Community Organizing Participatory Action Research (COPAR)
Definitions of COPAR
A social development approach that aims to transform the apathetic, individualistic and voiceless poor into dynamic, participatory and politically responsive community. A collective, participatory, transformative, liberative, sustained and systematic process of building people‘s organizations by mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards effecting change in their existing oppressive and exploitative ex ploitative conditions (1994 National Rural Conference) A process by which a community communit y identifies its needs and objectives, develops confidence to take action in respect to them and in doing so, extends and develops cooperative and collaborative attitudes and practices in the community (Ross 1967) A continuous and sustained process of educating the people to understand and develop their critical awareness of their existing condition, working with the people collectively and efficiently on their immediate and long-term problems, and mobilizing the people to develop their capability and readiness to respond and take action on their immediate i mmediate needs towards solving their long-term problems (CO: A manual of ex perience, PCPD)
Importance of COPAR
1. COPAR is an important tool for community development and people empowerment as this helps the community workers to generate community participation in d evelopment activities. 2. COPAR prepares people/clients to eventually take over the management of a
development programs in the future. 3. COPAR maximizes community participation and involvement; community resources are mobilized for community services.
Principles of COPAR
1. People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change and are able to bring about change. 2. COPAR should be based on the interest of the poorest sectors of society 3. COPAR should should lead to a self-reliant community and society.
COPAR Process
A progressive cycle of action-reflection action which begins with small, local and concrete issues identified by the people and the evaluation and the reflection of and on the action taken by them. Consciousness through experimental learning central to the COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action. COPAR is participatory and mass-based because it is primarily directed towards and biased in favor of the poor, the powerless and oppressed. COPAR is group-centered and not leader-oriented. Leaders are identified, emerge and are tested through action rather than appointed or selected by some external force or entity.
COPAR Phases of Process
1. Pre-entry Phase
Is the initial phase of the organizing process where the community/organizer looks for communities to serve/help. It is considered the simplest phase in terms of actual outputs, activities and strategies and time spent for it
Activities include: o
o o
Designing a plan for community development includ ing all its activities and strategies for care development. Designing criteria for the selection of site Actually selecting the site for community care
2. Entry Phase
development programs in the future. 3. COPAR maximizes community participation and involvement; community resources are mobilized for community services.
Principles of COPAR
1. People, especially the most oppressed, exploited and deprived sectors are open to change, have the capacity to change and are able to bring about change. 2. COPAR should be based on the interest of the poorest sectors of society 3. COPAR should should lead to a self-reliant community and society.
COPAR Process
A progressive cycle of action-reflection action which begins with small, local and concrete issues identified by the people and the evaluation and the reflection of and on the action taken by them. Consciousness through experimental learning central to the COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action. COPAR is participatory and mass-based because it is primarily directed towards and biased in favor of the poor, the powerless and oppressed. COPAR is group-centered and not leader-oriented. Leaders are identified, emerge and are tested through action rather than appointed or selected by some external force or entity.
COPAR Phases of Process
1. Pre-entry Phase
Is the initial phase of the organizing process where the community/organizer looks for communities to serve/help. It is considered the simplest phase in terms of actual outputs, activities and strategies and time spent for it
Activities include: o
o o
Designing a plan for community development includ ing all its activities and strategies for care development. Designing criteria for the selection of site Actually selecting the site for community care
2. Entry Phase
Sometimes called the social preparation phase as to the activities done here includes the sensitization of the people on the critical events in their life, innovating them to share their dreams and ideas on how to manage their concerns and eventually mobilizing them to take collective action on these. This phase signals the actual entry of the community worker/organizer into the community. She must be guided by b y the following guidelines however. o
o
o
Recognizes the role of local authorities by b y paying them visits to inform them of their presence and activities. The appearance, speech, behavior and lifestyle should be in keeping with those of the community residents without disregard of their being role models. Avoid raising the consciousness of the community residents; adopt a low-key profile.
3. Organization Building Phase
Entails the formation of more formal structures and the inclusion of more formal procedures of planning, implementation, and evaluating community-wide activities. It is at this phase where the organized leaders or groups are being given trainings (formal, informal, OJT) to develop their skills and in managing their own concerns/programs.
4. Sustenance and Strengthening Phase
Occurs when the community organization has already been established and the community members are already actively participating in communit y-wide undertakings. At this point, the different communities setup in the organization building p hase are already expected to be functioning by way of planning, implementing and evaluating their own programs with the overall guidance from the community-wide organization. Strategies used may include: o o o o o
Education and training Networking and linkaging Conduct of mobilization on health and development concerns Implementing of livelihood projects Developing secondary leaders
Communicable Diseases (Chronic)
Chronic 1. Tuberculosis
TB is a highly infectious chronic disease that usua lly affects the lungs.
Causative Agent: Mycobacterium Tuberculosis Sign/Symptoms:
cough afternoon fever weight loss night sweat blood stain sputum
Prevalence/Incidence:
ranks sixth in the leading causes of morbidity (with 114,221 cases) in the Philippines Sixth leading cause of mortality (with 28507 cases) in the Philippines.
Nursing and Medical Management
Ventilation systems Ultraviolet lighting Vaccines, such as the bacillus Calmette Guerin (BCG) vaccine drug therapy
Preventing Tuberculosis
BCG vaccination Adequate rest Balanced diet Fresh air Adequate exercise Good personal Hygiene
National Tuberculosis Control Program – key policies
Case finding – direct Sputum Microscopy and X-ray examination of TB symptomatics who are negative after 2 or more sputum exams
Treatment – shall be given free and on an ambulatory basis, except those with acute complications and emergencies Direct Observed Treatment Short Course – comprehensive strategy to detect and cure TB patients.
DOTS (Direct Observed Treatment Short Course)
Category 1- new TB patients whose sputum is positive; seriously ill patients with severe forms of smear-negative PTB with extensive parenchymal involvement (moderately- o r far advanced) and extra-pulmonary TB (meningitis, pleurisy, etc.) Intensive Phase (given daily for the first 2 months) - Rifampicin + Isioniazid + o pyrazinamide + ethambutol. If sputum result becomes negative after 2 months, maintenance ph ase starts. But o if sputum is still positive in 2 months, all drugs are discontinued from 2 -3 days and a sputum specimen is examined for culture and drug sensitivity. The pa tient resumes taking the 4 drugs for another month and then another smear exam is done at the end of the 3rd month. Maintenance Phase (after 3rd month, regardless of the result of the sputum o exam)-INH + rifampicin daily Category 2- previously-treated patients with relapses or failures. Intensive Phase (daily for 3 months, month 1, 2 & 3)-Isioniazid+ rifampicin+ o pyrazinamide+ ethambutol+ streptomycin for the first 2 months Streptomycin+ rifampicin pyrazinamide+ ethambutol on the 3rd month. If sputum is still positive after 3 months, the intensive phase is continued for 1 more month and then another sputum exam is done. If still positive after 4 months, intensive phase is continued for the next 5 months. Maintenance Phase (daily for 5 months, month 4, 5, 6, 7,& 8)-Isionazid+ o rifampicin+ ethambutol Category 3 – new TB patients whose sputum is smear negative for 3 times and chest xray result of PTB minimal Intensive Phase (daily for 2 months) – Isioniazid + rifampicin + pyrazinamide o Maintenance Phase (daily for the next 2 months) - Isioniazid + rifampicin o
2. Leprosy
Sometimes known as Hansen's disease is an infectious disease caused by , an aerobic, acid fast, rod-shaped mycobacterium Gerhard Armauer Hansen Historically, leprosy was an incurable and disfiguring disease Today, leprosy is easily curable by multi-drug antibiotic therapy
Signs & Symptoms Early stage (CLUMP)
Late Stage (GMISC)
Change in skin color Loss in sensation Ulcers that do not heal Muscle weakness Painful nerves
Gynocomastia Madarosis(loss of eyebrows) Inability to close eyelids (Lagopthalmos) Sinking nosebridge Clawing/contractures of fingers & nose
Prevalence Rate
Metro Manila, the prevalence rate ranged from 0.40 – 3.01 per one thousand population.
Management:
Dapsone, Lamprene clofazimine and rifampin Multi-Drug-Therapy (MDT) six month course of tablets for the milder form of leprosy and two years for the more severe form
Leprosy Control Program
WHO Classification – basis of multi-drug therapy Paucibacillary/PB – non-infectious types. 6-9 months of treatment. o Multibacillary/MB – infectious types. 24-30 months of treatment. o Multi-drug therapy – use of 2 or more drugs renders patients non-infectious a week after starting treatment Patients w/ single skin lesion and a negative slit skin smear are treated w/ a single o dose of ROM regimen For PB leprosy cases- Rifampicin+Dapsone on Day 1 then Dapsone from Day 2o 28. 6 blister packs taken monthly within a max. period of 9 mos. All patients who have complied w/ MDT are considered cured and no longer regarded as a case of leprosy, even if some sequelae of leprosy remain. Responsibilities of the nurse: Prevention – health education, healthful living through p roper nutrition, adequate o rest, sleep and good personal hygiene; Casefinding o Management and treatment – prevention of secondary injuries, handling o f o utensils; special shoes w/ padded soles; importance of sustained therap y, correct dosage, effects of drugs and the need for medical check-up from time to time; mental & emotional support Rehabilitation -makes patients capable, active and self-respecting member of o society.
Communicable Disease (Vector Borne)
Leptospirosis (Weil’s disease)
An infectious disease that affects humans and animals, is c onsidered the most common zoonosis in the world
Causative Agent: Leptospira interrogans Sign/Symptoms:
High fever Chills Vomiting Red eyes Diarrhea Severe headache muscle aches may include jaundice (yellow skin and eyes) abdominal pain
Treatment: PET - > Penicillins, Erythromycin, Tetracycline
Malaria
Malaria (from Medieval Italian: mala aria - "bad air"; formerly called ague or marsh fever) is an infectious disease that is widespread in many tropical an d subtropical regions.
Causative Agent: Anopheles female mosquito Signs & Symptoms:
Chills to convulsion Hepatomegaly Anemia Sweats profusely Elevated temperature
Treatment:
Chemoprophylaxis – chloroquine taken at weekly interval, starting from 1-2 weeks before entering the endemic area. Anti-malarial drugs – sulfadoxine, quinine sulfate, tetracycline, quinidine Insecticide treatment of mosquito nets, house spraying, stream seeding an d clearing, sustainable preventive and vector control meas
Preventive Measures: (CLEAN)
Chemically treated mosquito nets Larvae eating fish Environmental clean up Anti mosquito soap/lotion Neem trees/eucalyptus tree
Filariasis
name for a group of tropical diseases caused b y various thread-like parasitic round worms (nematodes) and their larvae larvae transmit the disease to humans through a m osquito bite can progress to include gross enlargement of the limbs and genitalia in a condition called elephantiasis
Sign/Symptoms:
Asymptomatic Stage
Characterized by the presence of microfilariae in the peripheral blood No clinical signs and symptoms of the disease Some remain asymptomatic for years and in some instances for life
Acute Stage
Lymphadenitis (inflammation of lymph nodes) Lymphangitis (inflammation of lymph vessels) In some cases the male genitalia is affected leading to orchitis (redness, painful and tender scrotum)
Chronic Stage
Hydrocoele (swelling of the scrotum) Lyphedema (temporary swelling of the upper and lower extremities Elephantiasis (enlargement and thickening of the skin of the lower and / or upper extremities, scrotum, breast)
Management:
Diethylcarbamazine citrate or Hetrazan Ivermectin, Albendazolethe No treatment can reverse elephantiasis
Schistosomiasis
parasitic disease caused by a larvae
Causative Agent: Schistosoma intercalatum, Schistosoma japonicum, Schistosoma mansoni Signs & Symptoms: (BALLIPS)
Bulging abdomen A bdominal pain Loose bowel movement Low grade fever Inflammation of liver & spleen Pallor Seizure
Preventive measures
health education regarding mode of transmission and methods of protection; proper disposal of feces and urine; improvement of irrigation and a griculture practices Control of patient, contacts and the immediate environment
Treatment:
Diethylcarbamazepine citrate (DEC) or Praziquantel (drug of choice)
Dengue
DENGUE is a mosquito-borne infection which in recent years has become a major international public health concern.. It is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas.
Sign/Symptoms: (VLINOSPARD)
Vomiting Low platelet
Nausea Onset of fever Severe headache Pain of the muscle and joint A bdominal pain R ashes Diarrhea
Treatment:
The mainstay of treatment is supportive therapy. Intravenous fluids o A platelet transfusion o
Control of Diarrheal Diseases (CDD)
Management of the Patient with Diarrhea A. No Dehydration
Condition – well, alert Mouth and Tongue – moist Eyes – normal Thirst – drinks normally, not thirsty Tears – present Skin pinch – goes back quickly TREATMENT PLAN A- HOME Treatment.
Three Rules for Home Treatment
1. Give the child more fluids than usual use home fluid such as cereal gruel o give ORESOL, plain water o 2. Give the child plenty of food to prevent under nutrition continue to breastfeed frequently o if child is not breastfeed, give usual milk o if child is less than 6 months and not yet taking solid food, dilute milk for 2 days o if child is 6 months or older and already taking solid food, give cereal or other o starchy food mixed with vegetables, meat or fish; give fresh fruit juice or mashed banana to provide potassium; feed child at least 6 times a day. After diarrhea stops, give an extra meal each day for two weeks. 3. Take the child to the health worker if the child does not get better in 3 days or develops any of the following: many watery stools o repeated vomiting o marked thirst o eating or drinking poorly o fever o blood in the stool o Oresol Treatment Amount of ORS to give after each loose stool < 24 months 50-100 ml 2-10 years 100- 200 ml Age
Amount of ORS to provide for use at home 500 ml/day 1000 ml/day
10 years up As much as wanted
2000 ml/day
B. Some Dehydration
Condition – restless, irritable Mouth and Tongue – dry Eyes – sunken Thirst – thirsty, drinks eagerly Tears – absent Skin pinch – goes back slowly WEIGH PT, TTT. PLAN B
Approximate amount of ORS to give in 1st 4 hours Age 4 months 4- 11 months 12-23 months 2-4 yrs. 5-14 yrs. 15 yrs. up
Weight (kg) 5 5- 7.9 8- 10.9 11- 15.9 16- 29.9 30 up
ORS (ml) 200- 400 400- 600 600- 800 800- 1200 1200- 2200 2200- 4000
1. If the child wants more ORS than shown, give more 2. Continue breastfeeding 3. For infants below 6 mos. who are not breastfeed, give 100-200 ml clean water during the period 4. For a child less than 2 years give a teaspoonful every 1-2 min. 5. If the child vomits, wait for 10 min, then continue giving ORS, 1 tbsp/2-3 min 6. If the child‘s eyelids become puffy, stop ORS, giv e plain water or breast milk, Resume ORS when puffiness is gone 7. If ( -) signs of DHN- shift to Plan A Use of Drugs during Diarrhea
Antibiotics should only be used for dysentery and suspected cholera Antiparasitic drugs should only be used for amoebiasis and giardiasis
C. Severe Dehydration
Condition – lethargic or unconscious; floppy Eyes – very sunken and dry Tears – absent Mouth and tongue – very dry Thirst- drinks poorly or not able to drink Skin pinch – goes back very slowly
1. 2. 3. 4.
Treatment PLAN C- treat quickly Bring pt. to hospital IVF – Lactated Ringers Solution or Normal Saline Re-assess pt. Every 1-2 hrs Give ORS as soon as the pt. can drink
Role of Breastfeeding in the Control of Diarrheal Diseases Program Two problems in CDD
1. High child mortality due to diarrhea 2. High diarrhea incidence among under fives
Highest incidence in age 6 – 23 months Highest mortality in the first 2 years of life Main causes of death in diarrhea : o Dehydration To prevent dehydration, give home fluids ―am‖ as soon as diarrhea starts and if dehydration is present, rehydrate early, correctly an d effectively by giving ORS Malnutrition o For under nutrition, continue feeding during di arrhea especially breastfeeding.
Interventions to prevent diarrhea
1. 2. 3. 4. 5. 6. 7.
breastfeeding improved weaning practices use of plenty of clean water hand washing use of latrines proper disposal of stools of small children measles immunization
Breastfeeding
1. Risk of severe diarrhea 10-30x higher in bottle fed infants than in breastfed infants. 2. Advantages of breastfeeding in relation to CDD a. Breast milk is sterile b. Presence of antibodies protection against diarrhea c. Intestinal Flora in BF infants prevents growth of diarrhea cau sing bacteria. 3. Breastfeeding decreases incidence rate by 8-20% and mortality by 24- 27% in infants under
6 months of age. 4. When to wean?
4-6 months – soft mashed foods 2x a day 6 months – variety of foods 4x a day
Summary of WHO-CDD recommended strategies to prevent diarrhea 1. Improved Nutrition
Exclusive breastfeeding for the first 4-6 months of life and partially for at le ast one year. Improved weaning practices
2. Use of safe water
collecting plenty of water from the cleanest source protecting water from contamination at the source and in the home
3. Good personal and domestic hygiene
handwashing use of latrines proper disposal of stools of young children
4. Measles immunization
Control of Acute Respiratory Infections (CARI)
Classification A. No Pneumonia: Cough or Cold 1. No chest in drawing 2. No fast breathing ( <2 mos. - <60/min,2-12 mos. – less than 50 per minute; 12 mos. – 5 years – less than 40 per minute) Treatment:
1. 2. 3. 4.
