Community Health Nursing Handouts

COMMUNITY HEALTH NURSING
CHN BASIC CONCEPT

The GOAL of CHN is promotion of OLOF through teaching and delivery of care, to raise the level of
the health of the citizenry
Philosophy: According to Dr. Margaret Shetland, the philosophy of CHN is based on the WORHT &
DIGNITY of man.
CONCEPTS
Primary FOCUS is HEALTH Promotion
NURSES are Generalist in terms of their there practice to the through life’s continuum
The nature of CHN practice requires that current knowledge delivered from
1. Biological ad social science
2. Ecology
3. Clinical nursing
4. Community health organizations
PRINCIPLES
● Based on recognized needs of communities, families, groups and individuals
● FAMILY is the Unit of Service
● HEALTH TEACHING is the Primary responsibility of the community Health Nurse
● Nurses work as members of the health team
HEALTH PRINCIPLES
● MODERN CONCEPT OF HEALTH: focuses on the Optimum Level of Functioning of
individuals, families and communities
● Families from the lower income groups are the ones mostly served
● GOAL of Public Heath: to contribute to the most effective total development and life of the
individual and his society
● ECO-SYSTEM influences the Optimum Level of Functioning (OLOF)
FACTORS:
⮚ Political
⮚ Behavioral
⮚ Heredity
⮚ Health care delivery system
⮚ Environment
⮚ Socioeconomic influence
Health Care Delivery System:

TOTALITY of all policies, infrastructures, facilities, equipment, products, human resources and
services that address the health needs problems and concern of all people.
Local Government Code
RA 7160: the Local Government Code
DECENTRALIZATION
FAMILY:
● BASIC UNIT OF SERVICE
● DEFINITION:
Arby James Abonalla, RN, MSN, PhDN©
CHN
A social unit consisting of two or more people
-usually related by blood, marriage or adaption
-who live together by mutual consent and with a sense of common identity or shared
goals.
Two major functions:

⮚ REPRODUCTION
⮚ SOCIALIZATION
MODERN CONTEXT;
Families nowadays are considered to be
⮚ Less structured
⮚ Broader
⮚ More flexible
⮚ More inclusive
⮚ Not rule-bounded
POPULATION GROUPS
⮚ CHILDREN
⮚ WOMEN
⮚ ELDERLY
⮚ DISABLED
COMMUNITY
Defined by geographic boundaries
Common interests/values
Made up of institutions
PRIMARY CLIENT in CHN
COMMUNITY COMPETENCE
Ability to:
1. Identify needs effectively
2. Achieve consensus
3. Agree on ways to implement goals
4. Work together to implement desired activities
Categories of Health Problem

HEALTH THREATS
HEALTH DEFICITS
FORESEEABLE CRISIS
FIVE FOLD MISSION OF CHN:

1. Health Promotion
2. Health Protection
CHN
3. Health Balance
4. Disease Prevention
a. Primary Prevention-
b. Secondary Prevention-
c. Tertiary Prevention-
5. Social Justice
Duties and Responsibilities of the Community Health Nurse

According to Jacobson, community health nursing is a discipline with the ultimate goal of
contributing to the promotion of the clients optimum level of functioning through teaching and
delivery of care.
⮚ Our roles are:
CLINICIAN
ADVOCATE
COLLABORATOR
CONSULTANT
COUNSELOR
EDUCATOR
RESEARCHER
CASE MANAGER
RURAL HEALTH MIDWIFE

⮚ Under the general supervision of the PHN
⮚ Works with the PHN in planning and evaluating health services at the Barangay level
⮚ Plans for activities in the clinic BHS; follow-up in homes and field visit in the community
⮚ Mobilizes community for health action
QUALIFICATIONS:
● Supervising Public Health Nurse at least FIVE YEARS experience as PHN
● Nurse Instructor II: MAN, 3 years experience as CHN
● Regional Training Nurse: six years nursing experience, three of which in training or Nursing
education
● Regional Nurse Supervisor: at least SEVEN years in CHN training
● Chief Nurse: at least FIVE YEARS experience in CHN – 3 either as supervisor or assistant
chief nurse
CHN CLINIC VISIT

● PRE-CONSULTATION CONFERENCE:
● MEDICAL EXAMINATION:
● POST-CONSULTATION:
HOME VISIT
Professional face-to-face contact made by a nurse to a patient or the family to provide necessary
health care activities and to further attain an objective of the agency.
Should have a PURPOSE/OBJECTIVE
Planning for a home visit should make use of all available information about the patient and
his/her family.

CHN
BAG TECHNIQUE
TOOL making use of the public health bag through which the nurse during the visit can perform
nursing procedures with ease and deftness, saving time & effort at the end in view of rendering
effective nursing care.
PUBLIC HEALTH BAG – essential & indispensable equipment
PRINCIPLES:
1. Ease and deftness
2. Save time and effort
3. Prevent/minimize spread on infection
● Special consideration: HAND WASHING
● Contents of the bag:
- BP apparatus & stethoscope are carried separately;
- Medicines include: butadiene, 70% alcohol, benedict’s solution
● Place waste paper bag outside of work area to prevent contamination of clean area
INTRAVENOUS THERAPHY
● Refers to the insertion of the needle/catheter/cannula into a vein based on physicians
written prescription
● ANSAP (Association of Nursing Service Ad ministration of the Phil)
- accrediting body
● INDICATIONS
- Maintenance/correction of dehydration in px unable to tolerate adequate volumes
of oral fluid medications;
- Parental nutrition
- Administration of drugs
- Blood transfusion
● CONTRAINDICATIONS
- Administration of irritant fluids/drugs through peripheral access (e.g. Sodium
chloride; Hypertonic potassium chloride)
COMMUNITY ORGANIZING
⮚ PRE-ENTRY PHASE
⮚ ENTRY PHASE
⮚ ORGANIZATION-BUILDING
⮚ SUSTENANCE & STRENGTHENING
⮚ PHASE OUT
DEPARTMENT OF HEALTH
VISION
Health for all Filipinos (old)
“THE LEADER OF HEALTH FOR ALL IN THE PHILIPPINES” (new)
MISSION
Enhance accessibility & quality of health care to improve the quality of life of all Filipinos,
especially the poor (old)
Guarantee equitable, sustainable and quality health for all Filipinos, especially the poor, and to
lead the quest for excellence in health.” (new)

CHN
BASIC PRINCIPLES
- Ensured universal access to basic health services
- Health & nutrition of vulnerable groups must be prioritized
● PRIMARY STRATEGIES
S–
A–
I–
D–
PRIMARY HEALTH CARE

Essential health care made universally accessible to individuals & families in the community by
means acceptable to them.
● GOAL
Health for all Filipinos & Health in the Hands of the People by the year 2020.
● MISSION
To strengthen the health care system by increasing opportunities & supporting the
conditions wherein people will manage their own health care.
Core Strategy: PARTNERSHIP & EMPOWERMENT towards SELF-RELIANCE
PHC cornerstones/Pillars
M – Multi sectoral linkage
A – Active community participations
U – Use of appropriate technology
S - Support mechanism made available
PRIMARY HEALTH WORKERS

The higher the level the more qualified the health personnel & the more sophisticated the health
equipment
Concept: TEAMWORK
TWO levels:
❖ Village/BHWs – trained community health workers, health auxillary volunteers, traditional
birth attendants, healers
❖ Intermediate Level – professional group
ALTERNATIVE THERAPHIES
HERBAL MEDICINES
10 herbal medicines being advocated by the DOH
L LAGUNDI
U ULASIMANG BATO
B BAWANG
B BAYABAS
Y YERBA BUENA
S SAMBONG
A AMPALAYA
N NIYOG-NIYOGAN
T TSAANG GUBAT
A AKAPULKO
Reminders (BONUS)
⮚ Boiling: remove cover

