COMMUNITY HEALTH NURSING John Messiah E.

dela Cruz, RN, cMAN

I. Definition and Focus: Public/ Community Health Nursing Community Health Nursing Synthesis of public and nursing practice. Technical nursing, interpersonal, analytical and organizational skills are applied to problems of health as they affect the community (Freeman, 1963). A specialized field of nursing practice. 1. Utilitarianism: greatest good for the greatest number. 2. Nursing Process. 3. Priority of health-promotive and disease-preventive strategies over curative interventions. 4. Tools for measuring and analyzing Community Health problems. 5. Application of principles of management and organization in the delivery of health services to the community. Occupational Health Nursing Nursing in the workplace. Research-based with an emphasis on optimizing health, preventing illness and injury, and reducing health hazards. School Health Nursing Nursing in an educational environment (school) Aims at promoting the health of school children and preventing health problems that would hinder their learning and performance of their developmental tasks. Community Health Nursing Goal: To raise the level of citizenry by helping communities and families to cope with the discontinuities and threats to health in such a way as to maximize their potential for highlevel wellness. Four (4) Levels of Clientele 1. Individual 2. Family unit of care 3. Population Group 4. Community - patient Principles: affected by the changes in technology affected by changes in society goals are achieved through multi-sectoral efforts part of the health system and the larger human service system people through health departments or related government agencies. Core Functions of Public Health Assessment Policy Development Assurance Health State of complete physical, mental, and social well being and not merely the absence of disease and infirmity. (WHO) It primarily affects the physical wellbeing of people in a society. Health is a fundamental human right. A personal and social responsibility. A multifactorial approach. Illness Highly subjective feeling of being sick or ill Community Health Nurse Roles of Community Health Nurse C: _____________________________ H: _____________________________ E: _____________________________ F: _____________________________ S: _____________________________ Supervision and care of women during pregnancy, labor and puerperium Performance of internal examination during labor, in the absence of antenatal bleeding, and delivery Suturing of lacerations in the absence of a physician Provision of first aid measures and emergency care Participate in the development of an overall plan, its implementation, and evaluation Provide quality nursing service Maintain networking/ links with other health team members and agencies in the provision of health care services Conduct researchers related to Community Health Nursing Provide opportunities for professional growth and education Provision of health care services Development and utilization of family nursing care plan Community organizing and mobilization; community development and people empowerment Case-finding and epidemiological investigation Program planning, implementation and evaluation Influencing executive and legislation in matters concerning health and developments

Public Health Art and science of: Preventing diseases Prolonging life Promoting health and efficiency through organized community efforts Connotes an organized, legislated, and tax supported efforts that serve all

Preventive Approach to Health Health Promotion Activities Enhance resources directed at improving well being Disease Prevention Activities Protect people from disease and the effects of disease

3 Levels of Prevention Primary Prevention Activities that prevent a problem before it occurs What is the most Sensitive indicator of the community health status??? ___________________________________ Leading Causes of Infant Mortality in 2002 1. Respiratory Condition of Fetus and Newborn 2. Pneumonia 3. Sepsis 4. Diarrhea 5. Congenital Malformation of the Heart Leading Causes of Maternal Mortality in 2002 1. Other Complication r/t pregnancy occurring in the course of labor and delivery 2. HPN r/t pregnancy 3. Post-partum hemorrhage 4. With Abortive outcome 5. Hemorrhage r/t pregnancy Leading Causes of Morbidity (2002) 1. Pneumonia 2. Diarrhea 3. Bronchitis 4. Influenza 5. HPN Leading Causes of Ailments/ Defects among School Children 1. Dental Caries 2. Intestinal Helminthiasis 3. Colds 4. Pediculosis 5. URTI Health Services The countrys public health care system has achieved significant milestones in the past 25 years PHC strategy integration of public health and hospital services reorganization of the Department of Health devolution of health services to LGUs streamlining of its organization and functions Vital Statistics Application of statistical measures to vital events that is used to gauge the levels of health, illness and health services of a community Crude Birth Rate

Secondary Prevention Activities that provide early detection and intervention Tertiary Prevention Activities that correct a disease state and prevent it from further deteriorating II. National Health Situation Demography Study of the population as to size, characteristics, health, illness. Study of the population as to: Size How many are they now? How many are they X years ago / later (projection)? Distribution Where is the population located? Urban? Rural? Composition? What are the characteristics of the population? Age? Patterns of Morbidity? Mortality? Philippines The population can be reflected by a pyramid This shows that the age of the population is very young Health Trends Increasing population growth rate - Population pressure on the environment -Investment in basic health services! Increasing Population Least Populated: Cordillera Region Most Populated: Metro Manila Life Expectancy (2005) Both sexes 70.46 years Male 67.83 years Female 73.08 years WOMEN live longer than MEN TOP Mortality Disease: Diseases of the Heart (CVD) MAWRA (Married Women in Reproductive Age)

Measures the natural growth or increase in the population Total live births____ x 1000 Midyear Population

2. 3. 4. 5.

Support Issuance Promulgation Development

Crude Death Rate Measures the natural decrease in the population Number of deaths__ x 1000 Midyear Population

Primary Function of DOH Promotion Protection Preservation Restoration Vision of DOH Old: Health for all Filipinos New: The Leader of Health for All in the Philippines Mission of DOH Old: Ensure accessibility and quality of health care services to improve the quality of life of all Filipinos, especially the poor. New: Guarantee equitable, sustainable, and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health. Important Concept!!! In the community setting, the marginalized refers to... D O P E A S Philosophy of DOH Quality is above Quantity! Principles of DOH PUSH!!! P performance of health sector must be enhanced. U universal access to basic health services. S shifting from infectious to degenerative diseases must be managed. H health and nutrition of vulnerable group must be prioritized. Strategies of DOH SAID!!! S support the local health system and frontline workers. A assurance of health care for all. I increase investment of PHC. D development of national standards. Goals and Objectives of DOH GREEPPP!!! G general health status of Filipino must improve R reduce morbidity, mortality and disability to different diseases E eradicate poliomyelitis E eliminate certain endemic disease

Infant Mortality Rate Measures the risk of dying before age of one (1) Total deaths of infants before age 1 x 1000 Total live births

Maternal Mortality Rate Measures the risk of dying from maternal causes Number of Maternally-related deaths 1000 Total live births

Neonatal Death Rate Rate of death among children before reaching the age of one (1) month Total deaths of infants < 28 days old x 1000 Total live births Morbidity Rates Incidence Rate new cases of a disease in a population over a period of time Prevalence Proportion Rate old and new cases of a specified disease existing at a given time Attack Rate cases as percent of exposed population World Health Organization A specialized agency of the United Nations with a primary responsibility for international health matters and public health. HEALTH IN THE HANDS OF THE PEOPLE BY THE YEAR 2020 Department of Health Lead agency in the health sector Sets the goals for the nations health status Establishes PARTNERSHIP! DOH Mandate 1. Formulation

