NCM 104 LEC

COMMUNITY HEALTH NURSING

COMMUNITY HEALTH

 Community - These are group of people that shares the common Geographic location,
institution where they are organized into population aggregate concept (age group),
common values or interest.
 Health
 Complete state of physical, mental and social well-being and not merely the
absence of disease or infirmity (WHO)
 Right of every individual
 Art. 25 Sec 1 of Universal Declaration of human Rights: Health is a
basic right of every individual.
o Everyone has the right to a standard of living adequate for the
health and wellbeing of himself and of his family
o Dual responsibility of the government and the individuals.
 Art. 2, Sec. 15
o The state shall protect and promote the right to health of the
people and instill health consciousness among them.
 Art. 13, Sec. 11
o The state shall adopt an integrated and comprehensive approach
to health development
 Levels of Clientele
 Individual
 Family – focus of care (CHN)
 Community – group of families; CHN directs its services to the community
because the client is the community
 Population Groups – common health needs
 Nursing - “Assisting an individual, sick or well, in the performance of those activities
contributing to health or its recovery (or to peaceful death) that he would perform if he
heads the necessary strength, will, or knowledge, and to do this in such a way as to help
him gain independence as rapidly as possible.” – Virginia Henderson (1964)
 Community Health
 Part of paramedical and medical intervention/approach which is concerned on
the health of the whole population
 Aims:
 Health promotion
 Disease prevention
 Management of factors affecting health
 Community Health Nursing
 direct, goal-oriented, and adaptable to the needs of the individual, the family, and
community during health and illness – ANA (1973)
  an area of human services directed toward developing and enhancing the health
capabilities of people – either singly, as individuals, or collectively as groups and
communities. – Ruth Freeman & Janet Heinrich (1981)
 Public Health
 Philosophy—health and longevity as birthright
 Objectives:
 Prevent disease
 Prolong life
 Promote health and efficiency
 Through: organized community effort
 “The application for science in the context of politics to remove inequalities in
health and deliver the best health for the greatest number” WHO
 Public Health Nursing
 Public health + Nursing + Social Assistance
1. Promotion of health
2. Improvement of the physical & social environment
3. Rehabilitation
4. Prevention of illness and disability
 WHO Expert Committee on Nursing
Milestone in history of Public Health

 1601- Elizabeth Poor Law

 1617- Sisterhood of Dames de Charite organized by St. Vincent de Paul
 1789- Baltimore Health Department
 1798- Marine Hospital Service, nuns visited poor
 1813- Ladies Benevolent Society of Charleston, South Carolina founded
 1836- Lutheran deaconesses provided home visits in Germany
 1851- Nightingale visited Kaiserwerth, 3 months of nursing training
 1855- Quarantine Board, established in New Orleans; beginning of tuberculosis
campaign in US
 1859- district nursing established by William Rathbone
 1860- Florence Nightingale Training School for Nurses established in St. Thomas
Hospital in London
 1864- Beginning of Red Cross
History of Public Health and Public Health Nursing in the Philippines

 1577 - Franciscan FriarJuan Clemente opened medical dispensary in Intramuros for the
indigent
 1690 – Dominican Father Juan de Pergero worked toward installinga water system in
San Juan del Monte and Manila
 1805 – smallpox vaccination was introduced by Franciwsco de Balmis , the personal
physician of King Charles IV of Spain
 1876 – first medicos titulares were appointed by the Spanish government
 1888 - 2-year courses consisting of fundamental medical and dental subjects was first
offered in the University of Santo Tomas. Graduated were known as
“cirujanosministrantes” and serve as male nurses and sanitation inspectors
  1901 – United States Philippines Commission, through Act 157, created the Board of
Health of the Philippine Islands with a Commissioner of the Public Health, as its chief
executive officer (now the Department of Health)
 Fajardo Act of 1912 – created sanitary divisions made up of one to four municipalities.
Each sanitary division had a president who had to be
 1915 - the Philippine General hospital began to extend public health nursing services in
the homes of patients by organizing a unit called Social and Home Care services
 Asociacion Feminista Filipina (1905) – Lagota de Leche was the first center dedicated
to the service of the mothers and babies
 1947 – the Department of Health was reorganized into bureaus: quarantine, hospitals
that took charge of the municipal and charity clinics and health with the sanitary divions
under it.
 1954 – Congress passed RA 1082 or the Rural Health Act that provided the creation of
RHU in every municipality
 RA 1891 – enacted in 1957 amended certain provisions in the Rural Health Act
-Created 8 categories of rural health units corresponding to the population size of the
municipalities
 RA 7160 (Local Government Code) – enacted in 1991, amended that devolution of
basic health services including health services, to local government units and the
establishment of a local health board in every province and city of municipality
Roles of a Public Health Nurse

 Clinician - who is a health care provider, taking care of the sick people at home or in the
RHU
 Health Educator - who aims towards health promotion and illness prevention through
dissemination of correct information; educating people
 Facilitator - who establishes multi-sectoral linkages by referral system
 Supervisor - who monitors and supervises the performance of midwives
 Epidemiologist
 Health Advocator - who speaks on behalf of the client
 Advocator – who act on behalf of the client
 Collaborator – who working with other health team member
Health Care Delivery Nurse

 Primary
 Prevention
 Management of prevalent conditions
 Out-patient services
 Providers:
 Barangay Health Station
 Rural Health Units
 Secondary
 Hospitalization
 Providers:
 Provincial Hospitals
 District Hospitals
  Tertiary
 Rehabilitation
 Specialized care
 Highly trained personnel
 Highly departmentalized
 Sophisticated equipment
 Providers:
 Regional Hospital
 National Hospitals
 DOH national office
 Medical Centers
 University Hospital
 RITM
 Two-way Referral System
 Communication among facilities
 Competent care
 Efficiency of health care delivery
 Least possible cost
 Maximize resources

Health Sectors

 Government Sectors
 Non-Government Sectors
 Private Sectors

 RA 7160 - Devolution Code Local Government Code

Aim: to transform local government units into:
 Self-reliant communities
 Active partnership with the people
 Responsive government representatives
 Accountable government representatives
 Decentralization system of health decision making
 Department of Health
 Vision: Health for all by year 2000 and Health in the Hands of the People by 2020
 Mission: In partnership with the people, provide equity, quality and access to
health care esp. the marginalized
 National hospitals/DOH, national office, Medical
 Centers
 Chair: Health Secretary
 Major Functions:
1. Ensure equal access to basic health services
2. Ensure formulation of national policies for proper division of labor and
proper coordination of operations among the government agency
jurisdictions
 3. Ensure a minimum level of implementation nationwide of services
regarded as public health goods
4. Plan and establish arrangements for the public health systems to achieve
economies of scale
5. Maintain a medium of regulations and standards to protect consumers
and guide providers
 Provincial Health Board
 Regular hospitals/RHO
 Provincial Hospital/PHO
 District Hospital
 Chair: governor
 Vice chair: PHO
 Members: Chairman, NGO, DOH
 Municipal Health Board
 RHU/BHS
 Chair: Mayor
 Vice Chair: MHO
 Members: Chairman, NGO,
 DOH representative
Primary Strategies to Achieve Health Goals

