CHN History Act No. 157- Creation of Board of Health of the Philippine (BON) Act No.

1407- Abolish BOH DILG

12.

There should be accurate recording and reporting in CHN.

1919 Mrs. Carmen Del Rosario – 1st Filipino Nurse Supervisor 1990-1992 – Local Revolutionary Code of 1991, RA 7160 Revolution Code National to local Definition Health – (WHO) state of complete physical, mental and social well being, not merely the absence of disease or infirmity Public health – (Dr. C.E. Winslow) the science and art of preventing disease, prolonging life, promoting health and efficiency through organized community effeort. Community Health Nursing (Jacobson)- is a learned practice discipline with the ultimate goal of contributing as individual and in collaboration with others to the promotion of clients optimum level of function through teaching and delivery of care. Factors affecting Optimum Level of Function (OLOF) 1. Political 2. Behavioral 3. hereditary 4. Health Care Delivery System 5. Environmental Influences 6. Socio economic Influences Concepts 1. The primary focus of community health nursing practice is on health promotion. 2. Community health nurses are generalist in term of their practice through life but the whole community. 3. Community health nurses are generalist in terms of their practice through life continuity in its full range of health problems and needs.

Public Health Nurse 1. Planner/programmer 2. Provide of Nursing Care/Caregiver 3. Manager/Supervisor 4. Community Organizer 5. Coordinator of Service 6. Trainer/ Health Educator/ Counselor 7. Health monitor 8. Role Model 9. Change Agent 10. Recorder/ Reporter/ Statistician 11. Researcher Community Health Process Assessment Collection of data, collected from family, groups and community. Examples: Demographic Data Vital Health Statistics Community Dynamics Health Status Education Methods: Community Survey Interview Statistics Epidemiological studies Common indicators of health status  Morbidity  Mortality Categories of Health Problems Health Deficit (HD)- instances of failure in health maintenance ( disease, disability, developmental lag) ö -ex. Dse/ illness- URTI, marasmus, scabies, edema disabilities- blindness, polio, colorblindness, deafness dev’tl problems like mental retardation, gigantism, hormonal, dwarfism

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The nature of CHN practice requires that current knowledge derived from the biological, social science, ecology, clinical nursing and community health organizations be utilized Contact with the client and or family may continue over a long period of time which includes all ages and all types of health care. The dynamic process of assessing, planning, implementing and intervening provide measurements of progress, evaluation and a continuum of the cycle until the termination of nursing is implicit in the practice of community health nursing.

Principles 1. CHN is based on recognized needs of communities, families, groups and individuals. 2. The community health nurse must understand fully the objectives and policies of the agency she represents. 3. In CHN, the family is the Unit of services. 4. CHN must be available to all regardless of race, creed and socioeconomic status 5. Health teaching is a primary responsibility of the CHN. 6. The community health nurse works as a member of the health team.

Health Treat (HT)- conditions conducive to dse, accidents or failure to realize one’s health potential ö healthy people ö ex. Family hx of illness- hereditary like DM, HPN  nutritional problems- eating salty foods  personal behavior- smoking, self-medication, sexual practices, drugs, excessive drinking  inherent personality charshort temperedness, short attn span  short cross infectx  poor home envi  lack/inadequate immunization  hazards- fire, falls, or accidents family size beyond what resources can provide

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There must be a provision for period’s evaluation of community health team. Opportunities for continuation staff education programs nurses must be provided by the CHN agency. The community health nurse also has a responsibility for his/her own professional growth. The community health nurse makes use of available community health resources. The community health nurse utilizes the already existing active organized groups in the community. There must be provision for educative supervision CHN

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Foreseeable Crisis (FC)- anticipated periods of unusual demand on indiv or fam in terms of adjustment or family resources ( nature situatxs) ö ex. Entrance in school adolescents (circumcision, menarchs, pubarche courtship (falling in love, breaking up) marriage, pregnancy, abortion, puerperium death unemployment, transfer or relocation graduation, board exam Identify the ff: Ex: Active TB- HD 45 yr, old male smoke- HT Sedimentary health style- Ht Early pregnancy- FC Father of family losses his job FC

