Maternal and Child

Health Programs
 Maternal Health Programs
• National Safe Motherhood Programs
• Women’s Health and Safe Motherhood Project
Antenatal Registration
Tetanus Toxoid Immunizations
Micronutrient Supplementation
Treatment of Disease and other condition
Clean and safe delivery
 Antenatal Registration
PRENATAL VISIT PERIOD IN PREGNANCY
1st As early in pregnancy as possible; first three
months
2nd 2nd trimester
3rd 3rd trimester
4th After 8th month ‘til delivery
 Tetanus toxoid immunization
Dose Time Given Protection
TT1 Anytime in Pregnancy -
Standard
TT2 1 month after TT1 80%, 3 years
TT3 6 months after TT2 95%, 5 years
Booster TT4 1 year after TT3 99%, 10 years
TT5 1 year after TT4 Lifetime

*After completion of the 5 doses, the mother is called a fully immunized mother.
 Micronutrient Supplementation
Vitamin Dose Schedule
Vitamin A* 10,000 IU 2x/week rom 4 month
Iron 60 mg/400 µg tab Daily

*Not given during 1st trimester;

Treatment of disease and other conditions

BEmONC (Basic Emergency Obstetric & Newborn Care

• Facilities: Upgraded BHS, RHU, district and community hospitals
• Emergency Services:
• Parenteral administration of oxytocin on 3rd Stage of Labor
• Parenteral administration of loading dose of anti-convulsant
• Parenteral administration of initial dose of antibiotics
• Assisted vaginal delivery during imminent breech delivery
• Manual removal of placenta
• Removal of retained placental fragments
Treatment of disease and other conditions

BEmONC (Basic Emergency Obstetric & Newborn Care

• Facilities: Upgraded BHS, RHU, district and community hospitals
• Emergency Services:
• Parenteral administration of loading dose of steroids for premature labor
• Administration of IVF, blood volume expander and/or blood transfusion
• Newborn resuscitation
• Treatment of neonatal sepsis PRN
• Oxygen support for newborns
Treatment of disease and other conditions

CEmONC (Comprehensive Emergency Obstetric & Newborn Care

• Facilities: departmentalized district, provincial, and regional hospitals
• Emergency Services:
• In addition to services rendered in BEmONC, CEmONC also provides the
following:
• Cesarean section delivery
• Blood transfusion
• Management of newborn complications
Treatment of disease and other conditions

CEmONC (Comprehensive Emergency Obstetric &

Newborn Care
• Life support management of:
• Low birth weight newborns
• Premature newborns
• Sick newborns (sepsis, fetal alcohol syndrome, asphyxia, severe
birth trauma, severe jaundice, etc.)
 Clean and safe delivery
• Recommended schedule for postpartum visits:

Visit Schedule
1st Visit 1 week postpartum, preferably 3-5 days
2nd Visit 6 weeks postpartum
Essential Intrapartum
and Newborn Care
 4 Core Steps of EINC:
First 90 minutes of life
1st 30 seconds • ?????

After 1st 30 seconds • ?????

1-3 minutes after delivery • ?????

Within 1st 90 minutes of life • ?????

 Maternal,
Newborn, Child
Health and
Nutrition Strategy

Essential
Intrapartum
and Newborn
Care
Maternal, Newborn,
Child Health and
Nutrition Strategy
(MNCHN)
 Policy Objective
• Administrative Order 2008-0029
• Administrative Order 2009-0025

• To reduce maternal and neonatal mortality rates faster from

2007 to 2015 to meet MDG targets
 MNCHN
Every pregnancy is wanted, Every pregnancy is
planned and supported adequately managed

Intermediate
Goals
Every mother and newborn pair secures proper
Every delivery is postpartum and postnatal care with smooth
facility-based and managed by transitions to the women’s health care
package for the mother and child survival
skilled health professional package for the newborn.
 Integrated MNCHN Service Package

Pre-Pregnancy Services Antenatal care

Financing
Health Facilities and Service Packages
Human Resource, Health information**
Health Products and Pharmaceuticals
Other Support Systems
Postpartum
Care during Delivery
and Postnatal Care
Community Health Teams (CHTs)
Under the universal health care,
• P-Noy’s (Aquino) Health Agenda (DOH Administrative
Order 2010-0036)
• Cabinet collaboration
• DOH, PhilHealth, DSWD, DepEd, DILG, etc.

