counseling 4. Mental health 5. Family planning and responsible sexual behavior 6. Dental care 7. Screening and management of lifestyle related and other degenerative diseases D. INTEGRATED COMMUNITY BASED NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL PROGRAM 1. Comprehensive Approach Focused on Primary Prevention a comprehensive long term strategy for control of NCDs must focus on primary prevention. It must include: a. Prevention of emergence of risk factors refereed to as primordial prevention b. Specific protection from NCD by removal of the risk factors or reduction in their levels 2. Community-based approach- a community based NCD prevention and control program recognizes people as the center of health and development effort. The program provides the means to respond to their needs and the basic tools for mobilizing the people. Key ingredients include: -active community participation -involvement of community leaders, committees and other community groups - Strong and support guidance from local governments and technical experts -Multi-sectorial collaboration 3. Integrated Approach- health community contributes to the socioeconomic development of the community. Improved economic and social status will enable the population to attain healthy condition.

E. COMMUNICABLE DISEASE PREVENTION CONTROL PROGRAM Tuberculosis- National Tuberculosis Control Program Key Policies A. Case finding 1. Direct sputum smear microscopy (DSSM) shall be primary diagnostic tool in NTP case finding 2. All TB symptomatic identified shall be asked to undergo DSSM for diagnosis before start of treatment, regardless of whether or not they have available X-ray results or whether or not they are suspected of having extra-pulmonary TB 3. Pulmonary TB symptomatic shall be asked to undergo other diagnostic tests, if necessary, only after they have undergone DSSM for diagnosis with three sputum specimens negative 4. Since DSSM is the primary diagnostic tool, no TB dx shall be made based on the results of Xray examinations alone. 5. Passive case finding shall be implemented in all health stations 6. Only trained medical technologists or microscopists shall perform DSSM. B. Treatment 1. Aside form clinical findings, treatment of all TB cases shall be based on a reliable diagnostic technique namely DSSM 2. Domiciliary treatment shall be the preferred mode of care. C. Patients with the following conditions shall be recommended for hospitalization: 1. Massive hemoptysis 2. Pleural effusion 3. Military TB 4. TB pneumonia 5. Those requiring surgical intervention or with complications D. All patients undergoing treatment shall be supervised (DOT) E. The national and local government units shall ensure provision of drugs to all smear positive TB cases There are two formulations of anti-TB drugs: 1. Fixed-dosed combination 2. Single drug formulation F. Quality of FDCs must be ensured. G. Treatment shall be based on recommended category of treatment regimen

F. MAJOR ENVIRONMENTAL HEALTH AND SANITATION PROGRAM a. Water supply sanitation program Policies: - Approved types of water facilities - Unapproved type of water facility - Access to safe and potable drinking water - Water quality and monitoring surveillance - Waterworks/water system and well construction

b. Proper excreta and sewage disposal program Policies: Level 1 -non-water carriage toilet facility -toilet facilities requiring small amount of water to wash the waste into the receiving space Level 2- with water carriage type with water sealed and flush type with septic tank disposal facilities Level 3 -blind drainage -conventional sewerage facilities G. SENTRONG SIGLA Guiding Principles 1. Recognition for achieving good quality shall be the main incentive in SS Certification 2. Quality improvement in an unending process, thus the certification should promote the continuing drive for ever improving quality by providing multi-tired and progressively higher quality standards 3. Focus shall be on core public health programs that have proven to be most beneficial to the people such as child health, maternal care and family planning, prevention and control of infectious diseases and promotion of health lifestyle 4. Quality improvement s a partnership that empowers all stakeholders and is based on trust and transparency 5. The DOH shall give purposive technical assistance to targeted health facilities in order to help them achieve quality improvement in their health services particularly in the undeserved and marginalized areas 6. Assessment for certification shall involve other stakeholders I order to provide objectivity and varying perspective in the process Objectives 1. To establish an efficient system of: - Providing technical and other forms of assistance - Assessing health services against established standards - Monitoring key indicators in the SS Certification process 2. To progressively raise the average quality of public health services through recognition of successful attainment of quality standards - At least 50% of health centers successfully meet revised SS phase II Basic Certification standards (level 1) - Atl east 20% of level 1 certified health centers successfully meet SS phase II specialty award (level 2) standards for all core public health program 3. To raise public health awareness of public support and demand for and client participation in SS certification of their health services facilities G. BOTIKA NG BARANGAY Objectives

1. To rationalize the distribution of common drugs and medicines among intended beneficiaries 2. To serve as mechanism for DOH to establish partnership with LGUs and Community Organizations 3. Optimize involvement of the Barangay Health Workers addressing the health need of the community