Pamantasan ng Lungsod ng Maynila (University of the City of Manila) Intramuros, Manila

COLLEGE OF NURSING

WRITTEN REPORT In PRIMARY HEALTH CARE

Submitted by: Emmanuelle Arana Jane April Castillo Ma. Franchesca Espiel Elijah Legazpi Cassly Jane Ruiz Arlyn Vista

Submitted to: Prof. Kahlil Z. Arbo

PRIMARY HEALTH CARE

Defined as the essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination. Is an approach of organizing the community thru involvement and participation by the use of community resources, indigenous technologies and linkages in attaining self-reliance and development. Is a community based approach to make basic needs accessible and effective to the people through partnership among government, non-government and community to achieve self-reliance. Is an approach whereby essential health services are made available, acceptable, accessible, affordable and sustainable through active community participation, utilizing appropriate technology supported by intra/inter sectoral collaboration leading to self-reliance and social transformation. Is a partnership approach to community development thru services which are community-based, affordable, accessible, sustainable thru community

participation, inter sectoral linkages towards self-reliance as knowledge response to the interrelated needs of the community.

Objectives: To develop and maximize peoples potential and self -reliance of the community for the improvement of their own health To maximize the contribution of other sectors to health To maximize the extension of effective health care services to the periphery

A. Concepts, Principles and Strategies Basic Concepts of Primary Health Care 1. Health is related to social structures. Health problems are brought about by economic, political and cultural problems and vice versa. 2. Health and development are interrelated. 3. Peoples participation is essential. 4. Community organizing is the core of PHC. 5. Use of appropriate technology. Making use of available resources is a step to self-reliance and making the community aware of its potential and resources bring about self-appreciation. Principles of PHC 1. People as the center of development. 2. Concern for equity depressed, deprived and underserved individuals, families and communities are high in the agenda of the DOH. 3. Respect for area-based knowledge and capacities. 4. Social accountability to the community. 5. Devolution as an opportunity for empowerment

6. Balancing promotive/preventive care and curative/rehabilitative care 7. Continuing concern for strengthening the capacity of PHC 8. Paradigm shift as a requirement of PHC. Strategies of Primary Health Care 1. Reorientation and reorganization of the national health care system with the establishment of functional support mechanism in support of the mandate of devolution under the local government code of 1991. 2. Effective preparation and enabling process for health action at all levels. 3. Mobilization of the people to know their communities and identifying their basic health needs with the end in view of providing appropriate solutions leading to self-reliance and self-determination. 4. Development and utilization of appropriate technology focusing on local indigenous resources available in and acceptable by the community. 5. Organization of communities arising from their expressed needs that they have decided to address and that this is continually evolving in pursuit of their own development. 6. Increase opportunities for community participation in local level planning management, monitoring and evaluation within the context of regional and national objective. 7. Development of intra-sectoral linkages with other government and private agencies so the programs of the health sector are closely linked with those of other socio economic sectors at the national, intermediate and community levels.

8. Emphasizing partnership so that the health workers and the community

leaders/members view each other as partners rather than merely providers and receiver of health care respectively.

B. Cornerstones of Primary Health Care Active Community Participation and Involvement

In community involvement, the people in the community share the responsibility to participate in: 1. Defining their health and health related needs and problems 2. Identifying realistic solutions 3. Organizing community for health action 4. Mobilizing local resources 5. Providing essential health services 6. Evaluating the results of health actions The desire to get involved must me generated from within the community. Its participation entails productive contact between the health service and the people for specific needs. Health actions must be a response of community to problems that the people themselves perceived and carried out in a way that is acceptable to them.

Multi-sectoral Linkages
1. Intersectoral Linkages PHC forms an internal part on the health system and the overall social and economic development of the community. It is essential to unify

health efforts within the health organization and other sectors concerned such as agricultural education, public works, local governments, social welfare, population control and private sectors. Government sectors like agricultural and private sectors contribute to the social and economic upliftment of the people. It can assist the farmers employ better agricultural methods to increase rice production and quality products besides producing nutritious foods for our health. 2. Intrasectoral Linkages PHC is the hub of the health system. It broadens health coverage and makes health services available to all. A widely accepted pyramidal organization that provides levels or services starting with the primary health and progressing the specialty care is illustrated as follows:

National Health Services

Regional/District Health Service Rural (Local Hospital Services) Rural Health Units Barangay Health Stations
Pyramidal Organization Showing Levels of Services

o National Level the community health service shall take the lead role in advocating and implementing all the essential services in PHC o Regional Level PHC directors and coordinators will lead and ensure that advocacy work is propagated especially in the LGUs.

Appropriate Technology
This emphasizes equity and justice that health is a basic right of individual and not just of these who can afford to pay for their own health care. Criteria in determining the use of appropriate technology: 1. Effectiveness and Safety produces the desired effect without harm. 2. Complexity simple and easy to apply by the healthcare providers and clientle. 3. Cost affordable for the people 4. Scope of technology directly related to effectiveness, safety,

appropriateness and affordability (e.g. DPT vaccine) 5. Acceptability understandable and attuning with the cultural practices of people. 6. Feasibility compatible with the local condition of the community.

Support Mechanism
It comes from community, government and non-government

organizations; for the improvement of referral system and working conditions of the health team, formation and use of referral system.

C. Levels of PHC Workers

Village or Grassroot Health Workers These people are the first contact that you will encounter in the community. They are the trained community health worker or health auxiliary volunteers, or a traditional birth attendant or healers, who provide elementary curative and preventive health care and measures that promote a healthy environment. They work in liaison with the local health services.

Intermediate Level of Health Workers These people represent the first source of professional health care general medical practitioners or resident, public health nurse, midwife or sanitary inspector. They provide support to the front-line health workers in terms of supervision, training, referral services and supplies. -

Health Personnel of the 1st line Hospital Facility These people provide back-up health services for cases that require hospitalizations or diagnostic facilities not available in the health center. They consist of physicians with specialty area, nurses, dentists, pharmacists, and other health professionals.

D. Roles of the Nurse in PHC

1. FACILITATIVE The nurse makes it easy for people to carry out desirable health actions. Example: making referrals, removes barriers in health care, explains procedures to clients 2. DEVELOPMENTAL The nurse improves ones capacity for healthy living Example: health teaching

3. SUPPLEMENTAL The nurse carries out an activity in behalf of the patient

4. SUPPORTIVE The nurse establishes and maintains a responsive referral and support system Example: gives moral support by training

5. CLINICIAN

The nurse performs the technical aspects of nursing in rendering

therapeutic care to clients.

E. Essential Elements/ Services in PHC

Essential Elements H ospital as a Center of Wellness O ral and Dental Health M ental Health E lderly Care

E ducation for Health L ocal Endemic Disease Prevention & Control E xpanded Program on Immunization M aternal and Child Health/Family Planning E ssential Drugs Provision/ Herbal Medicines N utrition T reatment of Communicable Disease S afe Water and Sanitaion

Traditional and Alternative Health Care Practice Herbal Medicine as a part of primary health care and because of increasing

cost of drugs, the use of locally available medicinal plants has been advocated by the DOH.

1. AKAPULKO (Cassia, alata L.)

Bayabas-bayabasan, Sonting(tag)

Kapurko,

Kantada,

Ktandang

aso,

Pakagonkon,

Use:

Andadasi-bugbugtong (Ikl) Adalan (Sulu) Pakayomkom Kastila( Pamp) Kasitas (Bis) Ringworm bush or shrub (Eng)

Anti-fungal: Tinea Flava, Ringworm, Athletes foot and Scabies

Preparation: Fresh, matured leaves are pounded. Apply sap to the affected areas 1-2 times a day.

2. AMPALAYA (Mamordica charantia)

Use:

Amorgoso Margoso, Amplaya (Tag) Apalia(Pamp) Apape(Ibn) Apapet (Itn) Balsam Apple, Balsam Pear, Bitter Gourd(Eng)

Diabetes Melliitus (Mild-insulin dependent)

Preparations: Note: Young leaves may blanched/steamed and eaten glassful 2 times a day. Gather and wash young leaves very well Chop. Boil 6 tablespoons in two glassfuls of water for 15 mins. Under slow fire. Do not cover pot. Take one third cup 3 times a day after meals.

3. BAWANG

Uses:

Ajos Span.Bis) Garlic (Eng)

To lower cholesterol levels in blood for hypertension For toothache

Preparation: May be fried, toasted, soaked in vinegar for 30 mins or blanched in boiled water for 5 mins. Caution: Take only on a full stomach to prevent stomach and intestinal ulcers. Take two piece 3 times a day after meals

For toothache: Pound a small piece and apply on the affected part.

4. BAYABAS / GUAVAS (Psidium Guajava)

- Commonly seen in the backyards of Filipino homes in the country is a tropical plant known for its edible fruit, and healing properties. - Wash well and chop. Boil for 15 minutes at low fire without the cover of the pot. Cool and strain.