ö

Death in the family- FC Patient is sick due to pneumonia- HD Children who are not immunized- HT Lack of prenatal check – up- HT Eclampsia- HD Working hazard- HT Hypertensive- HD With measles “child”- HD Family members has liprosy (microbactria liporea)HD Marriage- FC Community diagnosis A. B. C. D. E. Physical Characteristics Population Characteristics Environmental factors Knowledge, attitude, practices of the people Community resources and facilities

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Performance of nursing care should recognized dangers in the patients’ over- prolonged acceptance of support and comfort. Nursing care is an opportunity for detecting abnormal signs and symptoms.

Isolation Techniques  All Articles used by the patient should not be mixed with the articles used by the rest of the members of the household. Frequent washing and airing of beddings and other articles and disinfectants of room are imperative The one caring for the sick member should be provided with a protective gown that should be use with in the room of the sick. All discharges, especially from the nose and throat of a communicable disease patient should be carefully discharged. Articles with discharges should be first boiled for 30 minutes before laundering. Thos could be burned, should be burned.

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Planning: Based on the actual and potential problems that were identified and prioritized Goal: Declaration of purpose or intent, gives essential direction to action Specific objectives: Made in terms of activities of daily living Implementation:  Carries out nursing procedures which are consistent with nursing with nursing care plans.  Involve the patient with his/her family  Utilized support system Evaluation Frame works a. b. c. Structural elements Process elements Outcome elements

DOH Vision: HEALTH FOR ALL BY 2000 & HEALTH IN THE HANDS OF THE PEOPLE BY 2020 Mission: Ensure accessibility and quality of health care to improve the quality of life of all Filipinos, especially the Poor. National Objectives 1. 2. 3. 4. 5. 6. 7. Improve general health status Reduce morbidity, mortality and disability rates Eliminate public health problems Eradicate poliomyelitis Promote healthy lifestyle Promote health and nutrition Promote environmental health

Nursing Procedures Clinic Visit 1. 2. 3. 4. Pre-consultation conference Medical examination Nursing intervention Post consultation conference

Basic Principles 1. 2. 3. 4. Universal access to basic health services Health and nutrition of vulnerable groups Epidemiological shift from infectious to degenerative Performance of the health sector must be enhanced

Home Visit- face to face contact with the client Principles 1. A home visit should have a purpose or objective 2. Planning for a home visit should use every available information about the family, and individual 3. Planning should revolve around the essential needs of the individual 4. Planning of a continuing care involve the individual or family 5. Planning should be flexible and practical Bag technique- Tool Public health bag- is an indispensable equipment of the public health nurse Principles 1. 2. 3. 4. • Prevent the spread of infection Save time and effort should not shadow the concern for the patient Can be performer in a variety of ways Zippiram solution- disinfectant

Primary strategies to achieve health goals a. Increase investment for primary health care b. Development of national standards and objectives for health Herbal Medicine 1. aromatic- has volatile oil for tx of fever, cough, colds, itchiness and gas pain. Luya, bawang, sibuyas, yerba Buena, oregano, manzanilla, tanglad, sambong, lagundi, ___ or petals of sampaguita, jasmine & rosal Luya- shd not be taken on an empty stomach Elixir- ______ Shake week after week—tx for TB Bawang crush 1 ear & drink it Tincture of bawang 1:5 Add 5 tbsp. of gin; 1 tbsp chopped bawang Shake 10 mins for 1 week – good for superficial wounds Tanglad- lemon grass—for fever Sambong—stomachache Suha/kalamansi- for fever, TSB 2. astringent-tasting- bitter- has tannin & pectin for diarrhea & wound A vocado leaves B ayabas leaves K amilo leaves D uhat leaves S aging leaves (saba cut into chips, let dry, pulverize then add to _____) 3. bitter-tasting a. skin problems--Acapulco, kalachuchi, malunggay, kakawati, inakabuhay