• CCT areas
• Door-to-door campaign
• Health messages, identification of health facilities, PhilHealth
membership and enrollment
Community Health Teams (CHTs)
With the support of barangay leaders,
• CHTs known before as “women’s health teams”
• Led by the public health midwife (CHT Team Leader)
• Members:
• RN HEALS
• Barangay nutrition scholars
• Barangay health workers
• Barangay service point officers
• Women’s groups
 Life Events
Pre-union
Conception Birth and Under 5
Premarital
Pregnancy Delivery years
counseling

MBFHI

BEmONC with POGS MDG

EINC
NBS, EPI, IMCI, IYCF

Family Planning, Adolescent Health

Healthy Lifestyle

Micronutrient Supplementation
 Pre-union
Conception Birth and Under 5
Premarital
Pregnancy Delivery years
counseling

Healthy Lifestyle

• Anti-smoking campaign
• Health nutrition and diet (low-fat, low salt, high fiber)
• Increase physical activity
• Anti-drug abuse
• Mental health – Stress Management
• Oral health
 Pre-union
Conception Birth and Under 5
Premarital
Pregnancy Delivery years
counseling

Micronutrient Supplementation

• Iron supplementation
• Folic acid supplementation
• Deworming
• Use of iodized salt
 Pre-union
Conception Birth and Under 5
Premarital
Pregnancy Delivery years
counseling

Family Planning, Adolescent Health,

Sexuality and Reproductive Health
• Responsible parenthood – family planning
• Fertility awareness
• Adolescent health advocacy
• Reproductive organs cancer advocacy, prevention and screening –
self-breast exam, digital rectam exam, pap smear
• Prevention and Treatment of STIs/HIV-AIDS
• Immunization update – tetanus and diphtheria toxoid, pertussis, Hepatitis
B, Measles-Mumps-Rubella
• PhilHealth membership
 Pre-union
Conception Birth and Under 5
Premarital
Pregnancy Delivery years
counseling

MBFHI

BEmONC with POGS MDG

EINC
• Prenatal care visits and education – including birth preparedness, birth planning, breastfeeding education
• Iron supplementation and folic acid supplementation
• Advocacy on facility-based delivery and skilled health professional (EINC and BEmONC-trained midwife,
OBGyne, pedia)
• Pro-active participation - pregnancy tracking, motivation
• Barangay level advocacy on birth and emergency obstetric and newborn care preparedness
• Health lifestyle, healthy pregnancy and safe motherhood
 Pre-union
Conception Birth and Under 5
Premarital
Pregnancy Delivery years
counseling

MBFHI

• Essential intrapartum and newborn care

• Rooming-in and breastfeeding
EINC
• Breastfeeding and infant and young child feeding (IYCF) NBS, EPI, IMCI, IYCF
• Breastfeeding during emergencies and disasters
• Newborn screening and newborn hearing screening
• Postpartum care and postnatal care *Mother-Baby Friendly Hospital
Initiative
• Birth spacing, family planning *Infant & Young Children Feeding
• Health lifestyle
• Oral health
 Pre-union
Conception Birth and Under 5
Premarital
Pregnancy Delivery years
counseling

MBFHI

EINC

• Complementary feeding with continued breastfeeding

• Expanded programme on immunization
• BCG, 3 doses of Hepatitis B, 3 doses of DPT, 3 doses of oral Polio, two doses of measles containing vaccine
(Anti-Measles Vaccine and Measles-Rubella vaccine)
• Pentavalent (DPT and Hepatitis B and HiB vaccine)
• Integrated Management of Childhood Illness (IMCI)
• Oral Health
• Iron supplementation
• Deworming
Infant and Young Child
Feeding
 IYCF components
• Initiate breastfeeding withing 1 hour after birth
• Exclusive breastfeeding for the firsts 6 months of life
• Complementary feeding at 6 months with appropriate food, excluding milk
supplementations
• Continue breastfeeding two years and beyond
 Advantages of breastfeeding
House/
Infant Mother
community
• BM is nutritionally complete • Decreased risk of maternal • Economical
for infants blood loss
• Improves immunity (IgA) • Used as nature FP method
• Safe for rehydrating the sick (LAM)
child • Decreased ovarian, breast
• Reduces exposure to CA and osteoporosis risk
infection
• Improves cognitive
development
Characteristics of complementary feeding

