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Act No. 157- Creation of Board of Health of the Philippine (BON)

Act No. 1407- Abolish BOH DILG

1919 Mrs. Carmen Del Rosario – 1st Filipino Nurse Supervisor

1990-1992 – Local Revolutionary Code of 1991, RA 7160 Revolution Code

National to local


Health – (WHO) state of complete physical, mental and social well being, not merely
the absence of disease or infirmity

Public health – (Dr. C.E. Winslow) the science and art of preventing disease,
prolonging life, promoting health and efficiency through organized
community effeort.

Community Health Nursing (Jacobson)- is a learned practice discipline with the

ultimate goal of contributing as individual and in collaboration with others to
the promotion of clients optimum level of function through teaching and
delivery of care.

Factors affecting Optimum Level of Function (OLOF)

1. Political
2. Behavioral
3. hereditary
4. Health Care Delivery System
5. Environmental Influences
6. Socio economic Influences


1. The primary focus of community health nursing practice is on health

2. Community health nurses are generalist in term of their practice through life
but the whole community.
3. Community health nurses are generalist in terms of their practice through
life continuity in its full range of health problems and needs.
4. The nature of CHN practice requires that current knowledge derived from
the biological, social science, ecology, clinical nursing and community health
organizations be utilized
5. Contact with the client and or family may continue over a long period of time
which includes all ages and all types of health care.
6. The dynamic process of assessing, planning, implementing and intervening
provide measurements of progress, evaluation and a continuum of the cycle
until the termination of nursing is implicit in the practice of community
health nursing.


1. CHN is based on recognized needs of communities, families, groups and

2. The community health nurse must understand fully the objectives and
policies of the agency she represents.
3. In CHN, the family is the Unit of services.
4. CHN must be available to all regardless of race, creed and socioeconomic
5. Health teaching is a primary responsibility of the CHN.
6. The community health nurse works as a member of the health team.
7. There must be a provision for period’s evaluation of community health team.
8. Opportunities for continuation staff education programs nurses must be
provided by the CHN agency. The community health nurse also has a
responsibility for his/her own professional growth.
9. The community health nurse makes use of available community health
10. The community health nurse utilizes the already existing active organized
groups in the community.
11. There must be provision for educative supervision CHN
12. There should be accurate recording and reporting in CHN.

Public Health Nurse

1. Planner/programmer
2. Provide of Nursing Care/Caregiver
3. Manager/Supervisor
4. Community Organizer
5. Coordinator of Service
6. Trainer/ Health Educator/ Counselor
7. Health monitor
8. Role Model
9. Change Agent
10. Recorder/ Reporter/ Statistician
11. Researcher

Community Health Process

Collection of data, collected from family, groups and community.

Examples: Demographic Data

Vital Health Statistics
Community Dynamics
Health Status

Methods: Community Survey

Epidemiological studies

Common indicators of health status

 Morbidity
 Mortality

Categories of Health Problems

1. Health Deficit (HD)- instances of failure in health maintenance ( dse,

disability, dev’tl lag)
ö -ex. Dse/ illness- URTI, marasmus, scabies, edema
 disabilities- blindness, polio, colorblindness, deafness
 dev’tl problems like mental retardatx, gigantism, hormonal,

 Health Treat (HT)- conditions conducive to dse, accidents or failure to realize

one’s health potential
ö healthy people
ö ex. Family hx of illness- hereditary like DM, HPN
 nutritional problems- eating salty foods
 personal behavior- smoking, self-medication, sexual practices,
drugs, excessive drinking
 inherent personality char- short temperedness, short attn span
 short cross infectx
 poor home envi
 lack/inadequate immunization
 hazards- fire, falls, or accidents
 family size beyond what resources can provide
ö Foreseeable Crisis (FC)- anticipated periods of unusual demand on indiv
or fam in terms of adjustment or family resources ( nature situatxs)
ö ex. Entrance in school
 adolescents (circumcision, menarchs, pubarche
 courtship (falling in love, breaking up)
 marriage, pregnancy, abortion, puerperium
 death
 unemployment, transfer or relocation
 graduation, board exam
Identify the ff:
Ex: Active TB- HD
45 yr, old male smoke- HT
Sedimentary health style- Ht
Early pregnancy- FC
Father of family losses his job FC
Death in the family- FC
Patient is sick due to pneumonia- HD
Children who are not immunized- HT
Lack of prenatal check – up- HT
Eclampsia- HD
Working hazard- HT
Hypertensive- HD
With measles “child”- HD
Family members has liprosy (microbactria liporea)- HD
Marriage- FC

