BASIC CONCEPTS OF COMMUNITY HEALTH ○ Multidimensional

NURSING ● Health is a basic human right

○ Phil. Constitution
COMMUNITY (CLIENT) ● Health is not only to be well, but to be able to use
● People that don’t look like they are at risk well, every power we have
● Goal is to promote health, prolong life, and prevent ○ Nightingale
disease ● Health necessitates developing human potential.
● Group of people that live in a certain area, sharing Health therefore is development.
common beliefs, values, traditions, and customs ● It is a shared reality because each and everyone of
○ made up of: us is connected
■ Person/People ● Implication: Holistic Care and foster self-reliance
■ Place
■ Interaction CORE DETERMINANTS
■ Common interests, beliefs, and ● Gender
culture ● Health Services
○ Defined by geographic boundaries ● Employment Conditions
○ Able to interact so they develop something ○ Income loss
in common ● Education and Literacy
■ Culture ● Physical Environment
○ To be in a community, you must be living ● Social Support Networks
together in a particular area and interact ● Personal Health Practices and Coping Skills
with each other, therefore may share ● Social Environment
something in common ● Healthy Child Development
● Biology and Genetic Endorsements
C’s of Dealing with the Community ● Culture
● CULTURE ● Financial and Social Status
○ Should be able to understand their culture ● Implication:
○ This helps shape their view on health and ○ Highlights that health is not independent
why they get sick from social realities
● COMMUNICATION
○ Share information FACTORS AFFECTING HEALTH
○ Introduce change through communication POLITICAL
○ Deliver information to liberate people from ● Related to the core determinants
dark ignorance ● With power comes better access to health
● CHANGE ● Government budgeting; funding
○ Starts with awareness BEHAVIORAL
● Implication: Culture-specific care and use of ● Culture, attitude, mindset
effective communication to promote behavioral ● Views about health affect the behavior of people
change HEREDITY
○ Bound to achieve a common goal at any ● Diseases that can be gotten from your parents
circumstances despite any differences (GENES)
○ Breast Cancer
ENVIRONMENT
● Cleanliness
HEALTH (GOAL) ● Ventilation
● State of complete physical, mentual, social ● Sanitation
well-being and not merely the absence of disease. SOCIOECONOMIC INFLUENCE
○ Holistic ●
■ acknowledge that you need others HEALTH CARE DELIVERY SYSTEM

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 ● Availability of resources and facilities
● Availability of health services
THE ONE HEALTH CONCEPT
● Recognizes the interrelationship between animal,
human, and environmental health.
■ Training
● Capacity building
● This means that Community Health and Public
Health are the same
● CHN is about capacity building
● An area of human services directed toward
developing ​and ​enhancing ​the ​health capacities ​of
people — either singly, as individuals, or
collectively as groups and communities
○ Capacity building = Enhancing health
capabilities
○ Want people to acquire skills on their own
to maintain wellness
Community Health Public Health

communitare - French populus/populi - Latin

● derived from ● meaning people
“communitas”
○ meaning
people
HEALTH
● Article 2 Sec. 15 All but one are diseases transmitted by animals to humans
○ The state recognizes the right to healthcare except —
and shall instill health consciousness ● Leptospirosis
● Health is a basic human right ● Tuberculosis
● Is not only to be well, but to be able to use every ● Rabies
power we have (Nightingale) ● Lyme Disease
○ Role of the Nurse is to empower people -Tuberculosis
● Necessitates developing human potential
The CHN has which of the following concerns? Select all
NURSING (MEANS) that applies
● Putting people in the best possible condition for 1. Maternal and child welfare
nature to restore or tot preserve health (Nightingale) 2. Sanitation
● The unique function of the nurse is to assist the 3. Workplace hazard - threat to workmates
individual, sick or well, in the performance of those 4. Road safety
activities contributing to health or its recovery (or to 5. Healthcare delivery system
a peaceful death) that he would perform unaided if -All
he had the necessary strength, will, or knowledge.
And to do this in such a way as to ​help gain Which of the following statements about health are
independence as rapidly as possible​ (Henderson) applicable in the context of nursing?
1. Health is a human right and all should be given
COMMUNITY HEALTH NURSING equal access to healthcare
● Field of nursing practice that renders care to 2. Global warming and climate change results to
individuals, families, groups, and communities disasters that cause loss of lives and disrupts
focusing on health promotion and disease healthcare systems
prevention ​through people empowerment 3. Employment and education impacts health literacy
● Equipping them with knowledge and skills and ​decreases​ sensitivity of people to information
○ Empowerment = enabling 4. Animal and human health depends on
■ Teaching environmental health
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-all except 3 The basic principle in CHN is to promote a self reliant
community
Which of the following accurately describes a healthy
community? FEATURES OF CHN
1. Absence of all forms of illness across all age groups ● Developmental in approach
2. People are actively involved in various health ○ You have to educate
forums and programs ○ Each has a capacity to take of his/her own
3. Children are provided routine immunization so you teach the individual so he/she can
a. 80% must be vaccinated to promoted Herd independently do it
immunity according to the WHO ○ Equipping people with knowledge and
4. Sanitation policies are well placed at the barangay skills
-all except 1 ○ Care is coupled with teaching

