Objectives:

► At the of discussion students will be able:

1. To know what are the DOH Programs
►
DOH Programs Related to Family Health
►
A. Expanded Program of
►
Immunization (EPI)
►
B. Integrated Management of
►
Childhood Illnesses (IMCI)
►
C. Early Essential Intrapartal and
►
Newborn Care (EEINC)
►
D. Newborn Screening
►
E. BEmONC/CEmONC
►
F. Nutrition
►
G. MhGap
►
H. Other Related Programs
EXPANDED PROGRAM
ON IMMUNIZATION

► National Immunization Program

► PD 996 compulsory immunization
► RA 7846 HEPA B VACCINATION
► PP 1066 TETANUS ELIMINATION
► PP773 KNOCK OUT POLIO CAMPAIGN
► RA10152 INFANT AND CHILD HEALTH IMMUNIZATION
► TETANUS TOXOID IMMUNIZATION
FOR PREGNANT WOMAN:
▪ TT is given not only to protect the mother from tetanus but
also to prevent occurrence of neonatal tetanus
▪
TT is 0.5 ml given IM at the deltoid region of the upper arm
▪ FULLY IMMUNIZED MOTHER
VACCINE INTERVAL PROTECTION DURATION

TT1 AS EARLY AS ----- ----

POSSIBLE
TT2 AFTER 4 80% 3YRS
WEEKS
TT3 AFTER 6 95% 5YEARS
MONTHS
TT4 AFTER 1 YR 99% 10YRS
TT5 AFTER 1 YR 99% LIFETIME
BECAUSE OF THE GLOBAL BURDEN OM CHILD
MORBIDITY AND MORTALITY EXPANDED
PROGRAM ON IMMUNIZATION WAS DEVELOPED
IT PRIMARILY FOCUSSES ON REACHING THE
BRIGHT GOAL OF FULLY IMMUNIZED CHILD
(FIC) AND TO IMPROVE THE RATE FOR CHILD
PROTECTED AT BIRTH (CPAB) IN THE COUNTRY
EPI WAS ESTABLISHED TO ENSURE THE ACCESS
OF INFANT AND CHILDREN (0-12 MONTHS OLD)
TO THE RECOMMENDED VACCINES WHICH
RETURN COULD PREVENT THE SEVEN COMMON
DISEASES ; TUBERCULOSIS, POLIOMYELITIS,
DIPTHERIA, TETANUS, PERTUSSIS OR
WHOOPING COUGH, MEASLES AND HEPATITIS.
REPUBLIC ACT NO. 10152
► AN ACT PROVIDING FOR MANDATORY BASIC
IMMUNIZATION SERVICES FOR INFANTS AND
CHILDREN, REPEALING FOR THE PURPOSE
PRESIDENTIAL DECREE NO. 996, AS AMENDED
► SECTION 1. Title.—This Act shall be known as
the “Mandatory Infants and Children Health
Immunization Act of 2011”.
► SEC. 2. Declaration of Policy
► SEC. 3. Coverage.—The mandatory basic immunization for all
infants and children provided under this Act shall cover the following
vaccine-preventable diseases:
►
(a) Tuberculosis;
►
(b) Diphtheria, tetanus and pertussis;
►
(c) Poliomyelitis;
►
(d) Measles;
►
(e) Mumps;
►
(f) Rubella or German measles;
►
(g) Hepatitis-B;
►
(h) H. Influenza type B (HIB); and
► (i) Such other types as may be determined by the Secretary of
Health in a department
►
SEC. 4. Education and Information Campaign
►
SEC. 5. Obligation to Inform.
► SEC. 6. Continuing Education and Training of
Health Personnel.
► SEC. 7. Appropriations.(The Philippine Health Insurance
Corporation (PHIC) shall include the basic
immunization services in its benefit package)
►
SEC. 8. Implementing Rules and Regulations
►
SEC. 9. Separability Clause.
►
SEC. 10. Repealing Clauss.
►
SEC. 11. Effectivity.
EPI GOAL
1. To immunized all infants/children against the most
common vaccine-preventable diseases
► A child is said to be fully immunized child if he receives one dose of
BCG, 3 doses of OPV, MONOVALENT HEP B 3 doses of DPT, 4 doses
of HBV and one dose of measles BEFORE HIS FIRST BIRTHDAY.
► 2. To sustained the polio-free status of the Philippines
► 3. To eliminate measles infection
► 4. To eliminate maternal and neonatal tetanus
► 5. To prevent extra pulmonary tuberculosis among children
EPI PRINCIPLE
❑ The program is based on epidemiological situation: schedules are
drawn on the basis of occurrences and characteristic features of the
said diseases
❑ The whole community rather that just an individual is to
be protected, thus mass approach is applied
❑ Immunization is basic health services and as such, it is integrated
into the health services provided for by the RHU

