Public Health and Community Health Nursing

Concept of Public Health

Public Health Nursing defined...

 Science and art of preventing disease, prolonging life, promoting health and efficiency, through organized community effort for the sanitation of the environment, control of communicable diseases, the education of individuals in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery to ensure everyone a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to realize his birthright of health and longevity

-Dr. C.E. Winslow

Art of applying science in the context of politics so as

to reduce inequalities in health while ensuring the best health for the greatest number -WHO

Special field of nursing that combines the skills of

nursing, public health and some phases of social assistance and functions as part of the total public health programme for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability -WHO Expert Committee of Nursing

Core Business of Public Health

Disease control Injury prevention Health protection Healthy public policy including those in relation to

environmental hazards such as in the workplace, housing, food, water, etc. Promotion of health and equitable health gain

Principles of Public Health

y The client or unit of care is the population. y The primary obligation is to achieve the greatest good for the greatest y y y y y

number of people or the population as a whole. The processes used by public health nurses including working with the client(s) as an equal partner. Primary prevention is the priority in selecting appropriate activities. The focus is on selecting strategies that create healthy environmental, social and economic conditions in which populations may thrive. There is an obligation to actively identify and reach out to all who might benefit from a specific activity or service. Optimal use of available resources to assure the best overall improvement in the health of the populations is a key element of the practice. Collaboration with a variety of other professions, populations, organizations and other stakeholder groups is the most effective way to promote and protect the health of the people.

Essential Public Health Functions

 Health situation monitoring and analysis  Epidemiological surveillance/disease prevention and control  Development of policies and planning in public health  Strategic management of health systems and services for population health gain  Regulation and enforcement to protect public health  Human resources development and planning in public health  Health promotion, social participation, and empowerment  Ensuring the quality of personal and population based health services  Research, development and implementation of innovative public health solutions

Roles and Function of the Public Health Nurse

Management function: - Planning - Organizing - Staffing - Directing - Controlling

Supervisory function:

-supervisor of midwives and other auxilliary health workers -formulates a supervisory plan and conducts supervisory visits to implement the plan -conducts supervisory visits using a supervisory checklist

Nursing care function:

-based on the science and art of caring -uses knowledge and skill in the nursing process -establishes rapport with the client to ensure good quality data and to facilitate or enhance partnership in addressing identified health needs and problems -home visit is a must activity for a PHN

Collaborating and coordinating function:

-establishes linkages and collaborative relationships with other health professionals, government agencies, the private sector, non-government organizations, and people s organizations to address health problems

Health promotion and education function:

-uses skills in advocacy for the creation of supportive environment through policies and reengineering of the physical environment for healthier actions -provides clients with information that allows them to make healthier choices and practices -health education activities is a major component of any public health program

 Training function:

-initiates the formulation of staff development and training programs for midwives and other auxiliary workers -does training needs assessment, designs training program and conducts them in collaboration with other resource persons, and evaluates training outcomes -community organizing is a means of mobilizing people to solve their own problems

Research function:

-disease surveillance is a research activity of a nurse -surveillance is an integral part of many programs -data collected can be used to improve strategies and thus prevent these diseases from occuring

Concept of CHN

Community Health Nursing defined...

The utilization of the nursing process in the different

levels of clientele namely the INDIVIDUALS, FAMILIES, POPULATION GROUPS, and COMMUNITIES, concerned with the promotion of health, prevention of disease and disability, and rehabilitation

A learned practice discipline with the ultimate goal of

contributing as individuals and in collaboration with others to the promotion of the client s optimum level of functioning through teaching and delivery of careJacobson

A service rendered by a professional nurse with

communities, groups, families, individuals at home, in health centers, in clinics, in schools, in places of work for the promotion of health, prevention of illness, care of the sick at home and rehabilitation-Ruth B. Freeman

Goals and Objectives of CHN

y Refer to Community Health Nursing by Cuevas, pp. 16-

20

CHN IS A SYNTHESIS OF NURSING AND PUBLIC HEALTH PRACTICE:  emphasis on the importance of the greatest good for the greatest number  assessing health needs PLANNING, IMPLEMENTING, and EVALUATING the impact of health services on population groups  priority of HEALTH-PROMOTIVE and DISEASE-PREVENTIVE over CURATIVE interventions  tools for measuring and analyzing community health problems  application of principles of management and organization in the delivery of health services to the community