CHN
⮚ One kind of plant for each type of sx
⮚ No insecticides
⮚ Use clay pot and plant part advocated
⮚ Stop in case of untoward reactions; seek consultation if s/sx not relieved after 2-3 closes
ACUPRESSURE
QI Principle: traditional Chinese medicine – upon birth life energy enters the boy
HEALTH: state of balance of the YIN and YANG
CONTRAINDICATIONS:
o Pregnancy
o Full stomach
o Cardiac ailments
ACUPUNCTURE
GOAL. Manipulation of energy flow throughout the body following a thorough assessment by a
practitioner
PRECAUTIONS
● PREGNANCY
● HEMOPHILIA
● ACUTE CVD
AROMA THERAPY
USE OF ESSENTIAL OILS OF PLANTS TO TREAT SYMPTOMS
INDICATIONS
● INSOMNIA
● STRESS/RELAXATION
● INDUCE SLEEP
REPUBLIC ACT NO. 8423

T.A.M.A OF 1997 (TRADITIONAL AND ALTERNATIVE MEDICINE ACT)
Created PITAHC (Phil. Institute of Traditional & Alternative Health Care)
- Scientific research & development of traditional & alternative health care system that have
impact on public health care.
Public Health Programs

D - Dental Health Program
O - Osteoporosis Prevention
H - Health Education and Community Organization
P - Primary Health Care

R - Reproductive Health
O - Older Persons Health Services
G - Guidelines for Good Nutrition
R - Respiratory Infection Control
A - Accupressures
M - Maternal and Child Care
S - Sentrong Sigla Movement
HEALTH ACTIVITIES
1. Family planning/Reproductive Health
CHN
2. Nutrition
3. Womens Health and Safe Motherhood
4. Adolescent Health
5. Breastfeeding: Milk Code
6. Dental Health
7. Integrated Management of Childhood Illnesses (IMCI)
8. Newborn screening
9. CDD: Control of Diarrheal Diseases
10. Health Programs for Older Person
11. Environmental health
12. Occupational Health: industrial Hygiene
13. Cardiovascular Disease, Visual Health
14. Cancer, Asthma, COPD
15. Diabetes, Osteo, Arthritis, Musculoskeletal
16. Community Base Rehabilitation
17. Rabies
18. Philippine Registry for Disabled Persons
LIGTAS BUNTIS 2005 CAMPAIGN
GOAL
To increase the visibility of FP as an essential public health service, and to dramatically improve the
access of men, women an couples to FP & safe motherhood services.
POINTERS
1. Assurance of women’s safety
2. Advocates to assist Filipino couples to successfully plan their families
3. Shall provide appropriate services based on the clients choice of health facilities
Set for February to March 2005
▪ Brings affirmation on women’s co-equal importance in nation building
▪ Prioritizing and supporting the emancipation of Filipino women’s risks (too many, too
frequent & unsafe pregnancy)
Key success features
o Good campaign plan & gender-culture sensitive IEC
o Realistic target coverage
o Availability of adequate logistics & health services
o Competent health care providers
o Effective supervision
RERODUCTIVE HEALTH
▪ Exercise of reproductive right with responsibility
▪ VISION
Reproductive health practice as a way of life for every man & woman throughout life for
every man & woman throughout life
GOALS
▪ 3Es
▪ Every pregnancy should be intended
▪ Every birth should be healthy
▪ Every sex act should be free of coercion & infection

CHN
A – Achieve a desired family size
FRAMEWORK
▪ INTERNATIONAL
Focus on WOMEN’S HEALTH
Ultimate Goal: QUALITY OF LIFE
▪ LOCAL
Both Men and Women; based on its elements
FAMILY PLANNING
❖ Planning intended to determine the number of children based on a couple’s belief’s, health
and economic circumstances
❖ Proper spacing of child
❖ Giving birth at the right age and at the right time
Importance of FP
▪ For the health of the mother
▪ For the health of the new borne
▪ For the health of the entire providing
Executive Order 199: created the PFPP (Philippine Family Planning Program)
NATURAL FP
▪ CERVICAL MUCUS METHOD/ BILLING’S OVULATION
o Sensations & mucus
▪ BASAL BODY TEMPERATURE
▪ LACTATIONAL AMENORRHEA METHOD
▪ SYMTO-THERMAL METHOD
o Makes use of the woman’s BBT, cervical mucus at the vulva & other signs
Advantages of natural FP
N no physical side effects
E effect is reversible
E enables woman to know more about her body
C can lead to early diagnosis of some gynecological disorder
ARTIFICIAL FP
TEMPORARY
● ORAL CONTRACEPTIVES: composed of synthetic hormones which when taken regularly
prevents pregnancy
▪ IUD – small plastic sterile device that is introduction into the uterus to prevent pregnancy
▪ Depo-Medroxyprogesterone Acetate (DMPA) effective for 3 months
▪ Condom
▪ Diaphragm

CHN
PERMANENT
▪ Tubal ligation
Blocking of fallopian tubes to prevent sperm & egg
▪ Vasectomy – tying & cutting of vas deference
The ROOMING-IN & BREASTFEEDING ACT of 1992
RA 7600
ADVANTAGES of breastfeeding
o Infant-material bonding
o First preventive health measure to the child at birth
o Economical
APPLICABILITY
NSD: room in the ff within 30 min.
o Well infants regardless of AOG
o With low birth weight but can suck
Caesarean
o Within 3 to 4 hours after birth
NSD: outside health institutions
o Immediately on admission
EXEMPTIONS: mothers who are:

o Seriously ill
o Taking medications contraindicated to breastfeeding
o Violent psychotics
o Other conditions as determined by the doctor
Complicated births
o Sick baby/mother or both
o Breastfeed first with:
o EBM: expressed breast milk
o Wet-nursing
SICK INFANTS
Breastmilk, especially colostrum: given as tolerated
Newborn: no prelacteal feeds
Sterile water
Glucose water
Milk formula
Acceptable medical condition for supplemental feeding

Special milk formula: inborn errors of metabolism
Galactosemia; phenylketonuria
o Continue breastfeeding for mild to moderate mother’s illness:
Malaria, STD, Diabetes, CHD, TB (-) sputum
The ff DO NOT permit rooming-in & breastfeeding

▪ Seriously ill (eclampsia, CHD class IV, severe infection)
▪ Taking meds contraindicated to nursing (e.g. anticancer)

Milk storage:
Refrigerated- 24 hours
Frozen ( -180C) a MONTH

CHN
MILKCODE: E.O. 51
NOT PERMITTED USE of professional services for teaching parents/staff in promoting branded milk
products.
Common breastfeeding problem
▪ Breast engorgement
▪ Sore nipples
▪ Mastitis
EXPANDED PROGRAM ON IMMUNIZATION
PD 996:
IMMUNIZATION SCHEDULE:
Provides maximal immunity to the seven EPI diseases BEFORE CHILD’S FIRST BIRTHDAY
Goal: morbidity and mortality reduction of immunizable diseases
Schedule:
At birth: BCG
1 ½ months: First doses of DPT, Hep B, OPV
2 ½ months: Second doses of DPT, Hep B, OPV
3 ½ months: Third doses of DPT, Hep B, OPV
Tetanus Toxoid:
First Pregnancy: TT1- 5th to 6th mo of pregnancy, after 4 weeks TT2 (3 years immunity)
Second Pregnancy: TT3 (1st booster dose) – 5th to 6th (5 years immunity) Third
Pregnancy: TT4 (2nd booster dose) – 5th to 6th (10 years immunity)
Fourth Pregnancy: TT5 (3rd booster dose) – 5th to 6th (life-long long immunity)
Administration:
BCG: (infants) 0.05 ml intradermal