Which of the following factors is related to an increasing ● Population-focused

number of cases of HIV/AIDS in the country ○ We don’t talk of individual patients only,
1. Physical environment we talk about ​population groups​.
2. HCDS ○ Make sure services are ​not just for one,
3. Genetics but for the group​.
4. Politics ○ If a particular need isn’t given to a
5. Behavior particular population, problems arise.
6. Socioeconomic influence ○ Example:
-2,5,6 ■ If sex education isn’t given,
teenage pregnancy may arise
What organized framework does a nurse use follow in among adolescents
hospitals and in the comm ○ Talk to lawmakers to make these policies
● Scientific method implemented and to protect the people from
● Review of health systems the health risks
● Cephalocaudal assessment ○ Thinking of needs of specific groups
● The nursing process ■ Workers
- Nursing process ■ Adolescents
○ Assess based on needs
Assistance in physical therapy of a trauma patient is a ○ Come up with strategies to promote
● Primary people’s health
● Secondary ○ Think of them as a group
● Tertiary ■ Ex. Women need to be screened for
● Specialized breast cancer and need health
-Tertiary teachings for when they reach
menopause
The emphasis of CHN is empowerment of the community ● Driven by Social Justice
by education. ○ Greatest good for the greatest number
○ Which of the following can I do that can
Multisectoral approach encourages collaboration in the impact more people?
implementation of health programs. ○ Common good
● work with everybody because all of them and their ■ Allocating supplies to the barangay
jobs will influence health. with the highest number of people
(vs barangay with few population)
The main responsibility of the CHN is to educate the public. ■ Conducting immunization in
schools (vs house to house which
will take more time)
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 ■ MMR vaccine that goes bad after 4
hours — tell patient to come back
on another day
● Reason for immunization
days
● Reduce wastage of medical
products to benefit more
people
○ Aim for equity
■ Give more to those who need more
● Ecology-oriented
○ Talks about how care is given in the natural
environment
■ Going where people are
● Schools, workplaces,
homes
● Ex. At work - Occupational
Health Nursing
● Do home visits since
people would be at their
homes
● In schools, perform School
Health Nursing and teach
hygiene and disease
transmission
● Multidisciplinary
○ Collaborative
■ Solution ​lies on everybody’s
hands, not just on one person
■ Fostering partnerships and building
linkages
○ Dogs and rabies
■ Developmental
● Teachings to dog owners,
etc about how rabies worth
■ Multidisciplinary
● Veterinarians:
immunization of pets
● Barangays: ordinances on
dogs
○ Working with others
○ Everyone needs to contribute to health
● Preventive Service
○ We are heavy on ​prevention (​Three
Levels)
○ Children coming to the health center with
chief complaint if diarrhea who are at risk
for dehydration and electrolyte imbalance
— Contact sanitary inspector because of
suspected coliform contamination —
Assemble the people and inform them with
the current health risk and teach to boil
water
○ Epidemiologic nursing
○ Preventing what’s about to happen
■ Think in advance
● Comprehensive Care
○ You cannot choose who your patients are
so you need to be prepared
○ Everytime we are on the field, expect
everyone
○ Care is general
○ Variety of cases
○ Loads of experience since it’s not for
beginners
● Consumer Involvement
○ We value patients as PARTNERS
■ Give them a sense of responsibility
so they don’t rely on us and we
make them involved
■ For them to participate, they must
know first
● Build on their awareness
○ We don’t see them as merely end users
○ TB DOTS
■ Instill in them that they need to be
responsible for their own health
● Pre-paid mechanism
○ People in power are paid to do it
○ Sugar beverage tax
■ To prevent people from buying it
■ Protect people from diabetes,
kidney disease
■ Gain money that the government
can use to fund UHC
■ Everyone is entitled to UHC
○ Health services we receive are coming from
our own pockets due to our taxes
5 C’s IN COMMUNITY HEALTH
● Clients as partners
○ They have endowed faculties so they can
improve and protect their health
○ Giving them a sense of responsibility
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 ● Collective in scope
○ Health is a ​shared reality and
responsibility
○ Inclusive
○ Everyone is covered
● Collaborative approach
○ Work together
○ Everyone can contribute
○ Multisectoral and multidisciplinary
○ The solution is in ​our hands
○ Nurses don’t have the solution to all the
problems, they have to work with
everybody to solve the problem
● Capacity building
○ Empowerment
○ Helping people acquire knowledge skills
by giving them information
○ Nurses are catalyst bc we facilitate people
acquire knowledge
○ Developmental
■ Combine with teaching
○ Justice is observed and adhered to
● Common good
○ Always for the ​majority
○ Would this be of benefit for more?
○ Greatest good for greatest number
○ Clinic visits would make you cover a lot
more people
PUBLIC HEALTH
● The art and science of ​preventing disease,
prolonging life, and promoting health
and efficiency through​ organized
community effort
○ The strategy is by organized
community efforts
■ Everything is systematic
and structured
○ Everybody should exert effort
through collaborating
○ People empowerment
○ Patients should be self-reliant
■ Able to perform things on
their own
○ There should be policies and laws
to have an organized community
■ Add legislative efforts
● The application of science in the context of
politics to remove inequalities in health in
delivering the best health for the greatest
number
○ Politics is crucial to health because
of the production of policies to
make things happen
○ Promote healthcare equality and
equity
● The ​collective effort​ of improving the
health of the population
○ We need each other
○ Any one can take the lead because
health is everybody’s business
○ Core is ​health education
● A special field of nursing that ​combines
the skills of public health, nursing and
some phases of social assistance ​and
functions as part of a total public health
program for the promotion of health,
improvement of the physical and social
environment ​rehabilitation, and prevention
of illness and disability (WHO Expert
Committee on Nursing)
○ Speaks of how CHN is an
integration of multiple disciplines
(since health is multidimensional)
○ We’re not simply meant
● May be defined as a field of professional
practice in nursing and in public health in
which technical nursing, interpersonal,
analytical, and organizational skills are
applied to problems of health as they affect
the community. These skills are applied in
concert with those if other persons engaged
in healthcare, through comprehensive
nursing care of families and other groups
and through measures for evaluation or
control of threats to health, for health
education of the public, and for the
mobilization of the public for health action
● The practice of promoting and protecting
the health of populations using knowledge
from nursing, social, and public health
issues
BASIC CONCEPTS
● Scope is collective because health connects us all
● Our starting point of care is in the communities
(Families tayo magsstart not sa individuals)
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Levels of Clientele ● Strengthen community action
● Individual - Family - Groups - Community ○ Work with communities
Unit of Service ○ Help them realize that everyone should
● Family participate to solve problems
● Place where we acquire concept of health and ● Develop personal skills
illness ○ An element of nursing is to teach people
● Health of community begins with the family how to do it so they can do it on their own
● It is through our families where we get our next time
knowledge of who gets sick and why they get sick ● Reorient health services
Philosophy ○ Focus on primary healthcare
● Worth and Dignity of Man
● All share the same worth and dignity 3 PILLARS OF HP
● For all, fair for all, respect 1. Good Governance
Principle: ○ Healthy public policy begins with good
● Greatest good for the greatest number governance
Primary Activity 2. Healthy Cities
● Health Education ○ Most people dwell in cities today
● People Empowerment 3. Health Literacy
● Equipping people with knowledge ○ After people acquire information, they
Primary Focus: utilize​ it
● Health Promotion/ Disease Prevention CORE FUNCTIONS OF PHN
ASSESSMENT
HEALTH PROMOTION AND DISEASE ● Gathering, processing, analyzing data
PREVENTION ○ Research: Major tool
● Health promotion is the process of ​enabling people ■ Generating evidence
to increase control over and improve their health ■ Help us create policies
○ WHO ○ Makes use of research to generate evidence
● Combination of ​educational and environmental that will convince decision makers that they
support​ for action and conditions conducive to need to make a policy to promote and
health protect health
○ Lawrence Green POLICIES
○ Knowledge is not enough ● Rooted in evidence
○ Include policies ● Think of benefit and burden, must be equal and not
■ Funding singling out a group
○ Healthy comprised of going to exercise and ● Train law (Sugar beverage tax) ​- Compels people
eating healthy diet to consume less sugary products
● Republic Act 9211
HEALTH PROMOTION STRATEGIES ○ Tobacco Regulation Act
● Build healthy public policy ○ Prohibits multimedia tobacco endorsements
○ Taxation is the single, most cost-effective ASSURANCE
measure to reduce tobacco and alcohol ○ Guarantee
consumption
○ RA 8980 LEVELS OF PREVENTION
■ Barangays should have
Level Focus Goal Activities
playgrounds for children
■ To promote physical activity Primary Well clients Promote Risk reduction
● Create supportive environments health
○ Infrastructures Specific
○ Facilities OLOF protection