► IMMUNIZATION- is a process by which vaccines are introduce to the

body, before infectious sets in
 EPI ELEMENTS
1. Target setting (0-12 mos.)
2. Cold chain management (for vaccine life span and utilization)
3. Information, education and communication
► Three reasons:
► a. for parents to be motivated to submit their child to immunization
► b. to provide health teachings on benefits and importance of immunization

►c. to inform the public about its availability and schedule(RHU every
Wednesday, BHS every once a month, and remote area every quarterly)
► 4. Assessment and evaluation of the programs over all performance
► 5. Surveillance, studies and research
► Bacille Calmette-Guérin (BCG)
► • Given intradermally (ID)
► • The dose of BCG is 0.05 ml for children < 12
months of age and 0.1 ml for children > 12
months of age
► • Given at the earliest possible age after birth
preferably within the first 2 months of life
► • For healthy infants and children > 2 months
who were not given BCG at birth, PPD
prior to BCG vaccination is not necessary.
▪ BCG Vaccines
▪ Given at birth = 0.05ml intradermal at right deltoid
▪ INTERVAL= GIVEN ONCE
▪ Booster school entrance= 0.1ml at left deltoid
▪ Side effects of BCG:
1. Koch ‘s phenomenon- acute inflammatory process starting within 24
hours and may last for 2-4 days. Wheal must disappear in about 30 mins
to 1hr.
st nd
2. Abscess formation- 1 week (soreness and inflammation), 2 week to
th
11 week healing of abscess and ulceration. If no scar develop repeat
the procedure after 2 months
3. Indolent ulceration : wrong technique, or exposure of infant to patient
with active TB
4. Glandular enlargement: unsterile syringe or needle was used, too
much vaccine was injected, the vaccine might be injected under the skin
layer, and not instead in its superficial layer
► Management: incision and drainage: isoniazid
► Hepatitis B Vaccine (HBV)
► • Given intramuscularly (IM)
► • Administer the first dose of monovalent HBV to all
newborns >2kgs within 24 hours of life.
► • A 2nd dose is given 1-2 months after the birth dose
► • The final dose is administered not earlier than 24 weeks
of age. Another dose is needed if the last dose was
given at age <24 weeks.
► For infants born to HBsAg
(+) mothers:
► • Administer HBV and HBIG (0.5ml) within 12
hours of life. HBIG should be administered not later
than 7 days of age if not immediately available
► Haemophilus influenzae Type b
Conjugate Vaccine (Hib)
► • Given intramuscularly (IM)
► • Given as a 3-dose primary series with a minimum age of 6 weeks and a
minimum interval of 4 weeks
► • A booster dose is given between 12-15 months of age with an interval of

