COMMUNITY HEALTH NURSING I
What is a community?
"a group of people with common characteristics or
interests living together within a territory or
geographical boundary *place where people under
usual conditions are found
What is health?
-Health-illness continuum
-High-level wellness
Agent-host-environment
-Health belief
-Evolutionary-based
-Health promotion
-WHO definition
What is community health?
part of paramedical and medical intervention/
approach which is concerned on the health of the
whole population
aims:
1. health promotion
2. disease prevention
3. management of factors affecting health
What is nursing?
-assisting sick individuals to become healthy and
healthy individuals achieve optimum wellness
Public Health Nursing: the term used before
for Community Health Nursing
According to Dr. C.E. Winslow, Public Health is
a science & art of 3 P's -Prevention of Disease -
Prolonging life - Promotion of health and efficiency
through organized community effort
Primary Health Care
WHO: PHC was declared in the ALMA ATA
CONFERENCE(USSR) in September 6 - 12, 1978,
as a strategy to community health development.
Philippines: Adopted through LOI 949 signed by
President Marcos on October 19, 1979 with the
theme "Health in The Hands of the People by
2020"
Development of Public Health Nursing
Period of Emperical Environmental Sanitation
1.Florence Nightingale – clean up measures and
control of communicable disease.
2.Lilian Wald- first American Public Health Nurse,
linked nursing motherhood, social welfare and the
public. Creation of Henry Street Settlement house,
through nursing sick in their homes.
Development of Public Health Nursing
1898- Creation of Department of Public Works,
Education and Hygiene and Board of Health
Physicians.
1906-Creation of Bureau of Health
1912- Fajardo Act (Act No. 2156)- created Sanitary
Divisions. President of Sanitary Divisions took
charge 2 -3 municipalities were no physicians are
available. Assigned 4 graduate nurses from PGH to
take care of mothers and their babies.
1914- School nursing was rendered. Bureau of
Health was renamed Philippine Health Service
Reorganization Act of 2462 created Office of
General Inspection where Office of District Nursing
was under and headed by Dr. Rosario Pastor
1916-1918 Ms. Perlita Clarke took charge of Public
Health Nursing work. Staff composed of 1
American nurse supervisor, 1 American dietitian
and 36 Filipino nurses working in the provinces.
1917- 4 graduate nurses of City of Manila were
employed to work in city schools.
1919- PHN inaugurated its pioneer work inTondo,
Manila where visiting nurse Ms. Balbina Basa was
assigned to do house to house visit. Red Cross
introduced Operation of puericulture centers (health
centers) Ms. Camen del Rosario- First Filipino
nurse supervisor
1930- Section of Public Health Nursing was
converted into Section of Nursing

1941 Department of Public Health and Welfare was
created 6 PHN were transferred to the new dept
under Dr. Mariano Icasiano, first City Health
Officer of Manila, Ms. Vicenta Ponce as Chief
Nurse.
Dec 8 1941- WWII
1947 EO 47 of 1947, Bureau of Public Welfare was
transferred to Office of the President and
Department of Health was renamed with the ff
setup:
✓ Office of Secretary- Division of Accounting,
Drug Inspection, Nursing Service,
Laboratories, and Board Examiners (Medical,
Dental, Nursing, Pharmaceutical and Optical)
✓ Bureau of Health ( health promotion and
maintenance and sanitation)
✓ Bureau of Quarantine
✓ Bureau of Hospitals
✓ All City Health Departments
May 18, 1954- R.A 1082 ( Rural Health Act) was
passed and implemented. Personnel assigned to
work in RHU’s.
1957 R.A 1891 ( Strengthening Health And Dental
Services in Rural Health Areas and Providing
Funding thereto)
1986- Ministry of Health became DOH again.
1987- National Drug Policy- implementation of RA
6675 (Generics Law of 1988)
1991- R.A 7160 ( Local Government Code of 1991)
– Devolution code: transfer of power from National
to LGU. Aimed to build capabilities for self-
government and develop them fully as self-reliant
communities.
1993-1998 National League of Philippine
Government Nurses request to Secretary of DOH to
create an Office of Nursing was not put into reality.
1996- Primary Health Care as a strategy to attain,
“Health for all by the year 2000.
1999-2004- Health Sector Reform Agenda of the
Philippines was launched. Provide Fiscal Autonomy
COMMUNITY HEALTH NURSING I
to government hospitals, secure funding for priority
health programs; promote development of local
health systems and ensure its performance;
strengthen capacities of health regulatory agencies
and expand coverage of National Health
InsurancePrograms.
2005- FOURmula one for health. Ensure speed,
precision and effective coordination towards
improving the efficiency, effectiveness and equity
of health care delivery.
✓ Health Financing
✓ Health Regulation
✓ Health Service Delivery
✓Good Governance and Health
2005-2010 National Objectives for Health
Vision: “Health for All Filipinos”
Mission: Ensure accessibility and quality of
healthcare to improve QOL of all Filipinos
especially the poor
What is Community Health Nursing?
"The utilization of the nursing process in the
different levels of clientele-individuals, families,
population groups and communities, concerned with
the promotion of health, prevention of disease and
disability and rehabilitation." - Maglaya, et al
COMMUNITY HEALTH NURSING (CHN):
-a specialized field of nursing practice
-a science of Public Health combined with Public
Health Nursing Skills and Social Assistance with
the goal of raising the level of health of the
citizenry, to raise optimum level of functioning of
the citizenry (Characteristic of CHN)
BASIC PRINCIPLES OF CHN
✓ The community is the patient in CHN, the family
is the unit of care and there are four levels of
clientele: individual, family, population group
(those who share common characteristics,
developmental stages and common exposure to
health problems - e.g. children, elderly), and the
community.
✓ In CHN, the client is considered as an ACTIVE
partner
NOT PASSIVE recipient of care

✓ CHN practice is affected by developments in
health technology, in particular, changes in society,
in general
✓ The goal of CHN is achieved through multi-
sectoral efforts
✓ CHN is a part of health care system and the
larger human services system.
ROLES OF THE PUBLIC HEALTH NURSE
Clinician, who is a health care provider, taking care
of the sick people at home or in the RHU Health
Educator, who aims towards health promotion and
illness prevention through dissemination of correct
information; educating people
Facilitator, who establishes multi-sectoral linkages
by referral system
Supervisor, who monitors and supervises the
performance of midwives
TARGET POPULATION (IFC) ARE:
1. Individual
2. Family
3. Community
3 Elements considered in CHN:
* Science of Public Health (core foundation in
CHN),
* Public Health Nursing Skills and
* Social Assistance Functions
OBJECTIVES OF PUBLIC HEALTH: CODES
Control of Communicable Diseases
Organization of Medical and Nursing Services
Development of Social Machineries
Education of IFC on personal Hygiene Health -
Education is the essential task of every health
worker
Sanitation of the environment
3 ELEMENTS IN HEALTH EDUCATION:
IEC
Information: to share ideas to keep population
group knowledgeable and aware
Education: change within the individual 3 Key
Elements of Education:
Knowledge
Attitude
Skills
COMMUNITY HEALTH NURSING I
Communication: interaction involving 2 or more
persons or agencies
3 Elements of Communication:
Message
Sender
Receiver
PUBLIC HEALTH WORKERS (PHW)
PHW's: are members of the health team who
are professionals namely
Medical Officer (MO)-Physician
Public Health Nurse (PHN)- Registered Nurse
Rural Health Midwife (RHM)-Registered Midwife
Dentist
Nutritionist
Medical Technologist
Pharmacist
Rural Sanitary Inspector (RSI)-must be a sanitary
engineer
DEPARTMENT OF HEALTH
5 MAJOR FUNCTIONS:
1. Ensure equal access to basic health services
2. Ensure formulation of national policies for proper
division of labor and proper coordination of
operations among the government agency
jurisdictions
3. Ensure a minimum level of implementation
nationwide of services regarded as public health
goods
4. Plan and establish arrangements for the public
health systems to achieve economies of scale
5. Maintain a medium of regulations and standards
to protect consumers and guide providers
3 Major Functions:
1. LEADERSHIP in health
 National policy - formulation, monitoring and
evaluation
 Regulatory institution
 Advocates adoption of health policies, plans and
programs
2. Enabler and Capacity Builder
 Innovate new strategies to improve health
programs
 Exercise oversight function
 Ensure highest achievable standards

3. Administrator of Specific Services
 Manage selected national health facilities and
hospitals
 Administer direct services for emergent health
concerns
 Administer health emergency response services
BASIC HEALTH SERVICES UNDER OPHS
OF DOH
Education regarding Health
Local Endemic Diseases
Expanded Program on Immunization
Maternal & Child Health Services
Essential drugs and Herbal plants
Nutritional Health Services (PD 491): Creation of
Nutrition Council of the Phils.
Treatment of Communicable & Non communicable
Diseases
Sanitation of the environment (PD 856): Sanitary
Code of the Philippines
Dental Health Promotion
Access to and use of hospitals as Centers of
Wellness
Mental Health Promotion
VISION BY 2030 (DREAM OF DOH)
 A Global Leader for attaining better health
outcomes, competitive and responsive health
care systems, and equitable health financing
MISSION
 To guarantee EQUITABLE, SUSTAINABLE
and QUALITY health for all Filipinos,
especially the poor and to lead the quest for
excellence in health
Principles to attain the vision of DOH
 Equity: equal health services for all-no
discrimination
 Quality: DOH is after the quality of service not
the quantity
 Philosophy of DOH: “Quality is above
quantity"
 Accessibility: DOH utilize strategies for
delivery of health services
COMMUNITY HEALTH NURSING I
HEALTH CARE DELIVERY SYSTEM
"the totality of all policies, facilities,
equipment, products, human resources and services
which address the health needs, problems and
concerns of the people. It is large, complex, multi-
level and multi-disciplinary.”
THREE STRATEGIES IN DELIVERING
HEALTH SERVICES (ELEMENTS)
✓ Creation of Restructured Health Care Delivery
System (RHCDS) regulated by PD 568 (1976)
✓ Management Information Systems regulated by
R.A. 3753: Vital Health Statistics Law
✓ Primary Health Care (PHC) regulated by LOI 949
(1984): Legalization of Implementation of PHC in
the Philippines
CREATION OF RHCDS
 RHO (National Health Agency) or existing
national agencies like PGH or specialized
agencies like Heart Center for Asia, NKI
 MHO & PHO (Municipal/Provincial Health
Office)
 BHS & RHU (Barangay Health Station/Rural
Health Unit)
3 LEVELS OF HEALTH CARE
1. Primary-prevention of illness or promotion
of health
2. Secondary-curative
3. Tertiary-rehabilitative

