ESSENTIAL HEALTH PACKAGES

FOR ADOLESCENCE, ADULT, MEN,
WOMEN AND OLDER PERSON

SUBMITTED TO: SUBMITTED BY:
PROF. ROSEMARIE G. ASUNCION ANGELIKA LEINE A. CID
BRIDGETT CHELSIE VENTURA
BSN-II A
An Essential Health Package in a low-income country consists of a limited list of public
health and clinical services which will be provided at a primary and/or secondary care level. In
contrast, in richer countries, packages are often described according to what they exclude.
Essential Health Package or EHP obviously include different interventions in different countries-
reflecting variations in economic, epidemiological and social conditions. In EHP, human skills,
drugs, equipment and other resources required to deal with the interventions within the package
should be available. An EHP does not mean that clients with other health problems need to be
turned away from health facilities-but there is no guarantee that resources will be available to
deal with their particular needs.
During the late 1970s and 1980s, Essential Health Package were one aspect of the debate
on the merits of a limited package of interventions versus the notion of comprehensive primary
health care. EHPs took centre-stage in the debate when the 1993 World Development Report
posed a practical question – “how should governments in low-income countries spend their very
limited health budgets?” Since the 1993 World Development Report, many middle and low-
income countries have adapted the EHP idea to their own situations. In some countries this led to
implementation.
Why have Essential Health Package?
 Priority setting on the grounds of effectiveness and relative cost.
 Poverty reduction.
 Equity
 Political empowerment and accountability

ESSENTIAL HEALTH PACKAGES FOR ADOLESCENCE:
Oral Health Programs
The individual so affected with such handicap also has disturbed speech, becomes
withdrawn and avoids socializing with people and so lessen his opportunities for
advancement. More critical however is the effect of poor or defective teeth to overall
nutrition to maintain good general health that begins with the first bite and chewing the food
efficiently.

Related Laws:

 AO 101 s. 2003 dated October 14, 2013- National Policy on Oral Health
 AO 2007-0007 dated January 3, 2013 - Guidelines in the Implementation of Oral Health
Program for Public Health Services in the Philippines
 AO 4 s. 1998 - Revised Rules and Regulations and Standard Requirements for Private
School Dental services in the Philippines.
 AO 11-D s. 1998 - Revised Standard Requirements for hospital Dental services in the
Philippines.
 AO 3 s. 1998 - Revised Rules and Regulations and Standard Requirements for
Occupational Dental Services in the Philippines
 AO 4-A s. 1998 - Infection Control Measures for Dental Health Services

Target Priorities:

Pre-school children, Adolescents, Mothers, Elderly

Latest Results:

NCDPC have allotted 8.5 million pesos each year to implement the programing day care centers.
Activities include both tooth brushing activities, training of day care workers, awards, IEC
materials among others. The DOH is hoping to attain 12% OFC in 2016 and 20% in 2020. To date
more or less 3.20% pre-schoolersare OFC.

TYPES OF SERVICE
LIFECYCLE
(Basic Oral Health Care Package)
 Oral Examination
 Oral Prophylaxis (scaling)
Mother(Pregnant
 Permanent fillings
Women) **
 Gum treatment
 Health instruction
 Dental check-up as soon as the first tooth
Neonatal and Infants erupts
under 1 year old**  Health instructions on infant oral health care
and advise on exclusive breastfeeding
 Dental check-up as soon as the first tooth
appears and every 6 months thereafter
 Supervised tooth brushing drills
 Oral Urgent Treatment (OUT)

- removal of unsavable teeth
Children 12-71
- referral of complicated cases
months old **
- treatment of post extraction complications

- drainage of localized oral abscess

 Application of Atraumatic Restorative
Treatment (ART)
 Oral Examination
School Children (6-12
 Supervising tooth brushing drills
years old)
 Topical fluoride theraphy
 Pits and Fissure Sealant Application
 Oral Prophylaxis
 Permanent Fillings
 Oral Examination
 Health promotion and education on oral
Adolescent and Youth
hygiene, and adverse effect on consumption
(10-24 years old)**
of sweets and sugary beverages, tobacco and
alcohol
 Oral Examination
Other Adults (25-59  Emergency dental treatment
years old)  Health instruction and advice
 Referrals
 Oral Examination
 Extraction of unsavable tooth
Older Person (60 years
 Gum treatment
old and above)**
 Relief of Pain
 Health instruction and advice