BASIC CONCEPTS AND PRINCIPLES OF CHN:  the FAMILY is the unit of care, the community is the patient and there are four levels of clientele in CHN  the goal of improving community health is realized through multidisciplinary effort  the community health nurse works WITH and not FOR the individual patient, family, group or community. The latter are active partners, not passive recipients of care  the practice of CHN is affected by changes in society in general and by developments in the health field in particular  CHN is part of the community health system which in turn is part of the larger human services system

Roles of the Nurse in Caring for Communities and Population Groups

 CLINICIAN

health care provider, taking care of the sick people at home or in the RHU  HEALTH EDUCATOR aim is towards health promotion and illness prevention through dissemination of correct information; educating people  FACILITATOR establishes multi-sectoral linkages by referral system  SUPERVISOR monitors and supervises the performance of midwives

Other specific responsibilities of a Nurse spelled by the implementing rules and regulations of R.A. 7164 (Phil. Nursing Act of 1991)
 supervision and care of women during pregnancy,

labor, and puerperium  performance of internal examination and delivery of babies  suturing lacerations in the abscence of the physician  provision of first aid measures and emergency care  recommending herbal and symptomatic meds.

In the care of the families:

 provision of primary health care services  developmental/utilization of family nursing care

plan in the provision of care

In the care of the communities:

 community organizing mobilization, community

development, and people empowerment  case finding and epidemiological investigation  program planning, implementation, and evaluation  influencing executive and legislative individuals or bodies concerning health and development

Specialized Field in Community and Public Health Nursing

School Health Nursing -primarily determined by the characteristics of their clientele-age, developmental stage, and their common health problems and concerns -determinants of school health nursing practice include policies and standards of DECS and the DOH and standards of the nursing profession -aims at promoting the health of school children and preventing health problems that would hinder their learning and performance of their developmental task

Occupational Health Nursing

-nursing in the workplace -provides for and delivers health care services to workers and worker population -focuses on promotion, protection, and restoration of worker s health within the context of a safe and healthy work environment -foundation for occupational health nursing practice is research-based with an emphasis on optimizing health, preventing illness and injury, and reducing health hazards -aimed at assisting workers in all occupations to cope with actual and potential stresses in relation to their work and work environment. It is primarily geared at helping workers attain and maintain optimum level of physical and psychological functioning -determinants of occupational health nursing practice are government policies and standards (DOLE, DOH, SSS, Phil. Health Insurance Corporation, Employees Compensation Commission) and professional standards such as those recommended by the Occupational Health Nurses Association of the Phils. And the PNA

Community Mental Health Nursing

-a unique clinical process which includes an integration of concepts from nursing, mental health, social psychology, psychology, community networks and the basic sciences

Executive Order 102 (The DOH)

VISION: Health for ALL in the Philippines MISSION: Guarantee equitable, sustainable, and quality health for all Filipinos, especially the poor and shall lead the quest for excellence in health GOAL: Health Sector Reform Agenda (HSRA) through sound organizational development, strong policies, systems, and procedures, capable human resources, and adequate financial resources

Roles and Functions

y Leadership in Health y Enabler and Capacity Builder y Administrator of Specific Services

Millennium Developmental Goals

(Based on the fundamental values of freedom, equality, solidarity, tolerance, health, respect for nature, and shared responsibility) 1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AIDS, malaria, and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development

Health Sector Reform Agenda 1999-2004

5 major reforms contained in HSRA:  Provide fiscal autonomy to government hospitals  Secure funding for priority public health programs  Promote the development of local health systems and ensure its effective performance  Strengthen the capacities of health regulatory agencies  Expand the coverage of the National Health Insurance Program

Rationale for HSRA

 Slowing down in the reduction in the IMR and the

MMR  Persistence of large variations in health status across population groups and geographic areas  High burden from infectious diseases  Rising burden from chronic and degenerative diseases  Unattended emerging health risks from environmental and work related factors  Burden of disease is heaviest on the poor

Reasons why the Rationale for HSRA still exist...

 Inappropriate health delivery system  Inadequate regulatory mechanisms for health

services  Poor health care financing and inefficient sourcing or generation of funds for healthcare IMPLICATIONS:  Poor coverage of public health and primary care services  Inequitable access to personal health care services  Low quality and high cost of both public and personal health care

FOURmula ONE for Health

Goals : - better health outcomes - more responsive health systems - equitable health care financing 4 ELEMENTS of the strategy: Health Financing-foster greater, better, and sustained investments in health Health Regulation-to ensure the quality and affordability of health goods and services Health Service Delivery-to improve and ensure the accessibility and availability of basic and essential health care in both public and private facilities and services Good Governance-to enhance health system performance at the national and local levels KEY FEATURE-National Health Insurance Program (NHIP)  Financing-reduces the financial burden placed on Filipinos  Governance-as it is a prudent purchaser of health care thereby influencing the health care market and related institutions  Regulation-accreditation and payments based on quality acts as a driver for improved performance in the health sector  Service delivery-demands fair compensation for the costs of care directed at providing essential goods and services in health