P promote the health and nutrition of the family P promote healthy lifestyle P promote environmental sanitation Five Major Functions of the DOH Ensure equal access to basic health services Ensure formulation of health policies for proper division of labor and proper coordination of operations among agencies Ensure maximum level of implementation nationwide of services regarded as public health goods Plan and establish arrangements for public health systems to achieve economics of scale Maintain a medium of regulation and standards to protect consumers and guide providers National Health Plan A long-term directional plan for health covering the period 1995 to 2020. Indicates general directions and broad strategies for an effective and efficient health care system in the country. Health is __________________________________! NHP Vision An actively participating community Intersectoral collaboration Equitable distribution of health and other resources Use of effective technology that is affordable and that respects the sensibilities of the people Practice of sound management Development of the requisite health human resources Overall Goal of NHP To enable the Filipino population to achieve a level of health that will allow them to lead a socially and economically productive life through measures that will guarantee access of everyone to essential health care. Systems View of Health Philippine Health Care Delivery System Totality of all policies, infrastructures, facilities, equipment, products, human resources and services that address the health needs, problems and concerns of all people. ________________________ is a major concern of the _______________________ while ___________ is provided by ______________________________ Rural Health Care Delivery System To strengthen the rural health services and to effect a more efficient and effective delivery care of health services in the country

Main Health Center Located in the municipality and has its own catchments area of 5,000 populations more or less. Staffed by a complete health team. Barrio Health Stations Located in a strategic area beyond a 35 kilometer radius from the main health center and each serves a catchments area of 5,000 populations more or less. Staffed by a rural health midwife whose service are available 24 hours a day as she provides primary level of health care within their competence as defined in the Operational Manual for Nursing Personnel. Devolution of Health Services Devolution Transfer of power and authority from the national government to LGUs to enable them to perform specific functions and responsibilities. Local Government Code of 1991 Republic Act No. 7160 (October 10, 1991) Devolved Services and Functions Primary Health Care Maternal and Child Health Care Mental Health Family Planning Nutrition Control of Communicable Diseases Purchase of Medicines Medical Supplies and Equipment Access to Primary, Secondary, and Tertiary Health Services Maintenance of Barangay Health Workers, Regional Health Units, City, Municipal, District and Provincial Hospitals Sentrong Sigla Aims at promoting availability of quality health services in health centers and hospitals and at making these services more accessible to every Filipino. CERTIFICATION and RECOGNITION PROGRAMS Develops and promotes standards for health facilities DOH serves as provider of ____________________________ for health care and the LGUs as ________________ of health systems and ________________ of health programs. FOURmula ONE for Health Designed to implement critical health interventions as a single package, backed by effective management infrastructure and financing arrangements.

Includes the public and private sectors, national agencies and LGUs, external development agencies, and civil society involved in the implementation framework of health reforms. FOURmula ONE Components Health Financing To secure more, better and sustained investment in health. Health Regulation To assure access to quality and affordable health products, devices, facilities and services. Health Service Delivery To improve accessibility and availability of basic and essential health care for all. Good Governance of Health To improve health systems performance at the national and local levels. III. Primary Health Care Primary Health Care An essential health care made universally accessible to individuals and families of the community by means acceptable to them through their full participation at the cost that the family and the country can afford at every stage of development. Goal: Health for all Filipinos and Health in the Hands of the People by the year 2020. FOCUS: SELF-RELIANCE! Mission: To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care. Concept: Characterized by partnership and empowerment of the people. Includes the full participation and active involvement of the community towards the development of self-reliant people, capable of achieving an acceptable level of health and wellbeing. PHC: Legal Basis Letter of Instruction (LOI) _____ Signed on __________________ by President Ferdinand E. Marcos Alma Ata (Russia) Conference First International Conference on PHC _______________________ Sponsored by the WHO and UNICEF Launching of PHC strategy: ___________________________

Delegates sent to Alma-Ata Conference: ___________________________ ___________________________ Four (4) As: 1. 2. 3. 4. Characteristics Accessibility Acceptability Affordability Availability

Pillars of Primary Health Care SCAN!!! S: ___________________________ C: ___________________________ A: ___________________________ N: ___________________________ Components of PHC ELEMENTS!!! E: ________________________________________ L: ________________________________________ E: ________________________________________ M: ________________________________________ E: ________________________________________ N: ________________________________________ T: ________________________________________ S: ________________________________________ Types of PHC Workers 1. Village or Grassroot Health Workers 2. Intermediate Level Health Workers (professional health workers) A. Levels of HC Facilities Primary Level Individuals in fair health Patients with diseases in the early symptomatic stages RHU, Barangay Health Station, Health Center, Puericulture Clinic, Lying-in Secondary Level services offered to patients with symptomatic stages of disease which require moderately specialized knowledge and technical resources for adequate treatment. City/ Provincial Health Services or Hospital, laboratories Tertiary Level Services rendered at this level are for clients afflicted with diseases which seriously threaten their health and which require highly technical and specialized knowledge, facilities and personnel to treat effectively. Regional Medical Centers, Teaching/ Training Hospitals B. Levels of Prevention Primary prevention No illness Focuses on health promotion and specific prevention against diseases. Applied to:

- Healthy individuals e.g. health education, marriage counseling, family planning, immunization, prenatal care, environmental sanitation

Secondary Prevention Emphasizes on early diagnosis, case finding, prompt treatment for individual experiencing health problems. To limit or prevent disability and complications Applied to: people with s/sx e.g. screening survey, sputum exams, check-ups, dental examinations, breast and testicular examinations, first aid, tx. of ARI, diarrhea, and TB. Tertiary Prevention Rehabilitation To help individuals restore their optimum level of functioning ROM exercises Community-based rehabilitation program Referring client to support group and rehab center The DOHs 10 Herbal Medicines Herbal Medicines LUBBY SANTA!!! L: _______________________________ U: _______________________________ B: ________________________________ B: ________________________________ Y: ________________________________ S: ________________________________ A: ________________________________ N: ________________________________ T: ________________________________ A: ________________________________ Planting Organic Gardening Use only natural fertilizers Avoid pesticides Keep garden premises clean Harvesting Collect only healthy parts of the plants, also from healthy plants Harvest when flowering Drying o Patuyuin sa hangin at malilim na lugar Avoid sun drying Storage Plastic Use colored (opaque) containers Charcoal at the bottom of the container Close tightly

Basic Principles: Avoid the use of INSECTICIDES on plants Use CLAY POT and remove cover while boiling at low heat in preparing/ cooking the herbal medicine CORRECT DOSE! Use only the part of the plant being advocated Use only ONE (1) kind of herb for each disease (pito-pito is not endorsed) STOP use of herbal medicine at the first sign of untoward reaction (i.e. allergy. If signs and symptoms are not relieved after 2 or 3 doses of herbal medication, CONSULT A DOCTOR! 1. Lagundi Vitex negundo Indicated for CAF C: ______________________ A:______________________ F: ______________________ Other indications: Dysentery, colds and pain Skin diseases and wounds Headache, rheumatism, sprain, contusions, insect bites Aromatic bath of sick patients Preparation: Wash leaves Rinse Boil in two (2) cups of water Simmer in slow fire for fifteen (15) minutes Do not cover the pot Use clay pot Allow to cool For asthma and cough o Drink in three (3) parts Morning Noon Evening