Community diagnosis

A. Physical Characteristics
B. Population Characteristics
C. Environmental factors
D. Knowledge, attitude, practices of the people
E. Community resources and facilities

Planning: Based on the actual and potential problems that were identified and

Goal: Declaration of purpose or intent, gives essential direction to action

Specific objectives: Made in terms of activities of daily living

 Carries out nursing procedures which are consistent with nursing with
nursing care plans.
 Involve the patient with his/her family
 Utilized support system


Frame works

a. Structural elements
b. Process elements
c. Outcome elements

Nursing Procedures

Clinic Visit

1. Pre-consultation conference
2. Medical examination
3. Nursing intervention
4. Post consultation conference

Home Visit- face to face contact with the client

1. A home visit should have a purpose or objective
2. Planning for a home visit should use every available information about the
family, and individual
3. Planning should revolve around the essential needs of the individual
4. Planning of a continuing care involve the individual or family
5. Planning should be flexible and practical

Bag technique- Tool

Public health bag- is an indispensable equipment of the public health nurse


1. Prevent the spread of infection

2. Save time and effort
3. should not shadow the concern for the patient
4. Can be performer in a variety of ways

• Zippiram solution- disinfectant

Nursing Care in the House

1. Nursing care utilizes a medical plan of care and treatment.
2. Performance of nursing care utilities skills that would give maximum
comfort and security.
3. Nursing care at home should be used as a teaching opportunity.
4. Performance of nursing care should recognized dangers in the patients’ over-
prolonged acceptance of support and comfort.
5. Nursing care is an opportunity for detecting abnormal signs and symptoms.

Isolation Techniques

 All Articles used by the patient should not be mixed with the articles used by
the rest of the members of the household.
 Frequent washing and airing of beddings and other articles and disinfectants
of room are imperative
 The one caring for the sick member should be provided with a protective
gown that should be use with in the room of the sick.
 All discharges, especially from the nose and throat of a communicable
disease patient should be carefully discharged.
 Articles with discharges should be first boiled for 30 minutes before
laundering. Thos could be burned, should be burned.


Mission: Ensure accessibility and quality of health care to improve the quality of
life of all Filipinos, especially the Poor.

National Objectives

1. Improve general health status

2. Reduce morbidity, mortality and disability rates
3. Eliminate public health problems
4. Eradicate poliomyelitis
5. Promote healthy lifestyle
6. Promote health and nutrition
7. Promote environmental health

Basic Principles

1. Universal access to basic health services

2. Health and nutrition of vulnerable groups
3. Epidemiological shift from infectious to degenerative
4. Performance of the health sector must be enhanced

Primary strategies to achieve health goals

a. Increase investment for primary health care
b. Development of national standards and objectives for health

Herbal Medicine
1. aromatic- has volatile oil for tx of fever, cough, colds, itchiness and gas pain.
Luya, bawang, sibuyas, yerba Buena, oregano, manzanilla, tanglad, sambong,
lagundi, ___ or petals of sampaguita, jasmine & rosal
Luya- shd not be taken on an empty stomach
Elixir- ______

Shake week after week—tx for TB

Bawang crush 1 ear & drink it
Tincture of bawang 1:5
Add 5 tbsp. of gin; 1 tbsp chopped bawang
Shake 10 mins for 1 week – good for superficial wounds

Tanglad- lemon grass—for fever

Suha/kalamansi- for fever, TSB
2. astringent-tasting- bitter- has tannin & pectin for diarrhea & wound
A vocado leaves
B ayabas leaves
K amilo leaves
D uhat leaves
S aging leaves (saba cut into chips, let dry, pulverize then add to _____)

3. bitter-tasting
a. skin problems--Acapulco, kalachuchi, malunggay, kakawati, inakabuhay
b. depressants- to put hyper people to sleep--dapdap, dita, makabuhay,
c. anti-cancer drug-- tsitsirika
d. aches & pains-- sambong, damong arya
e. asthma- talampugay- can cause psychosis
4. seeds- fixed oils, anti-helmentics- niyug-niyogan (urine), patola, ipil-ipil, betel nut
or bunga, balanyog, squash seeds, lanzones- do not throw peelings instead, burn it—
good insect repellant

5. grass family- diuretics—kagon, tubo, tanglad, pandan, pugo-pugo, buto-butones,

gatas-gatas, atajuo kahol, pansit-pansitan or ulasimang bato,
stones- meis hairm, HPN- palay

10 Medicinal Plants:
L agundi- asthma, cough, colds
U lasimang bato- uric acid, HPN
B awang- HPN
B ayabas- Diarrhea
Y erba Buena- arthritis, toothache, swollen gums, cough & colds
S ambong- cough and colds, renal stones
A mpalaya- DM
N iyug-nyogan- ascariasis
T saang gubat- diarrhea
A capulco- fungal infection, scabies

RA 8423- utilization of medicinal plants as alternative for high cost medications.

Epidemiology- study of distribution and dynamic of disease occurrence in human


Endemic- constant presence of disease or infection agent with in a given geographic


Epidemic- occurrence in a community or region of cases of an illness clearly in

excess of expectancy

Pandemic- epidemic so widely spread that vast numbers of people in different

countries are affected

Sporadic- disease that occurs only occasionally or in a few isolated places

Surveillance- a continuing scrutiny of all aspects of occurrence and spread of a

disease that is pertinent to effective control ( promotion, preventive
patient and rehabilitative)

Sentinel sites- are health facilities which are selective as representatives of what is
happening in areas whose reports are accurate, complete and prompt
(health center)

Statistics- that science involved in the collection, organization, analysis and

interpretation of numerical data

Biostatistics- the scientific discipline concerned with the application of statistical

methods to problems in biological and medicine.

Fertility Rate
1. CBR (Crude birth rate)- relative pop due to births
Total number of births in a calendar year
CBR= Birth x 1000
Pop ex. 25.8= CBR
There are 26 births in every 1000 pop
2. General Fertility Rate (GFR) - true fertility rate – specific segments of pop that is

GFR= ________Birth___________ x 1000

Pop of women (15 to 44 yo)

Ex. GRF=32 There are 32 births in every woman in 15-44

Mortality Rates
1.Crude Death Rate ____ x 1000
Decrease in pop due to death
CDR= death x 1000
Ex. CDR= 6 there are 6 in every 1000 pop

2. Specific Mortality Rate- can apply to any pop grp

SMR = death from or particulare grp x 1000
Pop of that grp
a. SMR (males) = death (males) x 1000
pop of males
b. SMR (females) = death of females 15-44
pop of females 15-44
 Infant Mortality Rate: IMR= Death 0 -1 year x 1000
 Neonatal Mortality Rate: NMR= deaths 0-28 days x 1000
 Post Neonatal Mortality Rate: PNMR = deaths 28 days to 1 year x 1000
Neonatal deaths + Post neonatal deaths= Infant deaths
Ex. Birth 200
NMR= 20
Death – 28 to 1
20 + 10 = 30 (ANS)
2_ x 1000 = 1000 = 10
200 100

 Maternal Mortality Rate (MMR)

MMR= death of women r/t pregnancy, delivery, & puerperium x 1000
Ex. IMR = 30 There are 30 infant deaths in every 1000 births

NMR = 20 There are 20 neonatal deaths in every 1000 births

PNMR = 10
MMR = .92

 Proportionate Mortality Rate = PMR ( for any grp)

PMR= death from a particular grp x 100
total death
Ex. 52% PMR of males = deaths of males x 100
total deaths
In every 100 death, 52 are males

PMR = deaths 0-1 x 100

0.1 total deaths


A. Swaroop’s Index = SI
SI = death of 50 yrs & up x 100
total deaths
The SI, the better the situation is!

B. Relative importance of a killer ( TB, heart dse, diarrhea)

Death due to TB x 100
total deaths

PMR = 30%
--In every 100 deaths, 30 are due to TB

 Case Fatality Rate (CFR)

ö How is survival rate, how strong is killing power, prognosis
CFR= death due to part cause x 100
total cases

Ex. CFR = 98

___death HIV___ x 100

Total cases of TB
In every 100 cases of HIV, there are 98 deaths

 Cause-of-death Rate (mortality rate)

ö Rank as a killer

C of DR= death due to particular cause x 100,000

total pop

Ex. C of DR =320

In every 100,000 pop there are 320 deaths due to TB

 Prevalence Rate = (Morbidity rate)

ö Rank as a common dise
PR = old and new case of TB x 100,000
TB total pop

Ex. PR = old & new case of TB x 100,000

Ex. PR = 326

There are 326 cases of TB out of 100,000 population.

