Professional Documents
Culture Documents
C H N: A O: What Is A Community?
C H N: A O: What Is A Community?
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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
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What is health?
§ Health-illness continuum
§ High-level wellness
§ Agent-host-environment
§ Health belief
§ Evolutionary-based
§ Health promotion
§ WHO definition
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§ What is nursing?
- assisting sick individuals to become healthy
and healthy individuals achieve optimum
wellness
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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
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1. I ndividual
2. F amily
3. C ommunity
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3 Elements of Communication:
Message
Sender
Receiver
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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
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MISSION
To guarantee EQUITABLE,
SUSTAINABLE and QUALITY
health for all Filipinos,
especially the poor and to
lead the quest for
excellence in health
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CREATION OF RHCDS
LEVELS OF PREVENTION
PRIMARY LEVEL SECONDARY LEVEL TERTIARY LEVEL
Health Promotion and Illness Prevention of Complications thru Early Prevention of Disability, etc.
Prevention Dx and Tx
REFERRAL SYSTEM:
CHARACTERISTICS OF PHC
Acceptable
Accessible
Affordable
Available
Sustainable
Attainable
UTILIZES APPROPRIATE TECHNOLOGIES USED
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BY PHC: ACCEFS
ECONOMY:
Co-Trimoxazole:
§ it’s a combination of 2 generics of drugs which is antibacterial
Trimethoprim(TMP)
§ Has a bacteriostatic action that stops/inhibits multiplication
of bacteria
§ For GUT, GIT & URTI (TMP combined with SMX)
Sulfamethoxazole (SMX)
§ Has bactericidal action that kills bacteria
§ For GUT, GIT, URTI & Skin Infections
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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
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TB DRUGS:
Rifampicin (RIF)
Isoniazid (INH)
Pyrazinamide (PZA)
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Paracetamol
Has an analgesic & anti-pyretic effect
Oresol:
a management for diarrhea to prevent dehydration
under the Control of Diarrheal Diseases (CDD)
Program
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Nifedipine:
§ An anti-hypertensive drug
§ According to DOH, 16% of population
belonging to 25 years old & above in the
community are hypertensive
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C. HERBAL PLANTS
LUBBY SANTA
POLICIES TO ABIDE:
Know indications
Know parts of plants with therapeutic value: roots,
fruits, leaves
Know official procedure/preparation
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Procedures/Preparations:
Decoction
Ø Gather leaves & wash thoroughly, place in a
container the washed leaves & add water
Ø Let it boil without cover to vaporize/steam to
release toxic substance & undesirable taste
Ø Use extracts for washing
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PROCEDURES/PREPARATIONS:
Poultice
Ø Done by pounding or chewing leaves used by
herbolaryo
Ø Example: Akapulko leaves-when pounded, it releases
extracts coming out from the leaves contains enzyme
(serves as anti-inflammatory) then apply on affected
skin or spewed it over skin
Ø For treatment of skin diseases
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PROCEDURES/PREPARATIONS:
Infusion
PROCEDURES/PREPARATIONS:
Juice/Syrup
PROCEDURES/PREPARATIONS:
Cream/Ointment
D. ORESOL
Glucose 20 grams 1° Significance:
For re-absorption of Na
Facilitates assimilation of
Na
2° Significance:
Provides heat & energy
Sodium Chloride/NaCl 3.5 grams For retention of water/fluid
Sodium 2.5 grams Buffer content of solution
Bicarbonate/NaHCO3 Neutralizer content of
solution
Potassium Chloride/KCl 1.5 grams Stimulates smooth muscle
contractility especially the
heart & GIT
PREPARATION OF PROPER HOMEMADE
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ORESOL
REFERRED TO AS KALUSUGAN
PANGKALAHATAN (KP)
REFERRED TO AS KALUSUGAN
PANGKALAHATAN (KP
The Aquino administration puts it as the availability
and accessibility of health services and
necessities for all Filipinos.
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.
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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.
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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.
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COMPONENTS OF FHSIS
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:
(1) Health Program Accomplishment this can serve as proof of
accomplishments to show LGU officials whenever they visit
the facility.
(2) 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.
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FHSIS REPORTING
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.