6 months from the 3rd dose Refer to Vaccines for Special Groups
► Diphtheria and Tetanus Toxoid and
Pertussis Vaccine (DTP)
►
• Given intramuscularly (IM)
►
• Given at a minimum age of 6 weeks with a minimum interval of 4 weeks
► • Complete a 5-dose series at ages 2, 4, 6, 15 through 18 months, and 4
through 6 years. The recommended interval between the 3rd and 4th dose
is 6 months, but a minimum interval of 4 months is valid
►
Inactivated Poliovirus Vaccine (IPV)
►
• Given intramuscularly (IM)
► • Usually given in combination with DTaP and
Hib, with or without Hep B
► • Given at a minimum age of 6 weeks with a
minimum interval of 4 weeks
► • The primary series consists of 3 doses
► • A booster dose should be given on or after the 4th
birthday and at least 6 months from the previous
dose
► Rotavirus Vaccine (RV)
► • Given per orem (PO)
► • Given at a minimum age of 6 weeks with a
minimum interval of 4 weeks between doses.
The last dose should be administered not later
than 32 weeks of age.
► • The monovalent human rotavirus vaccine
(RV1) is given as a 2-dose series and the
pentavalent human bovine rotavirus vaccine
(RV5) is given as a 3-dose series.
► Pentavalent vaccines:
► Compose of : DPT, HEP B. HIB-MENINGITIS
► Given at upper outer portion of the thigh
intramuscularly 0.5 ml
► 3 doses
st
► 1 dose given at 6 weeks
nd
► 2 dose given at 10 weeks
rd
► 3 dose given at 14 weeks

► 4 weeks interval
►
Pneumococcal Conjugate Vaccines (PCV)
►
• Given intramuscularly (IM)
► • Given at a minimum age of 6 weeks for PCV10 and
PCV 13
► • Primary vaccination consists of 3 doses with an
interval of at least 4 weeks between doses plus a
booster dose given 6 months after the 3rd dose.
► • Healthy children 2 to 5 years old who do not have
previous PCV vaccination may be given 1 dose of
PCV 13, or 2 doses of PCV 10 at least 8 weeks
apartRefer to Vaccines for Special Groups for
Pneumococcal Vaccine recommendation in high-risk
children
►PCV( Pneumococcal
conjugate vaccine)
►
=3 dose; 0.5ml
►
=IM Vastus lateralis
► =6week,1oweeks and 14 weeks

►
=4 weeks interval
►
MCV
►
=for measles
►
2 doses
►
=0.5ml SQ deltoid
►
=MCV1(monovalent measles: rubeola) 85% at 9 months
►
=MCV2(combination: MMR) 95%
►
=give 12-15 months
►
Side Effects of Measles Vaccine:
► 1.Fever and Rashes – for rashes mother mjay
giveANTIHISTAMINES (Benadryl) and for itchiness
(Calamine Lotion)
►
Japanese Encephalitis Vaccine (JE)
►
• Given subcutaneously (SC)
►
• Given at a minimum age of 9 months
► • Children 9 months to 17 years of age should
receive one primary dose followed by a
booster dose 12-24 months after the primary
dose
► • Individuals 18 years and older should
receive a single dose only
► Hepatitis A Vaccine (HAV)
► • Given intramuscularly (IM)
► • Given at a minimum age of 12 months
► • 2 doses of the vaccine are recommended
► • The 2nd dose is given at least 6 months from the
1st dose
► HPV VACCINE
► 3 DOSES IM DELTOID
ST
►1 FROM 10-18 YEARS OLD
ND
►2 AFTER 1 MONTH
RD
► 3 AFTER 5 MONTHS
►Integrated management

of childhood illness
chart booklet
 EARLY ESSENTIAL INTRAPARTUM
AND NEWBORN CARE(EEINC)
► Is a package of evidence-based practices
recommended by the Department of Health
(DOH), Philippine Health Insurance
Corporation (PhilHealth), and the WHO as the
standard of care in all births by skilled
attendants in all government and private setting
FROM 0-30 SECONDS
1 MINUTE
3 MINUTES
90 MINUTES
►
NEWBORN SCREENING LAWS RA 9288
►
WITHIN 48-74 HOURS HEEL PRICK
►