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 ● Initiated by the DOLE in collab with the BON of
Secondary Sick clients Prevent Early detection
complication the Ph, DOH, PNA, and other stakeholders to
First aid (Early stage / Prompt promote nurse entrepreneurship
Asymptomatic) treatment ● FCNC’s
● Hospice, domiciliary and healthcare facility
Acute Surveillance management
● Public health advocacy
Emergency ● Home healthcare services
services
● Outsourcing public health delivery for LGUs, and
Tertiary Sick clients Limit Supportive care other government institutions
Disability ● Medical transcription services
(Late stage / Symptomatic
symptomatic) Management Healthcare Training Management
Rehabilitation ● PD442: NEW LABOR CODE
Chronic ● RA 11058
● Law on Occupational Health and Safety
FIELDS OF CHN
School Health Nursing Roles and Functions of the Public Health Nurse
● Focus: ​Health Promotion and Health Screening ● Three Roles sa BON (?) basta once you are
○ Health Promotion and Health Screening licensed:
○ Disease Prevention and Early Detection ○ Healthcare provider
○ Referral ○ Manager/Leader
○ Emergency Care ○ Researcher
● Activities about good food habits, how to prepare
food ROLES AND FUNCTIONS OF THE PHN
1. HCP
Occupational Health Nursing ● Being able to deliver care to
● Focus patients/community
○ Health Promotion ● Nurse employing the NP
■ Health Risk Assessment ● ADPIE
○ Health Protection ● Annual Physical Examination
■ Health Risk Management ○ Early signs and symptoms
● Encourage the higher ups to provide gyms for free 2. MANAGER/LEADER
because at risk na ang workers for CVD and DM ● Leader
● Guarantee that everyone will be of lesser risk ○ Influencing and motivating people
● Supervisor
Faith Community/Parish Nursing ○ Staffing and scheduling other
● Dealing with a population in the same workers
denomination ● Trainor
● Nursing ​combined with spiritual care​, ● Property Custodian
● They may work in either paid or unpaid positions in ○ Inventories, requisition if supplies
a variety of religious faiths ● Environmental Manager
○ Resources must be used efficiently
Correctional Nursing and effectively
● In jails and correctional facilities 3. RESEARCHER/EDIDEMIOLOGIST
● Provision to healthcare to prisoners and developing ● Participant in epidemiologic investigations
programs to ensure health ● Statisticians
○ Municipal stats thru tools such as
Entreprenurse/Independent Practice graphs and tables
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 ● Prepares and submits report ● Government and NGOs
● Health monitor of the community ● Taxation
● Gather data to identify trends and diseases - Taxation
in the community to come up with
preventive solutions or protective measures Level of healthcare delivery that offers basic hospitalization
4. HEALTH EDUCATOR under LGU
● After providing care, it is a must that you ● Secondary
educate them
● Teaching and training to sharing Health services were devolved to the LGUs for the
information following reasons except
5. PROGRAM IMPLEMENTER ● To transform LGus into
● Being able to deliver policies to
patients/community All of the ff are true of CHN except
● Protect people’s health ● Care is comprehensive and general
6. COMMUNITY ORGANIZER ● Care is episodic and focuses on individuals
● Help people solve their own problems ● Care is geared toward self reliance
7. ADVOCATE
○ Ensure the patient’s rights - Care is episodic

PHC aims to strengthen the hcds by

RA 1132
● Aims to prevent epidemics through mandatory
reporting of notifiable diseases and health events of
public health concern
ACT 3573 - LAW ON NOTIFIABLE DISEASES
HEALTHCARE DELIVERY SYSTEM
● Refers to the sum of all agencies, personnel, and
services directed to provide health care to the
population
● Critical for the need of a system - the Nurse

Weekly monitoring Sectors: Public and Private

Neonatal tetanus ● Ideally, public sector should play a larger role in the
Severe acute diarrhea healthcare delivery system
Acute flaccid paralysis polio ● RA 11123: Universal Healthcare System
Measles
AIDS COMPONENTS OF THE HEALTHCARE DELIVERY
SYSTEM
Within 24 hrs
Acute flaccid paralysis polio AGENCIES
Measles Department of Health (National)
For eradication ● Lead agency for health in the country
Rabies ● Develops, initiates and monitors health programs at
ACP the national level
Measles ○ Duty is not limited to providing health care
Neonatal Tetanus alone
● HCDS ● Mandate from ​Constitution 1986 Article 2 Section
15​: The state recognizes the health of all Filipinos
Quiz in CHN and shall instill health consciousness among them.
● Dimensions of Healthcare: ​Promotive, Preventive,
All but one are components of the HCDS Curative, and Rehabilitative
● Health professionals ○ Problem in our HCDS is that we are
● Facilities and services focusing on curative
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 ● Vision: ​Filipinos are among the healthiest among
people in Southeast Asia by 2022 and Asia by 2040
● Mission: ​To lead the country in the development to
a ​productive, resilient, equitable, ​and
people-centered health system.
○ Equity: Give more to those who have less
● Given its mandate, it is necessary for DOH to be a
both a ​policy and regulatory body​ for health
○ Issues license of hospitals to operate
○ Sets standards for LGUs to follow
● As a major player the DOH is a:
○ Technical resource
■ Conducts research, offer support
and guidance
○ Catalyzer for health policy
■ Takes the first steps to lobby in
congress to benefit public health
■ Accessible cheaper medicine law
○ Political sponsor and advocate ​for health
issues in behalf of health sector
Comprehensive Reforms in Health
● FOURmula 1+ (2018-present)
● All for Health towards Health for All (Duterte
Agenda until 2017)
● Universal Health Care (2005-2016)
● FOURmula One for Health (2005-2010)
● Health Sector Reform Agenda (1999-2004)
● LALABAS SA EXAM
The direction of the DOH depends on the president in
power
● Sustainability should always be considered
NATIONAL OBJECTIVES FOR HEALTH
(2017-2022)
● Serves as the ​medium-term roadmap​ of the
Philippines towards achieving Universal
Healthcare
● It specifies the objectives, strategies, and targets of
the Department of Health FOURmula 1+ for Health
NATIONAL OBJECTIVES FOR HEALTH GENERAL
GOALS 2022
1. Better health outcomes​ with ​no major disparity
among population groups
○ Reduce mortality cases of hypertension,
diabetes, cancer, etc.
○ Health Disparity - Equal outcomes
■ To reduce disparity, ​push for
legislation​, and make sure that
health programs are ​funded by the
law
■ Universal health care - Everybody
receives the benefit
■ Ordinance - Only for the
government
2. Financial risk protection​ for all especially the
poor, marginalized, and vulnerable
○ UHC is an answer to this goal
3. A ​responsive health system​ which makes Filipinos
feel respected, valued, and empowered
○ Give opportunity to learn by sharing
information
F1 Plus for Health
● Framework and game plan of the DOH to achieve
targets
● Aims to attain the goals
LOCAL GOVERNMENT UNITS
● RA 7160: Local Government Code
○ The local governement can lihis to the sht
of the national government and that they
can start their own health care
○ Giving local governments autonomy
○ Aim: To transform local government units
into:
■ Self-reliant communities
■ Active partnership with the people
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 ■ Responsive to the needs of the ■ TBA (
people ■ Traditional Healers
■ Accountable government - These people help immediate health
representatives workers
■ Decentralization system on health - Include lay persons = community
decision making participation
■ Bottomline: Provide access to - Educational attainment is not a priority
healthcare ○ Intermediate Health Workers
● Implements health programs at the community level ■ MDs - 50,000 (ideally 20,000)
■ PHNs - 20,000
■ Midwife - Primary health worker;
5000
● Teams
○ Basic PHC Team (3)
■ Midwife, nurse, physician
○ Basic RHU Team (6)
■ Midwife, nurse, physician, dentist,
sanitary inspector, BHW
Grass roots