National Laws and Policies

 National Objectives for Health
 Fourmula One for Health
 Adolescent and Youth Health Policy (AYH)
 Adolescent and Youth Health and Develoment Program
 National Directional Plan for reaching the Un reahced Youth Population
 Reproductive Health Program AO#1 s1998
 Local Government code

ESSENTIAL HEALTH PACKAGES FOR MEN AND ADULT:

SMOKING CESSATION PROGRAM

The use of tobacco continues to be a major cause of health problems worldwide. There is currently
an estimated 1.3 billion smokers in the world, with 4.9 million people dying because of tobacco
use in a year. If this trend continues, the number of deaths will increase to 10 million by the year
2020, 70% of which will be coming from countries like the Philippines. (The Role of Health
Professionals in Tobacco Control, WHO, 2005)

RELATED LAWS:
 Republic Act No. 9211, otherwise known as the "Tobacco Regulation Act of 2003", makes
it unlawful for any person under the age of 18 years to purchase, sell or smoke tobacco
products.
 In 2010, the DOH issued an administrative order requiring the inclusion of graphic warning
labels on packs and prohibiting the use of misleading descriptors such as "mild" and "light"
on tobacco product packaging and labels pursuant to Article 11 of the WHO FCTC.
 In June 2014, a legislative committee composed of senators and congressmen passed a bill,
called "The Graphic Health Warnings Law" compelling cigarette manufacturers to print
pictures and illustrations that warn about the dangers of smoking on cigarette packs.

TARGET PRIORITIES:

 Men
 Women
 Adult

INSIDENTS:

The Philippine Global Adult Tobacco Survey conducted in 2009 (DOH, Philippines GATS
Country Report, March 16, 2010) revealed that 28.3% (17.3 million) of the population aged 15
years old and over currently smoke tobacco, 47.7% (14.6 million) of whom are men, while 9.0%
(2.8 million) are women. Eighty percent of these current smokers are daily smokers with men and
women smoking an average of 11.3 and 7 sticks of cigarettes per day respectively.

FAMILYPLANNING:

A national mandated priority public health program to attain the country's national health
development: a health intervention program and an important tool for the improvement of the
health and welfare of mothers, children and other members of the family. It also provides
information and services for the couples of reproductive age to plan their family according to their
beliefs and circumstances through legally and medically acceptable family planning methods.

RELATEDLAWS:

 EO 119-reorganizing the ministry of health, its attached agencies and for other purposes.
 EO 102
 Republic Act No. 9710-The Magna Carta of Women is comprehensive women’s human
rights law that seeks to eliminate discrimination against women by recognizing, protecting,
fulfilling and promoting the rights of Filipino women, especially those in marginalized
sector.

TARGETPRIORITIES:

 Men and women of reproductive age (15-49) years old) including adolescents.

INCIDENTS:
One in ten young Filipino women age 15-19 has begun childbearing: 8 percent are already mothers
and another 2 percent are pregnant with their first child according to the results of the 2013
National Demographic and Health Survey (NDHS).