Uses: For washing wounds- use twice a day For diarrhea- take 3-4 times a day Relieves toothache- use as gargle

5. LAGUNDI (Vitex Negundo)

- A shrub growing in vacant lots and waste land. Flowers are blue and bellshaped. The leaves should be collected when flowers are in bloom. Uses: Asthma, Cough, and Fever - boil raw fruits/ leaves in 2 glasses of water for 15 minutes until decoction is left to 1 glass, strain. Dried Leaves Adult 7-12 years 2-6 years 4 tbsp. 2 tbsp. 1 tbsp. Fresh Leaves 6 tbsp. 3 tbsp. 1 tbsp.

Dysentery, Colds and Pain in any body part - 3 times a day Skin diseases (Dermatitis, Scabies, Ulcers, Eczema) - Wash/clean wound with decoction

Headache - apply crushed leaves on forehead Rheumatism, Sprain, Contusions, Insect bites - apply leaves on affected part

Aromatic bath for sick patients - Use decoction for bathing

6. NIYUG- NIYOGAN (Quisqualis Indica)

- A vine which bears tiny fruits that grows wild in backyards. The medicinal seeds should be obtained from mature, dried but newly opened fruits.

Use: Anti-helminthic- used to expel round worms. Take 2 hours after dinner. If no worms are expelled, the dose may be repeated after one week. Adult 7-12 years 6-8 years 4-5 years Caution: Not to be given to children below four years old 8-10 seeds 6-7 seeds 5-6 seeds 4-5 seeds

7. SAMBONG (Blumea Balsamiferal Conyza Balsamifera)

- A plant that reaches 1 to 3 meters in height with rough, hairy leaves.

Uses: Anti-edema, Diuretic, Anti-urolithiasis- boil leaves for 15 minutes, strain. Divide decoction into 3 parts. Drink one part 3 times a day.

Dried leaves Adult 7-12 years 4 tbsp. of adult dose

Fresh leaves 6 tbsp.

Note: Sambong is not a medicine for kidney infection

8. TSAANG GUBAT (Carmona Retusa)

- A shrub with small, shiny nice-looking leaves that grows in wild uncultivated areas and forests. Uses: Diarrhea - divide decoction into 4 parts. Drink 1 part every 3 hours. Dried Leaves Adult 7-12 years 2-6 years Stomachache Dried Leaves Adult 7-12 years 2 tbsp. 1 tbsp. Fresh Leaves 3 tbsp. 1 tbsp. 10 tbsp. 5 tbsp. 2 tbsp. Fresh Leaves 12 tbsp. 6 tbsp. 3 tbsp.

9. ULASIMANG BATO / PANSIT-PANSITAN (Peperonia Pellucida)

- A weed with heart-shaped leaves and grows in shady parts of the garden and yard - Wash one and a half cup leaves well and boil in 2 glasses of water over low fire without the pot cover, strain. Divide into 3 parts and drink each part 3 times a day after meals

Use: Lowers uric acid (Rheumatism and Gout)

10. YERBA BUENA / PEPPERMINT (Mentha Cordifelia)

- A small, multi-branching aromatic herb with small, elliptical and with toothed margined leaves. Uses: Pain in different body parts- boil chopped leaves in 2 glasses water for 15 mins. Dried Leaves Adults 7-12 years 6 tbsp. of adult dose Fresh Leaves 4 tbsp.

Rheumatism, Arthritis, Headache- Massage sap on painful parts with eucalyptus

Cough and Colds- Soak leaves in hot water. Drink as tea Swollen Gums- Use solution as gargle Toothaches- Squeeze sap, soak a piece of cotton in it and insert in the aching tooth cavity. Rinse mouth with salt solution before inserting the cotton

Menstrual and Gas Pains- Drink infusion to induce menstrual flow and sweating

Nausea and Fainting- Crush leaves and apply at nostrils Insect bites- Rub crushed leaves on affected parts Pruritus- Use decoction as wash on affected area

REMINDERS ON THE USE OF HERBAL MEDICINES: 1. Avoid the use of insecticides on plants. 2. Use clay pot and remove cover while boiling at low heat in cooking the herbal medicines. 3. Use one kind of herbal plant as needed and prepare as instructed 4. If ailments are not relieved, of if there are untoward reactions discontinue medicine and consult a doctor.

Reference: Rodolfo, Maria Jesusa Lourdes D., et al. Community Health Nursing: An Approach to Families and population Groups. Manila: Merriam and Webster Bookstore, Inc. 2007.