NATIONAL HEALTH SITUATION

This strategy identifies five strategic priorities to support attainment of the national vision of All for Health
towards Health for All as articulated in the Philippine Health Agenda 2016-2022.

Its overarching goal is to ensure that all Filipinos, regardless of age, gender, socioeconomic status or cultural
background have the opportunity to lead healthy lives in healthy environments with access to quality health
services.

The Filipino Vision: Vision of Filipinos for the country

“By 2040, the Philippines shall be a prosperous, predominantly middle-class society where no one is poor. Our
people will enjoy long and healthy lives, are smart and innovative, and will live in a high-trust society.”

The Philippine Health Agenda 2016-2022

Five strategic priorities for WHO collaboration with the Philippines 2017-2022:
1. Save lives - ensure full access to immediate-impact interventions.
2. Promote well-being - empower people to lead healthy lives and enjoy responsive health services.
3. Protect health - anticipate and mitigate disasters, and environmental and emerging health threats.
4. Optimize health architecture - overcome fragmentation to achieve universal health coverage.
5. Use platforms for health - support health in all settings, policies and sectors.
The global vision of the world 15 years from now aligns with the Philippines’ 25-year vision AmBisyon Natin
2040. This vision guides the development and implementation of four subsequent Philippine development
plans until 2040.

National Health Situation (Maternal and Child Health)

Improve the health and well-beiong of women, infants, children, and families.

Why are Maternal, Infant, and Child Health Important?

- Pregnancy can provide an opportunity to identify existing health risks in women and to prevent future
health problems for women and their children.
 Determinants of Maternal, Infant, and Child Health
Environmental and Social Factors
- Access to health care and early intervention services, educational, employment, and economic
opportunities, social support and availability of resources to meet daily needs influence maternal health
behaviors and health status.
- The Philippines faces unique challenges in aligning its health system with the needs of its inhabitants,
mainly because of the country’s geography and income distribution.
- Many communities are located in isolated mountain regions of the country or the coastal areas that are
difficult to reach.
- Also, there are wide disparities in the use of health services across income levels.
- A recent study found that 94% of women in the richest quintile delivered with a skilled birth attendant,
compared with 25% in the poorest.
- 84% of women in the richest quintile have a facility-based birth compared with 13% in the poorest.
- The maternal mortality cases in 2020 can increase to up to 670 additional deaths from the 2019 llevel
(26% increase). …
- 2020 may end up seeing 18, 000 more Filipino teenage girls getting pregnant because of the indirect
effect of COVID-19, compared to 2019.
- Already before COVID-19, the Philippines saw about 2,600 women dying every year due to
complications from pregnancy or childbirth.
- As the national and local health systems are overwhelmed by the necessary response to the COVID-19
patients, attention and resources for women’s health might have been diverted.

TYPES OF GENETIC COUNSELLING

1. Prospective - wider application to cover a number of recessive defects. It identifies the individuals for
any particular defect by screening.
Ex. sickle cells anemia which can be prevented.

2. Retrospective - this can be done after contraception, pregnancy, termination, and sterilization.

STEPS OF GENETIC COUNSELING

 APPLICATIONS OF GENETIC COUNSELLING
- Genetic counselors work with people concerned about the risk of an inherited disease or condition. These
people represent several different populations.

Prenatal Genetic Counselling

- There are several different reasons a person or couple may seek prenatal genetic counselling.
1. A woman is of age 35 or older and pregnant.
2. There is an increased chance that the fetus may have a change in the number of chromosomes
present.
3. A personal or family history of infertility
4. A chance of being a carrier of a genetic condition based on ethnicity
5. A risk to have a child with a genetic condition or birth defect based on family history or maternal
age
6. An abnormal …..
Prenatal Tests
- Level II Ultrasound
- The maternal serum AFP
- Chorionic Villus sampling (CVS)
- Amniocentesis

Pediatric Genetic Counseling

- Families or pediatricians seeks genetic counseling when a child has features of an inherited conditions
- Any child who is born with more than one defect, mental retardation or dysmorphic features has an
increased chance of having a genetic syndrome.
- A common type of mental retardation in males for which genetic testing is available is fragile
X-syndrome
- Children who have a personal history of:
1. Birth defect
2. Intellectual or learning disability
3. Developmental delay
4. Failure to thrive
5. Autism
6. hearing/visual impairment
7. Metabolic disorder

