CHN Lecture

PHCDS: Philippine Health Care

Delivery System
*under ng PHCDS yong DOH
Department of Health (DOH) :
National Lead Agency for Health
- RA 71! : Local "o#ern$ent
Code of 1%%1
Decentrali&ation
De#olution
- 'O 1!( : Redirecting the role)
and o*eration of
De*art$ent of
Health
Decentralization
-Local "o#ern$ent
+udget Allocation
,an*o-er
.nfra)tructure
Devolution
-/co$*o)ition0
Municipal
Health Board
(MHB)
Provincial
Health Board
(PHB)
Chairman: ,ayor Chairman:
"o#ernor
ice Chairman :
,unici*al Health
O1cer 2 ,HO 34
City Health O1cer
2CHO3
ice Chairman :
Pro#incial Health
O1cer
( Sector) of PHCDS
Pri#ate 5 /,ar6et-oriented0
Pu7lic 5 /8ree0 4 /rea)ona7le0 4
/ta9 7a)ed0
: Role) of DOH 2according to 'O 1!(3
!"#
!eader in Health
8unction: 8or$ulate)
La- and Regulation);
Ado*t) Policy
"na7ler and ca*acity 7uilder
8unction: .nno#ate;
'n)ure highe)t
achie#a7le )tandard ;
'9erci)e 4 O#er)ight
#d$ini)trator of )*eci<c
)er#ice)
8unction: ,anage Health
8acility 27oth local and
national3
$S$O% : !e#d Mo He&# Philipines
- =he DOH a) the leader;
)taunch advocate and Models
in Pro$oting Health for all the
8ili*ino)
M$SS$O%: "S' for He&# &ilipinos
- =o guarantee e(uita)le;
sustaina)le and (uality
health for all 8ili*ino) e)*ecially
the *oor and )hall lead the
>ue)t in '9cellence in Health?
2note that health i) for all -ith
e)*ecially the *oor; 7ut not for
the *oor only3
*O#!(DOH): Health Sector +eform
#,enda (HS+#)
8OC@S: Health i) agenda of the (
)ector 2*u7lic and *ri#ate3
- Pro7le$ .denti<ed:
+urden of di)ea)e -ith hea#ie)t
a$ong the *oor 2=+ i) concern3
High ca)e) of infectiou) and
co$$unica7le di)ea)e
@nattended '$erging High Ri)6
Ri)ing Ca)e) of Chronic and
Degenerati#e Di)ea)e 2e?g
De*re))ion3
Per)i)tence of Large #ariation in
Health
Slo-ing do-n in the reduction
of $aternal and infant $ortality
&rame-or.: 8O@R$ula One for
Health 2813
Outco$e : BeMor"
+etter Health Outco$e)
,ore Re)*on)i#e Health
Care Sy)te$
'>uita+L' Health Care
8inancing
'le$ent) 2813
Health &inancin, :
/<nance0 5 .n#e)t$ent
in health
Health re,ulation :
/regulate0 5 >uality and
aAorda7ility
Health Service
Delivery : /)er#ice)0 5
acce))i7ility and
a#aila7ility 2(A da*at3
*ood *overnance :
2under ci#il la-3 5
enhance *erfor$ance of
a health )ector
Strategy 2813
1 B P a g e
National Health
.n)urance Progra$
2 NH.P3 5 Phil Health
*No +alance +illing 2N++3 :
2*rogra$ of *hil? Health
6ung )aan -alang
7a7ayran3
N++ Re>uire$ent):
o C81 : co$*any
o ,e$7er) data record
o C8( : doctor4
Ho)*ital
'le$ent) 2 Stategy -
*hil? Health3
&inancin, :
/$oney0 5 =o
reduce) <nancial
7urden
+e,ulation:
/i$*ro#e
*erfor$ance0
Service
Delivery: / fair
co$*en)ation0
*overnance:
/go#ern0 5 to
inCuence health
care $ar6et
2note: Ang *ag6a6ai7a ng ele$ent) ng
81 )a 'le$ent) ng )trategy ay lahat
$ay health at good )a ele$ent) ng 81
*ero )a ele$ent) ng )trategy -ala 3
%urse Deployment Pro,ram
A6a - Nur)e to the +arrio Progra$
- RN H'ALS (!1D 2Health
'nhance and Local Ser#ice3 :
Progra$ of DSED and DOH
NARS 2Nur)e A))igned
Rural Ser#ice3 : <r)t
*rogra$ of P",A
o 2: $onth)
co$$unity; :
$onth) ho)*ital :
63
RN H'ALS 1
o 2 $onth)
co$$unity;
$oth) ho)*ital :
63
RN H'ALS (
o 2 $onth)
ho)*ital : 6
)alary F (6 local
go#t? G H63
RN H'ALS :
o 2 $onth) health
center; $onth)
ho)*ital : H63
RN H'ALS (!1D
o 2ho)*ital : 1163
$onth) )ila )a
ho)*ital $a9 of (