 Support for health goal

 Assurance of health care
 Increasing investment for PHC
 Development of National Standard
Milestone in Health Care Delivery System

 RA 1082 – RHU Act

 RA 1891 – Strengthen Health Services
 PD 568 – Restructuring HCDS
 RA 7160 – LGU Code
Elements in Primary Health Care
1. Education for Health
2. Locally Endemic Disease Control
3. Expanded Program on Immunization
4. Maternal and Child Health and Family Planning
5. Environmental Sanitation and Promotion of Safe Water Supply
6. Nutrition and Promotion of Adequate Food Supply
7. Treatment of Communicable Diseases and Common Illness
8. Supply of Essential Drugs
Major Strategies of Primary Health Care

 Elevating Health to a Comprehensive and Sustained National Effort

 Promoting and Supporting Community Managed Health Care
 Increasing Efficiencies in the Health Sector
 Advancing Essential National Health Research
Four Cornerstones/Pillars in Primary Health Care
1. Active Community Participation
2. Intra and Inter-sectoral Linkages
3. Use of Appropriate Technology
4. Support mechanism made available
Primary Health Care (PHC)

 Legal Basis—LOI 949

 October 1979 by Ferdinand Marcos, one (1) year after the First International
Conference on Primary Health Care in Alma Ata (Russia) sponsored by WHO &
UNICEF
 Goal - Health for all Filipinos & Health in the Hands of the People by the
 Mission - To strengthen the health care system by increasing opportunities and
supporting the conditions wherein people will manage their own health care
 Essential health care made universally:
1. Accessible – to the people in the catchment of the barangay
 2. Available
3. Appropriate – to the needs of the people
4. Affordable
 Acceptable – does not conflict their values and beliefs in the locality year 2020.
Two levels of Primary Health Care

 Barangay Health Workers - trained community health workers or health auxiliary

volunteers or traditional birth attendants or healers.
Village/BHWs—trained community health works, health auxiliary volunteers,
traditional birth attendants, healers (Grassroots Levels)
 Intermediate Level—Professional group
 Primary
 Rural Health Midwife (1:5,000)
 Secondary
 Public Health Nurse (1:20,000) – WHO 1:10,000
 Dentists (1:50,000)
 Rural Sanitary Inspector (1:20,000)
 Tertiary
 Municipal Health Officer -
 Physician (1:20,000)
 Intermediate Level Health Worker - include the Public Health Nurse, Rural Sanitary
Inspector and midwives

8 Essential Health Services

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 noncommunicable diseases
S Safe water and sanitation

Types of Health Care Systems

 Traditional - a. E.g. client provider

 Non-Traditional
 Holistic Health Centers
 Believes that time, space and encouragement can help people find
strength to deal with problems confronting them
  Spiritual, physical and psychological care
 Acts:
o Pastoral counseling
o Stress reduction
o Parenting
o Dietary conditioning
 Faith Healing - Believes that disease is a state of mind so one can alter his state
of mind so he will be healed
 Chiropractic
 System of manipulation treatment which teaches that all diseases are caused by
impringement on spinal column and corrected by spinal adjustment
 Daniel Palmer- founder
 Acupuncture - Insertion of needles into selected body parts to control pain
 Acupressure - Finger pressure to control pain in body parts
 Kinesiology - Study of movement which applies principles of anatomy to movement
 Reflexology
 Systematic massage of soles of feet
 Applies same principles as applied in acupressure
 Massage - Relieves tension, enhances flexibility and creates coordination between mind
and body
R.A. 8423 – Traditional and Alternative Medicine Act of 1997 (Juan Flavier)
Medicinal Plant Preparation

 Decoction - boiling the plant material in water for 20 min

 Infusion - plant material is soaked in hot water for 10 - 15 minutes
 Poultrice - directly apply plant material on the affected part, usually in bruises, wounds
and rashes
 Tincture - mix the plant material in alcohol
Alternative Health Care Modalities

Primary Care

 Includes health promotion, disease prevention, health maintenance, counseling,

patient education and diagnosis and treatment of acute and chronic illness in
different health settings (American Association of Family Medicine)
Philippine Health Care Laws

