MARIST BROTHERS

NOTRE DAME OF KIDAPAWAN COLLEGE

KIDAPAWAN CITY
COLLEGE OF NURSING

DIFFERENT PROGRAMS ON MATERNAL

AND CHILD HEALTH

In Partial Fulfillment of the

Requirements in CA1

Submitted To:
Ms. Gay R. Sandique, RN, MN
Dean of Nursing

Submitted By:
Maureen Louise L. Ramirez
BSN-4

October 7, 2014

DIFFERENT PROGRAMS ON MATERNAL AND CHILD HEALTH

The Maternal Health Program is a set of actions and services administered by

the Department of Health to aid women before, during and after pregnancy. The
Philippines is tasked to reduce the maternal mortality ratio (MMR) by three quarters by
2015 to achieve its millennium development goal.
The Strategic Thrust for 2005-2010
Basic Emergency Obstetric Care (BEMOC)
Launch and implement the Basic Emergency Obstetric Care or BEMOC strategy
in coordination with the DOH. The BEMOC strategy entails the establishment of
facilities that provide emergency obstetric care for every 125, 000 population and which
are located strategically. The strategy calls for families and communities to plan for
childbirth and the upgrading of technical capabilities of local health providers.
Improve the quality of Prenatal and Postnatal Care
Pregnant women should have at least four prenatal visits with time for adequate
evaluation and management of diseases and conditions that may put the pregnancy at
risk. Postpartum care should extend to more women after childbirth, after a miscarriage
or after an unsafe abortion.
Reduce womens exposure to health risks
Through the institutionalization of responsible parenthood and provision of
appropriate health care package to all women of reproductive age especially those who
are:

less than 18 years old and over 35 years of age,

women with low educational and financial resources,

women with unmanaged chronic illness and

women who had just given birth in the last 18 months.

Appropriate Allocation of Resources

LGUs, NGOs and other stakeholders must advocate for health through resource
generation and allocation for health services to be provided and are in place in the
health system.
To address the problem, packages of health services are provided to the clients. These
essential health care packages are available and are in place in the health system.
Essential Health Service Package Available in the Health Care Facilities
These are the packages of services that every woman has to receive before and
after pregnancy and or delivery of a baby.
Clean and Safe Delivery

The presence of a skilled birth attendance will ensure hygiene during labor and
delivery. It may also provide safe and non traumatic care, recognize complications and
also manage and refer the women to a higher level of care when necessary. The
necessary steps to follow during labor, childbirth and immediate postpartum include the
following:
Do a quick check upon admission for emergency signs:

Unconscious/convulsion

Vaginal bleeding

Severe abdominal pain

Looks very ill

Severe headache with visual disturbance

Severe breathing difficulty

Fever

Severe vomiting
Make woman comfortable
Establish rapport with the client by greeting and interviewing to make her
comfortable.
Assess the woman in labor
Assessing the client is a reference guide for a health worker to determine its
status during labor stage. This can be done by taking the history of the ff:

Last menstrual period (LMP)

Number of pregnancy

Start of labor pains

Age/height

Danger signs of pregnancy

Taking the history through interview will help determine the clients condition during
delivery of a baby.
Determine the stage of labor
Labor can be determined when womans response to contraction is observed
pushing down and vulva is bulging, with leaking amniotic fluid, and vaginal bleeding. A
vaginal examination can be performed to determine the degree of contraction.
Decide if the woman can safely deliver
By assessing the condition of the client and not finding any indication that could
harm the delivery of a baby, a trained health worker can decide a safe delivery of a
mother.
Give supportive care throughout labor
There are many things that a woman needs to do during labor. This will help her deliver
clean, safe and free from fatigue. These are:

Encourage to take a bath at the onset of labor

Encourage to drink but not to eat as this may interfere surgery in case needed.
Encourage to empty bladder and bowels to facilitate delivery of the baby. Remind
to empty bladder every 2 hours
Encourage to do breathing technique to help energy in pushing baby out the
vagina. Panting can be done by breathing with open mouth with 2 short breaths
followed by long breath. This prevent pushing at the end of the first stage.

Others

Monitor closely within one hour after delivery and give supportive care

Continue care after one hour postpartum. Keep watch closely for at least 2 hours.

Educate and counsel on FP and provide FP method if available and decision was
made by a woman.

Birth registration

Importance of BF

Newborn Screening for babies delivered in RHU or at home within 48 hours up to

2 weeks after birth
Schedule when to return for consultation for postpartum partum visits

Integrated Maternal, Neonatal, and Child Health and Nutrition Strategy

The health of mothers and children were placed at the center of health sector
reform, consistent with the advocacy that all women have the right to safe and quality
emergency obstetric services (EmOC) to prevent maternal and newborn deaths, and
achieve the MDG target to cut maternal and child deaths by 2015.With pregnancy and
childbirth posing serious risks to Filipino mothers and their newborn, the country
recognizes the need to accelerate the reduction in maternal and child mortality. In
response to this need, the Department of Health (DOH) has initiated key health reforms
for the rapid reduction of maternal and neonatal mortality through the DOH
Administrative Order (AO) No. 2008-0029 on Implementing Health Reforms for Rapid
Reduction of Maternal and Neonatal Mortality.17 This mandates the implementation of
an Integrated Maternal, Neonatal and Child Health and Nutrition Strategy within the
framework of the F1. It adopts a unified strategic framework for maternal and newborn
health that is linked with child survival strategies, maximizing the delivery of service
packages, and ensuring a continuum of care across the life cycle stages. Under this

strategy, all pregnancies are considered at-risk. Likewise, it takes into consideration the
three major pillars in reducing maternal mortality and morbidity, namely, emergency
obstetric care, skilled birth attendants and family planning.AO 2008-0029, issued on
September 9, 2008, outlines specific actions for national and local health systems to
systematically address health risks with the end goal of rapidly reducing maternal and
neonatal deaths. It states that the strategy shall guide the development,
implementation, and evaluation of various programs aimed at women, mothers and
children, with the ultimate goal of rapidly reducing maternal and neonatal mortality in the
country.18 It aims to address service delivery, regulation, financing, and governance of
the Philippines health system. The integrated MNCHN strategy, implemented in all
provinces and cities, is aimed to meet the following reproductive health (RH) indicators
by 2010:- increase CPR to 60 percent; - increase the proportion of pregnant women
having at least four antenatal care visits to 80 percent;- increase skilled birth attendance
and facility-based births to 80 percent; and increase percentage of fully-immunized
children to 95 percent.
On September 18, 2009 the Philippines Department of Health (DOH) announced that
the three United Nations (UN) agencies - UNFPA, UNICEF, and WHO - have joined
forces and resources to undertake a joint program on rapidly reducing maternal and
neonatal deaths in the country and meet the MDGs. The new project, with the support
of the Australian Agency for International Development (AusAID) is divided into two
significant phases: the Transition period (2009-2011), which will cover the provinces of
Eastern Samar, Ifugao, Lanao del Sur, Maguindanao, North Cotabato, and Saranggani,
and the urban poor areas in Tacloban, General Santos, Taguig, Navotas, Paraaque
and Makati; and the Full Operationalization Period covering the years 2011-2016.19
On December 7, 2009, the DOH released a new Administrative Order on the subject
Adopting New Policies and Protocol on Essential Newborn Care (ENC), which details
specific policies and principles to follow for all health care providers involved in newborn
health care.20 Consistent with AO 2008-0029, the newly-released AO will provide key
behaviors and appropriately-timed interventions to make the post-natal period for
newborns safer. It is also seen to help pave the way for a globally accepted, and
evidence-based essential newborn care health system.
Womens Health and Safe Motherhood Project
As a measure to accelerate efforts on MMR reduction, the Philippine government
has adopted Womens Health and Safe Motherhood as its flagship program under the
sector-wide F1 for Health with the help of other stakeholders such as the World Bank,
ADB, EU/GTZ, JICA, USAID, WHO, UNICEF, and UNFPA. The Second Womens
Health and Safe Motherhood Project (WHSMP2) will contribute to the national goal of
improving womens health by: Demonstrating in selected sites a sustainable, cost-

effective model of delivering health services that increases access of disadvantaged