Referral System in Levels of the Health Care:
✓ Barangay Health Station (BHS) is under
the management of Rural Health Midwife (RHM)
✓ Rural Health Unit (RHU) is under the
management or supervision of PHN.
✓ Public Health Nurse (PHN) caters to
1:10,000 population, acts as managers in the
implementation of the policies and activities of
RHU, directly under the supervision of MHO (who
acts as administrator)
REFERRAL SYSTEM:
BHS →RHU→ MHO →PHO →RHO→ National
Agencies Specialized Agencies
CHARACTERISTICS OF PHC
Acceptable
Accessible
Affordable
Available
Sustainable
Attainable
UTILIZES APPROPRIATE TECHNOLOGIES
USED BY PHC: ACCEFS
Affordable, accessible, acceptable, available
Cost wise=economical in nature
Complex procedures which provide a
simple outcome
Effective
Feasibility of use=possibility of use at all times
Scope of technology is safe & secure
COMMUNITY HEALTH NURSING I
SENTRONG SIGLA MOVEMENT (SSM) was
established by DOH with LGUs having a logo of a
Sun with 8 Rays and composed of 4 Pillars:
1. Health Promotion
2. Granted Facilities
3. Technical Assistance
4. Awards: Cash, plaque, certificate
4 CONTRIBUTIONS OF PHC TO DOH &
ECONOMY:
 Training of Health Workers
 Creation of Botika sa Baryo & Botika sa Health
Center
 Herbal Plants
 Oresol
A. TRAINING OF HEALTH WORKERS
3 Levels of Training:
Grassroot/Village
 Includes Barangay Health Volunteers (BHV)
and Barangay Health Workers (BHW)
 Non-professionals, didn't undergo formal
training, receive no salary but are given
incentive in the form of honorarium from
the local government since 1993
Intermediate - these are professionals including the
8 members of the PHWS
First Line Personnel - the specialist
B. CREATION OF “BOTIKA SA BARYO
& BOTIKA SA HEALTH CENTER”
RA 6675: Generics Act of 1988: Implementing
 “Oplan Walang Reseta Program”-solution to the
absence of a medical officer who prescribed the
medicines so PHN are given the responsibility
to prescribe generic medicines and
 “Walong Wastong Gamot Program"- available
generics in “Botika sa Baryo” & Health Center
- Father of Generics Act: Dr. Alfredo Bengzon
 COMMUNITY HEALTH NURSING I
8 COMMONLY AVAILABLE GENERICS HERBAL PLANTS
(CARIPPON)  RA 8423: Alternative Traditional Medicine Law
Co-Trimoxazole  A program where patient may opt to use
herbal plants especially for drugs that are not
 It’s a combination of 2 generics of drugs which
available in dosage form or patients has no
is antibacterial
financial means to buy the drug
 Trimethoprim (TMP)  Traditional Medicine = Use of herbal plants
 Has a bacteriostatic action that stops/
inhibits multiplication of bacteria 10 ADVOCATED HERBAL PLANTS BY DOH:
 For GUT, GIT, and URTI (TMP LUBBY SANTA
combined with SMX)
 Sulfamethoxazole (SMX)
 Has bactericidal action that kills bacteria
 For GUT, GIT, URTI, and Skin
Infections
Amoxicillin/ Ampicillin
 An antibacterial drug that comes from the
Penicillin family
 Effect is generally bacteriostatic (when source
of infection is bacterial)
 These 2 drugs provide the least sensitivity
reaction (rashes & GI) and the adverse effect of
other antibiotics is anaphylactic shock
TB DRUGS:
Rifampicin (RIF)
Isoniazid (INH) POLICIES TO ABIDE:
Pyrazinamide (PZA)  Know indications
Paracetamol  Know parts of plants with therapeutic value:
 Has an analgesic & anti-pyretic effect
Acetyl Salicylic Acid (ASA) or Aspirin is never
kept in the “Botika” because of its effects:
 Anticoagulant-highly dangerous to Dengue
patients that’s why it’s not available in roots; fruits; leaves
“Botika” and Health Center  Know official procedure/ preparation
Oresol
PROCEDURES/ PREPARATIONS:
 A management for diarrhea to prevent  DECOCTION
dehydration under the Control of Diarrheal  Gather leaves & wash thoroughly, place in a
Diseases (CDD) Program container the washed leaves then add water
Nifedipine  Let it boil without cover to vaporize/ steam
 An anti-hypertensive drug to release toxic substance and undesirable
 According to DOH, 16% of population taste
belonging to 25 years old & above in the  Use extracts for washing
community are hypertensive  POULTICE
 Done by pounding or chewing leaves used
by herbolaryo

 Example: Akapulko leaves - when pounded,
it releases extracts coming out from the
leaves that contains enzyme (serve as anti-
inflammatory) then apply on affected skin or
spewed it over skin
 For treatment of skin diseases
 INFUSION
 To prepare a tea (use lipton bag), keep
standing for 15 minutes in a cup of warm
water where a brown solution is collected,
pectin which serves as an adsorbent and
astringent
 JUICE/ SYRUP
 To prepare a papaya juice, use ripe papaya
& mechanically mashed then put inside a
blender then add water
 To produce it into a syrup, add sugar then
heat to dissolve sugar and mix it
 CREAM/ OINTMENT
 Start with poultice (pound leaves) to turn it
semi-solid
 Add flour to keep preparation pasty then
make it adhere to skin lesions
 To make it into an ointment: add oil
(mineral, baby or any oil - serves as
moisturizer) to the prepared cream to keep it
lubricated while being massage on the
affected area
ORESOL
UNIVERSAL HEALTH CARE (UHC)
 Also referred to as KALUSUGAN
PANGKALAHATAN (KP)
 Is the “provision to every Filipino of the highest
possible quality of health care that is accessible,
efficient, equitably distributed, adequately
funded, fairly financed, and appropriately used
by an informed and empowered public”
 The Aquino administration puts it as the
availability and accessibility of health services
and necessities for all Filipinos
COMMUNITY HEALTH NURSING I
 It is a government mandate aiming to ensure
that every Filipino shall receive affordable and
quality health benefits. This involves providing
adequate resources - health human resources,
health facilities, and health financing
UHC’s Three Thrusts
1. Financial risk protection through expansion
in enrollment and benefit delivery of the
National Health Insurance Program (NHIP)
2. Improved access to quality hospitals and
health care facilities
3. Attainment of health-related Millennium
Development Goals (MDGs)
Financial Risk Protection
 Protection from the financial impacts of health
care is attained by making any Filipino eligible
to enroll, to know their entitlements and
responsibilities, to avail of health services, and
to be reimbursed by PhilHealth with regard to
health care expenditures
Improved Access to Quality Hospitals and
Health Care Facilities
 Improved access to quality hospitals and health
facilities shall be achieved in a number of
creative approaches. First, the quality of
government-owned and operated hospitals and
health facilities is to be upgraded to
accommodate larger capacity, to attend to all
types of emergencies, and to handle non-
communicable diseases.
Health Facility Enhancement Program (HFEP)
 Shall provide funds to improve facility
preparedness for trauma and other emergencies.
The aim of HFEP was to upgrade 20% of DOH
- retained hospitals, 46% of provincial hospitals,
46% of district hospitals, and 51% of rural
health units (RHUs) by end of 2011
ATTAINMENT OF HEALTH RELATED
MDGs
 Further efforts and additional resources are to be
applied on public health programs to reduce
maternal and child mortality, morbidity and
mortality from Tuberculosis and Malaria, and
incidence of HIV/AIDS. Localities shall be
prepared for the emerging disease trends, as
well as the prevention and control of non-
communicable diseases

