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Community Health Nursing

Community:
Group of people with common characteristic or interests living together with in a
territory or geographical boundary
A social organization that is territorially localized and through which its members
satisfy most of their daily needs and deal with most of their common problems
Health - state of complete physical, mental, and social well-being, not merely the absence of
disease or infirmity
Community Health part of paramedical or medical intervention/ approach which is
concerned on the health of the whole or population
Public Health the science and art of preventing disease, prolonging the efficiency thru
organized community effort to:
1. Sanitation of the environment
2. Control of communicable diseases
3. Education of the individual in personal hygiene
4. Organization of medical and nursing service for the early diagnosis and
preventive treatment of disease
5. Development of social machinery to ensure everyone a standard of living,
adequate for the maintenance of health to enable every citizen to realize
his birth right of health and longevity.
- Dr. C. E. Winslow
Priorities in Public Health:
1. Survival of human species
2. Prevention of conditions which lead to the destruction of retardation of human function
and potential in the early years of life
3. Achievement of the human potential
4. Prevention of the loss of productivity of young adults and those in the middle period of
life
5. Improvement of quality of life, especially in later years
Community Health Nursing
Learned practice discipline with the ultimate goal of contributing, as individual and in
collaborative with others, to the promotion of the clients optimum level of functioning
through teaching and delivery of care
Public Health Nursing (WHO Expert Committee on Nursing)
A special field of nursing that combines the skills of nursing, public health and some
phases of social assistance for the promotion o health, the improvement of conditions
in the social and physical environment, rehabilitation, prevention of illness and
disability.
Principles
1. CHN services is based on recognized needs and problems of communities, families,
groups and individuals.
2. The Community Health Nurse must understood fully the objectives and policies of the
agency he/she represents
3. In CHN, the family is the unit of service.
4. CHN must be available to all regardless of race, creed, and socio-economic status
5. Health teaching is a primary responsibility of the Community Health Nurse.
6. The community health nurse works as a member of the health team.

7. There must be a provision for periodic evaluation of community health nursing


services
8. Opportunities for continuation staff execution program nurses must be provided by
the community health nursing agency. The community health nurse also has
responsibility for his/her own professional growth.
9. The community health nurse utilizes already existing active organized groups in the
community.
10. There must be provision for educative supervision in CHN.
11. The community health nurse make use of available community health resources
12. There should be accurate recording and reporting in CHN
13. The CHN does not provide material relief but refers the patient and family to
appropriate community resources for necessary financial, social assistance.

Qualifications of a Public Health Nurse:


Professional Qualifications: BSN, RN
Personal Qualifications
1. Good physical and mental health
2. Interest and willingness to work in the community
3. Capacity and ability to:
Relate practice with ongoing community health activities
Work cooperatively with other disciplines and community members
Take actions needed to improve self and service
Analyze combination of factors that influence health
Apply nursing process in meeting health and nursing needs of the community
Mobilize resources in the community
Leadership potential
Resourcefulness and creativity
Honesty and integrity
Active membership to professional working organizations
Functions of the Public Health Nurse:
Management Function
nurse organizes the nursing services of the local health agency
involves preparation of the nursing service plan as well as the overall municipal health
plan
involves program management: the delivery of package services provided by the
program to the target clientele
Supervisory Function
generally supervises midwives and auxiliary health workers
formulates supervisory plan and conducts supervisory visits for implementation
Nursing Care Function
the inherent function of a nurse
makes use of knowledge and skills in nursing process
home visits are visible manifestations of her caring function
involves referrals to appropriate levels of care when indicated

Collaborating and Coordinating Function


bringing activities and group of activities systematically into
proper relation or harmony with each other
establish linkages and collaborative relationships with other agencies and health
professionals
Health Promotion and Education Function
health teachings and health information campaigns
involves understanding of the multidimensional level of health essential in planning
and promoting interventions for communities
educator: involves providing clients with information that allows them to make
healthier choices and practices
Training Function
initiates formulation of staff development and training program for midwives and
other auxiliary health worker
Research Function
participates in conducting research and utilization of research findings in practice
disease surveillance: continuous collection and analysis of data cases and deaths
Primary Health Care
Essential Health made universally accessible to individuals and families in the community
by means acceptable to them thru their full participation and at cost that the community
and country can afford at every stage of development.
MissionTo strengthen the health care system by increase opportunities and
supporting the conditions wherein people will manage their own health
Alma Ata Conference First conference on Primary Health Care was held in Alma Ata,
USSR
Legal Basis: Letter of Instruction 949 signed on October 19, 1979 by Pres. Marcos a
year after Alma Ata Conference
PHC was declared in the ALMA ATA CONFERECE in September 6-12, 1978 as a strategy
to community health development.
It is a strategy aimed to provide essential health care that is (concept): (CAPAS)
Community-based
Accessible
Part and parcel of the total socio-economic development effort of the nation
Acceptable
Sustainable at an affordable cost
Department of Health (DOH)
Legal Framework:
R.A. 7160 (1991) Local Government Code
-Provided for the decentralization of the entire government.
-All structures, personnel, and budgetary allocations from the provincial health level
down to the barangays were devolved to the local government units (LGUs) to
facilitate health service delivery
-LGUs are now responsible for the delivery of basic health services (implementation
function)
-DOH (governance function)

E.O. 102 (1999)


The Department of Health is the national authority on health, providing technical and other
resource assistance to local government units, peoples organization, and other members of
the civic society in effectively implementing programs, projects, and services that will
(a) promote the health and well-being of every Filipino,
(b) prevent and control diseases among population at risks,
(c) protect individuals, families, and communities exposed to hazards and risks that
could affect their health, and
(d)treat, manage, and rehabilitate individuals affected by diseases and disability
Roles and Functions: DOH EO 102
1. Leadership in Health
-national policy and regulatory institution where LGUs and NGOs will base their direction for
health
2.Enabler and Capacity Builder
-innovates new strategies in health to improve effectiveness of health programs
- ensures highest achievable standards of quality health care
3. Administrator of Specific Services
-manage selected national health facilities that shall serve as national referral centers
-administers health emergency response services
Vision: Health for all Filipinos
DOH is the leader, staunch advocate, and model in promoting Health for All in the
Philippines
Mission: Ensure accessibility and quality health care to improve the quality of life of Filipinos,
especially the poor.
DOH shall guarantee equitable, sustainable, and quality health for all Filipinos, especially the
poor, and shall lead the quest in excellence for health
National Objectives for Health (NOH) 2005 to 2010
Roadmap (plan or guide) that intensifies and harmonizes the efforts of all
stakeholders in health and health-related sectors

Objectives:
Improve the general health status of the population
Reduce morbidity, mortality, disability and complications from diseases and
disorders
Eliminate the certain diseases as public health problems
a. Schistosomiasis
b. Malaria
c. Filariasis
d. Leprosy
e. Rabies
f. Vaccine- preventable diseases: measles, tetanus, diphtheria, and pertussis
g. Vitamin A deficiency
h. Iodine deficiency disorders
Promote healthy lifestyle and environmental health
Protect vulnerable groups with special health and nutrition needs
Strengthen national and local health systems to ensure better health services
delivery