Nursing Care in the House Principles 1. Nursing care utilizes a medical plan of care and treatment. 2. Performance of nursing care utilities skills that would give maximum comfort and security. 3. Nursing care at home should be used as a teaching opportunity.

b. depressants- to put hyper people to sleep-dapdap, dita, makabuhay, makahiya c. anti-cancer drug-- tsitsirika d. aches & pains-- sambong, damong arya e. asthma- talampugay- can cause psychosis 4. seeds- fixed oils, anti-helmentics- niyug-niyogan (urine), patola, ipil-ipil, betel nut or bunga, balanyog, squash seeds, lanzones- do not throw peelings instead, burn it—good insect repellant 5. grass family- diuretics—kogon, tubo, tanglad, pandan, pugopugo, buto-butones, gatas-gatas, atajuo kahol, pansit-pansitan or ulasimang bato, stones- meis hairm, HPN- palay 10 Medicinal Plants: L agundi- asthma, cough, colds U lasimang bato- uric acid, HPN B awang- HPN B ayabas- Diarrhea Y erba Buena- arthritis, toothache, swollen gums, cough & colds S ambong- cough and colds, renal stones A mpalaya- DM N iyug-nyogan- ascariasis T saang gubat- diarrhea A capulco- fungal infection, scabies RA 8423- utilization of medicinal plants as alternative for high cost medications. Epidemiology- study of distribution and dynamic of disease occurrence in human population Endemic- constant presence of disease or infection agent with in a given geographic area Epidemic- occurrence in a community or region of cases of an illness clearly in excess of expectancy Pandemic- epidemic so widely spread that vast numbers of people in different countries are affected Sporadic- disease that occurs only occasionally or in a few isolated places Surveillance- a continuing scrutiny of all aspects of occurrence and spread of a disease that is pertinent to effective control ( promotion, preventive patient & rehabilitative) Sentinel sites- are health facilities which are selective as representatives of what is happening in areas whose reports are accurate, complete and prompt (health center) Statistics- that science involved in the collection, organization, analysis and interpretation of numerical data Biostatistics- the scientific discipline concerned with the application of statistical methods to problems in biological and medicine. Fertility Rate 1. CBR (Crude birth rate)- relative pop due to births Total number of births in a calendar year CBR= Birth x 1000 Pop ex. 25.8= CBR There are 26 births in every 1000 pop 2. General Fertility Rate (GFR) - true fertility rate – specific segments of pop that is fertile GFR= ________Birth___________ x 1000 Pop of women (15 to 44 yo) Ex. GRF=32 There are 32 births in every woman in 15-44 Mortality Rates 1.Crude Death Rate ____ x 1000 Decrease in pop due to death CDR= death x 1000

Pop Ex. CDR= 6 there are 6 in every 1000 pop 2. Specific Mortality Rate- can apply to any pop grp SMR = death from or particulare grp x 1000 Pop of that grp a. SMR (males) = death (males) x 1000 pop of males b. SMR (females) = death of females 15-44 pop of females 15-44

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Infant Mortality Rate: IMR= Death 0 -1 year x 1000 Births Neonatal Mortality Rate: days x 1000 NMR= deaths 0-28 Births Post Neonatal Mortality Rate: days to 1 year x 1000 PNMR = deaths 28

Births NMR + PNMR = IMR Neonatal deaths + Post neonatal deaths= Infant deaths Ex. Birth 200 NMR= 20 Death – 28 to 1 NMR + PNMR = IMR 20 + 10 = 30 (ANS) 2_ x 1000 = 1000 = 10 200 100  Maternal Mortality Rate (MMR) MMR= death of women r/t pregnancy, delivery, & puerperium x 1000 Births Ex. IMR = 30 There are 30 infant deaths in every 1000 births NMR = 20 There are 20 neonatal deaths in every 1000 births PNMR = 10 MMR = .92  Proportionate Mortality Rate = PMR ( for any grp) PMR= death from a particular grp x 100 total death Ex. 52% PMR of males = deaths of males x 100 total In every 100 death, 52 are males PMR = deaths 0-1 x 100 0.1 total deaths PROPORTIONATE MORTALITY INDICATOR A. Swaroop’s Index = SI SI = death of 50 yrs & up x 100 total deaths The SI, the better the situation is! B. Relative importance of a killer ( TB, heart dse, diarrhea) Death due to TB x 100 total deaths