Primary Health Care As An Approach To Delivery Of Health Care Services

 Declared during the 1st International Conference on

Primary Health Care held in Alma Ata, USSR on Sept. 6-12, 1978 by WHO  Goal: Health for all by the year 2000  Adopted in the Phils. through Letter of Instruction 949 signed by Pres. Marcos on Oct. 19, 1979  Theme: Health in the Hands of the People by 2020

Levels of Health Care and Referral System

 Primary Level of Care

-devolved to the cities and municipalities -health care provided by health center physicians, PHN, RHM, BHW, traditional healers and others at the barangay health stations and RHU  Secondary Level of Care -given by physicians with basic health trainings -given in health facilities privately owned or government operated such as infirmaries, municipal and district hospitals, and OPD of provincial hospitals -capable of performing minor surgeries and simple laboratory exams  Tertiary Level of Care -rendered by specialists in health facilities including medical centers as well as regional and provincial hospitals, and specialized hospitals -complicated cases and intensive care requires tertiary care

Public health nurses need to know the laws affecting health and nursing practice in the Philippines. As practicing nurse in the community setting, the PHN must be familiar with the existing laws and standards that governs safe nursing practice.

Types of Laws/Policies: Republic Acts Administrative Orders Department Memorandum Executive Orders Presidential Decrees

Republic Acts Laws (RA's) created by the Congress and signed by the President. Administrative Orders Prescribed policies, rules, and regulations and procedures (AO's) individuals and organizations outside of the DOH. Department Memorandum Issuances that deals usually with guidelines/reminders of action and obligations of all or group of offices within the Department . Executive Orders Executive legislations (EO's) that are health-related. Presidential Decrees Executive decrees (PD's) that are health-related.

Magna Carta of Public Health Workers

Republic Act 7305

Magna Carta any fundamental constitution or law guaranteeing rights and liberties

RULE I COVERAGE

These Rules and Regulations shall cover all person engaged in health and health-related work, employed in all hospital, sanitaria, health centers, rural health units, barangay health station, clinics and other health-related establishments owned and operate by the government or its political subdivisions, regardless of the employment status. Also covered are medical and allied professional and support services personnel.

RULE II INTERPRETATION This Act aims: To promote and improve the social and economic wellbeing of health workers, their living and working conditions and terms of employment To develop their skills and capabilities in order that they will be more responsive and better equipped to deliver health projects and programs To encourage those with proper qualifications and excellent abilities to join and remain in government

CODE ON SANITATION
PRESIDENTIAL DECREE No. 856

The Code on Sanitation provides for the control of all factors in man s environment that affect health including the quality of water, food, milk, control of insects, animal carriers, transmitters of disease, sanitary and recreation facilities, noise, pollution, unpleasant odors and control of nuisance.

CLEAN AIR ACT

REPUBLIC ACT NO. 8749

AN ACT PROVIDING FOR A COMPREHENSIVE AIR POLLUTION CONTROL POLICY AND FOR OTHER PURPOSES
The State shall protect and advance the right of the people to a balanced and healthful ecology in accord with the rhythm and harmony of nature. The State shall promote and protect the global environment to attain sustainable development while recognizing the primary responsibility of local government units to deal with environmental problems. The State recognizes that the responsibility of cleaning the habitat and environment is primarily area-based. Finally, the State recognizes that a clean and healthy environment is for the good of all and should therefore be the concern of all.

The following rights of citizens are hereby sought to be recognized and the State shall seek to guarantee their enjoyment: The right to breathe clean air;
1. The right to utilize and enjoy all natural resources according to the principle of sustainable development; 2. The right to participate in the formulation, planning, implementation and monitoring of environmental policies and programs and in the decision-making process; 3. The right to participate in the decision-making process concerning development policies, plans and programs projects or activities that may have adverse impact on the environment and public health; 4. The right to be informed of the nature and extent of the potential hazard of any activity, undertaking or project and to be served timely notice of any significant rise in the level pollution and the accidental or deliberate release into the atmosphere of harmful or hazardous substances; 5. The right of access to public records which a citizen may need to exercise his or her rights effectively under this Act; 6. The right to bring action in court or quasi-judicial bodies to enjoin all activities in violation of environmental laws and regulations, to compel the rehabilitation and cleanup of area, and to seek the imposition of penal sanctions against violators of environmental laws; and 7. The right to bring action in court for compensation of personal damages resulting from the adverse environmental and public health impact of a project or activity.