Pursue public health and hospital reforms


Reduce cost and ensure the quality of essential drugs
Institute health regulatory reforms to ensure quality and safety of health goods and
services
Strengthen governance and management support systems
Institute safety nets for the vulnerable and marginalized groups
Expand the coverage of social health insurance
Mobilize more resources for health
Improve efficiency in the allocation, production and utilization of resources for health
Goal: Health Sector Reform Agenda (HSRA) - set in National Objectives for Health 1999-2004
Health Sector Reform Agenda (HSRA) overriding goal of the DOH
Conceptualized because although there has been a significant improvement in the health
status of Filipinos for the fast 50 years some the following conditions were still seen in the
population:
slowing down in the reduction of Infant Mortality Rare (IMR)
persistence of large variations in health status across population groups
high burden from infectious diseases
rising burden from chronic and degenerative diseases
unattended emerging health risks
burden of disease heaviest among the poor
Support mechanisms of HSRA:
Sound organizational development
Strong Policies, Systems, and procedures
Capable Human Resources
Adequate Financial Resources
Framework for Implementation: FOURmula One for Health
Four Elements (F1 for Health)
Health financing investment
Health regulationensure quality and affordability of health goods
Health Service Delivery improve and ensure the accessibility and availability of
basic and essential care
Good governance enhance health system performance at national and local levels
Goals (F1)
Better health Outcomes
More responsive health systems
Equitable health care financing
Community development organized effort of the people to improve the conditions of
community life and the capacity of the people for participation, self-direction and integrated
efforts in community affairs. It advocates the principle of self-help and the voluntary
participation and cooperation of people of the community, but usually couples them with
technical assistance for the government or voluntary organizations.
Community development rests upon certain assumptions:
1. Worth and Dignity of the individual are the basic values in a democratic society.
(rooted in human development)
2. Everyone has something to contribute to the life of the community (in terms of
talents and skills)
3. People have the ability to learn and grow.
4. Provides opportunity

Characteristics of Community Development:


1. Concerned with all people of the community, rather than just a particular group or
segment of the population.
2. Concerned with the whole of community life (total needs of the community)
3. Concerned about bringing about social change in the community
4. Concerned with finding solutions to social problems and conflicts
5. Based on the philosophy of self-help and participation by as many members of the
community as possible
6. Usually involves technical assistance for the government or voluntary private
organizations, whether domestic or foreign
7. Essentially interdisciplinary. It implies integrated attempts to make available
professional skills and resources for the service of the communitys various
specialties
8. Concerned with both task goals and process goals
9. Involves educational process. Always concerned with teaching and learning from the
people
10. Continues over a substation period of time. It is not an ad hoc or crash program
rather it is a process
11. Should be based on felt needs and desires, as well as the aspirations of the people in
the community
12. Open to any community resident who wishes to participate (direct participation)
Community Organization
- a process by which people, health services and agencies of the community are
brought together to:
learn about the common problems
identify these problems as their own
plan the kind of action needed to solve these problems
act on this basis
5 Stages:
1. Community Analysis/ Community Diagnosis/ Community Needs Assessment/ Health
Education Planning/ Mapping
- process of assessing and defining needs, opportunities and resources involved initiating
community health action program
2.
3.
4.
5.

Design and Initiation


Implementation- put design plans into action
Program Maintenance- Consolidation
Dissemination- Reassessment

Definitions of COPAR:
A social development approach that aims to transform the apathetic, individualistic
and voiceless poor into dynamic, participatory and politically responsive community.
A collective, participatory, transformative, liberative, sustained and systematic
process of building peoples organizations by mobilizing and enhancing the
capabilities and resources of the people for the resolution of their issues and
concerns towards effecting change in their existing oppressive and exploitative
conditions (1994 National Rural Conference)
A process by which a community identifies its needs and objectives, develops
confidence to take action in respect to them and in doing so, extends and develops
cooperative and collaborative attitudes and practices in the community (Ross 1967)

The process and structure through which members of a community are/or become
organized for participation in health care and community development activities
Principles of COPAR:
1. People, especially the most oppressed, exploited and deprived sectors are open to
change, have the capacity to change and are able to bring about change.
2. COPAR should be based on the interest of the poorest sectors of society
3. COPAR should lead to a self-reliant community and society.
COPAR Process:
A progressive cycle of action-reflection action which begins with small, local and
concrete issues identified by the people and the evaluation and the reflection of and
on the action taken by them.
Consciousness through experimental learning central to the COPAR process because
it places emphasis on learning that emerges from concrete action and which enriches
succeeding action.
COPAR is participatory and mass-based because it is primarily directed towards and
biased in favor of the poor, the powerless and oppressed.
COPAR is group-centered and not leader-oriented. Leaders are identified, emerge and
are tested through action rather than appointed or selected by some external force or
entity.
Phases of COPAR
Pre-Entry Phase
The initial phase of the organizing process where the community / organizer looks for
communities to serve / help.
It is considered to be the simplest phase in terms of actual outputs, activities and
strategies and time spent for it.
Designing a plan for community development including all its activities and strategies
for care / development
Designing criteria for the selection for the site.
Actual Selecting the site for community cares
Preparation of the Institution
o Train faculty and students in COPAR.
o Formulate plans for institutionalizing COPAR.
o Revise/enrich curriculum and immersion program.
o Coordinate participants of other departments.
Site Selection
o Initial networking with local government.
o Conduct preliminary special investigation.
o Make long/short list of potential communities.
o Do ocular survey of listed communities.
Criteria for Initial Site Selection
o Must have a population of 100-200 families.
o Economically depressed.
o No strong resistance from the community.
o No serious peace and order problem.
o No similar group or organization holding the same program.
Identifying Potential Municipalities
o Make long/short list.
Identifying Potential Barangay

o Do the same process as in selecting municipality.


o Consult key informants and residents.
o Coordinate with local government and NGOs for future activities.
Choosing Final Barangay
o Conduct informal interviews with community residents and key informants.
o Determine the need of the program in the community.
o Take note of political development.
o Develop community profiles for secondary data.
o Develop survey tools.
o Pay courtesy call to community leaders.
o Choose foster families based on guidelines.
Identifying Host Family
o House is strategically located in the community.
o Should not belong to the rich segment.
o Respected by both formal and informal leaders.
o Neighbors are not hesitant to enter the house.
o No member of the host family should be moving out in the community.
2. Entry Phase - sometimes called the social preparation phase. Is crucial in determining
which strategies for organizing would suit the chosen community. Success of the activities
depend on how much the community organizers has integrated with the community.
Guidelines for Entry
o Recognize the role of local authorities by paying them visits to inform their
presence and activities.
o Her appearance, speech, behavior and lifestyle should be in keeping with
those of the community residents without disregard of their being role model.
o Avoid raising the consciousness of the community residents; adopt a low-key
profile.
Activities in the Entry Phase
o Integration - establishing rapport with the people in continuing effort to imbibe
community life.
o Deepening social investigation/community study
Core Group Formation
3. Community Study/diagnosis Phase (Research Phase)
Selection on the research team
Training on Data Collection methods and techniques; capability-building (includes
development of data collection tools)
Planning for the actual gathering of data
Data-gathering
Training on data validation (includes tabulation and preliminary analysis of data)
Community validation
Presentation of the community study / diagnosis and recommendations
Prioritization of community needs / problems for action
4. Organization-building Phase (Community Organization and Capability Building Phase)
Entails the formation of more formal structure and the inclusion of more formal procedure of
planning, implementing, and evaluating community-wise activities. It is at this phase where
the organized leaders or groups are being given training (formal, informal, OJT) to develop
their style in managing their own concerns/programs.
Key Activities
o Community Health Organization (CHO)

o
o
o

Research Team Committee


Planning Committee
Formation of by-laws by the CHO

5. Community Action Phase


Organization and training of community health workers
Setting up of linkages/network referral systems
PIME of health services/intervention schemes and community development projects
Initial identification and implementation of resource mobilization schemes
6. Sustenance and Strengthening Phase
Occurs when the community organization has already been established and the community
members are already actively participating in community-wide undertakings. At this point,
the different committees setups in the organization-building phase are already expected to
be functioning by way of planning, implementing and evaluating their own programs, with
the overall guidance from the community-wide organization.
Key Activities:
o Training of CHO for monitoring and implementing of community health
program.
o Identification of secondary leaders.
o Linkaging and networking.
o Conduct of mobilization on health and development concerns.
o Implementation of livelihood projects.