 The organization of Community Health Teams
(CHTs) in each priority population area is one
way to achieve health-related MDGs. CHTs are
groups of volunteers, who will assist families
with their health needs and provide health
information
 RNheals nurses will be trained to become
trainers and supervisors to coordinate with
community-level workers and CHTs. By the end
of 2011, it is targeted that there will be 20,000
CHTs and 10,000 RNheals
 Another effort will be the provision of necessary
services using the life cycle approach. These
services include family planning, ante-natal
care, delivery in health facilities, newborn care,
and the Garantisadong Pambata package
 Better coordination among government
agencies, such as DOH, DepEd, DSWD, and
DILG, would also be essential for the
achievement of these MDGs
MILLENIUM DEVELOPMENT GOALS
(MDGs) by WHO
GOAL 1: ERADICATE EXTREME POVERTY
AND HUNGER
 Target: Halve, between 1990 and 2015, the
proportion of people whose income is less than
one dollar a day
 Target: Halve, between 1990 and 2015, the
proportion of people who suffer from hunger
GOAL 2: ACHIEVE UNIVERSAL PRIMARY
EDUCATION
 Target: Ensure that, by 2015, children
everywhere, boys and girls alike, will be able to
complete a full course of primary schooling
GOAL 3: PROMOTE GENDER EQUALITY
AND EMPOWER WOMEN
 Target: Eliminate gender disparity in primary
and secondary education preferably by 2005 and
to all levels of education no later than 2015
GOAL 4: REDUCE CHILD MORTALITY
 Target: Reduce by two-thirds, between 1990 and
2015, the under-five mortality rate
GOAL 5: IMPROVE MATERNAL HEALTH
 Target: Reduce by three-quarters, between 1990
and 2015, the maternal mortality ratio
COMMUNITY HEALTH NURSING I
GOAL 6: COMBAT HIV/ AIDS, MALARIA
AND OTHER DISEASES
 Target: Have halted by 2015 and begun to
reverse the spread of HIV/AIDS
 Target: Have halted by 2015 and begun to
reverse the incidence of malaria and other major
diseases
GOAL 7: ENSURE ENVIRONMENTAL
SUSTAINABILITY
 Target: Integrate the principles of sustainable
development into country policies and programs
and reverse the loss of environmental resources
 Target: Halve, by 2015, the proportion of people
without sustainable access to safe drinking
water
 By 2020, to have achieved a significant
improvement in the lives of at least 100 million
slum dwellers
GOAL 8: DEVELOP A GLOBAL
PARTNERSHIP FOR DEVELOPMENT
 Target: Develop further an open, rule-based,
predictable, non-discriminatory trading and
financial system
 Target: Address the special needs of the least
developed countries
 Target: Address the special needs of landlocked
countries and small island developing states
 Target: Deal comprehensively with the debt
problems of developing countries through
national and international measures in order to
make debt sustainable in the long term
SUSTAINABLE DEVELOPMENT GOALS
(SDGs) by WHO
 Adopted by nations of the world on 25th
September, 2015 to be achieved till 2030
 PHHEEWE GIRRLLS CPP
1. Poverty
2. Hunger
3. Health Care
4. Education
5. Equality (Gender)
6. Water
7. Energy
8. Good Jobs and Economic Growth

9. Innovation and Infrastructure
10. Reduced Inequality
11. Responsible consumption and production
12. Life below water
13. Life on land
14. Sustainable cities and communities
15. Climate action
16. Peace and Justice
17. Partnerships for the goals
FIELD HEALTH SERVICE INFORMATION
SYSTEM (FHSIS)
 It is a network of information
 It is intended to address the short-term needs of
DOH and LGU staff with managerial or
supervisory functions in facilities and program
areas
 It monitors health service delivery nationwide
 OBJECTIVES of FHSIS:
 To provide summary data on health service
delivery and selected program
accomplishment indicators at the barangay,
municipality/city, and district, provincial,
regional and national levels
 To provide data which when combined with
data from other sources, can be used for
program monitoring and evaluation purposes
 To provide a standardized, facility-level data
base that can be accessed for more in-depth
studies
 To minimize the recording and reporting
burden at the service delivery level in order
to allow more time for patient care and
promote activities
 IMPORTANCE OF FHSIS
 Helps local government determine public
health priorities
 Basis for monitoring and evaluating health
program implementation
 Basis for planning, budgeting, logistics and
decision making at all levels
 Source of data to detect unusual occurrence
of a disease
 Needed to monitor health status of the
community
 Helps midwives in following up clients
 Documentation of RHM/ PHN day to day
activities
 COMPONENTS OF FHSIS
1. Individual Treatment Record (ITR)
COMMUNITY HEALTH NURSING I
 The fundamental building block or
foundation of the Field Health Service
Information System is the
INDIVIDUAL TREATMENT
RECORD
 This is a document, form or piece of
paper upon which is recorded the date,
name, address of patients, presenting
symptoms or complaint of the patient on
consultation and the diagnosis (if
available), treatment and date of
treatment
2. Target Client List (TCL)
 Constitute the second “building block”
of the FHSIS and are intended to serve
several purposes:
 To plan and carry out patient care
and service delivery. Such lists will
be of considerable value to
midwives/nurses in monitoring
service delivery to clients in general
and in particular to groups of patients
identified as “targets” or “eligibles”
for one or another program of the
Department
 To facilitate the monitoring and
supervision of service delivery
activities
 To report services delivered
 To provide a clinic-level data base
which can be accessed for further
studies
 TARGET CLIENT LISTS TO BE
MAINTAINED IN THE FHSIS
 Target Client List for Prenatal Care
 Target Client List for Post-Partum
Care
 Target Client List of Under 1 Year
Old Children
 Target Client List for Family
Planning
 Target Client List for Sick Children
 NTP TB Register
 National Leprosy Control Program
Form 2-Central Registration Form

3. Summary Table
 The Summary Tables is a form with 12-
month columns retained at the facility
(BHS) where the midwife records
monthly all relevant data. The Summary
Table is composed of:
 Health Program Accomplishment
this can serve as proof of
accomplishments to show LGU
officials whenever they visit the
facility.
 Morbidity Diseases the source of
ten leading causes of morbidity for
the municipality/city. This summary
table will help the nurse and MHO to
get the monthly trend of diseases.
4. Monthly Consolidation Table (MCT)
 The Consolidation Table is an essential
form in the FHSIS where the nurse at the
RHU records the reported data per
indicator by each BHS or midwife.
 This is the source document of the
nurse for the Quarterly Form.
 The Consolidation Table shall serve
as the Output Table of the RHU as it
already contains listing of BHS per
indicator.
 FHSIS REPORTING
 These are summary data that are transmitted
or submitted on a monthly, quarterly and on
annual basis to higher level. The source of
data for this component is dependent on the
records.
 THE MONTHLY FORM
 Program Report (M1)
 The Monthly Form contains selected
indicators categorized as maternal care,
child care, family planning and disease
control.
 Morbidity Report (M2)
 The Monthly Morbidity Disease Report
contains a list of all diseases by age and
sex. The Midwife uses the form for the
monthly consolidation report of
Morbidity Diseases and is submitted to
the PHN for quarterly consolidation.
COMMUNITY HEALTH NURSING I
 THE QUARTERLY FORM
 Program Report (Q1)
 The Quarterly Form is the
municipality/city health report and
contains the three-month total of
indicators categorized as maternal care,
family planning, child care, dental health
and disease control
 Morbidity Report (Q2)
 The PHN uses the form for the Quarterly
Consolidation Report of Morbidity
Diseases to consolidate the Monthly
Morbidity Diseases taken from the
Summary Table.
 THE ANNUAL FORMS (A-BHS, A1, A2 &
A3)
 ABHS Form is the report of midwife which
contains data on demographic,
environmental and natality.
 The report of nurse at the RHU/MHC are the
Annual Form 1 which is the report on vital
statistics: demographic, environmental,
natality and mortality.
 Annual Form 2 is the report that lists all
diseases and their occurrence in the
municipality/city. The report is broken down
by age and sex.
 Annual Form 3 is the report of all deaths
occurred in the municipality/city. The report
is also broken down by age and sex.
 FLOW OF REPORT
 COMMUNITY HEALTH NURSING I
HEALTH INDICATORS FAMILY HEALTH NURSING PROCESS
A systematic approach of solving an existing
Fertility problem/meeting the needs of family
 Crude Birth Rate (CBR) - Overall total reported
births I. RAPPORT
𝑂𝑣𝑒𝑟𝑎𝑙𝑙 𝑡𝑜𝑡𝑎𝑙 𝑟𝑒𝑝𝑜𝑟𝑡𝑒𝑑 𝑏𝑖𝑟𝑡ℎ𝑠 ✓ Trust building
 𝐶𝐵𝑅 = 𝑥 1000
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 ✓ Knowing your client
✓ Adjusting to the situation and environment
Morbidity - Illnesses affecting the population group ✓ RESPECT

 Incidence Rate (IR): reported new cases II. ASSESSMENT

affecting the population group Data Gathering: tools or instruments used during
𝑁𝑒𝑤 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑑𝑖𝑠𝑒𝑎𝑠𝑒 survey
 𝐼𝑅 = 𝑥 100
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 ✓ Interview
✓ Observation
 Prevalence Rate (PR): determine sum total of
new + old cases of diseases per percent ✓ Questionnaires - mostly patronized & used
population ✓ Records & Reports available
𝑁𝑒𝑤 𝑐𝑎𝑠𝑒𝑠+𝑂𝑙𝑑 𝑐𝑎𝑠𝑒𝑠
 𝑃𝑅 = 𝑥 100
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 Consolidation or Collation: collecting back the
questionnaires, tabulate and summarize
Mortality - Reports causes of deaths
 Crude Death Rate (CDR): overall total reported Validation: uses statistical approaches
death
𝑂𝑣𝑒𝑟𝑎𝑙𝑙 𝑡𝑜𝑡𝑎𝑙 𝑑𝑒𝑎𝑡ℎ𝑠
 𝐶𝐷𝑅 = 𝑥 1000
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
Statistical Approaches:
 Maternal Mortality Rate (MMR): maternal 1. Central Tendencies: 3 M's
deaths due to maternal causes Mean = average
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑚𝑎𝑡𝑒𝑟𝑛𝑎𝑙 𝑑𝑒𝑎𝑡ℎ𝑠 Median = range (Highest - Lowest Score)
 𝑀𝑀𝑅 = 𝑥 1000
𝑅𝐿𝐵 Mode = frequency of occurrence of a variable,
used if there's too many variable occur
 Infant Mortality Rate (IMR): # of infant deaths
(0-12 months) or less than 1 year old 2. Standard Deviation: used if there are too many
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑓𝑎𝑛𝑡 𝑑𝑒𝑎𝑡ℎ𝑠
 𝐼𝑀𝑅 = 𝑥 1000 variables available to be treated which is seldom
𝑅𝐿𝐵
used in CHN
 Neonatal Mortality Rate (NMR): # of deaths
among neonates (newborn 0-28 days, < 1 √∑(𝑥 − 𝑦)
𝑆𝐷 =
month) 𝑛−1
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑛𝑒𝑜𝑛𝑎𝑡𝑎𝑙 𝑑𝑒𝑎𝑡ℎ𝑠
 𝑁𝑀𝑅 = 𝑥 1000
𝑅𝐿𝐵 Σ = summation of; x = variables available; y =mean
(given special attention); n = # of existing variables
 Swaroops Index (SI): deaths among individual
in the age group of 50 and above
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 (>50 𝑦𝑟𝑠 𝑜𝑙𝑑)
 𝑆𝐼 = 𝑥 100 3. Percentile (%) Method: most commonly used in
𝑇𝑜𝑡𝑎𝑙 𝑑𝑒𝑎𝑡ℎ𝑠
CHN by adding all cores then multiply by 100