For Fever o Drink every four (4) hours

2. Ulasimang Bato Peperonia pellucida Indicated for Gouty Arthritis Salad o One-half (1/2) cup; three times a day Decoction o Same as Lagundi o Use one and a half cups of leaves 3. Bawang Allium sativum Indicated for: Regulation of blood pressure Decreasing cholesterol levels Use two (2) cloves; three times a day after meals

Preparation: Fried Roasted Soaked in vinegar Blanched in boiled water CAUTION: Take on a full stomach to prevent stomach and intestinal ulcers 4. Bayabas/ Guava Psidium guajava L. Indicated for: Antiseptic Cleaner Mouth infections & Gingivitis Toothache Diarrhea (3-4 times a day) Decoction o Use to clean wound at least two (2) times a day Gargle --- Warm Decoction 5. Yerba Buena Mentha cordifelia Indicated for: General Body Pains Cough and cold Swollen gums and toothache Menstrual and gas pain Nausea and fainting Insect bites and pruritus Decoction o Same as Lagundi Poultice o Apply to affected area 6. Sambong Blumea balsamifera Indicated for: Diuretic effect Anti-urolithiasis (pantunaw ng bato) Decoction o Same as Lagundi CAUTION: NOT A MEDICINE FOR KIDNEY INFECTION!!! 7. Ampalaya Mamordica charantia Indicated for: Non-Insulin Dependent Diabetes Mellitus (NIDDM) Decoction o Boil 6 tablespoons in 2 glassfuls of water for 15 mins under slow fire o One-third cup; three times a day after meals Buds o Steamed and eaten o One-half (1/2) cup; two times a day 8. Niyug-Niyogan Quisqualis indica Indicated for: Ascariasis

Eat seeds two (2) hours before going to bed If theres no effect: Repetition of the same dose after 1 week CAUTION: NOT to be given to children BELOW FOUR (4) YEARS OLD 9. Tsaang Gubat Carmona retusa Indicated for: Abdominal Pains boil chopped leaves in 1 glass of water for 15 mins. Cool and strain. Diarrhea boil chopped leaves in 2 glasses of water for 15 mins. Cool and strain. 10. Akapulko Cassia alata/ Herpetic alata ANTI-FUNGAL! Indicated for: Skin infections: Scabies Tinea flava, ringworm, athletes foot Poultice / Extract o Apply to the affected area at least two (2) times a day IV. Family-based Nursing Family Basic unit of society, a primary entity of health care or institution responsible for the physical, emotional and social support of its members. Two types: Family of Orientation Family of Procreation Family Nurse Contact: Definition An activity with or on behalf of a particular family or individual. A crucial approach in delivering community health nursing service for the family. Family Nurse Contact: Objectives Assess health needs and problems of the family; Ensure familys understanding and acceptance of their problems; Provide the needed support and assistance to the family; Develop the individuals and/or familys competence to cope with their health problems, and; Contribute to the personal and social development of the family through varied health activities. Family Nurse Contact: Methods Home Visit Clinic Visit Group Conference

Telephone Contact Written Communication

Plan for next visit and referrals

Clinic Visit The patient visits the Health Center/ Clinic to avail of the services thereto offered by the facility primarily for consultation on matters that ailed them physically. Pre-natal and post partum care Well baby check up Immunization Free medicines under DOTS and other health care Pre-consultation Conference A pre-clinic lecture is usually conducted prior to the admission of patients Standard Procedures Performed During Clinic Visits I. Registration/ Admission II. Waiting Time III. Triaging IV. Clinical Evaluation V. Laboratory and other Diagnostic Examinations VI. Referral System VII. Prescription/ Dispensing VIII. Health Education Home Visit: An Approach to Families Professional face to face contact made by a nurse to the client or family to provide necessary health care activities and to further attain the objectives of the health agency. Frequency of Home Visit PAP! P Physical, psychological, and educational needs of the individual and family A Acceptance of the family P Policy of a given agency Steps in Home Visit Greet client and family then introduce yourself. Explain the purpose Look into detailed aspects of family and households. Place bag into convenient place. Wash hands and perform nursing care. Three Phases of Home Visit Preparatory Phase Review existing records or referral data of the family Notify the family of your intention to make a home visit Home Visit Phase Make plans, interventions, and evaluation with the family Set the schedule for the next visit Post-Visit Phase Record data

Priorities during Home Visit Newborn Post-partum Pregnant mother Morbid individuals Father of the Community??? ___________________________________________ What is the first step in Home Visit??? ___________________________________________ What is the most priority reason for identifying how frequent should a nurse conduct a Home Visit??? ___________________________________________ Public Health Bag Bag Technique A tool by which the nurse, during her visit, will enable her to perform a nursing procedure with ease and deftness, to save time and effort, with the end view of rendering effective nursing care to clients. Public Health Bag An essential and indispensable equipment of the public health nurse used during home visit. Principles of Bag Technique Minimize, if not, totally prevent the spread of infection Save time and effort Show effectiveness of total nursing care to an individual or family Contents and Arrangement of the PHN Bag 1. Front of bag left to right Thermometers in case Tape measure Adhesive plaster Cotton applicator 2. On right rear of bag 2 test tubes and 1 holder Medicine dropper Alcohol lamp 3. On left rear of bag Medicine glass Baby scale Bandage scissor Rubber suction 4. Back of bag left-right 70% alcohol Betadine solution Hydrogen peroxide Terramycin ophthalmic ointment

 Zephiran solution Spirit of ammonia Acetic acid Benedicts solution Liquid soap Cotton in sterile water 5. In the center of the bag 2 pairs of forceps 1 surgical scissor Sterile dressing Roller bandage Syringes Hypodermic needles Sterile cord clamp Kidney basin 6. On the top pile, center of bag Hand towel in plastic bag Soap in soap dish Apron Plastic/ Linen lining 7. Pocket of bag Surgical gloves Waste paper receptacle Special Considerations: PHB BAG!!! B bag and its contents must be protected from any contamination A Always wash your hand to prevent spread of infection G gather all necessary equipments in delivering basic health services Benedict Solution Test To check the presence of sugar in the urine Alcohol lamp, test tube & test tube holder 8-10 drops of urine + 0.5 ml of benedict solution BLUE (-) GREEN (1+) YELLOW (2+) ORANGE (3+) RED (4+)

3rd moistened with alcohol Rectum ___________ Oral ______________ Axilla _____________ Typology of Nursing Problems in Family Nursing Practice Health Problem A situation or condition which interferes with the promotion and/or maintenance of health and recovery from illness or injury. Nursing Problem A situation or condition which interferes with the promotion and/ or maintenance of health and recovery from illness or injury, and which is subject to change or modification through nursing intervention.