(Conceptual) Framework of Primary Health Care Peoples Empowerment and Partnership


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 and Non-communicable Diseases/Conditions
Supply and Proper Use of Essential Drugs and Herbal Medicines
Dental Health Promotion
Access to and use of Hospitals as Centers of wellness
Mental Health Promotion
PILLARS or CORNERSTONES of Primary Health Care:
1. Multi-sectoral approach
2. Support mechanism made available
3. Community Participation
4. Appropriate Technology
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.
WHO Principles of Health Promotion

Involves population as a whole in context of everyday life


Directed towards action on the determinants or cause of health
Combines diverse, but complementary approaches: communication, education,
legislation, fiscal development, spontaneous local activities against health hazards
Aims particularly at effective and concrete public participation
Societal and political venture-not a medical service, although health professionals have
an important role in advocating and enabling health promotion
Types of Primary Health Care Workers:
1. Village or Grassroot Workers
trained community health workers
health auxiliary volunteer
traditional birth attendant
healer
hilots
barangay health workers
2. Intermediate level health workers
general medical practitioner
public health nurse
rural sanitary inspectors
midwife
community health nurses
3. Health personnel of First Line Hospital
Physician with specialty area
Nurses
Dentists
Med tech
Nutritionists
NATIONAL TUBERCULOSIS CONTROL PROGRAM (NTCP)
Tuberculosis (TB) is one of the major public health problems in the country. It is the sixth
leading cause of morbidity with a rate of 141.4/100,000 population.
Vision: A country where TB is no longer a public health problem
Mission: Ensure that TB DOTS services are available, accessible, and affordable to the
communities in collaboration with the LGU
Goal: Reduce the prevalence and mortality from TB by half by the year 2015
Targets: Cure at least 85 % of the sputum smear positive TB patients
Detect at least 70 % of the estimated new sputum smear positive TB case
Objectives:
A. Improvement of access to quality of services
B. Enhancement of stake holders health seeking behavior
C. Sustainability of support for TB control activities
D. Strengthening management of TB control services at all levels
Objective A:
Strategies:
1. Enhance quality of TB diagnosis
2. Ensure TB patients treatment compliance

3. Ensure public and private health care providers adherence to the implementation of the
national standard of care
4. Improve access to services thru innovative service delivery mechanisms for patients
living in challenging areas
Objective B:
Strategies:
1. Develop effective, appropriate and culturally- responsive IEC materials
2. Organize barangay advocacy groups
Objective C:
Strategies:
1. Facilitate implementation of TB DOTS Center certification and accreditation
2. Build TB coalitions among sectors
3. Advocate input from LGU
4. Mobilize resources to address program limitation
Objectives D:
Strategies:
1. Enhance managerial capability of all NTP program managers
2. Establish efficient data management system for public and private sectors
3. Implement a standardized recording and reporting system
4. Conduct regular monitoring and evaluation at all levels
5. Advocate political support thru effective local governance
Case Finding
Direct sputum microscopy for identified TB symptomatics
X-ray exam for 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
1. All TB cases must be treated for free, on ambulatory and domicillary (home basis,
except those with acute complications and emergencies
2. All sputum positive and cavitary shall be given priority
TB Network. It is the official communication handle of the National Tuberculosis Control
Program or NTP that will stand for DOHs re-energized fight against TB.
1.
It is a product of DOHs collaboration with the LGUs, PhilCAT, and Philhealth.
2.
It is a special group dedicated to help/ take care of TB symptomatics and TB
patients.
3.
Initially, it comprises regular health workers in the RHUs, MHOs and PHOs.
4.
Eventually, it will include everyone in the community who wish to help in the
administration and financing of D.O.T.S.; family and relatives of TB symptomatics /
patients, church, church organizations, civic organizations, NGOs, schools,
companies/corporations.
D.O.T.S
D.O.T.S. stands for Directly-Observed Treatment Short-course. It is a comprehensive strategy
endorsed by the World Health Organization (WHO) and International Union Against
Tuberculosis and Lung Diseases (IUATLD) to detect and cure TB patients. Tutok
Gamutan

According to the WHO Report on the TB Epidemic, 1997:


DOTS cure TB patients and it can produce cure rates as high as 95% even in the
poorest countries.
DOTS prevent new infections among children and adults.
DOTS can stop resistance to anti-TB drugs.
DOTS is cost-effective.
How can we avail of D.O.T.S. Services?
DOTS services are available in the rural health units, city health centers and
government hospitals around the country. Currently, there are also private facilities
that are offering DOTS services to their clients.
LEPROSY CONTROL PROGRAM
Objectives of the Program:
1. Provide MDT to all leprosy cases within 3 years and complete the treatment of
90% of all cases out of MDT within the prescribed period
2. Identify all correctable deformities and institutions of appropriate intervention
3. Reduce the stigma attached to the disease thru IEC
4. Formulate research proposals on topics associated with leprosy
Management/ Treatment
Ambulatory chemotherapy thru the use of Multi-Drug therapy
Domiciliary treatment as embodied in R.A. 4073 which advocates home treatment
LOCALLY ENDEMIC DISEASE CONTROL & PREVENTION
Malaria Control Program
Major Strategies of the Program
Vector Control
Treatment of mosquito nets with insecticides
House Spraying
Stream seeding
Stream clearing
Cutting of the vegetation overhanging along stream banks to expose the breeding
stream to sunlight
Wearing of clothing that covers arms and legs in the evening
Avoid outdoor night activities: 9 pm to 3 am
Zooprophylaxis
- typing of domestic animals like the carabao, cow near human dwellings to deviate
mosquito bites from man to these animals
Community Action Campaign
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, the continuous until 4
6 weeks after leaving the area
This may be done thru:

Clinical
signs and symptoms

Microscopic
- 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 cases
Insecticide-treatment of mosquito nets
Medical management:
1. Chloroquine Phosphate
2. Quinine Sulfate
3. Quinine Hydrochloride
4. Sulfadoxine/ Sulfalene
5. Tetracycline Hydrochloride
6. Quinidine Sulfate
7. Quinidine Glucolate
EXPANDED PROGRAM OF IMMUNIZATION
Goal: morbidity and mortality reduction of immunizable diseases
Schedule:
1 months: First doses of DPT, OPV
2 months: Second doses of DPT, OPV
3 months: Third doses of DPT, OPV
Tetanus Toxiod
First Pregnancy: TT1 5th to 6th month 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 immunity)
ADMINISTRATION OF VACCINES
BCG: (infants) 0.05 ml intradermal; (school entrants) 0.10 ml intradermal
DPT:
0.5 ml intramuscular
Pentavaccine: 0.5 ml, intramuscular
Hep B: 0.5 ml intramuscular
OPV:
2 drops per orem
Measles: 0.5 ml subcutaneous
Rotavirus: 1.5 ml PO
Tetanus Toxoid: 0.5 ml intramuscular
COLD CHAIN Logistics
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.
Storage
Storage of vaccine should not exceed:
6 mos. @ the Regional Level
3 mos. @ the Provincial 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:
1. Type

