BHW Reference Manual

BARANGAY
HEALTH
WORKERS
Reference
Manual
Towards
Effective Service
Provision and
Improved Health
Outcomes
Department of Health
2015
BARANGAY HEALTH WORKERS Reference Manual
Towards Effective Service Provision and Improved Health Outcomes
January 2015
Published by the Health Human Resource Development Bureau (HHRDB), in cooperation with the Bureau of
Local Health Systems Development (BLHSD) Department of Health
San Lazaro Compound, Rizal Avenue, Sta. Cruz, Manila 1003 Philippines
Telephone +632 651-7800
Articles may not be reproduced in full or in part for any purpose without prior permission from the
aforementioned DOH offices.
ISBN No.
February 2015
Acknowledgment
The Department of Health-Health Human Resource Development Bureau (HHRDB) and the
Bureau of Local Health Systems Development (BLHSD) acknowledge the individuals, DOH
offices and other partners that have contributed to the development of the Barangay Health
Workers(BHW) Reference Manual and Pocket Handbook. We are very grateful to Dr.
Jennifer G. Coritico as the main author of this document. The BHW Reference Manual and
Pocket Handbook were put together through the efforts of a core team--without which
these documents would not materialize. The core team that spent countless hours
consolidating technical materials, coordinating with technical and support offices,
facilitating consultative meetings and pilot tests with BHWs, and facilitating administrative
and technical processes, are composed of: Ms. Marjorie Dungca, Dr. Maria Lourdes Gajitos,
Ms. Maria Olga Bulasa, Ms. Maria Teresa Santiago, Ms. Ma. Graziella Cardano, Ms. Dina
Sarne and Ms. Janice Feliciano. Contributing to the focus group discussions, manual and
handbook framework, editing and proofreading is Dr. Christine Joan Co. We also
acknowledge the efforts of Ms. Cristina Flor Marifosque for the design and layout for both
the BHW Reference Manual and Pocket Handbook.
We very much appreciate the assistances rendered by the following DOH offices: Disease
Prevention and Control Bureau, Health Emergency Management Bureau, and the Philippine
Institute for Traditional and Alternative Health Care, for contributing to the contents of this
document; and, DOH Regional Offices 1, 4-A and 9 for supporting the on-site consultative
FGDs with regional BHWs. Special thanks to the regional BHW Coordinators and BHWs who
were involved in the regional consultative meetings.
Sincere appreciation is being extended to Director Nestor Santiago of the BLHSD and
Director Kenneth Ronquillo of the HHRDB for their support.
Table of Contents
Guide to Use this Manual

Acronyms
Scope and Limitations
Introduction
I. DOH PROGRAMS IMPLEMENTATION IN THE COMMUNITY

A. Pre-pregnancy Healthcare
1. Family Planning
B. Maternal Health in Pregnancy

1. Pre-natal Care
2. Intrapartum Care
3. Postpartum Care
C. Newborn Health
1. Essential Intrapartum and Newborn Care
2. Newborn Screening
3. Breastfeeding
D. Neonate and Infant Health

1. Expanded Program on Immunization
2. Infant and Young Child Feeding Program
E. Child Health
1. Garantisadong Pambata (GP) Program
2. Integrated Management of Childhood Illnesses (IMCI)
3. Oral Health Program
F. Adolescent Health
1. Substance/Drug Abuse
2. Alcohol Abuse
3. STI-HIV
G. Healthcare for Adults
1. Communicable Diseases
a. Dengue
b. Filariasis
c. Hepatitis
d. Influenza
e. Leprosy
f. Leptospirosis
g. Malaria
h. Rabies
i. Schistosomiasis
j. Tuberculosis
k. Typhoid Fever
2. Non-Communicable Diseases
a. Breast Cancer
b. Cervical Cancer
c. Lung Cancer
d. Prostate Cancer
e. Chronic Obstructive Pulmonary Disease
f. Diabetes
g. Hypertension
H. Elderly
1. Vaccines for the Elderly
2. Senior Citizens on Health Related Goods and Services
II. SPECIAL HEALTH CONCERNS IN THE COMMUNITY
A. Environmental Health
1. Proper Waste Disposal
2. Provision of Safe Drinking Water
3. Construction and Use of Sanitary Toilets
4. Food Safety
B. Violence Against Women and Children
C. Disaster Risk Reduction and Management
III. FIRST AID TECHNIQUES FOR COMMON INJURIES AND ILLNESSES
A. Benign Febrile Convulsion

B. Shock
C. Loss of Consciousness
D. Drowning
E. Poisoning
F. Wounds
G. Bleeding
H. Suspected Fractures and Dislocations
I. Insect Bites and Stings
J. Snake Bites
K. Essential Contents of the First Aid Kit
IV. HERBAL MEDICINES
References
Guide to Use this Manual
DOH programs in this Manual are organized using the life-cycle approach. Each cycle
is discussed based on the latest DOH program guidelines. Some special topics are subsumed
under the life-cycle of the most vulnerable groups (e.g., Violence among Women of
Reproductive Age).
Using the latest IEC materials available in the community, the BHW will be oriented
on what to say (e.g., signs and symptoms, or mode of transmission for
infectious/communicable diseases).
The BHW is required to refer to the latest recording and reporting forms. This is
important when identifying danger signs or determining the DOH-recognized first aid
methods that they are allowed to perform.
Some DOH programs are not applicable to communities because the disease or
illness is uncommon; in such cases, it is no longer necessary to conduct comprehensive
discussions. However, it is still important for the BHWs to know what to say as part of their
role on prevention and control.
This manual also comes with a Handbook which can be readily referred to by the
BHWs. This manual contains brief descriptions of the programs and diseases. The
Handbook on the other hand, only contains information campaigns per program or disease.
However, it is highly encouraged that this manual be translated to the local dialect of
the community to facilitate ease of discussion among BHWs.
Acronyms
BCG Bacillus CalmetteGurin

BHW Barangay Health Worker
BNS Barangay Nutrition Scholar
BP Blood Pressure
BTL Bilateral Tubal Ligation
COPD Chronic Obstructive Pulmonary Disease
CPR Cardiopulmonary Resuscitation
DASH Dietary Approach to Stop Hypertension
DOH Department of Health
DPT Diptheria, Pertussis, Tetanus
DSWD Department of Social Welfare and Development
EDC Expected Date of Confinement
EINC Essential Intrapartum and Newborn Care
EPI Expanded Program on Immunization
FP Family Planning
GP Garantisadong Pambata Program
HBMR Home Based Maternal Record
HIV Human Immunodeficiency Virus
HPN Hypertension
IMCI Integrated Management of Childhood Illnesses
IUD Intra-uterine Device
IYCF Infant and Young Child Feeding Program
LAM Lactational Amenorrhea Method
LMP Last Menstrual Period
MMR Measles, Mumps, Rubella
NCD Non-Communicable Disease
NFP Natural Family Planning
NSV No-scalpel Vasectomy
NTP National Tuberculosis Program
OPV Oral Polio Vaccine
PEP Post-exposure prophylaxis
PHN Public Health Nurse
RHM Rural Health Midwife
SMS Short Message Service
STH Soil Transmitted Helminthiasis
STI Sexually Transmitted Infection
TB Tuberculosis
TT Tetanus Toxoid
Scope and Limitations
This BHW Reference Manual aims to guide barangay health workers (BHWs) in
promoting disease prevention and prompt referral of common cases in the community. It
focuses on their specific roles and responsibilities in their respective catchment households
while assisting their rural health midwives (RHMs) in providing basic and essential health
care services for all. It aims to guide the BHWs on what to say, what to do, and when to
refer using the latest Information, Education and Campaign (IEC) materials and
recording/reporting forms from the DOH that are already available in the community.
It does not aim to comprehensively discuss the various forms of DOH protocols,
along with its accompanying rules and regulations, diseases and illnesses, or treatment
modalities; nor does it require the creation of new records and reporting systems.
Introduction
Good health requires a balanced interplay of the physical, social and mental well-
being of any individual. Any imbalance will result to sickness, illness or disease. To establish
a wholistic mindset among BHWs, the current DOH programs were discussed using the life-
cycle approach, from womb to tomb (see Fig. 1), covering the physical aspects (e.g., signs
and symptoms of communicable and non-communicable diseases or proper nutrition); the
social aspects (e.g., community involvement in prevention and control); and, mental well-
being (e.g., lifestyle modification techniques).
Figure 1. Life-cycle approach: DOH programs per life-cycle.

Risks that cause diseases/illnesses may also result from internal and external causes
(see Fig. 2). Internal causes may include: inborn or acquired physical defect; decreased
resistance against infection secondary to malnutrition; and/or, family history of diseases
(e.g., diabetes or asthma). External causes, on the other hand, may include exposure to
airborne or flood-borne diseases; smoke and chemical exposure; and, air and water
pollution.
Other contributory factors include poor nutrition due to lack of knowledge or
ignorance, overcrowding, unhygienic practices, inadequate shelter, calamities and
environmental destruction which results to air and water pollution, and inadequate health
services provision (e.g., medicines, health facilities, services, and health personnel).
Figure 2. External and internal risk-associated factors that lead to disease formation.
BHWs need to understand the essential determinants of good health and their
significant roles and responsibilities in keeping a population healthy not only in providing
adequate information and education campaign to their respective communities, but also in
establishing an adequate referral system for prompt health service delivery.
SPECIFIC ROLES AND RESPONSIBILITIES OF A BHWi:
1. An advocate of current health programs, projects and activities to improve access

and use of health services;
2. An educator who will advise and counsel the community;
3. A disseminator to maintain regular communication between local professional
health workers and their catchment households;
4. A linker to facilitate access to or association of the community with relevant network
of health and non-health service providers within or outside their catchment areas;
and,
5. A record keeper to maintain updated lists/records of health data, health
activities/events in the community.
Overall, to attain good health, the following contributory factors should always be
considered by the BHW each time they conduct their household visits:
1. Proper nutrition
2. Proper sanitation
3. Good compliance to applicable DOH protocols among members of their HH
catchment area
4. Regular exercise
5. Enough rest/sleep
6. Healthy lifestyle by avoiding high risk behaviours such as smoking, multiple sex
partners, drug abuse and excessive alcohol intake
DOH
PROGRAMS
IMPLEMENTATION
IN THE
COMMUNITY
A. PRE-PREGNANCY HEALTHCARE
The pre-pregnancy phase of the life-cycle approach refers to women of reproductive

age (WRA) who are 15-49 yrs. old, single or married, and capable of becoming pregnant.
This section covers discussions on the different roles and responsibilities of BHWs in
promoting the Reproductive Health Programs of the DOH.
FAMILY PLANNING
Family planning (FP) is a reproductive right of all women.ii It refers to a program
which enables couples and individuals to decide freely and responsibly, and have access to a
full range of safe, affordable, effective, non-abortifacient, modern, natural and artificial
methods of planning pregnancy.iii
There are 2 methods by which family planning may be achieved:
Through adequate birth-spacing of at least 2-3 yrs., where couples can avail of the
short-acting methods (e.g., pills, Lactational Amenorrhea Method, LAM; Natural Family
Planning/NF methods; or use condoms); or,
Through birth limiting, where couples can avail of the long-term methods such as intra-
uterine device (IUD) insertion or permanent methods such as No-scalpel Vasectomy
(NSV) or Bilateral Tubal Ligation (BTL).
ROLE OF THE BHW:

Under the FP, adequately trained BHWs are expected to identify and record the
eligible population of their HH catchment areas who belong to WRA. They are not expected
to be able to comprehensively discuss the FP methods to the eligible population.
WHAT TO SAY:
What is the importance of FP?
FP prevents high-risk pregnancies among those younger than 18yrs old or older than 35
yrs old; those with 4 or more pregnancies; who have closely spaced pregnancies; or who
are currently ill.
FP allows the WRA to regain her strength after pregnancies and avoid prematurity and
malnutrition.
FP allows the couple to produce healthy children and avoid malnutrition.
FP allows the couple to send their children for better education and improved social
welfare.
o If the couple decides to space their children, they can avail of the short-acting
methods.
o On the other hand, if the couple decides to limit their number of children, they can
avail of the long-term or permanent methods such as IUD insertion or NSV.
o Comprehensive discussion on the different FP methods can be counselled by the
RHMs in the community.
WHAT TO DO:
1. Using the latest family profiling form for FP, the BHWs should have a masterlist/record of
the following within their designated HH catchment areas:
a. Name and age of the eligible client
b. Number of pregnancies, if any
c. FP method practiced, if any
d. FP method preferred, if any
2. For BHWs who already have FP acceptors within their catchment areas, they should do
the following:
a. Replenish supply of condoms and pills during follow-up visits, if necessary; and,
b. Identify and record complaints of the FP acceptor, if there is any, and refer to the
midwife, or inform the client of the BHS schedule for FP counselling.
B. MATERNAL HEALTH IN PREGNANCY
The pregnancy phase of the life-cycle approach covers discussions on the different
roles and responsibilities of BHWs in promoting the Maternal Health Program of the DOH.
Discussions on teenage pregnancies are also included in this section.
MATERNAL HEALTH
Maternal health services refer to a range of services that covers care during the
prenatal period, during childbirth or delivery and the postpartum period.
Teenage pregnancy is currently considered as one of the priority public health
concerns for maternal health due to its increasing trend. Along with it are the concomitant
risks of abortion due to unwanted pregnancy; maternal death; and, infection. The DOH is
currently encouraging the establishment of adolescent or teen health centers to cater to the
adolescent who would like to seek medical consult if there are signs and symptoms of
suspected pregnancy.
Consultations and counselling done in these centers are strictly confidential to ensure trust
and increased active participation, through prompt consultation among teenagers.
ROLE OF THE BHW:

Under the Maternal Health Program, adequately trained BHWs are expected to identify
and record the eligible population of their household catchment areas who belong to WRA, and
are pregnant.
Under the Adolescent Health Program of the DOH, adequately trained BHWs are
expected to identify and record the eligible population of their household catchment areas who
belong to the adolescent age group at highest risk for teenage pregnancy. They are not
expected to be able to comprehensively discuss all the essential elements of pre-natal check-
ups, childbirth or delivery, or the postpartum period to the eligible population. However, they
are expected to refer them to the nearest health facility.
PRE-NATAL CARE
WHAT TO SAY:
What is the importance of having a pre-natal check-up?
1. Prenatal check-ups are given to pregnant women to monitor the following:
a. Health of the mother and the baby, and detect any abnormality brought about
by pregnancy, such as high blood pressure, eclampsia or diabetes
b. Nutritional status of the mother because of its consequent effects on the baby
(e.g., Vitamin A deficiency)
c. Good nutrition is important during pregnancy and this can be achieved by eating
a balanced diet. A balanced diet refers to eating a variety of food from the 4
food groups namely:
Rice or its alternatives like corn and sweet potato, which provide energy,
fiber, vitamins and minerals
Fruits which are necessary for the normal functioning of the body through
adequate blood formation and building of body resistance
Vegetables which are good sources of vitamins, minerals and dietary fiber
Meat or its alternatives, which is necessary for the growth and repair of body
tissues, and used for the formation of the fetus organs
d. Growth, size and position of the baby in each trimester

e. Presence of infection to the mother, whether viral or bacterial which may greatly
affect the condition of the baby (e.g., Rubella)
2. Help women and couples (pregnant woman and her husband/male partner) prepare for
delivery and plan subsequent pregnancy
3. Health care services given during prenatal check-ups include:
a. Tetanus toxoid immunization to protect the baby against neonatal tetanus
Table 1. Tetanus Toxoid Immunization Schedule
VACCINE MINIMUM DURATION OF PROTECTION

