MERGEF

Family Medicine & Community Health 3
Triple Burden of Disease

Annabel Pabiloña-Tiu, MD | 10 August 2019
Reason why the pilippines bear a triple burden of disease

1. Increasing health impact of globalization and escalating
climate change
2. Changes in lifestyle and the increasing prevalence of risk
factors
3. Advances in the management and treatment of infectious
diseases, Filipinos continue to suffer from diseases for
which interventions are available (HIV, TB, Vaccine
preventable disease)
WHO estimated that:

1. Communicable and non-communicable diseases have
been the primary culprit of deaths all over the world in the
last 2 decades
2. About half of the 56.4 million deaths worldwide can be
attributed to just 10 causes; a total of 15 million deaths
were due to ischemic heart disease and stroke
3. In recent years, cases of road injuries have gradually
increased to become one of the top causes of mortality.
4. Economic growth, which is usually characterized by
urbanization, food availability, employment and
technology, have influenced daily lifestyles, including
physical activity, diet, and exposure to vices.
WHO: the impact of chronic disease in the Philippines

• Chronic disease accounted for 57% of all death
• At least 80% is due to premature heart disease, stroke and
type 2 DM
• 40% is due to cancer
First Guarantee of TBD
Philippine Health Agenda Framework
• “all life stages and triple burden disease” means that the
health system will ensure services that keep the well
healthy, and the sick return to their full health from
pregnancy to old age
• This guarantee summarizes that a Filipino is entitled to a
comprehensive range of services that promote health and
protect everyone from getting sick at all ages and all stages
• From WOMB to TOMB
COMMUNICABLE DISEASES
1. Emerging and re-emerging infectious disease program (EREID)

In the recent past, the Philippines has seen many
outbreaks of emerging infections diseases and it continues to be
susceptible to dengue, meningococcemia, tuberculosis
Contributing factors
1. Demographic factors like the population distribution and
density,
2. International travel/ tourism and increased OFWs,
3. Socio-economic factors and
4. Environmental factors.
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Family Medicine and Community Health 3
Vision • Laboratory-based surveillance/ virus surveillance through
A health system that is resilient, capable to prevent, detect Research Institute for Tropical Medicine (RITM)
and respond to the public health threats caused by emerging and re- Department of Virology, as national reference laboratory,
emerging infectious diseases and sub-national reference laboratories.
• Vector Surveillance through DOH Regional Offices and
Mission RITM Department of Entomology
Provide and strengthen an integrated, responsive, and
collaborative health system on emerging and re-emerging infectious 2. Case Management and Diagnosis
diseases towards a healthy and bio-secure country.
• Dengue Clinical Management Guidelines training for
hospitals.
Goal
• Dengue NS1 RDT as forefront diagnosis at the health
Prevention and control of emerging and re-emerging
center/ RHU level.
infectious disease from becoming public health problems, as
indicated by EREID case fatality rate of less than one percent. • PCR as dengue confirmatory test available at the sub-
national and national reference laboratories.
Program Strategies: • NAAT-LAMP as one of confirmatory tests will be available
The EREID Strategies are: at district hospitals, provincial hospitals and DOH retained
1. Policy Development hospitals.
2. Resource Management and Mobilization
3. Coordinated Networks of Facilities 3. Integrated Vector Management (IVM)
4. Building Health Human Resource Capacity • Training on …
5. Establishment of Logistics Management System o Vector Management,
6. Managing Information to Enhance Disease Surveillance o Basic Entomology for Sanitary Inspector,
7. Improving Risk Communication and Advocacy o Integrated Vector Management (IVM) for health
workers
Target Population/Client • Insecticide Treated Screens (ITS) as dengue control
• All ages; Citizen of the Philippines strategy in schools.
Area of Coverage 4. Outbreak Response

• Philippines and its international borders • Continuous DOH augmentation of insecticides such as
adulticides and larvicides to LGUs for outbreak response.
2. Dengue
• Dengue is the fastest spreading vector-borne disease in 5. Health Promotion and Advocacy
the world endemic in 100 countries· • Celebration of ASEAN Dengue Day every June 15
• Dengue virus has four serotypes (DENV1, DENV2, DENV3 • Quad media advertisement
and DENV4)
• IEC materials
• Dengue virus is transmitted by day biting Aedes aegypti
and Aedes albopictus mosquitoes 6. Research
Vision
• A dengue free Philippines Strategies
• Enhanced 4S Strategy
Mission
o S - earch and Destroy mosquito breeding places
• Ensure healthy lives and promote well-being for all at all
o S - eek Early Consultation on the 1st sign and
ages
symptoms of the disease
o S - elf Protection Measures
Goal
o S - ay yes to fogging only during outbreaks
• To reduce the burden of dengue disease
DOH – Declared
Objectives
National Dengue Alert and Code blue on July 15 2019
1. To reduce dengue morbidity by at least 25% by 2022 National Dengue epidemic – August 6 2019
2. To reduce dengue mortality by atleaset 50% by 2022
• July 14 to 20, 2019 - 10,502 cases, 71% higher compared to
3. To maintain Case Fatality Rate (CFR) to < 1% every year.
the same period in 2018
Program Components • Cases: January 1 to July 20, 2019 - 146,062
Surveillance • Increase by 85% as compared to cases last year of the
• Case Surveillance through Philippine Integrated Disease same month
Surveillance and Response (PIDSR)
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Region that exceeded the threshold for the past 3 consecutive b) Implementing surveillance and treatment among
weeks – July 2019 people living with HIV/AIDS through the Research
1. Regions that exceeded the ALERT THRESHOLD Institute for Tropical Medicine
a) Region 1 c) Drafted the Strategic Plan 2012-2016 for Prevention
b) Region VII of Mother to Child Transmission and the Strategic
c) BARMM Plan 2012-2016 for Most at Risk Young People and
2. Regions that exceeded the EPIDEMIC THRESHOLD HIV Prevention and Treatment
a) Region IV-A – CALABARZON 2. For capability building
b) Region IV-B – MIMAROPA a) revision of the training curriculum for HIV counseling
c) Region V and testing
d) Region VI b) Twenty five priority LGUs provided support in
e) Region VIII strengthening local AIDS councils
f) Region IX ▪ March 2011 - 17 Treatment Hubs
g) Region X nationwide
3. For leveraging services
3. HIV/AIDS a) baseline laboratory testing is being provided
• The Philippine is a low-HIV prevalence country with <0.1% b) male condoms are being distributed through social
of the adult population estimated to be HIV (+), but the Hygiene Clinics
rate of increase in infections is one of the highest
• June 2018 DOH AIDS registry reported 56,275 cumulative 4. Filariasis Elimination Program
cases since 1964 Description
• March 2019 HIV/AIDS registry • The Elimination started in 2001 after a pilot study using
o 1172 newly confirmed HIV(+) individuals the combination drugs in 2000 in five selected
o NCR- 348 cases municipalities in five provinces.
o Region IVA - 171 cases • Total no. of province: 81
o Region III - 140 cases • Total population in the country: 108,241,936 as of 2019
o Region IX - 140 cases August 4 (1.4% of the total world population)
o Region VI - 79 cases • Total Endemic Provinces: 46 Provinces in 12 Regions
• Presently: 63,000 plus cases • Total Endemic Population: 8 Million
• Daily: 43 cases detected • Parasite: Majority is Wuchereria bancrofti
• Vectors incriminated: Aedes poecilus, Anopheles
Objective flavirostris
• Reduce the transmission of HIV and STI among the Most At
Risk Population and General Population and mitigate its Vision
impact at the individual, family, and community level. • Healthy and productive individuals and families for
Filariasis-Free Philippines
Program Activities
With regard to the prevention and fight against stigma and Mission
discrimination, the following are the strategies and interventions: • Elimination of Filariasis as a public health problem thru
1. Availability of free voluntary HIV Counseling and Testing comprehensive approach and universal access to quality
Service; health services
2. 100% Condom Use Program (CUP) especially for
entertainment establishments; Objectives
3. Peer education and outreach; 1. To sustain transmission interruption in provinces through
4. Multi-sectoral coordination through Philippine National strengthening of surveillance
AIDS Council (PNAC); 2. To intensify interventions and interrupt transmission in
5. Empowerment of communities; persistent infection provinces
6. Community assemblies and for a to reduce stigma; 3. To strengthen Morbidity Management & Disability
7. Augmentation of resources of social Hygiene Clinics; Prevention (MMDP) activities and services to alleviate
and suffering among chronic patients
8. Procured male condoms distributed as education 4. To strengthen the health system capacity to secure LF
materials during outreach. elimination
5. Secure adequate investment from governmental and non-
governmental sources to sustain all program objective
Target of program
1. Health policy and program development
a) Dissemination of manual of procedure/ standard /
guidelines
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WHO – Global Program For Elimination of Filariasis o To secure government and non-government
WHO’s strategies are based on 2 key components: financing to sustain malaria control and
1. Stopping the spread of infection through large scale annual elimination efforts at all levels
treatment of all eligible people in the area 4. Health Information and Regulation
2. Alleviating suffering caused by lymphatic filariasis through o To ensure quality malaria services, timely
provision of basic package care. detection of infection and immediate response,
and information and evidence to guide malaria
Adopted by the national program: elimination
1. INTERRUPTION OF TRANSMISSION:
o Elimination level prevalence of microfilaremia of Program Components
less than 1% and Antigen rate of < 1% through 1. Program Management and Health System -
Mass Drug Administration (MDA) 2. Diagnosis and Treatment
2. CONTROL AND REDUCE THE MORBIDITY 3. Vector Control
o by alleviating the sufferings and disability caused 4. Advocacy and Social Mobilization
by its clinical manifestations through Morbidity 5. Surveillance, Outbreak Preparedness and Response
Management Disability Prevention (MMDP) 6. Monitoring and Evaluation
7. Partnerships
Strategies, action points, and Timeline 8. Assessment of Other Factors - assessment of the possible
1. Mass Drug Administration - combination drug of contribution of factors such as government health
diethylcarbamazine citrate and albendazole for a minimum expenditure, poverty, forest cover, etc
of 5 years to individuals ages 2 years old and above living
in established endemic areas Strategies, Action points, and Timeline
2. Disability Management 1. Early Detection and Prompt Treatment through a
3. Monitoring thru Midterm Sentinel surveys and Evaluation strengthened case-finding mode;
thru Transmission Assessment Survey 2. Foci investigation and Classification as a means to
4. Post Validation Surveillance determine need for interventions;
5. Private-Public Partnership 3. Strengthened recording and reporting;
4. Use of Primaquine as a transmission-blocking agent;
Program Accomplishments/Status 5. Use of Artesunate ampoules and suppositories;
• Provinces have reached elimination level and declared as 6. Quality assurance monitoring to cover all aspects of
Filariasis-free as of 2017: 38 Provinces malaria service delivery;
• Filariasis awareness month: every November 7. Structured capability-building of local health system staff
5. Malaria Control Program Program Accomplishments

Vision • The sub-national elimination of DOH-National Malaria
• A Malaria–Free Philippines by 2030 Control Elimination Program has resulted to the
declaration of 42 provinces declared malaria-free out of 81
Mission provinces.
• Further accelerate malaria control and transition towards • P. falciparum 70-80%, P. vivax 20-30%, P. knowlesi rare
elimination • Currently, 4 provinces continue to be endemic - Palawan,
Sulu, Occidental Mindoro and Sultan Kudarat
GOAL: National Malaria Control Program • Year 2018, a total of 4870 malaria cases with 4 deaths
1. Reduce the number of cases and death
2. Reduce transmission to a level where it is no longer a Calendar of Activities
public health problem • World Malaria Day every April 25
Objectives 6. Rabies prevention and control program

1. Universal Access Philippines – top 10 countries with rabies problem responsible for
o To ensure universal access to reliable diagnosis, 300-600 deaths yearly
highly effective and appropriate treatment and Most affected – 5-14 yrs old
preventive measures Biting animals : dog 98%: 88% pets , stray 10%, cats 2%
2. Governance and Human Resources
o To strengthen governance and human resources
capacity at all levels to manage and implement Vision
malaria interventions • To declare Philippines Rabies-Free by year 2022
3. Health Financing
Mission
• To eliminate human rabies by the year 2020
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Objectives sparked an epidemic of these NCDs which pose a public threat and
• To eliminate rabies as a public health problem with economic burden.
absences of indigenous cases for human and animal
Current prevalence of NCD risk factor among adults are:
Partner Institutions 1. Overweight and obesity (27%)
The following organizations/agencies take part in attaining the goal 2. Hypertension (25%)
of the National Rabies Prevention and Control Program: 3. High total cholesterol level (10%)
• Department of Agriculture (DA) 4. High blood sugar (5%)
• Department of Education (DepEd)
Vision
• Department of Interior and Local Government (DILG)
• Department of Environment and Natural Resources (DENR) • A Philippines free from the avoidable burden of NCDs
• World Health Organization (WHO) Mission
• Animal Welfare Coalition (AWC) • Ensure sustainable health promoting environments and
• Bill and Melinda Gates Foundation accessible, cost-effective, comprehensive, equitable and
quality health care services for the prevention and control
Strategies of NCDs, and guided by the principle of
• Reduce risks of rabies exposure and appropriate o “Health in All, Health by All, Health for All”
management of animal bites whereas
• Cases from 2014-2018 - average of 258 cases each year ▪ Health in All refers to Health in All
• June 30, 2018: 144 cases reported Policies,
▪ Health by All involves the whole-of-
Program Components government and the whole-of-society
1. Post Exposure Prophylaxis ▪ Health for All captures the KP
2. Pre- Exposure Prophylaxis (PrEP) (Kalusugan Pangkalahatan) or the
3. Health Education and advocacy campaign Universal Health Care (UHC).
4. Training/Capability Building
5. Training on National Rabies Information System (NaRIS) Objectives
1. To raise the priority accorded to the prevention and
6. Zika control of non-communicable diseases in national, regional
• The Disease Prevention and Control Bureau (DPCB) and local health and development plans
spearheaded the development of the Zika Action Plan 2. To strengthen leadership, governance, and multisectoral
(ZAP) in February 2016 actions for the prevention and control of non-
communicable diseases
Goal 3. To reduce modifiable risk factors for non-communicable
• to contain and prevent transmission of the Zika virus and diseases and underlying social determinants through
other possible mosquito-borne diseases. creation of health-promoting environments
4. To strengthen health systems and increase access to
Strategies quality medicines, products and services, especially at the
1. Surveillance and Clinical Management; primary health care level, towards attainment of universal
2. Vector Control; health coverage
3. Management of Potential Impact on Women, 5. To promote and support research and development for
4. Health Promotion. the prevention and control of non-communicable diseases
6. To monitor the trends and determinants of non-
NON-COMMUNICABLE DISEASES communicable diseases and evaluate progress in their
prevention and control
Top killer diseases in the Philippines (as well as globally)
• cardiovascular conditions (hypertension, stroke), Program Components
• diabetes mellitus, 1. Cardiovascular Disease
• lung/chronic respiratory diseases 2. Diabetes Mellitus
• cancers 3. Cancer
4. Chronic Respiratory Disease
These diseases are considered as lifestyle related and is mostly the
result of unhealthy habits. Administrative Order-2011-0003: National Policy On Strengthening
the Prevention and Control of Chronic Lifestyle Related Non-
Behavioral and modifiable risk factors like smoking, alcohol abuse, Communicable Diseases
consuming too much fat, salt and sugar and physical inactivity have
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MISSION
• To reduce the impact of cancer and improve the wellbeing
of Filipino people with cancer and their families
OBJECTIVES / GOALS
1. To reduce premature mortality from cancer by 25% in
2025
2. To ensure relative reduction of the following risk factors
for cancer:
a) 10% harmful use of alcohol
b) 10% physical inactivity
c) 30% tobacco use
3. To guarantee the availability of the following services for
selected population:
a) Selected cancer screening
b) Human Papilloma Virus and Hepatitis B vaccination
Diseases of the heart remain the top cause of mortality in the c) Access to palliative care
country. d) Drug therapy and counseling
The Tamang Serbisyo para sa Kalusugan ng Pamilya (TSEKAP) The National Cancer Prevention and Control Action Plan 2015-2020
Program shall cover the following key areas of concern:
• launched in March 2016, aims to provide 20 million poor 1. Policy and Standards Development
and marginalized Filipinos with free access to essential a) Development of “National Policy on the Integration of
health packages under the “All for Health Towards Health Palliative and Hospice Care into the Philippine Health
for All.” Care System”
• It provides free check-ups and screening for the poor for b) Development and Operationalization of National
early detection of lifestyle-related diseases such as heart Cancer Prevention and Control Website and Social
disease, diabetes, and cancers. Media Sites
c) Development of “Comprehensive National Policy on
TSEKAP PACKAGES Cancer Prevention and Control”
• provision of basic health services for the poor through d) Establishment of National Cancer Center and
primary care facilities such as Barangay Health Stations, Strategic Satellite Cancer Centers
Rural Health Units, and Health Centers. e) Expansion of PhilHealth Z Benefit Package Coverage
• 25,000 TSEKAP packages distributed to 1,677 to Other Cancers
municipalities and cities o PhilHealth Z-Benefit Package for catastrophic
• The package includes two thermometers, a stethoscope, a diseases (breast, prostate, cervical cancers and
digital BP apparatus, a glucometer set, a dressing set, two childhood acute lymphocytic leukemia) is an in-
nebulizers, and a plastic container for storage. patient package which includes mandatory
diagnostics, operating room expenses,
• 4.6 Million poor Filipinos received basic physical and
doctor/professional fees, room and board, and
laboratory examinations and medicines.
medicines.
• 14.2 Million treatment packs for hypertension and
diabetes distributed through health facilities nationwide
2. Advocacy and Promotions
• For diagnosed patients, maintenance medications for a) Cancer Awareness Campaigns
diabetes and hypertension are available in health facilities b) Partnership with DepEd, CHED, DOLE-Bureau of
to ensure compliance to medications and control of the Working Conditions, and Civil Service Commission
disease.
3. Capacity Building and Resource Mobilization
1. CANCER a) Training of Trainers on Cervical Cancer Prevention
• Among Filipino MEN, the 6 common sites of cancer are and Control
lung, liver, colon/rectum, prostate, stomach and leukemia. b) Training of Trainers on Palliative and Hospice Care
• Among Filipino WOMEN, the 6 common sites of cancer are o Palliative and hospice care has been the missing
breast, cervix, lung, colon/rectum, ovary and liver link in our health care delivery system. Our
Universal Health Care or Kalusugan
VISION Pangkalahatan would not be complete without
• Comprehensive Cancer Care and Optimized Cancer integrating palliative and hospice care into the
Survival in 2025 existing promotive–preventive–curative-
rehabilitative continuum of care. It is therefore
imperative to institutionalize and integrate
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palliative and hospice care both in the hospitals 8. Establish and carry out effective training program
or health facilities and in community or home- 9. Ensure the collection and analysis of data from registry
based level. and surveillance
c) Training of Trainers on Patient Navigation Program 10. Implement, monitor and evaluate the NCPCP regularly
o Patient Navigation Program / Medicine Access through implementation review and impact evaluation
Program: It provides chemotherapy for early 11. Empower and engage all the stakeholders to actively work
stage breast cancer and acute lymphocytic on and participate in on various areas of NCPCP
leukemia and other diagnostic standard 12. Endorse support for researchers in the clinical,
procedures for eligible patients at no cost. This epidemiological, public health and knowledge
project involves seven (7) government hospitals, management areas and in collaboration with international
namely: Philippine General Hospital, Jose Reyes institutes
Memorial Medical Center, East Avenue Medical 13. Others that may be identified and approved by the
Center, Rizal Medical Center, Amang Rodriguez Secretary of Health
Memorial Medical Center, Philippine Children’s
Medical Center and Bicol Regional Training and 2. DIABETES
Teaching Hospital. November 14: World Diabetes Day
4. Service Delivery 3. SMOKING CESSATION PROGRAM

a) Availability of Free Cervical Cancer Screening in all • The Philippine Global Adult Tobacco Survey conducted in
trained RHUs 2009 (DOH, Philippines GATS Country Report, March 16,
b) Availability of cryotherapy equipment in every 2010) revealed that 28.3% (17.3 million) of the population
province (81 provinces) aged 15 years old and over currently smoke tobacco,
c) Availability and accessibility of screenings for selected 47.7% (14.6 million) of whom are men, while 9.0% (2.8
cancers in all trained RHUs million) are women.
d) School-based HPV vaccination of 9 to 13-year-old • Eighty percent of these current smokers are daily smokers
females with men and women smoking an average of 11.3 and 7
e) Hepatitis B vaccination for all health workers sticks of cigarettes per day respectively.
nationwide • “The National Smoking Cessation Program” support the
National Tobacco Control and Healthy Lifestyle Program
5. Information Management and Surveillance
a) Establishment of National Cancer Registry (hospital- Vision
and population-based)
• Reduced prevalence of smoking and minimizing smoking-
b) Development and Operationalization of Cancer
related health risks.
Helpline (including Telemedicine)
c) Research and Development
Mission
d) Establishment of National Research and Development
Program for Cancer Control • To establish a national smoking cessation program (NSCP).
e) Research: Study on the Socio-Economic Burden and
Impact Assessment of Cancer in the Philippines Objectives:
f) Determination of Cancer Incidence in the Philippines 1. Promote and advocate smoking cessation in the
2008-2013 Philippines; and
2. Provide smoking cessation services to current smokers
ROLES AND FUNCTIONS OF NATIONAL CANCER CONTROL interested in quitting the habit.
COMMITTEE
1. Set the roadmap of National Cancer Prevention and Program Components:
Control Program (NCPCP) 1. Training
2. Plan, establish and implement policies, guidelines and o Consistent with good clinical practices
standards throughout the continuum of holistic health 2. Advocacy
care (preventive, promotive, curative, rehabilitative and o A smoke-free environment (SFE)
palliative) 3. Health Education
3. Advise / recommend upgrading of existing cancer o Smokers shall be assisted to quit their habit and
management facilities in the country their immediate family members shall be
4. Coordinating body for all cancer works in the country empowered to assist and facilitate the smoking
5. Ensure the implementation of NCPCP down to the cessation process.
grassroots level 4. Smoking Cessation Services
6. Establish and carry out an effective nationwide cancer o World No Tobacco Day (WNTD) every 31st of
education program / dissemination May and the World No Tobacco Month every
7. Provide technical and financial support on cancer June.
prevention, early detection, treatment and palliative care
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5. Research and Development FUTURE PLAN / ACTION ON MICRONUTRIENT DEFICIENCIES
o To be conducted to better understand the 1. Focus on population groups and areas affected or at-risk to
nature of nicotine dependence among Filipinos micronutrient malnutrition
and to undertake new pharmacological 2. Scale up with key interventions such as micronutrient
approaches. supplementation, food fortification 7 dietary
diversification through food based approach
Program Accomplishments/Status ON Non-Communicable Diseases 3. Development & formulation of strategic plan 2012-2016
1. Finalization of the Philippine Multi-sectoral Strategic Plan
for the Prevention and Control of NCDs (2017 – 2025) Micronutrient supplementation is a crucial for child survival, it
2. The Philippine Package of Essential NCD Intervention for significantly reduces:
the integrated management of hypertension and diabetes 1. The risk from mortality by 23-34%
is being implemented nationwide. This is being 2. Deaths due to measles by about 50%
supplemented by developing the DOH Hypertension and 3. Deaths due to diarrhea by about 40%
Diabetes Health Clubs in primary health care facilities
which will ensure continuity of care and provision of NCD B. FOOD FORTIFICATION PROGRAM
drugs. A registry of hypertensives and diabetics was also Objectives:
developed and is maintained by the department. 1. To provide the basis for the need for a food fortification
3. Training on Diabetes management using Insulin for program in the Philippines: The
Regional Offices and LGUs Micronutrient Malnutrition Problem
4. Provision of NCD drugs through the Medicine Access 2. To discuss various types of food fortification strategies
Programs (Breast Cancer, Childhood Cancer, Colon and 3. To provide an update on the current situation of food
Rectum Cancer, Insulin, NCD maintenance medicines for fortification in the Philippines
hypertension and diabetes)
5. Training on cervical cancer screening using visual Fortification as defined by Codex Alimentarius
inspection using acetic acid (VIA) among health care • “the addition of one or more essential nutrients to food,
workers started in 2013 and on-going. Monitoring of whether or not it is normally contained in the food, for the
trained institutions started in 2014. purpose of preventing or correcting a demonstrated
6. NCD indicators are integrated in existing DOH current deficiency of one or more nutrients in the population or
performance reporting systems like Field Health Service specific population groups”
Information System, Local Government Unit scorecard
7. DOH support for proposed legislative bills focusing on Food Fortification Law
addressing the harmful effects of alcohol consumption, • Republic Act 8976, “An Act Establishing the Philippine Food
and integrating palliative and hospice care into the health Fortification Program and for other purposes” mandating
care system fortification of flour, oil and sugar with Vitamin A and flour
and rice with iron by November 7, 2004 and promoting
4. MALNUTRITION voluntary fortification through the SPSP, Signed into law
A. MICRONUTRIENT PROGRAM on November 7, 2000
• Micronutrient deficiencies can cause inter-generational
consequences. Status of the Philippine Food Fortification Program
• The level of health care and nutrition that women receive • There are 139 processed food products with Sangkap
before and during pregnancy, at childbirth and Pinoy Seal
immediately post-partum has significant bearing on the o 83% with vitamin A,
survival, growth and development of their fetus and o 29% with iron and
newborn. o 14% with iodine
• Undernourished babies tend to grow into undernourished • 37% of the products are snack foods
adolescents. • National Food Fortification Day November 7
• When undernourished adolescents become pregnant, they
in turn, may give birth to low-birth weight infants with DISEASES OF GLOBALIZATION AND RAPID URBANIZATION
greater risk of multiple micronutrient deficiencies.
• Another burden faced by Filipinos are diseases due to
Micronutrient Malnutrition: urbanization, which may be attributed to the high
• Iron Deficiency Anemia - number 1 population density and poverty in urban areas that lead to
o Infants - 56.6% unsafe environments and crime.
o Pregnant women - 50.7% • In cooperation with the Philippine National Police on the
o Lactating women - 45.7% country’s campaign against drugs, services for treatment
o Male, older persons - 49,1% and rehabilitation of drug dependents have been provided
by the DOH.
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1. SUBSTANCE ABUSE 4. To leverage quality data and research evidence for mental
On November 29, 2016, the first Mega Drug Abuse Treatment and health
Rehabilitation Center in the country was inaugurated at Fort 5. To set standards for compliance in different aspects of
Magsaysay, Nueva Ecija services
• 2,500 beds in the Mega Treatment and Rehabilitation
Center in Fort Magsaysay, Nueva Ecija Program Components
• Drug Rehabilitation Services Provided through TSeKaP 1. Wellness of Daily Living
(December 22, 2016) o All health/social/poverty reduction/safety and
o 17,761 Screening security programs and the like are protective
o 5,743 Drug testing factors in general for the entire population
o 19,807 Counseling o Promotion of Healthy Lifestyle, Prevention and
o 3,822 Referrals Control of Diseases, Family wellness programs,
etc
Latest survey conducted 2018, showed that 66% of Filipinos claimed o School and workplace health and wellness
that the number of drug addicts in their area has decreased over the programs
past years. 2. Extreme Life Experience
2019- government data showed: 5,104 drug suspects have died in o Provision of mental health and psychosocial
anti-drug operations, 167,135 have been arrested, and 316,494 drug support (MHPSS) during personal and
users have graduated from recovery and wellness program. community wide disasters
3. Mental Disorder
2. INJURIES: 2016 OPLAN IWAS PAPUTOK 4. Neurologic Disorders
“Iwas Paputok, Fireworks Display ang Patok! Makiisa sa Fireworks 5. Substance Abuse and other Forms of Addiction
Display sa inyong lugar!”
Calendar of Activities
• The annual campaign for reducing fireworks-related • September 10 - World Suicide Prevention Day
injuries and deaths, particularly during the Christmas and • October 10 -World Mental Health Day
New Year celebrations, started in 1994. • 2nd Week of October - National Mental Week
• For 2016, the theme is “OPLAN: Iwas Paputok, Fireworks
Display ang Patok! Makiisa sa Fireworks Display sa Inyong The World Health Organization (WHO) estimates that
Lugar.” • 154 million people suffer from depression
• Target: 0 injury • million from schizophrenia
• Yearly, a decrease in number of injuries were noted. • 877,000 people die by suicide every year
o Suicide rate for males is 2.5 per 100,000
3. MENTAL HEALTH PROGRAM population, female is 1.7 per 100,000 population
Vision • 50 million people suffer from epilepsy
• A society that promotes the well-being of all Filipinos, • 24 million from Alzheimer’s disease and other dementias
supported by transformative multi-sectoral partnerships, • 15.3 million persons with drug use disorders
comprehensive mental health policies and programs, and a • Neuropsychiatric disorders contribute to 14.4% of the
responsive service delivery network global burden of disease
Mission HOPELINE
• To promote over-all wellness of all Filipinos, prevent • Hopeline, a phone-based service that provides 24/7
mental, psychosocial, and neurologic disorders, substance support for people suffering from anxiety, suicidal
abuse and other forms of addiction, and reduce burden of thoughts, depression, and other mental health issues.
disease by improving access to quality care and recovery in
• Launched on September 13, 2016 as part of the highlights
order to attain the highest possible level of health to
of the 2016 Suicide Prevention Day on September 10.
participate fully in society.
• Hopeline is a collaboration between the DOH, WHO, the
Objectives Natasha Goulbourn Foundation, and Globe
1. To promote participatory governance and leadership in Communications.
mental health • It is estimated that 5% of the total health budget goes to
2. To strengthen coverage of mental health services through mental health services
multi-sectoral partnership to provide high quality service
aiming at best patient experience in a responsive service
delivery network
3. To harness capacities of LGUs and organized groups to
implement promotive and preventive interventions on
mental health
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4. ENVIRONMENTAL HEALTH PROGRAMS 5. VIOLENCE AND INJURY PREVENTION PROGRAM
Vision • The Global Burden of Diseases, Injuries, and Risk Factors
• Environmental Health (EH) related diseases are prevented Study conducted in 2010 showed that interpersonal
and no longer a public health problem in the Philippines violence, road injury, drowning, and self-harm (suicide) are
(based on on-going Strategic Plan 2019-2022) the leading causes of premature deaths in the Philippines.
• Accidents are the fifth leading cause of mortality as
Mission reported in the Philippine Health Statistics of the National
• To guarantee sustainable Environmental Sanitation (ES) Epidemiology Center.
services in every community • Transport or vehicular crash was the leading cause of
unintentional injuries
Objectives • Interpersonal violence (mauling/assault, contact with
1. Expand and strengthen delivery of quality ES services sharp objects, and gunshot) was the leading cause of
2. Institute supportive organizational, policy and intentional injuries.
management systems • The Department of Health (DOH) shall serve as the focal
3. Increase financing and investment in ES
agency with respect to violence and injury prevention.
4. Enforce regulation policy and standards
5. Establish performance accountability mechanism at all VIPP Program Strategies
levels A. Evidence-Based Research and Electronic Surveillance System
o Multi-disciplinary and multi-sectoral
Program Components interventions shall be developed based on
1. Drinking-water supply, evidence-based research. DOH shall establish
2. Sanitation (e.g excreta, sewage and septage and institutionalize a system of data reporting,
management), recording, collection, management and analysis
3. Zero Open Defecation Program (ZODP),
at the national, regional, and local levels. An
4. Food Sanitation, information system, that is, Online National
5. Air Pollution (indoor and ambient), Electronic Injury Surveillance System (ONEISS)
6. Chemical Safety, WASH in Emergency situations, and Philippine Network for Injury Data
7. Climate Change for Health and Health Impact Assessment Management System (PNIDMS), shall be fully
(HIA) operationalized for this purpose.
B. Networking and Alliance Building
Partner Institutions o DOH shall promote partnerships with and among
• DENR, DILG, DPWH, DA, PIA stakeholders to build alliance and networks and
• World Health Organization (WHO), UNICEF, USAID, AusAID to generate resources for activities related to
VIPP.
Calendar of Activities (year 2019) C. Capacity Building and Community Participation
• 1st Quarter o DOH shall develop and enhance the violence and
o Training on Prioritizing Drinking Water Quality injury prevention capabilities of a wide range of
Parameters for Surveillance as per PNSDW of sectors and stakeholders at the national,
2017 regional and local levels.
• 2nd Quarter D. Advocacy
o National Environmental Health Action Plan o DOH shall advocate to LGUs for ordinance
(NEHAP) Orientation development and lobby to Congress for
o Climate Change and Health Orientation enactment of laws.
• 3rd Quarter E. Equitable Health Financing Package
o Training on Prioritizing Drinking Water Quality o DOH, in collaboration with various stakeholders,
Parameters as per PNSDW of 2017 shall advocate to health financing institutions
o Orientation on Septic tank Guidelines And and financial intermediaries, i.e. the Philippine
Sanitation technologies Health Insurance Corporation (PHIC) and
o Training on Philippine Approach to Sustainable insurance companies, the development and
Sanitation implementation of policies that would be
o National Environmental Health Action Plan beneficial for the victims of all forms of violence
(NEHAP) Orientation and injury.
o World Environmental Health Day Celebration F. Service Delivery
• 4th Quarter o In collaboration with stakeholders, DOH shall
o Orientation on Septic tank Guidelines And institutionalize systems and procedures for the
Sanitation technologies integration and provision of services at the
o National Environmental Health Action Plan community level. In collaboration with various
(NEHAP) Orientation stakeholders, DOH shall undertake advocacy,
S1T3 10 of 13
information and education, political support, and Objectives
multi-sectoral action on violence and injury • To institutionalize and standardize the quality of service
prevention. Appropriate interventions at all and training of all women and children protection units.
levels of prevention shall be crucially provided. • Specifically, the program aims to:
G. Six (6) E’s. 1. Prevent violence against women and children from ever
o Strategies shall utilize the concept of the six E’s occurring (primary prevention)
(Education, Enactment / Enforcement, 2. Intervene early to identify and support women and
Empowerment, Engineering, Emergency Medical children who are at risk of violence (early intervention);
Service, and Engagement in surveillance and and
research) in the prevention of violence and 3. Respond to violence by holding perpetrators accountable,
injuries. ensure connected services are available for women and
o Education entails wide dissemination of their children (response).
information and communication related to
violence and injury prevention; Description
o Enactment / Enforcement of laws and policies • In 1997, Administrative Order 1-B or the “Establishment of
related to violence and injury prevention; a Women and Children Protection Unit in All Department
o Empowerment of all stakeholders in the of Health (DOH) Hospitals” was promulgated in response
implementation of VIPP. This also covers the to the increasing number of women and children who
provision of psychosocial support to the victims consult due to violence, rape, incest, and other related
of violence and injury to help them recover from
cases.
the psychological trauma;
• As of 2011, there are 38 working WCPUs in 25 provinces of
o Engineering control provides the most effective
the country.
way of reducing the cause and impact of
violence and injuries. This involves the • As of 2016, a total of 94 WCPUs were established
improvement of facilities and infrastructures to nationwide that served about 8,000 cases in the past year.
promote safe environments; • “The DOH shall provide medical assistance to victims”
o Emergency Medical Services prior to hospital through a socialized scheme by the Women and Children
care. This is vital in providing pre-hospital Protection Unit (WCPU) in DOH-retained hospitals or in
trauma life support to the injured on site at the coordination with LGUs or other government health
soonest possible time so as to prevent needless facilities (RA 9262:Anti-violence Violence Against Women
mortality or long-term morbidity or permanent Against Women And Their Children And Their Children Act
disability; and Of 2004 )
o Engagement in surveillance and research to
promote evidence-based, substantial, scientific, Policies and Laws
and systematic approach to VIPP. • Republic Act 7610: Anti-Child Abuse Law
H. Monitoring and Evaluation • Republic Act 9262: Anti-Violence Against Women and their
o DOH, together with various stakeholders, shall Children Act
identify indicators, targets and milestones for • Republic Act No. 8353: Anti-Rape Law
program monitoring and evaluation purposes. • Republic Act 10364: Expanded Anti-Trafficking in Persons
There shall be a regular audit and feedback (RA 9208: Anti-Trafficking in Persons Act of 2003)
mechanism of all VIPP-related strategies and
• Republic Act No. 8505: Rape Victim Assistance & Protect
activities.
Act
Online National Electronic Injury Surveillance System (ONEISS) shall • Republic Act 9710: Magna Carta of Women
be the standard reporting system for the collection, storage, analysis • RA 7877: Anti-Sexual Harassment Act
and reporting of data pertaining to violence and injury • Republic Act 10354 (The Responsible and Reproductive
Health Act of 2012)
6. WOMEN AND CHILDREN PROTECTION PROGRAM • Administrative Order 1-B s. 1997: DOH Policy on the
Vision establishment of Women & Children’s Protection Units
• A gender-fair and violence-free community where women (WCPU)
and their children are empowered • Administrative Order 2013-0011: Revised guidelines on the
establishment of WCPUs in all hospitals
Mission • Administrative Order 2014-0002: Violence and Injury
• Improved strategy towards a violence-free community Prevention
through more systematic primary prevention, accessible
and effective response system and strengthened
functional mechanisms for coordination, planning,
implementation, monitoring, evaluation and reporting
S1T3 11 of 13
Strategies, Action Points and Timeline o India to Asia to Europe to North America to
• PRIMARY PREVENTION Africa
o address the underlying conditions that influence o Death 1M
women and children's health, building a gender 8. THE BLACK DEATH (Bubonic Plague)
responsive community (family as entry point) o 1346-1353
• SERVICE DELIVERY o Europe to Africa to Asia
o foster collaborative partnerships which improve o Death: 75 – 200 M
health outcomes 9. PLAGUE OF JUSTINIAN (Bubonic Plague)
• ADVOCACY & SOCIAL MOBILIZATION
o 541-542
o expand the reach and influence of our work, o Byzantine Empire to Mediterranean port cities
empowered communities
o Death: 25 M
10. ANTONINE PLAGUE (Plague of Galen)
• RESEARCH & INNOVATION
o 165 AD
o research current and emerging issues affecting
o Asia Minor to Egypt to Greece to Italy
women and children
o Death 5M
• ORGANIZATIONAL EXCELLENCE
o ensure quality systems and practices that 8. MEASLES OUTBREAK 2019
promote organizational sustainability, Philippines:
continuous improvement and innovation
• February 2019 - Measles outbreak in 5 regions
Calendar of Activities • NCR, Regions IVA, III, VI, VII
• Participation to the Celebration of 18-Day Campaign to • 59% unvaccinated persons
End Violence Against Women (every November- • 53% under 5 years of age
December) • According to WHO: 2.6M Filipino children under 5 years
• Participation to the Celebration of National Children’s old are unvaccinated
Month every November • Root cause: chronic low routine immunization coverage
and vaccination hesitancy
7. PANDEMIC
• Is an epidemic of disease that has spread across a large 9. TRAVEL MEDICINE
region, multiple continents or even worldwide • Emporiatrics
• Multidisciplinary specialty that requires expertise in travel-
10 Worst Pandemics in History related illnesses, as well as up-to-date knowledge on the
1. HIV/AIDS PANDEMIC global epidemiology of infectious and noninfectious health
o Peak 2005-2012 risks, health regulations and immunization requirements in
o Sub-saharan Africa, various countries, and the changing patterns of drug-
o death 36M resistant infections
2. FLU • Covers complete travel care from consultation,
o Hongkong Flu - 1968 (H3N2 strain) immunization and preventive medicine to post travel care
o Hongkong to Singapore to Philippines, in an event of an illness
o death 1M • WHO recommended vaccines before travel:
3. ASIAN FLU o Measles
o 1956-1958 (H2N2) o Rubella
o China to Singapore to Philippines, o Mumps
o death 2M o Diphtheria
4. FLU PANDEMIC o Pertussis
o 1918, o Poliomyelitis
o tore across the globe infecting over a 3rd of the
world’s population, 10. CLIMATE CHANGE
o death 20-50M • The Philippines is considered as one of the most
5. SIXTH CHOLERA PANDEMIC
vulnerable countries in the world due to its archipelagic
o 1910-1911 make-up and location
o India (death 800,000) to Middle East to North
• According to the World Disaster Report in 2012,
Africa to Eastern Europe to Russia
Philippines ranked 1st as the most vulnerable to tropical
6. FLU PANDEMIC
cyclone occurrences and 3rd as to the people exposed to
o 1889-1890 (H3N8)
seasonal events worldwide. Average of 20 typhoons
o Central Asia to Canada to Greenland
yearly.
o Death 1M
7. THIRD CHOLERA PANDEMIC
o 1852–1860
S1T3 12 of 13
• Refers to significant changes in global temperature,
precipitation, wind patterns and other measures of climate
that occur over several decades or longer
• Impact of warmer climate: mosquito-borne diseases
includes malaria, elephantiasis, yellow fever, dengue fever,
cholera
• Increase risks of disasters such as storm, cyclones,
flooding, long term increase in sea level
Goal
• To protect the health of Filipinos with priority to those
living in vulnerable areas from the impact of climate
change
Objectives:
1. Improve the adaptive capacity of the health care delivery
system
2. Enhance support mechanisms to adaptation and
mitigation efforts on climate change in the health sector
3. Empower communities to manage health impacts of
climate change
S1T3 13 of 13
Program Mgmt. of Health Service and PhilHealth Agenda
Ma. Teresita Chua, MD | 24 August 2019
PAGBABALANGKAS NG ARALIN (OPTIONAL) What do managers do?

I. Management
A. Managerial skills Management Functions (Different Scope at job level)
B. Roles of manager Planning
II. Philippine Agenda ● Setting objectives and determining in advance exactly(?)
Organizing
● Delegating and Coordinating tasks and allocating resources
I. MANAGEMENT to achieve objectives
● Concerned with the direction of the personnel and other Leading
techniques related to operation ● Influencing employees to work toward achieving
● The process of integrating resources and tasks towards the objectives
achievement of stated organizational goals ● Setting an example (shadow of the leader)
Controlling
A. MANAGER ● Establishing and implementing mechanisms to ensure that
● The individual responsible for achieving organizational objectives are achieved
objectives through efficient and effective utilization of
resources Leadership is the art of motivating a group of people to act towards
achieving a common goal
Leadership and management must go hand to hand
All managers are entrusted with these basic resources
● People
● Money
● Material
● Time
1. Managerial skill
Technical skills
● Use of tools, techniques and procedures in a specialized
manner
Human and communication skills
● Interpersonal relationship Management roles
Conceptual and decision making skills Management role categories (Mintzberg)
● Ability to critically analyze and solve complex problems Interpersonal
● Figurehead, leader, and liaison
Qualities of a good supervisor Informational
● Practices democratic supervision ● Monitor, disseminator and spokesperson
● Adopts his style to different needs Decisional
● Has the ability to identify problems and constraints and ● Entrepreneur, disturbance handler, resource allocator, and
tries to overcome them negotiator
● Tactful in expressing suggestions and negative feedback
● Serve as model to his subordinates
● Has the ability to promote better and harmonious
relationship among the team members
What does it take to ne a successful manager?

The Ghiselli Study
6 traits of successful managers
● Initiative
● Self-assurance
● Decisiveness
● Intelligence
● Need for occupational achievement
Managers play various roles as necessary while performing their
● Supervisory ability management functions so as to achieve organizational objectives
S 1 T 6,7 | Guinea Pig Batch 2021: OBE is Life 1 of 7

Family Medicine and Community Health III
Program Mgmt of Health Service and PhilHealth Agenda
Principles of management ● An answer to the question: What can we commit ourselves
● Work assignment to share with patients/ clients and the community?
● Work should be divided so that each person will perform a Policies
specialized portion • A broad guideline, philosophy or principles which
● Each employee’s work assignments should be based on management establishes in support of its organizational
his/her special strength and talent goals and which it follows in seeking these goals
● Absence of clearly defined job duties and responsibilities
THE LIFE OF ALL FILIPINO IN 2040
makes it more difficult to hold an employee
● Accountable to unsatisfactory performance
COMMENSURATE AUTHORITY AND RESPONSIBILITY

● States that individual who are given the responsibility to
undertake a task must also be given an appropriate
amount of authority to ensure task completion
● Managers must have the right/authority to give orders and
instructions but must accept responsibility for whether or
not the work is done right
Employee Empowerment Matatag, Maginhawa at Panatag na Buhay
Empowered employees are encouraged to participate as much as By 2040, Filipinos enjoy a strongly rooted, comfortable, and secure
possible in making decisions that affect all aspects of their job tasks. life.
Managers should encourage initiative among employees In 2040, we will all enjoy a stable and comfortable lifestyle,
secure in the knowledge that we have enough for our daily needs and
Unity of Command unexpected expenses, that we can plan and prepare for our own and
• States that each employee should be directly responsible our children’s future. Our family lives together in a place of our own,
to one supervisor and we have the freedom to go where we desire, protected and
• An individual should have only one boss enabled by a clean, efficient, and fair government .
• If an employee reports to more than one superior,
confusion and conflict result
Organization’s Objectives
• Must be clearly defined, understood, and accepted by
each individual concerned with their attainment
• Organizational interest should be above personal/
individual goal
• Pay and rewards/ remunerations should reflect each
person’s efforts and contribution to the organization's goal
Chain of Command
• Identifies who reports to whom within an organization
• Orders and instructions should flow down the chain of
command from the higher to lower one PERFORMANCE APPRAISAL
• Employees should be treated equally and fairly A formal and systematic evaluation of how well a person is
performing his/ her work and fills the appropriate role in the
organization
Every organization should have only one master plan, one set goal: 3 Basic Reasons For Employee Performance Appraisal
VISION-MISION-GOAL 1. To encourage good behavior or to correct and discourage
Vision below-standard performance
● A description of a desired future state 2. To satisfy employees’ curiosity about how well they are
● an expression of desired impact on customers, clients, doing
patients and environment 3. To provide a foundation for later judgement that concern
● an answer to the question: What do we want to see in our an employee’s career, pay raise, promotion, transfer,
health sector in next 10-15 years? separation, benefits, etc.
Mission
● A description of the reason for being Remember…. Management is.. Getting things done through other
● Specifies unique characteristics in achieving its vision people
S 1 T 6,7 2 of 7
HEALTH PLANNING at a disadvantage in achieving a stated
- Process of defining community health problems, objective
identifying needs and resources, establishing priority goals ❖ OPPORTUNITIES
and setting out administrative action to reach those goals. - Refer to elements that the
❖ Features of Planning organization, process or program could
➔ A good plan should have: exploit to its advantage
- Clear mision / vision; goals and ❖ THREATS
objectives - Refer to elements in the environment
- Clear picture of the tasks to be that could cause trouble for the
accomplished organization, process or program
- Even the resources needed
➔ Planning takes place at ALL levels. PLANNING IS BASED ON …
➔ Planning takes place continuously, it is indeed a ● Needs and demands of the public
cyclic process. ● Available resources
● Attitude of the public
➔ Planning must be a collective undertaking.
❖ Types of Planning
THE PLANNING CYCLE
● Strategic Planning: - Situational Analysis / Community Diagnosis
- Also refers to “allocative planning” - Plan formulation:
- Has an envisioned time allotment of 5 - Objective Setting
years or more - Target Setting
● Tactical Planning: - Plan Implementation
- Also refers to “operational planning” - Plan Evaluation
Has an activity planning for 1 year only
SWOT Analysis
6 steps in Planning
1. Situational Analysis
- Stands for: Strength -> Weaknesses -> Oppotunities -> 2. Analyzing and Selecting Critical / Priority Problems
Threats 3. Setting Objectives and Targets
- Refers to a strategic planning tool that matches internal 4. Identifying Potential Obstacles
organizational strengths and weaknesses with external 5. Designing the Strategies
opportunities and threats. 6. Writing Up the Plan
❖ STRENGTHS
- Refer to the characteristics of the Step 1: Situational Analysis
organization, process or program that ● Consider national health policies and programs, analyze
give it an advantage in achieving a organizational structure, and function of health services
stated objective. ● Study size, composition and distribution of the population
❖ WEAKNESSES ● Collect information about resources
- Refer to the characteristics that place
the organization, process or program
S 1 T 6,7 3 of 7
Step 2: Selecting Critical Problem Step 6: Writing up the plan
● To request for funds/resources
● For monitoring and evaluating implementation process
WHAT EXISTS WHAT SHOULD BE
NOW THE 7 GUIDELINE WORDS:
● Why are we doing this?
(Program Objective, PROBLEM GAP
(The present Ideal Situation) ● What is to be done?
situation) ● How will it be done?
● Who will do it and what are the things we need?
● Where will the work be done?
EXAMPLE: ● When will the work be done?
● by whom and how will it be controlled?
50% Vaccination 95% coverage 45%
coverage
CRITERIA IN SELECTING PRIORITY PROBLEM

Does the problem:
● Affect a large number of people
● Cause high infant mortality
● Affect maternal health
● Affect children and young persons
● Cause chronic conditions and handicap
● Affect socio-economic development
● Cause worry to the community
Step 3: Setting The Objective/Target EVALUATION

● Objectives are desired end states (outcome) of a program 1. Plan for evaluation in terms of:
● Objectives must be SMART ● ‘what’, ‘how’, ‘when’
○ Specific: to avoid differing interpretations 2. Set up criteria for evaluation.
● Were the objectives achieved?
○ Measurable: to allow monitoring/evaluation
● If not, why?
○ Appropriate: to the problems, goals, and
strategies
○ Realistic: achievable, challenging, meaningful
Elements of Evaluation:
○ Time bound: time period for achieving them
• Relevance
Step 4: Identifying Potential Obstacles • Adequacy
● Why objectives could not be attained? • Accessibility
● Which are the limitations and obstacles? • Acceptability
● Resources: people, equipment, money, and time • Effectiveness
● Environment: geographical, climate, technical, and social • Efficiency
• Impact
Step 5: Designing The Strategies • Main Purpose of Evaluation:
● Outline: • · To note the shortcomings, deficiencies, duplicities,
etc. in the system
○ Potential strategies
• · To justify the governmental expenditure on a
○ Technique to be applied program
○ Procedure to be used
● Define role of the community
● Determine resources required
● Estimate strategy cost and assess adequacy
S 1 T 6,7 4 of 7
• DOH resources to promote local health system
development
• Fiscal autonomy for government hospitals
• Good governance Programs (ISO,IMC,PGS)
• Funding for UHC
Persistent Inequalities in Health Outcomes:
• Every year, around 2000 mothers die due to pregnancy

related complications
• A Filipino child born to the poorest family is 3 times more
likely to not reach his 5th birthday compared to one born
in the richest of family
• 3 out of 10 children die
Restrictive and Impoverishing Healthcare Cost:

II. PHILIPPINE HEALTH AGENDA 2016-2022
• Every year, 1.5 million families are pushed to poverty due
to health care expenditures
• All for Health towards Health for All • Filipinos forego or delay care due to prohibitive and
• Healthy Philippines 2022 unpredictable user fees or co-payments
• Lahat Para sa Kalusugan! Tungo sa Kalusugan Para sa Lahat • Php 4,000/month healthcare expenditure considered
catastrophic single income
Goals: The Health System We Aspire for:
Poor quality and undignified care synonymous with public clinics and
1. Financial Protection – Filipinos, especially hospitals:
the poor marginalized and vulnerable are
protected from high cost of health care • Long wait times
• Limited autonomy to choose provider
2. Better Health Outcomes- Filipinos attain • Less than hygienic restroom lacking amenities
the best possible health outcomes with no
• Privacy and confidentiality taken lightly
disparity
• Poor record keeping
• Overcrowding and under-provision of care
3. Responsiveness- Filipinos feel respected,
valued, empowered in all of their interaction
AMBISYON NATIN 2040
with the health system
• Investing in People
• Protection Against Instability
o Universal Health Coverage
o Strengthen Implementation of RPRH Law
o War Against Drugs
o Additional Funds from PAGCOR
Attain Health Related SDG Targets
• Financial Risk Protection

• Better Health Outcomes
During the last 30years of Health Sector Reform, we have • Responsiveness
undertaken key structural reforms and continuously built
• Values:
on programs that take us a step closer to our aspiration. o Equity
o Quality
Milestones: o Efficiency
o Transparency
• Devolution o Accountability
• Use of Generics o Sustainability
• Milk Code o Resilience
• PhilHealth (1995)
S 1 T 6,7 5 of 7
3 Guarantees: • Located close to the people (Mobile clinic and
o Service Delivery Network Transportation cost)
o All Life Stages and Triple Burden of Disease • Enhanced by Telemedicines
o Universal Health Insurance
Guarantee # 3: Universal Health Insurance (Financial Freedom
when accessing services)
· Services are financed predominantly by PhilHealth
ü PhilHealth as the gateway to free affordable care
• 100% of Filipinos are members

• Formal sector premium paid through payroll
• Non-formal sector premium paid through tax subsidy
ü Simplify Philhealth Rules
• No balance billing for the poor/basic accommodation and

Fixed co-payment for non-basic accommodation
Guarantee # 1: All life stages and Triple Burden of Disease (Services
for both the well and sick) ü Philhealth as main revenue source for public health care providers
• Stages: • Expand benefits to cover comprehensive range of services

• Contracting networks of providers within SDNs
Pregnant – Newborn – Infant – Child – Adolescent – Adults – Elderly
OUR STRATEGY
• Communicable Diseases:
• A – dvance quality, health promotion and primary care
o HIV/AIDS, TB, Malaria • C – over all Filipinos against health-related financial risk
o Diseases for Elimination • H – arness thepower of strategic HRH development
o Dengue, Leptospirosis, Ebola and Zika • I – nvest in eHealth and data for decision making
• E – nforce standards, accountability and transparency
• Non-Communicable Diseases and Malnutrition • V – alue all clients and patients, especially the poor,
marginalized and vulnerable
o Cancer, Diabetes, Heart Disease and their Risk • E – licit multi-sectoral and multi-stakeholder support for
Factors (Obesity, Smoking, Diet, Sedentary health
Lifestyle)
o Malnutrition · A – dvance quality, health promotion and primary care
• Diseases of Rapid Urbanization and Industrialization ▪ Conduct annual health visits for all poor
families and special populations (NHTS, IP,
o Injuries PWD, Senior Citizens)
o Substance abuse ▪ Develop an explicit list of primary care
o Mental illness entitlements that will become the basis for
o Pandemics licensing and contracting arrangements
o Health consequences of climate change/diseases ▪ Transform select DOH hospitals into mega-
hospitals with capabilities for multi-specialty
Guarantee # 2: Services Delivered training and teaching and reference laboratory
▪ Support LGUs in advancing pro-health
Services delivered by networks that are: resolutions or ordinances (e.g. city-wide
smoke-free or speed limit ordinances)
▪ Establish expert bodies for health promotion
• Fully functional - Complete with Equipments, Medicines
and survey response
and Health Professionals
• Compliant with Clinical Practice Guidelines
• Available 24/7 and even during disasters
• Practicing gatekeeping
S 1 T 6,7 6 of 7
C – over all Filipinos against health-related financial risk ▪ Make all health entitlements simple, explicit and
widely published to facilitate understanding, and
▪ Raise more revenues for health, e.g. impose generate demand
health-promoting taxes increase NHIP premium ▪ Set up participation and redress mechanisms
rates, improve premium collection efficiency ▪ Reduce turnaround time and improve
▪ Align GSIS, MAP, PCSO, PAGCOR and minimize transparency and processes at all DOH health
overlaps with Philhealth facilities
▪ Expand Philhealth benefits to cover outpatient ▪ Eliminate queuing, guarantee decent
diagnostics, medicine blood and blood products accommodation and clean restrooms in all
aided by health technology assessment government hospitals
▪ Update costing of current Philhealth case rates
to ensure that it covers it full cost of care and · E – licit multi-sectoral and multi-stakeholder support for health
link payment to service quality
▪ Enhance and enforce Philhealth contracting ▪ Harness and align the private sector in planning
policies for better availability and sustainability supply side investments
▪ Work with other national government agencies
· H – arness the power of strategic HRH development to address social determinants of health
▪ Make health impact assessment and public
▪ Revise health professionals curriculum to be more health management plan a prerequisite for
primary care-oriented and responsive to local and initiating large-scale, high-risk infrastructure
global needs projects
▪ Streamline HRH compensation package to ▪ Collaborate with CSOs and other stakeholders on
incentivize service in high risk or GIDA areas budget development, monitoring and evaluation
▪ Update frontline staffing complement standards
from profession based to competency-based
▪ Make available fully-funded scholarships for HRH
billing from GIDA areas or IP groups
▪ Formulate mechanisms for mandatory return of
services schemes for all health graduates
· I – nvest in eHealth and data for decision making
▪ Mandate the use of electronic medical records in

all health facilities
▪ Make online submission of clinical, drug dispensing,
administrative and financial records a prerequisite
for registration, licensing and contracting
▪ Commission nationwide surveys, streamline
information systems and support efforts to
improve local civil registration and vital statistics
▪ Automate major business processes and invest in
warehousing and business intelligence tools
▪ Facilitate ease of access to researchers to available
data
· E – nforce standards, accountability and transparency
▪ Publish health information that can trigger better

performance and accountability
▪ Set up dedicated performance monitoring unit to
track performance or progress of reforms
· V – alue all clients and patients, especially the poor,

marginalized and vulnerable
▪ Prioritize the poorest 20 million Filiipinos in all

health programs and support them in non-direct
health expenditures
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RA 11223: Universal Health Care Act of 2018
Lyndon Lee Suy, MD | 03 August 2019
PAGBABALANGKAS NG ARALIN • Amenities

I. General Provisions o Refers to features of the health services that
II. Universal Health Coverage provide comfort or convenience, such as private
III. National Health Security Program (National Health accommodation, air conditioning, telephone,
Insurance Program) television and choice of meals, among others;
IV. Health Services Delivery • Basic/Ward Accommodation
V. Organisation of Local Health Systems o Refers to provision of regular meal, bed in shared
VI. Human Resources for Health room, fan ventilation, and shared toilet and bath
VII. Regulation • Co-insurance
VIII. Governance and Accountability o Refers to a percentage of a medical charge that is
IX. Appropriations paid by the insured, with the rest paid by the
X. Penal Provisions health insurance plan;
XI. Miscellaneous Provisions • Co-payment
o Refers to flat fee or predetermined rate paid at
point of services;
• Direct Contributors
I. GENERAL PROVISIONS o Refers to those who have the capacity to pay
It is the policy of the state to protect and promote the right to health premiums, are gainfully employed and are bound
of all Filipinos and instil health consciousness among them. Towards by an employer-employee relationship, or are
this end, the state shall adopt: self-earning, professional practitioners, migrant
• An integrated and comprehensive approach to ensure that workers, including their qualified dependents,
all Filipinos are health literate, provided with healthy living and lifetime members;
conditions, and protected from hazards and risks that could • Emergency
affect their health; o Refers to a condition or state of a patient wherein
• A health care model that provides all Filipinos access to a based on the objective findings of a prudent
comprehensive set of quality and cost-effective, promotive, medical officer on duty, there is immediate
preventive, curative, rehabilitative and palliative health danger and where delay in initial support and
services without causing financial hardship, and prioritizes treatment may cause loss of life or permanent
the needs of the population who cannot afford such disability to the patient, or in the case of a
services; pregnant woman, permanent injury or loss of her
• A framework that fosters a whole-of-system, whole-of- unborn child, or a non-institutional delivery;
government, and whole-of-society approach in the • Entitlement
development, implementation, monitoring, and evaluation o Refers to any singular or package of health
of health policies, programs and plans; and services provided to Filipinos for the purpose of
• A people-oriented approach for the delivery of health improving health;
services that is centered on people’s needs and well-being, • Essential Health Benefit Package
and cognizant of the differences in culture, values, and o Refers to a set of individual-based entitlements
beliefs. covered by the National Health Insurance
Program (NHIP) which includes primary care;
GENERAL OBJECTIVES medicines, diagnostics and laboratory; and
• Progressively realize universal health care in the country preventive, curative, and rehabilitative services;
through a systemic approach and clear delineation of roles • Fraudulent Act
of key agencies and stakeholders towards better o Refers to any act of misrepresentation or
performance in the health system; and deception resulting in undue benefit or
• Ensure that all Filipinos are guaranteed equitable access to advantage on the part of the doer or any means
quality and affordable health care goods and services and that deviate from normal procedure and is
protected against financial risk. undertaken for personal gain, resulting thereafter
to damage and prejudice which may be capable
DEFINITION OF TERMS of pecuniary estimation;
• Abuse of authority • Health Care Provider
o Refers to an act of a person performing a duty or o Health facility - which may be public or private,
function that goes beyond what is authorized by devoted primarily to the provision of services for
this Act and Republic Act No. 7875, otherwise health promotion, prevention, diagnosis,
known as the “National Health Insurance Act of treatment, rehabilitation and palliation of
1995”, as amended, or their implementing rules individuals suffering from illness, disease, injury,
and regulations (IRR), and is inimical to the public; disability, or deformity, or in need of obstetrical
or other medical and nursing care;
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o Health care professional - who may be a Doctor • Private Health Insurance
of Medicine, nurse, midwife, dentist, or other o Coverage of a defined set of health services
allied professional or practitioner duly licensed to financed through private payments in the form of
practice in the Philippines; a premium to the insurer;
o Community-based health care organization - an • Unethical Act
association of members of the community o Any action, scheme or ploy against the NHIP, such
organized for the purpose of improving the health as overbilling, upcasing, harbouring ghost
status of that community; or patients or recruitment practice, or any act
o Pharmacies or drug outlets, laboratories and contrary to the Code of Ethics of the responsible
diagnostic clinics; person’s profession or practice, or other similar,
• Health Care Provider Network analogous acts that put or tend to put in disrepute
o Group of primary to tertiary care providers, the integrity and effective implementation of the
whether public or private, offering people- NHIP;
centered and comprehensive care in an
integrated and coordinated manner with the II. UNIVERSAL HEALTH COVERAGE
primary care provider acting as the navigator and
• Every Filipino citizen shall be automatically included into
coordinator of health care within the network;
the NHIP
• Health Maintenance Organization (HMO)
o Entity that provides, offers, or covers designated
§6. SERVICE COVERAGE
health services for its plan holders or members
• Every Filipino shall be granted immediate eligibility and
for a fixed prepaid premium;
access to preventive, promotive, curative, rehabilitative,
• Health Technology Assessment (HTA)
and palliative care for medical, dental, mental and
o Systematic evaluation of properties, effects, or
emergency health services, delivered either as population-
impact of health-related technologies, devices,
based or individual-based health services: Provided, That
medicines, vaccines, procedures and all other
the goods and services to be included shall be determined
health-related systems developed to solve a
through a fair and transparent HTA process;
health problem and improve quality of lives and
• Within two (2) years from the effectivity of this Act,
health outcomes, utilizing a multidisciplinary
PhilHealth shall implement a comprehensive outpatient
process to evaluate the social, economic,
benefit, including outpatient drug benefit and emergency
organizational and ethical issues of a health
medical services in accordance with the recommendations
intervention or health technology;
of the Health Technology Assessment Council (HTAC)
• Individual-Based Health Services
created under Section 34 hereof; Ensure that all Filipinos
o Services which can be accessed within a health
are guaranteed equitable access to quality and affordable
facility or remotely that can be definitively traced
health care goods and services and protected against
back to one recipient, has limited effect at a
financial risk.
population level and does not alter the underlying
• The DOH and the local government units (LGUs) shall
cause of illness such as ambulatory and inpatient
endeavour to provide a health care delivery system that will
care, medicines, laboratory tests and procedure,
afford every Filipino a primary care provider that would act
among others;
as the navigator, coordinator, and initial and continuing
• Population-Based Health Services
point of contact in the health care delivery system:
o Interventions such as health promotion, disease
Provided, That except in emergency or serious cases and
surveillance, and vector control, which have
when proximity is a concern, access to higher levels of care
population groups as recipients;
shall be coordinated by the primary care provider; and
• Primary Care
• Every Filipino shall register with a public or private primary
o Initial-contact, accessible, continuous,
care provider of choice. The DOH shall promulgate the
comprehensive and coordinated care that is
guidelines on the licensing of primary care providers and
accessible at the time of need including a range of
the registration of every Filipino to a primary care provider.
services for all presenting conditions, and the
ability to coordinate referrals to other health care
§7. FINANCIAL COVERAGE
providers in the health care delivery system,
• Population-based health services shall be financed by the
when necessary;
National Government through the DOH and provided free
• Primary Care Provider
of charge at point of service for all Filipinos. The National
o Health care worker, with defined competencies,
Government shall support LGUs in the financing of capital
who has received certification in primary care as
investments and provision of population-based
determined by the Department of Health (DOH)
interventions.
or any health institution that is licensed and
• Individual-based health services shall be financed primarily
certified by the DOH;
through prepayment mechanisms such as social health
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insurance, private health insurance, and HMO plans to one-half percent (1.5%) for self-earning,
ensure predictability of health expenditures. professional practitioners, and migrant workers.
BREAK MUNA §10. PREMIUM CONTRIBUTIONS

• For direct contributors, premium rates shall be in
accordance with the following schedule, and monthly
income floor and ceiling:
Year Premium Rate Income Floor Income Ceiling