2. Expiration date
3. Duration of Storage
4. Number of times they have been brought out to the field
The vaccine stored the LONGEST AND THOSE THAT WILL EXPIRE FIRST should be distributed
or used 1st

Storage
Vaccine
Temperatur
e
Most Sensitive -25C to
to Heat
-15C
FREEZER

Form

Dose/ ContainerConditions when


exposed to HEAT/
FREEZING

OPV

Liquid

Measles

Freeze
dried

20 dose/
Easily damaged by heat:
special
not destroyed by
bottle or
freezing
25 dose/special
bottle
10 dose/vial

BODY OF THE BCG


REFREGERATO
R
+ 2C TO
DPT
+ 18C

Freeze
dried

20 dose/amp
50 dose/amp

LIQUID

20 dose/vial

Destroyed by heat,
sunlight; not
destroyed by
freezing
Destroyed by freezing
Damaged by heat and
freezing

Least Sensitive
to heat

Hepa-B

Liqiud

20 dose/vial

Damaged by heat or
freezing

Liquid
Tetanus
Toxiod

TARGET SETTING
- involves the calculation of the 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.
REPRODUCTIVE Health
Is the exercise of reproductive right with responsibility
Safe pregnancy and delivery
Protection from unwanted pregnancy
Protection from harmful reproductive practices and violence
Assures access to information on sexuality to achieve sexual enjoyment

Vision: RH practice as a way of life for every man and woman throughout life
Factors/Determinants of Reproductive Health
Socio-economic conditions
Education
Employment
Poverty
Nutrition
Living Conditions. Environment
Family environment
Status of Women
Social and Gender Issues
Biological, cultural and Psycho-Social Factors
Adolescent Health Program
Adolescent
- Period of life between 10 and 30 years of age (WHO)
Youth
- who are between 15 and 24 years old
Young People
- refers to both age group; 10-24 years old
Accidents and injuries - common cause of death among young people
Strategic thrust for 2005- 2010:

Adolescent friendly health services and adolescent friendly environments

Organize and build the capability of young people to promote healthy


lifestyles

Continue fertility awareness activities

Health care package for the Adolescent and Youth:

Management of illness

Counselling on substance abuse, sexuality and reproductive tract infections

Nutrition and diet counselling

Mental Health

Family Planning and responsible sexual behavior

Dental care
Adult Men
Strategic thrust for 2005-2010:
1. Improve the over all participation of men in the heaklt5h care system
2. Develop male focused information system and strategic communication plans
3. Develop and implement a health package for the adults
4. Improve the health seeking behavior of the Filipino adult through health education
5. Intensify the implementations of policies and laws that protect and improve the
quality life of adults
6. Essential Health Care package for the Adult male and Female
7. Management of illness
8. Counselling o sexual abuse, sexuality and reproductive tract infection
9. Nutrition and diet counseling
10. Mental health
11. Family planning and responsible sexual behavior

12. Dental care


13. Screening and management of lifestyle related and other degenerative diseases
Adult Women
1. Cardiovascular disease- leading cause of death among adult women
2. Malignant neoplasm- 2nd leading cause of death among adult women
Older Persons
Non communicable or degenerative diseases
- leading cause of mortality in this age group
Goal: Reduce morbidity and mortality of older persons and improve their quality of life
Strategic thrusts for 2005-2010:
3. Redefine the health care package for older persons
4. Build the capacity of human health resources towards the preventive, medical,
and supportive care
5. Integrate into current licensing and accreditation requirements, building facilities,
equipment and personnel standards for appropriate care
6. Develop community based and institution based models of health care
7. Pursue the implementation laws and policies for the protection and improvement
of the quality of life of the older persons
RA 9257- Expanded Senior Citizen Act of 2003
Essential Health Care package:
8. Management of illness
9. Counselling on sexual abuse, sexuality and reproductive tract infection
10. Nutrition and diet counselling
11. Mental health
12. Family planning and responsible sexual behaviour
13. Dental care
14. Screening and management of lifestyle related and other degenerative disease
15. Screening and management of chronic debilitating and infectious disease
16. Post productive care
Maternal and Child Health and Family Planning
Protecting the health of the mother and child is the primary concern of this program. It
aims to provide quality maternal care to all eligibles. Concerted efforts of various health
workers had been made to maintain/improve the well-being of this vulnerable group.
Millenium Developmental Goal: Reduce the maternity mortality ratio by three quarters by
2015

Strategic thrusts:
BEMOC (Basic Emergency Obstetric Care ) establishment of facilities that
provide emergency obstetric care for every 125,000 population.
4 Prenatal visit
Responsible parenthood and provision of appropriate health package to women
of reproductive age 18-35 years

Strategies:
A Provision of Regular and Quality Maternal Care Services
Regular and quality prenatal care
o History taking, utilization of HBMR (Home-Based Mothers Record) as a guide
in the identification of risk factors
o PE: weight, height, BP taking
o Perform Head to toe assessment, abdominal exam
o Tetanus Toxoid Immunization
o Fe supplementation
o Vitamin A Supplementation
o Laboratory exam
o Oral/ Dental exam
Provision of Safe Delivery Care
All Birth attendants shall ensure clean and safe deliveries at home or at the
facilities (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
Qualifications for Home Delivery:
full term
less than 5 pregnancies
cephalic presentations
without existing diseases
no history of complications during the previous deliveries
no history of difficult delivery and prolonged labor
no previous caesarian sections
imminent deliveries
if risk remains after delivery refer to nearest health facility
no premature rupture of membranes
adequate pelvis
abdominal enlargement is appropriate for age of gestation
Provision of quality post-partum care
Proper schedule of follow-up must be followed:
1.
1st postpartum visit for home deliveries must be done within 24 hours after
delivery
2.
2nd done at least 1 week after delivery
3.
3rd done 2-4 weeks thereafter
Attendants must be aware of the early signs, symptoms and complications. They follow the 3
CLEANS:
CLEAN Hands
CLEAN Surface
CLEAN Cord

Family Planning Program


Goal Provide universal access to family planning information and services whenever and
wherever these are needed.
Strategies:
Focus service delivery to the urban and poor
Re establish the family planning outreach program
Strengthen family planning
Promote frontline participation of hospitals
Public Health Nurse Intervention:
Provide counselling:
1. inform and educate on the use of family planning
2. inform and discuss the advantaged/ disadvantages
3. inform its side effects and complications
4. inform its effectiveness
Provide packages of health services:
1. Family planning
2. MCHN
3. Management of reproductive tract infection
4. Violence against women
5. Management of breast and reproductive cancers
6. Ensure availability of family planning supplies and logistics
Family Planning Program
Methods of Family Planning
I. Spacing
HormonalOral Contraceptives
Injectables
Implants
BarrierIUD
Condom
Diaphragm, Cervical Cap
BiologicLactation Amenorrhea Method
NaturalBasal Body Temperature (BBT)
Symtothermal
Cervical Mucus
II. Permanent (surgical/irreversible)
Tubal Ligation- done in women; a 15 min. surgical procedure in which the fallopian tubes are
tied and cut to prevent passage of sperms.
Vasectomy- done in men, vas deferens is tied and cut to block passage of sperm
EO 119 gave 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:
o
To improve family welfare with main focus on:
o
Womans health
o
Safe motherhood
o
Child survival
o
To promote family solidarity and responsible parenthood