Adult Genetic Counselling

- Adults may seek genetic counseling when a person in the family decides to be tested for the presence
of a known genetic condition, when an adult begins exhibiting symptoms of an inherited condition, or
when there is a new diagnosis of someone with an adult-onset disorder in the family.
- In addition, the birth of a child with obvious features of a genetic disorder leads to diagnosis of a parent
who is more mildly affected.
- Genetic counselling in adults may lead to the consideration of presymptomatic genetic testing.
TYPES OF GENETIC TESTING
1. Diagnostic Testing
- Those with symptoms of a disease that may be caused by genetic changes sometimes called mutated
genes; genetic testing can reveal if you have the suspected disorder
- Example, genetic testing may be used to confirm a diagnosis of cystic fibrosis or Huntington’s disease.

2. Presymptomatic and Predictive Testing

- With family history of a genetic condition, getting genetic testing before you have symptoms may show
if you’re at risk of developing that condition.
- Example, this type of test may be useful for identifying your risk of certain type of colorectal cancer.

3. Pharmacogenetics
- If with a particular health condition or disease, this type of genetic testing may help determine what
medication and dosage will be most effective and beneficial.

4. Prenatal Testing
- For pregnant woman, tests can detect some types of abnormalities in the baby’s genes
- Down syndrome and trisomy 13 syndrome are two genetic disorders that are often screened for as part
of prenatal genetic testing.
- Traditionally this is done looking at markers in blood or by invasive testing such amniocentesis
- Newer testing called cell-free DNA testing looks at baby’s DNA via a blood test done on the mother.

5. Newborn Screening
- Most common type of genetic testing in the Philippines, requires that the newborn be subjected for
newborn screening.

6. Preimplantation Testing/Preimplantation genetic diagnosis

- May be used when a woman attempts to conceive a child through in vitro fertilization
- The embryos are screened for genetic abnormalities
- Embryos without abnormalities are implanted in the uterus in hopes for achieving pregnancy

TYPES OF PRENATAL GENETIC SCREENING TEST

1. Carrier Testing
- With a family history of a genetic disorder - such as sickle cell anemia or cystic fibrosis - or in ethnic
group that has a higher risk of a specific disorder, may choose to have genetic testing before having
children.
- An expanded carrier screening test can detect genes associated with a wide variety of genetic diseases
and mutations and can identify if the patient and the partner are carriers for the same conditions.

2. First-trimester Screening
- Includes a test of the pregnant woman’s blood and an ultrasound exam. Both tests usually are done
together between 10 weeks and 13 weeks of pregnancy
- The blood test measures the level of two substances

3. Cell-free DNA Testing

- Small amount of DNA that is released from the placenta into a pregnant woman's bloodstream
- The cell-free DNA in a sample of a woman’s blood can be screened for Down syndrome, Patau
syndrome (trisomy 13), Edwards syndrome and problems with the number of sex chromosomes.
 - Can be done starting at 10 weeks of pregnancy. It takes about 1 week to get the results. A positive
cell-free DNA test result should be followed by a diagnostic test with amniocentesis or CVS.

Indications of the results of the prenatal screening tests

- A negative result means that your fetus is at lower risk of having the disorder compared with the
general population. It does not rule out the possibility that your fetus has the disorder.

CODE OF ETHICS
The National Society of Genetic Counselors has created a Code of Ethics to guide Genetic Counselors in
caring people
● Beneficence
● Non-maleficence
● Autonomy
● Justice
● Non-directive counseling

Role of a Nurse in Genetic Counseling:

1. Guiding a woman or couple through prenatal diagnosis.
2. Helping parents make decisions in regard to abnormal prenatal diagnostic results.
3. Assisting parents who have a child with a birth defect to locate needed service and support
4. Providing support to help the family deal with the emotional impact of a birth defect
5. Coordinate services of other professionals such as social workers, physical and occupational therapist,
psychologist & dietitian.

Roles of Genetic Nurses:

1. Taking family history
2. Constructing a family pedigree
3. Attend patient’s concerns
4. Explaining genetic test
5. Obtain informed consent
6. Collecting blood samples for genetic testing
7. Give the results of genetic testing
8. Psychological support
9. Follow up to the family
10. Coordinate

Ethical Issues:
● Artificial insemination by donor
● Genetic screening
● In vitro fertilization
● Sex selection via prenatal testing
● Surrogate mother
● Fetal tissue transplantation
● Abortion