• TO DETERMINE: BASIC
• CONGENITAL ADRENAL HYPERPLASIA
• CONGENITAL HYPOTHYROIDISM
• GALACTOSURIA
• G6PD
• MSUD
• PKU
EXPANDED NBS
► ENBS Allows the detection of more genetic disorder
► The expanded newborn screening program
increased the screening panel of disorders
from siX (6) to more than twenty-eight.
► Aside from the six conditions in the present panel
► Congenital Hypothyroidism,
► Congenital Adrenal Hyperplasia,
► Galactosemia,
► Phenylketonuria,
► Maple Syrup Urine Disease and
► Glucose-6-Phosphate Dehydrogenase deficiency
Expanded newborn screening will screen for additional
disorders falling under various groups of conditions namely:
► hemoglobinopathies,
► disorders of amino acid and organic acid metabolism,
► disorders of fatty acid oxidation,
► disorders of carbohydrate metabolism,
► disorders of biotin metabolism and cystic fibrosis.
 EMONC
(EMERGENCY OBSTETRIC AND NEWBORNCARE)
► BEMONC ► CEMONC

Basic simple w/o OR Comprehensive w/ OR

RHU, HC, BHS Regional hospital,

national hospital,
Lying in, puireculture, provincial hospita
district hospital Ob.gyne specialist
4 facilities: 1 facilities: 500,000
500,000 population population
I facilities: 125,000
► Function of BEMONC
• Antibiotic
• Anticonvulsant
• Assisted vaginal delivery
• Manual removal of the placenta
• Oxytocin
• Removal of the retain products
• Imminent delivery
• Corticosteroid
• Essential newborn care or
unang yakap
► Function of CEMONC
• Antibiotic
• Anticonvulsant
• Assisted vaginal delivery
• Manual removal of the placenta
• Oxytocin
• Removal of the retain products
• Imminent delivery
• Corticosteroid
• Essential newborn care or unang
yakap
► BLOOD TRANSFUSION
► CESARIAN SECTION AND
OTHER RELATED SURGERY
NUTRITION PROGRAM
 NUTRITIONAL
HEALTH ► PROGRAM
PD 491 PHIL-NUTRITIONAL LAW
► GUIDELINES IN NUTRITION PROGRAM
► #1 Eat variety of food everyday
► #2 Pure breastfeeding
► #4 Consume meat, fish, protein, poultry and beans
► #5 Eat more vegetables, fruits and root crops
► #8 iodized salt
► #9 Eat clean and safe food
► #10 Healthy lifestyle
NUTRITIONAL HEALTH PROGRAM

► GUIDELINES IN NUTRITION PROGRAM

► #1 Eat variety of food everyday
► #2 Pure breastfeeding
► #4 Consume meat, fish, protein, poultry and beans
► #5 Eat more vegetables, fruits and root crops
► #8 iodized salt
► #9 Eat clean and safe food
► #10 Healthy lifestyle
NUTRITION

healthy, repair damage tissue and supply energy

► 2 types of nutrients
► 1. Macro-nutrient
► CHO= 50% UPDATE 55-70%
► CHON= 20% UPDATE 10-15%
► FATS= 30% UPDATE 20-30%

► 2. MICRO-nutrients= vitamins and minerals

 PROTEIN ENERGY
MALNUTRITION
► MARASMUS ► KWASHIORKOR

Total energy malnutrition Protein deficiency

Muscle wasting, Muscle wasting, with fats
without fats Moon shape and unhappy
Old man’s face face
Swollen extremities, edema
Prominent ribs
of the feet
Anxious and always hungry Apathetic and does not
want to eat
 MICRO-NUTRIENT
• Fortification added to the food
• ASAP(araw ng sangkap pinoy or garantisadong pambata) done
during child health week 2x a year
• 4 B’s (bata, buntis, bakona, bitamina)
• Common Nutritional Deficiency:
• Vitamin A #1 deficiency; lead to night
blindness, or total blindness
• IRON
• IODINE
VITAMIN A SUPPLEMTATION