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FLOW OF REPORT
OFFICE PERSON RECORDING FORMS FREQUENCY SCHEDULE OF
TOOLS SUBMISION
BHS Midwife - ITR Monthly Form Monthly Every 2nd week of the
- TCL (M1 & M2) succeeding month
- ST
A-BHS Form Annually Every 2nd week of
January
Fertility
§ Crude Birth Rate (CBR) - Overall total reported births
I. RAPPORT
II. ASSESSMENT
Data Gathering: tools or instruments used during
survey:
ü Interview
ü Observation
ü Questionnaires-mostly patronized & used in CHN
ü Records & Reports available
Statistical Approaches:
1. Central Tendencies: 3 M’s
Mean=average
Median=range (Highest – Lowest Score)
Mode=frequency of occurrence of a variable, used if
there’s too many variable occur
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Presentation of Data
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Sales
Series
1. Table/Chart Categ 1 1st Qtr
Categ
Series
2. Graph: Categ
2
2nd Qtr
Categ
Pie Series
0 20 3 6
Bar-2 variables only 4 Series
2 1
Line 0
Series
Catego
Catego
Catego
Catego
2
Polygon-connecting the results
Histograph-2 or more variables & appear adjacent to
each other
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ACCORDING TO NATURE
Jobless Father
Suffering from TB
th
Wife is pregnant for the 8 time
2 y/o youngest child lacks immunization
rd
9 y/o eldest child is 3 degree
malnourished
Poor environmental sanitation
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III. PLANNING
§ Steps:
a. Decide on a score
b. Score x weight
-----------------
Highest Score
b. Get the sum total of all the scores
§ Interpretation:
Perfect score=5, if score nearing 5 then prioritize the problem
Criteria 1, 2 & 3 has to be assessed objectively by the health
worker
Criteria 4 has to be assessed by the perception of the family
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IV. INTERVENTION
V. EVALUATION
Three (3) Things to be evaluated: SPO
1. Structure of program & activity -what articles, equipments, supplies are
utilized
2. Process utilized -steps used
3. Outcome of activity -results can be:
§ Desirable -to be implemented, advocated, strengthen
§ Undesirable -to be avoided
Two (2) Aspects to be evaluated in the Outcome:
§ Quality -characteristic or kind of outcome; no numerical value, not measurable
§ Quantity -from the word “quantum”, with numerical value, measurable
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OBJECTIVES OF COPAR
Patterns to be followed:
1. Organize people
2. Mobilize people
3. Work with people
4. Educate people
ü Knowledge
ü Attitude
ü Skills
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PHASES OF COPAR
1. Preparatory
2. Organizing
3. Mobilizing
4. Educating
5. Collaborating
6. Phase Out
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1. PREPARATORY PHASE
A. Area of Selection
§ It should be DOPE Community: Depressed,
Oppressed, Poor & Exploited, a new criteria for
community organization
§ “Old Criteria”→ it must be a virgin
community=meaning no agency has gone there.
§ This is a dangerous situation that’s why RA 7305:
Magna Carta for Public Workers was provided-a PHN
is to receive a hazard pay of 20-25% of monthly
salary
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1. PREPARATORY PHASE
1. PREPARATORY PHASE
C. Integration/Immersion
§ Immersion is imbibing the life situation/
condition of the community by living, eating &
sleeping with the family to be able to
understand their situation
§ It requires 2 Qualities of PHN:
§ Empathy
§ Sympathy (Integration)
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1. PREPARATORY PHASE
Health Resource(s):
5 M’s-Manpower/Man, money, machinery, material & methods
(+) available facilities-Hospital/Clinic, mode of transportation,
market, school & movie houses for recreation
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2. ORGANIZING PHASE
Choosing Potential Community Leaders
Core Group Formation
Community Assembly: Community Organizing Participatory Action
Research (COPAR)
§ Attend the assembly of the family/families
§ Families in the community should be represented, any
family members can represent his/her family as long as he/
she is a RESPONSIBLE (one who also can comprehend)
member of that family.
§ Barangay Captain/Chairman need not necessary be the
leader. He can recommend
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3. MOBILIZATION PHASE
Mobilization
- let the members of the community do the work.