Generics Act
Republic Act 6675

The Generics Act of 1988 which promotes, requires and ensures the production of an adequate supply, distribution, use and acceptance of drugs and medicines identified by their generics name.

Statement of Policy
To promote, encourage and require the use of generic terminology in the importation, manufacture, distribution, marketing, advertising and promotion, prescription and dispensing of drugs; To ensure the adequate supply of drugs with generic names at the lowest possible cost and endeavour to make them available for free to indigent patients; To encourage the extensive use of drugs with generic names through a rational system of procurement and distribution; To emphasize the scientific basis for the use of drugs, in order that health professionals may become more aware and cognizant of their therapeutic effectiveness; and To promote drug safety by minimizing duplication in medications and/or use of drugs with potentially adverse drug interactions.

National Health Insurance Act

REPUBLIC ACT NO. 7875

National Health Insurance Act of 1995 This Act seeks to: a. provide all citizens of the Philippines with the mechanism to gain financial access to health services; b. create the National Health Insurance Program, hereinafter referred to as the Program, to serve as the means to help the people pay for health care services; c. prioritize and accelerate the provisions of health services to all Filipinos, especially that segment of the population who cannot afford such services; and d. establish the Philippine Health Insurance Corporation, hereinafter referred to as the Corporation, that will administer the Program at central and local levels.

National Blood Services Act

REPUBLlC ACT No.7719

National Blood Services Act of 1994

AN ACT PROMOTING VOLUNTARY BLOOD DONATION, PROVIDING FOR AN ADEQUATE SUPPLY OF SAFE BLOOD. REGULATING BLOOD BANKS. AND PROVIDING PENALTIES FOR VIOLATION THEREOF

In order to promote public health, it is hereby declared the policy of the State:
a. to promote and encourage voluntary blood donation by the citizenry and to instil public consciousness of the principle that blood donation is a humanitarian act; to lay down the legal principle that the provision of blood for transfusion is a professional medical service and not a sale of a commodity; to provide for adequate, safe, affordable and equitable distribution of supply of blood and blood products; to inform the public of the need for voluntary blood donation the hazards caused by the commercial sale of blood; to teach the benefits and rationale of voluntary blood donation existing health subjects of the formal education system in all public /private schools, in the elementary, high school and college levels as the non-formal education system; to mobilize all sectors of the community to participate in mechanisms for voluntary and non-profit collection of blood;

b.

c. d. e.

f.

g.

h.

i. j. k. l.

to mandate the Department of Health to establish and organize a National Blood Transfusion Service Network in order to rationalize and improve the provision of adequate and safe supply of blood; to provide for adequate assistance to institutions promoting non-profit blood services, either through a system of reimbursement for costs from patients who can afford to pay, or donations from governmental and non-governmental entities; to require all blood collection units and blood banks/center to operate on a non-profit basis; to establish scientific and professional standards for the operation of blood collection units and blood banks/center in the Philippines; to regulate and ensure the safety of all activities related to the collection, storage and banking of blood; and to require upgrading of blood banks/center to include preventive services and education to control spread of blood transfusion transmissible diseases.

Senior Citizens Act

Republic Act No. 9257

Expanded Senior Citizens Act of 2003

AN ACT GRANTING ADDITIONAL BENEFITS AND PRIVILEGES TO SENIOR CITIZENS AMENDING FOR THE PURPOSE REPUBLIC ACT NO. 7432, OTHERWISE KNOWN AS AN ACT TO MAXIMIZE THE CONTRIBUTION OF SENIOR CITIZENS TO NATION BUILDING, GRANT BENEFITS AND SPECIAL PRIVILEGES AND FOR OTHER PURPOSES

DANGEROUS DRUG ACT

REPUBLIC ACT No. 9165

Comprehensive Dangerous Drug Act of 2002

The Comprehensive Dangerous Drugs Act of 2002 (R.A. 9165) provides for stiffer penalties for illegal drug possession and pushing. It imposes capital punishment on those convicted for selling, trading, trafficking, importing and cultivating dangerous drugs and their controlled precursors. The same penalty is also imposed on those who possessed 10 grams or more of opium, morphine, heroin, cocaine, ecstasy and other dangerous drugs as listed in the annex of the law, 50 grams or more of shabu, 500 grams of marijuana. For the possession of lesser quantities of the same drugs mentioned above, the law imposes the penalty of life imprisonment. But persons found guilty of possessing less than five grams of the drugs listed in the annex would be meted a 12-year prison term.