Presentation of Data
1. Table/Chart
2. Graph (Pie, 2-Variable bar, Polygon
connecting results, Histograph-2 or more
variables adjacent to each other)
TYPOLOGY OF NURSING PROBLEMS
A. First Level Assessment: to determine problems
of family
Sources of Problems using IDB
Family: use of Initial Data Base (IDB)
Nature: Health Deficit (HD), Health Threat (HT),
Foreseeable Crisis (FC)
USE OF INITIAL DATA BASE (IDB):
1. Family Chart Structure:
Nuclear -Father, mother, children
Extended (3rd generation)-Relatives staying with
the family
Multi-generational extended-“apo sa tuhod” or “apo
sa talampakan”
Dyad - Husband & wife only (childless couple)
Blended -widow married another widow & have
children
Gay-Same sex living together Matriarchal -Mother
is the decision maker
Patriarchal -Father is the decision maker
Communal -different families forming a community
2. Socio-economic: poverty level, educational
attainment & nature of occupation of members of
the family (sources of income)
COMMUNITY HEALTH NURSING I
DEFINE THE PROBLEM AFTER
IDENTIFYING IT ACCORDING TO NATURE
Health Deficit (HD)
- If identified problem is an abnormality, illness or
disease, there's a gap/difference between normal
status (ideal, desirable, expected) & actual status
(the outcome/result/problem encountered on that
actual day)
Health Threat (HT)
- Any condition or situation which will be
conducive to health alteration, health interference &
health disturbance.
Foreseeable Crisis (FC) -stress points, anything
which is anticipated/expected to become a problem
III. PLANNING
Four (4) Standard Steps:
Prioritization - start if there are multiple identified
problems
Formulation of objectives - planning a procedure
will start here if there is only one problem
Developing strategies of action
Formulation of evaluation tools for the identified
strategy developed
CRITERIA IN IDENTIFYING THE
PROBLEM

3. Socio-cultural: different nature of religion

4. Home environment: assessment according to ES,

treatment of garbage, preparation of food,
availability of toilet, water & food sanitation,
sources of diseases Steps:
a. Decide on a score
5. Medical history: history of certain disease, family 𝑆𝑐𝑜𝑟𝑒
b. 𝐻𝑖𝑔ℎ𝑒𝑠𝑡 𝑆𝑐𝑜𝑟𝑒 x 𝑤𝑒𝑖𝑔ℎ𝑡
member with disease
c. Get the sum total of all the scores
6. Resources available in community for use by the
Interpretation:
family: Perfect score = 5, if score nearing 5 then prioritize
the problem
Criteria 1, 2 & 3 has to be assessed objectively by
5 Generalized M's in resources available in the health worker
community: Criteria 4 has to be assessed by the perception of the
Man/Manpower, Money, Machine, Materials, family
Methods
Compute for 3rd Degree Malnutrition
 COMMUNITY HEALTH NURSING I
IV. INTERVENTION 1. PREPARATORY PHASE
✓ Is the capacity to provide management A. Area of Selection
✓ Is the professional phase of nursing process -It should be DOPE Community: Depressed,
✓ Is the time when the PHN executes the standard Oppressed, Poor & Exploited, a new criteria for
function of an RN community organization
✓ Three (3) Standard Functions of RN: - “Old Criteria” → it must be a virgin community =
o Dependent-giving of medicines meaning no agency has gone there.
o Independent-monitor, assess, provide, educate -This is a dangerous situation that's why RA 7305:
o Interdependent-referrals Magna Carta for Public Workers was provided-a
PHN is to receive a hazard pay of 20-25% of
V. EVALUATION monthly salary
Three (3) Things to be evaluated: SPO B. Entry: the 1st thing to do upon entering the
1. Structure of program & activity -what articles, community is to have a courtesy call with the
equipment, supplies are utilized Barangay
2. Process utilized - steps used C. Integration/Immersion
3. Outcome of activity -results can be: -Immersion is imbibing the life situation/condition
o Desirable -to be implemented, advocated, of the community by living, eating & sleeping with
strengthen the family to be able to understand their situation
o Undesirable-to be avoided - It requires 2 Qualities of PHN:
Two (2) Aspects to be evaluated in the Outcome: Empathy & Sympathy (Integration)
D. Community Study: Diagnosis of Community-
o Quality -characteristic or kind of outcome; no
COPAR
numerical value, not measurable
-Makes use of the Nursing Process/Problem
o Quantity -from the word “quantum", with
numerical value, measurable Solving Approach
-Prioritized which among the problems identified is
to be attended 1st like in nature, magnitude,
COMMUNITY ORGANIZING -
modifiability, preventive potential, salience
PARTICIPATORY ACTION RESEARCH
(COPAR)
PRIORITIZATION OF COMMUNITY
PROBLEMS
OBJECTIVES OF COPAR
Patterns to be followed:
Indicators of Health Status/Condition:
1. Organize people
Fertility: 1 CBR = overpopulated community = HS
2. Mobilize people
Morbidity: IR (new cases) & PR (old cases) = HS
3. Work with people
Mortality: Deaths like children dying of
4. Educate people
pneumonia=HS
✓ Knowledge Health Resource(s):
✓ Attitude 5 M's-Manpower/Man, money, machinery, material
✓ Skills & methods (+) available facilities-Hospital/Clinic,
mode of transportation, market, school & movie
PHASES OF COPAR houses for recreation
1. Preparatory Health Related:
2. Organizing Categories according to 5 Aspects of Man =
3. Mobilizing PEMSS
4. Educating Physical, Physiological, Psychological
5. Collaborating Emotional
6. Phase Out Mental
Social
Spiritual

2. ORGANIZING PHASE
- Choosing potential community leaders
- Core group formation
- Community Assembly: Community
Organizing Participatory Action Research
(COPAR)
o Attend the assembly of the
family/families
o Families in the community should be
represented, any family members can
represent his/her family as along as
he/she is a RESPONSIBLE (one
who also can comprehend) member
of that family
o Brgy. Captain/ chairman need not
necessary be the leader.
3. MOBILIZATION PHASE
- Mobilization  let the member of the
community do the work. PHN should only
supervise
4. HEALTH EDUCATION
- Adjust on the level of understanding of the
community
- Return demonstration is the best way of
teaching
- Focus on the KSA
- Respect of the custom and tradition
5. COLLABORATING
6. PHASE OUT
Epidemiology  the pattern of occurrences &
distribution of diseases, defects & deaths
COMMUNITY HEALTH NURSING I
Epidemic
- Greater than 50% of populations are
susceptible or less immune individual
- Greater % of the population is affected by
the occurring disease
e.g. Health worker reports that community Lanting
has an epidemic of measles affecting children less
than 7 years old
- total susceptible population: 3000
- children affected by measles: 1750
Endemic
- the disease occurs regularly, habitually,
constantly affecting the population group
- 2 local endemic diseases: where causative
agent is available on those places
o Schistosomiasis  Samar, Leyte,
Mindoro, Davao
o Malaria  Palawan, Mindanao –
reasons why it’s prevalent
 Forested areas
 Surrounded by bodies of
water
Sporadic
- The pattern of occurrence is on & off where:
o On  available causative agent
o Off  no available causative agent
- It’s intermittent (unpredictable) in
occurrence
- Disease occurs only if there’s a susceptible
host like in rabies

Pandemic
- Worldwide, international, universal, global
in occurrence like in AIDS, Hepatitis B,
PTB, measles, mumps, diphtheria,
pneumonia
o SARS is categorized by WHO as an
outbreak only because out of 191
nations, 33 countries are reported to
have it
Home Visit
- Is a professional contact between PHN and
the family
- The services provided is an extension of the
Health Service Agency (Health Centers)
COMMUNITY HEALTH NURSING I
- Opportunity to provide or extend health
services
- Standard role of the Nurse  independent,
dependent and interdependent
- To be effective, come in complete uniform
(also bring a long umbrella with pointed end
which serve as protection)
4. Summarization
- Ability to put into record & report (orally)
about the outcome of the activity
Public Health Bag  indispensable tool that
should be organize to save time & effort and to
prevent cross infection and contamination