SERVICE
- Exceptions to this would be cities ● Primary
○ Out-patient services
PRIMARY ● Secondary
● Midwife ○ In-patient services
○ 1 is to 5000 ■ Bed and space will be occupied
SECONDARY ■ Not all may be accommodated
● Nurse ● People must seek primary
○ 1 is to 20,000 health care services first
● And all other HCP ○ Basic hospitalization
TERTIARY ● Tertiary
● Physician ○ In-patient services
○ 1 is to 50,000 ○ Specialized care
○ Critical care
COMPOSITION OF LOCAL HEALTH BOARDS
● Chairperson: Mayor or Governor TWO WAY REFERRAL SYSTEM
● Vice-chairperson: Municipal/Provincial Health ● Communication among facilities
Officer ● Increased competency of specialized care
● Members
○ Chairman of the Health Committee of In secondary and tertiary, not all can be accommodated
Sangguniang Pambayan/Panlalawigan because of the number
○ NGO Representative
○ DOH Representative As you go up, the cost, competency, and care also rise

PERSONNEL PRIMARY HEALTH CARE

● Categories of Health Workers ● Focuses on delivering care to individuals and
○ Grass Roots population groups
■ BHW/VHW ● Overall strategy to address the social determinants
■ Volunteers of health
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 ○ Require multidisciplinary efforts or
initiatives
○ Valuing knowledge and opinions of other
professionals
○ Health in the hands of the people
○ Health within reach
● Total approach to healthcare
● Has to begin with what’s basic
● Gives importance to collaboration
● Considers patients as partners
● Health is more than a right but also a responsibility
● We want people to acknowledge that health is in
their hands = health within reach
● 3 Dimensions
○ Goal
■ 17 Sustainable Development Goals
○ Strategy
■ Active participation of the
community
■ Organized community efforts
○ Philosophy
■ Introduced in the country on 1978
■ Goal by 2000 which became 2020
then now at 2030
Primary Care
○ More medical in context/approach
○ Point of contact care in which we expect
that
○ Provides basic healthcare services like
consultation, simple lab test
○ Majority are private
○ We refer them as clinics which are
privately owned by physicians
○ Require Out of pocket expenses, deriving
people of ​access
○ Use beyond primary care which is ​primary
health care
PRIMARY HEALTH CARE: HISTORICAL
PERSPECTIVE
● 1977 - 20th World Assembly of WHO and the HFA
2000 Movement
○ Health for All the Year 2000
○ They weren’t able to talk about how nila
maachieve
○ GOAL
● 1978 - Alma Ata Conference and Declaration
○ First ever conference on Primary
Healthcare
○ Primary Healthcare was officially launched
○ STRATEGY
● PHC identified as a key strategy in achieving the
HFA by the year 2000 goal
● 1979 - PH adopting PHC through Letter of
Instruction 949
● 2018 Astana Declaration reaffirming commitment
to PHC globally and commit to UHC
○ Implement primary healthcare and
universal health coverage
○ Brought UHC in the Mainstream
○ Echoes the Alma Ata Declaration
○ Promotive, Preventive, Curative,
Rehabilitative, and Pallative
■ Rehabilitative, you expect them to
still recover but in Pallative, you do
not expect them to recover; both
are
● 2000-2015 MDGs
○ Global health targets
● 2016- 2030 SDGs or Agenda 2030
● Underlying concepts touch on health
● The way to achieve all of the targets is through
Primary Healthcare
PRIMARY HEALTH CARE DEFINITION
● Essential healthcare based on practical,
scientifically sound and acceptable methods and
technology made universally accessible to
individuals in communities through ​full
participation​ and at a cost the community and the
country can afford to maintain at every stage of
their development in the spirit of ​self-reliance​ and
self-determination
○ Full participation - organizing communities
to empower the people, so that they are
aware of their responsibilities and rights
○ Self-reliance - we want them to be
independent; equip them with knowledge
skills, and attitudes for capacity building
○ Self-determination - patients have
autonomy so let them but stop or intervene
when it already affects other people
● Definition: Essential healthcare made universally
accessible​ to the people by means ​acceptable​ to
them
○ Essential healthcare: basic
○ Everyone is entitled to it
○ Health for all by all
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 ○ 5 A’s of the Characteristics of Primary
Health Care
■ Accessible - must be within 5 km
or 30 mins
■ Available
■ Affordable - both for patient and
government to maximize resources
for the greatest good and the
greatest number
■ Acceptable - respect culture and
social norms
■ Appropriate - criteria, has to be
effective, safe, and sensitive; went
through research
● Mission: Strengthen the HCDS by providing and
supporting conditions wherein the people will
manage their own health