Initial Database for FNP Family Structure, Characteristics, and Dynamics Socio-economic and Cultural Characteristics Home and Environment Health Status of each Family Member Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention Family Assessment Systematic collection of data to determine the familys status and to identify any actual or potential health problems. Includes the analysis of data to serve as a basis for planning and delivering nursing care to the whole family. First-Level Assessment Presence of Wellness Condition clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level. Presence of Health Threats conditions that are conducive to disease and accident or may result to failure to maintain wellness or realize health potentials. Presence of Health Deficits instances of failure in health maintenance. Presence of Stress Points/ Foreseeable Crisis Situations anticipated periods of unusual demand on the individual or family in terms of adjustment/ family resources Second-Level Assessment Inability to recognize the presence of a problem Inability to make decisions with respect to taking appropriate health action Inability to provide adequate nursing care to the sick, disabled, dependent or

Acetic Acid Test To check the presence of albumin in the urine 2/3 part of the test tube is urine; 1/3 is the acetic acid Clear (-) Cloudy (+) Thermometer Technique Method of checking clients temperature with due attention given to the cleanliness of the thermometers used. 3 cotton balls 1st moistened with soap 2nd moistened with water

vulnerable/ at risk member of the family Inability to provide a home environment which is conducive to health maintenance and personal development Failure to utilize community resources for health care

V. Community-based Nursing Practice Community A social group determined by geographic boundaries and/or common values and interests. Its members know and interact with each other. It functions within a particular social structure and exhibits and creates norms, values, and social institutions. Community: Characteristics Environment Physical, socio-cultural, educational and employment milieu Population Behavior or Lifestyle Self-responsibility, self-care competency Human Biology Genetic characteristics of population Systems of Health Care Prevention, promotion, cure, rehabilitation Community: Classification Urban High density, socially heterogeneous population Complex structure, non-agricultural occupations Complex interpersonal social relations Rural Small and the occupation of the people is usually farming, fishing and food gathering. Characterized by primary group relations, well-knit and having a high degree of group feeling Community: Components Eight (8) Subsystems of the Community 1. Housing 2. Education 3. Fire and Safety 4. Politics and Government 5. Health 6. Communication 7. Economics 8. Recreation Healthy Community Members of the community display a high degree of awareness that they belong in the community.

Openly recognizes the existence of sub-groups and welcomes their full participation in community affairs. Prepared to meet crises. A problem-solving community Seeks to make each of its systems resources available to all members of the community. Has a legitimate and effective ways to settle disputes and meet hands that arise within the community. Encourages maximum citizen participation in decision-making. Promotes a high-level wellness among its members

Healthy Community: Elements People are partners in health care. People work together to attain goals. Physical environment promotes health, safety, order and cleanliness. Safe water and nutritious food. Families provides members with basis needs. COPAR Community Organizing Process by which health services, agencies and the people of the community are brought together to: Learn and identify common problems as their own Plan appropriate actions Act on the basis of necessity and priority Evaluate programs Objectives A. To make people aware of social realities towards the development of local resources. B. Structure that will hold the peoples basic interests as oppressed and deprived sectors of the community and as people bounded by the interest to serve others. C. To initiate the responsible actions intended to address holistically the various community health and social problem. D. Self-reliance!!! Critical Steps in Building Peoples Organization 1. Preparatory Phase Immersion 2. Social Investigation Process of collecting, collating, analyzing data to draw a clear picture of the community AKA COMMUNITY STUDY 3. Tentative Program Planning Choose one issue to work on in order to begin organizing the people.. 4. Groundwork

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Going around and motivating the people on a one-on-one basis to do something on the issue that has been chosen. 5. The Meeting People collectively ratifying what they have already decided individually. Community organizer gives the people the collective power and confidence. 6. Role Play Means to act out the meeting A way of training the people to anticipate events and participate in all the activities which resulted from the meeting. 7. Mobilization or Action Actual exercise of people power. 8. Evaluation The people and the community organizer review the success/ failure of the program Phases of COPAR 1. PREPARATORY PHASE A. Pre-entry Area Selection Community Profiling B. Entry Community Integration Community Study Community Assembly 2. ORGANIZATIONAL PHASE A. Social Preparation B. Spotting and Developing Potential Leaders C. Core Group Formation D. Setting up the Organization 3. EDUCATION AND TRAINING PHASE A. Conducting Community Diagnosis B. Training of Community Health Workers C. Health Services and Mobilization D. Leadership-Formation Activities 4. INTERSECTORAL COLLABORATION PHASE Intersectoral Linkages (support systems) NGOs, POs, GOs 5. PHASE-OUT A. Sustenance and Strengthening Phase B. Termination of Work C. Turn over of work COMMUNITY DIAGNOSIS Basis for developing and implementing community health nursing interventions and strategies. Aims to obtain general information about the communitys profile to determine the communitys strengths and weaknesses. TYPES OF COMMUNITY DIAGNOSIS A. COMPREHENSIVE COMMUNITY DIAGNOSIS B. PROBLEM-ORIENTED COMMUNITY DIAGNOSIS

ELEMENTS OF A COMPREHENSIVE COMMUNITY DIAGNOSIS A. Demographic Variables B. Socio-Economic and Cultural Variables C. Environmental Variables D. Health Statistics Variables E. Health Resources F. Political/ Leadership Patterns STEPS IN CONDUCTING COMMUNITY DIAGNOSIS 1. Determine the Objectives 2. Defining the Study Population 3. Determine Data to be Collected 4. Collecting the Data Ocular Survey Interview Records Review Participant Observation 5. Developing the Instruments 6. Actual Data Gathering 7. Data Collation 8. Data Presentation 9. Data Analysis 10. Identifying the Community Health nursing Problems Health status high morbidity and mortality rate associated with particular diseases Health resources lack of medicines, vaccines, manpower, and facilities to solve health problems Health related existence of social, economic, environmental and political factors that aggravate the illnessinducing situations in the community 11. Priority Setting Nature of the problem Magnitude of the problem severity of the problem which can be measured in terms of the proportion of the population affected by the problem. Modifiability of the problem probability of reducing or controlling the problem Preventive Potential probability of controlling or reducing the effects posed by the problem Social Concern perception of the community to the problem VI. Health Programs, Services and Strategies Priority Health Programs of the Philippines

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GMA 50 Social health insurance through Philippine Health Insurance Corporation (PhilHealth) National Tuberculosis Program (NTP) Expanded Program on Immunization Micronutrient Program (salt iodization and Vitamin A) Maternal Care and Family Planning Rabies Prevention and Control Program Malaria Control Program HIV/AIDS/STD Prevention and Control Program Healthy lifestyle promotion including responsible parenthood