Newborn Screening
1. Congenital Hypothyroidism (CH)
CH results from lack or absence of thyroid hormone, which is essential to growth of the brain
and the body. If the disorder is not detected and hormone replacement is not initiated within
(4) weeks, the baby's physical growth will be stunted and she/he may suffer from mental
retardation.
2. Congenital Adrenal Hyperplasia (CAH)
CAH is an endocrine disorder that causes severe salt lose, dehydration and abnormally high
levels of male sex hormones in both boys and girls. If not detected and treated early, babies
may die within 7-14 days.
3. Galactosemia (GAL)
GAL is a condition in which the body is unable to process galactose, the sugar present in
milk. Accumulation of excessive galactose in the body can cause many problems, including
liver damage, brain damage and cataracts.
4. Phenylketonuria (PKU)
PKU is a metabolic disorder in which the body cannot properly use one of the building blocks
of protein called phenylalanine. Excessive accumulation of phenylalanine in the body
causes brain damage.
5. Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD Def)
G6PD deficiency is a condition where the body lacks the enzyme called G6PD. Babies with
this deficiency may have hemolytic anemia resulting from exposure to certain drugs, foods
and chemicals.
Effect
SCREENED

Effect if SCREENED and treated

CH (Congenital Hypothyroidism)

Severe Mental Retardation

Normal

CAH (Congenital Adrenal


Hyperplasia)

Death

Alive and Normal

GAL (Galactosemia)

Death or Cataracts

Alive and Normal

PKU (Phenylketonuria)

Severe Mental Retardation

Normal

G6PD Deficiency

Severe Anemia, Kernicterus Normal

Disorder
Screened

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 Minimization

Water Supply Sanitation Program


3 Types of Approved Water Supply and Facilities
Level I
Point Source

Level II
Communal faucet system
or stand posts

Level III
Waterworks system or
individual house
connections Level III
Protected well or developed Source of reservoir, A
source, reservoir, a piped
spring with an outlet but
piped distribution network, distributor network and
with out a distribution
communal faucets
households tap
system
Rural areas that are
urban areas where
Rural areas
clustered densely
population is dense
Serves around 15 to 25
not more than 25 meters
households
from the farthest user
Outreach: not more than
deliver 40 to 80 liters per
250 meters from the
day to 100 households
A system with a source, a
farthest user
one faucet per 4 to 6
reservoir, a piped
Yield or discharge: 40 to
households
distributor network and
140 liters per minute
household taps that is
A system composed of a
suited for densely
A protected well or a
source, a reservoir, a piped populated urban areas.
developed spring with an distribution network and
outlet but without a
communal faucets located
distribution system for rural at not more than 25 meters
areas where houses are
from the farthest house in
thinly scattered.
rural areas where houses
are clustered densely.
. Unapproved type of water facility:
Open dug wells
Unimproved springs
Wells that need priming
Disinfection of water supply sources is required on the following:
Newly constructed water supply facilities
Water supply facility that has been repaired or improved
Found to be positive bacteriologically by lab analysis
Open dug wells
Unimproved springs
Surface water
Proper Excreta and Sewage Disposal System
Level 1

Level 2

Level 3

Non-water carriage toilet


facility:
- Pit latrines
- Reed Odorless
Earth Closet
- Bored-hole
- Compost
- Ventilated
improved pit

On site toilet facilities of


the water carriage type
with water sealed and
flushed type with septic
vault/tank disposal
facilities.

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

Proper Solid Waste Management


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

Community

Burial
Deposited in 1m x 1m deep pits
covered with soil, located 25m
away from water supply.
Open Burning
Animal feeding
Composting
Grinding and disposal sewer

Sanitary landfill or controlled tipping


Excavation of soil deposition of refuse
and compacting with a solid cover of 2
feet.
Incineration

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.
DOH AO #1
- requires all laboratories to use Formalin Ether Concentration Technique
( FECT ) instead of the direct fecal smear in the analysis of stools of foodhandlers.
- this will enable laboratories to identify food handlers with parasitic infection and treat
them before they are allowed to work in food establishment.
All ambulant vendors must submit a health certificate to determine present of intestinal
parasite and bacterial infection
Food establishment shall be rated and classified as:
Class AExcellent
Class BVery Satisfactory
Class CSatisfactory

3 Points of Contamination
Place of production processing and source of supply
Transportation and storage
Retail and distribution points
Hospital Waste Management
Goal:
To prevent the risk of contraction nosocomial infection from type disposal of infectious;
pathological and other wastes from hospital.
Policies:

All newly constructed/ authorized and existing government and private hospitals shall
prepare and implement a Hospital Waste Management ( HMW ) as a requirement for
registration and renewal of licenses.

Use of appropriate technology and indigenous resources

Training of all hospital personnel

Public information campaign on health and environmental hazard shall be the


responsibility of the hospital administration.
HEALTH RISK MINIMIZATION
Anti- smoking Belching Campaign and Air Pollution Campaign
Zero Solid Waste Management
Toxic, chemical, and Hazardous Waste Management
Red Tide Control and Monitoring
Integrated Post Management and Sustainable Agriculture
Pasig River Rehabilitation Management
Nutrition and Food Supply
NUTRITIONAL GUIDELINES
1. Eat a variety of food everyday.
2. Breastfeed infants exclusively from birth to 4-6 months, and then, give appropriate
foods while continuing breastfeeding.
3. Maintain children's normal growth through proper diet and monitor their growth
regularly.
4. Consume fish, lean meat, poultry, and dried beans.
5. Eat more vegetables, fruits and root crops.
6. Eat foods cooked in edible/cooking oil daily.
7. Consume milk, milk products or other calcium-rich foods such as small fish and dark
green leafy vegetable everyday.
8. Use iodized salt but avoid excessive intake of salty foods.
9. Eat clean and safe food.
10. For healthy lifestyle and good nutrition, exercise regularly, do not smoke, and avoid
drinking alcoholic beverages.
Four Rights in Food Safety
Right Source:
Always buy fresh meat, fish, fruits & vegetables.
Always look for the expiry dates of processed foods and avoid buying the
expired ones.
Avoid buying canned foods with dents, bulges, deformation , broken seals
and improperly seams.
Use water only from clean and safe sources.

When in doubt of the water source, boil water for 2 minutes.


Right Preparation:
Avoid contact between raw foods and cooked foods.
Always buy pasteurized milk and fruit juices.
Wash vegetables well if to be eaten raw such as lettuce, cucumber,
tomatoes & carrots.
Always wash hands and kitchen utensils before and after preparing food.
Sweep kitchen floors to remove food droppings and prevent the harbor of
rats & insects.
Right Cooking:
Cook food thoroughly. Temperature on all parts of the food should reach 70 degrees
centigrade.
Eat cooked food immediately.
Wash hands thoroughly before and after eating.
Right Storage:
All cooked foods should be left at room temperature for NOT more than two hours to
prevent multiplication of bacteria.
Store cooked foods carefully. Be sure to use tightly sealed containers for storing food.
Be sure to store food under hot conditions (at least or above 60 degrees centigrade) or in
cold conditions (below or equal to 10 degrees centigrade). This is vital if you plan to
store food for more than four to five hours.
Foods for infants should not be stored at all. It should always be freshly prepared.
Do not overburden the refrigerator by filling it with too large quantities of warm food.
Reheat stored food before eating. Food should be reheated to at least 70 degrees
centigrade.
Rule in Food Safety: When in doubt, throw it out!
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:
o Incorporation of Monosodium Glutamate (MSG) with vitamin A to reduce
clinical signs of Xerophthalmia
o The use of FIDEL salt in lieu with the national Salt Iodization Program
F- ortification for
I- odine
D- efficiency
EL- imination
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.
NON COMMUNICABLE DISEASES
Integrated Community- Based Non- Communicable Disease Prevention and Control Program
Leading Lifestyle- Related Causes of Morbidity
1.Cardiovascular Diseases
2.Cancer
3.COPD
4.Diabetes Mellitus
Leading Lifestyle- Related Causes of Mortality

1.
2.
3.
4.
5.
6.