(school entrants) 0.10 ml intradermal
DPT: 0.5 ml intramuscular Hepa B: 0.5
ml intramuscular OPV: 2 drops per
orem Measles: 0.5 ml subcutaneous
Tetanus toxoid: 0.5 ml intramuscular
Side Effects:
BCG: inflammation at the site (Koch’s phenomenon) – warm compress

Glandular enlargement, deep abscess, indolent ulceration: insicision and drainage and powered
INH
DPT: inflammation at site: warm compress; fever for a day; abscess: incision and drainage and
antiseptic(betadine
Measles: fever 3-5 days within a week after injection; mild rashes
Frequently Asked Questions (FAQs)

Q: What if the child failed to return after the first dose of the vaccine (D.O.H.),
can we still give it?
A: YES. It is a MUST to complete the doses
Q: Is it necessary to repeat the 1st dose?
CHN
A: NO. just give the REMAINING doses not given

CHN
Remember the principle:
Even if the interval exceeded that of the expected interval, continue to give the doses of the
vaccine.
Q: What is the eligible age for giving immunization (up to what age can we give the
immunization)?
A: Before the child reaches 6 years old
Q: If there has been a reported epidemic of measles, is it okay to give measles vaccine at an earlier
age?
A: In case of measles epidemic, we can give MEASLES as early as 6 months of age
* a booster dose of BCG shall also be given to all school entrants both in private and public schools
REGARDLESS of presence of BCG scar.
Q: What if the 2nd dose of Tetanus Toxoid was not given to the mother, when is the best time to
give the dose?
A: It has to be given after birth in order to protect the mother and the succeeding pregnancies.
Q: Is there any contraindication to giving DPT, OPV, Hepa-B?

A: There is none, EXCEPT when the child had convulsions upon giving the 1st dose of DPT. Mothers
must be warned that the incident of CONVULSION upon giving the 1st dose of DPT, MUST BE
REPORTED
Q: What if the child has fever of <38.5 C, mild respiratory infections and diarrhea, should
the child be given the vaccine?
A: The abovementioned conditions are not to be considered as a
contraindication to immunization. Thus, vaccine can still be given.
Q: What if the child Is malnourished?

A: MALNUTRITION is not a contraindication, but RATHER an INDICATION for immunization
since common childhood diseases are often severe to malnourished children.
COLD CHAIN
► A system used to maintain the potency of a vaccine from that of manufacture to the time it is
given to child or pregnant woman.
Principles:
I. Storage
Storage of vaccine should not exceed:
- 6 mos. @ the Regional Level

- 3 mos. @ the Provincial Level/District Level
- 1 mo. @ Main Health Centers (with refrigerators)
- not more than 5 days @ Health Centers (using transport boxes)
Important points to remember:

CHN
► Arranging of stored vaccine according to :
■ Type

CHN
■ Expiration date
■ Duration of Storage
■ # of times they have been brought out to the field
Storage Vaccine Form Dose/Container Conditions

Temperature when exposed
to
heat/freezing
Most Sensitive - 15 C to – 25 OPV Liquid 20 dose/special Easily
to Heat C FREEZER bottle or damaged by
25 dose/special heat; not
bottle destroyed by
freezing
Measles Freez 10 dose/vial

e dried
BODY OF THE BCG Freez 20 dose/amp

REFRIGERATOR e dried 50 dose/amp Destroyed by
+ 2C TO + 18 C heat,sunlight;
not destroyed
D LI 20 dose/vial by freezing
Q
Destroyed by
P U freezing; heat
I
T D Damaged by
heat
Liquid
Damaged by
heat and
freezing
Hepa-B Liquid 20 dose/vial Damaged by

Least Sensitive Tetanus heat
to heat or freezing
Toxoid
Most sensitive to heat:
Most sensitive to freezing:
► The vaccine stored the LONGEST AND THOSE THAT WILL EXPIRE FIRST should be
distributed or used 1st.
► It is MUST to mark ampules / vials with an “X” mark each time they are carried to the field,
because if a VACCINE IS NOT USED on the third trip, it must already BE DISCARDED.

CHN
II. Transport
use cold dogs
III. Handling
Once opened or reconstituted, vaccines must be placed in a special cold pack during immunization
sessions.
Vaccine Half life
BCG 4 hours DPT
Polio
Measles 8 hours
Tetanus Toxoid
Hepa-B

CHN
LIGTAS TIGDAS 2004
Target: 9 mos - <8 y/o
Main component: PMEC
o PMEC- Philippine Measles Elimination Campaign
o Includes continuing routine vaccination of infants @ 9 months old after LIGTASTIGDAS
2004
o May be repeated every 4 or 5 years
o BAKUNADOORS: vaccination team
COMMON QUESTIONS
▪ My child been vaccinated against measles. Is she exempted?
Ans: NO, this will increase her protection from measles
▪ My child had measles previously is she exempted?
Ans. NO, there are many measles like disease. This won’t harm.
▪ Ans. NONE, Antibodies in the blood which provide protection against the disease decrease as
the
▪ What will happen to my child after receiving the measles immunization?

Ans. NOTHING, some develop SLIGHT FEVER (1-2days)
Give Paracetamol q 4 hours

Increase fluids; rest, sleep
GMA 50%
DOH undertaking to effect the SONA pledge of PGMA
Primary goal
Ensure that
● A Affordable
● S Safe
● H High quality
● E Effecitive
Drugs & meds are always available, especially to the poor.
NUTRITIONAL GUIDELINES FOR FILIPINOS GOAL

Improvement of the nutritional status, productivity & quality of life of the population, through
adoption of desirable dietary practices and healthy lifestyle
GUIDELINES
1. Eat variety of food everyday
2. Breastfeed infants exclusively from birth to 4-6 mos
3. Maintain children’s normal growth
4. Consume fish, leanmeat, poultry or dired beans
5. Eat more vegetables, fruits & rootcrops
6. Eat foods cooked in edible/cooking oil daily
7. Consume milk, milk products/ other calcium-rich foods
8. Use Iodized salts but avoid excessive intake of salty food
9. Eat clean & safe food
10. HEALTHY LIFESTYLE & GOOD NUTRITION:
a. Exercise regularly
b. No smoking
c. Avoid alcoholic beverages

CHN
NUTRIENTS
Chemical substances present in the food that keep the body healthy, supply materials for growth &
repair of tissues, and provide energy from work & physical activities
STOP TB: D.O.T.S.