deaths

PMR = 30% TB --In every 100 deaths, 30 are due to TB  Case Fatality Rate (CFR) ö How is survival rate, how strong is killing power, prognosis CFR= death due to part cause x 100 total cases Ex. CFR = 98 HIV ___death HIV___ x 100 Total cases of TB In every 100 cases of HIV, there are 98 deaths  Cause-of-death Rate (mortality rate) ö Rank as a killer C of DR= death due to particular cause x 100,000

total pop Ex. C of DR =320 TB In every 100,000 pop there are 320 deaths due to TB  Prevalence Rate = (Morbidity rate)

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protection from harmful reproductive practice and violence assures access to information on sexuality to achieve sexual environment

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PR = TB

Rank as a common disease old and new case of TB x 100,000 total pop

Determinants of RH: 1. socio- economic 2. status of women 3. social and gender issues 4. biological, cultural and psycho-social factors GOALS: MCH AND NUTRITION > every pregnancy should be intended > every birth should be healthy > every sex act should be free of co erection and infection > achieve desired family size Ten Elements of RH 1. 2. 3. 4. Maternal and child health nutrition Family planning Prevention and management of abortion complication Prevention and treatment of reproductive tract infection, respiratory infection and STD, HIV/ AIDS Education and counseling on sexuality and sex health Breast and reproductive tract cancer Other gynecological condition Men’s RH Adolescent RH Prevention and treatment of infertility

Ex. PR = old & new case of TB x 100,000 TB Ex. PR = 326 TB There are 326 cases of TB out of 100,000 population.  Incidence Rate IR= ___new cases___ x 100,000 pop at risk

Swaroff’s Index Total death of a person aging above 50 Total number of deaths of all ages X 100

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Situation: Barangay X has a total population of 1362 for the year 1999-2000 bases on the following date, solve for the swaroff’s index, infant mortality rate, crude death rate and the maternal mortality rate Swarrof’s index= 7/57 x 100= 12.8 IMR= 17/1294 x 1,000 = 13 6/1362 x 1,000= 4090 CBR= 1294/1362 x 1,000 = 950 CDR= 57/1362 x 1,000= 42 MMR= 3/1294 x 1,000 = 2.33 Essential Health Services (ELEMENTS) of PHC E- Education on methods of preventing and controlling health problems L- Local endemic disease prevention and control M- Maternal and child care including family planning E- Essential drugs N- Nutrition T. Treatment S- Sanitation and H2O supply Four Corner stone/ Pillar in PHC 1. Active community participation 2. Intra and inter sectoral linkages 3. Use of appropriate technology 4. Support mechanism made available Levels Health Care Primary- Brangay “ district midwife/ trained health workers” Secondary- Regional/District “NURSE” Tertiary- Hearth Center, Lung Center etc. - doctor Reproductive Health (RH) Vision: reproductive health practices as a way of life for ever man and woman throughout life Concept: a. married couples has the capability to reproduce Measles Vaccine BCG half life 4hours IR=

Route R dorsal Deltoid L Deltoid IM Right/ Left/ Right

Dosage 0.05/ml 0.1/ml 0.5/ml

Frequency At birth School entrance DPT 1- 6th weeks DPT 2- 10 weeks DPT 3- 3 ½ months

Live attenuated bacteria “stored @ 2-8degree Celsius DPT half life 8 hours Weakened toxin killed bacteria stored @2 Weakened toxin to 8 degree Cel sius OPV Hepa B

Oral IM anterior thigh left/right/ left

2-3 gtts .05/ml

6 weeks@ 3 doses 6 weeks2 3 doses

4th weeks i n t e r v a l

SQ outer part of the arm

0.5ml

9 months

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reproductive health is exercise of reproductive right purpose of enhancement of life and personal relation safe pregnancy, safe delivery protection from unwanted pregnancy