Objectives of Home Visit Guiding Principles in the use of PH bag

- Assessment 1. Content – should be prepared by the one
- Nursing Care who will make home visit
- Treatment a. Note: BP Apparatus is kepy
- Health Education separately from PHN bag
- Referral (if care fails) 2. Cleaning
a. The inner part of the bag should be
Priorities (in the care): to prevent cross clean and sterile
contamination b. Should be done every after home
1. Newborn visit
2. Post-partum c. Ever endorse the bag
3. Pregnant mothers 3. Contamination
4. Morbid cases a. The less one opens the bag, the lesser
- The families need the assistance of the chance of contamination
health center that’s why home visit was done 4. In general, the bag is opened 3x:
to the family a. Putting out materials for hand
- The person who makes the home visit is washing
rendering services on behalf of the health b. Putting out materials used for
center nursing care
c. Returning all what have been used
Phases of Home Visit 5. Care of Communicable Case  should be
1. Planning disinfected with the use of 70% isopropyl
- Starts at the health center alcohol or Lysol which should be done at the
- Makes a study on the status of the family health center and not at home
- Statement of the problem
- Formation of objective
2. Socialization
- First activity is to establish rapport and gain
the trust of the family
3. Activity
- Intervention/professional phase

Strategies/Programs to Promote Health of the
Vulnerable Sectors of the Population
DOH Endemic Disease Control Program
I. Schistosomiasis Control Program
- Policies: CHES
o Case Finding
o Health Education
o Environmental Sanitation
o Snail Eradication
Case Finding:
6 aspects or thing to know:
- Disease: Schistosomiasis
- Other Name: Bilhariasis or Snail Fever
- Causative Agent: Schistosoma blood fluke
(parasite)
3 types of species:
- Schistosoma japonicum – endemic in the
Philippines & affecting Indonesia, China,
Japan, Korea
- Schistosoma mansoni
Schistosoma haematobium
Laboratory procedure:
- Blood examination: heightened eosinophil
level indicated parasitism
- Fecalysis: Kato Katz (plain stool exam that
uses a special apparatus resembling a
feeding bottle sterilizer)
o Procedure:
 Collect specimen
 Have the test tube undergo
centrifugation for 20 mins
 Get specimen from
precipitate & swab it on glass
slide
 Observe it on microscope
Signs & Symptoms:
- CNS  High grade fever  cerebral
convulsion
- GIT  Nausea & vomiting, Diarrhea 
Chronic dysentery (prolonged diarrhea of
more than 2 weeks & consistency of mucoid
& bloody (with streaks of blood)
- Liver  presence of infection manifested by
jaundice & hepatomegaly
COMMUNITY HEALTH NURSING I
- Spleen  infection of spleen 
inflammation  enlargement of organ
(Splenomegaly)  abdominal distension 
abdominal pain of the right upper quadrant
- Blood  Anemia and weakness
Treatment
- Drug of choice - Praziquantel (Biltricide) 
60mg/KBW/day
- Length of treatment: takes months to a year
e.g. if patient is 50 kg., 50kg x 60 mg/KBW/day =
3000 mg/day
Health Education  it affects mostly farmers so
education them to wear rubber boots
Environmental Sanitation
- 1st concern  Snail
- 2nd concern  water, where snail thrives
- 3rd concern  Toitlet
- Food
- Garbage
Snail Eradication  use molluscicides treat the
entire suspected soil with chemical solution that
kills snails
II. Malaria Control Program
Case Finding
- Disease: Malaria
- Other name: Ague
- Causative agent: Plasmodium-a protozoa
4 types of species:
- Plasmodium falciparum – more fatal that
affect Philippines
o Vector  Female Anopheles
Mosquito (FAM)
- Plasmodium viax
- Plasmodium ovale
- Plasmodium malariae

Laboratory Procedure  malarial smear-extract
blood at the height of fever because plasmodium is
very active & ruptures at this period
Signs and symptoms:
- 1st stage  cold: chilling sensation for 1-2
hrs
- 2nd stage  hot: high grade fever lasting for
3-4 hrs
- 3rd stage  wet: Diaphoresis (excessive
sweating)
Treatment  drug of choice  Quinine
2 forms:
- Chloroquine (Aralen)
- Primaquine
If quinine is not available, ma use Silfadoxime-an
antibacterial drug paired with pyrinthamine
Personal protection
- Sleep under a mosquito net
- Sleep in a screened room
- Sleep with long sleeve attire
- Use repellants that contain DET (diethyl
toluamide or toluene which has a pungent
odor that drives awat mosquitoes and an
irritant to mucous membrane of respiratory
tract when inhaled
- Plant a neem tree using leaves
CLEAN
Attendants must be aware of the early signs,
Chemical Method  insecticide spraying at night
symptoms and complication. They should follow
Larvae eating fish  Tilapipa
the 3 CLEANS:
Environmental Sanitation & Health Education 
insect, water, trash
Anti-mosquito soap  basil citronelli
Neem Tree  banana, gabi, eucalyptus, provide
repellent effect
III. Maternal Care Program
Strategies:
A. Provision of Regular and Quality Maternal
Care Services
- Regular and quality pre-natal care
o Hx-taking, utilization of HBMR
(Home-Based Mother’s Record) as a
guide in the identification of risk
factors
o PE: weight, height, BP-taking
COMMUNITY HEALTH NURSING I
o Perform head-to-toe assessment,
abdominal exam
o Tetanus toxoid immunization
o Fe supplementation: given from 5th
month of pregnancy to two months
postpartum (100-120 mg orally/day
for 210 days)
o Laboratory exam: heat-acetic acid
test. Benedict’s test
o Oran/dental exam
- Pre-natal counseling
- Provision of safe, deliver care
o All birth attendants shall ensure
clean and safe deliveries at the
facilities (RHUs/hospitals)
o At-risk pregnancies and mothers
must be immediately referred to the
nearest institution
- Provision of quality postpartum care
- Proper schedule of follow-up must be
followed:
o 1st postpartum, visit for home
deliveries must be done within 24
hours after delivery
o 2nd, done at least 1 week after
delivery
o 3rd, done 2-4 weeks thereafter
- CLEAN hands
- CLEAN surface
- CLEAN cord
B. Improvement of the health personnel’s
capabilities on newborn care, midwifery thru
trainings
a. Note: all deliveries should be done in
health care facilities only
C. Improvement on the quality of care at the
first referral level
a. Orientation, training should be done
on the use of proper filling-up of
HBMR card
b. Proper referrals/endorsements must
be done for future if-ups
D. Prevention of unwanted pregnancies through
family planning service
 COMMUNITY HEALTH NURSING I
E. Prevention and management of STDs Tetanus Toxoid Immunization
F. Promotion of Appropriate health practices Protection among neonatal tetanus. Both mother and
G. Upgrade reporting services child are PROTECTED against tetanus and neonatal
H. Mobilize political commitment and tetanus.
community involvement to provide support
to basic health care delivery
Maternal Health Program
Components of Pregnancy Care:
1. Antenatal Registration
2. TT immunization
3. Macronutrient and micronutrient
Supplementation
4. Early detection and management of
Micronutrient Supplementation
complications of pregnancy
Vitamin Dose Schedule Remarks
5. Clean and Safe Delivery
Vitamin 10,000 IU Twice a Do not
6. Support to Breast feeding
A week give
7. Family planning and counseling
starting on before 4th
8. STD/HIV/AIDS Prevention and management
the 4th month
9. Treatment of disease and other condition
month of
10.Oral care
pregnancy
Iron 60mg/400ug daily
Antenatal Registration
Home Based Mother Record (HBMR) serves as tablet
passport to appropriate health care. Simple card
designed to facilitate easy recording and
interpretation of comprehensive information on
health status of a women, before, during and after Treatment of Disease and other conditions
pregnancy.
Pre-natal visit Period of pregnancy
1st visit As early in pregnancy
as possible before 4
months or during 1st
trimester
2nd visit During 2nd trimester
3rd visit During 3rd trimester
Every 2 weeks After 8 months of
pregnancy till delivery