 Incidence Rate
IR= ___new cases___ x 100,000
pop at risk

Swaroff’s Index

Total death of a person aging above 50 X 100

Total number of deaths of all ages

Situation: Barangay X has a total population of 1362 for the year 1999-2000 bases
on the following date, solve for the swaroff’s index, infant mortality rate, crude
death rate and the maternal mortality rate

Swarrof’s index= 7/57 x 100= 12.8

IMR= 17/1294 x 1,000 = 13 IR= 6/1362 x 1,000= 4090

CBR= 1294/1362 x 1,000 = 950

CDR= 57/1362 x 1,000= 42

MMR= 3/1294 x 1,000 = 2.33

Essential Health Services

E- Education on methods of preventing and controlling health problems

L- Local endemic disease prevention and control
M- Maternal and child care including family planning
E- Essential drugs
N- Nutrition
T. Treatment
S- Sanitation and H2O supply

Four Corner stone/ Pillar in PHC

1. Active community participation

2. Intra and inter sectoral linkages
3. Use of appropriate technology
4. Support mechanism made available

Levels Health Care

Primary- Brangay “ district midwife/ trained health workers”

Secondary- Regional/District “NURSE”

Tertiary- Hearth Center, Lung Center etc. - doctor

Reproductive Health (RH)

Vision: reproductive health practices as a way of life for ever man and woman
throughout life

a. married couples has the capability to reproduce
b. reproductive health is exercise of reproductive right
c. purpose of enhancement of life and personal relation
d. safe pregnancy, safe delivery
e. protection from unwanted pregnancy
f. protection from harmful reproductive practice and violence
g. assures access to information on sexuality to achieve sexual

Determinants of RH:
1. socio- economic
2. status of women
3. social and gender issues
4. biological, cultural and psycho-social factors

> every pregnancy should be intended

> every birth should be healthy
> every sex act should be free of co erection and infection
> achieve desired family size

Ten Elements of RH

1. Maternal and child health nutrition

2. Family planning
3. Prevention and management of abortion complication
4. Prevention and treatment of reproductive tract infection, respiratory
infection and STD, HIV/ AIDS
5. Education and counseling on sexuality and sex health
6. Breast and reproductive tract cancer
7. Other gynecological condition
8. Men’s RH
9. Adolescent RH
10. Prevention and treatment of infertility

Tetanus Toxiod

T1- anytime during pregnancy

T2- 4 weeks of pregnancy
T3- 6months/ 244 weeks of pregnancy
T4- 1 year old
T5- above 1 year

*PPD 996 immunization program

Vaccine Route Dosage Frequency

BCG half life 4hours R dorsal 0.05/ml At birth
Live attenuated bacteria
“stored @ 2-8degree Celsius 0.1/ml School entrance
L Deltoid
DPT half life 8 hours IM 0.5/ml DPT 1- 6th weeks
Right/ Left/ DPT 2- 10 weeks
Weakened toxin Right DPT 3- 3 ½ months
killed bacteria stored @2
Weakened toxin to 8 degree
OPV Oral 2-3 gtts 6 weeks@ 3 doses
Hepa B IM anterior .05/ml 6 weeks2 3 doses 4th
thigh weeks
left/right/ interval
Measles SQ outer 0.5ml 9 months
part of the

Side effects
1. Koch’s phenomenon- 2-4 days after vaccines
- acute inflammation

• deep abscess- deeper injection

tx: incession / drainage/ INH powder

2. Fever- after and last for 1 day

- Tx: antipyretics
- more that 24 hours after dose “ local soreness at the site”

*Abscess- wrong injection technique

Tx: incision and drainage

*Convulsion- rare and occurs 3 months due to pirtosis of vaccine-

(don’t continue)

3. Salk – IM
Sabin – Oral

4. FEVER and Rash – 5 – 7 days “vaccination”

- last 1-3 days
- Management: antipyretic
Leprosy Control Program

- Multi Drug therapy 1988 RA 4073

- Chronic disease of the skin and peripheral nerves caused by Mycobacterium
Leprea or Han’s Bacillus

Early s/s:

Change in skin color- reddish or white

Loss of sensation
Decrease hair growth- dermis
Loss of sweating- exocrine
Muscle weakness- nerves
Thickened/ painful nerves
Ulcer that do not heal

Late s/s

Lagophthalmos- inability to close the eye lids
Clawing of fingers and toes
Sinking of nose bridge
Chronic ulcers


Fast breathing
Chest in drawing
Abnormally sleepy
Severe under nutrition
Not able to drink
Stridor upon inhalation- auscultation
Wheezing- upon exhalation
Fever or low body temp.