• I capsule 1 drops
• For infant 6-1yr: one dose 100,000 iu, color blue
• For 1-2yrs old: one dose 200,000 iu, color red
• For pregnant : 10,000 iu, color yellow
VITAMIN A
SUPPLEMENTATION SCHEDULE
AFTER 6 MONTHS
► VIT A. DEFICIENCY:
TREATMENT TODAY,
TOMORROW AND AFTER
2 WEEKS
► MICRO-NUTRIENT
SUPPLEMENTATION
FOR MOTHERS:

VITAMINS DOSE SCHEDULE

VIT A 10,000IU TWICE A WEEK
STARTING ON
TH
THE 4
MONTH OF
PREGNANCY
IRON/FOLIC 60MG/400UG DAILY
TH
ACID STARTING 5
MONTH OF
PREGNANCY
UPTO2
LAW THAT PROTECT INFANT AND
YOUNG CHILD FEEDING

• Milk code (EO 51)

• RA 7600; rooming in and breastfeeding act of 1992
• RA10028 combination of milk code
and breasfeeding
• RA 8976 food fortification act- sangkap pinoy seal
► green(iron), yellow(vit a), red(iodine)
Mental Health Gap Action
Programme(mhGAP)
Background:
► WHO recently launched the Mental Health Gap
Action Programme (mhGAP) for low- and middle-
income countries with the objective of scaling up
care for mental, neurological and substance use
disorders. This mhGAP Intervention Guide
(mhGAP-IG) has been developed to facilitate
mhGAP-related delivery of evidence-based
interventions in non-specialized health-care settings.
► The priority conditions included are
depression, psychosis, bipolar disorders,
epilepsy, developmental and behavioural
disorders in children and adolescents,
dementia, alcohol use disorders, drug use
disorders, self-harm / suicide and other
significant emotional or medically
unexplained complaints. These priority
conditions were selected because they
represent a large burden in terms of
mortality, morbidity or disability, have high
economic costs, and are associated with
violations of human rights.
► Development of the mhGAP Intervention Guide (mhGAP-IG)
► The mhGAP-IG has been developed through an intensive process
of evidence review. Systematic reviews were conducted to develop
evidence-based recommendations.
► The mhGAP-IG is based on the mhGAP Guidelines on
interventions for mental, neurological and substance use disorders
► Purpose of the mhGAP Intervention Guide
► The mhGAP-IG has been developed for use in non-
specialized health-care settings. It is aimed at health-care
providers working at first- and second-level facilities
► The mhGAP-IG is brief so as to facilitate interventions by
busy non-specialists in low- and middle-income countries. It
describes in detail what to do but does not go into descriptions
of how to do. It is important that the non-specialist health-care
providers are trained and then supervised and supported in
using the mhGAP-IG in assessing and managing people with
mental, neurological and substance use disorders.
► mhGAP implementation – key issues
► Implementation at the country level should start
from organizing a national stakeholder’s meeting,
needs assessment and identifi cation of barriers to
scaling-up. This should lead to preparing an action
plan for scaling up, advocacy, human resources
development and task shifting of human resources, fi
nancing and budgeting issues, information system
development for the priority conditions, and
monitoring and evaluation.
 How to use the mhGAP-IG