Emergency Signs during Pregnancy
- Unconscious/Convulsion
- Profuse vaginal bleeding
- Severe abdominal pain
- Looks very ill
- Severe headache and visual disturbances
- Severe difficulty of breathing
- Fever
- Severe vomitting
Family Planning
- The program is anchored in the following
principles:
R – Responsible Parenthood
R – Respect for Life. The 1987 Constitution states
that the government protects the sanctity of life.
Abortion is not a family planning method.
B – Birth Spacing  refers to interval between
pregnancies (which is ideally 3 years)
I – Informed Choice that is upholding and ensuring
the rights of couples to determined.
Goals:
A. Safe Pregnancy
- Right age to be pregnant = 20 – 35 years
old, not less than 20 and not more than 25
- Right interval of pregnancy = once in 2 or 3
years
- Home Base Mother’s Record (HBMR) = the
record used for care of mothers in CHN.
Laboratory Examinations:
Benedict’s Test – test for sugar in the urine; test for
diabetes.
- Heat test tube with 5 cc of Benedict’s
solution (blue) in the burner then add 3-5
gtts of urine (amber yellow) then heat again.
Observe for the change in color:
o Blue  (-) sugar in urine
o Green  trace of sugar in urine; +1
or +
o Yellow  traces of sugar in urine; +2
or ++
o Orange  more traces of sugar in
urine; +3 or +++
o Brick Red  surely diabetic; +4 or
++++
COMMUNITY HEALTH NURSING I
Acetic Acid Test – test for albumin in urine; test for
Pregnancy Induced HPN.
- Collect urine in test tube, heat it in burner
then add 3-5 gtts of acetic solution (clear
white). Observe for change in color:
o If it remains clear  (-) CHON or
albumin in urine
o If it turns cloudy  (+) CHON =
proteinuria
Policies
1. Non coercive (give freedom of choice)
2. Integration of Family Planning in all
Curricular Program:
o LOI 47 DECS states that Family
Planning is to be integrated in all
school curricular programs, either
baccalaureates or non baccalaureates,
enrolled separately as one unit
3. Multi-Sectoral Approach: establish
relationship with other agencies which can
either be:
o Intrasectoral
o Intersectoral-Local or International
(WHO, Uniced, USAID, Japhiego)
METHODOLOGIES
Biological
A. Basal Body Temperature (BTT)
- Get the temperature early morning before
waking up which should be monitored daily
at the same time
- There should be a sudden drop of
temperature between 0.3 – 0.6 deg. C
followed by an increase of temperature by
0.3 – 0.6 deg. C which means that the
woman is fertile.
B. Sympto-thermal
C. Cervical Mucus Test
- Billing’s method by Dr. Billing
- Spinnbarkheit 9came from a German word
Spinner which means to play with the
cervical mucus with the finger) or Wet &
Dry Method:
o Wet Cervical Mucus (Fertile) 
abundant, stretchy & transparent
 COMMUNITY HEALTH NURSING I
o Dry Cervical Mucus (Safe & Not  Upper inner arm because it
Fertile)  whitish, pasty & adhesive is nearest to the brain
D. Calendar (Rhythm)  External oblique
- Deleted already since 1998 because it’s not  Thigh
recommended for irregular cycle of  Gluteal muscles
menstruation B. Mechanical
- Menstrual cycle should be regular, obtain 4- o IUD  up to 10 years protection
6 month cycle o Cervical cap & Diaphragm
E. Lactation Amenorrhea Method (LAM):  Prevent the sperm to pass the
RA 7600-Breastfeeding & Rooming in cervix
Law  Works better with spermicide
- DOH organized Maternal & Child Family  Wore 30 minutes coitus and
Health Institute (MCFHI) with the following keep up to 6 after coitus
members: o Condom  most effective way to
o All government hospitals prevent STD’S / STI’s
o Private hospitals (volunteer) C. Behavioral
- Normal involution (uterus goes back to o Abstinence
normal) of the uterus: after 45 days or 5-6 o Withdrawal
weeks or 1 ½ months if not breastfeeding D. Permanent
- Frozen breast milk is to be put out of the o Vasectomy (reversible)  since year
freezer 2 hours before feeding (Body of Ref: 200 in the Philippines
2-3 days / Freezer: 3-4 months) o BLT
- Left over milk should be discarded & should
not be re-preserved or re-frozen because it NUTRITIONAL HEALTH SERVICES
is already contaminated Policies:
Temporary I. Nutritional Surveillance (NS)  to
A. Chemical determine victims of malnutrition
o Oral Pills (Logentrol)  has low A. Anthropometric Measurement  study of
dose of estrogen & progesterone that measurements of human dimensions
inhibits ovulation a. Age of weight  if weight is not
o Parenteral  Depot appropriate with the age:
Medroxyprogesterone Acetate i. Stunting  growth
(DMPA)/ Depoprovera – inhibits retardation
ovulation making women ii. Wasting  connoted
amenorrheic malnutrition
b. Age for height  if height is not
1991, DMPA was found to be causing cancer of the appropriate with the age:
cervix c. Weight for height
1994, DMPA is given IM 4x a tear every 3 months
(90 days interval)
o Implants  Norplant-it inhibits
ovulation effective for 5 years but
seldom advocated for use it is
usually expensive; the client buys the
device (consists of 5 capsules) &
have it implanted at the health center
by minor surgical incision in:
 COMMUNITY HEALTH NURSING I
Rule Male Female Goiter: Iodine Deficiency Disease (endemic in
Every height of uphill)
110 lbs 105 lbs. - Target age group: 0 -59 months
5ft.
Every - Give 1 capsule (200 mg) of potassium iodate
increment of an in oil once a year
+6 +5
inch above 5 ft.
ADD For a child< <5 years old, empty contents of capsule
Every in a cup with warm water because he can’t tolerate
decrement of it
-6 -5 - Adverse effect of iodine deficiency disease
an inch below 5
ft. SUBTRACT that must be avoided:
o Mental retardation-intelligence
d. Skin Folds Test-pinch  the quotient: idiot, moron & imbecile
external oblique muscle with your o Growth retardation-cretinism (pedia)
palm & dwarfism (adult)
i. Normal  1 inch
Macronutrient Malnutrition  available in large
ii. Overweight  >1 inch amount in the body 9Protein Energy Malnutrition or
e. Middle Upper Arm Circumference PEM)
(MUAC)  used in children below - Kwashiorkor  protein deficiency
5 years old by measuring the middle - Marasmus  carbohydrate deficiency
upper arm with a tape measure (energy giving food)
i. Normal  13 cm. and above
ii. Malnutrition  <13cm
B. Biochemical Method
Micronutrient Malnutrition  available in small
amount in the body VADAG:
Vitamin A Deficiency:
- Deficiency: Xerophtalmia-opacity of cornea
leading to night blindness
o Infants (6-12 months)  give
100,000 i.u.
o Pre-schoolers (12-83 months) 
give 200,000 i.u.
o Post partum  give 200,000 i.u.
- Never give Vitamin A to infants less than 6
months & pregnant women because it is
toxic
Anemia: Iron Deficiency Anemia II. Food Production
- Target age group: 0-59 months (less than 5 - Fortification-products without any nutrient
years) are added with nutrients
- Give 3-6 mg/kbw/day - RA 8172 (Asin Law)  Fidel Salt
- Always give the maximum 9Fortification of Iodine Deficiency
Elimination) = iodized salt – “Patak sa
Example: child weighs 8 kg. Asin” by Secretary elavier on December 1-5,
 8x6 = 48mg/day for the 1st 3 months then 2003 where DOH workers go to marker to
monitor, if still anemic, continue giving but check if salt sold contains iodine by placing
compute again 6mg/kbw. few drops of reagent:

o If salt color turns to blue violet 
fortified with ioding
o If salt color show no change  not
fortified with iodine
- RA 832 (Rice Fortification)  FVR
(Fortified Vitamin Rice) by Secreatry
Elavier under FVR, Erap Rice under Erap,
Gloria Rice or “Bigas ni Gloria” under
PGMA
CHILD Health Programs
1. Infant and Young ChildFeeding
2. Newborn screening
3. Expanded Program on Immunization
4. Management of ChildhoodIllnesses
5. Micronutrient Supplementation
6. Dental Health
7. Early ChildDevelopment
8. Child Health Injuries
Food Fortification Program
Fortification  the addition of a micronutrient
deficient in the diet to a commonly and widely
consumed food or seasoning
E.g. The use of FIDEL salt
Fortification for Iodine Deficiency Elimination
COMMUNITY HEALTH NURSING I
Sangkap Pinoy
- Or micronutrients
- Are vitamins and minerals required by the
bod in very small quantities. These are
essential in maintaining a strong, healthy,
and active body; sharp mind; and for women
to bear healthy children
- Vitamin A, iron and iodine, which cannot be
synthesized by the human body, and
therefore must be provided through the diet
Sentrong Sigla Movement
- Is a joint effort of the DOH and the LGUs
- It aims at promoting availability of quality
health services in health centers and
hospitals and at making these services
accessible to every Filipino
- Its main component is the certification and
recognition program that develops and
promotes standards for health facilities
 COMMUNITY HEALTH NURSING I
Republic Act 10028 or the Expanded Breastfeeding Early identification and timely intervention
Promotion Act of 2009 can lead to significant reduction of
RA7600 (or the “Rooming-in and Breastfeeding Act morbidity, mortality, and associated
of 1992) disabilities in affected infants. NBS in the
EO 51: Milk Code of the Philippines Philippines started in June 1996 and was
Benefits of Breastfeeding integrated into the public health delivery
- Bonding
system with the enactment of the Newborn
- Resistance
Screening Act of 2004 (Republic Act 9288).
- Economical
- Currently, PHIC is funding the basic
- Allergy free screening of six disorders for P550 for its
- Safe members. The expanded newborn screening
- Time saving costs P1500 and remains as an option to
- Family Planning parents, wherein PhP 550 is covered by
- Energy Giving PHIC and the remaining PhP 950 as an out
- Error Free Formula of pocket expense of the family.
- Digestible - RA 9288 or the Newborn Screening Act of
- Inexhaustible supply 2004 and DOH AO No. 2014-0045 or the
- No vitamins needed Guidelines on the Implementation of the
- Guaranteed Expanded Newborn Screening Program

Newborn Screening
Republic Act 9288
- Newborn screening (NBS) is a public health
program aimed at the early identification of
infants who are affected by certain
genetic/metabolic/infectious conditions.
 COMMUNITY HEALTH NURSING I
5. Absolute contraindication
- DPT or DPT3to a child who has had convulsions
or shock 3 days the previous dose. (Pertusis content
contraindicated to children with progressing neuro
disease)
- Live vaccines (BCG) should not be given to
individuals who are immunosuppressed d/t
malignancy, therapy with immunosuppresive agents
or irradiation
6. Mild side effects after vaccination is okay!
- Fever
PD 996 (Compulsory Basic Immunization for - Local Reaction
Infants and Children below 8 yrs. Old) 7. Giving doses of a vaccine at less than 4 weeks
- BCG interval may lessen the antibody response.
Lengthening the interval between the doses of
- DPT
vaccine leads to higher antibody levels.
- OPV
8. NO EXTRA dose must be given to
- AMV children/mother who missed dose of
- MMR DPT/HB/OPV/TT. Vaccination must be continued
- Other basic immunization for infants asD as if no time had elapsed.
9. Strictly followed the principle, NEVER, EVER
reconstitute the freeze dried vaccines in anything
other than diluent supplied with them.
RA 10152 An Act Providing Basic Immunization
10. Use one syringe one needle per child during
Services for Infants and
vaccination.
Children, Repealing for The Purpose Presidential
Decree 996.
- TB
- DPT
- Polio
- Measles
- Mumps
- Rubella
- Hepa B
- HIB
- Such other vaccines as may be determined
by DOH