○ We want the people to manage their own
health and gain independence and feel
empowered
● Goal:Health in the hands of the people by the year
2020
○ Health for all, by all
○ Give access to health
○ Achieved through Universal Health
Coverage to achieve the SDGs
● Strategy: Believes in working together -
collaboration
● Philosophy: The spirit of PHC lives on,
acknowledging that people should be independent,
self reliant and want to build their capacity
○ As a guide, this is involves ppl, work with
other professionals/people
PHC SERVICES ELEMENTS
Core is capacity building
● E ​Education on Health
○ Risk reduction, health promotion like
smoking cessation
○ Should be applied on all settings
■ School: Promote healthy eating
habits
■ Occupational settings: Stress
management like gyms and going
on exercise to raise their
consciousness
● L ​Local Disease/Endemic Disease Control
○ IMCI - Integrated Management on
Childhood Illness
■ Protocol on treating children under
5
○ Best managed in primary care
● E ​Essential Drugs
○ These are medicines that are must haves,
life saving and good for the
○ Hyperetensive Drugs (Losartan,
Amlodipine)
○ Mitformin for Diabetes
○ Oresol
○ Antibiotic (Amoxycillin)
○ Paracetamol (For febrile patients)
○ Contraceptives
■ RPRH: RA 10354
● Responsible Parenthood
Reproductive Health Law
● M ​Maternal and Child Health
○ Safe Motherhood
■ Prenatal checkups for early
detection (Secondary)
■ High-risk Pregnancy
● Too young, Too old, Too
many (more than 5), Too
close, Too sick
○ Dealing with childhood conditions
● E ​Expanded Program of Immunization
○ Herd immunity - 80%
● N ​Nutrition
○ Food fortification
● T ​Treatment of Simple Ailments
○ First Aid
○ Wound Care
● S ​Sanitation
○ Food Safety
○ Water Sanitation - safe drinking water
○ Waste Management
○ All three can be vectors of disease
PHC SERVICES CORNERSTONES (AIUS)
● Active Community Participation
○ Forming groups who will start initiating
health programs
○ Health in the hands of the people
○ Give them a sense of ownership, they must
be involved, take responsibility
○ Most important
● Inter-Intra-Sectoral Linkages
○ Working with others
○ Collaboration
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 ● Use of Appropriate Technology ○ Remove cover and use clay pot to allow
○ Effective and safe oxidation of impurities
○ Use of Eastern from Western = Alternative ● O​ne kind of plant for each type of symptoms to
○ Use of Eastern and Western = avoid possibility of drug
Complementary ● N​o pesticides
○ SANTA LUBBY ○ Avoid poisoning
○ Use of Herbal Medicines: RA 8423 ● U​se only the part recommended
Traditional Alternative Medicine Act ● S​top in case of untoward reactions; seek
○ Sambong (Camphor) consultation if s/sx not relieved after 2-3 doses
■ Diuretic
■ Prevent edema AROMATHERAPY
○ Akapulko (Ringworm Bush) ● Alternative form of holistic therapy that uses
■ Anti-fungal essential oils to help improve and create an
■ Tinea infections emotional and physical balance in the individual
○ Niyog-niyugan ● Works on three main levels: through teh sense of
■ Anti-helminthic smell, through absorption, and through absorption
○ Tsaang-gubat (Wild tea) via the skin
■ Diarrhea
■ High in chlorine content AGENDA 2030 or SDGs
■ Stomachache ● Elaborated MDGs lang
■ Tooth decay ● Most important is #3
○ Ampalaya ○ Good health and well-being
■ Mild NIDDM ○
■ Diabetes ● SDG 3 has 9 targets
○ Lagundi ○ To ensure healthy lives and promote well
■ Fever, cough, cold, and asthma being for all ages
■ Can be used for pain except for ■ Reduce Maternal Mortality
dysmenorrhea bc it can worsen the ■ Newborn and Child Mortality
pain ■ Communicable Diseases
○ Ulasimang bato (Peperomia) ■ NCDs and Mental Health
■ Lowers uric acid ■ Substance Abuse
■ Gouty arthritis ■ Road Traffic Accidents
○ Bawang ■ Reproductive Health
■ Anti-lipidemic ■ Universal Health Coverage
■ Lowers cholesterol, reduces bp ■ Environmental Health
■ Used as an antiseptic ● 4 Means/Mechanisms of Implementation
○ Bayabas ○ Tobacco Control
■ Toothache ■ Syntaxes
■ Antiseptic wash ○ Vaccines and Medicines
○ Yerba buena ○ Health Financing and Workforce
■ Rye - pain ■ Syntaxes and pushing for UHC
■ Pain reliever ○ Global Health Security
■ Arthritis ○ What happens in the national level impacts
● Support System made available the global level
○ Primary to Secondary to Tertiary if di
mahandle sa lower UNIVERSAL HEALTH COVERAGE
● All people having access to quality HS without
NURSING CONSIDERATIONS (BONUS) suffering financial hardship association with paying
● B​oiling for care
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 ○ All people (population coverage)
○ Access to quality health service (service
coverage)
○ W/o suffering financial hardship (financial
risk protection)