If coughing more than 30 days, refer for assessment Assess and treat ear problems/sore throat if present Advise mother to give home care Treat fever/wheezing if present
Home Care:
1. Feed the Child
Feed the child during illness Increase feeding after illness Clear the nose if it interferes with feeding
2. Increase Fluids
offer the child extra to drink Increase breastfeeding
3. Soothe the throat and relieve the cough with a safe remedy 4. Watch for the following signs and symptoms and return quickly if they occur
Breathing becomes difficult Breathing becomes fast Child is not able to drink Child becomes sicker
B. Pneumonia
1. No chest in drawing 2. Fast breathing (less than 2 mos- 60/min or more ; 2-12 mos. – 50/min or more; 12 mos. – 5 years – 40/min or more) Treatment
1. 2. 3. 4.
Advise mother to give home care Give an antibiotic Treat fever/wheezing if present If the child‘s condition gets worst, refer urgently to hospital; if improving, finish 5 days of antibiotic.
Antibiotics Recommended by WHO
Co-trimoxazole, Amoxycillin, Ampicillin, (p.o) or Procaine penicillin (I.M.)
C. Severe Pneumonia 1. 2. 3. 4.
Chest indrawing Nasal flaring Grunting ( short sounds made with the voice) Cyanosis
Treatment
Refer urgently to hospital Treat fever ( paracetamol), wheezing ( salbutamol)
D. Very Severe Disease 1. 2. 3. 4. 5.
Not able to drink Convulsions Abnormally sleepy or difficult to wake Stridor in calm child Severe undernutrition
Treatment
Refer urgently to hospital
Assessment of Respiratory Infection
Ask the Mother
1. 2. 3. 4. 5. 6.
How old is the child? Is the child coughing? For how long? Age less than 2 months: Has the young infant stopped feeding well? Age 2 months up to 5 years: Is the child able to drink? Has the child had fever? For how long? Has the child had convulsions?
Look, Listen
1. Count the breaths in one minute. Age
Fast Breathing 60/minute or Less than 2 months more 2 months- 12 50/minute or months more 40/minute or 12 months – 5 years more
2. Look for chest in drawing. 3. Look and listen for stridor. Stridor occurs when there is a narrowing of the larynx, trachea or epiglottis which interferes with air entering the lungs. 4. Look and listen for wheeze. Wheeze is a soft musical noise which shows signs that breathing out (exhale) is difficult. 5. See if the child is abnormally sleepy or difficult to wake. (Suspect meningitis) 6. Feel for fever or low body temperature. 7. Check for severe under nutrition
Community Assessment
Community Assessment
Status Structure Process
Types of Community Assessment
1. Community Diagnosis
A process by which the nurse collects data about the community in order to identify factors which may influence the deaths and illnesses of the population, to formulate a community health nursing diagnosis and develop and implement community health nursing interventions and strategies.
2 Types:
Comprehensive Community Diagnosis Problem-Oriented Community Diagnosis aims to obtain general type of assessment responds to a information about the particular need community
Steps:
Preparatory Phase 1. 2. 3. 4. 5. 6. 7.
site selection preparation of the community statement of the objectives determine the data to be collected identify methods and instruments for data collection finalize sampling design and methods make a timetable
Implementation Phase 1. 2. 3. 4. 5.
data collection data organization/collation data presentation data analysis identification of health problems
6. prioritization of health problems 7. development of a health plan 8. validation and feedback Evaluation Phase
Biostatistics
DEMOGRAPHY - study of population size, composition and spatial distribution as affected by births, deaths and migration. Sources: Census – complete enumeration of the population
2 Ways of Assigning People
1. De Jure - People were assigned to the place where assigned to the place they usually live regardless of where they are at the time of census. 2. De Facto - People were assigned to the place where they are physically present at are at the time of census regardless, of their usual place of residence. Components
1. Population size 2. Population composition Age Distribution o Sex Ratio o Population Pyramid o Median age - age below which 50% of the population falls and above which 50% o of the population falls. The lower the median age, the younger the population (high fertility, high death rates). Age – Dependency Ratio - used as an index of age-induced economic drain on o human resources Other characteristics: o occupational groups economic groups educational attainment ethnic group Population Distribution Urban-Rural - shows the proportion of people living in urban compared to the o rural areas Crowding Index - indicates the ease by which a communicable disease can be o transmitted from 1 host to another susceptible host. Population Density - determines congestion of the place o
Vital Statistics
The application of statistical measures to vital events (births, deaths and co mmon illnesses) that is utilized to gauge the levels of health, illness and health services of a community.
Types of Vital Statistics Fertility Rate
1. Crude Birth Rate Total # of livebirths in a given calendar year Estimated population as of July 1 of the same given year
X 1000
2. General Fertility Rate Total # of livebirths in a given calendar year Total number of reproductive age
X 1000
Mortality Rate
1. Crude Death Rate X 1000 _Total # of death in a given calendar year_ Estimated population as of July 1 of the same calendar year
2. Infant Mortality Rate Total # of death below 1 yr in a given calendar year X 1000 Estimated population as of July 1 of the same calendar year 3. Maternal Mortality Rate Total # of death among all maternal cases in a given calendar year Estimated population as of July 1 of the same calendar year Morbidity Rate
1. Prevalence Rate Total # of new & old cases in a given calendar year Estimated population as of July 1 of the same calendar year
X 100
2. Incidence Rate Total # of new cases in a given calendar year_
X 100
X 1000
Estimated population as of July 1 of the same calendar year 3. Attack Rate Total # of person who are exposed to the disease Estimated population as of July 1 of the same calendar year
X 100
Epidemiology
the study of distribution of disease or physiologic condition among h uman population s and the factors affecting such distribution the study of the occurrence and distribution of health conditions such as disease, death, deformities or disabilities on human populations
1. Patterns of disease occurrence Epidemic
A situation when there is a high incidence of new cases of a specific disease in excess of the expected. when the proportion of the susceptible are hi gh compared to the proportion of the immunes
Epidemic potential
an area becomes vulnerable to a disease upsurge due to causal factors such as climatic changes, ecologic changes, or socio-economic changes
Endemic
habitual presence of a disease in a given geographic location accounting for the low number of both immunes and susceptibles.E.g. Malaria is a disease endemic at Palawan. The causative factor of the disease is constantl y available or present to the area.
Sporadic
disease occurs every now and then affecting only a small number of people relative to the total population intermittent
Pandemic
global occurrence of a disease
Steps in Epidemiological Investigation:
1. 2. 3. 4.
Establish fact of presence of epidemic Establish time and space relationship of the disease Relate to characteristics of the group in the community Correlate all data obtained
2. Role of the Nurse
Case Finding Health Teaching Counseling Follow up visit
DOH Programs
Dental Health Program
To improve the quality of life of the people through the attainment of the highest possible oral health. Objective: To prevent and control dental diseases and conditions like dental caries and periodontal diseases thus reducing their prevalence.
Osteoporosis Program
It is characterized by a decrease in bone mass and density that progresses without a symptom or pain until a fracture occurs generally in the hip, spine or wrist. Objectives: To increase awareness on the prevention and control of osteoporosis as a chronic o debilitating condition; To increase awareness by physicians and other health professionals on the o screening, treatment and rehabilitation of osteoporosis; To empower people with knowledge and skills to adopt healthy lifestyle in o preventing the occurrence of osteoporosis.
Health Education & CO
Accepted activity at all levels of public health used as a means of improving the health of the people through techniques which may influence peoples thought motivation, judgment and action.
Three aspects of health education:
Information Communication Education
Sequence of steps in health education:
Creating awareness Creating motivation Decision making action
Reproductive Health
1. Family Planning
2. MCH & Nutrition 3. Prevention / treatment of Reproductive Tract Infection & STD 4. Prevention of abortion & its complication 5. Education & counseling on sexuality & sexual health 6. Adolescent sexual reproductive health 7. Violence against women 8. Men‘s reproductive health (Male sexual disorder ) 9. Breast CA & other gyne problem 10. Prevention / treatment of infertility
Older Persons Health Services
Participation in the celebration of Healthy National Elderly Week (Oct 1 -7) Lecture on healthy lifestyle for the elderly o Provision of drugs for the elderly (20% discount)
Guidelines for Good Nutrition
Nutritional Guidelines are primary recommendations to promote good health through proper nutrition.
Activities:
1. Malnutrition Rehabilitation Program
Targeted Food Task Force Assistance Program (TFAP) Nutrition Rehabilitation Ward Akbayan sa Kalusugan sa Kabataan (ASK Project)
2. Micronutrient Supplementation Program
―23 in ‗93‖ Fortified Vitamin Rice ―Health for More in ‗94‖ ―Buwan ng Kabataan, Pag-asa ng Bayan‖ National Focus: National Micronutrient Day or ―Araw ng Sangkap Pinoy‖
Protein Energy Malnutrition
1. Marasmus – looks like an old worried man Less subcutaneous fats o 2. Kwashiorkor - a moon face child With flag sign (hair changes) o
Vitamin A Deficiency
Respiratory Infection Control
Provision of medicines Consultative meetings with CARI coordinators Monitoring of health facilities on the implementation of the program
Alternative Medicine
RA 8423 23 IN 93
Herbal Medicine (LUBBY SANTA) Herbal Medicine
Lagundi ( Vitex Negundo) SHARED
Ulasimang Bato (Peperonia Pellucida) Bawang ( Allium Sativum) HAT
USES Skin diseases Headache, Asthma,fever,cough&colds R heumatism Eczema Dysentery
Lowers uric acid Headache and Tootache
Bayabas ( Psidium Guajava) Yerba Buena (Mentha Cordifolia)
Anti septic, Anti-diarrheal Rheumatism and other body aches, analgesics
Sambong (Blumea Balsamifera)
Edema, diuretics
Akapulko
Fungal infection, skin diseases
Niog Niogan (Quisqualis Indica)
Anti-helminthic
Tsaang Gubat (Carmona Retusa)
Diarrhea
Ampalaya (Momordica Charantia)
DM
Maternal- Child Care
I. Maternal Care 1. F amily Planning A. Spacing / Artificial Method a. Hormonal b. Mechanical & Barrier c. Biologic d. Natural B. Permanent (surgical/irreversible) a. Tubal Ligation b. Vasectomy C. Behavioral Method 2. Breastfeeding II. Child Care 1. Un der F ive Care Progr am o
A package of child health-related services focused to the 0-59 months old children to assure their wellness and survival
Growth Monitoring Chart (GMC) o
A standard tool used in health centers to record vital information related to child growth and development, to assess signs of malnutrition.
2. Expanded Program on Immunization
Legal Basis: PD #996 – Compulsory basic PP #147 – National Immunization Day PP #773 – Knock out Polio Days PP # 1064 – polio eradication campaign PP #4 - Ligtas Tigdas month
Mental Health
A state of well-being where a person can realize his or her own abilities, to cope with the normal stresses of life and work productively
Components of Mental Health Program
Stress Management and Crisis Intervention Drugs and Alcohol Abuse Rehabilitation Treatment and Rehabilitation of Mentally-Ill Patients Special Project for Vulnerable Groups
Sentrong Sigla Movement Aim: to promote availability of quality health services 4 pillars:
Quality assurance Grants & technical assistance Health promotion Award
Community Organizing Participatory Action Research Community Organizing
A continuous and sustained process of; EDUCATING THE PEOPLE, o CRITICAL AWARENESS o MOBILIZING o
Participatory Action Research
A combination of education, research and action.
The purpose is the EMPOWERMENT of people
4 Phases:
Pre entry Entry Organizational Building Sustenance and Strengthening
Laws Affecting CHN Implementation
RA 8749 - Clean Air Act (2000) RA 6425 – Dangerous Drug Act: sale, administration and d istribution of prohibited drugs is punishable by law RA 9173 RA 2382 – Philippines Medical Act: define the practice of medicine in the Philippines RA 1082 – Rural Health Act: employment of more physicians, nurses, midwives who will live in the rural areas to help raise the h ealth condition. RA 3573 - Reporting of Communicable Disease RA 6675 – Generic Act: promotes, requires and ensures the production of an adequate supply, distribution, and use of drugs identified by their generic names. RA 6365 RA 6758 RA 4703 RA 7305 – Magna Carta for Public Health Workers (approved by Pres. Corazon C. Aquino): aims to promote and improve the social and economic well being of health workers, their living and conditions. RA 7160 – Local Government Code: responsibility for the delivery of basic services of the national government
Department Department of Health (DOH)
Vision
Health for all Filipinos
Mission
Ensure accessibility & quality of health care to improve the quality of life of all Filipinos, especially the poor.
National Objectives
1. Improve the general health status of the population p opulation (reduce infant mortality rate, reduce child morality rate, reduce maternal mortality rate, reduce total fertility rate, increase life expectancy & the quality of life years). 2. Reduce morbidity, mortality, disability & complications from Diarrheas, Pneumonias, Tuberculosis, Dengue, Intestinal Parasitism, Sexually Transmitted Diseases, Hepatitis B, Accident & Injuries, Dental Caries & Periodontal Diseases, Cardiovascular Diseases, Cancer, Diabetes, Asthma & Chronic Obstructive Pulmonary Diseases, Nephritis & Chronic Kidney Diseases, Mental Disorders, Protein Energy Malnutrition, and Iron Deficiency Anemia & Obesity. 3. Eliminate the ff. diseases as public health problems: 1. Schistosomiasis 2. Malaria 3. Filariasis 4. Leprosy 5. Rabies 6. Measles 7. Tetanus 8. Diphtheria & Pertussis 9. Vitamin A Deficiency & Iodine Deficiency Disorders 4. Eradicate Poliomyelitis 5. Promote healthy lifestyle through healthy diet & nutrition, physical activity & fitness, personal hygiene, mental health & less stressful life life & prevent violent & risk-taking behaviors. 6. Promote the health & nutrition of families & special populations through ch ild, adolescent & youth, adult health, women‘s health, health of older persons, persons, health of indigenous people, health of migrant workers and health of different disabled persons and of the rural & urban poor. 7. Promote environmental health and sustainable development through the promotion and maintenance of healthy homes, schools, workplaces, establishments and communities‘
towns and cities.
Basic Principles to Achieve Improvement in Health
1. 2. 3. 4.
Universal access to basic health services must be ensured. The health and nutrition of vulnerable groups must be prioritized. The epidemiological shift from infection to degenerative diseases must be managed. The performance of the health sector must be enhanced.
Primary Strategies to Achieve Goals
1. 2. 3. 4. 5.
Increasing investment for Primary Health Care. Development of national standards and objectives for health. Assurance of health care. Support to the local system development. Support for frontline health workers.
Expanded Program for Immunization (EPI)
Principles of EPI
1. Epidemiological situation 2. Mass approach 3. Basic Health Service
The 7 immunizable diseases
1. 2. 3. 4. 5. 6. 7.
Tuberculosis Diptheria Pertussis Measles Poliomyelitis Tetanus Hepatitis B
Target Setting
Infants 0-12 months Pregnant and Post Partum Women School Entrants/ Grade 1 / 7 years old
Objectives of EPI
To reduce morbidity and mortality rates among infants and children from six childhood immunizable disease
Elements of EPI
Target Setting Cold chain Logistic Management- Vaccine distribution through cold chain is designed to ensure that the vaccines were maintained under proper environmental condition until the time of administration. Information, Education and Communication (IEC) Assessment and evaluation of Over-all performance of the program Surveillance and research studies
Administration of vaccines Vaccine BCG (Bacillus Calmette Guerin)
Content
Form & Dosage
Freeze dried Infant- 0.05ml
Live attenuated bacteria
# of Doses
Route
1
ID
liquid-0.5ml
3
IM
weakened virus
liquid-2drops
3
Oral
Plasma derivative Weakened virus
Liquid-0.5ml 3 Freeze dried- 0.5ml 1
Preschool-0.1ml DPT (Diphtheria Pertussis Tetanus)
DT- weakened toxin P-killed bacteria
OPV (Oral Polio Vaccine) Hepatitis B Measles
Schedule of Vaccines Vaccine Age at 1st dose
Interval between dose
BCG
At birth
DPT
6 weeks
4 weeks
OPV
6weeks
4weeks
Hepa B @ birth
Measles 9m0s.-11m0s.
Protection
BCG is given at the earliest possible age protects against the possibility of TB infection from the other family members An early start with DPT reduces the chance of severe pertussis The extent of protection against polio is increased the earlier OPV is given. An early start of Hepatitis B reduces
@birth,6th week,14th week
the chance of being infected and becoming a carrier. At least 85% of measles can be prevented by immunization at this age.
6 months – earliest dose of measles given in case of outbreak
IM Subcutaneous
9months-11months- regular schedule of measles vaccine 15 months- latest dose of measles given 4-5 years old- catch up dose Fully Immunized Child (FIC) - less than 12 months old child with complete immunizations of DPT, OPV, BCG, Anti Hepatitis, Anti measles.
Tetanus Toxiod Immunization Schedule for Women Vaccine
TT1 TT2 TT3 TT4 TT5
Minimum age % Duration of interval protected Protection
As early as possible 4 weeks later 6 months later 1year later/during next pregnancy 1 year later/third pregnancy
0%
0
80% 95%
3 years 5 years
99%
10 years
99%
Lifetime
There is no contraindication to immunization except when the child is immunosuppressed or is very, very ill (but not slight fever or cold). O r if the child experienced convulsions after a DPT or measles v accine, report such to the doctor immediately. Malnutrition is not a contraindication for immunizing children rather; it is an indication for immunization since common childhood diseases are often severe to malnourished children.