Stiff penalties are also been imposed on convicted dangerous drug financiers, protectors, coddlers and traders who use cellular phones and the Internet in making illegal deals. The new law seeks the speedy destruction of seized dangerous drugs as it provides punishment for policemen and prosecutors who delay or bungle drug cases. To protect the people from the bad effects of dangerous drugs, the new law provides mandatory drug tests for drivers and firearms holders, random drug tests for students and workers in the government and private sectors, and compulsory education on dangerous drugs in all school levels. RA 9165 also gives Congress oversight functions over drug cases, while providing funds to fully implement the law. An initial P25 million has been appropriated for various activities.

CHEAPER MEDICINE ACT

REPUBLIC ACT NO. 9502

Universally Accessible Cheaper and Quality Medicines Act of 2008

aims to bring down the price of medicines by encouraging more competition in the local market through parallel importation of cheaper but quality drugs.

LAWS ON NOTIFIABLE DISEASE

DEPARTMENT CIRCULAR No. 176 S. 2001

A notifiable disease is any disease that is required by law to be reported to government authorities. This collation of information allows the authorities to monitor the disease, and provides early warning of possible outbreaks. Many governments have enacted regulations for reporting of both human and animal (generally livestock) diseases. This usually happens during pandemics.

Purpose of Notification
I. Immediate Purposes: Serves as a warning device for local health authorities in the occurrence of diseases for immediate action. Stimulate prompt action for preventing the spread of infectious disease Institute preventive and control measures Educate public to observe precautionary measures. II. Subsequent Purposes: To obtain specific knowledge that will serve as a basis in planning more effective program for prevention and control of those diseases Information used for the epidemiological study on the natural history of diseases. To provide statistical material to those engaged in medical research. To meet the needs of commercial organization in planning & development of their services and products.

Notifiable Diseases

Notifiable Diseases

PRIMARY HEALTH CARE

y Essential health care made universally

accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country can afford at every stage of development (WHO)

GOAL: Health for all Filipinos and Health in the Hands of the People by the year 2020 MISSION: To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care

Characteristics
1.

Partnership and empowerment of the people as the core strategy in the effective provision of essential health services that are community based, accessible, acceptable and sustainable at a cost which the community and government can afford. Strategy responsible for the health of individuals, his family and the community

2.

3. Full participation and active involvement of the

community towards the development of self-reliant people.

4. Recognizes the inter-relationship between health

and the overall political, socio-cultural and economic development of society.

y First International Conference of Primary

Health Care 6-12, 1978

Alma Ata USSR, September

y Letter of Instruction (LOI) 949

October 19, 1979 by Former President Ferdinand Marcos

Strategies:
1.

2. 3.

Establishment of functional support mechanism in support of the Mandate of Devolution under Local Government Code of 1991. Effective preparation and enabling process for health action at all levels Mobilization of the people to know their community, identifying their basic health needs and providing appropriate solutions on their own. (Self-reliance, Self-determination)

4. Development and utilization of appropriate

5. 6.

7. 8.

technology focusing on local indigenous resources available. Community organization as it continually evolves in pursuit of their own development. Increased opportunities for community participation in planning, management, monitoring and evaluation. Development of intra-sectoral linkages Partnership between health worker and the community

Health Education
Is one of the potent methodologies for information dissemination. It promotes the partnership of both the family members and health workers in the promotion of health as well as prevention of illness.

Health Education
- Process whereby knowledge, attitude and practice of

people are changed to improve individual, family and community health - Basic health services provided by every member of the health care team - Means of improving health of people by using various methods to show the most healthful ways of living

Teaching Methods and Strategies

1. 2. 3. 4. 5. 6.

Interview Counselling Lecture- Discussion Open forum Workshop Case study

Locally Endemic Disease Control

The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate.

Locally Endemic Diseases

1. Schistosomiasis
- caused by a blood fluke Schistosoma Japonicum transmitted by a tiny snail oncomelania quadrasi. S/Sx diarrhea, bloody stools, enlargement of abdomen, spleenomegaly, weakness, anemia, inflamed liver.