Primary Health Care

● Is a critical foundation for UHC

RA 11223
UHC = PAGCOR/PCSO + PhilHealth + Sin Tax

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SAFE MOTHERHOOD PROGRAM
PRENATAL SERVICES
ACTIVITIES UNDER ANTENATAL
MATERNAL DEATHS BY MAIN CAUSE ● Intensive Assessment
1. Complications​ related to pregnancy occuring in the ○ Serves both primary and secondary levels
course of ​labor, delivery, and puerperium of prevention
2. Hypertension​ complicating pregnancy, childbirth, ○ Profile of Patient
puerperium ■ Demographics
3. Postpartum hemorrhage ● Age - Identify if too young
4. Pregnancy with ​abortive outcome​s or too old
○ Dystocia (?)
❖ Pregnancy is their common ground ○ Psychological
❖ We want all deliveries and unpreparedness
❖ Assessment - Women are dying because of labor ■ Anthropometric Measurement
and delivery ● Weight
❖ Policy - Evidence is translated into policy - EINC ○ Obese - Baby may
❖ Assurance - All pregnancies will be safe be too big
○ Uterus becomes
too stretched and
● WHO recommends a ​minimum ​of ​four antenatal uterus may become
visits atonic and flabby
○ Before delivery, during pregnancy ○ Leading to
○ Reduce risk of woman and baby hemorrhage
○ Helps screen if woman is going through a ○ Labor is prolonged
complicated pregnancy causing decreased
■ Too young tissue perfusion to
■ Too old the fetus
■ Too many ● Height
■ Too close ○ Woman under 5ft
■ Too sick ○ Might affect her
○ 1st visit: Before 4 months pelvic structure
○ 2nd visit: 6 months and ability to
○ 3rd visit: 8 months ○ Pelvic inlet and
○ 4th visit: 9 months outlet may be too
● Lying-in clinics - puericulture centers small making
○ 5Ps
■ Power
Number of WHO/UNICEF/DOH PHN 2007
■ Passageway
Visits CPG 2005/2006 Book
■ Passenger
First Before 4​th​ month of 1​st​ trimester ■ Psych11
pregnancy ■ Position
○ Obstetric History
Second Between 6​th​ to 7​th 2​nd​ trimester ■ If more than ​5 Pregnancies
month of pregnancy ● May lead to ​uterine
prolapse​ causing heavy
Third 8​th​ month of pregnancy 3​rd​ trimester bleeding - death
■ GPTPAL
Fourth 9​th​ month of pregnancy After 8​th​ month: ■ LMP (Last Menstrual Period)
every 2 weeks ■ AOG (Age of Gestation)
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 ■ EDC (Expected Date of ○ Most Common:
Confinement) ○ Prevent anemia and neural defects
○ Comorbidity ○ Pallor-anemia:
■ Identifying underlying conditions ○ Normal 11g/dl
that may affect pregnancy Iron Supplementation
○ Physical Exam
TARGETS PREP DOSE AND
■ Objective Data DURATION
■ Inspection
● Edema Pregnant women Tab containing 1 tab 1x/day for
● Bleeding 60mg El w/ 400 6 months or 2
● Gaining weight is normal mcg Folic Acid tabs/day if 2nd or
mga 24lbs / 12kg for 3rd trimester
Filipinos Lactating women Tab containing 1 tab 1x/day for
● Rapid weight gain in 60mg El w/ 400 3 months or 90
pregnancy is expected at mcg Folic Acid days
the Third Trimester
■ Palpation
● For Vit. A Deficiency (VAD)
■ Percussion
● Vit A: Can cause congenital problems if given early
■ Auscultation
● Do not give Vit. A if woman is taking
○ Laboratory Tests
multivitamins
■ Urinalysis
● UTI: If left undetected may TARGETS PREP DOSE AND
cause ​pelvic inflammatory DURATION
disease ​- may result to Pregnant women 10,000 IU 1 cap/tab 2x/wk
premature labor (4th mo. until
● Proteinuria - Preeclampsia delivery)
● Glucosuria
■ CBC Lactating women 200,000 IU 1 cap 1x
● Hemoglobin (within 4 weeks
after delivery)
○ 12-14: Female
○ 14-16: Male ● Iodine Supplementation
○ Anemia - not a TARGETS PREP DOSE AND
disease condition DURATION
but a manifestation
that there is Children of Iodized oil 1 cap for 1 year
something wrong school age capsule w/ 200
in the body mg iodine
○ Pre-eclampsia: Women Iodized oil 1 cap for 1 year
Pregnancy Induced 15-45 years old capsule w/ 200
Hypertension mg iodine
○ Polycythemia
● Hematocrit Adult males Iodized oil 1 cap for 1 year
■ Venereal Disease Research capsule w/ 200
mg iodine
Laboratory
● Syphilis
■ HIV test ● Immunization
● Micronutrient Supplementation ○ Tetanus Diphtheria
○ Purpose​: Risk reduction against ■ Protection against Tetanus
Micronutrient Deficiency
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 ■ Preferably given at 4th month of ●​ ​Continuous maternal support, by a companion of
pregnancy her choice, during labor and delivery
■ Fully Immunized Mother (5 shots) Companion​ is needed to alleviate stress
● 3 at minimum - offer Stress​ – leads to higher blood pressure, which
immediate protection for leads to vasoconstriction, which affects
mother and baby perfusion at the level of the placenta
Mother​ – usual companion (assists during labor
and delivery)
DOSE WHEN LENGTH
●​ ​Mobility during labor - the mother is still mobile,
1st Anytime during within reason, during this stage
pregnancy Facilitates fetal descend
Form of diversion to minimize stress
2nd 1 month after 1st 3 yrs
●​ ​Position of choice during labor and delivery
dose
●​ ​Non-drug pain relief, before offering labor
3rd 6 months after 5 years anesthesia
2nd dose ●​ ​Spontaneous pushing in a ​semi-upright position
○​ ​Encouraged but not done due to the lack of
4th 1 year after 3rd 10 years practice even with evidence/research
dose
●​ ​Episiotomy will not be done unless necessary
5th 1 year after 4th Lifetime Shaving​ is not routinely done
dose *​Metargin​ – never administered during labor
Analgesic​ – may arrest the process of labor
Dose: 0.5ml
Labor too long – causes fetal distress (usually,
Route: IM
there is a need for CS)
Site: Deltoid Muscle
●​ ​Active management of third stage of labor
(AMTSL)
● If 2nd dose is given at least 2 weeks before delivery
●​ ​Monitoring the progress of labor with the use of
○ Assurance of full protection against
partograph
neonatal tetanus
● Look at the number of pregnancies
POSTNATAL VISITS
● 2nd dose is given if mother has already delivered,
●​ ​Minimum of 2
for the protection of future pregnancies
● 3 doses of Pentavalent in Infancy
○ 1st 2 doses of tetanus toxoid # OF WHO/DOH/UNIC PHN
● 2 shots para protected both baby and mother VISIT EF 2005/2006 2007
● No such thing as overdose S BOOK

Precautions: 1st 1st 24 hours to 48 Within

● Ask if they already ate because it causes GI upset hours after delivery 3-5
● Ask if right/left handed because it causes soreness days

2nd 6 weeks after 6

Health in SDG 3
delivery weeks
● To ensure healthy lives and promote wellbeing
after
● 4 Means of Implementation
deliver
○ Tobacco control
y

EINC PRACTICES DURING INTRAPARTUM First 24 hours check up:​ (​mother​) to identify if there is
PERIOD hemorrhage or uterine atony, (​infant​) to identify if the
infant is sucking well (may be a sign that the child is
AMPATUAN | ANURAN | COLCOL | CONCIO
 suffering from a neurologic condition, causing change in ●​ ​Ask: ​about h​ im/herself
the level of consciousness ●​ h​ ealth center and the ​services​ provided
​Tell:

●​ ​Help: ​make the​ decision​ that is best for him/her

RA 11148​ - KALUSUGAN AT NUTRISYON NG ●​ ​Explain: ​relevant ​information​ about the

MAG-NANAY ACT symptoms, diagnosis, treatment.

