✓ An estimated 10 million (range, 8.

9–11 million)

CHN LEC
OUTLINE HIV
✓
people fell ill with TB in 2019

New HIV infections have been reduced by 40% since

the peak in 1998.
✓ In 2019, around 1.7 million people were newly
infected with HIV, more than a million fewer than in
1998.
MALARIA
✓ The malaria mortality rate has been more than halved:
from 25 deaths per 100 000 population at risk in 2000
to just 10 per 100 000 population at risk in 2019.
✓ The total number of malaria deaths worldwide fell
from 736 000 in 2000 to 409 000 in 2019.

FOUR MAJOR NCDS (CANCER,

CARDIOVASCULAR DISEASES (CVD), DIABETES
AND CHRONIC RESPIRATORY DISEASES (CRD))

✓ The greatest decline in mortality was seen as follows:

GENDER AND DEVELOPMENT
1. CRD - with a 37% decline in age-standardized rates
(ASR) for all ages
Fairness and equity demands that everyone in society whether
2. CVD and Cancer - ASR at 27% and 16% respectively
male or female has the right to the same opportunities to
3. Diabetes - with 3% increase in ASR
achieve a full and satisfying life.
POVERTY AND HEALTH
OVERVIEW OF PUBLIC HEALTH NURSING IN THE
PHILIPPINES
✓ Poverty is a major reason for the health problems.
✓ Most of the leading causes of morbidity and mortality
GLOBAL HEALTH SITUATION
are associated with factors that could be attributed to
poverty.
85%
✓ The poor have poor health because they...
116 million infants received 3 doses of
- do not have the resources to afford the basic requisites of
diptheria-tetanus-pertussis (DTP3) in 2019
health
- could not afford to buy emergency medicines if they got sick
- do not have the capacity to negotiate with the health care
system.

CULTURE INFLUENCES ON HEALTH

✓ Culture is a way of life.

✓ But culture per se, may not be the culprit for poor
health; in many instances it is poverty and inadequacy
of the health system.
✓ Many unhealthy and unsafe practices continue
particularly among poorly educated and poor people.
LIFE EXPECTANCY AND HEALTHY LIFE
✓ Although some cultural practices are harmful to
EXPECTANCY
health, certain aspects of our culture exert positive
influences on health.
• Between 2000 and 2019, global life expectancy (LE)
✓ In CHN, it should be considered as a major social
at birth increased from 66.8 years in 2000 to 73.3 years
resource.
in 2019, and healthy life expectancy (HALE)
increased from 58.3 years to 63.7 years. ENVIRONMENTAL INFLUENCES ON HEALTH
• Despite sharing similar increasing trends, LE and ✓ The environment plays a direct influence on the health
HALE among females were consistently higher than of people.
males. ✓ Exposure to chemicals and other air pollutants has
been identified as a major cause of a number of
BURDEN OF DISEASE diseases such as cancer and respiratory diseases.
✓ The state of the country’s environment is the direct
TUBERCULOSIS result of the interaction of a number of factors such as
✓ Remains as the top leading cause of death
 industrialization, government policies, poverty and an
uncaring attitude towards the environment.
✓ In CHN, the environment should be included in its
health programs.
Health is defined as a state of a complete physical, mental and
social well-being and not merely the absence of disease or
infirmity (WHO, 1995)
PUBLIC HEALTH
➢ Public health is the science and art of 3Ps:
1. Preventing disease
2. Prolonging life
3. Promoting health and efficiency through organized
community effort
COMMUNITY HEALTH
✓ focuses on the maintenance, protection, and
improvement of the health status of population groups
and communities
✓ part of paramedical and medical intervention/approach
which is concerned on the health of the whole
population that aims to:
1. Health promotion
2. Disease prevention
3. Management of factors affecting health
COMMUNITY HEALTH VS. PUBLIC HEALTH
Community health is considered a sub-discipline of public
health, one focused on improving the health outcomes of
different groups of individuals, often at the local level.
1. Emphasis on the importance of the “greatest good for
the greatest number”
2. Assessing health needs, planning, implementing and
evaluating the impact of health services on population
groups
3. Priority of health-promotive and disease-preventive
strategies over curative interventions
4. Tools for measuring and analyzing community health
problems
5. Application of principles of management and
organization in the delivery of health services to the
community
COMMUNITY HEALTH NURSING VS. PUBLIC
HEALTH NURSING
Deliver health services to individuals, groups, and families.
Assessing the populations health needs.
Diagnosis is based on the needs of individuals, family, or group.
Diagnose and develop policy in relation to community health
needs.
Work to promote health and prevent illness in groups and
families with the main goal being to increase community health.
For example, meeting with a group of young mothers to provide
information on immunizations.
Plan for the community as a whole in order to prevent disease
and disability and preserve the health of the community. For
example, after an illness outbreak, the public health nurse will
assess the need and develop a program for an immunization
clinic.

Public health is defined by the CDC Foundation as “the science
of protecting and improving the health of people and their
communities.”
Community health workers typically support specific
geographical regions, from small rural towns to large districts
in urban areas.
Implementation is based on individual needs. For example, a
new diabetic who is a kinesthetic learner would be taught how
to give insulin injections by practicing with an orange.
Implementing the plan means the nurse ensures the resources
are available to all who need them within the community.

Public health workers are more concerned with preventing
disease, prolonging life and promoting healthy behaviors that
impact entire nations or society as a whole.
PUBLIC HEALTH NURSING
Evaluate whether health needs were met on the individual,
family or group level.
Evaluate the health status of the whole community and whether
planned goals and objectives were met.

✓ Special field of nursing that combines the skills of ROLES AND FUNCTIONS OF A COMMUNITY
nursing, public health and some phases of social HEALTH NURSE
assistance and functions as part of the total public
health programme for the promotion of health, the 1. Planner/Programmer
improvement of the conditions in the social and 2. Provider of Nursing Care
physical environment, rehabilitation of illness and 3. Community Organizer
disability. (WHO Expert Committee of Nursing). 4. Coordinator of Services
5. Trainer/Health Educator
COMMUNITY HEALTH NURSING 6. Health Monitor
7. Role Model
It is a specialized field of nursing practice. Its baisc knowledge 8. Change Agent
and skills are anchored on nursing theories and important 9. Recorder/Reporter/Statistician
concepts from the science of public health such as: 10. Researcher
CLIENTS OF A COMMUNITY HEALTH NURSE
There are different levels of clientele:
I - Individual
F - Family
P - Population group
C - Community
HEALTH CARE DELIVERY SYSTEM
• is the totality of all policies, infrastructures,
facilities, equipment, products, human resources,
and services that address the health needs,
problems and concerns of all people.
WORLD HEALTH ORGANIZATION
• The World Health Organization works with 194
Member States, across six regions, and from more than
150 offices
• WHO Member States are grouped into 6 regions.
Each region has a regional office.
• WHO Africa
• WHO Americas
• WHO Mediterranean
• WHO Europe
• WHO South East Asia
• WHO Western Pacific
WHO collaborates with Member States to provide on-the-
ground planning, implementing and monitoring of health
programmes. Today, more than half of WHO staff work in
country offices.
Guiding Principle
✓ The principle that all people should enjoy the highest
standard of health, regardless of race, religion,
political belief, economic or social condition, has
guided WHO’s work for the past 70 years, since it was
first set up as the lead agency for international health
in the new United Nations system.
targets laid out in the Sustainable Development Goals
(SDGs).
✓ The SDGs underscore the key role health plays in
assuring the world’s future, with SDG3 calling on all
stakeholders to “ensure healthy lives and promote
well-being for all at all ages”.
✓ Aligned with WHO’s goal of ensuring that everyone,
everywhere, can realize their right to a healthy life.
✓ Emphasized the importance of collaboration, between
different actors working in different fields, in all
countries of the world.
WHO’s New General Programme of Work
✓ Mission: Promote health, keep the world safe, serve
the vulnerable
✓ Targets to be achieved by 2023:
a. 1 billion more people benefitting from universal health
coverage
b. 1 billion more people better protected from health
emergencies
c. 1 billion more people enjoying better health and well-
being
DEPARTMENT OF HEALTH (DOH)
✓ The DOH holds the over-all technical authority on
health as it is a national health policy-maker and
regulatory institution.
✓ The DOH has three major roles in the health sector: (1)
leadership in health; (2) enabler and capacity builder;
and (3) administrator of specific services. Its mandate
is to develop national plans, technical standards, and
guidelines on health. Aside from being the regulator of
all health services and products, the DOH is the
provider of special tertiary health care services and
technical assistance to health providers and
stakeholders.

Standards

✓ WHO has brought together the world’s top health

experts to produce international reference materials
and to make recommendations to bring better health to
people throughout the world.
✓ WHO’s work has led to global standards for air and
water quality, so important in a world where pollution
is an increasing threat to our health; safe and effective
vaccines and medicines, thanks to its prequalification
programme; and height and weight charts for children,
to guide health professionals and parents in helping
young people grow up healthy and strong.
✓ WHO has also led to guidelines and advice on
preventing and treating health conditions ranging from
asthma and hepatitis to malnutrition and Zika.

Working towards the Sustainable Development Goals

✓ WHO works alongside a host of health and
development partners to achieve the health-related

Health Service Delivery
✓ The Philippines has a mixed public-private healthcare
system that operates within a fragmented environment.
✓ Both the national government and LGUs manage the
delivery of promotive, preventive, curative and
rehabilitative health services.
✓ The DOH supervises the government corporate
hospitals, specialty and regional hospitals while the
Department of National Defense (DND) runs the
military hospitals. Both agencies provide tertiary care.
✓ At the local level, the provincial governments manage
district and provincial hospitals. Meanwhile,
municipal governments provide primary care
including preventive and promotive health services
and other public health programs through the RHUs,
health centers and BHSs, which are the first point of
contact for government-provided health services,
(Dayrit, et al., 2018).
Health Financing
✓ PhilHealth serves as the national social health
insurance agency which purchases services from
public and private providers on behalf of its members.
Health Governance and Regulation
✓ The enactment of LGC in 1991 led to dual governance
in health, with the DOH governing at the national level
and the LGUs at the subnational level.
✓ The DOH serves as the over-all steward and technical
authority on health being the national health policy-
maker and regulatory institution.
Health Sector Reform Agenda in 1999 - Supported the
development and strengthening of local health systems,
facilitated the fiscal autonomy of government hospitals,
increased funding for priority public health programs and
expanded NHIP coverage.
FOURmula One (F1) for Health - Sought to fill the remaining
gaps in the health system not addressed by previous reforms by
leveraging central government funds to promote inter-LGU
collaboration in attaining desired health outcomes.
Universal Health Care (UHC) or Kalusugan Pangkalahatan
- A policy goal, leading to the expansion of SHI coverage
mainly due to sin taxes earmarked for health, the introduction
of no-balance billing (NBB) scheme for indigents, and
intensified support to health facility construction and
enhancement.
CHALLENGES AND IMPLICATIONS
• Mixed health outcomes
• Disjointed health system
• High out-of-pocket expenditure
CLASSIFICATION OF HEALTH FACILITIES
66 hospitals - The DOH directly supervises and controls the
management and
operations of these hospitals. Majority of these facilities are
Level 3 Hospitals (56%).
4 specialty hospitals - Four specialty hospitals attached to the
DOH operating as Government-Owned and -Controlled
Corporations (GOCC) namely, National Kidney and Transplant
Institute, Philippine Heart Center, Philippine Children’s
Medical Center and Lung Center of the Philippines
CLASSIFICATION OF HOSPITAL (ACCORDING TO
FUNCTIONAL CAPACITY)
General - a hospital that provides services for all kinds of
illnesses, diseases, injuries or
deformities. A general hospital shall provide medical and
surgical care to the sick and uninjured, maternity, newborn and
child care. It shall be equipped with the service capabilities
needed to support board certified/eligible medical specialists
and other licensed physicians rendering services in, but not
limited to, the following:
a. Clinical Services (Family Medicine, Pediatrics,
Internal Medicine, Obstetrics and Gynecology,
Surgery)
b. Emergency Services
c. Outpatient Services
d. Ancillary and Support Services such as, clinical
laboratory, imaging facility and pharmacy
Specialty - a hospital that specializes in a particular disease or
condition or in one type of
patient. A specialized hospital may be devoted to treatment of
any of the following:
a. Treatment of a particular type of illness or for a
particular condition requiring a range of treatment
 b. Treatment of patients suffering from diseases of a
particular organ or group of organs
LEVEL OF HOSPITAL
- defined as the service capabilities of hospitals
reflected in the 2020 license to operate.
- These service capabilities can be classified into the
following categories.
CLASSIFICATION OF HOSPITAL (ACCORDING TO
OWNERSHIP)
Government - created by law, may be under DOH, DND, DOJ,
PNP, LGU, SUCs, GOCC and others
Private - may be a single proprietorship, partnership,
corporation, cooperative, foundation, religious, non-
government and others
CLASSIFICATION OF HOSPITAL (ACCORDING TO
TRAUMA CAPABILITY)
Trauma-Capable Facilty - DOH licensed hospital designated
as a trauma center
Trauma-Receiving Facilty - DOH licensed hospital within the
trauma service area which receives trauma patients for transport
to the point of care or trauma center
PRIMARY HEALTH CARE (PHC)
- ...essential health care based on practical,
scientifically sound and socially acceptable methods
made universally accessible to individuals and
families in the community through their full
participation and at a cost that the community can
afford to maintain at every stage of their development
in the spirit of self reliance and self determination
Brief History of PHC
1977
✓ WHO members, International Conference on Primary
Health Care in Alma Ata, Kazakhstan
✓ Resolution - 20th Word Health Assembly
✓ “the main social targets of governments and WHO in
the coming decades should be the attainment by all
citizens of the world by year 2000 of a level of health
that will permit them to lead a socially and
economically productive life”
1978
- Health, which is a state of complete physical, mental,
and social wellbeing, and not merely the absence of
disease or infirmity, is a fundamental human right and
that the attainment of the highest possible level of
health is a most important world-wide social goal
whose realization requires the action of many other
social and economic sectors in addition to the health
sector.
— Alma-Ata Declaration, 1978
2018
- Forty years later, global leaders ratified the
Declaration of Astana at the Global Conference on
Primary Health Care which took place in Astana,
Kazakhstan in October 2018
PHILIPPINE SETTING
✓ The 1992 implementation of the devolution of health
care to the local governments and the 1999 health
sector reform have brought about changes in the health
care delivery system.
✓ The revitalization of primary health care is a policy
issue to be addressed by national government, local
government, civil society groups and even the private
business sector, in the present set-up of a devolved
health care system.
PHILIPPINE SETTING: HISTORICAL TIMELINE
1978 – The Pilot Year
✓ The 1978 Alma Ata Declaration definitely spurred
changes in the Philippine health sector through
primary health care approach.
✓ The public health system experienced innovative and
pioneering changes when the Marcos administration
adopted the national plan and strategy for PHC
implementation.
✓ Pilot provinces in each of twelve (12) regions in the
country were selected according to certain criteria,
namely: health needs of the population, lack of
people's access to health services at the regional
center, poor peace and order condition.
1981 - Second Stage- Pre-Devolution: Institutionalization of
PHC
✓ The government moved the PHC from pilot stage to
institutionalization nationwide, until the ouster of
President Ferdinand Marcos in 1986.
✓ Initially under Pres. Marcos, the Ministry of Health
marshaled local government involvement and
community participation. This stage was sustained by
the new government of President Corazon Aquino in
1986 as the Department of Health pursued the policy
of engaging non-government organizations and
volunteer community/barangay health workers in
innovative health programs.
 ✓ Village drugstores (Botika ng Barangay) were set up
to make medicines affordable and accessible to the
poor and low income population.
1991 – Third Stage Devolution
✓ The Congress passed the Local Government Code and
the government began the process of devolution in
1992 that changed the system of health service
delivery, the role and functions of-national
government (Department of Health), and the
responsibilities of local government units.
✓ The process of transition to the devolved set up that
started in 1992 created some difficulties for the
Department of Health. The responsibilities over health
service delivery were transferred from national
government to local government.
✓ The hospitals came under the jurisdiction and
management of the provincial government, the rural
health clinics under the charge of the municipality/city
government, and the barangay health stations by the
respective barangays within the municipality/city.
Health personnel were also devolved from the national
level to the local government units in different parts of
the country.
✓ The national government, through the Department of
Health, took the view that PHC is an approach, a
strategy for application in health programs; that it is
not a program to be implemented by specific
offices/units as it was in the pre-devolution years.
✓ In 1996, the DOH affirmed its policy of Primary
Health Care for Community Health Development,
within the framework of devolution. It asserted the
principle of "health in the hands of the people" that
can be done through various community processes
✓ In different parts of the country, the NGOs played a
crucial role in the Department of Health's Partnership
for Community Health Development (PCHD) by using
their expertise in community organizing,
empowerment and mobilization for primary health
care.
1999 – Fourth Stage Devolution
✓ The Department of Health embarked on the process of
health sector reform. Specifically, the Health Sector
Reform Agenda (HSRA) aimed to address the problem
of fragmentation of the public health system during the
period of transition when health care services had just
been devolved from national to local government; as
well as to improve the system for health care services.
✓ The Department of Health began with initial pilot sites
and later expanded the implementation of the Health
Sector Reform Agenda (HSRA).
✓ The continuing adherence to PHC can be gleaned from
the following structures, policies and activities:
1. Formal inclusion of barangay health workers as a
category in the classification of health workers in
the public health system and formulation of
policies on their rights and privileges.
2. Continuing cooperation and support from NGOs
in government programs and projects, as
recognized pioneers in primary health care and
experts in community processes.
3. Existence of models and best practices in PHC
experience, including the legacies of trained
primary health care-oriented health professionals
and community workers and of processes in
organizing and mobilizing for community based
and community managed health interventions.
4. Enactment of relevant laws, i.e., National Health
Insurance Act, the Generics Act, and the National
Drug Act.
UNIVERSAL TARGET
✓ Health for all by the year 2000 (HFA 2000)
✓ Does not mean that nobody will get sick anymore
✓ Concept was left for every country to define and
interpret in consideration of the:
➢ Health status
➢ Morbidity
➢ Mortality
➢ State of development of a health care system
PHC Goals
✓ To achieve Health for All that is:
➢ Accessible to everyone
➢ Acceptable and affordable to everyone
➢ Based in the community or workplace
Essential Health Services in Primary Health Care
E – Education for Health
L – Locally endemic disease control
E – Expanded program for immunization
M –Maternal and Child Health including
responsible parenthood
E – Essential drugs
N – Nutrition
T – Treatment of communicable and non-
communicable diseases
S - Safe water and sanitation
Essential Elements/Services of PHC
1. Education concerning prevailing health problems and
the methods of preventing and controlling them
2. Promotion of food supply and proper nutrition
3. An adequate supply of safe water and basic sanitations
4. Maternal and child health care, including family
planning
 5. 5. Immunization against the major infectious diseases
6. 6. Prevention and control of locally endemic diseases
7. 7. Appropriate treatment of common diseases and
injuries
8. 8. Provision of essential drugs
Guiding Principles
1. Equitable distribution of health services
✓ Based on need
✓ Services to the majority
2. Active community participation and involvement in the
planning, implementation and evaluation of health services
✓ Active partners in the health development process
✓ Not as passive recipients of health services
3. The use of appropriate technology in the delivery of
health services
✓ Includes facilities, equipment, methods, techniques,
procedures, supplies and materials
✓ Scientifically sound, affordable and within the
community’s ability and resources to use, maintain,
and manage
e.g. Water sealed toilets not appropriate in areas with water
supply problems
4. Focus on health promotion and disease prevention
✓ Shift of health care system priorities
✓ From hospitals and curative care to health promotion
and disease prevention
5. A multi-sectoral approach to community health
development
✓ Agriculture, industry, education, mass media, religion,
culture and politics
✓ Role and contribution are recognized and utilized
LEVELS OF PREVENTION
UNIVERSAL HEALTH CARE
- Universal health coverage means that all people have
access to the health services they need, when and
where they need them, without financial hardship. It
includes the full range of essential health services,
from health promotion to prevention, treatment,
rehabilitation, and palliative care.
UHC’s Three Thrusts
- To attain UHC, three strategic thrusts are to be
pursued, namely:
- 1) Financial risk protection through expansion in
enrollment and benefit delivery of the National Health
Insurance Program (NHIP);
- 2) Improved access to quality hospitals and health care
facilities; and
- 3) Attainment of health-related Millennium
Development Goals (MDGs).
RA 11223: Universal Health Care Act
The policy of the State to protect and promote the right to health
of all Filipinos and install health consciousness among them.
Towards this end, the State shall adopt:
a. An integrated and comprehensive approach to ensure
that all Filipinos are health literate, provided with
healthy living conditions and protected from hazards
and risks that could affect their health;
b. A health care model that provides all Filipinos access
to a comprehensive set of quality and cost-effective,
promotive, preventive, curative, rehabilitative and
palliative health services without causing financial
hardship, and prioritizes the needs of the population
who cannot afford such services;
c. c. A framework that fosters a whole-of-system, whole-
of-government, and whole-of-society approach in the
development, implementation, monitoring and
evaluation of health policies, programs, and plans; and
d. d. A people-oriented approach for the delivery of
health services that is centered on people’s needs and
well-being, and cognizant of the differences in culture,
values, and beliefs.
Universal Health Care Act: OBJECTIVES
✓ Progressively realize universal health care in the
country through a systematic approach and clear
delineation of roles of key agencies and stakeholders
towards better performance in the health system; and
✓ Ensure that all Filipinos are guaranteed equitable
access to quality and affordable health care goods and
services, and protected against financial risk.
POPULATION-BASED HEALTH SERVICES
-refer to interventions such as health promotion, disease
surveillance, and vector control, which have population groups
as recipents
Province-wide and city-wide health systems shall have the
following minimum components:
1. Primary care provider network with patient records
accessible throughout the health system
2. Accurate, sensitive, and timely epidemiologic
surveillance systems
3. Proactive and effective health promotion programs or
campaigns
INDIVIDUAL-BASED HEALTH SERVICES
-refer to services which can be accessed within a health facility
or remotely that can be definitely traced back to one (1)
recipient, has limited effect at a population level and does not
alter the underlying cause of illness such as ambulatory and
inpatient care, medicines, laboratory tests and procedures,
among others
INTEGRATION OF LOCAL HEALTH SYSTEMS
Integration of Local Health Systems into Province-wide and
City-wide Health System (P/CWHS)
 ✓ The DOH, DILG, PhilHealth and the LGUs shall RA No. 7846
endeavor to integrate health systems into P/CWHS.
✓ The Provincial and City Healths Boards shall oversee
An Act requiring compulsory immunization against
and coordinate the integration of health services for
P/CWHS, to be composed of municipal and Hepatitis B for infants and children below eight years old,
component city health systems, and city-wide health amending for the purpose Presidential Decree No. 996,
systems in highly urbanized and independent December 30, 1994.
component cities, respectively.
DOH AO No. 39, s. 2003
KEY ACTIVITIES OF THE DOH FOR UHC ACT
1. Engagement of the 58 UHC Integration Sites
2. Development of 59 Operational Guidelines and (April 21, 2003) guided the nationwide implementation
Policies of the EPI.
3. Capacity building through E-Learning Modules
*UHC Integration Sites referes to LGUs that expressed their RA No. 10152
commitment to integrate local health systems into province-
wide and city-wide health systems.
Mandatory Infants and Children Health Immunization
Act of 2011Signed by President Benigno Aquino III in July
26, 2010. The mandatory includes basic immunization for
EPI (Expanded Program on Immunization) children under 5 including other types that will be
determined by the Secretary of Health.
The Expanded Program on Immunization
(EPI) was established in 1976 to ensure that infants/children Supporting Data and Statistics
and mothers have access to routinely recommended
infant/childhood vaccines. Six vaccinepreventable diseases
POLIOMYELITIS- The Philippines has sustained its polio-
were initially included in the EPI: tuberculosis, poliomyelitis,
diphtheria, tetanus, pertussis and measles. free status since October 2000.

The Fundamental Law of the Land
the 1987 Philippine Constitution – says that “…to make
essential goods, health and other social services available
to all people at affordable cost… There shall be priority
for the needs of the underprivileged, sick, elderly,
disabled, women, and children” (Article XIII, Section 11,
1987)
Measles Elimination Conducted 4 rounds of mass
measles campaign: 1998, 2004, 2007 and 2011. 2-dose
measles-containing vaccine (MCV) was implemented in
2009 MCV1 (monovalent measles) at 9-11 months old
MCV2 (MMR) at 12-15 months old.

Presidential Decree (PD) No. 996

(September 16, 1976) provides for compulsory basic

immunization for infants and children below eight years
old.

Presidential Proclamation No. 6

Implementing the Expanded Program on Immunization

(EPI), in response to the United Nation’s goal of universal
child immunization by 1990.
Proclamation No. 46
(September 16, 1992) reaffirmed the Philippines’
commitment to universal goal of eradicating polio by
2000 through child and mother immunization.
Maternal and Neonatal Tetanus Elimination
10 areas were classified as highest risk for neonatal
tetanus (NT). These areas are the following: Abra,
Banguet, Isabela City and Basilan, Lanao Norte, Cotabato
City, Maguindanao, Lanao Sur, Marawi City and Sulu.
Hepatitis B Control

The goal of Hepatitis B control is to lower the chronic

hepatitis B infection rate, as defined by HBsAg
prevalence, to less than 1% in five-year-olds born after
routine vaccination began with a 100% Hepatitis B at PARTNER INSTITUTION
birth immunization.
INTERNATIONAL HEALTH PARTNERS

-Global Alliance for Vaccines and Immunization (GAVI)

-Coalition for Epidemic Preparedness Innovations (CEPI)
-Centers for Disease Control and Prevention (CDCP)
-United Nations Children’s Fund (UNICEF)
-World Health Organization (WHO)

LOCAL HEALTH PARTNERS

Introduction to New Vaccines
-Department of Health (DOH)
As of 2012, Rotavirus and Pneumococcal vaccines were
-Department of Education (DepEd)
introduced in the national immunization program.
-Department of Social Welfare and Development (DSWD)
Immunization are prioritized among the infants of
- Department of the Budget and Management (DBM)
families listed in the National Housing and Targeting
-Material Management Division (MMD)
System (NHTS) for Poverty Reduction nationwide.
-Research Institute for Tropical Medicine (RITM)
- Food and Drug Administration (FDA)
PROGRAM COMPONENTS: GOALS AND OBJECTIVES
STRATEGIES AND ACTIVITIES
Important components of management of EPI
1. Expand the package of quality immunization
1. cold chain maintenance
services and scale up coverage
2. record keeping and evaluation
2. Generate clients demand and multisectoral
3. uniform vaccination coverage standards 12:01 PM
support for immunization services
4. communication with the public through various media.
3. Strengthen surveillance and response
4. Build-up supervision, monitoring and evaluation
The ultimate Objective of EPI
5. Institute supportive governance, financing and
regulatory measures
To reduce the morbidity of the diseases for which vaccine
is available.
EPI ACTIVITIES
SPECIFIC GOALS
• 1976 BCG first administered among school
entrants DPT introduced in priority areas
1. To immunize all infants/children against the most
• 1979 BCG and DPT provided nationwide; OPV
common vaccinepreventable diseases.
and tetanus toxoid (TT) for pregnant women
2. To sustain the polio-free status of the Philippines.
provided in high risk areas
3. To eliminate measles infection.
4. To eliminate maternal and neonatal tetanus • 1983 MV provided nationwide 2005 Hepatitis B
5. To control diphtheria, pertussis, hepatitis b and provided nationwide
German measles. • 2012 PENTA administered Nationwide Rotavirus
6. To prevent extra pulmonary tuberculosis among vaccine provided among children in indigent
children. families Anti-Influenza Vaccine and PPV 23
provided for indigent senior citizens
TARGET CLIENTS • 2016 Switch from tOPV to bOPV IPV provision
expanded to 6 regions Td and MR vaccines
provided in all public schools HPV vaccination
expanded to 48 provinces
• 2017 MV was replaced with MMR TT vaccine for
CBAW was replaced with Td Anti-Influenza
Vaccine and PPV 23 provided for all senior citizen
at ages 60 to 65 year
EPI STRATEGIES AND ACTIVITIES (MIMAROPA)
S1. Conduct of Routine Immunization for
Infants/Children/Women through the Reaching Every
Barangay (REB) or Reaching Every Purok (REP) strategy.
S2. Supplemental Immunization Activity (SIA):
• 1998- Ligtas Tigdas 2004- Ligtas Tigdas (follow -
up of 1998)
• 2007- Knockout Tigdas (sequel of 1998 and 2004)
• 2011- Iligtas sa Tigdas and Pinas/Mr Sia)
• 2014- Measles Rubella- Oral Polio Vaccine (MR
OPV)
• 2015- School-Based Adolescent Imm. Activity
(SBAI
• S3. Strengthening Vaccine – Preventable Disease
Surveillance
IMCI
WHAT IS IMCI?
IMCI is an integrated approach to child health that
focuses on the well-being of the whole child.
It is a major strategy for child survival, healthy growth
and development and is based on the combined delivery
of essential interventions at community, health facility
and health systems levels.
It is a case management process and strategy for first-
level facility such as a health center to achieve a
significant reduction in the number of deaths from
communicable diseases in children under five.
IMCI includes elements of prevention as well as curative
and addresses the most common conditions that affect
young children.
IMCI POLICIES AND LAWS
IMCI aims to reduce death, illness and disability, and to
promote improved growth and development among
infants and children aged less than 5 years. IMCI includes
both preventive and therapeutic elements that are
implemented by families and communities as well as by
health workers in facilities.
RA 11148
This Act covers those who are nutritionally-at-risk,
especially pregnant and lactating women, particularly
teenage mothers, women of reproductive age,
adolescent girls, and all Filipino children who are newly
born up to age twenty-four (24) months.
RA 10821
Republic Act (RA) 10821 or the Children's Emergency
Relief and Protection Act sets a standard of
accountability to children in terms of protection and
provision of their needs before, during, and after a
disaster.
REPUBLIC ACT No. 10028
An act expanding the promotion of breastfeeding,
amending for the purpose republic act no. 7600,
otherwise known as "an act providing incentives to all
government and private health institutions with
rooming-in and breastfeeding practices and for other
purposes"
Revised Implementing Rules And Regulations of
Executive Order No. 51,
Otherwise Known as The "Milk Code", Relevant
International Agreements, Penalizing Violations Thereof,
and for Other Purposes
Components of IMCI
➢ Improving case management skills of health
workers
11-day Basic Course for RHMs, PHNs
and MOHs
5 - day Facilitators course
5 – day Follow-up course for IMCI
Supervisors
➢ Improving over-all health systems.
➢ Improving family and community health
practices
OBJECTIVES OF IMCI
Reduce death and frequency and severity of illness and
disability, and
Contribute to improved growth and development
TARGET CLIENTS
Sick children birth up to 2 months
(Sick Infant)
Sick children 2 months up to 5 years old (Sick Child)
IMCI PARTNER INSTITUTIONS
National/Government
• -Department of Interior Local Government (
DILG)
• -Public Information Agency
• Local/Youth/CSOs, NGOs
• -Local Government Units (LGUs)
International Partners
• -World Health Organization (WHO)
• -United Nations Children’s Funds
• -Save the Children
BASIS FOR CLASSIFYING THE CHILD’S ILLNESS
PINK- indicates urgent hospital referral or admission
YELLOW- indicates initiation of specific Outpatient
Treatment
GREEN – indicates supportive home care
STRATEGIES AND PRINCIPLES
1. Ask the mother what is the problem of the child.
2. All sick children aged 2 months up to 5 years are
examined for GENERAL DANGER SIGNS (GDS):
-A general danger signs is present if the child is/has:
C-onvulsions
U-nable to feed, drink or breastfeed
V-omits everything
A-bnormally sleepy/difficult to awaken (lethargic
or unconscious)
Remember: 1 Danger Sign =Severe Classification
• -All Sick Young Infants Birth up to 2 months are
examined for VERY SEVERE DISEASE AND LOCAL
BACTERIAL INFECTION. These signs indicate
immediate referral or admission to hospital
• -The children and infants are then assessed for
main symptoms. For sick children, the main
symptoms include: cough or difficulty
breathing, diarrhea, fever and ear infection. For
sick young infants, local bacterial infection,
diarrhea and jaundice.
• All sick children are routinely assessed for
nutritional, immunization and deworming status
and for other problems
• Only a limited number of clinical signs are used
• A combination of individual signs leads to a
child’s classification within one or more
symptom groups rather than a diagnosis.
• IMCI management procedures use limited
number of essential drugs and encourage active
participation of caretakers in the treatment of
children
• Counselling of caretakers on home care, correct
feeding and giving of fluids, and when to return
to clinic is an essential component of IMCI
THE IMCI CASE MANAGEMENT PROCESS
1. Assess and classify
-taking a history and doing a physical
examination
-making a decision on the severity of the illness.
2. Identify appropriate treatment
-the charts recommend appropriate treatment
for each classification.
3. Treat/refer
-giving treatment in health center, prescribing
drugs or either treatments to be given at home,
and also teaching the mother how to carry out the
treatments.
4. Counsel
 -includes assessing how the child is fed and
telling her about the foods and fluids to give the child and
when to bring back to the health center.
5. Follow-up
describe what to do when a child returns to the
health center by arrangemnet for a follow-up visit.
UNANG YAKAP:
ESSENTIAL
NEWBORN CARE
(PROTOCOL FOR
NEWLIFE)
I. INTRODUCTION
• What is EINC?
Essential Intrapartum Newborn Care is a package
of evidenced based practices recommended by
the DOH, PhilHealth and WHO as the standard of
care by all births by skilled attendants in all
Government and Private Settings
• EINC is a series of time-bound and evidence-
based interventions for newborn babies and
their mothers that ensure the best care for
them, when it was developed and further
studies was made, WHO supported the
Philippine government in promoting safe and
effective health care for mothers and babies
including the development and
implementation of the EINC protocols.
• Development of EINC
• The ENC Protocol was developed by the
Newborn Care Technical Working Group
(TWG)
• The TWG conducted a systematic search and
critical appraisal of foreign and local medical
and allied health literature on practices in the
immediate newborn period.
• An evidence-based draft was then developed
and reviewed by the Department of Health
(DOH)
• Organizations like UN, UNICEF, UNFPA
and POGS reviewed the draft.
• Goals and Objectives
1. Guide health workers and medical practitioners in
providing evidenced-based essential newborn
care.
• This is to ensure that newborn babies receive the
best and quality newborn care that is based on
evidences and studies, and also to reduce the risk
for complications such as hypothermia and
sepsis.
2. Define the roles and responsibilities of the
different DOH Offices and other agencies in the
implementation of the Newborn Protocol.
• This goal is included in the Administrative Order
No. 2009-0025. It aims to define the roles and
responsibilities of the people and agencies that
are connected with the implementation of EINC
to provide a safe, organized and evidenced-based
protocol to ensure the quality care for newborn.
One of its main goals is to promote evidence-based care
eliminating stereotyped newborn care practices such as
unnecessary suctioning and bathing instead of carrying
out a step-by-step time bound intervention and to achieve
the United Nations Millennium Development Goal 4 of
Reducing Under 5 Child Mortality (through reduction of
neonatal deaths).
• Unang Yakap
Unang Yakap is a simple and evidence-based
interventions that may help in ensuring the survival of
all newborns and young infant. This compasses
interventions such as ensuring warmth, breastfeeding,
love and safety and infection control.
• The most important outcome of Unang Yakap is
the promotion of breastfeeding. Since the baby is
placed closely to the mother’s breast he becomes
familiar with the breast as the source of food.
According to Dr Teresita “Tetchie” Cadiz Brion,
from an interview with UNICEF, the most
important outcome of Unang Yakap is the
promotion of breastfeeding. Since the baby is
placed closely to the mother’s breast he becomes
familiar with the breast as the source of food. She
highlighted the importance of collaboration
between and continuous training of all the health
workers and volunteers involved in the care of
mothers and newborns. Even doctors who are
non-first liners from other specialties were
trained for additional support.
 II. INTERVENTIONS AND
PROCESSES
• Introduction
Standard essential newborn care practices and guidelines
are organized by time, beginning at the time of perineal
bulging until one week of life. In EINC, interventions are
given emphasis that should be provided from birth of the
newborn until the first 6 hours of life ‘til the first week of
life.
• This is to ensure and prevent risks and
complications for newborns. In the
Administrative Order 2009-0025, it mentioned
the Ensure Quality Provision of Time-bound
Intervention where the aspect of newborn care in
the Philippines has not met the International
Standards, and should be re-learned and re-taught
by all healthcare providers. That is why they
formulated the four-time bound interventions of
EINC.
• 4-Time Bounded Interventions
1. Immediate thorough drying –
- Use a clean, dry cloth to thoroughly dry
the newborn by wiping the eyes, face,
head, front and back, arms and legs.
- Do a quick check of newborn's breathing
while drying
- Do not put the newborn on a cold or wet
surface.
- Do not bathe the newborn earlier than 6
hours of life.
2. early skin-to-skin contact –
- Place the newborn prone on the mother's
abdomen or chest, skin-to-skin.
- Cover the newborn's back with a blanket
and head with a bonnet.
- Do not separate the newborn from the
mother, as long as the newborn does not
exhibit severe chest in-drawing, gasping
or apnea and the mother does not need
urgent medical/surgical stabilization e.g.
emergency hysterectomy.
- Do not wipe off vernix if present.
3. properly-timed clamping and cutting of the cord
after 1 to 3 minutes
- Clamp and cut the cord after cord
pulsations have stopped (typically at 1 to
3 minutes). Do not milk the cord towards
the newborn.
- Put ties tightly around the cord at 2 em
and 5 em from the newborn's abdomen.
- Cut between ties with sterile instrument.
- Observe for oozing blood.
After cord clamping, ensure 10 IU Oxytocin 1M is given
to the mother.
4. non-separation of the newborn from the mother
for early breastfeeding initiation and rooming-in
- Leave the newborn on the mother's chest
in skin-to-skin contact. Health workers
should not touch the newborn unless
there is a medical indication.
- Observe the newborn. Advice the mother
to start feeding the newborn once the
newborn shows feeding cues (e.g.
opening of mouth, tonguing, licking,
rooting). Make verbal suggestions to the
mother to encourage her newborn to
move toward the breast e.g. nudging.
- Counsel on positioning and attachment.
When the newborn is ready, advise the
mother to position and attach her
newborn.
- Advise the mother not to throwaway the
colostrum.
4.2. Objective: To prevent ophthalmia neonatorum
through proper eye care
- Administer erythromycin or tetracycline
ointment or 2.5% povidone-iodine drops
to both eyes after the newborn has
located the breast.
- Do not wash away the eye antimicrobial.
• Non-intermediate Interventions
1. Give Vitamin K prophylaxis
- Inject a single dose of Vitamin K 1 mg
1M (if parents decline intramuscular
injections, offer oral vitamin K as a 2nd
line).
2. Inject Hepatitis Band BCG vaccinations
- Inject hepatitis B vaccine 1M and BCG
intradermally.
3. Examine the newborn. Check for birth
injuries, malformations or defects.
- Look for possible birth injury and/or
malformations.
4. Cord Care
- Explain to the mother that she should
seek care if the umbilicus is red or
draining pus.
 - Teach the mother to treat local umbilical
infection three times a day.
• Discontinued Newborn Care Practices in the
Delivery Room
1. Manipulation such as routine suctioning of
secretions if the baby is crying and breathing
normally.
- Doing so may cause trauma or introduce
infection.
2. Putting the newborn on a cold or wet surface.
- The reason why this is discontinued it’s
because of the risk and possibility for the
newborn to acquire hypothermia that’s
why it was mentioned in the 4-Time
bounded interventions that immediate
thorough drying is essential and is the
first step to newborn care.
3. Wiping or removal of vernix caseosa if
present
- Vernix caseosa is a white, creamy,
naturally occurring biofilm covering the
skin of the fetus during the last trimester
of pregnancy. Vernix coating on the
neonatal skin protects the newborn skin
and facilitates extra-uterine adaptation of
skin in the first postnatal week if not
washed away after birth.
4. Foot printing
- In the first few minutes following
delivery, the newborn’s feet are pressed
into a common inkpad and later pressed
onto an identification sheet. Not only is
this practice is usually done by untrained
personnel with variable results, but more
importantly also increases the risk of
cross-contamination among the babies.
In 1988, the American Academy of
Pedicatrics (AAP) and the American
College of Obstetricians and
Gynecologists (ACOG) stated that
“individual hospitals may want to
continue the practice of footprinting or
fingerprinting, but universal use of this
practice is no longer recommended.”
5. Bathing earlier than 6 hours of life
- The minimum time recommended falls
between 6-8 hours after birth (WHO,
AWHONN, Save the Children). It is
suggested that the bath be done with the
parents involved so that they can learn
the process and limit separation.
Additionally, it is important to get baby
back in a skin to skin position
immediately after to minimize effects
from the cold.
• Significance of EINC and Unang Yakap
- Dr. Teresita Brion explained that “The
Unang Yakap or Essential Intrapartum
Newborn Care was really conceptualized
in order to have early initiation of
breastfeeding. So how early is early? As
early as delivery. The newborn is placed
strategically on the mother’s breast so he
will be able to feed immediately when he
is hungry. What’s good about Unang
Yakap is that it respects the readiness of
the baby to breastfeed as manifested by
feeding cues”.
III. DATA AND STUDIES
1. First Slide
(read the slide first)
- In the Philippines, an estimated 82 000 of
2.4 million children die annually before
their fifth birthday with half occurring
among newborns. While post-neonatal
deaths decreased between 1990 and
2005, neonatal mortality did not.
2. Second Slide
(read slide first)
- As what was mentioned, 82,000 of 2.4
million children dies annually before
their fifth birthday, this decreased from
52 per 1000 livebirths in 1998 to 32 per
1000 livebirths in 2003, the problem is
that neonatal deaths decrease slowly. As
a response, the Philippines Department
of Health (DOH), World Health
Organization (WHO) and partners
developed and adopted a systems
approach to improve newborn care
practices.
3. Third Slide
(read slide first)
- These are the most common reasons for
neonatal deaths according to the analysis
and data of DOH.
o Birth Asphyxia - happens when a baby's
brain and other organs do not get enough
oxygen and nutrients before, during or
right after birth. This can happen without
 anyone knowing. Without oxygen and
nutrients, cells cannot work properly.
o Complications of Prematurity - Management of Childhood Illnesses
Premature births can happen suddenly,
with no known cause. Sometimes
providers have to induce (start) labor
early for medical reasons. Women can
also go into premature labor due to:
- Chronic health conditions, such as
diabetes or infections.
- Drug or alcohol abuse.
- Multiple pregnancies, such as twins
or triplets.
- Preeclampsia (high blood pressure
during pregnancy).
• Severe Infection – with the initiation of
skin-to-skin contact of the newborn and
mother, this will prevent infection and
increases colonization with protective
bacterial flora.
4. Fourth and Fifth Slide
(self-explanatory)
IV. POLICIES AND LAWS
• Implementing Mechanism
- The signing of the Administrative
Order 2009-0025 last Dec. 1, 2009
institutionalizes policies and
guidelines for government and
private health facilities to adopt the
essential newborn care protocol.
Advocacy and dissemination for a
have been done since its launch.
Scale-up implementation in all health
facilities and social marketing are
both in the pipeline to ensure that the
policy is implemented all over the
country.
- The Teams are strategically
dispersed throughout the Province to
ensure timely access to obstetric and
newborn emergency care by
mothers. The Teams shall provide
the full maternal and newborn care,
family planning, adolescent
reproductive health and STI and HIV
service packages to the general
population as well child survival
packages: Infant and Young Child
Feeding (IYCF), Integrated
(IMCI), Expanded Program on
Immunization (EPI), etc.
• Laws and Administrative Orders in line
with the Implementation of EINC
protocol
• Maternal, Newborn and Child Health
Nutrition (MNCHN) Strategy (In line
with the DOH Administrative Order
2008-0029
- Administrative Order 2008-0029
entitled: “Implementing Health
Reforms for the. Rapid Reduction of
Maternal and Neonatal Mortality”,
requires that “every birth delivery
should be done by skilled birth
attendants”. Thus, it may be manned
by a physician – obstetrician –
gynecologist, pediatrician, family
medicine specialist, general
practitioner, midwife and/or a nurse.
The MNCH strategy was acquired by
the DOH and used it’s service
delivery team for implementation of
the EINC Protocol.
• Mother-Baby Friendly Hospital Initiative
(MBFHI) and Infant and Young Child
Feeding Strategy and Republic Act
10028
- Mother-Baby Friendly Hospital
Initiative - What is the main purpose
of Baby-Friendly Hospital Initiative?
The Baby-friendly Hospital Initiative
is a global effort to implement
practices that protect, promote and
support breastfeeding. It aims to
ensure that all maternity facilities
become centres of breastfeeding
support.
- Infant and Young Child Feeding
Strategy - What is the aim of infant
and young child feeding? The aim of
this strategy is to improve – through
optimal feeding – the nutritional
status, growth and development,
health, and thus the survival of
infants and young children.
- RA 10028 - "An act providing
incentives to all government and
private health institutions with
 rooming-in and breastfeeding
practices and for other purposes".
- Moreover, the connection of these
laws and policies with the EINC
protocol is to promote breastfeeding
and proper nutrition for children as
early as right after birth. That is why
early skin-to-skin contact is initiated
in the 4-time bounded interventions
to promote latching and nudging on
to the mother’s breast.
- Congenital Adrenal Hyperplasia
(CAH)
- Phenylketonuria (PKU)
- Galactosemia (GAL)
- Glucose-6-Phosphate
Dehydrogenase (G6PD) Deficiency
- Maple Syrup Urine Disease
(MSUD)
CONDITIONS THAT NBS TESTS:

NEWBORN SCREENING PROGRAM

TESTS FOR NEWBORN SCREENING

- Blood Test or Heel Stick
- Hearing Screen
- Pulse Oximetry
CLAIMING OF RESULTS NEWBORN PACKAGE

- Results can be claimed from the

health facility where ENBS was
availed. Normal ENBS results are
available by 7-14 working days
from the time samples are received at
the NSC.
- Positive ENBS results are relayed to
the parents immediately by the health
facility. Please ensure that the
address and the phone number you
will provide to the health facility are
ELIGIBILITY CONDITIONS FOR NEWBORNT
correct.
TO AVAIL NCP
DISORDERS INCLUDED IN NEWBORN
- Either of the parents are eligible to
SCREENING TEST
avail the benefits, newborns
- Congenital having qualified dependents are
- Hypothyroidism (CH) also eligible
 - They were born in accredited
facilities that perform deliveries,
such as hospitals and birthing
homes
- Services were availed upon
delivery
REQUIREMENT FOR HEALTH CARE INSTITUTION
TO REIMBURSE WITH NCP
- HCI are accredited to facilities
that can perform deliveries
- The new born is eligible to claim
for NCP.
- The newborn is attended by an
accredited health care professional
- Essential new born care and new
born screening were given to the
new born prior to discharge
NBS CAN BE PERFORMED IN:
- Hospital
- Lying-in (paanakan)
- Health center
- Private Clinic
GOAL AND OBJECTIVE
- Program Objectives: By 2030,
all Filipino newborns are screened;
Strengthen quality of service and
intensify monitoring and evaluation
of NBS implementation; Sustainable
financial scheme; Strengthen patient
management
Policies and Laws:
RA 9288 or the Newborn Screening Act of 2004 and DOH
AO No. 2014-0045 or the Guidelines on the
Implementation of the Expanded Newborn Screening
Program
Target Population:
All Filipino newborns
Area of Coverage:
Nationwide
The following institutions/units and bodies are the
primary partners of DOH-Family Health Office at the
national level to ensure that appropriate policies,
standards, logistics and technical assistance are
available to all implementing units:
A. National Technical Working Group on Newborn
Screening Program (NTWG- NBS)
B. National Institutes of Health (NIH)
C. NIH-Newborn Screening Reference Center (NIH-
NSRC)
D. DOH Epidemiology Bureau (EB)
E. DOH Health Facilities and Services Regulatory Bureau
(HFSRB)
F. DOH Health Facility Development Bureau (HFDB)
G. DOH National Center for Health Promotion (NCHP)
H. NIH - Institute of Human Genetics (NIH-IHG)
I. Department of the Interior and Local Government
(DILG)
K. Council for the Welfare of Children (CWC)
L. Philippine Health Insurance Corporation (PhilHealth)
STRATEGIES AND ACTIVITIES

● National Safe Motherhood Program (NSMP)
Focus on making pregnancy and childbirth safer
and sought to change fundamental societal dynamics that
influence decision making on matters related to
pregnancy and childbirth while it tries to bring quality
emergency obstetrics and newborn care facilities nearest
to homes. this move ensures that those most in need of
quality health care by competent doctors, nurses and
midwives have easy access to such care.
Program Description in Relation to Family Health
➢ In many families, the responsibility of family
health falls mainly to the mother. Establishing
core knowledge base and support systems that
facilitate the delivery of quality maternal and
newborn health services to the families of the
country.
Mothers, Pregnant Women, and Children
Program Components
Component A
➢ This component supports LGUs in
establishing and mobilizing the service
delivery network of public and private
providers to enable them to deliver the
integrated maternal-newborn service package.
In each province and city, the following shall
continue to be undertaken:
1. Establishment of critical capacities to provide
quality maternal-newborn services through
the organization and operation of a network of
Service Delivery Teams.
2. In collaboration with the Centers for health
Development and relevant national offices:
Establishment of Reliable Sustainable Support
Systems for Maternal-Newborn Service
Delivery through such initiatives as:
a. Establishment of Safe Blood Supply
Network with support from the
National Voluntary Blood Program
b. Behavior Change Interventions in
collaboration with the Health
Promotion and Communication
Service
c. Sustainable financing of maternal -
newborn services and commodities
through locally initiated revenue
generation and retention activities
including PhilHealth accreditation
and enrolment.
Component B
1. Operational and Regulatory Guidelines
a. Identification and profiling of current
FP users and identification of potential
FP clients and those with unmet need
for FP
b. Mainstreaming FP in the regions with
high unmet need for FP
c. Development and dissemination of
Information, Education
Communication materials
d. Advocacy and social mobilization for
FP
● 2. Network of Training Providers
a. 31 Training Centers that provide
BEmONC Skills Training
b. 3. Monitoring, Evaluation, Research,
and Dissemination with support from
the Epidemiology Bureau and Health
Policy Development and Planning
Bureau
c. Monitoring and Supervision of Private
Midwife Clinics in cooperation with
PRC Board of Midwifery and
Professional Midwifery
Organizations.
d. Maternal Death Reporting and Review
System in collaboration with
Provincial and City Review Teams
 e. Annual Program Implementation
Reviews with Provincial Health
Officers and Regional Coordinators
Goals/ Objectives
The Program contributes to the national goal of improving
women’s health and well-being by:
1. Collaborating with Local Government Units in
establishing sustainable, cost-effective
approach of delivering health services that
ensure access of disadvantaged women to
acceptable and high quality maternal and
newborn health services and enable them to
safely give birth in health facilities near their
homes.
2. Establishing core knowledge base and support
systems that facilitate the delivery of quality
maternal and newborn health services in the
country.
Policies and Laws
Republic Act No. 10354: Responsible Parenthood and
Reproductive Health Law (RPRH Act of 2012)
1. Administrative Order 2008-0029:
Implementing Health Reforms to Rapidly
Reduce Maternal and Neonatal Mortality
2. Department Order 2009-0084: Guidelines
Governing the Payment of Training Fees
relative to the Attendance of Health Workers
to Basic Emergency Obstetric and Newborn
Care Skills Training Course at Duly
Designated Training Centers
3. Administrative Order 2011-0011:
Establishment of Basic Emergency Obstetric
and Newborn Care Training Centers in
Regional Hospitals and Medical Centers
Republic Act No. 10354: Responsible Parenthood and
Reproductive Health Law (RPRH Act of 2012)
4. Administrative Order 2015-0020: Guidelines in the
Administration of Life Saving Drugs During Maternal
Care Emergencies by Nurses and Midwives in
Birthing Centers
5. Administrative Order 2016-0035: Guidelines on the
Provision of Quality Antenatal Care in All Birthing
Centers and Health Facilities Providing Maternity
Care Services
6. Administrative Order 2018-0003: National Policy
on the Prevention of Illegal and Unsafe Abortion and
Management of Post-Abortion Complications
Strategies
Strategic change in the design of safe motherhood
services:
✓ a shift in emphasis from the risk approach
that identifies high-risk pregnancies during
the prenatal period to an approach that
prepares all pregnant women for the
complications at childbirth
✓ improved quality of family planning
counseling and expanded services availability
of post-partum family planning in hospitals
and primary birthing centers
✓ the integration of cervical cancer, syphilis,
hepatitis B and HIV screening among others
into the antenatal care protocols
An integrated package of women’s health and safe
motherhood services:
✓ This service delivery strategy is
focused on maximizing synergies among key
services that influence maternal and newborn
health and on ensuring a continuum of care
across levels of the referral system. At the
ground level, this implies that a woman who
seeks care from a public health provider for
reproductive health concerns, could expect to
be given a comprehensive array of services
that addresses her most critical reproductive
health needs.
“New normal” adaptive plan
To improve the services for pregnant women, Dr.
Danila said that they are implementing a “new
normal” adaptive plan.
This plan includes:
• strengthening the health system response
within the Health Care Provided Network
while maintaining the BEmONC - CEmONC
configuration;
• ensure continuous provision of maternal
health services;
• maximize teleconsulting and teleprescription
platforms for antenatal and postpartum care;
and
 • all other activities such as BEmONC training
and conduct of death reviews as well as safe
motherhood shall be conducted online.
NUTRITION PROGRAMS
- refers to a program that is
implemented through a 1. Appropriate complementary feeding
collaborative effort from multiple
sectors .
- to improve people's nutritional
status, and reduce maternal and
child mortality and stunting
Presidential Decree 491 of 1974 or the Nutrition Act of
the Philippines created the National Nutrition Council
(NNC) to supervise, coordinate and evaluate the
implementation of the national nutrition program which
shall be implemented by all agencies and
instrumentalities of both the government and the private
sector concerned with improving the nutrition of our
people.
Presidential Decree no. 1569
strengthens the Barangay Nutrition Program by
providing for a Barangay Nutrition Scholar (BNS) in every
barangay to assist in the coordination and
implementation of nutrition programs, projects and
activities in the barangay level
Letter of Instruction 441 of 1976 Instructs various
departments of government to address malnutrition.
This issuance authorizes the Department of the Interior
and Local Government (DILG) to establish functioning
nutrition committees at different administrative levels
(barangay, municipality, city, province, and region) to
coo.
The Local Government Code of 1991 (Republic Act 7160)
mandates local government units to exercise their
powers and discharge their functions as are necessary
and appropriate for the effective provision of basic
services including child welfare and nutrition services.
PROGRAM DESCRIPTION IN RELATION TO FAMILY
HEALTH
These programs tend to target children, women of
childbearing age, and pregnant or lactating women.
These groups are especially vulnerable to the
detrimental effects of malnutrition.
PROGRAM COMPONENTS
A. Breastfeeding Practices (IYCF)
1. Exclusive Breastfeeding for the first six months
2. Extended breastfeeding up to three years.
B. Complementary Feeding Practices (IYCF)
C. Micronutrient Supplementation
1. Universal Vitamin A supplementation
2. Iron Supplementation
D. Universal Salt Iodization
E. Food Fortification
F. Mother Baby Friendly Health Initiative (MBFHI)
G. Philippine Integrated Management of Acute
Malnutrition (PIMAM)
H. Home, school and Community Food production
I. FOOD ASSISTANCE
PROGRAM GOALS AND OBJECTIVES
To improve quality of life of Filipinos through better
nutrition, improved health and increased productivity
1. Reduction in the proportion of Filipino
households with intake below 100% of the
dietary energy requirement from 53.2% to
44.0%.
2. Reduction in:
A. Underweight among pre school children
B. Stunting among pre school children
C. Chronic energy deficiency among pregnant
women
D. Iron deficiency among children 6 months to five years
old, pregnant and lactating mothers
E. Prevalence of overweight, obesity and non-
communicable diseases
F. Reduction in the prevalence of iron deficiency disorder
among lactating mothers
G. Elimination of moderate and severe IDD among school
children and pregnant women
H. Reduction in the prevalence of low birth weight
TARGET POPULATION/ CLIENT
Infants, 0-11 months Young Children, 1 year up to 3 years
old Adolescent females (Grades 7-10, ALS, Out of School)
Pregnant/Lactating women
PARTNER INSTITUTIONS
National Nutrition Council, Other Govt. Agencies,
Academe, NGOs, LGUs
STRATEGIES
Nutritional planning
- This involves political commitment by the government
Nutritional planning involves formulation of a nutrition
policy and overall long-term planning.
Direct nutrition and health interventions
- Improved health care system Direct nutrition and
health interventions Infections like malaria, measles and
diarrhea.
Nutrition education People can be educated on:
- The nutritional quality of common foods
- Importance and nutritional quality of locally available
and culturally accepted foods
- Importance of exclusive breastfeeding for six months to
two years
- Damage caused by irrational beliefs and cultural
practices of feeding 1
Early detection of malnutrition and intervention
- Intervention must occur during pregnancy and first
three years of life.
A well recorded growth chart can detect malnutrition
very early. Nutritional deficiency must be evaluated and
taken care of. If growth chart is not maintained,
anthropometric indices can be measured and used for
evaluation of nutrition.
Nutrition supplementation
Calories, proteins and micronutrients like iron, vitamin A
and zinc are supplemented.
MENTAL HEALTH PROGRAM
- Through a comprehensive mental health program that
includes a wide range of promotive, preventive,
treatment and rehabilitative services; that is for all
individuals across the life course especially those at risk
of and suffering from Mental, Neurological, and
Substance Use (MNS disorders; integrated in various
treatment settings from community to facility that is
implemented from the national to the barangay level;
and backed with institutional support mechanisms from
different government agencies and CSOs, we hope to
attain the highest possible level of health for the nation
because there is no Universal Health Care without
mental health.
1. To promote participatory governance and leadership
in mental health
2. To strengthen coverage of mental health services
through 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
4. To leverage quality data and research evidence for
mental health
5. To set standards for compliance in different aspects of
services
PROGRAM COMPONENTS
- Wellness of Daily Living
- Extreme Life Experience
- Mental Disorder
- Neurologic Disorders
- Substance Abuse and other Forms of
Addiction
STRATEGY
- GOVERNANCE
- SERVICE COVERAGE
- ADVOCACY
- EVIDENCE
- REGULATION
POLICIES AND LAWS
DOH Administrative Order No. 8 series of 2001 The
National Mental Health Policy
- The National Mental Health Policy sets to achieve
quality mental health care through the development of
efficient and effective structures, systems, and
mechanisms that will ensure equitable, accessible,
affordable, appropriate, efficient and effective delivery
to all its stakeholders by qualified, competent,
compassionate; and ethical mental health care
professionals and service providers. Implementation
shall be pursued through a Mental Health Program
strategy prioritizing the promotion of mental health,
protection of the rights and freedoms of persons with
mental diseases and the reduction of the burden and
consequences of mental ill- health, mental and brain
disorders and disabilities.
Republic Act No. 11036
- An Act Establishing a National Mental Health Policy for
the Purpose of Enhancing the Delivery of Integrated
Mental Health Services, Promoting and Protecting the
Rights of Persons Utilizing Psychosocial Health Services,
Appropriating Funds Therefor and Other Purposes.
DOH Administrative Order No. 2016-0039 Revised
Operational Framework for a Comprehensive National
Mental Health Program
- Through Revised Operational Framework for a
comprehensive mental health program, the Department
of Health shall promote and facilitate the conduct of
research, monitoring and evaluation that generates
relevant and timely information for sound program
planning and implementation, policy formulation,
service development and financial risk protection. The
same issuance intends to establish interconnectedness,
collaboration and linkages and other partnership
mechanisms between and among different government
agencies.
Environmental Health
According to WHO(2016), Environmental health
addresses all the physical, chemical, and biological
factors external to a person, and all the related factors
impacting behaviors. It encompasses the assessment and
control of those environmental factors that can
potentially affect health.
Concerned with preventing illness through managing the
environment and by changing people's behaviour to
reduce exposure to biological and non-biological agents
of disease and injury. Concerned primarily with effects of
the environment to the health of the people.
8 Environmental Factors that Affect Health
1. Chemicals
2. Air pollution
3. Climate change and natural disasters
4. Diseases caused by microbes
5. Lack of access to health care
6. Infrastructure issues
7. Poor water quality
8. Global environmental issues
Five Major Subdiscipline of Environmental Health
Environmental Epidemiology
This field seeks to understand how various external risk
factors may predispose to or protect against disease,
illness, injury, developmental abnormalities, or death.
Toxicology
Uses the power of science to predict what, and how
chemicals may cause harm and then shares that
information to protect public health.
HIV/STI PROGRAM
Laws and Policies
· Philippine HIV and AIDS Policy Act of 2018
(Republic Act 11166) An Act Strengthening the
Philippine Comprehensive Policy on Human
Immunodeficiency Virus (HIV) and Acquired
Immune Deficiency Syndrome (AIDS)
Prevention, Treatment, Care, and Support, and,
Reconstituting the Philippine National Aids
Council (PNAC), Repealing for the Purpose
Republic Act No. 8504, Otherwise Known as
The "Philippine Aids Prevention and Control Act
of 1998"
· The 1987 Philippine Constitution ((RA 11223)
The 1987 Philippine Constitution declares that it
is the policy of the State to protect and promote
the right to health of the people and instill health
consciousness among them.
· Philippine AIDS Prevention and Control Act
of 1998 (Republic Act No. 8504)
· An act promulgating policies and prescribing
measures for the prevention and control of
HIV/AIDS in the Philippines, instituting a
nationwide HIV/AIDS information and
educational program, establishing a
comprehensive HIV/AIDS monitoring system,
strengthening the Philippine National Aids
Council, and for other purposes.
· Section 504 of the Rehabilitation Act of 1973
and the Americans with Disabilities Act of
1990 (ADA)
· An act that guarantees equal opportunity for
individuals with disabilities in public
accommodations, employment, transportation,
State and local government services, and
telecommunications. People with HIV, both
symptomatic and asymptomatic, are protected
 by the ADA. The ADA also protects persons Contain the prevalence of HIV/AIDS among the high risk
who are discriminated against because they or more in less than 3%
have a record of or are regarded as having
Reduce the Incidence of gonorrhea among the high-risk
HIV, or have a known association or
vulnerable population. Reduce the transmission of STIs
relationship with an individual who has HIV.
in the general population among the vulnerable group
· Under the Philippine HIV and AIDS Policy Act, by 12% or less. And condom use rate at least to high risk
all private employers and employees shall be sex by 80%.
regularly provided with standardized basic
Target Clients
information and instruction on HIV and AIDS,
including topics on confidentiality in the Some of the recognized key populations
workplace and the reduction or elimination of for HIV risk in the Philippines
stigma and discrimination. include:
Program Description in relation to family health Men who have sex with men (MSM), Transgender
people,
- It provides initiatives to promote safety in terms of
health and did not engage in HIV/STI Female sex workers (FSW), Youth, and overseas workers
It prevents HIV/STI to be transmitted Partner Organizations/Agencies:
It creates a culture nor group to expand the awareness of The following organizations/agencies take part in
what truly HIV/STI means achieving the goal of the National HIV/STI
Prevention Program:
It improves the quality of every family members life It
provides the safest place where they belong in · Department of Interior and Local Government
(DILG)
It builds relationships with others and at the same time
they can be accompanied each and everyone to what · Philippine National AIDS Council (PNAC)
outcomes it befall when HIV/STI was transmitted
· Research Institute for Tropical Medicine (RITM)
Program Components
· STI/AIDS Cooperative Central Laboratory
- Sexual and reproductive health (SCCL)
services HIV testing and counseling
- Mental health Family planning · World Health Organization (WHO)
- National safe motherhood Sanitation · United States Agency for International
- Diseases and infections Development (USAID)
- Health Promotion and
Communication on HIV and STI · Pinoy Plus Association
prevention and care services · AIDS Society of the Philippines (ASP)
- Sustainable HIV responses
· Positive Action Foundation Philippines, Inc.
Program Goals and Objectives (PAFPI)
Goals: · Action for Health Initiatives (ACHIEVES)
Contain the transmission of HIV/AIDS and other · Affiliation Against AIDS in Mindanao
reproductive tract Infections and mitigate their impact. (ALAGAD-Mindanao)
Objectives: · AIDS Watch Council (AWAC)
Contain the Prevalence of HIV/AIDS among the general · Family Planning Organization of the Philippines
population less than one year (1) per 100,000 population (FPOP)
by the end of 2010.
Contain the prevalence of HIV/AIDS among pregnant
women ages 15-24 years.
Strategies and Activities
With regard to the prevention and fight against stigma and
discrimination, the following are the strategies and
interventions:
1. Availability of free voluntary HIV Counseling and
Testing Service;
2.100% Condom Use Program (CUP) especially for
entertainment establishments;
3. Peer education and outreach;
4. Multi-sectoral coordination through Philippine
National AIDS Council (PNAC);
5. Empowerment of communities;
6. Community assemblies and for a to reduce
stigma;
7. Augmentation of resources of social Hygiene
Clinics; and
8. Procured male condoms distributed as education
materials during outreach.
The Women and Children Protection
Program (WCPP) provides technical and management
support to ensure that Women and Children Protection
Units (WCPUs) are established and operational as
mandated under Section 40 of Republic Act 9262. This
program aims to provide medical assistance to violence
against women and their children (VAWC) survivors and
increase cases appropriately managed in health facilities.
To achieve this, the WCPP focuses on the primary
prevention and response through establishing and
ensuring the functionality of WCPUs, strengthening
management structures, capability building of public
health workers and hospital staff, health promotion, and
advocacy.
Vision:
A gender-fair and violence-free
community where women and their children are
empowered.
Mission:
Improved strategy towards a violence-
free community through more systematic primary
prevention, accessible and effective response system and
strengthened functional mechanisms for coordination,
planning, implementation, monitoring, and evaluation
and reporting.
Goal/Objectives
The goal of the WCPP is to increase the
number of VAWC cases appropriately managed in health
facilities. To achieve this goal, the WCPP should focus on
the primary prevention and response through
establishment and ensuring the functionality of WCPUs,
strengthening management structures, capability building
of public health workers and hospital staff, health
promotion and advocacy.
Types of Services
4Rs (Recognition, Reporting, Recording and Referral)
The 4Rs refer to recognizing, reporting,
recording, and referring of women and children abuse.
The Online 4Rs training is open to any person, parent, and
member representing any agency or institution interested
in or involved in dealing with children and women who
are suspected victims of abuse or any form of domestic
violence or gender-based violence.
Laypersons, parents, teachers,
counsellors, health professionals, social workers, law
practitioners, police officers, citizens interested and
dealing with children and women abuse who complete
this training should be able to:
Multidisciplinary Team Training (MDT) on Handling
Violence Against Women and Children for
Frontliners in the Community
The MDT is especially designed for
medical practitioners, social workers, and PNP officers
whose career paths focus on women and children
protection work. This is composed of four online modules
for women and children protection unit (WCPU)
practitioners and program managers. The modules are
also ladderized such that the first serves as prerequisite to
the next until the completion of all the four.
Licensed professionals like physicians,
social workers, guidance counsellors, and officers of the
Philippine National Police who have completed MDT
Training are expected to:
Enhanced Training on Handling Violence Against
Women and Children (EnTHAWC) for Hospitals
It is a 2-and-a-half-day training course
that utilizes lectures and workshops. The lectures provide
the child protection foundation of the learners, while the
workshops provide an opportunity for the learners to
apply the concepts they have learned through small group
case discussions. The training typically involves social
workers, police officers and medical practitioners, since it
emphasizes the importance of the multi-disciplinary d. Dating partner or former dating
approach in handling cases of abuse within the partner
community.
• Classifies VAWC as a public crime
Other laws include:
National/Government
• Presidential Decree No. 603, otherwise known as
• Department of the Interior and Local Government the Child and Youth Welfare Code and issued in
December 1974, legally defines special
• Department of Social Welfare and Development
categories of youths, including youthful
• Philippine Commission on Women offenders, and directs the Ministry of Social
Services and Development (MSSD) to provide
• Council for the Welfare of Children comprehensive services to assist in youth
International Partners development.

• World Health Organization Department of Social Welfare and Development (DSWD)

• United Nations International Children’s Community-based Services Section (CBSS)

Emergency Fund
• United States Agency
Development
• United Nations Population Fund
Local/Youth/CSOs, NGOs
• UP-College of Public Health
• Social Watch Philippines
Partner Organizations
Legarda, Manila
for International Tel. Nos.: 733-0014 to 18 local 116 / 488-2861
The Signal for Help (or the Violence at
Home Signal for Help) is a single-handed gesture that
can be used over a video call or in person by an individual
to alert others that they feel threatened and need help.
Originally, the signal was created as a tool to combat the
rise in domestic violence cases around the world linked to
self-isolation measures that were related to the COVID-
19 pandemic.

One in four Filipino women age 15-49 The signal is performed by holding one
hand up with the thumb tucked into the palm, then folding
has experienced physical, emotional or sexual violence by the four other fingers down, symbolically trapping the
their husband or partner. It is indeed alarming that despite thumb by the rest of the fingers. It was designed
efforts to address the concern, VAW persists. intentionally as a single continuous hand movement,
PREVENTION AND RESPONSE rather than a sign held in one position, so it could be made
easily visible.
Integrated Laws
and Policies
The Anti-Violence Against Women and their Children ETHICAL CONSIDERATIONS IN CHN
Act of 2004 (RA 9262)
• Seeks to address the prevalence of violence
against women and their children (VAWC) by
their intimate partners like:
a. Husband or ex-husband
b. Live-in partner of former live-in
partner
c. Boyfriend/girlfriend or ex-
boyfriend/ex-girlfriend
NEW TECHNOLOGIES RELATED TO PUBLIC
HEALTH