Dental Health Program

Principles - Vision  A lifetime of oral health and no
1. Safe and immunologically effective to
tooth decay for the next generation
administer all EPI on the same day at different site
- Strategies:
2. Measles vaccine should be given as soon as the
child is 9 months old, regardless of whether other o Social mobilization
vaccines will be given on that day.(85%) o Coordination and partnership with
3. Moderate fever, malnutrition, mild respiratory sectoral groups
infection, cough, diarrhea and vomiting are NOT o Networking
contraindication. o Capacity building and work value
4.Vaccination sched should NOT be restarted from formation
the beginning even if the interval years between
doses exceed the recommended interval per month
 COMMUNITY HEALTH NURSING I
Sang Milyong Sepilyo  Modified refrigerator
- Project for social mobilization o Freezer compartment
- Aim: o Body
o Emphasize the importance of oral  Top- OPV, AMV
health in relation to total body health  Middle- BCG, DPT, Hep B, TT,
o Increase public awareness on the Diluent
prevention of common dental  Lower- Bottles/ ice packs with water
diseases
o Solicit one million new toothbrushes HOW TO MAINTAIN COLD CHAIN
Stocking of Vaccines in the Transport Box
from concerned citizens
Vaccine Carrier
Elements of EPI (SACIT)  Make sure you have enough ice packs
- Surveillance, studies and research o Transport box- 24 pcs
- Assessment and evaluation of the program’s o Vaccine carrier- 4 pcs
overall performance  Place OPV, AMV in contact with frozen ice
- Cold chain logistic management packs
- Information, education and communication  Wrap DPT, Hep B, TT with paper
- Target setting  Place BCG in between AMV, OPV and
wrapped vaccines
Principles & Legal Basis
- Based on Epidemiological Situation What to do with opened vials of vaccines?
- Mass Approach I. Continue to use opened vials in the subsequent
- Basic health service (it’s integrate into the sessions if all these conditions are met:
health system) 1) Expiry date has not passed
- P.D. 996 – compulsory basic immunization 2) Vaccines are stored appropriately (+2 to 8
for infants and children below 8 years old ⁰C)
3) Sterile procedures have been fully observed
Discard Point of OPV using the VVM
4) Opened vial has not been contaminated
Constant Temperature, Length of Time VVM
Day and Night Reaches “Discard NOTE: Discard opened BCG and MV after 6 hours
Point” of reconstitution. Opened vials of DPT, Hep B, TT
At room temperature + 8 days can still be used for 4 weeks provided condition 1-4.
25⁰C II. Discard an opened vial immediately if any of
At room temperature + 20 days the following conditions apply:
20⁰C 1) Sterile procedures have not been fully
At room temperature + 180 days observed
4⁰C 2) + suspicion of contamination of the opened
At room temperature - Over 2 years vial
20⁰C
3) + visible evidence of contamination of the
opened vial (e.g. change in appearance or
Proper stocking of Vaccines (refrigerator)
 Neatly arrange the vaccines (segregated by presence of floating particles)
type) 4) If the label has come off, or
5) If the VVM has reached discard point
 Domestic refrigerator
o Freezer compartment -OPV, AMV a) the inner square matches, or
o Body - BCG, DPT, Hep B, TT, Diluent b) is darker than the circle
6) Reconstituted vaccines (BCG, AMV) after
6 hours of reconstitution
 COMMUNITY HEALTH NURSING I
What is thermal shock?
 It is the process of damage to the vaccine
resulting from the usage of diluent that is at too
high a temperature (above +8⁰C)
 It results in the death of some or all of the
essential live organisms in the vaccine.
How to read a vaccine vial monitor
 The inner circle is lighter than the outer circle. If
the expiry date has not passed, USE the vaccine.
 As time passes the inner square is still lighter
than the outer circle. If the expiry date has not
passed, USE the vaccine
 Discard point: the color of the inner square
matches that of the outer circle, DO NOT USE
the vaccine.
 Beyond the discard point: inner square is darker
than the outer circle, DO NOT USE the vaccine.
Sizes of Syringe and Needle to Use during
Vaccination
DPT, MV use 2-3 mL syringe with
and TT 25 or 30 mm 23 or 25 gauge
needle
BCG use 1 mL tuberculin syringe with
10 mm 26 gauge needle STEPS TO CALCULATING HEP B
In mixing use 5 or 10 mL syringe with REQUIREMENT
vaccines 18 gauge needle 1) Identify the important data for computation
Eligible Population (EP) of infants
“First Expiry and First Out” EP= Total Population (TP) x 3%
 A “first expiry and first out” (FEFO) vaccine Wastage Multiplier: 1.2
system is practiced to assure that all vaccines National:
are utilized before its expiry date. Proper Reserve stock: 25%
arrangement of vaccines and/or labeling of Reserve stock multiplier: 1.25
expiry dates are done to identify those close to Region/province/city:
expiring. Reserve stock: 12.5%
Reserve Stock Multiplier: 1.125
 Vaccine temperature is monitored twice a day
Municipality:
(early in the morning and in the afternoon) in all
Reserve stock: 12.5%
health facilities and plotted to monitor break in Reserve Stock Multiplier: 1.1
the cold chain. 2) Formula
Target Setting  Hep B requirements of
Wastage Factor: (constant) National/Provincial/city level
DPT= 1.67 =EP x no. of doses x wastage multiplier x
OPV= 1.67 reserve stock multiplier
Measles= 2
BCG= 2.5
HepB= 1.10
Tetox= 1.67
 COMMUNITY HEALTH NURSING I
 Hep B requirements of lower level b) inadequate antibody production response to
= EP x no. of doses x wastage multiplier x children in that area
reserve stock multiplier c) risk of hematoma formation
d) potential injury to the sciatic nerve
Which of the following is NOT an element of EPI
a) Information, Education, and Which of the following is an inappropriate nursing
Communication intervention about Hepatitis B vaccine?
b) Surveillance, studies and research a) Shouldn’t be given intradermal
c) Target setting b) Should be given in the anterolateral thigh
d) Vaccine safety muscle
c) Should do shake test to determine if the
The law which requires compulsory basic vaccine has been damaged by heat
immunization for infants and children below 8 years d) Shouldn’t be frozen to preserve its potency
old.
a) R.A. 7846 Which of the following is appropriate?
b) P.D. 996 a) No mother/child should be discharged from
c) R.A. 8746 the hospital without providing the mother
d) P.D. 966 the required Hepatitis B vaccine.
b) Provision of birth dose of Hepatitis B
Which of the following does not belong to the 7 vaccine to infants weighing equal to or more
target EPI diseases? than 1000 grams at birth.
a) Diphtheria c) Infants attended at birth by midwives shall
b) Tuberculosis be given the combination of Hepatitis B
c) Diabetes vaccine within 24 hours after birth.
d) Tetanus d) If birth is attended by TBA outside regular
health facilities, the midwife will give
It is a highly communicable infectious disease of
immunization during house visit within 7
children with paroxysm of coughing that reach a
peak of violence ending in a long-drawn inspiration days after delivery
that produces a characteristic “whoop”. It assure that all vaccines are utilized before its
a) Emphysema expiry date?
b) Pertussis a) vaccine vial monitoring
b) FEFO system
c) Tuberculosis
c) cold chain management
d) Bronchial asthma
d) ECCD monitoring
Which of the following is a fully immunized child? Which of the following is an example of relative
a) a 7 month child who has received 1 MV, 1 contraindication to immunization?
a) Melena, a newborn baby of a mother with
BCG, 1 Hep B, 3 DPT and 3 OPV
b) an 18 month old child who had just AIDS, about to be given BCG
completed his 1 BCG, 1 Hep B, 1 MV, 3 b) Shigella, a Eurasian child who develops
DPT and 3 OPV convulsion within 3 days of givin DPT, and
c) a 1 year old child who had just completed is due to receive DPT2
his 1 BCG, 1 Hep B, 1 MV, 3 DPT and 3 c) Bordatella, a 6 week infant-relative of the
OPV nurse, who has active neurologic disease
d) none of the above d) Rubella, a 14 week infant, admitted to the
hospital due to fever and chills.
Hepatisis B vaccine should not be given in the
buttocks because of: Which of the following follows the standard
a) gluteal muscle irritation and pain protocol on immunization?