year); ta*o)
7ahala yong
ho)*ital nila na
$aghire )a
6anilaI
Re>uire$ent):
1? +SN; RN
(? Jalid PRC licen)e
:? Su7$it =OR
D? Su7$it
A**lication
K? Phy)ically and
$entally Health
Priority:
1? =ho)e nur)e
li#ing 4 )taying ni
an area -here
there i) DOH
(? =ho)e -ho had
undergone
training
2Sinong nag iidentify ng *oorI National
Anti Po#erty Co$$i))ion and DSED
ta*o) ang /conditional ca)h tran)fer0
ang nag7i7igay din ay yong NAPC and
DSED3
*O#!: #ttainment &or Health &or
#ll
/AO (!1!-!!:0
(#(uino
#,enda for Health) a6a
A>uino @ni#er)al Health Care
/LAL@S@"AN"
PAN"LALAHA=AN0
/hrust:
1? 'nroll$ent and 'ntitle$ent on
Phili**ine Health
(? .$*ro#e$ent and Acce)) on
,edical 8acilitie)
:? Achie#e$ent of Health Relati#e
,D"
(!1K 5 Achie#e of H ,D"M)
0 Millennium Development *oal
("r# P+$C"D)
12 'radicate '9tre$e Po#erty and
Hunger
32 Achie#e @ni#er)al Pri$ary
'ducation
42 Pro$ote "ender '>uality and
e$*o-er -o$en
52 Reduce Child ,ortality
( B P a g e
2Progra$): 'P.; .,C.;
,icronutrient Su**le$entation3
62 .$*ro#ed $aternal Health
2.,PAC 5 .ntegrated
,anage$ent of *regnant and
Child +irth; ==3
72 Co$7at H.J; A.DS; ,alaria and
other *u7lic health di)ea)e
82 'n#iron$ental Su)taina7ility
02 De#elo* "lo7al Partner)hi* in
Health
2Note: ( and : are non health
related -hile 1;D-H are health
related *rogra$)3
P9B!$C H"#!/H %9+S":
COMM9%$/; H"#!/H %9+S"
Pu7lic Health 2Dr? Charle) 'd-ard
Ein)lo-3
- Science and art of : PM) 2cla))ic
de<nition3
Pro$otion of Health
Pre#ention of Di)ea)e)
Prolonging Life
=o achie#e the : PM): Organi&e
Co$$unity 'Aort)
Acti#itie) 2DHOCS3
De#elo*$ent of Social
,achinerie) /a-arene))0 :
.nfor$ation; 'ducation and
.nfor$ation
Health 'ducation : 8ocu) of
Per)onal Hygiene
Organi&ation of ,edical and
Nur)ing Ser#ice) to-ard)
$edical $i))ion 2Le#el (:
Screen; diagno)e and cure3
Pur*o)e: for *ro$*t treat$ent
and diagno)ing a di)ea)e
Control of Co$$unica7le
Di)ea)e) 2Health =eaching3
Sanitation of the 'n#iron$ent
*O#! of PH
- '#ery citi&en )hould reali&e
their 7irth right of health and
longe#ity
2Ehat i) the +a)ic '))ential and
8unda$ental Right of a 8ili*inoI
H'AL=H3
<HO (Pu)lic health) : A**lying
)cience in the conte9t of *olitic)
*oal accordin, to <HO (PH) : =o
reduce ine>uality in health for the
greate)t nu$7er
EHO (Pu)lic Health %ursin,) :
S*ecial <eld of nur)ing
- Occu*ational health
nur)e4Co$*any Nur)e4.ndu)trial
Health Nur)e 2DOL'3
- School health Nur)e 2CH'D3
Re)*on)i7ilitie): 2PHN3
1? Pre#ent) di)ea)e : /-ala *ang
)a6it0
(? Pro$otion of Health: /,ay )a6it
na0
:? Reha7ilitation of .llne)) and
Di)a7ility
+uth &reeman (PH%) : )*ecial
)er#ice 7y a *rofe))ional to her client)
in the co$$unitie)
1? Client
(? 8a$ilie)
:? "rou*)
2PD; PH; R.D and Sanitation3
<ald (PH%) : )er#ice $ade a#aila7le
to all in the co$$unity
=aco)son(PH%) : nur)ing *ractice in a
-ide #ariety of )etting u)ually clinical
Nudg$ent and it i) inde*endent
nur)ing *ractice? PHN i) a nur)e
generali)t
Ma,laya (PH%) : utili&ation of the
CH% process
#ssessment : /data gathering
collection0 : a)6 the client
2)hould 7e 6een o7)er#er3
Diagno)i) 2under
a))e))$ent3 : recogni&e
and identi<ed *ro7le$
Plannin, : /fea)i7le0
$mplementation: -ith the
client2al-ay)3 : *artner)hi*
"valuation : /inter-o#en0 4
/re0
/ype of #ssessment
12 1st level of assessment :
Pro7le$ .denti<cation /-hat0
e2,2
a2 Health De>cit: /$ay )a6it0
5 e9i)ting condition
)2 <ellness state: /gu)to 6o
-ala a6ong )a6it0
c2 Health /hreat :
/$ag6a6a6)a6it0 5 ac>uiring :
any acti#itie) that *ro$ote
di)ea)e or inNury
: B P a g e
d2 &orseea)le Crisis: any
e#ent) 4 )ituation in life that
*ro$ote) )tre))
32 3
nd
level of assessment :
/'9*lain -hy there i) a
*ro7le$I / /-hy0 4 'tiology
e2,
a2 $na)ility to reco,nize :
/@ne9*lained0
Pro)lem Prioritization
&amily
12 %ature of the Pro)lem (1pt2)
(Pro)lem Presented)
<ellness State
(4pts) : *o))i7le le#el of
health4 de)ira7le
Health De>cit (4pts) :
gat 7et-een actual and
achie#a7le
Health /hreat (3pts) :
*ro$ote di)ea)e or
inNury
&oreseea)le
Crisis(1pt) : /)tre))
*oint0
circu$)tance)4ho- you
react
32 Modi>a)ility of the
Pro)lem(3 points) :
*ro7a7ility of reducing;
eradicating and controlling a
condition
42 Preventive potential(1pt2)
52 Saliance(1pt2) : Perce*tion of
a fa$ily to a *ro7le$
Community
12 %ature of the Pro)lem (1pt2)
(Pro)lem presented)
Health Status (4pts2):
increa)e ca)e) of
$ortality and $or7idity
Health +esource
(3pts2):
a7)ence4lac6ing of
$aterial) and $oney
Health +elated (1pt2)
32 Modi>a)ility of the Pro)lem
(5pts2) : 'radication; control
and redirection
42 Preventive Potential (1 pt) :
,ini$i&e
52 Ma,nitude (4 pts2) : )e#erity
of the condition 2igure4 nu$7er3
62 Social Concern (1pt2) :
Perce*tion of entire
*o*ulation4co$$unit
Shetland (PH%) : Pro*o)ed guiding
*hilo)o*hy in Pu7lic Health Nur)e
*oal of PH% : =o increa)e the le#el of
health of the *eo*le
#%# (PH%) : Practice *ro$ote) and
*re)er#e the health of the *o*ulation
7y integrating the )6ill) and 6no-ledge
of nur)ing and *u7lic health
Health (<HO) : )tate of co$*lete
*hy)ical; $ental and )ocial -ell 7eing
and not $erely the a7)ence of di)ea)e
21%7K3
- State of enough *hy)ical;
$ental; )ocial -ell 7eing of an
indi#idual to *artici*ate acti#ely
and *roducti#ely in the )ocial
and econo$ic life of the
co$$unity in -hich he4)he
li#e)? 21%7H3
Ma?or Concepts of Health
- O*ti$u$ Le#el of 8unctioning
2*ertain) to client3
$ndividual : Sic6 or Eell 2*oint
of entry3
&amily : ( or $ore indi#idual)
that are 7inded 7y $arriage;
7lood and ada*tation
Purpose:
1? =o )er#e the *ur*o)e of
reproduction
(? =he *roce)) of socialization
Concept:
1? +a)ic unit of )ociety
(? +a)ic unit of )er#ice
:? +a)ic unit of care : 7e)t
*roup : diAerent *eo*le -ith
the )a$e intere)t
Community: co$*o)e of
diAerent grou* of *eo*le -ith
the )a$e *ractice); culture;
7elief) and tradition) (primary
client)
Characteristics of Healthy
Community:
1? .t ha) a leader -ho -or6) -ith
the *eo*le 2i$*ortant
colla7oration3
(? .t i) co$*o)ed of ain grou* and
a )u7grou* 2 infor$ and
*artici*ate3
:? .f there i) conCict) ; di)*ute) in
the co$$unity; it )hould 7e
)ettled in a legal -ay
D? Re)ource) )hould 7e $ade
a#aila7le to all in the
co$$unity and it )hould
con)er#e in future u)e
D B P a g e
K? Peo*leM) a-arene)) that they
are a co$$unity
? .t ha) a territorial 7oundary
OLO8 5 aAected 'CO )y)te$
2SH'+HP3
Socioecono$ic
Hereditary
"n#iron$ental 2$an-$ade
*ollution3
Beha#ioral 2life)tyle related
di)ea)e)4 Non CD3
Health Care Deli#ery Sy)te$
Politic)
Common: Ma?or %on@
Communica)le diseases
2+eha#ioral3
12 Cancer
32 Chronic O7)tructi#e Pul$onary
Di)ea)e2COPD3
42 Cardio#a)cular Di)ea)e 2CJD3
52 Dia7ete) ,ellitu) 2D,3
@)ual Ri)6 8actor):
12 O)esity
,ale - :K inche)
8e$ale 5 :1?K inche)
Lg4$( : +,.
Pound): (?( l7)4 1 6g
%ormal: 1H?K 5 ((?%
9nder-ei,ht: under 1H?K
Over-ei,ht: (:
O)ese 1: (:?1 5 (D?%
O)ese 3 : (K 5 (%?%
32 Ci,arette Smo.ers
1 cigarette5 7 $in)?
42 Physical in activity
52 Poor ve,eta)le and &ruits
inta.e
Jegeta7le): (-: )er#ing)4day
1 )er#ing 5 1 cu* ra- #eg) and O
cu* coo6ed #eg)
8ruit): ( )er#ing)4day 2$orning and
afternoon3
62 &amily -ith a history of HP%
1(!4H! ( reading in 1 -ee6
Pre HP% : )y)tole 1(!-1(!
Dia)tole H!-H%
HP% Sta,e 1 : )y)tole 1:!-1D!
dia)tole %!-%%
HP% Sta,e 3 : )y)tole 1D!-1K%
dia)tole 1!!
HP% crisis : )y)tole P1!
Dia)tole P1!!
72 &amily -ith a history of DM
&BS: 7!-11! $g4dl
HB#1C : D-Q 2accurate3
*oal of Primary Health Care
- Health 8or all
- Self reliance
,i))ion of PHC: Peo*le -ill $anage the
health care
- =o )trengthen the health care
)y)te$ 7y increa)ing
o**ortunitie) and )u**orting
the condition) -herein *eo*le
-ill $anage their o-n health
care
/-o level of Primary Health Care
<or.er
1? .nter$ediate Le#el Health
Eor6er)
(? +arangay Health -or6er 4
"ra))root4trained 7irth
attendant)
Principles of Primary Health Care
12 5#AS
Acce))i7ility
A#aila7ility
AAorda7ility
Acce*ta7ility
A**ro*riatene)) of
Health Ser#ice)
(? Community Participation : it
i) the center4heart4core4 )oul of
PHC
42 People are the centerB
o)?ect and su)?ect of
development
D? Self reliance (3
nd
)est
choice)
62 Partnership )et-een the
community and the health
a,encies in the provision of
(uality of life
72 +eco,nition of
interrelationship )et-een
the health and client
82 Social Mo)ilization
02 Decentralization
Barriers of Community
$nvolvement
1? Lac6 of $oti#ation
K B P a g e
(? Attitude of the *eo*le
:? Re)i)tance to change
D? De*endence on the *art of
co$$unity *eo*le
K? Lac6 of $anagerial )6ill)
"lements of Primary Health Care
"ducation for Health
!ocally 'nde$ic Di)ea)e Control
"9*anded Progra$ on .$$uni&ation
Maternal and Child and 8a$ily
Planning
"n#iron$ental Sanitation and
Pro$otion of Safe Eater Su**ly
%utrition and *ro$otion of ade>uate
food )u**ly
/reat$ent of Co$$unica7le Di)ea)e)
and Co$$on .llne))
Su**ly of '))ential Drug)
&ield Health Service $nformation
System (&HS$S)
- =o *ro#ide the 7a)ic )er#ice
data needed to $onitor
acti#itie) in each *rogra$) and
ha) D co$*o)ition
Composition of &ield Health
Service $nformation System
(&HS$S)
&amily treatment +ecord
- 8unda$ental 7uilding 7loc6 :
Health Care Sy)te$ Record
/ar,et : Client !ist
- (
nd
7uilding 7loc6 : )er#ice and
data7a)e
+eportin,: /ally forms
- Data routinely tran)$itted fro$
one to another facility
Output +eports
- '#aluation and outco$e
DOH Pro,rams
/SeC (/amaB SapatB ".s.lusi)o)
- +rea)tfeeding
- Sign of "ood Attach$ent
- A6a Sto*; =i$ely; Ade>uate;
Pro*erly 8ed 2S=AP3
- Attain the <r)t ,D" : 'radicate
*o#erty and hunger
- Reduce 7y half of (!1K
- Pre#alence of under-eight 5 for
age a$ong under K year)
- Percent of hou)ehold) -ith
inade>uate energy
/o tha- mil.
=ha- )lo-ly in the refrigerator
2thi) ta6e) a7out 1( hour)3 try
*utting it in the fridge the night
7efore you need it
Do not refree&e
/o -arm mil.
Heat -ater in a cu* or other
)$all container; then *lace
fro&en $il6 in the -ater to
-ar$ or
@)e a 7ottler -ar$er
Ne#er $icro-a#e hu$an $il6
or heat it directly on the )to#e
Do not )ha6e R
=he crea$ -ill ri)e to the to* of
the $il6 during )torage
.f 7a7y doe) not <ni)h $il6 at
one feeding; it i) *ro7a7ly )afe
!#<S
+#87DD E Roo$ing in and
+rea)tfeeding Act
+#1DD30 E An Act Pro#iding
.ncenti#e) to all "o#ern$ent and
Pri#ate Health .n)titution) -ith
Roo$ing in and +rea)tfeeding
Practice) and for other *ur*o)e)
"O 61 s2 1F07@ National code of
$ar6eting of 7rea)t $il6 )u7)titute
and *roduce 2,il6 Code3
#O 3DD6@DD15 E .nfant and Soung
Child 8eeding
#O 3DD7@DD13@ =he $il6 code
#O 3DD8@DD37 E ,other-+a7y 8riendly
Ho)*ital .nitiati#e
#O 3DD0@DD3F E ,other-+a7y 8riendly
Ho)*ital
#O 3DDF@DD36 E '))ential Ne-7orn
Care
#O 3D1D@DD1D E ,icronutrient
Su**le$entation
PP 7 E @ni#er)al La- on .$$uni&ation
PP 57 E Polio 'radication Progra$
#O 353 E .nclude He*a + a)
.$$uni&ation Di)ea)e
#D 74@# E He*a + i) included in
Penta#elant #accine
PD FF7 5 Co$*ul)ary i$$uni&ation of
children TH year) old and infant) T1
year again)t i$$uni&a7le di)ea)e)
B P a g e
5 CO+" S/"P O& "%C
.$$ediate and thorough drying
2-ithin :! )econd) U ( 7lan6et)3
'arly )6in to )6in contact
Pro*erly ti$ed cord cla$*ing
7et-een 1 5 : $inute)
2*ul)ation ha) cea)ed or )to*3
Non )e*aration of the Ne-7orn
-ith $other for early initiation
of 7rea)tfeeding 2%! $in)? Of
life3
'arly Cue) 2+83
Stirring
,outh O*ening
=urning head
Suc6ing4Rooting
,id Cue)
Stretching
.ncrea)e *hy)ical $o#e$ent
Head to $outh
Late Cue)
Agitated 7odily $o#e$ent
Color red
Crying
Maternal Health Pro,ram
- #,e : 1K-D% year) old
- ==; .ron 8olate; Jita$in A
Maternal $mmunization a,ainst
/etanus
All -o$en gi#ing 7irth and their
Ne-7orn +a7ie) )hould 7e
*rotected again)t tetanu)
Ad$ini)ter if the -o$an ha)
not *re#iou)ly 7een #accinated
or if her i$$uni&ation )tatu) i)
un6no-n
Child Protected at +irth 2 CPA+ 3
"i#e t-o do)e) of ==4 =d
one $onth a*art 7efore
deli#ery and further
do)e) 2H!Q *rotection
7oth $other and 7a7y U
: year) 5 $other3
.f the -o$en ha) had 1-
D do)e) of == in the
*a)t; gi#e one do)e of
==4=d 7efore gi#ing 7irth
8., 28ully .$$uni&ed ,other3 :
K== 2co$*o)ed of ( )tandard
do)e) 7efore gi#ing 7irth and :
7oo)ter do)e)3
==
1
At <r)t
contact4 a)
early a)
*o))i7le in
*regnancy

none
,other
== At lea)t D 1-: ,other47a
( -ee6) after
==1
year)
old
7y
==
:
At lea)t
$onth)
after ==( or
during
)u7)e>uent
*regnancy
At
lea)t
K
year)
,other47a
7y
==
D
At lea)t 1
year after
==: or
during
)u7)e>uent
*regnancy
At
lea)t
1!
year)
,other47a
7y
==
K
At lea)t 1
year after
==D or
during
)u7)e>uent
*regancy
,4+ :
*rotected
all
)ucceed
*regnancy
*DOSA"'-S.='-RO@='
Age at
la)t
#accinati
on
Pre#iou)
i$$uni&ati
on 7a)ed
on record
At
*re)en
t
contac
t4
*regn
ancy
Later
2at
inter#
al of
at
lea)t 1
year3
.nfancy : D=P
(
do)ed
of ==
of D
-ee6)
inter#
al 7et?
do)e)
1
do)e
of
==4td
Childhoo
d
D D=P 1
do)e
of
==4=d
1 do)e
of
==4td
School
Age
: D=P F 1
D=4 =d
1
do)e
of
==4=d
1 do)e
of
==4td
School
Age
DD=P F 1
D=4=d
1
do)e
of
==4=d
none
Adole)ce
nt
D D=P F
1D=4=d at
D- year)
old F=d4==
at 1D-1
year) old

none

none
8or the -o$en to 7e *rotected
during *regnancy; the la)t do)e
of == $u)t 7e gi#en at least 3
-ee.s *rior to deli#ery
Record the do)e) gi#en on a
)tandard == i$$uni&ation
*Note that tetanu) antito9in )hould
ha#e a )6in te)t <r)t 7efore
ad$ini)tering unli6e =etanu) =o9oid
you can ad$ini)ter it -ithout the )6in
te)t
7 B P a g e
Ca)e of neonatal tetanu) 2identi<ed3
"i#e 1 do)e ASAP to the $other
=reat the 7a7y
"i#e a )econd do)e
=hird do)e
4 Delays Model
&actors #Gectin, 9tilization and
Outcome
&actors
#Gectin,
9tilization and
Outcome
Phases of Delay
Socio 'cono$ic4
Cultural 8actor)
Acce))i7ility of
8acilitie)
Vualitie) of Care
Pha)e 1 U Deci)ion)
to )ee6 care
2to-ard) the
*atient3
Acce))i7ility of
8acilitie)
Pha)e ( :
.dentifying and
Reaching ,edical
8acility
2=ran)*ortation and
Co$$unication3
Vualitie) of care Pha)e : : Recei*t
of Ade>uate and
a**ro*riate
treat$ent 2Attitude
of Health Care
=ea$3
Maternal Care: /he Paradi,m Shift
+is. #pproach 5 identi<e) high ri)6
*regnancie) for referral during the
*renatal *eriod
"mO%C ("mer,ency O)stretical
Care) : Con)ider all *regnant at ri)6 of
co$*lication
/-o types of "mO%C
B"mO%C 52+a)ic '$ergency
O7)tretical Care3
C"mO%C 5 2Co$*rehen)i#e
'$ergency O7)tretical Care 3
B"mO%C Services
Ad$ini)tration of *arenteral
anti7iotic 2initial loading do)e
only : no )ucceeding do)e)3
Ad$ini)tration of *arenteral
o9ytocin drug) 2for acti#e
$anage$ent of the :
rd
)tage of
la7or only3
Ad$ni)tration of *arenteral
anticon#ul)ant) for
ecla$*)ia4*re-ecla$*)ia
2initial loading do)e only3
DOC: ,gSOD 2)hort acting3
Dia&e*a$ 2fa)t acting3
Do not gi#e if the RR i)
decrea)e?
Perfor$ance of $anual re$o#al
of *lacenta
Perfor$ance of re$o#al of
retained *roduct) of conce*tion
Perfor$ance of i$$inent
7reech deli#ery
Ad$ini)tration of
Cortico)teroid) in *reter$ la7or
Perfor$ance of '))ential
Ne-7orn Care
B"mO%C /eam 2Co$*o)ition of
.tinerant =ea$3
1 doctor 2 general
*ractitioner4)urgeon3
( nur)e) 21 nur)e4$id-ife3
C"mO%C Services
All of the +'$ONC function
Ca*a7ility of 7lood tran)fu)ion
Ca*a7ility of Cae)arean Section
C"mO%C /eam
: doctor) *refera7ly O+-"yne
)*eciali)t or "eneral
Practitioner trained in C'$ONC
21 *er )hift3
1 ane)the)iologi)t or "P trained
in anae)the)iology 2on call 3
1 Pediatrician
: OR nur)e 21 *er )hift3
,aternity -ard nur)e) 2( *er
)hift3
: ,edical =echnologi)t) 21 *er
)hift3
#ntenatal +e,istration
Prenat
al
isits
Period of
Pre,nancy
1
)t
#i)it A) early in
*regnancy a)
*o))i7le 7efore
D $onth) or
during the <r)t
tri$e)ter
Once >
$onth
(
nd
#i)it During the (
nd

tri$e)ter
Once >
$onth
:
rd
#i)it During the :
rd

tri$e)ter
7
$onth)
: once
>
$onth
H
$onth)
: > (
-ee6)
> (
-ee6)
After H $onth)
of *regnancy
till deli#ery
> -ee6
H B P a g e
Post natal visit
&re(uenc
y
Home
visit
Clinic
visit
1
)t
Eithin (D
hour)
Eithin 1
-ee6
2ideally :-
K day)3
(
nd
Eithin 1
-ee6
-ee6)
Post natal visit
&re(uency Home
visit
Clinic
visit
1
)t
Eithin in
(D hour)
Eithin 1
-ee6
(
nd
Eithin 1
-ee6
( -ee6)
:
rd
D -ee6)
D
th
-ee6)
,aternal Child Health Care
$ntestinal Parasite (5
th
@6
th
month): Me)endazole
6DDm, ta)let sin,le dose
Anyti$e fro$ D-%
$onth) of *regnancy
if none -a) gi#en in
the *a)t $onth)?
Do not gi#e
$e7enda&ole in the
1
)t
1-: $onth) of
*regnancy? =hi)
$ight cau)e
congenital *ro7le$)
in 7a7y?
Malaria (5
th
@6
th
month) :
SulfadoHin:6DDm, :
Pyrimethamine:36m,
"i#e )ulfado9in-
Pyri$etha$ine to
-o$en fro$ $alaria
ende$ic area) -ho
are in 1
)t
or (
nd

*regnancy;
K!!$g4(K$g ta7; :
ta7) at the 7eginning
of (
nd
to :
rd
tri$e)ter
#nemia (any month)
T11$g4dl 5 1
)t
and :
rd
T1!?K$g4dl 5 (
nd

8or$: =a7let 2enteric coated3
"lemental $ron &olate : 7Dm,: 5DD
mc,
itamin #
Pre@ natal Post natal
1!; !!! .@ (!!;!!! .@
D $onth until 7irth Eithin D -ee6)
1 ta74t-ice a -ee6 Single do)e
'#ery =hur)day 2con)ultation
$aternal3: *ag $ay /night 7lindne))0 ;
gi#e na anyti$e; ; inter#al (-: day)
after 1
)t
do)e
,icronutrient Su**le$entationI Eag
ng $ag7igay
$ron &olate 2enteric coated3
,eta7olic A7)or*tion Site
Dude .)
Duodenum E $ron
Wu)t 8eeling
=e?unum E &olate
.ll; +ro
$leumB B13
I1 ta): once a day for 10D days
2around $onth)4(
nd
tri$e)ter3
*Pre#ent Neural tu7e defect)
*+e)t ti$e to gi#e folateI 1
)t
tri$e)ter
*Safe)t do)eI H!! $cg
*On the la)t $onth of *regnancy; gi#e
( ta74day
itamin #
$nfant Children
1!! L .@ (!!L .@
Single do)e '#ery $onth)
( gtt) "i#e all
-11 $onth)
.f T $onth) K!L
.@ 2 1dro* 3
Pentavalent accine introduction
(6 in 1)
He*a +;
Di*hteria;Pertu))i);
=etanu); Hae$o*hilu)
.nCuen&ae =y*e +
!?K $l; right
deltoid4#a)tu)
laterali)4u**er
thigh4outer thigh
-ee6)41! -ee6)41D
-ee6)
Contraindicated for
*er)on) 6no-n to ha#e
e9*erienced a )e#ere
allergic reaction
2ana*hyla9i)3 follo-ing a
*rior data
% B P a g e
He*a + : !--1!-1D
All -ee6)-11 $onth
old infant)
&ully $mmunized Child (&$C): 7efore
1 year old
Completely $mmunized Child (C$C):
After 1 year old
*eneral Principles on accine
#dministration
1? ,ini$u$ inter#al for #accine
ad$ini)tration i) D -ee6)
(? .t i) )afe to ad$ini)ter all
#accine) on the )a$e day u)ing
diAerent route and )ite of
ad$ini)tration
:? Regardle)); -hen -a) the la)t
inter#al gi#en; gi#e the ne9t
do)e a) the )ucceeding do)e
D? :H?K increa)e : do not gi#e the
#accine : :H?K
decrea)e: gi#e the #accine
K? Child ha) diarrhea; cold and
$alnouri)hed: gi#e the #accineR
&alse Contraindication: $ndication
:H?K 7elo-
Nau)ea4#o$iting
,alnouri)hed
Chro$o)o$al
A)y$*to$atic )ign of H.J
8a$ily hi)tory of Sei&ure
Contraindication
Sy$*to$atic 2H.J4He*a +3
Pregnant $other) 2li#e
attenuated #accine3
OPJ; +C"; ,,R : Do not gi#e to
tho)e i$$uno)u**re))ed4
.$$unoco$*ro$i)ed
Iuse 1 syrin,e:vaccine
IMana,e >rst the sic.: illness and
then ,o )ac.