 Republic Act
 Republic Act 349 – Legalizes the use of human organs for surgical, medical
and scientific purposes.
 Republic Act 1054 – Requires the owner, lessee or operator of any
commercial, industrial or agricultural establishment to furnish free emergency,
medical and dental assistance to his employees and laborers.
 Republic Act 1080 – Civil Service Eligibility
 Republic Act 1082 – Rural Health Unit Act
 Republic Act 1136 – Act recognizing the Division of Tuberculosis in the DOH
 Republic Act 1612 – Privilege Tax/Professional tax/omnibus tax should be
paid January 31 of each year
 Republic Act 1891 – Act strengthening Health and Dental services in the
rural areas
 Republic Act 2382 – Philippine Medical Act which regulates the practice of
medicines in the Philippines
 Republic Act 2644 – Philippine Midwifery Act
 Republic Act 3573 – Law on reporting of Communicable Diseases
 Republic Act 4073 – Liberalized treatment of Leprosy
 Republic Act 4226 – Hospital Licensure Act requires all hospital to be
licensed before it can operative
 Republic Act 5181 – Act prescribing permanent residence and reciprocity as
qualifications for any examination or registration for the practice of any
profession in the Philippines
 Republic Act 5821 – The Pharmacy Act
 Republic Act 5901 – 40 hours work for hospital workers
 Republic Act 6111 – Medicare Act
 Republic Act 6365 – Established a National Policy on Population and
created the Commission on population
 Republic Act 6425 – Dangerous Drug Act of 1992
 Republic Act 6511 – Act to standardize the examination and registration fees
charged by the National Boards, and for other purposes.
 Republic Act 6675 – Generics Act of 1988
 Republic Act 6713 – Code of Conduct and Ethical Standards for Public
Officials and Employees
 Republic Act 6725 – Act strengthening the prohibition on discrimination
against women with respect to terms and condition of employment
 Republic Act 6727 – Wage Rationalization Act
 Republic Act 6758 – Standardized the salaries
 Republic Act 6809 – Majority age is 18 years old
 Republic Act 6972 – Day care center in every Barangay
 Republic Act 7160 – Local Government Code
 Republic Act 7164 – Philippine Nursing Act of 1991
 Republic Act 7170 – Law that govern organ donation
 Republic Act 7192 – Women in development nation building
  Republic Act 7277 – Magna Carta of Disabled Persons
 Republic Act 7305 – The Magna Carta of public Health Workers
 Republic Act 7392 – Philippine Midwifery Act of 1992
 Republic Act 7432 – Senior Citizen Act
 Republic Act 7600 – Rooming In and Breastfeeding Act of 1992
 Republic Act 7610 – Special protection of children against abuse,
exploitation and discrimination act
 Republic Act 7624 – Drug Education Law
 Republic Act 7641 – New Retirement Law
 Republic Act 7658 – An act prohibiting the employment of children below 15
years of age
 Republic Act 7719 – National Blood Service Act of 1994
 Republic Act 7875 – National Health Insurance Act of 1995
 Republic Act 7876 – Senior Citizen Center of every Barangay
 Republic Act 7877 – Anti-sexual harassment Act of 1995
 Republic Act 7883 – Barangay Health workers Benefits and Incentives Act of
1992
 Republic Act 8042 – Migrant Workers and Overseas Filipino Act of 1995
 Republic Act 8172 – Asin Law
 Republic Act 8187 – Paternity Leave Act of 1995
 Republic Act 8203 – Special Law on Counterfeit Drugs
 Republic Act 8282 – Social Security Law of 1997 (amended RA 1161)
 Republic Act 8291 – Government Service Insurance System Act of 1997
(amended PD 1146)
 Republic Act 8344 – Hospital Doctors to treat emergency cases referred for
treatment
 Republic Act 8423 – Philippine Institute of Traditional and Alternative
Medicine
 Republic Act 8424 – Personal tax Exemption
 Republic Act 8749 – The Philippine Clean Air Act of 1999
 Republic Act 8981 – PRC Modernization Act of 2000
 Republic Act 9165 – Comprehensive Dangerous Drugs Act 2002
 Republic Act 9173 – Philippine Nursing Act of 2002
 Republic Act 9288 – Newborn Screening Act
 Presidential Decree
 Presidential Decree 148 – Regulation on Woman and Child Labor Law
 Presidential Decree 166 – Strengthened Family Planning program by
promoting participation of private sector in the formulation and
implementation of program planning policies.
 Presidential Decree 169 – Requiring Attending Physician and/or persons
treating injuries resulting from any form of violence.
 Presidential Decree 223 – Professional Regulation Commission
 Presidential Decree 442 – Labor Code Promotes and protects employees
self-organization and collective bargaining rights. Provision for a 10% right
differential pay for hospital workers.
 Presidential Decree 491 – Nutrition Program
  Presidential Decree 539 – Declaring last week of October every as Nurse’s
Week. October 17, 1958
 Presidential Decree 541 – Allowing former Filipino professionals to practice
their respective professions in the Philippines so they can provide the latent
and expertise urgently needed by the homeland
 Presidential Decree 568 – Role of Public Health midwives has been
expanded after the implementation of the Restructed Health Care Delivery
System (RHCDS)
 Presidential Decree 603 – Child and Youth Welfare Act / Provision on Child
Adoption
 Presidential Decree 626 – Employee Compensation and State Insurance
Fund. Provide benefits to person covered by SSS and GSIS for immediate
injury, illness and disability.
 Presidential Decree 651 – All births and deaths must be registered 30 days
after delivery.
 Presidential Decree 825 – Providing penalty for improper disposal garbage
and other forms of uncleanliness and for other purposes.
 Presidential Decree 851 – 13th Month pay
 Presidential Decree 856 – Code of Sanitation
 Presidential Decree 965 – Requiring applicants for Marriage License to
receive instruction on family planning and responsible parenthood.
 Presidential Decree 996 – Provides for compulsory basic immunization for
children and infants below 8 years of age.
 Presidential Decree 1083 – Muslim Holidays
 Presidential Decree 1359 – A law allowing applicants for Philippine
citizenship to take Board Examination pending their naturalization.
 Presidential Decree 1519 – Gives Medicare benefits to all government
employees regardless of status of appointment.
 Presidential Decree 1636 – requires compulsory membership in the SSS
and self-employed
 Presidential Decree 4226 – Hospital Licensure Act
 Proclamation
 Proclamation No.6 – UN’s goal of Universal Child Immunization; involved
NGO’s in the immunization program
 Proclamation No. 118 – Professional regulation Week is June 16 to 22
 Proclamation No. 499 – National AIDS Awareness Day
 Proclamation No. 539 – Nurse’s Week – Every third week of October
 Proclamation No. 1275 – Declaring the third week of October every year as
“Midwifery Week”
 Letter of Instruction
 LOI 47 – Directs all school of medicine, nursing, midwifery and allied medical
professions and social work to prepare, plan and implement integration of
family planning in their curriculum to require their graduate to take the
licensing examination.
 LOI 949 – Act on health and health related activities must be integrated with
other activities of the overall national development program. Primary Health
Care (10-19-79)
  LOI 1000 – Government agencies should be given preference to members of
the accredited professional organization when hiring.
 Executive Order
 Executive Order 51 – The Milk Code
 Executive Order 174 – National Drug Policy on Availability, Affordability,
Safe, Effective and Good Quality drugs to all
 Executive Order 180 – Government Workers Collective Bargaining Rights
Guidelines on the right to Organize of government employee.
 Executive Order 203 – List of regular holidays and special holidays
 Executive Order 209 – The Family Code (amended by RA 6809)
 Executive Order 226 – Command responsibility
 Executive Order 503 – Provides for the rules and regulations implementing
the transfer of personnel, assets, liabilities and records of national agencies
whose functions are to be devoted to the local government units.
 Executive Order 857 – Compulsory Dollar Remittance Law
 Other
 Administrative Order 114 – Revised/updated the roles and functions of the
Municipal Health Officers, Public Health Nurses and Rural Midwives
 ILO Convention 149 – Provides the improvement of life and work conditions
of nursing personnel.
Health Promotion
 Is the process of enabling people to increase control over, and to improve their health
 A behavior motivated by the desire to increase well-being and actualize human health
potential. It is an approach to wellness
Disease Prevention

 activities protect people from disease and effects of disease

Leavell and Clark’s Three Levels of Prevention

 Primary Prevention - relates to activities directed at preventing a problem before it

occurs by altering susceptibility or reducing exposure for susceptible individuals.
 Secondary Prevention - early detection and prompt intervention during the period of
early disease pathogenesis
 Tertiary Prevention - targets populations that have experienced disease or injury
and focuses on limitations of disability and rehabilitation
Ottawa Character
 Output of the first international conference on health promotion, meeting in Ottawa this
21st day of November, 1986
 A call for action to achieve health for all by the year 2000 and beyond
1. Building healthy public policies – Breastfeeding Law, Rooming-in
2. Create a supportive environment
3. Strengthen community action
4. Develop personal skills
5. Reorient health services
Prerequisites for Health

 Advocate
 Enable the community of health education
 Mediate – facilitate decision making process
Millenium Development Goals
 The 3-day summit held on 6–8 September, 200 @ NY was the largest ever gathering of
world leader.
 They agreed to achieve a set of concrete, measurable
 The millennium development goals are the world’s time-bound and quantified targets