► The mhGAP-IG starts with “General

Principles of Care”. It provides good
clinical practices for the interactions of
healthcare providers with people
seeking mental health care. All users of
the mhGAP-IG should familiarize
themselves with these principles and
should follow them as far as possible.
► The mhGAP-IG includes a “Master Chart”, which provides information
on common presentations of the priority conditions. This should guide the
clinician to the relevant modules.In the event of potential co-morbidity
(two disorders present at the same time), it is important for the clinician to
confirm the co-morbidity and then make an overall management plan for
treatment.
► The most serious conditions should be managed first. Follow-up at next
visit should include checking whether symptoms or signs indicating the
presence of any other priority condition have also improved. If the
condition is flagged as an emergency, it needs to be managed first. For
example, if the person is convulsing, the acute episode should be managed
first before taking detailed history about the presence of epilepsy.
► The modules, organized by individual priority conditions, are a tool for clinical
decision-making and management. Each module is in a different colour to
allow easy differentiation. There is an introduction at the beginning of each
module that explains which condition(s) the module covers.
► Each of the modules consists of two sections. The first section is
the assessment and management section. In this section, the contents are
presented in a framework of flowcharts with multiple decision points. Each
decision point is identified by a number and is in the form of a question.
Each decision point has information organized in the form of three columns
– “assess, decide and manage”.
► The left-hand column includes the details for
assessment of the person. It is the assess
column, which guides users how to assess the
clinical condition of a person. Users need to
consider all elements of this column before
moving to the next column.
► The middle column specifies the different
scenarios the health-care provider might
be facing. This is the decide column.
► The right-hand column describes suggestions on how to
manage the problem. It is the manage column. It provides
information and advice, related to particular decision
points, on psychosocial and pharmacological interventions.
The management advice is linked (crossreferenced) to
relevant intervention details that are too detailed to be
included in the flowcharts. The relevant intervention
details are identified with codes. For example, DEP 3
means the intervention detail number three for the
Moderate-Severe Depression Module.
► NOTE: Users of the mhGAP-IG need to
start at the top
of the assessment and management section
and move
through all the decision points to develop a
comprehensive
management plan for the person.
 Instructions to use flowcharts
correctly and comprehensively
► The second section of each module consists
of intervention details which provides more
information on follow-up, referral, relapse
prevention, and more technical details of
psychosocial / non-pharmacological and
pharmacological treatments, and important
side-effects or interactions. The intervention
details are presented in a generic format. They will
require adaptation to local conditions and
language, and possibly addition of examples and
illustrations to enhance understanding,
acceptability and attractiveness.
► Although the mhGAP-IG is primarily
focusing on clinical interventions and
treatment, there are opportunities for
the health-care providers to provide
evidence-based interventions to prevent
mental, neurological and substance use
disorders in the
community. Prevention boxes for these
interventions can be found at the end of
some of the conditions.
► Section V covers “Advanced Psychosocial
Interventions” For the purposes of the mhGAP-IG,
the term “advanced psychosocial interventions”
refers to interventions that take more than a few
hours of a health-care provider’s time to learn and
typically more than a few hours to implement.
► Such interventions can be implemented in non-
specialized care settings but only when sufficient
human resource time is made available. Within
the flowcharts in the modules, such interventions
are marked by the abbreviation INT indicating
that these require a relatively more intensive use
of human resources.
MATERNAL HEALTH PROGRAM

►
Check up at least 4x
►
RECORD: mother and child book
PRENATAL VISITS PERIOD OF
PREGNANCY
ST AS EARLY IN
1 VISIT
PREGNANCY AS
POSSIBLE
ND ND
2 VISIT DURING 2
TRIMESTER
RD RD
3 VISIT DURING 3
TRIMESTER
EVERY 2 WEEKS AFTER 8 MONTH OF
PREGNANCY UNTIL
Republic Act No. 11210

105 DAYS FOR FEAMALE WORKERS WITH AN OPTION TO

AN EXTEND FOR AN ADDITIONAL 30 DAYS WITHOUT PAY,
AND GRANTING FOR SOLO MOTHERS, AND FOR OTHER
PURPOSES
► SECTION 1. THIS ACT SHALLL BE KNOWN AND CITED
AS” 105 DAY EXPANDED MATERNITY LEAVE LAW
► SIGNED BY PRESIDENT RODRIGO DUTERTE