2019 2.75% 10,000.00 50,000.00
2020 3.00% 10,000.00 60,000.00
2021 3.50% 10,000.00 70,000.00
2022 4.00% 10,000.00 80,000.00
2023 4.50% 10,000.00 90,000.00
2024 5.00% 10,000.00 100,000.00
2025 5.00% 10,000.00 100,000.00
• For Provided, That for indirect contributors, premium

subsidy shall be gradually adjusted and included annually in
the General Appropriations Act (GAA):
• Provided, further, That the funds shall be released to
III. NATIONAL HEALTH SECURITY PROGRAM (NHIP) PhilHealth:
• Provided, furthermore; That the DOB, in coordination with
§8. PROGRAM MEMBERSHIP PhilHealth, may request Congress to appropriate
• Membership into the Program shall be simplified into two supplemental funding to meet targeted milestones of this
(2) types, direct contributors and indirect contributors, as Act:
defined in Section 4 of this Act. • Provided, finally, That for every increase in the rate of
contribution of direct contributors and premium subsidy of
§9. ENTITLEMENT TO BENEFITS indirect contributors, PhilHealth shall provide for a
• Every member shall be granted immediate eligibility for corresponding increase in benefits.
health benefit package under the Program:
o Provided, That PhilHealth Identification Card shall §11. PROGRAM RESERVE FUNDS
not be required in the availment of any health • PhilHealth shall set aside a portion of its accumulated
service: revenues not needed to meet the cost of the current year’s
o Provided, further, That no co-payment shall be expenditures as reserve funds: Provided, That the total
charged for services rendered in basic or ward amount of reserves shall not exceed a ceiling equivalent to
accommodation: the amount actually estimated for two (2) years’ projected
o Provided, furthermore, That co-payments and co- Program expenditures: Provided, further, That whenever
insurance for amenities in public hospitals shall be actual reserves exceed the required ceiling at the end of the
regulated by the DOH and PhilHealth: fiscal year, the excess of the PhilHealth reserve fund shall
o Provided, finally, That the current PhilHealth be used to increase the Program’s benefits and to decrease
package for members shall not be reduced. the amount of members’ contributions.
• PhilHealth shall provide additional Program benefits for • Any unused portion of the reserve fund that is not needed
direct contributors, where applicable: to meet the current expenditure obligations or support the
o Provided, That failure to pay premiums shall not above-mentioned programs shall be placed in investments
prevent the enjoyment of any Program benefits: to earn an average annual income at prevailing rates of
o Provided, further, That employers and self- interest and shall be referred to as the Investment Reserve
employed direct contributors shall be required to Fund. The Investment Reserve Fund shall be invested in any
pay all missed contributions with an interest, or all of the following:
compounded monthly, of at least three percent o In interest-bearing bonds, securities or other
(3%) for employers and not exceeding one and evidences of indebtedness of the Government of
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the Philippines: Provided, That such investment managers to manage the reserve fund, as it may deem
shall be at least 50% of the reserve fund; appropriate, through public bidding. The fund manager
o In debt securities and corporate bonds of prime shall submit an annual report on investment performance
or solvent corporations created or existing under to PhilHealth.
the laws of the Philippines: Provided, That the • The PhilHealth shall set up the following funds:
issuing or its predecessor entity shall not have o A fund to secure benefit payouts to members
defaulted in the payment of interest on any of its prior to their becoming lifetime members;
securities: Provided, further, That the securities o A fund to secure payouts to lifetime members;
are issued by companies with high growth and
opportunities and earnings potentials: Provided, o A fund for optional supplemental benefits that
finally, That such investment shall not exceed are subject to additional contributions.
thirty percent (30%) of the reserve fund; • A portion of each of the above funds shall be identified as
o In interest-bearing deposits and loans to or current and kept in liquid instruments. In no case shall said
securities in any domestic bank doing business in portion be considered part of invested assets.
the Philippines: Provided, That in the case of such • The PhilHealth shall allocate a portion of all contributions to
deposits, this shall not exceed at any time the the fund for lifetime members based on an allocation to be
unimpaired capital and surplus or total private determined by the PhilHeaIth actuary based on a
deposits of the depository bank, whichever is predetermined percentage using the current average age of
smaller: Provided, further, That the bank shall members and the current life expectancy and morbidity
have been designated as a depository for this curve of Filipinos.
purpose by the Monetary Board of the Bangko • The PhilHealth shall manage the supplemental benefits and
Sentral ng Pilipinas; the lifetime members’ fund in an actuarially sound manner.
o In preferred stocks of any solvent corporation or • The PhilHealth shall manage the supplemental benefits
institution created or existing under the laws of fund to the minimum required to ensure that the
the Philippines listed in the stock exchange with supplemental benefit payments are secure.
proven track record or profitability over the last
three (3) years and payment of dividends for a §12. ENTITLEMENT TO BENEFITS
period of at least three (3) years immediately • No more than seven and one-half percent (7.5%) of the
preceding the date of investment in such actual total premium collected from direct and indirect
preferred stocks; contributory members during the immediately preceding
o In common stocks of any solvent corporation or year shall be allotted for the administrative cost of
institution created or existing under the laws of implementing the Program.
the Philippines listed in the stock exchange with
high growth opportunities and earnings §13. PHILHEALTH BOARD OF DIRECTORS
potentials;
• The PhilHealth Board of Directors, hereinafter referred to as
o In bonds, securities, promissory notes, or other
the Board, is hereby reconstituted to have a maximum of
evidences of indebtedness of accredited and
thirteen (13) members, consisting of the following:
financially sound medical institutions exclusively
o (1) five (5) ex officio members, namely: the
to finance the construction, improvement and
Secretary of Health, Secretary of Social Welfare
maintenance of hospitals and other medical
and Development, Secretary of Budget and
facilities: Provided, That such securities and
Management, Secretary of Finance, Secretary of
instruments shall be guaranteed by the Republic
Labor and Employment;
of the Philippines or the issuing medical
o (2) three (3) expert panel members with expertise
institution and the issued securities are both
in public health, management, finance, and
rated triple ‘A’ by authorized accredited domestic
health economics; and
rating agencies: Provided, further, That said
o (3) five (5) sectoral panel members, representing
investments shall not exceed ten percent (10%) of
the direct contributors, indirect contributors,
the total reserve fund; and
employers group, health care providers to be
o In debt instruments and other securities traded in
endorsed by their national associations of health
the secondary markets with the same intrinsic
care institutions and health care professionals,
quality as those enumerated in paragraphs (a) to
and representative of the elected local chief
(e) hereof, subject to the approval of the
executives to be endorsed by the League of
PhilHealth Board. No portion of the reserve fund
Provinces of the Philippines, League of Cities of
or income thereof shall accrue to the general fund
the Philippines and League of Municipalities of
of the National Government or to any of its
the Philippines:
agencies or instrumentalities, including
▪ Provided, That at least one (1) of the
government owned or -controlled corporations.
expert panel members and at least two
• As part of its investments operations, PhilHealth may hire
institutions with valid trust licenses as its external local fund
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(2) of the sectoral panel members are expedient, necessary and feasible and to inspect or cause to
women. be inspected periodically such offices, subject to the
• The sectoral and expert panel members must be Filipino approval by the Board;
citizens and of good moral character. • To maintain a Provident Fund which consists of
• The expert panel members must: contributions made by both PhilHealth and its officials and
o (i) be of recognized probity and independence employees and earnings thereon, for the payment of
and must have distinguished themselves benefits to such officials and employees or their
professionally in public, civic or academic service; dependents or heirs under such terms and conditions as
o (ii) be in the active practice of their professions for may be prescribed by the Board, subject to the approval of
at least seven (7) years; and the President of the Philippines; and
o (iii) not be appointed within one (1) year after • To adopt or approve the annual and supplemental budget
losing in the immediately preceding elections, of receipts and expenditures including salaries, allowances
whether regular or special. and early retirement of PhilHealth personnel and to
• The Secretary of Health shall be an ex officio non-voting authorize such capital and operating expenditures and
Chairperson of the Board. disbursements as may be necessary and proper for the
• All appointive members of the Board shall be required to effective management and operation of PhilHealth:
undergo training in health care financing, health systems, Provided, That this shall be subject to the budgetary
costing health services and HTA prior to the start of their limitations stated under Section 12 hereof: Provided,
term. Noncompliance shall be a ground for dismissal. further, That the submission of the corporate budget to the
• Within thirty (30) days following the effectivity of this Act, Department of Budget and Management (DBM) shall be for
the Governance Commission for Government-Owned or - information purposes only.
Controlled Corporations (GCG) shall, in accordance with the
provisions of Republic Act No. 10149, promulgate the IV. HEALTH SERVICES DELIVERY
nomination and selection process for appointive members §17. HEALTH SERVICES DELIVERY
of the Board with a clear set of qualifications, credentials, • The DOH shall endeavour to contract province-wide and
and recommendation from the concerned sectors. city-wide health systems for the delivery of population-
based health services. Province-wide and city-wide health
§14. PRESIDENT AND CEO OF PHILHEALTH systems shall have the following minimum components:
• Upon the recommendation of the Board, the President of o Primary care provider network with patient
the Philippines shall appoint the President and CEO of records accessible throughout the health system;
PhilHealth from the Board’s non-ex officio members: o Accurate, sensitive, and timely epidemiologic
Provided, That the Board cannot recommend a President surveillance systems; and
and CEO of PhilHealth unless the member is a Filipino citizen o Proactive and effective health promotion
and must have at least seven (7) years of experience in the programs or campaigns.
field of public health, management, finance, and health
economics or a combination of any of these expertise. §18. INDIVIDUAL-BASED HEALTH SERVICES
• PhilHealth shall endeavour to contract public, private, or
§15. PHILHEALTH PERSONNEL AS PUBLIC HEALTH WORKERS mixed health care provider networks for the delivery of
• All PhilHealth personnel shall be classified as public health individual-based health services: Provided, That member
workers in accordance with the pertinent provisions under access to services shall not be compromised: Provided,
Republic Act No. 7305, also known as the Magna Carta of further, That these networks agree to service quality, co-
Public Health Workers. payment/co-insurance, and data submission standards:
Provided, furthermore, That during the transition,
§16. ADDITIONAL POWERS AND FUNCTIONS OF PHILHEALTH PhilHealth and DOH shall incentivize health care providers
• To fix the reasonable compensation, allowances and other that form networks: Provided, finally, That apex or end-
benefits of all positions, including its President and CEO, referral hospitals, as determined by the DOH, may be
based on a comprehensive job analysis and audit of actual contracted as stand-alone health care providers by
duties and responsibilities, subject to the approval of the PhilHealth.
President of the Philippines. The compensation plan shall be • PhilHealth shall endeavour to shift to paying providers using
comparable with government social security institutions performance-driven, close-end, prospective payments
and shall be subject to periodic review by the Board no based on disease or diagnosis related groupings and
more than once every four (4) years without prejudice to validated costing methodologies and without
merit reviews or increases based on productivity and differentiating facility and professional fees; develop
efficiency; differential payment schemes that give due consideration
• To establish the organizational structure and staffing to service quality, efficiency and equity; and institute strong
pattern of PhilHealth’s central and regional offices to cover surveillance and audit mechanisms to ensure networks’
as many provinces, cities and legislative districts, including compliance to contractual obligations.
foreign countries, whenever and wherever it may be
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V. ORGANISATION OF LOCAL HEALTH SYSTEMS Human Resource Master Plan that will provide policies and
strategies for the appropriate generation, recruitment,
§19. INTEGRATION OF LOCAL HEALTH SYSTEMS INTO PROVINCE-
retraining, regulation, retention and reassessment of health
WIDE AND CITY-WIDE HEALTH SYSTEM
workforce based on population health needs. To ensure
• The DOH, Department of the Interior and Local Government
continuity in the provision of the health programs and
(DILG), PhilHealth and the LGUs shall endeavour to
services, all health professionals and health care workers
integrate health systems into province-wide and city-wide
shall be guaranteed permanent employment and
health systems. The Provincial and City Health Boards shall
competitive salaries.
oversee and coordinate the integration of health services
for province-wide and city-wide health systems, to be
§24. SPECIAL HEALTH FUND
composed of municipal and component city health systems,
• A national health workforce (NHW) support system shall be
and city-wide health systems in highly urbanized and
created to support local public health systems in addressing
independent component cities, respectively. The Provincial
their human resource needs: Provided, That deployment to
and City Health Boards shall manage the Special Health
Geographically Isolated and Disadvantaged Areas (GIDAs)
Fund referred to in Section 20 of this Act and shall exercise
shall be prioritized.
administrative and technical supervision over health
facilities and health human resources within their
respective territorial jurisdiction: Provided, That §25. SCHOLARSHIP AND TRAINING PROGRAM
municipalities and cities included in the province-wide and • The Commission on Higher Education (CHED), Technical
city-wide health systems shall be entitled to a Education and Skills Development Authority (TESDA),
representative in the Provincial or City Health Board, as the Professional Regulation Commission (PRC) and the DOH
case may be. shall develop and plan the expansion of existing and new
allied and health-related degree and training programs
§20. SPECIAL HEALTH FUND including those for community-based health care workers
• The province-wide or city-wide health system shall pool and and regulate the number of enrolees in each program based
manage, through a special health fund, all resources on the health needs of the population especially those in
intended for health services to finance population-based underserved areas.
and individual-based health services, health system • The CHED and the DOH shall expand scholarship grants for
operating costs, capital investments, and remuneration of allied and health-related undergraduate and graduate
additional health workers and incentives for all health programs: Provided, That scholarships shall be based on the
workers: Provided, That the DOH, in consultation with the needed cadre of national and local health managers and
DBM and the LGUs, shall develop guidelines for the use of health professionals: Provided, further, That scholarships
the Special Health Fund for bona fide residents of unserved or underserved areas or
members of indigenous peoples shall be given priority.
§21. INCOME DERIVED FROM PHILHEALTH PAYMENTS • The PRC and the DOH, in coordination with duly-registered
medical and allied health professional societies, shall set up
• All income derived from PhilHealth payments shall accrue
a registry of medical and allied health professionals,
to the Special Health Fund to be allocated by the LGUs
indicating, among others, their current number of
exclusively for the improvement of the LGU health system:
practitioners and location of practice.
Provided, That PhilHealth payments shall be credited to the
annual regular income (ARI) of the LGU. • The CHED, PRC, and DOH, in coordination with duly-
registered medical and allied professional societies, shall
§22. INCENTIVES FOR IMPROVING COMPETITIVENESS OF THE reorient medical and allied medical professional education,
PUBLIC HEALTH DELIVERY SYSTEM and health professional certification and regulation towards
producing health workers with competencies in the
• The National Government shall make available
provision of primary care services.
commensurate financial and non-financial matching grants,
including capital outlay, human resources for health and
§26. RETURN SERVICE AGREEMENT
health commodities, to improve the functionality of
province-wide and city-wide health systems: Provided, That • All graduates of allied and health-related courses who are
underserved and unserved areas shall be given priority in recipients of government-funded scholarship programs
the allocation of grants: Provided, further, That the grants shall be required to serve in priority areas in the public
shall be in accordance with the approved province-wide and sector for at least three (3) full years, with compensation,
city-wide health investment plans, which shall account for and under the supervision of the DOH: Provided, further,
complementation of public and private health care That those who will serve for additional two (2) years shall
providers and public or private health sector investments. be provided with additional incentives as determined by the
DOH: Provided, further, That graduates of allied and health-
VI. HUMAN RESOURCES FOR HEALTH related courses from state universities and colleges and
private schools shall be encouraged to serve in these areas.
§23. NATIONAL HEALTH HUMAN RESOURCE MASTER PLAN The DOH shall coordinate with the CHED and PRC for the
• DOH, together with stakeholders, shall ensure the
formulation and implementation of a National Health
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effective implementation of this section including the facilities and contracting of health services. The DOH shall
establishment of guidelines for noncompliance. develop the framework and guidelines to determine the
appropriate bed capacity and number of health care
VII. REGULATION professionals of public health facilities.
• The government shall guarantee that the distribution of
§27. SAFETY AND QUALITY
health services and benefits provided for in this Act shall be
• PhilHealth shall establish a rating system under an incentive
equitable by prioritizing GIDAS in the provision of assistance
scheme to acknowledge and reward health facilities that
and support.
provide better service quality, efficiency and equity:
• All government hospitals are required to operate not less
Provided, That PhilHealth shall recognize third party
than ninety percent (90%) of their bed capacity as basic or
accreditation mechanisms and may use these as basis for
ward accommodation: Provided, That specialty hospitals
granting incentives.
are required to operate not less than seventy percent (70%)
• The DOH shall institute a licensing and regulatory system for
of their bed capacity as basic or ward accommodation:
stand-alone health facilities, including those providing
Provided, further, That private hospitals are required to
ambulatory and primary care services, and other modes of
operate not less than ten percent (10%) of their bed
health service provision.
capacity as basic or ward accommodation: Provided, finally,
• The DOH shall set standards for clinical care through the
That all government hospitals, specialty hospitals and
development, appraisal, and use of clinical practice
private hospitals shall regularly submit a report on the
guidelines in cooperation with professional societies and
allotment or percentage of their bed capacity to basic or
the academe.
ward accommodation to DOH. which shall issue the
necessary guidelines for the immediate implementation of
§28. AFFORDABILITY
this provision.
• DOH-owned health care providers shall procure drugs and
devices guided by price reference indices, following
VIII. GOVERNANCE AND ACCOUNTABILITY
centrally negotiated prices, sell them following the
prescribed maximum mark-ups, and submit to DOH a price §30. HEALTH PROMOTION
list of all drugs and devices procured and sold by the health • The DOH, as the overall steward for health care, shall
care provider. strengthen national efforts in providing a comprehensive
• An independent price negotiation board, composed of and coordinated approach to health development with
representatives hum the DOH, PhilHealth and the emphasis on scaling up health promotion and preventive
Department of Trade and Industry (DTI), among others, care.
shall be constituted to negotiate prices on behalf of the • The DOH shall transform its existing Health Promotion and
DOH and PhilHealth, guided by certain parameters including Communication Service into a full-fledged Bureau, to be
new technology, innovator drugs, and sourced from a single named as the Health Promotion Bureau, to improve health
supplier: Provided, That the negotiated price in the literacy and mainstream health promotion and protection.
framework contract shall be applicable for all health care • The Health Promotion Bureau shall formulate a framework
providers under DOH: Provided, further, That the price strategy for health promotion which shall serve as the basis
negotiation board shall adhere to the guidelines issued by for DOH programs in increasing health literacy with focus
the Government Procurement Policy Board. on reducing non-communicable diseases, implement
• Health care providers and facilities shall be required to population-wide health promotion programs and activities
make readily accessible to the public and submit to DOH across social determinants of health, exercise policy
and PhilHealth, all pertinent, relevant, and up-to-date coordination across government to ensure the attainment
information regarding the prices of health services, and all of the framework strategy and its programs, and promote
goods and services being offered. and provide technical support to local research and
• Drug outlets shall be required at all times to carry the development programs and projects: Provided, That within
generic equivalent of all drugs in the Primary Care two (2) years from the effectivity of this Act, the cost of
Formulary and shall be required to provide customers with implementing health promotion programs shall be at least
a list of therapeutic equivalents and their corresponding one percent (1%) of the DOH’s total budget appropriations.
prices when fulfilling prescriptions or in any transaction. • The schools under the supervision of the Department of
• The DOH, PhilHealth, HMOs, life and non-life private health Education (DepEd) are hereby designated as healthy
insurance (PHIs) shall develop standard policies and plans settings for the purpose of this Act. The DepEd, in
that complement the Program’s benefit schedule: Provided, coordination with DOH, shall formulate programs and
That a coordination mechanism between PhilHealth, PHIs modules on health literacy and rights to be integrated into
and HMOs shall be set up to ensure that no benefits shall the existing school curricula to intensify the fight against the
be unnecessarily dropped. spread of communicable diseases and increase in
prevalence of non-communicable diseases through, among
§29. EQUITY others, the effective promotion of healthy lifestyle, physical
• DOH shall annually update its list of underserved areas, activity, proper nutrition, and prevention of smoking and
which shall be the basis for preferential licensing of health alcohol consumption among students. The program shall
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likewise acquaint the students on their entitlements, which shall also be mandated to provide adequate funding
privileges and responsibilities under this Act. support for the conduct of these researches.
• The DOH and DepEd shall submit annual reports on the
health promotion and literacy programs they have §32. MONITORING AND EVALUATION
respectively implemented, including an assessment of the • The Philippine Statistics Authority (PSA) shall conduct the
impact thereof, to the President of the Philippines, the relevant modules of household surveys annually during the
Senate President, and the Speaker of the House of first ten (10) years of the implementation, and thereafter
Representatives. follow its regular schedule.
• Furthermore, the LGUs are also directed to enact stricter • The DOH shall publish annual provincial burden of disease
ordinances that strengthen and broaden existing health estimates using internationally validated estimation
policies, the laws to the contrary notwithstanding, and methods and biennially using actual public and private
implement effective programs that promote health literacy sector data from electronic records and disease registries,
and healthy lifestyle among their constituencies to advance to support LGUs in tracking progress of health outcomes.
population health and individual wellbeing, reduce the
prevalence of non-communicable diseases and their risk §33. HEALTH IMPACT ASSESSMENT (HIA)
factors, particularly tobacco and alcohol use, lower the • HIA shall be required for policies, programs, and projects
incidence of new infectious diseases, address mental health that are crucial in attaining better health outcomes or those
issues and improve health indicators. An annual report on that may have an impact on the health sector.
the policies adopted and programs undertaken and an
assessment of the impact thereof shall be submitted by the §34. HEALTH TECHNOLOGY ASSESSMENT (HTA)
LGUs to the DILG. • The HTA process shall be institutionalized as a fan‘ and
transparent priority setting mechanism that shall be
§31. EVIDENCE-INFORMED SECTORAL POLICY AND PLANNING FOR recommendatory to the DOH and PhilHealth for the
UHQ development of policies and programs, regulation, and the
• All public and private, national and local health-related determination of a range of entitlements such as drugs,
entities shall be required to submit health and health- medicines, pharmaceutical products, and other devices,
related data to PhilHealth including, among others, procedures and services as provided for under this Act:
administrative, public health, medical, pharmaceutical and Provided, That investments on any health technology or
health financing data: Provided, That PhilHealth shall development of any benefit package by the DOH and
furnish the DOH a copy of the health data: Provided, PhilHealth shall be based on the positive recommendations
further, That these shall be used for the purpose of of the HTA: Provided, further, That despite having
generating information to guide research and policy- undergone the HTA process, all health technology,
making: Provided, finally, That the DOH shall strengthen its intervention or benefit package shall still be subjected to
research capability by supporting health systems periodic review: Provided, furthermore, That a health
development and reform initiatives through policy and technology assessment may be conducted as new evidence
systems research, and shall support the growth of research emerges which may have substantial impact on the initial
consortia in line with the vision of the Philippine National coverage decision by the DOH or PhilHealth: Provided,
Health Research System. finally, That the HTA process shall adhere to the principles
• The DOH and Department of Science and Technology of ethical soundness, inclusiveness and preferential regard
(DOST) shall develop a cadre of policy systems researchers, for the underserved, evidence-based and scientific
technical experts and managers by providing training grants defensibility, transparency and accountability, efficiency,
in globally-benchmarked institutions: Provided, That enforceability and availability of remedies, and due process.
grantees shall be required to serve for at least three (3) full • The following criteria must be observed in the conduct of
years, under supervision and with compensation, in DOH, HTA:
PhilHealth and other relevant government agencies: o Responsiveness to Magnitude, Severity, and
Provided, further, That those who will serve for additional Equity. The “health interventions must address
two (2) years, shall be provided with additional incentives the top medical conditions that place the heaviest
as determined by the agency concerned. burden on the population, including dimensions
• All health, nutrition and demographic-related of magnitude or the number of people affected by
administrative and survey data generated using public a health problem, and severity or health loss by
funds shall be considered public records and be made an individual as a result of disease, such as death,
accessible to the public unless otherwise prohibited by law: handicap, disability or pain, and conditions of the
Provided, That any person who requests a copy of such poorest and most vulnerable population;
public records may be required to pay the actual costs of o Safety and Effectiveness. Each intervention must
reproduction and copying of the requested public records. have undergone Phase IV clinical trial, and
• Participatory action researches on cost-effective, high- systematic review and meta-analysis must be
impact interventions for health promotion and social readily available. The interventions must also not
mobilization shall form part of the national health research
agenda of the Philippine National Health Research System
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pose any harm to the users and health care term of four (4) years: Provided, That no member shall serve
providers; for more than three (3) consecutive terms: Provided,
o Household Financial Impact. The interventions further, That the members of the HTAC shall receive an
must reduce out-of-pocket expenses. honorarium in accordance with existing policies: Provided,
Interventions must have economic studies and furthermore, That the DOB shall promulgate the
cost-of-illness studies to satisfy this criterion; nomination process for all HTAC members with a clear set
o Cost-effectiveness. The interventions must of qualifications, credentials and recommendations from
provide overall health gain to the health system the sectors concerned: Provided, finally, That the Secretary
and outweigh the opportunity costs of funding of the DOST shall appoint the members of the HTAC upon
drug and technology; and its transition into an attached agency under DOST.
o Affordability and Viability. The interventions
must be affordable and the cost thereof must be §35. MONITORING AND EVALUATION
viable to the financing agents. • The implementation of UHC shall be strengthened by
• The HTAC, to be composed of health experts, shall be commitment of all stakeholders to abide by ethical
created within the DOH and supported by a Secretariat and principles in public health practice:
a Technical Unit for Policy, Planning and Evaluation with o Conflict of interest declaration and management
evidence generation and validation capacity. The HTAC shall be routine in all policy-determining
shall: activities, and applicable to all appointed
o Facilitate provision of financing and/or coverage decision-makers, policymakers and their staff.
recommendations on health technologies to be o All manufacturers of drugs, medical devices,
financed by DOH and Philhealth; biological and medical supplies registered by the
o Oversee and coordinate the HTA process within FDA shall collect and track all financial
DOH and PhilHealth; and relationships with health care professionals and
o Review and assess existing DOH and PhilHealth health care providers and report these to the
benefit packages. Within five (5) years after the DOH, which shall then make this list publicly
establishment and effective operation of the available in accordance with existing laws.
HTAC, it shall transition into an independent o A public health ethics committee shall be
entity separate from the DOH, attached to DOST. constituted as an advisory body to the Secretary
• The HTAC shall conduct the HTA in accordance with the of Health to ensure compliance with the provision
principles, criteria and procedures of this Act and ensure of this section.
that its process is transparent, conducted with reasonable
promptness, and the result of its deliberations is made §36. HEALTH INFORMATION SYSTEM
public. The HTAC shall consist of a core committee and • All health service providers and insurers shall each maintain
subcommittees. a health information system consisting of enterprise
• The core committee, which shall elect from among resource planning, human resource information, electronic
themselves its Chairperson, shall be composed of nine (9) health records, and an electronic prescription log consistent
voting members, namely: a public health epidemiologist; a with DOH standards, which shall be electronically uploaded
health economist; an ethicist; a citizen’s representative; a on a regular basis through interoperable systems: Provided,
sociologist or anthropologist; a clinical trial or research That the health information system shall be developed and
methods expert; a clinical epidemiologist or evidence-based funded by the DOH and PhilHealth: Provided, further, That
medicine expert; a medico-legal expert; and a public health patient privacy and confidentiality shall at all times be
expert. upheld, in accordance with the Data Privacy Act of 2012.
• The subcommittees to be constituted shall include, among
others: Drugs, Vaccines, Clinical Equipment and Devices,
Medical and Surgical Procedure, Preventive and Promotive
Health Services, and Traditional Medicine. Each
subcommittee shall have a minimum of one (1) and
maximum of three (3) non-voting members for each
subcommittee.
• The HTAC may call upon technical resource persons from
the PhilHealth, Food and Drug Administration (F DA),
patient groups and clinical medicine experts as regular
resource persons; and representatives from the private
sector and health care providers as by-invitation resource
persons.
• The HTAC’s core committee and subcommittee members
shall be appointed by the Secretary of Health for a term of
three (3) years except for the medico-legal expert, ethicist,
and the sociologist or anthropologist who shall serve for a
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IX. §37. APPROPRIATIONS accreditation whichever is shorter, or both, at the discretion
of the PhilHealth, taking into consideration the gravity of
• The amount necessary to implement this Act shall be
the offense.
sourced from the following:
• The same shall also constitute a criminal violation
o Total incremental sin tax collections as provided
punishable by imprisonment for six (6) months and one (1)
for in Republic Act No. 10351, otherwise known
day up to six (6) years, upon discretion of the court without
as the “Sin Tax Reform Law”: Provided, That the
prejudice to criminal liability deemed under the Revised
mandated earmarks as provided for in Republic
Penal Code.
Act Nos. 7171 and 8240 shall be retained;
o If the health care provider is a juridical person, its
o Fifty percent (50%) of the National Government
officers and employees or other representatives
share from the income of the Philippine
found to be responsible, who acted negligently or
Amusement Gaming Corporation (PAGCOR) as
with intent, or have directly or indirectly caused
provided for in Presidential Decree No. 1869, as
the commission of the violation, shall be liable.
amended: Provided, That the funds raised for this
Recidivists may no longer be contracted as
purpose shall be transferred to PhilHealth at the
participants of the Program.
end of each quarter subject to the usual
• A member who commits any violation of this Act or
budgeting, accounting and auditing rules and
knowingly and deliberately cooperates or agrees; whether
regulations: Provided, further, That the funds
explicitly or implicitly, to the commission of a violation by a
shall be used by PhilHealth to improve its benefit
contracted health care provider or employer as defined in
packages;
this section, including the filing of a fraudulent claim for
o Forty percent (40%) of the Charity Fund, net of
benefits or entitlement under this Act, shall be punished by
Documentary Stamp Tax Payments, and
a fine of Fifty thousand pesos $50,000.00) for each count or
mandatory contributions of the Philippine Charity
suspension from availment of the benefits of the Program
Sweepstakes Office (PCSO) as provided for in
for not less than three (3) months but not more than six (6)
Republic Act No. 1169, as amended: Provided,
months, or both, at the discretion of PhilHealth.
That the funds raised for this purpose shall be
transferred to PhilHealth at the end of each • Any employer who:
quarter subject to the usual budgeting, o Deliberately or through inexcusable negligence,
accounting, and auditing rules and regulations: fails or refuses to register employees regardless
Provided, further, That the funds shall be used by of their employment status, accurately and timely
PhilHealth to improve its benefit packages; deduct contributions from the employee’s
o Premium contributions of members; compensation or to accurately and timely remit
o Annual appropriations of the DOH included in the or submit the report of the same to PhilHealth
GAA; and shall be punished with a fine of Fifty thousand
o National Government subsidy to PhilHealth pesos (P50,000.00) for every violation per
included in the GAA. affected employee, or imprisonment of not less
than six (6) months but not more than one (1)
• The amount necessary to implement the provisions of this
year, or both such fine and imprisonment, at the
Act shall be included in the GAA and shall be appropriated
discretion of the court.
under the DOH and National Government subsidy to
▪ Any employer or any officer authorized
PhilHealth. In addition, the DOH, in coordination with
to collect contributions under this Act
PhilHealth, may request Congress to appropriate
who, after collecting or deducting the
supplemental funding to meet targeted milestones of this
monthly contributions from the
Act.
employee’s compensation, fails or
X. §38. PENAL PROVISIONS
refuses for whatever reason to
Any violation of the provisions of this Act, after due notice and accurately and timely remit the
hearing, shall suffer the corresponding penalties as herein provided: contributions to PhilHealth within thirty
• A health care provider of population-based health services (30) days from due date shall be
who violates any of the provision in its respective contract presumed prima facie, to have
shall be subject to sanctions and penalties under its misappropriated the same and is
respective contracts without prejudice to the right of the obligated to hold the same in trust for
government to institute any criminal or civil action before and in behalf of the employees and
the proper judicial body. PhilHealth, and is immediately
• A health care provider contracted for the provision of obligated to return or remit the
individual-based health services who commits an unethical amount. If the employer is a juridical
~act, abuses the authority vested upon the health care person, its officers and employees or
provider, or performs a fraudulent act shall be punished by other representatives found to be
a fine of Two hundred thousand pesos (P200,000.00) for responsible, whether they acted
each count, or suspension of contract up to three (3) negligently or with intent, or have
months or the remaining period of its contract or directly or indirectly caused the
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commission of the violation, shall be • PhilHealth may enumerate circumstances that will mitigate
liable. or aggravate the liability of the offender or health care
o Deducts, directly or indirectly, from the provider, member or employer.
compensation of the covered employees or • Despite the cessation of operation by a health care provider
otherwise recover from them the employer’s own or termination of practice of an independent health care
contribution on behalf of such employees shall be professional While the complaint is being heard, the
punished with a fine of Five thousand pesos proceeding shall continue until the resolution of the case.
(P5,000.00) multiplied by the total number of
affected employees or imprisonment of not less XI. MISCELLANEOUS PROVISIONS
than SIX (6) months but not more than one (1)
§39. OVERSIGHT PROVISION
year, or both such fine and imprisonment, at the
discretion of the court. • There is hereby created a Joint Congressional Oversight
▪ If the unlawful deduction is committed Committee on Universal Health Care to conduct a regular
by an association, partnership, review of the implementation of this Act which shall entail
corporation or any other institution, its a systematic evaluation of the performance, impact or
managing directors or partners or accomplishments of this Act and the performance of the
president or general manager, or other various agencies involved in realizing universal health care,
persons responsible for the commission particularly with respect to their roles and functions.
of the act shall be liable for the • The Joint Congressional Oversight Committee shall be
penalties provided for in this Act. jointly chaired by the Chairpersons of the Senate
• Any director, officer or employee of PhilHealth who: Committee on Health and Demography and the House of
o Without prior authority or contrary to the Representatives Committee on Health. It shall be composed
provisions of this Act or its IRR, wrongfully of five (5) members from the Senate and five (5) members
receives or keeps funds or property payable or from the House of Representatives, to be appointed by the
deliverable to the PhilHealth, and who Senate President and the Speaker of the House of
appropriates and applies such fund or property Representatives, respectively.
for personal use, or shall willingly or negligently • The National Economic and Development Authority, in
consents either expressly or implicitly to the coordination with the PSA, National Institutes of Health,
misappropriation of funds or property without and other academic institutions shall undertake studies to
objecting to the same and promptly reporting the validate and evaluate the accomplishments of this Act.
matter to proper authority, shall be liable for These validation studies and annual reports, on the
misappropriation of funds under this Act and shall performance of the DOH and PhilHealth shall be submitted
be punished with a fine equivalent to triple the to the Joint Congressional Oversight Committee.
amount misappropriated per count and • The DOH and PhilHealth shall allocate an adequate funding
suspension for three (3) months without pay. for the purpose of conducting these studies.
o Commits an unethical act, abuse of authority, or • The Joint Congressional Oversight Committee shall
performs a fraudulent act shall be punished by a commission an independent study to evaluate the
fine of Two hundred thousand pesos implementation of this Act.
(P200,000.00) or suspension for three (3) months
without pay, or both, at the discretion of §40. PERFORMANCE MONITORING DIVISION
PhilHealth, taking into consideration the gravity • The DOH shall establish a Performance Monitoring Division
of the offense. The same shall also constitute a to monitor and evaluate the proper and effective
criminal violation punishable by imprisonment for implementation of the provisions of this Act. The office in
six (6) months and one (1) day up to six (6) years, charge of field implementation performance of the DOH
upon discretion of the court without prejudice to shall comprise the core personnel of the office which shall
criminal liability defined under the Revised Penal be augmented by the DOH Secretary, as may be deemed
Code. necessary.
• Other violations of the provisions of this Act or of the rules
and regulations promulgated by PhilHealth shall be §41. TRANSITORY PROVISION
punished with a fine of not less than Five thousand pesos • Within thirty (30) days from the effectivity of this Act, the
(P5,000.00) but not more than Twenty thousand pesos President of the Philippines shall appoint the new members
920,000.00). of the Board and the President of PhilHealth. The existing
• All other violations involving funds of PhilHealth shall be board of directors shall serve in a hold-over capacity until a
governed by the applicable provisions of the Revised Penal full and permanent board of directors of PhilHealth is
Code or other laws, taking into consideration the rules on constituted and functioning.
collection, remittances, and investment of funds as may be • All officers and personnel of PhilHealth, except members of
promulgated by PhilHealth. the Board who shall be governed by the first paragraph of
this section, shall continue to perform their duties and
responsibilities and receive their corresponding salaries and
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benefits. The approval of this Act shall not cause any percent (40%) of the charity fund per year, in accordance
demotion in rank or diminution of salary, benefits and other with Section 37(c) of this Act, to enable the PCSO to
privileges of the incumbent personnel of PhilHealth: conclude and liquidate its Individual Medical Assistance
Provided, That qualified officers and personnel may Program At-Source-ang-Processing (IMAP-ASAP)
voluntarily elect for retirement or separation from service obligations.
and shall be entitled to the benefits under existing laws.
• All affected officers and personnel of the PCSO shall be §42. INTERPRETATION
absorbed by the agency without demotion in rank or • All doubts in the implementation and interpretation of this
diminution of salary, benefits and other privileges: Act, including its IRR, shall be resolved in favour of
Provided, That qualified officers and personnel of the upholding the rights and interests of every Filipino to
agency may voluntarily elect for retirement or separation quality, accessible and affordable health care.
from service based on PCSO Board-approved Early • Nothing in this Act shall be construed to eliminate or in any
Retirement Incentive Program (ERIP), utilizing internally- way diminish Program benefits being enjoyed at the time of
generated funds, or savings from its operating fund: promulgation of this Act.
Provided, finally, That the retirement benefit package shall
be reasonable and within the bounds of existing laws. §43. PERFORMANCE MONITORING DIVISION
• In the first six (6) years from the enactment of this Act, the • The DOH and the PhilHealth, in consultation and
National Government shall provide technical and financial coordination with appropriate national government
support to selected LGUs that commit to province-wide agencies, civil society organizations, non-government
integration, subject to further review after the lapse of six organizations, private sector representatives, and other
(6) years: Provided, That in the first three (3) years from the stakeholders, shall promulgate the necessary rules and
enactment of this Act, the province-wide and city-wide regulations for the effective implementation of this Act no
systems shall exhibit managerial integration: Provided, later than one hundred eighty (180) days upon the
further, That within the next three (3) years thereafter, the effectivity of this Act.
province-wide and city-wide systems shall exhibit financial
integration: Provided, finally, That upon positive §44. TRANSITORY PROVISION
recommendation by an independent study commissioned • If any part or provision of this Act is held invalid or
by the Joint Congressional Oversight Committee on unconstitutional, the remaining parts or provisions not
Universal Health Care of the overall benefit of province- affected shall remain in full force and effect.
wide integration and the positive recommendation of the
Secretary of Health, all local health systems shall be §45. REPEALING CLAUSE
integrated as prescribed by Section 19 of this Act through The pertinent provisions of the following laws are hereby amended
the issuance of an Executive Order by the President. accordingly:
• In the first ten (10) years from the enactment of this Act, • §6, 7, 10, 12, 16(n), 18, 19, 25, 26, 27, 28, 44, 45, 46, 47, 48
PhilHealth may outsource certain functions to ensure and 54 of Republic Act No. 7875, otherwise known as the
operational efficiency and towards the fulfillment of this “National Health Insurance Act of 1995”, as amended by
Act: Provided, That any outsourcing shall comply with the Republic Act No. 9241 and Republic Act No. 10606;
provisions of Republic Act No. 9184, otherwise known as • §8(0) of Republic Act No. 10351, otherwise known as the
the “Government Procurement Reform Act”, and its IRR. “Sin Tax Reform Law”;
• In the first three (3) years from the enactment of this Act, • Presidential Decree No. 1869, otherwise known as the
PhilHealth and DOH shall provide reasonable financial and PAGCOR Charter, as amended; and
licensing incentives to contracted health care facilities to • Republic Act No. 1169, otherwise known as the PCSO
form health care provider networks. Thereafter, these Charter, as amended, with respect to the provision of
incentives shall be withdrawn and providers shall be fully Section 37 of this Act.
subject to the provisions of Section 19 of this Act.
• All other laws, decrees, executive orders and rules and
• The HTAC under the DOH shall be established within one (1) regulations contrary to or inconsistent with the provisions
year from the effectivity of this Act: Provided, That the of this Act are hereby repealed or amended accordingly.
existing health benefit package shall be rationalized within
two (2) years from the establishment of the HTAC. §46. PERFORMANCE MONITORING DIVISION
• Within three (3) years from the effectivity of this Act, all • This Act shall take effect fifteen (15) days after its
private insurance companies and HMOs, together with DOH publication in the Official Gazette or in any newspaper of
and PhilHealth, shall have developed a system of co- general circulation.
payment that complements PhilHealth benefit packages.
• Within ten (10) years from the effectivity of this Act, only
those who have been certified by the DOH and PRC to be
capable of providing primary care will be eligible to be a
primary care provider.
• For the first two (2) years from the effectivity of this Act, the
P080 shall transfer at least fifty percent (50%) of the forty
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Integration of Primary Care & Occupational Health Services
DR. M. F. R. Jr. | 14 September 2019
Unfortunately, health services for workers do not adapt
I. Key Messages sufficiently quickly to new conditions
II. Introduction Occupational health services tends to focus on medical check
III. Occupational Health ups, registration, treatment and compensation of occupational
IV. Primary Health Care diseases and injuries
V. Integration General health services fails to detect and address health
VI. Background of the Integration of Primary Health problems related to employment and working conditions
Care with Occupational Health The linkages between occupational and general health care
VII. Integrating Primary Health Care with services are often very poor and in some countries the two are
Occupational Health structurally separated.
VIII. Next Steps The results:
o Insufficient primary and secondary prevention of work-
I. KEY MESSAGES related health problems
o Rising rates of sickness absenteeism
Workers health is an integral part of general health and daily o An inability to reintegrate sick and injured workers back
life into the workplace
Health system should facilitate local strategies to meet worker o A lack of continuity of care
health needs And inefficient use of human and financial resources
In moving towards universal coverage, those at greatest risk of
having greatest needs should be included first III. OCCUPATIONAL HEALTH
When developing policies about worker health all relevant
stakeholders should be involved Occupational diseases and injuries, work-related and workplace
Training in health and work should be part of all healthcare preventable disease and injuries are responsible for:
professional training o Current levels of reduced work capacity
Empowerment of workers and the encouragement of decision- o Increased temporary and permanent work disability
makers are critical for the promotion of the health and safety of o Shortened life expectancy
workers o And premature retirement or death
High rate and early onset of chronic diseases contribute
II. INTRODUCTION o High expenditure of national health care systems
o High demands for disability pensions
The health of the worker is determined by occupational o And compensation from social insurance funds
hazards, individual risk factors and access to health services
Industrial and other enterprises that lack adequate prevention
And these are also influenced by social factors, such as and control measures, contribute to environmental pollution
employment status and power relations. and pose health risks to the population
Work provides income to support human needs. There are emerging challenges that require policy changes for
It has a positive impact on the health and well being of health at the workplace. Some of them are:
individual and on social and economic development. o Ageing of working populations- resulting in different
World’s worker still labor under unhealthy and unsafe working occupational health needs
conditions, resulting in about 2 million of deaths annually from o Changing structure of employment - increase in temporary
disease and injuries. employment
Occupational risks account for a substantial portion of the o Diversity and dispersal of the traditional work structures
burden of chronic diseases (i.e.: outsourcing)
Between 3 - 4% of global GDP is being lost to costs associated There are emerging challenging that require policy changes for
with sickness, absenteeism, diseases and injuries resulting from health at the workplace. Some of them are:
work. o Increased number of interpersonal contacts at work -
The changing world of work is characterized by: psychosocial problems
o Increasing mobility of the workforce Intensification and repetitive work
o Growing numbers of small- and medium-sized enterprises o Unpredictable working hours
(SMEs) o Violence and harassment at the workplace
o An informal economy None of these problems can be solved using traditional
o Subcontracting methods focused on reduction of physical, chemical or
o Precarious forms of employment biological hazards at work.
o The rapid spread of new technologies However, they can be addressed by the holistic approach to
o And transfer to occupational health hazards between and management of health, environment and safety
within countries Changes in the global economy
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VELASCO/VENTURA/YU 1 of 5
DR. M. F. R. Jr | 14 September 2019
Continuous restructuring of production and sever o In some contests, it has referred to the provision of
organizations, ambulatory or first level of personal health care services
Subsequent changes in working life and in the responsibilities o In other contexts, it has been understood as a set of
priority health interventions for low-income populations
All of these have created an urgent need to strengthen
and adapt the tools and methods used to ensure that (also called “ selective primary health care)
health, environment and safety measures are protected, Others have understood it as an essential component of
promoted and properly managed at the enterprise level human development, focusing on the economic, social and
political aspects
Successful leading multinational enterprises and
integrating health, environment and safety issues into WHO has developed a cohesive definition based on the three
their overall management systems components:
1. Meeting people’s health needs through comprehensive
Challenges posed by globalization require enterprises to
promotive, protective, preventive, curative, rehabilitative
adapt holistic and integrated views of health and
and palliative care throughout the life course, strategically
environment management to retain competitiveness on
prioritizing key health care services aimed at individuals
well-regulated markets
and families through primary care and the population
The decisions of enterprise leaders & government and through public health functions as the central elements of
municipal leaders: Create an obvious impact on their own integrated health services;
health, on their families, neighbors and customers 2. Systematically addressing the broader determinants of
Health, Environment, Safety and Social Management in health through evidence-informed public policies and
Enterprises (HESME): actions across all sectors, and;
o A multidisciplinary approach to promote health at the 3. Empowering individuals, families and communities to
workplace and to minimize its harmful impacts on the optimize their health, as advocate for policies that
environment promote and protect health and well-being, as co-
o Also deals with the impact of the workplace on the developers of health and social services, and as self-carers
neighborhood health, on the health and and care givers to others.
environmental impact of products and services and The Alma-Ata declaration on PHC of 1978 emphasized the
on the preservation of the general environment importance of bringing health care as close as possible to
o May be a powerful tool for municipal and other local “where people live and work”.
authorities willing to promote an effective health
When PHC was put into [practice, focus was on health services
dimension to social, economic, environmental and
where people live
development policies
The provision of health care where people work was absent
from the debate, the programmes and the strategies on PHC
IV. PRIMARY HEALTH CARE
Many countries reforming their health systems based on the
PHC is a whole-of-society approach to health and well being primary health care approach have asked WHO to provide
centered on the needs and preferences of individualism policy options for the provisions of health care to WORKING
families and communities POPULATIONS.
It addresses the broader determinants of health and focuses Concerned about the low level of access of the workers to
on the comprehensive and interrelated aspects of physical, health services, the World Health Assembly (WHA) urged
mental and social health and well being Member States in 2007 “to work towards full coverage of all
It provides whole person care for health needs throughout the workers, including those in the informal economy, small- and
lifespan, not just for a set specific diseases medium-sized enterprises, agriculture and migrant and
Primary health care ensures people receive comprehensive contractual workers, with essential interventions and basic
care - ranging from promotion and prevention to treatment, occupational health services for primary prevention of
rehabilitation and palliative care - as close as feasible to occupational and work-related diseases and injuries”
people’s everyday environment (Resolution 60.26, “Workers’ Health: Global Plan of Action”)
Rooted in a commitment In 2008, the WHO launched a set if reforms to provide PHC to
o To social justice and equity all citizens
o In the recognition of the fundamental right to the highest The 62nd World Health Assembly in 2009 emphasized the need
attainable standard of the health to strengthen health system based on PHC in keeping with the
Article 25 of Universal Declaration on Human values and principles enshrined in the Alma-Ata Declaration
Rights: “Everyone has the right to a standard of living This renewed attention to developing PHC provides plentiful
adequate for the health and well-being of himself and of his opportunities to scale up occupational health services based on
family, including food, clothing, housing and medical care and the values of equity, solidarity and social justice and the
necessary social services. principles of multisectoral action and community participation
Different concept of PHC: The process could enable health systems to adequately respond
to the specific health needs of a large groups of workers,
S 1 T 1 MORALES/OXIMOSO/RIMANDO/TOLENTINO KC/TOLENTINO V. /VALDEZ/

particularly by providing channels to participation and Following the World Health Report 2008 (WHR 2008) Primary
intersectoral action, covering working populations in a given Health Care: Now More Than Ever, the 62nd World Health
territory and integrating approaches to health at work and in Assembly (WHA) urged Member States to take a number of
family life. actions to strengthen health systems based on PHC (resolution
V. INTEGRATION WHA 62.12 “Primary Health Care, Including Health Systems
Strengthening”)
The 62nd WHA also discussed the reducing health inequities
“A discrete set of techniques and organizational models
through action on social determinants of health
designed to create connectivity alignment and collaboration
within and between the cure and care sectors at the funding, The WHA resolution emphasizes the need to take health equity
administrative and/or provider levels.” (Kodner & Kyriacou, into account in national policies that address such
2000) determinants, including employment, to strengthen
intersectoral collaboration, to involve all partners, and to
Result of a workshop on the topic of integrated care held at
empower individuals and groups to improve societal conditions
the 2006 European Social Network Conference in Edinburgh
that affect their health
suggest that integrated care has different meanings for
various stakeholders, including the user, frontline provider, Universal PHC would help to achieve these goals
manager & policy maker. The 60th WHA in 2017 endorsed the WHO Global Plan of Action
(GPA) on Workers’ Health 2008-2017 (resolution WHA 60.12
For example, the user might perceive integrated care as care
“Workers’ Health: Global Plan of Action)
that is “seamless, smooth, easy to navigate” whereas to the
This plan deals with all aspects of workers’ health and is
policy maker, it implies consolidating budgets and conducting
underpinned by certain common principles
joint policy evaluations (Lloyd & Wait, 2005).
All workers should be able to enjoy the highest attainable
Not only can integration have different meaning to different standard of physical and mental health and favorable working
users, it also occurs at different levels of the healthcare conditions
system
The workplace should not be detrimental to health and well-
Delnoij et al. (2002) specifies integration at the macro, meso being
and micro levels of the healthcare system Primary prevention of occupational health hazards should be
Functional integration occurs at the macro level and involves given priority
the financing and regulation of cure and prevention activities All components of health systems should be involved in an
of both sectors integrated response to the specific health needs of working
At the meso or community level, there are (2) types of populations
integration: Organizational Integration & Professional The workplace cal also serve as a setting for delivery of other
Integration. The former implies a strategic alliance or merger essential public health interventions, and for health promotion
between public health and primary care. The latter suggests Activities related to workers’ health should be planned,
that such mergers involve healthcare professionals working implemented and evaluated with a view to reducing
together, for example, in group practices. inequalities within and between countries
Finally, at the micro level, there is clinical integration, in which Workers and employers and their representatives should also
it involves continuity, cooperation and coherence of participate in such activities
healthcare delivery to individual patients.
One of the objectives of GPA is to improve the performance of
and access to occupational health services
VI. BACKGROUND OF THE INTEGRATION OF PRIMARY HEALTH
CARE WITH OCCUPATIONAL HEALTH
VII. INTEGRATING PRIMARY HEALTH CARE
There have been many calls to renew PHC at international, WITH OCCUPATIONAL HEALTH
regional and national conferences organized by or in
collaboration with WHO, many coinciding with the 30th
GPA states that coverage and quality of these services should
anniversary of the Alma-Ata Declaration.
be improved by:
The basic idea behind health for all through PHC is that taking o Integrating their development into national health
into account both priority health needs and fundamental strategies, health-sector reforms and plans for improving
determinants of health enables people to lead socially and health systems performances;
economically productive lives, which in turn helps to drive o Determining standards for their organization and coverage
overall development. o Setting targets for increasing the working population
The call represent the goal of dealing effectively with current covered
and future challenges to health, mobilizing health professionals o Creating mechanisms for pooling resources and for
and lay people, government institutions and civil society in financing the delivery of services
support of an agenda whose key elements include o Ensuring sufficient and competent human resources and
transforming health-system inequities, organizing service establish quality assurance systems
delivery, setting public policy and furthering development.

o Providing basic occupational health services for all The following strategic directions for delivering occupational
workers, including those in the informal economy, small health in the context of integrated primary health care were
enterprises and agriculture developed devoted to universal coverage, people-centered
o Occupational health and primary care share common care, participatory leadership. Health in all policies:
values that are important for the health of people and All workers should have access to essential interventions and
populations, but health services that adequately addresses basic health services for prevention of occupational and work-
work is not universally available for people related diseases and injuries
In particular relevant are:
o The holistic approach, looking at individuals in the context This requires:
of their life o Emphasizing the role of national and local government for
o The interest in communities - be it work-communities or guaranteeing the access of all workers to curative and
living communities - to secure equity and the involvement preventive health care that allows for full and productive
of those with greatest needs working life
o Focus on improving individuals functioning (in work and o Including essential interventions for occupational health
other aspects of life ) and not only on disease outcomes and work ability in the delivery of comprehensive,
Currently, health services based on these values are not as integrated primary care, such as
widely available as is desirable advice for improving working conditions
Closer collaboration between occupational health and primary promoting health at work
care would enhance the opportunities to contribute to early detection of occupational and work-related
productivity and to extend working life diseases
This requires moving from a care oriented on diseases and support for return to work and preservation of
health problems to care that emphasizes optimizing functional working capacity
capability of individuals Including the financing of basic occupational health care for
A more integrated approach to occupational health and primary those most in need or at greatest risk, within existing
health care will yield a bigger impact on the health of people, arrangements for financing of basic primary health care.
than each can achieve on their own, to secure work-focused New mechanism may need to be developed where existing
health care. ones are inadequate to meet priority needs. These should, as
How that integration works in practice, depends on national far as possible, be integrated into existing national or local
and local circumstances health financing system.
Substantial global demographic trends, changing health Developing human resources and technological capacities at
problems and the changing nature of work mean that this the primary care level for the effective delivery of essential
integrated approach will become even more important in the interventions and basic health services for prevention of
decades to come occupational and work-related injuries and diseases through
This will require more care to be provided, without the training consultation, information, and supportive tools,
certainty of any increase the professional manpower including telecare
Important assets in initiating this collaboration are the Strengthening and expanding specialized occupational health
experiments that can be found in a number of countries and services, including the basic occupational health services and
settings around the world scaling up access to such services and increasing the number of
interventions with priority on primary prevention of
The following principles should guide further development in
occupational hazard
pursuing an integrated approach to occupational health and
Evaluating the models for service delivery and financing for
primary care:
occupational health and primary care and carrying out research
o Workers’ health is part of general health and life
on barriers to access to and coverage with preventive
o Health system should facilitate local strengths to meet
interventions
workers’ health needs
o In moving towards universal coverage, those at greatest people in their environment, including work, should be in the
risk for having greatest needs should be targeted first center of health care. This requires:
o Strengthening the role and responsibilities of the primary
The following principles should guide further development in
care providers for all health-related aspects of personal
pursuing an integrated approach to occupational health and
life, including early recognition of occupational and work-
primary care:
related ill-health, as well as preserving and resorting
o When developing policies about workers health all
working capacity of individuals
relevant stakeholders should be involved
o Building the capacities of primary care centers to respond
o Training in health and word should be part of all health
effectively to the general and specific health needs and
care professional training
expectations of working populations in the catchment
o Empowerment of workers and the encouragement of
area, including training in basic occupational health and
decision makers are critical for the promotion of the
supportive tools for interventions
health and safety of workers

o Linking occupational health services and primary care benefits and risks and enabling healthy public policies as a
centers under local primary health care networks, common ground for dialogue across sectors
including joint training, referral systems, information on o Development of national parts of action on workers health
occupational hazards and other mechanisms for involving all stakeholders and sectors, creating common
collaboration and continuity of care grounds as whole-of-government health initiatives and
o Providing clinical guidelines and standards for health care identifying the non-health benefits from action on
professionals that take into account the impacts of work workers’ health
and employment and working capacity o Ensuring input from primary care to the development and
o Empowering and supporting individuals and work implementation of national public programmes for
communities to take over the control of their own health, occupational health and safety, identifying, measuring and
to protect themselves against occupational hazards and to highlighting the benefits of such programmes for the
promote health at the workplace, for example by training delivery of integrated, comprehensive primary care
and developing programs for healthy workplaces, o Addressing the health needs of workers and hazardous
introducing tools for self-assessment and for work working conditions in the policies dealing with the
improvement, supporting workers health and safety informal economy, rural development and labor migration,
representatives and community health activities including the provision of health services to such
o Carrying out research on the effect of the tools for populations
empowering workers and work communities for take
control over their health, including the effectiveness of VIII. NEXT STEPS
work improvement techniques and community based
participatory research WHO and its networks of collaborating centers for occupational
health and primary care will collaborate with ILO, the non-
Protecting and promoting health at work requires a new,
governmental organizations in official relations with WHO and
participatory health leadership. This should include:
with the other international stakeholders, such as the World
Bank and the International Social Security Association on the
o An integrated response by all building blocks of health
following actions:
systems to the health needs of workers in the ongoing
o Developing policy options, methodologies and case studies
healthcare reforms with priority being given to the needs
and integrated financing mechanisms, including costing of
in the informal sector, migrant and self-employed workers
the delivery of essential interventions for occupational
and small enterprises
health at the primary care level
o Involving labor stakeholders, such as employers, trade
o Encouraging collaboration between the professional
unions, governments, civil society and the private sector in
associations of occupational health and primary care, such
the debates about health care reforms and the
as the International Commission on Occupational Health
development of national and regional (preclinical, district)
(ICOH) and the World Federation of Family Physicians
health strategies and plans
(Wonca
o Developing and maintaining national profiles for workers’
o Establishing a global repository of training materials and
health including measuring health outcomes and the
information for building human resource capacities for
performance of health systems regarding the health of
basic occupational health among primary care teams -
workers, basic information on working conditions,
doctors, nurses, technicians and community health
workers’ lifestyle, education, as well as interventions and
worker, for facilitating the inclusion of occupational health
services.
into undergraduate and postgraduate training and
o Strengthening the collaboration between health and labor
education in medicine, nursing and allied health
sectors for the ratification and implementation of core
o Collecting, evaluating and disseminating case studies and
international instruments for occupational safety and
examples of delivery of essential interventions and basic
health, such as Occupational Safety and Health Convention
services for occupational health in the context of
155, Occupational Health Services Convention 161 and
integrated primary health care and setting up an agenda
Promotional Framework for Occupational Safety and
for interdisciplinary research on the occupational health
Health Convention 187, establishing connections between
aspects of health systems and health services delivery
labor inspections and occupational health and safety and
o Supporting governments to adapt policies based on the
primary care.
outcomes of research on occupational hazards, to
The health of workers should be taken into account in designing promote healthy environment at the workplace and to
and implementing policies in all sectors, this includes the minimize the sickness absence, working incapacity and the
following: related costs.
o Identification of workers’ health impacts and co-benefits
of national policies and strategies in the area of labor, REFERENCES
environment, education, agriculture, economic
development, trade etc. as well as capitalization of 1. Dr. M.F.R.J.’s power point lecture

OLFU-College of Medicine
Department of Family Medicine and Community Health
FMCH 3
PRIMARY CARE FOR ALL LIFE STAGES
Dr. Renato A. Carasig
PRIMARY HEALTH CARE IN THE PHILIPPINES

Definition:
Essential health care made universally acceptable , readily available to individuals and
families in the community by means that will inspire and encourage their full participation,
and at a cost that the community and country can afford at EVERY STAGE OF DEVELOPMENT
DEFINITIONS;
WORLD HEALTH ORGANIZATION:
The WHO defines PHC as essential health care made universally acceptable to them through
their full participation and at a cost that the community and country can afford at every
stage of development.
ALTA ATA DECLARATION
The Declaration of Alma Ata was adopted at the International Conference of Primary Health
Care held in Alma Ata , Kazakhstan ( formerly Kazakh Soviet Socialist Republic) ,in
September 6- 12, 1978.
Eight Essential Elements;

1. Health Education
2. Treatment of Locally Endemic Diseases
3. Expanded Program on Immunization
4. Maternal and Child Health
5. Provision of essential , basic drugs
6. Nutrition
7. Treatment of Communicable and non- communicable diseases
8. Safe water and good waste disposal
GOALS
The ultimate goal is better health for all. WHO has identified with five key elements to
achieving that goal;
A. Reducing exclusion and social disparities in health (universal coverage reforms)

B Organizing health services around people needs and expectations ( service delivery
reforms).
C. Integrating health into all sectors ( public policy reforms)
D. Pursuing collaborative models of policy dialogue ( leadership reforms); and
E. Increasing stakeholder participation.
HISTORY:
1. May 1977.The 30th World Health Assembly adopted resolution which decided that the
main social target of governments and of WHO should be the attainment by all the people
of the world by the year 2000 a level of health that will permit them to lead a socially and
economically productive life at all age levels.
2. September 6-12 . International Conference in PHC was held at Alma Ata.
3. October 19, 1979 . The then President of the Philippines ( Ferdinand Marcos) issued a
letter of Instruction 949 as an approach towards design, development, and implementation
of programs which focus on health development at the community level
RATIONALE
Adopting PHC has the following rationales;

1. Magnitude of Health Problems
2. Inadequate and unequal distribution of health resources.
3.increasing cost of medical care
4. Isolation of health care activities from other development activities.
1|Page
OBJECTIVES
1. Improvement in the level of health care community .

2. Favorable population growth structure
3. Reduction in morbidity and mortality rates especially among infants and children.
4. Extension of essential health services with priority given to the undeserved sectors.
5. Improvement of basic sanitation .
6. Development of the capability of the community aimed at self-reliance.
7. Reduction in the prevalence of preventable, communicable and other diseases.
8. Maximizing the contribution of the other sectors for the social and economic development
of the community.
TYPES OF PHC WORKERS;
1. Barangay Health Worker or Village Health worker

2. Intermediate level Primary Health worker.
MAJOR STRATEGIES;
1. Elevating health to comprehensive and sustained national effort.

2. Promoting and supporting community managed health care.
3. Increasing efficiency in health sector.
4. Appropriate technology if available.
5. Advancing National Health Research.
ELEMENTS
1. Education for Health

2. Locally Endemic Disease Control
3. Expanded program on immunization .
4. Maternal and Child Health and Family Planning
5. Environmental Sanitation and Promotion of Safe water supply.
6. Nutrition and Promotion of Adequate Food Supply.
7. Treatment of Communicable Diseases .
8. Supply of Essential Drugs
THE SCOPE OF GENERAL PRIMARY CARE PRACTICE:
Defined as the IMMEDIATE- and often continuing - medical and health management if a
child, adult , or family when the patient first presents to the formal health system .
In low and middle- income countries , such as care is often provided from publicly funded
health posts and health centers by nurses or other abled and trained l health workers,
with you and me as health providers to play vital support, training and referral role..
CHALLENGE
Although the primary care level constitutes the first point of patient or family contact, it is
also critical base for extending care to communities and vulnerable groups which may focus
on individual preventive measures (such as immunization, Vitamin A, or oral rehydration
therapy) or community wide health promoting strategies.
PRIMARY CARE FOR EACH LEVELS OF DISEASE
1. Prenatal Stage
The antenatal care recommendations aim to provide a positive experience for all pregnant
women and to reduce pregnancy complications and to break down myths and lowers anxiety.
2. Labor stage
Care throughout labor and birth by observing respectful maternity care, effective
communication, companionship during labour and childbirth, and continuity of care
throughout stages of labour.
3.Postpartum , most common activities such as encouraging breastfeeding, devising plans

and guidelines on contraception methods, food and nutrition , orientation regarding sexual
activities and screening fir mood disorders
2|Page
4. Neonatal stage Birth to 28 days
High priority needs to be given improving the survival of the newborns.
A large of neonatal deaths have their origin in the perinatal period and are mainly
determined by the health and nutritional status of the mother, the quality of care during
pregnancy and delivery, and the immediate care of the newborn.
5. Infancy 0 - 1 year
Preventive services visits at regular intervals , breastfeeding, usual health issues and
concerns eg colds, cough and ear infections, diarrhea and vomiting, allergies. Parasitism,
Immunizations.
6. School age 6 to 12 years acute health problems in form of injuries that arise during
school( such as bumps, scrapes, short term health problems eg throat and ear infection,
unusual bruises, injuries or illnesses that require immobilization or limitations on physical
activities.
7. Adolescents , 13 to 18 years- road traffic and other unintentional injuries, suicide and
mental health problems including humiliation and feeling devalued, interpersonal violence,
HIV /AIDS, early pregnancy and early childbirth, alcohol and tobacco use, lack of physical
activity, vaccinations , drugs and substance abuse, nutrition and micronutrient deficiencies,
faulty and healthy eating habits, undernutrition and obesity.
8.Younger women 19 - 59 years , heart diseases, malignancies, sexually transmitted

diseases, autoimmune diseases, mental illness, substance abuse, smoking, violence outside
and inside the home, reproductive health, fertility and infertility, environmental health.
9. Adult men- Sexually transmitted inflections and Diseases, malignancies such as prostate
and colon, cardiovascular diseases, erectile dysfunction, diabetes, alcohol related health
problems, COPD and Chronic respiratory disease, pneumonia
10. Adult women- cardiovascular diseases, chronic ailments such as diabetes mellitus and
thyroid problems, chronic anemia malignancies such as breast. ovarian and cervical,
gynecologic health such as bleeding and discharge, autoimmune diseases, nutrition,
depression and anxiety, chronic debilitating diseases such as osteoarthritis and
osteoporosis, dementia, exercise, safety issues, medications and drug interactions,
sexuality, domestic violence issues, grief and loss and impending death.
3|Page
Primary Care for All Life Stages
Renato A. Carasig, MD | 24 August 2019
OUTLINE methods and technology made universally

I. Guidelines on the Adoption of Baseline Primary Health accessible to the individuals and families in the
Care Guarantees for All Filipinos community through their full participation and at
A. Rationale a cost that the community and country can afford.
B. Objective • Primary Care
C. Definition of Terms o First contact, accessible, continued,
D. General Guidelines comprehensive, and coordinated care
E. Specific Guidelines o Focuses on long term health appropriate to the
F. Roles and Responsibilities common problems in the respective population
a. Department of Health • Primary Care Facilities (DOH)
b. Civil Society Organisations o First contact health care facility that offers basic
II. Primary Health Care Guarantees for All Life Stages services including emergency services and
A. Pregnancy provision for normal deliveries
B. Labour/Delivery
C. Post-partum D. GENERAL GUIDELINES
D. Neonate • Health guarantees are organized per life stage.
E. Infant • Baseline set of guarantees is summarized and initially
F. Child developed by a technical working group participated in by
G. School Age various DOH offices and its attached agencies.
H. Adolescent • Baseline set of primary health care guarantee shall be
I. Adult Men (20-60yrs) regularly updated through a single, fair, and transparent
J. Adult Women (>60yrs) priority setting process or health technology assessment.
E. SPECIFIC GUIDELINES
I. GUIDELINES ON THE ADOPTION OF BASELINE PRIMARY HEALTH
• Baseline Health Guarantees
CARE GUARANTEES FOR ALL FILIPINOS
o Clinically and cost-effective interventions that
A. RATIONALE address 80% of the local disease burden (Wong et al)
• The Philippine Health Agenda 2016-2022 underscores the • Financing on health guarantee
need for: • Enabling quality access and ensuring adequate and
o A health system that is built on health promotion appropriate provisions
and strong family health care with referral
system to higher levels as needed. F. ROLES AND RESPONSIBILITIES
o Citizens engaged and empowered to demand to 1. Department of Health
their entitlement. • Defines the baseline primary care guarantees and facilitate
expansion
B. OBJECTIVE • Formulate and review strategic and operational policies,
• To define the guaranteed population-based and individual- plans and programs related to the Primary Health Care
based primary health care interventions for each life stage Guarantees
• To identify the health financing agent/mechanism for the
identified primary health care intervention 2. Philippine Health Insurance Corp. (PhilHealth)
• To facilitate the citizen’s knowledge and understanding of • Develops Primary Care benefit package in line with the
their health guarantees. Primary health Care guarantees and facilitate expansion
C. DEFINITION OF TERMS 3. Local Government Units

• Health Guarantee • Enact local legislations and ensure availability of essential
o Services shall be geographically accessible with inputs and investments to realize the primary health care
the least financial burden guarantees
o Specifically, at no cost when accessed in public
health facilities and a fixed co-payment when 4. Civil Society Organisations
accessed in private health facilities. • Participate in the advocacy and or delivery of the of the
• Health Technology Assessment Primary Health Care guarantees and DOH, PHIC, and LGUs
o Refers to the systematic evaluation of properties, accountable in the quality provisions of primary health care
effects, and/or impacts of health technology to guarantees.
inform family policy decision-making. • Development Partners shall adopt, develop, and implement
• Primary Health Care supporting operational policies, plans, and programs
o Refers to essential health care based on practical, consistent with the Primary health care guarantee
scientifically sound, and socially acceptable
S1T5| OBE is Life 1 of 41

Population Level Primary Care Services for l Primary Care Services for
I
I Well Individuals i Sick Individuals
i SuiTeiii3:nce ai1d monitoring ! Clinical
l regnancy I ofthe popnlaljon's health !INITIAl. VISIT: j ronditjon !
!• !• i
I
I
I
I•
system
Pregnancy Tracking
'
History and Physical examination
• Oral Health Examination and appropriate interventions
j • Referral and Transportation Services ·
! DENIAL CONDITIONS
] " Crisis helplines (self- ] • Nutritional Assessment and Counseling f • Provision of oral LdfC services as
. I harm) • Counseling Services for Mothers with Prenatal findings of Birth
Defects
needed
• Preyentjon and Control of 1 ENVIRONMENTAL HAZARD

End emir Diseases • NOT SPECIFIC TO A TRIMESTER (FOR SUCCEEDING VISITS): i EXPOSURE OR POISONING
I, • Integrated Vector Control j • STI testing using syndromic approach and etiologic tests · • Early recognition and initial
'I Management 1 • Antenatal mental health services (screening) management
• Mass Drug II • Referral to higher facility or trained
, Administration (for Soil laboratory health worker on poison control
j Transmitted Helminths, INITIAL VISIT: and clinical toxicology
Schistosomiasis, and J • Ki:
Filariasis) ! • Hepa.ti.tts B Screenmg i FINDINGS OF BIRTH DEFECTS OR
• Therapeutic management ! e Syphths VDR/RPR · RARE DISEASES
for Soil Transmitted • Complete Blood Count (CBC) • Referral to subspecialist-
Helminths (STH), • Blood Typing Obstetrician- Gynecologist (Ob·
Filariasis • Ultrasound (as necessary) Gyn), geneticis• metabolic
Schistosa'miasis 1 .• Acetic Acid Wash spedalist or other spedalist
1
Urinalysis I
Assurance of quality and • Fasling,Biood Sugar (FBS) I BEHAVIORAL OR PSYCHIATRIC
acCcssjbility ofseryjcCs • HIV Testing (offered to all) DISORDERS
• Establishment ofWomen • Fecalysis • Screening, treatment/management
& Child Protection Unit in and referral to higher level facilities
all hospitals NOT SPECIFIC TO A TRIMESTER (FOR SUCCEEDING VISITS): • Provision of drugs, as indiGtted
• Services for PWDs and • Oral Glucose Tolerance Test (OGTT) Psychosocial intervention
other special groups • Pap Smear (as necessary) I"
•
Referral to a higher • Ultrasound(as necessary) OBSTETRIC COMP!.!CATIONS
facility for the
provision of assistive I Hypertensive Disorders of
Pregnancy
•
1
devices as indicated I Ferrous Sulfate with FolicAcl'd l• Referral and Transportation to Ob-
! Gyn and Tertiary Care Facility
J
I J-----'-
• Iodine supplement . J 0 On Follow Up DOC: 1
• L1p1d -based nutnent supplement- Small Quantity (LNS-Sq) 1 Antihypertensive drugs

· - - L '_(according to guidelines) .J .•
All "" """ ,, "'""" "' "''"''" '"''' """" """'"'"' '"" 3 of 44
.I
I Population Level Primary Care Services for ; Primary Care Services for ·
communicatjon and
Well Individuals __l Individuals I
,Pregnancy
1
•
: dissemination strategies
I
SECOND TRIMESTER- if indicated:
• Calcium C.arbonate •
j Gestational Diabetes Mellitus
Clinic.:d Service: Blood Sugar
I 1
I ·
Mother's Classes:
With focus on !
1
• Albendazole
I,
Monitoring [ti·equency depending
on results/risk prolile)
prenatal care I NOT SPiiCIFIC TO A TRIME5>"1'ER (FOR SUCCEEDING VISITS): lI • Advice on Diet Modification
I I. · · Expanded Program on · • Long Lasting Insecticidal Nets (LLIN)(for malaria endemic
Immunization I areas) i
I • Ret"erral and Transportation
Service to OB-Gync, as needed
I• Exclusive
breastfceding
1 • Insect repellent lotion [for all vector-borne diseases)
! • Tet1nus ·Diphtheria (Td) Toxoid Vaccines
I • Referral and follow up Labs: FBS,
: OGTT, HbAIC, Ultrasound
I I
] Rooming-in, Mother 1• Consultation with a
:
Baby Friendly J Purjng Emergell.!:X \ dietitian
1
Hospital Initiative j Mental health and psychosocial services (MHPSS)
(MBFfll] i
Minimum Initial Service Package lor Motherhood (MISP) I
• Community Health and
! Commodities: Water treatment with hyposol,jerry cans, clean
I
delivery kits, hygiene kits
! RENALflJRO!,OG!C
j Urinary Tract Infection
Nutrition Education: l • Labs: Ultrasound, Urinalysis, and
Non-exposure to ; Urine Culture and Sensitivity
cigarette smoke and ! • Therapeutic Management
unhealthy food
Water, Sanitation and i PULMONARY
Hygiene (WASH)
Occupational health
Infectious diseases
I 1
I•
Lower Respiratory Infections
Clinical: Referral and
Injury prevention-
I Transportation Services
I • Labs: Chest X-ray, as needed
fulls, burns, poisoning. :. Therapeutic Management
drowriing. road t.raffic ,.I'
injuries Tuberculosis
Mental health 1 • Clinical: Direct Observed Treatment
Promotion on the use
of fortified foods I
I•
Short course [DOTS)
Labs: Sputum AFB and smear, Xpert
MTB/RIF, Drug Susceptibility Test
MASTER (DST)
• I COPY . Therapeutic Management

on:
Phil Health
· GASTROINTESTINAL
1 Peptic Ulcer
Membersliip
Enrollmentto I • CliniCal: Prevention of
All services shall he nuHh: available only when clinically indicated. Page4of44
'"' """
Population Level Primary Care Services for ' Primary Care Services for
Well Individuals Sick Individuals
Drug
IPregnancy Phi!Hcalth
Women about to Give
!
i (NSAID)-induccd ulcer
' llirth (WATGB) 1• Therapeutic Management
Advocacy for llirth I• Referral for endoscopy, testing for
Planning I Helicobacter pylori (!-I- pylori); urea
Family development
sessions (FDS)
I! breath test and stool antigen
Availability ofBloodf i INFECTIOUS D!SEASF.S

Blood Donors ! HIV /AIDS, ST!s AND OTHER
Giving birth in a 'IGYNECOLOGIC CONDITIONS
health facility • Clinical: Referral and
Rights ofWoman ! Transportation to social hygiene
I
During Labor and ! clinics contact tracing (Prevention
Delivery- Respectful ! of mother to child transmission)
Care :' • Labs: Speculum Examination,
Phil Health enrolment Vaginal Swab, Microscopy, Rapid
Personal preventive Plasma Reagin (RPR], TPPA or T.
and promotive pallidum hemagglutination assay
practices such as (TPHA), HIV rapid test,
prompt referral ' confirmatory test at National
Media campaigns: Reference Laboratory-San Lazaro
Lifestyle Hospital/ STD AIDS Cooperative
moditkations: Central Lahoratory (NRI.-SI.H/
Healthy Diet
(Reducing saturated I SACCL), or treatment hub, Purified
Protein Derivative (PPD) test
futcontent)
Physical Activity I. Therapeutic management will
depend on the organism, as
t. appropriate
Condoms, safe blood supply
I· Counseling/Education
-STI_ control, harm reduction in
injecting drug user, peer education
among sex workers, initiation of
1\jCAQSp!lv.==,R precaution among healthcare
{: proViders
! DC: I
= _, ___ .. _________ _j
All services shall available only when clinically indicated. Page 5 of44
Population Level [ Primary Care Services for Primary Care Services for
'' Well Individuals Sick Individuals
-· _________
:·.• Pregnancy :develtmment·
rub lie health policy
lj
I' • Labs: Blood smear, Rapid
i • Prenatal care Diagnostic Test tOr Malaria
I• Prevention and l• Therapeutic Management
j Management of Abortion ''
j and Its Complication I Rabies
•
i
l •
(P!MAC)
Prevention ofMother to
I•! Referral to Animal Bite Treatment
Center (ABTC) & provision of anti-
i Child Transmission of ! Rabies vaccine (as needed)
I HIV-AlDS l
! Dengue
!
I •
: •
Omnibus Policy on
Disaster Risk Reduction
Regulation on:
: • Lab: CBC, Blood Typing, Bleeding
Parameters, Rapid Dengue Test
smoking and
alcohol use
I
.
l •
(RDT)
Therapeutic Management: fluid
substance abuse I replacement/therapy;
l
i and I
I• Referral to higher level facility for
management (as indicated)
response
Il • Surveillance
Extreme Emergencies
1 Leprosy
j • Therapeutic management
I and Disasters (SPEED)
I
! syndramic surveillance l Filariasis
• Risk comrriunication j• Lab: Nocturnal blood smear
• Risk management and I• Therapeutic management
Early_ warning system
• ·lnCidentcommand Schistosomiasis
I•
I
system/OPCEN Therapeutic management
• Deployment of self- ·
sufficient health team
!• Lab: Kato katz examination
I NUTRITION
II • responders and
1
! volunteers \11 , STI=R j Evaluation of Anem1a (Eg.lron
1 Mobile health care 11-\ '-' .:: Deficiency, Anemia of Renal Disease,
services . C0 F) Y 1Anemia of Chronic Illness)
I
I 1
I • Women frie.ndly spaces ,..J<; . ...l.tf,la · . Clinical: Referral to
' and evacuation Centers •J · _!.!..:__1-
--- D2 s· . • Lab: CBC
!__________ ,_ .____;!_"__M_o_b_il_iz_a_ti_o_n_o_f_ __:__ __ , _ _ _ _ _ _ _ _ _ _ _ _ _ · 1
All shall made available l)nly when clinically indicated. Page 6 of44
I r Population- 1.1
Primary Care Services for Primary Care Services for i
Well Individuals Sick Individuals
----- ..1---::-:---------------
' p regnancy
1 I prepositioned
logisticsjresources (dean
l Management '
1 delivery kits) ! DERMATOLOGY

l •
I
Resilient health facilities
with DRRM plans and
I• Clinical: Referral to specialists
!• ManagementofDermatologic
inddent command 1 Conditions (Eg. Atopic, Irritant
system (ICS) Contact, Bacterial and Fungal
•
0
Mass casualty
management
Barangay health
I Infections, and Suspicious
Malignant Lesions)
emergency response
team (BHERT)
,__L_____b jD •. Suryeillance and monjtodng

i I Clinjcal•
a or e Ivery I of the population's health Monitoring on the progress of Labor
1•
j REGUlAR CONSIJI.TATION fqrany
i condition
! .ilil.Uis ; • Monitoring of Vital Signs • History and Physical examination
I • Surveillance system • Provision of Mother-Friendly Practices during Labor and
I Delivery [ DRUGS AND COMMODITIES
j Preyention;1nd cnntrnl nf • Maintaining intCction control practices during labor and delivery ! For Facilities with BEMONC trained
II •
l endemic djseases l health care worker:
! • Integrated Vector Control Provjsjon of Normal Spontaneous De!jyery (NSD) Magnesium .sulfate
, • Dexamethasone I Betamethasone-
Management
Laboratory for women at risk of giving birth to a
Assurance ofqua!jty and • CBC, Blood Typing (if indicated) 1 preterm newborn
j accessjhjlity ofseryjces I • Antibiotics
j o Integrated MNCHN Drugs and Commodities 'i • Oxytocin
Strategy e Clean delivery set including culting instruments I
• Tnmexamic Acid
1 j • Plasma Expander
• Services for PWDs and • Oxytocin, Magnesium Sulfate, Antibiotics, Steroids,
other special groups • Cord Clamp • Referral for Blood transfusion
services
Public health policy Durjng Emergency
development I •o Minimum Initial Service Package for safe Motherhood (MISP)
Commodities: Water treatment witl1 hyposol, Jerry cans, clean
Uterine Inversion
• Intrauterine Balloon Tamponade
• Basic Emergency
Obstetrics and Newborn j delivery kits. hygiene kits
L
Care facility per 250,000 1
-------·..· - - - - · - - - - - - - -
population
(J"_r____
J
, -------------------·-- __
- -
_-- ------ _____ I
All services shall he made available unly when clinically iudicat ·tJc: ... r,rJ.n Page 7 of44
-,-.-_____,_.,- Da1e"'Fj-Q-
------ --- -----·--· -·----- -----·------ ---- --- -- .. ----· - ..- --- ····-· -- . -- -,.-·- -· ------ ·-- ·-·
Population Level i Primary Care Services for Primary Care Services for
Well Individuals I Sick Individuals
500,000 population
Facility based delivery
Skilled birth attendance
Phil Health Maternal Care
Package and Women
about to Give Birth
Omnibus Policy on
Disaslcr Risk Reduction
Disaster nrenaration anl1

response
• Phi!Health
Reimbursement for
Deliveries during
Fortuitous events
• SPEED syndromic
surveillance
• Risk communit-ation
Risk management and
Early warning system
I: Incident command
i system/OPCEN
I • Deployment of self-
; sufficient health team
i responders and
i volunteers
Mobile health care
I. services
Women friendly spaces
and evacuation centers
I: Mobilization of
prepositioned
I
I
logistics/resources (dean
delivery kits) MJ-\STl=R
I • Resilient health racilities
i with DRRM plans and !COPY
l ---
incident command _______________ -------/ DC· ----- --
All scrvit.:L'.S shall ht.:. made availubk \Ht!y when Pa-ke 8 of44
Primary Care Services for Primary Care Services for
L______ ! ___ _ Well Individuals Sick Individuals
1
l.,- Labor/Delivery!,' . system (ICS)
Mass casualty
I
1 )
• Barangay health
I emergency response
__ !_ _ ____ . __ _ ____ ___ _ _ ... __
j Syryei!lance and monjtorjng Clinjcal i' "iiEGIJI.AJr coNSin)·AriON
Post-partum i of the ponulation's health • Mental health screening and counseling services ! conditinrr
i sti!tl!S j • Assessment ofbreastfeeding difficulties 1 • History and Physical ex;:unination
• Surveillance system I• Breastfeeding counseling !
j DRI!GS AND COMMODITIES
Prevention and control of • Drugs and Commodjties / Management of breast conditions
endemic diseases • Ferrous Sulfate with Folic Acid ! during lacta.tion:
• Integrated Vec..tor Control • Calcium Carbonate j • Assessment and Counseling
j Management • Vitamin A capsule- single dose 200,000 IU i • Referral to surgeon if needed
• Family Planning Commodities 1• Dexamethasone
! Assn ranee ofqua!il;y and PP-IUD
Injectable (Depot medroxyprogcstemne acetate)
i! Post-Partum Bleerlim:
\ accessjhility ofseryices
• Establishment of Women Pills (POP)
Modern Natural Family Planning Chart<
I
l•
j
Referral for blood transfusion
services as indicated
I
!
& Child Protection Unit in
all hospitals Cycle beads 1• Referral for vaginal tears
• Services for PWDs and
other special
Sub-dermal Progestin Implants
Bilateral Tubal Ligation I NEIJROLOGJC/PSVCIIIATRJC
1 Post-Partum Depression/ P>ychosis
Purjng Emergency • Assessment and Counseling
Health communication-and
• Mental health and psychosocial services (MHPSS) • Referral to Psychiatrist as needed
dissemination strategies
• Community Health and
e Minimum Initial Service Package for Reproductive Health
(MISP) Self-harm
Nutrition Education:
s Commodities: Water treatment with hyposol. ferry cans, hygiene
Non-exposure to
kits, oral contraceptives ·
• Clinical: Immediate Assessment,
cigarette smoke and First Aid and Transport to Nearest
unhealthy food · Tertiary Facility
Substance Abuse • On Follow-up: Referral to
Water, Sanitatiqn and Psychiatrist for Psychiatric
Hygiene (WASH) Assessment
Occupational health
Infectious diseases
I Injury prevention -
·--------------
" I
MASTER
;\11 services shall made availahf·e unly when dinit:HIIy indic<-Jt d. Page9.of44
DC: D;:;1e: 'S[t\-h
" . 'j
-- -····- - -------- -->' ...... _, _____________ " ... _ . ---.---. -· - ..
Population Leveljl Primary Care Services for Primary Care Services for
I [ ___ _ _ Well Individuals Sick Individuals
falls, burns, poisoning, I ----+-::IN"'F"'E"'c"'T"'J"'o""'!IS DISEASES
I Post-partum I drowning. road traftic Rabies
injuries • Referral to Animal Bite Treatment
Mental health Center (ABTC) & provision of anti·
I ! Promotion on the use
of fortified foods
Rabies vaccine (as needed)
including iodized salt Dengue

Food safety • Labs: CBC, Blood tying, RDT
• Promotion of exclusive • Therapeutic Management: fluicl
breastfeeding (EBF) and replacement/therapy;
;
lactation amenorrhea ; • Referral to higher level facility for
II • method (LAM)
Promote National Family
management [as indicated]
! Planning Policy I STD/ HIV/AIDS

i • Advocacy for Birth • For emergency/disaster situations,
I
Planning syndrornil: treatment of
Family development STD/fliV/AIDS
sessions [FDS)
Availability of Blood
products and non-
i Leprosy
:i • Therapeutic Management
renumerated Blood
Donors '
f Filariasis
public health policy
!I • Lab: Nocturnal blood smear
• . Therapeutic Management
development
visit
I•
o
1 Schistosomiasis
•
1 Therapeutic Management.
1 Planning • Lab: Kitto katz examination
• Minimum Initial Service
II Package for Health (Sexual INUTRITION
I•
and Reproductive Health)
Omnibus Policy on n 1\ STr::R IIEvaluation of Anemia (Eg. Iron
I Deficiency, Anemia of Renal Disease,
1 i
I\
Disaster Risk Reduction
! C0 tM I:)'(
'i
Anemia of Chronic Illness)
•
.
!
JI .
1 Clinical: Referral to specialists
Community Mobilization
l , and Development 1 ••• JS . .'!I'\-\'\ Lab: CBC
D.J. ·-IQ"- DalE. Appropriate Therapeutic
Il
i • Environmental
J
· Management
r_
L_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___!. assessment and
..
!\II shall made avuilabk only whl!n clinically indicated. Page 10 of44
Population level
_____
Primary Care Services for Primary Care Services for I
I
i' Well Individuals ,, Sick Individuals i
'p .-:----::-:-
rnodit1cation for injury
:
1
ost-partum Ij prevention i
• Voluntary blood donation
I ! in communities
! I Disaster preparation and