 Goal 1: Eradicate extreme poverty and hunger

 Reduce by half the proportion of people living on less than a dollar a day
 Proportion of population below $1/day
 Poverty gap ratio
 Share of poorest quintile in national consumption
 Goal 2: Achieve Universal Primary Education
 Ensure that all boys and girls complete a full course of primary schooling
 Net enrollment ratio in primary education
 Proportion of pupils starting grade 1 who reach lest grade of primary
 Literacy rate of 15–24 year–olds, women and men
 Goal 3: Promote Gender Equality and Empower Women
 Eliminate gender disparity in primary and secondary education preferable by
2005, and at all levels by 2015
 Ratios of girls to boys in primary, secondary and tertiary education
 Share of women in wage employment in the non-agricultural sector
 Proportion of seats held by women in national parliament
  Goal 4: Reduce Child Mortality
 Reduce by 2/3 the mortality rate among children under 5
 Under 5 mortality rates
 Infant mortality rate
 Proportion of 1 year old children immunized against measles
 Goal 5: Improve Maternal health
 Reduce by 3⁄4 the maternal mortality ratio
 Maternal mortality ratio
 Proportion of births attended by skilled health personnel
 Achieve by 2015, universal access to reproductive health
 Goal 6: Combat HIV/AIDS, malaria, and other diseases
 Halt and begin to reverse the spread of HIV/AIDS
 Achieve by 2010, universal access to treatment for HIV/AIDS for all those who
need it
 Halt and begin to reverse the incidence
 Goal 7: Ensure environmental sustainability
 Integrate the principles of sustainable development into country politics and
programs; reverse loss of environmental resources
 NGPs – 1.5 billion trees
 Goal 8: A global partnership for development

Formula One for Health as Implementation Framework

 Goals:
 Better health outcomes
 More responsive health system
 Equitable health care financing
 Four thrusts:
 Financing (increased, better and sustained)
 Regulation (assured quality & affordability)
 Service Delivery (access & availability)
 Good Governance (improves performance)
Sentrong Sigla Movement

 Goal - Quality Health

 Objective - Better and more effective collaboration between the DoH and LGUs
 DOH - Technical and financial assistance
 LGUs - Developers of health systems and implementer\
 Pillars
 Quality assurance – ongoing process of improving health care services
 Grants and technical assistance
 Awards – Sentrong Sigla Movement seal
  Health promotion – health education
Aquino Health Agenda

 Achieving universal health care (UHC) for all Filipinos

 Kalusugan Pangkalahatan (KP)
 AO No. 2010-0036
 Objective:
 To achieve universal healthcare
Home Visit

 Professional face to face contact made by the nurse to the family

 Purpose:
 To provide necessary health care activities
 To further attain an objective of the agency
Principles in Planning for a Home Visit
1. Have a purpose or objective
2. Make use of all available information
3. Focus on essential needs of the individual and family but prioritize needs recognized by
the family
4. Should involve the individual and family
5. Flexible and practical
Bag Technique

 A tool making use of public health bag through which the nurse, during his/her home
visit, can perform nursing procedures with ease and deftness, saving time and effort with
the end in view of rendering effective nursing care.
Principles
1. Minimize & Prevent spread of infection
 All articles from the family are considered as
contaminated
 Well to Sick
 Hold the lining on the outside
 Clean technique
2. Save time & effort of nurse
3. Effectiveness of care—not overshadow
4. Performed in variety of ways—do not spread infection
Types of Problems in he Community

 Family
 Wellness Condition
 Health Deficit
 Health Threat
 Foreseeable Crisis or Stress
  Community
 Health Status
 Health Resources (facilities, manpower)
 Health Related (political, environmental, social, economical)
Evaluation of Nursing Care

 Effectiveness - Measures attainment of objectives

 Efficiency - Cost, time, and resources
 Appropriateness - the ability of the intervention to solve the problem
 Adequacy - Comprehensiveness or the number of solutions to solve the problems
Community Organizing
 Is a continuous process of educating the community to develop its capacity to assess
and analyze the situation (which usually involves the process of consciousness raising),
plan and implement interventions (mobilization), and evaluate them.
 Is a process of educating and mobilizing members of the community to enable them to
resolve community problems. It is a means to build the community’s capacity to work for
the common good in general and health goals.
 Community organizing and community health nursing practice have common goals:
People empowerment, development of self-reliant community, and improved quality of
life. As a result, they become the health care professionals’ partners in health care
delivery and overall community development
Community Development

 entails a process of assessment of the current situation, the identification of needs,

deciding on appropriate courses of actions or response, mobilization of resources to
address these needs, and monitoring and evaluation by the people.
Core Principles in Community Organizing
 Community organizing is people-centered
 Community organizing is participative
 Community organizing is democratic
 Community organizing is developmental
 Community organizing is process-oriented
Phases of Community Organizing

 Pre-Entry
 Involves preparation one the part of the organizer and choosing a community for
partnership.
 Preparation includes knowing the goals of the community organizing activity or
experience. It also necessary to delineate criteria or
 guidelines for site selection. Making a list of sources of information and possible
facility resources, both government and private, is recommended.
 For the novice organizers, preparation includes a study or review of the basic
concepts of community organizing.
  Proper selection of possible barriers, threats, strengths, and opportunities at this
stage is an important determinant of the overall
 outcome of community organizing.
 Communities may be identified through different means:
 Initial data gathered through an ocular survey
 Review of records of a health facility
 Review of the barangay/municipality profile
 Referrals from other communities or institutions or through a series of
meetings
 Consultation from the local government units (LGUs) or private
institutions.
 An ocular survey done at this stage.
 Courtesy call to the mayor
 Entry into the Community
 Entry into the community formalizes the start of the organizing process. This is
the stage where the organizer gets to know the community and the community
likewise gets to know the organizer.
 An important point to remember this phase is to make courtesy call to
local formal leaders (barangay chairperson, council members)
 Equally crucial but often overlooked is a visit to informal leaders
recognized in the community, like elders, local health workers, traditional
healers, church leaders, and local neighborhood association leaders
Considerations in the Entry Phase:
 The community organizer’s responsibility to clearly introduce themselves and
their institution to the community.
 A clear explanation of the vision and mission, goals, programs, and activities
must be given in all initial meetings and contacts with the community.
 Preparation for the initial visit includes gathering basic information on
socioeconomic conditions, traditions including religious practices, overall physical
environment, general health resources.
 the community organizer must keep in mind that the goal of the process is to
build up the confidence and capacities of people
Manalili describe two strategies for gaining entry into a community:

 Padrino – a patron, usually barangay or some other local government official.

The padrino, in an effort to boost the organizer’s image, tends to preset the
intended project output, thereby creating false hopes.
 Bongga – as the easiest way to catch the attention and gain the “approval” of the
community. This strategy exploits the people’s weaknesses and usually involves
doles-out, such free medicines
Basic Emergency Obstetric Care (Bemoc) Services

 Are upgraded enhanced BHS, RHU, lying-in clinics or birthing homes, District and
Community hospitals that provide.
6 Basic Obstetric Functions:
 1. Administer Parenteral antibiotics
2. Parenteral Uterotonic drugs (Oxytocin)
3. Parenteral Anticonvulsants
4. Manual Removal of Placenta
5. Removal of Retained Placental Products
6. Perform assisted vaginal delivery
Comprehensive Emergency Obstetric Care (CEmoc) Services

 Are end-referral facilities capable of managing complicated deliveries and newborn

emergencies
 It should be able to perform 6 basic OB functions as well as to provide
 CS services
 Blood banking and transfusion services
Perinatal Care
 Prenatal/Antenatal Visits
 Home-based mother’s records
 Encourage all women to deliver in the health facility
 Pre-natal Check-up
 Age
 LMP
 Family history
 Fundic Height
 Leopold’s Manuever
 Blood Pressure
 Tetanus Toxoid Immunization
 Laboratory Tests
 CBC – Anemia
 Glucose Tolerance Test
– 24 to 28th week AOG– if with hx of DM
 Blood Typing – ABO Rh Incompatibility
 UA – Proteinuria, UTI, STIs
Leopold/s Maneuver
 Void first
 Position: supine or dorsal recumbent
 Palm not fingertips
 Provide privacy
Nutrition Program