● Most common sign of TB: Cough lasting for 2 weeks
● Biggest threat to economic development in the Philippines.
● 1997 Prevalence Survey:
More than 16 million Filipinos are infected with TB and 600,000 TB cases are actively
spreading the disease.
ELEMENTS:
● Microscopes
● Anti-TB drugs
● Health Care Providers/ Treatment Partners
● Reporting Books
● Funding & Support
Quality service through DOTS

● S – Screening; supervise sputum collection
● E – Examination of sputum specimens
● R – Recording, Reporting; Referral
● V – Verbalize with Px at the level of his understanding
● I – Instruct Px & Tx partner on the importance of compliance
● C – Counseling on Compliance
● E – Enlighten community
Rabies: P.R.O.
Pinoy Responsible Owner of Dog

● 350-400 Filipinos die of rabies every year
● WHAT TO DO IF BITTEN BY A DOG:
- Wash wound immediately with soap & water.
- Consult a health worker at the nearly health center.
- Observe the dog for 14 days for any change in behavior.
● If the dog cannot be observed (stray) or it suspected to be rabid, consult your physician
immediately for immunization.
● If dog shows s/sx of rabies, it usually dies within 3-7 days.
Pinoy Responsible Pet Owner
P.R.O.
- Have your pet immunized against rabies at 3 months old & every year after
Current WHO guide for Rabies Pre & Post Exposure Tx

- General considerations in Post-exposure Tx:
- WHO advocates the use of modern vaccines for PET
- Abandon the production of BRAIN-TISSUE VACCINES
- Immediate washing/flushing & disinfection of the wound
- Disinfecting with ETHANOL (700ml) or Iodine tincture
- Rapid administration of purified lg
Administration of RIG
● Infiltrate into the depth of the wound & around the wound
- Any remaining amount, administer IM to distal part (e.g. anterior thigh)
● Quantities/vol. Of RIG

CHN
- 20 IU/kg for Human RIG
- 40 IU/kg for Equine RIG
- If the calculated dose is insufficient to infiltrate all wounds, sterile saline may be
used to dilute it 2 to 3 fold to permit through infiltration.
Post exposure Tx IM
● TWO IM schedule for modern vaccine
● Vaccine shouldn’t injected into the gluteal region
● CLASSICAL 5 DOSE IM (“Essen” regimen)
● ALTERNATIVE: the 2-1-1 regimen
Post exposure Tx Intradermal

● Economical: use 1ml syringe & short hypodermic needles
● 3 vaccines:
- HDCV (Human Diploid Cell Vaccine)
RABIVAC
- PVRV (Purified Verocell Vaccine)
VERORAB, IMOVAX, Rabies vero
- PCECV (Purified Chick Embryo Cell Vaccine)
RABIPUR
● 8 SITE ID METHOD: 8-0-4-0-1-1 for use with HDC (Rabivac); PCECV (Rabipur)
- When no RIG is available in emergency
- For use: Rabivac & Rabipur 0.1ml per ID site
● 2 SITE ID: 2-2-2-0-1-1 for use with:
- PVRV (Verorab, Imovax, Rabies Vero, TRC verorab) 0.1ml
- PCECV (Rabipur) 0.2ml
ID minimum value of 2.5IU/ampule
CONTROL OF ACUTE RESPIRATORY INFECTION
(CARI)
OBJECTIVE:
45,000 children die every year because of pneumonia
STRATEGIES (TENA)
● Training of workers with the standard management of ARI
● Enable BHW to identify & refer cases for treatment
● NGO mobilization
● Advocacy and Social Mobilization
Contributory Fx to Pneumonia
● Mother’s failure to recognize early s/sx
● Indiscriminate use of antibiotics
● Not standardized management by health workers
LEPROSY CONTROL PROGRAM
“KILATIS KUTIS PROGRAM”
MOT: prolonged skin-to-skin; droplet

Prev./Control & Rehab:
1. BCG
2. Avoid MOT
3. Hygiene
4. Adequate nutrition
5. Health education
CHN
SCHISTOSOMIASIS CONTROL PROGRAM
Endemic area
o Bicol
o Samar
o Leyte
o Davao
PREVENTION
o Proper excreta disposal
o Toilet facilities
o Use of footware protection
o Mollucides
o Environmental sanitation
Drug of choice: PRAZIQUANTEL
MALARIA CONTROL PROGRAM
NATIONAL SITUATION
An average of 3 Filipinos die daily due to malaria despite government’s intensified efforts to control
the occurrence of the ailment.
THREE causes of Malarial treatment failure in the Philippines
o Drug resistance
o Non-compliance of patients
o Deficient drug absorption
Other reasons:
o Self-medication
o Resorting to herbal remedies
o Seeking help when the disease is already severe
MOSTLY AFFECTED: MALE YOUNG ADULTS

MOST VULNERABLE GROUPS: PREGNANT, CHILDREN
CURRENT INITIATIVES
o Global funding
o Infectious disease control and surveillance
PROGRAM THRUST:
VISION:
Malaria-free Philippines by the year 2020.
MISSION:
To empower the health workers, the population are risk, and all concerned to eliminate malaria in
the Philippines.
GOAL:
- Malaria is
TARGET-SETTING
- involves the calculation of the eligible population. “Eligible population consists of any
group of people targeted for specific immunizations due to their susceptibility to one or several of
CHN
the EPI diseases.”
3 Population with which the EPI is concerned.

Infants
School Entrants
Pregnant Women
For infants, target-setting should be based on the 3% of the total population, while for
pregnant women, it must be based on the 3.5% of the total population.
infants
Eligible Population = total population x 0.03
school entrants
x 0.035 pregnant women
To compute for the vaccines
I. Determine Annual Dose-doses required in a year for complete coverage

AD = EP x # of doses to consider that immunization is complete
II. Determine Wastage Allowance

Wastage Dose = Annual Dose x % wastage allowance
III. Combine complete coverage needs with wastage allowance

Annual doses = annual doses (no wastage) + wastage doses with wastage
IV. Determine # of ampules or vials needed per year

Amp: vials = annual doses/doses per ampule (per year)
V. Determine 3 of ampules/vials needed per month

Amp: vials = annual amp: vials/12 months (per month)
Solve: Total population = 6000, determine DPT vaccine to be used for infants. SURVEILLANCE
 Under Fives Care Program
UFC Program (Under Five Care Program)

A package of child health-related services focused to the 0-59 months old children to assure their
wellness and survival
A. Growth and Health Monitoring

Growth Monitoring Chart (GMC)
A standard tool used in health centers to record vital information related to child growth and
development, to assess signs of malnutrition.
Sallen “Ming Scale”, Bar and Detect type scales are being used
All newborns must be enrolled for UFCP B. Oresol Therapy
CHN
Diarrhea (Unusual frequency of bowel movements more than 3x/day) (Marked
change in the amount of stool)
(Increase in stool liquidity)
3 CLASSIFICATIONS:
Mild - 5 - 10 unformed stools/24 hours
Moderate - 10 - 15 unformed stools/24 hours
Severe - > 15 unformed stools/24 hours with associated
signs/symptoms
Dehydration
ORS, assess after 4 – 6 hours
Management of Moderate and Severe Dehydration
Intravenous fluids
If NOT possible, assess if the child can drink (give ORS and refer for IV) If cannot drink (
give fluids via NGT)
If no NGT, refer immediately!