Mode of transmission: Skin penetration from contaminated fresh water Methods of control: A. Preventive Measures 1. education regarding mode of transmission 2. proper waste disposal 3. improve irrigation and agricultural practices 4. Treatment of snail-breeding sites

5. Proper hygiene and safety practices (wearing of boots, etc) 6. Safe water for drinking, bathing and washing clothes. 7. Treatment of infected patients to prevent further transmission. B. Control 1. Report to local health authority

2. Filariasis - chronic parasitic infection caused by nematodes Wuchereria bancrofti, Brugia malayi or Brugia timori. Mode of Transmission: Mosquito bites ( Aedes poecilius) S/Sx: Lymphadenitis, lymphangitis, lymphedema, elephantiasis

hydrocoele,

Prevention and Control: A. Control of vector - environmental sanitation - use of insecticides B. Protection - use of mosquito nets - use of long sleeves, long pants and socks - insect repellents - health education

3. Malaria - produced by Plasmodium falciparum, P. Vivax, P. ovale, P. malariae. Mode of Transmission: - mosquito bites S/Sx - recurrent chills, fever, profuse sweating, anemia, malaise, hepatomagaly, spleenomegaly.

Prevention and Control a. treatment of mosquito net b. house spraying c. on stream seeding d. on stream clearing e. wearing long clothing f. avoiding outdoor night activities g. using mosquito repellents h. planting neem tree

Expanded Program on Immunization

This program exists to control the occurrence of preventable illnesses especially of children below 6 years old. Immunizations on poliomyelitis, measles, tetanus, diphtheria and other preventable disease are given for free by the government and ongoing program of the DOH

Expanded Program on Immunization

- Vaccination among infants and newborns (0-12

months) against 7 vaccine preventable diseases. - Fully immunized one dose BCG

3 doses OPV 3 doses DPT 3 doses Hep B one dose measles BEFORE 1ST Birthday

EPI
y TARGET SETTING: 1. INFANTS 0-12 MONTHS 2. PREGNANT AND POST PARTUM WOMEN 3. SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS OLD y OBJECTIVES OF EPI:

TO REDUCE MORBIDITY AND MORTALITY RATES AMONG INFANTS AND CHILDREN from SIX CHILDHOOD IMMUNIZABLE DISEASE

Age at No. of Vaccine st 1 Dose doses

BCG Birth or anytime after Birth or anytime after 6 weeks 1

Interval

Route
ID

Hep B

4 weeks

IM

DPT

4 weeks

IM

Age at No. of Vaccine st 1 Dose doses

OPV 6 weeks 9 mos 3

Interval
4 weeks

Route
oral SQ

Measles

Tetanus Toxoid
Vaccine
TT1

Duration Min. Age % Protected of Protection

As early as possible Infants protected, 3 years for mother 5 years for mother

TT2

4 weeks later

80%

TT3

6 mos later

95%

Vaccine

Min. Age
At least 1 year later At least 1 year later

% Protected
99%

Duration of Protection
10 years for mother Lifetime protection for mother

TT4

TT5

99%

Maternal & Child Health & Family Planning

The mother and child are the most delicate members of the community. So the protection of the mother and child to illness and other risks would ensure good health for the community. The goal of Family Planning includes spacing of children and responsible parenthood.

FAMILY HEALTH
AIMS TO: - Improve the survival, health and well-being of mothers and the unborn - Reduce morbidity and mortality rates for children 0-9 years - Reduce mortality from preventable causes among adolescent and young adults - Reduce morbidity and mortality among Filipino adults - Reduce morbidity and mortality of older persons

Maternal Health
- To reduce the maternal mortality ratio by three

quarters by 2015. Thrusts for 2005-2010 - Launch and implement the Basic emergency Obstetric Care - Improve quality of pre and postnatal care - Reduce women s exposure to health risks - LGU and NGOs must advocate health

Essential Health Services Antenatal Registration Tetanus Toxoid Immunization Micronutrient Supplementation y Vitamin A and Iron 4. Treatment of Diseases and other conditions. 5. Clean and Safe Delivery 6. Support to Breast Feeding 7. Family Planning Counselling
1. 2. 3.

FAMILY PLANNING PROGRAM - Overall goal is to provide universal access to family planning information and services wherever and whenever these are needed

Methods of Family Planning: 1. Female sterilization 2. Male sterilization 3. Pill 4. Male condom 5. Injectables 6. Lactating Amenorrhea (LAM) 7. Mucus/Billings/Ovulation 8. Basal Body Temperature 9. Sympto-thermal Method 10. Two day Method 11. Standard Days Method

Misconceptions:
- Some family planning methods causes

abortion - Causes sterility - Loss of sexual desire

Child Health
- Reduce morbidity and mortality rates for children 0-9

years Infant and Young Child feeding - Improve the survival of infants and young children by improving their nutritional status, growth and development through optimal feeding

Key Points; - Initiate breastfeeding within 1 hour after birth - Exclusive for the first 6 months of life - Complemented at 6 months with appropriate foods - Extend breastfeeding up to two years and beyond

Laws on Infant and Young Child Feeding Milk Code (EO 51) 2. Rooming-in and Breastfeeding Act of 1992 3. Food Fortification Law or Food Fortification Law ( Ra 8976)
1.