Tetanus Toxiod T1- anytime during pregnancy T2- 4 weeks of pregnancy T3- 6months/ 244 weeks of pregnancy T4- 1 year old T5- above 1 year *PPD 996 immunization program

standard antibiotics and good supportive care quick identification if severe cases and quick referral to the hospitals- prevent death

Treatent may include • antibiotics • advising mothers to give home care • treating fever and wheezing Home Care: (child with cough and colds) • • • • • no antibiotics needed feed the child increase fluid intake clear nose keep child warm and comfortable

Side effects 1. Koch’s phenomenon- 2-4 days after vaccines - acute inflammation • 2. deep abscess- deeper injection tx: incision / drainage/ INH powder Fever- after and last for 1 day Tx: antipyretics more that 24 hours after dose “ local soreness at the site” *Abscess- wrong injection technique Tx: incision and drainage *Convulsion- rare and occurs 3 months due to pirtosis of vaccine(don’t continue) 3. Salk – IM NO SIDE EFFECTS Sabin – Oral FEVER and Rash – 5 – 7 days “vaccination” - last 1-3 days - Management: antipyretic Leprosy Control Program Multi Drug therapy 1988 RA 4073 Chronic disease of the skin and peripheral nerves caused by Mycobacterium Leprea or Han’s Bacillus Early s/s: Change in skin color- reddish or white Loss of sensation Decrease hair growth- dermis Loss of sweating- exocrine Muscle weakness- nerves Thickened/ painful nerves Ulcer that do not heal Late s/s Madarosis Lagophthalmos- inability to close the eye lids Clawing of fingers and toes Contractures Sinking of nose bridge Gynecomastia Chronic ulcers Pneumonia Signs Fast breathing Chest in drawing Convulsion Abnormally sleepy Severe under nutrition Not able to drink Stridor upon inhalation- auscultation Wheezing- upon exhalation Fever or low body temp. Management of pneumonia: most pneumonia deaths are preventable if treated early Tx is based :  early recognition of pneumonia  prompt treatment of non severe cases at home with 4.

S/S that the child must be brought to health care facility: • • • • fast breathing difficulty breathing unable to drink feeding problem Role of Drugs in control of infection  children with cough and colds with no pneumonia must not be given antibiotics  antibiotics should only be given to cases pneumonia, severe pneumonia and very severe disease  COTRIMOXAZOLE Availabity of Drugs 1. 2. 3. Cotrimox azole injectable penicillin others: O2 may be delivered as a life saving measure

cough suppressant- antitussive antihistamine- bronchodilator Prevention of Pneumonia 1. Timely immunization against measles and pertussis

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Exclusive BF for the 1st 4-6 months of life Good nutrition Vit. A supplementation Reduce exposure to house smoke from cooking/tobacco Keeping young infants warm- prevent O2 loss Practicing good hygiene

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Control of Diarrhea Disease Management of patient with diarrhea: use this chart for patients with a. loose watery stools b. loose stools with blood Step 1- Asses your patient for dehydration Step 2- Asses for other problems 1. Look at condition: well alert Eye: normal Tears: present Mouth and tongue: moist Thirst: drinks normally, not thirsty 2. 3. 4. Feel- Skin Pinch: goes back quickly Decide: No dehydration Treatment: treatment A

Treatment Plan A > to treat diarrhea at home > use this plan to teach the mother to 1. Continue to treat at home her child’s current episode of diarrhea

2. give early treatment for future episode of diarrhea Treatment Plan C (Sever dehydration) Can you give IVF ------------Yes-------Start IVF immediately “PNSS and 0.9 % NaCl NO Is IV next available-----------Yes-------Send patient within 30 minutes NO Are you trained To------------Yes------Start with ORS Use NGT for Rehydration NO Can the patient-----------------Yes------Start with ORS per orem Drink Rehydration URGENT! Send the patient for IV or NGT Water Decontamination  Boiling 2-3 minutes  Chlorine 1 drop of 5% Na Hypo chloride in 10 L H2O Stat for 20-30 minutes Aerate

b. Extra pulmonary TB 2 months R ifampicin I soniazid P yrazinamide E thambutol “should not used 6 years old below because of visual disturbance 4 months R ifampicin I soniazid