AGE/INTERVAL
TT1 As early as Provides ptection for the mother

possible during for the first delivery
pregnancy
TT2 At least 4 weeks Provides 3 yrs protection for the

after 1st dose mother
TT3 At least 6 months Provides 5 yrs protection for the

after last dose mother
TT4 At least 1 year Provides 10 yrs protection for the

later after last mother
dose
TT5 At least 1 year Provides LIFETIME protection to

later after last both mother and child
dose
b. Micronutrient supplementation (e.g., ferrous sulphate with folic acid) once a day for
6 months to prevent nutritional disorders.
Iron is essential to prevent anemia in mothers which causes them to get tired
easily and look pale. Iron intake also helps to build the babys iron stored during
the first 6 months of life. It is found in liver, meat, fish, eggs and green leafy
vegetables.
Folic acid is needed for cell growth and reproduction. A deficiency in folic acid
also causes anemia in mothers. It is found in green leafy vegetables, eggs, nuts
and liver.
Calcium helps in the development of a babys bones and teeth. A pregnant
woman should consume 2-4 glasses of milk per day to meet their calcium
requirement.
Prenatal check-ups should be done at least once during the 1 st

and 2nd trimester,
and at least twice during the 3rd trimester.
4. Pregnant women should have a total weight gain of 11-15 kgs during the 2nd and 3rd
trimesters of pregnancy. If the woman is already overweight before pregnancy, she has
to gain only 6-9 kg more.
5. To prevent excessive weight gain, pregnant women must limit their intake of sweets
and sweetened drinks. They should also eat less fried food, and chocolate.
6. The adolescent should seek medical consult from the nearest adolescent or teen
health center if there are signs and symptoms of suspected pregnancy for proper
evaluation and management; these include:
Missed menstrual period
Signs of morning sickness (e.g. nausea and vomiting)
Swelling or soreness of breasts
7. A urine pregnancy test can be still be read as negative for up to 2 weeks after a missed
period, even if a woman is already pregnant. The pregnancy test should be repeated 2
weeks after the missed menstrual period.iii Once the test shows a positive result, the
BHW should refer the adolescent to the nearest health worker in the nearest
adolescent or teen health center available in the community.
8. Conversations held in adolescent or teen health centers are strictly confidential.
WHAT TO DO:
1. Using the latest family profiling and risk assessment form for Maternal Health, gather
the following data:
a. Name and age of the pregnant woman
b. Household number of pregnant mother
c. Number of pregnancies, if any and type of delivery (e.g., Normal or through
Caesarean Section)
d. Number of miscarriages, if any
e. Medical conditions, if any (e.g., Hypertension, Diabetes, Asthma)
f. Last Menstrual Period (LMP) and Expected Date of Confinement (EDC)
g. Preferred health facility for delivery, if any, and number of pre-natal check-ups
made for the current pregnancy
2. If properly trained, assist the couple or pregnant mother to develop a birth plan (that
includes transportation, companion during time of delivery, name of health or DOH-
accredited birthing facility, estimate of necessary expenses, materials needed at the
time of delivery, preferred family planning method after delivery, and contact
information).
3. During household visits constantly remind the pregnant woman of the next scheduled
prenatal check-up.
Among teen-agers, valid consent can only be given by minors if accompanied by

an adult.
Pregnancy among those who are less than 18 yrs of age is always placed at a
higher risk among other reproductive age groups; thus, it is always important to
follow-up on the next scheduled prenatal check-up.
4. Regularly counsel pregnant woman to eat healthy and nutritious foods, avoid smoking
and alcoholic beverages, maintain good personal hygiene and regular exercise (e.g. ,
walking, stretching).
5. Immediately refer the pregnant woman to the nearest RHM or health facility when she
complains of any of the following:
a. Vaginal spotting/bleeding
b. Fever
c. Severe headache
d. Abdominal pain
e. Paleness or pallor
f. Convulsions/loss of consciousness
g. Vomiting
h. Blurring or loss of vision
i. Difficulty of breathing
j. Chest pain
6. Pregnant women with co-morbidities (e.g., HPN, DM or asthma) should be immediately
referred to RHMs or private practicing Obstetric-Gynecologists for proper prenatal care
and management of co-morbidities.
7. Always ensure privacy and confidentiality of counselling among adolescent couples or
women.
8. If the adolescent decides not to proceed with the pregnancy, assist the adolescent and
her accompanying adult (preferably one or both of her parents), to the nearest mother
and child protection unit or DSWD for proper counselling and management.
9. Assist RHMs during health related community activities such as Mothers Class.
10. Constantly remind pregnant women within your HH catchment area of the scheduled
Mothers Class in the community.
BHWs may do the following:

a. For mild nausea, vomiting and constipation, advise pregnant woman to drink
small amounts of water frequently and refer to RHM if it persists for more than 1
day.
b. For minimal vaginal bleeding or spotting, advise bed rest with buttocks elevated.
DO NOT massage the abdomen; refer to RHM if it persists for more than 1 day.
Source: collections.infocollections.org
Figure 3. Buttocks lift for pregnant women

INTRAPARTUM CARE (Woman in Labor until 6 hours Post-partum)
All pregnancies are considered high-risk and should be delivered only by adequately
trained health personnel, in a health facility or a DOH-accredited birthing facility.
Pregnant mothers should prepare the following. at least 2 weeks prior to the
expected date of delivery:
a. Home Based Maternal Record (HBMR) or Mother and Baby book
b. Birth plan, if any
c. Philhealth documents (e.g., Philhealth card and Member Data Record/MDR), if
she is a member/beneficiary
d. Materials for her and her baby (e.g., diapers, blanket, clothes and cap for the
newborn)
The expected date of delivery is only an estimate; the pregnant woman may deliver
either 2 weeks before or 2 weeks after the expected date of delivery.
WHAT TO SAY:
What does the expectant mother need to prepare prior to her delivery?
Expectant mothers should have pre-packed the following, prior to her expected date of
delivery:
1. HBMR or Mother and Baby book

2. Birth plan, if any
3. Philhealth documents, if she is a member/beneficiary
4. Materials for her and her baby e.g. diapers, blanket, clothes and cap for the
newborn
If the pregnant woman cannot avail of Philhealth membership, request a

certification from the barangay/municipality.
What are the signs and symptoms of active labor?
The following are the signs and symptoms of active labor:
Increased urgency to urinate or defecate

Presence of blood-tinged or brownish discharge from the pregnant womans cervix
Fluid gushing or leaking from the vagina
Regular Contractions at intervals <10 minutes
WHAT TO DO:
1. Regularly advise pregnant women to monitor the signs of labor at home (e.g., regular
contractions <10 minutes).
2. Once the signs and symptoms of active labor have been noted, inform the preferred
health facility or the RHM through Short Message Service (SMS), or phone call or any
other means of communication, prior to transport, of the pregnant womans name, age,
number of previous pregnancies, if any, and presenting signs and symptoms of labor, to
allow sufficient time for preparation on the health facility.
3. Assist the pregnant woman in preparing her pre-packed materials and documents for
delivery and assist her, during transportation, to the preferred health facility in her birth
plan. If there is none, assist and refer to the nearest RHM or the nearest health or DOH-
accredited birthing facility, when the pregnant woman complains of any of the
following:
a. Increasing urgency to urinate or defecate - is a possible sign that the baby has
already positioned itself for delivery.
b. Bloody show - present as a blood-tinged or brownish vaginal discharge which can
occur days before or at the onset of labor.
c. Ruptured membranes - present as a fluid gushing or leaking from the vagina. This
condition increases the chances of intrauterine infection hence, should be referred
immediately.
d. Regular contractions contractions that occur at intervals of < 10 minutes usually
indicate that active labor has already begun.
4. Any untoward incidents during transport should be referred immediately to the RHM or
Public Health Nurse (PHN) through SMS, or phone call, or any other means of
communication for appropriate first aid management.
POSTPARTUM CARE (More than 6 hours after delivery until 6 weeks)
Postpartum visits should be done within 72 hours after delivery and on the 7 th day
postpartum to check for any signs of infection or bleedingIV. It is crucial during this period
that the mother starts to establish exclusive breastfeeding. Discussions on FP counselling
for the next planned pregnancy can also be initiated during this period.
WHAT TO SAY:
Risk of infection among pregnant women is highest during the postpartum period,
thus the need to maintain good personal hygiene and adequate nutrition.
What are the danger signs after delivery?
Go to the nearest RHM or health facility if there are any of the following:
Difficulty of breathing
Severe headache with or without blurring or loss of vision
High-grade fever
Foul smelling vaginal discharge
Severe lower abdominal pain
Profuse or severe vaginal bleeding
Paleness
Breast engorgement and tenderness
Loss of consciousness or convulsions
As early as 30 minutes after delivery or childbirth, breastfeeding may already be
initiated. Breastfeeding is also a natural method of family planning termed as LAM and
helps reduce the risk of ovarian and breast cancer. Breastmilk is always available, highly
nutritious for the newborn baby, safe and economical.
WHAT TO DO:
1. Gather the following data:
a. Name and age of the pregnant woman
b. Date of childbirth/delivery
c. Place of delivery
d. Danger signs noted, if any
2. Immediately refer to the RHM or to the nearest health facility if there are note of any of
the danger signs after delivery through SMS, or phone call or any other means of
communication for appropriate first-aid management:
a. Difficulty of breathing and/or chest pain
b. Severe headache with or without blurring or loss of vision
c. Severe vomiting
d. High-grade fever
e. Foul smelling vaginal discharge
f. Severe lower abdominal pain
g. Profuse or severe vaginal bleeding
h. Paleness or pallor
i. Breast engorgement and tenderness
j. Loss of consciousness or convulsions
3. For moderate to heavy vaginal bleeding, BHWs may apply first aid by placing ice packs
over the lower part of the abdomen while massaging the uterus to help keep it
contracted and firm. This can be done while waiting for the RHM or any other trained
health personnel to arrive. Regularly monitor the blood pressure at least every hour.
The top 3 leading causes of maternal death are bleeding, infection and
hypertension. Thus, it is very important that BHWs know and understand the
danger signs of pregnancy from the prenatal period up to the postpartum period.
In cases of maternal death, from whatever cause, within the household
catchment area, report the incident to the RHM for proper maternal death
review.
4. Family planning methods may already be introduced among adolescents by adequately

trained BHWs to ensure good maternal and reproductive health.
5. If the adolescent couple or individual decides to give her child up for adoption, refer and
assist the adolescent (preferably accompanied by her parents) to the nearest DSWD for
adequate counselling and processing on the adoption of the child.
C. NEWBORN HEALTH (0-28 days old)
The newborn phase of the life-cycle approach cover discussions on the different
roles and responsibilities of BHWs in promoting Essential Intrapartum and Newborn Care,
Newborn Screening, and Breastfeeding Programs of the DOH.
ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC)

There are 4 important interventions during the immediate postpartum phase of
pregnancy:
1. Immediate drying
2. Skin-to-skin-contact and delayed cord clamping
3. Non-separation of baby from mother
4. Exclusive breastfeeding
ROLE OF THE BHW:

Under the Newborn Package Program, adequately trained BHWs are expected
to identify and record the eligible population of their household catchment areas who
have newborn babies. They are not expected to be able to comprehensively discuss
all the elements of intrapartum and newborn care to the eligible population.
WHAT TO DO:
1. All pregnancies are considered high-risk and should be delivered only by adequately
trained health personnel, in a health facility or a DOH-accredited birthing facility.
However, in extreme situations where home or transit delivery is unavoidable, the
BHWs may do the following, while waiting for the RHM or any other trained personnel
to arrive:
a. Using a clean, dry cloth, thoroughly dry the baby and wipe the face, eyes, head, front
and back, arms and legs.
b. If a baby is crying and breathing normally, place the newborn prone on the mothers
abdomen and cover newborns back with a blanket and head with a bonnet to
prevent hypothermia. DO NOT manipulate or clamp the umbilical cord. Neonatal
sepsis or neonatal tetanus can be caused by unsterile materials and environment.
2. Using the latest family profiling and risk assessment form for Newborns/Infants, gather
the following data during your 1st postpartum visit:
a. Name of newborn or infant
b. Place of delivery
c. Name of parents
d. Date of birth
e. Place of delivery
f. Type of delivery
g. Date Registered at the municipal registry
h. Compliance to newborn program of the DOH (e.g., BCG or Hepa B immunization,
Newborn Screening, Breastfeeding)
3. Encourage mothers to have their newborn vaccinated and screened on time.
4. To prevent neonatal sepsis, educate mothers on proper cord care (e.g., keeping the
umbilical cord dry without any dressing or any material, alcohol or betadine).
5. Immediately refer the newborn to your RHM or to the nearest health facility if there are
any of the following:
a. Poor suck, cry or activity
b. Foul-smelling discharge on the umbilicus
c. Yellowish discoloration of the skin and eyes for more than 2 weeks
d. Difficulty of breathing
6. Educate mothers on the importance of breastfeeding and proper breastfeeding
techniques.
7. Assist the mothers in registering their newborn to the local civil registry.
NEWBORN SCREENING
Newborn Screening is a practical procedure to determine the possibility of having a
congenital metabolic disorder that may lead to mental retardation and death, if not
detected early and appropriately treated.
ROLE OF THE BHW:

Under the Newborn Screening Program, BHWs are expected to assist RHMs in
identifying within their household catchment areas who are qualified to undergo
newborn screening, or those who were born within 24-72 hours. They are expected to
assist in the information campaign on newborn screening (e.g., inform the community
of the nearest health facility that is conducts newborn screening).
WHAT TO SAY:
What is Newborn Screening?
Newborn Screening is a procedure that detects congenital metabolic disorders that may
lead to mental retardation or even death if not detected early. It uses Heel Prick
Method.
When should it be done?
It is done ideally in the first 24 hours of life but not later than 3 days after complete
delivery. The procedure is performed only by a physician, nurse, trained midwife, or
medical technologist.
Where can it be availed?
It is available in hospitals, lying-in clinics, rural health units, health centers and some
private clinics.v
WHAT TO DO:
1. Assist the mother in identifying the nearest newborn screening facility within the
community.
2. If mothers are residing in far-flung areas or geographically isolated areas, assist the
mother in the follow-up of results, if necessary.
BREASTFEEDING
Exclusive breastfeeding is best for babies during the first 6 months of life and may be
initiated within 30 minutes after birth by initiating skin-to-skin contact. The first few drops
of breast milk, called colostrum, contains high level of antibodies which can increase their
babies resistance against common infections (e.g., diarrhea and pneumonia).
ROLE OF THE BHW:

Under the Postpartum and Lactating Program, adequately trained BHWs are
expected to identify and record the eligible population of their household catchment
areas. There are women who can breastfeed. They are not expected to be able to
comprehensively discuss the program to the eligible population.
WHAT TO SAY:
Breastfeeding is still the best source of nutrition for babies until 6 months of age. It
may be continued until 2 years of age and beyond. It is always available, safe and
economical.
What do we mean by exclusive breastfeeding?

Exclusive breastfeeding means giving only breastmilk without water, other liquids, teas,
herbal preparations or other food and fluid intake for the first 6 months of life.vii It
provides protection to the child against common infections such as diarrhea and
pneumonia.
For working mothers, they can still continue breastfeeding by storing expressed
breastmilk in a clean, safe and cool place that is properly labelled and covered, or they
may bring along with them their babies if there is a breastfeeding area within their office
or establishment.
How do we store breastmilk?

