COPAR Community Organizing Participatory Action Research

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 peoples 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 conditions (1994 National Rural
Conference)
A process by which a community 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
needs towards solving their long-term problems (CO: A manual of experience, 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 development
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 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 Designing a plan for community development including all its activities and
strategies for care development.
o Designing criteria for the selection of site
o 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 the following guidelines however.
o Recognizes the role of local authorities by paying them visits to inform them of
their presence and activities.
o The appearance, speech, behavior and lifestyle should be in keeping with those of
the community residents without disregard of their being role models.
o 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 community-wide undertakings.
At this point, the different communities setup in the organization building phase 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 Education and training
o Networking and linkaging
o Conduct of mobilization on health and development concerns
o Implementing of livelihood projects
o Developing secondary leaders

Communicable Diseases (Chronic)

Chronic

1. Tuberculosis
TB is a highly infectious chronic disease that usually 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- or
far advanced) and extra-pulmonary TB (meningitis, pleurisy, etc.)
o Intensive Phase (given daily for the first 2 months) - Rifampicin + Isioniazid +
pyrazinamide + ethambutol.
o If sputum result becomes negative after 2 months, maintenance phase starts. But
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 patient
resumes taking the 4 drugs for another month and then another smear exam is
done at the end of the 3rd month.
o Maintenance Phase (after 3rd month, regardless of the result of the sputum
exam)-INH + rifampicin daily
Category 2-previously-treated patients with relapses or failures.
o Intensive Phase (daily for 3 months, month 1, 2 & 3)-Isioniazid+ rifampicin+
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.
o Maintenance Phase (daily for 5 months, month 4, 5, 6, 7,& 8)-Isionazid+
rifampicin+ ethambutol
Category 3 new TB patients whose sputum is smear negative for 3 times and chest x-
ray result of PTB minimal
o Intensive Phase (daily for 2 months) Isioniazid + rifampicin + pyrazinamide
o Maintenance Phase (daily for the next 2 months) - Isioniazid + rifampicin

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 Gynocomastia
Loss in sensation Madarosis(loss of eyebrows)
Ulcers that do not heal Inability to close eyelids (Lagopthalmos)
Muscle weakness Sinking nosebridge
Painful nerves 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
o Paucibacillary/PB non-infectious types. 6-9 months of treatment.
o Multibacillary/MB infectious types. 24-30 months of treatment.
Multi-drug therapy use of 2 or more drugs renders patients non-infectious a week
after starting treatment
o Patients w/ single skin lesion and a negative slit skin smear are treated w/ a single
dose of ROM regimen
o For PB leprosy cases- Rifampicin+Dapsone on Day 1 then Dapsone from Day 2-
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:
o Prevention health education, healthful living through proper nutrition, adequate
rest, sleep and good personal hygiene;
o Casefinding
o Management and treatment prevention of secondary injuries, handling of
utensils; special shoes w/ padded soles; importance of sustained therapy, correct
dosage, effects of drugs and the need for medical check-up from time to time;
mental & emotional support
o Rehabilitation-makes patients capable, active and self-respecting member of
society.

Communicable Disease (Vector Borne)

Leptospirosis (Weils disease)
An infectious disease that affects humans and animals, is considered 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 and 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 and 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 by various thread-like parasitic round
worms (nematodes) and their larvae
larvae transmit the disease to humans through a mosquito 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
Abdominal 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 agriculture 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
Abdominal pain
Rashes
Diarrhea
Treatment:
The mainstay of treatment is supportive therapy.
o Intravenous fluids
o A platelet transfusion

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
o use home fluid such as cereal gruel
o give ORESOL, plain water
2. Give the child plenty of food to prevent under nutrition
o 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
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:
o many watery stools
o repeated vomiting
o marked thirst
o eating or drinking poorly
o fever
o blood in the stool
Oresol Treatment
Age
Amount of ORS to give
after each loose stool
Amount of ORS to provide
for use at home
< 24 months 50-100 ml 500 ml/day
2-10 years 100- 200 ml 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 Weight (kg) ORS (ml)
4 months 5 200- 400
4- 11 months 5- 7.9 400- 600
12-23 months 8- 10.9 600- 800
2-4 yrs. 11- 15.9 800- 1200
5-14 yrs. 16- 29.9 1200- 2200
15 yrs. up 30 up 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 childs eyelids become puffy, stop ORS, give 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
Treatment PLAN C- treat quickly
1. Bring pt. to hospital
2. IVF Lactated Ringers Solution or Normal Saline
3. Re-assess pt. Every 1-2 hrs
4. 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 and effectively by
giving ORS
o Malnutrition
For under nutrition, continue feeding during diarrhea especially
breastfeeding.
Interventions to prevent diarrhea
1. breastfeeding
2. improved weaning practices
3. use of plenty of clean water
4. hand washing
5. use of latrines
6. proper disposal of stools of small children
7. 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 causing 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 least 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. If coughing more than 30 days, refer for assessment
2. Assess and treat ear problems/sore throat if present
3. Advise mother to give home care
4. 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. Advise mother to give home care
2. Give an antibiotic
3. Treat fever/wheezing if present
4. If the childs 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. Chest indrawing
2. Nasal flaring
3. Grunting ( short sounds made with the voice)
4. Cyanosis
Treatment
Refer urgently to hospital
Treat fever ( paracetamol), wheezing ( salbutamol)
D. Very Severe Disease
1. Not able to drink
2. Convulsions
3. Abnormally sleepy or difficult to wake
4. Stridor in calm child
5. Severe undernutrition
Treatment
Refer urgently to hospital