Nutrition Program
y
y

Goal:
To improve the quality of life of Filipinos through better nutrition, improved health and increased productivity.

Programs: 1. Micronutrient supplementation - Twice a year distribution of Vitamin A to 6-71 month olds - Iron supplements to target groups

2. Food Fortification - Food Fortification act of 2000 provides for mandatory fortification of: flour- with iron and vitamin A cooking oil and refined sugar with Vit A rice with iron and household utilization of iodized salt

3. Essential Maternal and Child Health Service Package 4. Nutrition information, communication and education 5. Home, school and community Food Production - establishment of kitchens and gardens in homes and schools to serve as source of additional food.

6. Food Assistance - food discounts and rice distribution 7. Livelihood Assistance - provision of credit and livelihood opportunities

Non-Communicable Diseases
A. Cardiovascular Diseases

1. Hypertension- sustained elevation in mean arterial pressure Risk Factors: Family history, age, high salt intake, obesity, excessive alcohol intake

y Prevention

- encourage proper nutrition (low fat and salt intake) - weight reduction - smoking cessation - identify people with risk factors and encourage regular check-ups

2. Coronary Artery Disease caused by impaired coronary blood flow. Also known as ischemic heart Disease Risk Factors: elevated blood lipids/cholesterol, smoking/tabacco use

Prevention; - promote regular physical activity -encourage proper nutrition - maintain normal body weight - advise smoking cessation - early diagnosis, prompt treatment and control

3. Cerebrovascular Disease or Stroke - loss or alteration of bodily function that results from an insufficient supply of blood to some parts of the brain. Risk Factors: Increasing age, sex, heredity and race, hypertension, cigarette smoking, diabetes mellitus, heart disease, high rbc count, season and climate, socioeconomic factors, excessive alcohol intake, drug abuse

Prevention: - Treatment and control of hypertension - smoking cessation - prevent thrombus formation with medications - limit alcohol intake - avoid intravenous drug abuse - prevent all other risk factors of atherosclerosis

B. Cancer - cancer develops when cells in part of the body begin to grow out of control Causes: Hereditary, carcinogens, chemicals and environmental agents, benzopyrene, nitrosamines, radiation, viruses.

Prevention: - smoking cessation - proper nutrition - limit alcohol consumption - weight control - early detection and treatment

3. Diabetes Mellitus Type I characterized by absolute lack of insulin due to damaged pancreas, prone to develop ketosis, and dependent on insulin injections Risk factors: genetic, environment or viruses and chemical toxins Type II fasting hyperglycemia despite availability of insulin. Risk factors: family history, overweight, sedentary lifestyle, hypertension, high cholesterol

Prevention: - maintain normal body weight - encourage proper nutrition - promote regular physical activity - smoking cessation

4. Chronic Obstructive Pulmonary Disease - airflow limitation that is not fully reversible. Risk Factor: cigarette smoking

5. Bronchial Asthma - inflammatory disorder of the airways Risk factors: Hereditary, allergy, gender, race, environmental factors (allergens), smoke, infections, diet and drugs, obesity

Prevention: - recognize triggers - avoid triggers - promote exclusive breastfeeding as long as possible

Healthy Lifestyle
Healthy Lifestyle- a way of life that promotes and protects health and well-being Promotion of healthy lifestyle is imperative to preventing these non communicable diseases.

1.

Promoting physical activity - at least 30 minutes, cumulative, moderate intensity, most days of the week - at least 30 minutes, cumulative, vigorous intensity 3 times a week

2. Promoting Proper Nutrition Strategies: - Aim for ideal body weight -Build healthy nutrition-related practices -Choose foods wisely

Nutrition & Promotion of Adequate Food Supply

One basic need of the family is food. And if food is properly prepared then one may be assured healthy family. There are many food resources found in the communities but because of faulty preparation and lack of knowledge regarding proper food planning, Malnutrition is one of the problems that we have in the country.

y Nutrition Guide fro Filipinos

- eat a variety of foods everyday - breastfeed exclusively up to 6 months - maintain children s normal growth - consume fish, lean meat, poultry or dried beans - eat more vegetables, fruits and root crops - eat foods cooked in edible/cooking oil daily - consume milk and milk products and other calcium rich foods everyday - use iodized salt - eat clean and safe food - exercise regularly, do not smoke and avoid alcoholic beverages

Supply of Essential Drugs

This focuses on the information campaign on the utilization and acquisition of drugs. In response to this campaign, the GENERIC ACT of the Philippines is enacted . It includes the following drugs: Cotrimoxazole, Paracetamol, Amoxycillin, Oresol, Nifedipine, Rifampicin, INH(isoniazid) and Pyrazinamide,Ethambutol, Streptomycin,Albendazole,Quinine

Treatment of Communicable Diseases

The diseases spread through direct contact pose a great risk to those who can be infected. Tuberculosis is one of the communicable diseases continuously occupies the top ten causes of death. Most communicable diseases are also preventable. The Government focuses on the prevention, control and treatment of these illnesses.