Heart and Vascular System Disease


Cancers
COPD
Accidents
Diabetes
Kidney Problems

Health Promotion Major strategy for the prevention of the emergence of risk factors
Healthy Lifestyle
- a way of life that promotes and protects well- being
- includes practices that promote health such as: healthy diet and nutrition, regular and
adequate physical activity and leisure, avoidance of substances that can be abused,
adequate stress management and relaxation, safe sex, immunization
Goal:
To reduce the toll of morbidity, disability, and premature deaths due to chronic, noncommunicable lifestyle- related diseases
Objectives:
1. Analyze the social, economic, political, and behavioral determinants of NCD
2. Reduce exposure of individuals and population to major determinants of NCD while
preventing emergence of preventable common risk factors.
3. Strengthen health care for people with NCD through health sector reforms and costeffective interventions
Approaches Used in Non- Communicable Disease Prevention and Control:
1. Comprehensive Approach Focused on Primary Prevention
2. Community- Based Approach
3. Integrated Approach
Key Intervention Strategies
1. Establishing program direction and infrastructure
2. Changing environments
3. Changing lifestyle
4. Reorienting health services
Role of the Public Health Nurse in NCD Prevention and Control
1. Health advocate
2. Health educator
3. Health care provider
4. Community Organizer
5. Health Trainer
6. Researcher
Role of the Public Health Nurse in Risk Assessment and Screening:
1. Educate as many people and in every opportunity
2. Educate people on how to prevent the NCD risk factors
3. Every client, not only the patient seeking consultation, should be assessed for the
presence of risk factors
4. Train other health workers on performing risk factor assessment
When risk factors are present:
1. Advise retesting if needed
2. Explain the significance of the finding
3. Educate on how to modify risk factors and promote positive lifestyle change
4. Monitor and follow up

5. Refer for confirmation of diagnosis

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
National Prevention of Blindness Program
Vision: All Filipinos enjoy the right to sight by the year 2020
Vision 2020: The Right to Sight
- a global initiative to eliminate avoidable blindness by the year 2020
- a partnership between the World Health Organization (WHO) and the International agency
for Prevention of Blindness
5 preventable/ treatable conditions:
cataract - opacification of the normally clear lens of the eye; most common cause of
blindness worldwide; corrected by surgery
refractive errors and low vision- corrected by spectacle glasses, contact lenses, or
surgery
trachoma
onchocerciasis
childhood blindness- highly specialized services are needed for diagnosis; can be
done by pediatricians and in school clinics
Botika ng Barangay
developed and established under AO 23- A dated July 5, 1996
a drug outlet managed by a legitimate community organization (CO), NGO, and the
LGU with a trained operator and a supervising pharmacist, and specifically licensed
by BFAD
makes available low- priced generic home remedies, OTC drugs, two selected,
publicly- known prescription antibiotic drugs (Amoxicillin and Cotrimoxazole) and
recently selected medication for chronic diseases that requires lifetime medications
such as diabetes, hypertension, and asthma
Goal: To promote equity in health by ensuring the availability and accessibility of
affordable, safe, and effective quality essential drugs to all, with priority for
marginalized, underserved, critical, and hard- to- reach areas
Objectives:
o To rationalize the distribution of common drugs and medicines
o To serve as the mechanism for the DOH to establish partnership with Local
Government Units (LGUs) and Community Organizations
o To optimize the involvement of Barangay Health Workers addressing the
health need of the community
Criteria for Establishing a Botika ng Barangay
.1
Managed or operated by an established community organization or cooperative
(recognized as the judicial body)
.2
Service or coverage area is the Barangay that is a far- flung and hard- to reach area
.3
At least 1/3 of the initial capital requirements are community- sourced funds

.4
.5
.6

Barangay resolution, barangay socio-economic profile, health profile should be


submitted
Identification and selection of at least 2 barangay health workers or Community
Volunteer Health Workers as Botika ng Barangay Aides
Availability of a Botika ng Barangay space

List of OTC Drug Preparations for Botika ng Barangay:


1. Analgesic/ Antipyretics: Paracetamol
2. Antacid: Aluminum Hydroxide
3. Anti Helmintics: Pyrantel Embonate, Mebendazole
4. Anti histamine: Diphonhydramine, Chlorphenamine
5. NSAIDS: Mefenamic acid, Ibuprofen, Aspirin
6. Anti vertigo:
Meclozine
7. Bronchodilator: Lagundi
8. Diuretic: Sambong
9. Anti tussive: Dextromethorphan
10. Nasal decongestant: Phenylpropanolamine
11. Anti motility: Loperamide
12. ORS
13. Laxatives/ Cathartics: Bisacodyl, Standard Senna Concentration, Magnesium Hydroxide,
Castor oil
14. Anti scabies, anti lice, anti fungal: Benzyl Benzoale, Crotamiton, Sulfur
15. Anti anemic: Ferrous sulfate
16. Anti fungals: Benzoic acid, Clotrimazole, Miconazole, Ketoconazole
17. Vitamins: A, B1B2B6B12, C,D,E, Folic Acid, Niacin
18. Vitamin and Mineral
19. Minerals: Calcium lactate, Calcium carbonate
20. Anti infectives: Amoxicillin, Cotrimoxazole
21. Meds for Chronic Disease: Metformin, Glibenclamide, Metoprolol, Captopril, Salbutamol
22. Topical Nasal Decongestant:Oxymetazoline
23. Disinfecants: Chlorhexidine
DENTAL HEALTH PROMOTION
Vision: A lifetime of oral health and no tooth decay for the next generations
STRATEGIES
Social mobilization
Coordination and partnership with sectoral groups
Networking with other offices/services
Capability building and work value formation
Monitoring and feedback
Operation research study
DIRECT SERVICES
Dental Health Promotion and Advocacy
Dental Preventive Program
Dental Curative Program
Oral Habilitation and Rehabilitation Program
SUPPORT SERVICES
Dental Health Planning
Training Program

Dental Research Program


Monitoring and Evaluation

EPIDEMIOLOGY
study of occurrences and distribution of diseases as well as the distribution and
determinants of health states or events on specified population, and application of
this study to the control of health problems
-concerned not only with deaths and illnesses, but with positive health states and
means to improve health
Environme
considered as the backbone of preventing disease

nt

2 Main Areas of Investigation:


distribution of disease
search for determinants (causes) of disease and its observed distributions
Uses of Epidemiology: (Morris)
Study the history of the health population and rise and fall of diseases
Diagnose health of the community and condition of people to measure distribution
and dimension of illness in terms of:
-incidence
-prevalence
-disability
-mortality
Study the work of health services with a view of improving them
Estimate risk of disease, accident, defects, and chances of avoiding them
Identify syndromes by describing the distribution and association of clinical
phenomena
Complete the clinical picture of chronic disease
Search for causes of health and disease by comparing the experience of groups
The Epidemiologic Triangle
- a change in any of the components will alter an existing equilibrium to increase or
decrease the frequency of the disease

host

agent

Classifications of Agents, Hosts, and Environmental Factors which determine the Occurrence
Disease in the Human Population
1. Agents of Disease
a. Nutritive Elements

b. Chemical Agents
c. Physical Agents
d. Infectious Agents
2. Host Factors (Intrinsic Factors)
a. Genetic
b. Age
c. Sex
d. Ethnic group
e. physiologic
f. Immunologic
g. Inter- current or pre- existing disease
h. Human behavior
3. Environmental Factors
a. physical environment
b. biologic environment
c. socio- economic environment
Patterns of Occurrence and Distribution
-