R R I I P P E E S- streptomycin “IM” 5 months R I E

serious) 2months 2 months R R I I P

 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 dse transmission through the provision of basic services and facilities to all households. 1. Water Supply Sanitation Program

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MDT PB non infectious infectious Tuberculoid LEpramatous/ Borderline Indetermidiate 6-9 months 24-30 months Day 1/ 2-8 28 Rifampicin/Dapsone Rifampicin Clofazimine Dapsone ROM- Rifampicin. Ofloxacin, Minocyclinc Prevention- BCG Pneumonia Very Severe Unable to drink Convulsion Difficult to wake stridor

MB-

Day 1/ 2-

1 types of Approved Water Supply Facilities Level 1 Level II Level III Point Source Communal Faucet Waterworks system or stand system or posts individual house connections A protected well A system A system with a of a developed composed of a source, a sprung with an source, a reservoir, reservoir, a piped outlet but a piped distribution distributor without a network and network and distribution communal faucets, household taps system for rural located at not more that is suited for areas where than 25 meters from densely houses are the farthest house populated urban thinly scattered. in rural areas where areas. houses are clustered densely. Water must pass the National Standards for Drinking Water set by the DOH. 2. Proper Excreta and Sewage Disposal System

Severe Fast breath Chest indrawing

Pneumonia Fast breathing No chest indrawing

No Pneumonia No fast breathing No chest indrawing

Tb Network: Nurse Physician Midwives Early case Med Tech Findings Category 1 New (+) cases PTB Seriously ILL a. Intensive Phase Advance pulmonary TB Category 2 2-8 months maintenance Treatment replaces Failure 2 months 3 months Category 3 PTB minimal(-) 3x sputum smear x-ray PTB minimal Extra TPB (not

3 types of Approved Toilet Facilities Level 1 Level 2 Level 3 Non- water carriage toilet facility: On site Water Pit Latrines toilet carriage facilities types of Reed Odorless of the toilet Earth Closet water facilities Bored-Hole carriage connected Compost type with to septic Ventilated water tanks improved pit sealed and/or to Toilets requiring small amount of and sewerage water to wash waste into receiving flushed system to space type with treatment -pour flush septic plant. -aqua privies vault/tan k disposal facilities. 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. Refuse Garbage Rubbish 2 ways to Refuse Disposal Household Community

-Burial > deposited in 1m x 1m deep pits covered with soil, located 25m away from water supply - open burning - animal feeding - composting - grinding and disposal sewer

-Sanitary landfill or controlled tipping > excavation of soil deposition of refuse and compacting with a solid cover of 2 feet - Incineration

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 cert to det presence 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 6. Programs related to health-risk minimization secondary to environmental pollution These include the following:  Anti-smoke Belching 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 activitiy at all levels of public health used as a means of improving the health of the people through techniques which may influence people’s thought motivation, judgement and action.

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 he/she lives Involves the promotion of a healthy state of mind amont the whole pop through ♥ Developing positive outlook in life ♥ Strengthening coping mechanisms Vulnerable group to the dev of Mental Illness: ♥ Women ♥ Street children ♥ Victims of torture or violence ♥ Internal refugees ♥ Victims of armed conflicts ♥ Victims of natural and man-made disasters Components of Mental Health Program A. Stress B. Drugs and Alcohol Abuse Rehabilitation C. Treatment and Rehabilitation of Mentally-ill Patients D. Special Project for Vulnerable Groups Stresses in the environment of children such as times of disasters and natural 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. GOOD LUCK!

Prnster

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 Operational Strategies:  Promotion of health/ health education  Disease detection  Treatment program  Contact tracing  Clinical services Program components:  Case-finding  Case management  Training  Monitoring  Reporting system  Operations research

MENTAL HEALTH A state of well-being where a person can realize his or her own abilities, to cope with

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