Communicable Diseases
1.

Tuberculosis worlds deadliest disease - highly infectious chronic disease caused by Mycobacterium tuberculosis, M. africanum, M. bovis. Mode of transmission: -airborne droplet

S/Sx: cough for 2 weeks or more, fever, chest or back pains, hemoptysis, significant weight loss, body malaise, fatigue, shortness of breath Prevention: - prompt diagnosis and treatment - BCG vaccination - education - improve social conditions - make available medical facilities - home supervision of patients

TB DOTS (National TB Control Program) Recommended Category Treatment Regimen Category I Type New + smear, New smear but extensive lesions in CXR, EPTB, HIV Intensive Continuation treatment 2HRZE 4HR

Category II

Type Tx failure, relapse, return after default, others New smear with min lesions Chronic + smear after treatment

Intensive Continuation treatment 2HRZES/1 5HRE HRZE

III

2HRZE

4HR

IV

Refer to DOTS plus center

2. Dengue Hemorrhagic Fever -caused by Aedes Aegypti bite 3 stages: First 4 days invasive stage high fever, abdominal pain and headache, later flushing which may be accompanies by vomiting, conjunctival infection and epistaxis 4th - 7th days Toxic/ hemorrhagic stage lowering of temp, severe abdominal pain, vomiting, frequent bleeding from GIT, unstable BP, (+) torniquet test

y 7th -10th days convalescent or recovery stage

generalized flushing, appetite regained, blood pressure stable Prevention: - early recognition of the disease - isolation of patient - epidemiological investigation - case finding - health education

Prevention: - eliminate vectors by changing stagnant water once a week - destroy breeding places - proper disposal of rubber tires, empty bottles, cans - keep water containers covered - avoid too many hanging clothes - residual spraying of insecticides

3. Measles - acute highly communicable infection Mode of transmission: - droplet spread or direct / indirect contact S/Sx fever, rashes, coryza, koplik spots

Prevention: - avoid exposure - isolation of cases until 5-7 days after onset of rash - vaccination

4. Hepatitis A - acute hepatitis introduced by fecally contaminated water or food. S/Sx : headache, malaise, anorexia, abdominal pain, nausea/vomiting, fever, lymphadenopathy, jaundice

Prevention - ensure safe drinking water - sanitary preparation of food - proper waste disposal - handwashing - separate and proper cleaning of articles used by patient

5. Rabies - acute viral encephalomyelitis by rabies virus Mode of transmission: - bites of rabid animals, thru breaks in the skin S/Sx: sense of apprehension, headache, fever, sensory change near animal bite, spasms of muscles or deglutition, paralysis, delirium or convulsions

National Rabies Prevention and Control Strategies: - manpower development - social mobilization - local program implementation - dog immunization - conduct of dog vaccination - post-immunization evaluation

Environmental Sanitation & Promotion of Safe Water Supply

Environmental Sanitation is defined as the study of all factors in the man s environment, which exercise or may exercise deleterious effect on his well-being and survival. Water is a basic need for life and one factor in man s environment. Water is necessary for the maintenance of healthy lifestyle. Safe Water and Sanitation is necessary for basic promotion of health.

Safe Water and Sanitation

Policies: 1. approved types of water facilities - Level I (point source) protected well or developed spring with an outlet but without distribution system, serves 15-25 households, must not be more than 250 meters from the farthest user.

- Level II (Communal faucet system) composed of a source, reservoir, piped distribution network and communal faucets, not more than 25 meters fro the farthest house, one faucet per 46 households. - Level III (Waterworks systems) system with a source, reservoir, piped distributor network and household taps.

2. Unapproved type of water facility - water coming from doubtful sources shall not be allowed fro drinking water unless treated through proper container disinfection. 3. Access to safe and potable drinking water. - all households shall be provided with safe and adequate water. 4. Water quality and monitoring surveillance - done every year and must meet provisions of the National Standards for Drinking Water set by the DOH

5. Waterworks/water system and well construction - should comply with sanitary requirements of the Department of health.