Key points in storing milk:
o Expressed breastmilk that is not refrigerated can be stored for at least 8 hours at
room temperature
o When stored in a refrigerator, it is good for 24 hours
o When stored in a freezer compartment of the refrigerator, it is good for 2 weeks
o When stored in a freezer section or refrigerator with separate door, it is good for 3
months
o When stored in deep freeze in 180C or lower, it is good for 6-12 monthsvii
WHAT TO DO:
1. Teach the mother how to perform the proper techniques for breastfeeding:
a. Wash nipples with a clean cloth and warm water before and after every
breastfeeding.
b. To prevent breast swelling or engorgement, breastfeed at least every 2-3 hours and
use both breasts at each feeding.
c. After breastfeeding or washing the nipples, leave some breast milk on the nipples
and allow them to air dry.
d. Breastfeed whenever the baby shows signs of hunger (e.g., sucking fingers or moving
lips).
e. Allow the baby to suck at the areola of the mothers breast and not just the nipples
to allow free flow of breast milk.
f. At each feeding, encourage the baby to empty the breast and then offer the other
breast.
2. Using the latest materials on proper positions for breastfeeding, teach the mother these
positions during postpartum or household visits.
a. Key points in helping a mother position a baby:
i. Babys head and body in line
ii. Babys head held close to the mothers body
iii. Babys whole body supported
iv. Baby approaches breast, nose to nipplevii
Source: mypositiveparenting.org
Figure 4. Proper Positions for Breastfeeding

b. Signs of good attachment :
i. Mouth widely opened
ii. Lower lip turned upward
iii. Chin touching the breast
iv. More of the areola is seen above the babys mouth than below it
Source: thepassionatemom.wordpress.com
Figure 5. Steps for Proper Breastfeeding
3. Encourage the mother to maintain good nutrition and avoid alcohol and tobacco, which
can decrease milk production
Nutritional advice for lactating mothers:
Eat at least 2 additional servings of staple food per day
Eat at least 3 additional servings of calcium-rich foods (e.g., dark green leafy
vegetables, sardines, milk/dairy products) per day
Drink at least 8 glasses of fluids (2 liters) each day
Eat smaller, more frequent meals if unable to consume larger amounts in fewer
meals
Take micronutrient supplements such as iron and iodine through the use of iodized
salt as directed
4. Encourage the mother to join breastfeeding support groups within the community to
help her know more about the proper techniques for breastfeeding, and some practical
answers to commonly asked questions about breastfeeding.
5. Refer to the RHM if the mother experiences difficulty in breastfeeding.
D. NEONATE AND INFANT HEALTH

Neonates refer to babies from birth up to 28 days of life, while infancy refers to
those who are older than 28 days old to younger than 12 months. The neonate and infant
phase of the life-cycle approach cover discussions on the different roles and responsibilities
of BHWs in promoting Expanded Program on Immunization and Infant and Young Child
Feeding Programs of the DOH.
EXPANDED PROGRAM ON IMMUNIZATION (EPI)
EPI aims to reduce neonatal, infant and child mortality due to vaccine-preventable diseases
and ensures normal growth and development of infants by increasing resistance against
infections and preventing malnutrition.
Table 2. EPI Schedule
VACCINE MINIMUM AGE NUMBER OF MINIMUM INTERVAL PURPOSE

ST
AT 1 DOSE DOSES BETWEEN DOSES
BCG
Birth or anytime 1 dose None To prevent the
(Bacillus Calmette- after birth possibility of
Gurin) tuberculosis
meningitis and
other tuberculosis
infections
Pentavalent vaccine 6 weeks old 3 doses 6 weeks (DPT 1), 10 To reduce the risk
weeks (DPT2), 14 of severe pertussis,
weeks (DPT 3) severe forms of
pneumonia and
diarrhea
OPV (Oral Polio Vaccine) 6 weeks old 3 doses 4 weeks The extent of
protection against
polio is increased
the earlier the OPV
is given
HepaB (Hepatitis B) At birth 4 doses 4 weeks Reduces the

(***final 3 likelihood of
doses as part of becoming a carrier
Pentavaccine) or becoming
infected
Measles vaccine 9 months old 1 dose None Measles is

preventable
through
immunization in
almost 85% of
those who were
vaccinated
MMR (Measles, Mumps, 12-15 months old 1 dose None Intended for those
Rubella) who do not respond
to first dose
ROLE OF THE BHW:
Under the EPI program, adequately trained BHWs are expected to identify and
record the eligible population of their household catchment areas. They are not expected
to comprehensively discuss the vaccine preventable diseases to the eligible population.
WHAT TO SAY:
What are the vaccines needed to be adjusted to be considered as fully immunized?
A fully-immunized child has 1 dose of BCG; 3 doses of DPT; 3 doses of OPV; 3 doses
of HepaB, and 1 dose of measles before the age of 12 months.
What are the vaccines included in Pentavalent vaccine?

At present DPT vaccination is included in the Pentavalent vaccine which also contains
immunizations against Haemophilus influenza type B (HIB) virus and Rotavirus.
What are the possible side effects after immunization?

Fever may occur after immunization, and swelling at the injection site is expected
from administration of BCG vaccine.
WHAT TO DO:
1. Using the latest immunization booklet (e.g., Mother and Baby Book), gather the following
data during your household visit:
a. Name and age of the child < 5 yrs old
b. Immunization and micronutrient supplementation given, if any
c. Weight
d. Height
2. In areas where the BHW is also functioning as a Barangay Nutrition Scholar (BNS), the
BHW should be able to do the following during their scheduled immunization:
a. Weigh the infant and plot his/her weight in relation to his/her age in months
b. Using the plotted growth curve, inform and educate the mother on the
following:
i. The growth of the child is within normal limits if the plotted weight over age
is between the line curves
ii. The growth of the child is not improving if the plotted weight over age is in a
straight or same line from the previous plot
iii. The infant is at risk of malnutrition and decreased resistance to infection if
his/her weight goes beyond the curve lines
3. If there is a possible risk of malnutrition based on the plotted growth curve, refer the
infant to the RHMs for adequate management.
4. Encourage the mother to bring her infant on the next scheduled immunization or
micronutrient supplementation date. This will provide increased resistance of her baby
against infections.
5. Encourage the mother to continue breastfeeding until 6 months of age and start
complementary foods (e.g., mashed vegetables, bananas) from 6 months until 12
months of age.
INFANT AND YOUNG CHILD FEEDING PROGRAM

Exclusive breastfeeding is best for babies during the first 6 months of life and
recommended to be continued until 2 yrs of age or beyond. During illness, increased fluid
intake will help, along with continued breastfeeding.
ROLE OF THE BHW:

Under the Infant and Young Child Feeding Program, adequately trained BHWs are
WHAT TO
areas. SAY:
They are not expected to comprehensively discuss the diseases related to
malnutrition or nutritional requirements of the eligible population.
When does complementary feeding begin?
Complementary feeding may be given to infants 6 months of age or older.
How do you initiate complementary feeding?
Start with small amounts of nutrient-rich foods and increase gradually as the child gets
older.
Among infants 6-8 months of age, complementary feeding should be given 2-3 meals
per day; 3-4 meals per day are given to infants 9-23 months of age.
WHAT TO DO:
1. Using the latest immunization booklet (e.g., Mother and Baby Book), gather the
following data during your household visit:
c. Weight
d. Height
BHW should be able to do the following during their scheduled immunization day or
household visit:
a. Weigh the infant or young child and plot his/her weight in relation to his/her age
in months.
b. The growth of the child is within normal limits if the plotted weight over age is
between the line curves.
c. The growth of the child is not improving if the plotted weight over age in months
is in a straight or same line from the previous plot.
d. The infant or young child is at risk of malnutrition and decreased resistance to
infection if his/her weight goes beyond the curve lines.
infant or young child to RHMs for adequate management.
4. Encourage the mother to bring her infant or young child on the next scheduled
immunization or micronutrient supplementation date. This will provide increased
resistance of her baby against infections.
5. Encourage the mother to maintain proper nutrition, good personal hygiene, and proper
sanitation with her baby or young child to help prevent risk of exposure to common
childhood diseases (e.g., pneumonia or diarrhea).
Table 3. Complementary Feeding Guide
AGE OF
APPROPRIATE METHOD OF
INTRODUCTION EXAMPLE AMOUNTS
FOOD(S) PREPARATION
(IN MONTHS)
Cereals 6 months Cooked, well Thick rice gruel, cup thick
(first semi-solid foods strained oatmeal gruel
given to the baby) Cooked, mashed root 2-3 tablespoons
crops
8 months Cooked Thick gruel, soft cooked cup thick
rice gruel
10-12 months Cooked Soft cooked rice 1 cup
Sliced bread, biscuits 1 piece
Fruits 6 months Mashed Ripe bananas, ripe 2 tablespoons
papaya, ripe mango
8 months Cut into small Soft fruit 3 tablespoons
pieces
10-12 months Cut into finger Any fruit 4 tablespoons
sized pieces
Vegetables 7 months Cooked very Carrots, sayote, 1 tablespoon
soft squash, abitsuelas,
potatoes, kamote
tops, kangkong tops,
pechay, malunggay
leaves
8 months Cooked and All vegetables 1 tablespoon
finely chopped
10-12 months Cooked and All vegetables 1-2 tablespoons
coarsely
chopped
Meat and Alternatives 7 months Cooked Chicken egg egg yolk
11 months Cooked Chicken egg egg

Meat/Fish/ Poultry or 6-11 months Deboned, Minced meat, fresh or 1 1/3 servings
Legumes, dried beans cooked well, dried fish or minced
mashed or chicken, mashed 1 serving
ground monggo cooked
meat = 30 g or
about
10-12 months Deboned, Meat, fresh or dried 3 cm cube;
cooked, flaked fish or chicken fish:2 pieces,
or chopped monggo medium size
well (55-60 g each),
about 16 cm
long; 1 1/2 cups
cooked dried
beans/nuts
preferably
taken 3 times a
week
AGE OF
APPROPRIATE METHOD OF
INTRODUCTION EXAMPLE AMOUNTS
FOOD(S) PREPARATION
(IN MONTHS)
Whole milk/ follow on 12 months 2 cups
formula
(if not on breastfeeding)
Other Foods 8 months Steamed, Custards, simple 1 teaspoon

baked pudding, plain
gulaman or jello
Fats and Oils 6-11 months Margarine, cooking oil 4 teaspoons
Sugar 6-11 months 3 teaspoons
Source: FNRI-DOST, 2000
E. CHILD HEALTH
Children 12 months to 59 months old are included under this age group. This section
covers the different roles and responsibilities of BHWs in promoting the Garantisadong
Pambata Program, Integrated Management of Childhood Illnesses (IMCI) and Oral Health
Program of the DOH.
GARANTISADONG PAMBATA PROGRAM (GP)

Malnutrition is still considered a nationwide problem among Filipino children. It
causes decreased resistance against infections and often result to higher risk for
complications. It is preventable through micronutrient supplementation and proper
nutrition (i.e., eating nutrient-rich foods like vegetables and fruits).
Intestinal parasitism or soil-transmitted helminthiasis (STH) is one of the
multifactorial causes of malnutrition. It mostly affects children aged 1 to 12 yrs old causing
nutritional deficiencies on iron and vitamin A.viii
ROLE OF THE BHW:

School children are included in the GP Program. Adequately trained BHWs are
areas and assist RHMs in providing different services under this program on micronutrient
supplementation. They are not expected to comprehensively discuss malnutrition or
specific nutritional needs of children.
WHAT TO SAY:
What is the importance of GP program?
GP is an integrated package of services concerning health, nutrition and environmental

sanitation but mainly covers micronutrient supplementation of vitamin A and iron
among children. This program also include deworming among preschoolers ages 1-5
years.
What is the importance of Deworming, Vitamin A and Iron supplementation?
Deworming significantly improves language and memory development.viii

Vitamin A supplementation provides protection to children against measles and
prevents malnutrition which causes decreased resistance against infections.
Iron supplementation provides protection to children against iron-deficiency anemia
which is one of the most common forms of nutritional deficiency among children,
causing paleness and easy fatigability.
WHAT TO DO:
1. Using the latest immunization booklet (e.g., Mother and Baby Book, and forms for GP),
gather the following data during household visit:
b. Name and age of school children
c. Immunization and micronutrient supplementation given, if any
d. Weight
e. Height
BHW should be able to do the following during their scheduled household visit:
a. Weigh the child < 6 yrs old and plot his/her weight in relation to his/her age in
months
b. Explain and discuss to the mother the meaning of the plotted growth curve:
i. The growth of the child is within normal limits if the plotted weight over age is
between the line curves.
ii. The growth of the child is not improving if the plotted weight over age in months is
in a straight or same line from the previous plot.
iii. The child is at risk of malnutrition and decreased resistance to infection if his/her
weight goes beyond the curve lines.
child to RHM for adequate management.
4. Constantly remind the mother to bring her child on the next scheduled micronutrient
supplementation date. This will provide increased resistance against infections.
5. Encourage the mother to maintain proper nutrition, good personal hygiene and proper
sanitation with her child to help prevent risk of exposure to common childhood diseases
(e.g., pneumonia or diarrhea).
6. Assist the mother in going to their designated health facility for micronutrient
supplementation of her child.
7. Constantly remind mothers that deworming activities for preschoolers 1-5 years old is
simultaneously done during the GP campaign while deworming activities for
schoolchildren is scheduled every January and July of the year.viii
8. Using the latest referral form for Integrated Helminth Control Program, refer a child who
present with any of the following signs and symptoms within the first 10 hours after
intake of the deworming drugsviii, to the RHMs or to the nearest health facility for
appropriate management:
Local sensitivity or allergy
Mild abdominal pain
Diarrhea
Erratic worm migration
9. Using the latest IEC materials for nutritional guidelines for Filipinos, discuss to the mother
nutrient-rich foods which can readily be found within the community.
10. Encourage mothers to plant vegetable gardens within their household for additional
sources of fresh and nutritious foods for their family.
INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

Early detection and adequate management of common childhood symptoms such as
cough, diarrhea and fever are provided under the IMCI program. It aims to reduce
morbidity and mortality of cases due to common childhood illnesses such as pneumonia,
diarrhea and measles.
ROLE OF THE BHW:

Adequately trained BHWs are expected to identify common childhood illnesses within their
household catchment areas and assist the RHMs in providing adequate first-aid
management. They are not expected to be able to comprehensively discuss the different
types of childhood illnesses and its treatment modalities.
WHAT TO SAY:
What are the childhood symptoms included in the IMCI program?
Included in the IMCI program are the following common childhood symptoms:
1. Cough
2. Diarrhea
3. Fever
4. Ear infection
COUGH, with or without phlegm, and difficulty of breathing, despite increased fluid intake
lasting for more than 2 days should be consulted to BHWs, the RHM or nearest health
facility for adequate treatment.
NEVER self-medicate with antibiotics to prevent occurrence

of antibiotic-resistant bacteria.
What can mothers do at home when their children have cough?
For ordinary cough and colds, encourage mothers of sick children to increase fluid
intake of their child and provide nutrient-rich foods to improve resistance against
infection and prevent dehydration.
Adequately trained BHWs may teach mothers of sick children on how to prepare
lagundi decoction (refer to Annex on Herbal Medicine), a DOH recommended
medicinal plant for cough and asthma.
Refer the sick child to the RHM or to the nearest health facility if cough persists for
more than 3 days with or without signs of pneumonia for adequate management.
DIARRHEA is a symptom of gastrointestinal infection that is highly preventable and

curable. It is caused by a virus, bacteria or parasitic organism. Not all forms of diarrhea will
require antibiotics.
NEVER self-medicate with antibiotics to prevent complications.
Diarrhea often results from ingestion of contaminated food and water because of
poor personal hygiene and poor sanitation.
Neonates and infants are at a higher risk for dehydration. A few hours of diarrhea
can cause dehydration; thus, should be immediately consulted to the RHM or
nearest health facility when there are any of the following:
o Profuse, watery stools at least 3 times a day
o Foul smelling, yellowish to greenish stools with or without blood
o Excessive thirst
o Sunken eyeballs
o Sunken fontanel in infants
What can mothers do at home when their children have diarrhea?
Mothers are encouraged to continue breastfeeding her child with diarrhea and/or
give am or oresol to replace lost body fluids.
Oresol sachets may be requested from BHWs or at the nearest health facility.
If there are no available oresol sachets, homemade oresol may be prepared by

mixing the following:
o 1 Liter of clean water (5 glasses of 200ml each)
o 6 teaspoons of sugar
o teaspoon of salt
The best and practical way to prevent diarrhea include the following:
o Regularly practice good hand washing techniques before eating and after using
the toilet;
o Wash fruits and vegetables before eating or cooking; and,
o Drinking water only from safe sources and avoiding street foods that are not
properly covered against insects or bacteria.
What are the usual signs and symptoms of ear infections?
The usual signs and symptoms of ear infections include any of the following:
o Foul-smelling ear discharge
o Ear pain
o Fever
o Impaired hearing capacity on the affected ear
WHAT TO DO:
1. Using the latest immunization booklet (e.g., Mother and Baby Book, and forms for IMCI),
gather the following data during your household visit:
a. Name and age of the sick child < 5 yrs old

c. Weight
d. Height
e. Danger signs of pneumonia, dehydration or measles, if any
2. For patients with cough, refer the child to the RHM immediately when there is cough with
any of the following:
Short rapid breathing

Fever (37.8 C and above)
Loss of appetite or poor suck among neonates
Table 4. Normal respiratory rate per age group

AGE OF PATIENT NORMAL RESPIRATORY RATE
2 to 12 months 60 breaths per minute
1 to 5 yrs old 50 breaths per minute
More than 5 yrs old 40 breaths per minute
3. For patients with diarrhea, refer the child to the RHM immediately when there are of any
of the following:
Profuse, watery stools at least 3 times a day

Foul smelling, yellowish to greenish stools with or without blood
Excessive thirst
Sunken eyeballs
Sunken fontanel in infants
4. Encourage the community to avoid indoor air pollution and cigarette smoke within the
household.
5. Encourage members of the household to cover mouth when sneezing or coughing within
or outside their household to prevent spread of infection.
6. Encourage members of the household to regularly eat nutrient-rich foods (e.g.,

vegetables and fruits) for increased resistance against infections.
7. Encourage members of the household to maintain cleanliness and proper hand washing
techniques most specially when handling neonates and infants.
ORAL HEALTH PROGRAM
Dental carries or tooth decay and gum diseases are the two most common oral
health diseases in the Philippines.
ROLE OF THE BHW:

Under the Oral Health program, school children, adolescents and adults are
also included. Adequately trained BHWs are expected to identify and record the
eligible population of household catchment areas and assist the RHMs in providing
the different services under this program. They are not expected to comprehensively
discuss oral health diseases.
WHAT TO SAY:
What are the causes of oral health diseases?
Risk factors causing oral health diseases include the following:

o Unhealthy diet
o Poor oral hygiene
o Tobacco use and alcohol, among adults
How can oral health diseases be prevented?
Healthy diet should start from birth up to 6 months through exclusive breastfeeding and
continued with complementary feeding up to 2 years of age.
Good oral hygiene should start as soon as the first tooth erupts at 5-6 months of age. It
is important to visit the dentist as they are more knowledgeable to discuss good oral
hygiene and have follow-up visits every 6 months thereafter.
Low-grade fever (T = 37.80C to 38.50C) may still be due to tooth eruption among infants;
diarrhea and moderate to high-grade fever are no longer due to tooth eruption. Advise
patient to go to the nearest health facility for adequate management.
Adequate tooth brushing techniques may also be already taught to children as early as 1
to 2 yrs of age.
WHAT TO DO:
1. Assist the mother to locate the nearest health facility with dental services.
2. Encourage members of the household to practice and train their children for good oral
hygiene (e.g., tooth brushing after meals).
3. Encourage members of the household to return their children on the scheduled dental
visit to ensure adequate oral examination.
4. Constantly remind members of the household that low-grade fever (T = 37.80C to 38.50C)
may still be due to tooth eruptions among infants, but diarrhea and moderate to high-
grade fever is no longer due to tooth eruption.
F. ADOLESCENT HEALTH
The adolescent age group refers to young individuals between the ages of 10 to 19
years of age who are in transition from childhood to adulthood. It is also during this phase
that risk-taking behaviours either due to peer pressure or simple curiosity are at its highest
peak.
Adolescent health refers to a state of complete physical, mental and social well-
being of persons aged 10-19 years; thus, this section covers the different roles and
responsibilities of BHWs in promoting Adolescent Health particularly on Substance/Drug
Abuse, Alcohol Abuse and STI-HIV programs of the DOH.
SUBSTANCE/DRUG ABUSE
Risk-taking behaviours are at its peak at the adolescent phase and are usually
secondary to peer pressure thus result to certain mental health conditions such as anxiety
and depression.
ROLE OF THE BHW

Under the Drug Abuse Program of the DOH, BHWs are expected to assist the RHMs in
promoting essential information and education campaigns on abused substances. They are
not expected to comprehensively discuss the effects of abused substances or its rehabilitative
modalities.
WHAT TO SAY:
What are the risk factors for drug abuse?
Anxiety and depression are the most common factors that cause initial drug
dependence and subsequent addiction.
How can it be prevented?
Parental supervision is most critical during this phase to prevent the adolescent from
experimenting with drug use.
Active community participation on the promotion of healthier activities (e.g.,
sportsfest) is also one of the practical ways to prevent adolescents from drug addiction.
Family members or relatives are highly encouraged to immediately refer adolescents
who are suspected for drug dependence and/or addiction, to the nearest drug
rehabilitation or treatment facility to prevent further complications.
WHAT TO DO:
Drug addiction is best evaluated and managed by an adequately trained health
personnel for counselling and behaviour modification. It should be referred immediately to
the appropriate authorities for prompt evaluation and management on the earliest sign of
drug dependence to prevent subsequent addiction which is more difficult to manage.
1. Refer to the RHM or to the appropriate authorities if there are usual signs and symptoms
of a drug addict (e.g., ecstasy) among members of the household catchment area:
Nausea
Chills
Involuntary teeth clenching
Cramped or tensed muscles
Blurred vision
Excitement and increased energy
Confusion
Profuse sweating
Dry mouth
Dilated pupils
2. Encourage members of the household to assist the adolescent to the nearest drug
rehabilitation center if there are any of the usual signs and symptoms of drug addiction,
for proper counselling.
3. Encourage members of the household to allow their children to actively participate in
community activities such as sportsfest activities and minimize participation from
activities that might encourage or promote drug use.
ALCOHOL ABUSE
Alcohol abuse is characterized by a pattern of excessive drinking despite its negative
effects on the physical, social and economic being of the individual.
ROLE OF THE BHW

Under the Lifestyle Modification Program of the DOH, BHWs are expected to assist
RHMs in promoting essential information and education campaigns on alcohol abuse. They
are not expected to comprehensively discuss the effects of alcohol intoxication or its
treatment and rehabilitative modalities.
WHAT TO SAY:
What are the risk factors for alcohol abuse?
It is caused by a complex group of genetic, psychological and environmental factors.
Peer pressure is one of the causative factors for alcohol abuse among adolescents.
Because alcohol abuse is multifactorial in nature, it is essential that there is active
community participation for support, along with mutual family support and personal
desire to achieve treatment and rehabilitation.
WHAT TO DO:
Alcohol abuse is best evaluated and managed by adequately trained health
personnel for counselling and behaviour modification. It should be referred immediately to
the appropriate authorities for prompt evaluation and management at the earliest sign of
alcohol dependence to prevent subsequent addiction which is more difficult to manage.
1. Refer to the RHM or to the appropriate authorities if there are usual signs and symptoms
of alcohol abuse among members of the household catchment area:
Alcohol breath or smell on skin
Deterioration in persons appearance or personal hygiene
Decreased ability to pay attention
2. Encourage members of the household to assist the adolescent to the nearest alcohol
rehabilitation center if there are any of the usual signs and symptoms of alcohol
dependence, for proper counselling.
3. Encourage members of the household to allow their children to actively participate in
community activities such as sportsfest activities and minimize activities that might
encourage or promote alcohol abuse (e.g., bar-hopping).
SEXUALLY TRANSMITTED INFECTIONS (STI)

Sexually transmitted infections are caused by a variety of microorganisms (e.g.,
gonorrhoea, hepatitis B or syphilis).
WHAT TO SAY:
What is an STI?
STIs are caused by a variety of bacteria, viruses and parasites that are spread primarily
through sex.
How are STIs transmitted?
STIs (e.g., syphilis and Human Immunodeficiency Virus) are not only spread through
person-to-person sexual contact but may also be transmitted through:
o Infected blood products (e.g., single infected needle used by multiple drug addicts
or infected needles used in unsterile body piercing or tattooing)
o From mother to child during pregnancy and childbirth
What are the usual signs and symptoms of STIs?
There are some types of STIs which are asymptomatic, but the usual signs and
symptoms include any of the following:
o Pain when urinating
o Unusual discharge from the genitals
o Itching
o Soreness
o Unusual lumps or sores
What is HIV?
HIV stands for Human Immunodeficiency Virus. It attacks and weakens the immune
system, making the body more susceptible to infections.
HIV does not have specific signs and symptoms.
A person living with HIV may look and feel healthy even if already infected with the
virus.
HIV infection is PREVENTABLE but it has NO CURE.
HIV is transmitted only through 4 body fluids namely:
o blood
o semen
o vaginal fluid
o breast milk
ANY person can get HIV by:
o having sex with a person who has HIV
o blood transfusion or organ transplant contaminated with HIV
o using or sharing contaminated needles and syringes
o mother to child transmission from an HIV-infected mother to her child through
pregnancy, delivery and breastfeeding
What are the usual signs and symptoms of HIV infection?
The usual signs and symptoms of HIV may include any of the following:
o Fever
o Swollen lymph nodes
o Diarrhea
o Cough
o Weight loss
o Shortness of breath
If you know anyone within your HH who may have the signs and symptoms of STIs, do
not hesitate to consult a health worker in the health facility for early detection and
adequate management. ALL consultations in STI/HIV clinics are strictly confidential.
How can it be prevented or controlled?

The best and practical way to prevent STI or HIV infection is to maintain mutually
monogamous relationship between couples or practice safe sex (e.g., correct use of
condoms among or those with multiple sex partners).
Avoid sharing of needles or sharp objects which may have been contaminated.
ROLE OF THE BHW

Under the STI-HIV Program of the DOH, BHWs are expected to assist the
RHMs in promoting essential information and education campaigns on STI and HIV
prevention. They are not expected to comprehensively discuss the different types of
infections or its treatment modalities.
WHAT TO DO:
STI/HIV infections should always be evaluated and managed by adequately trained
health professionals in STI or HIV clinics.
Encourage members of the HH to assist the adolescent or any individual suspected of
having STI/HIV infection to the nearest health facility with an adequately trained health
professional, if there are any of the usual signs and symptoms, for proper counselling
and management.
ALWAYS ENSURE confidentiality of information of any individual who is suspected/
confirmed of STI/HIV infection.
G. HEALTHCARE FOR ADULTS
Adulthood starts from 20 yrs of age until 59 yrs of age. The adulthood phase of the
life-cycle approach cover the different roles and responsibilities of BHWs in promoting and
preventing common communicable and non-communicable disease programs of the DOH.
COMMUNICABLE DISEASESix
Discussions on this section will only include common communicable diseases such as
Dengue, Filariasis, Hepatitis A, B and C, Influenza, Leprosy, Leptospirosis, Malaria, Rabies,
Schistosomiasis, Tuberculosis and Typhoid Fever.
ROLE OF THE BHW

Adequately trained BHWs are expected to identify common types of
communicable diseases within their HH catchment areas and assist the RHMs in
providing adequate DOH-recognized first-aid management. They are not expected to
comprehensively discuss the different types of communicable diseases and its treatment
modalities.
DENGUE
Dengue is transmitted through the bite of an infected Aedes aegypti mosquito
affecting infants, children and adults; management/treatment of dengue DOES NOT require
ANY type of antibiotics. In most instances, delayed recognition of the disease may lead to
severe bleeding and death.
WHAT TO SAY:
What is dengue infection?
Dengue is a mosquito-borne viral infection that causes flu-like symptoms and

occasionally develops into a potentially fatal complication such as dengue hemorrhagic
fever. It may affect ANYONE in the community but seldom causes death if detected early.
What are the usual signs and symptoms of Dengue?

The usual signs and symptoms of dengue include the following:
o High-grade fever
o Joint and muscle pain
o Skin rashes
o Loss of appetite
o Nausea/Vomiting
Danger signs of possible bleeding from dengue infection may present with any of the
following:
o Nose bleeding usually when the fever subsides
o Abdominal pain
o Vomiting of coffee-ground vomitus
o Dark-colored stools
o Difficulty of breathing
Go to the nearest health facility within the community if there are any of the signs
and symptoms of dengue infection.
How is dengue infection prevented or controlled?
For prevention and control, follow the 4-S against dengue:
Search and Destroy

Cover water containers which may serve as breeding sites of dengue mosquitoes
Replace water of flower vases at least once a week
Regularly clean gutters of leaves and debris
Dispose all unused materials that can collect and hold water
Self-protection
Use mosquito repellent or mosquito nets
Wear long pants and a long-sleeved shirt
Seek early medical consultation if there is/are:
Persistent fever for more than 2 days
Rashes
Any signs of possible internal bleeding:
o Nose bleeding usually when the fever subsides
o Abdominal pain
o Vomiting of coffee-ground vomitus
o Dark colored stools
Say yes to fogging ONLY WHEN there is an impending outbreak or hotspot

Dengue fever may be supported with PARACETAMOL. DO NOT give Aspirin.
Increase fluid intake to prevent dehydration from high-grade fever.
WHAT TO DO:
1. Using the latest forms for Community Based Monitoring and Information System
(CBMIS), gather the following data during your household visit:
a. Name and age of members of the household
b. Duration of high-grade fever, if any
c. Note of the danger signs of bleeding from dengue infection, if any
2. Refer the members of the household within the catchment area to the RHM, if there is
high-grade fever (T = > 390C) persisting for more than 2 days, despite increased oral
fluid intake and treatment with Paracetamol.
3. Immediately refer members of the household to the RHM or to the nearest health
facility, if there are any of the danger signs of bleeding from dengue infection, namely:
Nose bleeding usually when the fever subsides
Abdominal pain
Vomiting of coffee-ground vomitus
Dark colored stools
4. Regularly conduct community campaign drives to eliminate breeding sites of mosquitoes
5. Regularly update the color coding signs of Dengue infection in the catchment area:
White = no case of dengue
Green = with > 2 cases of dengue
Yellow = already considered a hot spot
Red = there is already an outbreak
6. Explain to the community the meaning or significance of the color coding scheme for
Dengue
White = maintain Search and Destroy activities
Green to Red = encourage intensified implementation of 4-S activities within
the community against Dengue
FILARIASIS
Filariasis is a parasitic infestation that is transmitted through the bite of an infected
mosquito. It is commonly known as elephantiasis.
WHAT TO SAY:
What is a filarial infection?
Filariasis is commonly known as elephantiasis, caused by parasitic worms such as

Wuchereria bancrofti or Brugia malayi. It is transmitted to humans through the bite of an
infected Aedes mosquito.
What are the usual signs and symptoms of Filariasis?
The usual signs and symptoms include any of the following:

o Pain and swelling of the breast, vagina, scrotum, legs and arms
o Fever
o Cough
o Chills
o Noisy breathing
Go to the nearest health facility within the community if there are any of the signs
and symptoms of filariasis infection.
How is filariasis prevented or controlled?
Similar to dengue prevention, preventive measures include: wearing of long-sleeved

shirt and long pants when working in areas where filariasis is endemic; and, use of mosquito
repellants or mosquito nets.
November is the declared month for Filariasis Treatment in endemic areas.

WHAT TO DO:
1. Using the latest forms for Filariasis Prevention and control, the BHWs should have a
masterlist/record of the following within their designated HH catchment areas during
their household visit:
Name and age of the members of the household

Signs and symptoms of possible filariasis infection, if any
2. Encourage members of the household to actively participate and be part of the Mid
Sentinel Survey and Transmission Assessment Survey.
3. Immediately refer members of the household, suspected of having filariasis, to the RHMs
or to the nearest health facility for adequate treatment.
4. Encourage patients with diagnosed filariasis to comply with the medications to prevent
complications.
5. Assist patients during follow-up visits at the health center.
HEPATITIS
Hepatitis is a viral disease which may present with symptoms that may be so mild to
be noticed, like jaundice (common yellowish discoloration of the eyes). There are 3
common types of Hepatitis in the Philippines: Hepatitis A, B and C.
WHAT TO SAY:
What is a Hepatitis infection?
Hepatitis A is a viral infection that is preventable and curable.
It is transmitted through the feco-oral route (i.e., from ingestion of food contaminated
with human waste or urine of persons who also have Hepatitis A infection).
Hepatitis B is preventable but NOT curable.
It is transmitted in various ways:

o From mother to child during childbirth
o Through blood transfusion
o Through sharing of contaminated or infected sharp objects (e.g., needles)
o Through sexual intercourse with an infected individual
Hepatitis C is also preventable but NOT curable. There is NO vaccine for Hepatitis C.
It is transmitted through any of the following:

o Through blood transfusion
o Through sharing of contaminated or infected sharp objects (e.g., needles)
o Through sexual intercourse with an infected individual
Persons infected with Hepatitis B and Hepatitis C may become carriers for life, or may
have liver cirrhosis, liver failure or liver cancer later in life.
What are the usual signs and symptoms of Hepatitis?
The usual signs and symptoms of Hepatitis A include any of the following:
o Fever
o Flu-like symptoms (e.g., muscle and joint pains, loss of appetite)
o Fatigue or tiredness
o Abdominal discomfort
o Dark/brownish urine
o Yellowish discoloration of the eyes or jaundice
The usual signs and symptoms of Hepatitis B include any of the following:
o Weakness
o Stomach upset
o Dark urine or very pale stools
Hepatitis B carriers are asymptomatic.