[ resnonsc ·
I • SPEED syndromic
j surveillance
! • Risk communication
• Hisk management and
1
1 Early warning system
1 • Incident command
1 systemfOPCEN
i • Deploymentofself-
sufticient health team
responders and
volunteers
• Mobile health'carc
services
• Women friendly spaces
and evacuation centers
! • Mobilization of
! prepositioned
logistics/resources
• Resilient health facilities
with DRRM plans and
incident command
system (ICS)
• Mass casualty
management
• IJarangay health
emergency response
team (BHERT)
I • Water ,Sanitation and. j

.. _ .. ________.____________ ----·-·-- _ _ _ I'-'I"'"\1AS..Ir-.;::R(,........-
/COPY
!\II services shall h;,; made uvailable only when l.'linkally indil'atL'Xl. DC:4- ellof44
--,
Population Level Primary Care Services for
! ' Well Individuals ;
eon a e I and monjtorjng of lQiPir.d

the (JO!!Uiation's health status
• Surveillance system
I •Eady Essential Newborn Care
j • Physical examination (vital signs, anthropometries)
1
!. REGJJLAU CONSULTATION for any condition
,• History and Physical examination
,_,
·
I Pn•vcmtion ;md rontrol of
I • Visual and hearing screening
e Breastfeeding Initiation
i DRUGS AND COMMODITIES
: If (+)for Newborn Screening &
J cndemjc diseases Ie Referral and Emergency Transport Services , Confirmatory Test
I • lntcgrdted Vector Control j • Basic newborn resuscitation with oxygen support ) • Assessment then refer to tertiary care
J Management 1 • Kangaroo mother care for low birth weight and facility I pediatrician
l l pretcrm babies
I Pr1hlic health polj(;y clt•yelopmt•nt l J If(+) for Newborn Hearing Screening &
! • Newborn Screening I
Laboratory j Confirmatory Test
l o Birth dose ofBCG and ,. • Newborn Screening i • Assessment then refer to tertiary care
I Hepatitis 8 • Universal Newborn Hearing Screening & confirmatory I facility 1 pediatrician (before age 7)
!•
1
Early Essential Newborn Care testing of newborns with out-of-range screening f • Referral to ENT for hearing aid device
• Newborn care results 1 fitting and I or for cochlear implant
· • Infant and Young Child • Confirmatory tests for disorders detected in the 6- 1 Refer to pediatric ophthalmology for
j Feeding panel I expanded newborn screening 1_ retinopathy of prematurity
• Omnibus Policy on Disaster j • Critical congenital heart disease screening (CCHD)- /
Risk Reduction I Pulse oxymeter I AEFI events
! Assurance o[ qualj ty and

, • II!V screening (as needed)
Drugs and Commodities

1 • Assessment and Referral to Pediatrician
1 for appropriate management
II
accessjbilit:y o(seryjces o Bacillus Calmette-Guerin (BCG) vaccine at birth INFANTS BORN TO A DRUG-DEPENDENT
• Establishment of Women & • Hepatitis B vaccine at birth MOTHER
Child Protection Unit in all • VitaminK ,. Referral to higher facility with specialist
hospitals • Erythromycin eye ointment
I. Services for PWDs and other

special groups
• Hepatitis B immunoglobulin for babies born to
Hepatitis B surface antigen reactive mothers
l RARE DISEASES
II ._ Referral to pediatric subspecialist-
I
I Health comnmnicatjon and , geneticist, metabolic specialist or
_j pediatric endocrinologist
I djssemimlti.on
J •
'I •
Mothers' Education on:
Expanded Program on ;_·•1 [\ e TI:::D
Ii • BIRTH DEFECTS
Referral and counselingto appmpriatc
Immunization 'c' ;-ri 1 specialists regarding Neural tube defects,
I • Exclusive breastfceding and \ q I Cleft lip I cleft palate, Congenital
-··--------------·1..
iJ {
I' i '' I
All shall be made a vnilabk only when clini-:ally indicated. Page 13 of 44
L_- Population Level Primary Care Services for Primary Care Services for Sick
Neonate interventions through

Well Individuals
----·-+! Individuals
I·
mother-infant interactions NEWBORNS WITH TRISOMY 21 OR THOSE
Developmental milestones i II! Gil RISK FOR DEVF.LOPMENTAI.IJE!.AY
monitoring \ (Ett. Cerebral Bjrth asphyxia. or
I o Community Health and j Prcrnahtdty)
Nutrition Education : Retcrral to a pediatric
I. Non-exposure to cigarette 'J •
neurodevelopmental spedalist and for
smoke and unhealthy food I neurologist
I
II •
• Water, Sanitation and Hygiene
(WASil)
Occupational health
I NEIIRO!.OG!CINE!!RODEVE!.OPMENTAI.
Neonatal hypoxic-ischemic encephalopathy
I
i
Infectious diseases (HIE) due to intrapartum related events
I:
I
Injury prevention -falls,
burns, poisoning. drowning,
("birth asphyxia") and traumatic birtb
1 injuries
road traffic injuries 'j • Assessment then refer to tertiary care
j • Mental health : facility, support to caregiver
) • Promotion on the use of I• Provision of medicines for
1 fortified foods including 1 neuroprotection (e.g. Piracetam)
! iodized salt
\
l • Diagnostic evaluation (EEG, cranial
i • Food safety ! ultrasound, Cf scan or MR!)
! Community Mobilization and

l Dey"elopment
i CARDIAC DISEASES
I Congenital Heart Anomalies
J • risk !• Refer to tertiary care facility
I assessment and modification • Labs: 20 Echocardiography, Pediatric
l for injury pr:cvcntiOn ECG, and Chest X-Ray
I• Emergency Transportation
I p!!!.MONARY
'I nnd Communication services
j Neonatal Respiratory Distress Syndrome
. Djsash•r prepardtion and • Provide bag and mask ventilaUon if
1
•
response
SPEED syndromic smveillance
I neededAssessment then refer to tertiary care
I
J •
J •
!
• Risk communication
Risk management and Early
waming system
I S
C(JP'}-'
\A
•
facility, support to caregiver
Provide ventilator support at end-referral
facility (e.g. continuous positive airway
pressure [CPAP] machine or mechanical
I• :''
__________L____________________L_____________
I ventilation for infants)
_j_. Surfuctant
All services slmll made availablt: only whcu clinkally indicaLcd. Page14of44
Population Level Primary Care Services for , Primary Care Services for Sick
I
Neonate • Deployment of sci f·sufficien t
j_
'
Well Individuals
------------ ------ j_Hematologic Disorders
Individuals
health team responders and I Neonatal jaundice
volunteers
I
I • Lab: CBC, Blood typing, Peripheral smear,
• Mobile health care services Coombs Test-Direct and Indirect, Total
• Women friendly spaces and
evacuation centers I! 1
Serum Billirubin
• Treatment: Phototherapy
• Mobilization ofprepositioned 1
logistics/resources (dean I
I i INt'ECTJO!IS DISEaSES
delivery kits) i HIV (if mother is positive]
• Resilient health facilities with • Treatment: HlV prophylaxis
DRRM plans and inddent • Early infant diagnosis
command system (lCS) • Lab: Malaria smear
• Mass casualty management
• Barangay health emergency , Neonatal sepsis and other neonatal
response team (HHERT) infections
• Antibiotic Treatment
• Refer to tertiary care f3cility, if needed
I Dengue
• Lab: CBC, Blood Typing. Bleeding
Parameters, RDT
• Therapeutic Management: fluid
replacement/therapy;
• Referral to higher level facility for
NEONATAL COMPLICATIONS
Management of Prematurity and Low Birth
I Weight
• Assessment then refer to tertiary care
facility, support to caregiver
• Provision of routine newborn care, prior
to transfcr(Eg. BCG, Vitamin K, Hepatitis
I B Vaccine, Erythromicin· Eye ointment]
• Provide kangaroo mother care all
I' throughgut transport until reaching the

referral facility
All scrvict:s shall be nmde availahk only diniL:ally indicall.:d. Page 15 of44
i
Le-vel--l--
------- - tor sick
1
>-----
i Neonate II ' Anemia of Prematurity
• Lab: CBC
·,
,
Ir----------- -- ' .
i Infant I the pnpulatjon's health stah1s j • llistory and Physical examination (vitals, / • History and Physical examination
I (0-12 months) • Surveillance system I anthropometrks)

• Cancer Registry , • Oral Health Examination Lmd Services (Fluoride ' DRUGS AND COMMODITIES
' Vamish, etc.)
I AEFI events
Prevention and control of • Early Childhood Care and Development(ECCD) • Assessment then refer to tertiary care
I endemic diseases
• Integrated Vector Control
screening including developmental milestones;
assessment of developmental delays I
fucility I pediatrician (bet(>re age 7)
I Management •
•
Visual and hearing screening
Referral and Emergency Transport Services
i ENVIRONMENTAL HAZARD EXPOSURE AND 1
' POISONING
: Assurance ofcumlity and 1
,f j arressjhilily nfseryire:;- l.abordtory
• Early recognition and initial management
e Referral to higher facility or trained
I , • EstablishmentofWomen & •CilC and peripheral blood smear"'( for liT A) for iron health worker on poison control and
' Child Protection Unit in all deficiency anemia evaluation I clinical toxicology
'1 hospitals
1 • Services for Children with Urugs.J.tlld Medicines I RARE DISEASES
Disabilities (CWDs) and • Vitamin A (at 6 months) I • Referral to subspecialist · geneticist,
other special groups • [ron sulfate drops to LBW Ol' prcterm infants metabolic specialist or endocrinologist
• Safe settings assessment for • Micronutrient powder for infants 6-23 months 1
community, schools and • Lipid -based nutrient small quantity (LNS-SQ) 6-23 Bl RTH DEFECTS
home for child injury months • Referral and Counseling to appropriate
prevention( cg. drowning, • Pentavalent vaccine (Diphtheria, tetanus, pertussis, specialists regarding Neural tube defects,
violence, poisoning) Hep B, HiB) Cleft lip/cleft palate, Congenital
• Bacillus Calmette-Guerin (BCG), if not given at birth hydrocephalus, Club foot [E.g. Orthopedic
• Bivalent oral polio vaccine (BOPV)- 3 doses surgeon, ENT, Neurosurgeon, Pediatric
j Public health policy develornnent • Inactivated polio vaccine (IPV) -1 dose Dentist, etc.)
' • IYCF (MBFHI, EBF) • Pneumococcal Conjugated Vaccine (PCV) - 3 doses
• Human Milk Banking • Measles Mumps Rubella (MMR)- 2 doses DEVEWPMENTAL DELAYS AND
• Early Child Development BEHAVIORAL DISORDERS
• Child Disability Prevention _ • Referral to pediatric subspecialist-
, (Visual and Hearing MAS l ER genetidst, metabolic specialist or
i Impairment, and Injury) / C0 PY pediatric endocrinologist
L Oral Health
_Micronutrient_____ ___
All
- - - - - - - ._!_
, IlL\ 101
sha II be made <ll·adablcl:ln!y-,,-lt=-el>*I"'IHJ"""'"""'l.t!ilJ

I
-- - - ... --- _____ _.!
Page16of44
Population Level Primary Care Services for ' Primary Care Services for Sick
l I Individuals
r.i ·
Well Individuals I ·:::-:-:===
---,--·---··-'
Supplementation I CARDIAC DISEASES
I Infant food fortitication I Congenital Heart Anomalies
1
Omnibus Policy on Disaster • Refe1· to tertiary care facility
i (0-12 months) ;
Risk Reduction ' • Labs: 2D Echocardiography
1
\ Health communication and : RENA!./UROI.OCIC

I djssemjnatjon strategies i Urinary Tract Infections
1 o Mothers' Education on: j • Labs: Urinalysis, Urine Culture and
11 Expanded Program on l Sensitivity, CBC, Ultrasound
Immunization j • Therapeutic Management
• Exclusive breastfeeding
and Complement..1ry j PULMONARY
Feeding with Continued i Lower Respiratory Infections or
breastteeding ! Pneumonia
• Early d1ild development • If Mild: Manage in primary care center
.i
interventions through • If Moderate/Severe: Refer to Tertiary
mother-intant interactions Care
• Developmental milestones • Lab: CBC, Chest X-Ray (as needed)
monitoring • If with HiB Vaccine give Amoxicillin
• Usc of fortified foods • If without HiB Vaccine give Co-amoxidav
including iodized salt • Other regimen:
• Community Health and • Therapeutic Management
Nutrition Education: • Ancillary treatment based on risk
• Non-exposure to cigarette classification (cough preparation, vitamin
smoke and unhealthy food A, vitamin D, clemcnt.1.l Zinc, 02 delivery,
• Water, Sanitation and probiotic)
Hygiene (WASH) I
•
•
Occupational health
Infectious diseases
I GASTROINTESTINAl.
Diarrheal diseases
• Injury prevention- falls, • Clinical: Counseling on exclusive
burns, poisoning, breastfeeding
drowning. road traffic • Lab: Fecalysis
injuries • Therapeutic Management: ORS, zinc
• Mental health supplement.1tion, Vitamin A, IV fluid
• Promotion on the use of
fortified foods including
I iodized salt
CANCERS
• For definitive
,
All $Crvice!i shull made available only when dinit..:ally itH.Iit.::n..xi. Page 17 of44
Population Level Primary Care Services for ! Primary Care Services for Sick
i Welllndividuals Individuals
r------ '--1---------- to f.,ciiiiy-
i Infant • Food ;ofety
(0-12 months) Community Mobilization and

' INI!IR!ES
I For Child injury and trauma
Development I• RcferTal to pediatric orthopedic or burn
• Environmental risk l1 specialist
assessment and • Diagnostic: and other medical
modification for injury imaging modalities
prevention
• Emergenc.:y transportati011 IINFECTIO!IS DISEASES
and communication 1 Rabies
services 1
• Referral to ABTC & provisiuH ufanti·
1, Rabies vaccine (as needed)
[ Disaster prepa ratimLarul
) response I1 Dengue
• SPEED syndromic i• Lab: CBC, Blood Typing. Bleeding
surveillance 1 Parameters, RDT
• Risk communication • TherJpeutic Managentent: fluid
• Risk management and I replacement/therapy;
Early warning system I Referral to higher level facility for
• Incident command
systcm/OPCEN
' management (as indkated)
• Deployment of self-
sufficient health team
I Leprosy
!• Therapeutic Management:
responders and volunteers
• Mobile health care services Filariasis
• Women friendly spaces • Therapeutic Management
and evac.uation centers l • Lab: Nocturnal blood smear
• Mobilization of I
prepositioncd \ Schistosomiasis
i•
•
logistics/resources (clean ; .
delivery kits)
Resilient health facilities [l;i,i\ STER
I• Therapeutic Management
L1.b: Kato katz examination
0 py 1
with DRRM plans and
incident command system /_
ti.IJ
· t[\\1\ 1 NIJTRII!ON
Moderate (MAM) and Severe Amte (SAM)
(ICS) 0, j malnutrition
• Mass casually management 1 1
- ' J • Clinical: measure mid·upper arm
L - - · - __B_a_ra_n_ga_y_he_a_lth__ .... .L._ cirCUilJfere"':e_ (MUAC), we_J_!\!t_t ...
;\II services shall he made available only when di nically indicated. Page 18 of 44
PoplliatioDiOVet 1.. _-_"_- for Sick
'J f t emergency response team and length/height, assess for presence or
n an [lli!ERT) I absence of edema, provision of oral health
I services, deworming medicines
(0 -12 month s ) I • Therapeutic Management forMAM: Ready
I To Use Supplementary Food (RlJSF),
I' J, Therapeutic Management tOr SAM
1 (RUTF), F75, FlOO, Rehydration Solution
i ror Malnutrition (ReSoMal)
i lron-Defidency Anemia
I -
I Child
l
j Surveillance and monitorjng of
\ the population's health status
Clinical
• History and Physical Examination (vitals,
. •
!
j
j•
Lab: CBC, peripheral blood smear
REGl)LAR CONSULTATION for any condition

'I (>1-4 y jo) f •

f
!
•
Surveillance system
Crisis help lines (self-harm)
•
anthropometries)
• Oral Health Examination and Services
ECCD screening
I DRJ!GS AND COMMODITIES
1 AEFI events
j Preyentjon and control of • Referral and Emergency Transport services i• Assessment then refer to tertiary care
J endemic • Visual and hearing screening I facility I pediatrician (before age 7)
i • Integrated Vector Control • Skin screening for Leprosy
I
;
Management • Provide special servic1!S for special health problems
I• Mass Drug Administration (for and conditions such as disability, rape and abuse- DENTAL CONDITIONS
medical, legal, and rehabilitation services as well as . • Provision of oral care services as needed
I Soil Transmitted Helminths,
Schistosomiasis, and - social, legal and support services
I• Filariasis)
STH: Albendazole and/or Laboratory
ENVIRONMENTAL I!AZARD EXPOSJ!RE OR
POISONING
I Me,bendazole • esc (and peripheral blood smear, if needed) for iron 1 • Early recognition and initial management
deficiency anemia evaluation • Trained health worker on poison control
• Filariasis: Diethyl • Conduct PPD test for PTB screening (c/o TB DOTS
Carbamazine (DEC)- for clifiical toxicology
endemic centers)
I• Schistosomiasis: Praziquantel
- for endenlic areas
RARE DISEASES
• · Referral to pediatric sub specialist-
I Drugs and Medicines
geneticist, metabolic spedaliSt: or
_ II Assurrince ofnual·j.tvaf!d pediatric endocrinologiSt j
· . accessibility of services • Micronutrient powder for children (12 mos- 23
• Establishment of Women & months) BIRTH DEFECTS 1
• Fluoride varnish • Referral and Counfeling to
- . 1 Child Pro.tection Unit in all
________1__ hospitals • Vitamin A (200,000 IU) -2 doses per year
'---------'
All services shall ll!Hdc available only when clinieally indknted.
DC: Da1ef('4111
l
'
Population Level Primary Care Services for
r. - - -- ·- . - --- -
i Primary Care Services for Sick
Well Individuals i Individuals
I
Child • Apply safe settings
assessment for community,
schools and home for child
I
• Other vaccines for catch up
• Rota virus- for HTA
Cleft lip I cleft palate, Congenital
hydrocephalus, Club foot, amblyopia and
[
1
(>1-4yfo) injury prevention (e.g. I squinting (Eg. Orthopedic surgeon, ENT,

Neurosurgeon, Pcdiarric Dentist, etc.)
drowning. violence, I
poisoning) P!WEI.OPMENTAI. PEI.A¥5 AND
• ServiceS for Children with . BEHAVIORAl. D!SORPERS
Disabilities (CWDs) and other
special groups
I
1
• Referral to a pediatric
neurodevelopmental spetialistandjor
pediatric neurologist,
tfealt'h commJJnjcatjon and 1 therapist and speech pathologist
djssemjnation strategies
•
• Mother's education:
Advocacy for complete
!
1
l
• Referral to a higher facility for the
provision of assistive devices as indicated
immunization CARDIAC Q!SFASES

• Nutrition education program Congenital Heart Anomalies
• Community Health and • Refer to tertiary care facility
i
Nutrition Education: i• Labs: 20 Echocardiography
l •
i
I
I o
Non·exposure to cigarette
smoke and unhealthy food
Water, Sanitation and Hygiene
I RENAI./!!ROI.OG!C
1 Urinary Tract Infection
I• (WASH)
Occupational health
1 •
i
Labs: Urinalysis, Urine Culture and
Sensitivity, CBC, Ultrasound
• Infectious diseases Medicines: Antibiotics (Cephalosporins,
I
1 •
• Injury prevention- falls, Penicllins)
i •
burns, poisoning, drowning.
road traffic injuries
Mental health
I PULMONARY
Pediatl'ic Community Acquil'ed Pneumonia
II • Promotion on the use of A/B
fortified foods including •- Lab: CBC, Chest X-ray, as needed
iodized salt • Therapeutic Management
I
I: Food safety
Media campaigns:.
- Lifestyle modifications: MASTER peak flow meter, nebulizer
(machine)
I o Healthy Diet CReducing
saturated fat content) / V·JJ-
'• Therapeutic Management
I!
1
I
[______ _ • Physical Activity
-L----------------------------------1_I
All st:rvil:cs .shalllK· HHH.h:. available only when dini\.:ally indicated. Page20of44
•
Population Level Primary Care Services for Primary Care Services for Sid<
______ __ Individuals
I
: Tuberculosis !
Child ,. Community Mobilization and I• Clinical: DOTS
( > 1 •4 YI 0 ) : •
Development
Conduct targeted feeding
I•
I
Lab: Sputum AF'B and smear, Xpert
MTB/RIF, Drug Susceptibility Test [DST), '
programs Tuberculin skin lest/Purified Protein
• Environmental risk
assessment and modification I• Derivative (PPD)
Therapeutic Management
I' o
for injury prevention
Emergency transportation
I! GASTROINTESTINAL
i and communication services
! public health poliry deye!opment
I
1
Diarrheal
• Lab: F'ccalysis
I• Therapeutic Management: ORS. zinc
I• Oral Health j supplementation, Vitamin A, IV fluid
! • Early Child Development
i • Child Disability Prevention I NEUROLOGIC/PSYCHIATRIC
• Micronutrient j Mentallllness ·
Supplementation II • Referral to Child Psychiatrist
i • IMCI • Psychosocial intervention and
I
I • PIMAM psychotropic drugs
I .•
'
Food fortication
Omnibus Polky on Disaster Self-harm
Risk Reduction • Clinical: immediate assessment, first aid,
and transport to the nearest tertiary
Djsastcr preparation and facility
response • On referral to psychiatrist for
• SPEED syndromicsurveillance psychiatric assessment
• Risk communication
Risk management and Early CANCER
warning system • For definitive-diagnosis and management:
Incident command Referral to secondary or tertiary facility
systemjOPCEN
• Deploymentof self-sull1cient --- ---·-. ------- - - - INFECTIOI!S DISEASES
-R
health team responders and
volunteers fi·.'r/\STf=
Note: Contact Tracing Should Be Done in the
,. cornmumty
· I
1
•
•
Mobile health care services
Women friendly spaces and .">
0 ... \ Blood extraction and send referral for
f') S·
1
evacuation centers laboratory confirmation (vaccine preventable
.
.1
1 _______
L__ _ _ _ _ _ _ _ _ _L_ _________________ _
All services shall he made avuilable ouly when clinically indica led. Page 21 of 44
I . . -- Level Primary Care Services for Primary Care Services for Sick ;
I l Mobilization
Well Individuals
! Rabies
Individuals
_,..... __ ,"""'"_"""""' ---
l logistics/resources (clean • Referral to ABTC & provision of anti-
i
(> 1 -4 YI 0 ) i•
delivery kits)
Resilient health facilities with
j DRRM plans and incident

i command system (ICS) I Dengue
, • Lab: CBC, Blood Typing. Bleeding
j • Mass casualty management Parameters, ROT
1 • Baran gay health emergency a Therapeutic Management: fluid
I response team (BHERT) I
I
replacement(therapy;
I • Referral to higher level facility for
I I management (as indicated)
I
f Diarrheal diseases
j • Clinical: Counseling on exclusive

I' breastfeeding
Lab: Fecalysis
DOC: ORS, zinc supplementation, Vitamin
A, Antibiotics tOr infectious diarrhea
Cholera
• Referral to hospital
• Clinical: Advise the mother to continue
breastfeeding
• If child is 2 years or older and there is
cholera in the area, give oral antibiotic for
cholera.
• Therapeutic management
• Referral to hospital
• Clinical: Advise the mother to continue
breastfecding
• management
MASTER
L._l IY>
(COPY
9 \Q:
0<!1r/1'""l _'\
All services shall be made available<lniT\vl1eii·'ciiilicnlly indic;iicd.
.STH
• Population: MDA of entire community
j • Labs: Stool examination
Page22 of44
Population Level+-f Primary Care Primary Care Services for Sick
I
f , Welllndividuals
•
Individuals
Therapeutic management
i
Measles
(>1-4 yjo) o Lab: lgM blood test and send to RlTM
Ii • Counseling I education:
, • Supportive care: nutrition support,
breastfeeding counseling
I•
• e
Malaria
• Lab: Blood smear, Rapid Diagnostic Test
I tbr Malaria
j • Therapeutic management
I Leprosy
! o Therapeutic Management
i! Filariasis
' • Therapeutic Management
o Lab: Nocturnal blood smear
Schistosomiasis
• Therapeutic Management
• Lab: Kato katz examination
N!!TR!TlON
malnutrition
• Clinical: measure mid-upper arm
circumference, monitor child gl'\)wth, oral
health screening
o Ready to Use Therapeutic Food, F75/100
Iron-Deficiency Anemia
o Lab: CBC, petipheral blood smear
DERMATOLOGY
o Clinical: Referral to specialists
• Management of Dermatologic Conditions
All scrviL:t.!S shall be madt available only whl..;'n dinicalty indicated. Page 23 of 44
···-····. --· .. - . -·· ----1 --
Population Level . ---P--rimary for )" tor sick •
1 Well I Individuals
[Eg.
r h
j SC 00
I
-age
___-___. .j.__-_____
i Suryeillaitce and monitoring of
j the JWJmlation's health stahts
J
__ -··· .
Clinical
l • History and
- -- ---
examination (vital signs.
J
"-
Fungal Infections, and Suspicious
Malignant Lesions)
-------·-----------
! REGULAR CONSULTATIONformJvrom!Won
1
. • History and Physical examination
I ( j ) ;• Surveillance system I anthropornetncs, BMI)
f 5-9 Y 0 i • Crisis helplines [self-harm) I • Oral health examination 1 DR!!GS AND COMMODITIES
! • Canrer Registry I o ECCD and disability screening I
'1 AEFI events
! • Visual & hearing screening Assessment and Referral to Pediatrician
!•
1 •
j Conduct complete eye examination (refraction, color for appropriate management

testing vision testing. strabismus)
I Pn•ytmtion and qmtrol of I•
1
Assess nutritional status I DENTAL CONDITIONS
! endt•mjc diseases • Mental health assessment and counseling [ • Provision of oral care services as needed
1 e Integrated Vector Control I• Skin StTecning for Leprosy i
1
Management • Provide special servires for special health problems I ENVIRONMENTAl. !lAZARD EXPOSURE AND
i • Mass Drug AdrninistrJtian 1 and conditions such as disability, rape and abuse- j .Pll!SONI NG
1
j (ror Soil Transn1itled medical, legal. and rehabilitation services as well as j • Early recognition and initial management
1
Helminths. Schistosomiasis, social, legal and support services j • Trained health worker on poison control
I
I•
and Filariasis) and clinical toxicology
STH: Albendazole
Mebendazole I.ahoQJtory RARE DISEASES
I o Filariasis: Dicthyl • CBC (and periphera! blood smear, if needed) for iron • Referral to subspecialist- geneticist,
I•
Carhamazinc [DEC) -for deficiency anem ia evaluation metabolic specialist or endocrinologist
i
endemic areas Conduct PPD tes t fur PTB screening [TB DOTS centers)
I • Schistosomiasis: Pra7jquantel • Stool exam LEt\Bflllf\IG [!IStllll!,JIY Aflllll!EHA\o'IQBAI-
i -for endemic areas D!SOB!lEBS
I
I Assurance of quality and
Drugs and Medjd nes
• Re!erral to a pediatric
• Fluoride vamis h, Glass I anomer neurodevelopmental spectalist and/or
! accessibility of services o Measles Ruhclla and Tetanus diphtheria [MRTd) pediatric neurologist. occupational
• Establishment of Women & • Tetanus contain ing vaccines therapist and speech pathologist
Child Protection Unit in all • Human Papill01navirus Vaccine (9 year old female*)
hospitals
• Referral to a higher fucility for the
provision of assistive devices as indk"ated
• Apply safe settings
assessment tool for
community, schools ami home
[\iiASTFR PSYCHIAIBIC Afllll MQQlllliSQBllEBS lf\1
,
for child injury prevention
(e.g. drowning, violence, road
(.COPY 4-\rt CHILDRE[II
Mental Illness
L _______________!__ _ _ _ _ _ _ _ _ · - - - - - - · - - - -·-! . • to Child Psychiatrist -
All servi..:c:; shall he mudL' availah( c onlvwl"· .;; · ... " · · · Page24of4 4
-- __s_ic_k_
1
safety) • Psychosocial intervention and
I SchOO 1-age Services for Children with psychotropic drugs
(5 _9 yjo)
I' •
Disability(CWDs)andother
j special groups Self-harm
! Clinical: immediate assessment, first aid,
i He-alth communication am1 and transport to the nearest tertiary
! dissemination strategies facility
j • School Health and Nutrition • On follow-up: referral to psychiatrist for
l Promotion and Education psychiatric assessmen l
I • Non-exposure to cigarette
I smoke and unhealthy food CARDIAC DISEASES
l • Water, Sanitation and Hygiene Congenital Heart Anomalies
'
(WASH)
I• Occupational health
•
•
Refer to tertiary care tacility
Labs: ZD Echocardiography, ECG, Chest X-
i • Infectious diseases Ray
Injury prevention -falls,
I • burns,
I road
poisoning. drowning,
traffic injuries
I
Urina1·y Tract Infection
I • Mental health • Labs: Urinalysis, Udnc Culture and
I • Promotion on the use of Sensitivity, CBC, Ultrasound
I iodized salt
Food safety P!II,MONARY
I : Information Campaign on: Pediatric Community Acquired Pneumonia
I o Immunization
I A/8
Prevention of risky behavior
• Labs: CBC, Chest X-ray, as needed
I. like tobacco use, alcohol usc,
drug abuse
I• 0
Road safety
Anti-bullying
Asthma
• Lab: peak tlow meter, nebulizer
• Sclmol·based education on
(machine)
HIV/AIDS
• Nutrition education program
• Media campaigns ---------- Tuberculosis
• Lifestyle modifications: ,, r. r, <:-·-r::b:l
- Healthy Diet (Reducing 1\· :r\\.J 1
DY • Clinical: DOTS
1 saturated fat content) __:Q, "'J\.Jr.\\0.. • Labs: Sputum AFB and smear, Xpert
MTB/RIF, Drug Susceptibility Test (DST),
_____L __-_ -- --- . . . . . . --·-
A II scrv ict!s :-;hall be made availabl/u<!JHJ!l Page25of44
--- -- .. ------ -----
Primary Care Services for 1 Primary Care Services for Sick
Well Individuals 1 Individuals
·----·-----]i---T-u'"""berculin skin test
! SchOO -age I Develonment .1 • Therapeuticmanagement
(5 -9 YI 0 ) c Conduct targeted feeding
programs [ GASTROINTESTINAl.
o School-based physical activity ! Diarrheal diseases
i • School-based interventions J • Lab: Fecalysis
1' harm} I o Therapeutic management: ORS, zinc
• Environmental assessment supplementation, Vitamin A. Antibiotics
and modification for injury for infectious dia1rhea
1 prevention J
j • Emergency transportation ( CANCER

! and communication services II • For definitive diagnosis and management:
• Reterral to secondary or tertiary facility
I
i
i PuhHc health policy deyelonnwnt ! l OPHTHA!.MO!.OGJC
li • School Health and Nutrition ) I Uncorrected refractive error:
Clinical: Snellen's chart fot· adult; LEA
Policy I 1 •
i
.• Weekly Iron and Folic Add i chart for. children; refer for corrective
Ii • Supplementation
Regulation on:
j 'I
1
•
lenses
Corrective lenses
I Sale of salty and
I INFECTIOUS DISEASES
'I sweetened food and
sugary beverages Note: Contact Tracing Should Be Done in the
Inappropriate marketing ICommunity
I
1
of food and beverages
Firecracker use I Blood extraction and send referral for
1
Video-game free school laboratory confirmation (vaccine preventable
smoking and alcohol use diseases)
• Update school health services,
standards, and curriculum for Dengue
implementation • Lab: CBC, Blood Typing. Bleeding
• Omnibus Policy on Disaster Parameters, RDT
Risk Reduction • Therapeutic Management: t1uid
Djsaster prepamtion and • Reterral to higher level fucility
response management (as indicated)
• SPEED syndromic
:\II services shall he made availah!t..: when clinically Page 26 of 44

- --
Population Level Primary Care Services for 'I Primary Care Services for Sick
Well Individuals I1 Individuals
' surveillance
1
School-age i
I • Risk communication
I
! Diarrheal diseases
(5-9yfo) j • Lab: Fecalysis
I: warning system
Incident command
system/OPCEN
1 •
I
i
Therapeutic management: ORS, zinc
supplementation, Vitamin A, Antibiotics
for infectious diarrhea
I• Deployment of self-sufficient
health team responders and lj •Measles
I
! •
volunteers
Labs: lgM blood test and send to RITM;
. • Clinical:
I • Women friendly spaces and complic-dtions
evacuation centers
I.! ••
1
Ther.1peutic management
! • Mobilization ofprepositioned
1 •
Counseling I education:
I logistics/resources (dean
Supportive care: nutrition support,
' delive•y kits) breastfceding counseling,
G Resilient health f.:1cilities with
DRRM plans and inddent
i Malaria
I
l •
command system (ICS)
Mass casualty management
i • Lab: Blood smear, Rapid Diagnostic Test
for Malaria
I • Barangay health cmergcnL)'
response team (BHERT)
I N!ITBITION
I Evaluation of Anemia (Eg. Iron Deliciency,
· Anemia of Renal Disease1 Anemia of Chronic
Illness)
• Clinical: Referral to specialists
• Lab: CBC
• Appropriate Therapeutic Management
DERMATOI.OGY
MASTER (Eg. Atopic, Irritant Contac1:, Bacterial and
(COPY Fungal Infections, and Suspicious '

Malignant Lesions)
---·-···---·· . . ·--·· -·-··---·...·--L·-·----------.. ....- .........-...... ---------·--- -- ----·--· ··--

I
.. ·-·- -· . -- -- -··--··----- --·· ---· _____ j
All scrvil.:CS shall be made uvailahlt.: only clinically Page27of44
Primary Care Services for Services for Sick
' Welllndividuals Individuals
. Leprosy
1 School-age I. • Therapeutic management
!
(5-9yjo) i
Filariasis
o Lab: Nocturnal blood smear
Schistosomiasis
! • Lab: Kato katz examination
·1 Sllrv.Cit-i3-oc;· 3iid mODitOfiDii of .II Clinical

-- ··-- - -- - - ..
Adolescent 1 the vmmlation's health status • History and Physical Examination (Anthropometries,
R EGI JI.AR CONS! fiJATJON for any mndiUan
• History and Physical examination
I ••
., (10-19 yjo)
Surveillance system BMI, Blood pressure)
Crisis helplines (self-harm) • Oral Health Examination DRUGS AND COMMODITIES
• Cancer Registry • Conduct complete eye examination (refraction, colo1· • Assessment and Referral to Pediatrician
testing vision testing, stmbismus) for appropriate management
Prryt>otjon and control of • Screen and counsel on (1) healthy lifestyle (physical
endemic diseases I activity, substance use, smoking. diet and
l • lntegrated Vector Control
1
Management I sexual education) (Z) Psychosocial risk assessment
(HEADSSS) (3) Reproductive health
DENTAl. CONDITIONS
• Provision of oral care services as needed
· • Mass Drug Administration • Provide health counseling with the use of Adolescent
! (for Soil Transmitted
I
· )obAid ENVIRONMENTAl. HAZARD EXPOSURE AND
Helminths, SchistOsomiasis, • Provide special services for spedal health problems ·POISONING
and Filariasis) ant.l conditions such as disability, r.1pe and abuse- • Early recognition and initial management
• STH: Albendazole andjor medical, legal, and rehabilitation services as Well as • Trained health worker on poison conlrol
Mebendazole social, legal and support services and clinic-al toxicology
o Filariasis: Diethyl • Skin for leprosy I
Carbamazine (DEC)- for
endemic areas ·
• Hearing screening I RARE DISEASES
• Referral to pedia tric subspecialist -
• Schistosomiasis: Praziquantel Laborato ry
geneticist, metabolic spedalist or
-for endemic areas · o PapSmcar test (if sexually active for Z yearsjas
pediatric endocri nologist
necessa ry)
Assurance ofqualityand • STI sereenfng and referral for managemcllt
L
accessjhiJitr ofscryjces • HIV seteening (voluntary),and CD4+ viral count (as l,!lABNII'lG L!ISAilll.l TY Al'lD BEHAVIORAL
• Establishment ofW9men & necessa ry)
ll!SOBI:!EBS
Re I •rral to a pedi atric
Child Protection Unit in all o Routine urinalysis MASTt::RI· ne rodevclopme ntal spedalist and/or
______.________,__ _!l<>spitals _____ • Stool ex·amination ______ j
All services shall be ma(k available only when Page28of44
Population Level for Sick j
.L
l pediatric neurologist, occupational !
) therapist,speech pathologist and !
1 adolescent psychiatrist j
!• Referrdl to a higher facility for the
j provision ofassistive devices as indicated i
i' CARDIAC DISEASES
[)rugs and Medicines
Health communication and o Iron pills folic acid II Rheumatic
Disea.•e
Fever and Rheumatic Heart
djsseminatj(in strategies • Family Planning Commodities (with consent): • Population: Develop ARF/RHD Registry
• Community Health and -Condoms I, • Lab: Throat swab
Nutrition Education:
• Non-exposure to cigarette
- Pills (POP, COC)
-MNFP
1· Therapeutic management
• Water, Sanitation and Hygiene
-DMPA
-IUD
I RENAL(!!BOI.OGIC
; Urinary Tract Infection
(WASH) -(Implants)- can be provided by private facilities J • Labs: Urinalysis, CBC, Ultr.J.sound
• Occupational health within the network
• Infectious diseases
!• Therapeutic management
• Injury prevention- falls,
burns, poisoning, drowning.
road traffic injuries
• Human Papillomavirus (HPV) Vaccine
• Measles Rubella and Tetanus diphtheria (MR. Td)
o Tetanus containing vaccines
II PI!I.MONARY
•
Lower Respiratory Infections
Labs: CBC, Chest X-ray, as needed
• Mental health
• Therdpeutic management
• Promotion on the use of
fortified foods inducting
Iodized salt Asthma
• Food safety I• Labs: peak flow meter, nebulizer
1 _(machine)
• ln10rmation Calnpaign on:
1 • Therapeutic management
• Prevention of risky behavior
I
like tobacco use, alcohol use,
dmgabuse I Tuberculosis
I.
• . Clinical: DOTS
• Road safety
Reproductive health • Lah: Sputum AFB and smear, Xpert
(sexuality and gender-based l'v1ASTER' . MTB/RIF, Drug Susceptibility Test (DST),
violence) including school-
/COPY .. Tuberculin skin test (for patients less
than 15 yo)
based education on HIV, AIDS
and sn resulting in other i OC: . I• Therapeutic management
I• diseases
Anti-bullying . I
All scrvict::s shu II b0 available only when clinically indicated. Page29of44
Population Level -·--·--- for Sick
I Welllndividuals I Individuals
lifestyle (healthy IGASTROINTESTINAI.
Adolescent physical attivity) j Diarrhealdiseases
• Mental health • Lab: Fecalysis
(10-19 yfo) I •
. •
Phil Health Membership • Therapeutic management: ORS, zinc
1
Media campaigns: supplementation, Vitamin A, IV fluid
I • Lifestyle modifications:
I NE!!RO!.OG(C/PSYCHIATRIC
l
I
, •
0 Healthy Diet [Reducing
saturated fat content)
Physical Activity·
I Mental Illness
• Psychosocial intervention and
psychotropic drugs
! Community Mobilization and
.! •
Development
Conduct t-argeted feeding
Self-harm
• Clinical: immediate assessment. first aid,
I 0
programs
School-based physical activity
j • School-based interventions
and transportto the nearesllert.i:Jry
facility
• On follow-up: rcferrJl to p!:.ychiatrist for
[self-hann] psychiatric assessment
i • Environmental assessment
I an d mo d'fl
1 JGJ.tiun fior -mJury
-
CANCER
prevention
• For definitive diagnosis and management:
• Emergency transportation Referral to secondary or tertiary facility
and communication services
INJURIES
Pt•blic health Motor vehicle road injuries
• Capacitate RHUs/CHOs in the
• Clinical: pre-hospital emergency services
4Rguidelines to prevent
- first aid, ambulance services, rcfeiTal
harassment ofyoun'g mCn and
women
0 VAWC in hospitals and RHUs
I• Update school health services,
standards, and curriculum_ for
• Clinical: pre-hospital emergency services
- first ciid, ambulance refcJTal
implementation
Assault by firearm
• Omnibus Policy on Disaster ' • Clinical: Immediate Assessment. First Aid
Risk Reduction /P;ASTER and Transport to Nearest Tertiary Facility
• Regulation on: COPY
- firecrdcker use
. video-game /0\.: Da1e:3[4k1 OPHTHA(,MO!.OGIC
Uncorrected refractive error
- smoking and alcohol use
• Clinical: Snellen's chart for adult; LEA
All services :shall b0 mi.HJl: only when duucally tndH.:atcd. Page 30 of44
---
Population Level Primary Care Services for '1Primary Care Services for Sick
Well Individuals I
.
Individuals I
j Disaster nreparntjon and chart for children; rcfCr
Adolescent ! response
II• lenses
(10-19 yjo) I• Gender -based watch groups Corrective lenses

o SPEED syndromic
I surveillance INFECTIO!!S QISFASES
II
I
I • 0
Risk communication
Note: Contact Tracing Should Be Done in the
Community ,
1
I
I
0
warning system
Incident command
system/OPCEN
Blood extraction and send referral for
II laboratory confirmation (vaccine preventable
I
Ii • Deployment of self-sufticient , diseases)

I
0
volunteers
! Dengue
J • Lab: CBC, Blood Typing, Bleeding
• Women friendly spaces and ! Parameters, ROT
: . evacualion centers
Mobilization ofprepositioned
logistics/resources (clean
J •
J
Therapeutic Management: fluid
, • Reterral to higher level facility for
delivery kits] management (as indicated)
i o Resilient health facilities with
DRRM plans and incident Rabies
I• command system (ICS)
Mass r.Isualty management I
1
•Referral to ABTC & provision ofanti-
• Barangay health emergency HlV, AIDS and STDs
response team (BHERT) • Clinical: refer to social hygiene clinics,
contact tracing, if newborns: early Infant
Diagnosis and referral
• Lab: HlV rapid test. confirmatory test at
San Lazaro. RITM, or treatment hub, PPD
test
• DOC: condoms, ART, antibiotics (for SID)
.. ' STr-R
1'-,/-,
Malaria
0 Lab: Blood smear, Rapid Diagnostic Test
· for Malaria
______]I
• Therapeutic rna nagement
·------------·----'--
All services shall
- . . J---'------
only when diuically indic:.ncd. Page31of44
. "--,-- -- I - ---·- --------- ------ ------ -· ·.
Population Level Primary Care Services for . Primary Care Services for Sick ;
_1____ Well Individuals I
1
Individuals
·-·---·'
Adolescent i
I Evaluation ofAnemia (Eg. Iron Deficiency,
Anemia of Renal Disease, Anemia of Chronic
(10-19 yjo) Illness)
• Lab: CBC
I • Appropriate Therapeutic Management
I DERMATO!.OGY
• Clinical: Referral to specialist-;
(Eg. Atopic, Irritant Contact, Bacterial and
Fungal Infections, and Suspicious
Malignant Lesions)
Leprosy
I•
I
Therapeutic managcrnenl
Filariasis
• Lab: Nocturnal blood smear
Schistosomiasis
• Lab: Kato katz examination
---'----------------------'---'=:::::..:=:.=====----- I
----------------.
fv1!\STER
(COPY
DC: "1'
All shall be made available only when clinically indicated. Page 32 of44
Population Level .I for -, Primary Care Services for Sick
I , _
!ADULT MEN i Suryemance and monjtoring of / Clinical ! REGULAR CONSULTATION formtvconditiou
. the population's health status • History and physical examination (vital.c,igns, DMI) 1• History and Physical examination
(20-60 yfo) I •
j •
Surveillance system
Crisis hclplines (self·lmrm)
1 • Oral health examination
l e Visual and hearing screening
'
DR!IGS AND COMMO!JITIES
! • Population: Renal Disease I • on physical. substance_ use, . AEFI events
; Prevention and Control smokmg, d1et and nutnt10n, sexual educatwnjfarmly • Assessment and Referral to Pediatrician
i Program (RED COP) program planning for appropriate mailagement
!• Cancer Registry • Mental health screening and psychological care, as
needed QENTALCONQIT!ONS
l Prevention and control of • Assessment and screening of:2: 25 years old with no • Provision of oral care services as needed
! endemic djseases established cardiovascular disease (angina pectoris1
• Integrated Vector Control corona1y heart disease, myocardia! intarction, ENVIRONMENTAL HAZARD EXPOSURE AND
Management transient ischemic attacks), cerebrovascular disease POISONING
I, • Mass Drug Administration (for [CeVIJ) or peripheral vascular disease (PVIJ) or have • Early recognition and initial management
Soil Transmitted Helminths, not undergone coronary rcvascularization or carotid • Trained health worker on poison control
Schistosomiasis, and endarterectomy and clinical toxicology
Filariasis) • For OFWs: (1) Psychological exam (2) 16 PF Test
STH: Albendazole andfor (English or Filipino) (3) Raven's Progressive Matrices RA.RE DISEASES
•
Mebendazole or Purdue Non-Language Test (Referral to DOH
Accrec..lited facilities)
• Referral to subspedalist
Filariasis: Diethyl metabolic specialist or endocrinologist
Carbamazinc (DEC)- for
endemic areas l.ahoratorv BEHAVIORAL OR
• Drug test PSYCHIATRIC/NEUROLOGIC DISORDERS
• SchiStosomiaSis: Praziquantel • I!IVTest(voluntary)
- for endemic areas • Screening, treatment/management and
• Fecal Occult Blood Test (FOBT) or Fecal referral to higher level facilities
lmmw10chemical Test (FIT), for men and women 50-
Assurnnce of quality and
accessjbility ofseryices 75
!• Provision of drugs, as indicated
I• Servims for PWDs and other • Lipid profile/ cholesterol screening, starting at 40 I l • Psychosocial intervention
special groups years old, and to be repeated every 3 years, <40 if with CARDIAC DISEASES
i
I .· . other risk factors (HTN, DM, etc.] \Ischemic Heart Disease
1 Healtl1 communjca!ion and PSA, 50 a11:d over, annually
I djsseminatiOn strategies • Fasting plasma glucose/random plasma glucose foc40 I • Lab: 12-L ECG (exercise ECG test); stress
echocardiography
t e
. . ·1
Community Health and yfo, 1f normal may repeat every 3 years. May do . . .
f Nutrition Education: screening for those< 40 yfo,i(withJndirntions like I• Therapc.utiC Manage.mcnt, as Indicated
i • Non-exposure to cigarette presence
k.
of risk
)
factors (e.g. obesity, HPN, DM, • ---,.
1
•
- Lhesty
I EducatiOn
1
I• smoke and unhealthy food
Water,
(WASH)
and Hygiene
smo mg etc;
• BHioo? chTem•stry
• eanng est
. /
,
{ ]
.
1
· \ , 1 --
I J;, •;:; ER
J
'
All services shall be made available only when clinically >

.. age 34 of44
-- ------
-'
- Level Primary Care Services for I Primary Care Services for Sick
I Well Individuals Individuals
health o Vasecto.my Hypertensive Heart Disease
ADULT MEN 1 • Infectious diseases I Drugs and Medicines • Lab: Blood pressure monitoring. eye
(20-60 yfo) I• Injury prevention .... falls, j o Family Planning Commodities (with consent): exam; ECG
burns, poisoning, drowning, I -Condoms • Therapeutic Treatment
/,· road traffic injuries I -
Pills (POP, COC) • Counseling J Education
• Mental health I - MNFP Lifestyle interventions:
• Promotion on the use of . -
DMPA
N
fortitled foods including I

-IUD
- [Implants)- can be provided by private facilities
Congenital Heart Anomalies
iodized salt • Clinical: Refer to tertiary hospital
i Food safety I
within the network • Labs: Echocardiography
l: Information Campaign on:
I o Hepatitis Band Influenza Vacdnation (Extended NCO
Risk Assessment Package for Apparently Healthy
• Healthy diet Rheumatic Heart Disease
I• Smoking and tobacco use I
Individuals]
• Diphtheria. Tetanus and Pertussis- one time in place
• Population: Develop ARF /RHO Registry
i • Drug and alcohol use J • tab: Throat swab, 20 Echocardiogrdphy,
ii • Physical activity
of tetanus booster
j Anti-Streptolysin 0 (ASO) Titer
l •
ii
Mental health
I
I
• Diphtheria/Tetanus Vaccine - up to 65 years old
(every 10 ears)
1 • Therapeutic Management
• Road safety I
• Hep A, Hep B, Meningococcal
i • Reproductive health (sexuality I
• Influenza
i RENALI!!ROLOGIC
I and gender-based violence]
I j Urinary Tract Infection
I. Promotion of violence-free,
drug-free and healthy
workplace
i•
! •
Labs: Urinalysis, CBC, Ultrasound
Medicines: Antibiotics (Cephalosporins,
Penidlins]
I • Promotion of violence-free,
drug-free and healthy Chronic Kidney Disease/ End Stage Renal
workplace Disease
• Enrollment Of patients in the • Refermllo Nephrologist for Peritoneal
disease registries Dialysis and/or Hemodialysis and regula•·
• Media campaigns:· follow-up; Consider referral to a
- Lifestyle modifications: Transplant Surgeon
• Healthy Diet (Reducing • Lab: CBC, Blood typing. Urinalysis, kidney
saturated fat content) function tests
• Physical Activity • Therapeutic Management
• Counseling/Education:
Cnmoiunitv-.Mobilizaljoo and. -Lifestyle interventions
I DeyeloJiment
• Eri\riibnmentll assessment
and modification for injury .I •
Benign Prostatic Hyperplasia
Rectal Examination.
[_ ··-------------------- --'-==----'-------- --------
All shall be made availabk: only when clinically iudicaLecL Page 35 of 44
Population Level - ·- Primary Care Primary Care Services for Sick
Welllndividuals Individuals
',· ADULT·-M--E-N----t. _____..
Emergencytr.msportation and Urologist as Needed
j( 60 / ) !' communication services • Lab: PSA, Ultrasound
l
I
2 0- Y 0
11 public health poljcv development
I, 1 • Omnibus Polity on Disaster I PULMONARY
! Risk Reduction Lower Respiratory Infections
I• Regulation on: ! • Clinical: Referral and Transportation
I •• !1recrdcker use
smoking and alcohol use
Services
• Lab: CBC, Chest X-ray, as needed
Therapeutic Management and
Disaster preparation and j Rehabilitation, as necessary
response
• SurveilJance Post· Extreme 1 Tuberculosis
Emergencies ami Disasters • Clinical: DOTS
(SPEED] syndromic • Lab: Sputum AFB and smear, Xpert
surveillance MTB/RIF, Drug Susceptibility Test (DST)
• Risk communication !• Therapeutic management
• Risk management and Early I
warning system j Chronic obstructive pulmonary disease
• Incident command • Clinical: Smoking cessation program
system/OPCEN • Lab: Spirometry;
• Deployment of self-sutlicient • Therapeutic J;llanagement
health team responders and Other regimens:
volunteers
• Mobile health care services
I
1
• Long term oxygen therapy
t • lnterventional therapy
• Women friendly spaces and • Non-invasive mechanical intervention
evacuation centers • Exacerbation management
• Mobilization ofprepositioned • Invasive mechanical intervention
logistics/resources (dean.
• Counseling I education:
delivery kits]
• Lifestyle modification: physical activity;
• - Resilient health fucllities with
smoking cessation; diet modification
DRRM plans and inddcnt
comniand system (lCS] • Education and self-management
• --M3.ss casualty m3nagement · Asthma
• Barangay health emergency
L _ _ _ _ _ _ _ _ _ _L__ team (BilERT) • Lab! Spirometry, Peak now meter,
- - - - - - - - - - - - - - - -.. i
. :\II shall be mtHk available ouly when clinically Page 36 of 44

,..
'
---· ---- .. --· -·-- ----- -- ·-
1
Population Level I Primary Care Services for i Primary Care Services for Sick
I Well Individuals .._. ___ ,
__a.n.dJJ1Qlli!:!JflDJ!Jl.f !I !J illkill nebuiizer {ntachine)
ADULT .tl!.c_p_npulatiou's healllLS:t!lilJ..S
SurveillaJJCl' system
[ a !-lislory and physic<d t'&.Hninalion ( l.'il:ll !iigns, HMlj
Or,1l health examination
• Tht•rapClltil" man<tgenu:nt
• 1 •
• Other regimen: Low dose inhales
WOMEN • Crisis
Hegi:\rry
1 0 Visual ;.lrJd hearing sat'l'tiing
o Cotmsding on physictll activny, subst:Htct·
corticosteroid for mild persistent asthuu;
• li.'iL", Inh.Jlc(l t.:oJ·tiCllS(t•roids f.lCS)/LO!Ig acting
(20-60 yjo) Prev(•ntiou am! qmtrol of
smoking. diet and nutrition, sexual edtJGitionjlarnily
plawung -1nduding fl·rtiilty
beta agonist ( LABA_); lnhalt.·d
corti<:usteruids {JCS) and short beta
diseasPs ( Cervic;1] Mucus Mt.:thud. BBT, Sympt1 2 agonist (SABA)
o Vectot· Control Mt>ththl, LAM :md St;Judard Days Mt•thod) Cnunseling J cduGllilln
o tUllalligaliun. iltsertioJJ nfJUDor suhdermal
• LifCstyle int"C!"VCnt'ions: SrrhJkiJlg cess.ltinn
• Mass Administr:1t ion (lot Jmpbnts
Soil Transmitted 1-le\minths. o Clinical brcas1t"Xdlllin:nknl 8.:. !ea1.:h pati£•1H to dn sdl lililli)£B.!.I'l_E
Schistosomiasis, and breast l":xam Diabcle.s mellitus
Fibrbsis) • !\·!ental ht>alth scrt:l'lling and psycholugical Ci1re, ;;...;
• ClinicaL Annual eye L'X<lmination when
• STH: Alheodaz(l[c ,IJHljor llt:t:d(;'d
diagnosed and t'very 2 years 1fwitlt nc•
Metv.·tJdaznte o ;HJd st:rt'("!Hllg for Lift>styll·-n:J.ned nhnonnai !lmiings, ru1
• l;il,Jri;t'\J:-.: [ lil·thyl Lhilnge, fool C<!t"t;, ({fl lllUllitorillg (tGr a!J
Carb.tJn.l'l.ttn: (!lEI.j tor PL'rsons 40 Yl.':J:rs J;
<lreas II Lillllu:al.urJC Management of complications {detectilHl
• Schistosontiasi.s: Praziqu<l tltt'! • llrug test and treatment of eye diseases
-· t()r L'ildr•mic areas • I!IV Test (voluntary) ' Lab: FilS or RBS, Urinalysis. Kidnt•y <llld
I ·•Pap Smt•ar or VJA 21 years (J)d and l)l'
liver functi{ln tests, JlbAl C;
Assurance• nf qnrtlity i.Ulll
acct>ssihiljty of scn1 jccs
I Sl'Xually il\.'tive, t\tUHI<llly, lOr j ,Yt!;lrs; It negatiV(!, ev<•ry
i 5-7 yt•ars
I: Therapeutic.: management
• Services !Cu· PWOs am! other • FL•cal Occult Bluod Tl'st (FOirl') or Fcr<Il I• 1 education:
lmmuuodlt:mical Tcsl {FIT). {iJr men .HH1 women 50- I• Lifestyle modification [physical activity;
diet modification, smoking cessation)
Health conum1nigtjon iJnd
75
o Lipid profile/ dtole::>tcrol screening, starting;lt40
• Diabetes self-manJgement educttion
dissemination years old, and to be repeated every 3 <40 ifwitb I program
• Community lh.•alth and other risk (HTN, OM, etc.) • Glycemic management and control
Nutrition Education: • Fasting pbsma glucos(ljrandom plasma glucose tbr ·lO "' Blood pressure and cholesterol control
• Non-exposure to cigarette y jo, if normal111ay repeat t•very 3 years. May do
lif,STROI NTESTI NAL
smoke and unhealthy footl screening for those< 40 y/o if with indications like
• · · ;m d fl ygJCne
Water, Samtatton · Pentic Ulcer
l
presence of risk tiKtors (e.g. obesity, H?N. DM. t·
t\VASH") smokJitgetc.)illood clwmJstJy • ClirJical: prevention ofNSAID-induced
• Occup.woncil hPdlth w 1\(:ar ing Tl'St · ulcer
• lufe-ctioth disL'l:->e.s
. ,
; ; t ,: r··r .. -R ••
DOC: acid suppression \•vith PPI
b 1 . [I li I .
--------- • _ _l,_lJUty =-f•tlb, _ _ ___ -G '_'r_l;_l_tr_ea__ j
All services shall be made available only
1 ,
indicQ.te<'?lll\-1101
l.Ja 1e: -=---I
Page 37 of44
i_ _ _ _ _ _ _ _ _ _ __J
·-------------
Population Level --r--- --- sick :
; . . . - - - - _ _ _ ___L_ ____
i burns, poisoning. drowning. Drugs and Medicines breath test and stool antigen
ADULT ! road traffic injuries • Pneumococcal Vaccine- if only considered as high risk
WOMEN i .• Mental health (e.g. health care providers even less than 60 years old) NEIIROJ.OGICIPSYCHJATRIC
(20-60 yjo)
l
1
Promotion on the use of
forti tied foods including
iodized salt
• Influenza Vaccination (for 50+ or high risk groups)
• Hepatitis B Vaccination- (Extended NCD Risk
Assessment Package for Apparently Healthy
Hemorrhagic Stroke
• Acute Phase: assessment, ambulance
conduction, early referral for blood exams
I• Food safety Individuals) and CT-scan
I Information Campaign on: • Diphtheria/Tetanus Vaccine • Chronic Phase: community based
I• Healthy diet occupational and speech therapy, physical
j• Smoking and tobacco use • Family Planning Commodities (with consent): therapy, maintenance medicines, home
' • Dn1g and alcohol use care
!• Physical activily -Pills (POP, COC) • For referral : CT scan
! • Mental health -MNFP (neuroimaging),Ccrebrospinal Fluid
'
!•
0 Road safely
Reproductive health
- DMPA
-IUD
Analysis, surgery
i (scxualily and gender-based -(Implants) -can be provided by private facilities -Lifestyle interventions:
violence) within the network [physical activity, diet modification,
Promotion ofviolence·free, smoking cessation, alcohol
drug-free and healthy consumption)
workplace management and
Promotion of violence-free, control
drug-free and healthy sugar and serum lipid control
workplace
Enrollment of patients in the Ischemic Stroke
disease registries • Acute Phase: assessment, ambulance
Media campaigns: conduction, early referral for blood exams
Lifestyle modi fica lions: and CT-scan
Healthy Diet (Reducing
• Chronic Phase: community based
saturated tat content]
occupational and speech therapy, physical
Physical Activily
therapy, maintenance medicines, home
care
Community Mobiljzation and
• Thempeutic Management
DeveloJ>ment fVlJ-\STER • For referral: CT scan (neuroimaging),
.·
1
• Environmental assessment
and modification for injury
prevent1on J i"'
,_ I COPY
-,rill'("'
neuroprotection
interventions:
__ ------------· _ __ (physical activily, diet modification,
-.1\11 scrvil::e:-;. shall made avuilubk \)JIIy wlwn diniL-"ally indicatL't.L Page 38 of 44
,-
Population Level Primary Care Services for Primary Care Services for Sick
Well Individuals Individuals
l Public health nolicy deyelonrnent ;king cessation, alcohol ..
jADULT l' • Omnibus Policy on Disaster consumption)
' Risk Reduction ·Hypertension management and
!WOMEN • Regulation on: control
o nrecracker use
i (20-60 yfo)
f ! ·Blood sugar and serum lipid control
! o smoking and alcohol use
I Headache
1
'
1 Disaster preparation and ! • Clinical: Assessment if caused by
· response II secondary disease
• SPEED syndromic surveillance ,. Therapeutic Management
• Risk communkation
• Risk management and Early 1 Major Depressive Disorder
warning system I • DOC: TCAs, SSRI [tor elderly, TCA
• Incident command I
, conLraindicated)
systemfOPCEN I
I
• Deployment of se lf-sufticien t i Anxiety Dism·dcrs
health team responders and l• Clinical: brown bag. referral to
!' •
volunteers
' psychiatrist for cognitive behavioral
therapy
I• Women friendly spaces and
evacuation centers
II Schizophrenia
I.
t
Mobilization of prepositioned 1
• Clinical: Referral to psychiatrist. then
logistics/resources (dean 1 community-based trealment
1
I·
delivery kits) i• DOC: antipsychotics
Resilient health facilities with I
DRRM plans and lnddcnt J Bipolar Disorder
I Mass casualty management
; • Clinical: Referral to psychiatrist,
I: Barangay health emergency
;
I
ge1iatrician neurologist then psychosocial
+community· based treatment
l
i
response team (BHERT)
I
! • Therc1peutic Management and
Rehabilitation, as necessary
l Community Mobilization and ----·--------,
J Deyelomnent
I• Environmental assessment
Dysthymia
• Clinical: Referral to psychiatrist lor
. and modification for injury
J•
episodic psychosocial treatment
1 prevention
Emergen.cy and
communication serv1ces
---
All services shall be made available only when clinically indicated. Page39 of44
. --·-,----·- --
!
Population level Primary Care Services for 1 Primary Care Services for Sick
.) Public health nolicy develonment
---LI
'I' ADULT I• Omnibus Policy on Disaster I !• Clinical: Homecare, Referral to
1 Risk Reduction ! j neurologist, psychiatrist, or geriatrician,
woMEN ! o Regulation on: 1
1 1 then community based follow-up and
! firecracker use .
1(20-60 yfo)
1
1 counseling (inducting family counseling)
J .
smoking and alcohol use
! Disaster preuaratjon and

I Epilepsy
Clinical: RetCrral to neurologist
I ! response
f •
• Therapeutic Management and
I f • SPEED syndromic surveillance Rehabilitation. as necessary
1 • Risk communication • Counseling/Education
I
• Risk management and Early i -Self management of patient with
warning system !I epilepsy
I • Incident command I
i system/OPCEN I Ml!SCJJJ,OSKELETA!, D!SQRJ)ERS

• Deployment of scJf.. sufticicnt I • Clinical: Comprehensive assessment
health team responders and I (determine if complicated or not), Screen
volunteers ! for occupational health risks. counseling
• Mobile health care services on lifestyle modillcation, physiotherapy,
; • Women friendly spaces and community based physical rehabilitation
evacuation centers
•
Mobilization of prepositioncd '
'CANCER
logistics/resources (clean ! • For definitive diagnosis and man<Jgement:
delivery kits) Heferral to secondary or tertiary facility
• Resilient health facilities with
l •
DRRM plans and incident
I. IMASTf.::R
COP'-'
! INJ!!RIES
:
Motor vehicle road injuries
•
Clinical: pre·hospital emergency services
I
Barangay health emergency 4\ I -
first aid, ambulance services, refen-al
------·- _, ___________1___ ____ ___ _______ 4G'
! - ·-1,.4
lh/ __
._. . _ -
_!'1_--j b
1 Suryeiiiancc and monjtodng of Clinjcal Assau 1t y firearm
ELDERLY MEN the population's he;llth stHtus • -Comprehensive • Clinical: Immediate Assessment, F1rstAid
(>60yo) , • I
Cancer Registry History and Physical Examination and Transport to Nearest Tertiary Facility
o Surveillance sYstem General VisioniScreening 1
• Crisis help lines (self-harm) Hearing Screening
o Oral health examination • Clinical: Clinical: Immediate Assessment
• Counseling (physical activity, substance usc1 smoking, First Aid and Transport to Nearest
ELDERLY MEN diet and nutrition) Tertiary Facility
All scr\•iccs shall be made uvnilabk only when clinically mdic:llL'<.L Page40 of44
' -- -T -- I- Primary Care Services for Primary Care Services for Sick
I Well Individuals Individuals
I
t Preyeotjon and control of • Referral and Transportation Services as Needed • On Follow-up: Referral to Psychiatrist for
I (>60yo) I endemjc djseases • First-aid, referral, counsel on home modification for Psychiatric Assessment
!• Integrated Vector Control full prevention
· Management Laboratory f OPHTHALMOLOGIC
/ • Mass Drug Administration (for •
•
Blood chemistry
Fasting blood glucose
i• Clinical: Snellen's chart; refer for
corrct'tive lenses; refCr for cataract and
Soil Transmitted Helminths,
Schistosomiasis, and • Oral glucose tolerance test other retinopathy for evaluation and
Filariasis) • Lipid profile other management
I • ST/1: Albendazole and/or • I'OBT & Sigmoidoscopy or Colonoscopyespecially i
I Mebendazole FOBT to identify those al high risk ! INFECTIOUS DISEASES
• Filariasis: Diethyl o PSA test and ORE [ir70+, per discretion of physician] I , Note: Contact Tracing Should Be Done in the
I
Carbamazine (DEC) - for • HlV Test (optional) Community
'
I
endemic areas • TB Sputum Test i I
I
I • Schistosomiasis: Praziquantel • Chest X-ray (CXR) j Blood extraction and send referral for.
- for endemic areas • Electrocardiogram (ECG) )labordtory confirmation (vaccine preventable
i l diseases)
:
Assurance ofnualit! and ) Drugs and Mcdjchws !
: ! • lntluenza vaccine I Rabies
• Pneumococcal Vaccine (PPV) i• '
I • Services for PWDs and other Referral to ABTC & provision of anti-
special groups •
o
Other vaccines as recommended by NIP
Condom i Rabies vaccine (as needed)
I
Uealtb r2mmunit11tion and J Dengue I
dissemination strdtegies I• Lab: CBC. Blood Typing. Bleeding ii
• Community Health and i Parameters, ROT I
i
Nutrition Education: • Therapeutic Management: fluid I
• Non-exposure to cigarette replacement/therapy; i
•
Water, Sanitation and Hygiene
I MASTER • Referral to higher level facility for
II
(WASH) /COPY I
i
• Occupational health HIV /AIDS and STDs I
oa-Ie:
r---· • Infectious diseases I • Clinical: refer to social hygiene clinics, I
contact tracing, if newborns: early ID and
ELDERLY
Surveillance and munjtodng of Cljnjcal I
llhe• health Slil!l!S
Cancer registry
• Comprehensive Geriatric Assessment
- History and Physical Examination
:
j
referral
• Lab: HlV rapid test, confirmatory test I
!
WOMEN -
I• • Surveillance system General Vision Screening @NRL/ SLH SACCL or treatment hub, PPD
1
I·
Crisis helplines (self-harm) - lleaiing Screening test I
(>60yo) • Oral health examination DOC: condoms, ART, antibiotics (for STD)
i
'
All services shall be made available only when dinic:dly Page41 of44
--- ---· -- - -- -- Primary Care Services for Primary Care Services for Sick
Welllndividuals Individuals
l1,' ______ 1
_______..
endemic diseases diet and nutrition) If uncomplicated:
I WOMEN • Integrated Vector Control I• CliniCal breast examination 1 • Labs: CBC, Stool Exam
, Management • Referral and transportation Service a"i Needed DOC: ORS, Antibiotics, anti-parasitic
(> 6 Qyo)
j •
I
. l • Mass Drug Administration (for
Soil Transmitted Helminths,
J
I
• First-aid, referral. counsel on home moditkation for
tall prevention
;
j •
medication, steroids
Therapeutic management for
I
:
Schistosomiasis. and
Filariasis) Jt.ahoratory
I
,. •
uncomplicated typhoid fever
Supportive therapy, referral for surgery
:
II
STH: Albcndazole r • Blood chemistry
1
andjor Mebendazole 1' Fasting blood glucose
• j STII
1 Filariasis: Diethyl • Oral glucose tolerance test !• Population: MDA of entire community
Carbamazinc [DEC)- • Lipid profile (until BO years old) ; • Labs: Stool examination
for endemic areas j e FOBT & Sigmoidoscopy or Colonoscopy especially i• DOC: Iron for management of anemia
Schistosomiasis: FOBT to identify those at high risk
Praziquantcl-lor • Pap smear or VIA [ <70yo) / Measles
endemic areas • HIV Test I• Lab: lgM blood test ond send to RITM
; • TB Sputum Test i 1
'I Assurance of quality and • CXR I• DOC: Vitamin A, Mcas es-containing
i accessihility of se1vices
' 1 • ECG vaccine, paracetamol. ORT/PRS
I • Establishment of Women & I Malaria
l Child Protection Unit in all Drugs jmd Medicines
hospitals t • Vitamin D supplement • Lab: Blood smear, Rapid Diagnostic Test
I • Se1viccs for PWOsand other
special groups
• Influenza vaccine
• Pneumococcal Vaccine (PPV)
tor Malaria
I
l Health romnmniratjnn and
o Other vaccines as recommended by NIP
Leprosy
j dissemination :;trategjes • Therapeutic management
l • Community Health and
1 Nutrition Education : ! Filariasis
I Non-exposure to
dgarette smoke and
\ •
I•
Lab: Nocturnal blood smear
unhealthy food I-
Water, Sanitation and
I Mf.STER Schistosomiasis
Hygiene (WASH]
(COPY , • Therapeutic management
Occupational health
Infectious diseases I • Lab: Kato katL examination
I
Injury prevention-
1
!
-··-..-·------- ______ j
/\II shall be nmdr.: available ouly when clinically indicutcd. Page42 of44
-,- ----·--- ·-· -. ·-· - -- r
Population level Primary Care Services for Primary Care Services for Sick :
L---..,-.......,..--,-
drowning. road trallk
Well Individuals
i NIITRIT!ON
Individuals , ___ _____ _
"' _,:
ELDERLY 1
injuries 1
Evaluati_on of Anemia (Eg. Iron Deficiency.
Mental health Anemia of Renal Disease, Anemia of
WOMEN Promotion on the usc of
1
I1 Chronic ll!ness)
(>60yo) iodized salt I•
• Clinical: Referral to spedalists
Lab: CBC
Food safety ! • Appropriate Therapeutic Management
Information Campaign on:
!
• DERMATO! OGY
Healthy diet I • Clinical: Referral to specialists
Smoking and toban:o
use
!•
1
ManagernentofDerrnatologic Conditions
I (Eg. Atopic, lnitant Contact, Bacterial and
Drug and alcohol use i Fungal Infections. and Suspicious
Physical activity : Malignant Lesions)
Mental health
Road safety '
Reproductive
[sexuality and gender-
based violence)
Dementia and
Alzheimer's disease
Injuries
• Promotion
drug-free and healthy
workplace
• Enrollment of patients in the
disease registries
• Enrollment to Phil Health
• Media campaigns:
- Lifestyle modifications:
Healthy Diet (Reducing
saturated fat content)
Physical Activity
Community MohUizatjon and

MASTER
f: Q py
Development t:: __,.J ,q
---------'---"- Environmental assessment __ -------------t--DC;j_M4S ----------
All se1 vices >hall be made dvailable unly "hen clinically in(he,lll-d: Page 4-3 of 44
------------------------------------ ---
l - - Primary Care Services for Primary Care Services for Sick

1ELDERLY I
I and modification for injury
prevention
WOMEN I1 • Emergency n·ansportation

and communication services
(>60yo) Public health policy developruenl

I - Omnibus Policy on Disaster
I Risk Reduction
j e Regulation on:
I use
j Disaster preparation and

J response
r • SPEED syndromic surveillance
• • Risk communication
:
: • Risk management and Early
warning system
' • lncidentcommand
I system/OPCEN
• Deployment of self-sufficient
I volunteers
I• Mobile health care services
• Women friendly spaces and
evacuation centers
• Mobilization ofprepositioned
----,
logisticsfresources (clean
;
! delivery kits)
Resilient health facilities with I i
I
l YfI
IJRRM plans and incident
I command system (ICS)

MASTER I
I
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Continuity of Care
Dr. R. San Diego | 05 October 2019
While the whole-whole people, whole systems, whole
Topic Outline: communities-gets worse.
I. Continuity of Care and Its Importance While the governments, healthcare systems and
II. The Four Domains of Continuity individual spend more and more on healthcare, for
III. Aspects of Good Practice less and less value.
IV. Priorities of Continuity of Care
V. Measurement of Continuity of Care
A. HEALING
Healing requires relationship-relationship which lead to
I. CONTINUITY OF CARE AND ITS IMPORTANCE trust, hope, and a sense of being known
“All people have equal access to quality health services that are co- but our health system doesn’t deliver healing. It doesn’t
produced in a way that meets their life course needs are deliver relationship
coordinated across the continuum of care and are comprehensive, Increasingly it delivers commodities that can be sold,
safe, effective, timely, efficient and acceptable, and all carers are bought, quantified and incentivized
motivated, skilled and operate in a supportive environment.” While the whole-whole people, whole systems, whole
communitties-gets worse
Is how one patient experiences care over time as coherent While government, health care systems and individualized
and linked spend more and more on healthcare, for less and less
Is the result of good information flow, good interpersonal value
skills and good coordination of care
Continuity of care occurs when separate and discrete B. IMPORTANCE OF CONTINUITY OF CARE TO PATIENTNTS
Continuity of care becomes increasignly important for
elements of care are connected and when those elements
patients as the age, develop multiple morbidities and
of care that endure over time are maintained and
complex problems, or become socially or psychologically
supported
vulnerable
Continuity of care is concerned with quality of care over
Bill proposed by LACON: “Any children who abandons their
time
parents require punishments.”
It is the process by which the patient and his/her
physician-led care team are cooperatively involved in
ongoing health care management toward the shared goal B.1 What Types of Cases Qualify for Continuity of Care?
of high quality, cost effective medical care. I am or a member of the family is, pregnant
Continuity of care in the sense of a patient repeatedly I am, or a member of my family is, presently in an acute
coming back to the same doctor and forming a therapeutic hospital or scheduled to be in the hospital immediately
relationship I am, or a member of my family is, presently undergoing a
course of chemotherapy, radiation therapy or psychiatric
Case Example: counseling.
A wealthy man I know went from doctor to doctor to try to find
I am, or a member of my family is, presently on a
a reason for his fatigue. Each doctor looked in depth of the
transplant list.
organ in which s(he) was an expert. Each did the latest tests.
Each prescribed the latest drugs and devices. C. IMPORTANCE OF CONTINUITY OF CARE TO
HEALTHCARE PROFESSIONALS
And the patient, the person got worse. He was in charge of his Continuity was also important to the practices
health care, he bought the best of each commodity; but in the Emphasized sharing information, good communication
end his fatigue remained and he only felt more alone. within the practice team and establishing systems that
supported effective patient management
This man’s experience was the opposite of healing.
Their attempts to coordinate care with professionals
Healing requires relationship-relationship which leads
outside the practice were sometimes a source of
to trust, hope and a sense of being known.
frustration
But our healthcare system doesn’t deliver healing. It
doesn’t deliver relationships.
Increasingly, it delivers commodities that can be sold,
bought, quantified, and incentivized.
S1T1| Hamster Batch 2021, Yani OH 1 of 3