ENDEMIC
habitual presence of a disease in a given geographic location accounting for the low
number of immunes and susceptible
causative factor of the disease is constantly available or present in the area
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 susceptible are high compared to the proportion of the
immunes.
PANDEMIC
global occurrence of a disease
SPORADIC
disease occurs every now and then affecting only a small number of people relative to
the total population

Outline of Plan for Epidemiological Investigation


1. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relations to characteristic of the group of community
4. Correlation of all data obtained
Epidemiology and Surveillance Units
-established in regional and some local office as support to the public health system
-responsible for providing timely and accurate information on diseases in the locality
-responsibilities include:
surveillance of infectious diseases
assisting LGUs in investigation of outbreaks
developing information package
providing technical assistance
Public Health Surveillance
-an on- going systemic collection, analysis, interpretation, and dissemination of health data

- considered information loops or cycles involving health care providers, public health
agencies, and the public
Information Loop:
1. Cases of disease occur
2. Cases are reported by health care providers to health agencies
3. Information about cases is relayed to those responsible for disease prevention
4. Feedback of surveillance information is received by health providers, health agencies,
and the public

HEALTH CARE

PUBLIC

PROVIDERS

SUMMARIES,
INTERPRETATIONS,
RECOMMENDATIONS

REPORTS

HEALTH
AGENCIES
Surveillance
-an continuous collection and analysis of data of cases and death
-public health nurse function as a researcher in disease surveillance
Objectives:
-measures magnitude of the problem
-measures effect of the control program
National Epidemic Sentinel Surveillance System (NESSS)
- hospital based information system that monitors the occurrence of infectious disease with
outbreak potential
- supplemental information system of the DOH
Objectives:
Provides early warning on occurrence of outbreaks
Provide program managers, policy makers, and public administrators, rapid, accurate and
timely information do that inventive control measures can be instituted.
NESSS shows:
Trends of cases across time
Demographic characteristics of cases
Estimates case fatality ratio
Clustering of cases in a geographical area
Formulate hypothesis for disease causation
Diseases under surveillance:
Laboratory
diagnosed:
Cholera
Hepatits A
Hepatits B
Malaria

Clinically diagnosed:

Under Surveillance System:

DHF
Diptheria
Measles
Meningococcal disease

Acute flaccid paralysis


Measles
Maternal and neonatal
tetanus

Typhoid fever

Neonatal Tetanus
Non neonatal tetanus Pertussis
Rabies
Leptospirosis
Acute flaccid paralysis /
Poliomyelitis

Paralytic shellfish poisoning


Fireworks related injury
HIV/ AIDS

Importance of Outbreak Investigation:


Control and prevention measures
Severity and risk to others
Research opportunities
Public, political or legal concerns
Program consideration
Training
Sources:
Surveillance data
Medical practitioner
Affected persons/ group
Concerned citizen
Media
Functions of the Epidemiologic Nurse:
Implement public health surveillance
Monitor local health personnel conducting disease surveillance
Conduct or assist other health personnel in outbreak investigation
Assist in and conduct of rapid surveys and surveillance during disasters
Assist in the conduct of surveys, programs evaluations, and other epidemiologic
studies
Assist in the conduct of training course in epidemiology
Assist the epidemiologist in preparing the annual report and financial plan
Responsible for inventory and maintenance of epidemiology and surveillance
equipment
Role during Epidemiologic Investigation:
Maintains surveillance of the occurrence of notifiable disease
Coordinates with other members of the health team during disease outbreak
Participates in case finding and collection of laboratory specimen
Isolate cases of communicable disease
Renders nursing care, teaches and supervises giving of care
Performs and teach household members about methods on concurrent and terminal
disinfection
Gives health teachings to prevent further spreads of disease to individual and
families
Follow up cases and contacts
Organized, coordinates, and conducts community health education campaign
Refers cases when necessary
Coordinates with other concerned community agencies
Accomplishes and keeps records and reports and submits to proper office/ agency
VITAL STATISTICS
- systematic study of vital events such as births, deaths, illness, marriages and divorce
SOURCES OF DATA:
Population Census

Registration of vital data


Individual Health records and family records
Weekly Reports from Field health Personnel

Categories of Data according to Sources:


1. Primary data- those obtained first hand by the investigator for the purpose of
the study
2. Secondary data- those which are existing and obtained by other people for
purposes not necessarily those of the investigator
Methods of data Collection
- Documented sources
- Ocular inspection
- Participant observation
- Interview
- Group interview
- Sample survey
- Focus group discussion

Crude Birth Rate


- measure of one characteristic of the natural growth or increase of a population
Number of live births during a given year x 1000
population estimated at mid year
Crude Death Rate
- measure of one mortality from all causes which may result in a decrease of population
number of deaths from all causes during a given year
x 1000 population
population estimated at mid year
Specific Death rate
- Describes the risk of certain classes or groups to particular disease.
Cause specific
Number of deaths from a specific condition during a given year x 100,000
population estimated at mid year
Age Specific
Number of deaths for a specified age group during a given year x 1000
population estimated at mid year for the specific age group
Infant Mortality Rate
- Measures the risk of dying during the first year of life. It is a good index of the general
health condition of the community.
Number of deaths under 1 year of age during the given year
x 1000 live
births
Number of live births during the same year
Maternal Mortality Rate
- Measures the risk of dying from causes related to pregnancy, childbirth and
puerperium.
Number of deaths from the puerperal complications during a given year
100,000
number of live births during the same year

Fetal Death Rate


- Measures pregnancy wastage. Death of the product of conception occurs prior to its
complete expulsion, irrespective of duration of pregnancy
Number of fetal deaths at 20 weeks of gestation (or more) during a given year x 1000
number of live births and fetal deaths during the same year
Neonatal Death Rate
- measures the risk of dying the 1st month of life
- serves as an index of the effects of prenatal care and obstetrical management of the
newborn
Number of deaths under 28 days of age during a given year x 1000
Number of live births during the same year
Birth Death Ratio
Number of live births in a specified population
Number of deaths in the same population

x 1000

Case Fatality Ratio


Number of deaths from a specified disease or condition
x 100,000
Number of reported cases of the specified disease or condition
Incidence Rate
- measures the frequency of occurrence of the phenomenon; deals with NEW CASES
number of new cases of a specific disease or condition
occurring during a given period of time
population at risk during the same time period

x 100,000

Prevalence Rate
-measures the proportion of the population which exhibits a particular disease at a particular
time; deals with NEW and OLD CASES
Number of old and new cases of a specific disease of condition
existing at a point in time
x 100,000
total population at the same point in time
General Fertility Rate
Number of live births during a given year
x 1000 female pop (15-44 y.o.)
population estimated at mid-year for females age 15-44 during the same year
Attack rate
-accurate measure of the risk of exposure
Rate
- relationship between a vital event and those persons exposed to the occurrence of
said event, within a given area and during a specified time
Ratio
- describes the relationship between 2 numerical quantities or measures of events
without taking particular considerations to the time or place

Field Health Services and Information System (FHSIS)