a) Open a vial of vaccine eve if only one
eligible child or pregnant woman is present
for immunization.
b) Distribute health information materials on
family planning
c) Conduct health education among mothers
with high risk infants only
d) Use on sterile needle and one syringe for
each type of vaccine for all patients
During administration of DPT, MV, and TT, what
syringe size is appropriate?
a) 1 ml syringe
b) 5 ml syringe
c) 2-3 ml syringe
d) none of the above
When injecting BCG to your infants, which of the
following needle sizes is most appropriate?
a) 26 gauge needle
b) 23 gauge needle
c) 19 gauge needle
d) 18 gauge needle
Upon inspection of the vaccine vial monitor, you
noticed that the inner square is darker than the outer
circle. Which of the following is correct?
a) it has reached the discard point, do not use
b) it is already expired, do not use
c) it is already beyond discard point, do not use
d) it is already expired, do not use if already
opened
In storing OPV, which of the following is
appropriate?
a) middle portion of the body of a modified
refrigerator
b) lower body of a domestic refrigerator
c) freezer compartment of both the domestic or
modified refrigerator
d) top body of a modified refrigerator
COMMUNITY HEALTH NURSING I
In storing diluents, which of the following is
appropriate?
a) middle portion of the body of a modified
refrigerator
b) lower body of a domestic refrigerator
c) freezer compartment of both the domestic or
modified refrigerator
d) top body of a modified refrigerator
In storing AMV, which of the following is
appropriate?
a) middle portion of the body of a modified
refrigerator
b) lower body of a domestic refrigerator
c) freezer compartment of both the domestic or
modified refrigerator
d) top body of a modified refrigerator
SAMPLE COMPUTATION PROBLEM
Given: Tagbilaran City, with a total population
of 1,000,000 for 2007. Compute for the annual
requirements for Hepatitis B.
Compute for the eligible population (infants)
1,000,000 x 0.03
= 30,000 infants
Calculate for the annual needs (in doses)
30,000 x 3 doses x 1.2 (WM) x 1.125 (RSM)
= 121,500 doses
Calculate for the annual needs (in vials)
121, 500 doses/ 10 doses per vial
= 12,150 vials
ENVIRONMENTAL SANITATION
 refers to all factors available in the environment
affecting the health of the individual or
population
 regulated by PD 856: Comprehensive Sanitation
Code of the Philippines
ENVIRONMENTAL HEALTH SERVICES
(EHS) OF DOH IS RESPONSIBLE FOR
 Promotion of healthy environmental conditions
and prevention of environmental related
diseases through appropriate sanitation
strategies
 Promotion & implementation of sanitation
programs through the Department of Health
Field Health Units

 Conceptualization of new programs/projects to
contend with emerging environmentally related
health problems
COMPONENTS:
 Water Supply Sanitation Program
 Proper Excreta and Sewage Disposal
Program
 Insect And Rodent Control
 Food and Sanitation Program
 Hospital Waste Management Program
1. WATER SUPPLY SANITATION
PROGRAM
 Potable
 Free from any particles that might cause
illness to a individual
Ways to Make Water Potable:
 Boiling: minimum of 3 minutes to maximum of
10 minutes for drinking
 Sterilization: 30 minutes after the water starts
to boil
 Filtration: makes use of filter paper or cotton
cloth to separate solid particle from liquid if
water comes from river
 Coagulation/Flocculation: uses aluminum
crystal (tawas) that collects or absorbs particles
from liquid part & becomes slimy
 In 1 gallon of water, drop tawas (the size
of magi cubes) & allow to sstand for 608
hours
 Initially, water appears to be cloudy then
after 6-8 hours of standing, the water
becomes clear
 Chlorination: uses 100% pure concentrated
chlorine bought from botika or given free by
health centers
 To prepare stock solution (SS): in 1 liter
drinking water, add 1 tablespoon of
concentrated chlorine which is potent for
3-4 months
 To prepare the chlorinated water: in 2 ½
gallons of drinking water (10,000 ml=10
liters), add 1 tablespoon from the prepared
stock solution & let it stand for 30 minutes
to react with water
COMMUNITY HEALTH NURSING I
 Fluoridation: adding fluoride to prevent dental
caries (primary significance) & whitens enamel
of teeth ( 2nd significance)
 Aeration: exposing drinking water in air to
strengthen taste within 24 hours which is
usually used in uphill areas where there’s less
or no pollution
3 TYPES OF APPROVED WATER SUPPLY
AND FACILITIES
Level I -Point Source
A protected well or a developed spring with an
outlet but without a distribution system for rural
areas where houses are thinly scattered.
Level II Communal faucet system or stand posts
A system composed of a source, a reservoir, a piped
distribution network and communal faucets, located
at not more than 25 meters from the farthest house
in rural areas where houses are clustered densely.
Level III Waterworks system or individual house
connections
A system with a source, a reservoir, a piped
distributor network and household taps that is suited
for densely populated urban areas.
2. PROPER EXCRETA AND SEWAGE
DISPOSAL SYSTEM
3 TYPES OF APPROVED TOILET
FACILITIES
Level 1
Non-water carriage toilet facility:
- Pit latrines
- Reed Odorless Earth Closet
- Bored-hole
- Compost
Toilets requiring small amount of water to wash
waste into receiving space
- Pour flush
- Aqua privies
Pit latrines
 most commonly observed in rural area
 has three components: the pit, a squatting plate
and the super-structure

types of pit include
 “Antipolo type”, a pit type of toilet
provided with concrete floor and an elevated
seat with a cover
 Ventilated Improved Pit or VIP, pit with a
vent pipe
 Reed Odourless Earth Closet or ROEC, a
pit completely displaced from the
superstructure and connected to the
squatting plate by a curved chute.
Bored Hole Latrine
 consists of relatively deep holes bored into the
earth by mechanical or manual earth-boring
equipment
 holes are about 10-18 inches in diameter and
usually 15-35 feet deep. The hole is provided to
facilitate squatting.
Two types of bored-hole latrines are:
 Wet Type - when the hole penetrates ground
water table or other strata.
 Dry Type - when the hole does not reach
ground water table; fills up at a faster rate
than the wet type.
Level 2
On site toilet facilities of the water carriage type
with water sealed and flushed type with septic
vault/tank disposal facilities.
Level 3
Water carriage types of toilet facilities connected to
septic tanks an/or to sewerage system to treatment
plant.
THINGS TO CONSIDER IN CONSTRUCTING
A TOILET
FACILITY:
 At least 25 meters away from water sources at a
lower elevation
 It should be within your financial capability
 It should be approved by the local health
authorities
COMMUNITY HEALTH NURSING I
CARE AND MAINTENANCE OF YOUR
TOILET FACILITY:
 Water must be provided at all times.
 Use toilet paper
 Use lysol once a month for odor removal
 Clean the bowl by muriatic acid to remove the
stains.
 Avoid depositing solid objects on the bowl to
prevent clogging
 Always check your toilet if it’s clean
 Use plunger when clogging occurs. Don’t use
sticks or rods to avoid the breakage of the trap
or the bowl.
3. PROPER SOLID WASTE MANAGEMENT
refers to satisfactory methods of storage, collection
and final disposal of solid wastes
SOURCES OF SOLID WASTE
 Household Waste - these are wastes generated
in or discharged from household including
shops but excluding commercial activities
 Commercial Waste - restaurants, stationery
shops, grocery shops or any commercial
activity are the main sources of commercial
waste.
 Market Waste - only refers to waste generated
in or discharged from markets both for whole
sale and retailing
 Institutional Waste - these are wastes
generated in government, state enterprise and
private firm office.
 Street Sweeping Waste - these are wastes
generated by the street sweeping cleansing
service.
 River Waste - includes all the wastes
generated by the river and creek cleansing
 Medical Waste - these are wastes generated in
hospitals.
COMPONENTS OF SOLID WASTE
 Garbage refers to left over vegetable, animal
and fish material from kitchen and food
establishments. These materials have the
tendency to decay giving off foul odors and
sometimes serve as food for flies and rats.

 Rubbish refers to waste materials such as
bottles, broken glass, tin can, waste papers,
discarded textile materials, porcelain wares,
pieces of metal and other wrapping materials.
 Ashes are left over from burning of wood and
coal. Ashes may become a nuisance because
of the dust associated with them.
 Stable manure is animal manure collected
from stables.
 Dead animals like dead dogs, cats, rats, pigs,
and chickens that are killed by cars and trucks
on streets and public highways. They include
small and large animals that died from disease.
 Street sweeping includes dust, manure, leaves,
cigarette buts, waste papers and other
materials that are swept from streets.
 Night soil is human waste normally wrapped
and thrown into sidewalks and streets. This
also includes human waste from pail system of
toilets.
 Yard cuttings includes leaves, branches, grass
and other
SANITARY WAYS OF TREATING
GARBAGE:
 Segregation-separating biodegradable from
non-biodegradable
 Collection-adherence to the proper collection
time→ the City of Manila coordinates with
Leonel Waste Management (a private firm
which collects garbage) where the truck driver
coordinates with the Barangay Chairman on
the time they will collect garbage so don’t
bring out garbage before the collection time
WAYS OF DISPOSAL
Household
 Burial ► Deposited in 1m x 1m deep pits
covered with soil, located 25 m. away from
water supply
 Open burning
 Animal feeding
 Composting
 Grinding and disposal sewer
COMMUNITY HEALTH NURSING I
Community
 Sanitary landfill or controlled tipping
o Excavation of soil deposition of refuse and
compacting with a solid cover of 2 feet
 Incineration
o Ecological Solid Waste Management: RA
9003- the use of incinerator approved in
2000 but was implemented in 2003 because
of lack of funding to purchase
4. FOOD SANITATION PROGRAM
POLICIES:
 Food establishment are subject to inspection
(approved of all food sources containers and
transport vehicles)
 Comply with sanitary permit requirement
 Comply with updated health certificates for food
handlers, helpers, cooks
 All ambulant vendors must submit a health
certificate to determine present of intestinal
parasite and bacterial infection
3 POINTS OF CONTAMINATION
 Place of production processing and source of
supply
 Transportation and storage
 Retail and distribution points
5. HOSPITAL WASTE MANAGEMENT
RA 4226-Hospital Licensure Act monitors the
hospital license & proper management of wastes as
well as renewal of license to operate
GOAL: To prevent the risk of contraction
contracting nosocomial infection from type disposal
of infectious, pathological and other wastes from
hospital
COLOR CODING OF BIN TO KEEP WASTE:
 Green: wet waste
 Black: dry waste
 Yellow: infectious/pathological waste like
blood, sputum, urine, feces & gauze
 Orange: toxic/hazardous waste