Management of pneumonia: most pneumonia deaths are preventable if treated

Tx is based :
 early recognition of pneumonia
 prompt treatment of non severe cases at home with standard
antibiotics and good supportive care
 quick identification if severe cases and quick referral to the
hospitals- prevent death

Treatent may include

• antibiotics
• advising mothers to give home care
• treating fever and wheezing

Home Care: (child with cough and colds)

• no antibiotics needed
• feed the child
• increase fluid intake
• clear nose
• keep child warm and comfortable

S/S that the child must be brought to health care facility:

• fast breathing
• difficulty breathing
• unable to drink
• feeding problem

Role of Drugs in control of infection

 children with cough and colds with no pneumonia must not be
given antibiotics
 antibiotics should only be given to cases pneumonia, severe
pneumonia and very severe disease

Availabity of Drugs
1. Cotrimoxazole
2. injectable penicillin
3. others: O2 may be delivered as a life saving measure
cough suppressant- antitussive
antihistamine- bronchodilator

Prevention of Pneumonia
1. Timely immunization against measles and pertussis
2. Exclusive BF for the 1st 4-6 months of life
3. Good nutrition
4. Vit. A supplementation
5. Reduce exposure to house smoke from cooking/tobacco
6. Keeping young infants warm- prevent O2 loss
7. Practicing good hygiene
Control of Diarrhea Disease
Management of patient with diarrhea:

use this chart for patients with

a. loose watery stools
b. loose stools with blood

Step 1- Asses your patient for dehydration

Step 2- Asses for other problems
1. Look at condition: well alert
Eye: normal
Tears: present
Mouth and tongue: moist
Thirst: drinks normally, not thirsty

2. Feel- Skin Pinch: goes back quickly

3. Decide: No dehydration
4. Treatment: treatment A

Treatment Plan A
> to treat diarrhea at home
> use this plan to teach the mother to
1. Continue to treat at home her child’s current episode of diarrhea
2. give early treatment for future episode of diarrhea

Treatment Plan C
(Sever dehydration)

Can you give IVF ------------Yes-------Start IVF immediately “PNSS and 0.9 % NaCl

Is IV next available-----------Yes-------Send patient within 30 minutes

Are you trained To------------Yes------Start with ORS
Use NGT for

Can the patient-----------------Yes------Start with ORS per orem

Send the patient for IV or NGT

Water Decontamination
 Boiling 2-3 minutes
 Chlorine
• 1 drop of 5% Na Hypo chloride in 10 L H2O
• Stat for 20-30 minutes
• Aerate

PB non infectious MB- infectious
Tuberculoid LEpramatous/ Borderline

6-9 months 24-30 months

Day 1/ 2-8 Day 1/ 2-28
Rifampicin/Dapsone Rifampicin

ROM- Rifampicin. Ofloxacin, Minocyclinc

Prevention- BCG

Very Severe Severe Pneumonia No Pneumonia
Unable to drink Fast breath Fast breathing No fast breathing
Convulsion Chest indrawing No chest indrawing No chest indrawing
Difficult to wake

Tb Network: Nurse
Early case Med Tech
Category 1 Category 2 Category 3
New (+) cases PTB 2-8 months maintenance PTB minimal(-) 3x
Seriously ILL Treatment replaces sputum smear
a. Intensive Phase Failure x-ray PTB minimal
Advance pulmonary TB Extra TPB (not serious)
2 months 3 months
b. Extra pulmonary TB R R 2months 2 months
2 months I I R R
R ifampicin P P I I
I soniazid E E P
P yrazinamide S- streptomycin “IM”
E thambutol “should
not used 6 years old 5 months
below because of visual R
disturbance I
4 months
R ifampicin
I soniazid

Environmental Sanitation is defined as the study of all factors in man’s physical environment,
which may exercise a deleterious effect on his health, well-being and survival.