Cold Chain under EPI
Cold Chain is a system used to maintain potency po tency of a vaccine from that of manufacture to the time it is given to child or pregnant woman. The allowable timeframes for the storage of vaccines at d ifferent levels are: 6months- Regional Level o 3months- Provincial Level/District Level o 1month-main health centers-with ref. o Not more than 5days- Health centers using transport boxes. o Most sensitive to heat: Freezer (-15 to -25 degrees C) OPV o Measles o
Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius) BCG o DPT o Hepa B o TT o Use those that will expire first, mark ―X‖/ exposure, 3rd3rd- discard, Transport-use cold bags let it stand in room temperature for a while before storing DPT. Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B. FEFO (―first expiry and first out‖) - vaccine is practiced to assure that all vaccines are utilized before the expiry date. Proper arrangement of vaccines and/or labeling of vaccines expiry date are done to identify those near to expire vaccines.
Breastfeeding Breastfeeding or Lactation Management Management Education Training
Introduction
Breastfeeding practices has been proved to be very beneficial to both mother and baby thus the creation of the following laws support the full implementation of this program:
Executive Order 51 Republic Act 7600 The Rooming-In and Breastfeeding Act of 1992
Program Objectives and Goals
Protection and promotion of breastfeeding and lactation management education training
Activities and Strategies
1. Full Implementation of Laws Supporting the Program a. EO 51 THE MILK CODE – protection protection and promotion of breastfeeding to ensure the safe
and adequate nutrition nutrition of infants through regulation of marketing of infant foods and related related products. (e.g. breast milk substitutes, infant formulas, feeding bottles, teats etc. ) b. RA 7600 THE ROOMING – ROOMING – IN IN and BREASTFEEDING ACT of 1992
An act providing incentives to government and a nd private health institutions promoting and practicing rooming-in and breast-feeding. Provision for human milk bank. Information, education and re-education drive Sanction and Regulation
2. Conduct Orientation/Advocacy Meetings to Hospital/ Community Advantage Advan tages s of B r eastf astf eedin edin g:
Mother
Oxytocin help the uterus contracts Uterine involution Reduce incidence of Breast Cancer Promote Maternal-Infant Bonding Form of Family planning Method (Lactational Amenorrhea)
Baby
Provides Antibodies Contains Lactoferin (binds with Iron) Leukocytes Contains Bifidus factorpromotes growth of the Lactobacillusinhibits the growth of pathogenic bacilli
Posit Posit ion s in Br eastf astf eedin g of the baby: baby:
1. Cradle Hold = head and neck are supported 2. Football Hold 3. Side Lying Position
BEST FOR BABIES EDUCE INCIDENCE OF ALLERGENS R EDUCE ECONOMICAL A NTIBODIES PRESENT STOOL INOFFENSIVE (GOLDEN YELLOW) TEMPERATURE ALWAYS IDEAL FRESH MILK NEVER GOES OFF EMOTIONALLY BONDING
EASY ONCE ESTABLISHED DIGESTED EASILY IMMEDIATELY AVAILABLE NUTRITIONALLY OPTIMAL GASTROENTERITIS GREATLY REDUCED
Family Planning Program
Overview
The Philippine Family Planning Program is a nation al program that systematically provides information and services needed by women of reproductive age to plan their families according to their own beliefs and circumstances.
Goals and Objectives
Universal access to family planning information, education and services.
Mission
To provide the means and opportunities by which married couples of reproductive age desirous of spacing and limiting their pregnancies can realize their reproductive goals.
Types of Methods
1. NATURAL METHODS a. Calendar or Rhythm Method b. Basal Body Temperature Method c. Cervical Mucus Method d. Sympto-Thermal Method e. Lactational Amennorhea 2. ARTIFICIAL METHODS a. Chemical Methods i. Ovulation suppressant such as PILLS ii. Depo-Provera iii. Spermicidals iv. Implant b. Mechanical Methods i. Male and Female Condom ii. Intrauterine Device iii. Cervical Cap/Diaphragm c. Surgical Methods i. Vasectomy ii. Tubal Ligation
Warning Signs Pills
A bdominal pain (severe) Chest pain (severe) Headache (severe) Eye problems (blurred vision, flashing lights, blin dness) Severe leg pain (calf or thigh) Others: depression, jaundice, breast lumps
IUD
Period late, no symptoms of pregnancy, abnormal bleeding or spotting A bdominal pain during intercourse Infection or abnormal vaginal discharge Not feeling well, has fever or chills String is missing or has become shorter or longer
Injectables
Dizziness Severe headache Heavy bleeding
BTL
Fever Weakness Rapid pulse Persistent abdominal pain Vomiting Dizziness Pus or tenderness at incision site Amenorrhea
Vasectomy
Fever Scrotal blood clots or excessive swelling
Functions of a Health Worker
Community Health Service Provider
Carries out health services contributing to the promotion of health, prevention of illness, early treatment of illness and rehabilitation. appraises health needs and hazards (existing or potential)
Facilitator
helps plan a comprehensive health program with the people continuing guidance and supervisory assistance
Health Counselor
provides health counseling including emotional support to individuals, family, group and community
Co-researcher
Provides the community with stimulation necessary for a wider or more complex study or problems. Enforce community to do prompt and intelligent reporting of epidemiologic investigation of disease. suggest areas hat need research (by creating dissatisfaction) participate in planning for the study in formulating procedures assist in the collection of data helps interpret findings collectively act on the result of the research
Member of a Team
in operating within the team, one must be willing to listen as well as to contribute, to teach as well as to learn, to lead as well as to follow, to share as well as to work under it helps make multiple services which the family receives in the course of health care, coordinated, continuous and comprehensive as possible consults with and refers to appropriate personnel for any other commun ity services
Health Educator
Health education is an accepted activity at all levels of public works. A health educator is the one who improves the health of the people by employing various methods of scientific procedures to stimulate, arouse and guide people to healthful ways of living. She takes into consideration these aspects of health education: information - provision of knowledge o education - change in knowledge, attitude and skills o communication - exchange of information o
Garantisadong Pambata (GP)
Definition
Garantisadong Pambata is a biannual week long delivery of a package of health services to children between the ages of 0-59 months old with the purpose of reducing morbidity and mortality among under fives through the promotion of positive Filipino values for proper child growth and development.
Routine Health Services Health Service
Dosage
Route of Administration
Target Population
Vitamin A capsule
200,000 IU or 1 capsule
Orally by drops
12-59 months old, nationwide 9-12 months old infants receiving AMV nationwide
100,000 IU or ½ cap or 3 drops
Ferrous Sulfate (25 mg. Elemental Iron per ml; 30 ml. Bottle as taken home medicine with instructions)
0.3ml(2-6 mos) once a day 0.6ml(611mos) once a day
Orally by drops
2-11 months old infants in Mindanao area, including evacuation centers in armed conflict areas.
Routine Immunization
Nationwide
0.05ml
-BCG*
Intradermal on right deltoid
0.5ml
-DPT* -OPV* -AMV* -Hepa B (if
2 drops
Intramuscularly on anterior thigh
0.5ml
Orally
0.5ml
0-11 mos 0-11 mos 9-11 mos 0-11 mos
Intramuscularly
available)
Deworming drug
Subcutaneously on deltoid
0-11 mos
1 tablet as single dose
Orally
36-59 mos, nationwide
(if available)
Weighing
o
o
0-59 mos, nationwide
The child should not have received megadose of Vit. A above the recommended dosage within the past 4 weeks except if the child has measles or signs and symptoms of Vit A. deficiency. For any child between 12-23 months, who missed any of his routine immunization, the health worker should give the child the necessary antigen to complete FIC and shall be recorded as such.
Garantisadong Pambata Sangkap Pinoy
Vitamin A, Iron and Iodine Sources: green leafy and yellow vegetables, fruits, liver, seafoods, iodized salt, pan de bida and other fortified foods. These micronutrients are not produced by the body, and must be taken in the food we eat; essential in the normal process of growth and development: 1. Helps the body to regulate itself 2. Necessary in energy metabolism 3. Vital in brain cell formation and mental development 4. Necessary in the body immune system to protect the body from severe infection. 5. Eating Sangkap Pinoy-rich foods can prevent and control:
Protein Energy Malnutrition Vitamin A Deficiency Iron Deficiency Anemia Iodine Deficiency Disorder
Breastfeeding
Breast milk is best for babies up to 2 years old. Exclusive breastfeeding is recommended for the first six months of life. At about six months, give carefully selected nutritious foods as supplements. Breastfeeding provides physical and psychological benefits for children and mothers as well as economic benefits for families and societies.
Benefits : For infants
1. Provides a nutritional complete food for the young infant. 2. Strengthens the infant‘s immune system, preventing many infections. 3. Safely rehydrates and provides essential nutrients to a sick child, especially to those suffering from diarrheal diseases. 4. Reduces the infant‘s exposure to infection. For the Mother
1. Reduces a woman‘s risk of excessive blood loss after birth 2. Provides a natural method of delaying pregnancies. 3. Reduces the risk of ovarian and breast cancers and osteoporosis. For the Family and Community
1. Conserves funds that otherwise would be spent on breast milk substitute, supplies and fuel to prepare them. 2. Saves medical costs to families and governments by preventing illnesses and by providing immediate postpartum contraception.
Complimentary Feeding for Babies 6-11 Months Old What are Complementary Foods?
1. foods introduced to the child at the age 6 months to supplement breastmilk 2. Given progressively until the child is used to three meals and in-between feedings at the age of one year.
Why is there a Need to Give Complementary Foods?
1. breastmilk can be a single source of nourishment from birth up to six months of life. 2. The child‘s demands for food increases as he grows older and breastmilk alone is not enough to meet his increased nutritional needs for rapid growth and development 3. Breastmilk should be supplemented with other foods so that the child can get additional nutrients 4. Introduction of complementary foods will accustom him to n ew foods that will also provide additional nutrients to make him grow well 5. Breastfeeding, however, should continue for as long as the mother is able and has milk which could be as long as two years How to Give Complementary Foods for Babies 6-11 Months Old?
1. Prepare mixture of thick lugao/ cooked rice, soft cooked vegetables. Egg yolk, mashed beans, flaked fish/chicken/ground meat and oil. 2. Give mixture by teaspoons 2-4 times daily, increasing the amount of teaspoons and number of feeding until the full recommended amount is consumed 3. Give bite-sized fruit separately 4. Give egg alone or combine with above food mixture
Health and Sanitation
Overview
Environmental Sanitation is still a health problem in the country. Diarrheal diseases ranked second in the leading c auses of morbidity among the general population. Other sanitation related diseases : tuberculosis, intestinal parasitism, schistossomiasis, malaria, infectious hepatitis, filariasis and dengue hemorrhagic fever DOH thru‘ Environmental Health Services (EHS) unit is authorized to act on all issues and concerns in environment and health including the very comprehensive Sanitation Code of the Philippines (PD 856, 1978).
Water Supply Sanitation Program EHS sets policies on:
Approved types of water facilities Unapproved type of water facility Access to safe and potable drinking water Water quality and monitoring surveillance Waterworks/Water system and well construction
Approved type of water facilities
Level 1 (Point Source)
a protected well or a developed spring with an outlet but without a distribution system
indicated for rural areas serves 15-25 households; its outreach is not more than 250 m from the farthest user yields 40-140 L/ min
Level II (Communal Faucet or Stand Posts) With a source, reservoir, piped distribution network and communal faucets Located at not more than 25 m from the farthest house Delivers 40-80 L of water per capital per day to an average of 100 households Fit for rural areas where houses are densely clustered
Level III (Individual House Connections or Waterworks System) With a source, reservoir, piped distributor network and household taps Fit for densely populated urban communities Requires minimum treatment or disinfection
Environmental Sanitation The study of all factors in man‘s physical environment, which may exercise a deleterious effect on his health, well-being and survival.
Includes :
Water sanitation Food sanitation Refuse and garbage disposal Excreta disposal Insect vector and rodent control Housing Air pollution Noise Radiological Protection Institutional sanitation Stream pollution
Proper Excreta and Sewage Disposal Program EHS sets policies on approved types of toilet facilities:
Level I
Non-water carriage toilet facility – no water necessary to wash the waste into receiving space e.g. pit latrines, reed odorless earth closet. Toilet facilities requiring small amount of water to wash the waste into the receiving
space e.g. pour flush toilet & aqua privies Level II
On site toilet facilities of the water carriage type with water-sealed and flush type with septic vault/tank disposal.
Level III
Water carriage types of toilet facilities connected to septic tanks and/or to sewerage system to treatment plant.
Food Sanitation Program
sets policy and practical programs to prevent and control food-borne diseases to alleviate the living conditions of the population
Hospital Waste Management Program
Disposal of infectious, pathological and other wastes from hospital which co mbine them with the municipal or domestic wastes pose health hazards to the people. Hospitals shall dispose their hazardous wastes thru incinerators or disinfectants to prevent transmission of nosocomial diseases
Program on Health Risk Minimization due to Environmental Pollution
1. Prevention of serious environmental hazards resulting from urban growth and industrialization 2. Policies on health protection measures 3. Researches on effects of GLOBAL WARMING to health (depletion of the stratosphere ozone layer which increases ultraviolet radiation, climate change and other conditions)
Nursing Responsibilities and Activities
Health Education – IEC by conducting community assemblies and bench conferences. The Occupational Health Nurse, School Health Nurse and other Nursing staff shall impart the need for an effective and efficient environmental sanitation in their places of work and in school. Actively participate in the training component of the service like in Food Handler‘s Class, and attend training/workshops related to environmental health. Assist in the deworming activities for the school children and targeted groups. Effectively and efficiently coordinate programs/projects/activities with other government and non-government agencies. Act as an advocate or facilitator to families in the community in matters of program/projects/activities on environmental health in coordination with other members
of Rural Health Unit (RHU) especially the Rural Sanitary Inspectors. Actively participate in environmental sanitation campaigns and p rojects in the community. Ex. Sanitary toilet campaign drive for proper garbage disposal, beautification of home garden, parks drainage and other projects. Be a role model for others in the community to emulate terms of cleanliness in the home and surrounding.
Health Care Delivery System
Definition
The totality of all policies, facilities, equipments, products, human resources and services which address the health needs problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary.
Health Sectors
Government Sectors Non Government Sectors Private Sectors
Department of Health
Vision : Health for all by year 2000 ands Health in the Hands of the People by 2020 Mission : In partnership with the people, provide equit y, quality and access to health care esp. the marginalized
5 Major Functions :
1. Ensure equal access to basic health services 2. Ensure formulation of national policies for proper division of labor and proper coordination of operations among the government agency jurisdictions 3. Ensure a minimum level of implementation nationwide of services regarded as
public health goods 4. Plan and establish arrangements for the public health systems to achieve economies of scale 5. Maintain a medium of regulations and standards to protect consumers and guide providers
Primary Strategies to Achieve Health Goals
Support for health goal Assurance of health care Increasing investment for PHC Development of National Standard
Milestone in Health Care Delivery System
RA 1082 - RHU Act RA 1891 - Strengthen Health Services PD 568 - Restructuring HCDS RA 7160 - LGU Code
Health Education (Principles)
It considers the health status of the people, which is determined by the economic and social conscience of the country. It is a process whereby people learn to improve their personal habits and attitudes, to work responsibly for the improvement of health conditions of the family, community, and nation. It involves motivation, experience, and change in conduct and thinking, while stimulating active interest. It develops and provides experience for change in people‘s attitudes, customs, and habits in relation to health and everyday living. It should be recognized as the basic function of all health workers. It takes place in the home, in the school, and in the community. It is a cooperative effort requiring all categories of health personnel to work together in close teamwork with families, groups, and the co mmunity. It meets the needs, interests, and problems of the people affected. It finds means and ways of carrying out plans b y encouraging individual and community participation. It is a slow, continuous process that involves constant ch anges and revisions until objectives are achieved. Makes use of supplementary aids and devices to help with the verbal instructions. It utilizes community resources by careful evaluation of the different services and resources found in the community. It is a creative process requiring methods and technique s with various characteristics, not following a rigid and flexible pattern. It aims to help people make use of their own efforts and education to improve their conditions of living, It makes careful evaluation of the planning, organization, and implementation of all
health education programs and activiti
Health Situation of the Philippines
Philippine Scenario
In the past 20 years some infectious degenerative diseases are on the rise. Many Filipinos are still living in remote and hard to reach areas where it is difficult to deliver the health services they need The scarcity of doctors, nurses and midwives add to the poor health delivery system to the poor
Vital Health Statistics 2005 Projected Population:
Male - 42,874,766 Female - 42,362,147 Both Sexes - 85,236,913
Life Expectancy:
Female - 70 yrs. old Male - 64 yrs. Old
Leading Causes of Morbidity
Most of the top ten leading causes of morbidity are communicable disease These include the diarrhea, pneumonia, bronchitis, influenza, TB, malaria and varicella Leading non CD are heart problem, HPN, accidents and malignant neoplasms
Leading Causes of Mortality
The top 10 leading causes of mortality are due to non CD Diseases of the heart and vascular system are the 2 most common causes of deaths. Pneumonia, PTB and diarrheal diseases consistently remain the 1 0 leading causes of deaths.