 Goal: Improve quality of life through better nutrition, improved health and increased
productivity
Nutritional Programs

 Nutritional assessment
 Micronutrient supplementation
 Food fortification
 Maternal and child health service packages
 Nutrition information communication, education
 Home, school and community food production
 Food assistance
 Livelihood assistance
 Treatment of conditions associated with malnutrition
Legislations Affecting the Philippine Nutrition Program

 PD No. 491 - declared July as the Nutrition Month and creation of National Nutrition
Council
 LOI 441 - declared July as the Nutrition Month and creation of National Nutrition Council
Tetanus Toxoid

 Mother - Artificial Active

 Baby – Natural Passive
  Mother is protected after 1 dose
 Baby is protected after 2 doses
 IM – 0.5 mL – deltoid
Micronutrient Supplementation

 Iron Deficiency – can cause neural tube defects

 Anemia – presence of pallor, N = 11g/dl
Iron Supplementation

Vitamin A Supplementation

 Plant sources: Carotene

 Animal sources: Retinol
 Vit A Deficiency – can cause
congenital problems
 Do not give Vit. A if woman is
taking multivitamins
 2nd trimester – teratogenic
 Blue – 100,000 IU
Iodine Supplementation

 Iodine deficiency – can cause

congenital
 hypothyroidism or cretinism
 Sources: seafood
 Avoid goitrogenic foods –
cabbage, broccoli, potato,
peanuts, cauliflower - inhibit the
absorption of iodine in the body
Post-Partum Care

 Breast
 Uterus
 Bowel
 Bladder
 Lochia – rubra, serosa, alba
  Episiotomy
 Skin
 Homan’s Sign
 Emotions
Sleep Hygiene

 Avoid caffeine and nicotine close to bedtime

 Avoid alcohol as it can cause sleep disruptions
 Retire and get up at the same time everyday
 Exercise regularly but finish all exercise and vigorous activity at least 3 hours before
bedtime
 Establish a regular relaxing bedtime routine (a warm bath, reading a book)
 Create a dark, quiet, cool sleep environment
 As much as circumstances allow, have comfortable beddings
 Use the bed for sleep only. Do not read, listen to music or watch TV in bed
 Avoid large meals before bedtime
Sleep - Essential component of chronic disease prevention and health promotion

Smoking Cessation - an important step in achieving optimum health

Steps to Quit Smoking
 Make decision to quit.
 Set a date to quit and choose a plan
 Deal with withdrawal through. Avoid temptation
 Staying off tobacco is a lifelong process. Remind yourself of the reasons why
 you quit
Alcohol Consumption - Health authorities have defined moderation as not more than 2 drinks
a day for the average sized man and not more than 1 drink a day for the average size woman

 Heavy Drinking - consuming more than 2 drinks/day on average for men and more than
1 drink per day for women
 Binge Drinking - drinking 5 or more drinks on a single occasion for men / 4 or more
drinks on a single occasion for women
 Excessive Drinking - can take the form of heavy drinking/ binge drinking/ both
The 10 Nutritional Guidelines for Filipinos
1. Eat variety of foods everyday
2. Breast feed infants exclusively from birth to 4-6months and give appropriate foods while
continuing breastfeeding
3. Maintain children’s normal growth through proper diet and monitor their growth regularly
4. Consume fish, lean meat, poultry or dried beans
5. Eat more vegetables, fruits and root crops
6. Eat foods cooked in edible/cooking oil daily
7. Consume milk and milk products and other calcium rich foods such as small fish and
dark leafy vegetables everyday
8. Use iodized salt but avoid intake of excessive intake of salty foods
9. Eat clean and safe food
10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke and avoid
drinking alcoholic beverages
Common Intestinal Parasites

 Ascaris (Giant Roundworm)

 Nutritional competition
 Source: Soil, fecal-oral
 Vomit worms
 Ancylostomiasis/Hookworm
 Blood sucker
 Heavy infestation is seen as severe anemia
 Enters the human body by skin penetration, abd.
 Pain
 Enterobius (pinworm)
 Habitat is the rectum
 Major symptom is pruritis ani
 Highly contagious
 Source: fingernails
 Taenia saginata/ solium (tapeworm)
 The longest intestinal parasite (average adult length is about 15 to 25 meters)
Nutritional Methods of Assessment
A – anthropometry
B – biochemical or lab exams
C – clinical exam
D – dietary history
H – health history
Anthropometry

 Weight for age

  Under 5 - Operation Timbang
 Not used when patient has edema
 Used in diagnosis of:
 Acute (current) malnutrition
 Overweight – obesity
 Underweight – wasting
 Height for age
 Body mass index
 Normal 18-24
 Mid Upper Arm Circumference
 Only for children under 5 years old (1-4 years old)
 Rapid screening for malnutrition
 Skin Fold Thickness
Macronutrient Deficiencies

 Kwashiorkor
 Qualitative Deficiency
 Manifestations:
 Edema
 Ascites
 Irritable
 Alternating black or black hair – Flag Sign – discoloration of hair
 Skin desquamation
 Normal
weight –
edema
 Marasmus
 Quantitative
Deficiency
 Protein,
Carbohydrates,
Fats
 Manifestations:
 Muscle
Wasting
 Normal
hair and
skin
 Skin and
bones
 Weight between 2nd to 3rd degree malnutrition
Micronutrient - a substance found in very small amounts in the body (<0.005% of body weight
Major Micronutrient Deficiency in the Philippines
 Vitamin A deficiency
 Iron deficiency anemia
  Iodine deficiency disorders
Vitamin A Deficiency (VAD)
 Xerophthalmia - Night Blindness
 Susceptible population: 1-4 year; usually occurs together with PEM
 Deficiency: irreversible blindness
 Foods rich in vitamin A
 Richest: liver, egg yolk and milk; contain retinol
 Best (considering socio-economic status of family): dark green leafy vegetables,
yellow fruits and vegetables; contain carotene
Signs of Vitamin A deficiency
 Night blindness
 Photophobia
 Conjunctival xerosis
 Bitot’s spot
 Corneal opacity
 Keratomalacia - can cause irreversible blindness
Iron Deficiency Anemia
 Susceptible population: pregnant women and infants
 Foods rich in Fe
 Liver and other internal organs
 Egg yolk
 Dark green leafy vegetables
 Major sign of IDA: Palmar Pallor (Color of the palm darker than the color of the skin)
 Management:
 150mg/5mL = 14 days
 Below 4 months—2.5 mL
 4–12 months—4 mL
 1–3 yrs.—5ml
 3–5 yrs.—10 mL
 Taken once a day for 3 months
Iodine Deficiency Disorder (IDA)
 Susceptible population – Pregnant women
 Most serious effect – mental retardation (cretinism) in the baby if the mother
does not have enough supple of Iodine during pregnancy
 200mg capsule once a year
 Other Signs of Cretinism
 Growth stunting
 Pasty Skin
 Protruding Abdomen
 Foods rich in Iodine: sea foods
 Iodine in vegetables and fruits depends on the soil on which they are
grown
  Goitrogens – substances that interfere with iodine use; found in
cabbage, turnips, mustard, red skin of peanuts, cauliflower, broccoli,
Brussels sprouts, cassava
Fortification - Addition of a nutrient to food during processing