GMA 50 G is for GAMOT na M is for MABISA at A is for ABOT-KAYA Fifty percent (50%) off on selected drugs: Antibiotics Paracetamol PTB drugs GMA 50: Goal AHSE!!! A affordable H high quality S safe E effective GMA 50: Strategies Importation of high-quality, safe and effective, affordable drugs and medicines Expand as appropriate, the list of drugs and medicines for importation Increase the number of outlets Promote use of generic drugs and medicines Ensures continuous supply Develop reimbursement scheme for medicines with PHILHEALTH Reduce significantly the prices of drugs and medicine NATIONAL HEALTH INSURANCE PROGRAM Focuses on broadening the reach, in terms of product recognition, ensuring reenrolments, enhancing benefits and improving Phil-Health - DOH - LGU coordination National Tuberculosis Program (NTP) Basis: R.A. 3573 communicable diseases should be reported to the nearest health care facilities. Tuberculosis 80 million people in 2003 Causative Agent: Mycobacterium tuberculosis Mode of Transmission: Airborne (most common)

Important Concept!!! There is no need to separate eating utensils! Tuberculosis is not acquired through shared utensils. Tuberculosis is also acquired through ingestion of contaminated milk Causative agent is Mycobacterium bovis or Mycobacterium bovine Tuberculosis of Cattle From improperly pasteurized or improperly boiled milk Tuberculosis may also be acquired from birds o Mycobacterium avium is the causative agent o Obtained when taking care of infected bird o Eating of the bird is not necessary to get infected Mycobacterium avium Complex o Most common opportunistic infection for AIDS patients in the United States TB: Diagnostic Procedures Sputum Analysis Confirmatory test! 3x a day (Tuesday on collection) o 8 pm on Monday store in room temperature o 6 am on Tuesday o 8 am on Tuesday Chest X-ray Haziness in lobes, infiltration of lungs Mantoux Test/ PPD To detect exposure to tubercle bacilli 0.1-0.2 cc via ID Reading: 2-3 days/ 48-72 hours (+)! 8-10 mm diameter NTP/ NTCP Objectives: General: to reduce the morbidity and mortality rates of the disease. Specific: vaccinate BCG in all children Key Policies: Case finding; treatment PROGRAM COMPONENTS CASEFINDING Objectives -To identify TB symptomatics - Cough for two (2) weeks Passive Case finding - TB symptomatic patients present themselves at the health facility Active Case finding Personal efforts to find TB cases among the symptomatics who do not seek help

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MAJOR POLICIES IN CASEFINDING Direct sputum smear microscopy shall be the primary National Tuberculosis Program (NTP) diagnostic tool Three sputum specimen must be submitted: First Spot NOW upon seeing patient Early Morning patient does this Second Spot The early morning spot is brought by the patient to the RHU TYPES OF TUBERCULOSIS CASES New No treatment or less than one (1) month treatment Relapse Cured and Smear Positive again Transfer In Changed treatment facility Return after Default Interrupted treatment Smear Positive Treatment Failure Still positive on the fifth (5th) month Others Became positive on the second (2nd) month Interrupted treatment / Smear negative Classification of Patients CATEGORY 1 Newly diagnosed; (+) sputum test; seriously ill INTENSIVE PHASE 2 mos. RIPE MAINTENANCE PHASE 4 mos. RI Classification of Patients CATEGORY 1 Newly diagnosed; (+) sputum test; seriously ill with extra PTB INTENSIVE PHASE 2 mos. RIPE MAINTENANCE PHASE 7 mos. RI Before maintenance, repeat sputum exam!!! (+) additional 1 month RIPE; (-) RI If still after 1 month (+) sputum test, proceed to RI CATEGORY 2 Previously treated patients with relapses or failure INTENSIVE PHASE 2 mos. RIPES 1 mo. RIPE MAINTENANCE PHASE 5 mos. RIE Before maintenance, do the sputum exam (+), 1 more month RIPE If (+) at the end of 4 months, RIPE for the next 5 mos.

CATEGORY 3 Newly diagnosed TB patient; (-) sputum test for 3x; chest x-ray result of PTB minimal. INTENSIVE PHASE daily for 2 mos. RIP MAINTENANCE PHASE daily for 2 mos. RI * If recur, add 1 month RIPE TB: Methods of Prevention Preventive Measures BCG Immunization primary prevention Health education MOT Do not give BCG vaccine to patients with (+) tubercle bacilli! Side Effects of Drug Regimen Rifampicin Orange urine Orange tears Orange secretions and excretions Orange saliva Orange sputum Orange feces Isoniazid peripheral neuritis, tingling sensation Nursing Management Give Vitamin B6 or pyridoxine o Improve nerve sensation Pyrazinamide (PZA) hyperuricemia gouty arthritis o Patient is predisposed to stone formation Nursing Management Therefore, make urine alkaline Increase fluid intake Increase intake of vegetables Ethambutol Optic disturbances optic neuritis o Causes color blindness or inability to distinguish red from green Nursing Management IMMEDIATELY STOP the medication because this side effect is IRREVERSIBLE Not given to patients younger than 6 y/o Streptomycin Ototoxicity Renal Toxicity Nursing Management Assess patient for tinnitus or ringing of the ears Assess patient for vertigo, which is another sign indicative of ototoxicity

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Monitor the Creatinine levels, Blood Urea Nitrogen (BUN) levels and Intake and Output Should not be given to pregnant women

Nursing Alert!!! Before meals: RIE After meals: P Submit sputum specimen every 2 months for sputum microscopy Direct Observed Treatment Short Course (DOTS) Comprehensive strategy to detect and cure TB patients. Expanded Program on Immunization (EPI) Basic element of Primary Health Care Based on epidemiological situation Communities to be protected rather than just individuals GOAL: Reduction of morbidity and mortality of children 0 11 months old against the seven (7) immunizable diseases. EPI: Legal Bases P.D. _____ (_______________) Marcos Providing compulsory basic immunization for infants and children below eight (8) years of age. P.P. ___ (_______) Aquino Implementing a United Nations goal on Universal Child Immunization by 1990. Enjoining all government agencies and organizations to achieve goal of immunizing every Filipino against the six (6) EPI diseases. P.P.____ (_____________________) Ramos Reaffirming the commitment of the Philippines to the Universal Child and Mother Immunization goal of the World Health Assembly. EPI: Other Laws P.P. _________ National Immunization Day (every Wednesday) P.P. _________ (polio) Knock-out Polio day P.P. _________ (tetanus) NTEC (Neonatal Tetanus Elimination Campaign) P.P. _________ (measles) PMEC (Philippine Measles Elimination Campaign) R.A. _________ Compulsory Immunization for Hepatitis B EPI: Elements TICAS!!! T target setting (eligible population) I information, education, communication C cold chain logistic system A assessment and evaluation S surveillance and research

Cold Chain System To maintain the potency of the vaccine How long can the vaccine be stored? Six (6) months at a regional health office Three (3) months at a district / province One (1) month at the Health Center Not more than five (5) days using transport boxes Nursing Alert!!! All vaccines are destroyed by HEAT... LOGISTICS OF EPI Vaccines Mixing system AD syringe Autodisposable Mixing Syringe Safety Deposit Boxes SEVEN (7) IMMUNIZABLE DISEASES Tuberculosis Measles Poliomyelitis Diphtheria Pertussis Tetanus Hepatitis