Herbal Medicine Plants Approved by the DOH
These are the list of the ten (10) medicinal plants that the Philippine Department of Health (DOH) through its "Traditional Health Program" has endorsed. All ten (10) herbs have been thoroughly tested and have been clinically proven to have medicinal value in the relief and treatment of various aliments:
Plant Name: Lagundi
(Vitex negundo)
Uses & Preparation: Asthma, Cough & Fever - Decoction ( Boil raw fruits o leaves in 2 glasses of water for 15 mi nutes)Dysentery, & Pain - Decoction ( Boil a handful of leaves & flowers i water to produce a glass, three times a day) Skin diseases (dermatitis, scabies, ulcer, eczema) Wash & clean the skin/wound with the decoction Headache - Crush leaves may be applied on the forehe Rheumatism, sprain, contusions, insect bites - Poun leaves and apply on affected area
Plant Name:
Uses & Preparation: Pain (headache, stomachache) - Boil chopped leaves glasses of water for 15 minutes. Divide decoction into 2 drink one part every 3 hours. Rheumatism, arthritis and headache - Crush the fres
leaves and squeeze sap. Massage sap on painful parts with eucalyptus Cough & Cold - Soak 10 fresh leaves in a glass of hot water, drink as tea. (expectorant) Swollen gums - Steep 6 g. of fresh plant in a glass of boiling water for 30 minutes. Use as a gargle soluti on Toothache - Cut fresh plant and squeeze sap. Soak a piece of cotton in the sap and insert this in aching tooth cavity Menstrual & gas pain - Soak a handful of leaves in a lass of boiling water. Drink infusion. Nausea & Fainting - Crush leaves and apply at nostrils of patients Insect bites - Crush leaves and apply juice on affected area or pound leaves until like a paste, rub on affected area Pruritis - Boil plant alone or with eucalyptus in water. Use decoction as a wash on affected area.
Yerba (Hierba ) Buena
(Mentha cordifelia)
Plant Name: Sambong
(Blumea balsamifera)
Uses & Preparation: Anti-edema, diuretic, anti-urolithiasis - Boil chopped leaves in a glass of water for 15 minutes until one glassful remains. Divide decoction into 3 parts, drink one part 3 times a day. Diarrhea - Chopped leaves and boil in a glass of water for 15 minutes. Drink one part every 3 hours.
Plant Name: Tsaang Gubat
(Carmona retusa)
Plant Name:
Uses & Preparation: Diarrhea - Boil chopped leaves into 2 glasses of water f minutes. Divide decoction into 4 parts. Drink 1 part ever hours Stomachache - Boil chopped leaves in 1 glass of water minutes. Cool and strain.
Uses & Preparation: Anti-helmintic - The seeds are taken 2 hours after sup no worms are expelled, the dose may be repeated after week. (Caution: Not to be given to children below 4 year
Niyug-niyogan (Quisqualis
indica L.)
Uses & Preparation: For washing wounds - Maybe use twice a day
Plant Name: Bayabas/Guava (Psidium
guajava L.)
Plant Name:
Diarrhea - May be taken 3-4 times a day As gargle and for toothache - Warm decoction is used for gargle. Freshly pounded leaves are used for toothache. Boil chopped leaves for 15 minutes at low fi re. Do not cover and then let it cool and strain
Uses & Preparation: Anti-fungal (tinea flava, ringworm, athlete’s foot an scabies) - Fresh, matured leaves are pounded. Apply so the affected area 1-2 times a day
Akapulko
(Cassia alata L.)
Plant Name:
Uses & Preparation: Lowers uric acid (rheumatism and gout) - One a half cup l are boiled in two glass of water over low fire. Do not cove Divide into 3 parts and drink one part 3 times a day
Ulasimang Bato
(Peperonica pellucida)
Plant Name: Bawang
Uses & Preparation: Hypertension - Maybe fried, roasted, soaked in vinegar minutes, or blanched in boiled water for 15 mi nutes. Take pieces 3 times a day after meals. Toothache - Pound a small piece and apply to affected a
(Allium sativum)
Plant Name
Uses & Preparation: Diabetes Mellitus (Mild non-insulin dependent) - Ch leaves then boil in a glass of water for 15 minutes. Do no cover. Cool and strain. Take 1/3 cup 3 times a day after
Ampalaya
(Mamordica Charantia)
Reminders on the Use of Herbal Medicine
1. Avoid the use of insecticide as these may leave poison on plants. 2. In the preparation of herbal medicine, use a clay pot and remove cover while boiling at low heat. 3. Use only part of the plant being advocated. 4. Follow accurate dose of suggested preparation. 5. Use only one kind of herbal plant for each type of symptoms or sickness.
6. Stop giving the herbal medication in case untoward reaction such as allergy occurs. 7. If signs and symptoms are not relieved after 2 to 3 doses of herbal medication, consult a doctor.
Integrated Management of Childhood Illnesses (IMCI)
Definition
Goal
IMCI is an integrated approach to child health that focuses on the well-being of the whole child. IMCI strategy is the main intervention proposed to achieve a significant reduction in the number of deaths from communicable diseases in children u nder five
By 2010, to reduce the infant and under five mortality rate at least one third, in pursuit of the goal of reducing it by two thirds by 2015.
Aim
To reduce death, illness and disability, and to promote improved growth and development among children under 5 years of age. IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.
IMCI Objectives
To reduce significantly global mortality and morbidity associated with the major causes of disease in children To contribute to the healthy growth & development of children
IMCI Components of Strategy
Improving case management skills of health workers § Improving the health systems to deliver IMCI Improving family and community practices
**For many sick children a single diagnosis ma y not be apparent or appropriate Presenting complaint:
Cough and/or fast breathing Lethargy/Unconsciousness Measles rash ―Very sick‖ young infant
Possible course/ associated condition:
Pneumonia, Severe anemia, P. falciparum malaria Cerebral malaria, meningitis, severe dehydration Pneumonia, Diarrhea, Ear infection Pneumonia, Meningitis, Sepsis
Five Disease Focus of IMCI:
Acute Respiratory Infection Diarrhea
Fever Malaria Measles Dengue Fever Ear Infection Malnutrition
The IMCI Case Management Process
Assess and classify Identify appropriate treatment Treat/refer Counsel Follow-up
The Integrated Case Management Process Check for General Danger Signs:
A general danger sign is present if: The child is not able to drink or breastfeed o The child vomits everything o The child has had convulsions o The child is lethargic or unconscious o
Assess Main Symptoms
Cough/DOB Diarrhea Fever Ear problems
Assess and Classify Cough of Difficulty of Breathing
Respiratory infections can occur in any part of the respiratory tract such as the nose, throat, larynx, trachea, air passages or lungs.
Assess and classify PNEUMONIA
Cough or difficult breathing An infection of the lungs
Both bacteria and viruses can cause pneumonia Children with bacterial pneumonia may die from h ypoxia (too little oxygen) or sepsis (generalized infection).
** A child with cough or difficult breathing is assessed for: How long the child has had cough or difficult breathing Fast breathing Chest indrawing Stridor in a calm child.
Remember: o
o
** If the child is 2 months up to 12 months the child has fast breathing if you count 50 breaths per minute or more ** If the child is 12 months up to 5 years the child has fast breathing if you count 40 breaths per minute or more.
Color Coding PINK (URGENT REFERRAL)
YELLOW (Treatment at outpatient health facility)
GREEN (Home management)
HOME OUTPATIENT HEALTH FACILITY
Pre-referral treatments Advise parents Refer child
OUTPATIENT HEALTH FACILITY
Treat local infection Give oral drugs Advise and teach caretaker
Follow-up
REFERRAL FACILITY
Emergency Triage and Treatment ( ETAT) Diagnosis, Treatment Monitoring,
SEVERE PNEUMONIA OR VERY SEVERE DISEASE
Caretaker is counseled on: Home treatment/s Feeding and fluids When to return immediately Follow-up Give first dose of an appropriate antibiotic Give Vitamin A Treat the child to prevent low blood sugar Refer urgently to the hospital Give paracetamol
o
follow-up
for fever > 38.5 C
Any general danger sign or Chest indrawing or Stridor in calm child
PNEUMONIA
Fast breathing
NO PNEUMONIA : COUGH OR COLD
No signs of pneumonia or very severe disease
Assess and classify DIARRHEA A child with diarrhea is assessed for:
Give an appropriate antibiotic for 5 days Soothe the throat and relieve cough with a safe remedy Advise mother when to return immediately Follow up in 2 days Give Paracetamol o for fever > 38.5 C If coughing more than more than 30 days, refer for assessment Soothe the throat and relieve the cough with a safe remedy Advise mother when to return immediately Follow up in 5 days if not improving
How long the child has had diarrhoea Blood in the stool to determine if the child has dysentery Signs of dehydration.
Classify DYSENTERY o
Child with diarrhea and blood in the stool
Two of the following signs?
Abnormally sleepy or difficult to awaken Sunken eyes SEVERE Not able to drink or DEHYDRATION drinking poorly Skin pinch goes back very slowly
Two of the following signs :
Restless, irritable Sunken eyes SOME Drinks eagerly, thirsty DEHYDRATION Skin pinch goes back slowly
Not enough signs to classify as some or severe dehydration
NO DEHYDRATION
Dehydration present
SEVERE PERSISTENT DIARRHEA
If child has no other severe classification: Give fluid for severe o dehydration ( Plan C ) OR If child has another severe classification : Refer URGENTLY to hospital o with mother giving frequent sips of ORS on the way Advise the mother to continue o breastfeeding If child is 2 years or older and there is cholera in your area, give antibiotic for cholera Give fluid and food for some dehydration ( Plan B ) If child also has a severe classification : Refer URGENTLY to hospital o with mother giving frequent sips of ORS on the way Advise mother when to return o immediately Follow up in 5 days if not improving Home Care Give fluid and food to treat diarrhea at home ( Plan A ) Advise mother when to return immediately Follow up in 5 days if not improving Treat dehydration before referral unless the child has another severe classification Give Vitamin a
No dehydration
PERSISTENT DIARRHEA
Refer to hospital
Advise the mother on feeding a child who has persistent diarrhea Give Vitamin A Follow up in 5 days
Blood in the stool DYSENTERY
Treat for 5 days with an oral antibiotic recommended for Shigella in your area Follow up in 2 days Give also referral treatment
Does the child have fever? **Decide:
Malaria Risk No Malaria Risk Measles Dengue
Malaria Risk
Any general danger sign or Stiff neck
VERY SEVERE FEBRILE DISEASE / MALARIA
Give first dose of quinine ( under medical supervision or if a hospital is not accessible within 4hrs ) Give first dose of an appropriate antibiotic Treat the child to prevent low blood sugar Give one dose of paracetamol in health center for high fever o (38.5 C) or above Send a blood smear with the patient Refer URGENTLY to hospital
Blood smear ( + )
If blood smear not done:
NO runny nose, and NO measles, and NO other causes of fever
MALARIA
Blood smear ( - ), or Runny nose, or Measles, or Other causes of fever
FEVER : MALARIA UNLIKELY
Treat the child with an oral antimalarial Give one dose of paracetamol in health center for high fever o (38.5 C) or above Advise mother when to return immediately Follow up in 2 days if fever persists If fever is present everyday for more than 7 days, refer for assessment Give one dose of paracetamol in health center for high fever o (38.5 C) or above Advise mother when to return immediately Follow up in 2 days if fever persists If fever is present everyday for more than 7 days, refer for assessment
No Malaria Risk
Any general danger sign or Stiff neck
VERY SEVERE FEBRILE DISEASE
No signs of very severe febrile disease
FEVER : NO MALARIA
Give first dose of an appropriate antibiotic Treat the child to prevent low blood sugar Give one dose of paracetamol in health center for high fever o (38.5 C) or above Refer URGENTLY to hospital Give one dose of paracetamol in health center for high fever o (38.5 C) or above Advise mother when to return immediately Follow up in 2 days if fever persists If fever is present everyday for more than 7 days, refer for
assessment
Measles
Clouding of cornea or Deep or extensive mouth ulcers
SEVERE COMPLICATED MEASLES
Pus draining from the eye or Mouth ulcers
Measles now or within the last 3 months
Dengue Fever
MEASLES WITH EYE OR MOUTH COMPLICATIONS
MEASLES
Give Vitamin A Give first dose of an appropriate antibiotic If clouding of the cornea or pus draining from the eye, apply tetracycline eye ointment Refer URGENTLY to hospital Give Vitamin A If pus draining from the eye, apply tetracycline eye ointment If mouth ulcers, teach the mother to treat with gentian violet Give Vitamin A
Bleeding from nose or gums or Bleeding in stools or vomitus or Black stools or vomitus or Skin petechiae or Cold clammy extremities or Capillary refill more than 3 seconds or Abdominal pain or Vomiting Tourniquet test ( + )
SEVERE DENGUE HEMORRHAGIC FEVER
No signs of severe dengue hemorrhagic fever
FEVER: DENGUE HEMORRHAGIC UNLIKELY
If skin petechiae or Tourniquet test,are the only positive signs give ORS If any other signs are positive, give fluids rapidly as in Plan C Treat the child to prevent low blood sugar DO NOT GIVE ASPIRIN Refer all children Urgently to hospital
DO NOT GIVE ASPIRIN Give one dose of paracetamol in health center for high fever o (38.5 C) or above Follow up in 2 days if fever persists or child shows signs of bleeding Advise mother when to return immediately
Does the child have an ear problem?
Tender swelling behind the ear MASTOIDITIS
Pus seen draining from the ear and discharge is reported for less than 14 days or Ear pain
ACUTE EAR INFECTION
Give first dose of appropriate antibiotic Give paracetamol for pain Refer URGENTLY Give antibiotic for 5 days Give paracetamol for pain Dry the ear by wicking Follow up in 5 days
Pus seen draining from the ear and discharge is reported for less than 14 days No ear pain and no pus seen draining from the ear
CHRONIC EAR INFECTION
NO EAR INFECTION
Dry the ear by wicking Follow up in 5 days No additional treatment
Check for Malnutrition and Anemia Give an Appropriate Antibiotic: A. For Pn eumoni a, Acute ear i nf ection or V ery Sever e disease
Age or Weight
COTRIMOXAZOLE
AMOXYCILLIN
BID FOR 5 DAYS
BID FOR 5 DAYS
Adult
Syrup
Tablet
Syrup
tablet
2 months up to 12 months ( 4 - < 9 kg )
1/2
5 ml
1/2
5 ml
12 months up to 5 years ( 10 – 19kg )
1
7.5 ml
1
10 ml
B. F or D ysentery
AGE OR WEIGHT
COTRIMOXAZOLE
AMOXYCILLIN
BID FOR 5 DAYS
BID FOR 5 DAYS
TABLET
SYRUP
SYRUP 250MG/5ML
2 – 4 months
½
5 ml
1.25 ml ( ¼ tsp )
4 – 12 months
½
5 ml
2.5 ml ( ½ tsp )
( 6 - < 10 kg ) 1 – 5 years old
1
7.5 ml
( 1 tsp )
( 4 - < 6kg )
( 10 – 19 kg )
C. For Cholera
TETRACYCLINE
COTRIMOXAZOLE
QID FOR 3 DAYS
BID FOR 3 DAYS
AGE OR WEIGHT
Capsule 250mg
Tablet
Syrup
2 – 4 months ( 4 - < 6kg )
¼
1/2
5ml
4 – 12 months ( 6 - < 10 kg )
½
1/2
5 ml
1 – 5 years old ( 10 – 19 kg)
1
1
7.5ml
Give an Oral Anti malarial
CHOLOROQUINE Give for 3 days
AGE
2months –
TABLET ( 150MG )
DAY1 ½
DAY2 ½
DAY3 ½
Primaquine
Primaquine
Sulfadoxine + Pyrimethamine
Give single dose in health center for P. Falciparum
Give daily for 14 days for P. Vivax
Give single dose
TABLET
TABLET
TABLET
( 15MG)
( 15MG)
( 15MG) ¼
5months 5 months –
½
½
½
12 months 12months –
1
1
½
½
¼
¾
1½
1½
1
3/4
1/2
1
1/2
3 years old
3 years old 5 years old
GIVE VITAMIN A
AGE
6 months – 12 months
VITAMIN A CAPSULES 200,000 IU
1/2
12 months – 5 years old 1 GIVE IRON
AGE or WEIGHT
Iron/Folate Tablet FeSo4 200mg + 250mcg Folate (60mg elemental iron)
Iron Syrup FeSo4 150 mg/5ml (6mg elemental iron per ml )
2months-4months (4 - <6kg )
2.5 ml
4months – 12months (6 - <10kg )
4 ml
12months – 3 years 1/2 (10 - <14kg) 3years – 5 years ( 14 – 1/2 19kg )
5 ml 7.5 ml o
GIVE PARACETAMOL FOR HIGH FEVER (38.5 C OR MORE) OR EAR PAIN AGE OR WEIGHT 2 months – 3 years ( 4 - <14kg ) 3 years up to 5 years (14 – 19 kg )
TABLET ( 500MG )
SYRUP ( 120MG / 5ML )
¼
5 ml
1/2
10 ml
GIVE MEBENDAZOLE
Give 500mg Mebendazole as a single dose in health center if : hookworm / whipworm are a problem in children in your area, and o the child is 2 years of age or older, and o the child has not had a dose in the previous 6 months o
Laws Affecting Public Health and Practice of CHN
R.A. 7160 - or the Local Government Code
This involves the devolution of powers, functions and responsibilities to the local government both rural & urban. The Code aims to transform local government units into self-reliant communities and active partners in the attainment o f national goals thru‘ a more responsive and accountable local government structure instituted thru‘ a system of decentralization. Hence, each province, city and municipality has a LOCAL HEALTH BOARD (LHB) which is mandated to propose an nual budgetary allocations for the operation and maintenance of their own health facilities.