Assessment of Respiratory Infection

Ask the Mother
1. How old is the child?
2. Is the child coughing? For how long?
3. Age less than 2 months: Has the young infant stopped feeding well?
4. Age 2 months up to 5 years: Is the child able to drink?
5. Has the child had fever? For how long?
6. Has the child had convulsions?
Look, Listen

1. Count the breaths in one minute.
Age Fast Breathing
Less than 2 months
60/minute or
more
2 months- 12
months
50/minute or
more
12 months 5 years
40/minute or
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
information about the
community
type of assessment responds to a
particular need

Steps:

Preparatory Phase
1. site selection
2. preparation of the community
3. statement of the objectives
4. determine the data to be collected
5. identify methods and instruments for data collection
6. finalize sampling design and methods
7. make a timetable
Implementation Phase
1. data collection
2. data organization/collation
3. data presentation
4. data analysis
5. 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
o Age Distribution
o Sex Ratio
o Population Pyramid
o Median age - age below which 50% of the population falls and above which 50%
of the population falls. The lower the median age, the younger the population
(high fertility, high death rates).
o Age Dependency Ratio - used as an index of age-induced economic drain on
human resources
o Other characteristics:
occupational groups
economic groups
educational attainment
ethnic group
Population Distribution
o Urban-Rural - shows the proportion of people living in urban compared to the
rural areas
o Crowding Index - indicates the ease by which a communicable disease can be
transmitted from 1 host to another susceptible host.
o Population Density - determines congestion of the place

Vital Statistics
The application of statistical measures to vital events (births, deaths and common
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 X 1000
Estimated population as of July 1 of the same given year

2. General Fertility Rate

Total # of livebirths in a given calendar year X 1000
Total number of reproductive age

Mortality Rate

1. Crude Death Rate

_Total # of death in a given calendar year_ X 1000
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

3. Maternal Mortality Rate

Total # of death among all maternal cases in a given calendar year X 1000

Morbidity Rate

1. Prevalence Rate

Total # of new & old cases in a given calendar year X 100

2. Incidence Rate

Total # of new cases in a given calendar year_ X 100

3. Attack Rate

Total # of person who are exposed to the disease X 100

Epidemiology
the study of distribution of disease or physiologic condition among human 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 high 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 constantly 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. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relate to characteristics of the group in the community
4. 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:
o To increase awareness on the prevention and control of osteoporosis as a chronic
debilitating condition;
o To increase awareness by physicians and other health professionals on the
screening, treatment and rehabilitation of osteoporosis;
o To empower people with knowledge and skills to adopt healthy lifestyle in
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. Mens 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)
o Lecture on healthy lifestyle for the elderly
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
o Less subcutaneous fats
2. Kwashiorkor - a moon face child
o With flag sign (hair changes)
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 USES
Lagundi ( Vitex Negundo)
SHARED
Skin diseases
Headache,
Asthma,fever,cough&colds
Rheumatism
Eczema
Dysentery
Ulasimang Bato (Peperonia
Pellucida)
Lowers uric acid
Bawang ( Allium Sativum) HAT Headache and Tootache
Bayabas ( Psidium Guajava) Anti septic, Anti-diarrheal
Yerba Buena (Mentha Cordifolia)
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. Family 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. Under Five Care Program
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;
o EDUCATING THE PEOPLE,
o CRITICAL AWARENESS
o MOBILIZING
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 distribution 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 health 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 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 (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 & prevent violent & risk-taking
behaviors.
6. Promote the health & nutrition of families & special populations through child,
adolescent & youth, adult health, womens health, health of older 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. Universal access to basic health services must be ensured.
2. The health and nutrition of vulnerable groups must be prioritized.
3. The epidemiological shift from infection to degenerative diseases must be managed.
4. The performance of the health sector must be enhanced.

Primary Strategies to Achieve Goals
1. Increasing investment for Primary Health Care.
2. Development of national standards and objectives for health.
3. Assurance of health care.
4. Support to the local system development.
5. 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. Tuberculosis
2. Diptheria
3. Pertussis
4. Measles
5. Poliomyelitis
6. Tetanus
7. 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 Content Form & Dosage
# of
Doses
Route
BCG (Bacillus
Calmette Guerin)
Live attenuated
bacteria
Freeze dried
Infant- 0.05ml

Preschool-0.1ml
1 ID
DPT (Diphtheria
Pertussis Tetanus)
DT- weakened toxin

P-killed bacteria
liquid-0.5ml 3 IM
OPV (Oral Polio
Vaccine)
weakened virus liquid-2drops 3 Oral
Hepatitis B Plasma derivative Liquid-0.5ml 3 IM
Measles Weakened virus Freeze dried- 0.5ml 1 Subcutaneous

Schedule of Vaccines
Vaccine Age at 1st dose
Interval
between dose
Protection
BCG At birth
BCG is given at the earliest
possible age protects against
the possibility of TB infection
from the other family
members
DPT 6 weeks 4 weeks
An early start with DPT
reduces the chance of severe
pertussis
OPV 6weeks 4weeks
The extent of protection
against polio is increased the
earlier OPV is given.
Hepa B @ birth
@birth,6th
week,14th week
An early start of Hepatitis B
reduces

the chance of being infected
and becoming a carrier.
Measles 9m0s.-11m0s.
At least 85% of measles can
be prevented by immunization
at this age.

6 months earliest dose of measles given in case of outbreak
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
Minimum age
interval
%
protected
Duration of
Protection
TT1
As early as
possible
0% 0
TT2 4 weeks later 80% 3 years
TT3 6 months later 95% 5 years
TT4
1year
later/during next
pregnancy
99% 10 years
TT5
1 year later/third
pregnancy
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). Or if the child
experienced convulsions after a DPT or measles vaccine, 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 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 different levels are:
o 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.
Most sensitive to heat: Freezer (-15 to -25 degrees C)
o OPV
o Measles
Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius)
o BCG
o DPT
o Hepa B
o TT
Use those that will expire first, mark X/ exposure, 3rd- 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 or Lactation 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 and promotion of breastfeeding to ensure the safe
and adequate nutrition of infants through regulation of marketing of infant foods and related
products. (e.g. breast milk substitutes, infant formulas, feeding bottles, teats etc. )

b. RA 7600 THE ROOMING IN and BREASTFEEDING ACT of 1992
An act providing incentives to government and 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

Advantages of Breastfeeding:

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
Positions in Breastfeeding of the baby:
1. Cradle Hold = head and neck are supported
2. Football Hold
3. Side Lying Position
BEST FOR BABIES
REDUCE INCIDENCE OF ALLERGENS
ECONOMICAL
ANTIBODIES 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 national 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
Abdominal pain (severe)
Chest pain (severe)
Headache (severe)
Eye problems (blurred vision, flashing lights, blindness)
Severe leg pain (calf or thigh)
Others: depression, jaundice, breast lumps
IUD
Period late, no symptoms of pregnancy, abnormal bleeding or spotting
Abdominal 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 community 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:
o information - provision of knowledge
o education - change in knowledge, attitude and skills
o communication - exchange of information

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
100,000 IU
or cap or 3
drops
Orally by drops 12-59 months
old, nationwide
9-12 months old
infants receiving
AMV nationwide
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(6-
11mos) once
a day

Orally by drops

2-11 months old
infants in Mindanao
area, including
evacuation centers
in armed conflict
areas.

Routine
Immunization
-BCG*
-DPT*
-OPV*
-AMV*
-Hepa B (if
available)

0.05ml
0.5ml
2 drops
0.5ml
0.5ml

Intradermal on right
deltoid

Intramuscularly on
anterior thigh

Orally

Subcutaneously on deltoid

Intramuscularly

Nationwide
0-11 mos
0-11 mos
0-11 mos
9-11 mos
0-11 mos

Deworming
drug
(if available)
1 tablet as
single dose
Orally 36-59 mos,
nationwide
Weighing

0-59 mos,
nationwide

o 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.
o 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 infants 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 infants exposure to infection.
For the Mother
1. Reduces a womans 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 childs 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 new 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 causes 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 mans 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 combine 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 Handlers
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 projects 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 equity, 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 peoples
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 community.
It meets the needs, interests, and problems of the people affected.
It finds means and ways of carrying out plans by encouraging individual and community
participation.
It is a slow, continuous process that involves constant changes 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 techniques 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 10 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 or
leaves in 2 glasses of water for 15 minutes)Dysentery, Colds
& Pain - Decoction ( Boil a handful of leaves & flowers in
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 forehead
Rheumatism, sprain, contusions, insect bites - Pound the
leaves and apply on affected area

Plant Name:
Uses & Preparation:
Pain (headache, stomachache) - Boil chopped leaves in 2
glasses of water for 15 minutes. Divide decoction into 2 parts,
drink one part every 3 hours.
Rheumatism, arthritis and headache - Crush the fresh
Yerba (Hierba ) Buena
(Mentha cordifelia)
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 solution
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.

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)
Uses & Preparation:
Diarrhea - Boil chopped leaves into 2 glasses of water for 15
minutes. Divide decoction into 4 parts. Drink 1 part every 3
hours
Stomachache - Boil chopped leaves in 1 glass of water for 15
minutes. Cool and strain.

Plant Name:
Niyug-niyogan (Quisqualis
indica L.)
Uses & Preparation:
Anti-helmintic - The seeds are taken 2 hours after supper. If
no worms are expelled, the dose may be repeated after one
week. (Caution: Not to be given to children below 4 years old)

Uses & Preparation:
For washing wounds - Maybe use twice a day
Plant Name:
Bayabas/Guava (Psidium
guajava L.)
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 fire. Do not cover and
then let it cool and strain

Plant Name:
Akapulko
(Cassia alata L.)
Uses & Preparation:
Anti-fungal (tinea flava, ringworm, athletes foot and
scabies) - Fresh, matured leaves are pounded. Apply soap to
the affected area 1-2 times a day

Plant Name:
Ulasimang Bato
(Peperonica pellucida)
Uses & Preparation:
Lowers uric acid (rheumatism and gout) - One a half cup leaves
are boiled in two glass of water over low fire. Do not cover pot.
Divide into 3 parts and drink one part 3 times a day

Plant Name:
Bawang
(Allium sativum)
Uses & Preparation:
Hypertension - Maybe fried, roasted, soaked in vinegar for 30
minutes, or blanched in boiled water for 15 minutes. Take 2
pieces 3 times a day after meals.
Toothache - Pound a small piece and apply to affected area

Plant Name
Ampalaya
(Mamordica Charantia)
Uses & Preparation:
Diabetes Mellitus (Mild non-insulin dependent) - Chopped
leaves then boil in a glass of water for 15 minutes. Do not
cover. Cool and strain. Take 1/3 cup 3 times a day after meals

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
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 under five

Goal
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 may 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:
o 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

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 hypoxia (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 ** If the child is 2 months up to 12 months the child has fast breathing if you
count 50 breaths per minute or more
o ** 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)
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
HOME
Caretaker is
counseled on:
Home treatment/s
Feeding and fluids
When to return
immediately
Follow-up
REFERRAL
FACILITY
Emergency
Triage and
Treatment (
ETAT)
Diagnosis,
Treatment
Monitoring,

SEVERE PNEUMONIA OR VERY
SEVERE DISEASE

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
follow-up for fever > 38.5
o
C
Any general
danger sign or
Chest indrawing
or
Stridor in calm
child

PNEUMONIA
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
for fever > 38.5
o
C
Fast breathing

NO PNEUMONIA : COUGH OR COLD
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
No signs of
pneumonia or
very severe
disease

Assess and classify DIARRHEA

A child with diarrhea is assessed for:
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
Not able to drink or
drinking poorly
Skin pinch goes back
very slowly

SEVERE
DEHYDRATION
If child has no other severe
classification:
o Give fluid for severe
dehydration ( Plan C ) OR
If child has another severe
classification :
o Refer URGENTLY to hospital
with mother giving frequent
sips of ORS on the way
o Advise the mother to continue
breastfeeding
If child is 2 years or older and there is
cholera in your area, give antibiotic for
cholera
Two of the following signs :
Restless, irritable
Sunken eyes
Drinks eagerly, thirsty
Skin pinch goes back
slowly

SOME
DEHYDRATION
Give fluid and food for some
dehydration ( Plan B )
If child also has a severe classification :
o Refer URGENTLY to hospital
with mother giving frequent
sips of ORS on the way
o Advise mother when to return
immediately
Follow up in 5 days if not improving
Not enough signs to
classify as some or
severe dehydration

NO
DEHYDRATION
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
Dehydration present

SEVERE
PERSISTENT
DIARRHEA
Treat dehydration before referral unless
the child has another severe
classification
Give Vitamin a
Refer to hospital
No dehydration

PERSISTENT
DIARRHEA
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 )
appropriate antibiotic
Treat the child to prevent low
blood sugar
Give one dose of paracetamol
in health center for high fever
(38.5
o
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
Treat the child with an oral
antimalarial
(38.5
o
C) or above
immediately
Follow up in 2 days if fever
persists
If fever is present everyday
for more than 7 days, refer for
assessment
Blood smear ( - ), or
Runny nose, or
Measles, or Other
causes of fever

FEVER : MALARIA
UNLIKELY
(38.5
o
C) or above
immediately
persists
assessment

No Malaria Risk
Any general danger sign
or
Stiff neck

VERY SEVERE
FEBRILE DISEASE
Treat the child to prevent low
blood sugar
(38.5
o
C) or above
Refer URGENTLY to
hospital
No signs of very severe
febrile disease

FEVER : NO
MALARIA
(38.5
o
C) or above
immediately
persists
assessment

Measles
Clouding of cornea or
Deep or extensive mouth
ulcers

SEVERE
COMPLICATED
MEASLES
Give Vitamin A
If clouding of the cornea or
pus draining from the eye,
apply tetracycline eye
ointment
Refer URGENTLY to
hospital
Pus draining from the
eye or
Mouth ulcers

MEASLES WITH EYE
OR MOUTH
COMPLICATIONS
Give Vitamin A
If pus draining from the
eye, apply tetracycline eye
ointment
If mouth ulcers, teach the
mother to treat with gentian
violet
Measles now or within
the last 3 months

MEASLES
Give Vitamin A

Dengue Fever
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
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
No signs of severe
dengue hemorrhagic
fever

FEVER: DENGUE
HEMORRHAGIC
UNLIKELY
DO NOT GIVE ASPIRIN
Give one dose of
paracetamol in health
center for high fever
(38.5
o
C) or above
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
Give first dose of
appropriate
antibiotic
Give paracetamol
for pain
Refer URGENTLY
Pus seen draining from the ear and
discharge is reported for less than 14
days or
Ear pain

ACUTE EAR
INFECTION
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

CHRONIC EAR
INFECTION
Dry the ear by
wicking
Follow up in 5 days
No ear pain and no pus seen
draining from the ear

NO EAR
INFECTION
No additional
treatment

Check for Malnutrition and Anemia

Give an Appropriate Antibiotic:

A. For Pneumonia, Acute ear infection or Very Severe disease
COTRIMOXAZOLE
BID FOR 5 DAYS
AMOXYCILLIN
BID FOR 5 DAYS

Age or Weight

Adult
tablet

Syrup

Tablet

Syrup

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. For Dysentery
COTRIMOXAZOLE
BID FOR 5 DAYS
AMOXYCILLIN
BID FOR 5 DAYS

AGE OR
WEIGHT

TABLET

SYRUP

SYRUP 250MG/5ML

2 4 months
( 4 - < 6kg )

5 ml 1.25 ml ( tsp )

4 12 months
( 6 - < 10 kg )

5 ml 2.5 ml ( tsp )

1 5 years old
( 10 19 kg )
1

7.5 ml ( 1 tsp )

C. For Cholera
TETRACYCLINE
QID FOR 3 DAYS
COTRIMOXAZOLE
BID FOR 3 DAYS
AGE OR WEIGHT Capsule 250mg Tablet Syrup
2 4 months ( 4 - < 6kg ) 1 / 2 5ml
4 12 months ( 6 - < 10 kg ) 1 / 2 5 ml
1 5 years old ( 10 19 kg) 1 1 7.5ml

Give an Oral Antimalarial

CHOLOROQUINE
Give for 3 days

Primaquine
Give single
dose in
health center
for P.
Falciparum
Primaquine
Give daily for
14 days for
P. Vivax

Sulfadoxine +
Pyrimethamine
Give single
dose

AGE TABLET ( 150MG ) TABLET
( 15MG)
TABLET
( 15MG)
TABLET
( 15MG)
DAY1 DAY2 DAY3
2months
5months
5 months
12 months
1/2
12months
3 years old

1 1
3 years old -
5 years old
1 1 1 3/4 1/2 1

GIVE VITAMIN A
AGE
VITAMIN A
CAPSULES 200,000
IU
6 months 12 months 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
(10 - <14kg)
1/2 5 ml
3years 5 years ( 14
19kg )
1/2 7.5 ml

GIVE PARACETAMOL FOR HIGH FEVER (38.5
o
C OR MORE) OR EAR PAIN
AGE OR WEIGHT TABLET ( 500MG ) SYRUP ( 120MG / 5ML )
2 months 3 years
( 4 - <14kg )
5 ml
3 years up to 5 years
(14 19 kg )
1/2 10 ml

GIVE MEBENDAZOLE
Give 500mg Mebendazole as a single dose in health center if :
o 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

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 of 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 annual budgetary allocations for the
operation and maintenance of their own health facilities.
Composition of LHB

Provincial Level
1. Governor- chair
2. Provincial Health Officer vice chairman
3. Chairman, Committee on Health of Sangguniang Panlalawigan
4. DOH representative
5. NGO representative
City and Municipal Level
1. Mayor chair
2. MHO vice chair
3. Chairman, Committee on Health of Sangguniang Bayan
4. DOH representative
5. NGO representative
Effective Local Health System Depends on:
1. The LGUs 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 mans environment that 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 including 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 accountable 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 personal
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 employment; 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 encourage 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 PWDs \
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. All newborns be breastfeed within 1 hr after birth
2. Infants be exclusively breastfeed for 6 months.
3. Infants be given timely, adequate and safe complementary foods
4. 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
o unified whole
o holon
o dimorphism
2. Anthropological
o essentialism
o social constructionism
o culture
3. Psychological
o psychosexual
o psychosocial
o behaviorism
o social learning
4. Sociological
o family and kinship
o social groups

Family

Models:

1.Developmental

Stages of Family Development

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
parenting

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 nitial Data Base
Family structure and Characteristics
Socio-economic and Cultural Factors
Environmental Factors
Health Assessment of Each Member
Value Placed on Prevention of Disease
First Level Assessment

Health threats:
o conditions that are conducive to disease, accident or failure to realize ones 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 Level Assessment:
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 Prioritization:

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
Family Service and Progress Record

Population Group

Vulnerable Groups:
Infants and Young Children
School age
Adolescents
Mothers
Males
Old People
Specialized Fields:

Community Mental Health Nursing
A unique clinical process which includes an integration of concepts from nursing, mental
health, social psychology, psychology, community networks, and the basic sciences
Occupational Health Nursing
The application of nursing principles and procedures in conserving the health of workers
in all occupations
School Health Nursing
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 dry by wicking.
2. Paracetamol maybe given for pain or high fever.
3. Precautions for a child with a draining ear:
o 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.

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 meaning 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 Mothers 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. any type of vaginal bleeding
2. headache, dizziness, blurred vision
3. puffiness of face and hands
4. 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
Minimum Age
Interval
Percent
Protected
Duration of Protection
TT1
As early as possible
during pregnancy
0% None
TT2
At least 4 weeks
later
80%
Infants born to the mother will be
protected from neonatal tetanus.
Gives 3 years protection for the
mother from the tetanus.
TT3
At least 6 months
later
90%
Infants born to the mother will be
protected from neonatal tetanus.

mother.
TT4 At least 1 year later 99%
mother
TT5 At least 1 year later 99%
Gives lifetime protection for the
mothers. All Infants born to that
mother will be protected.
Dose: 0.5ml
Route: Intramuscular
Site: Right or Left Deltoid/Buttocks

Components of Prenatal Visits
History taking
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, Leopolds 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
countrys 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 peoples 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
Womens health
Childrens 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
o Causes: environmental factors, maternal diseases or genetic aberrations
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.
o higher among males than females for the latter are protected by estrogen before
menopause
o Predisposing Factor: Hypertension (HPN),Diabetes Mellitus (DM), Smoking
o Minor Risk Factor: stress, strong family history, obesity
Cardiovascular Disease
Period of Life Type of CVD Prevalence
At birth to early
childhood
Congenital Heart Disease
2/ 1000 school
children (aged 5-15
yrs. old)
Early to late childhood
Rheumatic Fever/
Rheumatic Heart Disease
1/1000 school
children (aged 5-15
yrs. old)
Early Adulthood
Diseases of Heart Muscles
Essential Hypertension
10/100 adults
Middle age to old age
Coronary Artery Disease
Cerebrovascular Accident
5/100 adults

Cardiovascular Disease
Diseases Causes/ Risk factors
Maternal Infections, Drug intake, Maternal
Disease, Genetic
Rheumatic
Fever/Rheumatic Heart
Disease
Frequent Streptoccocal Sore Throat
Essential Hypertension Heredity, High Salt Intake
Coronary Artery Disease
(Heart Attack)
Smoking, Obesity, Hypertension, Stress
Hyperlipidemia, Diabetes Mellitus Sedentary
Life Style
Cerebrovascular Accident
(Stroke)
Hypertension, Arteriosclerosis

Primary Prevention: CVD
Disease Primordial Specific Protection

Prevention of viral
infection and intake of
harmful drugs during
pregnancy.
Avoidance of marriage
between blood relatives
Adequate treatment of
viral infection during
pregnancy.
Genetic counseling of
blood related married
couples.

Rheumatic Heart Disease
Prevention of recurrent
sore throat thru adequate
environmental sanitation;
avoidance of
overcrowding; adequate
treatment
Identification of cases
of rheumatic fever
Prophylaxis with
penicillin or
erythromycin

Essential Hypertension
From early childhood
o low salt diet
o adequate physical
exercise
Continued low salt diet
and adequate exercise

Coronary Heart Disease
(Heart Attack)
Prevention of
development/ acquisition
of risk factors
o cigarette smoking
o high fat intake
o high salt intake
cessation of smoking
control /treatment of
diabetes, hypertension
weight reduction
change to proper diet
Adjustment of
activities

Cerebrovascular
Accident
(Stroke)
all measures to prevent
hypertension &
arteriosclerosis
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. diet - low fat
3. alcohol/smoking avoidance
4. exercise
5. 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
Obvious 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 Paps smear every 1-3 yrs
Cervical Monogamy, Safe sex Paps smear every 1-3 yrs
Liver
Hep B vaccination, Less
alcohol intake, Avoidance of
moldy foods
None
Colon High fiber diet
Regular medical checkup
after 40 yrs of age
Rectum Low fat intake
Fecal occult blood test
DRE Sigmoidoscopy
Mouth
No smoking, betel nut
chewing, Oral hygiene
Regular dental check-ups
Breast none
Monthly SBE, Yearly exam
by doctor, Mammography
for 50 yrs old and above
females
Skin No excessive sun exposure Assessment of skin
Prostate none 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

Natl 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 tubular 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 of 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 o He feels physically well
o o His thought are organized
o o His feelings are modulated
o o His behaviors are coordinated and
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
o Like hereditary predisposition, poor nutrition
2. Physical Factors
o Physical injuries, intoxication
3. Psychological Factors
o Failure to adjust to the difficulties in life.
4. Socio-economic Factors
o Unemployment, housing problems
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:
o Pharmacotherapy (use of medicines)
o Various therapies (physical, recreational, occupational, environmental)
o Psychotherapy and others
Prevention of Mental Illness
1. Maintain good physical health.
2. Choose worthwhile activities and develop a hobby
3. Solve problems as they come and avoid excessive worrying.
4. Cultivate friendships and choose a friend to confide in.
5. Strike a happy medium between work and play.
6. 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 hands 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. 5079 yrs. old, MENOPAUSE
main cause

Nursing Procedures in the Community

Clinic Visit
process of checking the clients 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 clients 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 any 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
physicians 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:
o It helps in the development of the brain, especially during the first years of the
childs life.
o It speeds up the growth and development of the body including the formation of
teeth and bones
o 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
Goal
To improve the nutritional status, productivity and quality of life of the population thru
adoption of desirable dietary practices and healthy 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 drippings 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- its 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
Vitamin A
Maintain normal vision, skin health, bone and tooth
growth reproduction and immune function; prevents
xerophthalmia.

Food sources: Breastmilk;poultry;eggs; liver;
meat;carrots;squash; papaya;mango;tiesa;
malunggay;kangkong; camotetops; ampalaya tops
Thiamine
Help release energy from nutrients; support normal
appetite and nerve function, prevent beri-beri.
Riboflavin
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.
Niacin
Help release energy from nutrients; support skin, nervous
and digestive system, prevents pellagra.
Biotin
Help energy and amino acid metabolism; help in the
synthesis of fat glycogen.
Pantothenic Help in energy metabolism.
Folic acid
Help in the formation of DNA and new blood cells
including red blood cells; prevent anemia and some
amino acids.
Vitamin B12
Help in the formation of the new cells; maintain nerve
cells, assist in the metabolism of fatty acids and amino
acids.
Vitamin C
Help in the formation of protein, collagen, bone, 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
Vitamin D
Help in the mineralization of bones by enhancing
absorption of calcium
Vitamin E
Strong anti-oxidant; help prevent arteriosclerosis; protect
neuromuscular system; important for normal immune
function.
Vitamin K
Involve in the synthesis of blood clotting proteins and a
bone protein that regulates blood calcium level.

MINERALS FUNCTIONS
Calcium
Mineralization of bones and teeth, regulator of many of
the bodys biochemical processes, involve in blood
clotting, muscle contraction and relaxation, nerve
functioning, blood pressure and immune defenses.
Chloride Maintain normal fluid and electrolyte balance.
Chromium
Work with insulin and is required for release of energy
from glucose.
Copper
Necessary for absorption and use of iron in the formation
of hemoglobin.
Fluoride
Involve in the formation of bones and teeth; prevents
tooth decay.
Iodine
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
Iron
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
Magnesium
Mineralization of bones and teeth, building of proteins,
normal muscle contraction, nerve impulse transmission,
maintenance of teeth and functioning of immune system.
Manganese Facilitate many cell processes.
Molybdenum Facilitate many cell processes.
Phosphorus
Mineralization of bones and teeth; part of every Cell;
used in energy transfer and maintenance of acidbase
balance.
Selenium
Work with vitamin E to protect body compound from
oxidation.
Sodium
Maintain normal fluid and electrolyte balance, assists
nerve impulse insulin.
Sulfur
Integral part of vitamins, biotin and thiamine as well as
the hormone.
Zinc
Essential for normal growth, development reproduction
and immunity.

Malnutrition
An abnormal condition of the body 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
o Majority of the victims of malnutrition comes from families of farmers, fisherfolk,
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. Early weaning of child and improper introduction of supplementary food
2. Incomplete immunization of babies and children
3. Bad eating habits
4. 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 intake 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:
o 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!
2. Kwashiorkor
This child does not get enough body-building food, although she/he may be getting
enough energy.
She/he:
o 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!
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 Signs
night blindness (early stage); total blindness (later stage)
bitots 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 Manifestations
increased cases of childhood sickness, and death 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 Factors
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)
Schedule for Receiving Vitamin A Supplement to I nfants, Preschoolers and Mothers
Schedule Infants (6-11 mos)
Preschoolers
(12-83 mos)
Post Partum
Mother
Give 1 Dose 100,000 IU 200,000 IU
200,000 IU
Within one month
Give after 6 months
High risk Condition
Present
100,000 IU 200,000 IU
After delivery of
each child only

Schedule for Treatment of Viamin A Deficiency
Schedule Infants (6-11 mos.) Preschoolers (12-83 mos.)
Give Today 100,000 IU 200,000 IU
Give Tomorrow 100,000 IU 200,000 IU
Give After 2 Weeks 100,000 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 internal 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

Treatment 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:
o daily intake of food rich in iodine
o use of iodized salt
I odine Supplementation
Dosage
Children 0-59
months ( in endemic
areas)
Iodine capsules (200mg)
potassium iodate in oil orally
once a year.