FULLY IMMUNIZED CHILD (FIC) Has received the following immunizations: o 1 BCG o 3 OPV o 3 DPT o 1 MV Before his first birth day Note that Hepatitis B is not included yet Philippine Nutrition Program Goal: Improvement of the nutritional health status, productivity and quality of life of the population through desirable dietary practices and healthy lifestyles. Targeted Food Assistance Program (TFAP) Eligible population 2nd-3rd degree malnourished Pregnant women Lactating mother Nutritional Guidelines Guideline 1: Eat of variety of foods everyday Guideline 2: Breastfeeding program Guideline 3: Proper feeding of children and regular monitoring of weight

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Food Fortification Program Strategic addition of micronutrients usually deficient in the diet to a widely consumed food. Food Fortification Program: Legal Bases Republic Act ______ ___________________________________________ Philippine Constitution The state shall protect and promote the right of the people and instill health consciousness among them SANGKAP PINOY SEAL PROGRAM To encourage manufacturers to fortify food, processed foods, or food products with essential nutrients at levels approved by the DOH manufacturers to use the DOH seal of acceptance Voluntary Food Fortification Food manufacturers may apply for DOH seal of acceptance should they choose to fortify Mandatory Food Fortification Obligatory fortification for staple foods: Rice with iron Wheat Flour with Vitamin A and iron Refined sugar with Vitamin A Cooking Oil with Vitamin A Micronutrient Supplementation (Vitamin A) Infants 6-11 months Today 100,000 I.U. Tomorrow 100,000 I.U. After 2 Weeks 100,000 I.U. Play School 12-83 months Today 200,000 I.U. Tomorrow 200,000 I.U. After 2 Weeks 200,000 I.U. Iron Supplementation Infants 6-12 months 12-59 months

Guideline 8 AKA National Salt Iodization Program R.A. ______ Asin Law December 1995 Ramos FIDEL salt!!! F fortification for I - iodine D - deficiency EL - elimination National Salt Iodization Program Objectives Virtual Elimination of Iodine Disorders through Universal Salt Iodization 80% iodized salt utilization of households by year 2003 90% iodized salt utilization of households by 2004 Institutionalization by 2005 National Salt Iodization Program IODINE Element required by tissues for synthesis of thyroid hormones IODINE DEFICIENCY Causes mental retardation, goiter and other growth and development abnormalities Effects of Iodine Deficiency Newborn / Infants Increased infant mortality Abnormal brain development Impaired mental ability Children / Adolescents Goiter Lower I.Q. (loss of 10 15 pts.) Learning disabilities Adults Goiter Slower response times Impaired mental function Effects of Iodine Deficiency Pregnancy and Lactation Increased incidence of: o Miscarriage o Stillbirths o Birth defects Others Loss of 13 I.Q. Points This translates to lower educability Net effect is lower economic productivity Guideline 9 Eat clean and safe food Guideline 10 Promote healthy lifestyle Maternal Health Care Program Family Planning Started 1960s Proper postponing/ birth spacing

0.7 mg daily 1 mg daily

Iodine Supplementation Children 1-59 months 200 mg once a year Avoid foods rich in goitrogens like cassava, cabbage and cauliflower These interferes with the absorption of iodine by the body. Guidelines 4, 5, 6, 7 Consume fish, poultry products, and beans Eat more vegetables and fruits Consume milk and milk products

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Giving birth at the right age at the right time 2-3 years spacing of child 2-3 children is ideal 5 pregnancy is a risk factor COUPLES FOR CHRIST DOH partner Abstinence is not accepted in the DOH Family Planning Program

Important Concept!!! COUPLE Decision-maker DOH Regulator Community Health Nurse - Facilitator Important Concept!!! High-risk Pregnancies Too early Too late Too frequent Too many FP Methods: Natural Basal Body Temperature 91-99% effective Observe temperature for six (6) months or more Taken per mouth or per axilla Take temperature upon waking up Graph Mark coitus schedule Mark time of menstruation Important Concept!!! Progesterone CAUSES AN INCREASE IN TEMPERATURE Estrogen CAUSES A DROP IN TEMPERATURE Cervical Mucus / Billing Method Spinbarkeit Test 91-99% effective Clear, stretchable and mucus is abundant Fertile Cevical mucus is pasty Not Fertile Sympto-thermal method 91-99% effective Combination of basal body temperature and billing method Lactational Amenorrhea Method (LAM) 98% effective Done for six (6) months Three Criteria for LAM: o Child less than six (6) months o Menses are still absent o Pure Breast-feeding No pacifier, water, supplementary food FP: Artificial Pills % effective Usually taken at night COCs (Combine Oral Contraceptives) o Not given on breastfeeding mother o With estrogen and progesterone POCs (Progestin Only Contraceptives) o taken by breastfeeding mothers Intrauterine Device (IUD) 98% effective

NFP: Legal Bases Philippine Constitution The right of spouses to found a family in accordance with their religious conviction and the demands of responsible parenthood Executive Order 307 Directed local Chief Executives to ensure that information on and sources for all methods, including NFP endorsed by the program are available at appropriate levels of service outlets, adhering to the standards of quality care promulgated by the national government Administrative Order 125 Series 2002 NATIONAL NATURAL FAMILY PLANNING STRATEGIC PLAN YEAR 2002 2006 Administrative Order 132 Series 2004 Created the DOH NFP Program and its program management A separate program from Family Planning Natural Family Planning Over-all Goal: to reduce health risks to females and children due to short birth intervals and frequent pregnancies and childbirth. Specific Objectives (2006) To raise fertility consciousness of at least 75% of young women immediately before or soon after menarche and of 75% of young females at puberty in preparation for responsible sexuality and family life To train at least 75% of frontline health providers on Natural Family Planning methods To raise the use of 20% among current married women / couples who are not yet using any method of contraception NFP: Implementing Strategies Policy and organization strengthening Advocacy and orientation Training and certification Networking and development of support groups Monitoring and evaluation Family Planning: 4 Pillars BIRR!!! B _____________________________ I ______________________________ R _____________________________ R _____________________________

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Sterile plastic device Best time for insertion During the second (2nd) day of menses You know you are not pregnant Cervix is slightly open ABSOLUTE CONTRAINDICATION o When you have abnormal uterine bleeding o Nulliparous o History of Pelvic Inflammatory Disease o History of Sexually Transmitted Disease

o o o o

G ____________________ O ____________________ B ____________________ I _____________________

Growth Monitoring Height for age stunting Weight by age wasting Arm circumference least indicator for growth monitoring Nutrition Arm Band Red severely malnourished Yellow moderately malnourished Green well nourished Oral Rehydration Program Diarrhea 3 Fs: o Feeding o Fluids o Fast referral Nursing Alert!!! Puffiness of the eye - Stop ORESOL and give fluid without salt (milk, orange) Vomiting Stop in 10 mins. Then resume oresol slowly Severe vomiting STOP Oresol!!! - refer to hospital for IV replacement (LR) Breastfeeding Exclusive breastfeeding of infants recommended for the first six months of their lives. Has many physical and psychological benefits for children and mother as well as economic benefits for families and societies. Breastfeeding B: _____________________________ R: ______________________________ E:_______________________________ A:_______________________________ S:________________________________ T:________________________________ F:________________________________ E:________________________________ E:________________________________ D:________________________________ I:_________________________________ N:________________________________ G:________________________________ Breastfeeding: Legal Bases E.O. 51 (Milk Code) Law that prohibits the commercialization of artificial feedings. R.A. 7600 (Breastfeeding and Rooming-In Act)

