NCM 104 PATRICIA XYRILLE C.

DORADO, RN

LECTURE

HEALTH PROGRAMS
 Maternal,
Newborn and
Child Health and
Nutrition
 POLICIES RELATED TO THE
IMPLEMENTATION OF THE MNCHN
STRATEGY
 The Department of Health has issued other policies to support
the implementation of the MNCHN Strategy.
1. Administrative Order 2009-0025 known as Adopting New
Policies and Protocol on Essential Newborn Care, issued on
01 December 2009.
2. Administrative Order 2010-0001 known as Policies and
Guidelines for the Philippine National Blood Services (PNBS)
and the Philippine Blood Services Network (PBSN), issued on
06 January 2010.
 POLICIES RELATED TO THE
IMPLEMENTATION OF THE MNCHN
STRATEGY

3. Administrative Order 2010-0010 known as Revised Policy on

Micronutrient Supplementation to Support the Achievement of
2015 MDG Targets to Reduce Under-Five and Maternal Deaths
and Address Micronutrient Needs of Other Population Groups,
issued on 19 April 2010.
 POLICIES RELATED TO THE
IMPLEMENTATION OF THE MNCHN
STRATEGY
4. Administrative Order 2010-0014 known as Administration of
Life Saving Drugs and Medicines by Midwives to Rapidly Reduce
Maternal and Neonatal Morbidity and Mortality, issued on 14
May 2010. These lifesaving interventions (i.e. administration of
Magnesium Sulfate, oxytocin, steroids and antibiotics) may be
carried out by midwives who have undergone training and
certification and while under the supervision of a physician
trained on the emergency management of maternal and
newborn complications.
 NATIONAL FAMILY
PLANNING PROGRAM
 VISION
• In line with the Department of Health
• For Filipino women and men achieve
their desired family size and fulfill the
reproductive health and rights for all
through universal access to quality
family planning information and
services.
MISSION
FOURmula One Plus strategy and Universal
Health Care framework, the National Family
Planning Program is committed to provide
responsive policy direction and ensure access
of Filipinos to medically safe, legal, non-
abortifacient, effective, and culturally
acceptable modern family planning (FP)
methods.
 OBJECTIVES

• 1. To increase modern Contraceptive Prevalence Rate (mCPR) among all women from 24.9% in 2017
to 30% by 2022
• 2. To reduce the unmet need for modern family planning from 10.8% in 2017 to 8% by 2022
 PROGRAM
COMPONENTS
• Component A: Provision of free FP Commodities that are medically safe, legal, non-abortifacient,
effective and culturally acceptable to all in need of the FP service:
• Component B: Demand Generation through Community-based Management Information System:
• Component C: Family Planning in Hospitals and other Health Facilities
• Component D: Financial Security in FP
 COMPONENT A: PROVISION OF FREE FP COMMODITIES THAT ARE
MEDICALLY SAFE, LEGAL, NON-ABORTIFACIENT, EFFECTIVE AND
CULTURALLY ACCEPTABLE TO ALL IN NEED OF THE FP SERVICE:

 Forecasting of FP commodity requirements for the country

 Procurement of FP commodities and its ancillary supplies
 Strengthening of the supply chain management in FP and ensuring of adequate FP supply at the
service delivery points
 COMPONENT B: DEMAND GENERATION THROUGH COMMUNITY-BASED
MANAGEMENT INFORMATION SYSTEM:

 Identification and profiling of current FP users and identification of potential FP clients and those
with unmet need for FP (permanent or temporary methods)
 Mainstreaming FP in the regions with high unmet need for FP
 Development and dissemination of Information, Education Communication materials
 Advocacy and social mobilization for FP
 COMPONENT C: FAMILY PLANNING IN HOSPITALS AND OTHER HEALTH
FACILITIES