CHN
Diarrhea Management at Home
3 F’s
Fluids Frequent Feeding Fast Referral

► Oresol ► Continue If child doesn’t
Rehydration breastfeeding get better in 3 days, or if
Therapy ► With children over danger signs develop
►Encourage/ensure intake of 6 mos.: – refer patient
any fruit Cereals/ starchy foods Danger Signs:
juices, “amlugaw” mixed with meat or ► Fever
fish and vegetables ► Sunken fontanel
homemade soup
► Mashed banana or ► Sunken eyeball
any fresh fruit ► Frequent
► Feed the child at watery stool
least 6x/day ► Repeated vomiting
► After diarrhea ► Blood in stool
episode, feed 1 extra ► Poor intake
meal/day for of meals
2 weeks ► Weakness
ORS :
1 pack
1 L of water

CHN
CHN
Home-made Oresol:
1 L of water: or 1 glass of water
8 tsp. of sugar: 2 tsp. of sugar
1 tsp. of salt 1 pinch of salt
Remember:
Infant must be given ¼ - ½ cup every after LBM Child must be given ½ - 1 cup
every after LBM Adult must be given 1 or more cup every after LBM
Measures on Diarrhea Prevention:
- Breastfeed infants
- Provide appropriate supplemental feeding
- Handwashing
- Utilize clean and potable water
- Clean toilet and observe proper feces disposal
- Immunize the child with measles
* No antibiotics must be given to a diarrheic patient except in infectious diarrhea (e.g. cholera)
C. Breastfeeding
Unique Characteristics of Breast milk:
B Fresh
Reduced allergic reaction Emotional bonding
Economical Easily established
Always available Digestible
Safe/maintains the stool soft Immunity
Temperature always right Nutritious
GIT disorders are decreased
Difference of breast milk from formula milk
BREASTMILK VS FORMULA*
CHO > CHO
CHON (LACTALBUMIN) < CHON (CASEIN) FATS
= FATS
Linoleic acid content (3x) > Linoleic acid content
MINERALS < MINERALS
* the high CHON and mineral content of cow’s milk may overwhelm the newborn’s kidney, thus it
still needs to be diluted. Casein is more difficult to digest.
LEGAL MILESTONES:
EO 51 MILK CODE OF THE PHILIPPINES
RA 7600 MOTHER-CHILD FRIENDLY HOSPITAL
- part of “23 in ’93 which aims to sustain breastfeeding efforts immediately after delivery

CHN
D. Immunization (see EPI)
E. Care of Acute Respiratory Tract Infections (CARI) Goal: treatment
of pneumonia
Assessment:
History:
Age, cough (since when), fever (since when), stop feeding?, convulsions?
Physical Examination:
Assess for fast breathing:
RR of 60/min (below 2 months)
50/min (2months to 1 year)
40/min (1 to 5 years)
stridor, wheeze
level of consciousness stop feeding
malnutrition
Standard ARI / PNEUMONIA Case Management (EO 110-E s, 1991)
○ Cotrimoxazole adult tabs

Injectable penicillin should be regularly available in
IM gentamycin DOH facilities
IM chloramphenicol
○ No DOH fund shall be used to regularly provide cough medicines except only for
the following emergency conditions.
- Single ingredient cough suppressant for severe pertussis
- Single antihistamine fro confirmed allergic conditions such as allergic rhinitis
○ O2 and flow meters must be regularly available in all government hospitals,

with O2 delivered properly according to Standard
ARI/Pneumonia Case Management
○ Children found to have Severe Pneumonia, Very Severe Pneumonia, wheezing, otitis
media, streptococcal sore throat should be referred to Municipal Health Officer (MHO) or
hospital physicians for proper management according to the referral scheme
Unit 8
STRATEGIES TO ADDRESS SPECIFIC HEALTH
PROBLEMS
 Communicable Disease Prevention and Control
Communicable Diseases
Chronic Communicable Vector-borne

CHN
Communicable

CHN
Diseases
► Tuberculosis ► Malaria (MCP)
Schistosomiasis (SCP)
► Leprosy (LCP) ► Filariasis (FCP)
► H-Fever (Dengue)
1. National Tuberculosis Control Program (NTBCP)
“Tuberculosis is a highly infectious, chronic respiratory disease caused by TB Bacilli. It is one of

the 10 leading causes of morbidity and mortality in the Philippines, which is also known as
“Koch’s Disease.”
Objective of the Program:

To control TB by reducing the annual risk of infection (prevalence and mortality rates)
Key Policies:
Prevention
○ BCG vaccination under the EPI Program
○ Annual identification of at least 45% of its prevalence
○ Public health education re: PTB mode of transmission, methods of control, and
importance of early diagnosis
○ Provide outreach services for home supervision of patients in Multi-Drug
Therapy and also for preventive treatment of contacts
Case Finding
○ Direct sputum microscopy for identified TB symptomatics
○ X-ray exam of TB symptomatics who are (-) after 2 or more sputum exam
○ Establishment of passive and active collection points for sputum samples of all identified
TB symptomatics, as well as validation centers to ensure the standard and quality of sputum exam
○ Case finding and treatment services shall be made available in the
BHS/RHUs
Treatment
○ All TB cases must be treated for free, on ambulatory and domiciliary
(home) basis, except those with acute complications and emergencies
○ All sputum positive and cavitary cases shall be given priority for short course
chemotherapy or SCC for 6 mos.
○ Standard Regimen or SR for a year or intermittent SCC for 6 mos. shall be given to all
infiltrative but sputum negative.
SR: isoniazid and streptomycin sulfate

SCC: Combo pack, Multi Drug Therapy
PTB TREATMENT REGIMEN
Categories:
6 SCC
Patient will be:
Rifampicin Rifampicin
2 mos. on Isoniazid + 4 mos.
Pyrazinamide Isoniazid
CHN
Indicated for patients who are

CHN
- (+) sputum smear
- seriously ill ---
- (-) sputum smear, (+) extensive lung lesion
- (+) radiographic lung lesion
- extrapulmonary cases
8 SCC
Patient will be:
Rifampicin Rifampicin Rifampicin

2 mos. on Isoniazid + 4 mos. Isoniazid + 5 mos Isoniazid
Pyrazinamide Ethabutol Ethambulol
Ethambulol
Streptomycin
Indicated for those with relapse

- failures
- others
4 SCC
Patient will be:
Rifampicin Rifampicin
2 mos. on Isoniazid + 2 mos.
Pyrazinamide Isoniazid
Indicated for PTB minimal

(-) sputum smear
3 Phases of Treating a PTB patient:
Rifampicin
1 - Intensive Phase 2 mos. on Isoniazid
Pyrazinamide
Diagnostic: Sputum
Exam if (+), proceed
to Rifampicin
2 - Maintenance Phase +4
mos. on if still (+) TB Colonies proceed to Isoniazid
Rifampicin
3 - Extensive Phase up to Isoniazid

12 mos. on
What is the purpose of SCC-MDT?

- prevent developing resistance against the three drug combinations
CHN
- shorten duration of treatment usually treatment lasts from 5-10 years.
With SCC-MDT. tx can be reduced to a minimum of 6 mos.
- eradicate and completely prevent the relapse of the disease
Direct Observation Treatment of Short-Course Chemotherapy (DOTS)

“Tutok-Gamutan”
DOH Activities on NTBCP:

CHN
Part of the “23 in ‘93” is the integrated disease control of TB together with schistosomiasis and
malaria through the formulation of a strategic plan for infectious disease control by specific DOH
units.
“Health for More in ‘94” had “Malakas na Baga, Malinaw na Mata” as its strategy National Focus:
TB Control Month
► laboratory and drug supplies were available to local governments in
1994 aimed to accelerate case finding and treatment
Strategies done:
Ensure that every microscopy and treatment center has the ff:
 Exnal microscope
 Microscopist trained within the last 3 years
 A 90% agreement rate in microscopy reading between
the microscopist and validator
 Available NTP manual of procedures
 Drugs for at least 6 months supply
 Reagents, sputum cups for at least 6 months
 Utilization of an itinerant team composing of at least 2
microscopists, nurse, midwife, and a medical officer who will stay for 2 – 3 days in far flung
communities to identify TB and start treatment
2. Leprosy Control Program
LEPROSY is a chronic disease of the skin and peripheral nerves caused by

Myobacterium Leprae
WHO CLASSIFICATION OF LEPROSY:
Paucibacillary (tuberculoid and indeterminate) – non-infectious

Duration of Treatment: 6-9 months
Multibacillary (lepromatous and borderline) – infectious
Duration of treatment: 24-30 months
Objectives of the Program:

- provide MDT to all leprosy cases within 3 years and complete the treatment of 90%
of all cases out on MDT within the prescribed period
- identify all correctible deformities and institution of appropriate
intervention
- reduce the stigma attached to the disease thru IEC
- formulate research proposals on topics associated with leprosy
Key Policies:
- MDT as the core strategy for the National Leprosy Control Program
- Procurement and supply of MDT Drugs, IEC and Training Materials by
CDCS
- Health education
- Supervision and Control of leprosy Control Activities
Strategies:
Prevention
- Health Education

CHN
- BCG vaccination
- Case Finding

CHN
- Validate old registered cases
- Early referral of suspected leprosy patients
- Epidemiologic investigation
Treatment
- Ambulatory
- Domiciliary chemotherapy through the use of MDT as embodied in RA
4073 which advocates home treatment
MDT Treatment Regimen
Paucibacillary Multibacillary
Supervised dose: Supervised dose: Rifampicin
600 mg Rifampicin 600 mg
Dapsone 100 mg Lamprene 300 mg
Taken once/month in the clinic Dapsone 100 mg
Self-administered Taken once/month in the
clinic
Dapsone 100 mg Self-administered dose
Taken OD, daily by the patient at home Lamprene 50 mg
Dapsone 100 mg
Take OD, daily at home Leprosy Patients must be taught ways to prevent secondary injury caused
by burns and rough sharp objects
Emphasize importance of sustained therapy, correct dosage, effects of drugs and the need for
medical check-up from time to time
Provide mental and emotional support to the families of leprosy patients
Refer patients as needed
Rehabilitation:
Imbibe patient’s participation in occupational activities
Family and community health (PD 304)
o non-segregation of leprosy patients
o counseling and guidance
 Locally-endemic Disease Prevention and Control
1. Malaria Control Program

Malaria a vector-borne disease caused by female Anopheles mosquito causing symptoms such a
fever, sweating, intermittent chills, anemia, and splenomegaly.
2 Major Strategies of the Program
I - Vector-Control
Highlight
In “24 in ‘94”
Project: “Kalusugan ng Kalikasan, Kalusugan ng Mamamayan”
National Focus: Awareness and prevention of mosquito borne disease day
Community Action Campaign Acronym CLEAN Chemically
treated mosquito nets
Larva-eating fish
Environmental clean-up of stagnant water
Anti-mosquito soap
Neem trees
● Chemoprophylaxis – Chloroquine 1-2 weeks before entering an area then continuous
until 4-6 weeks after leaving the area
2 - Detection and Early Treatment of Cases

CHN
● Early Recognition, Prevention, and Control of Malaria epidemics
a system which will recognize impending malaria epidemics
● Early diagnosis and prompt Treatment
identification of a patient with malaria as soon as he is examined.
This may be done thru:

► Clinical ► Microscopic
- Signs and symptoms - Mass Blood Smear Exam
- history of visit to an endemic area
In the event that an imminent epidemic occurs, the following should be done: Mass Blood
Smear Collection
Immediate confirmation and follow-up of cases
Insecticide-treatment of mosquito nets
2. Schistosomiasis, H-fever and Filariasis Control Programs
DOH measures to prevent and control in “24 in ‘94”

Project: “Kalusugan ng Kalikasan, Kalusugan ng Mamamayan”
National focus: Awareness and prevention of mosquito borne diseases day
Community Action Campaign Acronym: CLEAN
SCHISTOSOMIASIS H-FEVER (DENGUE) FILARIASIS CONTROL

CONTROL PROGRAM PROGRAM
Schistosomiasis – a parasitic Dengue – acute febrile ►A mosquito borne
infection caused by blood infection of sudden onset, disease caused by a
flukes inhabiting the veins of caused by Aedes tissue nematode
their vertebral victims Aegypti, vector mosquito attacking the lymphatic
transmitted thru skin system of humans
penetration causing diarrhea, thereby causing
ascites, hepatosplenomegaly. elephanthiasis,
lymphedema, and
hydrocele
►started in 1957 as an
operational research of
the malaria. Eradication
Service Three Filaria
Control were established
and later on integrated
with the Regional Health
Offices

CHN
Activities: Activities: Activities:
Case Fx: Surveillance of the Case Fx Case fx
disease Early reporting of any Early reporting of any
Health Education known case or outbreak known case of outbreak
– encourage use
of rubber boots for protection
Environmental
sanitation
– proper disposal of feces
Snail Eradication – use of
moluscides

CHN
Prevention, Control and Rehabilitation of Non-communicable Diseases
1. Philippine Cancer Control Program
AO 89-A s. 1990
provided the Guidelines for the Philippine Cancer Control Program specifying its program
policy, components, implementing guidelines and timetable.
6 Pillars:
Public Information and Health Education Cancer
Prevention and Early Detection Cancer Epidemiology and
Research Cancer Treatment
Cancer Pain Relief
In Cancer Nursing, the aim of management is to relieve physical, mental and spiritual distress.
Vital Task of the nurse: To help the patient maintain his dignity and integrity
Cancer care is multidisciplinary.
Who are to be prioritized for health supervision?

Newly diagnosed cases
Post-op case/discharge
Indigent cases needing continuity of hospital care
Terminal cases
DOH Strategies:
In Health for More in ’94,
► “Kayang-kaya ang Cancer”
National Focus: Cancer Awareness and Prevention Day
“Araw ng Pag-iwas sa Kanser”
Cancer Project: Public information and health education on Cancer
Cancer information desk nationwide
► “Kalusugan ng Kababaihan, Kalusugan ng Bayan”
Women are encourage to undergo the following screening procedures regularly
- Breast Self-Examination
- Regular Pap Smear
Nationwide demonstration on how to correctly do self breast-
examination
Information dissemination also on Urinary Tract Infection, Sexually
Transmitted Diseases, AIDS
2. Smoking Control Program
Health hazards of smoking: Lung

Cancer Cardiovascular diseases

CHN
Chronic Obstructive Pulmonary Diseases
Cancer of other body organs
Program objective:
decrease the prevalence of smoking-related diseases and subsequent premature deaths
Program components:
Information and Education on Campaign and Social Mobilization
Policy Development and Legislation
Training of Counselors in Smoking Cessation Clinics for Specialty
Hospitals
Resource Management and Monitoring
Strategies:
National Anti-Smoking Campaign
o World No Tobacco Day
o National No Smoking Month
o Yosi Kadiri Campaign
Support comprehensive bill on Tobacco Advertising

“Warning labels be written on tobacco products and ads in compliance with the consumer
code of ‘92
3. Renal Disease
In “23 in ‘93”
Preventive Cardiology and Nephrology
► Enhance public awareness thru health education regarding healthy lifestyles
► Improve access to basic health services
“Health for More in ‘94”

“Buwan ng Buhay na Bato”
► Requires urinalysis of ALL children entering Grade I so as to detect childhood kidney infections,
which may lead to Renal Failure
► Encourage adult Filipino to undergo urinalysis once a year
4. Cataract
In accordance with the Prevention of Blindness Program,

“Malakas na Baga, Malinaw na Mata”
National Focus: Cataracts Screening Week at DOH Centers
OPLAN: Sagip-Mata
► Eye Surgery for cataract and squint operations for cross-eyed children
 Nutrition and Adequate Food Supply
Goal:
The improvement of nutritional status, productivity and quality of life of the population through
adoption of desirable dietary practices and healthy lifestyle.
Coverage:

CHN
Philippine Food and Nutrition Programs
directed to the provision of nutrition services to the DOH’s identified priority vulnerable groups:
infants, pre-schoolers, schoolers, women of child bearing age (also included are the pregnant and
lactating mothers) and the elderly
Objectives: to decrease the morbidity and mortality rates secondary to Avitaminoses and
other nutritional deficiencies among the population mostly composed of infants and children.
1. Malnutrition Rehabilitation Program
Targeted Food Task Force Nutrition Rehabilitation Akbayan sa Kalusugan

Assistance Program Ward (ASK Project)
(TFAP)
Provision of food rations of Every hospital must have a Aimed to provide rice and
bulgur wheat Nurse ward, where an corn soya
and green peas. adequately blend supplemented with
Target population: trained nutritionist were local foods.
Preschoolers assigned (RA 422) Target population:
Pregnant women 6 mos. – 2 yrs.
Lactating mothers moderately and severely
underweight
preschoolers not served by
the DSWD and DA in Regions
2, 8, 9, 10, 11,
12
.
2. Micronutrient Supplementation Program
“23 in ‘93” “Health for More in ‘94”

Fortified Vitamin Rice “Buwan ng Kabataan, Pag-asa
ng
Bayan”
National Focus: National Micronutrient
Day or “Araw ng Sangkap Pinoy”
- a free enrichment program aimed to prevent - aimed to distribute vitamin
deficiencies in vitamin A A supplements, iodized oil for mothers
(blindness); iron (Anemia); Iodine (goiter, and seedlings of plants rich in Fe and other
mental retardation and delayed development) minerals
(1 cavan of rice + fistful processed, binilid
enriched with
essential micronutrients)
3. Food Fortification Program
Fortification is the addition of a micronutrient deficient in the diet to a commonly and widely

CHN
consumed food or seasoning. It involves:
Incorporation of Monosodium Glutamate (MSG) with Vitamin A to reduce clinical signs of
Xereopthalmia
The use of FIDEL salt in lieu with the National Salt Iodization Program
Fortification for Iodine Deficiency

CHN
ELimination
4. Nutrition Surveillance System

- a system of keeping close watch on the state of nutrition and the causes of malnutrition within a
locality, which involves periodic collection of data and analysis and dissemination of analyzed
information
Tools utilized are anthropometric measurements:
Weight for age

measures degree and presence of wasting or stunting
Height for age

measures the presence of stunting
< 90% of standard → stunting or past chronic malnutrition
Weight for height

determines the presence of muscle wasting
Male Rule Female

+6 For every increment of an +5
inch above 5 feet
105 – 110 lbs. For a height of 5 feet 100 – 105 lbs.
-6 For every decrement of an -5
inch below 5 feet
1. Compute for the Ideal Body Weight
if height = 5 feet and 6 inches actual weight = 115 lbs.

sex = Female
5 feet = 105 lbs.
6 inches = 30 lbs.
IBW = 135 lbs.
2. Determine the degree of malnutrition X 100%

Actual Body Weight a. Degree of Malnutrition
=
Ideal Body Weight
Thus;
Actual Body Weight (115)

x 100%
a. Degree of Malnutrition =
Ideal Body Weight (135)
= 85-18%
► 1st degree Malnutrition

CHN
Degrees of Malnutrition
110% and above - obese

90 –109 % - normal
75 – 89 % - 1st degree

CHN
60 – 75 % - 2nd
60% and below - 3rd
skinfold measurement
indicates amount of body fat with the use of fat-caliper
sites: triceps, biceps, subscapular, suprailiac
MUAC
estimates lean body mass or skeletal muscle
reserves
Legal Milestones:
PD 491 – Nutrition Act of the Philippines
- declares Nutrition as a priority of the

government
- creates the National Nutrition Council
- designates duly as the Nutrition Month
RA 832 – Rice Enrichment Law
“all milled rice have to be enriched with premix

Rice”
government’s nutrition program
RA 8172 – FIDEL Salt
Supply and Use of Essential Drugs
Essential drugs are medicinal preparations necessary to fill the basic health needs of the
population.
National Drug Formulary contains the list of essential drugs
“23 in ‘93” 4. tailored drug procurement

Philippine National Drug Policy
Objective: to promote access to –
High-quality Effective
Essential Low-cost
Safe Drugs and pharmaceuticals
ACRONYM HEELS
4 Pillars:
1. Assurance of safe, effective and useful
drugs
2. Rational drug use
- the practice of using only the
necessary, appropriate and effective drugs in
treating an illness
3. developing greater self-reliance in basic
production thru DOH herbal
processing plants
CHN
“Health for More in ‘94”
National Focus Generics information
Campaign Month
“Walong Wastong Gamot na Maabot”
- supports the Generics Act of 1998 through

aggressive information
campaigns on rational drug use, to provide
consumers options for les
expensive drugs with the use of generic
labeling and prescribing.
Pilot Program OPLAN WALANG

RESETA
Several prescription drugs were made available
without a MD’s prescription

CHN
Legal Milestones
Generics Act of 1998 Dangerous Drugs Act

RA 6675 RA 6425
“Formally proclaims the state policy of “The safe, administration
promoting the use of and transportation of prohibited drugs is
generic terminology in the punishable by law”
importation, manufacture, 2 Types of Drugs
distribution, marketing, promotion Prohibited Regulated
and advertising, labeling, prescribing LSD Benzodazepines
and dispensing of drugs.” “Reinforces the Eucaine Barbiturates
Cocaine/codeine
NDP with regards to the assurance of
Opiates
high-qualityand rational drug use”
Environmental Sanitation
Environmental Sanitation is defined as the study of all factors in man’s physical environment,
which may exercise a deleterious effect on his health, well-being and survival.
Goal:
to eradicate and control environmental factors
in disease transmission through the provision of
basic services and facilities to all households.
Components:
Water Supply Sanitation Program

Proper Excreta and Sewage Disposal Program
Insect and Rodent Control
Food and Sanitation Program
Hospital Waste Management Program
Strategies on Health risk immunization
1. Water Supply Sanitation Program
3 Types of Approved Water Supply and Facilities
Level I Level II Level III

Point Source Communal faucet system or Waterworks system or
stand posts individual house
connections
A protected well or A system composed of a A system with a source, a
a developed spring with source, a reservoir, reservoir, a
an outlet but without a piped piped distributor network
a distribution distribution network and and household
system for rural areas communal faucets, located taps thatis
where houses at not more than suited for
densely

CHN
are thinly scattered. 25 meters populated urban areas.
from the
farthest house in
rural areas where houses are clustered densely.
Water must pass the National Standards for Drinking Water set by the DOH
2. Proper Excreta and Sewage Disposal System
3 Types of Approved Toilet Facilities
Level 1 Level 2 Level 3

Non-water carriage toilet On site toilet facilities of Water carriage types of
facility: the water carriage type toilet facilities connected to
- Pit latrines with water sealed and septic tanks an/or to
- Reed Odorless Earth flushed type with septic sewerage system to
Closet vault/tank disposal treatment plant.
- Bored-hole facilities.
- Compost
- Ventilated improved pit
Toilets requiring small

amount of water to wash
waste into receiving space
- Pour flush
- Aqua privies
Rural Areas – “Blind drainage” type of wastewater collection and disposal facilities shall be
emphasized until such time that sewer facilities and off-site treatment facilities are available.
3. Proper Solid Waste Management

