[NCM 63-Community Health Nursing (individual and Family as Chents) Primary Health Care ‘© is an“Essential Health Care" based on practical and socially acceptable methods and technology ‘© made universally accessible o individuals, famay and community. History of Public Health Care WHAT: Alma Ala Conference The Intemational Conference on Primary Health Care (PHC) in Alma-Ata, Kazakhstan, in 1978, brought together 134 counties and 67 itemational organizations. The conference defined and granted intemational recognition tothe concept of Primary Health Care as a strategy to reach the goal of Health fo Allin 2000. WHEN: September 6-12, 1978 WHERE: Alma-Ata, Kazakhstan (USSR/RUSSIA) WHO: UNICEF (United Nations Intemational Childcen's Emergency Fund)/WHO (World Health Organization) WHO: Dr. DizoniDr. Vilar LETTER OF INSTRUCTION (LON 949: (October 19, 1978 — Letter of Instruction (LO) 948, the legal basis of PHC was signed by Pres. Ferdinand & ‘Marcos, which adopted PHC as an approach towards the design, development end implementation of programs focusing on health development al community level GOAL of Public Health Care “Heal fora Fipinos in 2000 and heath in he hands of the people by 2020" “Flipines are among the heathiest people in Southeast Asia by 2022, and Asia by 2040. “An improve state of heath and qualities of We fra people attained through SELF-RELIANCE” PUBLIC HEALTH CARE MISSION Strengthening the health system wherein people wil manage their own healthcare CORE STRATEGY Partnership with and empowerment of the people. PILLARS OF PUBLIC HEALTH CARE S- Support mechanism made avaiable C- Communty participation active ‘A. Appropriate technology M- Mul-Sectoral linkages Support mechanism made available 3 major resources © People © Government ‘© Private Sectors (GOs, Churches, etc) ‘Community Participation Active ‘Community Participation isa process in which people dently the problems and needs and assume responsiities themselves to plan, manage, and contolAppropriate Technology ‘© method used to provide a socilly and environmentally acceptable level of service or quality product at the least economic cost. ‘© health technology includes tools, drugs, methods, procedures and techniques, people's technology and Indigenous technology. Key Principles in Appropriate Technology Four As ‘© Accessibilly distancettravel ime required to get to a healthcare facity'services (Ex. the home must ’be within 30 mins from Bray. Heath Stations) Affordability: consideration of the individual, famuly, community, and government can afford the services. ‘© (Ex: The out of pocket expense determines the affordabiity of healthcare.) © (Ex: Inthe Philippines, government insurance is covered through PhilHisalth) = Acceptability health care services are compatible wth culture and traditions ofthe populations © Availabiliy-is a question whether the health service is offered in health care facities or is provided in & ‘regular and organized manner. ‘© (Ex: Botika ng Bayan- ensure the availabilty and accessibilt of affordable essential drugs, It sells low-priced generic home remedies, OTC and commen antiictics.) ‘© (Ex: Ligtas Tigdas- mass door-io-door measles immunization campaign.) Cost Wise- economical in nature ‘Complex procedures which provide a simple outcome Effective Feasibilly of use- possibility of use t al imes ‘Scope of technology is safe and secure ‘Multl-Sectoral Linkages ‘¢ Intrasectoralinkages: the heath sectors. «sIntersectoral Linkages- between the health sector and other sectors lke education. aan ‘government oficial. (two-way referral system)- communication, cooperation and collaboration within jcuture and local “Three Levels of Disease Prevention ‘¢ Primary Prevention most desirable form of prevention (mostly provided in BHS/Heath Centers; RHU focus is on health promotion and disease prevention Ex: Quit smoking ‘Avoidfimit sloohal Intake Exercise regularly Reduce fat and increase fiber in diet Take adequate Mid intake ‘Avid over exposure to sunlight Maintain ides! body weight ‘Complete immunization program Worksite Wellness (Ex. Wear Hazard devices at work site) Information Dissemination Environmental Contsol Programs Behavior Associated with Primary Prevention ‘© Have annual physical exam Regular pap smear test for woman ‘Monthly breast self (SE) for women who are 20 years old and above. Testicular Self Examination after a warm bath for men ‘Sputum exam for tuberculosis ‘Annual rectal examination for dients over 50 years oldSecondary Prevention curative, prevention of complications thtu SCREENING, EARLY DIAGNOSIS, and TREATMENT ‘mass screening (operation ibang, operation BP) case find Contacttracing ‘Survellance © Tertiary Prevention Rehabiltaive, prevention of dsabilty Continuing heath supervision during rehabiitation to restore an individual to an optimal level of functioning Minimizing residual disability and helping the client leam to lve productively with limitations ‘Behavior Associated with Tertiary Prevention ‘© Self moritoring of blood glucose among diabetics Physical therapy after CVA (Cerebrovascular Accident) Paricipate in cardiac rehabiitation afte Ml (Myocarcial Infarction), ‘Attend selt- management education for