DOH Programs

Related to Family
Health
Group 4 BSN II- B
EXPANDED PROGRAM ON
IMMUNIZATION
 HISTORY
• The Expanded Program on Immunization
(EPI) was established in 1976 to ensure
that infants/children and mothers have
access to routinely recommended
infant/childhood vaccines.
• Six vaccine-preventable diseases were
initially included in the EPI: tuberculosis,
poliomyelitis, diphtheria, tetanus, pertussis
and measles. In 1986, 21.3% “fully
immunized” children less than fourteen
months of age based on the EPI
Comprehensive Program review.
• In 2002, WHO estimated that 1.4
million of deaths among children
under 5 years due to diseases that
could have been prevented by
routine vaccination. This represents
14% of global total mortality in
children under 5 years of age.
 OVER-ALL GOAL

To reduce the morbidity and

mortality among children
against the most common
vaccine-preventable diseases.
 SPECIFIC GOAL

1. To immunize all infants/children against the

most common vaccine-preventable diseases.
2. To sustain the polio-free status of the
Philippines.
3. To eliminate measles infection.
4. To eliminate maternal and neonatal tetanus
5. To control diphtheria, pertussis, hepatitis b
and German measles.
6. To prevent extra pulmonary tuberculosis
among children.
 MANDATES

Republic Act No. 10152 “Mandatory Infants and

Children Health Immunization Act of
2011Signed by President Benigno Aquino III in
July 26, 2010. The mandatory includes basic
immunization for children under 5 including
other types that will be determined by the
Secretary of Health.
 LAW TITLE PROVISION
WHEREAS, the Child is one of the
most important assets of the nation and
every effort should be exerted to
promote his welfare and enhance his
opportunities for a useful and
happy life;

WHEREAS, the Child can be protected

against death, disease, and disability
through an integrated and
comprehensive basic immunization
program for infants and children below
PROVIDING FOR eight years of age;

COMPULSORY BASIC WHEREAS, immunization against

PRESIDENTIAL
IMMUNIZATION FOR tuberculosis, diphtheria, tetanus,
DECREE No. 996 pertussis, poliomyelitis, measles,
INFANTS AND CHILDREN rubella, and other diseases is proven
September 16, 1976 and universally applied and generally
BELOW EIGHT YEARS OF
accepted to be efficient, safe, and
AGE economical measures against the
morbid and devastating effects of these
diseases on infants and children;

WHEREAS, the Department of Health

has the necessary resources for
nationwide BCG Vaccination and
resources can be developed for other
immunizations to meet the needs for
preventive services for infants and
children;
 LAW TITLE PROVISION

• Section 2.Scope
“…Basic immunization
services shall include:
(a) BCG Vaccination against
tuberculosis;
(b) Inoculation against
diphtheria, tetanus, and
pertussis;
(c) Oral poliomyelitis
PROVIDING FOR
immunization; (d) Protection
COMPULSORY BASIC against measles;
PRESIDENTIAL
IMMUNIZATION FOR (e) Immunization against
DECREE No. 996
INFANTS AND CHILDREN rubella; and;
September 16, 1976
BELOW EIGHT YEARS OF (f) such other basic
AGE immunization services for
infants and children below
eight years of age which the
Council for the Welfare of
Children may recommend to
the Secretary of Health..”
 LAW TITLE PROVISION

• Section 3. Implementation
by the Department of
Health.
“... The Department of Health
shall provide free basic
immunization services under this
Decree, subject to rules and
regulations as the Secretary of
Health shall issue on the
immunization, ages, schedules,
procedures, and available
PROVIDING FOR resources to carry out the
COMPULSORY BASIC purposes of this Decree.:”
PRESIDENTIAL
IMMUNIZATION FOR •
DECREE No. 996 Section 4. Responsibility of
INFANTS AND CHILDREN Parents, the Guardian, or
September 16, 1976
BELOW EIGHT YEARS OF Person Having Custody of
AGE the Infant or Child.
• “...It shall be the duty of the
parents, guardian, or person
having custody of the infant or
child to see to it that such
infant or child is presented for
basic immunization services
at such place and time as
specified by the Department
 LAW TITLE PROVISION

• Section 5. Responsibility of the

Head of a School or Institution.
“... The head of an institution where
infants or children are educated,
treated, cared for, or committed by law
for preventive or rehabilitative
services shall provide basic
immunization services: Provided that
arrangements may be made by the
said institution with the Department of
Health for free immunization
PROVIDING FOR services..:”
COMPULSORY BASIC • Being one of the health care
PRESIDENTIAL practitioners or health care workers
IMMUNIZATION FOR who are administering prenatal
DECREE No. 996
INFANTS AND CHILDREN care, should be the one who is
September 16, 1976 knowledgeable and keen in
BELOW EIGHT YEARS OF educating mothers regarding what
AGE these vaccines is all about, its
purpose and its effects should be
known and understand accurately.
And it must be in unity with The
DOH, other government agencies,
non-government organizations,
professional and academic
societies, and local government.
They should act as one; as a role
model, an educator, councilor and a
client advocate to promote
continuity of care and to strengthen
the act.
 LAW TITLE PROVISION

• Section 6. Immunization
of School Entrants.
“... It shall be the duty of
all schools, public and
private, to provide basic
immunization services to
all pre-school and
PROVIDING FOR primary school entrants
COMPULSORY BASIC who have not received
PRESIDENTIAL
IMMUNIZATION FOR such immunization,
DECREE No. 996
INFANTS AND CHILDREN subject to rules and
September 16, 1976
BELOW EIGHT YEARS OF regulations as the
AGE Secretary of Health may
promulgate...:”
 Antigen Age Dose Route Site

Right deltoid
BCG vaccine At Birth 0.05 ml Intradermal
region (arm)

Hepatitis B Anterolateral
At Birth 0.5 ml Intramuscular
vaccine thigh muscle

DPT-HepB-Hib 6 weeks, 10
Anterolateral
(Pentavalent weeks, 14 0.5 ml Intramuscular
thigh muscle
Vaccine) weeks

6 weeks, 10
Oral Polio
weeks, 14 2 drops Oral Mouth
vaccine
weeks
Measles,Mumps
Outer part of the
, Rubella 12-15 months 0.5 ml Subcutaneous
upper arm
Vaccine (AMV2)

Anti -Measles Outer part of the

9-11 months 0.5 ml Subcutaneous
Vaccine upper arm
 INTEGRATED
MANAGEMENT OF
CHILDHOOD ILLNESS
(IMCI)
 HISTORY
• The Integrated Management of Childhood Illness
strategy has been introduced in an increasing
number of countries in the region since 1995.
• IMCI is a major strategy for child survival, healthy
growth and development and is based on the
combined delivery of essential interventions at
community, health facility and health systems
levels. IMCI includes elements of prevention as
well as curative and addresses the most common
conditions that affect young children.
• The strategy was developed by the World Health
Organization (WHO) and United Nations
Children’s Fund (UNICEF).
 HISTORY
• One million children under five years old die each
year in less developed countries. Just five
diseases (pneumonia, diarrhea, malaria, measles
and dengue hemorrhagic fever) account for
nearly half of these deaths and malnutrition is
often the underlying condition. Effective and
affordable interventions to address these
common conditions exist but they do not yet
reach the populations most in need, the young
and impoverish.
• In the Philippines, IMCI was started on a pilot
basis in 1996, thereafter more health workers and
hospital staff were capacitated to implement the
strategy at the frontline level.
OBJECTIVES OF IMCI
• Reduce death and frequency
and severity of illness and
disability, and
• Contribute to improved
growth and development
 COMPONENTS OF IMCI
• Improving case management skills of health
workers
11-day Basic Course for RHMs, PHNs and
MOHs
5 - day Facilitators course
5 – day Follow-up course for IMCI
Supervisors
• Improving over-all health systems
• Improving family and community health practices
 RATIONALE FOR AN INTEGRATED
APPROACH IN THE MANAGEMENT
OF SICK CHILDREN

• Majority of these deaths are caused by

5 preventable and treatable conditions
namely: pneumonia, diarrhea, malaria,
measles and malnutrition. Three (3) out of four
(4) episodes of childhood illness are caused by
these five conditions. Most children have more
than one illness at one time. This overlap means
that a single diagnosis may not be possible or
appropriate.
 WHO ARE THE CHILDREN
WHO ARE COVERED BY THE
IMCI

• Sick children birth up to 2

months (Sick Young Infant)
• Sick children 2 months up to
5 years old (Sick child)
 STRATEGIES OF IMCI
• All sick children aged 2 months up to 5 years are
examined for GENERAL DANGER signs and all
Sick Young Infants Birth up to 2 months are
examined for VERY SEVERE DISEASE AND
LOCAL BACTERIAL INFECTION. These signs
indicate immediate referral or admission to hospital
• The children and infants are then assessed for main
symptoms. For sick children, the main symptoms
include: cough or difficulty breathing, diarrhea, fever
and ear infection. For sick young infants, local
bacterial infection, diarrhea and jaundice. All sick
children are routinely assessed for nutritional,
immunization and deworming status and for other
problems
• Only a limited number of clinical signs are used
 STRATEGIES OF IMCI
• A combination of individual signs leads to
a child’s classification within one or more
symptom groups rather than a diagnosis.
• IMCI management procedures use limited
number of essential drugs and encourage
active participation of caretakers in the
treatment of children
• Counseling of caretakers on home care,
correct feeding and giving of fluids, and
when to return to clinic is an essential
component of IMCI
 BASIS FOR CLASSIFYING THE
CHILD’S ILLNESS
The child’s illness is classified based
on a color-coded triage system:
• PINK – indicates urgent hospital
referral or admission
• YELLOW – indicates initiation of
specific Outpatient Treatment
• GREEN – indicates supportive
home care
PNEUMONIA
MALNUTRITION AND
ANEMIA
MALARIA
MEASLES
DEHYDRATION
 LAW TITLE PROVISION
• Section 2. Declaration of
Policy
“…It is hereby declared the
policy of the State to promote
the rights of children to
survival, development and
special protection with full
recognition of the nature of
childhood and its special needs;
and to support parents in their
AN ACT PROMULGATING roles as primary caregivers and
A COMPREHENSIVE as their children's first
REPUBLIC ACT NO. POLICY AND A NATIONAL teachers.”
8980 SYSTEM FOR EARLY “The State shall
CHILDHOOD CARE AND institutionalize a National
DEVELOPMENT (ECCD) System for Early Childhood
Care and Development
(ECCD) that is
comprehensive, integrative
and sustainable, that involves
multi-sectoral and inter-
agency collaboration at the
national and local levels
among government...”
 LAW TITLE PROVISION

“…This System shall promote

the inclusion of children with
special needs and advocate
respect for cultural diversity.
It shall be anchored on
complementary strategies for
ECCD that include service
delivery for children from
conception to age six (6),
AN ACT PROMULGATING educating parents and
A COMPREHENSIVE caregivers, encouraging the
REPUBLIC ACT NO. POLICY AND A NATIONAL active involvement of parents
and communities in ECCD
8980 SYSTEM FOR EARLY
programs, raising awareness
CHILDHOOD CARE AND about the importance of
DEVELOPMENT (ECCD) ECCD, and promoting
community development
efforts that improve the
quality of life for young
children and families.”
 LAW TITLE PROVISION

• Section 3. Objectives

(a) To achieve improved infant

and child survival rates by
ensuring that adequates health
and nutrition programs are
accessible to young children
and their mothers from the pre-
natal period throughout the
AN ACT PROMULGATING early childhood years;
A COMPREHENSIVE
REPUBLIC ACT NO. POLICY AND A NATIONAL (b) To enhance the physical,
social, emotional, cognitive,
8980 SYSTEM FOR EARLY
psychological, spiritual and
CHILDHOOD CARE AND language development of young
DEVELOPMENT (ECCD) children;

(c) To enhance the role of

parents and other caregivers as
the primary caregivers and
educators of their children from
birth onwards;
 LAW TITLE PROVISION

(d) To facilitate a smooth

transition from care and
education provided at home to
community or school-based
setting and to primary school;

(e) To enhance the capabilities

of service providers and their
supervisors to comply with
AN ACT PROMULGATING quality standards for various
A COMPREHENSIVE ECCD programs;
REPUBLIC ACT NO. POLICY AND A NATIONAL
(f) To enhance and sustain the
8980 SYSTEM FOR EARLY efforts of communities to
CHILDHOOD CARE AND promote ECCD programs and
DEVELOPMENT (ECCD) ensure that special support is
provided for poor and
disadvantaged communities;

(g) To ensure that young

children are adequately
prepared for the formal learning
system and that both public and
private schools are responsive
to the developmental needs of
 LAW TITLE PROVISION

(h) To establish an efficient

system for early identification,
prevention, referral and
intervention for developmental
disorders and disabilities in
early childhood; and

(i) To improve the quality

standards of public and private
AN ACT PROMULGATING ECCD programs through, but
A COMPREHENSIVE not limited to, a registration and
REPUBLIC ACT NO. POLICY AND A NATIONAL credential system for ECCD
service providers.
8980 SYSTEM FOR EARLY
CHILDHOOD CARE AND
DEVELOPMENT (ECCD)
 EARLY ESSENTIAL
INTRAPARTUM AND
NEWBORN CARE
 LAW TITLE PROVISION

• “…In general, this policy aims to

ensure the provision of globally
accepted evidence-based
essential newborn care focusing
on the first week of life.”

 This law guides the health

workers and medical
practitioners in providing
evidence-based essential
newborn care

 This law defines the roles and

Adopting New Policies and
ADMINISTRATIVE
Protocol on Essential
ORDER No. 2009-0025
Newborn Care
responsibilities of the different
DOH offices and other agencies
in the implementation of the
Newborn Protocol.

• “...Emphasis is given to care

interventions that should be
provided to the newborn from
birth until the first 6 hours of life"”

 Ensure the quality provision of

time bound interventions

 Ensure the quality provision of

Non immediate interventions
 LAW TITLE PROVISION

“...This order shall apply to

the whole hierarchy of the
DOH and its attached
agencies, other public and
private providers of health
care and development
partners implementing the
Maternal, Newborn and Child
Health Nutrition (MNCHN)
strategy and to all health
practitioners involved in
Adopting New Policies and maternal and newborn care.”
ADMINISTRATIVE
Protocol on Essential
ORDER No. 2009-0025 "Administrative Order, emphasis
Newborn Care
is given to care interventions
that should be provided to the
newborn from birth until the first
6 hours of life"
 LAW TITLE PROVISION

SPECIFIC GUIDELINES
• Standard essential newborn
care practices guidelines are
organized by time, beginning
at the time of perineal
bulging until one week of life.

• However for this

Adopting New Policies and
ADMINISTRATIVE
Protocol on Essential
ORDER No. 2009-0025
Newborn Care
• The care for the newborn
Administrative Order,
emphasis is given to care
interventions that should be
provided to the newborn
from birth until the first 6
hours of life.
after six (6) hours till the first
week of life is mentioned
briefly but will be discussed
in more detail in a
Department Circular that is
issued corollary to this AO.
 LAW TITLE PROVISION

 Ensure Quality
Provision of Time-
Bound Interventions -

This is the aspect of

newborn care in the
Philippines that have not
met international standards,
and should therefore, be re-
taught and re-learned by all
Adopting New Policies and
ADMINISTRATIVE health care providers.
Protocol on Essential
ORDER No. 2009-0025
Newborn Care
 ACTION/TIME OBJECTIVE
Dry and provide warmth to the newborn and prevent
1. Within the first 30 hypothermia.
seconds

Facilitate bonding between the mother and newborn

through skin-to-skin contact to reduce likelihood of
2. After thorough drying infection and hypoglycemia.

Reduce the incidence of anemia in term newborns and

intraventricular hemorrhage in pre-term newborns by
3. While on skin-to-skin delaying or non-immediate cord clamping.
contact (up to 3 minutes
post-delivery)

4.1: Facilitate the newborn’s early initiation to

breastfeeding and transfer of colostrums through support
and initiation of breastfeeding.4.2: To prevent opthalmia
neonatorum through proper eye care.
4. Within 90 minutes of age
 LAW TITLE PROVISION

 Interventions – These
interventions are
usually given within 6
hours after birth and
should never be made
to compete with the
time-bound
interventions.
Adopting New Policies and
ADMINISTRATIVE 1. Give Vitamin K
Protocol on Essential
ORDER No. 2009-0025 prohylaxis
Newborn Care
2. Inject Hepatitis B and
BCG vaccinations
3. Examine the newborn.
Check for birth
injuries, malformations
or defects.
4. Cord Care
 LAW TITLE PROVISION
Newborn Resuscitation

1.Start resuscitation if the newborn is

not breathing or is gasping after 30
seconds of drying or before 30
seconds of drying if the newborn is
completely floppy and not breathing.

2.Clamp and cut the cord

immediately.

3.Call for help.

Adopting New Policies and 4.Transfer the newborn to a dry,

ADMINISTRATIVE clean and warm surface. Keep the
Protocol on Essential newborn wrapped or under a heat
ORDER No. 2009-0025
Newborn Care source if available. Inform the
mother that the newborn needs help
to breathe.

5.Refer to the Department Circular

for the step-by step newborn
resuscitation guideline.
 LAW TITLE PROVISION
Additional Care for a small
baby or twin

If a newborn is preterm, 1-2 months

early or weighing 1,500 – 2,499 g (or
visibly small where a scale is not
available)

1.If the newborn is delivered 2

months earlier or weighs <1500 g,
refer to a specialized hospital.

2.For a visibly small newborn or a

Adopting New Policies and newborn born >1 month early:
ADMINISTRATIVE
Protocol on Essential  Teach the mother how to keep
ORDER No. 2009-0025
Newborn Care the small newborn warm in skin-
to-skin contact via Kangaroo
Mother Care (KMC). Start
kangaroo mother care when:

a. The newborn is able to breathe on

its own (no apneic episodes).

b. The newborn is free of life-

threatening disease or
malformations.
 LAW TITLE PROVISION

 Provide extra blankets for the

mother and the newborn, plus
bonnet, mittens and socks for the
newborn.

 If the mother cannot keep the

Adopting New Policies and
ADMINISTRATIVE
Protocol on Essential  Give
ORDER No. 2009-0025
Newborn Care
newborn skin-to-skin because of
complications, wrap the newborn
in a clean, dry, warm cloth and
place in a cot. Cover with a
blanket. Use a radiant warmer if
the room is not warm or the baby
is small.
special support for
breastfeeding: Encourage the
mother to breastfeed every 2-3
hours.

Weigh the newborn daily.

When the mother and newborn are
separated, or if the newborn is not
sucking effectively, use alternative
feeding methods.
 LAW TITLE PROVISION

3. Discharge Planning

1. Breastfeeding well and gaining

weight adequately for 3
consecutive days.
2. 2.Body temperature between
36.5 and 37.5 C for 3 consecutive
days.
3. 3.Mother able and confident in
caring for the newborn.

Discharge Instructions
Adopting New Policies and 1. Advise the mother to return or go
ADMINISTRATIVE to the hospital immediately if:
Protocol on Essential Jaundice of the soles or any of the
ORDER No. 2009-0025 following are present:
Newborn Care
Difficulty of feeding

Convulsions

Movement only when stimulated

Fast or slow or difficult breathing

(e.g., severe chest in-drawing)

Temperature ≥37.5 C or <35.5 C

 LAW TITLE PROVISION

2. Advise the mother to bring her

newborn to the health facility for
routine check-up at the following
prescribed schedule:

Postnatal visit 1: at 48 – 72 hours

of life

Postnatal visit 2: at 7 days of life

Immunization visit 1: at 6 weeks of

life
Adopting New Policies and
ADMINISTRATIVE 3. Advise additional follow-up visits
Protocol on Essential appropriate to problems in the
ORDER No. 2009-0025
Newborn Care following:
Two days – if with breastfeeding
difficulty, Low Birth Weight in the first
week of life, red umbilicus, skin
infection, thrush or other problems.

Seven days – if Low Birth Weight

discharged more than a week of age
and not gaining weight adequately.

4. Advise for Newborn Screening

NEWBORN SCREENING
 PURPOSE OF NEWBORN
SCREENING
• The purpose of newborn screening is to detect
potentially fatal or disabling conditions in
newborns as early as possible, often before the
infant displays any signs or symptoms of a
disease or condition. Such early detection
allows treatment to begin immediately, which
reduces or even eliminates the effects of the
condition. Many of the conditions detectable in
newborn screening, if left untreated, have
serious symptoms and effects, such as lifelong
nervous system damage; intellectual,
developmental, and physical disabilities; and
even death.
 PURPOSE OF NEWBORN
SCREENING
• Newborn screening is a simple procedure.
Using the heel prick method, a few drops of
blood are taken from the baby's heel and
blotted on a special absorbent filter card. The
blood is air dried for 4 hours and sent to the
Newborn Screening Laboratory (NBS Lab) in
Manila
 WHEN IS NEWBORN SCREENING
CONDUCTED?

• Newborn Screening is done on

the 48th Hour or at least 24
hours from birth. The baby must
be screened again 2 weeks after
for more accurate results.
 WHEN IS NEWBORN SCREENING
RESULTS AVAILABLE?
• Seven (7) working days from the time
the newborn screening samples are
received.
• Laboratory result indicating an
increased risk or of a heritable
disorder (i.e. positive screen) shall be
immediately released, within twenty-
four (24) hours followed by
confirmatory testing can be
immediately done.
 WHO MAY COLLECT
THE SAMPLE FOR
NEWBORN SCREENING?

• A Trained: physician, nurse,

midwife, or medical
technologist
 WHAT ARE THE 5 IDENTIFIED
METABLOC DISORDERS
SCREENED FROM A CHILD?

• Congenital Hypothyroidism - causes

severe mental retardation
• Congenital Adrenal Hyperplasia -
cause death
• Galactosemia - Death or cataracts
• Phenylketonuria - Severe mental
retardation
• G6PD Deficiency - Severe anemia
and Kernicterus
 LAW TITLE PROVISION
• Section 2. Declaration of Policy
“…It is the policy of the State to protect and promote
the right to health of the people, including the
rights of children to survival and full and healthy
development as normal individuals...”

“...The National Newborn Screening System shall

ensure that every baby born in the Philippines is
offered the opportunity to undergo newborn
screening and thus be spared from heritable
conditions that can lead to mental retardation and
death if undetected and untreated.”

• Section 3. Objectives
1) To ensure that every newborn has access to
newborn screening for certain heritable conditions
REPUBLIC ACT Newborn Screening Act that can result in mental retardation, serious health
complications or death if left undetected and untreated;
No. 9288 of 2004
2) To establish and integrate a sustainable newborn
screening system within the public health delivery
system;

3) To ensure that all health practitioners are aware

of the advantages of newborn screening and of
their respective responsibilities in offering newborns
the opportunity to undergo newborn screening; and

4)To ensure that parents recognize their

responsibility in promoting their child's right to
health and full development, within the context of
responsible parenthood, by protecting their child
from preventable causes of disability and death
through newborn screening.
 LAW TITLE PROVISION
• SEC. 5. Obligation to Inform
“…Any health practitioner who delivers, or
assists in the delivery, of a newborn in the
Philippines shall, prior to delivery, inform the
parents or legal guardian of the newborn of
the availability, nature and benefits of
newborn screening. Appropriate notification and
education regarding this obligation shall be the
responsibility of the Department of Health
(DOH).”

• SEC. 6. Performance of Newborn

Screening.
REPUBLIC ACT Newborn Screening Act “...Newborn screening shall be performed
after twenty-four (24) hours of life but not later
No. 9288 of 2004 than three (3) days from complete delivery of
the newborn. A newborn that must be placed
in intensive care in order to ensure survival
may be exempted from the 3-day requirement
but must be tested by seven (7) days of age. It
shall be the joint responsibility of the
parent(s) and the practitioner or other person
delivering the newborn to ensure that
newborn screening is performed. An
appropriate informational brochure for parents to
assist in fulfilling this responsibility shall be made
available by the Department of Health and shall
be distributed to all health institutions and made
available to any health practitioner requesting it
 LAW TITLE PROVISION
• SEC. 7. Refusal to be Tested.
“…A parent or legal guardian may refuse
testing on the grounds of religious beliefs, but
shall acknowledge in writing their
understanding that refusal for testing places
their newborn at risk for undiagnosed
heritable conditions. A copy of this refusal
documentation shall be made part of the
newborn's medical record and refusal shall be
indicated in the national newborn screening
database.”

• SEC. 8. Continuing Education, Re-

education and Training Health Personnel.
REPUBLIC ACT Newborn Screening Act “...The DOH, with the assistance of the NIH and
other government agencies, professional
No. 9288 of 2004 societies and non-government organizations,
shall: (i) conduct continuing information,
education, re-education and training
programs for health personnel on the
rationale, benefits, procedures of newborn
screening; and (ii) disseminate information
materials on newborn screening at least
annually to all health personnel involved in
material and pediatric care.”
BEMONC / CEMONC
 LAW TITLE PROVISION
• Basic Emergency Obstetrics and Newborn
Care (BEmONC) Provider is a capable
private health facility or an appropriately
upgraded public health facility that is either a
Rural Health Unit (RHU) and/or its satellite
Barangay Health Station (BHS) or Hospital
capable of performing the following
emergency obstetric function:

Adaption of the Manual (1) parenteral administration of oxytocin in the

third stage of labor;
of Operation on
Maternal, Newborn, (2) parenteral administration of loading dose of
DEPARTMENT and Child Health anti-convulsants;

MEMORANDUM Nutrition (MNCHN) in (3) parenteral administration of initial dose of

No. 2009- 0110 the Implementation of antibiotics;
Programs, Projects and (4) performance of assisted deliveries in imminent
other Initiatives for breech;
Women and Children. (5) removal of retained placental products ; and

(6) manual removal of retained placenta. It is

also capable of providing neonatal emergency
interventions, which include at the minimum,
newborn resuscitation, provision of warmth, and
referral
 LAW TITLE PROVISION

• It is also capable of providing

neonatal emergency
interventions, which include at
the minimum, newborn
resuscitation, provision of
warmth, and referral.
Adaption of the Manual
of Operation on • The hospital BEmONC shall
Maternal, Newborn, also be capable of providing
DEPARTMENT and Child Health blood transfusion services.
MEMORANDUM Nutrition (MNCHN) in These facilities can likewise
No. 2009- 0110 the Implementation of serve as high volume providers
Programs, Projects and for IUD (intra-uterine device)
other Initiatives for and VSC (voluntary surgical
Women and Children. contraception) services. It can
also be a single or stand alone
facility or part of a network of
facilities in an inter-local health
zone.
 LAW TITLE PROVISION

• The BEmONC implementation

strength index score, which ranged
between zero and 10, increased
statistically significantly from 4.3 at
baseline to 6.7 at follow-up (p < .05).
Correspondingly, the health center
delivery rate significantly increased
Adaption of the Manual from 24% to 56% (p < .05).
of Operation on
Maternal, Newborn, • There was a dose–response
relationship between the explanatory
DEPARTMENT and Child Health
and outcome variables. For every
MEMORANDUM Nutrition (MNCHN) in unit increase in BEmONC
No. 2009- 0110 the Implementation of implementation strength score there
Programs, Projects and was a corresponding average of 4.5
other Initiatives for percentage points (95% confidence
Women and Children. interval: 2.1–6.9) increase in facility-
based deliveries; while a higher
score for BEmONC implementation
strength of a health facility at follow-
up was associated with a higher met
need.
 LAW TITLE PROVISION
• Comprehensive Emergency Obstetrics and
Newborn Care (CEmONC) Provider is a
tertiary level regional hospital or medical
center, provincial hospital or an
appropriately upgraded district hospital. It
can also be a capable privately operated
medical center. It is capable of performing
emergency obstetric functions as in
BEmONC provider facilities, as well as
Adaption of the Manual provides surgical delivery (caesarean
of Operation on section) and blood bank transfusion
services, and other highly specialized
Maternal, Newborn, obstetric interventions. It is also able to
DEPARTMENT and Child Health provide emergency neonatal care, which
MEMORANDUM Nutrition (MNCHN) in include the minimum:
No. 2009- 0110 the Implementation of (1) newborn resuscitation;
Programs, Projects and
other Initiatives for (2) treatment of neonatal sepsis/infection;

Women and Children. (3) oxygen support; and,

(4) antenatal administration of (maternal)

steroids for threatened premature delivery. It
can also serve as high volume providers for
intra-uterine device (IUD) and voluntary
surgical contraception (VSC) services.
Maternal and Child
Health
 LAW TITLE PROVISION

• Section 2. Declaration of Policy

“…The State recognizes and guarantees the human
rights of all persons including their right to equality
and nondiscrimination of these rights, the right to
sustainable human development, the right to health
which includes reproductive health, the right to
education and information, and the right to choose
and make decisions for themselves in accordance
with their religious convictions, ethics, cultural
beliefs, and the demands of responsible
parenthood..”

The State recognizes marriage as an inviolable social

Responsible Parenthood institution and the foundation of the family which in turn
is the foundation of the nation. Pursuant thereto, the
REPUBLIC ACT and Reproductive State shall defend:
No. 10354 Health Law (RPRH Act (a) The right of spouses to found a family in
of 2012) accordance with their religious convictions and the
demands of responsible parenthood;

(b) The right of children to assistance, including

proper care and nutrition, and special protection
from all forms of neglect, abuse, cruelty,
exploitation, and other conditions prejudicial to
their development;

(c) The right of the family to a family living wage

and income; and

(d) The right of families or family associations to

participate in the planning and implementation of
policies and programs
 LAW TITLE PROVISION

• SEC. 5. Hiring of Skilled Health Professionals for

Maternal Health Care and Skilled Birth
Attendance
“…The LGUs shall endeavor to hire an adequate
number of nurses, midwives and other skilled
health professionals for maternal health care and
skilled birth attendance to achieve an ideal skilled
health professional-to-patient ratio taking into
consideration DOH targets..”

• SEC. 6. Health Care Facilities

Responsible Parenthood “Each LGU, upon its determination of the necessity

based on well-supported data provided by its local
REPUBLIC ACT and Reproductive health office shall endeavor to establish or upgrade
hospitals and facilities with adequate and qualified
No. 10354 Health Law (RPRH Act personnel, equipment and supplies to be able to
of 2012) provide emergency obstetric and newborn care”

• SEC. 7. Access to Family Planning.

“...All accredited public health facilities shall provide a

full range of modern family planning methods, which
shall also include medical consultations, supplies and
necessary and reasonable procedures for poor and
marginalized couples having infertility issues who
desire to have children..”
 LAW TITLE PROVISION

• SEC. 8. Maternal Death Review and Fetal and

Infant Death Review
“…All LGUs, national and local government
hospitals, and other public health units shall
conduct an annual Maternal Death Review and
Fetal and Infant Death Review in accordance with
the guidelines set by the DOH...”

• SEC. 9. The Philippine National Drug Formulary

System and Family Planning Supplies
“The National Drug Formulary shall include hormonal
contraceptives, intrauterine devices, injectables and
Responsible Parenthood other safe, legal, non-abortifacient and effective family
planning products and supplies.”
REPUBLIC ACT and Reproductive
• SEC. 10. Procurement and Distribution of
No. 10354 Health Law (RPRH Act Family Planning Supplies.
of 2012) “...The DOH shall procure, distribute to LGUs and
monitor the usage of family planning supplies for the
whole country...”

• SEC. 11. Integration of Responsible Parenthood

and Family Planning Component in Anti-
Poverty Programs.
“..A multidimensional approach shall be adopted in the
implementation of policies and programs to fight
poverty.”
 LAW TITLE PROVISION

• SEC. 12. PhilHealth Benefits for Serious

.and Life-Threatening Reproductive Health
Conditions.
“…All serious and life-threatening
reproductive health conditions such as HIV
Responsible Parenthood and AIDS, breast and reproductive tract
REPUBLIC ACT and Reproductive cancers, and obstetric complications, and
No. 10354 Health Law (RPRH Act menopausal and post-menopausal-related
conditions shall be given the maximum
of 2012) benefits, including the provision of Anti-
Retroviral Medicines (ARVs), as provided in
the guidelines set by the Philippine Health
Insurance Corporation (PHIC)..”
NUTRITION
 GENERAL OBJECTIVE
• The overall objective is to improve
the survival of infants and young
children at early months and years of
life, and of the crucial role that
appropriate feeding practices play in
achieving optimal health outcomes
by improving their nutritional status,
growth and development through
optimal feeding.
 SPECIFIC OBJECTIVE
1.To raise awareness of the main problems
affecting infant and young child feeding, identify
approaches to their solution, and provide a
framework of essential interventions;

2.To create an environment that will enable

mothers, families and other caregivers in all
circumstances to make and implement informed
choices about optimal feeding practices for infants
and young children.

3.To increase commitment of the local chief

executives and other partners.
 SPECIFIC OBJECTIVE
1.To raise awareness of the main problems
affecting infant and young child feeding, identify
approaches to their solution, and provide a
framework of essential interventions;

2.To create an environment that will enable

mothers, families and other caregivers in all
circumstances to make and implement informed
choices about optimal feeding practices for infants
and young children.

3.To increase commitment of the local chief

executives and other partners.
BREAST FEEDING PRACTICES
a. EXCLUSIVE BREAST FEEDING - infant
receives breast milk (including expressed milk or
breast milk from a wet nurse) and allows the infant
to receive oral rehydration salt (ORS), drops,
syrups (Vitamins, minerals, medicines), but nothing
else. (WHO, 2007)
b. PREDOMINANT BREAST FEEDING - the
infant’s predominant sourxe of nourishment has
been breast milk, including milk expressed or from
a wet nurse as a predominant source of
nourishment. Infant may also had received liquids -
water and water based drinks, fruit juice, ritual
fluids, and Oresol drops or syrups, such as
vitamins, minerals, and medicines. (WHO, 2007)
c. COMPLIMENTARY FEEDING- the process of
giving the infant foods and liquids, along with breast
milk, when breast milk is no longer sufficient to meet
the infant’s nutritional requirements.
d. BOTTLE FEEDING - the child is given food or drink
(including breast milk) from a bottle with nipple/teat.
- Information on bottle feeding is useful because of the
potential interference of bottle feeding with optimal
breastfeeding practices and the association between
bottle feeding and increased diarrheal disease
morbidity and mortality.
e. EARLY INITIATION OF BREAST FEEDING-
initiating breast feeding of the newborn after birth
within 90 minutes of life in accordance to the essential
newborn care protocol.
- this will be stimulate early onset of full milk
production and promote bonding of the mother and
child.
EO No. 51 MILK CODE
Provision: Prohibits advertising,
promotion, or other marketing
materials that simply or create a
belief that bottle feeding is
equivalent or superior to breast
feeding.
RA 7600 Rooming-In Newborn infant should be put
and Breast to the breast of the mother
Feeding immediately after birth and
Act roomed-in within 30 minutes
after normal spontaneous
delivery and within 3-4 hours
after caesarian delivery.
Benefits of breastfeeding according to
UNICEF, (2012)
 Breast milk provides all of the nutrients an infant
needs for growth in the first 6 months.
 Breast milk carries antibodies from the mother
that help combat disease. Particularly true of
colostrum - the yellowish fluid secreted by the
mammary glands in the first few days after birth,
and it is rich with antibodies and white cells to
protect against infection.
 Breast milk prevents diarrhea.
 Breast fed infants have a lower risk of
developing later in life chronic conditions like
allergies, asthma, obesity, diabetes, and heart
disease.
 Breast feeding also provides benefits for
intellectual and motor development of the infant.
Positions of breast feeding
Cradle Hold - the mother sits with her arms supported
and, using her arm on the same side as the nursing breast,
cradles the infant in front of her body (Mayo Clinic, 2012)
Cross Cradle Hold - similar to the cradle hold, except that
the mother cradles her infant with the arm on the opposite
side of the nursing breast (Mayo Clinic, 2012)
Football, Clutch, or Underarm Hold - the mother sits,
holds the infant between her flexed arm and body, positions
the infant facing her, and supports the infant's head with her
open hand. Twins may be fed at the same time using the
double football hold (Mayo Clinic, 2012)
Side-Lying Hold - the mother lies on her side with one
arm supporting her head. The infant lies beside the mother,
facing the breast. The mother grasps and offers her breast to
the infant with the other hand. Once the infant had latched
on, she supports the infant's body (Mayo Clinic, 2012)
 RECOMENDED INFANT and YOUNG
CHILD FEEDING PRACTICES
a.Early initiation of breastfeeding
b.Exclusive breastfeeding for the first 6
months, which is possible, except for a few
medical conditions, such as galactosemia.
Infants suffering from phenylketonuria of
maple syrup urine disease may still be
breastfed with monitoring of the infant's
blood levels of the non-tolerated amino
acids
Extended breast feeding up to 2 years and
beyond, which is recommended even if the
infant's consumption of breast milk declines
as complementary foods are given.
RA 10028 EXPANDED Mandates the setting up of
Breast lactation stations in all health
Feeding and nonhealth facilities,
Promotion establishments, or
Act institutions; and also grants
break intervals for nursing
employees to breastfeed or
express milk.
 D. Complimentary Feeding
From the age of 6 months, an infant's need for energy and nutrients
starts to exceed what is provided by breast milk, and complementary
feeding becomes necessary to fill the energy and nutrient gap (WHO,
2009)
Infants are particularly vulnerable during the transition
period when complementary feeding begins. Ensuring that their
nutritional needs are met requires that complementary foods be:
 TIMELY - complimentary foods ar introduced when the need for
energy and nutrients exceeds what can be provided through
exclusive and frequent breastfeeding
 ADEQUATE- they should provide sufficient energy, protein, and
micronutrients to meet a growing child's nutritional needs.
 SAFE - foods ar hygienically stored and prepared, and fed with
clean hands using clean utensils and not bottles and artificial
nipples
 PROPERLY FED - foods are given consistent with a child's
signals of appetite and satiety, and that meal frequency and
feeding method-- actively encouraging the child, even during
illness, to consume sufficient food using fingers, spoon, or self-
feeding -- are suitable for age (WHO, 2003b)
 E. Micronutrient Supplementation
The value of micronutrient supplementation in the
attainment of MDG targets is emphasized in
Administrative Order 2010-0010.
 Micronutrient (vitamin and mineral) supplements are
sources in concentrated forms of those nutrients
alone or in combinations, marketed in forms such as
capsules, tablets, powders, and solutions, that are
designed to be taken in measured small-unit
quantities.
 The purpose of micronutrient supplementation is to
add to the vitamins and minerals provided by a
normal diet (DOH, 2010a).
 Micronutrient supplementation is a short-term
intervention for correcting high levels of micronutrient
deficiencies until more sustainable food-based
approaches can be used effectively (DOH, 2010a).
E. Micronutrient Supplementation

The 2008 National Nutrition Survey result show that

micronutrient deficiencies particularly VAD, iron deficiency
anemia and iodine deficiency disorders swill persists in the
Philippines (FNRI, 2008).
 micronutrient supplementation is recommended for 0 to
59-month-old children, in addition to pregnant and lactating
women and other women of reproductive age, or those
within the ages of 15-49 years old (DOH, 2010a).
 Zinc supplement is also given to children aged 0-59
months and who are having diarrhea.
 For infants less than 6 months, the dose is 10 mg
elemental zinc per day; for children 6-59 months, 20 mg
elemental zinc per day for 10-14 days (DOH-IMS, 2011).
 Given to children with diarrhea, zinc reduces the duration
and severity of the episode. Giving zinc supplements for
10-14 days lowers the incidence of diarrhea in the
following 2-3 months (WHO, 2010).
 F. Universal Salt Iodization

Families shall be encourage and

educated on the use of iodized salt in
the preparation of foods for older
infants and young children and even
adults to prevent iodine deficiency
disorders. Since ordinary salt contains
very little iodine that cannot provide for
the needs of the human body.
RA 8172 ASIN LAW Requires that all procedures
of food- grade salt to iodize
the salt that they produce,
import, trade, or distribute.
 G. Food Fortification
• Fortification is defined as the addition of
micronutrients to staple food such as rice,
sugar, cooking oil, flour and salt. This also
means the addition of micronutrients to
precessed foods at levels above the natural
state (DOH, 2003b)
 The Sangkap Pinoy seal is conferred by the
DOH and affixed to the packaging of food
products that have been certified as fortifies
euther singly or in combination of the
micronutrients Vitamin A, iron and iodine
(FNRI, 2008). The seal guarantees that the
food was processed in compliance with the
fortification standards of the government.
EO No. 382 DESIGNATING THE Food fortification, one of the impact
DEPARTMENT OF programs of the Philippine Plan of
HEALTH AS LEAD Action for Nutrition, is the long-term
AGENCY IN THE solution and most cost-effective
NATIONWIDE strategy in addressing the
OBSERVANCE OF micronutrient malnutrition problem
THE NATIONAL which affects the most vulnerable
FOOD population particularly mothers and
FORTIFICATION DAY young children;
EVERY 7TH OF
NOVEMBER
RA 8976 PHIL. Food Mandates the fortification of
Fortification Act rice with iron, wheat flour with
vitamin A and iron, refined
sugar with vitamin A, and
cooking oil with vitamin A; and
promotes fortification of food
products through the Sangkap
Pinoy Seal Program.
 3.DEWORMING
Deworming of children aged 1-12
years old is done every 6 months.

Children aged 12-24 months are

given Albendazole 200 mg or half
tablet or Menbendazole 500 mg tablet.

Children older that 2 years old are

given Albendazole 400 mg or
Mebendazole 500mg tablet. These
drugs require intake on a full stomach.
POTENTIAL ADVERSE EFFECTS:
• local sensitivity or allergy
• mild abdominal pain
• diarrhea
• erractic worm migration - pull our worms
form mouth/nose or from other body
orifices.

NOT ADVISABLE TO CHILDREN WITH:

• serious illness
• abdominal pain
• diarrhea
• hx of hypersensitivity to the drug, or
• severe malnutrition
A.O 36, s2010 EXPANDED A comprehensive and integrated
GARANTISAD package of services on helath,
ONG nutrition, and environment for
PAMBATA children available every day at
various settings such as homes,
schools, health facilities, and
communities by government and
non-government organizations,
private sectors, and civic groups.
 4. INFANT AND YOUNG CHILD
FEEDING
Goal: To reduce child mortality and
morbidity through optimal feeding of
infants and young children.

Beneficiaries: Infants (0-11

months) and young children (12-
36 months or 1-3 years old)
MENTAL HEALTH
• Mental, neurological and substance use disorders
are highly prevalent, burdensome and common in
all regions of the world, affecting every community
and age group across all income countries. While
14% of the global burden of disease is attributed
to these disorders, most of the people affected -
75% in many low-income countries - do not have
access to the treatment they need. The gap
between what is urgently needed and what is
available to reduce the burden is still very wide.

• WHO recognizes the need for action to reduce

the burden, and to enhance the capacity of
Member States to respond to this growing
challenge. mhGAP is WHO’s action plan to scale
up services for mental, neurological and
substance use disorders for countries especially
with low and lower middle incomes.
• The priority conditions addressed by mhGAP are:
depression
 schizophrenia and other psychotic disorders
 suicide
 epilepsy
 dementia
 disorders due to use of alcohol
 disorders due to use of illicit drugs
 and mental disorders in children.

• The mhGAP package consists of interventions

for prevention and management for each of
these priority conditions. WHO recognizes the
need for action to reduce the burden, and to
enhance the capacity of Member States to
respond to this growing challenge. mhGAP is
WHO’s action plan to scale up services for
mental, neurological and substance use
disorders for countries especially with low and
lower middle incomes.
 End of
Presentation
Shienny Nicole Villanueva Tristan Gem Gaspar
Rhea Mae Layaoen Erika Calapit
Brix Alvin Valdriz Allana Maye Ramal
Ferine Joy Jullian Sheena Mae Oao
Maruel Calano Irylle Bagasol
Eufenica Gajes

GROUP IV - BSN II B