Checking the Nutritional Status Weight
1. Weight is a very important indicator of a persons 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 maintains 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 parents 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 childrens 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, exercise 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 months
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 very 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 crops
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 salty foods as a hedge against
hypertension, particularly among high-risk individuals.
Guideline No.9 is intended to prevent food-borne diseases. It explains 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 energy 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 January
31 of each year
Republic Act 1891 Act strengthening Health and Dental services in the rural 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 any 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, exploitation 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 below 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 Day
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 self-
organization 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 Nurses Week.
October 17, 1958
Presidential Decree 541 Allowing former Filipino professionals to practice their
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 other
forms of uncleanliness and for other purposes.
Presidential Decree 851 13
th
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 self-
employed
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 UNs goal of Universal Child Immunization; involved NGOs 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 Nurses 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 conditions 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 by
Pres. Ferdinand E. Marcos, which adopted PHC as an approach towards the design,
development and implementation of programs focusing on health 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
HEALTH FOR ALL FILI PI NOS by the year 2000 AND HEALTH I N THE HANDS
OF THE 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, accessible,
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 children.
Extension of essential health services with priority given to the underserved sectors.
Improvement in Basic Sanitation
Development of the capability of the community aimed 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 opportunities and supporting the
conditions wherein people will manage their own health care.

Two Levels of Primary Health Care Workers
1. Barangay Health Workers - trained community health workers or health auxiliary
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 make
use of the available resources within the community, wherein 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
peoples participation at all levels of decision-making; planning, implementing, monitoring
and evaluating. Any undertaking must also be based on the peoples needs and problems
(PCF, 1990)
Part of the peoples 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 Lack of motivation
o Attitude
o Resistance to change
o Dependence on the part of community people
o Lack of managerial skills
4. Self-reliance
Through community participation and cohesiveness of peoples organization 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
peoples 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 mans environment,
which exercise or may exercise deleterious effect on his well-being and survival. Water is a
basic need for life and one factor in mans environment. Water is necessary for the
maintenance of healthy lifestyle. Safe Water and Sanitation 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 occupies the top ten causes
of death. Most communicable diseases are also preventable. The Government focuses on
the prevention, control and treatment of these illnesses.
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 desired 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 the 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. Active Community Participation
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. 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
(countrys 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 other Gynecological Conditions
Mens 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 enhancement 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 whats being said and whats behind the words
always available for the participant to voice out their 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 communitys 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 childs 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 development of the child.

Activities and Strategies
1. Regular height and weight determination/ monitoring until 5 years old. 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
childs 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. Members of the household and relationship to the head of the family.
2. Demographic data-age, sex, civil status, position in the family
3. Place of residence of each member-whether living with the family or elsewhere
4. Type of family structure-e.g. patriarchal, matriarchal, nuclear or extended
5. 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 familys 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 vector 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 for vulnerable or at risk members)
o Anthropometric data: measures of nutritional status of children-weight, height,
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)
o dietary history specifying quality and quantity of food or nutrient per day
o Eating/ feeding habits/ practices
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 lifestyle diseases-e.g. hypertension, 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
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 or capability to a higher
level. Wellness potential is a nursing judgment on wellness state or condition based on clients
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. Healthy lifestyle-e.g. nutrition/diet, exercise/activity
2. Healthy maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being-process of clients 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. Healthy lifestyle
2. Health maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being
6. 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. Examples 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. Inadequate food intake both in quality and quantity
2. Excessive intake of certain nutrients
3. Faulty eating habits
4. Ineffective breastfeeding
5. Faulty feeding techniques
F. Stress Provoking Factors. Specify.
1. Strained marital relationship
2. Strained parent-sibling relationship
3. Interpersonal conflicts between family members
4. 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 mothers role, father not assuming his
role.

M. Lack of Immunization/Inadequate Immunization Status Specially 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 by 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. Social-stigma, loss of respect of peer/significant others
2. Economic/cost implications
3. Physical consequences
4. 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 about 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 courses 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. Social consequences
2. Economic consequences
3. Physical consequences
4. 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 course(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. Members preoccupation with on concerns/interests

J. Prolonged disease or disabilities, which exhaust supportive capacity of family members.

K. Altered role performance, specify.
1. Role denials or ambivalence
2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion
6. 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 home 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 conducive 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
familys 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.

J. Negative attitude/ philosophy in life which hinders effective/maximum utilization of
community resources for health care

K. Others, specify __________

COPAR Community Organizing Participatory Action Research

Hochgeladen von

Dokumentinformationen

Originalbeschreibung:

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

COPAR Community Organizing Participatory Action Research

Hochgeladen von

Copyright:

Verfügbare Formate

Community Organizing Participatory Action Research (COPAR)

Das könnte Ihnen auch gefallen