●​ ​First 1000 days​ of life is the period of rapid
growth where nutrient deficiencies can have
long-term consequences.
●​ ​Good nutrition maximize the child’s ability to
grow, learn, and develop that has profound
effect in his/her future health, well-being and
success alter on in adulthood. The quality of
nutrition during the first 1000 days can have a
significant impact on the achievement of
national and global development goals
Helps reduce maternal and child mortality, and
gives emphasis on nutrition
FAMILY PLANNING
Determines the ​number of pregnancies
FOUR PILLARS
1.​ ​Responsible Parenthood
Involves both husband and wife
Begins with understanding that having kids is a
responsibility
2.​ ​Respect for Life
3.​ ​Child Spacing
Close interval pregnancies:
Will put the woman at high risk
May cause malnutrition: ​kwashiorkor​ (disease
of the 2​nd​ child)
4.​ ​Informed Choice
Autonomy
PRIORITIES
●​ ​Couples in the reproductive age: ​20 to 44 years
More capable of giving birth
●​ ​3 or more children
Beyond 3 may be economically challenging
●​ ​Close interval pregnancies
More people means more tax payers which
means more social services
●​ ​(+) chronic disease
Pregnancy will put their health at risk (for the
reduction of maternal and child mortality)
COUNSELING
●​ ​Greet: ​warmly and ​politely
●​ ​Return​: ​schedule​ a return visit.
RA 10354
●​ ​Responsible Parenthood and Reproductive Health
Law
Requires ​national budget to be allocated​ for
contraceptives
Mandatory family planning
Introduced ​sex education​ in basic education
Implemented: ​2014
Culture: ​where the gap lies
CHILD HEALTH PROGRAMS
ESSENTIAL NEWBORN CARE: UNANG YAKAP
(December 1, 2009)
●​ ​AO 2009-0025: ​Adopting Policies and Guidelines
on Essential Newborn Care
Used to reduce child mortality (neonates die
because of infection, hypothermia,
hypoglycemia, etc.)
●​ ​Focus​: MDG 4​ (out of 8)
●​ ​Performed in the ​first 90 minutes of life​.
This is a critical period where hypothermia and
hypoglycemia sets in
4 TIME-BOUND INTERVENTIONS
●​ ​Immediate drying
○​ ​Thorough drying for 30 seconds to one
minute warms the newborn and ​stimulates
breathing
Head to toe
Use two cloths
●​ ​Skin to skin contact
○​ ​Early skin-to-skin contact between mother
and newborn and delayed washing for at least
six hours prevents hypothermia, infection,
and hypoglycemia
*Don’t dry palms of hands
Don’t remove vernix caseosa
Delay bathing
3 benefits:​ prevents hypothermia
(​poikilothermia​),
Tummy then in between breasts
AMPATUAN | ANURAN | COLCOL | CONCIO
 Galactosemia Death or Alive and
●​ ​Proper cord clamping and cutting
Cataracts Normal
○​ ​Properly timed cord clamping and cutting
prevents ​anemia​ and protects against brain Phenylketonuria Severe Normal
hemorrhage​ in premature newborns. It (PKU Mental
means waiting for the cord pulsations to stop Retardation
(between 1 to 3 minutes)
■​ ​Clamp 2 cm and 5 cm from the base of the G6PD Deficiency Severe Normal
umbilicus Anemia,
Kernicterus
●​ ​Non-separation of baby from mother and
breastfeeding initiation Maple Syrup Death Normal
○​ ​Protects infants from dying from infection. Disease
The first feed provides colostrum, a substance ●​ T
​ imeline​:

equivalent to the babies’ first immunization ○​ ​Ideal​: 48-72 hrs or 2-3 days of life
in its protective properties Within 48 hours​, there is still maternal
○​ ​RA 7600​ - Rooming In blood in the system (which may make the
1st ever breastfeeding law result ​inaccurate​)
Basis for the ​MBF​ ​(mother-baby-friendly) The infant has to ​pass stool first ​(to check
hospital recognition for phenylketonuria)
○​ ​RA 10028​ -- Expanded Breastfeeding Law ○​ ​Maybe​: 24 hours

NEWBORN SCREENING PROGRAM 1.​ ​Using heel prick method, a few drops of blood are
●​ ​RA 9288 Newborn Screening Act of 2004 taken from the baby’s meal.
Mandatory​, but the cost is ​out-of-pocket 2.​ ​Blotted on a special absorbent filter card.
Screens for metabolic condition (which may 3.​ ​Blood is dried ​for 4 hours​ and sent to the NBS
result to mental retardation or premature death; center.
aims to reduce child mortality) 4.​ ​After ​7 working days​, parents claim the results
●​ ​Detect congenital metabolic disorders that may from the physician, nurse, midwife, or health
lead to mental retardation or even death if left worker:
untreated ■​ ​If ​positive (+) screen​:
●​ ​Expanded NBS offers 2 packages, ​basic 6​, and ●​ ​Released ​within 24 hours​ for
additional 22 for a total of 28 diseases. confirmatory testing
●​ ​Trained MD, RN, midwife. RMT ●​ ​Referred to a specialist for further
screening
6 DISORDERS IN THE NBS PACKAGE
Screened Effect if Effect if ROLES OF RHU STAFF IN NBS
NOT SCREENED 1.​ ​Adovcacy​ for NBS of every baby. This starts
SCREENED and during pregnancy. The family is advised to save
TREATED P600.
Best done at the ​first​ antenatal visit
Congenital Severe Normal 2.​ ​Collection​ of samples.
Hypothyroidism Mental 3.​ ​Assures ​Transport of specimen​ within 24 hours
(CH) Retardation following collection of the sample.
4.​ ​Advice and counsel parents ​upon receiving the
Congenital Death Alive and screening results.
Adrenal Normal
Hyperplasia RA 9709
(CAH) ●​ N
​ ewborn Hearing Screening Test