Composition of LHB
Provincial Level 1. 2. 3. 4. 5.
Governor- chair Provincial Health Officer – vice chairman Chairman, Committee on Health of Sangguniang Panlalawigan DOH representative NGO representative City and Municipal Level
1. 2. 3. 4. 5.
Mayor – chair MHO – vice chair Chairman, Committee on Health of Sangguniang Bayan DOH representative NGO representative Effective Local Health System Depends on:
1. The LGU‘s financial capability 2. A dynamic and responsive political leadership 3. Community empowerment
R.A. 2382 – Philippine Medical Act.
This act defines the practice of medicine in the country.
R.A. 1082 – Rural Health Act.
It created the 1st 81 Rural Health Units.
amended by RA 1891; more physicians, dentists, nurses, midwives and sanitary inspectors will live in the rural areas where they are assigned in order to raise the health conditions of barrio people ,hence help decrease the high incidence of preventable diseases
R.A. 6425 – Dangerous Drugs Act
It stipulates that the sale, administration, delivery, distribution and transportation of prohibited drugs is punishable by law.
R.A. 9165 – the new Dangerous Drug Act of 2002
P.D. No. 651
Requires that all health workers shall identify and encourage the registration of all births within 30 days following delivery.
P.D. No. 996
Requires the compulsory immunization of all children below 8 yrs. of age against the 6 childhood immunizable diseases.
P.D. No. 825
Provides penalty for improper disposal of garbage.
R.A. 8749 – Clean Air Act of 2000
P.D. No. 856 – Code on Sanitation
It provides for the control of all factors in man‘s environment th at affect health including the quality of water, food, milk, insects, animal carriers, transmitters of disease, sanitary and recreation facilities, noise, pollution and control of nuisance.
R.A. 6758
Standardizes the salary of government employees inc luding the nursing personnel.
R.A. 6675 – 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 generic name.
R.A. 6713 – Code of Conduct and Ethical Standards of Public Officials and Employees
It is the policy of the state to promote high standards of ethics in public office. Public officials and employees shall at all times be accou ntable to the people and shall discharges their duties with utmost responsibility, integrity, competence and loyalty, act with patriotism and justice, lead modest lives uphold public interest over pe rsonal interest.
R.A. 7305 – Magna Carta for Public Health Workers
This act aims: to promote and improve the social and economic well-being of health workers, their living and working conditions and terms of emplo yment; to develop their skills and capabilities in order that they will be more responsive and better equipped to deliver health projects and programs; and to encou rage those with proper qualifications and excellent abilities to join and remain in government service.
R.A. 8423
Created the Philippine Institute of Traditional and Alternative Health Care.
P.D. No. 965
Requires applicants for marriage license to receive instructions on family planning and responsible parenthood.
P.D. NO. 79
Defines, objectives, duties and functions of POPCOM
RA 4073
advocates home treatment for leprosy
Letter of Instruction No. 949
legal basis of PHC dated OCT. 19, 1979 promotes development of health programs on the community level
RA 3573
requires reporting of all cases of communicable diseases and administration of prophylaxis
Ministry Circular No. 2 of 1986
includes AIDS as notifiable disease
R.A. 7875 – National Health Insurance Act
R.A. 7432 – Senior Citizens Act
R. A. 7719 - National Blood Services Act
R.A. 8172 – Salt Iodization Act (ASIN LAW)
R.A. 7277- Magna Carta for PWD’s \
provides their rehabilitation, self development and self-reliance and integration into the mainstream of society
A. O. No. 2005-0014- National Policies on Infant and Young Child Feeding:
1. 2. 3. 4.
All newborns be breastfeed within 1 hr after birth Infants be exclusively breastfeed for 6 months. Infants be given timely, adequate and safe complementary foods Breastfeeding be continued up to 2 years and beyond
EO 51- Phil. Code of Marketing of Breast milk Substitutes
R.A. - 7600 – Rooming In and Breastfeeding Act of 1992
R.A. 8976- Food Fortification Law
R.A. 8980
promulgates a comprehensive policy and a national system for ECCD
A.O. No. 2006- 0015
defines the Implementing guidelines on Hepatitis B Immunization for Infants
R.A. 7846
mandates Compulsory Hepatitis B Immunization among infants and children less than 8 yrs old
R.A. 2029
mandates Liver Cancer and Hepatitis B Awareness Month Act (February)
A.O. No. 2006-0012
specifies the Revised Implementing Rules and Regulations of E.O. 51 or Milk Code, Relevant International Agreements, Penalizing Violations thereof and for other purposes
Levels of Clientele in CHN
Individual Basic approaches in looking at the individual:
1. Atomistic 2. Holistic Perspectives in understanding the individual:
1. Biological unified whole o holon o dimorphism o 2. Anthropological essentialism o social constructionism o culture o 3. Psychological psychosexual o psychosocial o behaviorism o social learning o 4. Sociological family and kinship o social groups o
Family Models:
1.Developmental Stages of F amily D evelopment
Stage I – Beginning Family (newly wed couples) TASK: compliance with the PD 965 & acceptance of the new member of the family Stage II – Early Child Bearing Family (0-30 months old) TASK: emphasize the importance of pregnancy & immunization & learn the concept of arenting Stage III – Family with Pre- school Children (3-6yrs old)
TASK: learn the concept of responsible parenthood Stage IV – Family with School age Children (6-12yrs old) TASK: Reinforce the concept of responsible parenthood Stage V - Family with Teen Agers (13-25yrs old) TASK: Parents to learn the concept of “let go system” and understands the “generation gap” Stage VI – Launching Center (1st child will get married up to the last child) TASK: compliance with the PD 965 & acceptance of the new member of the family Stage VII -Family with Middle Adult parents (36-60yrs old) TASK: provide a healthy environment, adjust with a new lifestyle and adjust with the financial aspect Stage VIII – Aging Family (61yrs old up to death) TASK: learn the concept of death positively 2.Structural-Functional I ni tial D ata Base
Family structure and Characteristics Socio-economic and Cultural Factors Environmental Factors Health Assessment of Each Member Value Placed on Prevention of Disease
F irst L evel Assessment
Health threats: o
conditions that are conducive to disease, accident or failure to realize one‘s health potential
Health deficits: o
instances of failure in health maintenance (disease, disability, developmental lag)
Stress points/ Foreseeable crisis situation: o
anticipated periods of unusual demand on the individual or family in terms of adjustment or family resources
Second L evel A ssessment:
Recognition of the problem Decision on appropriate health action Care to affected family member Provision of healthy home environment Utilization of community resources for health care
Problem Priori tization:
Nature of the problem Health deficit Health threat Foreseeable Crisis
Preventive potential High Moderate Low
Modifiability Easily modifiable Partially modifiable Not modifiable
Salience High Moderate Low
F amily Ser vice and Progr ess Record
Population Group Vulnerable Groups:
Infants and Young Children School age Adolescents Mothers Males
Old People
Specialized Fields: Communi ty M ental H ealth Nur sin g
A unique clinical process which includes an integration of concepts from nursing, mental health, social psychology, psychology, community networks, and the basic sciences
Occupational H ealth N ur sin g
The application of nursing principles and procedures in conserving the health of workers in all occupations
School H ealth Nur sin g
The application of nursing theories and principles in the care of the school population
Management of a Child with an Ear Problem
Classification of Ear Infection
1. Mastoiditis – tender swelling behind the ear (in infants, swelling may be above the ear) Treatment
1. Antibiotics 2. Surgical intervention 2. Acute Ear Infection – pus draining from the ear for less than 2 weeks, ear pain, red, immobile ear drum (Acute Otitis Media) Treatment
1. Cotrimoxazole,Amoxycillin,or Ampicillin 2. Dry the ear by wicking 3. Chronic Ear Infection – pus draining from the ear for more than 2 weeks (Chronic Otitis Media) Treatment
1. Most important & effective treatment : Keep the ear dr y by wick in g. 2. Paracetamol maybe given for pain or high fever. 3. Precautions for a child with a draining ear: Do not leave anything in the ear such as cotton, wool between wicking treatments. o Do not put oil or any other fluid into the ear. o Do not let the child go swimming or get water in the ear. o
Maternal and Child Health Nursing Program
Philosophy
Pregnancy, labor and delivery and puerperium are part of the continuum of the total life cycle Personal, cultural and religious attitudes and beliefs influence the meanin g of pregnancy for individuals and make each experience unique MCN is FAMILY CENTERED- the father is as important as the mother
Goals
To ensure that expectant mother and nursing mother maintain good health, learn the art of child care, has a normal delivery and bear healthy children That every child lives and grows up in a family unit with love and security, in healthy surroundings, receives adequate nourishment, health supervision and efficient medical attention and is taught the elements of healthy living
Classification of pregnant women
Normal – healthy pregnancy With mild complications- frequent home visits With serious or potentially serious complication – referred to most skilled source of medical and hospital care
Home Based Mother’s Record (HBMR)
Tool used when rendering prenatal care containing risk factors and danger signs
Risk Factors
145 cm tall (4 ft & 9 inches) Below 18 yrs old, above 35 yrs old Have had 4 pregnancies With TB, goiter, heart disease, DM, bronchial asthma, severe anemia Last baby born was less than 2 years ago Previous cesarian section delivery History of 2 or more abortions, difficult delivery, given birth to twins, 2 or more babies born before EDD, stillbirth Weighs less than 45 kgs. or more than 80 kgs.
Danger Signs
1. 2. 3. 4.
any type of vaginal bleeding headache, dizziness, blurred vision puffiness of face and hands pallor
Prenatal Care Schedule of Visits
1st – as early as pregnancy, 1st trimester 2nd - 2nd trimester 3rd & subsequent visits - 3rd trimester More frequent visits for those at risk with complications
Tetanus Toxiod Immunization Schedule for Women Vaccine
TT1
Minimum Age Interval As early as possible during pregnancy
Percent Protected
0%
TT2
At least 4 weeks later
80%
TT3
At least 6 months later
90%
TT4
At least 1 year later
99%
TT5
At least 1 year later
99%
Dose: 0.5ml Route: Intramuscular Site: Right or Left Deltoid/Buttocks Components of Prenatal Visits
History – taking
Duration of Protection
None Infants born to the mother will be protected from neonatal tetanus. Gives 3 years protection for the mother from the tetanus. Infants born to the mother will be protected from neonatal tetanus. Gives 5 years protection for the mother. Gives 10 years protection for the mother Gives lifetime protection for the mothers. All Infants born to that mother will be protected.
Determination of obstetrical score- G, P, TPAL, AOG, EDD U/A for Proteinuria, glycosuria and infxtn Dental exam Wt. Ht. BP taking Exam of conjunctiva and palms for pallor Abdominal exam - fundic ht, Leopold‘s maneuver and FHT Exam of breasts, face, hands and feet for edema and neck for thyroid enlargement Health teachings- nutrition, personal hygiene, common complaints Tetanus toxoid immunization Iron supplementation – from 5th mo. Of pregnancy - 2 mos. Postpartum In goiter endemic areas – iodized capsule once a year In malaria infested areas- prophylactic Chloroquine (150 mg/tab ) 2 tabs/ wk for the whole duration of pregnancy
National Health Plan
Definition
National Health Plan is a long-term directional plan for health; the blueprint defining the country‘s health – PROBLEMS, POLICY THRUSTS STRATEGIES, THRUSTS
Goal
to enable the Filipino population to achieve a level of health which will allow Filipino to lead a socially and economically-productive life, with longer life expectancy, low infant mortality, low maternal mortality and less disability through measures that will guarantee access of everyone to essential health care
Objectives
promote equity in health status among all segments of society address specific health problems of the population upgrade the status and transform the HCDS into a responsive, dynamic and highly efficient, and effective one in the provision of solutions to changing the health needs of the population promote active and sustained people‘s participation in health care
Health Plans Towards “Health In The Hands Of The People In The Year 2020”
1. Major Health Plan
23 IN 93 Health for more in 94 Think health…… Health Link 5 in 95
2. Priority Program in Year 2000
Plan 50 Plan 500 Women‘s health Children‘s health Healthy Lifestyle Prevention & Control of Infectious Disease
3. Priority Program in the Year 2005
Ligtas Buntis Campaign Mag healthy Lifestlye tayo TB Network Blood Donation Program (RA 7719) DTOMIS Ligtas Tigdas Campaign Murang Gamot Anti Tobacco Signature Campaign Doctors to the Barrios Program Food Fortification Program Sentrong Sigla Movement
4. National Health Events for 2006 JANUARY
National Cancer Consciousness Week - (16-22) FEBRUARY
Heart Month Dental Health Month Responsible Parenthood Campaign National Health Insurance Program MARCH
Women's Health Month Rabies Awareness Month Burn Injury Prevention Month Responsible Parenthood Campaign Colon and Rectal Cancer Awareness Month World TB Day - (24) APRIL
Cancer in Children Awareness Month World Health Day - (7) Bright Child Week Phase I Garantisadong Pambata (11-17) MAY
Natural Family Planning Month Cervical Cancer Awareness Month AIDS Candlelight Memorial Day - (21)
World No Tobacco Day - (31) JUNE
Dengue Awareness Month No Smoking Month National Kidney Month Prostate Cancer Awareness Month JULY
Nutrition Month National Blood Donation Month National Disaster Consciousness Month AUGUST
National Lung Month National Tuberculosis Awareness Month Sight-Saving Month Family Planning Month Lung Cancer Awareness Month SEPTEMBER
Generics Awareness Month Liver Cancer Awareness Month OCTOBER
National Children's Month Breast Cancer Awareness Month National Newborn Screening Week (3-9) Bright Child Week Phase II Garantisadong Pambata (10-16) NOVEMBER
Filariasis Awareness Month Cancer Pain Management Awareness Month Traditional and Alternative Health Care Month Campaign on Violence against Women and Children DECEMBER
Firecracker Injury Prevention Campaign:
―OPLAN IWAS PAPUTOK‖
Non-Communicable Diseases and Rehabilitation
Prevention and Control of Cardiovascular Diseases
heart – 1st leading cause of death ; blood vessels - 2nd Congenital Heart Disease (CHD) : Result of the abnormal development of the heart that exhibits septal defect, patent ductus arteriosus, aortic and pulmonary stenosis, and cyanosis; most prevalent in children Causes: environmental factors, maternal diseases or genetic aberrations o Rheumatic Fever or Rheumatic Heart Disease: Systematic inflammatory disease that may develop as a delayed reaction to repeated and an inadequately treated infection of the upper respiratory tract by group A beta -hemolytic streptococci. Hypertension: Persistent elevation of the arterial blood pressure.(primary or essential) ;frequent among females but severe, malignat form is more common among males Ischemic Heart Disease/ Atherosclerosis: Condition usually caused by the occlusion of the coronary arteries by thrombus or clot formation. higher among males than females for the latter are protected by estrogen before o menopause Predisposing Factor: Hypertension (HPN),Diabetes Mellitus (DM), Smoking o Minor Risk Factor: stress, strong family history, obesity o
Cardiovascular Disease Period of Life
Type of CVD
At birth to early childhood
Congenital Heart Disease
Early to late childhood
Rheumatic Fever/ Rheumatic Heart Disease
Early Adulthood Middle age to old age
Prevalence 2/ 1000 school children (aged 5-15 yrs. old) 1/1000 school children (aged 5-15 yrs. old)
Diseases of Heart Muscles 10/100 adults Essential Hypertension Coronary Artery Disease 5/100 adults Cerebrovascular Accident
Cardiovascular Disease Diseases
Causes/ Risk factors Maternal Infections, Drug intake, Maternal Congenital Heart Disease Disease, Genetic Rheumatic Fever/Rheumatic Heart Frequent Streptoccocal Sore Throat Disease Essential Hypertension Heredity, High Salt Intake
Coronary Artery Disease (Heart Attack)
Smoking, Obesity, Hypertension, Stress Hyperlipidemia, Diabetes Mellitus Sedentary Life Style
Cerebrovascular Accident Hypertension, Arteriosclerosis (Stroke) Primary Prevention: CVD Disease
Congenital Heart Disease
Rheumatic Heart Disease
Essential Hypertension
Coronary Heart Disease (Heart Attack)
Cerebrovascular Accident (Stroke)
Primordial Prevention of viral infection and intake of harmful drugs during pregnancy. Avoidance of marriage between blood relatives
Prevention of recurrent sore throat thru adequate environmental sanitation; avoidance of overcrowding; adequate treatment From early childhood low salt diet o adequate physical o exercise
Prevention of development/ acquisition of risk factors cigarette smoking o high fat intake o high salt intake o
all measures to prevent hypertension & arteriosclerosis
Specific Protection Adequate treatment of viral infection during pregnancy. Genetic counseling of blood related married couples.
Identification of cases of rheumatic fever Prophylaxis with penicillin or erythromycin
Continued low salt diet and adequate exercise
cessation of smoking control /treatment of diabetes, hypertension weight reduction change to proper diet Adjustment of activities
all measures to control hypertension & progression of arteriosclerosis
Primary Prevention thru health education is the main focus of the program:
1. Maintenance of ideal body wt.
2. 3. 4. 5.
diet - low fat alcohol/smoking avoidance exercise regular BP check up
Cancer Prevention and Early Detection
Any malignant tumor arising from the abnormal and uncontrolled division of cells causing the destruction in the surrounding tissues. Common Cancer: Lung cancer, cervical cancer, colon cancer, cancer of the mouth, breast cancer, skin cancer, prostate cancer. 3rd leading cause of illness and death (Phil.) Incidence can only be reduced thru prevention and early detection
Nine Warning Signs of Cancer:
Change in blood bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty in swallowing O bvious change in wart or mole Nagging cough or hoarseness Unexplained anemia Sudden unexplained weight loss
Prevention & Early Detection CA type Prevention Detection Lung No smoking None Uterine Monogamy, Safe sex Pap‘s smear every 1-3 yrs Cervical Monogamy, Safe sex Pap‘s smear every 1-3 yrs Hep B vaccination, Less Liver alcohol intake, Avoidance of None moldy foods Regular medical checkup Colon High fiber diet after 40 yrs of age Fecal occult blood test Rectum Low fat intake DRE Sigmoidoscopy No smoking, betel nut Mouth Regular dental check-ups chewing, Oral hygiene Monthly SBE, Yearly exam Breast none by doctor, Mammography for 50 yrs old and above
females
Skin Prostate
No excessive sun exposure none
Assessment of skin Digital transrectal exam
Principles of Treatment of Malignant Diseases
One third of all cancers are curable if detected early and treated properly. Three major forms of treatment of cancer:
1. Surgery 2. Radiation Therapy 3. Chemotherapy
Nat’l Diabetes Prevention and Control Program Aim:
Controlling and assimilating healthy lifestyle in the Filipino culture (2005- 2010) thru IEC
Main Concern:
modifiable risk factors ( diet, body wt., smoking, alcohol, stress, sedentary living, birth wt. ,migration
Prevention and Control of Kidney Disease
1. Acute or Rapidly Progressive Renal Failure : A sudden decline in renal function resulting from the failure of the renal circulation or by glomerular or tubula r damage causing the accumulation of substances that is normally eliminated in the urine in the body fluids leading to disruption in homeostatic, endocrine, and metabolic functions. 2. Acute Nephritis : A severe inflammation of the kidney caused by infection, degenerative disease, or disease of the blood vessels. 3. Chronic Renal Failure: A progressive deterioration of renal function that ends as uremia and its complications unless dialysis or kidney transplant is performed. 4. Neprolithiasis : A disorder characterized by the presence o f calculi in the kidney. 5. Nephrotic Syndrome: A clinical disorder of excessive leakage of plasma proteins into the urine because of increased permeability of the glomerular capillary membrane 6. Urinary Tract Infection : A disease caused by the presence of pathogenic microorganisms in the urinary tract with or without signs and symptoms. 7. Renal Tubular Defects: An abnormal condition in the reabsorption of selected materials
back into the blood and secretion, collection, and conduction of urine. 8. Urinary Tract Obstruction: A condition wherein the urine flow is blocked or clogged.
Program on Mental Health and Mental Disorders Mental Health
Mental health is not merely the absence of mental illness. According to the World Health Organization (WHO) Manual on Mental Health, a person is in a state of sound mental health when, o He feels physically well o o His thought are organized o o His feelings are modulated o o His behaviors are coordinated and o appropriate (*note: behaviors considered “normal” may vary according to cultural norms) § Any person may develop mental illness regardless of race, nationality, age, sex civil status and socio-economic background may develop mental illness.
Causes of Mental Illness
A Combination or One of These: 1. Biological factors Like hereditary predisposition, poor nutrition o 2. Physical Factors Physical injuries, intoxication o 3. Psychological Factors Failure to adjust to the difficulties in life. o 4. Socio-economic Factors Unemployment, housing problems o How is Mental Illness Detected?
1. Interview and assessment by the Clinical Social Worker. 2. Psychological testing and evaluation. 3. Psychiatric interview and mental status examination. Is Mental Illness Curable?
Yes. Mental illness is curable if detected early and prompt and adequate treatment is given. Treatment depends on severity of illness and includes: Pharmacotherapy (use of medicines) o Various therapies (physical, recreational, occupational, environmental) o Psychotherapy and others o
Prevention of Mental Illness
1. 2. 3. 4. 5. 6.
Maintain good physical health. Choose worthwhile activities and develop a hobby Solve problems as they come and avoid excessive worrying. Cultivate friendships and choose a friend to confide in. Strike a happy medium between work and play. Recognize early signs and symptoms.
Some Early Signs of Symptoms Mental Illness
Persistent disturbance in sleep and appetite Over sensitiveness and excessive irritability Loss of interest in activities or responsibilities of previous concern Constant complaint of headaches, weakness of ha nds and feet and other bodily complaints. Persistent seclusion of oneself from other people. Frequent attacks of palpitations usually expressed as ―nerbiyos‖ & associated with unexplained fears. Frequent attacks of dizziness & fainting. Exaggerated and /or unfounded suspicions Persistent worrying, forgetfulness & absentmindedness.
Program on Drug Dependence/ Substance Abuse
Community-Based Rehabilitation Program
A creative application of the primary health care approach in rehabilitation services, which involves measures taken at the community level to use and build on the resources of the community with the community people, including impaired, disabled and handicapped persons as well.
Goal:
To improve the quality of life and increase productivity of disabled, handicapped persons.
Aim:
To reduce the prevalence of disability through prevention, early detection and provision of rehabilitation services at the community level.
Program on the Elderly/Geriatric Nursing Services
Leading causes of illness: elderly
Influenza, HPN, diarrhea, bronchitis, TB, diseases. of the heart, pneumonia, malaria, malignant neoplasm, chickenpox
Leading causes of death: elderly
Diseases of heart and vascular system Pneumonia, TB, CCOPD Malignant neoplasms Diabetes Nephritis Accidents
Programs on Blindness, Deafness and Osteoporosis
Cataract- main causes of blindness VAD- main cause of childhood blindness; most serious eye problem of Filipino children below 6 yrs. old Osteoporosis special problem in women, highest bet. 50 — 79 yrs. old, MENOPAUSE main cause
Nursing Procedures in the Community
Clinic Visit
process of checking the client‘s health condition in a medical clinic
Home Visit
a professional face to face contact made by the nurse with a patient or the family to provide necessary health care activities and to further attain the objectives of the agency
Bag Technique
a tool making of the public health bag through which the nurse during the home visit can perform nursing procedures with ease and deftness saving time and effort with the end in view of rendering effective
Thermometer Technique
to assess the client‘s health condition through body temperature reading
Nursing Care in the Home
giving to the individual patient the nursing care required by his/her specific illness or trauma to help him/her reach a level of functioning at which he/she can maintain himself/herself or die peacefully in dignity
Isolation Technique in the Home Done by:
1. Separating the articles used by a client with communicable disease to prevent the spread of infection: 2. Frequent washing and airing of beddings and other articles and disinfections of room 3. Wearing a protective gown, to be used only within the room of the sick member 4. Discarding properly all nasal and throat discharges of an y member sick with communicable disease 5. Burning all soiled articles if could be or contaminated articles be boiled first in water 30 minutes before laundering
Intravenous Therapy
Insertion of a needle or catheter into a vein to provide medication and fluids based on physician‘s written prescription can be done only by nurses accredited by ANSAP
Nutrition
Definition Nutrition is a state of well-being achieved by eating the right food in every meal and the proper utilization of the nutrients by the body. Proper nutrition is important because: It helps in the development of the brain, especially during the first years of the o child‘s life. It speeds up the growth and development of the body including the formation of o teeth and bones It helps fight infection and diseases o It speeds up the recovery of a sick person o It makes people happy and productive o Proper nutrition is eating a balanced diet in every meal o
Goal
To improve the nutritional status, productivity and quality of life of the population thru adoption of desirable dietary practices and health y lifestyle
Objectives
Increase food and dietary energy intake of the average Filipino Prevent nutritional deficiency diseases and nutrition-related chronic degenerative diseases Promote a healthy well-balanced diet Promote food safety
Balanced diet
Balanced diet is made up of a combination of the 3 basic groups eaten in correct amounts. The grouping serves as a guide in selecting and planning everyday meals for the family.
The Three (3) Basic Food Groups are:
1. Body – building food which are rich in protein and needed by the body for:
normal growth and repair of worn-out body tissues supplying additional energy fighting infections Examples of protein-rich food are: fish; pork; chicken; beef; cheese; butter; kidney
beans; mongo; peanuts; bean curd; shrimp; clams
2. Energy-giving food which are rich in carbohydrates and fats and needed by the body for: providing enough energy to make the body strong Examples of energy-giving food are: rice; corn; bread; cassava; sweet potato; banana; sugar cane; honey; lard; cooking oil; coconut milk; margarine; butter
3. Body-regulating food which are rich in Vitamins and minerals and needed by the body for: normal development of the eyes, skin, hair, bones, and teeth increased protection against diseases Examples of body-regulating food are: tisa; ripe papaya; mango; guava; yellow corn; banana; orange; squash; carrot
Low Fat Tips
1. Eat at least 3 meals/day 2. Eat more fruits, vegetables, grain and cereals e.g. rice, noodles and potato 3. If you use butter or margarine, pat it on thinly 4. Choose low fat substitute i.e. replace whole milk with skimmed milk, low fat cheese 5. Become a label reader. Look for foods that have less than 5 g /100 g of product 6. Eat less high fat snacks and take away potato chips, sausage rolls or breaded meats 7. Cut all visible fat from meat; remove skin from chicken fat drippin gs and cream sauces 8. Aim for thin palm-size serving of lean meat, poultry and fish/ meal 9. Grill, bake, steam, stew, stir – fry and microwave, try not to fry 10. Drink lots of water all day- it‘s a food quencher 11. Ambulate: a. Start by walking for 10 min. b. Build up to 30-40 min/day c. Go for 3-4 times / week of any exercise you enjoy
Filipino Food Pyramid
Drink lot- water, clear broth Eat most – rice, root crops, corn, noodles, bread and cereals Eat more – vegetables, green salads, fruits or juices Eat some – fish, poultry, dry beans, nuts, eggs, lean meats, low fat dairy Eat a little – fats, oils, sugar, salt
Important Vitamins and Minerals VITAMINS
FUNCTIONS Maintain normal vision, skin health, bone and tooth growth reproduction and immune function; prevents xerophthalmia.
Vitamin A
Thiamine
Riboflavin
Niacin Biotin Pantothenic Folic acid
Vitamin B12
Vitamin C
Vitamin D Vitamin E Vitamin K MINERALS
Food sources: Breastmilk;poultry;eggs; liver; meat;carrots;squash; papaya;mango;tiesa; malunggay;kangkong; camotetops; ampalaya tops Help release energy from nutrients; support normal appetite and nerve function, prevent beri-beri. Helps release energy from nutrients, support skin health, prevent deficiency manifested by cracks and redness at corners of mouth; inflammation of the tongue and dermatitis. Help release energy from nutrients; support skin, nervous and digestive system, prevents pellagra. Help energy and amino acid metabolism; help in the synthesis of fat glycogen. Help in energy metabolism. Help in the formation of DNA and new blood cells including red blood cells; prevent anemia and some amino acids. Help in the formation of the new cells; maintain nerve cells, assist in the metabolism of fatty acids and amino acids. Help in the formation of protein, collagen, bon e, teeth cartilage, skin and scar tissue; facilitate in the absorption of iron from the gastrointestinal tract; involve in amino acid metabolism; increase resistance to infection, prevent scurvy. Food sources: Guava;pomelo;lemon;orange; calamansi; tomato; cashew Help in the mineralization of bones by enhancing absorption of calcium Strong anti-oxidant; help prevent arteriosclerosis; protect neuromuscular system; important for normal immune function. Involve in the synthesis of blood clotting proteins and a bone protein that regulates blood calcium level. FUNCTIONS
Calcium Chloride Chromium Copper Fluoride
Iodine
Iron
Magnesium Manganese Molybdenum Phosphorus Selenium Sodium Sulfur Zinc
Mineralization of bones and teeth, regulator of many of the body‘s biochemical processes, involve in blood clotting, muscle contraction and relaxation, nerve functioning, blood pressure and immune defenses. Maintain normal fluid and electrolyte balance. Work with insulin and is required for release of energy from glucose. Necessary for absorption and use of iron in the formation of hemoglobin. Involve in the formation of bones and teeth; prevents tooth decay. As part of the two thyroid hormones, iodine regulates growth, physical and mental development and metabolic rate. Aids in the development of the brain and body especially in unborn babies Food sources: Seaweeds;squids;shrimps;crabs; fermented shrimp;mussels;snails; dried dilis; fish Essential in the formation of blood. It is involved in the transport and storage of oxygen in the blood and is a co-factor bound to several non-hemo enzymes required for the proper functioning of cells. Food sources: Pork; beef; chicken; liver and other internal organs; dried dilis; shrimp; eggs; pechay; saluyot; alugbati Mineralization of bones and teeth, building of proteins, normal muscle contraction, nerve impulse transmission, maintenance of teeth and functioning of immune system. Facilitate many cell processes. Facilitate many cell processes. Mineralization of bones and teeth; part of every C ell; used in energy transfer and maintenance of acidbase balance. Work with vitamin E to protect body compound from oxidation. Maintain normal fluid and electrolyte balance, assists nerve impulse insulin. Integral part of vitamins, biotin and thiamine as well as the hormone. Essential for normal growth, development reproduction and immunity.
Malnutrition
An abnormal condition of the bod y resulting from the lack or excess of one or more nutrients like protein, carbohydrates, fats, vitamins and minerals.
Primary Cause: POVERTY
1. Lack of money to buy food Majority of the victims of malnutrition comes from families of farmers, fisherfolk, o and laborers who cannot afford to buy nutritious foods. 2. Lack of food supply 3. Lack of information on proper nutrition and food values Secondary Causes
1. 2. 3. 4.
Early weaning of child and improper introduction of supplementary food Incomplete immunization of babies and children Bad eating habits Poor hygiene and environmental sanitation:
a. lack of potable water b. lack of sanitary toilet c. poor waste disposal
Forms of Malnutrition Protein-Energy Malnutrition (PEM)
Is a nutritional problem resulting from a prolonged inadequate intak e of bodybuilding and/or energy-giving food in the diet. Kinds:
1. Marasmus
This child does not get the right amount and kind of energy food. She/he: is always hungry o has the face of an old man o is very thin o easily gets sick o looks weak o THIS CHILD IS JUST SKIN AND BONES! o
2. Kwashiorkor
This child does not get enough body-building food, although she/he may be getting enough energy. She/he: has swollen face, hands, and feet o easily gets sick o has dry, thin, pale hair o has sores on the skin o has thin upper arms o looks sad o has dry skin o is underweight o THIS CHILD IS SKIN, BONES, AND WATER! o
Vitamin A Deficiency (VAD)
A condition in which the level of Vitamin A in the body is low. Causes:
Not eating enough foods rich in vitamin A. E.g. yellow vegetables and yellow fruits Lack of fat or oil in the diet which help the body absorb Vitamin A. poor absorption or rapid utilization of Vitamin A during illness Eye Sign s
night blindness (early stage); total blindness (later stage) bitot‘s spot (foamy soapsuds-like spots on white part of the eye) dry, hazy and rough appearing cornea crater-like defect on cornea softened cornea; sometimes bulging Other Man if estation s
increased cases of childhood sickness, and de ath and decreased resistance to infection susceptibility to childhood malnutrition and infection (measles, diarrhea and pneumonia) Prevention
eating foods rich in Vitamin A, such as liver, eggs, milk, crab meat, cheese, dilis, malunggay, gabi leaves, kamote tops, kangkong, alugbati, saluyot, carrots, squash, ripe mango, including fats and oils breastfeeding the child immunizing the child taking correct dose of Vitamin A capsules as prescribed
Risk F actor s
VAD is most common in children suffering from PEM and other infectious diseases. Bottle-fed infants are also at risk of VAD especially if the milk formula used is not fortified with Vitamin A. Common among preschoolers and infants (FNRI) Schedul e for Receivi ng V itami n A Supplement t o I nf ants, Preschoolers and M others
Schedule
Infants (6-11 mos)
Give 1 Dose
100,000 IU
Give after 6 months High risk Condition Present
100,000 IU
Preschoolers Post Partum (12-83 mos) Mother 200,000 IU 200,000 IU Within one month
200,000 IU
After delivery of each child only
Schedul e for Tr eatment of V iami n A D efi ciency
Schedule
Infants (6-11 mos.)
100,000 IU Give Today 100,000 IU Give Tomorrow Give After 2 Weeks 100,000 IU
Preschoolers (12-83 mos.)