Infected individuals with Hepatitis C are usually asymptomatic but may also present
with any of the following:
o Headache
o Nausea and vomiting
o Abdominal pain
o Weakness and fatigue
o Dark yellow urine, light-colored stools, and yellowish eyes
Proper handwashing techniques after using the toilet, before preparing food, and
before eating is still the best and practical method to prevent the spread of Hepatitis
A.
Transmission of Hepatitis B infection from mother to child during childbirth can be

prevented through complete (3 doses) immunization of HepaB vaccine. Hepatitis B
immunoglobulin is also given in addition to the 3 doses of Hepatitis B vaccine for
newborns who have mothers properly diagnosed with Hepatitis B.
Mutual monogamous relationship between couples, consistent practice of safe sex

among those with multiple partners, and avoiding use of any object that may be
contaminated with the blood of an infected person are practical methods to prevent
infection of both Hepatitis B and C.
Hepatitis infections DO NOT require ANY type of antibiotic treatment.
WHAT TO DO:
Immediately refer members of the HH who are suspected of having any of the 3
typesof Hepatitis to the RHM, or to the nearest facility for proper evaluation and
management. Hepatitis infections are best evaluated by adequately trained health
professionals.
INFLUENZA
Influenza is a highly contagious viral infection that is commonly known as the flu.
Any person within the household or community who has a weakened immune system is
susceptible.
WHAT TO SAY:
What is influenza?
Influenza is a viral infection commonly called flu and usually lasts from 1-3 days even
without treatment. It is transmitted when an infected person coughs or sneezes or
when there is direct contact with contaminated surfaces, material and clothing of an
infected person.
What are the usual signs and symptoms of influenza?

o Fever with or without joint pains
o Headache
o Runny nose
o Sore throat
o Cough
Go to the nearest BHW or RHM or health facility if cough and fever persists for more
than 2 days despite increased oral fluid intake and eating of nutrient-rich foods (e.g.,
citrus fruits), for proper evaluation and management.
Adequate cough manners is one of the best and practical method to prevent its
spread.
Proper handwashing techniques are also a practical methods of preventing

contamination of surfaces or clothing in the household.
It is a self-limiting disease that does not usually require treatment and may only be
treated with rest, increased oral fluid intake, and eating nutrient-rich foods (e.g.,
fruits).
WHAT TO DO:
1. Refer and assist members suspected with influenza, to the RHM if there are any
complications such as pneumonia or ear infection.
2. Refer to the RHM immediately when pneumonia is accompanied by any of the following:
Short rapid breathing
Fever
Loss of appetite or poor suck among neonates
3. For ear infection, refer to the RHM immediately when any of the following are seen:
Foul-smelling ear discharge
Ear pain
Fever
Impaired hearing with the affected ear
LEPROSY
Leprosy is caused by a bacteria called Mycobacterium Leprae which is both
preventable and curable. It is transmitted by prolonged close contact through the
respiratory tract (inhalation of the bacteria) from an infected person who is not treated.
WHAT TO SAY:
What is Leprosy?
Leprosy is caused by bacteria called Mycobacterium Leprae that affects the skin and
peripheral nerves.
How is it transmitted?
It is transmitted by prolonged close contact through the respiratory tract (inhalation of
the bacteria) from an infected person who is not treated.
What are the usual signs and symptoms of Leprosy?
The usual presenting signs of leprosy include any of the following:
o Single or multiple whitish or reddish patches of skin with loss of feeling (e.g., does
not hurt or does not itch)
o Loss of sensation to heat, touch or pain of the affected area accompanied by
weakness of the muscles of the hands and eyes
If you know anyone within your community who may have the signs and symptoms of
leprosy, do not hesitate to consult any health worker in the health facility to prevent
its continuing spread.
How can it be prevented and controlled?

Preventive measures include the following:
o Regularly practice good personal hygiene (e.g., proper handwashing techniques
and cough manners)
o Avoid smoking and excessive alcohol intake
o Have enough rest and regularly exercise
o Eat nutrient-rich foods (e.g., vegetables and fruits) to maintain increased resistance
against infections
o For households who have a patient with confirmed leprosy, regularly practice
cough manners; DO NOT USE your hands when covering your mouth to prevent
the spread of infection on surfaces
How can it be cured?
1. The duration of treatment depends on the classification of the leprosy. If classified as
paucibacillary, treatment may last from 6-9 months depending on the response of your
body to the medications prescribed. If classified as multibacillary, treatment may last
from 24-30 months.
2. It is very important to religiously take your medications and follow-up as scheduled at
the health facility, regularly exercise, and eat nutrient-rich foods to improve ones health
and early recovery.
3. Regularly coordinate with your BHWs for any adverse reactions noted at home while on
treatment.
WHAT TO DO:
1. Using the latest family profiling form for leprosy, gather the following data:
Name and age of the suspected Leprosy patient
Number of members in the household
Past medical history of leprosy infection among members of the household, if any
Previous history of compliance on leprosy medications, if any
2. Refer suspected leprosy patients to the RHM or nearest health facility for proper
evaluation and management if there are any of the following:
Single or multiple whitish or reddish patches of skin with loss of feeling (i.e., does not
hurt or does not itch)
Loss of sensation to heat, touch or pain of the affected area accompanied by
weakness of the muscles of the hands and eyes
3. For BHWs who already have Leprosy patients within their catchment areas, they should
do the following:
Regularly follow-up leprosy patients to ensure their intake of anti-leprosy medicines
regularly and at the right dose
Refer the patient for any adverse reactions, if any
Constantly remind patients of their scheduled follow-up and assist, if necessary
Encourage family members to support the patient with leprosy to ensure completion
of treatment modality required
Constantly provide health education to family members and the patient (e.g., stop
smoking; cover mouth when coughing and sneezing to ensure control on the spread
of infection)
4. Regularly update the members of your household catchment area of any health-related
activities on the following health calendars:
Leprosy Week as a reminder to the public (February)
World Leprosy Day (January 29)
National Skin Awareness Month (November)
LEPTOSPIROSIS
Leptospirosis is a bacterial infection most commonly transmitted by urine and semen

of infected animals in flood waters, or muddy farms and in areas where there is a livestock.xx
WHAT TO SAY:
What is Leptospirosis infection?
Leptospirosis is a bacterial infection caused by Leptospira spirochetes. It is

transmitted through ingestion of contaminated food or water or through broken skin or
open wounds which come in contact with the contaminated water.
What are the usual signs and symptoms of Leptospirosis?

o Fever
o Calf-muscle pain
Immediately consult the nearest RHM or health facility if one suspects the possibility
of leptospirosis infection, for prompt evaluation and management.
NEVER self-medicate with antibiotics to prevent undetected complications such as

liver or kidney failure.
Use personal protective equipments such as boots and gloves when work requires
exposure to potentially contaminated water.
WHAT TO DO:
1. Encourage members of the household within the catchment area located in flood-
prone areas to avoid swimming or wading in potentially contaminated waters.
2. Encourage members of the household within the catchment area to maintain good
environmental sanitation through regular cleaning and drainage of potentially
contaminated waters.
3. Immediately refer to the RHM or nearest facility if there are any of the danger signs of
severe leptospirosis infection:
Yellowish body discoloration
Dark-colored urine and light stools
Low urine output
Severe headache
MALARIA
Malaria is a communicable disease caused by a protozoan parasite called
Plasmodium which is both preventable and curable. It is transmitted through the bite of an
infected Anopheles sp. mosquito.
WHAT TO SAY:
What is malaria?
Malaria is sometimes a fatal communicable disease, caused by a protozoan parasite
called Plasmodium. It is transmitted through the bite of an infected Anopheles sp.
mosquito.
What are the usual signs and symptoms of malaria?
o Chills
o High-grade fever with or without joint pains
o Severe headache
o Vomiting
o Body malaise
o Profuse sweating
Consult the nearest RHM or health facility if there are any of the signs of possible
malaria infection as soon as possible.
Malaria can be prevented through any of the following:
o Use mosquito nets that are preferably treated with long-lasting insecticide
o Wear protective clothing such as long sleeves and long pants if staying outdoors at
night in endemic areas (e.g., Palawan)
o Regularly search and destroy potential breeding sites of Anopheles mosquitoes (e.g.,
old tires)
o Place screens on doors and windows
Local or international travellers should take prophylactic anti-malarial drugs when
travelling to endemic areas and use insect repellents or lotion.
WHAT TO DO:
1. Encourage members of the household within the catchment area to maintain good
environmental sanitation through regular cleaning and drainage of potential breeding
sites of Anopheles sp. mosquitoes.
2. Encourage and assist members of the household suspected of having malaria to seek
medical consultation, as early as possible, when there are any of the signs and
symptoms of malaria:
Chills
High-grade fever with or without joint pains
Severe headache
Vomiting
Body malaise
Profuse sweating
3. Conduct follow-up visits to those who have been adequately diagnosed to have malaria
to ensure good compliance to prescribed medications.
RABIES
Rabies is a deadly viral infection that is PREVENTABLE but NOT CURABLE once
symptoms have already started.
WHAT TO SAY:
What is Rabies?
Rabies is a deadly viral infection that is spread by infected animals such as dogs, cats,
or bats. It is transmitted through direct contact with infected saliva of a rabid animal from
bites or scratches.
What are the usual signs and symptoms of Rabies?

o Fever and headache
o Pain or numbness of bite site
o Pain or difficulty in swallowing
o Fear of looking at water (hydrophobia)
o Fear of air (aerophobia)
o A lot of thick, sticky saliva dripping from the mouth
o Delirium and paralysis in severe cases
Rabies cannot be treated.
The only way to prevent rabies infection is to be vaccinated.
Post-exposure prophylaxis (PEP) must begin immediately after the biting incident to
prevent the onset of symptoms and death. PEP consists of local treatment of: the wound
right after rabies exposure; a course of potent and effective rabies vaccine; and, the
administration of rabies immunoglobulin, if indicated.
Pre-exposure and post-exposure anti-rabies vaccines are available at the animal bite
treatment centers.
What is the first-aid management for animal bites?
For any incidence of animal bites, wash the wound immediately with soap and running
water for at least 10 minutes. DO NOT apply garlic or tandok on the site of bite to avoid
contamination and further complications. DO NOT bleed the area of the wound.
Go to the nearest animal bite treatment center or health facility for proper
management.
What should pet owners do?
For pet owners:
o Have your pet vaccinated by a veterinarian at 3 months old and every year
thereafter, or during mass vaccination of pets scheduled in your community
o If your pet has bitten any person:
Leash your pet or put it in its cage
Observe for 14 days for possible signs of rabies
DO NOT kill or eat the dog
Assist the bitten victim to the nearest animal bite and treatment center for proper
post-exposure anti-rabies vaccination
Report to the animal bite treatment center or health facility where the post-
exposure anti-rabies vaccination was given when:
- Pet becomes wild
- Pet drools
- Pet bites any moving or non-moving objects
- Pet does not eat or drink
- Pet dies within the observation period
WHAT TO DO:
1. When presented with patients with animal bites, advise family members to:
Go to the nearest health facility or animal bite treatment center to have the victim
vaccinated against rabies immediately
Wash the wound with clean soap and water only
Not bleed the area of the wound
Observe the biting animal for 14 days
NEVER kill or eat the biting animal
2. Update and inform the community if there are any mass vaccination activities for animals
against anti-rabies.
SCHISTOSOMIASIS
Schistosomiasis is a parasitic infestation that affects the liver, central nervous
system, or other organs where eggs of Schistosoma japonicum get lodged. Its symptoms
depend on the type of species the person is infected with.
WHAT TO SAY:
What is schistosomiasis?
Schistosomiasis is a disease caused by a blood fluke/parasite called Schistosoma

japonicum. It is transmitted through skin penetration while bathing or swimming in
freshwater, infested with an infected snail; the snail serves as the intermediate host of
schistosomiasis. Freshwater is contaminated when an infected person either urinates or
defecates in the water.
What are the usual signs and symptoms of schistosomiasis?
o Abdominal pain
o Fever
o Loose bowel movement
o Bloody stool
o Bulging of the abdomen
Go to the nearest RHM or health facility if there are any of the usual signs and
symptoms of schistosomiasis.
NEVER self-medicate with antibiotics, to prevent complications.

Personal protective equipments such as boots and gloves should be used by farmers or
other workers whose work requires exposure to freshwater areas.
Proper environmental sanitation (e.g., use of sanitary toilets) is still the most practical
method to prevent its spread.
WHAT TO DO:
1. Using the latest forms for environmental sanitation, gather the following data within
your designated household catchment areas:
a. Name of members of the household catchment area

b. Presence and use of sanitary toilets, if any
2. Refer and assist members of the household catchment area who are suspected to have
schistosomiasis infection to the RHM, or nearest health facility, for proper evaluation
and management.
3. Encourage members of the HH to regularly practice proper environmental sanitation

(e.g., use of sanitary toilets, proper waste disposal).
4. Conduct regular follow-up visits to patients who are properly diagnosed to have
schistosomiasis to ensure their compliance to prescribed medications.
TUBERCULOSIS (TB)
TB is an infectious disease that primarily affects the lungs; this is commonly known
as pulmonary TB. TB may also affect other parts of the body such as the bones, brain; in
such cases, this is referred to as extra-pulmonary TB. It is curable AND preventable.
ROLE OF THE BHW:

Under the National Tuberculosis Program (NTP), adequately trained BHWs are
expected to identify and record presumptive TB patients within their household
catchment areas and act as treatment partners. They are not expected to
comprehensively discuss tuberculosis and its treatment modalities.
WHAT TO SAY:
What is TB?
TB is a disease caused by Mycobacterium bacilli acquired through inhalation of the air
droplets when an infected person coughs, sneezes, or spits in public areas.
What are the usual signs and symptoms of TB?
The usual signs and symptoms of presumptive TB patients include the following:
o Cough for 2 weeks or more
o Afternoon Fever
o Chest or back pain not referable to other diseases
o Loss of weight
o Lack of appetite
o Blood-streaked sputum
Continuing spread of TB may be controlled through:

o BCG vaccination of newborns
o Active community participation:
Avoid spitting in public areas
Cover mouth when sneezing or coughing within or outside their household
Referral of presumptive TB patients to trained health workers
o Completion of treatment modality
WHAT TO DO:
1. Using the latest family profiling form for TB, gather the following data:
a. Name and age of the presumptive TB patient
b. Number of members in the household
c. Past medical history of TB infection, if any
d. Previous history of compliance on TB medications, if any
2. Refer presumptive TB patients to the RHM or nearest health facility for proper
evaluation and management if there is note of any of the following:
a. Cough for 2 weeks or more
b. Fever
c. Chest or back pain not referable to other diseases
d. Loss of weight
e. Blood-streaked sputum
3. Presumptive TB is a condition in a patient who presents with symptoms or signs
suggestive of TB (previously called a TB suspect).
4. Ideally, there should be 3 sputum specimens collected (on the spot, early morning and
another on the spot). However, if the presumptive TB patient resides in geographically
isolated and depressed areas, the BHW should collect an early morning sputum, label
its container with name, age, address and date, and submit to the RHM or health center
if feasible, at the earliest possible time.
5. For those BHWs who already have confirmed TB patients within their catchment areas,
they should:
As a treatment partner, fill-up the NTP ID card and regularly visit the TB patient to
ensure compliance with medications
Refer the TB patient for any adverse reactions, if any (e.g., joint pains)
Constantly remind patient of his/her scheduled sputum follow-up and assist, if
necessary
Encourage family members to support the TB patient to ensure completion of
treatment modality required
Constantly provide health education to family members and the TB patient
himself/herself (e.g., stop smoking; cover mouth when coughing and sneezing)
If there are family members who are less than 5 yrs of age, encourage the family to
have newborns vaccinated with, or have children < 5 yrs old tested with PPD
6. ALWAYS ENSURE confidentiality of information of your TB patients, whether they are
presumptive or confirmed cases.
TYPHOID FEVER
Typhoid fever is a water and food-borne disease that is also known as enteric fever.
It can only spread in environments where human feces and urine can come in contact with
food or drinking water.x
WHAT TO SAY:
What is typhoid fever?
Typhoid fever is a bacterial infection caused by Salmonella typhi. It is transmitted

through ingestion of contaminated food and water.
What are the usual signs and symptoms of typhoid?
The usual signs and symptoms may include any of the following:
o High-grade fever
o Headache
o Body malaise
o Loss of appetite
o Either diarrhea or constipation
o Abdominal discomfort
Go to the RHM or nearest health facility if high-grade fever is persistent despite

increased oral fluid intake and Paracetamol intake.
Proper hand washing technique is still the best form of preventing its spread.
WHAT TO DO:
Name of members of the household catchment area
Presence and use of sanitary toilets, if any
2. Refer and assist members of the household catchment area to the RHM or nearest
health facility when there are any of the signs and symptoms of typhoid infection.
3. Encourage members of the household to regularly practice proper environmental

sanitation (e.g., use of sanitary toilets, proper waste disposal and proper handwashing
after using the toilet), before preparing or cooking food and before eating.
NON-COMMUNICABLE DISEASES
Lifestyle related or non-communicable diseases (NCDs) are considered a major
public health concern worldwide. Discussions on this section will only include common non-
communicable diseases such as Breast Cancer, Cervical Cancer, Lung Cancer, Prostate
Cancer, Chronic Obstructive Pulmonary Disease (COPD), Diabetes and Hypertension.
ROLE OF THE BHW
Under the NCD program of the DOH, adequately trained BHWs are expected to
identify and record the eligible population of their household catchment areas who
are at risk against the common types of NCDs. They are also expected to assist the
RHMs in providing adequate information and education campaigns on lifestyle-related
diseases. They are not expected to comprehensively discuss the different types of
NCDs and its treatment modalities.
BREAST CANCER
Breast cancer is multifactorial in nature. Men can also develop breast cancer.
WHAT TO SAY:
What is Breast Cancer?ix
Breast Cancer is a cancer that starts from the cells of the breast.
What are the risk factors for Breast Cancer?
Risk factors include any of the following:
o Family history of cancer

o Obesity
o High fat diet
o Smoking and drinking
o Women who are > 30 yrs old and above during their first pregnancy or those who
never had any children
What are the usual signs and symptoms of breast cancer?
o Lump or swelling of the breast

o Skin dimpling on the area of the breast
o Retraction of the nipple
o A sore or wound in the nipple
Go to the nearest RHM or health facility for proper evaluation and management of any
lump or swelling or discharge in the nipple.
Regular breast self-examination after menstruation is one of the key factors for early
detection of breast cancer. These are few steps you can follow to perform a basic self
examination (See Fig. 6):
a. In a clockwise direction, move 3 fingers of your left hand in a downward and

upward motion over your right breast while the right arm is raised over your
head
b. Check for any lump or thickening around your breast
c. Repeat the cycle in three circles and then check the other breast in the same
manner
d. Gently press your nipple and note if there is any pus or discharge
e. Other techniques may also be performed (See Fig. 6)
Regular exercise and healthy eating habits rich in fiber minimizes the risk for breast
cancer.
Source: magazine.raghunter.com
Figure 6. Self-Breast Examination
Source: magazine.raghunter.com
WHAT TO DO:
1. Using the latest family profiling form for Reproductive Health, gather the following data
within your designated household catchment areas:
a. Name and age of Women of Reproductive Age (WRA)

b. Age of menarche
c. Family history of breast cancer
2. Encourage members of the household in the eligible population to regularly conduct

breast self-examination either while taking a shower, lying-down or sitting
3. Encourage members of the household 30 yrs or older to undergo mammography when

there are any lumps in the breast
CERVICAL CANCER
ROLE OF THE BHW:
Under the Cervical Screening Program, adequately trained BHWs are expected to
identify and record the eligible population of their household catchment areas who
belong to WRA, at risk of cervical cancer. They are not expected to be able to
comprehensively discuss cervical cancer to the eligible population.
WHAT TO SAY:
Using the latest IEC materials for Cervical Cancer Screening, the BHWs may discuss
the following:
1. Cervical cancer is the second leading cause of death among WRA but can be cured as long
as it is detected early.
2. It is caused by an infectious agent, known as human papillomavirus (HPV), usually

transmitted through sexual intercourse with multiple sexual partners or whose sexual
partners have several sexual partners or among those who have had sexual intercourse at
an early age (15 or 16 yrs old).
3. The signs and symptoms of cervical cancer usually manifest only during the advance stage
of the disease. It is generally asymptomatic.
4. The most reliable and practical way to detect cervical cancer is through a Pap smear
which should regularly be done among:
a. Those who have their first intercourse at an early age (3 yrs after the first vaginal
intercourse but not done among those less than 21 yrs old)
b. Those who have multiple sex partners or whose partners have multiple sexual
partners
c. Those who have been in long-term use of oral contraceptives
d. Smokers
e. WRA with HIV infection
f. WRA 35 yrs old and above with or without sexual intercourse
5. If the Pap smear is negative for 3 consecutive years, it is advised that it should be
repeated after every 2 or 3 years.
WHAT TO DO:
1. Using the latest family profiling form for Cervical Cancer Screening, the BHWs should
have a masterlist/record of the ff. within their designated household catchment areas:
a. Name and age of all WRA in the household
b. Number of pregnancies, if any
c. FP method practiced, if any, and for how long
Sexual history is a sensitive topic and is best discussed during FP or STI-HIV

counselling by adequately trained health personnel.
2. Refer WRA who present with signs and symptoms of unusual vaginal bleeding, with or
without unpleasant vaginal discharge, to the RHMs or the nearest health facility for
further evaluation and management.
LUNG CANCER
Lung cancer is almost always due to the delayed effect of smoking. It is still the top
leading cancer among men and ranks 3rd among women.
WHAT TO SAY:
What is lung cancer?
Lung cancer is one of the common health risks associated with smoking, whether
voluntarily or involuntarily (e.g., second hand smoke).
What are the risk factors for lung cancer?
Risk factors may include any of the following:

o Smoking
o Second hand smoking or passive smoking
o Air pollution
What are the usual signs and symptoms of lung cancer?
o Persistent dry cough that gets worse over time

o Constant chest pain
o Shortness of breath, wheezing or hoarseness
o Difficulty of breathing
o Weight loss
o Easy fatigability
Go to the nearest RHM or health facility when there are any of the signs and
symptoms of lung cancer, for proper evaluation and management
Best and only way to prevent lung cancer is to stop smoking or avoid second hand
smoke.
Regular exercise and healthy eating habits minimizes the risk for lung cancer.
WHAT TO DO:
1. Using the latest family profiling form for non-communicable diseases, gather the
following data within your designated household catchment areas:
a. Name and age of household members

b. Family history of lung cancer, if any
c. Note of any of the signs and symptoms of lung cancer, if any
2. Encourage members to exercise regularly, avoid smoking and intake of alcoholic

beverages, and eat nutrient-rich foods to minimize the risk for lung cancer
3. For BHWs who already have patients properly diagnosed with lung cancer within their
catchment areas, they should:
Constantly remind patients to have regular follow-up check-up

Constantly remind patients to comply with medications given
NEVER self-medicate
PROSTATE CANCER
Prostate cancer is the 4th leading cancer in men, but the cause is still unknown.ix
WHAT TO SAY:
What is Prostate Cancer?
Prostate cancer is the most common type of cancer among Filipino men > 50 yrs old.
It is multifactorial in nature.
What are the risk factors for prostate cancer?
Risk factors may include any of the following:
o Age > 50
o Family history of prostate cancer
o High fat diet
o High intake of calcium
What are the usual signs and symptoms of Prostate Cancer?
The usual signs and symptoms may include any of the following:
o Difficulty in urinating
o Blood in the urine
o Blood in the semen
o Discomfort in the pelvic area
Go to the nearest RHM or health facility when there is note of any of the signs and
symptoms of prostate cancer, for proper evaluation and management.
Eat a balanced diet and avoid too much alcohol intake.
NEVER self-medicate to avoid possibility of missing early detection of prostate

cancer among high-risk individuals.
Regular exercise and healthy eating habits minimize the risk for prostate cancer.
WHAT TO DO:
1. Using the latest family profiling form for non-communicable diseases, gather the

b. Family history of prostate cancer, if any
c. Note of any of the signs and symptoms of prostate cancer, if any
2. Encourage members to exercise regularly, avoid smoking and intake of alcoholic

beverages and eat nutrient-rich foods to minimize risk for prostate cancer.
3. For those BHWs who already have patients properly diagnosed with prostate cancer
within their catchment areas, they should:
Constantly remind patient to have a regular follow-up check-ups

Constantly remind patient to religiously comply with medications given
NEVER self-medicate
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)

COPD is a life-threatening lung disease that leads to breathing-related problems. It is
NOT curable. Current medications available can only control its symptoms and improve
quality of life.
ROLE OF THE BHW:
Under the Lifestyle Related Program, adequately trained BHWs are expected to
identify and record the eligible population of their household catchment areas who are at
higher risk of having COPD. They are not expected to comprehensively discuss the
disease to the eligible population.
WHAT TO SAY:
What is COPD?ix
COPD is a life-threatening lung disease, usually affecting those who are > 40 yrs old,
that is NON-INFECTIOUS. The 2 most common types are emphysema and chronic
bronchitis.
What are the risk factors for COPD?
Risk factors include any of the following:

o Tobacco smoking
o Indoor and outdoor air pollution
o Occupational dusts and chemicals
What are the usual signs and symptoms of COPD?
Both emphysema and chronic bronchitis have symptoms of breathlessness and chronic
cough.
Cough with phlegm is more commonly seen in chronic bronchitis, while wheezing is
more prominent in emphysema.
Not all wheezing is caused by asthma.
Quit smoking or avoid second-hand smoke.
Wear proper face masks if your work will require exposure to dusts and chemicals.
Influenza and pneumococcal vaccination will help in decreasing the risk of acquiring
respiratory infections.
NEVER self-medicate with antibiotics to prevent further complications.
WHAT TO DO:
1. Using the latest family profiling form for lung diseases (e.g., TB and asthma), gather the
a. Name and age of all members in the household

b. History of tobacco smoking or exposure
c. Exposure to indoor air pollution
d. History of exposure to occupational dusts and chemicals
2. For those BHWs who already have COPD patients within their catchment areas, they
should:
Encourage the patient and household members to stop smoking.
Encourage the patient and household members to lessen or minimize indoor air
pollution (e.g., use indoor plants that absorb carbon monoxide or avoid burning of
solid fuels for indoor heating).
3. Refer household members who present with cough for more than 2 weeks to the RHMs
or the nearest health facility for further evaluation and adequate management.
DIABETES
Diabetes is a group of metabolic disorders characterized by high blood sugar levels
on 2 separate occasions.xi
WHAT TO SAY:
What is diabetes?
Diabetes results when the body cannot properly regulate the amount of sugar (e.g.,
glucose in the blood).
There are 4 clinical types of diabetesxii
o Type 1
these refer to insulin dependent diabetics.
o Type 2
these refer to those who can be managed through oral anti-diabetic medications
but may eventually also require insulin treatment to attain good blood glucose
control.
o Gestational diabetes
refer to diabetics who were first diagnosed to have diabetes during pregnancy.
o Secondary diabetes
refer to those who have acquired diabetes that may be drug or chemical-induced
such as those who are being treated for AIDS; or from other endocrine diseases such
as hyperthyroidism.
What are the risk factors for diabetes?
High blood pressure

High triglyceride levels
Giving birth to an 8-lb baby
Sedentary lifestyle
Obesity
Family history of type 2 diabetes mellitus among first degree relatives
What are the usual signs and symptoms of diabetes?
Fatigue
Unexplained weight loss
Excessive thirst
Excessive hunger
Excessive urination
Poor wound healing
If you know anyone within your household who may have the signs and symptoms of
diabetes, do not hesitate to consult anyone of us in the health facility. Early detection
is an important factor for preventing further complications.

Diabetes is a lifestyle-related disease which can be prevented through regular exercise
(at least 30 minutes every other day) and eating a heart healthy diet (i.e., low-salt,
low-fat diet).
Excessive alcohol consumption and cigarette smoking also increases the likelihood of
diabetes.
WHAT TO DO:
1. Using the latest Non-Communicable Disease Risk Assessment Form for non-
communicable diseases, gather the following data:
b. Past medical history of diabetes, if any
c. Family history of diabetes, if any
d. Personal and social history of tobacco smoking; alcohol intake; high-fat, high-salt
intake and physical activity, if any
e. Any of the signs and symptoms of diabetes
2. Refer members of the household catchment area who is suspected of having diabetes
when there are any of the following signs and symptoms:
o Fatigue
o Unexplained weight loss
o Excessive thirst
o Excessive hunger
o Excessive urination
o Poor wound healing
All pregnant women are advised to undergo screening for gestational diabetes
at their first prenatal visit.
3. Encourage members to exercise regularly and eat nutrient-rich foods to minimize risk
for diabetes.
4. For those BHWs who already have diabetic patients within their catchment areas, they
should:
Constantly remind patient to have a regular follow-up check-ups and monitoring of
glucose levels
Constantly remind patient to religiously comply with medications given to prevent
complications
NEVER self-medicate
Constantly remind patient to regularly inspect both feet to immediately identify any
ulcers or wounds which may not have been felt (because there is loss of sensation)
Regularly exercise and eat nutrient-rich foods
5. Assist in the risk assessment of clients using the Philippine package of essential non-
communicable disease intervention for primary care.
HYPERTENSION
Hypertension is an increase in blood pressure > 140/90mmHgxiii in 2 or more
occasions. It is one of the leading causes of disability among Filipinos due to stroke.
WHAT TO SAY:
What is hypertension?
Hypertension is an increase in blood pressure > 140/90mmHg in two (2) or more

separate occasions. It is one of the leading causes of disability among Filipinos due
to stroke.
Table 5. Classification of blood pressure for adultsxiii

BLOOD PRESSURE SYSTOLIC BP DIASTOLIC BP
CLASSIFICATION
Normal Less than 120 mmHg Less than 80 mmHg
Prehypertension 120-139 mmHg 80-89 mmHg
Stage 1 Hypertension 140-159 mmHg 90-99 mmHg
Stage 2 Hypertension 160 mmHg or higher 100 mmHg or higher

What are the risk factors for hypertension?
Smoking
Excessive alcohol consumption
Overweight
Family history of hypertension, heart disease, diabetes and kidney disease
Sedentary lifestyle
Chronic stress
Advancing age
What are the usual signs and symptoms of hypertension?
Not all hypertensive patients have symptoms, but the usual signs and symptoms are:
o Headache
o Dizziness
o Blurring of vision
o Nape/neck discomfort
If you know anyone within your household who may have the signs and symptoms of
hypertension, do not hesitate to consult anyone of us in the health facility. Early
detection is an important factor for preventing further complications.
What are the possible complications of hypertension?
Chronic, undiagnosed and untreated hypertension may result to:

o Heart attack
o Stroke
o Kidney failure
o Loss of vision
o Hypertension is a lifestyle-related disease which can be prevented through regular

exercise and eating a heart healthy diet (i.e., low-salt, low-fat diet).
Excessive alcohol consumption and cigarette smoking also increases the likelihood of
hypertension.
WHAT TO DO:
1. Using the latest NonCommunicable Disease Risk Assessment Form for non-
communicable diseases, gather the following data:
b. Past medical history of hypertension, if any
c. Family history of hypertension, if any
d. Personal and social history of tobacco smoking, alcohol intake, high-fat, high-salt
intake and physical activity, if any
e. Any of the signs and symptoms of hypertension
2. Not all hypertensive patients have symptoms, but refer members of the household
catchment area who are suspected of having hypertension (BP is 140/90 mmHg or
higher) PLUS any of the following signs and symptoms:
Headache
Dizziness
Blurring of vision
Nape/neck discomfort
3. Encourage members to exercise regularly, avoid smoking and excessive intake of
alcoholic beverages, and eat nutrient-rich foods, to minimize risk for hypertension.
4. Encourage lifestyle modification techniques to prevent and manage hypertension.
Table 6. Lifestyle modifications to prevent and manage hypertensionxiii
LIFESTYLE RECOMMENDATION APPROXIMATE
MODIFICATIONS SYSTOLIC BP
REDUCTION
Weight reduction Maintain normal body weight 5-20 mmHg
Adopt DASH* eating Consume a diet rich in fruits, vegetables and 8-14 mmHg
plan (Dietary Approach low fat dairy products
to Stop Hypertension)
Dietary sodium (salt) Reduce dietary sodium intake 2-8 mmHg

restriction
Engage in regular aerobic physical activity such 4-9 mmHg

Physical activity as brisk walking (at least 30 min per day, most
days of the week)
Limit consumption to no more than 2 drinks per 2-4 mmHg

Moderation of alcohol
day in most men, and not more than 1 drink
consumption
per day in women and lighter weight persons
5. For BHWs who already have hypertensive patients within their catchment areas, they
should:
a. Constantly remind patient to have a regular follow-up check-ups and monitoring of
blood pressure levels
b. For adequately trained BHWs, take the blood pressure of hypertensive patients
during your household visits
c. Constantly remind patient to religiously comply with medications given to prevent
complications
d. NEVER take anti-hypertensive drugs without a doctors prescription
e. Regularly exercise and eat nutrient-rich foods
6. Refer and assist the patient with high blood pressure (140/90mmHg or higher) to the
nearest RHM or health facility for proper evaluation and management.
7. Assist in the risk assessment of clients using the Philippine package of essential non-
communicable disease intervention for primary care.
H. ELDERLY
This phase of the life-cycle approach cover some DOH programs that the elderly (60
yrs of age or older) can avail, particularly on the following: a) vaccines for the senior
citizens/elderly; and, b) 20% discount for senior citizens on health related goods.
VACCINES FOR THE ELDERLY

Vaccines among those who are 60 years old and above are available in private clinics,
government and private hospitals. Discussions in this section include Influenza vaccine and
Pneumococcal vaccinations.
ROLE OF THE BHW:

As part of the BHWs role as an educator, linker and record keeper, they are
expected to assist RHMs in educating their respective HH catchment areas on the
importance of vaccines for the elderly and where it can be availed. They are not expected
to be able to comprehensively discuss the different types of adult immunization among
the elderly.
WHAT TO SAY:
What are the DOH vaccines available for the elderly?xiv
Pneumococcal vaccines and influenza vaccines are given FOR FREE AS SINGLE DOSE to
all indigent senior citizens
Who are qualified to avail of these vaccines?
These vaccines shall cover all indigent senior citizens 60 years old and above, living in:
o RESIDENTIAL CARE FACILITIES for INDIGENT senior citizens
o In the community BASED ON THE NATIONAL HOUSEHOLD TARGETING SYSTEM
FOR POVERTY REDUCTION list of the DSWD
An indigent senior citizen who has received a PNEUMOCOCCAL vaccine in the

LAST 5 YEARS and was less than 60 years of age at the time of immunization
should receive another dose of pneumococcal vaccine.
An indigent senior citizen who has received a pneumococcal vaccine when

he/she was 60 years old and above at the time of immunization is NOT
required to receive another dose of pneumococcal vaccine.
What is meant by a residential care facility?
It refers to a DSWD accredited-facility that provides 24-hour residential care services
operated for the purpose of promoting the well-being of abandoned, neglected,
unattached or homeless senior citizens.
Where are these vaccines available?
It is available in designated city/municipal health centers, government run residential
facilities and DSWD-accredited non-governmental home care facilities for senior
citizens.
Only health workers trained and skilled at adjusting vaccines are authorized
by the DOH to give immunizations.
WHAT TO DO:
1. Using the latest masterlist of Indigent Senior Citizens 60 years old and above, assist the
RHMs in annually updating the following data in your designated HH catchment area:
a. Name, sex, address and date of birth of the senior citizen
b. Office for Senior Citizens Affair ID and date of registration
c. Pneumococcal and Influenza vaccine received, if any
2. Regularly update the target beneficiaries when, where, and what to do for the
scheduled immunization activity.
20% SENIOR CITIZEN DISCOUNT ON HEALTH RELATED GOODS AND SERVICES

The Expanded Senior Citizens Act of 2010 apply to ALL hospitals and health-related
facilities from the government and private sectors, the health care professionals and other
related health care facilities and services and drug stores, hospital pharmacies and similar
establishment dispensing medicines and medical devices.xv
ROLE OF THE BHW:

As a linker to all health-related services provided within their community, BHWs
are expected to discuss the basic concepts in availing the 20% senior citizens discount
on health related goods and services. They are not expected to comprehensively discuss
the entire Expanded Senior Citizens Act, which is already a function of the point person
in their respective Senior Citizens Association.
WHAT TO SAY:
Who are qualified to avail of the 20% senior citizens discount?
All Filipino citizens who are residents of the Philippines and 60 years old and above
All senior citizens with dual citizenship, provided they prove their Filipino citizenship
AND they have been residents for at least 6 months in the Philippines
All senior citizens who are recipients of the DSWD NHTS-PR program
What are the necessary documents needed to avail of the 20% discount?
1. Any document or proof of being a senior citizen shall suffice, namely:
ID issued by the city or municipal mayor or Office of Senior Citizens Affairs or of the
barangay captain of the place where the senior citizen or the elderly resides;
The passport of the elderly person or senior citizen concerned; and,
Other government issued certificates which may include any of the following:
o Birth certificate
o Voters ID
2. EXCEPT for over the counter drugs such as paracetamol, a doctors prescription shall be
presented having the following information:
Name, age, sex, and address of the senior citizen
Date of consultation
Generic name of the medicine, dosage form, dosage strength, quantity
Name and signature, address, professional license number and S2 license number,
if applicable, of the prescribing physician
3. Purchase slip booklets

What are the health-related goods and services that are included?
1. Medical and dental services
2. Diagnostic and laboratory services (e.g., x-rays, CT scan, blood tests, hemodialysis)
3. Professional fees of attending physicians and other health professionals confined in pay
sections provided the confinement are in accordance with available clinical practice
guidelines or hospital treatment protocols
4. All medical devices (e.g., supplies, kits used or consumed during check-up or
confinement) regardless of the number of days
5. All medical devices to be used during the recovery at home, or for monitoring of a
particular ailment or disease (e.g., glucometer set including lancets and test strips,
insulin syringe and needle, blood pressure apparatus, wheelchair) provided that the
prescription for the use of a particular medical device shall be provided by the physician
The 20 % discount and VAT exemption shall apply only once for personal use of
senior citizen of non-disposable medical devices such as glucometer, blood
pressure apparatus, weighing scale.
What are NOT included?

Services that are not medically necessary for treatment and diagnosis. these include:
o Cosmetic surgery procedures
o Executive check-up packages
SPECIAL
HEALTH CONCERNS
IN THE COMMUNITY
A. ENVIRONMENTAL HEALTH
Climate change is a global concern because it causes flash floods, earthquakes and
super typhoons. Along with these effects are the continuing spread of diseases that arise
from contaminated air, soil and water. The climate changes because of our disregard of
environmental health.
Environmental health is the process of ensuring the health and safety of the
community through safe and accessible drinking water, clean toilets, proper waste disposal,
and food safety.
Ensuring adequate environmental protection requires proper waste disposal to
prevent air and water pollution; provision of safe drinking water to prevent the spread of
water-borne diseases; construction of sanitary toilets to prevent the spread of diseases
transmitted, and food safety measures to avoid contamination and food poisoning.
BHWs play a significant role in promoting environmental health by constantly
reminding members of his/her HH catchment areas of the importance of proper waste
disposal, provision of safe-drinking water, construction and use of sanitary toilets and food
safety.
PROPER WASTE DISPOSAL

Improper disposal of garbage in rivers, sapa, and canals can cause clogging and
encourages rats and insects that carry diseases. This can further lead to flooding and can
result to water contamination which can cause diarrhea, leptospirosis and amoebiasis.
WHAT TO DO:
1. Using the latest forms for environmental sanitation, gather the following data from
a. Name of members of the HH catchment area
b. What type of garbage materials are disposed
c. How are these garbage materials disposed
2. Encourage members of the HH to regularly practice proper waste disposal:

Throw garbage only on designated pick-up points/storage in the community for
garbage collection.
DO NOT burn waste products to prevent further damage to the ozone layer.
Burying biodegradable waste products within the backyard is an alternative way
of disposing garbage. It will at the same time serve as a fertilizer for organic
gardening.
Recycle non-biodegradable products such as plastic bottles, or sell them to junk
shops within the community.
DO NOT throw garbage in rivers or canals to prevent contamination of water.
3. Coordinate with barangay officials and local sanitary officer in promoting proper
waste disposal and to facilitate identification of HH without sanitary toilets, or if
there is possible water contamination within the HH catchment area.
PROVISION OF SAFE DRINKING WATER:

Safe water supply is important in disease prevention and for maintaining the health
of the community. Water sources and distribution must be protected to prevent
contamination through: a) leaking water pipes that are submerged in canals or stagnant
water; b) toilets built near the water sources; and, c) unclean water containers.
WHAT TO DO:
b. Source of drinking water
2. Encourage members of the household and barangay officials to regularly promote

safe water handling practices:
Regularly clean water containers at least once a week
Regularly clean water source at least every 6 months
Drink chlorinated/treated/boiled water only
Make sure that the water for drinking is safe:
a. Boil water from unsafe or doubtful sources
o Spring
o Rain water
o Other surfaces of water
o Unprotected wells
o Unprotected springs
b. Use clean, covered containers when collecting and transporting water
from source
c. If the container does not have any faucet, use a clean dipper to get water
d. DO NOT put hands or dirty cups into the water
3. Coordinate with barangay officials and the local sanitary officer to facilitate
identification of household with potentially contaminated water source, or if there is
possible water contamination within the household catchment area.
CONSTRUCTION AND USE OF SANITARY TOILETS:
Parasitism is common in communities with no toilet facilities. Construction and use
of sanitary toilets will minimize or address such problem.
WHAT TO DO:
b. Presence and use of sanitary toilets, if any
2. Encourage members of the household to regularly use sanitary toilets to prevent

parasitism which will aggravate malnutrition among children who are the most
vulnerable groups affected.
3. People should dispose their feces properly to prevent the spread of germs and
parasites that can cause diseases such as cholera, parasitism, and typhoid fever.
4. Unclean public toilets will also affect the entire community since it may potentially
contaminate nearby water sources. Its maintenance should therefore be considered
as a public health concern by the entire community.
5. Coordinate with barangay officials and local sanitary officer to facilitate identification
of household without sanitary toilets.
FOOD SAFETY
To prevent food and water-borne diseases, the following guidelines should be
considered:
1. Meat (pork, beef and chicken) must come from healthy animals and must have been
approved by the meat inspector
2. Fruits and vegetables must be fresh and washed with clean water
3. Fresh milk from cows, carabaos and other animals must be boiled before drinking
4. Fish and shellfish (oysters, mussels, clams) must come from clean sources
5. Food in plastic wrappers must be dry
6. Food must be carried in clean container and covered
7. Always take note of the expiry date when buying any type of food products
B. VIOLENCE AGAINST WOMEN AND CHILDREN
Reproductive health care also includes elimination of violence against women and
children and other forms of sexual and gender-based violencexvi which is currently
considered as the 5th leading cause of death among women of reproductive age; this is
secondary to unintended pregnancies, abortions and mental ill-health. xvi
Violence Against Women or Gender-Based Violence refers to all forms of violence,
whether mental, physical, or sexual.xvi
ROLE OF THE BHW:

Under the Anti-Violence against Women and Children Act, adequately trained
BHWs are expected to assist WRA who experience any form of violence. They are not
expected to be able to comprehensively discuss the different concepts on Violence
against Women and their Children.
WHAT TO SAY:
What are the different types of gender-based violence?
Violence against women does not only refer to physical or sexual violence.
Acts of withdrawing financial support to children or preventing women from engaging
in a legitimate profession is considered an economic abuse which is also a form of
violence against women.
Stalking, public ridicule or humiliation is considered psychological violence which is
another form of violence against women.
If there is anyone among the community, who knows someone who may be a victim of
violence against women and their children, it is best that they go to the nearest women
and child protection unit for proper counselling, or approach anyone among the health
facility who can assist you.
WHAT TO DO:
Whenever a BHW is approached by a victim of violence, domestic or non-domestic in
nature, it is best that the BHW assist the victim to the nearest women and child protection
unit within the community or municipality. If there is none available, referral and assistance
to the DSWD is also appropriate. Medical and psychological treatment is best given by
adequately trained professionals on anti-Violence Against Women and their Children.
C. DISASTER RISK REDUCTION AND MANAGEMENT
Disasters refer to situations brought about by flood, earthquake, typhoons, fire, or
armed conflict that may cause destruction of properties and loss of lives. In most cases,
national and local authorities will require mass evacuation and relief operations.
Disaster preparedness minimizes and effectively reduces destruction of properties
and loss of lives as well as prevent or control spread of contagious diseases commonly seen
in overcrowded and congested places. This chapter only discusses the general information
on what the BHWs should advocate during and after any disaster. For a more detailed
discussion on disaster risk reduction and management, please refer to Guide for
Community-Based Health Emergency Management Manual of DOH.
WHAT TO DO:
1. Using the latest family profiling forms and risk assessment forms for disaster
preparedness and management, gather the following data within your designated
household catchment areas:
b. Proximity to identified disaster prone areas within the community such as:
Low lying areas below sea level
Households near denuded mountains or garbage dumpsite
Households inside or near the earthquake fault line
Areas frequently visited by typhoons
2. Regularly coordinate with local officials to facilitate identification of potential

evacuation site/s of members of the household catchment area for ease of referral
and management once a disaster occurs. Include emergency hotline numbers and
point persons to contact
3. Regularly remind household members within your catchment areas what to do, for
incoming typhoons which will potentially affect the community:
Multimedia services (e.g., radio, television, internet) can be utilized for
announcements or news update
Prepare set of clothings, canned goods, rice, flashlight, fully charged batteries for
cellphones or emergency lights or radio and bottled drinking water
Prepare set of first-aid kit and medicines for fever, colds, wounds and diarrhea
Never panic. Anxiety and panic only adds problem to the current situation. It does
not provide any benefit
Go to the nearest BHW or other local officials designated to the household for
information on evacuation procedures, if necessary
4. Educate and regularly update the community on the following:
What to do during emergencies based on type of hazard
How, when and where to evacuate
What should be included in the family/household emergency kit
5. Advocate active community participation on drills and exercises like earthquake drills,
or fire drills
6. Advocate active community participation among HH heads on attending training on
Basic Life Support
7. Assist health workers at the evacuation center in the provision of public health care
and proper referral of patients
8. Act as Surveillance in Post Extreme Emergencies and Disasters reporter by reporting
diseases, injuries and other health trends through the Surveillance in Post Extreme
Emergencies and Disasters system, if applicable
FIRST-AID
TECHNIQUES FOR
COMMON
INJURIES AND
ILLNESSES
INTRODUCTION TO FIRST AID TECHNIQUES FOR COMMON INJURIES
AND ILLNESSES
As part of the community health team, adequately trained BHWs are also expected
to provide DOH-recognized first aid techniques within their respective HH catchment areas.
This chapter covers discussions on the first-aid methods that a BHW can provide while
waiting for health personnel or professionals to arrive or while in transit during actual
referral.
Common injuries and illnesses discussed are the following: benign febrile convulsion,
shock, loss of consciousness, drowning, poisoning, wounds, bleeding, suspected fractures
and dislocations, insect bites and stings, snake bites and the essential contents of a first aid
kit. In all emergencies, always call for help or ask a bystander to call for help before
starting first aid measures. Some of the fist aid measures require separate training such as
CPR or Cardiopulmonary Resuscitation given by trained licensed professionals.
A. BENIGN FEBRILE CONVULSION
Benign febrile convulsion present as generalized seizures secondary to high-grade

fever common among children < 6 yrs old. Persistent or recurrent seizure with or without
fever is no longer considered as benign febrile convulsion.
WHAT TO DO:
1. NEVER wrap a person with fever in several blankets since it will only increase his/her
body temperature and may result to convulsion.
2. NEVER attempt to stop or control the shaking movements.
3. Give a sponge bath by alternating use of clean cloth with cool water and dry clean
cloth, to prevent subsequent chilling episodes, until the temperature goes down to
normal.
4. Regularly check the body temperature of the patient while providing sponge bath to
monitor response to the sponge bath.
5. Encourage and assist family members to bring the patient to the nearest health
facility for adequate evaluation and management, most specially if the patient is a
child.
B. SHOCK
Shock is a serious and sometimes fatal condition where the blood circulating in the
body is not enough to meet the demands of the entire body.
WHAT TO DO:
1. Check the level of consciousness of the victim or patient
a. If the victim or patient is conscious, lay the patient or victim on his/her back with
his/her legs placed higher than the rest of his/her body; cover him/her with
blanket for comfort and check for other injuries.
b. If the victim or patient is unconscious, check for presence of heartbeat;
If present, lay the patient or victim on his/her back with his/her legs placed
higher than the rest of his/her body and check for other injuries
If there is no heartbeat, perform CPR only if you are properly trained
2. Check the blood pressure
a. Maintain the position of the victim if BP is > 90/60mmHg
b. If BP continues to go down, check for possible sites of bleeding. If victim is
bleeding, place direct pressure on the wound
3. Take an initial history to assist the health professionals in further assessing areas of
potential injuries.
C. LOSS OF CONSCIOUSNESS
Loss of consciousness is caused by a range of factors from injuries to the brain, to

injuries to the heart.
WHAT TO DO:
1. Remember to follow this sequence: C A B:
C for circulation
Are there any signs of bleeding?
o Apply direct pressure on the bleeding site, if any
Check the blood pressure
o If the BP is less than 90/60 mmHg, elevate the legs higher than the other
parts of the body and recheck BP
A for airway
Is the person breathing?
o Check for possible obstruction of airway from foreign objects and gently
remove, if there is any
B - for breathing
If the person is not breathing, perform CPR only if properly trained
D. DROWNING
Death caused by drowning is always due to lack of oxygen.
WHAT TO DO:
1. Check if the victim is breathing
If not, start mouth-to-mouth resuscitation, if properly trained, as soon as
possible.
If mouth-to-mouth resuscitation is not possible, place the victim on his/her side
with the head lower than the body and push the belly upwards to force the water
out .
2. Check if the victim has a heartbeat
If none, perform CPR if properly trained
3. Check for any other injuries
E. POISONING
Poisoning may either be voluntary (e.g., suicide attempts) or involuntary (e.g.,

inhalation of poisonous substances).
WHAT TO DO:
1. In all types of poisoning AND if the patient is conscious, give lots of water to drink.
2. Never ask the patient or victim to vomit if the suspected poison is a chemical
substance such as Lysol or ammonia, or when there are burn marks on the lips or
mouth.
3. Check for level of consciousness and vital signs.
4. Pesticide poisoning may present with frequent dizziness, headache and severe anemia.
5. Lead poisoning may present with loss of appetite and numbness.
F. WOUNDS
All types of wounds are potential entry points for infection. It is very important to
wash all types of wounds no matter how small its physical appearance may be, to prevent
infection.
WHAT TO DO:
1. Wash your own hands first with soap and water before touching the wound.
2. Clean the wound and the skin around it with bath soap and water to remove dirt, sand
or dried blood then apply betadine in a clockwise motion from the center of the
wound going out.
3. Cover the wound with a clean gauze or cloth.
4. If there are signs of infection (e.g., swelling, redness or heat), wash the wound with
warm water and guava decoction, a DOH-recognized medicinal plant for wounds,
gently removing the pus, if there is any.
5. Cover the wound with a loose bandage and refer immediately to the RHM or nearest
health facility for adequate management.
6. Wash your own hands again after providing first-aid.
G. BLEEDING
There are two types of bleeding which may be fatal because of too much blood loss.
1. External bleeding are those that can be seen from a wound or open fractures
2. Internal bleeding are those that can present as bloody discharge from the nose, ear,
vagina or anus, or may also present as dark, black (tarry) stools or dark brown vomitus
and requires immediate referral to the nearest hospital
WHAT TO DO:
1. Check the blood pressure (normal: from > 90/60 mmHg up to < 130/80 mmHg), pulse
rate (normal: 60-100 beats per minute) and respiratory rate (normal: 16-20 breaths
per minute) to immediately assess the possibility of shock. Cold, clammy perspiration
and changing levels of consciousness are indicative of an impending shock.
2. For external bleeding, elevate the area of the wound from the rest of the body and
apply direct pressure with a clean cloth or the palm of your hand on the wound until
the bleeding stops.
3. If the cloth is already soaked with blood, simply add another cloth on top of it. DO NOT
remove the soaked cloth.
4. If there is still bleeding, apply pressure on the pulse point above the wound. Pulse
points can be found in any of the following areas:
Neck
Armpit
Wrist
Groin
Leg
Foot
H. SUSPECTED FRACTURES AND DISLOCATIONS