 Sangkap Pinoy Seal - placed on label fortified foods

 RA 8976
 Philippine Food Fortification Act of 2000
 This provides for mandatory fortification of the following products:
 Rice with iron
 Wheat flour with Vit. A and Iron
 Refined Sugar with Vit. A
 Cooking Oil with Vit. A
 RA 8172 – “Asin” Law
 EO 382 - November 7 declared National Food Fortification Day
 Yellow—Vitamin A
 Green—Iron
 Purple—Iodine
Family Planning Program
 Reproductive Health Program (Responsible Parenthood Program)
 Ideal: Prior to marriage

Four Pillars
 Responsible Parenthood
 They can have as many child as they want provided that they can support
their needs
 PD 965
 mandates all couples prior to marriage must attend family
planning seminar
 done at the local municipal office
 Child Spacing – at least 3 to 5 years interval
 Respect for life – anti-abortion
 Informed Choice
 The right of every couple to be knowledgeable of the different family
planning methods, its advantages and disadvantages
 All health care workers must inform them of its contraindications
 Before they can teach, must attend a training seminar (PD 791)
Family Planning Priorities
 Couples in the reproductive age: 20 to 44 years
 3 or more children
 Close interval pregnancies
 (+) chronic disease
Family Planning Counseling
 Greet – warmly and politely
 Ask – about him/herself
 Tell – health center and the services provided
 Help – make the decision that is best for him/her
 Explain – relevant information about the signs, diagnose treatment
 Return – schedule a return visit
Early Childhood Care and Development (ECCD)
 RA 8980 - Refers to the full range of health, nutrition, early education and social services
programs that provide for the basic holistic needs of young children from birth to 6 years
of age, to promote their optimum growth and development
Center-based Programs
 Day-care Service (RA 6972)
 Public and Private Pre-schools
 Kindergarten
 Community or school-based early childhood
 Child-minding centers
 Health centers and stations
Home-based Programs
 Neighborhood-based play groups
 Supervised by the barangay captain
 Family day care programs
 Supervised by the public schools
 Parent education
 Home visiting Programs
Essential Intrapartal Newborn Care-Unang Yakap
 DOH Administrative Orders 2009-0025

Four Core Steps in EINC

 Immediate and thorough drying
 2 towels
 Early skin to skin contact
 To prevent hyperthermia
 Properly timed clamping and cutting of the cord
 To prevent intraventricular hemorrhages and anemia
 Non-separation of the newborn and the mother thru initiation of early
breastfeeding
 To prevent intraventricular hemorrhages and anemia
Newborn Screening

 RA 9288—Newborn Screening Act of 2004

  Detect congenital metabolic disorder that may lead to mental retardation or even death if
left untreated

6 Diseases
 Congenital Adrenal Hyperplasia
 Congenital Hypothyroidism
 PKU
 Galactosemia
 G6PD
 Maple Syrup Purine Disease
Recommended
- Get specimen after 48 – 72 hours after birth because PKU cannot be detected as early
as 24 hours
Advocacy
- Education of the mother about the benefits of Newborn Screening Test (as early as
pregnancy stage) and ask to prepare said amount
Universal Newborn Hearing Screening Program

 RA 9709
 Universal Newborn Hearing Screening and Intervention Act of 2009
 Early detection of congenital hearing loss and referral for early interventions for
infants (under 3 months of age)
 Newborn Hearing Screening Reference Center at the National Institute of Health
 BAAH Test – to detect initially whether the child has hearing loss
Breastfeeding Campaign – The first to raising a bright child
Promoting Breastfeeding

 RA 7600
 Rooming in and Breastfeeding Act of 1992
 Breastfeeding week: August 1-7
 EO 51
 Milk Code
 Avoid formula milk
 Do not give incentives who use formula milk
 RA 10028
 Expanded Breastfeeding Promotion Act of the Philippines
 Promotes that each facilities (if they have female employees) should have a
breastfeeding station
 Must include refrigerators
 AO 2006 – 0012
 Revised Implementing Rules and regulations in the EO 51
 AO 2005 – 0014
 National Policies on Infant
Breastfeeding Practices

 Exclusive Breastfeeding Practices - Allows ORS, drops, syrups (vitamins, minerals,

medicines)
 Predominant Breastfeeding - May also have water and water-based drinks, fruit juice,
ritual fluids and ORS – drops or syrups such as vitamins, minerals and medicines
 Complementary Feeding
 Interval of 1 week to check for food allergies
 Giving the infant foods and liquids along with breast milk
 When breast milk is no longer sufficient to nutritional requirements
 Bottle feeding - Child is given food or drink (including breast milk) from a bottle with a
nipple
 Early Initiation of breastfeeding - Initiating breastfeeding of the newborn after birth
within 90 minutes of life in accordance to the essential newborn care protocol
Positions

 How to get baby “latch on”

 The mother holds her breast in a C-hold position
 To anchor the breast
 Stimulate the baby’s rooting reflex
 Striking the cheek of the child
 Stimulate the sucking reflex using the nipple
 When the baby’s mouth opens wide, put the nipple and as much of the areola as
possible into his mouth
 Chin and breast must be in contact
 Signs that the baby has latched on properly to the breast
 The baby’s mouth is widely open
 The baby and the mother are into tummy-to-tummy
 Position
 Much of the areola is inside the baby’s mouth
 The mother does not feel nipple pain
 Baby is relaxed and happy
Breastfeeding Campaign

 Storage of breast milk

 If at room temp – 8 hours
 If refrigerated – 24 hours
 If frozen – 1 month
 Galactogen
 Malunggay (mammaloctin)
 Soups, Broths, Shellfish
 Breastfeeding should be fed on demand-at least 8x a day
 No coffee, alcohol, drugs, smoking
 If taken coffee, withhold feeding after 24 hours
Unique Characteristics of Breastmilk

 B – best for baby

 R – reduced allergic reaction
 E – economical
 A – always available
 S – safe
 T – temperature always right
 F – fresh always
 E – emotional bonding
 E – easily established
 D – digestible
 I – immunity
 N – nutritious
 G – GIT disorder decreased
Expanded Program on Immunization

 Launched by the DOH, WHO, &

UNICEF last July 1976
 Objective - reduce morbidity and
mortality among infants and
children caused by the 6 childhood
immunizable diseases

PD No. 996 (Sept. 16, 1976)

 Providing for compulsory basic immunization for infants and children below 8
 6 vaccines
RA 10152
 Inclusion of new vaccines
 Mandatory Infants and Children Health Immunization Act of 2011
 11 vaccines
RA 7846 (Dec. 30, 1994)
 Hep. B immunization
 7 vaccines
 PP No. 6 (April 3, 1996)
 Implementing a United Nations goal on Universal Child Immunization by 1990
Principles of EPI
Epidemiological Situation