200,000 IU 200,000 IU 200,000 IU
Anemia
A condition characterized by the lack of iron in the body resulting in paleness. Sign/Symptoms
Paleness of the eyelids, inner cheeks, palms and nailbeds; frequent dizziness and easy fatigability Common cause
Inadequate intake of food rich in iron; can also be caused by blood loss during menstruation, pregnancy and parasitic infections. Prevention
Eating iron-rich food such as liver and other intern al organs; green leafy vegetables; and foods rich in Vitamin C Prevention of I ron Deficiency
Recommended Iron Requirements Dosage Infants ( 6-12 months)
0.7 mg. Daily
Children ( 12-59 months)
1 mg daily
Tr eatment of I ron Deficiency
Dosage Children 0-59 month 3-6 mg. /kg. Body wt./day Goiter
Enlargement of thyroid gland due to lack of iodine in the body. Common in areas where the iodine content in the soil, water and food are deficient. Effect of Iodine deficiency to fetus: may be born mentally and physically retarded. Goiter can be prevented by: daily intake of food rich in iodine o use of iodized salt o I odine Supplementati on
Dosage Children 0-59 Iodine capsules (200mg) months ( in endemic potassium iodate in oil orally once a year. areas)
Checking the Nutritional Status Weight
1. Weight is a very important indicator of a person‘s nutritional status. It is measured in relation to either AGE or HEIGHT. Normally, a well nourished child gains weight as she/he grows older. 2. On the other hand, a malnourished child either decreases in weight or main tains his/her previous weight. 3. The nutritional status of a person can also be checked by looking for specific signs and symptoms of the different forms of nutritional deficiencies. Important
1. Weigh the child in minimal clothing, with no shoes, clogs or slippers on; and hands and pockets free of objects. 2. The same type of scale should be used for subsequent weighing. 3. Observe the proper maintenance of the weighing scale. 4. Do not use a bathroom scale to avoid inaccurate readings of weight.
*bring the malnourished child together with the p arents to the health center for proper nutritional advice and treatment. *visit the malnourished child regularly and monitor his/her weight. *advise parents and the whole community about better nutrition and proper feeding especially of infants, children and sick persons.
Nutritional Guidelines
1. Eat a variety of food everyday. 2. Breastfeed infants exclusively from birth to 4-6 months, and then, give appropriate foods while continuing breastfeeding. 3. Maintain children‘s normal growth through proper diet and monitor their growth regularly. 4. Consume fish, lean meat, poultry or dried beans. 5. Eat more vegetables, fruits, and root crops. 6. Eat foods cooked in edible/cooking oil daily. 7. Consume milk, milk products or other calcium-rich foods such as small fish and dark green leafy vegetables everyday. Use iodized salt, but avoid excessive intake of salty foods. 8. Use iodized salt, avoid excessive intake of salty foods 9. Eat clean and safe food. 10. For a healthy lifestyle and good nutrition, ex ercise regularly, do not smoke, avoid drinking alcoholic beverages. Aims and Rationale of Each of the Guidelines
Guideline No. 1 is intended to give the message that no single food provides all the nutrients the body needs. Choosing different kinds of foods from all food groups is the first step to obtain a well balanced diet. This will help correct the common practice of confining of choice to a few kinds of foods, resulting in an unbalanced diet. Guidelines No.2 is entitled to promote exclusive breastfeeding from birth to 4-6 mo nths and to encourage the continuance of breastfeeding for as long as two years or longer. This is to ensure a complete and safe food for the newborn and the growing infant besides imparting the other benefits of breastfeeding. The guideline also strongly advocates the giving of appropriate complementary food in addition to breast milk once the infant is ready for solid foods at 6 months. Malnutrition most commonly occurs between the ages of 6 months to 2 years, therefore there is a need to pay close attention to feeding the child properly during this ver y critical period. Guideline No. 3 gives advise on proper feeding of children. In addition, the guideline promotes regular weighing to monitor the growth of children, as it is a simple way to assess nutritional status. Guidelines No. 4, 5, 6 and 7 are intended to correct the deficiencies in the current dietary pattern of Filipinos. Including fish, lean meat, poultry and dried beans, which will provide good quality protein and dietary energy, as well as iron and zinc, key nutrients lacking in the diet of Filipinos as a whole. Eating more vegetables, fruits and root c rops
will supply the much needed vitamins, minerals and dietary fiber that are deficient in our diet. In addition, they provide defense against chronic degenerative diseases. Including foods cooked in edible oils will provide additional dietary energy as a partial remedy to calorie deficiency of the average Filipino. Including milk and other calcium-rich foods in the diet will serve to supply not only calcium for healthy bones but to provide high quality protein and other nutrients for growth. Guideline No. 8 promotes the use of iodized salt to prevent iodine deficiency, which is a major cause of mental and physical underdevelopment in the country. At the same time, the guideline warns against excessive intake of salt y foods as a hedge against hypertension, particularly among high-risk individuals. Guideline No.9 is intended to prevent food-borne diseases. It exp lains the various sources of contamination of our food and simple ways to prevent it from occurring. Finally, Guideline No. 10 promotes a healthy lifestyle through regular exercise, abstinence from smoking and avoiding consumption. If alcohol is consumed, it must be done in moderation. All these lifestyle practices are directly or indirectly related to good nutrition.
Nutrients in Food
Nutrients are chemical substances present in the foods that keep the body healthy, supply materials for growth and repair of tissues, and provide energ y for work and physical activities. The major nutrients include the macronutrients, namely; proteins, carbohydrates and fats; the micronutrients, namely vitamins such as A, D, E and K, the B complex vitamins and C and minerals such as calcium, iron, iodine, zinc, fluoride and water.
Philippine Health Care Laws REPUBLIC ACT – an act passed by the Congress of the Philippines, while the form of government is Republican government.
Republic Act 349 – Legalizes the use of human organs for surgical, medical and scientific purposes. Republic Act 1054 – Requires the owner, lessee or operator of any commercial, industrial or agricultural establishment to furnish free emergency, medical and dental assistance to his employees and laborers. Republic Act 1080 – Civil Service Eligibility Republic Act 1082 – Rural Health Unit Act Republic Act 1136 – Act recognizing the Division of Tuberculosis in the DOH Republic Act 1612 – Privilege Tax/Professional tax/omnibus tax should be paid Januar y 31 of each year Republic Act 1891 – Act strengthening Health and Dental services in the ru ral areas Republic Act 2382 – Philippine Medical Act which regulates the practice of medicines in the Philippines Republic Act 2644 – Philippine Midwifery Act Republic Act 3573 – Law on reporting of Communicable Diseases Republic Act 4073 – Liberalized treatment of Leprosy Republic Act 4226 – Hospital Licensure Act requires all hospital to be licensed before it can operative Republic Act 5181 – Act prescribing permanent residence and reciprocity as qualifications for any examination or registration for the practice of an y profession in the Philippines
Republic Act 5821 – The Pharmacy Act Republic Act 5901 – 40 hours work for hospital workers Republic Act 6111 – Medicare Act Republic Act 6365 – Established a National Policy on Population and created the Commission on population Republic Act 6425 – Dangerous Drug Act of 1992 Republic Act 6511 – Act to standardize the examination and registration fees charged by the National Boards, and for other purposes. Republic Act 6675 – Generics Act of 1988 Republic Act 6713 – Code of Conduct and Ethical Standards for Public Officials and Employees Republic Act 6725 – Act strengthening the prohibition on discrimination against women with respect to terms and condition of employment Republic Act 6727 – Wage Rationalization Act Republic Act 6758 – Standardized the salaries Republic Act 6809 – Majority age is 18 years old Republic Act 6972 – Day care center in every Barangay Republic Act 7160 – Local Government Code Republic Act 7164 – Philippine Nursing Act of 1991 Republic Act 7170 – Law that govern organ donation Republic Act 7192 – Women in development nation building Republic Act 7277 – Magna Carta of Disabled Persons Republic Act 7305 – The Magna Carta of public Health Workers Republic Act 7392 – Philippine Midwifery Act of 1992 Republic Act 7432 – Senior Citizen Act Republic Act 7600 – Rooming In and Breastfeeding Act of 1992 Republic Act 7610 – Special protection of children against abuse, ex ploitation and discrimination act Republic Act 7624 – Drug Education Law Republic Act 7641 – New Retirement Law Republic Act 7658 – An act prohibiting the employment of children b elow 15 years of age Republic Act 7719 – National Blood Service Act of 1994 Republic Act 7875 – National Health Insurance Act of 1995 Republic Act 7876 – Senior Citizen Center of every Barangay Republic Act 7877 – Anti-sexual harassment Act of 1995 Republic Act 7883 – Barangay Health workers Benefits and Incentives Act of 1992 Republic Act 8042 – Migrant Workers and Overseas Filipino Act of 1995 Republic Act 8172 – Asin Law Republic Act 8187 – Paternity Leave Act of 1995 Republic Act 8203 – Special Law on Counterfeit Drugs Republic Act 8282 – Social Security Law of 1997 (amended RA 1161) Republic Act 8291 – Government Service Insurance System Act of 1997 (amended PD 1146) Republic Act 8344 – Hospital Doctors to treat emergency cases referred for treatment Republic Act 8423 – Philippine Institute of Traditional and Alternative Medicine
Republic Act 8424 – Personal tax Exemption Republic Act 8749 – The Philippine Clean Air Act of 1999 Republic Act 8981 – PRC Modernization Act of 2000 Republic Act 9165 – Comprehensive Dangerous Drugs Act 2002 Republic Act 9173 – Philippine Nursing Act of 2002 Republic Act 9288 – Newborn Screening Act
PRESIDENTIAL DECREE – An order of the President. This power of the President which allows him/her to act as legislators was exercised during the Marshall Law period.
Presidential Decree 46 – An act making it punishable for any public officials or employee, whether of the national or local government, to receive directly or indirectly any gifts or valuable things Presidential Decree 48 – Limits benefits of paid maternity leave privileges to four children Presidential Decree 69 – Limits the number of children to four (4) tax exemption purposes Presidential Decree 79 – Population Commission Presidential Decree 147 – Declares April and May as National Immunization Da y Presidential Decree 148 – Regulation on Woman and Child Labor Law Presidential Decree 166 – Strengthened Family Planning program by promoting participation of private sector in the formulation and implementation of program planning policies. Presidential Decree 169 – Requiring Attending Physician and/or persons treating injuries resulting from any form of violence. Presidential Decree 223 – Professional Regulation Commission Presidential Decree 442 – Labor Code Promotes and protects employees selforganization and collective bargaining rights. Provision for a 10 % right differential pay for hospital workers. Presidential Decree 491 – Nutrition Program Presidential Decree 539 – Declaring last week of October every as Nurse‘s Week. October 17, 1958 Presidential Decree 541 – Allowing former Filipino professionals to practice the ir respective professions in the Philippines so they can provide the latent and expertise urgently needed by the homeland Presidential Decree 568 – Role of Public Health midwives has been expanded after the implementation of the Restructed Health Care Delivery System (RHCDS) Presidential Decree 603 – Child and Youth Welfare Act / Provision on Child Adoption Presidential Decree 626 – Employee Compensation and State Insurance Fund. Provide benefits to person covered by SSS and GSIS for immediate injury, illness and disability. Presidential Decree 651 – All births and deaths must be registered 30 days after delivery. Presidential Decree 825 – Providing penalty for improper disposal garbage and o ther forms of uncleanliness and for other purposes.
Presidential Decree 851 – 13 Month pay Presidential Decree 856 – Code of Sanitation Presidential Decree 965 – Requiring applicants for Marriage License to receive instruction on family planning and responsible parenthood. Presidential Decree 996 – Provides for compulsory basic immunization for children and infants below 8 years of age. Presidential Decree 1083 – Muslim Holidays Presidential Decree 1359 – A law allowing applicants for Philippine citizenship to take Board Examination pending their naturalization. Presidential Decree 1519 – Gives medicare benefits to all government employees regardless of status of appointment. Presidential Decree 1636 – requires compulsory membership in the SSS and selfemployed Presidential Decree 4226 – Hospital Licensure Act
PROCLAMATION – an official declaration by the Chief Executive / Office of the President of the Philippines on certain programs / projects / situation
Proclamation No.6 – UN‘s goal of Universal Child Immunization; involved NGO‘s in the immunization program Proclamation No. 118 – Professional regulation Week is June 16 to 22 Proclamation No. 499 – National AIDS Awareness Day Proclamation No. 539 – Nurse’s Week – Every third week of October Proclamation No. 1275 – Declaring the third week of October every year as ―Midwifery Week‖
LETTER OF INSTRUCTION – An order issued by the President to serve as a guide to his/her previous decree or order.
LOI 47 – Directs all school of medicine, nursing, midwifery and allied medical professions and social work to prepare, plan and implement integration of family planning in their curriculum to require their graduate to take the licensing examination. LOI 949 – Act on health and health related activities must be integrated with other activities of the overall national development program. Primary Health Care (10-19-79) LOI 1000 – Government agencies should be given preference to members of the accredited professional organization when hiring
EXECUTIVE ORDER – an order issued by the executive branch of the government in order to implement a constructional mandate or a statutory provision.
Executive Order 51 – The Milk Code Executive Order 174 – National Drug Policy on Availability, Affordability, Safe, Effective and Good Quality drugs to all Executive Order 180 – Government Workers Collective Bargaining Rights Guidelines on the right to Organize of government employee. Executive Order 203 – List of regular holidays and special holidays Executive Order 209 – The Family Code (amended by RA 6809) Executive Order 226 – Command responsibility Executive Order 503 – Provides for the rules and regulations implementing the transfer of personnel, assets, liabilities and records of national agencies whose functions are to be devoted to the local government units. Executive Order 857 – Compulsory Dollar Remittance Law
Other Important Information
Administrative Order 114 – Revised/updated the roles and functions of the Municipal Health Officers, Public Health Nurses and Rural Midwives ILO Convention 149 – Provides the improvement of life and work cond itions of nursing personnel.
Primary Health Care (PHC)
Overview
May 1977 -30th World Health Assembly decided that the main health target of the government and WHO is the attainment of a level of health that would permit them to lead a socially and economically productive life by the year 2000. September 6-12, 1978 - First International Conference on PHC in Alma Ata, Russia (USSR) The Alma Ata Declaration stated that PHC was the key to attain the ―health for all‖ goal October 19, 1979 - Letter of Instruction (LOI) 949, the legal basis of PHC was signed b y Pres. Ferdinand E. Marcos, which adopted PHC as an approach towards the design, development and implementation of programs focusing on he alth development at community level.
Rationale for Adopting Primary Health Care
Magnitude of Health Problems Inadequate and unequal distribution of health resources Increasing cost of medical care Isolation of health care activities from other development activities
Definition of Primary Health Care
essential
health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at cost that the community can afford at every stage of development. a practical approach to making health benefits within the reach of all people. an approach to health development, which is carried out through a set of activities and whose ultimate aim is the continuous improvement and maintenance of health status
Goal of Primary Health Care
HE AL TH F OR AL L F I LI PINOS by the year 2000 AND HEAL TH I N TH E H ANDS OF TH E PEOPLE by the year 2020.
An improved state of health and quality of life for all people attained through SELF RELIANCE.
Key Strategy to Achieve the Goal:
Partnership with and Empowerment of the people - permeate as the core strategy in the effective provision of essential health services that are community based, ac cessible,
acceptable, and sustainable, at a cost, which the community and the government can afford.
Objectives of Primary Health Care
Improvement in the level of health care of the community Favorable population growth structure Reduction in the prevalence of preventable, communicable and other disease. Reduction in morbidity and mortality rates especially among infants and c hildren. Extension of essential health services with priority given to the und erserved sectors. Improvement in Basic Sanitation Development of the capability of the community a imed at self- reliance. Maximizing the contribution of the other sectors for the social and economic development of the community.
Mission
To strengthen the health care system by increasing opp ortunities and supporting the conditions wherein people will manage their own h ealth care.
Two Levels of Primary Health Care Workers
1. Barangay Health Workers - trained community health workers or health aux iliary volunteers or traditional birth attendants or healers. 2. Intermediate level health workers- include the Public Health Nurse, Rural Sanitary Inspector and midwives.
Principles of Primary Health Care
1. 4 A's = Accessibility, Availability, Affordability & Acceptability, Appropriateness of health services.
The health services should be present where the supposed recipients are. They should mak e use of the available resources within the community, wh erein the focus would be more on health promotion and prevention of illness.
2. Community Participation
heart and soul of PHC
3.People are the center, object and subject of development.
Thus, the success of any undertaking that aims at serving the people is dependent on people‘s participation at all levels of decision-making; planning, implementing, monitoring and evaluating. Any undertaking must also be based on the people‘s needs and pr oblems (PCF, 1990) Part of the people‘s participation is the partnership between the community and the agencies found in the community; social mobilization and decentralization. In general, health work should start from where the people are and building on what they have. Example: Scheduling of Barangay Health Workers in the health center Barriers of Community Involvement o o o o o
Lack of motivation Attitude Resistance to change Dependence on the part of community people Lack of managerial skills
4. Self-reliance
Through community participation and cohesiveness of people‘s organiz ation they can generate support for health care through social mobilization, networking and mobilization of local resources. Leadership and management skills should be develop among these people. Existence of sustained health care facilities managed by the people is some of the major indicators that the community is leading to self reliance.
5. Partnership between the community and the health agencies in the provision of quality of life.
Providing linkages between the government and the nongovernment organization and people‘s organization.
6. Recognition of interrelationship between the health and development
Health- Is not merely the absence of disease. Neither is it only a state of physical and mental well-being. Health being a social phenomenon recognizes the interplay of political, socio-cultural and economic factors as its determinant. Good Health therefore, is manifested by the progressive improvements in the living conditions and quality of life enjoyed by the community residents (PCF, Development- is the quest for an improved quality of life for all. Development is multidimensional. It has political, social, cultural, institutional and environmental dimensions (Gonzales 1994). Therefore, it is measured by the ability of people to satisfy their basic needs.
7. Social Mobilization
It enhances people participation or governance, support system provided by the Government, networking and developing secondary leaders.
8. Decentralization
This ensures empowerment and that empowerment can only be facilitated if the administrative structure provides local level political structures with more substantive responsibilities for development initiators. This also facilities proper allocation of budgetary resources.