women to acceptable and high quality reproductive health services and enables them to
safely attain their desired spacing and number of children. The main objectives of the
WHSMP2 in the Philippines are the following:
1. To increase the access of disadvantaged women of reproductive age to acceptable,
high quality, and cost-effective reproductive health services and enable them to safely
attain their desired spacing and number of children; and
2. To assist in the development and implementation of sustainable and replicable
systems within the framework of the Health Sector Reform Agenda for financing and
delivery of reproductive health services.
Family planning
A national mandated priority public health program to attain the countrys national
health development: a health intervention program and an important tool for the
improvement of the health and welfare of mothers, children, and other members of the
family. It also provides information and services for the couples of reproductive age to
plan their family according to their beliefs and circumstances through legally and
medically acceptable family planning (FP) methods.
Philippine National Strategic Framework for Plan Development for Children, 20002025 (Child 21)
The health sectors contribution to the Philippine National Development Plan for
Children defines the vision for children by 2025, formulates cost-effective interventions,
and outlines a budget that will reflect contributions of different national and local
government units, the private sector, NGOs, and international organizations. It serves
as a framework for local government units (LGUs) in the formulation of their
development plans. Childrens Health 2025, a subdocument of Child 21, realizes that
health is a critical and fundamental element in childrens welfare.
The vision of Child 21 has been concretized through the formulation of the National Plan
of Action for Children for the period 2005-2010, aimed at reducing disparities in
development indicators for children. Subsequently, there will be a National Plan of
Action 2011-2015 (Catching up with the Millennium Development Goals); a National
Plan of Action 2016-2020 (Sustaining the gains); and a National Plan of Action 20212025 (Achieving the Child 21 vision).
Early Childhood Care and Development Program
Republic Act 8980, known as the Early Childhood Care and Development
(ECCD) Act of 2000, defines the ECCD System as the full range of health, nutrition,

early education, and social services programs that provide for the basic holistic needs of
young children from birth to age six (6), to promote their optimum growth and
development. It encourages the active involvement of parents and communities. The
implementation of this system shall be the responsibility of the national government,
LGUs, NGOs, and private organizations. The rearing of a child is a traditional role of
mothers. With the enactment and implementation of this law, raising a child is no longer
solely the responsibility of mothers. The community, the national and local governments,
and other institutions are now obliged to assist in providing for the basic holistic needs
of young children. ECCD programs include: child care programs; parent effectiveness
seminars; child minding centers; family day care services; parent-child development
programs; and kindergartens in public schools.
Promotion of Breastfeeding program / Mother and Baby Friendly Hospital
Initiative
Realizing optimal maternal and child health nutrition is the ultimate concern of the
Promotion of Breastfeeding Program. Thus, exclusive breastfeeding in the first four to
six months after birth is encouraged as well as enforcement of legal mandates. The
Mother and Baby Friendly Hospital Initiative (MBFHI) is the main strategy to transform
all hospitals with maternity and newborn services into facilities which fully protect,
promote, and support breastfeeding and rooming-in practices. The legal mandate to this
initiative are the RA 7600 (The Rooming-In and Breastfeeding Act of 1992) and the
Executive Order 51 of 1986 (The Milk Code). National assistance in terms of financial
support for this strategy ended in 2000, thus LGUs were advocated to promote and
sustain this initiative. To sustain this initiative, the field health personnel has to provide
antenatal assistance and breastfeeding counseling to pregnant and lactating mothers as
well as to the breastfeeding support groups in the community; there should also be
continuous orientation and re-orientation/updates to newly hired and old personnel,
respectively, in support of this initiative.
Food Fortification program
The Food Fortification program is the governments response to the growing
micronutrient malnutrition, which have been prevalent in the Philippines for the past
several years. Food Fortification is the addition of Sangkap Pinoy or micronutrients such
as Vitamin A, Iron and/or Iodine to food, whether or not they are normally contained in
the food, for the purpose of preventing or correcting a demonstrated deficiency with one
or more nutrients in the population or specific population groups. Micronutrients are
vitamins and minerals required by the body in very small quantities. These are essential
in maintaining a strong, healthy, and active body; sharp mind; and for women to bear
healthy children.

Expanded Program on Immunization

Children who are not fully immunized are more susceptible to common childhood
diseases. The Expanded Program on Immunization is one of the DOH Programs that
has already been institutionalized and adopted by all LGUs in the region. Its objective is
to reduce infant mortality and morbidity through decreasing the prevalence of six
immunizable diseases (TB, diphtheria, pertussis, tetanus, polio and measles).