Condom 97% effective Mother is most responsible in inserting the condom Depo Medroxyl Progesterone Acetate (DMPA) 98% effective Injectable; every 3 months Fertility after 6 months FP: Permanent Tubal Ligation 99% effective Best time o Post-partum o Within four (4) to six (6) hours after delivery Do not engage in coitus three (3) days before and after the procedure Restrict lifting of objects heavier than newborn Vasectomy 99% effective Vas deferens is cut Does not give immediate sterility There is a waiting time of six (6) months Sperm is still stored After six months, patient can engage in unprotected coitus Not popular among Filipinos Nursing Alert!!! Methods that are not part of NFP: (not accepted by the DOH) Withdrawal Calendar method Natural Family Planning SAVES!!! S ___________________________ A ___________________________ V ___________________________ E ___________________________ S - ____________________________ Child Health Care Program Under Five Clinic Program 0-59 months Focused on the following:

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Mother and Baby Friendly Hospital (MBFH) Senate Bill 1044 Implementation of Rooming-In Rabies Prevention and Control Program Goal: Rabies-free Philippines Objective: To reduce the incidence of rabies RPCP: Strategies and Activities RIP!!! R ________________________________ I _________________________________ P _________________________________ PRO Dog (Pinoy Responsible Owner of the Dog) 3 months 1st immunization of the dog then every year Rabies AKA Hydrophobia, Lyssa, La Rage A disease of a low form of animal Not a human infection Only accidentally transmitted to man Occurs in canine animals or animals with fangs: o Fox o Wolves o Boar o Monkeys o Bats o Cats o Dogs Infection may occur through: Corneal transplantation Kissing animal Dog licking wounds Management for Rabies WATER!!! W wash wound with water and soap A apply antiseptic (betadine) - antibiotic for infection Te tetanus toxoid (active) R rabies immunoglobulin (passive) Malaria Control Program Vision Malaria Free Philippines by 2020 Mission To empower the health workers, the population at risk, and all others concerned to eliminate malaria in the Philippines Top Ten (10) Provinces: Palawan Tawi-Tawi Agusan del Sur Sulu

Davao del Sur Isabela Davao del Norte Compostela valley Apayao Cagayan

Malaria: Agents Plasmodium falsiparum Most common in the Philippines, accounts for around 70% of cases Causes severe / complicated malaria and death if not treated promptly / appropriately Resistance to anti-malaria drugs is widespread but low grade Plasmodium vivax Accounts for 30% of cases Rarely causes severe disease Sensitive to anti-malarial drugs Resistance suspected in some countries Relapse is common if not treated adequately with anti-relapse drugs Plasmodium malariae Very rare, less than 1% of cases in the Philippines Infection is usually not severe but may last up to fifty (50) years if not treated Drug resistance has not yet been documented Plasmodium ovale Not found in the Philippines, found only in Africa Relapse may occur if not treated adequately with anti-relapse drugs Drug resistance has not yet been documented Nursing Alert!!! At HIGH RISK Pregnant Women Children Indigenous Cultural Communities Non-immune travelers to endemic areas Malaria: Strategies to achieve goals Early diagnosis and effective treatment Utilization of insecticide treated mosquito nets Immediate and effective responses to malaria epidemic Selective vector control in areas where it can be afforded and sustained VECTOR CONTROL Main not FOGGING (only during epidemics) But INSECTICIDE TREATED MOSQUITO NETS Target: One (1) treated mosquito net per household Vector Control Options

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INSECTICIDE TREATED NETS (Deltamax 1 cap for 1 liter of water) Reduce man-mosquito contact Initial treatment carried out by MCP personnel, six months after, the people were able to do it Place mosquito net inside plastic bag Immerse the mosquito net in an insecticide Air dry the mosquito net Avoid sun exposure Three (3) drippings Use only when thoroughly dried Vector Control Options INDOOR RESIDUAL SPRAYING Kills adult mosquitoes on walls; not the kiti-kiti Method of choice during outbreaks or epidemics Lasts for six months if not wiped away LARVICIDING and BIOLOGICAL CONTROL Flight range of malaria mosquito is three-hundred meters (300 m) Therefore, cleaning is a community effort Chemical Agents Paris Green Temephor Biological Agents Larvivorous fishes Gabusia affinis Malaria: ENVIRONMENTAL MANAGEMENT Cleaning of Streams Environmental not biological Covering openings in unfinished houses PERSONAL PROTECTIVE EQUIPMENT Chemoprophylaxis Use of mosquito repellants Burning of coconut husks Wear long sleeves Diagnostic Test: Malarial Smear peak of fever Treatment: Chemoprophylaxis Chloroquine! o 1-2 weeks before entering the area then continous for 4-6 weeks after leaving the area.. Chemotherapy Guidelines for Malaria CHLOROQUINE + SULFADOXINE PYRIMETHAMINE (CQ + SP) First line drug in the treatment of probable malaria and confirmed P. falsiparum provided disease is not severe

ARTHEMETHER-LUMEFANTRIN (co Artem) Second line drug Given only to microscopically confirmed P. falsiparum which did not respond to adequate CQ + SP treatment Not recommended for: o Pregnant women o Children < eight (8) years old QUININE + TETRACYCLINE/ DOXYCYCLINE Third line drug Given to those who did not respond to Co-Artem or if CQ + SP is not available Drug of Choice in the treatment of SEVERE MALARIA Tetracycline and Doxycycline are contraindicated for: o Pregnant women o Children < eight (8) years old Quinine and Clindamycin are given instead PRIMAQUINE Given single dose to confirmed P. falsiparum cases to prevent transmission Given for fourteen (14) days to confirmed P. vivax to prevent relapse CHLOROQUINE Used in the treatment of confirmed P. vivax Dengue Hemorrhagic Fever Aedes albopictus Aedes aegypti Common during the rainy season Aedes mosquito thrives at STAGNANT WATER Dengue is the MOST DANGEROUS MOSQUITO-BORNE VIRAL DISEASE IN THE WORLD Who are affected? o Anyone o Infants / school children (0 9 years old) are MOST AFFECTED Signs and Symptoms of Dengue High continuous fever lasting two (2) to seven (7) days Bleeding tendencies Presence of small reddish spots or skin flushing What to do? Bring all suspects to hospital Do not medicate Give paracetamol Never give aspirin Important Concept!!! Mosquito which bites a person with dengue hemorrhagic fever (DHF) will

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be infected eight (8) to ten (10) days after biting DHF infected person Small black and white mosquito with stripes Day biters Can fly 30 300 meters