Objectives:
To provide summary of data on health services delivery and select program
accomplished indicators at the barangay, municipality, district, provincial, regional
and national levels
To provide data which is used for program monitoring and evaluation purposes
To provide a standardized, facility level data base which can be accessed for a more
in depth studies
To ensure that the data reported to the FHSIS are useful and accurate and are
disseminated in a timely an easy to use fashion
To minimize recording and reporting burden at the service delivery level in order to
allow more time for patient care and promote activities
Components:
Family Treatment Record
Target Client List
Reporting Forms
Output Records
4 Purposes:
1. To plan and carry out patient care and service delivery
2. Facilitate monitoring and supervision of services
3. Report services delivered
4. Provide a clinic level data base which can be accessed for further study
Target

Client List:
EPI
Eligible Population
Children 0-59 months
Nutrition
Pre natal care
Post partum care
Family planning
TB symptomatic
TB cases under Short Course Chemotherapy
TB cases under Standard regimen
Leprosy cases

Tally/ Reporting Forms


FHSIS reports
- data are routinely transmitted from one facility to another
- prepared and submitted either monthly or quarterly
- prepared and submitted by the unit/ person responsible for the service/ activity being
provided and sent directly to the Provincial Health Office
Output Reports
- produced at the PHO from the data reported down to the RHU/ MHC and up through the
DOH system to the Regional Health Office
Records, Reports and Patient Flow
As a client enters the clinic/ facility, their individual treatment record is pulls out from the
file. If the clients history has come to the clinic for program service for which there is a
Target/ Client List, a appropriate entry is made in the TCL and an entry in the treatment

record to show what the finding or urine test results are. If the visit is a usual prenatal visit,
a tick would be made on the appropriate block on the Tally Sheet/ Report Form. No other
recording of information such as entries in a logbook or daily serviced record is required.
Geographic Coding
Reporting Unit
- DOH health care facility that renders/ delivers public care-related services to targeted
beneficiaries
Conditions for a Reporting Unit:
It renders/ delivers health services to a defined catchment area which composed of
one or more barangays
A midwife renders regular services to the areas
Health services may be provided for any physical structure designated for the
purpose:
BHS building, barangay hall, place of residence
The catchment area served is not a service area of any RHU
It should not include satellite BHS which are visited by the midwife but part of the
catchment of the mother BHS
Health Emergency Preparedness and Response Program
AO No. 6 Bs. Of 1999
- comprehensive, integrated, and responsive emergency disaster- related service and
research- oriented program
Legal mandate:
Presidential Decree No. 1566 (1978)
- Creation of the National Disaster Coordinating Council (NDCC)
-Creation of multilevel organizations
-funding of a 2% reserve for calamities
Disaster and Health Emergency Management:
Disaster
- a serious disruption of the functioning of a society, causing widespread human, material, or
environmental losses which exceed the ability of the affected society to cope, using only its
own resources (UN)
Emergency
- any occurrence, which requires an immediate response (WHO)
Hazards
-any phenomenon, which has the potential to cause disruption or damage to humans and
their environment
Risk
- level of loss or damage that can be predicted from a particular hazard affecting a particular
place, at a particular time from the point of view of the community
Susceptibility: involves factors, which allow a hazard to cause an emergency
Vulnerability: involves factors of a community, which allow a hazard to cause an
emergency
Classifications of Disasters:
1. According to Cause
-Natural Disaster
-Human Generated/ Manmade

2. According to Onset
-Acute/ Sudden Impact Events
-Slow or chronic genesis (creeping disasters)
Contributing factors to Disaster Occurrence and Severity:
Human Vulnerability
Environmental Degradation
Rapid Population Growth
General Principles of Disaster Management:
1st priority: protection of people who are at risk
2nd priority: protection of critical resources and systems on which the communities
depend
disaster management:
-an integral function of national development plans and objectives
-relies upon understanding of hazard risks
-must be based on interdisciplinary collaboration
-only as effective as the extent to which commitment, knowledge and capabilities can be
applied
capabilities must be developed prior to the impact of the hazard
Major

Risks to be Considered:
natural risks-includes flood, earthquakes
technological risks- chemical, radiological, failure of infrastructure and
transportation
epidemics- caused by infectious diseases
societal risks-includes poverty, violence

Principles of Emergency Preparedness:


the responsibility of all
should be woven into the community and administrative levels of government
organizations
an important aspect and is connected to other aspects of emergency management
should concentrate on processes and people rather than on documentation
should not concentrate only on disasters but integrate prevention and response
strategies
should not be done in isolation
Hospitals play a very vital role in the management of disaster
Main objective- decrease mortality and morbidity, prevent disability
Every Hospital should have a regularly- updated disaster plan
Purpose of the Disaster Plan :
to provide policy for effective response
identify hospital capability to handle mass casualty
identify responsibilities of individuals and departments in the event of a disaster
situation
identify standard operating guidelines for emergency activities and responses

National Voluntary Blood Services Program (NUBSP)


R.A. 7719 National Blood Services Act of 1994

-Mandated DOH, Philippine National Red Cross (PNRC), and Philippine Blood Coordinating
Council, government agencies, and NGOs to implement a National Voluntary Blood Services
Program (NVBSP)
Vision:
A network of modernized national and regional blood centers operating on a
fully voluntary, non- remunerated blood donation system
Mission:
Ensure adequate, safe, and accessible blood supply by:
Promoting voluntary blood donation as a way of life
Provide adequate, safe, affordable, and equitable distribution of supply of blood and
blood products
To mobilize all sectors of the community to participate in mechanisms for voluntary
and non- profit collection of blood
Eligible Blood Donors:
1. Weigh more than 45 kg (100 lbs) for 250 ml of donated blood and 50 kg (110 lbs) for 450
ml of donated blood
2. In good health
Without the following conditions:
Diabetes
Cancer
Hyperthyroidism
Cardiovascular Diseases
Severe psychiatric disorder
Epilepsy/ convulsions
Severe bronchitis/ other lung conditions
AIDS, Syphilis, and other STDs (past and present)
Malaria
Kidney and Liver Diseases (e.g. Hepatitis)
Prolonged bleeding
Use of prohibited drugs
3. 16- 65 years (parental consent needed for those below 18)
4. SBP 90-160 mmHg; DBP 60-100 mmHg
5. Hemoglobin at least 125 g/L
Steps

on how to donate blood:


Go to the nearest Blood Collection Unit (BCU) located in a government hospital
Register as a potential blood donor
Health history will be taken
Physical exam follows (weight, vital signs)
Blood test to determine blood group type

Blood extracted for donation:


Whole blood and red cell concentrates- stored for 4 to 5 weeks
Plasma- can be frozen up to 12 months
Things

to do after donating blood:


leave dressing on for at least 3 hours but not more than 12 hours
avoid carrying heavy objects with donating arm
do not smoke for the next two hours
eat regular meals and increase fluid intake

Walking Blood Donors

-donors blood will not be extracted immediately and stored. This will be required only when
the need arises.
-listed with corresponding blood types and are on call when needed.
Community- Based Rehabilitation Program
- application of Primary Health Care approach in rehabilitation services for persons with
disabilities
R.A. 7277 Magna Carta for Disabled Persons
provides rehabilitation, self- development, and self- reliance of disabled persons
Goal:
Improvement of quality of life of disabled handicapped persons
Objective:
To reduce the prevalence of disability through prevention, early detection, and
provision of rehabilitation services at the community level
Program Components:
Social Preparations- involves identification of site, organization of committee,
selection of supervisor, establishment of linkages, community survey
Services Preparation- provision of family care rehabilitation services, technical aids
(braces, prosthesis)
Training- provision of opportunities for manpower development
Information Education and Communication- creating a wide range of health
promotion activities, family counselling, organization of special events among
persons with disability with talent
Monitoring, Supervision, and Evaluation