PHN should only SUPERVISE
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4. HEALTH EDUCATION
5. COLLABORATING
6. PHASE OUT
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EPIDEMIOLOGY
is the pattern of occurrences & distribution of diseases, defects &
deaths
2 Population in Distribution
Patterns Susceptible Immune
(at risk to develop, acquire (those that did not
or experience the disease) experience the disease,
usually individuals develop
resistance against the
disease)
Epidemic 80% (more than 50%) 20%
Endemic 50% 50%
Sporadic 20% 80%
Pandemic ----- -----
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EPIDEMIC
§ Greater than 50% of populations are susceptible or less immune
individual
§ Greater % of the population is affected by the occurring disease
ENDEMIC
The disease occurs regularly, habitually, constantly affecting the
population group
2 Local Endemic Diseases: where causative agent is available on
those places
§ Schistosomiasis: Samar, Leyte, Mindoro, Davao
§ Malaria: Palawan & Mindanao-reasons why it’s prevalent
§ Forested areas
§ Surrounded by bodies of water
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SPORADIC
PANDEMIC
HOME VISIT
§ Assessment
§ Nursing Care
§ Treatment
§ Health Education
§ Referral (if care fails)
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1. Planning
ü Starts at the health center
ü Makes a study on the status of the family
ü Statement of the problem
ü Formation of objective
2. Socialization –first activity is to establish rapport
& to gain the trust of the family
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HEALTH BAG:
§ Cleaning
ü The inner part of the bag should be clean & sterile
ü Should be done every after home visit
ü Never endorse the bag
GUIDING PRINCIPLES IN THE USE OF PUBLIC
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HEALTH BAG:
§ Contamination
§ The less one opens the bag, the lesser
chance of contamination
§ In general, the bag is open 3x:
ü Putting out materials for hand washing
ü Putting out materials used for nursing
care
ü Returning all what have been used
GUIDING PRINCIPLES IN THE USE OF PUBLIC
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HEALTH BAG:
C ase Finding
H ealth Education
E nvironmental Sanitation
S nail Eradication
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CASE FINDING:
6 Aspects or Thing to Know
§ Disease: Schistosomiasis
§ Other name: Bilhariasis or Snail Fever
§ Causative agent: Schistosoma-a blood fluke (parasite)
3 Types of Species:
ü Schistosoma japonicum-endemic in the Philippines &
affecting Indonesia, China, Japan, Korea Vector: Oncomelania
quadrasi
ü Schistosoma mansoni
ü Schistosoma haematobium
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CASE FINDING:
§ Disease: Malaria
§ Other name: Ague
§ Causative Agent: Plasmodium-a protozoa
4 Types of Species:
ü Plasmodium falciparum-more fatal that affects the Philippine
Vector: Female Anopheles Mosquito (FAM)
ü Plasmodium vivax
ü Plasmodium ovale
ü Plasmodium malariae
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PERSONAL PROTECTION:
CLEAN:
Chemical Method=insecticide spraying at night
Larvae eating fish=Tilapia
Environmental Sanitation & Health
Education=insect, water, trash
Anti-mosquito soap=basil citronelli
Neem tree=banana, banaba, gabi, eucalyptus
provide repellent effect
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STRATEGIES:
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GOALS:
A. Safe Pregnancy
ü Right age to be pregnant=20-35 years old,
not less than 20 & not more than 35
ü Right interval of pregnancy=once in 2 or 3
years
ü Home Base Mother’s Record (HBMR): the
record used for care of mothers in CHN
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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:
Blue : (-) sugar in urine
Green : trace of sugar in urine +1 +
Yellow : traces of sugar in urine +2 ++
Orange : more traces of sugar in urine +3 +++
Brick Red : surely diabetic +4 ++++
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Laboratory Examinations:
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:
If it remains clear: (-) CHON or albumin in urine
If it turns cloudy: (+) CHON=proteinuria
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POLICIES:
1. Non coercive (give freedom of choice)
2. Integration of Family Planning in all Curricular Program:
§ 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:
§ Intrasectoral
§ Intersectoral-Local or International (WHO, Unicef, USAID,
Japhiego)
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METHODOLOGIES:
Biological
A. Basal Body Temperature (BBT)
§ 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°C followed by an increase of temperature by