 Establishment of FP service package in hospitals

 Organization of FP Itinerant team for outreach missions
 Delivery of FP services by hospitals to the poor communities especially Geographically Isolated and Disadvantaged
Areas (GIDAs):
 Provision of budget support to operations by the itinerant teams including logistics and medical supplies needed for
voluntary surgical sterilization services
 FP services as part of medical and surgical missions of the hospital
 Partnership with LGU hospitals for the FP outreach missions
 COMPONENT D: FINANCIAL SECURITY IN FP

 Strengthening PhilHealth benefit packages for FP

 Expansion of PhilHealth coverage to include health centers providing No Scalpel Vasectomy and FP
Itinerant Teams
 Expansion of Philhealth benefit package to include pills, injectables and IUD
 Social Marketing of contraceptives and FP services by the partner NGOs
 National Funding/Subsidy
PARTNER INSTITUTIONS
 Local Government Units
 Civil Society Organizations
 Non-Government Organizations
 Private Sector
 Faith-based Organizations
 Development Partners
 POLICIES AND LAWS
 Republic Act No. 10354: Responsible Parenthood and Reproductive Health Act of 2012 (RPRH Law)
 Executive Order No. 12, s. 2017: Attaining and Sustaining “Zero Unmet Need for Modern Family Planning”
Through the Strict Implementation of the Responsible Parenthood and Reproductive Health Act, Providing
Funds Therefor, and for other Purposes
 Administrative Order 2017-0005: Guidelines in Achieving Desired Family Size through Accelerated and
Sustained Reduction in Unmet Need for Modern Family Planning Methods
 Administrative Order 2016-0005: National Policy on the Minimum Initial Service Package (MISP) for Sexual
and Reproductive Health (SRH) in Emergencies and Disasters
 POLICIES AND LAWS
 Administrative Order 2017-0002: Guidelines on the Certification of Free Standing Family Planning Clinics
 Department Order 2017-0345: Guidelines on the Forecasting, Procurement, Allocation and Distribution of Modern
Family Planning Commodities
 Administrative Order 2015-0006: Inclusion of Progestin Subdermal Implant as One of the Modern Methods
Recognized by the National Family Planning Program.
 Administrative Order 2014-0042: Guidelines on the Implementation of Mobile Outreach Services for Family
Planning
 Department Memorandum 2015-0384: Establishment of the Family Planning Logistics Hotline
 STRATEGIES, ACTION POINTS AND
TIMELINE
 Apart from the routine means of FP service delivery, the National Family Planning Program also employs the
following main strategies to ensure universal access to FP:
 FP Outreach Mission – this maximizes opportunities where clients are and FP services are delivered down to the
community level.
 FP in hospitals – this address missed opportunities where women especially those who recently gave birth are
offered with appropriate FP services.
 Intensive Demand generation through house-to-house visits by the community health volunteers, Family
Development Sessions, Usapan sessions, among others
 PROGRAM ACCOMPLISHMENTS/STATUS

• The passage of the RPRH Law in 2012 is considered as a landmark legislation in the country’s law-
making history, and has laid down the legislative foundation in achieving reproductive health and
rights of all Filipinos towards better health outcomes and socioeconomic growth.
The 0-10 Point Socioeconomic Agenda of the current administration, President Rodrigo Duterte,
acknowledged the full implementation of the RPRH Law as an essential policy measure in achieving
the targets set by the Philippines in the Sustainable Development Goals (SDG) 2030 and Ambisyon
Natin (Our Ambition) 2040.
 PROGRAM ACCOMPLISHMENTS/STATUS
• In the first six months of the EO No. 12 implementation, a total of 610,998 women were reached and
identified to have unmet need for mFP, of which 356,460 accepted the FP service. The succeeding
report of the EO No. 12 was incorporated in the annual Responsible Parenthood and Reproductive
Health (RPRH) Accomplishment Report that was submitted in April 2018.
• In 2017, the Philippine Development Plan (PDP) 2017-2022 was formally introduced. The PDP is the
country’s medium-term plan geared towards achieving SDG and Ambisyon Natin. The Family Planning
was identified as a pivotal intervention in realizing the country’s demographic dividend.
 PROGRAM ACCOMPLISHMENTS/STATUS
• One of the major highlights in 2017 is the lifting of the Supreme Court’s Temporary Restraining Order
(TRO) to the DOH and Food and Drug Administration (FDA), particularly the DOH from utilizing its
progestin subdermal implant supplies - Implanon and Implanon NXT, and the FDA from issuing
certificates of product registration of contraceptives. The TRO was lifted on Nov. 10, 2017 when the
DOH promulgated the revised Implementing Rules and Regulations of the RPRH Law, and the FDA
re-certified all 51 contraceptive products to be non-abortifacient, including the subdermal implants
- Implanon and Implanon NXT.
STATISTICS
Year Total Pop WRA Current Users mCPR

2017 104,921,600 12,931,587 6,836,647 52.87%

2016 103,711,044 12,782,386 6,122,042 47.89%

2015 101,771,950 12,543,393 6,014,458 47.95%

2014 99,874,261 12,309,503 5,185,974 42.13%

2013 98,011,951 12,079,973 4,774,629 39.53%

STATISTICS
Targets Accomplishments

Indicators 2013 2014 2015 2016 2017 2013 2014 2015 2016 2017

mCPR 65% 65% 65% 65% 52% 39.5% 42.1% 47.9% 47.8% 52.9%

Please Note: Accomplishments from 2013-2017 are based on FHSIS Report.

 NEWBORN
SCREENING
PROGRAM
NEWBORN SCREENING PROGRAM

• Newborn screening (NBS) is an essential public

health strategy that enables the early detection and
management of several congenital disorders, which
if left untreated, may lead to mental retardation
and/or death. Early diagnosis and initiation of
treatment, along with appropriate long-term care
help ensure normal growth and development of the
affected individual. It has been an integral part of
routine newborn care in most developed countries
for five decades, either as a health directive or
mandated by law. In the Philippines, it is a service
available since 1996.
NEWBORN SCREENING PROGRAM
 PROGRAM
OBJECTIVES
• By 2030, all Filipino newborns are screened;
Strengthen quality of service and intensify
monitoring and evaluation of NBS implementation;
Sustainable financial scheme; Strengthen patient
management
STRATEGIES, ACTION POINTS AND
HIGHLIGHTS
1. Ensuring Efficient Operations,
Systems and Networks
Management
• This shall be upgraded to reach areas that need
access to newborn care. This includes construction
and/or renovation of well-planned and equipped
infrastructures to ensure quality service among
patients and to engage more health facilities to offer
NBS services (human resource for health-trained
and capacitated)
STRATEGIES, ACTION POINTS AND
HIGHLIGHTS
2. Expanding Package of Services and
Delivery Network
• In the next ten years, the program aims to shift
fully into expanded newborn screening.
Enrollment of new facilities and sustaining the
operations of existing facilities is critical in
increasing the coverage of service delivery.
Strategic actions to increase the uptake of ENBS
are critical to ensure nationwide implementation,
which involves strong promotion, advocacy and
cooperation of the newborn screening facilities.
STRATEGIES, ACTION POINTS AND
HIGHLIGHTS
3. Enhancing Health Promotion and
Advocacy
• This requires a developed and well-
coordinated comprehensive health
promotion and communication plan
targeting different audiences to increase
awareness and uptake on expanded newborn
screening. It shall also focus on information
campaign by strengthening communication
strategies using different media platforms.
STRATEGIES, ACTION POINTS AND
HIGHLIGHTS
4. Optimizing Health Information
Management Systems for Expanded Newborn
Screening
• This aims to optimize current investments on health
management information systems by adopting
interoperable, consensus-based, evidence—driven
and standards-based vocabularies and system that
maximize the use of electronic health record systems
that will automatically process and send information
and reports to (a) PhilHealth for verification of claims
for NBS, and (b) the NBS registry for program
planning and research purposes, among others.
STRATEGIES, ACTION POINTS AND
HIGHLIGHTS
5. Strengthen Monitoring and
Evaluation
• Program monitoring and evaluation
of procedures and systems, both for
laboratory and administrative units shall
be undertaken to ensure smooth
implementation of the program. Periodic
review of and tools should be done
including quality assurance assessment.
STRATEGIES, ACTION POINTS AND
HIGHLIGHTS
6. Establishing Sustainable Financing
Scheme
• The DOH, as the lead agency of the NBS program shall
allocate funds for the set-up of new strategically located
newborn screening centers. The National Comprehensive
Newborn Screening System (NCNBSS) also ensures
funding for researches relevant to the implementation of
newborn screening at the national level that maybe utilized
for policy recommendations The Philippine Health
Insurance Corporation (PHIC) also ensures full coverage of
expanded newborn screening, while LGUs and other
stakeholders and partners are empowered to provide ways
or means to make the NBS accessible and affordable,
particularly on the economically depressed areas.
 STATISTICS AND REPORTS
• NBS program has grew from one to seven (7) operational Newborn Screening Centers (NSCs); from 24 pilot
hospitals to more than 7000 Newborn Screening Facilities (NSFs) in 2020; from one to twenty-nine (29) G6PD
Confirmatory Centers; and now with 14 continuity clinics for the long term management of patients.
• Figure 1. National Newborn Screening Coverage per Year from 1996-2019
National Immunization Program
 National Immunization Program
 National program strategy to ensure that infants/children and mothers have access to
routinely recommended infant/childhood/ mothers vaccines (DOH Portal).
 VISION
• Enabled and strong immunization system for everyone, everywhere at every
age to attain a vaccine-preventable disease-free and a healthier Philippines.

MISSION
• Guided by the Universal Health Care Law, the program commits to ensure that every Filipino is
fully immunized from vaccine-preventable diseases by building a strong and well-supported
immunization system that is equipped for routine immunization service delivery and backed with
contingencies for and response to public health crises related to VPDs, vaccines and
immunization programs.
 SPECIFIC GOALS

1. Strengthen immunization services within the primary health care and eventually contribute to
universal health coverage and sustainable development.
2. Leave no one behind by expanding equitable protection with vaccination for all ages.
3. Reduce mortality and morbidity by proactively preventing outbreaks of VPDs and providing
timely response to outbreak and other potential health crises related to immunization.
4. Effectively communicate and address hesitancies and misinformation regarding immunization.
 BACKGROUND OF THE NATIONAL
IMMUNIZATION PROGRAM (NIP)

• The last version of the Manual of Operations (MOP) for the Expanded Program on Immunization (EPI)
was issued in 1995. As a reference, it guided health workers to deliver immunization services based on
national protocols and standards. It also helped EPI managers and supervisors coordinate different
program components at various levels of the health system. EPI eventually became the National
Immunization Program (NIP), which covered wider segments of the population.
• To date, the NIP provides immunity against 14 vaccine preventable diseases (VPDs) from only six in
1976. It expanded its population coverage beyond infants and pregnant women to include school
children, adolescents/youth, senior citizens and those in special situations.
 THE BENEFITS OF IMMUNIZATION

VACCINES SAVE LIVES. The increase in life expectancy during the 20th century was largely due
to increased child survival and reduced deaths due to infectious diseases. This was brought
about largely by immunization.
• Immunization saves lives, prevents diseases and reduces direct and indirect health costs.
• Vaccines are cost-effective and are a core component of any preventive services package.
• Vaccines protect children from VPDs that once were top killers and disablers worldwide.
These include diphtheria, whooping cough, tuberculosis, small pox, polio and measles.
• Vaccines continue to give protection against more diseases among various age groups as new
vaccines are developed and tested.
 THE BENEFITS OF IMMUNIZATION

• Vaccines also prevent the spread of these diseases among families, loved ones and
neighbours, resulting in healthier communities.
• Immunization prevents disease transmission from one generation to another, freeing the next
generation from the threat of disease.
• Vaccination not only benefits the health and welfare of the whole population but is also a
source of high investment return to the government. Health is fundamental to economic
growth for developing countries and vaccinations form the foundation of public health
programs. Good health can promote social development and economic growth. The yearly
return on investment in vaccination is estimated to be between 12 to 18%, but the economic
benefits of improved health continue to be largely underestimated (WHO Bulletin, 86(2),
February 2008).
Consequences of Non-vaccination

• Unvaccinated children can develop diseases resulting in prolonged or long-term disabilities, affecting
their full physical, emotional and social development and wellbeing.
• Sick children are unable to go to school, which can hamper their becoming fully productive
individuals.
• Prolonged treatment and out-of-pocket spending burdens families with medical expenses and lost
time at work. This can eventually lead to a lower quality of life for individuals and families. In addition,
VPDs are re-emerging and new infectious diseases are affecting the country. This makes it important for
various sectors to become involved in immunization activities and services to achieve and sustain the
desired herd immunity in the population.
 LEGAL BASIS OF THE NATIONAL
IMMUNIZATION PROGRAM
• The Philippine Immunization Program is mandated and supported by the following laws and policies.
• The fundamental law of the land – the 1987 Philippine Constitution – says that “The
State shall adopt a comprehensive approach to health development which shall endeavor to make
essential goods, health and other social services available to all people at affordable cost. There shall be
priority for the needs of the underprivileged, sick, elderly, disabled, women, and children” (Article XIII,
Section 11, 1987)
• Presidential Decree (PD) No. 996 (September 16, 1976) provides for compulsory basic
immunization for infants and children below eight years old • Presidential Proclamation No. 6,
implementing the Expanded Program on Immunization (EPI), in response to the United Nation’s goal of
universal child immunization by 1990.
• Proclamation No. 46 (September 16, 1992) reaffirmed the Philippines’ commitment
to universal goal of eradicating polio by 2000 through child and mother immunization.
 LEGAL BASIS OF THE NATIONAL
IMMUNIZATION PROGRAM
• RA No. 7846 (An Act requiring compulsory immunization against Hepatitis B for
infants and children below eight years old, amending for the purpose Presidential Decree No. 996,
December 30, 1994)) listed down basic immunization services to be provided. These include vaccination
against: (i) tuberculosis (TB), (ii) dipththeria, pertussis and tetanus (DPT), (iii) poliomyelitis (administered
orally), (iv) measles, (v) rubella, (vi) Hepatitis-B in newborns within 24 hours after birth, and (vii) provision
of other basic immunization services for infants and children below eight years of age.
• DOH AO No. 39, s. 2003 (April 21, 2003) guided the nationwide implementation of
the EPI.
• RA No. 10152 (July 2, 2011) otherwise known as the Mandatory Infants and Children
Health Immunization Act of 2011 mandated the adoption of a comprehensive, mandatory and sustainable
immunization program against VPDs among all infants and children under the age of five years. These
include vaccines against: (a) Tb; (b) DPT; (c) Poliomyelitis; (d) Measles; (e) Mumps; (f) Rubella or German
measles; (g) Hepatitis B; (h) H. Influenza Type B (HIB); and (h) other types as may be determined by the
Secretary of Health
A Brief History of the Immunization
Program in the Philippines

• The immunization program has been carried out in the Philippines over the past 40 years,
with the following milestones:
• The immunization program was officially launched in 1976. The BCG
vaccine against TB was administered to school entrants. This was followed by vaccines
against poliomyelitis, diphtheria, tetanus, pertussis (DPT) and measles.
• A comprehensive program implementation review was conducted in
1986. The review revealed that coverage was still less than optimal.
• In 1989, the country achieved for the first time the universal child
immunization goal of 90% - one year ahead of the target date.
A Brief History of the Immunization
Program in the Philippines

• The Philippines together with other nations pledged to attain three

immunization global goals by 1995: (i) eradication of poliomyelitis, (ii)
elimination of neonatal tetanus (NT) and (iii) control of measles.
• The Philippines reached polio-free status in 2000. The country also
completed the second validation for the declaration of NT elimination in 2014.
• Supplementary immunization campaigns (SIA) against measles were
conducted beginning 1998, followed by nationwide campaigns in 2004, 2007,
2011 and 2014.
• In the past three years, the country increased the scope and coverage of the
NIP by adding new vaccines for children and women and including other age
groups like school children, adolescents / youth and the elderly.
 INTEGRATED
MANAGEMENT OF
CHILDHOOD ILLNESSES
DEFINITION
• IMCI is an integrated approach to child health that focuses on
the well-being of the whole child. IMCI aims to reduce death,
illness and disability and to promote improved growth and
development among children under five years of age. IMCI
include curative and preventive elements that are implemented
by families and communities and by health facilities.
• The strategy was developed by World Health Organization and
UNICEF and is used by most countries in the world.
• The IMCI can be use by doctors, nurses, and other health care
professionals who see sick infants and children age 1 week up
to 5 years. It is a case management process for first-level
facility such as clinics, health center, rural health units, or an
out-patient department of the hospital.
BACKGROUND
• One million children under five years old die each year in
less developed countries. Just five diseases (pneumonia,
diarrhea, malaria, measles and dengue hemorrhagic fever)
account for nearly half of these deaths and malnutrition is
often the underlying condition. Effective and affordable
interventions to address these common conditions exist but
they do not yet reach the populations most in need, the
young and impoverish.
BACKGROUND
• The Integrated Management of Childhood Illness strategy has been
introduced in an increasing number of countries in the region since 1995.
IMCI is a major strategy for child survival, healthy growth and
development and is based on the combined delivery of essential
interventions at community, health facility and health systems levels.
IMCI includes elements of prevention as well as curative and addresses
the most common conditions that affect young children. The strategy was
developed by the World Health Organization (WHO) and United Nations
Children’s Fund (UNICEF).
• In the Philippines, IMCI was started on a pilot basis in 1996, thereafter
more health workers and hospital staff were capacitated to implement the
strategy at the frontline level.
OBJECTIVES OF IMCI

• Reduce death and frequency and severity of

illness and disability, and
• Contribute to improved growth and
development
RATIONALE FOR AN INTEGRATED APPROACH
IN THE MANAGEMENT OF SICK CHILDREN
• Majority of these deaths are caused by
5 preventable and treatable conditions
namely: pneumonia, diarrhea, malaria,
measles and malnutrition. Three (3) out of four
(4) episodes of childhood illness are caused by
these five conditions
• Most children have more than one illness at one
time. This overlap means that a single diagnosis
may not be possible or appropriate.
STRATEGIES AND PRINCIPLES OF IMCI
 All sick children aged 2 months up to 5 years are examined
for GENERAL DANGER signs and all Sick Young Infants
Birth up to 2 months are examined for VERY SEVERE
DISEASE AND LOCAL BACTERIAL INFECTION. These
signs indicate immediate referral or admission to hospital
 The children and infants are then assessed for main symptoms.
For sick children, the main symptoms include: cough or
difficulty breathing, diarrhea, fever and ear infection. For sick
young infants, local bacterial infection, diarrhea and
jaundice. All sick children are routinely assessed for
nutritional, immunization and deworming status and for
other problems
 Only a limited number of clinical signs are used
BENEFITS OF IMCI STRATEGY
1. Addresses major child health problems because it systematically
address the most important causes of children illness and death.
2. Responds to demands.
3. Promotes prevention as well as cure because IMCI emphasizes
important preventive interventions such as immunization and
breastfeeding.
4. Is cost-effective- most cost-effective interventions in low and middle
income countries (World Bank).
5. Promotes cost-saving.
6. Improves equity – IMCI improves inequity in global health care
MHGAP
 MHGAP
 According to WHO Mental Health Atlas 2014, more than
45% of the world population lives in a country where
there is less than 1 psychiatrist for every 100,000 people
and there are even fewer neurologists.
 The mhGAP approach consists of interventions for
prevention and management of priority MNS conditions,
identified on the basis of evidence about the
effectiveness and feasibility of scaling up these
interventions in low- and middle-income countries.
 These priority conditions include depression, psychoses,
self-harm/suicide, epilepsy, dementia, disorders due to
substance use and mental and behavioural disorders in
children and adolescents.
 The mhGAP-Intervention Guide (mhGAP-IG) is a resource
to facilitate delivery of the mhGAP evidence-based
guidelines in non-specialized health care settings.
General Principles
 Use Effective Communication Skills
Using effective communication skills allows healthcare providers to deliver good quality care
to adults, adolescents, and children with mental, neurological and substance use (MNS)
conditions. Consider the following core communication skills and tips:
 Create an environment that facilitates open communication
 Involve the person
 Start by listening
 Be friendly, respectful and nonjudgemental at all times
 Use good verbal communication skills
 Respond with sensitivity when people disclose difficult experiences (e.g. sexual
assault, violence or self-harm)
 General Principles
 Promote Respect and
Dignity
Persons with MNS conditions should be
treated with respect and dignity in a
culturally appropriate manner. As a
health care provider, make every effort
to respect and promote the will and
preference of people with MNS
conditions and support and engage
them and their carers in the most
inclusive way. Persons with MNS
conditions are often more vulnerable to
human rights violations:
 Essentials Of Mental Health
Clinical Practice
 Assess Physical Health
Persons with MNS disorders are at
higher risk of premature mortality from
preventable disease and therefore must
always receive a physical health
assessment as part of a comprehensive
evaluation
Assessment of Physical Health
 Take a detailed history and ask about risk factors. Physical
inactivity, inappropriate diet, tobacco, harmful alcohol and/or
substance use, risky behaviour and chronic disease.
 Perform a physical examination.
 Consider a differential diagnosis. Rule out physical conditions
and underlying causes of MNS presentations by history,
physical examination and basic laboratory tests as needed
and available.
 Identify comorbidities. Often, a person may have more than
one MNS condition at the same time. It is important to assess
and manage this when it occurs.
 Essentials Of Mental Health
Clinical Practice
Management of Physical Health
 Treat existing comorbidities concurrently with the MNS disorder. Refer to/consult with
specialists, if needed.
 Provide education on modifiable risk factors to prevent disease and encourage a healthy
lifestyle.
 To support physical health of persons with MNS conditions, health care providers should:
– Provide advice about the importance of physical activity and a healthy diet.
– Educate people about harmful alcohol use.
– Encourage cessation of tobacco and substance use.
– Provide education about other risky behaviour (e.g. unprotected sex). – Conduct regular
physical health checks and vaccinations.
– Prepare people for developmental life changes, such as puberty and menopause, and provide
the necessary support.
– Discuss plans for pregnancy and contraception methods with women of childbearing age.
Conduct a MNS Assessment
Conduct a MNS Assessment
Manage MNS
Conditions

Treatment Planning
 Discuss and determine
treatment goals that respect
the willingness and
preferences for care.
 Involve the carer after
obtaining the person’s
agreement.
 Encourage self-monitoring of
symptoms and explain when to
seek care urgently
Manage MNS
Conditions
Psychosocial Interventions
A. Psychoeducation Provide information about the MNS condition to the
person, including:
 What the condition is and its expected course and outcome.
 Available treatments for the condition and their expected benefits.
 Duration of treatment.
 Importance of adhering to treatment, including what the person can do (e.g.
taking medication or practising relevant psychological interventions such as
relaxation exercises) and what carers can do to help the person adhere to
treatment.
 Potential side-effects (short and long term) of any prescribed medication that
the person (and their carers) need to monitor.
 Potential involvement of social workers, case managers, community health
workers or other trusted members in the community.
 Refer to management section of relevant module(s) for specific information
on the MNS disorder
 Manage MNS
Conditions
Psychosocial Interventions
B. Reduce stress and strengthen social supports Address current psychosocial stressors:
 Identify and discuss relevant psychosocial issues that place stress on the person and/or impact their life including, but
not limited to, family and relationship problems, employment/occupation/livelihood issues, housing, finances, access to
basic security and services, stigma, discrimination, etc.
 Assist the person to manage stress by discussing methods such as problem solving techniques.
 Assess and manage any situation of maltreatment, abuse (e.g. domestic violence) and neglect (e.g. of children or the
elderly). Discuss with the person possible referrals to a trusted protection agency or informal protection network.
Contact legal and community resources, as appropriate.
 Identify supportive family members and involve them as much as possible and appropriate.
 Strengthen social supports and try to reactivate the person’s social networks.
 Identify prior social activities that, if reinitiated, would have the potential for providing direct or indirect psychosocial
support (e.g. family gatherings, visiting neighbours, community activities, religious activities, etc.).
 Teach stress management such as relaxation techniques
 Manage MNS
Conditions
C. Promote functioning in
daily activities
 Provide the person
support to continue
regular social, educational
and occupational activities
as much as possible.
 Facilitate inclusion in
economic activities.
 Offer life skills training,
and/or social skills training
if needed.
D. Psychological Treatment
 Psychological treatments are interventions that
typically require substantial dedicated time and
tend to be provided by specialists trained in
providing them.
 Nonetheless, they can be effectively delivered by
trained and supervised non-specialized workers
and through guided self-help (e.g. with use of e-
mental health programmes or self-help books).
 Manage MNS
Conditions
Pharmacological Interventions
 Follow the guidelines on psychopharmacology in each module.
 Use pharmacological interventions when available and when indicated in the management
algorithm and table provided.
 In selecting the appropriate essential medication, consider the side effect profile of the
medication (short and long term), efficacy of past treatment, drug-drug interactions or drug-
disease interactions.
 Consult the National Formulary or the WHO Formulary as needed.
 Educate the person about risks and benefits of treatment, potential side effects, duration of
treatment, and importance of adherence.
 Exercise caution when providing medication to special groups such as older people, those
with chronic disease, women who are pregnant or breastfeeding, and children/ adolescents.
Consult a specialist as needed.
 Manage MNS
Conditions
Referral to
specialist/hospital if needed
 Stay alert for situations that
may require referral to a
specialist/hospital, for
example, non-response to
treatment, serious side effects
with pharmacological
interventions, comorbid
physical and/or MNS
conditions, risk of self-harm/
suicide.
Follow-up
 Arrange a follow-up visit after the initial
assessment.
 After every visit, schedule a follow-up
appointment and encourage attendance.
 Schedule the appointment at a mutually
convenient time. Schedule initial follow-
up visits more frequently until the
symptoms begin to respond to
treatment. Once symptoms start
improving, schedule less frequent but
regular appointments
REFERENCES
• https://doh.gov.ph/health-programs/immunization-program
• https://doh.gov.ph/sites/default/files/health_programs/Booklet%201%20The%20National%20Immuniza
tion%20Program.pdf
• https://doh.gov.ph/sites/default/files/health_programs/Booklet%203%20The%20Vaccines.pdf
• https://doh.gov.ph/family-planning
• https://doh.gov.ph/sites/default/files/publications/MNCHNMOPMay4withECJ.pdf
• https://doh.gov.ph/newborn-screening
• file:///C:/Users/Patricia/Downloads/9789241549790-eng.pdf