Module 8: DOH Programs Related to Family Health

A. EPI (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 GOALTo 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
PRESID PROVIDING WHEREAS, the Child is one of
ENTIAL FOR the most important assets of the
DECRE COMPULSORY nation and every effort should be
E No. BASIC exerted to promote his welfare and
996 IMMUNIZATIO enhance his opportunities for a
Septemb N FOR useful and happy life;
er 16, INFANTS AND
1976 CHILDREN WHEREAS, the Child can be
BELOW EIGHT protected against death, disease,
YEARS OF and disability through an
AGE integrated and comprehensive
basic immunization program for
infants and children below eight
years of age;
WHEREAS, immunization against
tuberculosis, diphtheria, tetanus,
pertussis, poliomyelitis, measles,
rubella, and other diseases is
proven and universally applied and
generally accepted to be efficient,
safe, and 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
Section 2.Scope
"...Basic immunization services
shall include:
(a) BCG Vaccination against
tuberculosis;
(b) Inoculation against diphtheria,
tetanus, and pertussis;
(c) Oral poliomyelitis
immunization; (d) Protection
against measles;
(e) Immunization against rubella;
and;
(f) such other basic 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..”
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
resources to carry out the purposes
of this Decree.:”
Section 4. Responsibility of
Parents, the Guardian, or Person
Having Custody of 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 of
Health..” 

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 services..:”
Being one of the health care
practitioners or health care
workers who are administering
prenatal care, should be the one
who is knowledgeable and keen in
educating mothers regarding what
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.
 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
primary school entrants who have
not received such immunization,
subject to rules and regulations as
the Secretary of Health may
promulgate...:”

Antigen Age Dose Route Site

BCG At Birth 0.05 ml Intradermal Right
vaccine deltoid
region
(arm)
Hepatitis B At Birth 0.5 ml Intramuscul Anterolater
vaccine ar al thigh
muscle
DPT- 6 weeks, 10 0.5 ml Intramuscul Anterolater
HepB-Hib weeks, 14 ar al thigh
(Pentavalen weeks muscle
t Vaccine)
Oral Polio 6 weeks, 10 2 drops Oral Mouth
vaccine weeks, 14
weeks
Measles,M 12-15 0.5 ml Subcutaneo Outer part
umps, months us of the
Rubella upper arm
Vaccine
(AMV2)
 Anti 9-11 0.5 ml Subcutaneo Outer part
-Measles months us of the
Vaccine upper arm
B.INTEGRATED MANAGEMENT OF CHILDHOOD
ILLNESS (IMCI)
• 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).
• 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
• 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
 Law Title Provision
REPUB AN ACT Section 2. Declaration of Policy
LIC PROMULGATI "...It is hereby declared the policy
ACT NG A of the State to promote the rights
NO. COMPREHENS of children to survival,
8980 IVE POLICY development and special
AND A protection with full recognition of
NATIONAL the nature of childhood and its
SYSTEM FOR special needs; and to support
EARLY parents in their roles as primary
CHILDHOOD caregivers and as their children's
CARE AND first teachers.”
DEVELOPMEN
T (ECCD) "The State shall institutionalize a
National 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...”
"...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),
educating parents and caregivers,
encouraging the active
involvement of parents and
communities in ECCD programs,
raising awareness about the
importance of ECCD, and
promoting community
development efforts that improve
the quality of life for young
children and families.”

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 early childhood
years;
(b) To enhance the physical,
social, emotional, cognitive,
psychological, spiritual and
language development of young
children;
(c) To enhance the role of parents
and other caregivers as the primary
caregivers and educators of their
children from birth onwards;
(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 quality
standards for various ECCD
programs;
(f) To enhance and sustain the
efforts of communities to promote
ECCD programs and 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 these children;
(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
ECCD programs through, but not
limited to, a registration and
credential system for ECCD
service providers.
C.EARLY ESSENTIAL INTRAPARTUM AND NEWBORN
CARE
Law Title Provision
ADMINI Adopting New
STRATI Policies and "...In general, this policy aims to
VE Protocol on ensure the provision of globally
ORDER Essential accepted evidence-based essential
No. 2009- Newborn Care newborn care focusing on the first
0025 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
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
“...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 maternal and newborn care.”
"Administrative Order, emphasis
is given to care interventions that
should be provided to the newborn
from birth until the first 6 hours of
life"
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 Administrative
Order, emphasis is given to care
interventions that should be
provided to the newborn from
birth until the first 6 hours of life.
The care for the newborn 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.
Ensure Quality Provision of
Time-Bound Interventions
This is the aspect of newborn care
in the Philippines that have not
met international standards, and

ACTION/TIME
1. Within the first 30 seconds
2. After thorough drying
3. While on skin-to-skin
contact (up to 3 minutes post-
delivery)
4. Within 90 minutes of age
Law
should therefore, be re-taught and
re-learned by all health care
providers.
OBJECTIVE
Dry and provide warmth to the
newborn and prevent
hypothermia.
Facilitate bonding between the
mother and newborn through
skin-to-skin contact to reduce
likelihood of infection and
hypoglycemia.
Reduce the incidence of anemia
in term newborns and
intraventricular hemorrhage in
pre-term newborns by delaying
or non-immediate cord
clamping.
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.
Title Provision
ADMINISTRATIV Adopting New
E ORDER No. Policies and Interventions –
2009-0025 Protocol on These interventions
Essential Newborn are usually given
Care within 6 hours after
birth and should
never be made to
compete with the
time-bound
interventions.
1.Give Vitamin K
prohylaxis
2.Inject Hepatitis B
and BCG
vaccinations
3.Examine the
newborn. Check for
birth injuries,
malformations or
defects.
4. Cord Care
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.
4.Transfer the
newborn to a dry,
clean and warm
surface. Keep the
newborn wrapped or
under a heat 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.
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
newborn born >1
month early:
 Teach the
mother how to
keep 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.
- Provide extra
blankets for the
mother and the
newborn, plus
bonnet, mittens and
socks for the
newborn.
- If the mother
cannot keep the
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.
- Give 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.