BC* (Bacille Calmette@*uerin)
!?!K $l; right deltoid4 right
u**er ar$; .D; anyti$e after
7irth 2note: 6ahit )aang )ite
7a)ta $ay 7alat3
+oo)ter do)e: gi#en u*on
)chool; !?1 $l; Left deltoid
Loo6 li6e: end of an
un)har*ened *encil : S$ooth;
)hiny; glo))y
K$ in dia$eter
%ursin, +esponsi)ility:
Do not a**ly alcohol on
the inNection )ite
Do not touch the )car4
Do not a**y any
oint$ent
Local i)onia&id *o-der :
$edication for +C" )car
%ote: no to )u7cutaneou) and
dee* : .nci)ion and drainage for
+C"
Hepatitis B
!?K $l; Right outer a)*ect of
thigh; .,; i$$ediately right
after 7irth; gi#en : do)e) 2-1!-
1D342!--1D3; on *enta#alent;
gi#en D do)e) 2 !--1!-1D3
/*la)$a deri#ed #accine0 RNA
reco$7inant-t; )eru$ 7a)ed
#accine
Do not $a))ageR Alternate
-ar$ and cold co$*re))
DiptheriaB PertussisB /etanus
(DP/)
Di*theria 5 -ea6ened to9in
Pertu))i) 5 6illed 7acteria
=etanu) 5 -ea6ened
to9in4to9oid 2no need for )6in
te)ting3
!?K $l; Left outer a)*ect of the
#a)tu) laterali); .,; gi#en :
do)e) 2 -1!-1D3
Do not $a))ageR
'9*ect -ithin (D hour) that ha)
fe#er 7ut not con#ul)ion) 2 gi#e
*araceta$ol3
.f con#ul)ion e9i)t; -e do not
gi#e *ertu))i) in)tead D= only
Pertu))i) i) a -hole cell; it
tra#el) into CNS
=he DP= i) only gi#en 7elo-
year) old; if the child i) year)
old a7o#e -e gi#e only D=
Oral Polio accine (OP)
Li#e attenuated Jiru)
( gtt); )ide of the $outh; PO;
gi#en : do)e) 2 -1!-1D3
NPO for :! $inute);2a7)or*tion
ti$e of the #accine3
.f #o$it); gi#e another ( gtt)
again; and if #o$it) again; do
not gi#e?
No o#erdo)age of OPJ
S-eet-)our-7itter ta)te
D
th
do)e : 1H -ee6 U if the child
ha) a diarrhea on the )chedule
of OPJ #accination
#nti Measles accine (#M)
Li#e attenuated #iru)
!?K $l; Right outer *art of the
u**er ar$; )u7cutaneou);
gi#en % $onth)
1! B P a g e
,ea)le) ra)he) after :-K day)
a)ter ad$ini)tration i) nor$al
A)*irate 7efore ad$ini)ter 2-
11 $onth) hindi *a fully
de#elo*ed ang )u7cutaneou);
tendency you $ight hit the
ner#e3
A,J F JAC 1!!6 .@
Pro*hylactic agent) *-ede
)iyang i7igay *ag out7rea6 ng
$ea)le)
@ntil K year) old
!east Sensitive to heat ()ody
refri,erator)
=e$*erature : ( 5 H C
+C"; DP=; He*a +
Chiller 5 +C"
Most Sensitive to heat (&reezer)
=e$*erature : -1K - -(K C
MOS/ : ,ea)le); Oral *olio
Sen)iti#e =alaga
<hat is the safe stora,e of all
vaccinesJ (D @0 C)

11 B P a g e