diabetes Undergo speech therapy alrlamgectomy Referral System in Health Care ; '* Barangay Health Station (BHS) is under the management of Rural Health Micwife (RHI) ‘© Rural Health Unit (RHU) is under the management or supervision of PHN (Public Health Nurse) ‘© Public Heath Nurse (PHN) caters to 1:10,000 population, acts as managers inthe implementation of the policies and activites of RHU, ditectly under the supervision of MHO, who acts as administrators (Muricipal Health Office) Referral System in Public Health Care BHS — RHU — MHO—- PHO— RHO— National Agencies — Specialized Agencies ‘Quality Assurance: Sentrong Sigla Movement ‘8 The Senirong Sigla Movement is a quality improvement initiative through a cerification'ecognition program. Heath facilities are certified based on a set of standards, ‘Sentiong Siglaelso promotes continuous qualty improvement as complementing strategy itwas established by the Department of Health with Local Government Units having the logo of a sun with 8 rays. Sentrong Sigia Movement Certification Minimum input, process and output standards for integrated public heath services for 4 core programs (Family Planning, Expanded Program of Immunization, Matemal Programs and TB Programs), facity systems, cegulatory functions and basic curative services. Level 1-Basic Cortification f Level 2- Specialty Award ‘Second Level quality standards for selected public health programs (Includes other heath programs in ‘addition to Level 1 core programs) and facity systems. Level 3- Award of Excollonce Highest level qualty standards for maintaining level 2 standards forthe 4 core pubic heath programs ‘and level 2 facity systems for atleast 3 consecutive years, ‘Steps in the Sentrong Sigla Movement Certification Process, 4. Phillpine's Deparment of Hesltn (OOH) provides copes of qualty stansauds pilosa government wats aus) am: ~~ LGU facity conducts sett-assessment ‘MayoxiGovernor sends letter of intent to participate DOH Sentrong Sigla teams conducts assessment LGU tacity gets certified, receives Sentrong Sigla Seal Certied facity gets monitored twice a year and tries to strive for higher level standards Four Pillars Of Sentrong Sigla ‘© Heath Promotion ‘© Grants technical assistance © Quatty assurance © Awards: CAsh, Plaque, Certifoate Four contribution of Primary Health CAre (PHC) to the Department of Health (DOH) and the economy ‘Training of Heath Workers {Creation of Botke sa Baryo and Botha sa Heath Certer ¢ Herbal Plants © ORESOL ‘Training of Health Workers (Primary Health Workers) 3 Levels of Training ‘A. GrassroovVillage Health Workers, Barangay Health Workers Heath AtxdiayfTradtional Bith Atlendant(non-professionals who cid not undergo formal taining. ties not receive elary but ae glven incentive inthe form of honorarium from the cal government since 1993). Inia ok, tt contact ofthe commit {2 Work in iaison with the local health service workers 12 Provide elementary curative preventive healheere measures. B, Intermediate n._These are professionals including the 8 member of Public Health Workers (PHWs) © 1st source of professional heath care Attend to health problems beyond the competence of vitage health workers J prove suppor to the fontine workers in terms of supervision, taining, referal services end supplies through linkages with other sectors. C. First Line Personnel- the specialist ~, “Eatsbish close contact vith the vilages and intermeciate level health workers to promote the continuity of acre from hospital to community to home «Provide back-up health services for cases requiing hospital or diagnostic facies not avaliable in healthcare. Botika sa Baryo and Botika sa Health Centor '¢ Created through Administrative Order 144 of 2006 {Refers to drug outlet managed by a legitimate communityinon-government organization and/or the Local Government Unit (LGU), witha trained operator and a supersing pharmacist «sReters to drug outlet wherein primary, non-prescription generc drugs listed inthe Philippines Drug Formulary (PNOF) and selected prescription drugs (Cotrimoxazole, Amexicilin, Metoprolol, Captopril Metformin, Gibenclamide, and Salbutamo)) are sold or made available GOAL: ‘To promote equity in heath n ensuring the availabilty and accessibility of affordable, safe, and effective quality ‘esvental drugs o al, with pronty for marginalized, eiical, and hard o reach areas, RA 6675: Gonorics Act of 1988 ‘An Aet To Promote, Require And Ensure The Production Of An Adequate Supply, Distribution, Use And ‘Acceptance Of Drugs And Medicines denied By Their Generic Names, Dr. Alredo Bengzon: the Father of Generics ActOplan Walang Resita Program -Solution to the absence of a medical officer who prescribes the medicines PHNs are given the responsibilty {o prescribe generic medicines. ORESOL (Oral Rehydrating Solution 4 teaspoon of salt, 4 teaspoons of sugar mix o titer of water. Walong Wastong Gamot Program -available generics in Botika sa Baryo and Health Center - Cotrimoxazole (ant-biolic) ‘A- Amoniciin (ant-biotic) R- Rifampicin (TB Drugs) {- Isoniazid (TB Drugs) P- Pyrazinamide (TB Drugs) P- Paracetamol (anti-pyretic/analgesic) - Oresol (Oral Rehydrating Solution) N= Nifedipine (ant-hypertensive)