 Schedules are drawn on the basis of occurrence and characteristic feature of

the disease
 Applicable to children below 8
 Goal is to complete vaccines before 1 year (“Fully Immunized Child”)
 If achieved after 1 year—“Completely Immunized”
 Mass approach
 Integrated to the health services of the unit
Elements of EPI

 Target setting—all children before 1 year old

 Cold chain logistics
 PHN—Cold chain officer
 Vaccines must be stored in
a cold place
 Freezer (–15–
25oC) - OPV &
Measles
 Refrigerator
Compartment (2–
8oC) - BCG & DPT
 BCG—Light sensitive
 Measles/MMR—Heat
sensitive
 Information, Education, and
Communication (IEC)
 Assessment and evaluation of the
program overall performance
 Target: 95% every month
 Surveillance, studies and research
Supplementary Immunization Activities (SIAs)
 “Catch up” or “speed up” campaigns for the new vaccine to rapidly increase immunity in
older age groups that are outside of the immunization schedule
 Intended to reduce or interrupt transmission of the targeted disease with the goal of
elimination or eradication

Contraindications: Not Contraindications:

 History of seizures/convulsions for DPT 1
 If convulsions last for 3 days—DT
 If convulsions > 3 days—Do not give
 succeeding doses
 Clinical AIDS—Infant BCG
 Immunosuppression
 Fever up to 28.5 C
 Simple or mild acute respiratory infection
 Simple diarrhea without dehydration
 Malnutrition (it is indication for immunization)
Schedule for Immunization

Infant BCG
 0–11 months or 0-1 years
 At birth
 0.05 mL (dose)—ID, right upper deltoid
 Freeze dried then reconstituted with diluent
School Entrance BCG
 When the child enters Grade 1 with or without scar in the right arm then still go on with
the vaccination except if he is repeating grade 1
 0.1 mL
 Effects
 Wheal lasts for 30 minutes to 1 hour
 Inflammatory response lasts from 2 weeks -
 12 weeks
 Scar
 Administer warm compress on the site of injection
 Fever
 Antipyretic every 4o
 SQ Abscess - Marble-like mass present on the site of injection
 With persistent fever
 Management—I/D
Hepatitis B Vaccine
 3 doses, 2 types (Plasma derived and recombinant Hep B surface antigen)
 Target age:
  HBV 1
o At birth (Health Facility)
o For more than 7 days (home)
 HBV 2 & HBV
o 3—6 weeks
o 14 weeks
 Pentavalent
o 6, 10, 14 weeks
o 0.5 m, IM, Vastus Lateralis
 Effects:
 No fever
 Local tenderness; Do not massage; apply cold compress
Pentavalent
 DPT, Hib, Hep. B
 3 doses, 4 weeks or 1 month interval
 Target age—6, 10, 14
 0.5 mL, IM, vastus lateralis (upper outer thigh)
 Reduces chance of acquiring pneumonia and meningitis
 Effects:
 Fever, Antipyretic q4
 Local tenderness, do not massage site
OPV
 Against Poliomyelitis
 Pathognomonic—Tightening and spasms of Hamstring
 3 doses, 4 weeks/1 month
 Target population—same as above, eligibility until Grade 6 (12 years)
 2–3 drops, oral route
 Color—clear pink or pale orange liquid
 Keep Philippines Polio Free
 Effects:
 Vomiting—if after 30 minutes, do not re- administer
 Do not feed child for 30 minutes
Rotavirus
 2 doses, 8 weeks interval
 Target age: 6 and 14 weeks
 1.5 mL, PO
 1st – 6 to 15 weeks
 2nd – not more than 32 weeks
 Reduces chance of acquiring diarrhea
 Effects:
 Soft stool
 Dispose diapers – virus is there
 Wash cloth diapers separately
  OPV - Rotarix - Pentavalent
Measles
 9–11 months
 In cases of epidemics—can be given at 6 months
 0.5 mL, subcutaneous, any arm (outer part of the upper arm, preferably left)
 Fever and measles rash lasting for 1–3 days within 2 weeks after immunization
(modified measles)
 Vitamin A is given with measles—100,000 IU (Blue) - boost immune system
 At least 85% can be prevent by immunization at this age
 Freeze dried then reconstituted with diluent water
 Effects:
 Fever – Antipyretic every 4o
 Rashes within 2 weeks and lasts for 3 days –subside naturally
Measles, Mumps, Rubella (MMR)
 12–15 months
 Mumps - enlargement front and below the ear
 0.5 mL, SC, any arm (deltoid)
 Vitamin A is given with MMR, 200,000 IU (red)
 Freeze dried then reconstituted with diluent water
BGC, AMV, MMR
 Diluted – cold temperature
 Must be consumed within 4 to 6 hrs
Integrated Management for Childhood Assessment
Basic Steps in IMCI
1. Assess
a) Child’s problem – interview the mother
b) Check for general danger signs
 Ask
 Able to drink or breastfeed?
 Vomit everything?
 Had convulsions?
 Look
 Abnormally sleepy or difficult to awaken
c) Then ask for main symptoms
2. Classify
 Severe (Pink)
 Some/Disease (Yellow)
 No (Green)
3. Treat
4. Follow-up
Color Codes – Classification and Management
 Pink
 Severe Classification
 Management - Referral to hospital + Pharma (1st Dose)
 Yellow
 Some/Disease Condition
 Management - RHU + Pharma (3 days)
 Follow-up - 2 days
 If after 2 days, the child gets better - continue antibiotic
 If after 2 days, the child doesn’t improve -change to 2nd line antibiotic
 If after 2 days, the child gets worse – refer
 Green
 No Classification
 Management - Home
 Follow-up - 5 days
Management of Anemia

Control of Acute Respiratory Infections

 Assess
 Main Symptoms - cough/difficulty breathing
 Ask how long: acute (pneumonia), chronic (asthma)
 Look and Listen: Child must be calm
 Stridor
 Chest indrawing
 Count RR/min
 Wheeze
o If with chest indrawing, fast breathing and wheeze
o Trial of rapid acting bronchodilator for 3x 15 –20 mins apart.
o 1st choice – Inhaler
o 2nd choice – Oral
salbutamol

 Very severe
pneumonia or severe
pneumonia
 Any general
danger sign
 Chest in-
drawing or
 Stridor (noisy
inspiration) in a
calm child
 Pneumonia
 Fast Breathing
  Intramuscular Antibiotic for children being referred urgently
 Gentamicin (7.5 mg/kg)
 Benzyl penicillin (50 000 units/kg)
 Pneumonia
 Amoxicillin – 1st line BID
 Clotrimoxazole – 2nd line BID
 Soothe throat of child
 Calamansi
 Breastmilk
 Don’t give: codeine, cough syrup, nasal syrup
 IMCI: 3 weeks for TB
 Not taking any antibiotic but have cough for 30 days:TB
 Not IMCI: 2 weeks for TB
 Oral Antibiotic
 First line: Amoxicillin for 3 days, BID
 If 250/5ml
 Less than 2 months = 2.5 ml
 2-12 months = 5 ml
 12 months to 5 years = 10 ml
Control of Acute Respiratory Infections