Goal: to eradicate and control environmental factors in dse transmission through the provision of
basic services and facilities to all households.

1. Water Supply Sanitation Program

1 types of Approved Water Supply Facilities

Level 1 Level II Level III
Point Source Communal Faucet system or stand Waterworks system or
posts individual house
A protected well of a A system composed of a source, a A system with a source, a
developed sprung with an reservoir, a piped distribution reservoir, a piped distributor
outlet but without a network and communal faucets, network and household
distribution system for rural located at not more than 25 meters taps that is suited for
areas where houses are from the farthest house in rural areas densely populated urban
thinly scattered. where houses are clustered densely. areas.
Water must pass the National Standards for Drinking Water set by the DOH.

2. Proper Excreta and Sewage Disposal System

3 types of Approved Toilet Facilities

Level 1 Level 2 Level 3
Non- water carriage toilet facility: On site toilet facilities of the Water carriage types
- Pit Latrines water carriage type with of toilet facilities
- Reed Odorless Earth Closet water sealed and flushed connected to septic
- Bored-Hole type with septic vault/tank tanks and/or to
- Compost disposal facilities. sewerage system to
- Ventilated improved pit treatment plant.
Toilets requiring small amount of water to
wash waste into receiving space
-pour flush
-aqua privies
Rural Areas- “blind drainage” type of wastewater collection and disposal facilities shall be
emphasized until such time that sewer facilities and off-site treatment facilities are available.

3. Proper Solid Waste Management

- refers to satisfactory methods of storage, collection and final disposal of solid wastes.

2 ways to Refuse Disposal

Household Community
-Burial -Sanitary landfill or controlled tipping
> deposited in 1m x 1m deep pits covered with > excavation of soil deposition of refuse and
soil, located 25m away from water supply compacting with a solid cover of 2 feet
- open burning - Incineration
- animal feeding
- composting
- grinding and disposal sewer

4. Food Sanitation Program

Food establishment are subject to inspection (approved of all food sources containers
and transport vehicles)
Comply with sanitary permit requirement
Comply with updated health certificates for food handlers, helpers, cooks
All ambulant vendors must submit a health cert to det presence of intestinal parasite
and bacterial infection.
3 points of contamination
Place of production processing and source of supply
Transportation and storage
Retail and distribution points

5. Hospital Waste Management

To prevent the risk of contraction contracting nosocomial infection from type
disposal of infectious, pathological and other wastes from hospital

6. Programs related to health-risk minimization secondary to environmental pollution

These include the following:
Anti-smoke Belching campaign and Air Pollution Campaign
Zero Solid Waste Management
Toxic, chemical and Hazardous Waste Management
Red tide Control and Monitoring
Integrated Pest Management and Sustainable Agriculture
Pasig River Rehabilitation Management

7. Education of prevailing health problems

Accepted activitiy at all levels of public health used as a means of improving the health of
the people through techniques which may influence people’s thought motivation,
judgement and action.

Three aspects of Health education:

 Information- provision of knowledge
 Communication- exchange of information
 Education- change in knowledge, attitudes, and skills
Sequence of Steps in Health Education
Creating awareness
Creating motivation
Decision making action


Operational Strategies:
Promotion of health/ health education
Disease detection
Treatment program
Contact tracing
Clinical services

Program components:
Case management
Reporting system
Operations research

- A state of well-being where a person can realize his or her own abilities, to cope with
the normal stresses of life and work productively
- The emotional adjustment the person achieve in which he can live with reasonable
comfort, functioning, acceptably in the community where he/she lives
- Involves the promotion of a healthy state of mind amont the whole pop through
♥ Developing positive outlook in life
♥ Strengthening coping mechanisms

Vulnerable group to the dev of Mental Illness:

♥ Women
♥ Street children
♥ Victims of torture or violence
♥ Internal refugees
♥ Victims of armed conflicts
♥ Victims of natural and man-made disasters

Components of Mental Health Program

A. Stress
B. Drugs and Alcohol Abuse Rehabilitation
C. Treatment and Rehabilitation of Mentally-ill Patients
D. Special Project for Vulnerable Groups

Stresses in the environment of children such as times of disasters and natural calamities,
disintegration of the values, structure and functions of the family and urbanization, migration,
drugs, and physical and sexual abuse and poverty have direct effects on physical and mental