- refers to satisfactory methods of storage, collection and final disposal of solid
wastes
2 Major Components:
Garbage
Those having a tendency to decay and give off foul odor
Rubbish
Broken glass, bottles, papers
Zero Solid Waste Management featured in “23 in ‘93”
Household Community
○ Burial ○ Sanitary landfill or controlled tipping
► Deposited in 1m x 1m deep pits covered ► Excavation of soil deposition of refuse
with soil, located 25 m. away from water and compacting with a solid cover of 2 feet
supply
○ Incineration
○ Open burning
Animal feeding
Composting
Grinding and disposal sewer
CHN
2 Ways of Excreta Disposal

CHN
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
Goal:
To prevent the risk of contraction contracting nosocomial infection from type disposal of infectious,
pathological and other wastes from hospital
In 23 in ’93, hospitals were developed to be “Centers of Wellness” addressing the need for
preventive programs against smoking, cancer and other communicable diseases. This is further
pushed through with the concept of “Ospital Pinoy Style: Sentro ng Kalusugan” in Health for
More in ’94 its major aim is to continue upgrading the curative as well as basic services in hospitals,
which are available to all communities. One of its challenges is the implementation of Hospital
Waste Management program as a requirement to operate
6. Programs related to health-risk minimization secondary to environmental

pollution
These include the following:

Anti-smoke Beching Campaign and Air pollution Campaign
Zero Solid Waste Management
Toxic, Chemical and Hazardous Waste Management
Red Tide Control and Monitoring
Integrated Pest Management and Sustainable Agriculture
Pasig River Rehabilitation Management
7. Education of prevailing health problems
accepted activity at all levels of public health used as a means of improving the health of
the people through techniques which may influence peoples thought motivation, judgment and
action.
Three aspects of health education:

Information – provision of knowledge
Communication – exchange of information
Education – change in knowledge, attitudes and skills
Sequence of steps in health education:

Creating awareness
Creating motivation
Decision making action
HIV/STI Prevention and Control

CHN
Operational Strategies:
Promotion of health/health education
Diseases detection Treatment program Contact tracing Clinical services
Program components:
Case-finding
Case management
Training Monitoring Reporting system
Operations research
Ministry circular #2 s. 1986 includes AIDS as a notifiable disease

AO#57 –As 1989 provides the policies for the prevention and control of HIV/AIDS in the
Philippines.
National AIDS Program, featured in 23 in ‘93

►Aimed to establish Surveillance program to determine groups at increased risk of acquiring AIDS
►Create a Philippine National AIDS Council which define policies advocacy, strategies,
issues, and public health education for AIDS prevention
Mental Heath
-a state of well-being where a person can realize his or her own abilities, to cope with the normal
stresses of life and work productively
-the emotional adjustment the person achieve in which he can live with reasonable comfort,
functioning acceptably in the community where she lives
-involves the promotion of a healthy state of mind among the whole population through
developing positive outlook in life strengthening coping mechanisms
Vulnerable group to the development of Mental Illness:

Streetchildren
Victims of Torture or violence
Internal refugees
Victims of aimed conflict
Victims of natural and man-made disasters
Components of Mental Health Program
A. Stress Management and Crisis Intervention

B. Drugs and Alcohol Abuse Rehabilitation
C. Treatment and Rehabilitation of Mentally-Ill Patients
D. Special Project for Vulnerable Groups
DOH Events:
“Buwan ng Kabataan, Pag-asa ng Bayan”, featured in Health for More
in ’94
National Focus: National Mental Health Week: “Linggo ng Lusog-Isip”
Rationale:
Stresses in the environment of children such as times of disasters and national calamities,
disintegration of the values, structure and functions of the family and urbanization, migration,
drugs and physical and sexual abuse and poverty have direct effects on physical and mental
health

CHN
CHN

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COMMUNITY HEALTH NURSING

​CHN BASIC CONCEPT

⮚ Health care delivery system

​Health Care Delivery System:

​Two major functions:

Categories of Health Problem

FIVE FOLD MISSION OF CHN:

​Duties and Responsibilities of the Community Health Nurse

⮚ Our roles are:

​RURAL HEALTH MIDWIFE

⮚ Mobilizes community for health action

​CHN CLINIC VISIT

Arby James Abonalla, RN, MSN, PhDN©

⮚ SUSTENANCE & STRENGTHENING

Arby James Abonalla, RN, MSN, PhDN©

​PRIMARY HEALTH CARE

​Core Strategy: PARTNERSHIP & EMPOWERMENT towards SELF-RELIANCE

​PRIMARY HEALTH WORKERS

Arby James Abonalla, RN, MSN, PhDN©

⮚ Use clay pot and plant part advocated

​REPUBLIC ACT NO. 8423

​Public Health Programs

P - Primary Health Care

​LIGTAS BUNTIS 2005 CAMPAIGN

▪ Every pregnancy should be intended

▪ Every birth should be healthy

▪ Every sex act should be free of coercion & infection

Arby James Abonalla, RN, MSN, PhDN©

❖ Giving birth at the right age and at the right time

▪ For the health of the new borne

▪ For the health of the entire providing

▪ LACTATIONAL AMENORRHEA METHOD

▪ Depo-Medroxyprogesterone Acetate (DMPA) effective for 3 months

Arby James Abonalla, RN, MSN, PhDN©

​The ROOMING-IN & BREASTFEEDING ACT of 1992

EXEMPTIONS: mothers who are:

Acceptable medical condition for supplemental feeding

The ff DO NOT permit rooming-in & breastfeeding

▪ Taking meds contraindicated to nursing (e.g. anticancer)

Arby James Abonalla, RN, MSN, PhDN©

EXPANDED PROGRAM ON IMMUNIZATION

BCG: (infants) 0.05 ml intradermal

Tetanus toxoid: 0.5 ml intramuscular

BCG: inflammation at the site (Koch’s phenomenon) – warm compress

Frequently Asked Questions (FAQs)

Arby James Abonalla, RN, MSN, PhDN©

Q: Is there any contraindication to giving DPT, OPV, Hepa-B?

Q: What if the child Is malnourished?

Storage of vaccine should not exceed:

- 6 mos. @ the Regional Level

Important points to remember:

Arby James Abonalla, RN, MSN, PhDN©

Arby James Abonalla, RN, MSN, PhDN©

Storage Vaccine Form Dose/Container Conditions

Measles Freez 10 dose/vial

BODY OF THE BCG Freez 20 dose/amp

Hepa-B Liquid 20 dose/vial Damaged by

Most sensitive to heat:

Most sensitive to freezing:

Arby James Abonalla, RN, MSN, PhDN©

Arby James Abonalla, RN, MSN, PhDN©

▪ What will happen to my child after receiving the measles immunization?

Give Paracetamol q 4 hours

CHN BASIC CONCEPT

Health Care Delivery System:

Two major functions:

Duties and Responsibilities of the Community Health Nurse

RURAL HEALTH MIDWIFE

CHN CLINIC VISIT

PRIMARY HEALTH CARE

Core Strategy: PARTNERSHIP & EMPOWERMENT towards SELF-RELIANCE

PRIMARY HEALTH WORKERS

REPUBLIC ACT NO. 8423

Public Health Programs

LIGTAS BUNTIS 2005 CAMPAIGN

The ROOMING-IN & BREASTFEEDING ACT of 1992

NUTRITIONAL GUIDELINES FOR FILIPINOS GOAL

STOP TB: D.O.T.S.

Quality service through DOTS

Pinoy Responsible Owner of Dog

Pinoy Responsible Pet Owner

Current WHO guide for Rabies Pre & Post Exposure Tx

Post exposure Tx Intradermal

CONTROL OF ACUTE RESPIRATORY INFECTION

LEPROSY CONTROL PROGRAM

“KILATIS KUTIS PROGRAM”

MALARIA CONTROL PROGRAM