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 ●​ ​Focus​: Prevention and Detection of Hearing
Defects Among Neonates
●​ ​Otoacoustic Emission Test (OAE)​ one day after
the infant is born
Early detection and to limit disability (hearing
loss)
BREASTFEEDING
RA 10028
●​ ​Expanded Breastfeeding Law
●​ ​Responsible for mandating lactation break and
breastfeeding stations in establishments
Entitled to ​additional break​ for expressing
breastmilk
Assessment​: breastmilk is best for babies 2
years of age and beyond​ (provides immunity)
BREASTFEEDING TSEK
●​ ​Breastfeeding ​Tama​, ​Sapat​, at ​EKslusibo
●​ ​Launched​: February 23, 2011
●​ ​Target​: new expectant mothers in urban areas
●​ ​Encourages mothers to exclusively breastfeed their
babies from birth up to 6 months.
Complete nutrients
After six months​, maternal stores of vitamin A
and others are depleted (which would require
complementary feeding)
●​ ​Exclusive breastfeeding means that for the​ 1​st​ six
months ​for birth, nothing except breastmilk will
be given to babies.
BENEFITS
●​ ​Offers protection/immunity
●​ ​Offers complete nourishment (1​st​ 6 months)
●​ ​Promotes maternal-child bonding
The ​personality develops​ when the child
breastfeeds (reality orientation: source of
breastmilk is not the child, but the mother)
Autism​ – may develop due to
maternal-child bonding
*Id​ – begins to develop in toddlerhood
●​ ​Cost-efficient
RECOMMENDATIONS
●​ ​Frequency​: 8 x in 24 hours (minimum)
Day​ – 6 times
Night​ – 2 times
When they feed less frequently, the production
begins to drop – mas madalas mag-padede, mas
madami ang gatas
●​ ​Feed​ as long as the baby wants
●​ ​At 6 months, start supplementary feeding but
breastfeeding should be continued until 2 years of
age or beyond
Food​: encouraged to eat galactagogues
(malunggay oysters, clams, soups)
Fluid​: 1.5 to 2.5 L (too much fluid can suppress
prolactin secretion)
*Hygiene​: do not wash with soap and water
POSITIONS FOR BREASTFEEDING
●​ ​Cradle Hold/Madonna/Cross-Chest Position
●​ ​Football Hold/Clutch Position
●​ ​Side-lying Position
Not recommended at night
HOW TO GET BABY TO LATCH ON
Crucial in the first visit after delivery
1.​ ​C-hold
2.​ ​Stimulate the baby’s rooting reflex
Place nipple at the side of the breast
3.​ ​When the baby’s mouth opens wide, ut the nipple
and as much of the areola as possible into his
mouth
HOW TO MAKE BABY LET GO OF THE BREAST
WITHOUT HURTING THE MOTHER
1.​ ​Press down on the breast near his mouth
2.​ ​Pull down on his chin and insert a small finger and
in the corner of his mouth. This will break his seal
on the nipple
3.​ ​Then remove him from the breast
SIGNS THAT BABY HAS PROPERLY LATCHED
1.​ ​Mouth wide open
2.​ ​The baby and the mother are in tummy to tummy
position
3.​ ​Much of areola is inside baby’s mouth
4.​ ​Mother does not feel pain
5.​ ​The baby is relaxed and happy
EXPANDED PROGRAM ON IMMUNIZATION (EPI)
●​ ​ ​RA 10152
○​ ​Mandatory and Basic Immunization of
Infants and Children
■​ ​Under 5 years of age
■​ ​Priority Target: Under 1
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 ●​ ​Fully Immunized Child Strong immune system + Weakened antigen = Immunity
●​ ​1 BCG, 1 IPV, 2 MMR, 3 Stimulates the production of antibodies
POLIO PENTA PN (6, 10, 14) You become immune in the process
○​ ​PD 996 repealed already Weak immune system + Weakened antigen = Disease
○​ ​Gave authority to DOH Secretary to add more
vaccines as necessary All types of ​acquired​ is natural (except for
■​ ​Under 8 to under 5 immunization)
●​ ​Most vulnerable to infection are Vertical transmission​ (mother to baby): natural
children 5 below (Routine immunization via placental transfer or breastmilk
Immunization)
●​ ​Children who had vaccines Active​: ​antigen​ is usually administered, which makes
above 5 (Supplemental the body produce its ​own antibodies
Immunization) Lasts long-term​ (mobilizes the memory cells of
○​ ​At least 80 - 95% immune system)
Fever​ is invoked by vaccines that are highly potent
IMMUNIZATION (like pentavalent vaccine)
●​ ​Process of conferring ​artificial​ immunity When ​antigen​ is administered, the body is
alarmed so you get ​fever ​(good sign; not all
IMMUNITY vaccines cause fever, because it’s already
●​ ​Acquired ​specific​ resistance usually attributed to weakened)
the presence of ​antibodies Basta, natural = active (except vertical transmission)
○​ ​Active immunity is better than the passive Passive​: an a​ ntibody​ is introduced
type because it produces a secondary immune Lasts less than a year in the body
response which leads to the formation of Pass​ antibodies
memory cells which acts faster and stronger
and lasts for a lifetime OBJECTIVE OF THE EXPANDED PROGRAM ON
○​ ​Biologicals IMMUNIZATION
■​ ​Vaccine ​(antigen) ●​ ​To ​reduce morbidity and mortality​ rates
■​ ​Immunoglobulin ​(usually designated among infants and children from six childhood
by the prefix –anti) immunizable disease
■​ ​Toxoid ○​ ​Tuberculosis, Poliomyelitis, Diphtheria
Tetanus, Pertussis, and Measles
Natural Artificial
PRINCIPLES
Active ·​ ​Exposure Antigens ●​ ​It is based on epidemiological situation
·​ ​Carrier Attenuated​ – BCG, Schedule of routine immunization is depending
·​ ​Sick
of the OPV, AMV on the problems present in the area
disease Killed​ – DPT, HBV ●​ ​It is basic health service
Pertussis To make everyone protective
(pangingisay) Right of health and longevity
Weakend toxins ●​ ​It is mass in approach
Target is to build ​herd immunity ​(80% is the
Passive ·​ ​Breastmilk Gammaglobulin (B target but ideal is 95%)
(IgA) and T cells) (6 months
·​ ​Placenta to 1 year) ELEMENTS: TICAS
(IgB) Antitoxin, antiserum, ●​ ​Target-setting
serum Identifying who is our priority population (under
1 year old)
Target​: under 1
AMPATUAN | ANURAN | COLCOL | CONCIO
 Covered​: under 5 (children are eligble for CONTRAINDICATIONS
routine immunization until 5 years of age) ●​ ​Fever about 38C
As immunization goes up, the mortality goes Vaccines may cause febral seizure
down ●​ ​Conditions requiring hospitalization (severe)
Fully immunized child:​ child protected from Severe pneumonia
disease ●​ ​Immunosupression
Has received all routine immunizations by 1 If receiving steroids
year old Chemo
Completely immunized child HIV – results to disease rather than receiving
Has received all routine immunizations immunity
beyond 12 months Strong immunity + Weak antigen = Resistance
●​ ​Information, education, and communication Weak immunity + Weak antigens = Disease
4 things to teach the mother:​ ​(1)​ what it is for
(indication), ​(2)​ what to expect, ​(3)​ what to do Malnutrition is not a contraindication; it magnifies the
(warm compress, massage, etc.), ​(4)​ when to infection (he needs the protection)
return
●​ ​Cold chain logistic management STRATEGIES
Avoid vaccine wastage -> Deprived children -> ●​ ​Conduct of Routine Immunization for Infants/
Poor coverage Children/ Women through Reaching Every
FEFO rule​: first expiry, first out Barangay (REB) strategy’
Check the VVM​: vaccine vial monitoring House-to-house if they were not able to receive
●​ ​Assessment and evaluation immunization because the vaccines ran out: use
Check if the child is physically fit before Principle of Justice (those who missed
immunization immunization, must still be covered)
Check for contraindications ●​ ​Supplemental Immunization Activity (SIA)
●​ ​Surveillance and research ●​ ​Strengthening Vaccine-Preventable Disease
Surveillance
MAINTENANCE OF POTENCY OF BIOLOGICALS
OPV – offers protection in the GI tract
TYPE OF STORAGE
IPV – offers protection in the blood
VACCINE TEMP.
Pentavalent (heme) and pneumococcal – offers protection
Most OPV -15C TO 25C against meningitis
sensitive to AMV (freeze Freezer
heat dried) (traditional) Two topics:
Garantisadong pambata
Least DPT 2C to 8C IMCI
sensitive to Hepa B Refrigerator
heat
BCG

TT

DURATION OF STORAGE
●​ ​RHU​ - 1 month
In the event of a power failure, the ​wastage​ is
limited to one month (in RHU)
●​ ​Provincial Health Office​ - 1 month
●​ ​Regional Health Office​ - 3 months

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