Elements of Primary Health Care
1. Education for Health
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.
2. Locally Endemic Disease Control
The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate. Example Malaria Control and Schistosomiasis Control
3. 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
4. Maternal and Child Health and 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.
5. Environmental Sanitation and 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 h is 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 S anitation is necessary for basic promotion of health.
6. Nutrition and 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.
7. Treatment of Communicable Diseases and Common Illness
The diseases spread through direct contact pose a great risk to those who can be infected. Tuberculosis is one of the communicable diseases continuously occupi es the top ten causes of death. Most communicable diseases are also preventable. The Government focuses on the prevention, control and treatment of these illnesses.
8. 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
Major Strategies of Primary Health Care
1. Elevating Health to a Comprehensive and Sustained National Effort.
Attaining Health for all Filipino will require expanding participation in health and health related programs whether as service provider or beneficiary. Empowerment to parents, families and communities to make decisions of their health is really the d esired outcome. Advocacy must be directed to National and Local policy making to elicit support and commitment to major health concerns through legislations, budgetary and logistical considerations.
2. Promoting and Supporting Community Managed Health Care
The health in the hands of the people brings the government closest to the people. It necessitates a process of capacity building of communities and organization to plan, implement and evaluate health programs at their levels.
3. Increasing Efficiencies in the Health Sector
Using appropriate technology will make services and resources required for their delivery, effective, affordable, accessible and culturally acceptable. The development of human resources must correspond to the actual needs of th e nation and the policies it upholds such as PHC. The DOH will continue to support and assist both public and private institutions
particularly in faculty development, enhancement of relevant curricula and development of standard teaching materials. 4. Advancing Essential National Health Research
Essential National Health Research (ENHR) is an integrated strategy for organizing and managing research using intersectoral, multi-disciplinary and scientific approach to health programming and delivery.
Four Cornerstones/Pillars in Primary Health Care
1. 2. 3. 4.
Active Community Participation Intra and Inter-sectoral Linkages Use of Appropriate Technology Support mechanism made available
Reproductive Health
Definition
A state of complete physical, mental and social well-being and not merely the absence of disease/ infirmity in all matters relating to the reproductive system and to its functions and processes.
Basic RH Rights
Right to RH information and health care services for safe pregnancy and childbirth Right to know different means of regulating fertility to preserve health and where to obtain them Freedom to decide the number and timing of birth of children Right to exercise satisfying sex life
Factors/ Determinants of RH
Socioeconomic conditions – education, employment, poverty, nutrition, living condition/ environment, family environment Status of women – equal right in education and in making decisions about her own RH; right to be free from torture and ill treatment and to participate in politics Social and Gender Issues Biological (individual knowledge of reproductive organs and their functions), cultural (country‘s norms, RH practices) and psychosocial factors
Elements
Maternal and Child Health Nutrition Family Planning Prevention and Management of Abortion Complications Prevention and Treatment of Reproductive Tract Infections, including STDs, HIV and AIDS Education and Counseling on Sexuality and Sexual Health Breast and Reproductive Tract Cancers and oth er Gynecological Conditions Men‘s Reproductive Health Adolescent Reproductive Health Violence Against Women Prevention and Treatment of Infertility and Sexual Disorders
Selected Concepts
RH is the exercise of reproductive right with responsibility It means safe pregnancy and delivery, the right of access to appropriate health information and services It includes protection from unwanted pregnancy by having access to safe and acceptable methods of family planning of their choice It includes protection from harmful reproductive practices and violence It ensures sexual health for the purpose of enhan cement of life and personal relations and assures access to information on sexuality to achieve sexual enjoyment
Goal
To achieve healthy sexual development and maturation To achieve their reproductive intention To avoid diseases, injuries and disabilities related to sexuality and reproduction To receive appropriate counseling and care of RH problems
Strategies
Increase and improve the use of more effective or modern contraceptive methods Provision of care, treatment and rehabilitation for RH RH care provision should be focused on adolescents, men and unmarried and other displaced people with RH problems Strengthen outreach activities and referral system Prevent specific RH problems through information dissemination and counseling of client
Traits and Qualities of a Health Worker
Efficient
plans with the people, organizes, conducts, directs health education activities according to the needs of the community knowledgeable about everything relevant to his practice; has the necessary skills expected of him
Good listener
hears what‘s being said and what‘s behind the words always available for the participant to voice out t heir sentiments and needs
Keen observer
keep an eye on the proceedings, process and participants‘ behavior
Systematic
knows how to put in sequence or logical order the parts of the session
Creative/Resourceful
uses available resources
Analytical/Critical thinker
decides on what has been analyzed
Tactful
brings about issues in smooth subtle manner does not embarrass but gives constructive criticisms
Knowledgeable
able to impart relevant, updated and sufficient input
Open
invites ideas, suggestions, criticisms involves people in decision making accepts need for joint planning and decision relative to health care in a particular
situation; not resistant to change Sense of humor
knows how to place a touch of humor to keep audience alive
Change agent
involves participants actively in assuming the responsibility for his own learning
Coordinator
brings into consonance of harmony the community‘s health care activities
Objective
unbiased and fair in decision making
Flexible
able to cope with different situations
Under Five Clinic Program
Overview
The first five years of life form the foundations of the child‘s physical and mental growth and development. Studies have shown the mortality and morbidity are high among this age group. The Department of Health established the Under Five Clinic Program to address this problem.
Program Objectives and Goals
Monitor growth and development of the child until 5 years of age. Identify factors that may hinder the growth and de velopment of the child.
Activities and Strategies
1. Regular height and weight determination/ monitoring until 5 years o ld. 0-1 year old=monthly 1 year old and above =quarterly 2. Recording of immunization, vitamins supplementation, deworming and feeding. 3. Provision of IEC materials (ex. Posters, charts, and toys) that promote and enhance child‘s proper growth and development. 4. Provision of a safe and learning – oriented environment for the child. 5. Monitoring and Evaluation.
Initial Data Base for Family Nursing Practice
A. Family Structure Characteristics and Dynamics
1. 2. 3. 4. 5.
Members of the household and relationship to the head of the family. Demographic data-age, sex, civil status, position in the family Place of residence of each member-whether living with the family or elsewhere Type of family structure-e.g. patriarchal, matriarchal, nuclear or extended Dominant family members in terms of decision making especially on matters of health care 6. General family relationship/dynamics-presence of any obvious/readily observable conflict between members; characteristics, communication/interaction patterns among members.
B. Socio-economic and Cultural Characteristics
1. Income and expenses a. Occupation, place of work and income of each working member b. Adequacy to meet basic necessities (food, clothing, shelter) c. Who makes decision about money and how it is spent 2. Educational Attainment of each Member 3. Ethnic Background and Religious Affiliation 4. Significant others-role (s) they play in family‘s life 5. Relationship of the family to larger community-nature and extent of participation of the family in community activities
C. Home Environment
1. Housing a. Adequacy of living space b. Sleeping in arrangement c. Presence of breathing or resting sites of ve ctor of diseases (e.g. mosquitoes, roaches, flies, rodents, etc.) d. Presence of accident hazard e. Food storage and cooking facilities f. Water supply-source, ownership, pot ability
g. Toilet facilities-type, ownership, sanitary condition h. Garbage/refuse disposal-type, sanitary condition i. Drainage System-type, sanitary condition 2. Kind of Neighborhood, e.g. congested, slum etc. 3. Social and Health facilities available 4. Communication and transportation facilities available
D. Health Status of Each Family Member
1. Medical Nursing history indicating current or past significant illnesses or beliefs and practices conducive to health and illness 2. Nutritional assessment (especially (especially for vulnerable or at risk members) Anthropometric data: measures of nutritional status of children-weight, height, o mid-upper arm circumference; risk assessment measures for obesity : body mass index(BMI=weight in kgs. divided by height in meters2), waist circumference (WC: greater than 90 cm. in men and greater than 80 cm. in women), waist hip ration (WHR=waist circumference in cm. divided by hip circumference in cm. Central obesity: WHR is equal to or greater than 1.0 cm in men and 0.85 in women) dietary history specifying quality and quantity of food o r nutrient per day o Eating/ feeding habits/ practices o 3. Developmental assessment of infant, toddlers and preschoolers- e.g. Metro Manila DevelopmentalScreening Test (MMDST). 4. Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific specific lifestyle diseases-e.g. hypertension, physical physical inactivity, sedentary lifestyle, cigarette/ tobacco smoking, elevated blood lipids/ cholesterol, obesity, diabetes mellitus, inadequate fiber intake, stress, alcohol drinking, and other substance abuse. 5. Physical Assessment indicating presence of illness state/s (diagnosed or undiagnosed by medical practitioners ) 6. Results of laboratory/diagnostic and other screening procedures supportive of assessment findings.
E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention. Examples include:
1. Immunization status of family members m embers 2. Healthy lifestyle practices. Specify. 3. Adequacy of:
Rest and sleep Exercise/activities
Use of protective measure-e.g. adequate footwear in parasite-infested areas; use of bed nets andprotective clothing in malaria and filariasis endemic areas. Relaxation and other stress management activities
4. Use of promotive-preventive health services
A Typology of Nursing Problems in Family Nursing Practice
First Level Assessment
I. Presence of Wellness Condition -stated as potential or Readiness-a clinical or nursing judgment about a client in transition from a specific level of wellness wellness or capability to a higher level. Wellness potential is a nursing judgment on wellness state or cond ition based on client‘s client‘s performance, current competencies, or performance, clinical data or explicit expression of desire to achieve a higher level of state or function in a specific area on health promotion and maintenance. Examples of this are the following A. Potential for Enhanced Capability for: 1. 2. 3. 4. 5.
Healthy lifestyle-e.g. nutrition/diet, exercise/activity ex ercise/activity Healthy maintenance/health management Parenting Breastfeeding Spiritual well-being- process process of client‘s developing/unfolding of mystery through harmonious interconnectedness that comes from inner strength/sacred source/God (NANDA 2001) 6. Others. Specify. B. Readiness for Enhanced Capability for: 1. 2. 3. 4. 5. 6.
Healthy lifestyle Health maintenance/health management Parenting Breastfeeding Spiritual well-being Others. Specify.
II. Presence of Health Threats -conditions that are conducive to disease and accident, or may result to failure to maintain wellness or realize health potential. Ex amples of this are the following: A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic syndrome) B. Threat of cross infection from communicable disease case C. Family size beyond what family resources can adequately provide D. Accident hazards specify. 1. Broken chairs 2. Pointed /sharp objects, poisons and medicines improperly kept
3. Fire hazards 4. Fall hazards 5. Others specify. E. Faulty/unhealthful nutritional/eating habits or feeding techniques/practices. Specify. 1. 2. 3. 4. 5.
Inadequate food intake both in quality and quantity Excessive intake of certain nutrients Faulty eating habits Ineffective breastfeeding Faulty feeding techniques
F. Stress Provoking Factors. Specify. 1. 2. 3. 4.
Strained marital relationship Strained parent-sibling relationship Interpersonal conflicts between family members Care-giving burden
G. Poor Home/Environmental Condition/Sanitation. Specify. 1. Inadequate living space 2. Lack of food storage facilities 3. Polluted water supply 4. Presence of breeding or resting sights of vectors of diseases 5. Improper garbage/refuse disposal 6. Unsanitary waste disposal 7. Improper drainage system 8. Poor lightning and ventilation 9. Noise pollution 10. Air pollution H. Unsanitary Food Handling and Preparation I. Unhealthy Lifestyle and Personal Habits/Practices. Specify. 1. Alcohol drinking 2. Cigarette/tobacco smoking 3. Walking barefooted or inadequate footwear 4. Eating raw meat or fish 5. Poor personal hygiene 6. Self medication/substance abuse 7. Sexual promiscuity 8. Engaging in dangerous sports 9. Inadequate rest or sleep 10. Lack of /inadequate exercise/physical activity
11. Lack of/relaxation activities 12. Non use of self-protection measures (e.g. non use of bed nets in malaria and filariasis endemic areas). J. Inherent Personal Characteristics-e.g. poor impulse control K. Health History, which may Participate/Induce the Occurrence of Health Deficit, e.g. previous history of difficult labor. L. Inappropriate Role Assumption- e.g. child assuming mother‘s role, father not assuming his role. M. Lack of Immunization/Inadequate Immunization Status Sp ecially of Children N. Family Disunity-e.g. 1. Self-oriented behavior of member(s) 2. Unresolved conflicts of member(s) 3. Intolerable disagreement O. Others. Specify._________ III. Presence of health deficits- instances of failure in health maintenance. Examples include: A. Illness states, regardless of whether it is diagnosed or undiagnosed b y medical practitioner. B. Failure to thrive/develop according to normal rate C. Disability-whether congenital or arising from illness; transient/temporary (e.g. aphasia or temporary paralysis after a CVA) or permanent (e.g. leg amputation secondary to diabetes, blindness from measles, lameness from polio) IV. Presence of stress points/foreseeable crisis situations- anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources. Examples of this include: A. Marriage B. Pregnancy, labor, puerperium C. Parenthood D. Additional member-e.g. newborn, lodger
E. Abortion F. Entrance at school G. Adolescence H. Divorce or separation I. Menopause J. Loss of job K. Hospitalization of a family member L. Death of a member M. Resettlement in a new community N. Illegitimacy O. Others, specify.___________
Second-Level Assessment
I. Inability to recognize the presence of the condition or problem due to: A. Lack of or inadequate knowledge B. Denial about its existence or severity as a result of fear of consequences of diagnosis of problem, specifically: 1. 2. 3. 4.
Social-stigma, loss of respect of peer/significant others Economic/cost implications Physical consequences Emotional/psychological issues/concerns
C. Attitude/Philosophy in life, which hinders recognition/acceptance of a problem D. Others. Specify _________ II. Inability to make decisions with respect to taking appropriate health action due to: A. Failure to comprehend the nature/magnitude of the problem/condition B. Low salience of the problem/condition
C. Feeling of confusion, helplessness and/or resignation brought abo ut by perceive magnitude/severity of the situation or problem, i.e. failure to breakdown problems into manageable units of attack. D. Lack of/inadequate knowledge/insight as to alternative co urses of action open to them E. Inability to decide which action to take from among a list of alternatives F. Conflicting opinions among family members/significant others regarding action to take. G. Lack of/inadequate knowledge of community resources for care H. Fear of consequences of action, specifically: 1. 2. 3. 4.
Social consequences Economic consequences Physical consequences Emotional/psychological consequences
I. Negative attitude towards the health condition or problem-by negative attitude is meant one that interferes with rational decision-making. J. In accessibility of appropriate resources for care, specifically: 1. Physical Inaccessibility 2. Costs constraints or economic/financial inaccessibility K. Lack of trust/confidence in the health personnel/agency L. Misconceptions or erroneous information about proposed cou rse(s) of action M. Others specify._________ III. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk member of the family due to: A. Lack of/inadequate knowledge about the disease/health condition (nature, severity, complications, prognosis and management) B. Lack of/inadequate knowledge about child development and care C. Lack of/inadequate knowledge of the nature or extent of nursing care needed D. Lack of the necessary facilities, equipment and supplies of care
E. Lack of/inadequate knowledge or skill in carrying out the necessary intervention or treatment/procedure of care (i.e. complex therapeutic regimen or healthy lifestyle program). F. Inadequate family resources of care specifically: 1. Absence of responsible member 2. Financial constraints 3. Limitation of luck/lack of physical resources G. Significant persons unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair, rejection) which his/her capacities to provide care. H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at risk member I. Member‘s preoccupation with on concerns/interests J. Prolonged disease or disabilities, which exhaust supportive capacity of family members. K. Altered role performance, specify. 1. 2. 3. 4. 5. 6.
Role denials or ambivalence Role strain Role dissatisfaction Role conflict Role confusion Role overload
L. Others. Specify._________ IV. Inability to provide a home environment conducive to health maintenance and personal development due to: A. Inadequate family resources specifically: 1. Financial constraints/limited financial resources 2. Limited physical resources-e.i. lack of space to construct facility B. Failure to see benefits (specifically long term ones) of investments in ho me environment improvement C. Lack of/inadequate knowledge of importance of hygiene and sanitation D. Lack of/inadequate knowledge of preventive measures E. Lack of skill in carrying out measures to improve home environment
F. Ineffective communication pattern within the family G. Lack of supportive relationship among family members H. Negative attitudes/philosophy in life which is not con ducive to health maintenance and personal development I. Lack of/inadequate competencies in relating to each other for mutual growth and maturation (e.g. reduced ability to meet the physical and psychological needs of other members as a result of family‘s preoccupation with current problem or condition. J. Others specify._________ V. Failure to utilize community resources for health care due to:
A. Lack of/inadequate knowledge of community resources for health care B. Failure to perceive the benefits of health care/services C. Lack of trust/confidence in the agency/personnel D. Previous unpleasant experience with health worker E. Fear of consequences of action (preventive, diagnostic, therapeutic, rehabilitative) specifically : 1. Physical/psychological consequences 2. Financial consequences 3. Social consequences F. Unavailability of required care/services G. Inaccessibility of required services due to: 1. Cost constrains 2. Physical inaccessibility H. Lack of or inadequate family resources, specifically 1. Manpower resources, e.g. baby sitter 2. Financial resources, cost of medicines prescribe I. Feeling of alienation to/lack of support from the community, e.g. stigma due to mental illness, AIDS, etc.