Timely Adequate

COMPLEMENTARY
FEEDING

Safe Properly fed

 Laws related to IYCF

• EO 51: Milk Code

• RA 7600: Rooming in and Direct Breastfeeding Act of 1992
• RA 8976: Food Fortification Law
Breastfeeding TSEK
 Objectives
• To promote exclusive breastfeeding for children aged 6 months and below
• To raise awareness on the advantages of breastfeeding

T • Tama

S • Sapat

EK • EKslusibo
Newborn Screening
RA 9288: Newborn Screening Act of 2004
 Key Points
• NBS must be performed within 24-72 hours after birth
• If child is in ICU to ensure survival, he/she may be exempted form the
first provision but must be tested before 7 years of age

*A sample of the child’s blood is taken through the heel-prick test.

There are 28 disorders detected through NBS. In PH, 6 are the most
common:
 Disorder If detected and treated If undetected
Congenital Hypothyroidism (CH) Normal Severe mental
retardation
Congenital Adrenal Hyperplasia Alive and normal Death within 1-2 weeks
(CAH)
Phenylketonuria (PKU) Alive and normal Sever mental
retardation
Galactosemia (Gal) Normal Death or cataracts

Glucose-6-Phosphate Deficiency Normal Severe anemia,

(G6PD) kernicterus
Maple Syrup Urine Disorder Alive and Normal Death
(MSUD)
Expanded Program on
Immunization (EPI)
High prevalence of immunizable diseases Low percentage of fully immunized
children

RA 10152
Mandatory Infants and Children Health Immunization Act of 2011

1. Routine immunization for Infants/Children/Women through

Reaching Every Barangay (REB) Strategy to improve access to routine
immunizations and reduce drop-outs.
2. Supplemental Immunization Activity for unvaccinated children or
children who did not develop sufficient immunity post-vaccinations
3. Strengthening Vaccine-Preventable Disease Surveillance for disease
eradication.
 Route, Dosage &
Vaccine Disease/s Type/Component Age Doses Storage
Site
Bacillus Calmette Guerin Live attenuated bacteria; ID, 0.05 ml, right
Tuberculosis
(BCG) Freeze-dried with special diluent 1 arm/deltoid
At birth
Hepatitis B Vaccine RNA recombinant/ plasma (Hep B: if no Penta, 3)
Hepatitis B IM, 0.5 ml, vastus lateralis
(Monovalent) derivative; Cloudy Liquid
Diphtheria Diphtheria Weakened toxin
3
Pertussis Pertussis Killed bacteria
(DPT: if no Penta, 3)
Tetanus Tetanus Weakened toxin
Body: 2-8 ºC
Diphtheria
D- weakened toxins
Pertussis
Pentavalent Vaccine P- killed bacteria IM, 0.5 ml, vastus lateralis
Tetanus
(DPT-HepB-Haemophilus T- weakened toxin 3
Hepatitis B (6, 10, 14
Influenza HiB: polysacharride protein (PCV: For 2-5 years old
Pneumonia weeks)
conjugate give 1 dose)
Meningitis
Pneumococcal Conjugate Pneumonia Conjugate vaccine;
Vaccine (PCV) Meningitis Liquid, clear
Live attenuated virus
-for GI mucosal immunity (mouth &
Oral Polio Vaccine (OPV) Poliomyelitis 3 PO, 2 drops
GI tract)
-clear, pinkish Freezer: (-15 ºC) to
(-25 ºC)
-liquid, clear
Inactivated Polio Vaccine
Poliomyelitis -for serum immunity (blood) 14 weeks 1 IM, 0.5 ml, vastus lateralis
(IPV)

Mumps
9 months &
Mumps, Measles, Rubella Measles Live attenuated virus dried freeze SQ, 0.5 ml, outer aspect
12-15 1 Body: 2-8 ºC
(MMR) German with special diluent of upper arm
months
Measles
Integrated Management of
Childhood Illness(IMCI)
 IMCI

• Target population: under five children

• Sick child ages 2 months up to 5 years
• Sick young infant age 1 week up to 2 months
 METHODS CLASSIFICATION
Green: Mild
Assess the patient
Home Management