ESSENTIAL HEALTH PACKAGES FOR WOMEN:
The health of Filipino mothers and children determines the health of the next generation
of Filipinos. It is a given that socioeconomic development can happen only when people are able
to attain and maintain a certain level of health. Understandably, to attain the first Millennium
Development Goal (to eradicate extreme poverty and hunger), maternal and under-five mortality
rates have to be drastically reduced and diseases that take a heavy toll on human capital like
malaria and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS)
have to be controlled. As of 2014 the life span of a women is about 73.60.
The Maternal, Newborn and Child Health and Nutrition (MNCHN) core package of
services consists of interventions for each life stage:
Prepregnancy package (adolescence and adulthood)
1. Nutrition
 Nutritional counselling
 Promotion of the use of iodized salt; and
 Provision of micronutrient supplements:
o Iron and folate: 60 mg elemental iron/400 µg folic acid 1 tablet daily for
3-6 months.
o Vitamin A at least 5,000 IU every week or a daily multivitamin
supplement may be taken as option when the required vitamin A is not
available (DOH, 2009)
2. Promotion of Healthy lifestyle including advice relative to smoking cessation, healthy
diet, regular exercise and moderate alcohol intake (DOH,2009)
3. Advice on family planning and provision of family planning services. This is based on
the observation that unwanted pregnancies are associated with poorer health outcomes for
both the mother and her newborn (DOH, 2011)
4. Prevention and management of lifestyle-related diseases like diabetes, and cardiovascular
disease (DOH, 2009)
5. Prevention and management of infection, including deworming of women of
reproductive age to reduce other causes of iron deficiency anemia (DOH, 2011)
6. Counselling on STI/HIV/AIDS, nutrition, personal hygiene and consequences of abortion
(DOH 2009)
7. Adolescent health services (DOH 2009)
8. Provision of oral health services (DOH, 2009)
Prenatal package:
1. Prenatal visits:
 At least four visits throughout the course of pregnancy: at least one visit in the
first and second trimester and at least two visits in the third trimester (DOH 2011)
 Prenatal assessment includes weight and blood pressure monitoring, measurement
of fundic height against the age of gestation, fetal heart beat and fetal movement
count to assess the adequacy of fetal growth and well-being, and performance of
diagnostic examination like complete blood count, blood typing urinalysis,
screening for STIs, blood sugar screening and pregnancy test, cervical cancer
screening using acetic acid wash and Papanicolaou smear (DOH, 2009)
2. Micronutrient supplementation:
 Iron and folate (60 mg) once a day for 6 months or 180 tablets (DOH-IMS, 2011)
 Vitamin A 10,000 IU twice a week from the fourth month of pregnancy (DOH-
IMS, 2011)
 Elemental iodine 200 mg given once during the pregnancy (DOH, 2011)
3. Tetanus toxoid (TT) immunization (DOH, 2011)
 0.5 ml of TT is injected intramuscularly on the deltoid muscle (DOH, 1995)
o TT1- as early as possible during first pregnancy
o TT2- at least 4 weeks later
o TT3- at least 6 months later
o TT4- at least 1 year later
o TT5- at least I year later
 Adequate immunization of women with TT prevents tetanus in both the mother
and newborn. The newborn develops protection through passive immunity as
maternal antibodies pass through the placenta into the fetal circulation (DOH,
1995)
4. Promotion of exclusive breastfeeding, newborn screening (NBS), and infant
immunization (DOH, 2009)
5. Counselling on healthy lifestyle with focus on smoking cessation, health diet, and
nutrition, regular exercise, STI, and HIV prevention, and oral health (DOH, 2009)
6. Early detection and management of complications of pregnancy (DOH, 20090
7. Prevention and management of other conditions where indicated: hypertension, anemia,
diabetes, TB, malaria, schistosomiasis, and STI/HIV/AIDS (DOH, 2011)
8. Birth planning and promotion of facility-based delivery (DOH, 2011)
Childbirth package:
1. Skilled birth attendance/skilled health professional-assisted delivery and facility-based
deliveries including the use of partograph. Most maternal deaths occur during labor or
the first 24 hours of postpartum, and most complications cannot be predicted or
prevented (DOH, 2011)
2. Proper management of pregnancy and delivery complications and newborn
complications. (DOH , 2011) The DOH, PhilHealth, and WHO recommend essential
intrapartum and newborn care (IENC) practices in hospitals and other birthing facilities
in the country. EINC is called UnangYakap. EINC practices during intrapartum period
consists of measures that, based on scientific evidence, are necessary for safe and quality
care of the woman during childbirth. The recommended evidence-based practices
include (DOH, 2011):
 Continuous maternal support by having a companion of choice during labor and
delivery;
 Freedom of movement during labor;
 Monitoring progress of labor using the partograph; the partograph is graphic
recording of the progress of labor and significant conditions of the mother and the
fetus. It is useful in detecting deviations from normal and in early decision-
making on referral etc. (WHO, 1994)
 Nondrug pain relief before offering laboranesthesia;
 Position of choice during labor and delivery;
 Spontaneous pushing in a semi-upright position;
 Hand hygiene;
 Nonroutine episiotomy; and
 Active management of the third stage of labor (AMTSL)
3. Access to basic emergency obstetric and newborn care (BEmONC) or comprehensive
emergency obstetric and newborn care (CEmONC) services (DOH,2011)
Postpartum package:
1. Postpartum visits: within 72 hours and on the 7th day postpartum check for conditions
such as bleeding or infections (DOH, 2011)
2. Micronutrient supplementation
3. Counselling on nutrition, child care, family planning and other available services (DOH,
2011)
RELATED LAWS:
 The Magna Carta of Women (R.A. 9710)
-enacted in 2009, provides that the “state shall, at all times, provide for a comprehensive,
culture-sensitive and gender responsive health services and programs covering all stages
of woman’s life cycle and which addresses the major causes of women’s mortality and
morbidity”
 Responsible Parenthood and Reproductive Health Act of 2012 (R.A. 10354)
-the state recognizes and guarantees the human rights sustainable human development,
health, education and information, and the right to choose and make decisions and in
accordance with one’s religious convictions, ethics, cultural beliefs, and demands of
responsible parenthood.