0.3-0.6°C which means that the woman is fertile
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B. Sympto-thermal
C. Cervical Mucus Test
Ø Billing’s Method by Dr. Billing
Ø Spinnbarkheit (came from a German word Spinner which means
to play with the cervical mucus with the finger) or Wet & Dry
Method:
§ Wet Cervical Mucus (Fertile): abundant, stretchy & transparent
§ Dry Cervical Mucus (Safe & Not fertile): whitish, pasty &
adhesive
D. Calendar (Rhythm)
§ Deleted already since 1998 because it’s not recommended for
irregular cycle of menstruation
§ Menstrual cycle should be regular; obtain 4-6 months cycle
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METHODOLOGIES:
Temporary
A. Chemical
§ Oral Pills (Logentrol)-has low dose of estrogen & progesterone that
inhibits ovulation
§ Parenteral: Depot Medroxyprogesterone Acetate (DMPA)/Depo-
provera- inhibits ovulation making women amenorrheic;
1991, DMPA was found to be causing cancer of the cervix
1994, DMPA is given IM 4x a year every 3 months (90 days interval)
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B. Mechanical:
§ IUD
ü Up to 10 years protection
§ Cervical cap & Diaphragm
ü Prevent the sperm to pass the cervix
ü Works better with spermicide
ü Wore 30 minutes before coitus and keep up to 6
hours after coitus
§ Condom
ü Most effective way to prevent STD’s / STI’s
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METHODOLOGIES:
C. Behavioral
Ø Abstinence
Ø Withdrawal
D. Permanent
Ø Vasectomy (reversible)-since year 2000 in the
Philippines
Ø BLT
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POLICIES:
I. Nutritional Surveillance (NS): to determine victims of
malnutrition
A. Anthropometric Measurement: study of measurements of
human dimensions
Ø Age for Weight-if weight is not appropriate with the age:
ü Stunting: growth retardation
ü Wasting: connotes malnutrition
Ø Age for Height-if height is not appropriate with the age:
Stunting
Ø Weight for Height
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POLICIES:
I. Nutritional Surveillance (NS): to determine victims of malnutrition
B. Biochemical Method
Ø Micronutrient Malnutrition -available in small amount in the body VADAG:
Vitamin A Deficiency:
§ Deficiency: Xeropthalmia-opacity of cornea leading to night blindnes
Infants (6-12 months) : Give 100,000 i.u.
Pre-schoolers (12-83 months) : 200,000 i.u.
Post partum : 200,000 i.u.
§ Kwashiorkor-protein deficiency
§ Marasmus-carbohydrate deficiency (energy
giving food)
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Kwashiorkor Marasmus
Etiology Disease experienced by an elder Muscle wasting
child upon the birth of a new baby
POLICIES:
II. Food Production
Fortification-products without any nutrient are added with nutrients
RA 8172 (Asin Law): Fidel Salt (Fortification of Iodine Deficiency Elimination)
=Iodized Salt-“Patak” sa Asin” by Secretary Flavier on December 1-5, 2003
where DOH workers go to market to check if salt sold contains iodine by
placing few drops of reagent:
If salt color turns to blue violet→ fortified with iodine
If salt color show no change→ not fortified with iodine
ENVIRONMENTAL SANITATION
COMPONENTS:
ü Potable
ü Free from any particles that might
cause illness to an individual
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Level I
Point Source
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.
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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
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Pit latrines
Ø most commonly observed in rural area
Ø has three components: the pit, a squatting plate and the
super-structure
Ø 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.
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Level 2
Level 3
WAYS OF DISPOSAL
Household
○ Burial
► Deposited in 1m x 1m deep pits covered with
soil, located 25 m. away from water supply
○ Open burning
o Animal feeding
o Composting
o Grinding and disposal sewer
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WAYS OF DISPOSAL
Community
○ Sanitary landfill or controlled tipping
► Excavation of soil deposition of refuse and compacting
with a solid cover of 2 feet
○ Incineration
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
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POLICIES:
ü Food establishment are subject to inspection
(approved of all food sources containers and
transport vehicles)
ü Comply with sanitary permit requirement
ü Comply with updated health certificates for food
handlers, helpers, cooks
ü All ambulant vendors must submit a health
certificate to determine present of intestinal parasite
and bacterial infection
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3 POINTS OF CONTAMINATION
GOAL: