DOH Health Pograms

John Carlo L. Divina, MSN, RN, CDPO, CHA, FRIN

Assistant Professor
Contents

01 Maternal, Newborn & Child Health & Nutrition

02 Infant & Young Child Feeding

03 Garantisadong Pambata

04 Newborn Screening Tests

05 Expanded Program on Immunization

06 Reproductive Health

07 Laws on Senior Citizens & PHWs

 01
Maternal, Newborn & Child Health & Nutrition
R.A. 11210: 105- Day Expanded Maternity Leave Law
• 105 days maternity leave with full pay

• 60 days maternity leave with full pay if

miscarriage or emergency termination of
pregnancy.

• + 30 days without pay: optional, due notice

within 45 days prior to end of ML

• + 15 days with full pay if solo parent (RA

8972)

• Private sector: prior notice of EDC, full

payment advanced within 30 days post-
application, SSS refund of advanced
payment
The Context

https://data.unicef.org/country/phl/
Maternal Mortality
 Pregnancy complications

Neonatal deaths (within 1st week)

 Asphyxia, prematurity, severe infections, congenital
anomalies, newborn and other causes

3 Delays in Births attended by Traditional Attendants

 Identification of complications
 Referral
 Management of complications
4 Key Strategies

1. Ensuring universal access to and utilization of an MNCHN core

package of services and interventions in the community.

2. Establishment of a SDN at all levels of a care to provide services and

interventions.

3. Organized use of instruments for health systems development to bring

all localities to create and sustain their SDN.

4. Rapid build-up of institutional capacities of DOH & PHIC, being the

lead national agencies that provide support to local planning and
development through appropriate standards, capacity, build-up of
implementation and financing mechanism.
Aims of MNCHN Strategies

 Every pregnancy wanted, planned and supported.

 Every pregnancy is adequately managed throughout its

course.

 Every delivery is facility-based and managed by skilled birth

attendants or skilled health professionals.

 Every mother-and-newborn pair secures proper postpartum

and newborn care with smooth transitions to the women’s
health care package for the mother and child survival package
for the newborn.
Maternal Package

“All pregnant
women at risk of
such complications.”
Aims of MNCHN Strategies

 Every pregnancy wanted, planned and supported.

 Every pregnancy is adequately managed throughout its

course.

 Every delivery is facility-based and managed by skilled birth

attendants or skilled health professionals.

 Every mother-and-newborn pair secures proper postpartum

and newborn care with smooth transitions to the women’s
health care package for the mother and child survival package
for the newborn.
A. Pre Pregnancy Packages

1. Nutrition - Counseling, Iodized Salt, Vit A 5,000 IU q week or daily MV,

Iron 60 mg, Folic Acid 400 mcg 1 tab daily (3-6 mos)
2. Healthy Lifestyle - smoking cessation, healthy diet, regular exercise
& moderate alcohol intake
3. Advice on family planning & provide services
4. Prevention and management of lifestyle-related
diseases
5. Prevention and management of infection
6. Counseling on STI/HIV/AIDS, personal hygiene and
consequences of abortion
7. Provision of oral health services
B. Pre Natal Packages

1. Prenatal visits
 at least 4 visits: (1st, 2nd, 2x for 3rd trimester)
 Prenatal assessments: Weight, BP, FH vs AOG, FHR, Dx:
CBC, BT, UA, STI screening, PT, Cervical CA using acetic
acid wash & Pap Smear

2. Micronutrients
 Iron and Folate (60mg/400 mcg) OD x 6 months
 Vit A 10,000 IU 2x a week from 4th month of pregnancy
 Elemental Iodine 200 mg single dose
B. Pre Natal Packages

3. Tetanus Toxoid
 0.5 ml of TT IM on
deltoid muscle
B. Pre Natal Packages

4. Promotion of exclusive BF, NBS and infant immunization.

5. Counseling on healthy lifestyle with focus on smoking cessation,

healthy diet, nutrition, regular exercise, STI/HIV prevention, and oral
health.

6. Early detection and management of complications of pregnancy.

7. Prevention & management of other conditions: HPN, Anemia, DM,

TB, Malaria, Schistosomiasis and STI/HIV/AIDS.

8. Birth Planning and promotion of facility-based delivery.

Home-Based Mother’s Record (HBMR)

 Simplified record of the history of present and past

pregnancies; findings and measures of TBA, BHW or
health professionals
Uses
 Continuity of care
 Early recognition of risk factors
 Self-care and referral
 Initiation of care based on needs
 Record of care and health information: statistics
 Guide health educational needs
C. Childbirth Package

1. Skilled Birth
Attendants/ Health
professional-
assisted delivery
and facility-based
with partograph

• most deaths during

labor and 1st 24 hours
post-partum
C. Childbirth Package

2. Proper management  Continuous maternal support: companion

 Freedom of movement during labor
of pregnancy &  Monitoring progress of labor:
newborn PARTOGRAPH
complications.  Nondrug pain relief first before offering
labor anesthesia
 Position of choice during labor and delivery
• Essential Intrapartum  Spontaneous pushing in a semi-upright
& Newborn Care position
 Hand hygiene
(EINC) or “Unang  Non-routine episiotomy
Yakap”  Active management of 3rd stage of labor
(AMTSL)
C. Childbirth Package

3. Access to:

 Basic Emergency
Obstetric and Newborn
Care (BEmONC)

 Comprehensive
Emergency Obstetric
and Newborn Care
(CEmONC) services
Postpartum Package

 Visit within 72 hours and on 7th day post-partum: bleeding

or infections

 Micronutrients: Iron 60mg/Folate 400 mcg OD x 3 months;

Vit A 200,000 IU within 4 weeks after delivery

 Counseling on Nutrition, Child Care, Family Planning, and

other services
D. Newborn (1st week)
Care Package

1. Interventions within
first 90 minutes

01 – stimulates breathing, protect from

cold stress or hypothermia

02 – warmth, bonding, protect from

infection & hypoglycemia

03 – allows placental transfusion at

birth, increases blood volume and
prevent IDA

04 – reduce infant deaths & promote

uterine contraction
D. Newborn (1st week) Care Package

2. Essential Newborn Care after 90 minutes to 6 hours

 Vitamin K prophylaxis

 Hepatitis B and BCG vaccination

 Exam baby for injuries, malformations or defects

 Additional care for small baby (BW<2,500g) or twin

D. Newborn (1st week) Care
Package

3. Care prior to discharge

 Unrestricted, per demand BF

 Warmth of pre-term baby: skin to skin
(kangaroo mother care)
 Hygiene (washing & bathing)
 Danger signs and start resuscitation: O2,
1st 2 doses of IM antibiotics, keep warm;
 Look for signs of jaundice / local
infections
 Newborn Screening & Hearing
 Instructions on discharge
E. Child Care Package

1. Immunization
2. Nutrition
 Exclusive breastfeeding up to 6 months
 Sustained breastfeeding up to 24 months with complementary feeding
 Micronutrient supplementation
3. IMCI
4. Injury prevention
5. Oral health
6. Insecticide nets for mothers and children in malaria-
endemic areas
MNCHN Service Delivery Network

1. Community Health Teams (CHT)

Navigation functions:
 Health risk and needs assessment and info dissemination
 Assist families use birth plans (spacing & FP)
 Facilitate access to critical health services and financing
Basic service delivery functions:
 Advocate birth spacing & counseling on FP services
 Masterlisting pregnant, reproductive age, children < 1yo
 Early detection & referral: Hi-risk pregnancy
 Reporting maternal & neonatal deaths
MNCHN Service Delivery Network

2. BEmONC-capable facility

6 Signal Obstetric functions

 Oxytocin in 3rd stage of labor
 Loading dose of anticonvulsants
 Initial dose of Antibiotics (all 3 via parenteral route)
 Assisted deliveries (imminent breech delivery)
 Removal of retained products of conception
 Manual removal of retained placenta
Emergency Newborn Interventions:
 Newborn resuscitation
 Treatment of neonatal sepsis or infection
 Oxygen support
MNCHN Service Delivery Network

2. BEmONC-capable facility

 May provide Blood Transfusion if with qualifies staff &

facility

 At least operated by a Midwife: under MHO or with referral

arrangements with hospitals or doctors-on-call

 Midwife: life-saving measures DOH AO 2010-0014

 1 BEmONC facility per 125,000 population

MNCHN Service Delivery Network

2. CEmONC-capable facility

 6 signal obstetric function + CS, blood bank and

transfusion + other highly specialized OB interventions

 Neonatal emergency interventions + LBW, pre-term,

others

 1 CemONC facility: 500,000 population

 02
Infant & Young Child Feeding
Infant and Young Child Feeding Laws

EO 51 : Mild Code
EO 382 : National Food Fortification Day (Nov 7)

RA 8976 : Food Fortification (Sangkap Pinoy)

• rice w/ Iron, wheat flour w/ VitA & Iron, refined sugar w/ Vit A, Cooking oil w/
VitA
RA 7600 : Rooming In & Breastfeeding Act
• 30 mins roomed-in in NSVD; 3-4 hours CS
RA 8172 : ASIN (Salt Iodization)

AO 36, 2010 – Garantisadong Pambata

Infant and Young Child Feeding Laws

RA 10028: Expanded Breastfeeding Promotion Act of 2009

• Inclusion of breastfeeding in school curriculum

• Mother-Baby Friendly Establishments

• Breast milk banks are enciurgaed

• August = Breastfeeding Awareness Month
• Lactation stations
• Lactation periods (40 minutes per 8 hour work period)
Definition of Terms

 Exclusive BF – breast milk (expressed/ wet nurse)

except meds: ORS, drops, syrups (vitamins)

 Predominant BF – EBF + other liquids

 Complementary Feeding – infant foods & liquids + BM

 Bottle Feeding – from bottle with a nipple/teat

 Early initiation of BF – within 90 minutes of life

Nutritional Assessment

1. Anthropometry – weight for

age, length/height for age,
MUAC

• Sit or stand with arm loose at side

• Left upper arm (midway: acromion
(shoulder) & olecranon (elbow)
Nutritional Assessment

2. Clinical examination

• Physical exam, eye exam, history

taking

3. Biochemical examination

• Serum retinol determination in VAD,

hemoglobin in IDA, urine in iodine
deficiency
National Policies on IYCF

1. Early Initiation of BF
2. Exclusive BF for first 6 months except in few medical
conditions (Galactosemia)
3. Extended BF up to 2 years and beyond + complementary
4. Appropriate complementary feeding with use of locally
available and culturally acceptable foods
5. Micronutrient supplementation
6. Universal salt iodization
7. Food fortification
Signs of Proper Positioning

“BSM”
• Baby is facing the breast, with
nose toward the nipple
• Baby’s head and body are in a
Straight line (neck is not
twisted or flexed)
• Mother is holding the baby’s
body close to her body and
supporting the baby’s whole
body (not just neck and
shoulders)
4 Signs of Good
Attachment

“CALM” + S
• Chin is touching breast
• Areola (darker skin)
above baby’s mouth
• Lower lip is turned
outward/ everted
• Mouth should be wide
open
• Suckling is slow & deep with
occasional pauses
Signs of Effective
Suckling

“2F PCS”
• Feeds calmly
• Finishes by himself &
satisfied
• Painless
• Cheeks full & not drawn
in
• Slow, deep sucks and
swallowing sounds
Complementary
Feeding

• Timely

• Adequate

• Safe

• Properly Fed
Micronutrient
Supplementation Vitamin A
• Infants 6-11 mos: 100,000 IU once only
• Short-term • Children 12-71 mos: 200,000 IU every 6
intervention for months
correcting high
levels of Iron
micronutrient • Infants 2-6 mos w/ LBW (<2,500g) =
deficiencies until 0.3 ml OD until complementary foods are
given (preparation is 15mg elemental
more sustainable
iron/0.6ml)
food-based • Anemic children 2-59 mos = 1 tsp OD
approaches can be for 3 mos or 30 mg once a week for 6 mos
used effectively. with supervised administration
Universal Salt Fortification

RA 8172 – ASIN (An Act for Salt Iodization Nationwide)

Law

• Iodine deficiency is one of the most prevalent causes

of developmental delay and brain damage in regions
where little iodine occurs naturally in the diet.
• Preventing iodine deficiency can be achieved by
fortifying salt with iodine, a process known as Universal
Salt Iodization (USI).
Food Fortification

RA 8976 – Food Fortification Act of 2000

Voluntary Food Fortification - encourage the fortification of all processed

foods or food products using the Sangkap Pinoy Seal Program (SPSP) of
the Department of Health

Mandatory Food Fortification – staple foods:

(1) Rice with Iron;
(2) Wheat flour 0 with vitamins A and Iron;
(3) Refined sugar with vitamin A;
(4) Cooking oil with vitamin A;
(5) Other staple foods with nutrients as required by the Governing Board of
the National Nutrition Council (NCC).
Deworming

• Children 1-2 yrs: Albendazole 200mg or ½ tab of 400mg;

Mebendazole 500mg
• Older than 2 yrs: Albendazole 400mg or Mebendazole 500mg

 Full stomach
 A/E: allergy, mild abdominal pain, diarrhea, erratic
worm migration
 C/I: serious illness-hospitalization, abdominal pain,
diarrhea, hx of allergy & severe malnutrition
 03
Garantisadong Pambata
Garantisadong
Pambata

• AO 36, s.2010

• Comprehensive and
integrated package of services
and communication on health,
nutrition and environment for
children available everyday at
various settings such as home,
school, health facilities and
communities by government and
non-government organizations,
private sectors and civic groups
 04
Newborn Screening Tests
Newborn Screening Test

 RA 9288: Newborn Screening

Act of 2004

 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
6 Disorders Covered under the Basic NBS
1. Congenital Hypothyroidism (CH) - s a severe deficiency of thyroid hormone in
newborns. It causes impaired neurological function, stunted growth, and physical deformities
2. Congenital Adrenal Hyperplasia (CAH) - Congenital adrenal hyperplasia (CAH)
refers to a group of genetic disorders that affect the adrenal glands
3. Galactosemia (GAL) - a rare, hereditary disorder of carbohydrate metabolism that affects
the body's ability to convert galactose (a sugar contained in milk, including human mother's milk) to
glucose (a different type of sugar).
4. G6PD Deficiency - G6PD deficiency is an inherited condition. It is when the body doesn't have
enough of an enzyme called G6PD (glucose-6-phosphate dehydrogenase). This enzyme helps red blood
cells work correctly. A lack of this enzyme can cause hemolytic anemia.
5. Phenylketonuria (PKU) - an inherited disorder that increases the levels of a substance
called phenylalanine in the blood.
6. Maple Syrup Urine Disease (MSUD) - rare genetic disorder characterized by
deficiency of an enzyme complex (branched-chain alpha-keto acid dehydrogenase) that is required to
break down (metabolize) the three branched-chain amino acids (BCAAs) leucine, isoleucine and valine, in
the body.
 DISORDERS LONG-TERM EFFECTS

CONGENITAL Severe Mental

HYPOTHYROIDISM Retardation

CONGENITAL Death
ADRENAL
HYPERPLASIA
GALACTOSEMIA Death or Cataracts

PHENYLKETONURIA Severe Mental

Retardation

G6PD DEIFICENCY Severe Anemia;

Kernicterus

MAPLE SYRUP URINE Death

DISEASE
Newborn Hearing Screening

 RA 9709: Universal Newborn

Hearing Screening & Intervention
Act of 2009

 Early detection of congenital

hearing loss among newborns and
referral for early intervention
services to infants with hearing
loss

 Performed 3 months old or below

 05
Expanded Program on Immunization
Expanded Program on Immunization

 aims to reduce infant and child mortality due to VPD:

vaccine-preventable diseases (Tuberculosis, Hepatitis B,
Diptheria, Tetanus, Pertussis, Poliomyelitis, Pneumonia, Meningitis and Otitis
Media due to Hemophilus Influenza Type B, Measles, Mumps, Rubella and
Severe Diarrhea due to Rotavirus).

 RA 10152: Mandatory Infants & Children Health Immunization Act of 2011

mandates basic immunization covering vaccine preventable diseases

 RA 7846: Hepatitis B for infants and children below 8 yo

Vaccine Preventable Diseases
Vaccine Preventable Diseases
Goals of EPI

 The over-all goal is to reduce the morbidity and mortality

among children against the most common vaccine-
preventable diseases.

 to immunize all infants/children against the most common VPD

 to sustain the polio-free status of the Philippines
 to eliminate measles infection
 to eliminate maternal and neonatal tetanus
 to control diphtheria, pertussis, hepatitis b and German measles
 to prevent extra pulmonary tuberculosis among children.
Vaccines in the EPI
Vaccines in the EPI
Side-effects

 Soreness at injection
site (e.g. Koch’s
phenomenon for BCG)
 Headache & URTI
 Fever, joint pain, sore
throat
 Nausea, vomiting,
diarrhea
Absolute Contraindications
1. Pentavalent Vaccines: over 5 years old;
recurrent convulsions or another active
neurological diseases of CNS
2. Pentavalent 2/3 or DPT 2: convulsion or
shock within 3 days of most recent dose
3. Rotavirus: history of hypersensitivity to
previous dose of vaccine, intussusception or
intestinal malformation or AGE
4. BCG: S/S of AIDS or other immune
deficiency diseases

False Contraindications
 Malnutrition
 Low grade fever
 Mild respiratory infections
 Diarrhea: give OPV and do not count the
dose
Target Setting
 100% immunization
Formula for Eligible Population:
1. Est no. of INFANTS =
Total Population x 2.32%
(Cebu)
2. Est no. of 12-59 month old =
TP x 9.09% (Cebu)
3. Est no. of Pregnant Women =
TP x 2.32% (Cebu)
Computation of vaccine
requirement
Vaccine Requirement for the Year:
= Eligible Population x no. of
doses x wastage multiplier
Wastage multiplier:
DPT, OPV, TT = 1.67
Hep B = 1.20
AMV = 2.00
BCG = 2.50
Sample Computation
Population= 15,000

Eligible Population = 15,000 x 0.0232 = 35 infants

OPV requirement (yr) = 35 infants x 3 doses x 1.67 = 175.35/ 176 doses

There are 20doses/bottle: To convert doses to bottles:

Requirement for year in bottles = requirement for year in doses
no. of doses per bottle
= 176 doses/ 20 doses per bottle = 8.8/ 9 bottles

If request monthly:
Monthly OPV requirement = 9/12 = (0.75) / 1 bottle per month

Reserve stock of 25% maintained at the facility.

Considerations r/t schedule & administration

 One sterile syringe and needle per client

 Do not restart vaccination series regardless of elapsed time
between doses
 Do not mix vaccines in one syringe or use fluid vaccine to
reconstitute a freeze dried vaccine
 Administer at various sites, 2.5cm – 5 cm apart
 OPV first, Rotavirus 2nd and other PO follows
 OPV: give directly to tongue (do not let dropper touch
tongue)
 Monovalent Hep B at birth (no DPT and Hib vaccine)
Considerations r/t schedule & administration

 If not aware if given AMV1, give AMV1 then AMV2 1 month

after
 All day care entrants screened for Measles Immunization,
referred to nearest facility
 1st dose of Rotavirus vaccine = 6 -15 weeks only; 2nd dose
= 10 weeks to 32 weeks only
 Rotavirus: slowly down one side of mouth (between cheeks
& gum) with applicator directed at back of mouth; rooting
or sucking reflex is stimulated; if >5yo: stroke the throat
in a downward motion
Cold Chain Management
 System of ensuring potency of vaccine from
time manufactured to time given to an
eligible person
 Cold Chain Officer in RHUs = PHN

1. OPV = -15 to -25 degree Celsius (freezer);

contact with cold packs in vaccine bag
2. All other vaccines = +2 to +8 degree
Celsius (refrigerator); not at door shelves
of refrigerators
3. Hep B, Pentavelent and Rotavirus
vaccines, TT = damaged by freezing;
wrap with paper before putting in vaccine
bag with cold packs
4. Keep diluents cold by storing them in
refrigerator in lower or door shelves
Other Considerations to
maintain potency:

 FEFO policy
 At RHU, do not store
vaccines > 1 month; if with
transport boxes < 5 days
 Vaccine container must
have Vaccine Vial Monitor
(VVM)
 Protect BCG from sunlight;
Rotavirus from light
Other Considerations to
maintain potency:
 Use special diluents provided for
freeze-dried vaccines; discard 6 hours
post-reconstitution
 Open vial policy of DOH: multidose
vial can be used if one patient cannot
assure coming back; multidose liquid
vaccines (OPV, Pentavalent vaccine,
HepB, TT) may be used next for up to
4 weeks :
Not expired, not contaminated, appropriate
storage, vaccine vial septum has not been
submerged in water, VVM on vial has not reached
discard point
Unsafe Vaccine Practices
EPI Recording & Reporting

 Fully Immunized Child (FIC)

BCG, 3 OPV, 3 DPT & Hep B or 3 Pentavalent vaccine, 1 AMV before
reaching 1 year old

 Completely Immunized Child

Completed immunization schedule at age 12-23 months

 Child Protected at Birth (CPAB)

Child whose mother received 2 doses of TT during this pregnancy,
provided the 2nd dose was given at least a month prior to delivery; at
least 3 doses of TT anytime prior to pregnancy with this child
 06
Reproductive Health
Reproductive Health

RA 9710: Magna Carta for Women

• comprehensive, culture-sensitive
gender-responsive health services and
programs covering all stages of
women’s life cycle and which
addresses the major causes of women’s
mortality and morbidity

RA 10354 : Responsible Parenthood

and Reproductive Health Act
• Life-span approach
• Client-centered
Philippine Family Planning Program

AO 50-A s 2001:
• family planning as a health intervention be made available to
men and women of reproductive age (15-44 yo)
• prevents Hi-risk pregnancy: Too young (<18) & Too old (>34); Too Many
(>= 4); Too Close (<36 months); Too Sick (IDA)

4 Pillars
 Responsible parenthood – needs& aspirations of family
 Respect for life – prevent abortion
 Birth spacing – 3-5years spacing
 Informed choice
FP Client Counseling

Client-centered but major contents:

a. Effectiveness
b. Advantages & Disadvantages
c. Possible S/E, complications &
signs to visit facility
d. How to use
e. Prevention of STI
f. When to return to health facility
Natural Family Planning Methods
 ABSTINENCE: fertile phase

Types:
1. Lactational Amenorrhea Method (LAM)

2. Fertility Awareness-based (FAB) Methods:

Billing’s Ovulation Method (BOM)
Basal Body Temperataure (BBT)
Symptothermal Method
Standard Days Method
Two-day Method
 1. Lactational Amenorrhea Method (LAM)
 Breastfeeding is 98-99.5%
effective if:
 No menses
 85%-100% BF day & night
 Less than 6 months
2. Fertility Awareness Based Methods
 Menstrual Cycle: Physiologic Markers
2.1. Billing’s Ovulation Method 4 RULES
1. Avoid intercourse on menstrual days
(Cervical Mucus Method) 2. During Basic Infertile Pattern (BIP) /
 95-97% effective dryness or no vaginal discharge after
 Applicable to women in all menstruation, may have sex every other
evening (not AM: semen may mask
stages of reproductive stage
cervical mucus)
3. Avoid sex during days of Changing
Pattern of Fertility( thinner/clearer vaginal
discharge & no feeling of wetness or
slippery) until 4th day after peak (very
fertile)
4. May have sex at any time from 4th day
after peak (last day of slippery sensation)
until next menstruation
2.2. Basal Body Temperature
1. Take BBT every morning before arising,
using the same digital oral thermometer
(at least 3 hours of sleep)
2. Record daily BBT and look for pattern
(slight increase <0.5 degrees celsius
sustained for 3 days or more = fertile)
3. Woman is most fertile 2-3 days before
BBT rises. No sex from start of
menstruation up to 3-4 days after BBT
rises
Disadvantages:
• BBT is affected by many factors: stress,
hours of sleep, illness, alcohol intake
• Least effective NFP
2.3. Symptothermal Method

 All signs of fertility are considered: BBT + cervical mucus

+ other signs:

 Mittleschmerz (one-sided, lower abdominal pain that

occurs around ovulation)
 Spinnbarkeit (capacity of cervical mucus to stretch
before breaking)
 Breast tenderness
 Increased libido
 Mood changes such as depression and mood swings
2.4. Standard Days Method
2.5. Two Day Method

 96% effective with

correct use

 86% effective with

typical use
Artificial Family Planning Methods

1. Combined oral contraceptives (COCs)

2. Depot medroxyprogesterone acetate

3. Contraceptive Implant

4. Intrauterine Device

5. Barrier Methods

6. Permanent Methods
1. Combined oral contraceptives (COCs)

• Estrogen or progesterone
• Suppress ovulation; changes endometrium, thickens
cervical mucus making sperm transport inside uterus
difficult or unfavorable
• 99.7& effective with perfect use; 92% effective with
typical use
• 21 day or 28 day pack
• Take pills within the 1st 5 days of menstrual cycle
1. Combined oral
contraceptives

Serious
Complications:

Abdominal Pain
Chest Pain/ SOB
Headaches
Eye Problems/Vascular
Accident/ Inc. BP
Severe Leg Pain
1. Combined oral contraceptives

Instructions if with MISSED PILLS

1. Misses 1-2 hormone-containing pills or starts pack 1 day late:

• Take pill ASAP, next pill on regular time, Finish pack

2. Misses 3 or more or starts 2-3 days late:

• Take pill ASAP (as she remembers)
• Next pill as schedules
• No SEX or use additional Contraceptives for 7 days + Finish pack

3. Misses 3 or more on the 3rd week:

• Take pill ASAP (preferably from NEW PACK) or (Use old PACK until New
Pack arrives)
• Finish New Pack
2. Depot
Medroxyprogesterone
Acetate (DMPA)

 Progestin only preparation

injected IM q 3 months
• Suppresses ovulation,
changes cervical mucus &
endometrial lining
• 99% effective with perfect
use; 97% with typical use
2. Depot
Medroxyprogesterone
Acetate (DMPA)

 Contraindications:
 Liver Problems
 Blood Clots
 Stroke
 Abnormal Bleeding
 Breast, Reproductive Organ
Cancer
 Allergy
3. Contraceptive Implant
Implanon/ Nexplanon (etonogestrel
implant)

• Progestin-only, soft, flexible implant

preloaded in a sterile, disposable
applicator for subdermal use.
• 3 years effective
• It releases a low, steady dose of a
progestational hormone to thicken
cervical mucus and thin the lining of the
uterus (endometrium).
• Contraceptive implants are radio opaque
and can be seen on X-rays — useful for
identifying the location of an implant.
3. Contraceptive Implant
Side-effects:
Bleeding patterns are likely to change:
• periods may be at the normal times, but they may be lighter and less painful
• periods may stop altogether
• occasional bleeding may happen without a regular period
• increased bleeding happens sometimes, this can include bleeding more often, heavier
bleeding or a combination of this

Many people have no other side effects. Some may experience the following problems:
• Acne may develop, improve or get worse.
• Weight gain can occur over time and is often thought to be caused by the implant,
but has not been directly proven.
• Headaches, breast pain and mood changes can occur and may go away after the
initial few weeks.
• Bruising and mild soreness at the site of insertion or removal can last up to 2 weeks.
A small scar remains.
3. Contraceptive Implant
4. Intrauterine Device

• Small contraceptive devices that are

inserted into the uterus (womb) to stop
sperm from reaching & fertilizing eggs

• The 2 types: copper IUD (ParaGard)

and the hormonal (levonorgestrel) IUD
(Mirena).

• Inserted: menstrual bleeding;

amenorrhea who intends not to get
pregnant; 48 hours post-NSVD; 8
weeks post-CS
4. Intrauterine Device
5. Barrier Methods

• Prevent fertilization thru mechanical

or chemical means
• condoms, diaphragms, cervical
caps, spermicides

• 70% (cervical caps & spermicides);

85% (male condoms)

• Toxic shock syndrome: >24h

Diaphragm; >48 h Cervical cap
5. Barrier Methods

• Chemical Spermicidal – inserted

inside the vagina, near the cervix to
kill sperm substance

• Nonoxynol 9 – most popular

chemical spermicidal;

• 1 hour before coitus; non-

teratogenic
6. Permanent Methods

6.1. Vasectomy
• Surgical procedure where the vas
deferans is tied, cut or blocked through a
small opening
• No-scalpel vasectomy – choice; lesser
pain; shorter recovery time (uses vas
dissecting forceps)
• 100% effective 3 months after surgery: no
sperm in vas deferans
• Counseling before and written consent
needed
• Possible complications: scrotal
hematoma, wound infection and sperm
granuloma /leakage of sperm
6. Permanent Methods

6.2. Bilateral Tubal Ligation

• Blocking or cutting of 2 fallopian
tubes
• Acceptable: mini-laparotomy under
Local Anesthesia or Light Sedation
• 100 % effective; performed after
birth or abortion
• Not pregnant, written consent and
NPO x 4 hours pre-BTL
• Reversal not guaranteed
• Complications: bleeding, infection
and injury to internal organs
 07
Laws on Senior Citizens & Public Health
Workers
RA 9994 – Expanded Senior Citizens Act of 2010

 20% discount & VAT exempt: medicines, professional fees, hospital or

home healthcare fees, diagnostic tests, transport fees, dining, recreation, funeral &
burial
 Minimum wage earners exempted from income tax
 5% discount on water and electric bills
 Exempt from training fees for socioeconomic programs
 Free medical, dental, diagnostics in all gov’t facilities
 Free Flu and Pneumococcal vaccines
 Educational assistance
 Retirement benefits review at par with current market
 Express lane
 Death benefit assistance of Php 2,000
RA 7305 – Magna Carta of Public Health Workers

• 40 hours per week duty

• 10% night differential (10PM – 6AM)
• Salary based on SSL
• Additional Compensation: Hazard pay (25% of Basic
Pay); Subsistence Allowance; Longevity Pay(5% of Basic
Pay every 5 years); Laundry Allowance
• Leave Benefits
• Right to form Union/ Association