RECIPIENTS:
 Women (adolescent and adult)
 Pregnant mother
ESSENTIAL HEALTH PACKAGES FOR OLDER PERSON:
The proportion of older persons is expected to rise worldwide. In the 1998 World
Health Report, there were 390 million older people and this figure is expected to increase further
(WHO). This growth will certainly pose a challenge to country governments, particularly to the
developing countries, in caring for their aging population. In the Philippines, the population of
60 years or older was 3.7 million in 1995 or 5.4% of total population. In the CY 2000 census,
this has increased about 4.8 million or almost 6% (NSCB). At present there are 7 million senior
citizens, 1.3M of which are indigents.

1. Creation of a National Technical Working group on Health and Well-being of Older
person
2. Planning Meeting for the Senior Citizens Immunization Program
o Older people need a seasonal flu (influenza) vaccine every year. Flu vaccine is
especially important for people with chorionic health conditions, pregnant
women, and older adults.
o Every adult get the Tdap vaccine once if they did not receive it as an adolescent to
protect against pertussis (whooping cough), and then a Td (tetanus, diphtheria)
booster shot every 10 years.
3. Consultative Planning and Finalization of Immunization Guidelines for Indigent
Senior Citizens.
4. Provision of Pneumococcal and Flu Vaccine to Indigent Senior Citizens aged 60
years old and above using the NHTS of the DSWD including GO-NGO shelter
homes in 2011
5. Conduct Annual “Summer Camp ni Lolo at Lola”
6. Annual “Walk for Life” for the elderly every October
PROGRESS OF THE PROGRAM:
1. The total of pneumococcal and influenza vaccines delivered to all CHDs for the CY 2011
were 197,000 respectively including the sub-allotment per region for HWOP activities.
2. Training and orientation of Pneumo and Flu vaccines for HWOP coordinators
3. Signed guidelines to Implement the provisions Relevant to Health of RA 9994 or the
expanded senior citizen Act of 2010
4. Summer camp nilolo at lola 2012 held at Davao, City.
5. Support world Health day April 12, 2012 with the theme “Ageing and Health” in
coordination with NCHP and WHO.

RELATED LAWS:
 Health Development Program for Older Persons (R.A. 7432)
-An act to maximize the contribution of senior citizens to nation building, grant benefits
and special privileges and for other purposes.
 Expanded Senior Citizen Act of 2010 (R.A. 9994)
RECEPIENTS:
 Older person (60 years old and above)
a. Well and free from sypmtoms
b. Sick and frail
c. Chronically ill and cognitively impaired
d. In need of rehabilitation services
 Health workers and caregivers
 LGU and partner agencies