Fractures refer to a break in any bone in the body, while dislocations refer to
displaced bones at a joint.
WHAT TO DO:
1. Apply a splint to keep joints above and below the fracture/dislocation site from
moving or stabilized.
Apply the splint on the site of injury
Do not move the fractured or dislocated limb while applying the splint
Any stick-like object or material can be used for splinting
2. If you suspect that there may be an injury to the back, neck, chest or pelvis, DO NOT
attempt to move the person.
3. A person who is suspected to have a fracture or dislocation must be brought as soon
as possible to the nearest health facility for proper evaluation and management. The
longer the delay in consultation, the more difficult it is to correct the injury.
4. NEVER massage any part of the body that is suspected to have a dislocation or fracture
to prevent further harm.
5. Follow-up visit to a patient with fracture or dislocation is important to ensure
compliance with prescribed medications and evaluate possible secondary infections or
complications.
6. Immediately refer the post-treated patient to the RHM or to the nearest health facility
when he/she complains of any of the following:
Inability to move fingers or toes
Bluish discoloration of fingers or toes
Foul-smelling discharge on the area of the fracture or dislocation
I. INSECT BITES AND STINGS
Bites from mosquitoes, ants and ticks may cause mild skin reactions, while bites from
bees may cause allergic responses.
WHAT TO DO:
1. Wash area with soap and water
2. Apply cold pack on the affected area to reduce pain and swelling
3. Refer the victim to the nearest health facility if there are signs and symptoms of
allergic reactions such as mild nausea, diarrhea or swelling larger than 2 inches in
diameter, for prompt evaluation and management
J. SNAKE BITES
Majority of snakes are NOT poisonous.
WHAT TO DO:
1. Lay the victim in a comfortable position
2. Immobilize the bitten limb with a splint
3. Reassure the victim who may be very anxious; anxiety hastens absorption of the
venom
4. Assist the victim to the nearest health facility for proper evaluation and management
or antivenom treatment if needed
DO NOT:
1. Use tourniquet
2. Use ice pack
3. Puncture, pinch, or scrape bitten area
4. Suck venom from the patients open wound
5. Elevate the wound at the same level or higher than the chest/heart area
K. BURN INJURIES
Burns are classified into first-degree, second-degree or third-degree. Only first
degree burns can be treated at home, EXCEPT if the victim is an infant or an elderly.
Second-degree and third-degree burns ALWAYS require medical attention of a trained
health personnel.
The usual signs and symptoms of First degree burns are:
Reddish, painful discoloration of skin
With or without mild swelling
Second degree burns present with:
Deep reddening of skin
Painful, with blisters
Glossy appearance from leaking fluid and possible loss of some skin
Third degree burns are often painless and possibly charred with patches that appear white,
brown, or black.
WHAT TO DO for FIRST-DEGREE burns:

a. Apply cool, wet compresses, or immerse in cool, fresh water. Continue until pain
subsides.
b. Cover with a sterile, non-adhesive bandage or clean cloth. DO NOT apply any
ointment or butter to prevent secondary forms of infection.
c. Over the counter pain medications (e.g., Paracetamol) may be used to relieve pain and
reduce inflammation.
L. ESSENTIAL CONTENTS OF THE FIRST AID KIT
Supplies/equipment
o Cotton o Bulb syringe
o Gauze o Thermometer
o Elastic bandage o Penlight
o Adhesive tape o Stethoscope
o 2 forceps o Blood pressure apparatus
o Scissor
Medicines
o Ammonia
o Antiseptic solution
Hydrogen peroxide
Povidone iodine
70% alcohol
o For pain and fever
Paracetamol
o Oresol packs
HERBAL
MEDICINES
Medicinal plants are an essential component of first-aid management most
especially among those who are located in geographically isolated and depressed areas.
This chapter covers discussions on the 10 medicinal plants recommended by the DOH
namely: Lagundi; Yerba Buena; Sambong; Tsaang Gubat; Ulasimang Bato or Pansit-pansitan;
Garlic, Niyog-niyogan; Guava; Akapulko; and, Ampalaya.
ROLE OF THE BHW

BHWs are expected to at least know the use of the medicinal plant and its right
dosing for the different age groups.
A. LAGUNDI
Lagundi is a shrub approximately 5 meters in height
which is used for cough.
How to prepare lagundi decoction:
Chop the leaves and place them in an earthen
jar according to the following amounts
corresponding to the age:
Figure 7. Lagundi
Table 6. Quantity of Lagundi for preparation of decoction:
AGE GROUP IF DRIED LEAVES IF FRESH LEAVES
Adult 4 tbsp 6 tbsp
7-12 yrs 2 tbsp 3 tbsp

* tbsp - tablespoon
Pour in 2 glasses of water and cover

Bring the mixture to a boil
Remove the cover and let it continue to boil for 15 minutes or until one glass of
decoction is left
Let it cool, and then strain the mixture
Divide the decoction into 3 parts:
o For cough, drink 1 part 3 times a day
B. YERBA BUENA
Yerba buena is a creeping plant with rough and wrinkled leaves. It is used to treat body
pains as a decoction (similar in preparation to Lagundi decoction), or as crushed the fresh
leaves placed directly over the affected site. DO NOT give to children less than 7 yrs of age.
Figure 8. Yerba Buena
How to prepare yerba buena decoction:

Chop the leaves and place them in an earthen jar according to the following amounts
Table 7. Quantity of Yerba Buena for preparation of decoction:
Adult 4 tbsp 6 tbsp

Remove the cover and let it continue to boil for - 15 minutes
Divide the decoction into 2 parts and drink 1 part 3 times a day
C. SAMBONG
Sambong has rough leaves and grows 2 to 3 meters in height. It is used for kidney stones as
a decoction (similar in preparation to Lagundi decoction). DO NOT give to children less than
7 yrs of age.
Figure 9. Sambong
How to prepare sambong decoction:

Chop the leaves and place them in an earthen jar according to the following amounts
Table 8. Quantity of Sambong for preparation of decoction:
Adult 4 tablespoon (tbsp) 6 tbsp

Remove the cover and let it continue to boil for 15 minutes or until 1 glass of
decoction is left
Divide the decoction into 3 parts and drink 1 part 3 times a day
D. TSAANG GUBAT
Tsaang gubat is a shrub about 5 meters in height.

It is used for stomach ache as a decoction.
DO NOT give to children less than 7 yrs of age.
How to prepare tsaang gubat decoction:

Chop the leaves and place them in an
earthen jar according to the following
amounts corresponding to the age: Figure 10. Tsaang Gubat
Table 9. Quantity of Tsaang Gubat for preparation of decoction:
Adult 2 tbsp 3 tbsp
Pour in 1 glass of water and cover

Remove the cover and let it continue to boil for 15 minutes or until glass decoction
is left
Take the decoction
E. ULASIMANG BATO or PANSIT-PANSITAN:
Ulasimang Bato is a plant that grows 40 centimeters

in height and is usually seen during rainy seasons. It
is used to lower uric acid level.
There are 2 ways to prepare and take it:

Prepare 1-2 cups of fresh leaves and
Figure 11. Ulasimang Bato leaves
chew 3 times a day; or
Prepare and take a decoction:
Put 1-2 cups of fresh leaves in an earthen jar
o Pour in 2 glasses of water and cover
o Bring the mixture to a boil
o Remove the cover and let it continue to boil until the 2 glassfuls of water originally
poured has been reduced to 1 glassful
o Let it cool, and strain the mixture
o Divide the decoction into 3 parts and drink 1 part 3 times a day, after meals
F. GARLIC
Garlic is a popular medicinal plant to help control and decrease cholesterol level. Eat 2
cloves of garlic together with each meal.
Figure 12. Garlic cloves

G. NIYOG-NIYOGAN
Niyog-niyogan is a shrub about 8 meters in height

with hairy leaves that give a rusty color. It is used
for deworming ascaris. DO NOT give to children
less than 4 yrs of age.
2 hours after dinner, chew and swallow only
dried seeds according to the following
measurement, then drink water.
Figure 13. Niyog-niyogan leaves
Table 10. Quantity of Niyog-niyogan seeds for consumption:
AGE GROUP DRIED SEEDS
Adults 8-10
9-12 yrs 6-7
6-8 yrs 5-6
4-5 yrs 4-5
H. GUAVA
Guava is a popular medicinal plant for cleansing

wounds. It is also used as mouth wash for mouth
infection and sore gums or tooth decay.
How to prepare and take guava decoction:

Wash the leaves very well
Put 2 handfuls of chopped leaves in an
earthen jar Figure 14. Guava leaves
Pour in 4 glassfuls of water
Boil for 5 minutes and let it cool and strain
Use as mouth wash or gargle
I. AKAPULKO
Akapulko is a shrub with oblong-shaped leaf and has yellow flowers at the tip of its
branches. It is used to treat ringworm and athletes foot. Pound sufficient amount of fresh
leaves and apply the juice on the affected area 1 to 2 times a day for 3 weeks.
Figure 15. Akapulko leaves
J. AMPALAYA
Ampalaya is popular medicinal plant to help

control blood sugar level.
There are 2 ways to prepare ampalaya leaves

to be used as adjunct treatment for persons
with diabetes:
Eaten as a salad:
Measure cup of packed leaves and steam
Taken as a decoction:
1. Wash young leaves very well
2. Put 6 tablespoonfuls of chopped leaves in an earthen jar
3. Pour 2 glasses of water and cover
4. Boil the mixture for 15 minutes
5. Strain the mixture
6. Divide decoction into 3 parts and drink 1 part 3 times a day, after meals
REFERENCES
i. Department Memorandum 2009-0302 Reiteration of DOH Support for the Continuing
Development of BHWs
ii. DOH Administrative Order 50-A s. 2001 National Family Planning Policy
iii. Republic Act 10354 The Responsible Parenthood and Reproductive Health Act of 2012
iv. DOH MNCHN Strategy Manual of Operation 2011
v. Basic Information about NB Screening, accessed at www.newbornscreening.ph
vi. DOH Administrative Order 2006-0012 Revised IRR of Executive Order 51 (Milk Code)
vii. IYCF Guidelines
viii. DOH Administrative Order 2010-0023 Guidelines on Deworming Drug Administration and the
Management of Adverse Events Following Deworming
ix. 2012 Philippine Health Advisories
x. 2014 DOH HEMS Guide for Community-Based Health Emergency Management
xi. DOH Administrative Order 2012-0029 Implementing Guidelines on the Institutionalization of
Philippine Package of Essential Non-Communicable Disease Interventions (PHILPEN) on the
Integrated Management of Hypertension and Diabetes Milletus for Primary Health Care
Facilities
xii. 2014 UNITE for Diabetes: Philippine Practice Guidelines for Diabetes Mellitus
xiii. 7TH Joint National Committee Classification for Hypertension
xiv. DOH Administrative Order 2011-0018 Implementing Guidelines on Influenza and Pneumococcal
xv. DOH Administrative Order 2012-0007 Guidelines on the Grant of 20% discount to Senior Citizens
on Health-Related Goods and Services and for other Purposes
xvi. Republic Act 10354 The Responsible Parenthood and Reproductive Health Act of 2012
xvi. Philippine Health Advisories (DOH 2012)
xvi. Republic Act 10354 The Responsible Parenthood and Reproductive Health Act of 2012
NOTES

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BARANGAY

Guide to Use this Manual

I. DOH PROGRAMS IMPLEMENTATION IN THE COMMUNITY

B. Maternal Health in Pregnancy

D. Neonate and Infant Health

G. Healthcare for Adults

II. SPECIAL HEALTH CONCERNS IN THE COMMUNITY

B. Violence Against Women and Children

C. Disaster Risk Reduction and Management

III. FIRST AID TECHNIQUES FOR COMMON INJURIES AND ILLNESSES

A. Benign Febrile Convulsion

IV. HERBAL MEDICINES

BCG Bacillus CalmetteGurin

Figure 1. Life-cycle approach: DOH programs per life-cycle.

1. An advocate of current health programs, projects and activities to improve access

The pre-pregnancy phase of the life-cycle approach refers to women of reproductive

ROLE OF THE BHW:

B. MATERNAL HEALTH IN PREGNANCY

ROLE OF THE BHW:

d. Growth, size and position of the baby in each trimester

VACCINE MINIMUM DURATION OF PROTECTION

TT1 As early as Provides ptection for the mother

TT2 At least 4 weeks Provides 3 yrs protection for the

TT3 At least 6 months Provides 5 yrs protection for the

TT4 At least 1 year Provides 10 yrs protection for the

TT5 At least 1 year Provides LIFETIME protection to

Prenatal check-ups should be done at least once during the 1 st

Among teen-agers, valid consent can only be given by minors if accompanied by

BHWs may do the following:

Figure 3. Buttocks lift for pregnant women

1. HBMR or Mother and Baby book

If the pregnant woman cannot avail of Philhealth membership, request a

The following are the signs and symptoms of active labor:

Increased urgency to urinate or defecate

4. Family planning methods may already be introduced among adolescents by adequately

ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC)

ROLE OF THE BHW:

ROLE OF THE BHW:

ROLE OF THE BHW:

What do we mean by exclusive breastfeeding?

How do we store breastmilk?

Figure 4. Proper Positions for Breastfeeding

D. NEONATE AND INFANT HEALTH

VACCINE MINIMUM AGE NUMBER OF MINIMUM INTERVAL PURPOSE

HepaB (Hepatitis B) At birth 4 doses 4 weeks Reduces the

Measles vaccine 9 months old 1 dose None Measles is

What are the vaccines included in Pentavalent vaccine?

What are the possible side effects after immunization?

INFANT AND YOUNG CHILD FEEDING PROGRAM

ROLE OF THE BHW:

When does complementary feeding begin?

Complementary feeding may be given to infants 6 months of age or older.

How do you initiate complementary feeding?

11 months Cooked Chicken egg egg

Other Foods 8 months Steamed, Custards, simple 1 teaspoon

GARANTISADONG PAMBATA PROGRAM (GP)

ROLE OF THE BHW:

GP is an integrated package of services concerning health, nutrition and environmental

What is the importance of Deworming, Vitamin A and Iron supplementation?

Deworming significantly improves language and memory development.viii

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSES (IMCI)

ROLE OF THE BHW:

NEVER self-medicate with antibiotics to prevent occurrence

What can mothers do at home when their children have cough?