Continuity of Care
● Site continuity – “usual source of care”
II. THE FOUR DOMIANS OF CONTINUITY OF CARE D. INFORMATIONAL CONTINUITY
1. Interpersonal Continuity ● Informational continuity where previous patient
2. Longitudinal Continuity information is available (usually through a patient chart or
3. Management Continuity an electronic medical record and used to provide patient
4. Informational Continuity appropriate care.
● Ideally the patient information is available to multiple
A. INTERPERSONAL CONTINITY
health care professionals in different settings
Continued relationship and trust providers, patients and
● RECORD CONTINUITY:
caregivers
o Refers to availability of all the information about a
Care by the same central providers for all care needs
patient‘s history visits, tests, allergies, medications
Flexible, consistent, adaptable care along the continuum
and preferences in a medical record or clinical
Care adapted to patients behavioral, personal, cultural
database
beliefs and family influences
o Easily shared by all the clinicians caring for the
RELATIONAL / INTERPERSONAL CONTINUITY:
patient, whether in the same institution, between
o refers to the ongoing relationship between the care
institutions, or between care settings.
provider and the patient
o It refers to the duration of the relationship as well as
III. ASPECTS OF GOOD PRACTICE
the quality of the relationship
o Which is affected by the attentiveness inspiration of Providing information for patients about the physician in
confidence, and the medical knowledge of the health the practice and their availability for the face to face
professionals consultation, telephone and perhaps email contact
AREAS OF CONTINUITY CARE Ensure that patients, clinicians and reception staff all know
○ Clinician continuity highly appreciated by who is the patient’s usual or preferred GP
patients, refers to maintaining a relationship Sufficient time in the consultation for interaction that will
with the same doctor over time. In medical enable a relationship to form
education literature, this use appears in family Access arrangement that allow patients to exercise choice
practice general internal medicine and pedriatric about who to consult
journals. Identifying and providing additional help for patient who
may experience access difficulties
B. LONGITUDINAL CONTINUITY Cornerstone of the family medicine and key point for the
Starts from admission to discharge patient. HOLISTIC APPROACH
Care and follow-up by a professional or team in all settings Present in core competences
or care levels Promotes health, well being, empowering patients
Links and referral strategies for care professionals Relationship with the same doctor over the time
Care navigator or community connector
Support by informal care or social network IV. PRIORITIES OF CONTINUITY OF CARE
Case management across sectors Continuity with primary care professional
Shared collaborative care try an non-disciplinary case People who have continuous contact with their usual
Case-finding and detection of high-risk individuals primary care provider have fewer attendance and
Protective, regular monitoring of long-term conditions admissions to an emergency department for conditions
Care planning with the perspectives and recommendations requiring ambulatory care and are more satisfied with
of multiple providers their care
Collaborative planning of care and shared decision making
C. MANAGEMENT CONTINUITY Having patient centered goal oriented planning of care and
● Involves the use of standards and protocols to ensure that coaching that enables individuals, families and informal
are is provided in an orderly, coherent, complementary, caregivers to be fully involved in assessment and decisions
and timely fashion about care is a factor in successful care coordination.
● Often this applies to when care is being provided by Case management for people with complex needs
multiple providers Having a proactive , continuous relationship in case
● This also includes accessibility, flexibility adapt to care finding, assessment, care planning and care coordination
needs, and consistency of care and transition of care
S1T1 Hamster Batch 2021, Yani OH 2 of 3

Continuity of Care
to integrate the services needed by an individual reduces A. CONTNUITY OF CARE INDEX (COCI)
the probability that the will experience gaps in care Identifies the number of physicians providing service to a
Collocated services or a single point of access patient and the percentage of care by each physician.
Collocation of different professionals, providers and The index is created for each patient and is calculated by
services and links with people who know local community taking the number of visits to each individual physician
and voluntary resources helps people who require chronic divided by the total number of visits the patient had
care to navigate and less the services and community overall.
support they need. This index weights both the frequency of ambulatory visits
Transitional or intermediate care to each physician and the dispersion of visits between
Effective management of the transition of care from physicians.
hospital to home improves the quality of care, speeds Index values range from just greater than 0 (visits mode to
functional recovery, reduces the rate of re-hospitalization a number of different physician) to 1 (all visits made to the
and reduces the cost of care same physician).
Comprehensive care along the entire pathway
Effective care coordination anticipates crises and can 1. SCC_R: usual provider continuity standardized. It is
provide urgent responses in the evening and at the the proportion of visits made to the most frequently
weekend by professionals who communicate well and seen provider standardized to a mean of 0 and
share information from health and care records along the variance of 1.
entire pathway 2. COC_R: sensitive to changes in the total number of
Technology to support continuity and care coordination visits and in their distribution across different
Tools and platforms for the exchange of information providers. It ranges from 0 to 1, where 0 occurs when
facilitate adaptation of practice interventions and each visit is to a different provider and 1 occurs when
identification of people who have multiple conditions, all visits are to one provider.
complex circumstances or have the most to gain from care 3. SECON-R: measures the sequential nature of provider
coordination. continuity. It is the fraction of sequential visit pairs of
Building workforce capability which the same provider is seen. Like COC_R, it
Developing the skills, strength and confidence of the wider ranges from 0 to 1, but in contrast is dependent on
workplace ensures that they have the competence fill their the sequential order of visits. A patient who
potential roles in delivering continuity and care alternates between two providers will have a score of
coordination. 0.
V. MEASUREMENT OF CONTINUTIY IF CARE

1. For research such as studying the influence of continuity on
specific outcome
REFERENCES
2. Main use is for monitoring performance and quality assurance.
Existing measures of continuity 1. Mainly lifted from Dr. R. San Diego’s lecture.
Physician-sided continuity(PHY)
Patient-sided continuity/Usual provider continuity index
(UPC)
Known provider continuity (KPC)
Continuity of care index(COCI)
Sequential continuity (SECON)
Modified Continuity Index(MMCI)
How do we measure continuity?
Patient survey data
Administrative data
All measures vary from 0-1, with higher values indicating-
“better” continuity
No established standard or “best” measure
No established threshold
S1T1 Hamster Batch 2021, Yani OH 3 of 3

CONTINUITY OF CARE
FMCH3
WHAT IS CONTINUITY OF CARE
• Their attempts to coordinate care with professionals
outside the practice were sometimes a source of
• Continuity of care is how one patient experiences care
over time as coherent and linked frustration.
THE FOUR DOMAINS OF CONTINUITY

• Is the result of good information flow, good
interpersonal skills, and good coordination of care.
I: INTERPERSONAL CONTINUITY: The subjective
• Continuity of care occurs when separate and discrete experience of the caring relationship between a patient
elements of care are connected and when those and his or her health care professional
elements of care that endure over time are maintained
and supported. II. LONGITUDINAL CONTINUITY: a history of
• Continuity of care is concerned with quality of care interaction with the same health care professional in a
over time. series of discrete episodes
III. MANAGEMENT CONTINUITY: effective

• It is the process by which the patient and his/her
collaboration of teams across care boundaries to provide
physician-led care team are cooperatively involved in
seamless care
ongoing health care management toward the shared
goal of high quality, cost-effective medical care. IV. INFORMATIONAL CONTINUITY: the availability of
clinical and psychosocial information at all encounters
• the sense of a patient repeatedly consulting the same
with professionals.
doctor and forming a therapeutic relationship
INTERPERSONAL CONTINUITY:
IMPORTANCE OF CONTINUITY OF CARE TO
• Relational continuity (interpersonal) refers to the
PATIENTS
ongoing relationship between the care provider and
• Continuity of care becomes increasingly important for the patient.
patients as they age, develop multiple morbidities and
complex problems, or become socially or • It refers to the duration of the relationship as well as
psychologically vulnerable the quality of the relationship
CASES QUALIFIED FOR CONTINUITY OF CARE • Which is affected by the attentiveness, inspiration of
• I am, or a member of my family is, pregnant. confidence, and the medical knowledge of the health
• I am, or a member of my family is, presently in an professional.
acute hospital or scheduled to be in the hospital
immediately LONGITUDINAL CONTINUITY:
• I am, or a member of my family is, presently
• a patient needs to see the same doctor on a number
undergoing a course of chemotherapy, radiation
therapy or psychiatric counseling. of occasions to enable a therapeutic relationship to
• I am, or a member of my family is, presently on a develop
Transplant list.
MANAGEMENT CONTINUITY:
IMPORTANCE OF CONTINUITY OF CARE TO
• involves the use of standards and protocols to ensure
PRACTITIONER
that care is provided in an orderly, coherent,
• Emphasized sharing information, good communication complementary, and timely fashion.
within the practice team and establishing systems that
• Often this applies to when care is being provided my
supported effective patient management Their
multiple providers.
attempts to coordinate care with professionals outside
the practice were sometimes a source of frustration.
• This also includes accessibility (availability of • Present in core competences ( person-centered;
appointments, medical tests), flexibility to adapt to care comprehensiveness, community orientation; A
needs, and consistency of care and transitions of care approach.
(e.g., the coordination of home care by a family
• Promotes health, well-being , empowering patients.
physician).
• Relationship with the same doctor over the time.
• Means that patients have a "usual source of care" as
PRIORITIES OF CONTINUITY OF CARE
opposed, for example: Emergency departments, OPD
1. Continuity with a primary care professional.
INFORMATIONAL CONTINUITY:
People who have continuous contact with their usual
• Where previous patient information is available primary care provider have fewer attendances and
(usually through a patient chart or an electronic admissions to an emergency department for
medical record) and used to provide patient- conditions requiring ambulatory care and are more
appropriate care. satisfied with their care.
• Ideally the patient information is available to multiple 2. Collaborative planning of care and shared
health care professionals in different settings. decision-making. Having patient centered, goal
• refers to availability of all the information about a oriented planning of care and coaching that enables
patient's history, visits, tests, allergies, medications, individuals, families and informal caregivers to be
and preferences, in a medical record or clinical fully involved in assessment and decisions about
database care is a factor in successful care coordination.
• easily shared by all the clinicians caring for the patient, 3. Case management for people with complex
whether in the same institution, between institutions, or needs. Having a proactive, continuous relationship
between care settings. in case-finding, assessment, care planning and care
ASPECTS OF GOOD PRACTICE: coordination to integrate the services needed by an

individual reduces the probability that they will
• Providing information for patients about the physician
experience gaps in care.
in the practice and their availability for face-to-face
consultation, telephone and perhaps email contact 4. Collocated services or a single point of access.
Ensuring that patients, clinicians and reception staff all Collocation of different professionals, providers and
know who is the patient’s usual or preferred GP services and links with people who know local
community and voluntary resources helps people
• Sufficient time in the consultation for interaction that
who require chronic care to navigate and access the
will enable a relationship to form
services and community support they need.
• Access arrangements that allow patients to exercise
5. Transitional or intermediate care. Effective
choice about who to consult
management of the transition of care from hospital to
• Identifying and providing additional help for patients home improves the quality of care, speeds functional
who may experience access difficulties – for example, recovery, reduces the rate of rehospitalization and
because of language or learning difficulties, cultural reduces the cost of care.
differences, physical disability, mental health problems
6. Comprehensive care along the entire pathway.
or social isolation.
Effective care coordination anticipates crises and
• Cornerstone of family medicine and key point for the can provide urgent responses in the a and at the
patients. HOLISTIC APPROACH weekend by professionals who communicate well
and share information from health and care records • SCC_R: usual provider continuity standardized. It is
the proportion of visits made to the most frequently
along the entire pathway.
seen provider standardized to a mean of 0 and
7. Technology to support continuity and care variance of 1.
coordination. Tools and platforms for the exchange • COC_R: sensitive to changes in the total number of
visits and in their distribution across different
of information facilitate adoption of practice
providers. It ranges from 0 to 1, where 0 occurs when
interventions and identification of people who have each visit is to a different provider and 1 occurs when
all visits are to one providera
multiple conditions, complex circumstances or have
the most to gain from care coordination. • SECON_R: measures the sequential nature of
provider continuity. It is the fraction of sequential visit
8. Building workforce capability. Developing the pairs at which the same provider is seen. Like
COC_R, it ranges from 0 to 1, but in contrast is
skills, strengths and confidence of the wider
dependent on the sequential order of visits. A patient
workforce ensures that they have the competence to who alternates between two providers will have a
score of 0.
fill their potential roles in delivering continuity and
care coordination.
MEASUREMENT OF CONTINUITY OF CARE
• For research such as studying the influence of

continuity on specific outcome
• Main use is for monitoring performance and quality

assurance. Existing measures of continuity
• Physician-sided continuity (PHY)
• Patient-sided continuity/Usual provider continuity

index (UPC)
• Known provider continuity (KPC)
• Continuity of care index (COCI)
• Sequential continuity (SECON)
• Modified Modified Continuity Index (MMCI)
The Continuity of Care Index (COCI):
• identifies the number of physicians providing service

to a patient and the percentage of care provided by
each physician.
• The index is created for each patient and is

calculated by taking the number of visits to each
individual physician divided by the total number of
visits the patient had overall.
• This index weights both the frequency of ambulatory

visits to each physician and the dispersion of visits
between physicians.
• Index values range from just greater than 0 (visits

made to a number of different physicians) to 1 (all
visits made to the same physician).
Family and Health
Lourdes C Medalla, MD | 14 Sept 2019
FAMILY II. THE FAMILY AS PATIENT
CHARACTERISTICS OF A HEALTHY FAMILY
• Primary social agent in the promotion of health and well-
• Open to change
being —> greatest all in health care
• High self-worth
• Primary source of health beliefs, health related
• Functional defenses
behaviours, stress and emotional support
• Clear rules discussed
• Strongly influences most health behaviours and that
family-oriented approach is the most effective and • People take risk to express feelings
efficient way to prevent disease and promote health • Can deal with stress
• Welcomes life stages
I. THE FILIPINO FAMILY • Clear hierarchy
• Closely knit bilaterally extended • Affect is open
• Average household size is 4.6
• 14 M families remain poor (SWS Survey,2015) QUESTIONS TO IDENTIFY THE FAMILY AT RISK
• Expenditure pattern mostly on food and rent/housing • What family need to maintain or restore its health
• Life expectancy of 68.8 for men and 74.3 for women • Presence of physical, psycho-emotional, or socioeconomic
• Functional literacy rate of 84.1% threats to the health of this family
• Total fertility rate of 2.76 • What capacity does this family have to make healthy
choices?
• Contraceptive prevalence rate of 50.6%
• What family need from society to optimise its health
FACTORS AFFECTING HEALTH • How to promote a balance between the family’s needs and
expectations and the constraints of the health care system
INDIVIDUAL PATIENTS
RISK FACTORS
• A risk factor increases your risk of developing a disease or
health problem
Ex: Behaviors and lifestyle, Environment, Genes
• FAMILY HISTORY is a risk factor for common diseases
Population-based studies RR estimates

• CHD 2-5
• Asthma 2-4
• Colorectal cancer 2-5
• Type II diabetes 2-6
• Breast cancer 2-6
FAMILY WITH PROBLEM
FAMILY AS PATIENTS
• Use of SCREEM/SCREEM-RES family assessment tool
FACTORS STRENGTH/ WEAKNESS/

RESOURCE PATHOLOGY
Social
Cultural
Religion
Economic
Environmental
Medical
S1T1| Guinea Pig Batch: OBE is life 1 of 6

Family and Health
PANTAWID PAMILYA PILIPINO PROGRAM (4Ps)
MANAGEMEN Comprehen Family Intervention
(Filipino version of Conditional Cash Transfer)
T/INTERVENTI sive medical intervention s (COPC
1. Pregnant women: pre- and post-natal care and be attended
ONS intervention s to address based) to
by a trained health pro-fessional, during childbirth
s based on both addressed
2. Parents- Family Development Sessions (FDS)
evidence medical and the issues
3. 0-5 year-old children- regular preventive health check-ups
and psychosocial identified (
and vaccines
standards of issues existing and
4. 6-14 year old children- must receive deworming pills twice
care identified proposed)
school classes at least 85% of the time.
(encompassi
5. Children beneficiaries aged 3-18- must enrol in school and
ng all levels
maintain in attendance of at least 85% of class days every
of care)
month.
Individual
psychosocial
PATIENT-CENTERED, FAMILY FOCUSED, COMMUNITY- ORIENTED
intervention
CARE MATRIX (PFC MATRIX) BY LEOPANDO, 2000; NICODEMUS
s such as
2014
psycho-
educational
approach
COMPONENTS PATIENT FAMILY- COMMUNITY
(CEA),
CENTERED FOCUSED ORIENTED
motivational
DATA Relevant Assessment Assessment and
clinical of family of social behavioural
histories psychodyna determinant counselling
Physical mics using s of health appropriate
Findings family and building
Context of assessment blocks of a A. HEADING 2
psychosocial tools, family health • Exploring both the Disease & illness experience
issues systems system • Understanding the whole person
(individual) assessment relevant to • Finding common ground
such as (STFRED) the
emotions presented
attendant to medical and
the health psychosocial
condition issues of the
including case
bioethical
issues
ANALYSIS Salient Salient Salient

clinical features of features of
features and the family the
psychosocial dynamics assessments
, bioethical and/or on the social
issues, etc. family determinant
systems s
assessment FAMILY-ORIENTED PRIMARY CARE
• Learning to “think family”
DIAGNOSIS/CO Medical Summary Summary • The importance of genogram
NCLUSION/ASS diagnosis statements statements
• The family within a larger system - use an ecomap
UMPTIONS Psychosocial of the issues of the issues
• Chronic illness and disability - supporting family caregivers
diagnosis identified in identified in
• Working with family members - the family conference
(using ICD V the the
• Identifying the family at risk
Codes) assessments assessments
done (both done (both
COMMUNITY-ORIENTED PRIMARY CARE
enabling enabling
Key Features
and barriers and barriers
to care) to care) • Use epidemiological and clinical skills
• Address determinants and consequences of health and
illness
S1T1 2 of 6
Family and Health
• Concern with environment/family/individual; with health 9. Cultural factors
services and behaviours 10. Gender etc.
Ideal Features SCOPE AND COMPONENTS OF FAMILY HEALTH

• Population - identified community 1. Problems faced by family
• Governance - allow community involvement ➢ Broken Homes
• Information - facilitate planning and evaluation ➢ Drug abuse
• Funding - incentives for cost-effective services ➢ Unmarried mothers
• Workforce – team-based, combine public health and clinical ➢ Teenage pregnancy
medicine skills
• Service - comprehensive, coordinated, consumer focused 2. Reproductive Health
➢ Safe motherhood
➢ Ante-natal care, pre-natal care, delivery care, family
COPC: Principles and Process planning
➢ Nutritional deficiencies
➢ Infertility, Adolescent Health
FAMILY HEALTH CARE

Definition:
A process which encompasses screening for abnormalities,
early detection and diagnosis of disorders that can be alleviated and
prevent ill-health.
Vision:
Freedom from disease for the threat of the disease.
OBJECTIVES OF FAMILY HEALTH CARE

1. To educate every individual about their roles and
responsibilities in maintaining their own health.
THE FAMILY AND HEALTH 2. To detect disease at an early stage and alter its
progression.
3. To provide entry into the health care system.
4. To improve health care services specifically among the
socially disadvantaged groups.
5. To gain understanding of disease trends both in an
individual and in population.
FAMILY HEALTH CARE SERVICES

• Should offer complete medical services for every member
of the family.
• Should be committed to promoting health and wellness,
providing high quality, cost effective, compassionate
health care regardless of age, race, color, creed, and
disability.
• Should maintain the use of efficient and effective
management principles and practices.
GUIDING PRINCIPLES IN FAMILY HEALTH CARE

DETERMINANTS OF FAMILY HEALTH • Families and professionals work together in the best
1. Living conditions - shelter, food, clothing interest of the child and the family. As the child grows,
2. Working conditions - hours, rests, schedules s/he assumes a partnership role.
3. Physical environment - soil, climate, water supply • Everyone respects the skills and expertise brought to the
4. Psycho-social environment - culture and climate of the relationship.
workplace • Trust is acknowledged as fundamental.
5. Education
• Communication and information sharing are open and
6. Economic factors
objective.
7. Health factors
• Participants make decisions together.
8. Health practices
• There is a willingness to negotiate.
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Family and Health
WHAT FAMILY HEALTH CARE CAN DO?
Primary prevention Secondary Tertiary prevention
• Acknowledges the family as the constant in a child’s life. prevention
• Builds on family strengths.
• Supports the child in learning about and participating in chronic illness in
his/her care and decision-making. one patient
• Honors cultural diversity and family traditions.
• Recognizes the importance of community-based services.
• Promotes an individual and developmental approach.
• Encourages family-to-family and peer support Family life Compliance Coping with crisis
• Supports youth as they transition to adulthood. education sexuality, monitoring created by serious
• Develops policies, practices, and systems that are family- marriage, prenatal regarding illness or a dying
friendly and family-centered in all settings care, personal management family member
• Celebrates successes. hygiene and
sanitation, health
EFFECTIVE SKILLS NEEDED FOR HEALTH PROFESSIONAL IN FAMILY risk behaviour and
HEALTH CARE disease prevention,
• Taking family histories beyond medical information care of elderly
• Draw a genogram, including family relationships
• Lead family meetings to discuss family health issues SCREENING
• Understand the importance of family dynamics and life - is establishing a service that invite apparently well people
cycle to come in for check up
• Basic skills in family counseling to help family navigate
stressful situations impacting on health CRITERIA FOR SCREENING ACCORDING TO FRAME AND CARLSON:
1. The condition must have a significant effect on the quality
COMPONENTS OF FAMILY HEALTH CARE and quantity of life.
1. Prevention 2. Acceptable methods of treatment must be available.
2. Screening 3. The conditions must have an asymptomatic period during
which detection and treatment significantly reduce
PREVENTION morbidity and mortality.
LEVELS: 4. Treatment in asymptomatic phase must yield a therapeutic
I. Primary Prevention result superior to that obtained by delaying treatment until
Health promotion symptoms appear
Specific protection 5. Tests that are acceptable to patients must be available at
reasonable cost to detect the condition in the
II. Secondary Prevention asymptomatic period.
Early Diagnosis and Prompt Treatment 6. The incidence of the conditions must be sufficient to justify
Disability Limitation cost of screening.
III. Tertiary Prevention MEDICATION CONDITIONS APPROPRIATE FOR SCREENING:

Rehabilitation a) Hypertension, Dyslipidemia
b) Cataract Glaucoma
c) Hearing Deficits
Primary prevention Secondary Tertiary prevention
d) Carcinomas
prevention
e) Infectious Disease
Common lifestyle Health is shared Balanced support
diet, non-addictive responsibility between
behaviour, leisure between doctor, compliance
activity, basic living patient and family. monitoring and
habits (i.e monitoring of independent
well-being) activity of members
with chronic illness
Health Encouraging sick Adjustment of all

maintenance member to seek members to
screening activities appropriate help changes
and immunisation necessitated by
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Family and Health
USE OF PERIODIC HEALTH EXAMINATION
1. Health promotion, disease prevention and intervention
- Smoking cessation, exercise and immunisation
2. Case findings and screening for disease and risky behaviour
-Hypertension, tuberculosis, substance abuse, sexual
behaviour
3. Detect characteristics that are seen in patients at high risks
for particular conditions
-Family, socioeconomic, occupation, lifestyle
HEALTH EXAMINATION CONDITIONS TO CONSIDER BASED ON AGE

INFANT ADOLES YOUNG MIDDLE OLDER
AND CENTS ADULT AGE ADULT
CHILD ADULT
FAMILY LIFE CYCLE INJURY Nutrition Substanc Female Cardio- Fracture

• Single adult PREVENT Growth e abuse reproduc vascular Fall
• New couple ION Develop tive health preventi
• Couple with children ment health risks on
• Couple with teenagers
• Launching children
• Family in later life
Unattached LIFESTYL Abuse Sexual Occupati Cancer Nutrition
NMC Medical: Job related PE, episodic problems , gyne E activity onal screenin al Elder
problems,/infertility/early pregnancy. Emotional MODIFC health g Abuse
adjustments: in law, new role ATION risks
FYC Medical same, Emotional. Peer pressure on lifestyle , sexual
IMMUNI Neglect Osteopo Dementi
adequacies, problems on child rearing, financial difficulties,
ZATION rosis a
family violence, communication problem, taking care of
Occupati screenin
sick/old parents
onal g
FA Medical: common medical problems, OB gyne,
issues
premenopausal, lifestyle modification
Emotional: middle crisis, male climacteric, extra-marital
affairs, insecurities with changes in physical appearance or CLINICAL PREVENTIVES SERVICES FOR NORMAL RISK WOMEN
job
Launching Medical: episodic medical problem, OB Gyne, degenerative Counseling 18-35 40-50 years 60 + years
problem, urologic problems years
emotional: depression due to death of spouse and sickness
Psychomotor: problems due to children leaving home Calcium intake x x x
Loneliness, financial adjustment Folic acid x x
FLY Medical: degenerative disease, episodic problems, Hormone replacement x x
gynecologic problems, urologic problems therapy
emotional/ social: depression due to death of spouse and
sickness, psychosomatic problems secondary to children
leaving home, loneliness, financial adjustment Mamography screening x x
PERIODIC HEALTH ASSESSMENT

Purpose: Tobacco, drugs, alcohol, x x x
1. Evaluate health status STD’s, safety
• Asymptomatic people can harbour the disease
• Examination can detect disease in its early stages
• Early discovery of disease can decrease morbidity and
mortality
2. Screen risk factors of disease
3. Provide preventive counselling intervention in age appropriate
manner
S1T1 5 of 6
Family and Health
CLINICAL PREVENTIVES SERVICES FOR NORMAL RISK MEN FAMILY WELLNESS SYSTEM APPROACH
18-35 years 40-50 years 60+ years • practical approaches
• identified interventions that can be carried out
Immunization • care can be delivered in the house, private clinics, health
s centers, school clinics and industrial/workplace clinics
Tetanus- FAMILY DOCTORS’ DAY

Diptheria • The World Organization of Family Doctors (WONCA)
x x x
(every 10 declared May 19 of each year as World Family Doctors'
years) Day
• Philippine Academy of Family Physicians lobbied for Family
Varicella x x x Doctors' Day, now with Executive Order from President
Benigno Aquino
Pneumococcal
x • May 19 of every year- Family Doctors' Day
(one dose)
• During this day, all PAFP Chapters, Accredited Programs,
Influenza and Members will devote their time for family screening,
x health education, and anticipatory guidelines.
(yearly)
PARENTS’ CLASS/RESPONSIBLE PARENTHOOD PROGRAM

HEALTH RISK APPRAISAL • Either or both parents can undergo training to become
I. Health Behaviors "Family Health Advocate".
II. Family Determinants
III. Environmental and Community Determinants ENVIRONMENTAL PROTECTION PROGRAM
• Community based environmental programs
I. HEALTH BEHAVIORS
• Home based program for ecology like waste segregation
a. Tobacco use, Alcohol Use, Caffeine
and recycling
b. Nutrition, Diet, Obesity
c. Injuries, Accidents, Exercise
Management:
d. Infectious Disease, Stress
✔️ Family Wellness
II. FAMILY DETERMINANTS ✔️ Health Education
Heredofamilial diseases can help predict future problems ✔️ Family Meetings including caregiver support
a. Cardiovascular Diseases- Ischemic Heart Disease,
Hypertension GOVERNMENT AGENCIES WHICH HAS GIVEN EMPHASIS ON ROLE
b. Endocrine Diseases- Diabetes Mellitus, Thyroid Problems FAMILIES IN HEALTH
c. Carcinomas- Breast, Lung, Colon, Ovarian
• DOH- Family Health Program, Sustainable Developmental
III. ENVIRONMENTAL AND COMMUNITY DETERMINANTS Goals, Philippine Health Agenda and interventions at life
a. Socioeconomic factors stages
b. Sanitation • DSWD- Pantawid Pamilya Pilipino Program
- food contamination, improper waste disposal, safe and • DOLE- Family Welfare Program and Family Health Program
potable water supply • Phil Heath- Family Registration for Primary Care
Benefits/TSEKAP
FAMILY WELLNESS PLAN
a. Child: 0-12 years old REFERENCES
b. Adolescent: 13-21 years old 1. ppt
c. Adult: 22-60 years old
d. Elderly: > 60 years old
S1T1 6 of 6
Family Medicine
Functional defenses
Clear rules discussed
Lecturer: Dr. Zorayda Leopando People take risk to express feelings
Can deal with stress
Family
Welcomes life stages
Primary social agent in the promotion of health and well-being Clear hierarchy
greatest ally in health care Affect is open
Primary source of health benefits, health related behaviors,
Questions to identify the family at risk
stress & emotional support
Strongly influences most health behaviors and that family- What family need to maintain or restore its health?
oriented approach is the most effective & efficient way to Presence of physical, psycho-emotional or socio-economic
prevent disease and promote health threats to the health of this family?
What capacity does this family have to make healthy choices?
Filipino family
What family need from society to optimize its health?
Closely knit, bilaterally extended How to promote a balance between the family’s needs and
Average household size is 4.6 expectations and the constraints of the health care system
14 M families remain poor
Risk factor
Expenditure pattern mostly on food and rent/ housing
Life expectancy of 68.8 for men & 74.3 for women A risk factor increases your risk of developing a disease or health
Functional literacy rate of 84.1 % problem
Total fertility rate of 2.76 % Behaviors and lifestyle
Contraceptive prevalence rate of 50.6% Environment
Genes
Factors affecting health
Family history is a risk factor for common diseases
Individual Population based studies RR estimates
patients CHD 2-5
Gaps in primary
care
Asthma 2-4
Colorectal cancer 2-5
Type II DM 2-6
Mental health
Personal
issues Breast cancer 2-6
Pantawid Pamilyang Pilipino Program (4P’s)

Health
(Filipino version of Conditional Cash Transfer)
1. Pregnant women: pre- & post-natal care and be attended by

Environmental Behavioral
trained health professional during childbirth
2. Parents: family development sessions
Societal
3. 0-5 years old children: regular preventive health check-ups and
vaccines
4. 6-14 years old: must receive deworming pills twice; school
classes at least 85% of the time
5. Children beneficiaries aged 3-18: must enroll in school and
Family as patients maintain in attendance of at least 85% of class days every month
Patient centered, Family-focused community-oriented care matrix

Factors Strength/ Weakness/
Resources pathology - Leopando, 2000;
Social Nicodemus 2014
Cultural
Religious
Economic
Environmental
Medical
Classification of family according to health status
Characteristics of a healthy family

Open to change
High self-worth
Page 1 of 5
Pink Italic= Recording Blue= PPT
Family Medicine
Components Patient Family- Community Community oriented primary care

centered focused oriented
Data Relevant clinical Assessment of Assessment of Key principles:
histories family social
Physical findings psychodynamics determinants Use epidemiological and clinical skills
Context of using family of health and
psychosocial assessment building blocks
Address determinants and consequences of health & illness
issues tools, family of a health Concern with environment/ family/ individual; with health
(individual) such systems system services and behaviors
as emotions assessment relevant to the
attendant to the (STFRED) presented
health condition medical and Ideal features:
including psychosocial
bioethical issues issues of the Population: identified community
case Governance: allow community involvement
Analysis Salient clinical Salient features Salient
features and of the family features of Information: facilitate planning and evaluation
psychosocial, dynamics and or the Funding: incentives for cost-effective services
bioethical issues family systems assessment of
Workforce: team-based, combine public health and clinical
etc. assessment the social
determinants medicine skills
Diagnosis/ Medical Summary Summary Service: comprehensive, coordinated, consumer focused
conclusion/ diagnosis statements of statements of
assumptions Psychosocial the issues the issues
diagnosis (using identified in the identified in
ICD V codes) assessments the
done (both assessments
enabling and done (both
barriers to care) enabling and
barriers to
care)
Management Comprehensive Family Interventions
interventions medical interventions to to address the
interventions address both issues
based on medical and identified
evidence and psychosocial (existing and
standards of issues identified proposed)
care
(encompassing
all levels of care)
Individuals
psychosocial
interventions
such as psycho-
educational
approach (CEA),
motivational and
behavioral The family & health
counseling etc.
appropriate Social context of illness
and recovery
Lifestyle
Culture and religion
Diseases
Family interventions
Determinants of family health
Living conditions: shelter, food, clothing

Family oriented primary care Working conditions: hours, rest, schedules
Physical environment: soil, climate, water supply
Learning to “think family”
Psycho-social environment: culture & climate of the workplace
The importance of genogram Education
The family within a larger system: use an ecomap Economic factors
Chronic illness and disability: supporting family caregivers
Health practices
Working with family members: the family conference
Cultural factors
Identifying the family at risk Gender
Page 2 of 5
Family Medicine
Scope and components of family health Supports youth as they transition to adulthood
Develops policies, practices & systems that are family-friendly and
1. Problems faced by family family-centered in all settings
Broken homes Celebrates successes
Drug abuse
Unmarried mothers Levels of prevention
Teenage pregnancy
2. Reproductive health Primary Seconday Tertiary
Safe motherhood prevention prevention prevention
Ante-natal care, pre-natal care, delivery care, family planning • Health • Early dx & • Rehabilitation
Nutritional deficiencies promotion promt tx
• Specific • Disability
Fertility, adolescent health protection limitation
Family health care

Screening
Process which encompasses screening for abnormalities, early
detection & diagnosis of disorders that can be alleviated & Establishing a service that invites apparently well people to
prevent health come in for check up
Vision: Freedom from disease or the threat of the disease
Criteria for screening according to Frame & Carlson
Objectives of family health care
Tests that are acceptable to patients must be available at
To educate every individual about their roles and responsibilities reasonable cost to detect the condition in the symptomatic period
in maintaining their own health The incidence of the conditions must be sufficient to justify cost of
To detect disease at an early stage and alter its progression screening
To provide entry into the health care system Medical conditions appropriate for screening:
To improve health care services specially among the socially Hypertension, dyslipidemia
disadvantages groups. Cataract, glaucoma
To gain understanding of disease trends both an individual and Hearing deficits
in population Carcinomas
Infectious disease
Family health care services
Periodic health assessment
Should offer complete medical services for every member of the
family Evaluate health status
Should be committed to promoting health and wellness, providing Asymptomatic people can harbor the disease
high quality, cost effective, compassionate health care regardless Examination can detect disease in its early stages
of age, race, color, creed and disability Early discovery of disease can decrease morbidity & mortality
Should maintain the use of efficient and effective management Screen risk factors of disease
principles and practices Provide preventive counselling, intervention in age appropriate
manner
Guiding principles in Family health care
Uses of periodic health examination
Families and professionals work together in the best interest of
the child and the family. As the child grows, he/she assumes a Health promotion, disease prevention & intervention
partnership role Smoking cessation, exercise & immunization
Everyone respects the skills and expertise brought to the Case finding and screening for disease and risky behavior
relationship Hypertension, TB, substance abuse and sexual behavior
Trust is acknowledged as fundamental Detect characteristics that are seen in patients at high risk for
Communication and information sharing are open and objective particular conditions
Participants make decisions together Family, socioeconomic, occupation, lifestyle
There is willingness to negotiate
Periodic health examination conditions to consider based on age
What Family health care can do?
Infant & child Adolescents Young adult Middle age Older adult
Acknowledges the family as the constant in a child’s life adult
Nutrition Substance Female Cardio- Fracture
Builds on family strengths Growth abuse reproductive vascular Fall
Supports the child in learning about and participating in his/her Development Sexual health health risks prevention
care and decision-making activity Occupational Cancer Nutrition
health risks screening Elderly
Honors cultural diversity and family traditions Osteoporosis abuse
Recognizes the importance of community-based services Occupational Dementia
Health issues screening
Promotes an individual and developmental approach
Encourages family to family and peer support
Page 3 of 5
Family Medicine
Health behaviors
Tobacco use, alcohol use, caffeine

Nutrition, diet, obesity
Injuries, accidents, exercise
Infectious disease, stress
Family determinants
Heredo-familial diseases can help predict future problems

Cardiovascular diseases: ischemic heart disease, hypertension
Endocrine disease: DM, thyroid problems
Carcinomas: breast, lung, colon, ovarian
Environmental & community determinants Family wellness system approach

Socio-economic factors Are practical approaches
Sanitation Identified interventions that can be carried out
Food contamination, improper waste disposal Care can be delivered in the house, private clinics, health
Safe and potable water supply centers, school clinics and industrial/ workplace clinics
Family wellness plan I. Family health care program
Child 0-12 years old Practical approaches
Adolescent 13-21 years old
Adult 22-60 years old PRACTICE: a tool used in assessing the family as a unit of care
Elderly ➢ 61 years old
P Presenting Illness, hospitalization, behavioral &
problems relationship problems
R Roles & family
structures
A Affect: family Warmth, sadness, anger, humor
emotional tone
C Communication Verbal, non-verbal
T Time/ stage in
family life cycle
I Illness in the Past & present
family
C Coping with Adaptability, strength, resources
stress
E Ecology & Interaction of family with environment,
culture social, cultural, religious, educational,
medical resources
II. Family doctor’s day
The World Organization of Family Doctors (WONCA) declared

MAY 19 of each year as World Family Doctor’s day
Philippine academy of family physicians lobbied for national
family doctor’s day, now with executive order from President
Benigno Aquino
May 19 of every year: Family Doctor’s day
During this day, all PAFP chapters, accredited programs and
members will devote their time for family screening, health
education & anticipatory guidance
III. Parent’s class/ Responsible parenthood program
Either o both parents can undergo training to become “Family

health advocate”
Page 4 of 5
Family Medicine
IV. Environmental protection program
Community based environmental programs

Home based program for ecology like waste segregation and
recycling
Government agencies which has given emphasis on role of families

in health
Agencies Initiatives
DOH Family health program
Sustainable developmental
goals
Philippine health agenda and
intervention at life stages
DSWD Pantawid Pamilyang Pilipino
Program
DOLE Family welfare program &
family health program
Philhealth Family registration for primary
care benefits/ TSEKAP
Page 5 of 5

FMCH III - FINALS Topic: Continuity and Coordination of Care
Lectured by: Dr. Ronwaldo San Diego

CONTINUITY AND CORDINATION OF CARE IMPORTANCE OF CONTINUITY OF CARE TO PATIENTS
"All people have equal access to quality health services that are co- • Continuity of care becomes increasingly important for
produced in a way that meets their life course needs, are coordinated patients as they AGE, DEVELOP MULTIPLE MORBIDITIES
across the continuum of care and are comprehensive, safe, effective, and COMPLEX PROBLEMS, or become socially or
timely, efficient and acceptable; and all carers are motivated, skilled and PSYCHOLOGICALLY VULNERABLE.
operate in a supportive environment." – World Health Organization o Psychologically vulnerable: Must have Keen eye
and good skills in identifying patient who are
“Comprehensive interaction of roles that governs in applying health care psychologically vulnerable
towards an individual, patients or people as you may know consult in each part
of their lives in each part of their lives to Doctors or health care. For us to give
or provide them a good quality of care, we need combined efforts of other team
memebers or other health care providers in order to give patient a safe,
effective, timely, efficient and acceptable health care service”
WHAT IS CONTINUITY OF CARE

WHAT TYPES OF CASES QUALIFY FOR CONTINUITY OF CARE?
- Continuity of care is how one patient experiences care over time
as coherent and linked • Member of my family is, pregnant.
- Is the result of good information flow, good interpersonal skills, • Member of my family is, presently in an acute hospital or
and good coordination of care. scheduled to be in the hospital immediately
o Maintain good Doctor-Patient relationship
• Member of my family is, presently undergoing a course of
- Continuity of care occurs when separate and discrete elements of chemotherapy, radiation therapy or psychiatric
care are connected and when those elements of care that endure counseling. – needs long-time attention
over time are maintained and supported. • Member of my family is, presently on a Transplant list.
From American Academy of Family Physician (AAF): INTERPLAY OF DIFFERENT ASPECTS IN TERMS ON
- Continuity of care is concerned with quality care over time PROVIDING CARE TO PATIENTS:
- It is the process by which the patient and his/her physician-led care
team are cooperatively involved in ongoing health care
management toward the shared goal of high quality, cost-effective
medical care.
Continuity of care and the patient experience:

- Continuity of care – in the sense of a patient repeatedly consulting
the same doctor and forming a therapeutic relationship.
- Previous physician should always be there
- Seen by the same primary care physician so the patient is comforable in
telling his condition
- Different doctor everytime when the patient is going to check-up, it will be
hard to gather information.
This man’s experience was the opposite of healing.
• Healing requires relationships—relationships which lead to

trust, hope, and a sense of being known.
o Patient consult because of trust
o Trust is very important and must grows
o Establish raport to the patient
• But our healthcare system doesn't deliver healing. It doesn't IMPORTANCE OF CONTINUITY OF CARE HEALTH PRACTITIONER
deliver relationships.
• Increasingly it delivers commodities that can be sold, bought, • Emphasized sharing information, good communication
quantified, and incentivized. within the practice team and establishing systems that
o Money is just secondary supported effective patient management.
o Our primary role is provide quality health care to • Their attempts to coordinate care with professionals
our patient outside the practice were sometimes a source of frustration.
• While the whole-whole people, whole systems, whole
communities - gets worse. THE FOUR DOMAIN OF CONTINUITY
• While governments, health care systems, and individuals
spend more and more on healthcare, for less and less value. 1. INTERPERSONAL CONTINUITY:
- The subjective experience of the caring relationship
between a patient and
his or her health care professional
1


- If patient is seen by Doctor A, when the patient
comes back for follow-up, it must be Doctor A who
will still see her
- Trust, raport and comfort should always be there
and grow
2. LONGITUDINAL CONTINUITY:
- A history of interaction with the same health care
professional in a series
of discrete episodes
- How often the patient must be seen by the Doctor
- Trust, raport, and comfort must always be there and
grows, therefore longitudinal continuity wll be
followed so this will depend on how long or the
frequency the patient will be seen of by the Doctor.
3. MANAGEMENT CONTINUITY:
- Effective collaboration of teams across care
boundaries to provide seamless care
- Being referred to a specialist
4. INFORMATIONAL CONTINUITY:
- The availability of clinical
and psychosocial information at all encounters with
professionals. INTERPERSONAL CONTINUITY
- History, data and charts of patient so if Doctor A will
not be there, there will be good quality of AREAS OF CONTINUTY OF CARE
information that is available for the Doctor B who • Continued relationship and trust among providers, patients
will check-up. So information will not be asked again and caregivers
to the patient. • Care by the same central providers for all care needs
• Flexible, consistent, adaptable care along the continuum
Figure 3 The range of approaches and interventions for achieving • Care adapted to patients’ behavioural, personal, cultural
continuity of care beliefs and family influences
Interpersonal Longitudinal Management Informational o Doctors should adjust in terms of the needs to the
Continuity Continuity Continuity Continuity patient
Continued Discharge Case Positive o We should be sensitive and discuss these thing to
relationship planning management patient- the patient and address it
and trust from across sectors provider • Relational continuity (interpersonal) refers to the ongoing
among admission communication; relationship between the care provider and the patient.
providers, Shared patients • It refers to the duration of relatioship as well as the quality of
patients and Care and collaborative informed of the relationship
caregivers follow-up by care by an what and why • Which is affected by the attentiveness, insipiration of
a professional interdisciplinary their care is confidence, and the medical knowledge of the health
Care by the or team in all team changing professional.
same central settings or
providers for care levels Case-finding and Information
all care needs detection of high- shared among
Links and risk individuals providers and
Flexible, referral settings to
consistent strategies for Proactive, ensure
adaptable care care regular “collective
along professionals monitoring of memory”
the long-term
continuum Care conditions Shared.
navigator or synchronized
Care adapted community Care planning care records
to with the
connector
patients’ perspectives and Standardized.
behavioural, recommendations common
Support by
personal, of multiple clinical
informal
cultural beliefs carer or social providers protocols in all
and family network care settings
influences
2


CLINICIAN CONTINUITY, highly appreciated by patients, refers to SITE CONTINUITY
maintaining a relationship with the same doctor over time. • Means that patients have “usual source of care” as opposed,
In medical education literature, this use appears in family practice, for example: Emergency departments, OPD
general internal medicine, and paediatric journals.
INFORMATIONAL CONTINUITY
LONGITUDINAL CONTINUITY
AREAS OF CONTINUTY OF CARE
AREAS OF CONTINUTY OF CARE • Positive patient-provider communication; patients informed
• Discharge planning from admission of what and why their care is changing
• Care and follow-up by a professional or team in all settings • Information shared among providers and settings to ensure
or care levels “collective memory"
• Links and referral strategies for care professionals • Shared, synchronized care records
• Care navigator or community connector • Standardized, common clinical protocols in all care settings
o Before discharging the patient, identify first the
care navigator Informational continuity where previous patient information is
o Care navigator – who will take care of the patient available (usually through a patient chart or an electronic medical
when he or she is discharged. record) and used to provide patient appropriate care.
• Support by informal carer or social network
Ideally the patient information is available to multiple health care
Clearly, a patient needs to see the same doctor on a number of occasions professionals in different settings.
to enable a therapeutic relationship to develop
Frequency of the patient being seen by Doctor A at the same time RECORD CONTINUITY
• Refers to availability of all the information about a
patient's history, visits, tests, allergies, medications, and
MANAGEMENT CONTINUITY
preferences, in a medical record or clinical database
• To easily shared by all the clinicians caring for the patient,
AREAS OF CONTINUTY OF CARE
whether in the same institution, between institutions, or
• Case management across sectors
between care settings.
• Shared collaborative care by an interdisciplinary team
• Case-finding and detection of high-risk individuals
This improves quality of care in the presence of increasing mobility
• Proactive, regular monitoring of long-term conditions
increasing numbers of people involved in their care, and increasing
• Care planning with the perspectives and recommendations
amount of information to remember
of multiple providers
Provides efficient way of handling datas
• Management continuity involves the use of standards and

protocols to ensure that care is provided in an orderly,
coherent, complementary, and timely fashion.
• Often this applies to when care is being provided my multiple
providers.
• This also includes accessibility (availability of appointments,
medical tests), flexibility to adapt to care needs, and
consistency of care and transitions of care (e.g., the
coordination of home care by a family physician).
3


PRACTICE PRIMARY Care pathways,
OUTCOMES AIM
INTERVENTIONS DRIVERS guidelines, care
Peer support, be coordination
friending and agreements
community social
networks Clinical or care
networks
Community
connectors Single or shared
Interpersonal electronic care
Education and continuity: records
support for a continuing
caregivers therapeutic Information
Information
relationship governance and
continuity:
Community data-sharing
timely,
health agents protocols
comprehensive
and family-
information
centred care Patient and Technology- follows
caregiver enabled care and
patients
Workforce experience of decision support
education for continuity of
holistic practice care and Risk prediction
- Patient-centred smooth, well- tools to target
medical homes coordinated interventions
Longitudinal
- Houses of care care in all
continuity:
- Family health health care ASPECTS OF GOOD PRACTICE
seeing the
teams settings
same
- Health Providing information for patients about the physician in the practice
professional in
navigators Care and and their availability for face-to-face consultation, telephone and
a series of care
- Case support perhaps email contact
episodes
management or meet Integrated
guided care individuals’ people-
Health changing centred
promotion, personal health
prevention and health needs services
enablement
approach Care
professionals
Collaborative and Flexible work well
anticipatory care continuity: together to
planning adjustment of meet the
care plans to needs and
Personal the changing personal
outcome focus needs of the goals of
and goal-centred individual over people for
care time whom they
provide care 1. Ensuring that patients, clinicians and reception staff all know who
is the patient's usual or preferred Doctor
Tailored health and support
literacy and self-
2. Sufficient time in the consultation for interaction that will enable
management
a relationship to form – be sensitive on the patient
coaching
3. Access arrangements that allow patients to exercise choice about

Interdisciplinary
who to consult
team-based Cross-
practice boundary
team 4. Identifying and providing additional help for patients who may
Collocation of continuity: experience access difficulties. Example: Language barrier &
services effective teleconsultation (during COVID-19 and location)
collaboration
Intermediate among For example, because of language or learning difficulties, cultural
care, 'hospital at professionals differences, physical disability, mental health problems or social
in all care isolation.
home’
transitional care settings
4


- Cornerstone of family medicine and key point for the patients.
HOLISTIC APPROACH
- Present in core competences:
o Person-centered;
o Comprehensiveness,
o Community orientation; A approach.
- Promotes health, well-being, empowering patients.
o Preventive side
- Relationship with the same doctor over the time.
PRIORITIES OF CONTINUITY OF CARE
1. CONTINUITY WITH A PRIMARY CARE PROFESSIONAL

- People who have continuous contact with their usual primary
provider have fewer attendances and admissions to an
emergency department for conditions requiring ambulatory
care and are more satisfied with their care
Patient with Mycobacterium Tuberculosis
3. CASE MANAGEMENT FOR PEOPLE WITH COMPLEX NEEDS.

- Having a proactive, continuous relationship in case-finding,
assessment, care planning and care coordination to integrate
the services needed by an individual reduces the probability
that they will experience gaps in care.
- Treatment for TB is 6 months, patient needs continue
relationship with the Doctor for 6 months for treatment to
avoid transmission with other family memebers.

2. COLLABORATIVE PLANNING OF CARE AND SHARED

DECISION-MAKING.
- Having patient centered, goal oriented planning of care and
coaching that enables Pharmacy individuals, families and
informal caregivers to be fully involved in assessment and
decisions about care is a factor in successful care coordination.
- The main priority of medicine is “patient-centered”
COLLOCATED SERVICES OR A SINGLE POINT OF ACCESS.

- Collocation of different professionals, providers and services
and links with people who know local community and
voluntary resources helps people who require chronic care to
navigate and access the services and community support they
need.
5


Community ownership fosters self-reliance
Prevention cuts need for curative care
Training readily transferred to surrounding communities
Holistic needs met
4. TRANSITIONAL OR INTERMEDIATE CARE.

- Effective management of the transition of care from hospital
to home improves the quality of care, speeds functional
recovery, reduces the rate of rehospitalization and reduces
the cost of care.
EXAMPLE CASE:
Mr Yoso a 73 year old patient HPN and Diabetic suffered CVA ischemic
with right sided paralysis. After 1 week of hospitalization he was ordered
MGH. Given with several home medications
After 2 week Mr Yoso came in to follow up and you have noticed multiple
open wounds on the sacral. With unstable vital sign BP of 180/100 CR
112 bpm RR of 23 cpmandtempof39.8.Uponauscultation(+) crackelson 5. COMPREHENSIVE CARE ALONG THE ENTIRE PATHWAY.
both lower lung fields. He also told you that for the past days he has no - Effective care coordination anticipates crises and can
appetite. provide urgent responses by professionals who communicate
well and share information from health and care records
6


- All measures vary from 0-1, with higher values indicating “better”
continuity
- No established standard or “best” measure
- No established threshold
Existing measures of continuity

• Physician-sided continuity (PHY)
• Patient-sided continuity/Usual provider continuity index
(UPC)
• Known provider continuity (KPC)
• Continuity of care index (COCI)
• Sequential continuity (SECON)
Modified Modified Continuity Index (MMCI)
6. **
- All measures vary from 0-1,
o with higher values indicating "better" continuity
7. TECHNOLOGY TO SUPPORT CONTINUITY AND CARE
- No established standard or "best" measure
COORDINATION
- No established threshold
- Tools and platforms for the exchange of information facilitate
adoption of practice interventions and identification of
The Continuity of Care Index (COCI) identifies the number of
people who have multiple conditions, complex circumstances
or have the most to gain from care coordination. physicians providing service to a patient and the percentage of care
provided by each physician.
- Teleconsultation
The index is created for each patient and is calculated by taking the
number of visits to each individual physician divided by the total number
of visits the patient had overall.
This index weights both the frequency of ambulatory visits to each

physician and the dispersion of visits between physicians.
Index values range from just greater than 0 (visits made to a number of
different physicians) to 1 (all visits made to the same physician).
The Continuity of Care Index: How often the patient is always being
8. BUILDING WORKFORCE CAPABILITY
seen by Doctor A
- Developing the skills, strengths and confidence of the wider
workforce ensures that they have the competence to fill their
1. SCC_R: usual provider continuity standardized.
potential roles in delivering continuity and care coordination.
It is the proportion of visits made to the most frequently seen
- There should be team effort and everything should function
provider standardized to a mean of 0 and variance of 1.
in their fullest capacity in terms of their competencies. • How many times did the Doctor B seen the same
patient
2. COC_R: sensitive to changes in the total number of visits and in

their distribution across different providers.
It ranges from 0 to 1, where 0 occurs when each visit is to a different
provider and 1 occurs when all visits are to one provider
3. SECON_R: measures the sequential nature of provider continuity.

It is the fraction of sequential visit pairs at which the same provider
is seen.
Like COC_R, it ranges from 0 to 1, but in contrast is dependent on
the sequential order of visits.
A patient who alternates between two providers will have a score
MEASUREMENT OF CONTINUITY OF CARE of 0.
1. For research such as studying the influence of continuity on IMPORTANCE OF CONTINUITY OF CARE
specific outcome
2. Main use is for monitoring performance and quality assurance
1. Greater efficiency due to better communication and trust,
facilitating information gathering.
How do we measure continuity?
2. Increased safety because communication and awareness of subtle
• Patient survey data
changes not included in the electronic record or clinical guidelines.
• Administrative data
3. Higher patient satisfaction because of better reassurance and
confidence in care.
7


EVIDENCE IN SUPPORT OF GOOD CONTINUITY OF CARE
Continuous care not only increased patient satisfaction but also allowed
the doctor to accumulate knowledge that saved time, influenced their
use of laboratory tests, allowed for management, and to a lesser degree
affected the use of medication
MEASUREMENT OF CONTINUITY OF CARE INTERPERSONAL CONTINUITY

• Establishment of open communication and strong interpersonal
INTERPERSONAL CONTINUITY bond between the patient and the healthcare provider that reflects
- Relational continuity is usually measured by using either the the cooperation between them.
affiliation between patient and provider, or how long their • The physician also demonstrates an empathic and listening-
relationship has lasted as a proxy for continuity. based approach in handling the patient.
- There is a growing impetus to evaluate ongoing relationships • He follows the treatment guidelines set forth by healthcare
by asking patients and providers directly how strong their ties institutions but implements them with consideration of the
are. patient's customs, belief, socioeconomic status and respects the
- Trust, raport and confidence patient's autonomy.
• Lastly, the healthcare provider ensures his availability in providing
his service all throughout the treatment process.
- Measures of informational continuity relate to the
availability of documentation, the completeness of
LONGITUDINAL CONTINUITY
information transfer between providers, and to the extent to
• Physician carefully assess the condition of the patient and discharge
which existing information is acknowledged or used by a
him at an appropriate time wherein the patient has recovered and
provider or patient.
- Availability of records won't be able to transmit the disease to other family members.
• The physician also should set a schedule for follow-up to monitor
MANAGEMENT CONTINUITY the condition of the patient and ensure that he is compliant to his
- Measures of management continuity focus on the delivery prescribed treatment.
of one aspect of care in the continuum of the management • Oftenness of patient seeing by Doctor B
plan, most commonly whether follow-up visits are made when • You should always give extra time to patient
care crosses organizational boundaries. • Follow-up is under longitudinal continuity
- Measures of compliance with management protocols blur the
boundary between assessment of continuity and quality of MANAGEMENT CONTINUITY
medical care. • The physician considers the overall condition of the patient to
prevent a possible recurrence of the disease.
• The family members are also screened for tuberculosis since this
is a contagious disease, especially if there is a presence of risk
factors.
• Co-morbidities are also noted which may affect the course of
treatment.
• Clinical practice guidelines set by the department of health is
being applied by the healthcare provider to the patient.
• There is clarification of the patient doubts and other concerns
about the management.
• The physician keeps record of the patient's profile and updates it
from time to time.
8


• Build and continue to have a good

relationship as establishing good rapport by
explaining the condition of the patient
Interpersonal
• Get the Patient trust to get back on the same
Continuity
physician by giving the idea that PTB is highly
curable nowadays
• Know the family background of the patient
• Explain that patient about being outpatient;
• Also there will be a duration of 6 months
treatment, and the importance of taking Anti
Longitudinal
TB drugs as prescribed to make the treatment
Continuity
work and prevent to repeating the treatment
• Make a note that patient needs to follow up
and do some laboratory exam after treatment
• 6 months treatment of taking Anti-TB drugs
such as the Rifampicin, Isoniazid,
Pyranizamide, Ethambutol (RIPE) as for
Category 1
Management • Four months taking for RIPE as for intensive
Continuity phase and 2 months for Isoniazid &
Rifampicin for continuous phase
• Ask the patient to get back at the end of two
months of intensive phase to check for
sputum
• Check the Patient's Medical History if it is
available to know more other possible
complication or drug interaction may
interrupt the treatment
Informational • Ask the patients on its previous
Continuity hospitalization
• After treatment check the Chest Xray and
Sputum test
• If the said test above are negative, make the
certificate of completion in TB treatment
9
The World Book of Family Medicine – European Edition 2015
Francesco Carelli
francesco.carelli@alice.it
48 – Continuity of Care
Francesco Carelli Continuity of care is a cornerstone of family medicine and a key point for patients.
Professor, EURACT Council It has been included by EURACT (European Academy of Teachers in General Practice
Executive Board, and Family Medicine), in “Person-centred care”, and one of the “Core competences of
BME Committee Chair, LJPC GP/FM”(1), as the ability “to provide longitudinal continuity of care as determined by
International Editor the needs of the patient, referring to continuing and co-ordinated care management”.
It can be interpreted as following the patient from birth (sometimes also before) until
death (sometimes even after), throughout their whole life.
Continuity of care, also described as ‘the ability to manage in continuity of time, in
the individual, a series of multiple complaints and pathologies, both acute and
chronic health problems’ (3), enables doctors to promote health and well-being by
applying health care and disease prevention strategies appropriately, as described in
another core competence, the “Comprehensive Approach”.
It is firmly bound to other core competencies, in the “Holistic Approach” (considering
a biopsychosocial model taking into account cultural and existential dimensions), and
“Community Orientation” (also taking into account the community in which the
individual patient lives and trying to reconcile health needs of both individual patient
and community in balance with available resources).
With continuity of care, it is possible to adequately handle risk factors by promoting
self-care and empowering patients.
The family doctor knows the community's potential and limitations, health needs,
epidemiological characteristics, interrelationships between health and social care,
impact of poverty, ethnicity, and inequalities in health care. He also needs to have an
understanding of the structure of the health care system, with its economical
limitations, the correct use of its services by patient and doctor (referral procedure,
co-payments, sick leave, legal issues etc.) in their own context. All this is possible
through provision of continuity of care by GP/Family Doctor.
The multiple dimensions of continuity

Fletcher et al. (3) distinguish between “coordination” as “the degree to which various
components of care bear a useful relation to each other”, and “continuity” as “the
existence of some thread - individual, practitioner, group, or medical record - that
bind together episodes of care”. But the term ‘continuity of care’ has been used to
describe a great variety of relationships between patients and the delivery of health
care. (4)
Record Continuity refers to availability of all the information about a patient's history,
visits, tests, allergies, medications, and preferences, in a medical record or clinical
database, easily shared by all the clinicians caring for the patient, whether in the
same institution, between institutions, or between care settings. This can improve
1
The World Book of Family Medicine – European Edition 2015
quality of care in the presence of increasing mobility of patients, increasing numbers of people involved in their care,
and increasing amount of information to remember.
Clinician Continuity, highly appreciated by patients, refers to maintaining a relationship with the same doctor over time
(5). In medical education literature, this use appears in family practice, general internal medicine, and paediatric
journals.
Both record and clinician continuity are used in the definition of primary care that describe it as accessible,
continuous, comprehensive, family centred, coordinated, and compassionate, delivered or directed by well-trained
physicians, both able to manage or facilitate essentially all aspects of care and linked to the patient and family in a
relationship of mutual responsibility and trust with them. Of course nobody can be available 24 hours/day, but a GP/FD
can usually manage the care of a patient with occasional intervention of nurses or other colleagues, ward or
emergency doctors, or specialists, when not present. In various surveys, patients showed a preference for single doctor
practices, or multi-practice where they can see their own FD, even in limited hours, than for “Polyclinics” with rotas of
doctors and 24/7 visiting hours.
Clinician continuity is thought to be important, in that not all information is included in the medical records, and a
clinician who knows a patient can recognize significant changes, with a period of reference to go by (the patient as
his/her own control). Behaviour and body language compared to patients’ previous visits may be as important as
clinical findings in identifying a significant event.
A continuous relationship can promote trust, a core part of the clinician-patient relationship and possible part of the
healing process. Trust and mutual respect facilitate patients divulging private information, or posing questions
otherwise. This relationship is important not only to patients, but also to the clinicians, representing a valued part of
medical practice.
Site Continuity means that patients have a "usual source of care" as opposed, for example, to unrelated emergency
departments.
Continuity also appears in the literature as synonymous with accessibility or availability or even with compliance, such
as following post-hospital discharge instructions or follow-up appointment keeping.
The Continuum of Care. In long-term care literature, continuity is used as a synonym for the continuum of care (7)
which is defined as a client-oriented system composed of both services and integrating mechanisms that guides and
tracks patients over time through a comprehensive array of health, mental health, and social services spanning all
levels of intensity of care.
Continuity as an Attitudinal Contract. Finally, continuity has been described as a "contract of attitudes” (8). There is a
“cornerstone caregiver” who is in charge of the patient's care and is the sole responsible for decisions and for
communicating information to the patient and his or her family. If the previous uses of the term “continuity” could be
considered retrospective (to what extent has it occurred), the attitudinal contract - whether called coordination,
integration, or continuity - could be considered concurrent and prospective.
Continuity and Improved Outcomes of Care

Linking the degree of continuity, however defined, with improved clinical outcomes (e.g., for chronic problems,
preventive care) has been reviewed by Starfield , concluding that continuity of care is “associated with more indicated
preventive care, better identification of patients’ psychosocial problems, fewer hospitalizations (in emergency and in
general), shorter lengths of stay, better compliance with appointments and taking of medications, and more timely
care for problems”.
Take home messages

 Cornerstone of family medicine and key point for the patients.
 Present in core competences ( person-centred; comprehensiveness, community orientation; holistic
approach.
 Promotes health, well-being , empowering patients.
 Relationship with the same doctor over the time.
2
Blackwell Science, LtdOxford, UK
AFMAsia Pacific Family Medicine1444-1683© 2002 Blackwell Publishing Asia Pty Ltd
12-3August-December 2002
041
New in family medicine
LG Goh
10.1046/j.1444-1683.2002.00041.x
New GuidelinesBEES SGML
Asia Pacific Family Medicine 2002; 1: 57–58
REGIONAL ROUNDUP
What is new in family medicine?

Lee Gan GOH
Wonca Regional Vice President
Focus
Introducing a Guidebook on the Family medicine helps the different partners to
Contribution of Family Medicine focus on meeting people’s health needs
Divergent perspectives and conflicting priorities exist
for Improving Health Systems in all communities. Family medicine, because of its
A seminal guidebook titled Improving Health Systems: holistic outlook, can help to focus on basic unifying
The Contribution of Family Medicine has been released in priorities such as the health status of each person
April this year.1 within the community, the collective health of the
This guidebook is the outcome of the collaboration people, and work towards more equitable distribution
of the World Organization of Family Doctors (Wonca) of health care resources. Shared solutions can emerge
and the World Health Organization and the result of from this focus that maximizes the strengths and
the labors of a large number of leaders in family medi- aptitudes of partners whose contributions can then be
cine and public health. indispensable for a coherent approach to health ser-
This guidebook should have a place with every fam- vice delivery. The exact health care delivery solutions
ily doctor and every stakeholder who is working must vary according to the socioeconomic and devel-
towards improving health systems in their part of the opmental circumstances of a society. Leaders of society
world. These stakeholders include the policy makers, need to make critical decisions in order to implement
health managers, communities, academic institutions family medicine optimally within their specific coun-
and health professionals of all levels. Together with the tries in such a way that it could play the focusing role.
family doctors, they form the partnership pentagon.
It is increasingly clear that the reduction of disease Unify
burden in a locality, community, nation and region
Family medicine helps to unify the resources
is contingent upon uniting the existing stakeholders
needed to improve health care systems
through a strong partnership. Out of this partnership
comes the synergy from a common alignment of Resources that are dispersed and divergent cannot
vision, focus and resources to deal with what will make improve the health status of the people. Health for all
a difference in the health status of the people served. through primary health care is accepted as the basis of
The guidebook is about how to leverage the poten- effective health care systems from developed countries
tial of family medicine to meet the most important to developing countries. The seamless integration of
health needs of individuals and populations. There are the three levels of health care – tertiary, secondary and
five elements in meeting people’s health needs and primary – can only come about with the stakeholders
reducing the nation’s disease burden. working in unison. The resources that are concentrated
together can be used to ensure that there is/are:
• Prioritization of essential services
• Adequate organization and financing
• Consistent service delivery
Correspondence: Professor Lee Gan Goh, Wonca Regional
• Incentives that reinforce priorities
Vice President for Asia Pacific, College of Family Physicians • Proper equipment and facilities and
Singapore, College Medicine Building, 16 College Road • Appropriate training and support of health care
#01–02, Singapore 169854, Singapore. providers at each level of healthcare provision.
Email: cofgohlg@nus.edu.sg Family medicine and public health elements work-
Accepted for publication 7 October 2002. ing in unison can be the starting point if the unifica-
REGIONAL ROUNDUP
www.blackwell-science.com/afm 57
LG Goh
tion of resources based on partnership and trust of the personal, continuing and comprehensive care for the
different stakeholders that provide health care directly individual, family and community. This requires
or indirectly. These include the funding agencies and policy decisions and allocation of adequate training
organizations. and development resources for infrastructure, training
process and continuing professional development.
Recognise Details to achieve these are described in the guidebook.
Family doctors can contribute much health care Support

systems
Family practice needs supportive environment for
Family doctors provide primary, personal, continuing
it to be optimally effective
and comprehensive care to individuals, families and
the community. They can contribute as effective clini- A supportive environment is necessary for optimal
cians. They can also contribute as health care coordi- practice of any healthcare discipline. This is true of
nators, as leaders, managers and supervisors. Make family practice also. A supportive environment for
them the pivots of the health care system. practice, teaching, and research is needed for family
practice to be optimally effective. Relationships,
Empower resources, and reforms are needed for a supportive
environment to emerge. Family medicine leaders how-
Family doctors can help only if they are empowered ever, must make the first move. Armed with this guide-
through training and development book and the vision of reducing disease burden, they
Family doctors like their public health and hospital can begin their work to convince the relevant stake-
counterparts need empowerment through training holders to form the partnership pentagon. The writers
and development. The family doctor needs to be holis- of this guidebook will not have labored in vain. Carpe
tic, patient-centred, and be trained to provide primary, Diem
Reference
1 Kohn C, Haq C, Rivo M, Shahady E., Improving Health
Systems: The Contribution of Family Medicine.Singapore:
Wonca,2002.
58 www.blackwell-science.com/afm
support guidance, products and tools
Reaching underserved
and marginalised Practices Knowledge
Policy briefs Benefit entitlements design management
Strategic purchasing Resources
Innovation Multidisciplinary team work
Integrating traditional and
Population-based complementary medicine
services Communities
People’s rights
Integrating
vertical Participatory Capacity
Practice programmes assessment and
briefs planning toolkit building
Clinical
governance Indicators and
Continuity and performance
coordination of care measurement
Virtual courses
Advocacy and Advocacy brief
Primary health care Position
overall strategy papers
Critical pathways Hospitals

towards IPCHS
FRAMEWORK
ON IPCHS
(Resolution
WHA69.24, 2016)
Resolution WHA62.12 on primary health care, including health system strengthening (2009)
The world health report 2008: primary health care now more than ever
5
Continuity and coordination of care
A practice brief to support implementation of the WHO Framework on integrated people-centred health services
Glossary
Care coordination: a proactive approach to bringing People-centred care: an approach to care that
together care professionals and providers to meet consciously adopts the perspectives of individuals,
the needs of service users to ensure that they carers, families and communities as participants in
receive integrated, person-focused care across and beneficiaries of trusted health systems that
various settings. are organized around the comprehensive needs
of people rather than individual diseases, and that
Case management: a targeted, community-based,
respect social preferences. People-centred care
proactive approach to care that involves case finding,
is broader than patient and person-centred care,
assessment, care planning and coordination to
encompassing not only clinical encounters, but also
integrate services to meet the needs of people with
including attention to the health of people in their
long-term conditions.
communities and their crucial role in shaping health
Continuity of care: the degree to which a series of policy and health services.
discrete health care events is experienced by people
Person-centred care: care approaches and practices
as coherent and interconnected over time and
in which the person is seen as a whole, with many
consistent with their health needs and preferences.
levels of needs and goals, the needs being derived
eHealth: information and communication from their personal social determinants of health.
technologies that support remote management of
Population health: an approach to improving the
people and communities with various health care
health outcomes of a group of individuals, including
needs by supporting self-care and enabling electronic
the distribution of outcomes within the group.
communication among health care professionals
and patients. Primary care: the provision of integrated, accessible
health care services by practitioners who are
Empowerment: supporting people and communities
accountable for addressing a large majority of personal
in taking control of their own health, resulting,
health care needs, developing sustained partnerships
for example, in healthier behaviour or self-management
with people, and practicing in the context of the family
of illnesses.
and community. In some regions, it is also referred
Engagement: involving people and communities in to as the first level of care.
the design, planning and delivery of health services
Primary health care: essential health care based on
that, for example, enable them to make choices
practical, scientifically sound and socially acceptable
among care and treatment options or to participate
methods and technology made universally accessible
in strategic decision-making on how health resources
to individuals and families in the community, through
should be spent.
their full participation and at a cost that the community
High-quality care: care that is safe, effective, people- and country can afford to maintain, at every stage
centred, timely, efficient, equitable and integrated. of their development in the spirit of self-reliance
Integrated health services: health services that are and self-determination. It is the first level of contact
managed and delivered so that people receive a of individuals, the family and community with the
continuum of health promotion, disease prevention, national health system, bringing health care as
diagnosis, treatment, disease management, close as possible to where people live and work,
rehabilitation and palliative care services, coordinated and constitutes the first element of a continuing
across the different levels and sites of care within health care process.
and beyond the health sector and according to their
needs throughout the life course.
8
Executive summary
This practice brief addresses the relatively ill-defined, The practice brief is based on the classification
under-researched concepts of continuity and care published in reviews of continuity (4) and
coordination, which are broad and interrelated. coordination (1). Interpersonal continuity, sometimes
• Continuity of care: reflects the extent to which a referred to as “relational continuity”, results in
series of discrete health care events is experienced trusting relationships, which are more likely to
by people as coherent and interconnected over ensure empathic, collaborative consultations in which
time and consistent with their health needs people understand their conditions and medicines.
and preferences. It thus enhances empowerment, enablement and
• Care coordination: a proactive approach to adherence to treatment. Longitudinal management
bringing together care professionals and providers and informational continuity create the conditions for
to meet the needs of service users, to ensure more informed interactions over time and seamless
that they receive integrated, person-focused care coordination of care and support. The classification
across various settings. helps to frame the various practice interventions that
support continuity and care coordination.
Without good continuity or coordination of care and
support, many patients, carers and families experience A targeted literature review identified practice
fragmented, poorly integrated care from multiple intervention that increase continuity and care
providers, often with suboptimal outcomes and risk coordination and improve the experience of care
of harm due to failures of communication, inadequate for both patients and providers, improve the quality
sharing of clinical information, poor reconciliation of of care, enhance health outcomes or contribute to
medicines, duplication of investigations and avoidable improved health system performance (Figure 1).
hospital admissions or readmissions (1). This is a Analysis of the evidence identified eight priorities for
particular problem for people with chronic or complex intervention and action. For each priority, we describe
conditions that require care and support, many of the approach and its impact on the experience or
whom have multiple conditions associated with a outcomes of care and provide examples from both
low income or complex circumstances, who are often high-income and LMI countries. When possible,
underserved, in both high-income (2) and low- and the examples are linked to more comprehensive
middle-income (LMI) countries (3). Continuity and reviews or case studies.
coordination of care are therefore global priorities for
A detailed discussion of the management of change
reorienting health services to the needs of people.
is outside the scope of this document. However,
They are important for all health care systems and
we highlight some practical actions for implementation
economies, for care providers in a range of settings
of the eight priority practices.
and at all life stages.
9
Figure 1 Continuity and care coordination: key messages from the literature
.
75% High continuity means
13% fewer hospital
Patients who value seeing their
admissions (6).
usual primary care provider (5).
63% High continuity means

27% fewer visits to an
Patients who value seeing
emergency department (7).
someone they know and trust (5).
Coordinated home-based Hospital at home

primary care results in 17% results in 19%
lower medical costs (8). lower care costs (9).
People with mental health

Over 4 out of 5 needs who can be managed
23 out of 25 studies
of medical homes reported
through primary care (10).
reduced use of care (11).
10
1. Introduction
This practice brief is part of a suite of tools for implementing the WHO Framework on
integrated people-centred health services (IPCHS) (12).
This global framework (Annex 1) presents an Relationships

ambitious, compelling vision for a future, in which
Continuity enables care coordination by creating
the conditions and ongoing relationships to support
“All people have equal access seamless interactions among multiple providers,
within interdisciplinary teams or in care settings
to quality health services that or sectors.
are co-produced in a way that

meets their life course needs,
are coordinated across the “Without relationships built on
continuum of care and are security, reliability and continuity,
comprehensive, safe, effective, case management wasn’t
timely, efficient and acceptable; as effective.”(13)
and all carers are motivated,
skilled and operate in a Both continuity and care coordination bridge all five
IPCHS strategies and are critical to achieve people-
supportive environment.” centred care. They are perhaps most closely aligned
to the IPCHS strategies on Reorienting the model of
care and Coordinating services within and across sectors
The Framework proposes five interdependent around the needs of people. Continuity of care is also
strategies (Figure 2) that need to be adopted in a strong foundation for the trusting relationships,
order for health service delivery to better respond to shared decision-making and co-production of health
people’s needs throughout their life course. Action and well-being described in the strategy on Engaging
on each of these strategies is intended to have an and empowering people and communities.
influence at different levels – from the way services Implementation of continuity and care coordination
are delivered to people, families and communities, requires leadership support, information systems and
to changes in the way organizations, care systems educational, financial and contractual levers, which
and policy-making operate. Put together, the five are described in Creating an enabling environment.
strategies represent an interconnected set of actions Assuring effective continuity and care coordination
that seeks to transform health systems to provide also requires a number of system actions for
services that are more people-centred and integrated. Strengthening governance and accountability, including
strengthened integrated health services governance
and management at subnational and local levels.
12
INTRODUCTION
Figure 2 The five interdependent strategies of the WHO Framework on integrated people-
centred health services (IPCHS)
Engaging and empowering
people and communities
Coordinating services Creating an enabling Strengthening governance

within and across sectors environment and accountability
Reorienting the
model of care
Evidence review Limitations

The method used for the targeted literature review Much of the current evidence base is from managed
on continuity and care coordination is described in care settings in high-income countries, as many reviews
Annex 2. We conducted neither a full systematic of patient–provider relationships and continuity of
review nor a review of all aspects of IPCHS. Rather, care excluded studies in LMI countries on the basis of
the review focused on a classification of continuity language or other criteria developed in high-income
and care coordination, the relation between the two countries (14). The analysis was nevertheless tested
concepts and their impact on outcomes for people against key themes in a scoping review of the literature
and for health care systems. on the experience of compassion and continuity of
care in Latin American and Caribbean countries.
The search yielded 81 articles that were retained for
full reading: 21 were systematic reviews, 39 were In many countries, continuity and coordination
primary empirical studies, and 21 were “grey” literature depend heavily on the contribution of informal
on approaches and interventions in continuity and caregivers and family support. This is particularly
care coordination. The papers were analysed to true in LMI countries and where there are shortages
identify actionable priority practices associated with of health care workers and many dispersed, remote
good quality of care, improved outcomes or a positive communities. A targeted search of grey literature
patient or carer experience. revealed practice examples from a range of health
care systems, including in LMI countries, by various
providers, in a range of care settings and across the
different life stages.
13
2. Concepts
Continuity and care coordination are closely related. Continuity enables care coordination
by creating the conditions and relationships to support seamless interactions among
multiple providers within interdisciplinary teams or across care settings or sectors.
Two recent studies show that a continuing relationship In high-income countries and in emerging economies,
with a primary care professional is a solid platform as expectations rise, the public may by-pass their
for the effective collaboration and communication primary care professional to access hospital services
required to coordinate care and to improve the patient directly (16). Access to services may differ significantly
experience and outcomes. between affluent and less affluent regions (3) and
between permanent residents and migrants (17).
• An international health policy survey conducted
by the Commonwealth Fund in 2013 found a A review of the literature on interpersonal continuity,
significant association between a continuing from the perspectives of primary health care users
relationship with a primary care physician and in Latin America and the Caribbean, (18) explored
better care coordination outcomes (15). the relations between continuity, person-centred
• Analysis of linked data on primary and secondary care, coordination and outcomes in LMI countries,
care for 230 472 adults aged 62–82 years in 200 where care is highly variable and poorly regulated (19)
general practices in England showed that patients and people have limited opportunities for shared
who saw the same general practitioner a greater decision-making. Table 1 lists the impacts, enablers
proportion of the time had fewer admissions to and influencers of continuity and compassion in
hospital for ambulatory care-sensitive conditions (6). this context.
Table 1 Interpersonal continuity of care and compassion in low- and middle-income countries
Impact on people who receive care • Perceived comfort, rapport and trust
and support • Continuity of care
• Person-centred care processes
• Coordination of care based on personal trajectory
• Motivation and adherence
Enablers • Clarity and availability of information

• Sensitive oral and non-verbal communication
• Education for providers and informal caregivers
• Privacy and reduction of stigmatization
• Gender and community empowerment
Influencers • Gender and attitude of providers

• Time
• Perception of public as opposed to private health care
• Culture and language
• Civil and military conflicts
Source: adapted from (18).
16
CONCEPTS
Classification Sequential coordination and parallel coordination are

different ways of providing management continuity,
Deeny and colleagues (4) framed continuity as a in which professionals collaborate to provide seamless
complex concept with multiple dimensions and care across care boundaries. Many of the system
updated earlier frameworks described by Freeman influencers or enablers of care coordination, such as
et al. (20) and Haggerty et al. (21). protocols, pathways, financial incentives, technology
The four domains of continuity in the new and education, enhance management and informational
Framework are: continuity of care.
• interpersonal continuity: the subjective experience
of the caring relationship between a patient and Practice interventions
his or her health care professional;
• longitudinal continuity: a history of interaction Understanding these distinct elements helps to
with the same health care professional in a series frame the range of approaches and interventions
of discrete episodes; that support the delivery of continuity and care
• management continuity: effective collaboration of coordination. Figures 3 and 4 give examples of
teams across care boundaries to provide seamless practice interventions. The literature review identified
care; and interventions that enhance continuity and care
• informational continuity: the availability of clinical coordination, improve the experience and health
and psychosocial information at all encounters outcomes of people receiving long-term care
with professionals. or support, enhance the provider experience or
contribute to improved health system performance.
Øvretveit (1) described three types of clinical coordination: Effective models of integrated people-centred care
• sequential: planned handover of responsibility and often combine several practice interventions that
transfer of care; support different aspects of continuity and care
• parallel: collaboration among professionals with coordination. These may be integrated to amplify
agreed sharing of responsibility; and their effect at various stages of the pathway of care
• indirect influence: enabling coordination through and are, ideally, delivered within a comprehensive
tools, incentives or education. programme that can be tailored to a specific condition
This classification of the elements of continuity and or care group.
care coordination indicates some overlap. For example,
interpersonal continuity and longitudinal continuity enable
effective coordination of care for the needs of the
individual, so that the care is integrated and person-
centred in various episodes and care settings.
17
Figure 3 The range of approaches and interventions for achieving continuity of care
Interpersonal Longitudinal Management Informational

continuity continuity continuity continuity
Continued Discharge planning Case management • Positive

relationship and from admission across sectors patient provider
trust among • Care and follow-up Shared communication;
providers, patients by a professional or collaborative care patients informed of
and caregivers team in all settings by an what and why their
Care by the same or care levels interdisciplinary care is changing
central providers for Links and referral team • Information shared
all care needs strategies for care Case-finding and among providers and
• Flexible, consistent, professionals detection of settings to ensure
adaptable care along high-risk individuals collective memory
Care navigator or
the continuum community Proactive, regular • Shared,
Care adapted to connector monitoring of synchronized care
patients’ long-term conditions records
• Support by informal
behavioural, carer or social Care planning with • Standardized,
personal, cultural network the perspectives and common clinical
beliefs and family recommendations of protocols in all care
influences multiple providers settings
18
CONCEPTS
Figure 4 The range of approaches and interventions for optimizing care coordination
• Cross-sectoral care plans and discharge planning

• Technology systems to promote information transfer and sharing of care among
settings
Sequential Collocating multidisciplinary professionals
coordination • Shared, collaborative single point of entry to care
• Primary and specialist care referral pathways and processes
Specialist outreach and case-finding
Interdisciplinary teams
Care coordination roles (e.g. case and care managers, system navigators)
Parallel • Formal assessment tools (e.g. goal-setting, geriatric assessments)
coordination • Individualized and tailored care plans
Self-management support
Specialist support and training
Role clarification and agreements within and between sectors (e.g. accountability
agreements, care pathways and protocols)
System enablers Collaborative training and education of providers to improve skills and competence
for coordination uality improvement tools to assess and improve coordination
Technology enablers for care coordination
Continuity drives care coordination episodes and settings with changing needs and
well-coordinated, effective interdisciplinary practice.
A “driver diagram” represents the results chain or the These outcomes combine to contribute to the overall
hierarchy of contributions that may be anticipated aim of IPCHS.
from a package of interventions and processes
to deliver a desired outcome. Figure 5 shows a From analysis of the evidence for these practice
driver diagram for continuity and care coordination. interventions, we have identified eight priority
It illustrates the contributions of practice interventions approaches with evidence for action. For each
to the various aspects of continuity, to achieve the priority, we describe the approach and the impact on
desired outcomes: a positive experience of care, the experience or outcomes of care. The examples
a smooth, well-coordinated transition through care selected draw on the scientific and grey literature
from both high-income and LMI countries.
19
Figure 5 Drivers of continuity and care coordination
Practice
Primary drivers Outcomes AIM
interventions
• Peer support, befriending and community social networks

• Community connectors Interpersonal continuity:
• Education and support for caregivers a continuing therapeutic
• Community health agents and family-centred care relationship Patient and
• Workforce education for holistic practice
caregiver
experience of
• Patient-centred medical homes continuity of care
Longitudinal continuity:
• Houses of care and smooth,
seeing the same
• Family health teams well-coordinated
professional in a series of
• Health navigators care in all health
care episodes
• Case management or guided care care settings
Integrated
• Health promotion, prevention and enablement approach Flexible continuity: Care and support people-
• Collaborative and anticipatory care planning adjustment of care plans meet individuals’ centred
• Personal outcome focus and goal-centred care to the changing needs of changing personal health
• Tailored health literacy and self-management coaching the individual over time health needs services
Care professionals
• Interdisciplinary team-based practice Cross-boundary
work well together
• Collocation of services team continuity:
to meet the needs
• Intermediate care, “hospital at home”, transitional care effective collaboration
and personal goals
• Care pathways, guidelines, care coordination agreements among professionals in
of people for whom
• Clinical or care networks all care settings
they provide care
and support
• Single or shared electronic care records Information continuity:
• Information governance and data-sharing protocols timely, comprehensive
• Technology-enabled care and decision support information follows
• Risk prediction tools to target interventions patients
20
3. Priority practices
Continuity and care coordination have the greatest community and voluntary resources helps people
impact when practice interventions are delivered in who require chronic care to navigate and access the
a “bundle” along the care pathway, ideally as part of services and community support they need.
a comprehensive model of care with primary care
5. Transitional or intermediate care. Effective
as its focus.
management of the transition of care from hospital to
The evidence suggests eight key actionable priorities: home improves the quality of care, speeds functional
recovery, reduces the rate of rehospitalization and
1. Continuity with a primary care professional.
reduces the cost of care.
People who have continuous contact with their
usual primary care provider have fewer attendances 6. Comprehensive care along the entire pathway.
and admissions to an emergency department for Effective care coordination anticipates crises and can
conditions requiring ambulatory care and are more provide urgent responses in the evening and at the
satisfied with their care. weekend by professionals who communicate well
and share information from health and care records
2. Collaborative planning of care and shared
decision-making. Having person-centred, goal-
oriented planning of care and coaching that enables 7. Technology to support continuity and care
individuals, families and informal caregivers to be fully coordination. Tools and platforms for the exchange
involved in assessment and decisions about care is of information facilitate adoption of practice
a factor in successful care coordination. interventions and identification of people who have
multiple conditions, complex circumstances or have
3. Case management for people with complex
the most to gain from care coordination.
needs. Having a proactive, continuous relationship
in case-finding, assessment, care planning and care 8. Building workforce capability. Developing
coordination to integrate the services needed by the skills, strengths and confidence of the wider
an individual reduces the probability that they will workforce ensures that they have the competence
experience gaps in care. to fill their potential roles in delivering continuity and
care coordination.
4. Collocated services or a single point of access.
Collocation of different professionals, providers and
services and links with people who know local
22
PRIORITY PRACTICES
Priority 1: Continuity with a primary care professional

Description and shorter consultation times with their primary
care providers (2).
A positive, continuing relationship with a named
primary care professional within the extended Since much of the published evidence is from
primary care team. countries with established community health and
primary health care systems, interventions should be
adapted for LMI countries with less well developed
primary care. In addition to extending universal
“A trusting relationship with health coverage, plans to ensure the continuity of
consultations with a primary care professional should
someone who knows me.” address challenges of access and transport for people
living in remote and rural communities.
Why this is a priority Impact

Consulting someone who has the time to listen and Barker et al. (6) reported that patients in the United
has information on a patient’s previous clinical history Kingdom who saw the same general practitioner most
is particularly important for those with chronic or of the time had 13% fewer admissions to hospital for
complex conditions, who have to consult professionals conditions requiring ambulatory care than patients
more often and therefore value continuity of care. with less continuous care. The evidence was stronger
People with complex needs place more value on for older patients and for people with the most
continuity than on speed of access (22), unless they primary care contacts.
are consulting for a new problem or appointment In primary care in Quebec, Canada, older patients
times are directed by other commitments. with medium continuity of care, measured with the
Primary care practitioners generally consider usual provider-of-care index, made 27% more visits
continuity of care to be a core value of their profession to an emergency department than those with high
and that the continuity of a therapeutic relationship continuity of care (7).
increases their understanding of individual needs and A telephone survey by the Commonwealth Fund
circumstances, so that they can tailor care to what in 2015 in 11 high-income countries showed that
matters to their patient (6). Longitudinal continuity a continuous relationship with a primary care
over various episodes of care can be measured professional was associated with a lower probability
with the usual provider-of-care index, which is the of poor primary care coordination, defined as at
proportion of all contacts for primary care with the least three gaps in care coordination in the previous
health professional seen most frequently. People who two years (15).
live in poor areas often have longer waiting times
23
Continuity of primary care provider: patient-centred

medical home (PCMH), United States of America
A partnership between patients, families, access at all times and alternative methods
caregivers and a primary care provider can build of communication through technology; and
trusted relationships with an interdisciplinary
• committed to quality and safety: quality
team of clinicians and staff connected to
improvement methods and tools are used
the “medical neighbourhood” and the local
to support patients and families in making
community. The five core elements are:
informed decisions about health.
• patient-centred: support for full involvement
of people in planning care and managing Outcomes for people: personalized care
and organizing their own care according to plans, medication review, coaching, advice and
their preferences; peer support.
System impact: reductions in one or more
• comprehensive: holistic care from a team
measures of cost in 21 studies and a reduction
that is accountable for the patient’s physical
in health care use in 23 studies.
and behavioural health needs, including
prevention and wellness, acute care and Challenges: implementing PCMH with
chronic care; fragmented incentives and fee-for-service
payment models that fail to compensate for
• coordinated: care that includes specialty the scope of PCMH services.
care, hospitals, home health care, community
Enablers: payment reform to incentivize care
services and long-term care;
coordination; patient communication, telephone
• accessible: shorter waiting times, more flexible and e-mail encounters; population health
in-person hours, electronic or telephone management and quality improvement.
Source: (11).
24
PRIORITY PRACTICES
Continuity with community health workers: family health

teams, Brazil
Each multidisciplinary health care team in a family practice, including dental care and medications;
health unit serves up to 4000 people in a defined higher breastfeeding and vaccination rates.
area and includes about six community health System impact: more accurate health care
workers, each of whom has a caseload of up to registration and statistics, fewer avoidable
150 families. The community health workers hospitalizations for conditions that can be
participate fully in team meetings and act as addressed through primary care, lower infant
a bridge between patients and their families mortality, lower fertility rates and higher
and the professionals. The health workers visit school enrolment.
each family at least once monthly, provide
Challenges: limited induction and education on
health education, manage low-level health
the job for community health workers, difficulty
problems, undertake clinical triage, chronic
in recruiting primary care physicians and lack of
disease management, screening, vaccinations,
shared electronic health records.
advice on pregnancy and breastfeeding support,
monitor health and report data on households, Enablers: pay for performance to increase
social determinants and community participation. quality; legislated working week for primary
care physicians; plans for an integrated
Outcomes for people: greater satisfaction with
electronic medical record system with
health care, better access to family-centred
interoperability standards.
Source: (43).
25
One Family Health, Rwanda

One Family Health, in partnership with the records and programmes for stock ordering,
Rwandan Ministry of Health, established a monitoring and billing.
network of rural franchise health posts, owned By 2015, 92 health posts were operating in 11
and operated by local college-graduated nurses of the 30 districts, providing employment for
with 5–8 years of clinical experience. Each nurse over 300 health and support workers and nurses.
has access to a rent-free, community-owned Each nurse may see as many as 40 patients a
building in his or her village and generates income day. Since 2012, the programme has provided
by providing primary care services to the people in basic health services for common primary
the village. They are reimbursed for their services care conditions to 550 000 patients through
through the national community insurance 850 000 consultations.
scheme (mutuelle de santé) and by co-payments
Outcomes for people: less travel time and
received from patients at the point-of-service.
better access to primary care from nurses in
Nurses receive training in national primary
rural villages.
care protocols, basic financial management and
medicine stock management and spend one System impact: bet ter coverage of
week working with a “top-performing” nurse primary care at comparable cost and local
in the network, with continual supervision. employment opportunities.
They have access to a low-interest loan for Challenges: training and supervision of nurses
infrastructure, renovations, furniture, fittings, and co-payments for low-income families.
essential medical equipment and medicine Enablers: funding from community-based
stocks. Basic features include mobile phones with insurance scheme, mobile phone technology
real-time analytical support, electronic patient and analytics.
Source: (24).
Mister Sister mobile clinics, Namibia

In 2008, the “Mister Sister” mobile clinics were employees’ health services, in part through these
launched to improve geographical access and clinics. Promising results have been obtained in
equity for poor rural communities and other reducing anaemia, increasing vaccination and
vulnerable populations. The mobile clinics reducing the number of parasitic infections.
collocate and coordinate the delivery of a Outcomes for people: access to mobile primary
range of primary care services, including routine care for a range of common problems.
vaccinations, diagnosis and treatment of routine
System impact: better health outcomes for an
communicable diseases, management of minor
underserved population.
trauma, testing and follow-up treatment for
chronic diseases, voluntary counselling and testing Challenges: maintaining coverage over difficult
for HIV, antenatal care and health education. geographical areas.
Each mobile clinic has a team comprising a Enablers: training for the mobile team to help
registered nurse, an enrolled nurse and a driver them understand when and how to refer
to help with administrative tasks. The clinics problems that require specialist support in
collaborate with rural employers and farmers, public health facilities.
of whom nearly 80% contribute to financing their Source: (25).
26
PRIORITY PRACTICES
Priority 2: Collaborative planning of care and shared decision-making

Description can extend and sustain therapeutic relationships.
Therefore, educating caregivers, developing their
Involving patients, family and caregivers in holistic, skills and confidence in enablement and coaching and
anticipatory planning of care with care “navigators”, directing them to community resources can enhance
“connectors” or “health coaches” to help them manage and extend case management.
their conditions, build social connections and improve
their understanding and adherence to medicines. Differences in health literacy and in cultural attitudes
to the exercise of autonomy, both in the population
and among health and care providers, influence
collaborative planning of care and shared decision-
“Consultations with staff who making (28). In some countries, an enhanced role
for nurses, “navigators” or volunteers, for example,
really listen enable me to manage depends on public and professional attitudes about
my own health and connect me gender and the readiness to change the traditional
dominance of the physician's role.
to the support that I need to stay
Impact
well and achieve what matters
A randomized controlled trial was conducted of
to me.” elderly people with multiple conditions, who were
in the highest quartile of risk for high health care
costs and were cared for by 14 primary care teams
in Baltimore–Washington, USA (29). Use of guided
Why this is a priority care (30) to plan care and share decision-making
Continuity of relationships empowers, enables improved the self-reported quality of chronic
and increases adherence to treatment by creating care in terms of goal-setting, problem-solving and
the conditions for better support of people in patient activation.
understanding and managing their conditions, Baker and colleagues (31) studied the effect of
thus increasing patient satisfaction (26, 27). Continuity anticipatory care planning, which comprised open
of care is particularly important for effective dialogue with patients and carers to allow reflection,
consultations when time is limited (6). reorientation and recording of values and wishes
Grinberg et al. (13) describe the association between before deterioration of a patient's health or a crisis
the “security, genuineness and continuity” of authentic for the caregiver. The cohort with anticipatory care
healing relationships and patient motivation, self- plans had significantly fewer hospital admissions,
management and health-related behaviour. They also days in hospital and associated costs than the control
noted that continuity and coordination of support group matched for age, sex, multiple morbidity indices
from trusted family, friends and community networks and secondary care outpatient and inpatient activity.
27
Collaborative care planning and shared decision-making:

House of Care, Scotland
The House of Care programme in Scotland System impact: better organization, teamwork
involves a generic approach attuned to the needs and productivity in primary care; cost-neutral
of people with several conditions by: at practice level, but better biomarkers may
• collaborative planning of care and support; increase health gains.
Challenges: limited engagement with community
• engaged, informed, empowered individuals
partners, lack of awareness or trust in local
and carers;
community support; need for a cultural shift to
• a professional health and care team relational and interpersonal practice at all levels.
committed to working in partnership; Enablers: connecting primary and secondary
• harnessing informal and formal sources of care professionals with a care pathway or clinical
support and care; and network as the entry point; asset mapping
and accessible information on local support
• organization and arrangements that enable
for well-being.
the above.
Source: http://www.alliance-scotland.org.uk/
Outcomes for people: greater confidence, health-and-social-care-support-and-services/
control, health and well-being; better experience house-of-care/
of care; more self-care; increased knowledge,
skills and satisfaction for professionals.
Care planning and care coordination by Buurtzorg Home

Nursing, Netherlands
The Buurtzorg model involves a skilled, generalist, Outcomes for people: access to the team at
registered nursing team (maximum of 12) based all times; holistic continuity of care from one
in a neighbourhood of up to 15 000 residents nurse; local network of support; professional
to provide nursing and supportive home care satisfaction in autonomous practice and time
services to 50–60 people at any one time. with patients.
The self-organized, flat structure promotes the System impact: lower administrative overheads;
autonomy of nurses in responding to the needs promotion of self-care, independence and
of individuals. The model includes: disease prevention; fewer hours of home care
• holistic assessment of needs and care planning; but total costs per patient equivalent to those
in other models in The Netherlands.
• mapping and involving networks of
informal care; Challenges: governance and place within the
established external regulatory and supervisory
• identifying and coordinating care provided system; ensuring effective interactions with
by other formal carers; primary care staff.
• care delivery and support for patients in Enablers: digital technology to provide
their social environment; and information for direct support of care; home care
• promotion of self-care and independence. connected more firmly with other community
services and support.
Source: (32).
28
PRIORITY PRACTICES
Collaborative planning of long-term care: Rand Aid,

South Africa
Rand Aid is a registered, non-profit organization care, and residents are encouraged and enabled
in Johannesburg that offers multidisciplinary, to exercise autonomy in their day-to-day lives.
personalized long-term care to those who need Outcomes for people: person-centred care
help to maintain their functional ability. One of planning and autonomy for a vulnerable group.
the facilities is located in a retirement village,
System impact: managing dependence at home
so that residents’ care needs can be met as they
and in the community.
increase over time.
Challenges: lack of public funding for long-
Integrated care teams of nurses, nursing assistants,
term care.
social workers, occupational therapists, doctors,
recreation officers and volunteers provide a range Enablers: income from retirement villages
of services to residents. Older people and their subsidizes long-term care and outreach services.
families are involved in planning person-centred Source: (33).
29
Better health for older people in Africa, United Republic of

Tanzania
The project supports approximately 4500 Patients are also enrolled in psychosocial support
elderly people in four districts in three of the networks and engaged in programmes that
country’s regions. Care is provided by 425 allow them to socialize, prepare and eat meals
trained volunteers who, either directly or through together, discuss their health needs and learn
links with other services, ensure that patients’ about topics such as nutrition and exercise from
physical, emotional, social and spiritual needs health workers.
are addressed. Coordinators (typically registered Outcomes for people: person-centred care
nurses or clinical officers) supervise volunteers, planning and psychosocial support.
who are selected in consultation with older
System impact: access to services for poor older
people’s forums and local community and health
people at home reduces their vulnerability to
leaders. The volunteers live near the people
illness and worsening poverty.
they support and are assigned no more than 15
households at a time. They prepare individualized Challenges: training and skills development
care plans in consultation with their patients and for volunteers.
families and coordinate care at home as required, Enablers: training, supervision and day-to-
including help with eating, dressing, bathing, day support is co-financed by donors and
medication, companionship and support, as well local governments.
as accompaniment to medical appointments. Source: (33).
30
PRIORITY PRACTICES
Priority 3: Case management for people with complex needs

Description competence, effective practice in interdisciplinary
teams and experience in geriatric and community
Care and support are planned, reviewed and nursing and coaching for self-management (29, 36).
coordinated by a practitioner case manager, The same competence is required for integrated
who follows care over time and addresses community case management for child and maternal
both the physical and the mental health needs health, as described in a joint statement by WHO
of people with complex multiple conditions or and UNICEF (37).
complicated circumstances.
Impact
The report of a telephone survey in 11 high-income
“Having a named person or single countries for the study of international health policy
point of contact to coordinate by The Commonwealth Fund showed that adults who
had a care coordinator were less likely to find that their
my care.” care was poorly organized and uncoordinated (38).
Follow-up over 18 months of case management
for elderly people with several conditions in the
Baltimore–Washington DC metropolitan area, USA,
Why this is a priority showed that the self-reported quality of chronic
Case management is a targeted, community-based, health care was twice as high as that of people who
proactive approach that involves case-finding, did not have a case manager (29).
assessment, care planning and care coordination to
Some studies of case management and collaborative
integrate services to meet the needs of individuals
care for cardiovascular disease and cancer showed
with chronic conditions (34). The approach is
less depression and better self-management of
particularly important for people with complex
physical health (39, 40) and cost (41, 42). Reiss-Brennan
needs, multimorbidity and both physical and mental
et al. (10) reported that 80% of people with mental
ill-health (35). It is a complex, dynamic process for
ill-health enrolled in Intermountain Healthcare in
addressing frequently changing conditions and
the USA were fully supported by case management
circumstances and multiple providers in different
in mental health integration clinics in primary care.
sectors, and requires highly skilled health and care
The model resulted in 48% lower medical costs in the
professionals who are culturally sensitive and attuned
12 months after diagnosis of depression, a 54% lower
to the local context of health and care.
probability of attending an emergency department,
The necessary skills and competence for effective a significant reduction in hospital admissions for
case management include good communication ambulatory care and better diabetes control among
skills, an ability to solve complex problems, cultural patients with diabetes and depression.
31
Home health case managers, Canada

The Fraser Health system in British Columbia Outcomes for people: faster responses, better-
(serving a population of 1.6 million) designed informed assessments of health and needs,
an integrated model of community-based home proactive identification of emerging issues and
health case managers for social care and local risks and ability to live longer in their own home.
family physicians. They collaborate in supporting System impact: doubles the time that community
frail elderly people with medical problems who residents are able to remain living at home
require long-term support at home. The case (avoiding a premature move to institutional care).
managers discuss individuals’ needs and progress,
Challenges: assignment of case managers on
share information and coordinate care. They use
the basis of a patient’s address, who have no
a “resident assessment instrument” to identify
relationship with the primary care physician.
those with fewer needs or who are stable and
could be assigned to a “surveillance nurse” Enablers: time to build mutually trusting
for telephone follow-up and other actions to relationships and possibility of reducing the
maintain their stability. intensity of surveillance.
Source: (43).
Integrated community case management,

sub-Saharan Africa
Three quarters of deaths of children under five • service delivery: guidelines for clinical
are due to pneumonia, diarrhoea, malaria or assessment, diagnosis, management,
neonatal problems. Community health workers referral, including plans for the rational use
who are appropriately trained, supervised and of medicines (and rapid diagnostic tests
supported with uninterrupted supplies of where applicable) and a referral and counter-
medicines and equipment can identify and treat referral system;
these conditions. Integrated community case
• communication and social mobilization:
management is an equity-focused, integrated
communication plan, materials and messages;
approach to improving access to essential early
diagnosis, treatment and referral for malaria, • supervision and quality assurance tools and
suspected pneumonia and diarrhoea among resources; and
children aged 2–59 months and also for the • monitoring, evaluation and health
treatment of severe acute malnutrition and information systems.
newborn complications. The eight components
of integrated community case management are: Outcomes for people: earlier interventions
to diagnose and treat childhood illnesses
• coordination and policy-making;
and malnutrition.
• costing and financing; System impact: up to 63% reduction in all-cause
• human resources: roles and expectations, mortality among children under five.
training plan and strategies for retention Challenges: scaling up access to the programme.
and motivation; Enablers: partnerships between governments
• supply chain management: child-friendly and nongovernmental organizations for funding,
medicines and supplies, logistics and training and supply of medicines.
information systems; Source: (37).
32
PRIORITY PRACTICES
Case manager and health coach: guided care, USA

With a licence from Johns Hopkins University, point of contact for patients and families, with the
a 6-week online training programme is offered to option of home or telephone contacts.
nurses in guided care, which includes coaching, System impact: less use of acute care.
assessment, care planning, carer support and
Challenges: may depend on a particular
care management for people with common
professional; overlies established structures
chronic conditions. The nurses work at the
and risks becoming more complex unless roles
interface between primary care and specialty
are clarified and engagement is effective.
care and communicate with other professionals
and providers. They may operate from outpatient Enablers: effective targeting and matching of the
or specialty clinic settings but are generally not intensity of support with risk prediction tools;
fully integrated into primary care. closer integration with the mainstream health
care delivery system; introduction of nurses
Outcomes for people: better communication,
who provide guided care to the usual primary
continuity and coordination of holistic care
or secondary care provider, to develop trust
among providers and among settings; a single
and confidence.
Source: (30).
Rural Adversity Mental Health Program, New South

Wales, Australia
The Centre for Rural and Remote Mental Health, • inform: disseminating best practices in mental
in partnership with rural local health districts health; and
in New South Wales, funds local coordinators
• partner: creating new pathways to care and
of the programme to identify individuals and
flexible interagency responses.
communities that have or are at risk of developing
mental ill-health and to inform, educate and Outcomes for people: culturally sensitive,
connect them with appropriate treatment and relevant, locally tailored information on when
support. The coordinators live in the communities and how to access support for mental well-being;
and work with local agencies to ensure better greater confidence in mental health first aid.
mental health outcomes through online self- System impact: better mental health literacy;
help, social media, telephone and face-to-face more resilient community, ensuring good mental
services and by participation in rural community health and recovery.
events. The main roles of the coordinators are: Challenges: building trust, securing cross-sectoral
• link: providing a “soft” entry point and funding and reaching rural and remote areas.
personalized navigation of services Enablers: flexible responses to local community
and support; priorities and issues and identifying and mobilizing
• train: tailored mental health training for rural community champions.
providers and employers across sectors; Source: http://www.ramhp.com.au
33
Priority 4: Collocated services or a single point of access

Description geographically coherent local networks of providers
that can be accessed easily at a single entry point
A single entry point to access physically collocated to provide support for both physical and mental
services or to access staff and services linked by health needs.
online or telephone systems.
Impact
Zapata et al. (44) reported a new model of care in
“I can access the care or support Namibia, in which HIV and sexual and reproductive
I need by one call, or I have to health services are integrated and delivered with
other services at a public health facility. Thus,
make fewer appointments as my each health worker can deliver accessible, coordinated,
comprehensive services to the same patients over
care providers are together under time. The model improved access and communication,
reduced stigmatization, increased the quality of
one roof.” antenatal care, reduced waiting times, increased
nurse productivity and reduced the time spent in
a health facility, without compromising the uptake
of services for tuberculosis, HIV, antenatal care or
Why this is a priority
family planning.
Physical collocation of staff or support from different
The Support and Services at Home programme
services or sectors can improve communication, trust,
organized by six affordable housing associations
efficiency and coordination of care and help staff
in Vermont, USA (45), coordinates care through
to learn from each other. Thus, specialist staff can
community panels that include a “wellness” nurse
acquire generalist skills and community practitioners
and a care coordinator, who work with groups of
assume extended roles. Examples include community
about 100 tenants and local community partners.
health centres, polyclinics and ambulatory care
After three years, there were clear reductions in the
centres that offer a range of diagnostic and treatment
use of health care and in costs.
services by different specialists in a “one-stop-shop”
model. Other examples are regional specialist centres In Japan, a wide range of community hubs offer social
with various experts and support services in one space for older people, where relational continuity
hospital. A balance should be achieved between the and coordination of care are ensured by social, carer
advantages of facilities with many diverse services and peer support networks. These community hubs
collocated and the need people have to develop a are based in non-institutional settings, such as open
relationship of trust with one or a few care providers. houses, community cafes, dementia cafes, activity
The most appropriate model will depend on the centres and drop-in lunch clubs (46). Some hubs offer
common support and services that are frequently more support through a 24-h helpline, coordination
required concurrently by many groups of people. of respite care or bereavement counselling.
Another consideration is the feasibility of building
34
PRIORITY PRACTICES
INNOVCARE centres for rare diseases in Romania

and Sweden
The INNOVCARE model blends case management • electronic patient registry; and
and a one-stop-shop specialist centre for people
• research capacity.
and families living with a rare disease, creating a
bridge between patients, families and the wide Outcomes for people: less isolation from peer
range of professionals and health, social care and family support networks, better access to
and educational sectors involved in their care. information and advice about their rare condition.
The model offers continuity and coordination System impact: better transfer of information
to fill gaps in care and to link health, social and and expertise in rare diseases among providers.
community services, including for employment, Challenges: low prevalence of rare diseases,
school, welfare, housing, transport and leisure. so that patients and families are managed
The main elements are: at a distance; lack of flexibility of intensive
• interdisciplinary care and therapeutic programmes for people who are studying
education; or working.
• patient and family support groups; Enablers: digital technologies for communication
and coordination to supplement face-to-face
• summer camps and therapeutic weekends;
contacts; cross-sectoral funding initiatives to
• a help and advice line; develop a national or regional centre and network.
Source: https://innovcare.eu
Community-based health planning and services, Ghana

Compounds of community health planning and Outcomes for people: better access to
services were introduced to improve coverage community health care and medicines for people
and access to basic health services for people in remote villages.
in remote rural communities in Ghana. On the System impact: greater coverage of rural
basis of the model of the concept of primary communities with primary health care at the core.
health care, districts are divided into zones
Challenges: shortages of medicines, inability of
with populations of 3000–4500. In each zone,
households to pay for services and absences of
a resident community health officer provides
community health officers.
both mobile and facility health services and
collaborates with a community health committee Enablers: more likely use of community
and health volunteers to plan and deliver health planning and services by women and
community health programmes. younger households.
Source: (47).
35
Collocated management of depression and HIV, Uganda

A tiered pathway supports task-sharing and a • algorithm for prescription and management
protocol for diagnosing and managing depression of antidepressant treatment jointly by nurses
in 10 HIV clinics in health care centres in towns and primary care providers; and
and districts near Kampala. Implementation was
• continual supervision by a psychiatrist to
supported by a 2-day interdisciplinary training
ensure quality of care.
schedule for clinical staff, on-site support and
mentorship by a psychiatrist. The tiered care Outcomes for people: suicide prevention and life-
pathway involves: changing treatment for undiagnosed depression.
• routine screening for depression at each clinic System impact: task-shifting to extend
visit for all patients, with peer support from specialist mental health suppor t to
“expert patients” trained to assist in lower- underserved communities.
level tasks and to use a two-item patient Challenges: no direct means to address adherence
health questionnaire; or the interface with primary care providers.
• diagnosis and evaluation by trained nurses Enablers: trained, experienced peers engage with
for medically stable patients who are found patients, build triage capacity and continuity of
to be depressed on screening; support; continuity of a mentoring relationship
between expert patient, nurse and specialist.
Source: (48).
Integrating HIV and sexual and reproductive health

services: Epako Clinic, Namibia
HIV and sexual and reproductive health services spent 24% less time in the facility than they had
in Namibia have traditionally been provided in expected, without compromising the uptake of
silos, with fragmentation and poor coordination services for tuberculosis, HIV, antenatal care or
of care. The Epako Clinic introduced a model of first-visit family planning services.
IPCHS at the public health facility, including HIV Outcomes for people: reduced stigmatization,
and sexual and reproductive health services. Thus, better access to high-quality services and better
each health worker can provide comprehensive antenatal care.
services to patients, with continuity of care over
System impact: increased flow through the
time and a good external referral system.
facility and increased nurse productivity.
Integrated services improve access, reduce
Challenges: maintaining coverage in areas that
stigmatization and improve the quality of
are difficult to reach.
antenatal care services by enhancing provider–
patient communication, shortening the time Enablers: training for the mobile team, internal
that patients stay in the clinic by 16% and coordination of health workers and procurement
reducing waiting times by 14%. In addition, of equipment and medicines.
nurse productivity improved by 85%. Patients Source: (44).
36
PRIORITY PRACTICES
Priority 5: Transitional or intermediate care

Description half of readmissions to hospital occur when physicians
are not available for “hospital at home” (9), transitional
Teams manage transitions between hospital and home care services are required to cover evenings and
and offer urgent community assessment, treatment, weekends to decrease attendance at emergency
rehabilitation or palliative and end-of-life care as departments (7).
alternatives to readmission to hospital. The teams
also help people to understand and manage their Transitional care may involve reintegration of patients
medicines at home. into employment or into their wider societal role or
support in moving to palliative and end-of-life care.
This holistic, bio-psychosocial approach to transitional
care must be culturally sensitive and involve family
“I return home with the support carers, employers and local communities.
I need, or I am transferred for Impact
care closer to home. Staff review A care transition intervention delivered by an
advanced practice nurse who had a caseload of
my medicines and check my 24–28 patients was associated with lower readmission
understanding of any changes. rates after 30 and 90 days. Lower hospital costs and
lower readmission rates for the index condition were
I know how to get urgent advice seen at 180 days (49).
and treatment in the event of Patients managed by “hospital at home” in New

Mexico, USA, had comparable or better clinical
an emergency.” outcomes and greater satisfaction than similar
inpatients, resulting in a 19% reduction in costs (9).
Patients in a “hospital at home” programme in
Catalonia, Spain, had shorter hospital stays and
Why this is a priority better functional clinical outcomes than a matched
“Transitional care” and “intermediate care” refer to cohort managed only in acute and intermediate care
services during the transitions from hospital to home, hospitals (50).
from home to hospital and from illness or injury to In a home-based primary care programme for elderly
recovery and independence. In contrast to chronic people with severe, disabling chronic illnesses in the
case management, the service is shorter (usually USA, an interdisciplinary team offered same-day
weeks) and has the clear objectives of preventing urgent house visits for exacerbations of the illness
readmission, shortening hospital stays and reducing to prevent avoidable attendance or admission to
delays in transition to post-acute care. hospital (8). Team physicians also managed the hospital
Care management initiatives for transitions from episodes to ensure continuity of care. This model led
hospital to home have been the most successful in to 17% lower total Medicare costs during a mean
improving quality and reducing costs (36). As almost follow-up of two years.
37
Transitional care service, Singapore

The Aged Care Transition Programme (ACTION), cerebrovascular accident, diabetes, pneumonia,
implemented at five general public hospitals in dementia or heart failure for up to six months,
Singapore over four years from 2008, targeted with a family physician on the team.
elderly inpatients with significant functional Outcome for people: better continuity,
decline or complex medical problems. A team quality of life and self-rated health; support in
of dedicated nurses and social care coordinators managing medicines.
worked with the patients and their families during
System impact: fewer unplanned admissions
hospitalization, followed them up with telephone
and emergency department visits for up to six
calls and home visits for up to eight weeks
months after enrolment.
after discharge and coordinated placements
with appropriate community service providers. Challenges: optimizing the handover to primary
The coordinators supported people in expressing care of people with continuing complex
their preferences and goals and enabled self- care needs.
management. Some sites have extended this Enablers: extending the team expertise to
goal-oriented time-limited team model of care include family physicians.
transition to adults with conditions including Source: (51,52).
Noora health education, India

In India, most patients recovering from in size (5–30 people) and location (hallways,
medical interventions rely on care by family waiting rooms, wards). The programme has been
members, who are often ill-equipped to implemented in 26 hospitals in India, and 50 000
provide support during recovery, resulting in caregivers have been trained.
high rates of relapse and complications. Noora Outcomes for people: carers are more competent
Health is a nongovernmental organization that and confident in providing safe, effective care
provides patients’ families with actionable at home.
health information, so that they become more
System impact: a 3-month pilot study with
competent and confident in providing safe,
adult post-surgical cardiac patients showed a
effective care. The approach is a “train-the-
36% decrease in complications, a 23% decrease
trainer” certification programme for hospital
in 30-day readmissions and a 55% increase in
nurses, who deliver interactive practical health
patient satisfaction.
education and awareness to patients and their
families, with learning materials that can be Challenges: managing health literacy and
used at home to facilitate recovery following language needs.
treatment. This allows family members to support Enablers: materials co-designed with patients,
patients, alleviate their anxiety and ease the trainers and families.
transition from hospital to home. The classes Source: (53).
are available in several languages and vary
38
PRIORITY PRACTICES
Care transitions at the end of life: compassionate

communities, Colombia
The New Health Foundation’s model for mirrors the “todos contigo” (we are all with you)
integrated palliative care, introduced in Colombia model in Spain, where there are other examples
in 2015, raises public awareness and engagement of compassionate communities and cities.
in caring for people at the end of their lives and This community-led model is an important
in supporting them through collective learning driver of a more effective, sustainable network
in social networks. Although each network is for integrated palliative and end-of-life care.
largely self-organizing, this is facilitated by a Outcomes for people: less loneliness and
“community promoter”, whose role is to align isolation; better quality of end-of-life care and
social and health care services towards more support for caregivers; increased community
integrated palliative care and to strengthen the participation and well-being of volunteers.
natural support systems of family, friends and
System impact: reduced hospital costs and
neighbours. This is achieved through a dynamic
surgical interventions in the last month of life.
volunteer network that can offer care and
companionship at the end of life. Challenges: aligning policy, financial levers and
regulation of end-of-life care in the community.
More than 50 organizations (including schools,
universities, businesses, nongovernmental Enablers: professional, policy and political
organizations and faith groups) in Colombia’s leadership and a shared vision.
largest cities are working together to create a Source: (54).
network of compassionate cities. This approach
Transitional care for victims of sexual violence,

Democratic Republic of the Congo
In a project for survival after sexual violence use and identification of any additional care
at Panzi General Referral Hospital in Bukavu, required. It also encourages the girls and women
South Kivu, eastern Democratic Republic of the to participate in organized community collectives,
Congo, a one-stop centre was set up for the case such as micro-financing initiatives.
management of survivors of violence against One-stop centre models of care have been used
women and girls. The centre provides medical, globally in a number of settings for survivors of
psychosocial, legal and socioeconomic care by violence against women and girls. A reduced,
a team of doctors, nurses, midwives, laboratory adapted model functions in some rural areas
technicians, radiology technicians, pharmacy in low-income countries, in which good-quality
assistants, lawyers, paralegals, administrative services are scaled up during post-conflict
resources and people who coordinate and reconstruction and recovery.
manage the women’s discharge from hospital
Outcomes for people: coordinated care for
and reintegration into society. Personalized
complex health and psychological problems and
care based on listening closely to the personal
social support.
narrative of each abused girl and woman is
planned, implemented and documented with System impact: reintegration of vulnerable girls
the aim of restoring the health of the victims and women into society.
and their reintegration into society. Follow- Challenges: managing stigmatization and other
up home visits are organized to assess and cultural issues.
secure reintegration, including provision of Enablers: cross-sectoral interdisciplinary
family mediation, counselling for couples, partnership.
psychological support, guidance on medication
Source: (55).
39
Priority 6: Comprehensive care along the entire pathway

Description for a specific condition, care group or service.
Such networks allow virtual integration by
Comprehensive managed care models provide care collaboration within an agreed governance framework
coordination along the entire pathway, from home, and may improve the effectiveness of care and reduce
community services, ambulatory and emergency delays in access to expertise. For example, the former
care to hospital care. Community Care Access Centres in Ontario, Canada,
now provide assessment and care management under
agreed accountability within local health integration
“The professionals I see talk with networks, which are collaborations of organizations
that plan, integrate and fund local health care (57).
each other and agree who will
Impact
coordinate my care and support
Mukamel et al. (58) analysed 23 models of the
for my whole journey and as my Program of All-inclusive Care for the Elderly (PACE)
in the USA and reported that they resulted in better
needs change.” self-assessed health after 12 months and improved
functional outcomes, particularly in programmes with
more aides than professionals and greater ethnic
and cultural similarity between aides and patients.
Why this is a priority
The mortality rate was lower when there were more
Effective care for people who require complex and professionals, perhaps reflecting a more medically
chronic care and support cannot be provided by oriented programme. Better outcomes were observed
single practices in isolation. Instead, effective models in more mature programmes, suggesting that there
of care acknowledge the interconnectedness of is a “learning curve” for selection of the appropriate
practice interventions and deliver priority practices people, understanding their needs and establishing
1–5 together, as integrated, person-centred care an effective network of services.
tailored to individual needs along their care pathway.
After four years, the Program of Research to
For example, systems for reducing the number of
Integrate Services for the Maintenance of Autonomy
hospitalizations, or avoiding institutional care for frail
(PRISMA) for frail elderly people in Quebec, Canada,
elderly people ensure that care is well coordinated
saw significant reductions in functional decline,
by an interdisciplinary team and that the team
unmet needs and visits to emergency departments
meets regularly to evaluate individual needs and
and a statistically nonsignificant reduction in the
to plan, implement and review personalized care
number of hospital stays. Patient satisfaction and
plans, including ambulatory care, home care and
empowerment increased (59). Of 11 coordinated
transitional care (56).
demonstration Medicare programmes followed up
This comprehensive approach is operationalized for six years, four resulted in fewer hospitalizations
in clinical or care networks that link practitioners of people at high risk for admission (60).
at various sites and organizations to deliver care
40
PRIORITY PRACTICES
Health pathways for the elderly, France

The aim of this programme is to improve • education and guidelines are provided on
coordination of health and social professionals prevention of common risks (management of
to meet the needs and maintain the autonomy medicines and prevention of falls), including
of elderly people living at home. The first stage in nursing homes; and
involves about 550 000 people aged ≥ 75 years in
• medical prescriptions are reviewed and drugs
nine regions of France. Five actions are supported
reconciled by the general practitioner and
by standardized tools and an information system
a pharmacist.
for secure messaging:
• an interdisciplinary primary care team plans Outcomes for people: continuity of preventive
and coordinates care, and the care plan primary care; access to transitional care.
triggers an overall team payment under a System impact: structured pathway and
new remuneration system; education; anticipated reduction in costs for
acute care.
• a support platform offers professionals,
service users and caregivers a single point Challenges: sharing information without
of access to local health and social services; an electronic health record; limited
integrated working.
• discharge from hospital is planned,
Enablers: systematic approach after successful
transitional care is arranged, and information
pilot testing.
is transferred at discharge;
Source: (61).
41
Family-centred whole-system navigation: Whānau Ora,

New Zealand
Whānau Ora devolves planning and delivery of community providers; greater staff confidence
services to community commissioning agencies, in working with Māori families; family- and
which put whāna (families) in control of the services culturally-sensitive practices.
they need. Community partners, providers and System impact: higher rates of enrolment of
navigators work together and with individuals patients with prescriptions for asthma, depression
and families to coordinate personalized support or diabetes; better acceptance of vaccination;
and services that are culturally sensitive and build fewer admissions for rheumatic fever; fewer
on people’s strengths to achieve better health, children experiencing physical abuse.
education, housing, employment and income
Challenges: complex intervention throughout
and increase well-being and participation as
the public sector; extension to other
well. The community navigators help to identify
ethnic communities.
needs and resolve barriers to accessing services,
motivating partners around a common purpose Enablers: dedicated funding; devolved
for the individual, family or community. commissioning; education on goal-setting;
reporting of outcomes.
Outcomes for people: continuity of support to
navigate health care services; links to a range of Source: (62).
Network for diabetes care, Thailand

Thailand has introduced diabetes practice up appointments. A specific training course for
guidelines and a management system to foot and wound care has decreased the rate of
standardize and coordinate care, from prevention foot ulcers and amputations.
to primary care and secondary care. The guidelines Outcomes for people: continuity and
and protocols cover risk assessment and coordination provided by diabetes nurses;
screening; assessment of chronic complications support from volunteer coaches and educators;
and their risks; and clinical care schemes in earlier detection of chronic complications;
primary, secondary and tertiary care. The model fewer amputations.
is supported by a referral system, agreed outcome
System impact: earlier detection of diabetes;
indicators and regular training for primary care
more patients with diabetes attending health care
teams and interdisciplinary diabetes care teams
facilities; increased rate of annual assessments
delivered by the Diabetes Association of Thailand
of vascular risk.
and the Thai Society of Diabetes Educators.
More than 1000 diabetes manager-nurses Challenges: no standardized coordinated care
provide continuity and coordination of care. for children and young people yet.
The Ministry of Public Health developed the Enablers: effective task-shifting to extend care to
concept of “simple diabetes care” to enable underserved populations by trained volunteers;
village and district public health volunteers to visit local volunteers' engagement with patients and
patients at home and encourage their adherence provision of continuity of support.
to medical advice, treatment and regular follow- Source: (63).
42
PRIORITY PRACTICES
Spinal care network in underserved communities,

Botswana
World Spine Care has designed an with 90% managed with local conservative care
interprofessional, evidence-based, sustainable and 10% referred to hospital. Responses to
model of care for the management of spinal clinical follow-up questionnaires indicated less
disorders in underserved regions. In a pilot pain and disability, and feedback from patients,
study in Botswana, a coordinated network community members and health providers
model was created to link spine services in a indicates high satisfaction and consistently
community health centre with advanced testing high use of the services. The practice has been
and treatment at the local district hospital, extended to other jurisdictions and to the
supported by collaboration with the National Dominican Republic, Ghana and India.
Spinal Surgical Centre. Patients, the community Outcomes for people: better symptom
and all health team members were involved in the management and functioning; continuity of care.
design, delivery and evaluation of the integrated
System impact: coordination of evidence-based
model, and a partnership with the Government
care, closer to home.
and academic institutions is ensuring long-term
sustainability by training the health workforce to Challenges: consistent education and training
oversee clinical and community-based services. for professionals at all levels in the network.
Between 2012 and 2014, the programme Enablers: good communication systems among
provided spine care to over 1000 patients, professionals and across settings.
Source: (64).
Priority 7: Technology to support continuity and care coordination

Description Why this is a priority
The availability of information and communication “Technology” encompasses a continuum of telehealth
technologies that support the management of (home monitoring, telemedicine, video consultations),
people's care makes it easier to ensure continuity telecare or assistive living equipment, mobile health
and care coordination. and well-being applications and online platforms,
tools and resources to help people understand and
manage their health conditions. e-Health includes
the information and communication technology that
“My care professionals at home, supports the management of people and communities
in the community or in hospital with a range of health care needs by enabling
electronic communication among health and care
use technology to help me stay professionals, patients, carers and multiple providers
within health and care systems. New ways of sharing
well, involve me in my care, electronic health records ensure the continuity of
information for professionals in various care settings.
share information and coordinate
Information and communication technology can be
my support.” aligned with predictive risk tools, decision support tools,
algorithms and guidelines to target care coordination
more carefully for the greatest effect. For example,
successful models of care coordination target people
at risk of adverse outcomes with tailored decision
support and care coordination agreements (65) that
43
specify the roles and responsibilities of practitioners Impact

and their expected competence, specify the standards
of care and provide decision support tools to guide In Canterbury, New Zealand, professionals and
referral, escalation or transfer. organizations throughout the health and care system
develop and use electronic “health pathways” and
A review of technology in integrated care (66) specified decision support, which have improved care processes
five areas for action: and outcomes for people with certain conditions (67).
• data exchange with interoperable electronic
medical records; Comprehensive programmes for multimorbidity or
• engagement of individuals and carers in setting frailty that included decision support for providers
goals and using personal care plans; showed some evidence of improving health-related
• balancing standardization and tailoring to local quality of life, functioning and satisfaction with care,
care pathways and practice; but no reduction in health services use or costs (68).
• data for planning and management within a tiered A study in Catalonia, Spain, affirmed the value of
or stepped care system model; and electronic health information for patients’ perceptions
• research and innovation for successful of continuity of care (69).
implementation.
National Health Information System, Estonia

Estonia has introduced a system-wide health Information System coordinates the health
information system, including electronic medical system, connecting providers at all care levels
records, digital imaging, e-prescriptions and a and disciplines electronically for more integrated,
patient portal. The National e-Health Foundation streamlined service delivery. An online patient
was created in 2005, which facilitated cooperation portal increases patients’ involvement in their
among groups, each of which had an active care, provides individuals with secure access
role in steering the initiative. The e-Health to their health information and offers online
Foundation and a Government information appointment booking.
strategy were complemented by political support, Outcomes for people: information continuity;
legislation, incentives to encourage adoption by over 90% have health documents in the National
providers and partnerships with the private Health Information System; empowered by
sector, universities and research organizations logging in to the patient portal.
to drive innovation. Use of the National Health
System impact: timely, efficient communication
Information System by health providers and
and decision support.
the electronic submission of patient data are
now mandatory. Challenges: professional resistance to adoption
of new systems; securing public trust.
A central Government data exchange platform
(X-road) integrates and secures all data. X-road Enablers: e-Health Foundation support for
digitally records all interactions to ensure managing change and ensuring safe sharing
accountability and secure access to information. of information.
Central storage means that the National Health Source: (70).
44
PRIORITY PRACTICES
Telemedicine for remote diagnostics, Asunción, Paraguay

In Paraguay, people in rural and remote areas did receive incentives for each diagnostic report sent
not previously have access to specialist diagnostic to the health service delivery network, so that
services or treatment. A telemedicine system primary care teams can provide continuity of
was introduced for three diagnostic services: care to their patients.
tomography, electrocardiography and ultrasound, Outcomes for people: earlier treatment after
with the addition of electroencephalography earlier, better diagnosis; reduced travel time
from December 2015. Health professionals in and costs.
first- and second-level health centres are trained
System impact: coordination and collaboration
to capture images with these medical devices
among primary, secondary and tertiary levels;
and to transmit them to specialists in tertiary
shorter delays for test results.
hospitals some hundreds of kilometers away.
The specialists review the images, write up their Challenges: resistance to remote diagnosis;
diagnosis and upload the medical report to a low-speed Internet connection.
controlled system that can be accessed by each Enablers: trained technical assistance.
health professional to then follow up with the Source: (71).
patient. Specialists who participate in the project
Priority 8: Building workforce capability

Description Why this is a priority
Education and training are required to strengthen Building the competence of the health and
the knowledge, confidence, skills and competence care workforce to deliver continuity and care
of patients, families, volunteers, communities coordination prepares them for their specific roles
and all staff involved in delivering continuity and and responsibilities in prevention and enablement,
care coordination. proactive case management, navigation, goal-centred
care planning, advocacy and interdisciplinary practice
in different professions, teams, settings, specialities
and sectors. Appropriate education and training
“My care is planned with should also be provided for patients, families, carers,
people who work together to volunteers and community partners in providing or
supporting continuity and coordination of care.
understand me and my carer(s), A report by the WHO Regional Office for Europe (72)
put me in control, coordinate and on strengthening the workforce for integrated care
lists five clusters of competence that are fundamental
deliver services to achieve my for ensuring evidence-based, coordinated,
continuous care.
best outcomes.” • Patient advocacy: the ability to promote
entitlement and to empower patients to become
active participants in their own care.
• Effective communication: an ability to quickly
establish rapport in an empathetic and culturally
sensitive manner.
• Teamwork: the ability to function effectively
as a member of a team that includes providers,
patients and family members, to practise in a way
that reflects understanding of team dynamics
45
and processes and to build productive working in a different way. It also takes time for patients,
relationships that focus on outcomes for people. families and the public to trust and embrace new,
• People-centred care: the ability to create the emerging roles as models of care evolve. Changing
conditions for coordinated care centred on the professional behaviour and sharing and shifting
needs of individuals and their families and reflecting power and control depend on wider social attitudes
their values and preferences, along the continuum and require approaches that balance education and
of care and over the life course. social innovation.
• Continuous learning: an ability to demonstrate
Collaborative education must be incorporated
reflective practice based on the best available
into undergraduate and pre-registration training
evidence and to assess and continually improve
programmes and extend to continuous professional
care and support delivered as an individual provider
development, to ensure that the current workforce
or as a member of an interprofessional team.
update their skills and work in new, different ways.
Workforce development in this area is challenging, Innovative, person-centred educational approaches
as it takes time to build new relationships and to include the design and delivery of training by people
teach health and care professionals to practise who have lived the experience of receiving care.
Project ECHO
Project ECHO began in New Mexico, USA, said that their knowledge had increased, which
to increase the capability of rural primary care had improved the care they provided, and that
clinicians to deliver complex speciality care, ECHO had given them access to education that
initially for people with hepatitis C infection. would have been difficult to obtain otherwise.
Primary care and community practitioners This learning model can be readily transferred
receive guided practice mentoring and feedback to other disciplines and services, such as out-
from specialists in remotely delivered training of-hours care, assessment and management of
programmes, coordinated by a facilitator. frail elderly people, chronic care, intermediate
This learning community ensures that people care and rehabilitation.
receive the excellent care they need at home Outcomes for people: high-quality care delivered
or closer to home through “hub-and-spoke” by their own providers closer to home.
knowledge-sharing networks led by expert teams
System impact: specialist knowledge and
conducting multi-point videoconferencing to
capacity built for various professionals and teams.
conduct virtual clinics with community providers.
A three-year evaluation of ECHO in managing Challenges: dedic ated time for
chronic pain indicated significant improvements educational sessions.
in self-reported knowledge, skills and practice. Enablers: coordination of remotely delivered
In a study of ECHO for palliative care in the United training programmes by a facilitator.
Kingdom, 70% of community hospice nurses Source: (73, 74).
46
PRIORITY PRACTICES
Caregivers’ training, Nepal

A rapid, intensive training programme for Outcomes for people: better quality and
caregivers was pilot-tested in Nepal in 2016 to continuity of care; better experience of care.
promote the benefits of choosing caregiving as System impact: empowerment and employment
a career and to address the lack of availability opportunities for women from unprivileged
of well-trained caregivers to support the ageing backgrounds; increased capacity and capability
population of Nepal. The initiative stresses to provide safe, effective care and support.
the role of caregivers in providing continuity
Challenges: appropriateness of training for a
and quality of care and support at home or
wide range of educational and literacy levels.
in an aged care facility. The training covers
many domains of case management, including Enablers: nongovernmental organization
communication skills, assessment and planning support; experienced trainers work with local
of care, strategies for managing medicines and health and care professionals.
coping with behavioural changes associated Source: (75).
with dementia.
Volunteer community care for the elderly, Costa Rica

Costa Rica has trained elderly retired teachers various long-term care services, particularly those
in local communities to visit impoverished, for nutrition and companionship. Establishment
vulnerable elderly people and facilitate their of networks of volunteers to support care and
access to health and social services. The training facilitate access to local services permitted the
for the retired community volunteers includes Government to scale up long-term care provision
three-day workshops on geriatric health, for vulnerable groups of elderly people rapidly
integrated community care and identifying with relatively little financial support, building on
vulnerable elderly people. Volunteers use a previous experience of Government-supported
validated assessment tool to identify these community health volunteering.
people in their communities and report the Outcomes for people: coordinated support to
information to district health officers and the allow elderly people to remain well at home.
district council. They are expected to make home
System impact: building social capital; earlier
visits at least once a month or as the need arises
intervention to improve the health of vulnerable
and to provide assistance in nutrition, personal
elderly people.
hygiene and taking medications.
Challenges: developing the roles and
Between 2010 and 2016, Costa Rica established
responsibilities of volunteers.
50 community care networks, serving about
10 000 people and involving over 5000 Enablers: training and supervision of volunteers;
volunteers. More elderly people now use the infrastructure of referral services.
Source: (76).
47
Home helpers, Bulgaria

Twelve centres in Bulgaria employ nurses and in 2012 to establish the necessary political,
home helpers to work in interdisciplinary teams legal and financial frameworks to fully integrate
to provide health care and support to over 800 home care services into the health system and
elderly people at home. Home helpers assist safeguard sustainability.
patients in daily tasks, including personal hygiene, Outcomes for people: coordinated care and
preparing meals and cleaning their houses. support to enable elderly people to remain well
As the concept of home care was foreign to at home.
Bulgarians, it took several months for leaders
System impact: greater capacity for care at home;
to introduce the initiative to communities. Trust
employment opportunities for home helpers.
and understanding were built gradually by
consistent provision of high-quality home care Challenges: developing new roles and
services that enabled patients and communities responsibilities for home helpers.
to experience their associated benefits. A project Enablers: political, legal and financial frameworks
was initiated between the Bulgarian Red Cross, for sustainable funding and training.
Government ministries and other stakeholders Source: (77).
48
4. Putting priorities into practice

The eight priority practices listed above indicate what should be done to ensure
continuity and coordination of care. This section outlines how managers and
practitioners could take practical steps to implement the priority practices, tailored as
required to the local context.
Implementation requires a well managed process of • Support the heath literacy requirements of
change, with the involvement of all stakeholders – each individual.
patients, family members and caregivers; professionals, • Provide coaching in health behaviour for patients,
managers and administrators; educational bodies and family and caregivers to help them with self-
policy-makers; community partners and volunteers management and in building social connections
– to secure their support. It also requires strong and improving adherence to their medicines.
leadership, aligned governance and accountability, • Introduce volunteers, community connectors or
education and workforce development, an enabling navigators to increase providers’ knowledge about
technical infrastructure and a judicious use of financial local networks and voluntary resources.
and contractual levers. • Direct people to culturally appropriate motivational
support in their neighbourhood.
A detailed discussion of change management is
• Match the cultural background of care aides and
beyond the scope of this document, however, we have
patients and help them to develop an enabling,
listed some practical actions that could facilitate
social, motivational role.
implementation of the eight priority practices.
Priority 1: Continuity with a primary Priority 3: Case management for people

care professional with complex needs
• Integrate case managers into primary care teams.
• Make sure that patients are registered with a
• Build relationships and trust among professionals.
primary care practice close to their home.
• Clarify the role and optimal caseload and ensure
• Balance patient choice with promoting continuity
regular supervision for case managers.
of a relationship with a named professional.
• Provide coaching in self-management, and educate
• Provide incentives for appointments of flexible
and support family caregivers.
duration, booked in advance, and allow sufficient
• Support care managers in developing skill in
time for people to talk about what really matters
interdisciplinary team leadership.
to them.
• Provide training in assessment, care planning
• Support practice nurses, general practitioners,
and review of people who are vulnerable or have
pharmacists and other primary care professionals in
complex physical and mental health needs.
working as a team, with sufficient time to anticipate
and address individuals’ multiple problems.
• Establish recruitment and retention practices that Priority 4: Collocated services or a single
minimize “burn-out” and staff turnover. point of access
• Simplify access to services by using outreach,
Priority 2: Collaborative planning of care collocation or virtual network service models.
and shared decision-making • Develop local community health centres and hubs
that provide health and well-being services.
• Create a culture of empathy, compassion and
• Use houses, libraries and leisure facilities as well
trusting, healing relationships.
as conventional health and care facilities.
• Develop staff skills in conducting person-
• Collate sources of local community and voluntary
centred consultations, holistic care planning
information, advice or support.
and enablement.
• Optimize the number of services that can be
• Include physical, psychological, emotional and
accessed without payment for some.
spiritual well-being in care planning.
50
PUTTING PRIORITIES INTO PRACTICE
Priority 5: Transitional or Priority 7: Technology to support

intermediate care continuity and care coordination
• Introduce transitional care to ensure timely follow- • Introduce interoperable information technology
up by people with the right skills. systems or a single care record, with case-finding
• Provide assistance in reconciling and reviewing and decision-support tools for professionals and
medication, and support self-management. patients, and sufficient administrative capacity.
• Ensure access to urgent advice and review outside • Stratify population risk to identify people with
office hours. complex needs for care and support who are at
• Develop “hospital at home” alternatives to a higher risk of adverse outcomes, and adapt the
emergency admission. intensity of care coordination to the level of risk.
• Ensure that multi-professional assessments, support • Use technology for remote monitoring
and interventions are holistic and encourage a and consultations.
return to work and society or, when necessary,
acceptance of end of life. Priority 8: Building workforce capability
• Ensure that roles and responsibilities are clear.
Priority 6: Comprehensive care along • Ensure that all staff, carers, families and volunteers
the entire pathway have the right skills and competence.
• Design a system to connect multiple practice
interventions along the entire pathway that can
be accessed with no (or at least minimum) out-of-
pocket payment, which includes:
- a clear, single entry point within or with
primary care;
- individualized assessments, care planning
and reviews;
- case management;
- enablement;
- coordination of home and community services;
- effective management of care transitions;
• clear protocols, guidelines and accountability along
the pathway or within the network of services; and
• financial incentives that are aligned with
shared outcomes.
51
Action at all levels by Valentijn et al. (78), is a conceptual framework

for integrated care that can be used to identify
The priority practices and enabling actions are the point or level at which specific practices and
implemented at different levels of the health and care actions operate.
system. The “rainbow model” (Figure 6), developed
Figure 6 “Rainbow” model of integrated care
System integration
Organizational integration
Professional integration
Clinical
integration
Functional integration Normative integration
Population-based care Person-focused care Population-based care
Macro Meso Micro Meso Macro

level level level level level
Figure reproduced from (78).
52
PUTTING PRIORITIES INTO PRACTICE
Table 2 lists the points in the system at which

continuity and care coordination practices generally
exert their influence.
Table 2 Points in a health system at which continuity and care coordination exert an influence
Level Point Activity
Micro Clinical integration Interpersonal continuity
Holistic assessment and care planning
Coaching and peer support
Patient-centred medical home
Family health unit
Case management
Meso Professional integration Interdisciplinary teams
Transitional care services
Clinical pathways
Functional integration Continuity of information
Technology-enabled care
Decision support
Organizational integration Collocation of services
Single point of access
Community initiatives
Macro System integration Comprehensive managed care
Health and social care pathways
Health and social care networks
53
5. Conclusions
Continuity of care and care coordination are broad, practices are implemented at different levels of the
interrelated and, at times, overlapping concepts health and care system. Their collective impact is
that make significant contributions to how people greatest when they are delivered as a “bundle” along
experience health and care. They are global priorities the care pathway, ideally within a comprehensive
for reorienting health services towards the needs programme or model of care, with primary care as
of people. its focus.
Practice interventions that improve the continuity The findings from this review of the evidence apply
and coordination of care will invariably improve to different care providers in a range of care settings,
the care experience of people who require chronic at all life stages and in all health care systems and
support, enhance the experience of providers, economies. In many LMI countries, particularly those
improve health outcomes and increase health system with shortages of health care workers and with
performance. Eight priority practices ensure the many dispersed, remote communities, continuity and
aspects of continuity required to provide a positive coordination will depend particularly on informal care,
experience of care, smooth, well-coordinated care family support, community health workers, donor
from several providers, care episodes and settings and funding and social innovation.
contribute to the delivery of IPCHS. These priority
56
Annex 1. Framework on integrated

people-centred health services
Vision
“All people have equal access to quality health services that are co-produced in a way that meets their life course needs, are coordinated
across the continuum of care, and are comprehensive, safe, effective, timely, efficient and acceptable; and all carers are motivated, skilled
and operate in a supportive environment.”
Strategy 1: Strategy 2: Strategy 3: Strategy 4: Strategy 5:

Engaging and empowering Strengthening governance Reorienting the model of care Coordinating services Creating an enabling
people & communities & accountability within and across sectors environment
Strategic Approaches
1.1. Engaging and 2.1. Bolstering 3.1. Defining service 4.1. Coordinating care 5.1. Strengthening
empowering individuals participatory priorities based on life for individuals leadership and
and families governance course needs 4.2. Coordinating management for change
1.2. Engaging 2.2. Enhancing mutual 3.2. Revaluing promotion, health programmes and 5.2. Strengthening
and empowering accountability prevention and public providers information systems
communities health 4.3. Coordinating and knowledge
1.3. Engaging and 3.3. Building strong across sectors management
empowering informal primary care (PC)-based 5.3. Striving for quality
carers systems improvement and
1.4. Reaching the 3.4. Shifting towards more safety
underserved and outpatient and ambulatory 5.4. Reorienting the
marginalized care health workforce
3.5. Innovating and 5.5. Aligning
incorporating new regulatory frameworks
technologies 5.6. Improving funding
and reforming payment
systems
Potential policy options and interventions (non-exhaustive list)

• Health education • Community • Local health needs • Care pathways • Transformational and
• Informed consent participation in policy assessment • Referral and counter- distributed leadership
• Shared clinical decision formulation and • Comprehensive package of referral systems • Change management
making evaluation services • Case management • Information systems
• Self-management • National health plans • Strategic purchasing • Sub-national/district- • Systems research
• Knowledge of health promoting IPCHS • Gender, cultural and age- based health service and knowledge
system navigation • Strengthened sensitive services delivery networks management
• Community-delivered governance and • Health technology • Integration of vertical • Quality assurance
care management at assessment programmes into • Culture of safety
• Community health subnational and local • Monitoring population national health systems • Continuous quality
workers levels health status • Health in all policies improvement
• Civil society, user and • Donor harmonization • Population risk stratification • Intersectoral • Tackling health
patient groups and alignment with • Improved resources partnerships workforce shortages
• Social participation in national health plans allocated to promotion and • Merging of health and maldistribution
health • Decentralization prevention sector and social • Workforce training
• Training for informal • Clinical governance • Primary care with family services • Multidisciplinary teams
carers • Health rights and and community-based • Working with • Improvement of
• Informal carer entitlement approach education sector to working conditions
networks • Patient reported • Gatekeeping/first access to align professional and compensation
• Care for the carers outcomes other specialised services curriculum mechanisms
• Equity goals into health • Performance based • Greater proportion • Integrating traditional • Provider support
sector objectives financing and of health expenditure and complementary groups
• Outreach programmes contracting allocated to PC medicine with modern • Alignment of regulatory
and services • Population registration • Home and nursing care health systems frameworks
• Contracting out with accountable care • Outpatient surgery and day • Coordinating • Sufficient health
• Expansion of primary providers hospitals preparedness and system financing
care • eHealth response to health • Mixed payment models
crises based on capitation
Implementation principles
Country-led | Equity-focused | Participatory | Evidence-based | Results-oriented | Ethics-based | Sustainable | Systems strengthening
64
ANNEXES
Annex 2. Methods used

Medline (PubMed), CINAHL and Scopus were time series studies may be limited by regression to
searched for systematic reviews on continuity and care the mean, and differences in health literacy, social
coordination with regard to the concepts, their relations and functional factors and the human dimensions of
and empirical studies of practice interventions. practice may limit the value of cohort comparisons.
Most studies of care coordination included some
MeSH terms measure of effectiveness, but few reported useful
• Continuity of care: Transitional care, Patient qualitative data on the components of a positive
handoff, Care pathway, Patient navigation. provider and patient experience. Articles on continuity
• Care coordination: Managed care, Case management, of care were more likely to include rich qualitative
Integrated delivery of health care, Patient care descriptions of what patients and providers value
planning, Intersectoral collaboration. but had little quantifiable data.
Most of the published studies were conducted in
Inclusion criteria managed care settings in high-income countries.
Some of the studies were published in several
• reviews published between 2006 and 2017.
formats, amplifying their pre-eminence in the
• articles describing the implementation or evaluation
literature. Most published reviews of patient–provider
of interventions for continuity or coordination of
relationships and continuity of care are culturally
care delivered in primary care, community services
biased, as they exclude studies from LMI countries
or across sectors.
on the basis of language or other criteria developed
• studies indicating a positive effect on personal
in high-income countries. The analysis was tested
or system outcomes, satisfaction with care,
against key themes in a scoping review of the
patient activation or provider’s perception of
literature on the experience of compassion and
care and satisfaction.
continuity of care in Latin American and Caribbean
countries. A targeted search of the grey literature
Exclusion criteria revealed practice examples from a range of health
• articles in languages other than English. care systems, including LMI countries, by different
• publications with mainly a conceptual, organizational providers in a range of care settings and across the
or system focus that did not report on a specific life stages.
practice intervention.
Results
Limitations The search yielded 81 articles that were retained for
Many papers included continuity or care coordination full text reading: 21 were systematic reviews, 39 were
as one of a number of components in practice primary empirical studies, and 21 were grey literature
interventions. Few empirical studies demonstrated on continuity and care coordination approaches
their effectiveness at scale. This may reflect the and interventions. These papers were analysed to
interdependence of complex multidimensional identify actionable priority practices associated
interventions in many care contexts and structures. with good quality of care, improved outcomes or a
It is difficult to quantify effects discretely and to positive patient or carer experience. Tables A2.1–3
attribute changes to specific inputs and outputs in non- illustrate how these actionable priorities align with
linear, system-wide programmes with conventional and support the policy options and interventions
approaches to evaluation. Attempts to evaluate within IPCHS strategies 1, 3 and 4 in the WHO
Framework on IPCHS (2).
65
IPCHS strategy 1: Engaging and become actively engaged in coproducing healthy

environments and provide informal carers with the
empowering people and communities necessary knowledge to optimize their performance
The strategy of providing the opportunity, skills and and support in order to continue in their role.
resources that people need to be articulate and to Engaging and empowering people also includes
empower users of health services and advocates of a reaching underserved and marginalized groups of
reformed health system seeks to unlock community the population, to guarantee universal access to
and individual resources for action at all levels. It aims and benefit from high-quality services that are co-
to empower individuals to make effective decisions produced according to their specific needs.
about their own health, enable communities to
Table A2.1 Continuity and care coordination interventions aligned with IPCHS strategy 1
Strategic Selected policy options and interventions Practice interventions identified

approach proposed in the IPCHS Framework in the literature review
Engaging and • health education • health coaching

empowering • informed consent and shared decision- • care planning
individuals and making • anticipatory care planning
families • self-management, including personal • advanced care planning
care assessment and treatment plans • care navigators
• understanding how to navigate the
health system
Engaging and • community-delivered care • community health agents

empowering • community health workers • community connectors
communities • development of civil society • compassionate communities
• strengthening social participation in
health
Engaging and • training for informal carers • carer education

empowering • informal carer networks • peer networks
informal carers • peer support and expert patient groups
• caring for carers and respite care
Reaching • integration of health equity goals • community hubs

underserved and • provision of outreach services for • telemedicine
marginalized underserved populations
populations
66
ANNEXES
IPCHS strategy 3: Reorienting the model outpatient and ambulatory care and from curative to
preventive care. It requires investment in holistic and
of care comprehensive care, including health promotion and
Ensuring that efficient, effective health care services ill-health prevention strategies to support people’s
are designed, purchased and provided through health and well-being. It includes respect for gender
innovative models of care that prioritize primary and and cultural preferences in the design and operation
community care services and the co-production of of health services.
health. This encompasses the shifts from inpatient to
Strategic Selected policy options and interventions Practice interventions identified

Revaluing • monitoring population health status • risk stratification to target

promotion, • population risk stratification interventions
prevention and • surveillance, research and control of • community health agents.
public health risks and threats to public health • assets- and strengths-based
• improved financial and human resources practice
allocated to health promotion and • family–nurse partnership
prevention
Building strong • primary care services with a family and • patient-centred medical home
primary care- community approach • House of Care
based systems, • multidisciplinary primary care teams • family health units
particularly for • family medicine
people with • gatekeeping access to specialized
complex and/ services
or multiple • greater proportion of health expenditure
problems allocated to primary care
Shifting towards • home care, nursing homes and hospices • intermediate care
more outpatient • repurposing secondary and tertiary • “hospital at home”
and ambulatory hospitals for acute and highly complex • transition services
care care only • ambulatory care models
• outpatient surgery and day hospitals
• progressive patient care
Innovating and • shared electronic medical records • technology-enabled care

incorporating • telemedicine • home and mobile health
new technologies • mHealth monitoring
• self-management platforms
67
IPCHS strategy 4: Coordinating services action at the community level in order to address
the social determinants of health and optimize use
within and across sectors of scarce resources, including, at times, through
Coordination involves integrating care from providers partnerships with the private sector. Coordination
within and across health care settings, development focuses on improving the delivery of care by aligning
of referral systems and networks among levels of and harmonizing processes and information among
care and the creation of linkages between health different services.
and other sectors. It also includes intersectoral
Strategic Selected policy options and interventions Practice Interventions identified

Coordinating • care pathways • health navigators

care for • referral and counter-referral systems • care coordination
individuals • case management • transitional care
• improved care transition • intermediate care
• team-based care • case management
• clinical and care pathways
Coordinating • health service delivery networks • multi-specialty providers

health • purchasing integrated services • interdisciplinary teams
programmes and • integrating vertical programmes into • general practitioner clusters
providers national health systems
• incentives for care coordination
Coordination • health in all policies • clinical and care networks

across sectors • intersectoral partnerships • chains of care
• merging the health sector with social • cross-sector collaboratives
services • community connectors
• working with the education sector to • compassionate communities
align professional curricula for acquiring
new skills
• integrating traditional and
complementary medicine within modern
health systems
• coordinating preparedness and response
to health crises
References
1. Sinclair S, Norris JM, McConnell SJ, Chochinov 2. Framework on integrated people-centred health
HM, Hack TF, Hagen NA et al. Compassion: services. Report by the Secretariat. Geneva:
a scoping review of the healthcare literature. World Health Organization; 2016 (http://apps.
BMC Palliat Care. 2016;15:6. who.int/gb/ebwha/pdf_files/EB138/B138_37-
en.pdf, accessed 30 April 2018).
68
Family Health
UNIT ONE
Family Health
Learning Objectives
By the end of this session the learner will be able to:
• Tell what the word family and health means

• List justification for knowing family health
• Recall the objectives and strategies of family health
1. Definitions Of Family
Family is defined as “ a basic structure of society centred about
replacement.”
Family: According to Winch, (Robert F. Winch, 1963) family is
defined at three levels, nuclear, extended and general.
1. Nuclear family is defined as ‘’ a family consisting of a married
couples and their children; the children can be born or adopted’’.
2. Extended family is defined as ‘’ a nuclear family plus collateral
kinship.’’ – Lineal is vertical extension i.e. father, grand father,
mother collateral indicates relationships such as uncles, aunts,
nieces, nephews etc.
3. Joint family: a family consisting of two or more married couples
staying together with children.
1
Family Health
Family health is a part and component of community health. For

practical reasons, it may be sound to distinguish:
♦ The childbearing unit, nuclear or one parent family, where the
genetic factors are prominent.
♦ The child rearing unit, from nuclear to extended, with
predominance of the social and environmental factors.
“Family health is more than the sum of the personal health of
individuals (including father) who form the family since it also takes in
to consideration-interaction in terms of health (physical and
psychological) between members of the family-relationships between
the family and its social environment-at all stages of family life in its
different structural types’’. Family should be distinguished as: A unit
of health and unit for care.
What is health
Health is defined in different ways by different authors. It could be

defined as: A quality of life, which involves social, mental and
biological fitness on the part of the individual, which results from
adaptations to the environment.
World Health Organization (WHO) defines health as:

A state of complete,
♦ Physical,
2
Family Health
♦ Mental and social well-being and not merely the absence of

disease or infirmity.
Others consider health as being more holistic, including spiritual and

emotional components. The summary of different views
conceptualises health to be multidimensional and inclusive of many
components and many different aspects of one’s life.
We can consider health as a quality of life that is a function of at least

social, mental, emotional, spiritual and physical health.
Justification
Knowledge acquired in the past few decades has clarified the biological
and social bases underlying the health and health care of families. This
knowledge has strengthened the scientific justification for family health
care.
♦ The basic principle underlying family health is that there are specific
biological and psycho-social needs inherent in the process of
human growth and development which must be met in order to
ensure:
o The survival and healthy development of the children in the
family and future adult.
3
Family Health
♦ Child spacing is a means of bettering the health of mothers and

children. The positive impact of child spacing will be reflected. In
national socio-economic development.
♦ If preventive action is taken in pregnancy and early childhood, its

effectiveness and impact on general health is great.
♦ Healthy development of children is an investment in social

development and productivity.
♦ Mothers and children form the majority of the population.
♦ Family can also be seen as a unit of health: if one of the members

of a family is ill, the hole family suffers or is exposed to a health
risk such as contagious diseases or parasitic infestation which are
so easily transmitted from one member of the family to another
because of the closeness of home life.
♦ Healthy and happy parents, whose children have been desired

and fostered in their development from their earliest years:
children who have been protected from health risks while bearing
progressively their own responsibilities in this area. This
represents the image of a healthy family – the only real basis for
the self-realization of all its members.
4
Family Health
♦ Family as a unit of care: if the family is viewed as a unit for

care, it offers the possibility of global approach that can
render care for the individual more accessible, more
acceptable, and more effective. This approach also takes
account of the patterns of intra-family relationships in
regard to disease prevention, health education and health
care.
Objectives
The major objectives are:
♦ To reduce maternal, infant and child morbidity and mortality;
♦ To reduce total fertility (TFR);
♦ To increase contraceptive prevalence rates (CPR)
♦ To increase EPI services
Hence, the overall objectives of integrated family health services (HSDP,

2003) is to strengthen and to gradually expand family planning, health
and nutritional services for mothers, children and youth at all levels of the
health system, including community level.
Strategies
• Increasing utilization of information and knowledge about RH and
safe sexual practices.
• Integrating family health with other health services.
5
Family Health
• Strengthening logistic support

• Strengthening and expanding EPI services at all sites through
effective support and a well-functioning cold chain system.
• Developing and expanding emergency obstetric surgical
interventions, post-abortion care, and blood bank services to
strengthen maternal emergency services.
• Strengthning prenatal and postnatal counselling.
• Creating an enabling environment for all stakeholders involved in
EPI and RH activities to operate in an integrated approach.
• Initiation and creation of youth-friendly health services
• Initiating sugar and flour fortification with Vitamin A
• Promoting the use of iodised salt at household levels and
supplementing Vitamin A to pregnant mothers and children less
than five years.
• Conducting advocacy at all levels.
• Promoting exclusive breastfeeding for the first four to six months,
appropriate child feeding practices, growth monitoring and de-
worming.
• Develop training manuals and implementation guideline
• Conduct planned workshops, seminars, discussion forums;
• Strengthen intra and inter-sectoral collaboration among health
and other sectors.
• Conduct training of trainers.
6
Family Health
• Introduce a basic package of nutrition to health services

• Provide technical support to the Regional Health Bureaus.
Target
• Increase contraceptive coverage rate
• Increase ANC coverage
• Increase the proportion of deliveries assisted by trained health
workers
• Reduce measles morbidity and related mortality
• Increase post-natal service coverage
• Reduce the maternal mortality
• Increase EPI coverage
• Achieve polio elimination and certification
• Increase EPI coverage of TT2 to pregnant and non pregnant
women
• Reduce iodine deficiency
• Reduce the prevalence of micronutrient deficiencies
• Expand IMCI strategy in the health facilities.
• Increase utilization of integrated reproductive health services by
youths.
• Reduce vitamin A deficiency disorders among children under five
years
7
Family Health
Assessment And Group Discussion
1. What do you understand when we say family health?

2. Is family health care necessary for Ethiopia? Why? And why not?
3. What are the objectives, strategies and targets of family health in
Ethiopia?
8
Family Health
UNIT TWO
Maternal Health Care
Learning Objectives

♦ Recognize the extent of maternal health problems
♦ Identify the major health problems of women
♦ List the factors that cause maternal morbidity & mortality
♦ List and describe the components of family health
Maternal Morbidity and Mortality
Today an estimated 500,000 maternal deaths occur each year in the

world and ninety nine percent happening in developing countries
(WHO, 2000): In Ethiopia the estimated current maternal mortality
rate is 550,000 /100,000 LB (MOH).
The cause and factors to maternal morbidity and mortality could be:
Medical Factors
♦ Anaemia of pregnancy
♦ Obstructed labour
♦ Infections
♦ Hypertension
9
Family Health
Health delivery system factors

♦ Inadequate action taken by health personnel
♦ Lack of essential supply and trained staff.
♦ Lack of access to health services
♦ Low coverage of immunisation and
♦ Inadequate health care facility
Reproductive factors
♦ Pregnancy in age under 19 and greater than 35 years
♦ Four or more pregnancies
♦ Practice of early marriage
♦ High fertility
♦ HIV/AIDS/STI’s
♦ Unwanted pregnancy e.g. unsafe or induced abortion
Socio-economic factors
♦ Poverty,
♦ Malnutrition,
♦ Low level of female education
♦ Law status of women
♦ Practices of early marriage
♦ Poor environmental sanitation and personal hygiene,
10
Family Health
Harmful traditional practices

♦ Practices of early marriage
♦ Inappropriate timing of pregnancy
♦ Short pregnancy interval (less than two years)
♦ Female Genital Mutilation
Assessment and Group Discussion

A) Recall the extent of maternal health problems
B) Recall the major health problems of women in Ethiopia
C) List the factors to the cause of morbidity & mortality
Maternal health services

Components of maternal health services
♦ Preconception care
♦ Prenatal care (Antenatal care)
♦ Delivery care
♦ Care for the newborn
♦ Postnatal care
Preconception Care
Definition: Preconception care is a comprehensive care that women
need to be healthy getting pregnant.
To plan for a healthy pregnancy, preconception care includes:
11
Family Health
• A visit to a health care facility (health post) to identify and correct

any health problems
• Updating immunizations status
• Good nutrition education for mother
• Vitamin A supplementation including folic acid
• Counselling on regular physical activity
• Educating on unhealthy substances: alcohol use, cigarette
smoking, using drugs
• Counselling and testing for HIV/AIDS/STI if at risk
Antenatal Care/Prenatal Care
What is pregnancy?
We say a woman is pregnant when a male's sperm reaches in the
uterus of a woman, meets and fertilizes the woman's ovum.
Pregnancy lasts from 37 to 42 weeks, (40 weeks on the average).
The fertilized ovum gradually grows and develops in the uterus of the
woman and transforms itself into a foetus.
Antenatal care…
Definitions:
What is antenatal service?
Antenatal service is the provision of counselling and health service to
a pregnant woman by a health professional from the time of
conception to delivery. It would be good if the following cheek ups are
made for a pregnant woman.
12
Family Health
• Urine test for albumin and sugar.

• Haemoglobin (in Health Canter)
• Blood pressure (in the Health Post)
• Foetal auscultation (Foetal scope) (in the Health Post)
• Foetal palpation (in the Health Post)
Educating mothers the need to have regular check ups during

pregnancy.
The medical check up made during pregnancy helps mothers to get
advices during pregnancy and post delivery periods. This will help to
prevent and reduce morbidity and mortality among mothers and
children to be born. This is information that needs to be also shared
with women of childbearing age.
The following are the activities that would be undertaken during first
antenatal visit:
Registration of age, height, weight, last day of menstruation. From
these information, the expected date of delivery will be calculated.
Other information that would be collected from the mother are,
number of children born, where they were born, previous health
problems, information whether she ever taken vaccination or not.
After these and other information are collected, and when there are
some indications for risks during pregnancy and delivery, the mother
should be educated about the need for her to go to the next higher
13
Family Health
level of health facility. She must also be educated not to keep her
pregnancy as a secret.
Risks during pregnancy

Pregnant women can face some illnesses during their pregnancy
period. Unless these illnesses are known on time and the necessary
care is taken, the illnesses can lead to life threatening risks. The
signs of such illness are the following: -
Puffiness/ oedema of the face especially around the eye.
Oedema of fingers.
Consistent nausea and intense vomiting.
Severe headache, abdominal pain, blurred vision.
Bleeding from the uterus.
Blood-like vaginal discharge.
Fever.
Voluminous yellowish or white vaginal discharge.
When the following signs are observed, the woman should be

immediately referred to a health facility since this will lead her to
dangerous situations. There is a need to make close follow up and
know the outcome.
Conditions requiring close follow up

If the pregnant woman's age is below 18 years.
If a woman over 35 years of age is pregnant for the first time.
14
Family Health
If the previous delivery was by cesarian section.

If the height is below 150cm. and pregnant for the first time.
Pregnancy (parity) over five.
Less than 2 years spacing.
Absence of foetal movement after 20 weeks of gestation
Community support during pregnancy

• Share the workload so that heavy physical effort could be reduced
• Encourage woman to eat balanced diet and rest more than usual
• Establish transport readiness for emergency referral
• Risk mothers should be encouraged and supported to stay near a
health centre or hospital
Care during pregnancy

Balanced diet
Balanced diet is one of the major essentials for a woman during her
pregnancy. The food she takes must meet the nutritional
requirements of herself and her baby. She needs to regularly and
attentively feed herself with cereals, vegetables, fruits, milk, meat,
pulses, butter, and cereals with fat contents. If she cannot get these
food items, she should be educated on the use of other food items
that replace those ones. She must be also educated on attending
follow-up visits and about the role of the balanced diet she takes
15
Family Health
during pregnancy in the child's physical and mental growth and

development before and after birth.
Regular antenatal follow up

It is proposed that there should be:
♦ Nine visits for the healthy nulliparous
♦ Seven visits for the healthy parous
Actual visit is – Once per month up to 28 weeks (that is four times)
• Twice per week up to 32 weeks (four times)
• Then once per week till delivery. Such visits can help women to
monitor their pregnancies and seek advice along the way. Health
care providers can also help to detect and manage any warning
signs that might occur during pregnancy.
Personal hygiene
A pregnant woman must keep her personal hygiene more than ever
since the body easily gets dirty at this period than at other times;
because much waste is disposed as sweat through the body skin.
When this waste is accumulated on her body, it gives discomfort to
the woman. Hence, the woman must regularly wash her body and
keep her personal hygiene.
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Dressing
In order to make complete the personal hygiene status of the
pregnant woman, her clothing and dressings have to be clean. It
does not mean that she has to have new clothes all the time. The old
clothes can be regularly washed and kept clean.
Rest and Relaxation

Rest is very important for the health of the pregnant woman. She has
to get eight hours sleep every night. This does not mean that she
should not engage herself in any activity. She can perform routine
domestic functions. Nevertheless, she should not lift heavy material,
should not travel long distance by foot and perform heavy duties. For
example, she should not pound, carry full jars, and do such type of
heavy works. Nevertheless, she can undertake simple and useful
activities slowly and with care. She has to be advised to regularly
walk short distances and perform simple activities at home.
Vaccination against tetanus

Tetanus vaccination, given to the pregnant women, will help to
prevent the new born from acquiring tetanus. The importance of this
vaccine has to be explained to pregnant women and to all women of
childbearing age. It is important to ensure whether she has started
taking anti tetanus vaccine or not. If she has not completed the
vaccination, there could be a need to vaccinate her. But if she has
never been vaccinated, there is a need to immediately vaccinate her.
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Harmful practices to avoid during pregnancy

♦ Massaging the abdomen
♦ Repeatedly taking local anti taeniasis (Kosso)
♦ Alcohol
♦ Unprescribed use of drugs
♦ Cigarette smoking and other tobacco use
Preparations when delivery date approaches

♦ Clean clothes and dresses for the newborn.
♦ Make ready a sleeping place and washing basin for the baby.
♦ Correction of retracted nipple.
♦ Prepare foods for the mother, which she would take them during
her maternity period.
• Securing a transport and money
Nutrition during pregnancy

Balanced diet: It is one of the major essentials for a woman during
her pregnancy. This helps prevent anaemia, and difficult labor. The
food she takes must meet the nutritional requirements of herself and
her baby. Pregnant women should eat foods rich in protein (eggs,
milk and milk products, Soya bean, beans and lean meats), Calcium
(dairy products, green leafy vegetables, fish), iron and folic acid (lean
meat, legumes, green leafy vegetables, egg yolk).
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Work during pregnancy

There is little evidence that continuing to work adversely affects the
outcome of the normal pregnancy. However, women with certain
medical conditions, high-risk pregnancies, or other complications may
need to decrease working hours or discontinue working altogether.
As long as the job is safe, and does not cause any stress and
exhaustion, low-risk pregnant women can continue to work. Job
requirements may be modified to allow for less physical workload,
frequent breaks, elevation of legs, and frequent position changes.
Reduced hours may be allowed in the third trimester as the demands

of pregnancy increase. Working pregnant women should learn about
their organizations maternity benefits and leave plans, as well as
related local and national laws.
Travel during pregnancy
Pregnant women can safely travel until close to their due date.
Exceptions include women with medical conditions or high-risk
pregnancies. Some guidelines to follow include:
♦ Select the fastest mode of travel, if possible.

♦ Wear comfortable clothing.
♦ Stretch legs or walk every hour and a half.
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♦ Take antenatal care records along.

♦ Do not take any medication for motion sickness without advice
Sex during pregnancy
A healthy woman can have sex throughout her pregnancy, without

harm to the foetus. Intercourse will not induce pre-term labor.
However, labor may follow intercourse at or near term. Women at risk
for miscarriage or premature labor should abstain from intercourse
and breast stimulation. In addition, pregnant women should continue
to use condoms with partners that have Sexually Transmitted
Infections.
Delivery Services
Delivery care: Is a care given during delivery process

Labor: Labor is a natural force by which the foetus and placenta are
expelled from a mother's uterus.
Types of labor
• False labor: False labor is labor that is not true especially felt by
women with first pregnancy.
With false labor, there is no feeling of pushing, no wetting (discharge)

and opening of the cervix, In order to know the opening of the cervix,
there is a need to do vaginal examination.
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• True labor: Back pain, feeling of pushing, wetting (mucus

discharge) and opening of the cervix are associated with true
labor.
During true labor, contraction and relaxation of the uterus starts and a
force of pushing down is felt by the mother. This feeling is felt at the
end of nine months of pregnancy. The feeling of pushing down gets
stronger as the date for delivery approaches. Pushing down
(contraction of the uterus) comes and goes frequently and later stays
longer. The volume of discharge increases, placental fluid starts to
flow out and small haemorrhage starts.
The health extension worker must know the two types of labor and
must be able to provide the necessary delivery assistance when she
knows it is true labor.
Stages of labor
• First stage labor

This is labor which lasts from the beginning of a strong contraction of
the uterus until the baby drops into the birth canal. First stage labor
lasts 10 - 20 hours for women with first birth, 7 - 10 hours for mothers
with more than one births.
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• Second stage labor

Second stage labor is labor that lasts from dropping of the baby into
the birth canal until it is born. This stage lasts one hour on the
average.
• Third stage labor
Third stage labor is a process that lasts from the birth of the baby until
the expulsion of the placenta. Therefore, the health extension worker
should take into account these stages of labor and if the labor at each
stage is more than the expected time, she should take her to the next
health facility with supervision and assistance.
Preparations of the woman for delivery

To keep personal hygiene of pregnant women: water, soap and
clean cloth should be prepared for washing the legs, the pelvic
and genital areas.
The delivery room should be prepared to have adequate
ventilation and light.
Do every thing possible to make the room clean.
Prepare the sleeping place and make it comfortable to the
woman.
Prepare water and soap for hand washing.
Boil the razor blade for cutting and the thread for tying the
umbilical cord.
Prepare clean clothes for the new born.
Prepare clean gloves.
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Advice the woman that comes for delivery to pass urine and stool
before any delivery process.
The health extension worker should wash her hands with water
and soap.
Advice the woman to walk slowly in the house and to sleep on her
left side when she wants.
Care during intense labor

• Since labor entails tiredness, the woman on labor should be made
to get simple food on occasional basis.
• Something that could be drunk is also necessary. She should
occasionally be given clean water and light tea.
• Her husband, and if possible, her parents should be made to stay
around her.
Remember: The following steps or conditions should be followed to
conduct every safe deliveries:
WHO’S ‘’SIX CLEANS’’ FOR LABOR AND CHILD CARE
♦ Clean hands
♦ Clean perineum
♦ Nothing unclean introduced into vagina
♦ Clean delivery surface
♦ Clean cord-cutting instrument
♦ Clean cord care (clean cord ties and cutting surface)
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When the baby is born

• The baby's head will be seen first and later the face is seen.
When labor becomes intense, the body of the baby slips down to
the pelvic area.
• When the face is seen, the mouth and nose should be cleaned.
• When the head is out and the neck is seen, the health extention
worker should see if the umbilical cord is twisted around the neck.
• If the cord is twisted around the neck of the baby, attempt should
be made to untie the cord from the neck by turning the head or
trying to send the cord back to shoulder. The mother should be
told not to push down at this moment. If the umbilical cord is
tightly knotted around the neck of the baby, the cord can be
knotted and quickly cut at two places as it is on the baby's neck.
• After the baby's neck is seen and shoulder starts to come out, the
head should be held down with two hands (one hand below and
the other above) until one of the shoulders comes out. After one
of the shoulders comes out, it should be raised up to allow for the
body also to come out.
• Tie the cord at two places and cut it between the two tied places.
The cord on the side of the baby should be tied again at another
place.
• There is no need to paint the cut cord with anything. As
traditionally done, painting it with cow dung, mud, butter or
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another thing is dangerous to the baby. It can lead to tetanus

infection.
• The newborn should immediately be made to sleep on one of
body sides and then back should be gradually massaged until the
baby starts to cry.
• The body should be checked for any physical disability and if
there is any, the mother should be sent to a health facility where
assistance can be given. The health extension workers should
make follow up and a feedback should be received from the
health facility.
• The baby should be made to have physical contact with the
mother for warming and should breast feed after cleaning.
Expulsion of the placenta

• The mother will feel some labor after she has delivered. Most of
the time this is a normal uterine contraction to expel the placenta.
• The placenta will expel itself within a few minutes of the birth of
the baby.
• It is necessary to see that the placenta has been expelled without
being cut into pieces. This is known by seeing that there is no cut
in its soft side and that there is no cut on its sheath. This is done
by spreading and seeing it well.
• The baby shall be rolled with warm clothes and care should be
taken not to expose the baby to cold
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Care for the mother after delivery.

• Ensure that the uterus has completely contracted.
• Ensure that there is no much bleeding.
• If there is much bleeding, first aid and ergometrine should be
given to her and shall be urgently referred to the next health
facility.
• Check if there is or no genital tear. If there is tear, put cotton pad
or clean cloth and advice for urgent referral to the next health
facility.
• If there is no genital tear, clean with lukewarm water and advice
the mother to hold clean cotton/cloth in same area.
• Give the necessary information to provide the mother with hot tea,
atmit (local fluid food) and milk.
• Clean all equipment used for delivery. Now bury the placenta at
the backyard.
• Continue Iron/folic acid for the mother if she was previously on
this drugs
• Give Vitamin A to the mother
Care for the New born

• Register the new born/date of birth, time, sex, weight etc.
• Dress the baby with clean cloth
• Give BCG and Polio vaccination and give next appointment for
immunization.
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• Breastfeed the baby immediately

• Give polio and BCG Vaccination
• Educate mother to wash the baby with lukewarm water and dress
with clean clothes.
Postpartum Care
Definition: postpartum care is the period from completion of third

stage of labor to the return to the normal non-pregnant, or pre-
pregnant state, usually six weeks later. Lactation may continue after
this period, menstruation may not recommence yet, or sexual activity
is resumed. Overall it is a care given within the first 24 hours of
delivery up to six weeks to:
♦ Prevent complications
♦ Restore to normal health
♦ Check to adequacy of breast-feeding
♦ Provide Family Planning service
♦ Give basic health information
Complications during Postnatal period
♦ Puerperal sepsis/general infection
♦ Thrombo-phlebitis
♦ Secondary Haemorrhage
♦ Breast problems – engorgement, infection
♦ Incontinence – stool or urine
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Care to the mother during postnatal period.

♦ Establish breast-feeding: Give time for the mother and the baby to
make acquaintances and begin bonding. You should encourage
this immediately after birth, within 30 minutes of delivery.
♦ Teach the mother the advantages of breast-feeding.
The mother should be educated about family planning and get
contraceptive before next pregnancy occurs. (Progesterone only
pills can be given during this period)
Tell the mother that breast milk is sufficient to the baby until six
months and undertake home visit to ensure that she is breast-
feeding.
Tell her to begin supplementary feeding after six months and
continue breastfeeding until 2 years or more.
Tell the mother that giving butter or oil to the baby is harmful.
The mother should be advised not to breastfeed, if she is
confirmed positive for HIV.
Encourage the mother not to sleep in a dark room. The room
should have fresh air and light.
Encourage on adequate rest, balanced food, and light exercise.
Breastfeeding
Breast milk is: a perfect nutrient, easily digested, can be efficiently
used and protects against infection.
Breastfeeding: - helps mother child bonding, helps delay a new
pregnancy for some months and protects mother’s and baby's health.
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♦ Start breastfeeding within 30 to one hour of birth

♦ Breastfeed exclusively from 0 – 6 months of age
♦ Complementary foods can begin between 4 – 6 months
♦ Start full complementary food to all children from 6 month of age
♦ Continue breastfeeding up to 2 years of age or over
Breast-feeding
♦ After delivery, or as soon as the baby is alert and interested
♦ Make sure the area around the nipple (the areola), as well as the
nipple itself, is in the baby's mouth
♦ If the baby started breast-feeding from the right breast last time,
start with the left breast the next time (and vice versa)
♦ Breast-feed the baby " ON DEMAND " - whenever the baby seems
hungry
Advantages of breastfeeding
If all babies are to be healthy and grow well they must be fed breast
milk. Breast milk is food produced by the mother’s body especially for
the baby. It contains all the nourishment a baby needs.
Breast milk:
♦ Contain the right amount and type of nourishment for babies
♦ Is SAFE, and avoids potentially contaminated bottles,
♦ Has immunological properties and protect infants from infection
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♦ No cost incurs to the family

♦ Mothers usually have longer periods of infertility
♦ Breast fed infants are less likely get colic, allergy, diarrhoea
♦ Immediately after delivery encourages uterine contraction
♦ It is always available at right temperatures.
♦ Breastfeeding makes mother and baby close & loving
Care during breastfeeding (demonstration).

Wash hands before breastfeeding.
Clean and dry with clean cloth the washed breast.
Sit in a comfortable position while breastfeeding.
Breastfeed for 15-20 minutes at each breastfeeding on demand.
Hold up the baby after breastfeeding with cloth or breast holder.
Following the breastfeeding, up hold the baby in an up right
position. Repeatedly and smoothly tap the back of the baby until
it belches.
If one of the breast nipples cracks or gets infected, breast-feeding
should be continued with the other healthy breast.
Disadvantages of Bottle Feeding

Formula milk is expensive
Formula needs to be accurately mixed for adequate nutrition
Takes time for preparation
Baby more susceptible to diseases and infection
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Fuel is needed for heating water to mix the formula

More than one bottle is needed
Demonstration on getting sunlight for the baby.

• Educate the family about the prevalence of bone deforming
diseases (ricket) and the need to expose the baby to sunlight on a
daily basis to prevent rickets.
• Start Warming on the second week of birth.
• Warm the baby outside the house for 10 - 20 minutes in the
morning.
• The hands, legs and other body parts should be exposed to
sunlight.
• Follow up should be made by the health extension worker on this
practice.
Supplementary Feeding
• Wash hands before the preparation of child’s food
• Start supplementary feeding when the baby reaches 6 months of
age.
• Supplementary foods should be given with a cup and spoon
without interrupting breast milk.
• Baby can be fed with boiled and mashed potatoes, boiled eggs
and thin porridge. As the baby grows older feed thin and non-
spiced pulses sauce mixed with injera (shiro).
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• Avoid pepper and spices and too much fat.

• Limit the amount of food to be prepared for one time to serve hot.
• Avoid foods that have been prepared a day or night earlier that
could lack hygiene, which can endanger the health of the baby.
• Give only boiled and cooled water to a baby.
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UNIT TWO
Family Planning Services
Learning Objectives
By the end of this session the learner would be able to:
♦ Understand what Family planning means
♦ List the major objectives of Family Planning
♦ Tell the importance of Family Planning
♦ List the methods, advantage and disadvantages of FP
Definition: Deciding the number of children you want, when you want
them. It is a means of promoting the health of the women and families
and part of a strategy to reduce the high maternal, infant and child
morbidity and mortality.
Objectives:
General: Is to reduce morbidity and mortality of mothers and children by
spacing child bearing, preventing unplanned and unwanted pregnancy.
Specific:
• To increase awareness, knowledge and skills of the community to
utilize family planning services,
• To increase utilisation of family planning services by households,
• To prevent mothers from having too many pregnancies and children
• To avert population growth rate,
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• Prevent unwanted pregnancies and high risk abortions,

• Promote active participation of males in family planning activities.
Benefits Of Family Planning Services
General Benefits
For the family
F ood is available for the whole family; all can get enough food based
on their income
A naemia: the need for iron is supplied with some FP methods
M aternal Mortality: decreased
I nfertility: couples can have infertility service
L ow birth weight: because of 2-3 years spacing between births birth
weight
improves
Y oung children and infants competition for food and cloths minimized
H appier sexual relationships: no fear of unwanted and untimed
pregnancy
E ducational opportunity for all children in the family
A bortion: problem of induced or illegal abortion decreased
L actation continues: there are methods that do not interfere with
lactation
T eenage pregnancy decreases, for they can use the methods
H ealth screening test: pap smear done to screen malignancy
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b) For the health of the mother

• Mother’s body needs at least 2 years or more to get back to full
strength after the birth of a baby.
• By reducing undesired family size the need for health care and
education of a family is achieved
c) For the health of the children
♦ Increase birth weight,
♦ Children will get adequate care and affection,
♦ Children can be breast feed longer and receive proper amount of
nutrients, vitamins and minerals,
♦ Helps children to receive educational opportunities.
d) Benefits for national welfare

♦ Better rearing of children by devoting more time to each child
♦ Prevents excessive population growth,
♦ Promotes and speeds up national development, and helps women
to participate in development.
Traditional family planning methods
Breast-feeding method:
When a mother breast-feeds her baby, the message concerning the
feeding goes from the nipple to the vagus nerve and proceeds to the
front-part of the pituitary gland in the brain. Then the pituitary gland
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initiates the production of prolactin hormone to activate the milk

producing glands in the breasts. The prolactin hormone again
reduces the secretion of luteinizing hormone which initiates the
normal menstrual cycle. Thus the process interrupts ovulation and
prevents pregnancy.
Weaknesses
• Its effectiveness is low compared to all other natural methods of
contraceptives;
• It does not prevent HIV/AIDS and other sexually transmitted
diseases; and
• The effectiveness of this method decreases over time starting
from sixth months after delivery.
The calendar method:
If a woman has a regular cycle of 27 days, it is possible to know by

subtracting from 27-18 and 27-11 the first and last days of ovulation
respectively. Based on this calculation , the woman should avoid
sexual intercourse between day 9 and day 19 of the menstrual cycle
in order to prevent pregnancy. By the same token, women who have
regular menstrual cycles of 28 days, to 30 days should avoid sexual
intercourse between 10-17 days and 12-19 days respectively; this
time they are safe to do sexual intercourse during the remaining
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respective days. This method is only appropriate to the affluent

people.
Weaknesses
• This method of preventing pregnancy does not prevent
HIV/AIDS/ST.Is
Abstinence method:
This refers to stopping temporarily or permanently sexual intercourse.
Using this natural / traditional method requires a strong discipline,
thrust and good understanding between husband and wife or sexual
partners. The effects of this method in the prevention of pregnancy is
100%. It incurs no expenses. There are no side effects on the body. It
prevents early-age pregnancy and sexually transmitted diseases
including HIV/AIDS.
Withdrawal Method:
This method uses the withdrawal or the pulling out of the male genital
(penis) from the vagina, interrupting sexual intercourse just before
ejaculation so that sperm does not enter the vagina. The ejaculation
must be far away from the genital areas to make sure that no sperm
enter the vagina. The effect of this method is weak and unreliable
because of the following reasons.
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Weaknesses
• Many males may not be able to control ejaculation time to pull out
the penis on time; and
• Semen containing sperm may be leaking out into the vagina even
before ejaculation.
Modern Contraceptive Methods
Combined oral contraceptive pills:

Combined oral contraceptive is prepared from two hormones,
estrogen and progestin. This is the most commonly used method in
Ethiopia.
Mechanisms of action
• Prevents ovulation;
• Thicken cervical mucus making it difficult for the sperm to pass
through;
• Makes the lining of the uterus too thin for the fertilized egg to
implant itself making it difficult for further development.
Presentation
• It comes in a packet of 28 pills and organized in four rows of
seven pills. In the first three rows are the combined oral
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contraceptive pills, while the seven pills in the last row are body
supportive pills made of minerals.
Effectiveness
• It is highly effective;
• Avoids the fear of unwanted pregnancy during sexual intercourse;
• Can be taken by any female that has reached puberty-age;
• Pregnancy resumes immediately after interrupting the pills;
• Prevents extra-uterine pregnancy;
• Prevents unwanted pregnancy resulting from casual or
unexpected sexual intercourse.
• No backup method necessary.
Adverse effects
• Nausea (the first three months);
• Irregular menstruation or missed menses,
• Headache;
• Tenderness of the breast;
• Weight increase; and
• It is not the choice for breast-feeding mothers.
Weaknesses:
• Pills are taken every day, hence, inconsistent or incorrect use
raises a risk; and
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• Lack of protection from HIV/AIDS and other sexually transmitted

diseases.
Emergency contraception:
Emergency contraception is a combined oral contraceptive pills
method that women can use to prevent pregnancy expected from
unprotected sexual intercourse /violence, rape/. However, it should
be underlined that the use of such method is only limited to
unprotected sexual intercourse, but is never for regular usage.
Mechanism of action
Emergency contraceptive pills inhibit or delay to prevent fertilization.
When is emergency contraception used?

• When a woman is forced for sexual intercourse,
• Improper use or tearing of condom;
• When a loop inserted in a uterus has suddenly slipped out
Usage of emergency contraception:

• Take combined oral contraceptive two pills of 50 mcg
ethingestradiol and 250 mcg. of levonrgestral in one dose
immediately after sexual intercourse or during the first 72 hours
and repeat taking another two pills after 12 hours;
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• If the above types of pills are not available, take low combined
oral contraceptive four pills of 30 mcg estrogen and 150 mcg
progestin as one dose and repeat the same after 12 hours; and
• Continue to take the contraceptive pills with or without sexual
intercourse.
Weaknesses
• If previous pregnancy occurs,
• Heart diseases,
• High blood pressure,
• Breast-feeding mother; and
• Women who smoke and who are over 35 years old.
Progestin only pill

The content of progestin in the contraceptive pills is less than what is
contained in the combined oral contraceptive pills. This oral
contraceptive has 35 pills in one package/box. The strength of
progestin in each pill is the same.
Mechanism of action
• Highly effective in the body two hours after it has been taken.
• Make changes in the content of the cervical mucus and stays
effective for about four hours.
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• The change in the cervical mucus is effective to prevent

pregnancy for a period of 4-20 hours. The pill has to be taken
regularly every 24 hours.
• In general Suppresse ovulation,
• Thickness cervical mucus to prevent sperm entry into upper
genital tract,
Advantages
• Reduces bleeding during menstrual period;
• Does not affect breast – feeding in any way;
• Can be used by women with reasons to avoid COCs,
• Prevents infection of the uterus,
• Can be used by women who smoke and over 35 years of age.
• Easier to explain take every single day, no days off at all,
• Less nausea or vomiting.
Weaknesses
• Requires taking one pill every day without interruption and always
at exactly the same time of the day and so is hard to always
remember;
• Less effective to prevent pregnancy compared to the combined
oral contraceptive pills; and
• Has problems such as irregularity of menstrual cycles,
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Who uses single oral contraceptive pills?

• Users of oral contraceptives and breast-feeding mothers;
• Women with high blood pressure;
• Women who have problems with combined oral contraceptive
pills;
• Heavy smoking women and those above 35 years old; and
• Women who can take the pills regularly at the some interval and
exact time.
Single OC pills should not be given to women who:

• Have breast cancer or suspected for the disease;
• Who cannot regularly take the pills at the specified time period;
and
• Is breast-feeding a child less than six months old.
Procedures in the provision of single oral contraceptive pills:

• Introduce yourself and greet politely the family planning service
client;
• Assess the client’s knowledge about family planning services and
ask about her health conditions;
• Ask if the client is on menstruation;
• Register the client;
• Show and demonstrate to the client the single oral contraceptive
pills in the package;
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• Carefully explain to the client to take one of the following steps;

- To start taking the single contraceptive pills 24 hours after
her menstruation started; or
- Start on the 5th day of menstrual period;
• Carefully explain to the client to take every evening at the same
time before sleep or sexual intercourse one pill from the package
with water and without chewing;
• The client should take regularly contraceptive pill every evening at
the same time with or without sexual intercourse;
• If the client forgets to take her pill, she must be told to take the
missed pill and also continue on her normal schedule;
• Even if the client forgets to take two successive pills, she must be
told to take pills and continue on her normal schedule. In addition
she must be advised to use condom;
• A woman must be told to go to the health extension worker to
seek advice when she faces health problems while on the single
oral contraceptive pills; and
• Carefully inform a woman who has received one-month supply of
single oral contraceptive pills, to take the pills according to
instructions and to come back on the exact date of next
appointment.
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Male Condom:
• A plastic material that men wear over the erect penis just before
sexual intercourse in order to hold the sperm and prevent it from
spilling in the vagina. Condom is made from a thin plastic called
latex.
• Condom prevents pregnancy as well as sexually transmitted
infections including HIV/AIDS.
• Condoms are produced in different colours and size.
Effectiveness
• Condom is effective to prevent pregnancy and sexually
transmitted diseases including HIV/AIDS unless it is broken,
misused and exposed to the sun or other type of heat. Condom
is very effective when used combined with other contraceptives.
Mechanism of action
• Condom holds the sperm and prevents it from spilling in the
vagina and the cervix.
Weaknesses
• Most people are reluctant to use condoms;
• Can be broken due to inappropriate use during sexual
intercourse;
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• Disposal of condoms need precaution

• Creates itching feeling on the genitals of some males.
Injectable contraceptives
• A contraceptive which, are injected deep into muscle as a single.
The injectable contraceptive contains progestin.
• The injection is given every three months; and
• Noristerat contraceptive is injected once in two months, however,
in Ethiopia the commonly used contraceptive is the one injected
every three months.
Mechanism of action
• Prevent ovulation;
• Makes cervical mucus too thick and difficult for the sperm to pass
through to the uterus; and
• Makes the lining of the uterus too thin for the fertilized egg to
implant itself.
Advantages
Highly effective as compared to other contraceptives;,0Some
brands serve for two and for three months;
For the injection is invisible, can maintain client's secret if
opposition from a partner;
An option for those women who don't want to use other methods;
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Unlike OCs there is no risk of users forgetting to take;

Reversible when women stop taking it
Weakness:
Cannot prevent HIV/AIDS and sexually transmitted infections,
Difficult to discontinue or remove from the body if complications
arise
Can some times initiates prolonged heavy vaginal bleeding;
Delays return to fertility for about 6 - 12 months even after
stopping;
Increases weight; and
A long time use decreases the normal quantity of menstrual
bleeding.
Who can use the injectables

Clients who want to delay pregnancy for a specified time period;
Clients who cannot take contraceptive estrogen containing
contraceptive;
Those who want to space birth;
Comfortable and better quality contraceptive for many clients;
Contraindications:
Pregnancy or suspected for pregnancy;
Vaginal bleeding that have not been medically cheeked and
confirmed for any type of cause;
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Breast cancer or suspected for breast cancer;

If menstrual cycle has already stopped not because of pregnancy
or breast feeding;
Liver diseases or gall bladder diseases;
Heart diseases;
High blood pressure; and
Post-natal and breastfeeding mothers should not use at least for
six months.
Implantable contraceptives:
Noreplant is long acting contraceptives that contain progesterone
hormone.
The progesterone hormone is covered with plastic pill.
Its size is comparable to a matchstick.
It contains 34 mg of levonorgistral.
Six of the implantable contraceptives are inserted under the skin
of the inside left upper arm by trained health worker for this
purpose.
Effectiveness
• Once it is inserted it prevents pregnancy for five years.
• The levonoregistral slowly releases to the woman's body.
Mechanism of action
• Prevents the release of egg from the ovaries; and
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• Thickens the cervical mucus and difficult for the sperm to pass
through to the uterus;
Advantages
• Highly effective in preventing pregnancy;
• Serves for a long period and avoids concern about frequent
appointments and its daily administration;
• Prevents excess menstrual bleeding;
• The user can ask for the removal of the implants at any time when
she decides to have a child or other reason.
Weaknesses
• Cannot help to prevent STI/HIV/AIDS
• Its removal require experienced and professional;
• In few inplant users there may be increased menstrual bleeding
which decrease or stops within three months; and
• Headaches, weight increase or decrease are noted in some
users.
Who should use the implant contraceptives?

• Those women who decide to stay long without being pregnant;
• Breast feeding mothers;
• Women who cannot use combined oral contraceptives;
• Clients with High blood pressure;
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• Those women aged 35 and above years; and

• Those who weigh less than 70 kgm.
Contraindication:
• Women suspected for pregnancy;
• Those hiving cancer of the uterus, heart diseases and, liver
diseases;
• Those who have uterine bleeding for unknown causes; and
• Are epileptic and are on anti-epileptic drug regularly.
Role of health extension workers

• Cannot insert the inplant and infer interested clients to the nearby
Health Facility
• Disseminate information or educate potential users
• clients to nearby health facility
• Undertake home visits to follow up
Female voluntary surgical contraception:

• This is a procedure that requires surgical intervention.
• Is performed twice as frequently as vasectomy among couples in
many countries.
• It usually involves entering the abdominal cavity to ligate, cauterize,
clip, or otherwise interrupt the fallopian tubes, and it often requires
local anaesthesia.
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Mechanism of action
• Stop the egg traveling through the fallopian tubes for fertilization
• Hinder the sperm not to reach the uterus through fallopian tube
Advantages:
• Highly effective than all the other contraceptives in preventing
pregnancy;
• It can be administered in a few minutes.
• Sterilization is very effective and usually permanent.
Weaknesses:
• As with any surgical procedure, there are always risks, including:
- Haemorrhage
- Infection
- Anaesthetic complications
- Visceral injury
• Sterilization may fail from spontaneous re-canalization of a fallopian
tube and may result in an ectopic pregnancy, blocked ducts, or
fistula formation, but voluntary reversibility cannot be assumed.
• Procedure require adequately trained health workers;
• Health extension workers cannot do the procedure;
• Takes long time to counsel clients;
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Male voluntary surgical contraception (VSC):

• This is a surgical and permanent contraception that is performed
on agreement.
• The operation is done by cutting of the vas deferens (tubes).
Mechanism of action
Sperm cells cannot be ejaculated with the semen during intercourse.
Advantages
• Highly effective than all the other contraceptives;
• Administered within few minutes
• Prevention of pregnancy is ever lasting or permanent; and
Disadvantage
• Service requires adequate number of trained health workers;
• Cannot be provided by health extension workers;
• Cannot be reversed, once it is done;
• Takes longer time counselling clients; and
• There could exist minor problems related to the procedure.
INTRAUTERINE DIVICES (IUDS)

• IUDS are plastic and copper made devices that are placed in the
uterus.
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• The plastic materials from which IUDS are made do not change
its shape, or rust. It contains progesterone hormone.
• The IUDS are called loop.
Mechanism of action
Prevent pregnancy by blocking uterine tubes from sperms
Effectiveness
• The copper IUD is a thin copper thread coil/progesterone
hormone that is more effective than the one prepared from plastic.
Advantages
• IUD device is prepared in different shapes and size.
• Trained and experienced health worker inserts it into the uterus
with special instrument.
• The best loop or intrauterine contraceptive device is the copper
T380 that is covered with thin copper coil.
• It serves for a long period of about 5 – 10 years.
Weakness
• Health extension workers cannot insert IUD
• Not inserted if there is uterine infection
• If there is Irregular uterine bleeding in some women
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Who can use loops (IUDS) devices?

• Women who are free from uterine infection or lacerations;
• Couples restricted to one sexual partner;
• Women who cannot use other contraceptives;
• Women who have at least one child; and
• Women who select contraceptives that don't require frequent
regular visit, less or no health problems and unforgettable;
Contraindications
• Women who are pregnant or suspected for pregnancy;
• Have infected uterus;
• Women having uterine bleeding for unknown reasons;
• Cancer of the uterus;
• Women who have had extra-uterine pregnancies;
• Women who had wounds/ lacerations after delivery.
Health extension workers role in relation to IUD.

• Can provide information dissemination or education to potential
users.
• Advice/refer interested users to a nearby health facility.
• Register and keep record of the clients using loops,
• Undertake home visits for follow up the users.
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Criteria for a good contraceptive should include:

♦ Efficacy,
♦ Safety,
♦ Accessibility
♦ and reversibility.
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Table: Effectiveness of contraceptive methods

No method 80 - 90
Rhythm (mucus) method 10 - 30
Withdrawal method 20 - 35
Lactation (LAM)
during amenorrhea, first 6 months 2-6
when menstruating 30 - 60
Barrier
Condom 3 – 15
Diaphragm 4 - 15
Spermicides 10 - 25
Hormonal
Combined pill 1-8
Injectables and implants <1
IUCD 1–5
Surgical contraception <1
(Failure rates per 100 users each year)
The efficacy of contraceptive methods is often expressed in terms of

failure rates. Reported failure rates per 100 users per year for
different contraceptive methods vary greatly around the world, as can
be been from the above table.
Periodic abstinence (or natural family planning) is associated with 10-

30 pregnancies per 1000 users, while those relying on the diaphragm
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experience 4-25 pregnancies per 100 and those using Spermicides

experience 10-25 pregnancies 100.
Hormonal and intrauterine devices are generally associated with

higher efficacy. Women who use combined oral contraceptives
experience 1 - 8 pregnancies per 100 users per year, while failure
rates among those who rely on injectables and implants average less
than 1 pregnancy per 100 annually. Women who use the IUCD
experience 1 - 5 pregnancies per 1000, while couples that rely on
surgical contraception experience less than 1 accidental pregnancy
per 100 each year.
Practical Session Family Planning Methods
Male condoms may be right for you

There are a number of factors you should consider before deciding
whether male condoms are the right contraceptive method for you. As
with any method of contraception, you should first talk to your health
care provider or a counsellor at your local clinic or hospital before
using condoms as a contraceptive method.
Male condoms may be an appropriate

If any of the following is true:
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♦ You are at risk for exposure to or transmission of an STIs,

including HIV infection. Aside from abstinence, male and
condoms offer the best protection against these infections.
♦ You prefer to use a method that you can discontinue at any time.
♦ You and your partner are looking for a back-up method (for
example, in case your partner forgets to take her oral
contraceptive).
♦ Your partner has a medical condition that poses a health risk with
the use of other contraceptive methods.
♦ You have sexual intercourse only occasionally and do not need or
want ongoing contraception.
♦ You are concerned about the side effects of other methods
♦ You and your partner want to share responsibility for family
planning and the prevention of sexually transmitted infections.
♦ Your partner has just delivered a baby (You may begin using
condoms as soon as you resume sexual intercourse.)
♦ Your partner has just had an abortion. (You may begin using
condoms as soon as you resume sexual intercourse.)
Male condoms may not be appropriate

♦ You are unable to obtain regular supplies of condoms.
♦ You are allergic to latex (or your partner is).
♦ You cannot maintain an erection when using a condom.
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♦ You or your partner is unwilling to interrupt lovemaking in order to

use a condom.
Lam lactation amenorrhoea method

whether LAM is the right contraceptive method for you. As with any
method of contraception, you should first talk to your health care
provider or a counsellor at your local health post or hospital before
using LAM as a contraceptive method.
Lammay not be an appropriate method

If all of the following are true:
♦ Your baby is less than six months old.
♦ Your menstrual periods have not yet returned.
♦ You are fully or nearly fully breastfeeding your baby.
Lammy not be an appropriate method

If either of the following is true:
♦ You are at risk for exposure to, or transmission of, STI, including
HIV infection. LAM does not provide protection against these
infections. Aside from abstinence, male condoms offer the best
protection against these infections.
♦ You are HIV positive or suspect that you may be.
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Lam is not an appropriate method

♦ Your baby is six months old or older.
♦ Your menstrual periods have returned.
♦ Your breastfeeding’s are regularly more than six hours apart.
♦ You regularly give your baby food or liquids as substitutes for
breast milk.
Spermicides may not be appropriate method

♦ You are at risk of exposure to or transmission of STI including HIV
infection. Aside from abstinence, male and female condoms offer
the best protection against these infections. Recent studies indicate
that vaginal spermicides are not effective in preventing certain STIs
such as gonorrhea, chlamydia, and HIV infection
♦ You plan to use spermicides frequently or in large amounts.
Under these conditions, spermicides may cause vaginal irritation.
Frequent use of spermicides cause irritation and breaks in the
mucus layer or skin of the genital tract, creating a point of entry for
the virus and increasing the risk of HIV transmission.
♦ You cannot always insert the spermicide before sexual
intercourse.
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Spermicides are not appropriate method

♦ You cannot obtain a regular supply of spermicides.
♦ You dislike touching your genitals.
♦ You are allergic to spermicidal or have a partner who is allergic.
(Signs of allergy include redness, itching, and pain of the vagina
or penis during intercourse. The signs disappear after use of the
spermicide is stopped.)
Is withdrawal the right method

whether withdrawal is the right contraceptive method for you. As with
any method of contraception, you should first talk to your health care
provider or a counsellor at your local clinic or hospital before using
withdrawal as a contraceptive method.
Withdrawal may be an appropriate method

♦ You find other contraceptive methods unacceptable for religious
or other reasons.
♦ You prefer a method you can discontinue yourself.
♦ You are concerned about the side effects of other methods.
♦ You have sexual intercourse only occasionally and do not need or
want ongoing contraception.
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♦ You feel that the man should share responsibility for family
planning.
♦ You or your partner have medical conditions that pose health risks
for the use of other contraceptive methods.
♦ You and your partner have just had a baby. You may start using
withdrawal as soon as you resume sexual intercourse after
delivery.
♦ Your partner has just had an abortion. You and your partner may
start using withdrawal as soon as you resume sexual intercourse
after the abortion.
Withdrawal may not be appropriate method

♦ You are at risk of exposure to, or transmission of, STI, including
HIV infection. Withdrawal does not provide protection against
these infections. Aside from abstinence, male condom offer the
best protection against these infections.
♦ Either you or your partner are not willing to cooperate in using this
method.
Are fertility awareness right method

Fertility awareness methods include the calendar/rhythm method, the
basal body temperature method, the cervical mucus method, and the
standard days method. There are a number of factors you should
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consider before deciding whether fertility awareness methods are

right for you. As with any method of contraception, you should first
talk to your health care provider or a counsellor at your HP or hospital
before using fertility awareness methods.
Fertility awareness methods may be appropriate methods

♦ You find other contraceptive methods unacceptable for religious
or other reasons.
♦ You prefer a method you can discontinue yourself.
♦ You wish to use a barrier method only during the fertile phase of
your menstrual cycle.
♦ You have a condition considered to pose a health risk for the use
of other contraceptive methods.
♦ You are concerned about the side effects of other methods.
♦ You wish to share responsibility for family planning with your
partner.
Fertility awareness methods may not be appropriate methods

♦ You are at risk for exposure to or transmission of STI infection
including HIV. Fertility awareness methods do not provide
protection against these infections. Aside from abstinence, male
condom offer the best protection against these infections.
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♦ You intend to use only the calendar (rhythm) method and have
menstrual periods at irregular intervals.
♦ You intend to use only the basal body temperature (BBT) method
and cannot obtain or correctly use a basal body thermometer.
♦ You intend to use only the cervical mucus method and cannot
correctly interpret cervical mucus signs.
♦ You intend to use only the cervical mucus method and have
abnormal vaginal discharge.
You have just delivered a baby or had an abortion.
Fertility awareness methods are not appropriate methods If any

of the following is true:
♦ You have a partner who is unwilling to avoid unprotected sexual
intercourse during the fertile period of each cycle.
♦ You cannot keep track of your fertile period.
♦ You cannot abstain or use another method during your fertile
period.
How to increase FP method acceptability?
♦ Commitment of political leaders are required for effective program

implementation
♦ Raising FP as a public policy issues
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♦ Change of attitude of the health care providers to see more client

oriented strategies as treating with respect and dignity; giving
sufficient information to make an informed choice.
Respect cultural mores & build upon
♦ Improve the quality and acceptability of FP through involving the
communities in planning, implementation and evaluating activities.
Maintaining Sustainability Of FP Program

♦ Make regular home visits
♦ Make frequent inter personal communication
♦ Ease re-supply of the FP methods
♦ Conduct regular surveys. In your survey do appropriate
consultation of services such as:
♦ Decrease waiting time
♦ Take adequate time with the client
♦ Set conducive clinic hours and days
♦ Consider staff age and gender
Family planning facilities

♦ Make waiting rooms adequate
♦ Adequate, ventilated well lighted examination rooms
♦ Use teaching aids/posters, charts, flip charts etc.
♦ Make available adequate water and toilet.
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Information, education and communication for family planning

services
Family planning through the administration of contraceptives is an old
program. Even though it is an old program, easy access to FP services
is yet not successful.
The aims of FP program are to access all persons at the age of puberty
and married couples to make them know about the correct information
of FP method and raise their awareness on the types and utilization of
different contraceptives so that they benefit from the available services
depending on their choices.
Counselling services should use the GATHER (the six important points
in counselling) method to counsel their clients.
G Greet your client by name
A Ask what her problem is and how she believes you can help her.
Listen carefully and encourage her to ask questions
T Tell available methods: teach her the different ways to care herself
and her family
H help her select what is best for her and her family
E Explain in detail about the treatment, the family planning method
R Refer a client that is ill, is beyond your capacity, needing medical
help
While conducting counselling sessions use teaching AIDS to assist in
clarifying trouble points and you should have a sound knowledge of the
needs of the client.
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Main targets for IEC

♦ Women 10 - 49 years
♦ Men
♦ Community Health Workers
♦ Religious leaders
♦ Other influential people in the community
IEC must be included in all health activities at all levels. It is an area
where inter-sectoral collaboration with social workers, teachers,
religious groups, agricultural workers etc is very appropriate.
Counselling, Informed Choice, Consent, and the Rights
What is counselling?
Counselling is the process of helping clients confirm or make
informed and voluntary decisions about their individual care. It is a
two-way exchange of information that involves listening to clients and
informing them of their options. Counselling is always responsive to
each client's individual needs and values.
What is informed choice?

Informed choice is a voluntary, well-considered decision that an
individual makes on the basis of options, information, and
understanding. The decision making process should result in a free
and informed decision by the individual about whether or not he or
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she desires to obtain health services and, if so, what method or

procedure he or she will choose and consent to receive.
What is informed consent?

Informed consent is the communication between a client and a health
extension worker that confirms the client has made an informed and
voluntary choice to use or receive a medical method or procedure.
Informed consent can only be obtained after the client has been given
information about the nature of the medical procedure, associated
risks and benefits, and other alternatives. Voluntary consent cannot
be obtained by means of special inducement, force, fraud (criminal
deception), deceit (dishonest trick), duress (compulsion), bias, or
other forms of coercion or misrepresentation.
Health care providers are often required by law or institutional policies

to obtain informed consent before administering certain medical
procedures, including experimental methods or procedures. Although
informed consent is often equated with a signed written form used to
document an individual's decision, written consent is neither
inherently necessary nor sufficient. Regardless of the presence or
absence of written documentation, informed consent requires
providers to ensure that a client receiving a method or treatment has
knowingly and voluntarily agreed to be treated. Whether informed
consent is written or verbal, however, it cannot replace the informed
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choice process, which is dependent on counselling and the

information exchange between providers and clients.
The rights of the clients
Clients have the right to:

♦ Information
♦ Access to services
♦ Informed choice
♦ Safe services
♦ Privacy and confidentiality
♦ Dignity, comfort, and expression of opinion
♦ Continuity of care
Assessment and group discussion
1. Can you recall what Family planning means?

2. List the importance and major objectives of Family Planning
3. List the methods of pregnancy prevention, advantage,
disadvantages and efficacy of each?
4. Recall the available family Planning service outlets in Ethiopia and
tell the activities at each level?
5. Identify the barriers to the family planning service provisions?
6. List at least three side effects and problems associated with each
of the following contraceptive methods:
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a. IUCD
b. Injectables
c. Oral contraceptives
7. Tell 5 danger signs that a patient using an IUCD should know
8. What risks or problems are associated with pills?
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UNIT THRE
Child Health Care
Learning Objectives
At the end of this session the learner will be able to:

♦ Record important child health problems in Ethiopia
♦ List the aims and purposes of child health service
♦ Repeat the elements of child health service
♦ Report how to establish targets for immunisation in childhood
♦ Examine the benefits of growth monitoring and interventions
Objectives
♦ To reduce child morbidity and mortality.
♦ To ensure children's full physical and mental development.
♦ Raise the genuine participation of the family and community.
Child Health Problems
Under this heading we follow the integrated management of childhood

illness approaches (IMCI).
The IMCI strategy is applied in countries where infant mortality rates,

are above 40 per 1000. Since Ethiopia has an IMR of 97 per 1000, it
has contributed the outcomes of its many studies to the development
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of this strategy. Because of this, Ethiopia has also become one of the
few countries that implemented the strategy.
Signs of dangerous (fatal) illnesses

- If the child cannot drink or breast feed.
- If the child vomits as he breast feeds or vomits immediately after
food.
- If he had shivering related to the current illness or he is currently
shivering.
- If the child is weak or unconscious. It means he has dangerous/
fatal health problem. Therefore, the child should be urgently
referred to the next higher health facility after undertaking some
physical examinations. Before sending the child to the next health
facility, a reference should be made to the drug administration
manual on how we administer, any type of drug.
Cough/breathing problem
In our country pneumonia can be caused by viruses or bacteria. The

common causes of pneumonia are bacteria. Pneumonia it is usually
caused by the streptococcus pneumonia bacteria and hemophils
influenza virus.
Children can die due to shortage of oxygen or due to the spread of
the bacteria to all part of the body when they are caught with bacteria
pneumonia.
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Many children are brought to health facilities with simple health

problems such as cough or breathing problem. Most children can be
assisted by simple care, given at the household level. But, since few
seriously sick children require medicine (antibiotics), the health
extension workers can identify such patients using two indicative
signs. The signs are fast breathing and lower chest in drawing, which
both are signs of severe pneumonia.
Examination of a child with cough or breathing problem
- Asking the mother for how long the child has cough or breathing
problem.
- See that the child has fast breathing.
- See that the child has lower chest in drawing.
- Confirm that the child has wheezing.
A child who has cough or breathing problem for more than 30 days
could be suggestive for asthma, whooping cough or another problem
and therefore shall be referred to the next health facility for further
examination.
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The number of breathing per minute can be cross-checked with the

following age/ breathing values.
Age Fast breathing

2-12 months 50 or more breathings/ minute
12 months- 5 years 40 or more breathings/ minute
If we know the child is breathing fast through counting and checking

against the above values, then we can say that the child has
pneumonia.
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Classification of cough or breathing problem
Sign Classification Action to be taken

-If he has any sign Severe - Urgently refer to next
of a dangerous pneumonia or health facility.
disease. other very serious
- If he has lower disease.
chest inwarding.
- If wheezing is
observed on a
child that is silent.
Fast breathing Pneumonia Urgently refer to next
health facility.
If no sign of No pneumonia, - Refer child to next
pneumonia or simple coughs or health facility if cough
serious diseases can be common has been for more than
cold. 30 days.
- Advice the family to
bring the child, if there
are suggestive signs that
the illness is getting
worse
-See again the child if no
improvement in 5 days
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Actions to be taken
- Refer the child to the next health facility if he/she has severe
pneumonia or any other serious illness.
- Advice mother/parent to take the child to a health facility if child
has pneumonia.
- If conditions worsen as he/she takes the prescribed drug i.e
o If he/she has breathing problem
o If he/she has high fever
o If he/she fails to drink or suck breast
o Gets weak or is unconscious
The mother or guardian should be strongly advised to urgently take
the child back to the health facility.
- If the problem of the child is common cold or simple cough, the
mother or the guardian should be advised to give the child fluids
such as tea, gruel etc and breast milk. If the child sucks breast,
he/she should be breast feed more than the other times.
Since the condition of a child with simple cough or common cold can
worsen, strong advice can be given to take the child to a health
facility when the following signs are observed
- high fever
- failing to drink or breast feed
- dizziness or unconscious
- fast breathing
Diarrhoea
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Diarrhea is defined as a passage of three or more loose or watery

stools in a 24 hours period. Mothers usually know when their children
have diarrhea. Diarrhea is the major cause of morbidity and mortality
for children under five years in Ethiopia.
Aetiology
Diarrhea can be caused by bacteria, viruses, or parasites and other

causes. It is common in babies from 6 months to 2 years of age.
Types of Diarrhea
- Diarrhea that is watery, acute and lasts less than 14 days is called
acute diarrhea.
- If diarrhea is acute and lasts longer duration, usually over 14
days, it is called persistent diarrhea.
- If blood or mucus comes with diarrhea or alone, it is called bloody
diarrhea. Most of the bloody diarrheas come due to infections with
bacteria called Shigella. Diarrhea can also be due to amoeba. But
this is not common among children.
Examination of a child with diarrhea
- Ask the duration of the diarrhea

- Ask if the diarrhea is bloody (has blood in stool) or watery
- Check if there is body dehydration
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Signs and degrees of dehydration

Signs of dehydration Degree of Actions to be taken
dehydration
If two out of the following Severe dehydration - Urgently refer to next
signs are present, they health facility
indicate the degree of body - If he can, refer him with
dehydration. ORS.
- Dizziness
- Sunken eye balls
- Unable to drink or weak to
drink.
- Loose skin turgor
If two out of the following Moderate dehydration Urgently refer to next
signs are present, they health facility with ORS
indicate the degree of
dehydration.
-Restlessness and irritability
-Sunken eye balls
-Thirsty
-Loose skin turgor
No moderate and high No dehydration -If the child takes breast

dehydration milk only, one ORS and
frequent P.T.O breast
feeding.
- If the child does not
breast, milk for a child that
can take supplementary
food/give nutrient fluid that
can be prepared at home
gruel, fruit juice etc).
- When signs that show
the worsening of the
illness are seen, advice
the parents to immediately
bring back the child.
- If no improvement after 5
days, see the child again
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To know the situation of a child's skin turgor, clamp, raise and release
the skin of the abdomen with thumb and index finger and see whether
it immediately goes back
- If the skin remains wrinkled as we back off our fingers it is a sign
of extremely poor skin turgor.
- If the skin remains wrinkled for some time as we back off our
fingers it is a sign of extremely poor skin turgor
Care to a child at home
Force the child to take fluid more than usual

- The fluid that will be given to the child must be among those
which are easily available at home. Some of these fluids are
breast milk, boiled cows milk, gruel, soup, curd milk, whey, rice
water, fruit juice and clean water.
How much ORS or other fluids should be given?
- It necessary give 50-100 ml (one coffee cup) of fluid to children

below 2 years and 100-200 ml (two coffee cups) of fluids to
children 2-10 years of age when they have diarrhea. But if the
child wants to have more, he/she can be given. Children who are
above those ages can take any amount of water. The purpose of
giving extra fluid to the child is to replace the fluid that has been
lost by the diarrhea and to prevent further dehydration.
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- Feed the child more than before

- Some of the food items that can be given to a child (especially to
a child below the age of 6 months) are milk and milk products,
porridge, eggs, meat, mashed injera with pulses sauce (Alicha
shiro), banana and orange. But, if families cannot get these food
items, they can give any food that is available at home with a
quantity more than before.
- If possible, feed the child as he wants. He/she must be fed at 3 or
4 hours intervals (minimum of 6 times a day).
- The child can have one additional feed for two weeks from the
number of feeds he/she had before he was sick, after the diarrhea
has stopped. The purpose of providing the child with an additional
quantity of food is to replace the nutrients that have been lost due
to the diarrhea and to prevent malnutrition.
Preparation of ORS
- Wash hands with water and soap.

- Measure and make ready one liter of pipe water, or boiled and
cooled water.
- Add one sachet of oral rehydration salt to the measured water and
shake the mixture well.
- Take some from the solution with a cup and give in small quantity
with a spoon to the child. If he/she vomits, continue giving him
after 5-10 minutes.
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- Cap and keep the solution. It can be used until 24 hours.

- If it is not finished within 24 hours, it can be discarded and a new
solution can be prepared.
If this child is with diarrhea
- could not get well
- vomiting continues
- bloody diarrhea is observed and
- has fever
He/she has to be immediately referred to the next health facility.
Follow-up and reporting has to be undertaken.
Methods of preventing diarrheal diseases
Breast feeding
Children 4-6 months have to stay only on breast feeding. Breast

feeding means:- the child has to be fed on his mothers breast milk
without giving him other fluids like water, fruit juice or cows and
powder milk.
A child on breast milk only has less chance of having diarrheal
diseases than a child on a half breast feeding or bottle feeding. The
reasons are;-
- By breast feeding it is possible to avoid contaminated bottles,
bottle nipples and powder milks.
- Breast feeding helps to raise the antibody level of the child.
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Actions that should be taken by mothers in order to breast

feed
- Start breast feeding immediately after the baby is born
- No additional fluids such as water, sugar solution or
powder milk shall be given to the child especially for
the first 4-6 months.
- Breast feed whenever the child wants
- If it is not possible to take the child to the workplace,
breast feed the child before going to work, upon
returning from work, at night and at any time when the
child is with his mother.
- In order to prevent the swelling of the breasts due to
accumulation of milk, press the breast and expel the
milk and keep it in a clean container and give it to the
child.
Supplementary foods
Supplementary foods are soft and mashed foods, such as peas and
beans, milk products, eggs, meat, fish, fruits, green vegetables. For
additional information, refer to attached chart.
Activities that should be undertaken by family members with regard to
supplementary food:-
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- Washing hands with soap and water before starting the

preparation of food and feeding of the child.
- Preparing the food in a clean place.
- Washing with clean water those foods that would be eaten raw.
- Cooking well the food during food preparation.
- Feeding soon the hot foods prepared.
- Keeping the foods in cold places, and if possible in refrigerators.
- Washing until boiling, foods that have been boiled/ cooked and
kept closed for more than 2 hours.
- Feeding the child with clean spoon/ avoid bottle feeding.
Washing hands
Mothers should wash their hands:

- after cleaning the child that has passed stool and disposing the
stool into an appropriate a toilet
- after using the toilet
- before cooking/ preparing food
- before eating food
- before feeding the child
If the child feeds himself/herself, his/her hands should be washed.
- Cutting the nails short.
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Malaria
If the sick child has fever and is living in malariaous area or had been
taken to a highly malaria endemic area in the last month, the stage of
the disease can be categorized as follows and the child shall be given
malaria treatment immediately.
High Malaria Risks areas
Sign Types of Disease Action

- If there is any sign of Very severe febrile Immediately
dangerous disease disease refer to the next
-Has meningismus health facility
(stiff neck)
If he had fever, he is Malaria Treat with
febrile now or has a Artemeth
0
temperature of 37.5 c Lumefantrine
or above based on the
child's age and
weight
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Low Malaria Risk Areas
Sign Type of disease Action

-If there is any sign of Very severe disease Urgently refer to
a dangerous disease the next health
or facility.
-Has meningismus
(stiff neck)
-No cough Malaria Treat for malaria
-No measles and other
known cause of fever
-Has fever Fever/ the probability of Treat the cause
-Has measles or the fever to be due to
known cause of fever malaria is less
Prevention Methods
- Sleeping always inside insecticide impregnated mosquito nets.

- Drying or clean malaria mosquito breeding places, water
accumulations and springs.
- Taking malaria prophylactic drugs before going, when staying
and after returning from a malarious area.
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Measles
Definition and cause:-
Measles is a highly infections disease caused by the measles virus.
Signs:-
Fever and generalized red rashes are suggestive of measles. The

antibodies that children get from their mothers during pregnancy can
protect them from measles infections until they are six months old.
Measles reduces the immune system of children and exposes them
to other diseases. Because of this reason, 30% of the children with
measles have the following signs.
- Diarrhea
- Pneumonia
- Wheezing
- Ulceration of the mouth
- Ear infection /otitis media
- Severe eye infection (conjunctivitis) that can lead to blindness
Diagnostic methods
A child can be said to have measles when he has a history of

generalized blotchy rash lasting for 3 or more days, fever, cough,
running nose and red eyes (conjunctivitis)
A child having measles now or had in the last 3 months can be
identified on the basis of what are indicated in the table below.
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Sign Name of disease Action to be taken

-If there is any sign of Severe complicated -Give vitamin A
a dangerous disease measles -Urgently refer to
-If there is white next health facility
patches on the eyelid
- Severe mucal
ulceration
- If pus is coming from Measles with eye -Give vitamin A
the eyes or mouth -Give eye drops if he
- If there is mucal complications has eye disease
ulceration -Wash child's eye
with warm water
-Paint mouth with
gentian violet if there
is mouth ulceration
-Check him on the
second day
If he has measles Measles Give vitamin A
currently or in the past
three months without
complications.
If a patient is known to have measles currently or had in the last three

months, it is essential to check him for any complications. The
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complications are extensive ulceration of the mouth, and white

patches on the eyelid. If there are other signs of any dangerous
diseases, he should immediately be referred to the next health facility.
Administration of vitamin A
If the child has measles, it is necessary to give him vitamin A

three times as follows:-
- the first vitamin A today
- the second vitamin A tomorrow
- the third vitamin A after a month
If the child has severe malnutrition or severe measles or persistent
diarrhea with dehydration, he should be immediately referred to the
higher health facility.
Any child must get vitamin A every month starting from his ninth
month up to five years.
Table for Vitamin A Administration

Vitamin A capsule
Age 200,000 IU 100,000 IU 50,000 IU
Up to 6 month - 50,000 1capsule
6-12 months 50,000 100,000 2 capsule
12 month to 5 years 1 capsule 2 capsule 4 capsules
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Prevention Methods
Measles can be prevented by vaccinating the child against the
disease on time. The disease will not be serious on him provided
he is vaccinated.
A child should be taken to the nearest health facility, to get
appropriate treatment and to avoid its complications.
Since measles is a highly infectious disease, the child with the
diseases should be taken to a nearby health facility.
Since measles is a highly infectious disease, a child in the
neighborhood who is ill with measles shall not be visited by other
children.
Care of a child with measles
Children with measles usually lose appetite. Therefore, they

should be encouraged to take balanced diet. Refer to annex on
feeding a child with measles.
If there is high fever, lower the fever with antipyretics (fever
lowering drugs) and cold soothing.
Vitamin A should be given 5 times on the basis of their age or
weight i.e on same day, next day and after a month. With this it is
possible to prevent the eye disease which occurs due to measles
and other health problems.
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Malnutrition and Anaemia
Definition:-
We say there is malnutrition when a child fails to get adequate and
balanced diet commensurate to his age which is necessary for body
building, energy source and disease prevention.
According to the 2000 Demographic Health Survey (DHS) more than

50% of Ethiopian children's height was below the standard height. In
addition to this, malnutrition and other related diseases were found to
be causes for the deaths of 60% of children under the age of 5 years.
Therefore, any child, when visited by health extension worker, should
be checked for signs of malnutrition and anemia.
Causes and signs of malnutrition
Malnutrition occurs when a child does not get the necessary energy
giving and body building foods. A child that is repeatedly ill is prone to
malnutrition. When a child has malnutrition.
- He/she can be physically stunted
- He/she can have general body edema
- cannot grow well or can be short (retarded growth)
If a child does not get adequate vitamins in his/her food, he/she can
encounter vitamin deficiency. A child with vitamin A deficiency has a
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high probability of dying due to measles and diarrhea. His/her chance

of being blind is also high.
A child who does not take food with no adequate iron will have
anemia. Anemia means low number of red blood cells or low iron
content in the red blood cells.
A child can have anemia because of the following reasons

- Infections
- Intestinal parasites
- Malaria
Signs of malnutrition and anaemia
- Severe emaciation/ being thin/, wrinkling of the skin on hip and lap
areas, and clearly seen rib bones
- Oedema of both feet
- White palm/pale palm
- Under weight
Whitish palm is a characteristic of anemia. Very white palm indicates
severe anemia.
We can classify the degrees of malnutrition and anemia using the
following signs.
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Signs Classification of Disease Actions to be taken

-Severe body emaciation Severe malnutrition or Give vitamin A and urgently
(thinness) or very white severe anemia refer to the next health
palms facility
-Oedema of the lower
extremities
Moderate white palm or Anemia or low body -Ask how the child is feed
very low body weight weight and if there is a problem with
feeding give the necessary
advice. If feeding is done
well encourage the mother.
-If the child has anemia,
check up after 2 weeks
-If his weight is very low, do
check up after a month
-If he has anemia and the
chance of having malaria is
high, give anti malaria drug
and iron folate.
If there are no signs of Anemia or no severe -If the age of the child is
malnutrition and anemia malnutrition, or low body below 2 years, ask how the
and no low body weight weight child is fed and check his
weight. Give the necessary
advice if there is a feeding
problem. Encourage the
mother and advice her to
continue if she is feeding
him well.
-If he has feeding problem,
do check up after 5 days
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A child with severe malnutrition or anemia he/she should urgently be

referred to a higher health facility for proper treatment and follow up.
Prevention methods
Malnutrition can be prevented by providing nutrition education to the
parents of children on sufficient breast feeding, and starting
supplementary feeding after 4-6 months of age.
Anaemia can be also prevented if the child is given adequate and

balanced diet. If this is done, anaemia that occurs due to infections
can be prevented. If children are given balanced diet, they can get the
necessary nutrients from the diet. With this intervention, iron
deficiency anaemia can also be prevented.
Similarly, anaemia that occurs as a result of malaria can be prevented
in malaria areas by the effective use of impregnated mosquito nets.
Protein energy malnutrition

This is a word used to describe a spectrum of clinical pictures,
ranging from kwashiorkor to severe marasmus.
Kwashiorkor
A sever form of Protein Energy Malnutrition (PCM) which is manifested
usually due to gross deficiency of proteins and few deficiency of
calories.
kwash is usually associated with infections and occurs in age
between 1-3 years.
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Causes
• Inadequate intake
• Inadequate utilization
• Early cessation of breast milk and exposure to high CHO diet.
• Diseases - diarrhoea, measles
Signs and symptoms

o Growth failure – weight and height decreases, child between 60-8
0% of the standard
o Wasting of muscles
- Lack of proteins - stored protein used therefore wasting of
muscles occurs, but not evident due to the presence of
oedema.
- Oedema – pitting
- Mental changes – apathetic, easily irritable
- Hair changes – brown or reddish, easy plackable
- Skin changes – dermatitis
- Anaemia
- Moon looking face
- Usually followed by other deficiency.
Treatment:
- Diet – 150 cal/kg/day of dried skimmed milk
- Treat superimposed diseases as infections, anaemia,
parasites etc.
- Nutrition Rehabilitation Centre (NRC) – health education,
demonstration to mothers and follow – up child’s growth.
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Management and prevention of nutritional deficiencies
Family Health
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Marasmus
Deficiency of food in general, particularly of energy
Can occur in all ages, usually in less than 4 years, more common in
infants less than one year.
Causes:
- Poor feeding habits
- Infections eg. TBC, measles, diarrhoea
- Premature birth
Main signs and symptoms

- Failure to grow
- Face – old mans apprance
- Muscle wasting
- Diarrhoea
- Anaemia
Treatment
- Diet – 175 cal/kg/day
- Treat infection
- NRC
Assessment
Demonstrate special diet preparation for PEM children
Tell how to maintain hygiene
List health education topics to be given to mothers
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Nutrition education to families and community

Food and nutrition education is a process by which people gain
knowledge, attitude, confidence and skills necessary for developing
dietary practices.
Planning Nutritional education programs

Here we can apply the steps of problem solving method
o Identify problem
o Decide on chief problem
o Suggest causes
o Decide on changes needed
o Discuss some solutions needed
o Decide on the solution
o Develop plan of action
o Carry out plan
o Evaluate
Additionally
o Specific groups to be reached
o Kind of information to be delivered
o Ways to give information must also be considered
Identify people to be reached

Background data: identify and describe people who are most
affected by food and nutritional problems.
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These are those we teach:-

o Discuss with people – to have need and want
o Understand how problem affects them and the kind of help
they may need
o Intersect oral collaboration – community workers of other
sectors.
II. Develop message

Develop a series of message, which will help people solve their food
and nutrition problems. Eg. Grow and eat more leafy vegetables,
breastfeed babies at least for 4 months.
When developing message REMEMBER

o Message is clear and easily understood
o Message fits people’s life styles, tradition and culture
o Method used fits the characteristics and abilities of the group
o Message suggests changes, which the group can carry out
and are not very different from what they already know and
are doing
o Consistency: the message says the same thing said by other
community workers.
o The group actively participates in both developing and
responding to them (message)
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III. Make sure a message is well suited to the group for which it is
intended
o Methods
o Message
o Materials
IV. Communicating messages

Message may be delivered by:
o Spoken words – discussion, conversation, etc.
o Written words – books, pamphlets
o Visuals – diagrams, pictures, drawings
o Action – drama, demonstration…
These may be used either separately or together while choosing a
method, make sure that:-
o It suits the people (targets)
o It fits their circumstances
o It is geared towards solving the problem identified.
V. Techniques for good communications

The aims of good communication is to make sure that individuals or
groups can hear, see, and understand clearly the message that is
being shared with them.
To communicate clearly:
o Know your audience
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o Be sure that your message suits them

o Choose the right method
o Listen to them
o Be sure message communicated
Situation in which communication will be helpful:
Informal conversation – get views of many people

Home visits: - to watch families do things they have learned; to
learn what they do or say; to teach them new things.
Plan for home visits:-

• Be friendly
• Be sure you and family understand/ agree on future plans
• Do what you promised to do
• Keep appointments
• Keep home visit records.
Talks
o Give to get across a particular idea or practice
o To be given a time when the audience most needs that
specific information
o Tell audience what you want to say
o Encourage people to take part, observe peoples reaction
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Demonstration
o To show people new skills, lively way to combine practical
examples with facts.
o People can SEE, HEAR, TALK about and TAKE PART in a
demonstration
Advantage: teaches new skills
o Use right time, familiar things to people and involve them
Feeding Recommendations
The following table shows the feeding recommendations for children
under five years old in Ethiopia both during health and illness.
During illness, children may not to eat much. However, their should
be the types of food recommended for their age, even though they
may not take much at each feeding.
After illness, good feeding helps make up for weight loss and helps
prevent malnutrition. When the child is well, good feeding helps
prevent future illnesses.
A Sick child visit is good opportunity to counsel the mother on how to

feed the child during illness and when the child is well.
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Up to 4 months 4 – 6 months 6 – 12 months 12 months – 2 years 2 years and

Breast feed as Breastfeed as Breastfeed as Breastfeed as often older
often as the often as the often as the as the child wants. Give family foods
child wants, day child wants, day child wants. at least 3 meals
and night, at and night, at each day.
least 8 times in least 8 times in Also, twice daily,
24 hours 24 hours. Give adequate give nutritious
Give adequate servings of: porridge foods between
Do not give servings of: made of cereal and meals such as:
other foods or Add Shiro fitfit, legume mixes. egg, milk, fruits,
fluids complementary merek fitfit, kitta, dabo.
foods: mashed porridge made Shiro, kik, merek fitfit,
Expose the potatoes of cereal and mashed potatoes and
child to softened with legumes, carrot, gommen,
sunshine 20 – milk, cereal+ mashed undiluted milk and
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30 minutes legume mixes potatoes and egg and fruits.

daily with milk. carrot, mashed
gommen, egg Add extra butter or oil
Give these and fruits. to child’s food.
foods with cup
and spoon 1 or Add extra butter Give these foods
2 times per day or oil to child’s three times per day.
in addition to food.
breastfeeding. - 3 times per
day if breastfed
Expose the - 5 times per
child to day if not
sunshine for at breastfed.
least 20 – 30 Expose child to
minutes daily. sunshine.
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Assessment
• Give nutrition education for infants using food charts
• List source of food items important to Ethiopians
Vitamin A
Vitamin A deficiency occurs when a child has malnutrition and
measles. Vitamin A deficiency exposes to blindness and serious
health problem. A child that gets adequate vitamin A has a higher
defensive mechanism. By giving vitamin A to children, it is possible to
reduce child mortality by 20%.
Therefore, a child from 9 month to 5 years has to be sent to the next
health facility to get vitamin A every 6 months. Follow up on this is
necessary.
Sore throat
- A child with sore throat will have fever.
- The glands around the neck can swell.
- When his throat has swollen, redness and pus are seen in the
throat.
- He will have problem with taking food.
Care that will be given to a child with sore throat

- Giving much warm fluids
- Letting him to have adequate rest
- If there is pus in his throat, refer him to the next health facility.
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Trachoma
Trachoma is a disease that occurs due to different microscopic

organisms. The signs of trachoma are, redness of the eyes, burning
pain, sometimes pus discharge, adhesion of the eye lashes and
problem with opening the eyes, swelling of the eyelids.
Care that should be given to a child with trachoma
- washing his eyes with soap and water

- advising mothers to take the child to the next health facility
Preventive Methods
- Daily washing of the face with water and soap.

- Keeping personal and environmental hygiene.
- Appropriately disposing dry and fluid wastes
Meningitis
Meningitis, when it occurs in the form of epidemics, is caused by the
meningococcus meningitis bacteria. When signs of meningitis are
seen, the urgent referral of the child is required. Follow up is also
required to know the outcome.
The meningitis that occurs frequently is caused by other varieties of

bacteria (homophiles and streptococcus bacteria). Urgent diagnosis
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and urgent referral to the next health facility will help to save the life of
the child and to prevent the disability that results form the infection.
The signs of meningitis are:-
- fever
- headache
- vomiting
- lethargy
- swelling of the eye lids on children
- shivering (convulsions) fits
- anorexia (loss of appetite)
- menengismus ( stiff neck)
- bulging of the eyes
Scabies
Definition and cause
It is a skin disease that occurs due to poor personal hygiene and
transmitted through parasites.
Signs that are observed

Since scabies is a highly contagious skin disease, it mostly affects
more than one family member. The signs are itching of the skin
between the hand fingers, palm, elbow and other parts of the body
except the face and head.
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Actions to be taken
- Apply benzyl benzoate lotion on all parts of the body except the
face for three consecutive days.
- Patients shall wash their body well and wash and boil their clothes
before applying the medicine
- Since the disease is highly contagious, other members of the
family shall be educated to keep their personal hygiene.
- If no improvement with the education they should be seen again.
Prevention methods.
- Keeping personal hygiene.
- Washing the body well and ironing or boiling all dressings.
Common Neonatal Problems

- The child is premature if born before 37 weeks.
- If weight below the standard (2,500gm).
- Has yellow colour.
- Does not suck the breast.
- Has fever
- Has problem of breathing
- Is gasping
- Does not pass urine and stool in 48 hours
- Has persistent vomiting (does not include belching)
- Has bleeding
- Has fits or convulsions
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- His/her body is very much pale (severe pallor)

- Has open physical disability or problem
If the above listed health problem have occurred, advice should be

given to the family to immediately take the child to the next health
facility. Ensure that he/she is taken. Follow his/her health condition
after he/she has been brought back home.
Vaccination
Definition:-
Vaccination is a method to prevent diseases by giving weakened live
attenuated and killed micro organisms that cause diseases.
Vaccination helps to accentuate the body to create its own natural
defense mechanisms before a disease occurs.
The six childhood diseases that can be prevented by vaccination

The following diseases are the main causes of child morbidity,
mortality and disability and that can be prevented by vaccination.
Types of diseases Vaccination
1. Tuberculosis (TB) B.C.G.
2. poliomyelitis OPV
3. Pertusis
4. Diptheria --------------------- DPT
5. Tetanus
6. Measles measles
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Since vaccination very much helps to prevent child hood diseases or

weaken their severity, children should be taken to health post to get
their vaccination on time. Every child must complete his full
vaccination before celebrating his first birth day. In view of this, we
must check every child when we meet him in his home or at health
facilities, whether he has taken vaccination against the above disease
and if not shall be given on the same day, the vaccination that he has
not taken.
- If a child is confirmed to have AIDS, vaccination will not be given.

But if he/she is HIV carrier, he/she must be vaccinated.
- A child will not take the next DPT2 or DPT3 vaccination after 3
days of DPT vaccination if he develops shivering or goes to
shock. But, if a child has common cold, diarrhea or fever, he
should take the vaccination. He/She has to take his vaccination
on the day he/she is scheduled to take.
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Vaccination Schedules
Age of Type of Dose Made of

vaccination vaccination administration
At birth BCG 0.1 ml Upper arm of
right intradermal
OPV 2 drops Oral
6 weeks DPT1 0.5 ml Front outer side
of the thigh
muscle
OPV1 2 drops Oral
10 weeks DPT2 0.5 ml Front side of the
thigh muscle
OPV2 2 drops Oral
4 weeks DPT3 0.5 ml Front side of the
thigh muscle
OPV3 2 drops Oral
9 months MEASLES 0.5 ml Upper arm of
right hand
subcutaneous
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Harmful traditional practices applied on children
Tonsillectomy and extraction of the milk teeth

Most parents think and judge that their children have enlarged tonsil
when they see that their children have fever and are not taking food
as usual. But children will have fever whenever they have any illness.
Fever and loss of appetite are signs of many childhood illnesses.
They are not only signs of specific illnesses. There is fear from
mothers that the tonsil can explode and lead to death. This is not a
true judgment. The child can rather die from bleeding when the tonsil
is cut. In addition to this, since the instrument used for cutting the
tonsil is not clean, micro organisms can enter the body through the
wound and make children victims of HIV and other diseases.
Because of this, the child will be exposed to other illnesses and
death.
Sore throat is an infection when the left and right tonsils are swollen
and have pus discharges. When children are seen with this condition,
they should be taken to a nearby health facility. It is unwise to take
them to a traditional practitioner for removal of the tonsil
(tonsillectomy).
Extraction of the milk teeth

The explanation that parents give to the cause of vomiting and
diarrhoea is unremoved milk teeth. This is an explanation given due
to lack of knowledge. Diarrhoea and vomiting usually occur due to
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lack of hygiene. Since the growing teeth is extracted under the pretext
of gum extraction, it is important for mother's to refrain from taking
their children for such harmful traditional practice. The child should
rather be taken to the nearest health facility whenever he has
vomiting and diarrhoea.
Female circumcision
There is no need to circumcise female children. It will lead them to a
big problem due to heavy bleeding. The scar that remains after
circumcision will have also an effect during child birth. Therefore, an
intensified public education should be given to control this harmful
traditional practice.
Blistering of the skin

There will be no solution by blistering the skin when a child is sick. It
is just burning the skin. It is creating an additional suffering to the
child. Therefore, public education should be also given to control this
harmful traditional practice.
Cutting the eye brows

Cutting the eyebrows do not also give any solution to a sick child.
This practice will instead, expose the child to diseases such as HIV,
tetanus and other communicable diseases through the use of unclean
and unsafe instruments.
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Preventing children from getting sunlight

Children will be exposed to rickets (problem with the chest and leg
bones) if they are not exposed to sunlight at their early age.
Traditional medicines
There are many traditional medicines in Ethiopia. However, there is
nothing known about these medicines. The number of children who
died due to these medicines is not small. Therefore, it must be known
that giving traditional medicines to children, which their efficiency is
not yet known, is dangerous.
Swallowing of butter
Mothers say that swallowing butter will palliate (soften) the child's
abdomen. This is thinking far away from the truth. Since the butter is
heavy to the gastro intestinal system of the child, it causes diarrhoea
and vomiting. It can also cause other diseases since it is not hygienic.
If butter goes into the respiratory system of the child, he will be
suffocated and will die. Therefore, this practice should be
discouraged.
Mothers and families must be informed about the risks of the above
described traditional practices. If they are not informed, their children
will either become disabled or die at their early age.
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Accidents that can occur to children

Fire shall not be around places where children play. Children
should not be let to enter rooms where there is fire. The room
should be locked and stoves should be placed on an elevated
place.
Educate children to see either sides of the road (left and right)
while crossing a road. Inform them not to play on the road.
Keep out of reach of children, any type of medicine, gas,
benzene, alcohol, etc.
Children should not be left to sit or sleep on high places such as
table, mud bed etc. If they are left on these places, they will
suddenly fall and get fractured.
If the child is somewhat big, he should be educated to show to his
parents all the unique play materials he gets, and not to hide
these materials. These actions can prevent the child from
accidents such as land mine.
Educate children not to play with sharp materials such as pins,
needles, knives, blades. These materials should always be kept
out of the reach of children.
Care should be taken to prevent children from all forms of accidents.

But, they must be immediately taken to a place where urgent
assistance can be given to them when they are faced with accidents.
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Preparing balanced diet for families with local menu
What is balanced diet? Basic facts about food.

Every thing we eat and drink is called food. Things consumed as
food, differ from one country to another and some times even within
different regions of one country. The things people regard as food in
different parts of the world have been selected by trial and error over
years. The health worker must know what type of foods are
consumed in his/her area, what items of food people like, and what
foods people do not eat, even though they are cheap and available,
you should know certain type of food that people do not consume
Functions of foods
Foods have three important functions for our body:
- To sustain growth – help body to grow in size
- Provide energy for our activities
- To give protection from diseases
Foods contain chemical substances known as nutrients. This can be
divided into three categories according to their function:
o Energy giving nutrients
o Body building nutrients
o Protective nutrients.
Most foods contain a mixture of the three categories of nutrients, but
usually in one type of food categories one is found in large amount
than others.
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Eg. Cereals as rice and wheat contain all the three categories of
nutrients, but the energy-giving nutrients are the most abundant, it
can also supply sufficient nutrients promoting growth. Commonly
eaten foods can be broadly divided into three groups according to
these functions.
Energy-giving foods:
Cereals such as rice, wheat, corn, Teff, fats and oils, butter
Starchy vegetables like potatoes, sweat potato, sugar, and honey
Growth promoting Foods:

Most foods of animal origin: meat, milk, eggs and fish.
Some foods of vegetables origin: peas, beans and nuts
Protective foods
Vegetables- green leafy types
Yellow and orange colour fruits and vegetables like carrots, papaya,
mango, tomato, and orange.
Need for growth promoting foods

For infants growing rapidly e.g. babies double its weight in five
months. Thus children need foods to promote the growth of soft
tissues and bones.
Proteins are nutrients that promote the growth of soft tissues.
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Minerals such as calcium promote the growth of bones. Foods for

young children should contain both proteins and minerals.
Good foods necessary for infant growth

- Pulses such as lentils grams
- Peas and beans – Soya beans
- Nuts – peanuts
- Green leafy vegetables
- Milk and milk products
- Other foods of animal origin – meat, fish and eggs.
During pregnancy a woman’s body grows rapidly. The growth material

comes from what she eats. If she is on poor food during pregnancy,
she and her baby will be affected. The weight of the baby will be less
than 2500gm or will be a very low weight for date. Thus the mother
and baby will be malnourished as well as exposed to infectious
diseases. Dietary care is the starting point for good infant nutrition.
Breastfeeding mothers also need extra growth-promoting foods.
Human milk is produced in the breasts of the mother from raw
materials, which come from the diet. To produce enough milk of good
quality, a mother must have a diet consisting of adequate amounts of
cereals, beans, vegetables, oils as well as animal foods if possible.
- Infants and young children are very active and need a lot of
energy
- They cannot chew properly
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- They eat only a small amount of food at each feed. Therefore,

give them – both growth promoting and energy-rich foods; foods
of soft, semi-solid content and small but frequent feeds.
Some examples of weaning foods in Ethiopia

o Teff 60%, Field peas split 25%, Sugar 8%, And salt 3%
o Enset 80%, pea flour 17% and salt 3%
o Corn 67%, sour milk cheese 30%, and salt 3%
o Emmer wheat (mashilla) 67%, sour milk cheese 30% and salt 3%
o Corn 67%, sour milk cheese 30% and salt 3%
Promoting knowledge of use of local foods

o Teach and demonstrate about foods during ANC
o Teach in schools
o At women’s associations
o Teach mothers and communities at large how to grow these.
Growth monitoring and promotion
Learning Objectives
• Tell meaning of growth monitoring & promotion
• List the purposes of growth monitoring & promotion
• List components of growth monitoring & promotion
• Name 5 steps necessary for growth monitoring & promotion
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• Repeat the process of weighing under 5 and plotting on Childs’

card
• Restate reasons for doing growth monitoring in community
instead of during immunization
• Report factors which contribute to effective growth
• Report factors which contribute to poor growth
• Examine reasons for referring children under 5
• List the steps involved in preparing for referral
Meaning of growth monitoring promotion

Growth monitoring and promotion of children under 5 is the proper
weighing, clear and proper plotting of weight on a child health card,
interpreting and counselling the mother or caretaker to understand
what the weight means and take appropriate action. (Weighing should
be done monthly for the first 2 years and every after 2-month’s up to 5
years.)
Giving mother or care taker information on how to monitor baby’s

development and growth, care and diet given to baby will promote
both physical and mental development.
The effectiveness of growth monitoring and promotion is measured by

correct weighing of the child from birth up to 5 years at regular
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intervals correct plotting on the child’s growth curve interpretation of

curves and relevant follow up action.
Purposes of growth monitoring

• Create awareness among parents/ guardians about importance of
growth monitoring and promotion of under 5
• Encourage parents/guardians bring under 5 children for growth
monitoring
• Give information to enable parents/guardians and community
identify under 5 who need special attention
• Explain to parents the different steps that should be taken to
ensure successful growth and promotion
• Educate parents on factors which contribute to effective growth,
poor growth especially for the for the girl child
Components of growth monitoring

• Monthly weighing and plotting on growth chart
• Weighing all sick babies and plotting on chart
• Using the information on the child’s health growth and feeding to
decide what to do
• Counselling on the care and feeding of the child
• Deciding on follow-up to find out how the child is responding to
the actions
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• Sharing information with the community on the health of the

children
Steps for successful growth monitoring and promotion
Step 1: Motivate care takers to bring their children and become

involved in Whole process
Step 2: Measuring weight accurately and safely
Step 3: Recording/plotting the weight on the chart
Step 4: Interpreting growth curve
Step 5: counsel the mother according to growth curve and what you
may have found out to be the cause of poor growth
Performance of Growth Monitoring

Every mother should be provided with a child health care card after
delivery or at the first contact at the child health clinic. All relevant
identification data shall be entered on one side of the card is fully
devoted to growth monitoring. At each visit growth monitoring should
be done as follows:
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♦ Record the month of birth in the box for the month of the first year.
♦ Birth weight is recorded on the line to the right of the Kg numbers.
♦ The Kg numbers indicate the line on which they are printed.
♦ Indicate the month when the weight is plotted on the card.
Interpretation of growth monitoring chart
The first sign of different forms of protein energy malnutrition (PCM) is

growth failure. Weighing a child regularly, plotting the weights on a
growth chart and understanding the direction of the growth line are
the most important steps in detection of early malnutrition. Eventually,
the chart shall be interpreted as classified below for any child whose
weight is plotted.
Nutrition Classification: Normal= > 80%; mild Malnutrition= 70-80%;

Moderate malnutrition= 60-70%; Severe Malnutrition= < 60%. It is
very important to follow subsequent measurements and plotting, to
watch the direction of the line showing the child's growth.
Child's Condition good gaining weight: This means the child is

growing well and as intervention we have to compliment the mother.
Danger signs: Stagnant- meaning not gaining weight. Here find out
why. Poor nutrition? Infection? As an intervention process instruct the
mother, for support.
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Very dangerous: means loosing weight: losing weight may be ill and
needs care. As an intervention counselling. Return soon, admit or
refer.
Growth Monitoring Interventions

Health and nutrition education shall be given on prominent childhood
diseases in the area including diarrhoea, ARI, etc.
Importance of breast feeding, weaning food introduction
Practical demonstrations on the use of locally available foodstuffs.
Treat health problems of cases with mild to moderate cases of Protein
Energy Malnutrition (PEM).
Refer all cases with signs of severe malnutrition (ie. Those with
dangerous signs)
Educate the mother on Importance of breast feeding
Nutrition supplementation depending on the need
Recommendations for well child visit and GM/Program

♦ Monitor infant/child’s growth
♦ Assess and counsel on feeding (BE + CF)
♦ Assess and treat infant for anaemia
♦ Promote consumption of iodised salt
♦ Supplement vitamin A
♦ De-warm and check vaccination status
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Assessment and discussion
1. What do we mean by growth monitoring & promotion?

2. List three purposes of growth monitoring & promotion
3. List five components of growth monitoring & promotion
4. Name five steps for conducting growth monitoring & promotion
5. Plot the weight of a child 2 years old on the growth card &
interpret
6. What factors contribute to poor growth of a child?
7. When is referral indicated for children under 5 with malnutrition?
8. In a group make an assessment of nutritional status of under
fives
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Measuring and Monitoring Growth and Nutrition
Growth chart of Leela
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Training Community Health Workers in Nutrition
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Management and Prevention of Nutritional Deficiencies
Family Health
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UNIT FOUR
Adolescent Reproductive Health Services
Learning Objectives:
At the end of this session the trainee will be able to:
– Be able to understand the basic concepts of ARH
– Be able to describe major ARH problems
– Be able to describe ARH services
– Be able to understand how to live in harmony in the community
Adolescence is a period of high developmental changes in physical,

mental and social conditions.
In this period the adolescent youth fails to control his emotions, listen
to parents’ advice and begins to indulge him/her in unhealthy
behavioral activities.
The youth is categorized in three age-groups 10 to 14 years old as

teenage 15 to 19 year as early adolescent and 20 to 24 years as post-
adolescent. In general, the age-group from 10 to 19 years is classified
as adolescent.
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The problems of the adolescent arise from lack of understanding and

proper response to the changes that occur during development, due to
emotional behavior, peer pressure and the lack of experience of the
prevailing social system and its interactions. In order to be prepared
and respond to problems related to adolescence it is necessary to
acquire a comprehensive knowledge concerning adolescence.
The adolescent reproductive health programme is one of the priority

components of the Health Extension Package. The programme is
designed to focus on the production of healthy adolescents that will
effectively succeed the present generation.
Objective:
General objective:
Adolescent reproductive health program in general and the extension
package in particular aims at producing healthy adolescent population
that is physically, mentally and socially well-developed.
Specific objectives:
– provide adequate information and education to reduce and/or
gradually eliminate traditional harmful practices that cause
adolescent reproduction health related problems.
– Assist adolescents to protect themselves from HIV/AIDS and
other sexually transmitted diseases.
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– Protect adolescent young persons from unwanted pregnancy,

high risk abortion, and other reproductive health related problems.
– Assist the adolescent young persons to protect themselves and
their families from using addictive plants, narcotics and alcohol.
– Guide and alert/motivate adolescent to utilize available family
planning and reproductive health services.
Strategies:
Creating enabling conditions for the adolescents to receive
health education and services on HIV/AIDS and other sexually
transmitted diseases.
o Providing adequate information to protect
adolescents from casual sex, unwanted pregnancy,
early childbearing age, and high-risk abortion.
o Educating adolescents on traditional harmful
practices and protect them from incidents of rape,
early age marriage and female genital mutilation.
o Creating an enabling environment for adolescents to
receive adequate information and education, to
develop skills and improve their living styles and
eventually become responsible nationals.
o Providing adequate information and education to
adolescents to protect themselves from addictive
plants, alcoholic drinks and narcotics.
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o Establishing forums to discuss issues and problems

related to adolescent reproductive health.
o Expanding adolescent reproductive health
programmes in schools.
o Training of Trainers (TOT): Selecting and training
volunteer housewives who have completed
education and/or are dropouts from school. These
volunteers are residents of the Kebele and should be
able to coordinate the community members. The
volunteer house wives will be aids to the health
extension workers and will have the task of
educating their neighbors.
o Youth Day Organizing and initiating the youth groups
engaged in the activities of reproductive health to
develop and present short dialogues, dramas and
writings under the slogan youth to youth and present
them for the Kebele residents. In addition, celebrity
persons should be invited for discussions. The youth
should provide sustained education on adolescent
reproductive health and should commit itself to make
the day a special occasion to strive to bring
behavioral changes.
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Changes developing in young females:

• The breast starts to develop and grow, feeling of
breast pain; growth and sticking out of the nipples;
• Growth of hair in the armpit and pubic (around the
genitals).
• The initiation of menstrual period;
• Broadening of the pelvic;
• Change in the amount and smell of body sweat;
• Increased eagerness to know more about sex; and
• Developing keen Interest and/or falling in love with
opposite sex.
Changes developing in young males: -

• Change of voice;
• Building and broadening of shoulder and chest;
• Growing beard; starting to grow hair in the armpit, pubic and
perhaps in the chest;
• Development of male genitals and testicles;
• Starting to release sperm;
• Change in the amount and smell of body sweat;
• Increased eagerness to know more about sex;
• Developing keen interest and/or falling in love with opposite sex;
and
• Releasing sperm for the first time in bed during sleep.
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Education on adolesent reproductive health related problems:
HIV/AIDS and other sexually transmitted infections:

The major sexually transmitted disease are HIV/AIDS, syphilis,
chancroid, gonorrhea, etc, The prevention and control measures for
both HIV/AIDS and other sexually transmitted diseases are the same.
Therefore preventing and controlling sexually transmitted diseases
means without doubt preventing and controlling HIV/AIDS.
HIV/AIDS prevention and control measures:-

• Abstain /refrain from sexual intercourse before and outside
marriage;
• Sexual intercourse between two HIV/AIDS laboratory tested free
sexual partners must be based on absolute trust and sustained
one to one relationship.
• Use condom properly, if for any reason or reasons sexual
intercourse before and outside marriage is needed.
• Don’t ever share cutting and sharp instruments for use. At home
separate items used by adults and children such blade, needles,
etc;
• Advice and follow up patients sick from sexually transmitted
diseases other than HIV/AIDS to go to nearest health facility;
• Don’t use the services of legally uncertified health facilities;
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• Refrain from harmful traditional practices that expose to HIV/AIDS

and other sexually transmitted diseases;
• Keep clean the areas around genitals;
• Advise and motivate suspected young individuals to go to health
facilities and use HIV/AIDS counselling services.; and
• Provide support and care with affection to people living with
HIV/AIDS and victims at family and community levels.
Female genital mutilation

Female genital mutilation is one of the harmful traditional practices
that cause problems of adolescent reproduction health. It is widely
practiced in 28 African countries including Ethiopia. Mutilation of
female genitals causes immediate and delayed health problems in
young females. The immediate health problems of the young females
include bleeding, unconsciousness, septicemia, problem of urination
and sometimes death. Among the problems that come late are
infertility, scar, fistula, delay in labour, infant and maternal mortality
and HIVI/AIDS. In addition to the violation of human rights related to
females, it seriously affects the happy and peaceful marriage of such
victims. Furthermore, the number of deaths of mothers and infants is
increased. It is essential to prevent and eventually eliminate the
harmful traditional practices of mutilation of female genitals. The
choice of intervention would be to provide sustained and adequate
information on reproductive health. This could be realized through the
coordination and support of the Kebele management, religious
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leaders, schools, women and youth associations, other government

organizations, NGOs and the communities at large.
High risk abortion

The youth engages in casual sex in the absence of adequate
knowledge on sex and reproductive health and often without
contraceptive methods. The consequences of such traditional
practices is that the young females are exposed to illegal and high
risk abortion resulting in illness, disability and death.
Main reasons for abortion:-
• Lack of appropriate information on sex and reproductive

health;
• The non-existence of adequate services for abortion;
• The victims don’t have access to adequate financial and other
supports; and
• Communities don’t effectively utilize available family planning
services to prevent and control abortion.
Activities to prevent and control high risk abortion:-

• Increase awareness of the youth on sex abstinence and healthy
behaviours that reduce reproductive health related problems.
• Because of casual sexual motive, young females are frequently
subjected to rape and unwanted pregnancy. Therefore, they
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should be educated and convinced strongly to commit themselves

to utilize contraceptive methods to prevent unwanted pregnancy.
• Educate the youth to abstain /refrain from sex before marriage.
• Educate the youth to stick on one to one sex partnership as an
important option.
• In case of unforeseen circumstances use condom.
• Conduct frank discussions on sex with friends and family.
• Provide continuous education to communities to give moral, and
material support and care to HIV/AIDS patients and victims if
possible the support should include to communities working on
their farms,
• Provide adequate information and education on the complex
consequences of abortion on the female youth, so that the
communities will support the victims physically, mentally and
socially.
• Motivate and mobilize the youth in the farmers association to
establish health clubs that promote sex abstinence, healthy
reproduction and healthy sex behavior among the youth, in
addition, the health clubs should be supported in their efforts to
disseminate information and create healthy environment.
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Early-age marriage
Marriage in Ethiopia is often concluded according to
established traditional practices and norms in different nations
and nationalities. In the rural areas, however, it is common
practice by families to marry their young girls at an early age.
Early-age marriage is preferred by families for the following
reasons. First, families prefer to get their daughters married
while alive and or before they get old. Second, the marriage is
accomplished with wealthy family in order to improve the living
conditions of the bride’s family. Third, to establish better
relationship and tie between two families. Fourth, to prove that
the bride is virgin, a litmus test that reassure that the bride is
from a decent family. Fifth, to ensure that the bride is married
at the right and socially accepted age limit.
Consequences of early age marriage on young females:-

Miss education opportunity and /or become out of school: young
females miss the opportunity to go to school if she got married at an
early age. The next episode is that the married girls often get
pregnant. As the girls didn't get adequate education, their fate is
indeed decided by others such as her parents, her husband and his
parents and relatives etc.
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• Working/serving others:
Girls work at home for their parents and brothers. Even

though, girls are married at an early age and are too young,
they continue to work for their husband and his family (the
parents etc). At the same time their fate is decided by others.
This state of affairs becomes an impediment to develop and
acquire knowledge and skills to decide on their fate and
related affairs.
High maternal and child morbidity and mortality
Some of the consequences of early age marriage are delayed

labor, fistula and rupture of the bladder. These incidents occur
because the pelvics of the young girls is still fully undeveloped
and narrow. Fistula is a dirty injury that results in the loss of
control of urine and stool which results in incontinence and body
smell. The young female victims of such mishappening are
segregated by communities. Furthermore, abnormal labor often
ends in child death.
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Adolescent RH related problems
The consequences of alcoholism
• Intoxicates brain and liver;

• Reduces appetite and causes protein and vitamin deficiencies;
• Reduces the capacity of understanding of prevailing situations
and gradually dives individuals into fight;
• Initiates pain in the stomachs and spleen;
• Induces heart and kidneys illnesses.
Measures to prevent alcoholism:-
• Educate students in schools in the kebele on the consequences of

alcoholic drinks on their health.
• Disseminate adequate information and education to raise the
awareness of communities to enable them to participate in
sustained efforts to prevent the youth from alcoholism and its
adverse consequences on health and eventually to create alcohol
free society.
• Provide adequate information and education to raise the
awareness of communities on alcoholism to help them grow their
children with care, to be responsible nationals.
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• Young farmers often travel to nearby towns and village markets.

They drink alcohol as refreshment in these areas. Then these
young farmers get drunk and are triggered to fight between
themselves or some of them indulge in sex that may result in the
infection of HIV/AIDS and other sexually transmitted diseases.
Therefore, the young farmers have to be made aware that such
incidents can happen using pamphlets, health education in
planned community meetings and other venues.
Addictive substances and drugs:-

Chat, hashish and cannabis are the major known addictive
substances that cause the following health and related problems.
• Decayed tooth;
• Loss of appetite;
• Constipation;
• Reduced sex desire and /or feeling;
• Mental illness;
• Isolate oneself from family and community social values;
• Inability or loss of desire to participate in all development
activities, schooling, farming etc,
• Participate in criminal acts; and
• Exposed to HIV/AIDS and other sexually transmitted diseases.
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Measures to prevent addictives substances and drugs:-
• Provide planned health education to communities in kebeles

and in nearby schools.
• In order to raise search and bring behavioral changes, provide
adequate information and education focused on the grave
consequences of chat and other addictive substances to
communities in general and the youth in particular. These
activates should take place in youth forums in the form of
dramas, discussions etc. by elderly and religious people.
• The health extension workers in collaboration with the
agriculture extension workers should make continuous efforts
to convince and influence the youth and adult farmers to
acquire their income by harvesting other cash crops such as
coffee, fruits, vegetables etc. Instead of the harmful chat and
other addiction substances.
• Provide planned and continuous health education to the rural
population to use drugs officially prescribed by health workers
and by collecting them from clinics and rural drug vendors.
Provision of adolescent RH services:-

Establishment of adolescent reproductive health center:-
Activities on Youth Day:-
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• Drama:- initiate the youth to prepare and show drama that

focuses on youth problems to communities.
• Play /dialogue:- Initiate the youth to stage exciting and
educational but short play /dialogue to the youth at large.
• Short-writings:- initiate the youth to prepare short writings in
conjunction with nearby schools to be presented on the Youth
Day.
• Organize Youth peers to discuss on issues and problems related
to adolescent reproductive health.
Establishment and organization of youth recreational facilities:-

Establish youth recreational centers with rooms and other spaces for
traditional sports activities and meetings. This will keep away the
youth from harmful environment.
Provision of family planning and reproductive health services:
• Provide counselling service to the youth that wants to utilize family

planning health services; and
• Promote and distribute condoms to prevent the youth from
HIV/AIDS and other sexually transmitted infections;
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Assessment and group discussion
1. List some factors for Adolescent Health promotion

2. In what possible ways do we improve Adolescent Health?
3. Name some contributing factors to adolescent sexual and
reproductive health promotion
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UNIT FIVE
Sexually Transmitted Infections
Learning Objectives
By the end of this session you will be:

♦ Aware of the type of sexually transmitted infections in Ethiopia
♦ Be knowledgeable about the mode of transmission and prevention
of STD
♦ Knowledgeable about HIV/AIDS, transmission and prevention
STD is a group of disease, which are spread from person to person

by sexual intercourse. Each disease is caused by a germ, bacteria or
virus, which enters the body during intercourse with an infected
person.
Venereal disease can be attached to any part of the body and
produce serious complications. Most of them can be cured provided
person seeks medical advice and help as soon as possible.
The most common STD in Ethiopia is the following:

5.1. Gonorrhoea:- is a sexually transmitted disease caused by the
bacterium Neisseria gonorrhea. A person carrying the bacteria
when one mucus membrane comes into contact with another’s
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transmits it. It causes inflammation of the genital mucus

membrane in both sexes.
5.1.1. Incubation Period

The average incubation period is 3–7 days after sexual contact
although women may remain symptom – free for up to 3 months.
5.1.2. Signs and Symptoms

5.1.2.1. In women
• Vaginal discharge
• Frequency of urination
• Abdominal pain and backache
• Irregular and painful menses
• Pain with intercourse and post coital bleeding
5.1.2.2. In Men
• A thick yellow/green purulent urethra discharge
• Urethra irritation associated with dysuria and frequent
urination
5.1.3. Complications of gonorrhoea

If the disease is not properly treated at once, it can lead to permanent
damage of the reproductive organs in the women. This can result in
a couple not being able to have children or infertile.
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An infected pregnant woman can pass the germs to her baby during
birth. About two days after the infected child is born, it will have a
thick discharge (pus) from the eyes. If this is not properly treated the
child may later become blind.
5.2. Syphilis:
Is a sexually transmitted disease caused by the microorganism
(spirochete)- Treponema pallidum. The organism usually enter the
body through invisible breaks in the skin or through intact mucus
membranes lining the mouth, rectum, or genital tract

It is usually from nine to ninety days (3 to 4 weeks on average)
5.2.2. It is transmitted mainly in the following way:

♦ Sexual intercourse
♦ Occasionally by kissing when one partner has moist syphilitic
lesion of the month or throat
♦ Organism passing from the infected mother to fetus
♦ Blood transfused
5.2.3. Signs and Symptoms of Syphilis

Unlike gonorrhoea, a person who has syphilis has on pain while
passing urine. However, the person will notice a painless hard ulcer
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(sore or would) on the penis or vagina about 10 days after sexual

intercourse with an infected person.
Another common sign is painful swollen glands in the groin. At this
stage it is important to go for proper medical treatment because the
disease can be cured at this time.
If not treated, the sore and the swollen glands will go away on their
own but the germs remain in the blood.
5.2.3.1. Stage of Syphilis
5.2.3.1.1. Primary Syphilis

Three weeks after exposure chancre in an undulated penis, anus,
edge of vagina, cervix or mouth. The signs will disappear within two
to six weeks later even without treatment.
5.2.3.1.2. Secondary Syphilis

About six weeks after the healing of the primary infection rashes tend
to be quickly passing and do not itch. These symptoms may
disappear in 2 – 6 weeks even without treatment.
5.2.3.1.3. Tertiary Syphilis

10 – 20 years – Heart disease, brain damage, spinal cord damage,
blindness. One in four persons not treated for secondary syphilis will
eventually suffer incapacity or death from the disease.
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Symptoms may be absent until tertiary damage occurs. Congenital

syphilis - a serious infection in new born – occurs frequently if
pregnant women with syphilis are not treated.
5.2.3.2. Complications of Syphilis

About two months later the infected person will develop a fever,
headache and a skin rash. At this time it is still not too late to go for
proper medical treatment to get cured.
Even if a person is not treated the signs will go away, but the germs
still remain in the blood. Then the germs spread to various parts in
the body, such as the heart and brain. Even if a person gets
treatment at this stage, the damage is already done it cannot be
cured.
5.3. Chancroid:
A sexually transmitted disease caused by the bacillus Hemophilus
ducreyi.
It is usually happens from 3 to 7 days. Occasionally it may be longer.
5.3.1. Signs and symptoms
• There will be a soft ulcer on the genital area (penis or vagina)
within 3 – 4 days after sexual contact and frequently swollen
glands in the groin accompany it. The glands often break
through the skin, burst and start to discharge pus. The pus
from the ulcer and glands is infectious. Chancroid is more
common in males than females.
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5.3.1.1. In males
It is found on the under surface of the prepuce and shaft of the
penis.
5.3.1.2. In females
It is found on the labia minora and labia majora.
5.3.2. Complications
Ulcers (soft sore) will get infected with germs and healing will be
slow causing scaring.
5.4. Chlamydia: A sexually transmitted disease caused by

infection with the bacterium chlamydia trachomatis.
• Enlarged lymph gland in the groin areas which could be
unilateral, lateral or bilateral
• It is very painful fluctuate and may rupture causing fistula.
5.4.2. Complications
• Narrowing of the tissue affected.
• Infertility, fistulas.
5.5. Herpes:
It is a sexually transmitted disease caused by another type of germ.

It is spread from one person to another during sexual intercourse and
through sharing contaminated materials such as towels.
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• Painful sours on the penis and some pain during sexual
intercourse.
• An infected woman will have itching and pain during
intercourse.
• She may also have blisters that make her uncomfortable.
• The skin where herpes blisters are become weak, making it
easier for other STD and HIV virus to get in to the body.
5.5.2. Complication
People who have herpes must go for proper medical treatment. This
is because it is a very difficult disease to treat. Once it has been
treated, it goes away, but may come again Herpes infection is linked
to cancer of the cervix.
5.6. Infertility
This is one of the major complications of sexually transmitted
infections. Around the world, infertility represents a major health and
social problem. For women in many developing countries, the inability
to have children can result in stigmatization and abandonment by
their husbands. The highest rates of infertility in the world occur in
sub-Saharan Africa--ranging from 10-21%. These high rates of
infertility can partly be attributed to high rates of sexually transmitted
infections (STIs) and complications of delivery or unsafe abortions.
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Infertility is the inability to achieve and/or maintain pregnancy. About

35% of infertility is the result of male factors (including the absence of
sperm or abnormal or too few sperm), and another 35% is the result
of female factors (including problems in ovulation, blocked or scarred
fallopian tubes, and endometriosis). In other cases, infertility results
from a combination of both male and female factors, or it cannot be
explained. Although it can take some couples longer than 12 months
to achieve pregnancy, many people seek infertility
treatment/counselling if they haven't achieved pregnancy after 12
months of unprotected and well-timed intercourse.
5.6.1. When Should One Seek Infertility Treatment or Support?

If you have had trouble trying to get pregnant, you may want to seek
additional help and information about infertility treatment.
RESOLVE, a U.S. based national infertility support group, provides a
wide range of information about treatment options and referrals to
infertility specialists. They suggest seeking help if you have been
trying to conceive for more than 12 months and:
• Are over 35 years of age

• Have irregular menstrual cycles or a history of pelvic infection
• Your partner had an undescended testicle at birth, hernia
repair, or a history of urinary infections
• You've had two or more pregnancy losses
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5.6.2. Risk Factors for Infertility

Throughout the world, 38% of infertility can be traced to a previous
sexually transmitted infection (STI). When left untreated, many STIs
can place women and men at risk for becoming infertile. Untreated
gonorrhea and chlamydia in women can spread into the pelvic area
and infect the uterus, fallopian tubes, and ovaries--leading to pelvic
inflammatory disease (PID). In men, chlamydia can affect the
testicles--also leading to problems with fertility.
Pelvic inflammatory disease (PID) is an infection of the internal
female reproductive organs, usually affecting the uterus, one or both
fallopian tubes, the ovaries, and surrounding pelvic tissues. These
tissues become inflamed, irritated, and swollen. Untreated STIs,
tuberculosis, and other types of bacteria and microorganisms cause
PID.
PID can lead to infertility, because of the scar tissue that forms
around the pelvic organs. This scar tissue can cause blockage and
distortion of the fallopian tubes so that the egg cannot get through the
tube and into the uterus. After one episode of PID, a woman has an
estimated 15% chance of infertility. After two episodes, the risk rises
to 35%. After three episodes, the risk for infertility is nearly 75%.
5.7. What is HIV(Human Immuno Virus)/ AIDS

Acquired Immuno Deficiency Syndrome
The causative organism is a virus, which is the most deadly of all the
Sexually Transmitted agents. It is found in blood and body fluids.
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Family Health

The period between infection and the onset of AIDS symptoms
ranges from 6 months to 5 years and possibly longer.
It is also transmitted through blood transfusion, placenta to fetus,
needle prick and using common blades for shaving and incisions.
The white blood cells in the body damaged by the HIV virus cannot
protect the body from infections. A person who lacks immunity
becomes weak and eventually dies as a result of infections against
which the body cannot protect itself.
HIV virus cannot survive in air, water, or on things people touch. You
cannot get it from touching, hugging. Talking to or sharing a room
with a person who is HIV infected or has AIDS. You cannot get HIV
from being bitten by mosquitoes and other blood sucking insects,
using the same toilet or sharing plates, glasses, or towels used by
someone who has HIV or AIDS.

5.7.2.1. Frequently reported signs
• Persistent cough of over one month
• Skin infections
• Recurrent herpes zoster
• Oro – pharyngeal candidacies (ulcers)
• Chronic progressive and disseminated herpes simplex (sore
on the lips and genitals)
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Family Health
• Generalized by lymphedeopathy (swelling of the lymph)
5.7.3. Consequences
• Death
• Economic problems
• Social problems
5.7.4. Prevention and Management of STD/HIV -

• One partner
• Use condoms
• People should not have injection except at the health
institutions where equipment is sterilized and blood is
checked.
• Appropriate hygiene and sterilization of needles and surgical
instruments and care of lesions, rashes, body fluids and blood.
• Early detection and appropriate treatment including sexual
partners in all STD’s except HIV/AIDS patients.
• Continuous SRH education
• Infection prevention on STD, HIV/AIDS at all levels
• Avoiding to have unsafe sex with prostitutes
• Using known health institutions for injection
5.7.5. Assessment questions for discussion

• How can one know when a vaginal discharge is abnormal?
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Family Health
• Is it possible to get an STD and be infected with HIV at the

same time?
• What is Safer Sex?
1. Can syphilis be passed on to a baby just as AIDS can?
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Family Health
GLOSSARY
Age dependency ratio

The ratio of persons in the “dependent” ages (under 15 and older
than 64 years) to those in the “economically productive” age (15-64
years) in a population.
Antenatal coverage
Coverage to a health institution made by a pregnant women to be
sure that she has a safe pregnancy.
Average household size
The mean number of members per household
Child mortality
The probability of dying between exact ages one and the fifth birthday
per 1000 children surviving to the first birthday
Child woman ratio
The number of children under ages five per 1,000 women of
childbearing age in a given year. This measure id used as a rough
fertility indicator, especially when detailed data on births are lacking.
Contraceptive prevalence rate
The proportion of eligible women (15-49 years old) who got
contraceptive service.
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Crude birth rate

The number of births in a population during a specified period divided
by the number of person years lived by the population during the
same period.
It is frequently expressed as births per 1,000 populations.
Crude death rate
The number of deaths in a population during a specified period
divided by the number of person years lived by the population during
the same period It is frequently expressed as births per 1,000
population.
Delivery attended
The service given for pregnant women during labor; management of
normal delivery and detection of complications, management of risk
cases in labor and complicated cases.
Fully immunized
A child ages less than one who has taken all types of antigens
completely.
General fertility rate
The number of births occurring in a given year per 1000 women in the
reproductive ages (i.e. women age 15-49).
Infant mortality rate
The ratio of the number of deaths under one year of age occurring in
a given year to the number of births in the same year. Also used in a
more rigorous sense to mean the number of deaths that would occur
under one year of age in a life table with a index of 1,000
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Life Expectancy at Birth

The average number of years a newborn infant can expect to live
under current mortality levels.
Live birth
The complete expulsion or extraction from its mother of conception,
irrespective of the duration of pregnancy, which after such separation
shows any evidence of life.
Maternal mortality rate
Maternal mortality is defined as the death of a woman during
pregnancy or within 42 days of termination of the pregnancy.
Maternal mortality ratio is the number of maternal deaths per 100,000
live births in a given period, usually a year. Maternal mortality rate
refers to the number of maternal deaths per 100,000 women in the
reproductive age group 15-49 per year (WHO, 2001).
Morbidity
The extent of illness, injury or disability in a population.
Sex ratio
The number of males in a population or specific sub population, divided
by corresponding number of females, conventionally multiplied by 100.
Total fertility rate
The average number of children that would be born per woman of all
women lived to end of their childbearing years and born children
according to a given set of age specific fertility rates.
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Under five mortality

The probability of dying between birth and age five per 1000 live births
in given year.
Under 5 children
Under 5 year children visit to health institution for monitoring of growth
and development, screening of risk cases, and for management of
disease or mal development.
Culture
A complete set of attitude, a lifestyle, or a way of life. A system of
beliefs, patterns of behaviour, norms traditions, interactions performed
by a society.
Tradition
Part of a culture and are patterns of behaviour shared by members of a
particular society having deep rooted history.
Taboo
Prohibition imposed by social customs,
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Primary Care for all life Stages

Jena Angela T. Perano, MD, DFCM
Objectives
Describe what is Primary Care
Discuss the Different Programs of Philippines in regards in Primary Care
Revolutions in Medicine, 1900s Revolutions in

Medicine, 2000s
Ascendance of single disease
• Multiple interacting influences on
and chronic illness fucos illness/health
• Disparities in health (inequity)
Diagnostic challenges/ need of
• Illness as morbidity burden, not as
more technology Disease
• Risk factors as diseases
Single Cause (? Gene) – Magic
Bullet • Health as an impossibility (a healthy
person is someone without enough test)
All fostered an INDIVIDUAL • All require a POPULATION OREINTATION

OREINTATION in health services
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WHO Commission on Social Determinants

of Health. Closing the Gap
in a Generation
Health Equity through Action on the Social Determinants of

Health.
Action Area 2
Action Area 1
• Ensure that health-care system
financing, focusing on tax-based
Build health-care based on the principles of: financing, ensuring universal
coverage regardless of ability to
• Equity pay, and minimizing out-of-
• DiseasePrevention and pocket payments.
• Health promotion
With Civil Society, build healthcare services on

the principle of:
• Universal coverage of quality services focusing on Primary
Health Care
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Area 3: Build and Strengthen the health workforce and add

capacities to act on the social determinants of health
With donors, increase investment in medical and health personnel,

balancing health worker density in rural and urban
With international agencies and donors, address the health human resources
brain drain focusing on investment in increased health human resources and
training, and bilateral agreements to regulate gains and losses
A framework based on structure, Process and

outcome is helpful in describing and measuring
the components of health services system.
Are there difference in structure, process and

outcome that can explain variability in health even
across areas with similar wealth and resources?
Primary Health Care

and Primary Care
Primary Care is a major • Primary Health Care is a system-
wide approach to designing health
component of health services based on Primary Care
• Primary Care is the
services systems representation, on the clinical

level, of Primary health care
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The framework of structure,

process and outcome is useful in
defining primary care so that it
can be measured and Evaluated
Measurement of Primary Care
PRIMARY CARE SHARES MEASUREMENT OF PRIMARY CARE MEASUREMENT REQUIRES

ATTRIBUTES WITH OTHER LEVELS SHOULD ADDRESS ITS UNIQUE KNOWLEDGE OF THE SYSTEMS
OF CARE FUNCTIONS CHARACTERISTICS AND BEHAVIORS
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5
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Objectives
To define the guaranteed population-based and individual-

based primary care intervention for each life stages
To identify the health financing agent/mechanism for the

identified primary health care intervention and
To facilitate the citizens’ knowledge and understanding of their

health guarantees.
Enabling Quality Access and Ensuring

Enabling Quality Access and Ensuring
Adequate and Appropriate Provision
Adequate and Appropriate Provision
l. The primary health care guarantees shall be delivered through/ocal
communities and health facilities. Specifically, individual-based interventions shall 3. Provision of all primary health care guarantees shall be guided by local yrelevant
be accessed through networks of both public (state) and private (non-state) clinical practices guidelines and cost-effective, responsive clinical pathways.
providers that are linked to higher levels of service facilities in service delivery
networks. 4. All information and education campaign materials on primary health care
guarantees shall be developed using life stage approach and segmented by client,e.g.
health managers, health providers, and client families.
2. All product registration, licensing, accreditation, and contracting.standards for
both stand-alone primary health care facilities and primary care networks, 5. The effectiveness, efficiency, and equity dimensions of the primary health care(lt
including health professions education and training shall be aligned to the guarantees implementation shall be monitored by the DOH, PhilHealth, andLGUs. All
primary health care guarantees. health information systems shall enable tracking of utilization of health guarantees.
6
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Population Level
• Surveillance and monitoring of population's health status.
• Prevention and control of Endemic Disease
• Assurance of Quality and Accessibility of health Service
• Health Communication and Dissemination Strategy
• About Pregnant women
• Philhealth Enrollment
• ….
• Community Mobilization and development
• Public Health Policy Development
Pregnancy
• Disaster Preparedness and Response
Labor
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Population Level Primary Care Services for Well Adult

• Surveillance and monitoring of population's health status
Provision of Normal
• Prevention and control of Endemic Disease Clinical Spontaneous
Delivery (NSD)
Laboratory
Drugs and
Comodities
During Emerency
• Assurance of Quality and Accessibility of health Service •Monitor Progress of •CBC and blood •Clean Delivery set •Minimum Initial
Labor typing(As indicated) including cutting set Service Package for
• Public Health Policy Development •Monitoring of Vital
Signs
•Oxytocin,
Magnesium Sulfate,
safe motherhood
(MISP)
• Basic Emergency Obstetrics and Newborn Facility per 250,000 population •Monitoring of Anti biotic and •Commodities:
Mother-Friendly Steriods Water treatment
• CeMonc per Facility Practices during •Cord Clamp with hyposol, Jerry
Delivery Can, Clean delivery
• BHERT •Maintaining kits, hygiene Kits
infection control
practices during
labor and delivery
Primary Care Individual for Sick Adults
Drugs and Commodities (For

Regular Consultation for any
Facilities with BEMONC Trained Uterine Inversion
conditions
health care workers:
• History and Physical • Magnesium sulfate • Uterine Balloon Tamponade
Examination • Dexamethasone/Bethamesone
for patient that might give birth
to preterm babies
• Antibiotics
• Oxytocin
• Tranexamic Acid
Post Partum
• Plasma Expanders
• Referral for Blood transfusion
Services
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Population Level Primary

• Surveillance and monitoring of population's health status Care
• Assurance of Quality and Accessibility of health Service Services
• Control of Substance of Abuse
for Well
•
•
WASH (Sanitation)
Lactation Adult
• Family Planning
• Public Health Policy Development
• Post Partum Family Visit
• Family Planning
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Primary Care Individual for Sick Adults
Neonate
Infant
9
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Population Level
Primary Wellness for well
• Surveillance and monitoring of population's health status.
individual
• Assurance of Quality and Accessibility of health Service • History and Physical Examination (Vital and anthrometric Measure)
• Oral Health examination and Flouride Varnish
• Early Childhood Developmental Screeening
• Community Mobilization and development • Visual and hearing screening
• Public Health Policy Development • Medication

• Vitamin A at 6 months
• Disaster Preparedness and Response • Iron sulfhate drops for LBW
• Vaccine
Primary Care Services for Sick Individuals
Child
10
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School Age
11
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Adolescent
12
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Adult and
Late
Adulthood
Surveillance and Monitoring of the Population Health
• Cancer Registry
• Crisis helplines (self Harm)
Population Prevention and control of Endemic diseasez
Level Assurance of Quality and Accessibility of services
• Establishment of Women & Child Protection Unit in all hospital

• Services for PWDs and other special groups
Health communication and dissemination strategies
Population Level
Surveillance and Monitoring of the Population Health
• Cancer Registry
• Crisis helplines (self Harm)
Adult Women Prevention and control of Endemic diseasez
Assurance of Quality and Accessibility of services

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Adult Men
Elderly
Women
Surveillance and Monitoring of the Population Smoking and

Healthy Diet
Health tobacco Use
• Cancer Registry
• Crisis helplines (self Harm) Drug and Physical
Population Prevention and control of Endemic diseasez
Information
alcohol use Activity
Level Assurance of Quality and Accessibility of services

Campaign on:
Mental Health
Reproductive
Health
Dementia and
Alzhiemer Injuries
disease
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Clinical
Comprehensive Geriatric Assessment
• History and Physical Examination
Primary Care Services • General Vision Screening

• Hearing Screening
Oral Health Examination
for Well Individuals Counselling
Referral and Transportation Services as needed
Blood Chemistry
Vitamin D supplement
Fasting blood glucose
Oral glucose tolerance test
Influenza vaccine
Lipid Profile Drug and
Laboratory FOBT & Sigmiodoscopy/ colonoscopy Medicine
Pneumococcal Vaccine (PPV)
Pap smear or VIA (<70yo)
TB sputum Test Other vaccine as recommended by
Chest X-ray and ECG NIP
Elderly Primary Care Services

For Sick Aldults
Men
15
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Cardiac diseases
Primary Care Services For Sick Aldults
Ischemic Heart Hypertensive Heart Congenital Heart Rheumatic Heart
Disease Disease Anomaly Disease
• Lab: 12L ECG • Lab: Blood • Clinical: Refer to • Population:
(exercise ECG Pressure tertiary Hospital Develop ARF/RHD
test) Stress Echo monitoring, Eye • Labs: Registry
• Therapeutic exam, ECG Echocardiograhy • Lab: Throat swab,
Management as • Therapeutic 2D
indicated Treatment echocardiography,
• Counselling/ • Counselling/ Anti-Streptolysin
Regular Consultation Dental Conditions Environmental Hazard Behavioral or
for any Condition Exposure and Psychiatric/Neurologic Education Education O ASO titer
Poisoning Disorder (Lifestyle (Lifestyle • Therapeutic
Intervention) Intervention) Management
Renal Urologic Pulmonary
• Urinary Tract Infection • Lower Respiratory Tract Infection

• Chronic Kidney Disease/ End Stage Renal • Tuberculosis
Disease
• Chronic obstructive Pulmonary
• Benign Prostatic Hyperplasia disease
• Asthma
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• Diabetes Mellitus Gastrointestinal

• Clinical: Annual Eye Exam when diagnosed and
every 2 years if with no abnormal findings, • Peptic Ulcer
counselling on lifestyle change, foot care, BP
Monitoring ( for all persons 40 years and above); • Clinical: prevention of NSAID-
Management of Complications induced ulcer
• Lab: FBS or RBS, Urinalysis, Kidney and liver • DOC: acid suppression with PPI
Endocrinology function test, HBA1c • Lab: Endoscopy, testing for H-pylori,
• Therapeutic Management and counseling Urea breath test and stool antigen
• Lifestyle management and DSME Program
• Glycemic management and control
• Blood Pressure and Cholesterol control
16
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Musculoskeletal
Nuerologic/Psychiatry Disorder
• Clinical: Comprehensive
Hemorrhagic assessment (determine if
Ischemic Stroke Headache
Stroke
complicated or not), Screen for
occupational health risk,
Major counselling on lifestyle
Depressive Schizophrenia Bipolar Disorder modification, physiotherapy,
Disorder community based physical
rehabilitation
Alzheimer
Dysthymia Disease and Epilepsy
other Dementias
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Injuries
• Motor vehicles road Injuries
• Assault by firearm
Cancer • Self-harm
For definitive diagnosis and

management: Referral to secondary or
Tertiary facility
Infection Disease
Opthalmologic
HIV/ AIDS and
• Clinical: Snellen’s chart, refer for Rabies Dengue
STDs
corrective lenses; refer for
cataract and other retinophay for
evaluation and other Typhoid Fever STH Measles
management
Malaria Leprosy Filariasis
Schistosomiasis
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Dermatology
Nutrition
Clinical: Referral to specialists Management of Dermatologic Conditions

(Egg. Atopic, Irritant Contact, Bacterial and
Fungal Infections and Suspicious
Malignant Lesions)
Refrences
• https://clmmrh.doh.gov.ph/images/PhilippineHealthAgenda/Philippin
e-Health-Agenda_Dec1_1.pdf
18
FMCH3: FAMILY HEALTH CARE USE AT YOUR OWN RISK
DRA. A. TIU 2016-2017
Lifted from her ppt. :)
FAMILY HEALLTH CARE 7. Health practices - School age= monitor growth and
- Is a process which encompasses screening for 8. Cultural factors development, nutritional status,
abnormalities, early detection and diagnosis of 9. Gender, etc. immunization, dental care,
disorders that can be alleviated and prevent ill identification and intervention if
health. HEALTH CARE PLANNING FOR THE FAMILY with learning disabilities.
1. UNATTACHED YOUNG ADULT
VISION: a. Health encounters 4. FAMILY WITH ADOLOSCENTS
- Freedom from disease or the threat of ___ - Consultation for episodic problems a. Health encounters
- Physical examinations- employment - Consultation for episodic problems
FAMILY HEALTH CARE SERVICES: 2. NEWLY MARRIE COUPLES - Health maintenance plan
Should offer complete medical services for every a. Health encounters i. Mother- every year to include breast
member of the family. - Consultation for episodic problems examination, pap smear, pelvic
Should be committed to promoting health and - Health maintenance planning for medical examination, counseling for
wellness, providing high quality, cost effective, services menopausal problems.
compassionate health care regardless of age, - Behavioral assessment every 5 years ii. Father- one at age 40, then every 2
race, color, creed and disability. years to include testicular
Should maintain the use of efficient and ___ 3. FAMILY WITH YOUNG CHILDREN examination.
management principle and practices. a. Health encounters iii. Children- physical examination,
- Consultation for episodic problems measurements, lifestyle, risk
*HINDI KO NAPICTURAN YUNG MAY CHART. - Health maintenance plan assessment, nutrition and sexuality,
I. MATERNAL CARE counselling, dental examination,
FAMILY LIFE CYCLE - From prenatal to post-partum problems of adolescents and puberty
PERSPECTIVE IN HEALTH care, detection of risks, b. Health education and counseling for parents
1. Reflects a continuum of age stages where the amniocentesis for genetic test, and children
needs of an individual changes through life, from ultrasound when indicated, - Autonomy, peer acceptance, drug use
conception to death. immunization with tetanus toxoid, and abuse
2. Often brings with it a different status given to etc.
individuals such as becoming a couple, widower, II. CHILD CARE 5. LAUNCHING FAMILY
single mother, an adolescent, or unemployed. - Newborn care= complete history a. Health encounters
and P.E., identification of - Consultation for episodic problems
DETERMINANTS OF FAMILY HEALTH abnormalities, vitamin k, silver - Health maintenance plan
1. Living conditions- shelter, food, clothing nitrate to eyes, breastfeeding. i. Mother- every year to include breast
2. Working condition- hours, rest, schedules - Preschool= monitor growth and examination, pap smear, pelvic
3. Physical environment- soil, climate, water supply development, nutritional status, examination, counselling for
4. Psychosocial environment- culture and climate immunization, eye examination, menopausal problems, nutrition.
of the workplace behavioral assessment, dental ii. Father- every year until age 60 to
5. Education care and mental feeding. monitor degenerative diseases,
6. Economic status screening for ___ problem and cancer.
AKSL Lamentations 3:24-26 1

DRA. A. TIU 2016-2017
iii. Couple- blood pressure, tonometry, AREAS OF FAMILY PARTICIPATOIN IN PREVENTION iii. Tertiary prevention
Dental care, degenerative diseases, FAMILY’S FUNCTION IN PREVENTION: - Rehabilitation- intervention in the setting of
counselling for physiological changes, I. Primary prevention established disease to avoid complication and
marital adjustments. - Occurrence of any clinical manifestation of disability and to assist in rehabilitation.
iv. Launched children- P.E. for work, disease is prevented through: 1. Balanced support between compliance
immunization. a. Health promotion monitoring and the appropriate
b. Specific disease protection independent activity of members with
6. FAMILY IN LATTER YEARS chronic disease.
a. Health encounters 1. Lifestyle diet, addictive behavior, leisure 2. Adjustment of ill members to changes
- Consultation for episodic problems activity, basic living habits. necessitated by chronic illness in one
- Health maintenance plan 2. Health maintenance: screening activities, member.
i. Mother- every year with close immunizations 3. Coping with crisis created by a serious
screening for pap smear and pelvic 3. Family life education: sexuality, marriage, illness.
examination prenatal care, problems of aged members,
ii. Father- every year for close screening personal hygiene and sanitation. PERIODIC HEALTH ASESSMENT
for benign prostatic hypertrophy Purpose:
iii. Couple- close screening for II. Secondary prevention 1. Evaluate heath status.
degenerative and chronic diseases - The role of the family to decide= where, when 2. Asymptomatic people can harbor the disease.
and to whim to bring a sick member. 3. Examination can detect disease in its early
COMPONENTS OF FAMILY HEALTH CARE a. Early diagnosis and prompt treatment stages.
1. Prevention Case finding by surveys and selective 4. Early discovery of disease morbidity and
2. Screening examinations. mortality.
Use of all available laboratory 5. Screen risk factors of disease.
REMEMBER: procedures 6. Provide tentative counseling, intervention in age
“THE RIGHT OF EVERY CITIZEN IN THE WORLD TO Use of consultant specialists in appropriate manner.
PARTICIATE IN THEIR OWN HEALTH CARE” was communicable diseases.
emphasized during the 1978 Alma Ata conference of Adequate notification of cases USES OF PERIODIC HEALTH EXAMINATION
WHO and UNICEF. Examination contacts through 1. Health promotion, disease prevention and
periodic health examinations intervention.
LEVELS OF PREVENTION b. Disability limitation - Smoking cessation, exercise, immunization
Primary intervention 2. Case finding and screening for disease and risky
- Health promotion 1. Monitoring of well-being by the physician, behavior
- Specific protection the patient and family members. - Substance abuse
Secondary prevention 2. Encouraging sick members to seek 3. Detect characteristics that are seen in patients at
- Early diagnosis and prompt treatment appropriate help. high risk for particular conditions
- Disability limitation 3. Compliance monitoring regarding specific - Family, socioeconomic, occupation, lifestyle
Tertiary prevention management.
- Rehabilitation

DRA. A. TIU 2016-2017
PERIODIC EXAMINATION CONDITIONS TO CONSIDER III. ENVIRONMENTAL AND COMMUNITY FAMILY WELLNESS PLAN
BASED ON AGE DETERMINANTS CHILD 0-12 y/o
a. Socioeconomic factors ADOLESCENT 13-21 y/o
___ b. Sanitation, food contamination, improper ADULT 22-60 y/o
Injury prevention waste disposal, safe and potable water ELDERLY >61 y/o
Lifestyle modification supply.
Immunization FAMILY WELLNESS SYSTEM APPROACH
___ COMPONENTS OF FAMILY HEALTH CARE - Are practical approaches
Nutrition 1. HINDI KO NAPICTURAN - Identified interventions that can be carried out
Growth development 2. SCREENING - Care can be delivered in the house, private
Abuse - Is establishing a service that invites clinics, health center, school clinics, and
Neglect apparently well people to come in for check- industrial/workplace clinics.
Adolescents up.
Substance abuse 1. FAMILY HEALTH CARE PROGRAMS
Social activity CRITERIA FOR SCREENING ACCORDING TO FRAME - Practical approaches
Young adult AND CARLSON: - Practice- a tool use in assessing the family as a
Female reproductive health 1. The condition must have a significant effect on unit of care
Occupational health risks the quality and quantity of life. P= presenting problems- illness,
Middle age adult 2. Acceptance methods of treatment must be hospitalization, behavioral and relationship
Cardiovascular health risks available. problems.
Cancer screening 3. The condition must have an asymptomatic R= roles and family structure
Osteoporosis period during which detection and treatment A= affect- family emotional tone- warmth,
Occupational health risks significantly reduce morbidity and mortality. sadness, anger, and humor
Older adult 4. Treatment in asymptomatic phase must yield a C= communication- verbal, non-verbal
Fracture therapeutic result superior to that obtained by
T= time/stage in family life cycle
Fall prevention delaying treatment until symptoms appear.
I= illness in the family- past and present
Nutrition 5. Tests that are acceptable to patients must be
C= coping with stress (adaptability,
Elder abuse available at reasonable cost to detect the
strength, resources)
Dementia screening condition in the asymptomatic period.
E= ecology and culture (interaction of
6. The incidence of the conditions must be
family with environment, social, cultural,
I. HEALTH PROBLEMS sufficient to justify cost of screening
religious, educational, medical resources)
a. Tobacco use, alcohol use, caffeine - Medical conditions appropriate for
b. Nutrition, diet obesity screening:
2. FAMILY HEALTH CONSCOIUSNESS MONTH
c. Injuries, accidents, exercise a. Hypertension, dyslipidemia
- The Philippine academy of family physicians
d. Infection diseases, stress b. Cataract, glaucoma
lobby for an executive order declaring one
c. Hearing deficits
month of the year as “FAMILY HEALTH
II. HINDI KO NAPICUTRAN d. Carcinomas
CONSCIOUSNESS MONTH” 6TH YEAR 2016
e. Infectious diseases
- MAY of every year
DRA. A. TIU 2016-2017
- During this month, all PAFP chapters, - Optimum quality of life activities.
accredited programs, and members will - Physical fitness program.
devote their time for family screening, health - Regular physical examination.
education and anticipatory guidance. - Social programs at community level.
3. PARENT’S CLASS/RESPONSIBLE PARENTHOOD 8. ENVIRONMENTAL PROTECTION PROGRAM

PROGRAM - Community based environmental program
- Either or both parents can undergo training to - Home based program for ecology like waste
become “FAMILY HEALTH ADVOCATE”. segregation and recycling.
4. CHILD PROTECTION PROGRAM 9. ACTIVE LIVING FOR THE CHRONICALLY AND

- Children are the hope of the mother land. TERMINALLY ILL
- It is necessary that optimum health, not only - National asthma movement.
physical but emotional, social, mental health - Philippine coalition against Tuberculosis.
and moral aspects be given priority.
- Care should be coordinated by parents, school YUNG IBANG SLIDES NA MAY TABLE HINDI KO PINICTURAN
physicians and the family physicians. KASI DI KAYA NG PHONE FROM AFAR.
PA-ADD NA LANG YUNG SLIDES NA KULANG KUNG MERON
KAYO.
5. ADOLESCENTS HEALTH CARE PROGRAM THANK YOU!
- May be school based or community based for
those who are out of school youth.
- Health maintenance and health promotion
activities can be hospital based and clinic
based.
6. YOUNG ADULT AND MIDDLE AGED ADULT

HEALTH CARE PROGRAM
- Health risk appraisal and periodic examination
can be done by the family physician or at
workplace.
7. CARE FOR ELDERLY

- Respect or the elders and nurturing of parents
in the old age are embedded in the Filipino
culture.
- Senior citizen law which provides benefits for
the seniors.
- Action program for mental health.

Family Health Care – Dra. APT • Health encounters
o Consultation for episodic problems
FAMILY HEALTH CARE SERVICES: o Health maintenance plan
• Should offer complete medical services for every member
A. MATERNAL CARE
of the family
- From prenatal to postpartum care
• Should be committed in promoting health and wellness,
- Detection of risk
providing high quality, cost effective compassionate
- Amniocentesis for genetic test
health care regardless of age, race, color, creed and
- Ultrasound when indicated
disability
- Immunization with tetanus toxoid
• Should maintain the use of efficient and effective
- etc
management and practices
B. CHILD CARE
FAMILY LIFE CYCLE
• Unattached Young adult NEWBORN CARE
• Newly Married Couple - Complete history and pe
• Family with young children - Identification of abnormalities
• Family with adolescents - Vitamin k
• Launching family - Silver nitrate to eyes
• Family in Later years - Breastfeeding
Perspective in health: PRE-SCHOOL

1. Reflects a continuum of age stages where the needs of - Monitor growth and development
an individual changes through life, from conception to - Nutritional status immunization
death - Eye examination
2. Often brings with a different status given to individuals - Behavioral assessment
such as becoming a couple, widow/er, single mother, - Dental care
an adolescent, or unemployed - Mental feeding
DETERMINANT OF FAMILY HEALTH SCHOOL AGED

1. Living conditions – shelter, food, clothing - Monitor growth and development
2. Working conditions – hours, rests, schedules - Nutritional status
3. Physical environment – soil, climate, water supply - Immunization
4. Psycho-social environment – culture and climate of - Dental care
workplace - Identification and intervention if with learning
5. Education disabilities
6. Economic factors
7. Health practices FAMILY WITH ADOLESCENT
8. Cultural factors • Health Encounters
9. Gender o Consultation for episodic problems
10. Etc • Health maintenance plan
1. Mother – every year to include breast exam, pap

SCOPE AND COMPONENTS OF FAMILY HEALTH
smear, pelvic exam, counseling for menopausal
1. Problems faced by family problems
- Broken homes 2. Father – one at age 40, then every 2 years to include
- Drug abuse testicular exam
- Unmarried mothers 3. Children
- Teenage pregnancy - Physical examination
- Measurements
2. Reproductive health - Lifestyle risk assessment
- Safe motherhood - Nutrition and sexuality counseling
- Antenatal care, prenatal care, delivery care, family - Define examination, problems of adolescents
planning & puberty
- Nutritional deficiencies
- Infertility, adolescent health • Health education and counseling for parents and children
- autonomy, peer acceptance, drug use & abuse
HEALTH CARE PLANNING FOR THE FAMILY
UNATTACHED YOUNG ADULT LAUNCHING FAMILY
• Health encounters • Health Encounters
o Consultation for episodic problems o Consultation for episodic problems
o Physical examination – employment • Health maintenance plan
NEWLY MARRIED COUPLE 1. Mother – every year to include breast exam, pap
BEA - LFA
• Health encounters smear, pelvic exam, counseling for menopausal

o Consultation for episodic problems problems, nutrition
o Health maintenance planning for medical services 2. Father – every year until age 50 to monitor
o Behavioral assessment every 5 years degenerative diseases, screening for high risks problems
and cancer
FAMILY WITH YOUNG CHILDREN
1

3. Couple – blood pressure, tonometry, dental care,
degenerative diseases, counseling for physiological SECONDARY PREVENTION
changes, mental judgments The role of the family is to decide whether where, when and
4. Launched children – PE for work, immunization to whom to bring a sick member
FAMILY IN LATER YEARS
1. monitoring of well being by the physician, patient and
• Health Encounters
family members
o Consultation for episodic problems
2. encouraging sick members to seek appropriate help
• Health maintenance plan
3. compliance monitoring regarding specific
management
1. Mother – every year with close screening for pap smear and
pelvic exam A. Early diagnosis and prompt treatment
2. Father – every year for close screening for BPH
- Case finding by surveys and selective examination
3. Couple – close screening for degenerative and chronic
- Use of all available laboratory procedures
diseases
- Use of consultants specialist in communicable
diseases
- Adequate notification of cases
COMPONENTS OF FAMILY HEALTH CARE - Examination of contacts through periodic health
1. Prevention examination
2. Screening
B. Disability limitation
Remember: “The right of every citizen in the world to participate
in their own health care” was emphasized during the 1978 Alma TERTIARY PREVENTION
Ata conference of the WHO and UNICEF Rehabilitation
• Interventions in the setting of established disease to avoid
LEVELS OF PREVENTION complications and disability to assist in rehabilitation
PRIMARY PREVENTION
- Health promotion 1. balanced support between compliance monitoring
- Specific protection and the appropriate independent activity of members
with chronic disease
SECONDARY PREVENTION 2. adjustment of ill members to changes necessitated by
- Early diagnosis and prompt treatment chronic illness in one member
- Disability limitation 3. coping with crisis created by a serious illness
TERTIARY PREVENTION
- Rehabilitation PERIODIC HEALTH EXAMINATION
Purpose:
Areas of family participation in prevention:
1. Evaluate health status
PRIMARY PREVENTION - Asymptomatic people can harbor disease
Occurrence of any clinical manifestation of disease is - Examination can detect disease in its early stages
prevented through: - Early discovery if disease can decrease morbidity &
- Health promotion mortality
- Specific disease protection 2. Screen risk factors of disease
3. Provide preventive counseling, intervention in age
1. Lifestyle appropriate manner
- Diet
- Addictive behavior Use:
- Leisure activity • Health promotion, disease prevention & intervention
- Basic living habits - Smoking cessation
- Exercise
2. Health maintenance - Immunization
- screening activities
- immunization • Case finding and screening for disease and risk behaviors
- Substance abuse
3. Family life education
- sexuality • Detect characteristics that are seen in patients at high risk
- marriage for particular conditions
- prenatal care - Family, socioeconomic, occupation, lifestyle
- problems of aged members
- personal hygiene
- sanitation
BEA - LFA
2

PERIODIC HEALTH EXAMINATION CONDITIONS TO CONSIDER BASED ON AGE
All Ages Infant and Child Adolescents Young Adult Middle aged adult Old Adult
Injury prevention Nutrition growth Substance Abuse Female Cardiovascular Fracture Fall
development Reproductive health risk Prevention
Health
Lifestyle Abuse Sexual Activity Occupational Cancer screening Nutrition
Modification Health risk Elder Abuse
Immunization Neglect Osteoporosis Dementia
Occupational Screening
Health Issues
IMMUNIZATIONS
CLINICAL PREVENTIVE SERVICES FOR NORMAL RISK CHILDREN
Source: Guide to Clinical Preventive Services, 2nd ed (1996) Alexandria, VA: Report of the US Preventive Services Task Force, International
Medical Publishing Inc.
Intervention Birth 2m 4m 6m 12m 15m 18m 2y 4-6y 11-18y
Immunization
Hepatitis B x x
Polio x x x
Haemophilus x x x
Influenza
Type B x
Diphtheria x x x x
Tetanus
Pertusis
MMR x
Varicella x
CLINICAL PREVENTIVE SERVICES FOR NORMAL RISK WOMEN

INTERVENTION 18-35 YEARS 40-50 YEARS 60+ YEARS
Tetanus-Diphteria (every 10 x x x
years)
Varicella (2 dose none as a x x x
child)
MMR (1 dose) x x
Pneumococcal (1 dose) x
Influenza (yearly) x
COUNSELING
Calcium Intake X X X
Folic Acid X X
Hormone Replacement X X
Therapy
Mammography screening X X
Tobacco, drugs, alcohol, STD X X X
and safety
Immunization
Source: Guide to Clinical Preventive Services, 2nd ed (1996) Alexandria, VA: Report of the US Preventive Services Task Force, International
Medical Publishing Inc.
Tetanus-Diphteria (every 10 x x x
years)
Varicella (2 dose none as a x x x
child)
Pneumococcal (1 dose) x
Influenza (yearly) x
Health Risk Appraisals and Early Detection Health Behaviors

A. Tobacco Use, Alcohol use, Caffeine
BEA - LFA
I. Health Behaviors B. Nutrition, Diet, Obesity

II. Family Determinants C. Injuries, Accidents Exercise
III. Environmental and Community Determinants D. Infectious Disease, Stress
3

Family Determinants INTERVENTION 18-35 40-50 60+ YEARS
• Heredofamilial diseases can help predict future YEARS YEARS
problems BP, ht, wt, dental x x x
A. Cardiovascular diseases – IHD, HPN Alcohol use X X X
B. Endocrine Diseases – DM, Thyroid problems Cholesterol X X
C. Carcinomas – Breast Lung, Colon, Ovarian
Sigmoidoscopy X
(every 5-10 years)
Fecal Occult X
Environmental and Community Determinants
Blood (every year)
A. Socioeconomic Factors
Vision and Hearing X
B. Sanitation
(periodically)
- Food contamination, improper waste disposal,
safe and potable water supply Counseling
Prostate CA X
COMPONENTS OF FAMILY HEALTH CARE Screening
2. SCREENING Tobacco, drugs, X X X
- is establishing a service that invites apparently well people to alcohol, STD, and
come in for check up safety
CRITERIA FOR SCREENING ACCORDING TO FRAME AND

CARLSON: FAMILY WELLNESS PLAN:
1. The condition must have a significant effect on the 1. Child 0-12 years old
quality and quantity of life 2. Adolescent 13- 21 years old
2. Acceptable methods of treatment must be available 3. Adult 22-60 years old
3. The condition must have an asymptomatic period 4. Elderly > 61 years old
during which detection and treatment significantly
reduce morbidity and mortality FAMILY WELLNESS SYSTEM APPROACH
4. Treatment in asymptomatic phase must yield a • Are practical approaches
therapeutic result superior to that obtained by delaying • Identified interventions that can be carried out
treatment until symptoms appear. • Care can be delivered in the house, private clinics,
5. Test that are acceptable to patients must be available health centers, school clinics and industrial/workplace
at reasonable cost to detect the condition in the clinics
asymptomatic period
6. The incidence of the conditions must be sufficient to 1. FAMILY HEALTH CARE PROGRAM
justify cost of screening
PRACTICAL APPROACHES
Medical Conditions appropriate for screening: Practice: A tool used in assessing the family as a unit of care
A. HPN, Dyslipidemia
B. Cataract, glaucoma P: PRESENTING PROBLEMS – Illness, Hospitalization, Behavioral and
C. Hearing defects relationship problems
D. Carcinomas
E. Infectious Diseases R: ROLE AND FAMILY STRUCTURE
SCREENING A: AFFECT – family emotional tone – warmth, sadness, anger,

Intervention Birth 2m 4m 6m 12m 15m 18m 2y 4- 11- humor
6y 18
Newborn x
screening (eg. C: COMMUNICATION – verbal, non-verbal
Hypothyroidism)
Hearing T: TIME/STAGE IN FAMILY LIFE CYCLE
Head x x x x x x x
circumference I: ILLNESS IN THE FAMILY: past and present
Ht & Wt x x x x x x x x x x
C: COPING WITH STRESS – Adaptability, strength, resources
Lead x x
Vision x x x
E: ECOLOGY AND CULTURE – Interaction of family with
BP x x x x x environment, social, culture, religious, educational, medical
Dental Health x x
resources
Alcohol drug x
abuse 2. FAMILY HEALTH CONSCIOUSNESS MONTH
• The Philippine Academy of Family Physicians Lobby for
an executive order declaring one month of the year as
“FAMILY HEALTH CONSCIOUSNESS MONTH” 6th year 2016
• May of every year
• During this month, All PAFP Chapters, accredited
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programs, and members will devote their time for family

screening, health education and anticipatory
guidance
4

3. PARENT’S CLASS / RESPONSIBLE PARENTHOOD PROGRAM
• Either or both parents can undergo training to become
“Family health advocate”
4. CHILD PROTECTION PROGRAM

• Children are the hope of the Motherland
• Its necessary that optimum health, not only physical but
emotional, social, mental health and moral aspects be
given priority
• Care should be coordinated by parents, school
physicians and the family physician
5. ADOLESCENT HEALTH CARE PROGRAM

• Maybe school based or community based for those
who are out of school youth
• Health maintenance and health promotion activities
can be hospital based and clinic based
6. YOUNG ADULT AND MIDDLE AGED ADULT HEALTH CARE

PROGRAM
• Health risk appraisal and periodic examination can be
done by the family physician or at work place
7. CARE FOR THE ELDERLY
• Respect for the elders and nurturing of parents in the
old age are embedded in the Filipino culture
• Senior Citizen Law which provides benefits for the
Seniors
• Action Program for mental health
• Optimum quality of Life activities
• Physical fitness program
• Regular physical examination
• Social programs at community level
8. ENVIRONMENTAL PROTECTION PROGRAM

• Community based environmental programs
• Home based programs for Ecology like waste
segregation and recycling
9. ACTIVE LIVING FOR THE CHRONICALLY AND TERMINALL ILL

• National Asthma Movement
• Philippine Coalition against TB
BEA - LFA
5

FAMILY MEDICINE AND COMMUNITY HEALTH III
PRIMARY HEALTH CARE, MILLENIUM DEVELOPMENT GOALS,
SUSTAINABLE DEVELOPMENT GOALS, PHILIPPINE HEALTH SITUATION
Lecture by: Dr. Maria Teresita Chua, MD, FPAFP
Date: August 20, 2016
o And Health in the Hands of the People by the Year
Reminders: 2020
Notes in this format – additional discussion from Dra. Chua’s lecture.
WHAT IS PRIMARY HEALTH CARE?
Essential health care made universally accessible to individuals
PRIMARY HEALTH CARE
and families in the community by measures acceptable to them
through their full participation and at a cost that the
LEARNING OBJECTIVES:
community and country can afford in the spirit of self-reliance.
1. Discuss the PHC concept as an approach in the delivery of
health care.
FEATURES OF PRIMARY HEALTH CARE
a. Definition and Objective
Accessible
b. Relevance of PHC
o Everybody is able to avail
c. Characteristics of PHC
d. Principles and Rationale for PHC Acceptable
e. Strategies, Referral System, and Roles of various o Conform to social and cultural beliefs
agencies Affordable
f. Essential Elements o Less fortunate can avail
g. Design of administrative level, organizational Community based/Full participation by community
structure and staffing o Example: Healthy Lifestyle
h. Evaluation of success Good Nutrition and Hygiene
Self-reliance
HISTORY o Full community participation in planning,
Declaration of Alma-Ata organization and management
13th World Health Assembly
International Conference on Primary Health Care held Alma- ESSENTIAL COMPONENTS OF PRIMARY HEALTH CARE
Ata, USSR on September 6-12, 1978 Health Education
Developing countries adapted the health care system of o Health education is an integral part of health service
developed countries without considering the fact that they have delivery.
different socio-economic status. Adequate Food Supply and Proper Nutrition
Adequate Supply of Safe Water and Sanitation
RATIONALE Maternal and Child Health including Family Planning
Inequality in health care coverage o The child and the mothers are the most vulnerable
Costly urban based curative, hospital-oriented, doctor- members of the society. The status of health of the
centered services mother and children would reflect the efficacy of our
o The poor will not have access to health care versus the health service delivery.
wealthy individuals. Immunization against Major Infectious Diseases
Gap is evident within individual countries o Many diseases are prevented through immunization.
Prevention and Control of Locally Endemic Diseases
PRIMARY HEALTH CARE o In the Philippines, for example, we have
A new approach to health and health care is needed to achieve Schistosomiasis, Malaria, Filariasis, etc.
a more equitable distribution of health care Treatment of Common Diseases and Injuries
o Even those who do not have money should have o Common diseases like Respiratory Infections,
access to health care. So regardless of your socio- Diarrhea, or common injuries like simple burns,
economic status, gender, religion, you should have abrasions, lacerations
access to good quality health care and that is the Promotion of Mental Health
reason why they introduce the concept of Primary o If you’re not healthy mentally-speaking, you are not
Health Care. considered a healthy individual
Goal: Health for All by the Year 2000 Essential Drugs
progesteROME OLFU MD 2018 1

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o Essential Drugs are medicines that are needed for the Mass media
common diseases that are present within the Industrial sector
community
Access and Utilization of Hospital Care MANPOWER
MD
WHAT IS PRIMARY HEALTH CARE? RN
Address the main problems RM
Provides promotive, preventive, curative, and rehabilitative Community Health Worker
services o Volunteers who may not even have reached college
o Promotive, Preventive, Curative, Rehabilitative = degree. They have trainings about health services and
Levels of Prevention health care delivery. They typically live in the
o Primary Level – Promotive, Preventive community.
o Secondary Level – Curative
o Tertiary Level - Rehabilitative LEVELS OF HEALTH CARE
First level of contact of individuals with the national health Primary Care
system Secondary Care
o It brings health services to the people Tertiary Care
OBJECTIVES OF PRIMARY HEALTH CARE LEVELS OF HEALTH CARE AND REFERRAL SYSTEM
Promote and maintain health among people
Develop community leadership and initiatives
Provide relevant health and health-related services National Health Services, Medical Centers, Teaching and
Training Hospitals
Regional Health Services, Regional Medical Centers and
BASIC PRINCIPLES Training Hospitals
Equitable distribution of health care Provincial / City Health Services
o Provided equally to all Provincial / City Hospitals
Community participation Emergency / District Hospitals
o Residents are active participants
o They should be responsible in taking care of their own Rural Health Unit
Community Hospitals and Health Centers
health Private Practitioners / Puericulture Centers
Health workforce development
o Adequate distribution of trained health worker Barangay Health Stations
Appropriate technology
o Example: refrigerators for vaccines
Multi-sectoral approach
o Partnership among community, government, and
Primary Level of Care
NGOs
o Provided by:
o Health is the responsibility not only of the health
Barangay Health Stations
sector but it has to be the responsibility of everyone
Rural Health Unit
on the other sectors because they will also be
Community Hospitals and Health Centers
affecting the health sector
Private Practitioners and Peuriculture
Centers
PRIMARY HEALTH CARE
o Done in an outpatient basis
Integral part of socio-economic development process o They would cater to illness that would not need
Health cannot be attained by health sector alone hospitalization
Involves inter-sectoral linkages Secondary Level of Care
o Provided by:
RELATED SECTORS Provincial / City Health Services
Agriculture Provincial / City Hospitals
Housing Emergency / District Hospitals
Public works and communications
Educational sector

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o If the case is a bit complicated and was seen on the
Primary level, the case should be referred to a
Secondary level.
o The patient may be treated in an outpatient basis or
may be admitted in the hospital.
o The hospital should be able to provide basic
diagnostic examinations (e.g. CBC, Urinalysis, Chest
X-Rays)
Tertiary Level of Care Dark colors – no education
o Provided by: Light colors – with higher education
National Health Services For the Neonatal mortality rate, by education of mother (left
Medical Centers graph), there is increased neonatal mortality rate for those
Teaching and Training Hospitals mothers with no education.
Regional Health Services For Births attended by health professional (%), by education of
Regional Medical Centers and Training mother (right graph), those mothers with higher education are
Hospitals the ones seeking consult to a skilled health professional in
o If the case is a really complicated one, the Secondary delivering their babies.
level should be able to refer it to the Tertiary level.
5 COMMON SHORTCOMINGS OF HEALTH CARE DELIVERY
THE WORLD HEALTH REPORT – 2008 Inverse Care
Health Systems are not performing as well as they could and as o People with the most means consume the most care
they should Impoverishing Care
o There was improvement but not to as what they o People may fall into poverty when they have to pay
expected. for health care
o Most of the time, people would have to pay out of
pocket because in the developing countries like the
Philippines, we really don’t have an established
health insurance.
Fragmented and Fragmenting Care
o Excessive specialization and narrow focus of disease
control programs
o Supposed holistic approach was neglected, as well as
the need for follow-up care.
Dark Green – Lowest Quintile (Poorest)
Unsafe Care
Light Green – Highest Quintile (Richest)
o Unable to ensure safety and hygiene standards
The left graph will show you the per capita household
o Leading to cases of hospital-acquired infections and
spending on health as percentage of total household spending,
even medication errors that lead to morbidity and
by income group.
even cases of mortality.
o The Lowest quintile have higher expenses compare
Misdirected Care
with the Highest quintile
o Resource allocation cluster around curative services
The Right graph will show you the Mean time (minutes) taken
to reach an ambulatory health facility, per income group.
KEY ELEMENTS TO ACHIEVING HEALTH FOR ALL
o The Lowest quintile will take longer time to reach an
Universal Coverage Reforms
ambulatory health facility.
o “to improve health equity”
The Rich is still have more access to health care as compared
o Everyone should have access to health services,
to the Poor.
regardless of your socio-economic status, gender,
religion, etc.
Service Delivery Reforms
o “to make health systems people-centered”
o The health services should center around the people’s
needs and expectations
o “to promote and protect the health of communities”

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o Emphasizing the importance of inter-sectoral 8 Millennium Development Goals
cooperation and linkages in the delivery of health
services. MDG 1: ERADICATE EXTREME POVERTY AND
Leadership Reforms HUNGER
o “to make health authorities more reliable” Poverty is a very significant factor that has
o There should be leaders to implement what are the effect on health status of an individual
reforms that are needed.
Increasing Stakeholder Participation
MDG 2: ACHIEVE UNIVERSAL PRIMARY
EDUCATION
MDG 3: PROMOTE GENDER EQUALITY AND

EMPOWER WOMEN
There is inequality, especially when it
comes to access to health.
MDG 4: REDUCE CHILD MORTALITY
MILLENIUM DEVELOPMENT GOALS
MDG 5: IMPROVE MATERNAL HEALTH
LEARNING OBJECTIVES: MDG 6: COMBAT HIV/AIDS, MALARIA AND

1. Define the Millennium Development Goals OTHER DISEASES
2. Discuss the 8 goals with their related targets and specific dates
of achievements
3. Discuss the debates surrounding the MDGs
4. Present the current status of the Philippines’ commitment to
MDGs as it reaches 2015 MDG 7: ENSURE ENVIRONMENTAL
SUSTAINABILITY
Millennium Development Goals
UN Millennium Declaration
September 6-8, 2000
8 goals as roadmap to development towards HFA
Target to be achieved by year 2015: baseline 1990
MDG 8: A GLOBAL PARTNERSHIP FOR
DEVELOPMENT

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Millennium Development Goals 1. Proportion of
Target 6.B: Achieve, by 2010,
The MDGs are interdependent population with
universal access to treatment of
o Each one of the goals will have an effect on the other advanced HIV infection
HIV/AIDS for all those who need
with access to anti-
goals it
retroviral drugs
All MDGs influence health and health influences all MDGs 1. Incidence and death
Each goal has specific targets and indicators for monitoring rates associated with
progress malaria
2. Proportion of children
MILLENNIUM DEVELOPMENT GOALS (MDGs) under 5 sleeping under
Goals and Targets (from the Indicators for monitoring insecticide-treated
Millennium Declaration) progress bednets
Goal # 4: Reduce Child Mortality 3. Proportion of children
under 5 with fever who
1. Under-five mortality
Target 6.C: Have halted by 2015 are treated with
rate
and begun to reverse the appropriate anti-
Target 4.A: Reduce by two 2. Infant mortality rate
incidence of malaria and other malarial drugs
thirds, between 1990 and 2015, 3. Proportion of 1 year
major diseases 4. Incidence, prevalence
the under-five mortality rate old children
and death rates
immunized against
associated with
measles
tuberculosis
5. Proportion of
MILLENNIUM DEVELOPMENT GOALS (MDGs) tuberculosis cases
Goals and Targets (from the Indicators for monitoring detected and cured
Millennium Declaration) progress under directly
Goal # 5: Improve Maternal Health observed treatment
1. Maternal Mortality short course (DOTS)
Target 5.A: Reduce by three
Ratio
quarters, between 1990 and
2. Proportion of births
2015, the maternal mortality 2005
attended by skilled
ratio Rate of progress for some targets are slow – sanitation and
health professional
1. Contraceptive maternal and child health
prevalence rate HIV/AIDS epidemic continue to grow
2. Adolescent birth rate Inequalities between and within countries
Target 5.B: Achieve, by 2015, 3. Antenatal care
universal access to reproductive coverage (at least one 2010
health visit and at least four
Need to reduce maternal and newborn deaths is the most
visits)
4. Unmet need for family urgent priority
planning 99% of all maternal deaths in 2008 occurred in developing
countries
MILLENNIUM DEVELOPMENT GOALS (MDGs) On track to target safe water but not sanitation
Goals and Targets (from the Indicators for monitoring
Millennium Declaration) progress
Goal # 6: Combat HIV/AIDS, malaria, and other diseases
1. HIV prevalence among
population aged 15-24
years
2. Condom use at last
high-risk sex
3. Proportion of
Target 6.A: Have halted by 2015 population aged 15-24
and begun to reverse the spread years with
of HIV/AIDS comprehensive correct
knowledge of HIV/AIDS
4. Ratio of school
attendance of orphans
to school attendance
of non-orphans aged
10-14 years

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The Millennium Development Goals Report 2015
United Nations

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Which goals have been achieved? The 17 Sustainable Development Goals (SDGs) with 169 targets
o Poverty rate are broader in scope and go further than the MDGs by
o Equality in primary education addressing the root causes of poverty and the universal need
o Access to improved sources of water for development
o Malaria and tuberculosis o Involves not only the developing countries (which is
Which goals lag behind? targeted by the MDGs) but also the developed
o Many children still denied right to primary education countries.
o Mortality rate for children under five dropped by 53% o Sustainable Development has been described as
o MMR declined by 40% development that answers the needs of the present
Despite many successes, the poorest and most vulnerable without undermining the ability to provide for the
people are being left behind needs of the future generation.
o Gender inequality persists Over the next fifteen years, with these new goals that
o Big gaps exist between the poorest and richest universally apply to all, countries will mobilize efforts to end all
households, and between rural and urban areas forms of poverty, fight inequalities and tackle climate change,
Children from poorest households – 2x while ensuring that no one is left behind.
likely to be stunted and 4x likely to be out
of school SDG 1: END POVERTY IN ALL ITS FORMS
56% births in rural areas attended by SBA EVERYWHERE
vs 87% in urban Poverty is more than lack of income and
50% of people in rural areas lack improved resources
sanitation facilities Its manifestations include hunger and
Climate change and environmental degradation undermine malnutrition, limited access to education and the
progress achieved and poor people suffer the most basic services, social discrimination and exclusion as well as lack
Conflicts remain the biggest threat to human development of participation in decision making.
Millions of poor people still live in poverty and hunger, without
access to basic services SDG 2: END HUNGER, ACHIEVE FOOD SECURITY
AND IMPROVED NUTRITION AND PROMOTE
SUSTAINABLE AGRICULTURE
SUSTAINABLE DEVELOPMENT GOALS If done right, agriculture, forestry, and
fisheries can provide nutritious food for all and
generate decent incomes, while supporting
people-centered rural development and protecting the
environment
SDG 3: ENSURE HEALTHY LIVES AND PROMOTE

WELL-BEING FOR ALL AT ALL AGES
By 2030, reduce global MMR to less than 70
per 100,000 live births
Reduce neonatal mortality to at least as low
LEARNING OBJECTIVES: as 12 per 1,000 live births and under-5 mortality
1. Define what sustainable development goals are to at least as low as 25 per 1,000 live births
2. Enumerate and discuss the goals and associated targets End epidemics of AIDS, TB, malaria, tropical diseases, combat
covering the broad range of sustainable development issues hepatitis, water-borne diseases
3. Enumerate and discuss the proposed indicators to show Reduce by 1/3 premature mortality from NCDs
compliance of sustainable development goals Strengthen the prevention and treatment of substance abuse
4. Identify relationship between Millennium Development Goals By 2020, halve the number of global deaths and injuries from
and Sustainable Development Goal road traffic accidents
By 2030, ensure universal access to sexual and reproductive
17 SUSTAINABLE DEVELOPMENT GOALS health care services
The goals cover the three dimensions of sustainable Achieve universal health coverage, including financial risk
development: economic growth, social inclusion, and protection, access to quality essential health-care services, and
environmental protection

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access to safe, effective, quality, and affordable essential Over 1.2 billion people – one in five people of the world’s
medicines vaccines for all population – do not have access to electricity
By 2030, substantially reduce the number of deaths and
illnesses from hazardous chemicals and air, water, and soil SDG 8: PROMOTE SUSTAINABLE, INCLUSIVE
pollution and contamination. AND SUSTAINABLE ECONOMIC GROWTH, FULL
Strengthen the implementation of the WHO Framework AND PRODUCTIVE EMPLOYMENT AND DECENT
Convention on Tobacco Control WORK FOR ALL
Support research and development of vaccines and medicines Poverty eradication is only possible
Substantially increase health financing and the recruitment, through stable and well-paid jobs
development, training, and retention of the health workforce.
Strengthen the capacity of all countries, in particular SDG 9: BUILD RESILIENT INFRASTRUCTURE,
developing countries, for early warning, risk reduction and PROMOTE INCLUSIVE AND SUSTAINABLE
management of national and global health risks INDUSTRIALIZATION AND FOSTER INNOVATION
Inadequate infrastructure leads to a lack of
SDG 4: ENSURE EXCLUSIVE AND EQUIATABLE access to markets, jobs, information, and training,
QUALITY EDUCATION AND PROMOTE LIFELONG creating a major barrier to doing business
LEARNING OPPORTUNITIES FOR ALL
By 2030, ensure that all girls and boys SDG 10: REDUCE INEQUALITY WITHIN AND
complete free, equitable and quality primary and AMONG COUNTRIES
secondary education Inequality still persists and large disparities
By 2030, ensure equal access for all women and men to remain in access to health and education services
affordable and quality technical, vocational, and tertiary and other assets
education
Build and upgrade education facilities
By 2020, substantially expand globally the number of SDG 11: MAKE CITIES AND HUMAN
scholarships available to developing countries SETTLEMENTS INCLUSIVE, SAFE, RESILIENTS,
By 2030, substantially increase the supply of qualified teachers AND SUSTAINABLE
Common urban challenges include
SDG 5: ACHIEVE GENDER EQUALITY AND congestion, lack of funds to provide basic
EMPOWER ALL WOMEN AND GIRLS services, a shortage of adequate housing and
Ensure women’s full and effective declining infrastructure
participation and equal opportunities for
leadership SDG 12: ENSURE SUSTAINABLE CONSUMPTION
Ensure universal access to sexual and AND PRODUCTION PATTERNS
reproductive health and reproductive rights Water
o Less than 3% of world’s water is fresh
SDG 6: ENSURE AVAILABILITY AND SUSTAINABLE o Man is polluting water later than nature
MANAGEMENT OF WATER AND SANITATION can recycle and purify water
FOR ALL o More than 1 billion people do not have access to
By 2030, achieve universal and equitable fresh water
access to safe and affordable drinking water o Need for infrastructure
By 2030, achieve access to adequate and Energy
equitable sanitation and hygiene o Households consume 29 per center of global energy
By 2030, improve water quality by reducing pollution, having and consequently contribute to 21 per cent of
the proportion of untreated wastewater and increasing resultant CO2 emissions
recycling and safe reuse globally o One-fifth of the world’s final energy consumption in
2013 was from renewables
SDG 7: ENSURE ACCESS TO AFFORDABLE, Food
RELIABLE, SUSTAINABLE, AND MODERN ENERGY o 3 billion tons of food is waster per year
FOR ALL o Overconsumption of food
o Land/marine environment degradation, overfishing

OLFU
o Food sector accounts for 30% of total energy
consumption and 22% of total greenhouse gas Health Financing
emissions Four main sources of financing:
o National and local government
SDG 13: TAKE URGENT ACTION TO COMBAT o Insurance (government and private)
CLIMATE CHANGE AND ITS IMPACTS o User fees/out of pocket
People are experiencing the significant o Donors
impacts of climate change, which include changing
weather patterns, rising sea level, and more
extreme weather events
SDG 14: CONSERVE AND SUSTAINABLY USE THE

OCEANS, SEAS, AND MARINE RESOURCES FOR
SUSTAINABLE DEVELOPMENT
SDG 15: PROTECT, RESTORE, AND PROMOTE Total Health Expenditure by source, Philippines, 1997 vs 2007
SUSTAINABLE USE OF TERRESTRIAL
ECOSYSTEMS, SUSTAINABLY MANAGE FORESTS,
COMBAT DESERTIFICATION, AND HALT AND
REVERSE LAND DEGRADATION AND HALT
BIODIVERSITY LOSS
SDG 16: PROMOTE PEACEFUL AND INCLUSIVE

SOCIETIES FOR SUSTAINABLE DEVELOPMENT,
PROVIDE ACCESS TO JUSTICE FOR ALL AND BUILD Source of financing during inpatient visits, Philippines, 2008
EFFECTIVE, ACCOUNTABLE, AND INCLUSIVE
INSTITUTIONS AT ALL LEVELS Levels of Healthcare and Referral System
SDG 17: STRENGTHEN THE MEANS OF National Health Services, Medical Centers, Teaching and
Training Hospitals
IMPLEMENTATION AND REVITALIZE THE GLOBAL
Regional Health Services, Regional Medical Centers and
PARTNERSHIP FOR SUSTAINABLE DEVELOPMENT Training Hospitals
A successful sustainable development Provincial / City Health Services
agenda requires partnerships between Provincial / City Hospitals
governments, the private sector, and civil society Emergency / District Hospitals
Rural Health Unit

PHILIPPINE HEALTH SITUATION Community Hospitals and Health Centers
Private Practitioners / Puericulture Centers
LEARNING OBJECTIVES: Barangay Health Stations

1. Present an overview of the Philippine Health Situation from the
standpoint of:
a. Population
b. National health status
Levels of Health Care Services
c. Environmental indices
Primary hospitals outnumber government hospitals in all
d. Food consumption and supply
categories
e. Influence of the ecological factors on health
Except for NCR, Northern Mindanao, Southern Mindanao, and
f. Health resources
CAR, almost all regions have insufficient beds
g. Basic health service

OLFU
ARMM – 0.17 beds per 10,000 population
WHO recommendation is 20 hospital beds per 10,000
population
Health Human Resource

Main drivers of the health care delivery system
Mostly concentrated in urban areas
70% of health professionals – private sector
Philippine Health Picture (1993 – 2013)

Projected Population – increased from 66,981,614 to
98,011,951 (46% increase)
Crude Birth Rate – Decreased from 25.1 to 18.0 (28% decrease)
Crude Death Rate – Increased from 4.8 to 5.4 (12% increased)
Infant Death Rate – Declined from 20.6 to 12.5 (39% decrease)
Maternal Death Rate – Remained at 0.9
Fetal Death Ratio – Declined from 5.6 to 4.2 (25% Decrease)
Health Outcomes
Life Expectancy – 71.59 years

OLFU
PHILHEALTH BENEFITS
No balance billing policy
o Zero payment scheme for sponsored members and
dependent
Z benefit package
o Catastrophic diseases – cancer, etc.
All case rates
o Fixed rate
2014 DEPARTMENT OF HEALTH ANNUAL REPORT

OLFU
OLFU
END OF TRANS
If any of you lacks wisdom, you should ask God, who gives generously to
all without finding fault, and it will be given to you. But when you ask,
you must believe and not doubt, because the one who doubts is like a
wave of the sea, blown and tossed by the wind
James 1:5-6
#RoadToClerkship
#RoadToSurgeryBlock
#OperationTurtleNeck
God bless in our exams! To God be the Glory!

progesteROME

OLFU
PRIMARY HEALTH CARE FMCH III
Five key elements based on primary health care goal ______________________________________________
1. Reducing exclusion and social disparities in health
2. Organizing health services around peoples need and expectations UNITED NATIONS MILLENIUM DEVELOPMENTAL GOALS 8 MDG
3. Integrate health in all sectors (public policy reforms)
4. Pursuing collaborative models of policy dialogue ( leadership Adopted during the millennium summit in September 2000
reforms) Nations committed to a new global partnership to reduce extreme
5. Increasing stakeholder participation poverty
Set out a series of time bound targets, with a deadline. Of 2015,
Pillars of PHC MEMORIZE MEMORIZE MEMORIZE MEMORIZE that have become known as the millennium development goals
community participation (MDG)
Intra/ intersectoral linkages and cooperation The worlds time bound and quantified targets for addressing
Use of appropriate technology extreme poverty in its many dimensions
Support system Income poverty
Hunger
Factors that hamper PHC and HFA Disease
1. Slow socioeconomic development Lack of adequate shelter
2. Lack of political commitment Promoting gender equality
3. Failure to achieve equity in access to all PHC elements They are also basic human rights
4. Inappropriate use and allocations and resources The rights of each person on the planet to health education shelter
5. High cost of technology and security
6. Difficulty in achieving intersectoral action for health
7. Unbalanced distribution of and weak support for human 8 MDG goals
resources
8. Persistently low status of women Target 1a: eradicate extreme poverty and hunger
halve, between 1990 and 2015, the proportion of people whose
PHC' s Contribution in the improvement of peoples health status income is less than 1.25 dollars a day
decrease infant mortality rate was met five years ahead of the 2015 deadline
increase immunization coverage of children under 1 year of age 709 million fewer people lived in conditions of extreme poverty in
2010 than. In 1990
PHC Together with economic educational and technological advances however at the global, level by 2.2 billion are still living in extreme
RESULTED TO poverty
Expanded health infrastructure
Increased literacy Target 1B: achieve full and productive employment and decent work for all
Increased income including women and young people
Improved sanitation the gender gap employment persists with a 24.8 percent difference
Improved education and opportunities for women between men and women in the employment
The alternative approach to the principles of PHC Target 1c: halve between 1990 and 2015 the proportion of people who suffer
selective PHC from hunger
conceived 1 year after the alma mater declaration
Julia Walsh and Kenneth Warren targer 2a. achieve universal primary education
Presented selective primary health ensure that by 2015, children everywhere boys and girls would be
Care as an interim strategy to begin with the process of PHC able to complete a full course of primary schooling
implementation basta may progress!
Interim - intervening time gender gaps in youth literacy rated are also narrowing
They contended that resources constraints made its scope
unattainable Target 3: promote gender equality and empower women
Argued that the best way to improve health was to fight disease eliminate gender disparity in primary and secondary education
baed on cost effective medical intervention preferably by 2005, and in all levels of education no later than
2015.
PHC focused on four vertical programs: in many countries, gender inequality persists and women continue
GOBI to face discrimination in access to education, work and economic
growth monitoring assets, and participation in the government.
Oral rehydration violence against women continues to undermine efforts to reach all
Breast feeding goals
Immunization poverty is s major barrier to secondary education, especially among
older girls
FFF
FAMILY PLANNING Target 4: reduce child mortality
FEMALE EDUCATION reduce by two thirds between 1990 and 2015, the under five
FOOD SUPPLEMENTATION mortality rates
prevented death by immunization, for example,
Criticisms of PHC and the alma ata declaration as the rate if under five death overall declines, the proportion that
inconsistencies and poor understanding of primary care and occurs during the first month after birth is increasing, poor prenatal
primary health care raises unrealistic expectation indervices care
delivery children born into poverty are almost twice as likely to die before
the age of five in those from wealthier families
children of educated mothers, even mothers with only primary
schooling are more likely to survive
Et factum estutamicistranscribit 2014 -2015

Dr. Page 1 of 2
durumsimul in unum! medicine vade
PRIMARY HEALTH CARE FMCH III
Target 5: improve maternal health International planned federation ( IPPF)
reduce by three quarters the maternal mortality ratio empower the most vulnerable women, men and young people to
the maternal mortality ration in developing regions is still 15 times access life saving services and programmed to live with dignity
higher than the developed regions. The rural urban skilled care
during childbirth had narrowed. Vision 2020
ippf's global call to section to eradicate the poverty by. w2020.
Target 5b Sexual and reproductive health and rights key to achieving
achieve universal access to reproductive health and contraception sustainable development
Target 6a: combat HIV AND AIDS And other diseases 1. Establish by. 2015, a new International development framework
Have haltered by 2015 and begun to reverse the spread oh HIV that includes sexual and reproductive health and rights as essential
AIDS priorities
new HIV infections continue to decline in most regions 2. Increase access to sexual and reproductive health and rights in
comprehensive knowledge of HIV transmission remains low among order to close the gap between the top and bottom wealth
young people, along with condom use quintiles
*End of 2011, patient were given antiretroviral therapy 3. *access to sexual and health education among all
Target 6B: achieve by. 2010, universal access to treatment for HIV/ aids for all 4. Eliminate all forms of discrimination against women and girls
those who need it 5. *Women’s right ex: right for education, to vote, to work, for
opportunities, right to plan number of child to have
Target 6 C: have halted by 2015, and begun to. Reverse the incidence of
malaria and other major diseases 6. Recognize sexual rights and reproductive rights as human rights by.
2020
Target 7 : ensure environmental sustainability
integrate principles of sustainable development into country 7. Engage young people in all policy decisions affecting their lives
policies snd programmed and reverse the loss of environmental
resources 8. Provide comprehensive and integrated sexual and reproductive
global emission of co2 increased by more than 46 percent health and HIV services within public provstr and not for profit
Montreal protocol on substances that deplete the ozone layer - at health system
Rio+20, the united nations conference on sustainable development
world leaders approved on agreement entitled " the future we 9. Reduce un mets by flam planning
want"
*free from pest, diseases 10. Make comprehensive sexuality education available to all by 2020
11. *comprehensive sexual education starts at school
Target 7b:
12. Reduce maternal mortality due to unsafe abortion by 75% by the
reduce biodiversity loss, achieving by 2010, a significant reduction
year 2020
in the rate of loss
*environmental awareness inc. More territories were protected.
13. Allocate sufficient resources to make all nine targets achievable by
2020
Target 7c: halve by 2015, the proportion of the population without
sustainable access to safe drinking water and basic sanitation
Target 7d: achieve by 2020 according to slum dwellers
Target 8: global partnership for development

develop further and open, rule based, predictable
nondiscriminatory, trading and financial system
protectionism
protect domestic products by for example raise taxes on foreign
products
*but there should be a balance between foreign and local goods to
develop alliance
Target8c; address special needs of landlocked developing countries and small

island developing states
Target 8d: deal comprehensively with the debt problems of developing

countries
Taeget8e: in cooperation with pharmaceutical companies provide access to

afford essential drugs in developing countries
Target8f: in cooperation with private sectors, make available benefits of new

technologies, especially information and technology
2013: MDG acceleration and beyond 2015

follow up efforts made achieving the MDG
world leaders renewed their commitment to meet the MDG targets
and agreed to hold a high level summit un September 2015 to
adopt s new set of goals building on the achievement of the MDGs
Et factum estutamicistranscribit 2014 -2015

Dr. Page 2 of 2
durumsimul in unum! medicine vade
Lecturer: Dr. Annabelle Pabilona-Tiu
that
Reason why the Philippines bear a triple burden of disease
1. increasing health impact of globalization and escalating
climate change
2. changes in lifestyle and the increasing prevalence of risk
factors
3. advances in the management and treatment of infectious
diseases, Filipinos continue to suffer from diseases for
which interventions are available (HIV, TB, Vaccine
preventable disease)
First Guarantee of TBD

WHO estimated that:
● “all life stages and triple burden disease” means that the
1. Communicable and non-communicable diseases have
health system will ensure services that keep the well
been the primary culprit of deaths all over the world in
healthy, and the sick return to their full health from
the last 2 decades
pregnancy to old age
2. about half of the 56.4 million deaths worldwide can be
● This guarantee summarizes that a Filipino is entitled to a
attributed to just 10 causes; a total of 15 million deaths
comprehensive range of services that promote health
were due to ischemic heart disease and stroke
and protect everyone from getting sick at all ages and all
3. in recent years, cases of road injuries have gradually
stages
increased to become one of the top causes of mortality.
● From WOMB to TOMB
4. Economic growth, which is usually characterized by
urbanization, food availability, employment and
technology, have influenced daily lifestyles, including
I. COMMUNICABLE DISEASES
physical activity, diet, and exposure to vices.
1. Emerging and re emerging infectious disease program (EREID)

WHO: the impact of chronic disease in the Philippines
● Chronic disease accounted for 57% of all death
In the recent past, the Philippines has seen many outbreaks of
● At least 80% is due to premature heart disease, stroke
emerging infections diseases and it continues to be susceptible to
and type 2 DM
dengue, meningococcemia, tuberculosis
● 40% is due to cancer
Contributing factors
Philippine Health Agenda Framework
1. Demographic factors like the population distribution and
density,
2. international travel/ tourism and increased OFWs,
3. Socio-economic factors and
4. Environmental factors.
Vision
● A health system that is resilient, capable to prevent,
detect and respond to the public health threats caused
by emerging and re-emerging infectious diseases
Mission
● Provide and strengthen an integrated, responsive, and
collaborative health system on emerging and re-
emerging infectious diseases towards a healthy and bio-
secure country.
Goal
● Prevention and control of emerging and re-emerging
infectious disease from becoming public health
problems, as indicated by EREID case fatality rate of less
than one percent.
Program Strategies: The EREID Strategies are:
Page 1 of 13
1. Policy Development ● NAAT-LAMP as one of confirmatory tests will be available
2. Resource Management and Mobilization at district hospitals, provincial hospitals and DOH
3. Coordinated Networks of Facilities retained hospitals.
4. Building Health Human Resource Capacity
5. Establishment of Logistics Management System 3. Integrated Vector Management (IVM)
6. Managing Information to Enhance Disease Surveillance ● Training on …
7. Improving Risk Communication and Advocacy ○ Vector Management,
○ Basic Entomology for Sanitary Inspector,
Target Population/ Client ○ Integrated Vector Management (IVM) for
● All ages; Citizen of the Philippines health workers
● Insecticide Treated Screens (ITS) as dengue control
Area of Coverage strategy in schools.
● Philippines and its international borders
4. Outbreak Response
2. DENGUE ● Continuous DOH augmentation of insecticides such as
adulticides and larvicides to LGUs for outbreak response.
● Dengue is the fastest spreading vector-borne disease in
the world endemic in 100 countries· 5. Health Promotion and Advocacy
● Dengue virus has four serotypes (DENV1, DENV2, DENV3 ● Celebration of ASEAN Dengue Day every June 15
and DENV4) ● Quad media advertisement
● Dengue virus is transmitted by day biting Aedes aegypti ● IEC materials
and Aedes albopictus mosquitoes.
6. Research
Vision
● A dengue free Philippines Strategies
● Enhanced 4S Strategy
Mission ○ S - earch and Destroy mosquito breeding places
● Ensure healthy lives and promote well-being for all at all ○ S - eek Early Consultation on the 1st sign and
ages symptoms of the disease
○ S - elf Protection Measures
Goal ○ S - ay yes to fogging only during outbreaks
● To reduce the burden of dengue disease
DOH – Declared
Objectives National Dengue Alert and Code blue on July 15 2019
1. To reduce dengue morbidity by at least 25% by 2022 National Dengue epidemic – August 6 2019
2. To reduce dengue mortality by atleaset 50% by 2022 ● July 14 to 20, 2019 - 10,502 cases, 71% higher compared
3. To maintain Case Fatality Rate (CFR) to < 1% every year. to the same period in 2018
● Cases: January 1 to July 20, 2019 - 146,062
● Increase by 85% as compared to cases last year of the
Program Components
same month
1. Surveillance
Region that exceeded the threshold for the past 3 consecutive
● Case Surveillance through Philippine Integrated Disease
weeks – july 2019
Surveillance and Response (PIDSR)
1. Regions that exceeded the ALERT THRESHOLD
● Laboratory-based surveillance/ virus surveillance
a. Region 1
through Research Institute for Tropical Medicine (RITM)
b. Region VII
Department of Virology, as national reference laboratory,
c. BARMM
and sub-national reference laboratories.
2. Regions that exceeded the EPIDEMIC THRESHOLD
● Vector Surveillance through DOH Regional Offices and
a. Region IV-A - CALABARZON
RITM Department of Entomology
b. Region IV-B - MIMAROPA
c. Region V
2. Case Management and Diagnosis
d. Region VI
● Dengue Clinical Management Guidelines training for
e. Region VIII
hospitals.
f. Region IX
● Dengue NS1 RDT as forefront diagnosis at the health
g. Region X
center/ RHU level.
● PCR as dengue confirmatory test available at the sub-
national and national reference laboratories.
Page 2 of 13
3. HIV /AIDS 3. For leveraging services
● The Philippine is a low-HIV prevalence country with a. baseline laboratory testing is being provided
<0.1% of the adult population estimated to be HIV (+), but b. male condoms are being distributed through
the rate of increase in infections is one of the highest social Hygiene Clinics
● June 2018 DOH AIDS registry reported 56,275 cumulative
cases since 1964
● March 2019 HIV/AIDS registry 4. FILARIASIS ELIMINATION PROGRAM
○ 1172 newly confirmed HIV(+) individuals
○ NCR- 348 cases ● Aim: to reduce the prevalence of filariasis to less than 1%
○ Region IVA - 171 cases ● Implementation of mass treatment and parasitic control
○ Region III - 140 cases programs such as the Soil-transmitted Helminthiasis and
○ Region IX - 140 cases Schistosomiasis
○ Region VI - 79 cases
● Presently: 63,000 plus cases DESCRIPTION
● Daily: 43 cases detected ● The Elimination started in 2001 after a pilot study using
the combination drugs in 2000 in five selected
Objective: municipalities in five provinces.
● Reduce the transmission of HIV and STI among the Most ● Total no. of province: 81
At Risk Population and General Population and mitigate ● Total population in the country: 108,241,936 as of 2019
its impact at the individual, family, and community level. August 4 (1.4% of the total world population)
● Total Endemic Provinces: 46 Provinces in 12 Regions
Program Activities: ● Total Endemic Population: 8 Million
● With regard to the prevention and fight against stigma ● Parasite: Majority is Wuchereria bancrofti
and discrimination, the following are the strategies and ● Vectors incriminated: Aedes poecilus, Anopheles
interventions: flavirostris
1. Availability of free voluntary HIV Counseling and
Testing Service; VISION
2. 100% Condom Use Program (CUP) especially for ● Healthy and productive individuals and families for
entertainment establishments; Filariasis-Free Philippines
3. Peer education and outreach;
4. Multi-sectoral coordination through Philippine MISSION
National AIDS Council (PNAC); ● Elimination of Filariasis as a public health problem thru
5. Empowerment of communities; comprehensive approach and universal access to quality
6. Community assemblies and for a to reduce stigma; health services
7. Augmentation of resources of social Hygiene Clinics;
and OBJECTIVES
8. Procured male condoms distributed as education 1. To sustain transmission interruption in provinces through
materials during outreach. strengthening of surveillance
2. To intensify interventions and interrupt transmission in
Target of program: persistent infection provinces
1. Health policy and program development 3. To strengthen Morbidity Management & Disability
a. Dissemination of manual of procedure/ Prevention (MMDP) activities and services to alleviate
standard / guidelines suffering among chronic patients
b. Implementing surveillance and treatment 4. To strengthen the health system capacity to secure LF
among people living with HIV/AIDS through the elimination
Research Institute for Tropical Medicine 5. Secure adequate investment from governmental and
c. Drafted the Strategic Plan 2012-2016 for non-governmental sources to sustain all program
Prevention of Mother to Child Transmission objective
and the Strategic Plan 2012-2016 for Most at
Risk Young People and HIV Prevention and WHO- GLOBAL PROGRAM FOR ELIMINATION OF FILARIASIS
Treatment
2. For capability building WHO’s strategy is based on 2 key components:
a. A. revision of the training curriculum for HIV 1. Stopping the spread of infection through large scale
counseling and testing annual treatment of all eligible people in the area
b. Twenty five priority LGUs provided support in 2. Alleviating suffering caused by lymphatic filariasis
strengthening local AIDS councils through provision of basic package care.
■ March 2011 - 17 Treatment Hubs
nationwide Adopted by the national program:
Page 3 of 13
1. INTERRUPTION OF TRANSMISSION: and information and evidence to guide malaria
○ Elimination level prevalence of microfilaremia elimination
of less than 1% and Antigen rate of < 1%
through Mass Drug Administration (MDA) PROGRAM COMPONENTS
2. CONTROL AND REDUCE THE MORBIDITY 1. Program Management and Health System -
○ by alleviating the sufferings and disability 2. Diagnosis and Treatment
caused by its clinical manifestations through 3. Vector Control
Morbidity Management Disability Prevention 4. Advocacy and Social Mobilization
(MMDP) 5. Surveillance, Outbreak Preparedness and Response
6. Monitoring and Evaluation
STRATEGIES, ACTION POINTS, AND TIMELINE 7. Partnerships
1. Mass Drug Administration - combination drug of 8. Assessment of Other Factors - assessment of the possible
diethylcarbamazine citrate and albendazole for a contribution of factors such as government health
minimum of 5 years to individuals ages 2 years old and expenditure, poverty, forest cover, etc
above living in established endemic areas
2. Disability Management STRATEGIES, ACTION POINTS, AND TIMELINE
3. Monitoring thru Midterm Sentinel surveys and Evaluation 1. Early Detection and Prompt Treatment through a
thru Transmission Assessment Survey strengthened case-finding mode;
4. Post Validation Surveillance 2. Foci investigation and Classification as a means to
5. Private-Public Partnership determine need for interventions;
3. Strengthened recording and reporting;
PROGRAM ACCOMPLISHMENTS/STATUS 4. Use of Primaquine as a transmission-blocking agent;
● Provinces have reached elimination level and declared as 5. Use of Artesunate ampoules and suppositories;
Filariasis-free as of 2017: 38 Provinces 6. Quality assurance monitoring to cover all aspects of
● Filariasis awareness month: every November malaria service delivery;
7. Structured capability-building of local health system staff
5. MALARIA CONTROL PROGRAM PROGRAM ACCOMPLISHMENTS

● THe sub-national elimination of DOH-National Malaria
VISION Control Elimination Program has resulted to the
● A Malaria–Free Philippines by 2030 declaration of 42 provinces declared malaria-free out of
81 provinces.
MISSION ● P. Falciparum 70-80%, P. vivax 20-30%, P. knowlesi rare
● Further accelerate malaria control and transition towards ● Currently, 4 provinces continue to be endemic - Palawan,
elimination Sulu, Occidental Mindoro and Sultan Kudarat
● Year 2018, a total of 4870 malaria cases with 4 deaths
GOAL: National Malaria Control Program
1. Reduce the number of cases and death Calendar of Activities
2. Reduce transmission to a level where it is no ● World Malaria Day every April 25
longer a public health problem
OBJECTIVES 6. RABIES PREVENTION AND CONTROL PROGRAM

1. Universal Access
○ To ensure universal access to reliable diagnosis, Philippine – top 10 countries with rabies problem responsible for
highly effective and appropriate treatment and 300-600 deaths yearly
preventive measures Most affected – 5-14 yrs old
2. Governance and Human Resources Biting animals : dog 98%: 88% pets , stray 10%, cats 2%
○ To strengthen governance and human
resources capacity at all levels to manage and VISION
implement malaria interventions ● To declare Philippines Rabies-Free by year 2022
3. Health Financing
○ To secure government and non-government MISSION
financing to sustain malaria control and ● To eliminate human rabies by the year 2020
elimination efforts at all levels
4. Health Information and Regulation OBJECTIVES
○ To ensure quality malaria services, timely ● To eliminate rabies as a public health problem with
detection of infection and immediate response, absences of indigenous cases for human and animal
Page 4 of 13
PARTNER INSTITUTIONS 2. Hypertension (25%)
The following organizations/agencies take part in attaining the goal 3. High total cholesterol level (10%)
of the National Rabies Prevention and Control Program: 4. High blood sugar (5%)
● Department of Agriculture (DA)
● Department of Education (DepEd) Vision
● Department of Interior and Local Government (DILG) ● A Philippines free from the avoidable burden of NCDs
● Department of Environment and Natural Resources
(DENR) Mission
● World Health Organization (WHO) ● Ensure sustainable health promoting environments and
● Animal Welfare Coalition (AWC) accessible, cost-effective, comprehensive, equitable and
● Bill and Melinda Gates Foundation quality health care services for the prevention and
control of NCDs, and guided by the principle of
STRATEGIES ○ “Health in All, Health by All, Health for All”
● Reduce risks of rabies exposure and appropriate whereas
management of animal bites ■ Health in All refers to Health in All
● Cases from 2014-2018 - average of 258 cases each year Policies,
● June 30, 2018: 144 cases reported ■ Health by All involves the whole-of-
government and the whole-of-
PROGRAM COMPONENTS society
1. Post Exposure Prophylaxis ■ Health for All captures the KP
2. Pre- Exposure Prophylaxis (PrEP) (Kalusugan Pangkalahatan) or the
3. Health Education and advocacy campaign Universal Health Care (UHC).
4. Training/Capability Building
5. Training on National Rabies Information System (NaRIS) Objectives
1. To raise the priority accorded to the prevention and
7. ZIKA control of non-communicable diseases in national,
regional and local health and development plans
The Disease Prevention and Control Bureau (DPCB) spearheaded 2. To strengthen leadership, governance, and multisectoral
the development of the Zika Action Plan (ZAP) in February 2016 actions for the prevention and control of non-
communicable diseases
GOAL: 3. To reduce modifiable risk factors for non-communicable
● to contain and prevent transmission of the Zika virus and diseases and underlying social determinants through
other possible mosquito-borne diseases. creation of health-promoting environments
4. To strengthen health systems and increase access to
STRATEGIES: quality medicines, products and services, especially at the
1. Surveillance and Clinical Management; primary health care level, towards attainment of
2. Vector Control; universal health coverage
3. Management of Potential Impact on Women, 5. To promote and support research and development for
4. Health Promotion. the prevention and control of non-communicable
diseases
II. NON-COMMUNICABLE DISEASES 6. To monitor the trends and determinants of non-
communicable diseases and evaluate progress in their
Top killer diseases in the Philippines (as well as globally) prevention and control
● cardiovascular conditions (hypertension, stroke),
● diabetes mellitus, Program Components
● lung/chronic respiratory diseases 1. Cardiovascular Disease
● cancers 2. Diabetes Mellitus
3. Cancer
These diseases are considered as lifestyle related and is mostly the 4. Chronic Respiratory Disease
result of unhealthy habits.
Administrative Order-2011-0003: National Policy On
Behavioral and modifiable risk factors like smoking, alcohol abuse, Strengthening the Prevention and Control of Chronic Lifestyle
consuming too much fat, salt and sugar and physical inactivity have Related Non-Communicable Diseases
sparked an epidemic of these NCDs which pose a public threat and
economic burden.
Current prevalence of NCD risk factor among adults re:

1. Overweight and obesity (27%)
Page 5 of 13
● Comprehensive Cancer Care and Optimized Cancer
Survival in 2025
MISSION
● To reduce the impact of cancer and improve the
wellbeing of Filipino people with cancer and their
families
OBJECTIVES / GOALS
1. To reduce premature mortality from cancer by 25% in
2025
2. To ensure relative reduction of the following risk factors
for cancer:
a. 10% harmful use of alcohol
b. 10% physical inactivity
c. 30% tobacco use
3. To guarantee the availability of the following services for
selected population:
Diseases of the heart remain the top cause of mortality in the
a. Selected cancer screening
country.
b. Human Papilloma Virus and Hepatitis B
vaccination
The Tamang Serbisyo para sa Kalusugan ng Pamilya (TSEKAP)
c. Access to palliative care
Program,
d. Drug therapy and counseling
● launched in March 2016, aims to provide 20 million poor
and marginalized Filipinos with free access to essential
The National Cancer Prevention and Control Action Plan 2015-
health packages under the “All for Health Towards
2020 shall cover the following key areas of concern:
Health for All.”
● It provides free check-ups and screening for the poor for
1. Policy and Standards Development
early detection of lifestyle-related diseases such as heart
a. Development of “National Policy on the
disease, diabetes, and cancers.
Integration of Palliative and Hospice Care into
the Philippine Health Care System”
TSEKAP PACKAGES
b. Development and Operationalization of
● provision of basic health services for the poor through
National Cancer Prevention and Control
primary care facilities such as Barangay Health Stations,
Website and Social Media Sites
Rural Health Units, and Health Centers.
c. Development of “Comprehensive National
● 25,000 TSEKAP packages distributed to 1,677
Policy on Cancer Prevention and Control”
municipalities and cities
d. Establishment of National Cancer Center and
● The package includes two thermometers, a stethoscope,
Strategic Satellite Cancer Centers
a digital BP apparatus, a glucometer set, a dressing set,
e. Expansion of PhilHealth Z Benefit Package
two nebulizers, and a plastic container for storage.
Coverage to Other Cancers
● 4.6 Million poor Filipinos received basic physical and
■ PhilHealth Z-Benefit Package for
laboratory examinations and medicines.
catastrophic diseases (breast,
● 14.2 Million treatment packs for hypertension and
prostate, cervical cancers and
diabetes distributed through health facilities nationwide
childhood acute lymphocytic
● For diagnosed patients, maintenance medications for
leukemia) is an in-patient package
diabetes and hypertension are available in health
which includes mandatory
facilities to ensure compliance to medications and
diagnostics, operating room
control of the disease.
expenses, doctor/professional fees,
room and board, and medicines.
1. CANCER
2. Advocacy and Promotions

● Among Filipino MEN, the 6 common sites of cancer are
a. Cancer Awareness Campaigns
lung, liver, colon/rectum, prostate, stomach and
b. Partnership with DepEd, CHED, DOLE-Bureau
leukemia.
of Working Conditions, and Civil Service
● Among Filipino WOMEN, the 6 common sites of cancer
Commission
are breast, cervix, lung, colon/rectum, ovary and liver
3. Capacity Building and Resource Mobilization

VISION
Page 6 of 13
a. Training of Trainers on Cervical Cancer a. Establishment of National Research and
Prevention and Control Development Program for Cancer Control
b. Training of Trainers on Palliative and Hospice b. Research: Study on the Socio-Economic
Care Burden and Impact Assessment of Cancer in
■ Palliative and hospice care has been the Philippines
the missing link in our health care c. Determination of Cancer Incidence in the
delivery system. Our Universal Philippines 2008-2013
Health Care or Kalusugan
Pangkalahatan would not be ROLES AND FUNCTIONS OF NATIONAL CANCER CONTROL
complete without integrating COMMITTEE
palliative and hospice care into the 1. Set the roadmap of National Cancer Prevention and
existing promotive–preventive– Control Program (NCPCP)
curative-rehabilitative continuum of 2. Plan, establish and implement policies, guidelines and
care. It is therefore imperative to standards throughout the continuum of holistic health
institutionalize and integrate care (preventive, promotive, curative, rehabilitative and
palliative and hospice care both in palliative)
the hospitals or health facilities and 3. Advise / recommend upgrading of existing cancer
in community or home-based level. management facilities in the country
c. Training of Trainers on Patient Navigation 4. Coordinating body for all cancer works in the country
Program 5. Ensure the implementation of NCPCP down to the
■ Patient Navigation Program / grassroots level
Medicine Access Program: It 6. Establish and carry out an effective nationwide cancer
provides chemotherapy for early education program / dissemination
stage breast cancer and acute 7. Provide technical and financial support on cancer
lymphocytic leukemia and other prevention, early detection, treatment and palliative
diagnostic standard procedures for care
eligible patients at no cost. This 8. Establish and carry out effective training program
project involves seven (7) 9. Ensure the collection and analysis of data from registry
government hospitals, namely: and surveillance
Philippine General Hospital, Jose 10. Implement, monitor and evaluate the NCPCP regularly
Reyes Memorial Medical Center, through implementation review and impact evaluation
East Avenue Medical Center, Rizal 11. Empower and engage all the stakeholders to actively
Medical Center, Amang Rodriguez work on and participate in on various areas of NCPCP
Memorial Medical Center, Philippine 12. Endorse support for researchers in the clinical,
Children’s Medical Center and Bicol epidemiological, public health and knowledge
Regional Training and Teaching management areas and in collaboration with
Hospital. international institutes
13. Others that may be identified and approved by the
4. Service Delivery Secretary of Health
a. Availability of Free Cervical Cancer Screening
in all trained RHUs
b. Availability of cryotherapy equipment in every 2. DIABETES
province (81 provinces) November 14: World Diabetes Day
c. Availability and accessibility of screenings for
selected cancers in all trained RHUs
d. School-based HPV vaccination of 9 to 13-year- 3. SMOKING CESSATION PROGRAM
old females
e. Hepatitis B vaccination for all health workers ● The Philippine Global Adult Tobacco Survey conducted
nationwide in 2009 (DOH, Philippines GATS Country Report, March
16, 2010) revealed that 28.3% (17.3 million) of the
5. Information Management and Surveillance population aged 15 years old and over currently smoke
a. Establishment of National Cancer Registry tobacco, 47.7% (14.6 million) of whom are men, while
(hospital- and population-based) 9.0% (2.8 million) are women.
b. Development and Operationalization of ● Eighty percent of these current smokers are daily
Cancer Helpline (including Telemedicine) smokers with men and women smoking an average of
11.3 and 7 sticks of cigarettes per day respectively.
6. Research and Development ● “The National Smoking Cessation Program” support the
National Tobacco Control and Healthy Lifestyle Program
Page 7 of 13
6. NCD indicators are integrated in existing DOH current
Vision: performance reporting systems like Field Health Service
● Reduced prevalence of smoking and minimizing Information System, Local Government Unit scorecard
smoking-related health risks. 7. DOH support for proposed legislative bills focusing on
addressing the harmful effects of alcohol consumption,
Mission: and integrating palliative and hospice care into the
● To establish a national smoking cessation program health care system
(NSCP).
Objectives: 4. MALNUTRITION
1. Promote and advocate smoking cessation in the
Philippines; and A. MICRONUTRIENT PROGRAM
2. Provide smoking cessation services to current smokers ● Micronutrient deficiencies can cause inter-generational
interested in quitting the habit. consequences.
● The level of health care and nutrition that women
Program Components: receive before and during pregnancy, at childbirth and
1. Training immediately post-partum has significant bearing on the
○ Consistent with good clinical practices survival, growth and development of their fetus and
2. Advocacy newborn.
○ A smoke-free environment (SFE) ● Undernourished babies tend to grow into
3. Health Education undernourished adolescents.
○ Smokers shall be assisted to quit their habit ● When undernourished adolescents become pregnant,
and their immediate family members shall be they in turn, may give birth to low-birth weight infants
empowered to assist and facilitate the with greater risk of multiple micronutrient deficiencies.
smoking cessation process.
4. Smoking Cessation Services Micronutrient Malnutrition:
○ World No Tobacco Day (WNTD) every 31st of ● Iron Deficiency Anemia - number 1
May and the World No Tobacco Month every ○ Infants - 56.6%
June. ○ Pregnant women - 50.7%
5. Research and Development ○ Lactating women - 45.7%
○ To be conducted to better understand the ○ Male, older persons - 49,1%
nature of nicotine dependence among
Filipinos and to undertake new FUTURE PLAN / ACTION ON MICRONUTRIENT DEFICIENCIES
pharmacological approaches. 1. Focus on population groups and areas affected or at-risk
to micronutrient malnutrition
Program Accomplishments/Status ON Non-Communicable 2. Scale up with key interventions such as micronutrient
Diseases supplementation, food fortification 7 dietary
1. Finalization of the Philippine Multi-sectoral Strategic diversification through food based approach
Plan for the Prevention and Control of NCDs (2017 – 3. Development & formulation of strategic plan 2012-2016
2025)
2. The Philippine Package of Essential NCD Intervention for Micronutrient supplementation is a crucial for child survival, it
the integrated management of hypertension and significantly reduces:
diabetes is being implemented nationwide. This is being 1. The risk from mortality by 23-34%
supplemented by developing the DOH Hypertension and 2. Deaths due to measles by about 50%
Diabetes Health Clubs in primary health care facilities 3. Deaths due to diarrhea by about 40%
which will ensure continuity of care and provision of
NCD drugs. A registry of hypertensives and diabetics was B. FOOD FORTIFICATION PROGRAM
also developed and is maintained by the department.
3. Training on Diabetes management using Insulin for Objectives:
Regional Offices and LGUs 1. To provide the basis for the need for a food
4. Provision of NCD drugs through the Medicine Access fortification program in the Philippines: The
Programs (Breast Cancer, Childhood Cancer, Colon and Micronutrient Malnutrition Problem
Rectum Cancer, Insulin, NCD maintenance medicines for 2. To discuss various types of food fortification strategies
hypertension and diabetes) 3. To provide an update on the current situation of food
5. Training on cervical cancer screening using visual fortification in the Philippines
inspection using acetic acid (VIA) among health care
workers started in 2013 and on-going. Monitoring of
trained institutions started in 2014.
Page 8 of 13
Fortification as defined by Codex Alimentarius 2. INJURIES: 2016 OPLAN IWAS PAPUTOK
● “the addition of one or more essential nutrients to food,
whether or not it is normally contained in the food, for “Iwas Paputok, Fireworks Display ang Patok! Makiisa sa Fireworks
the purpose of preventing or correcting a demonstrated Display sa inyong lugar!”
deficiency of one or more nutrients in the population or
specific population groups” ● The annual campaign for reducing fireworks-related
injuries and deaths, particularly during the Christmas
Food Fortification Law and New Year celebrations, started in 1994.
● Republic Act 8976, “An Act Establishing the Philippine ● For 2016, the theme is “OPLAN: Iwas Paputok, Fireworks
Food Fortification Program and for other purposes” Display ang Patok! Makiisa sa Fireworks Display sa
mandating fortification of flour, oil and sugar with Inyong Lugar.”
Vitamin A and flour and rice with iron by November 7, ● Target: 0 injury
2004 and promoting voluntary fortification through the ● Yearly, a decrease in number of injuries were noted.
SPSP, Signed into law on November 7, 2000
3. MENTAL HEALTH PROGRAM
Status of the Philippine Food Fortification Program
● There are 139 processed food products with Sangkap Vision
Pinoy Seal ● A society that promotes the well-being of all Filipinos,
○ 83% with vitamin A, supported by transformative multi-sectoral
○ 29% with iron and partnerships, comprehensive mental health policies and
○ 14% with iodine programs, and a responsive service delivery network
● 37% of the products are snack foods
● National Food Fortification Day November 7 Mission
● To promote over-all wellness of all Filipinos, prevent
mental, psychosocial, and neurologic disorders,
substance abuse and other forms of addiction, and
III. DISEASES OF GLOBALIZATION AND RAPID URBANIZATION reduce burden of disease by improving access to quality
care and recovery in order to attain the highest possible
● Another burden faced by Filipinos are diseases due to level of health to participate fully in society.
urbanization, which may be attributed to the high
population density and poverty in urban areas that lead Objectives
to unsafe environments and crime. 1. To promote participatory governance and leadership in
● In cooperation with the Philippine National Police on the mental health
country’s campaign against drugs, services for treatment 2. To strengthen coverage of mental health services
and rehabilitation of drug dependents have been through multi-sectoral partnership to provide high
provided by the DOH. quality service aiming at best patient experience in a
responsive service delivery network
1. SUBSTANCE ABUSE 3. To harness capacities of LGUs and organized groups to
implement promotive and preventive interventions on
On November 29, 2016, the first Mega Drug Abuse Treatment and mental health
Rehabilitation Center in the country was inaugurated at Fort 4. To leverage quality data and research evidence for
Magsaysay, Nueva Ecija mental health
● 2,500 beds in the Mega Treatment and Rehabilitation 5. To set standards for compliance in different aspects of
Center in Fort Magsaysay, Nueva Ecija services
● Drug Rehabilitation Services Provided through TSeKaP
(December 22, 2016) Program Components
○ 17,761 Screening 1. 1. Wellness of Daily Living
○ 5,743 Drug testing ○ All health/social/poverty reduction/safety and
○ 19,807 Counseling security programs and the like are protective
○ 3,822 Referrals factors in general for the entire population
○ Promotion of Healthy Lifestyle, Prevention and
Latest survey conducted 2018, showed that 66% of Filipinos Control of Diseases, Family wellness programs,
claimed that the number of drug addicts in their area has etc
decreased over the past years. ○ School and workplace health and wellness
2019- government data showed: 5,104 drug suspects have died in programs
anti-drug operations, 167,135 have been arrested, and 316,494 2. Extreme Life Experience
drug users have graduated from recovery and wellness program.
Page 9 of 13
○ Provision of mental health and psychosocial 5. Establish performance accountability mechanism at all
support (MHPSS) during personal and levels
community wide disasters
3. Mental Disorder Program Components
4. Neurologic Disorders 1. Drinking-water supply,
5. Substance Abuse and other Forms of Addiction 2. Sanitation (e.g excreta, sewage and septage
management),
Calendar of Activities 3. Zero Open Defecation Program (ZODP),
● September 10 - World Suicide Prevention Day 4. Food Sanitation,
● October 10 -World Mental Health Day 5. Air Pollution (indoor and ambient),
● 2nd Week of October - National Mental Week 6. Chemical Safety, WASH in Emergency situations,
7. Climate Change for Health and Health Impact
The World Health Organization (WHO) estimates that Assessment (HIA)
● 154 million people suffer from depression
● million from schizophrenia Partner Institutions
● 877,000 people die by suicide every year ● DENR, DILG, DPWH, DA, PIA
○ Suicide rate for males is 2.5 per 100,000 ● World Health Organization (WHO), UNICEF, USAID,
population, female is 1.7 per 100,000 AusAID
population
● 50 million people suffer from epilepsy Calendar of Activities (year 2019)
● 24 million from Alzheimer’s disease and other ● 1st Quarter
dementias ○ Training on Prioritizing Drinking Water Quality
● 15.3 million persons with drug use disorders Parameters for Surveillance as per PNSDW of
● Neuropsychiatric disorders contribute to 14.4% of the 2017
global burden of disease ● 2nd Quarter
○ National Environmental Health Action Plan
HOPELINE (NEHAP) Orientation
● Hopeline, a phone-based service that provides 24/7 ○ Climate Change and Health Orientation
support for people suffering from anxiety, suicidal ● 3rd Quarter
thoughts, depression, and other mental health issues. ○ Training on Prioritizing Drinking Water Quality
● Launched on September 13, 2016 as part of the Parameters as per PNSDW of 2017
highlights of the 2016 Suicide Prevention Day on ○ Orientation on Septic tank Guidelines And
September 10. Sanitation technologies
● Hopeline is a collaboration between the DOH, WHO, the ○ Training on Philippine Approach to Sustainable
Natasha Goulbourn Foundation, and Globe Sanitation
Communications. ○ National Environmental Health Action Plan
● It is estimated that 5% of the total health budget goes to (NEHAP) Orientation
mental health services ○ World Environmental Health Day Celebration
● 4th Quarter
4. ENVIRONMENTAL HEALTH PROGRAMS ○ Orientation on Septic tank Guidelines And
Sanitation technologies
Vision ○ National Environmental Health Action Plan
● Environmental Health (EH) related diseases are (NEHAP) Orientation
prevented and no longer a public health problem in the
Philippines (based on on-going Strategic Plan 2019-
2022) 5. VIOLENCE AND INJURY PREVENTION PROGRAM
Mission ● The Global Burden of Diseases, Injuries, and Risk Factors

● To guarantee sustainable Environmental Sanitation (ES) Study conducted in 2010 showed that interpersonal
services in every community violence, road injury, drowning, and self-harm (suicide)
are the leading causes of premature deaths in the
Objectives Philippines.
1. Expand and strengthen delivery of quality ES services ● Accidents are the fifth leading cause of mortality as
2. Institute supportive organizational, policy and reported in the Philippine Health Statistics of the
management systems National Epidemiology Center.
3. Increase financing and investment in ES ● Transport or vehicular crash was the leading cause of
4. Enforce regulation policy and standards unintentional injuries
Page 10 of 13
● Interpersonal violence (mauling/assault, contact with injury prevention. Appropriate interventions
sharp objects, and gunshot) was the leading cause of at all levels of prevention shall be crucially
intentional injuries. provided.
● The Department of Health (DOH) shall serve as the focal
agency with respect to violence and injury prevention. G. Six (6) E’s.
○ Strategies shall utilize the concept of the six
VIPP Program Strategies E’s (Education, Enactment / Enforcement,
Empowerment, Engineering, Emergency
A. Evidence-Based Research and Electronic Surveillance Medical Service, and Engagement in
System surveillance and research) in the prevention of
○ Multi-disciplinary and multi-sectoral violence and injuries.
interventions shall be developed based on ○ Education entails wide dissemination of
evidence-based research. DOH shall establish information and communication related to
and institutionalize a system of data reporting, violence and injury prevention;
recording, collection, management and ○ Enactment / Enforcement of laws and policies
analysis at the national, regional, and local related to violence and injury prevention;
levels. An information system, that is, Online ○ Empowerment of all stakeholders in the
National Electronic Injury Surveillance System implementation of VIPP. This also covers the
(ONEISS) and Philippine Network for Injury provision of psychosocial support to the
Data Management System (PNIDMS), shall be victims of violence and injury to help them
fully operationalized for this purpose. recover from the psychological trauma;
○ Engineering control provides the most
B. Networking and Alliance Building effective way of reducing the cause and
○ DOH shall promote partnerships with and impact of violence and injuries. This involves
among stakeholders to build alliance and the improvement of facilities and
networks and to generate resources for infrastructures to promote safe environments;
activities related to VIPP. ○ Emergency Medical Services prior to hospital
care. This is vital in providing pre-hospital
C. Capacity Building and Community Participation trauma life support to the injured on site at
○ DOH shall develop and enhance the violence the soonest possible time so as to prevent
and injury prevention capabilities of a wide needless mortality or long-term morbidity or
range of sectors and stakeholders at the permanent disability; and
national, regional and local levels. ○ Engagement in surveillance and research to
promote evidence-based, substantial,
D. Advocacy scientific, and systematic approach to VIPP.
○ DOH shall advocate to LGUs for ordinance
development and lobby to Congress for H. Monitoring and Evaluation
enactment of laws. ○ DOH, together with various stakeholders, shall
identify indicators, targets and milestones for
E. Equitable Health Financing Package program monitoring and evaluation purposes.
○ DOH, in collaboration with various There shall be a regular audit and feedback
stakeholders, shall advocate to health mechanism of all VIPP-related strategies and
financing institutions and financial activities.
intermediaries, i.e. the Philippine Health
Insurance Corporation (PHIC) and insurance Online National Electronic Injury Surveillance System (ONEISS)
companies, the development and shall be the standard reporting system for the collection, storage,
implementation of policies that would be analysis and reporting of data pertaining to violence and injury
beneficial for the victims of all forms of
violence and injury.
6. WOMEN AND CHILDREN PROTECTION PROGRAM
F. Service Delivery
○ In collaboration with stakeholders, DOH shall Vision
institutionalize systems and procedures for ● A gender-fair and violence-free community where
the integration and provision of services at the women and their children are empowered
community level. In collaboration with various
stakeholders, DOH shall undertake advocacy, Mission
information and education, political support, ● Improved strategy towards a violence-free community
and multi-sectoral action on violence and through more systematic primary prevention, accessible
Page 11 of 13
and effective response system and strengthened
functional mechanisms for coordination, planning, Strategies, Action Points and Timeline
implementation, monitoring, evaluation and reporting ● PRIMARY PREVENTION
○ address the underlying conditions that
Objectives influence women and children's health,
● To institutionalize and standardize the quality of service building a gender responsive community
and training of all women and children protection units. (family as entry point)
● Specifically, the program aims to: ● SERVICE DELIVERY
1. Prevent violence against women and children from ever ○ foster collaborative partnerships which
occurring (primary prevention) improve health outcomes
2. Intervene early to identify and support women and ● ADVOCACY & SOCIAL MOBILIZATION
children who are at risk of violence (early intervention); ○ expand the reach and influence of our work,
and empowered communities
3. Respond to violence by holding perpetrators ● RESEARCH & INNOVATION
accountable, ensure connected services are available for ○ research current and emerging issues affecting
women and their children (response). women and children
● ORGANIZATIONAL EXCELLENCE
Description ○ ensure quality systems and practices that
● In 1997, Administrative Order 1-B or the “Establishment promote organizational sustainability,
of a Women and Children Protection Unit in All continuous improvement and innovation
Department of Health (DOH) Hospitals” was Calendar of Activities
promulgated in response to the increasing number of ● Participation to the Celebration of 18-Day Campaign to
women and children who consult due to violence, rape, End Violence Against Women (every November-
incest, and other related cases. December)
● As of 2011, there are 38 working WCPUs in 25 provinces ● Participation to the Celebration of National Children’s
of the country. Month every November
● As of 2016, a total of 94 WCPUs were established
nationwide that served about 8,000 cases in the past
year. 7. PANDEMIC
● “The DOH shall provide medical assistance to victims”
through a socialized scheme by the Women and ● Is an epidemic of disease that has spread across a large
Children Protection Unit (WCPU) in DOH-retained region, multiple continents or even worldwide
hospitals or in coordination with LGUs or other
government health facilities (RA 9262:Anti-violence 10 Worst Pandemics in History
Violence Against Women Against Women And Their 1. HIV/AIDS PANDEMIC
Children And Their Children Act Of 2004 ) ○ Peak 2005-2012
○ Sub-saharan Africa,
Policies and Laws ○ death 36M
● Republic Act 7610: Anti-Child Abuse Law 2. FLU
● Republic Act 9262: Anti-Violence Against Women and ○ Hongkong Flu - 1968 (H3N2 strain)
their Children Act ○ Hongkong to Singapore to Philippines,
● Republic Act No. 8353: Anti-Rape Law ○ death 1M
● Republic Act 10364: Expanded Anti-Trafficking in 3. ASIAN FLU
Persons (RA 9208: Anti-Trafficking in Persons Act of ○ 1956-1958 (H2N2)
2003) ○ China to Singapore to Philippines,
● Republic Act No. 8505: Rape Victim Assistance & Protect ○ death 2M
Act 4. FLU PANDEMIC
● Republic Act 9710: Magna Carta of Women ○ 1918,
● RA 7877: Anti-Sexual Harassment Act ○ tore across the globe infecting over a 3rd of
● Republic Act 10354 (The Responsible and Reproductive the world’s population,
Health Act of 2012) ○ death 20-50M
● Administrative Order 1-B s. 1997: DOH Policy on the 5. SIXTH CHOLERA PANDEMIC
establishment of Women & Children’s Protection Units ○ 1910-1911
(WCPU) ○ India (death 800,000) to Middle East to North
● Administrative Order 2013-0011: Revised guidelines on Africa to Eastern Europe to Russia
the establishment of WCPUs in all hospitals 6. FLU PANDEMIC
● Administrative Order 2014-0002: Violence and Injury ○ 1889-1890 (H3N8)
Prevention ○ Central Asia to Canada to Greenland
Page 12 of 13
○ Death 1M cyclone occurrences and 3rd as to the people exposed
7. THIRD CHOLERA PANDEMIC to seasonal events worldwide. Average of 20 typhoons
○ 1852–1860 yearly.
○ India to Asia to Europe to North America to ● Refers to significant changes in global temperature,
Africa precipitation, wind patterns and other measures of
○ Death 1M climate that occur over several decades or longer
8. THE BLACK DEATH (Bubonic Plague) ● Impact of warmer climate: mosquito-borne diseases
○ 1346-1353 includes malaria, elephantiasis, yellow fever, dengue
○ Europe to Africa to Asia fever, cholera
○ Death: 75 – 200 M ● Increase risks of disasters such as storm, cyclones,
9. PLAGUE OF JUSTINIAN (Bubonic Plague) flooding, long term increase in sea level
○ 541-542
○ Byzantine Empire to Mediterranean port cities Goal
○ Death: 25 M ● To protect the health of Filipinos with priority to those
10. ANTONINE PLAGUE (Plague of Galen) living in vulnerable areas from the impact of climate
○ 165 AD change
○ Asia Minor to Egypt to Greece to Italy
○ Death 5M Objectives:
1. Improve the adaptive capacity of the health care
8. MEASLES OUTBREAK 2019 delivery system
2. Enhance support mechanisms to adaptation and
Philippines: mitigation efforts on climate change in the health sector
● February 2019 - Measles outbreak in 5 regions 3. Empower communities to manage health impacts of
● NCR, Regions IVA, III, VI, VII climate change
● 59% unvaccinated persons
● 53% under 5 years of age
● According to WHO: 2.6M Filipino children under 5 years
old are unvaccinated
● Root cause: chronic low routine immunization coverage
and vaccination hesitancy
9. TRAVEL MEDICINE
● Emporiatrics
● Multidisciplinary specialty that requires expertise in
travel-related illnesses, as well as up-to-date knowledge
on the global epidemiology of infectious and
noninfectious health risks, health regulations and
immunization requirements in various countries, and
the changing patterns of drug-resistant infections
● Covers complete travel care from consultation,
immunization and preventive medicine to post travel
care in an event of an illness
● WHO recommended vaccines before travel:
○ Measles
○ Rubella
○ Mumps
○ Diphtheria
○ Pertussis
○ Poliomyelitis
10. CLIMATE CHANGE
● The Philippines is considered as one of the most

vulnerable countries in the world due to its archipelagic
make-up and location
● According to the World Disaster Report in 2012,
Philippines ranked 1st as the most vulnerable to tropical
Page 13 of 13

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Family Medicine & Community Health 3

Triple Burden of Disease

Reason why the pilippines bear a triple burden of disease

WHO estimated that:

WHO: the impact of chronic disease in the Philippines

1. Emerging and re-emerging infectious disease program (EREID)

S1T3| Guinea Pig Batch 2021: OBE is Life 1 of 13

Area of Coverage 4. Outbreak Response

5. Malaria Control Program Program Accomplishments

Objectives 6. Rabies prevention and control program

4. Service Delivery 3. SMOKING CESSATION PROGRAM

PAGBABALANGKAS NG ARALIN (OPTIONAL) What do managers do?

What does it take to ne a successful manager?

S 1 T 6,7 | Guinea Pig Batch 2021: OBE is Life 1 of 7

COMMENSURATE AUTHORITY AND RESPONSIBILITY

CRITERIA IN SELECTING PRIORITY PROBLEM

Step 3: Setting The Objective/Target EVALUATION

Persistent Inequalities in Health Outcomes:

• Every year, around 2000 mothers die due to pregnancy

Restrictive and Impoverishing Healthcare Cost:

Attain Health Related SDG Targets

• Financial Risk Protection

· Services are financed predominantly by PhilHealth

ü PhilHealth as the gateway to free affordable care

• 100% of Filipinos are members

ü Simplify Philhealth Rules

• No balance billing for the poor/basic accommodation and

• Stages: • Expand benefits to cover comprehensive range of services

· I – nvest in eHealth and data for decision making

▪ Mandate the use of electronic medical records in

· E – nforce standards, accountability and transparency

▪ Publish health information that can trigger better

· V – alue all clients and patients, especially the poor,

▪ Prioritize the poorest 20 million Filiipinos in all

PAGBABALANGKAS NG ARALIN • Amenities

S1T2| Hamster Batch 2021: OBE is Life 1 of 12

BREAK MUNA §10. PREMIUM CONTRIBUTIONS

Year Premium Rate Income Floor Income Ceiling

2020 3.00% 10,000.00 60,000.00

2021 3.50% 10,000.00 70,000.00

2022 4.00% 10,000.00 80,000.00

2023 4.50% 10,000.00 90,000.00

2024 5.00% 10,000.00 100,000.00

2025 5.00% 10,000.00 100,000.00

• For Provided, That for indirect contributors, premium

S1T1| MORALES/OXIMOSO/RIMANDO/TOLENTINO KC/TOLENTINO V. /VALDEZ/

S 1 T 1 MORALES/OXIMOSO/RIMANDO/TOLENTINO KC/TOLENTINO V. /VALDEZ/

S 1 T 1 MORALES/OXIMOSO/RIMANDO/TOLENTINO KC/TOLENTINO V. /VALDEZ/

S 1 T 1 MORALES/OXIMOSO/RIMANDO/TOLENTINO KC/TOLENTINO V. /VALDEZ/

S 1 T 1 MORALES/OXIMOSO/RIMANDO/TOLENTINO KC/TOLENTINO V. /VALDEZ/

PRIMARY HEALTH CARE IN THE PHILIPPINES

ALTA ATA DECLARATION

Eight Essential Elements;

A. Reducing exclusion and social disparities in health (universal coverage reforms)

Adopting PHC has the following rationales;

1. Improvement in the level of health care community .

TYPES OF PHC WORKERS;

1. Barangay Health Worker or Village Health worker

1. Elevating health to comprehensive and sustained national effort.

1. Education for Health

THE SCOPE OF GENERAL PRIMARY CARE PRACTICE:

PRIMARY CARE FOR EACH LEVELS OF DISEASE

3.Postpartum , most common activities such as encouraging breastfeeding, devising plans

8.Younger women 19 - 59 years , heart diseases, malignancies, sexually transmitted

,L___b jD •. Suryeillance and monjtodng