3 Discharge
Planning
1.Breastfeeding well
and gaining weight
adequately for 3
consecutive days.
2.Body temperature
between 36.5 and
37.5 C for 3
consecutive days.
3.Mother able and
confident in caring
for the newborn.
Discharge
Instructions
1.Advise the mother
to return or go to the
hospital
immediately if:
Jaundice of the soles
or any of the
following are
present:
-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
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
3. Advise additional
follow-up visits
appropriate to
problems in the
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
D.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.
• 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?
1. Hypothyroidism - causes severe mental retardation
2.Congenital Adrenal Hyperplasia - cause death
3.Galactosemia - Death or cataracts
4.Phenylketonuria - Severe mental retardation
5.G6PD Deficiency - Severe anemia and Kernicterus
Law Title Provision
REPUBLIC ACT Newborn Screening Section 2.
No. 9288 Act of 2004 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
that can result in
mental retardation,
serious health
complications or
death if left
undetected and
untreated;
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.
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.
“...Newborn
screening shall be
performed after
twenty-four (24)
hours of life but not
later 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 for
appropriate
distribution.”
SEC. 7. Refusal to
be Tested.
"...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.
“...The DOH, with
the assistance of the
NIH and other
government
agencies,
professional
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.”
E. BEMONC/CEMONC
Law Title Provision
DEPARTMENT Adaption of the Basic Emergency
MEMORANDUM Manual of Obstetrics and
No. 2009- 0110 Operation on Newborn Care
Maternal, Newborn, (BEmONC)
and Child Health Provider is a capable
Nutrition (MNCHN) private health
in the facility or an
Implementation of appropriately
Programs, Projects upgraded public
and other Initiatives health facility that is
for Women and either a Rural Health
Children. Unit (RHU) and/or
its satellite
Barangay Health
Station (BHS) or
Hospital capable of
performing the
following
emergency obstetric
function:
(1) parenteral
administration of
oxytocin in the third
stage of labor;
(2) parenteral
administration of
loading dose of anti-
convulsants;
(3) parenteral
administration of
initial dose of
antibiotics;
(4) performance of
assisted deliveries in
imminent breech;
(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
It is also capable of
providing neonatal
emergency
interventions, which
include at the
minimum, newborn
resuscitation,
provision of
warmth, and
referral.
The hospital
BEmONC shall also
be capable of
providing blood
transfusion services.
These facilities can
likewise serve as
high volume
providers for IUD
(intra-uterine
device) and VSC
(voluntary surgical
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.
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 from 24%
to 56% (p < .05).
There was a dose-
response
relationship between
the explanatory and
outcome variables.
For every unit
increase in
BEmONC
implementation
strength score there
was a corresponding
average of 4.5
percentage points
(95% confidence
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.
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
provides surgical
delivery (caesarean
section) and blood
bank transfusion
services, and other
highly specialized
obstetric
interventions. It is
also able to provide
emergency neonatal
care, which include
the minimum:
(1) newborn
resuscitation;
(2) treatment of
neonatal
sepsis/infection;
(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.
F.Maternal and Child Health
Law Title Provision
REPUBLIC ACT Responsible
No. 10354 Parenthood and Section 2.
Reproductive Health Declaration of
Law (RPRH Act of Policy
2012) "...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
institution and the
foundation of the
family which in turn
is the foundation of
the nation. Pursuant
thereto, the State
shall defend:
(a) The right of
spouses to found a
family in
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

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
“Each LGU, upon
its determination of
the necessity based
on well-supported
data provided by its
local health office
shall endeavor to
establish or upgrade
hospitals and
facilities with
adequate and
qualified personnel,
equipment and
supplies to be able
to 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..”
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 other
safe, legal, non-
abortifacient and
effective family
planning products
and supplies.”
SEC. 10.
Procurement and
Distribution of
Family Planning
Supplies.
“...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.”

SEC. 12. PhilHealth

Benefits for
Serious .and Life-
Threatening
Reproductive Health
Conditions.
"...All serious and
life-threatening
reproductive health
conditions such as
HIV and AIDS,
breast and
reproductive tract
cancers, and
obstetric
complications, and
menopausal and
post-menopausal-
related conditions
shall be given the
maximum benefits,
including the
provision of Anti-
Retroviral
Medicines (ARVs),
as provided in the
guidelines set by the
Philippine Health
Insurance
Corporation
(PHIC)..”
G.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.
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.
Law Title Provision
RA 7600 Rooming-In and Newborn infant
Breast Feeding Act should be put to the
breast of the mother
immediately after
birth and 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.
Law Title Provision
RA 10028 EXPANDED Breast Mandates the setting
Feeding Promotion up of lactation
Act stations in all health
and nonhealth
facilities,
establishments, or
institutions; and also
grants break
intervals for nursing
employees to
breastfeed or
express milk