Classify the disease Yellow: Moderate

Treat the patient RHU Management

Pink: Severe
Counsel the patient
Urgent referral to hospital
 Women and Child
Protection Program
 4 R’s of Abuse

• Recognizing
• Reporting
• Recording
• Referral
Adolescent and Youth
Health Program
Political & Economic
Factors:
Marginalization and
Poverty
-Limited access to
information
-Limited access to
services & commodities
-Limited awareness to
pertinent policies
Sociocultural
Factors:
Demographics Technological
-continuing rapid population Factors:
growth Rapid advancement of
-Increasing population movement communication (e.g.
impaired social
Attitudes & Behaviors interaction, misuse of
-health risk behaviors (e.g. social networking)
premarital sex, substance abuse)
-health seeking behaviors
-low contraceptive use,,
unprotected sex, and abortion

Threats to Adolescent Health:

Accidents and other inflicted injuries, pneumonia, drowning, congenital diseases,
transmission of STIs, nutritional deficiencies, disabilities
 ADOLESCENT AND YOUTH
HEALTH PROGRAM:
International Laws Target: National Programs
(e.g UN Rights of Childrean, 1. Decrease youth mortality NOH,
World Conference for 2. Improve reproductive health FOURmula One,
Women, SDGs) 3. Decrease malnutrition among adolescents Reproductive Health, LGUs

Strategies: Strategies:
1. Safe and nurturing environment 8. Developing/transforming health care centers to become
2. provision of adolescent services adolescent-friendly facilities
3. capacity-building for health workers 9. Expanding health insurance to young people
4. Adolescent involvement in community development 10. Enhancing skills of service providers, families and
5. Development of sustainable and improving interventions adolescents
for adolescents 11. Strengthening partnerships among adolescent groups,
6. Health promotion and behavior change for adolescents government agencies, private sectors, Civil Society
7. Adolescent participation in governance and policy organizations, families and communities
decisions. 12. Resource mobilization
13. Regular assessment and evaluation
Garantisadong Pambata
 • Target: 0-14 years old
• Services:
1. Vitamin A Supplementation
❑ Target: 6 – 59 month old children
❑ Routine Dose Frequency: Every 6 months
❑ Dosing: 100,000 IU for 6-11 months; 200,000 IU for 12-59 months
❑ Therapeutic Dosing:
▪ 1 capsule regardless of last dose if pre-schooler has measles
▪ 1 capsule upon diagnosis except if last dose is less than 4 weeks for pre-schoolers with
severe pneumonia or persistent diarrhea and pre-schoolers who are severely underweight
▪ 1 capsule upon diagnosis, 1 capsule the next day, and another capsule every two weeks for
pre-schooler with xeropthalmia
2. Breastfeeding
❑ 0-6 months: Exclusive BF
❑ 6 months – 2 years old: Complementary feeding
3. Immunization
4. Deworming
❑ Every 6 months for children ages 1-12
5. Proper hygiene and sanitation
6. Proper brushing of the teeth
7. Proper handwashing
Dental Health Program
 🡩 prevalence of dental problems 🡩 Oral fit children

Breech in immunity Potential physical deformities Speech problems

Poorer quality of life

 DENTAL HEALTH PROGRAM
🡩 prevalence of dental problems
Mothers/Pregnant Women:
Oral exam, prophylaxis; permanent filling,
gum tx, health education
Young and Middle Adults:
Oral exam, emergency dental tx,
health education, referrals
Older Adults:
Oral exam, extraction of unsavable tooth, gum tx,
Pain relief, health education
*removal of unsavable tooth, referral of complicated cases, tx of post-extraction complications, drainage of localized oral abscess
**Atraumatic Restorative treatment
🡩 Oral fit children
Neonates, Infant <1 y:
First dental visit upon teeth eruption, health education,
Exclusive breastfeeding
12-71 mos.:
Dental visit q6months, supervised toothbrushing drills,
Oral urgent tx*, application of ART**
School children:
Oral exam, supervised toothbrushing drills, topical fluoride therapy, pits
and fissure sealing application, oral prophylaxis, permanent fillings
Adolescents:
Oral exam, health education on oral hygiene and
adverse effects of sweets and vices
Thank you!