Aedes aegypti Commonly found in: o Closet o Drawers o Dark, cool places Aedes albopictus Commonly found: o Outdoors o Shrubs o Trees Dengue: Diagnostic Test Torniquet Test Presumptive test that checks for capillary fragility Pedia: 5-10 mins. Adults: 10-15 mins. (+) if > 20 petechiae formation in 1 square inch Dengue: Methods of Prevention and Control CLEAN!!! C ________________________________________ L ________________________________________ E ________________________________________ A ________________________________________ N ________________________________________ 4 Ss in Dengue Prevention 1. Search and Destroy 2. Self-protection measures 3. Seek early consultation 4. Say no to indiscriminate fogging Mag-HL (Healthy Living) Tayo To raise the awareness of the Filipinos on the need to practice a healthier lifestyle Raise the consciousness of policy makers on the need to provide the Filipinos with an environment supportive of healthy lifestyle KEY MESSAGES OF MAG HL TAYO Do not smoke Regular exercise Eat a healthy diet everyday Watch your weight / weight control Manage Stress Regular health check-up PRIMARY AUDIENCE OF MAG HL TAYO All family members belonging to the C E economic classes in urban areas

Each of the five (5) healthy messages will specifically prioritize the following target audiences: o Adults to elderly for exercise o School children for healthy diet o Mothers and daughters for watch your weight o Teenagers for do not smoke o Working adults for manage stress

SECONDARY AUDIENCE OF MAG HL TAYO Executives and employees of Local Government Units Legislators and politicians Media

COMMUNICATION STRATEGIES: MagHL Tayo January Regular health check-up February Exercise regularly May / June Do not smoke July Eat a healthy diet October Manage Stress December Watch your weight / Weight control Environmental Sanitation Program Study of all factors in mans physical environment which potentially affects health, well-being and survival. WHUP!!! W water for life H hospital waste management U urban health/ national project P pasig river rehab center Factors: Water Sanitation Food Sanitation Refuse and Garbage Disposal Excreta Vector and Rodent Control Housing Pollution Noise Radiological Protection Institutional Sanitation Legal Basis: PRESIDENTIAL DECREE ______ Sanitation Code of the Philippines in 1978 PRESIDENTIAL DECREE ______ Penalty for improper garbage disposal REPUBLIC ACT ____ of 2001 Clean Air Act

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Water Supply Sanitation Program Unapproved water facilities: Open dug wells Unapproved springs

o Health Certificates For FOODHANDLERS o Destruction and banning of foods unfit for consumption

Certification of Potability Permit given by the SECRETARY OF HEALTH or his LOCAL REPRESENTATIVE (LGU) Disinfection of water services in: New water supplies Improved / impaired water supply Previously infected Approved Types of Water Facility Level 1 POINT SOURCE Protected Well No distribution system Generally rural Serves 15 25 households Outreach of not more than 250 meters Spring Sinasalok Level 2 COMMUNAL FAUCET SYSTEM OR STAND POST Source reservoir Not more than 25 meters away from the farthest house Delivers to about 100 houses For clustered houses Does not enter the individual houses Level 3 WATERWORKS OR INDIVIDUAL HOUSE CONNECTIONS For densely populated communities Cities Urban Areas Requires minimum levels of treatment and disinfection PROPER EXCRETA AND SEWAGE DISPOSAL SYSTEM Level 1 No water necessary to wash waste Pit latrines Pit Privy Ash is poured here after defecation Level 2 Requires small amounts of water to wash waste into the receiving space Pour Toilets Flush Toilets Level 3 Connected to the treatment plants Food Sanitation Program Food establishments are appraised based on: o Inspection / approval of all food sources, containers, transport vehicles o Sanitary Permit For RESTAURANTS

Classification of establishments Class A Excellent Class B Very Satisfactory Class C Satisfactory Class D Good Class E Poor Hospital Waste Management Program Goal: To prevent the risk of contracting nosocomial infection from disposal of infectious, pathological and other wastes from hospitals. Hospital Waste Management Program: Policies All hospitals to prepare hospital waste management as a requirement for registration / license Use of appropriate technology and indigenous materials Training of all hospital personnel in waste management as an essential part of the hospital training program Nursing Roles in Environmental Health Health Education Training De-worming Coordination of Programs Advocate Sanitation Campaign Role Model Researcher Disaster management VII. Integrated Management of Childhood Illness What is IMCI? A strategy for reducing mortality and morbidity associated with major causes of childhood illnesses IMCI: Objectives To reduce SIGNIFICANTLY global mortality and morbidity associated with the major causes of disease in children To contribute to healthy growth and development of children Essential Package for Child Survival Skilled attendance during pregnancy, delivery and immediate postpartum Care of the newborn Breastfeeding Micronutrient supplementation

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Immunization of children and mothers IMCI Use of insecticide-treated bed nets

Training Follow-up after training Role of private providers

IMCI: Rationale The under five population is the most vulnerable group Child mortality remains UNACCEPTABLY HIGH Many of these deaths had no medical attendance or not seen by first-level health care facilities First-level facilities Undermanned/underpaid Health workers are NOT PROPERLY TRAINED Drugs supply is INADEQUATE/ NOT PROPERLY MANAGED Inaccessible and poor laboratory support o Family and community profile/ practices o Late help seeking behavior o Poor utilization of health facilities o Literacy o Traditional beliefs o Economics o Large families o Crowded, dense, and polluted environment Important Concept! Under Five Mortality the probability of dying between birth and exact age five (5) (the number of deaths below age five per 1ooo live births) Infant Mortality the probability of dying between birth and exact age five (5) (the number of infant deaths per 1000 live births during the first 12 months of life) Child Mortality the probability of dying between exact age one (1) and age five (5) (the number of deaths of children age 1-4 years per 1000 children surviving to age 12 months Neonatal Mortality the probability of dying within the first month of life Post neonatal Mortality the probability of dying after the first month but before age one (1) IMCI: Components Improvement of case management skills of health workers Improving the health system to deliver IMCI Improving family and community practices Improving case management health workers Standard guidelines skills of

Improving the health system to deliver IMCI Essential drug supply and management Organization of work in health facilities Management and supervision Referral system Improving family and community practices For physical growth and development For disease prevention For appropriate home care For seeking care

mental

IMCI: Case Management Process HW assesses the sick child HW classifies childs illness using a color-coded triage HW then identifies SPECIFIC TREATMENT TREATMENT INSTRUCTIONS are carried out Counseling mothers Follow-up instructions! HW assesses the sick child IDENTIFY any danger sign present ASK about the four (4) main symptoms REVIEW nutrition, Vitamin A, and immunization status HW classifies childs illness using a color-coded triage PINK = urgent referral YELLOW = specific medical treatment and advice GREEN = simple advice on home care HW then identifies SPECIFIC TREATMENT INTEGRATED TREATMENT PLAN Decides referral (hospital) or home TREATMENT INSTRUCTIONS are carried out Referral: pre-referral treatment, convincing mothers to go to hospital, arranging for transport Home Care: continue feeding, fluids, and others (oral drugs, ORS); treat local infections; signs to come back immediately; when to return for routine follow-up

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