 Dysentery/ Shigelosis
 EA: Shigella disentiriae
 Source: Feces
 2-3 times of loose watery stools (diarrhea for children)
 MOT: contaminated food, water and by hand to mouth transfer of contaminated
materials
 IP: 1 day
 Sx: Bloody mucoid stool
 Damage mucosa lining -- becomes necrotic – fibrin
 Cholera
 EA: Vibrio el tor (rod-shaped)/ coma (roung-shaped)
 Source: Vomitus, feces
 Mot: Contaminated food and water
 IP: Few hours to 5 days
 POC: 7 to 14 days
 Sx: Rice watery stool
Classify

 Severe Dehydration - 2 of the following signs

 Abnormally sleepy or difficult to awaken
 Sunken eyes• Not able to drink or drinking poorly
 Skin pinch goes back very slowly (>2 secs)
 Some Dehydration- following symptoms
 Restless, irritable
 Sunken eyes
  Drinks eagerly, thirsty
 Skin pinch goes back slowly
 No Dehydration – Not enough signs
Assessment

 Main symptoms-Diarrhea
 Ask
 How long?
 Blood in stools?
o Dysentery
o Cholera
 Look and feel
 Abnormally sleepy or difficult to awaken
 Restless and irritable
 Sunken eyes
 Not able to drink
 Pinch the skin (skin turgor)
Classification of Chronic Diarrhea

 If lasts for 14 days or more

 Severe persistent diarrhea
 Dehydration present
 Persistent diarrhea
 No dehydration
 Blood in stool - Dysentery
 Rice water stool – Cholera
* If the child is less than 2 mos w/ diarrhea lasting for 14 days or more = SEVERE
PERSISTENT DIARRHEA
Management

 Plan A – No dehydration (XZB5)

4 rules:
1. Give extra fluid and food (soup, rice water, or buko juice or ORS) every
after loose stool
 Below 2 yrs. = 50–100 mL
 2–5 yrs. = 100–200 mL
2. Zinc Supplements for 14 days
 2 - 6 months = 10 mg/day
 6 months - 5 yrs. = 20mg/day
3. Continue breastfeeding
4. Follow-up in 5 days if not improving
 Plan B – Some Dehydration
1. Give reformulate ORS within the first 4o
 Amount of ORS = weight in kg x 75mL/kg BW
 Homemade Oresol
  1L water + 1 tsp. salt + 4 tsp. sugar
 1 glass of water + 1 pinch of salt + 1 tsp. of sugar
 For under 6 months—give 100–200 mL in the first 4
2. Advise mother to continue breastfeeding
3. After 4o - continue feeding and give zinc
 If mother must leave before treatment - explain 4 rules of home mgt
4. Follow-up - 5 days if not improving
 Plan C – Severe Dehydration
1. Give IVF immediately - LRS or NSS
2. If no health facility, use NGT
3. Or if the child can drink, give ORS by mouth
4. If any of the above steps not possible, bring child immediately to the hospital
for IVF or NGT treatment
5. Give antibiotic if 2 years older or cholera epidemic
Severe Persistent Diarrhea (less than 2 months and with chronic diarrhea)
 Treat dehydration
 Give Vitamin A if not given last 30 days
 Refer to hospital
Persistent Diarrhea
 Advise feeding
 Give Vitamin A if not given last 30 days
 Give Zinc supplements for 14 days
 Follow-up - 5 days
 Advise when to return
Antibiotics
 Dysentery - Ciprofloxacin for 3 days, BID (15 mg/kgBW)
 Cholera - Tetracycline (250mg) or Erythromycin (250mg) BID for 3 days
Vitamin A
 Severe malnutrition, Very low weight, severe dehydration, pneumonia, severe persistent
diarrhea, persistent diarrhea
IV Fluids
 – D5W & D10W (prevent low blood sugar), PLRS and PNSS (Severe DHN) ORS
ORS
 1 L water + 1tsp NaCL + 4 tsp. sugar
Sugar Water
 200 mL H20 + 4 tsp sugar
Follow-up
 Antibiotics – 2 days
  Bronchodilator (Salbutamol) – 2 days
 Very low weight - 30 days
 Anemia – 14 days
 No DHN, Anemia, Pneumonia, not very low weight – 5 days
Soothe throat
 Calamansi except codeine, cough syrup and decongestant
Prevention and Management of Abortion Complications (PMAC) Abortion
 As a public health issue
 As a human rights issue
 As a resource issue
Adolescent (10-19 y/o Health Program Adolescent Health Issues

 Early pregnancy & childbirth – 30% of births

 HIV
 Malnutrition
 Mental Health
 Tobacco use
 Harmful use of alcohol – starts at 13 – 15 y/o
 Violence
 Injuries
Factors Affecting Adolescent Health Issues
1. Lack of Like Skills
2. Lack of Access to health services
3. Lack of Safe and Supportive environment
Characteristics of Adolescent friendly Health Services (WHO)

 Accessible
 Acceptable
 Appropriate
 Equitable
 Effective
Adolescent Health Services
1. Management of Illness
2. Counseling substance abuse, sexuality and Reproductive Tract Infections (RTI)
3. Nutrition and Diet Counseling
4. Mental Health
5. Family Planning and Responsible Sexual Behavior
6. Dental Care
Adult Men and Women Health Program
1. Management of Illness
 2. Counseling Substance Abuse, Sexuality and Reproductive Tract Infections (RTI)
3. Nutrition and Diet Counseling
4. Mental Health
5. Family Planning and Responsible Sexual Behavior
6. Dental Care
7. Screening and Management of Lifestyle Related and other Degenerative Diseases
 Men - Accidents And Injuries, Liver Diseases, BPH, Prostate Malignancies
 Women - Goiter, Malignancies (Breast), DM
Elderly Health Program

 6.8% of the 92.1 population (2010)

 Ageing index = 20.3% (2010) or 60 y/o & above: 15 y/o = 1:5
 Life Expectancy:
 Males = 64.10 y/o
 Females = 70.10 y/o
 Mortality = CVD, Cancer
 Morbidity = Influenza, Pneumonia, TB (Infectious)
Challenges of an Elderly
1. Maintaining health and fitness
2. Maintaining social networks and activities
3. Feelings of sadness and loss
4. Ensuring financial security
5. Decrease in mobility
6. Increase reliance on others
Elderly Population

 RA 9257 - Expanded Senior Citizen Act of 2003

 RA 7432 - An Act to Maximize the Contribution of Senior Citizens to Nation Building,
Grant Benefits and Special Privileges and for other purposes
 Proc. 470 - 1st week of October every year as “Elderly Filipino Week”
Facilities for the Elderly

 National Center for Geriatric Health (Manila)

 Golden acres Home for the Aged (Gov’t)
 Mountain Crest Residential Care (Cavite)
 Kanlungan ni Maria
 Blessed Family Home Care Facility (QC)
Elderly Health Services
1. Management of Illness
2. Counseling substance abuse, sexuality and Reproductive Tract Infections (RTI)
3. Nutrition and Diet Counseling
4. Mental Health
5. Family planning and Responsible Sexual Behavior
 6. Dental Care
7. Screening And Management Of Lifestyle Related And Other Degenerative Diseases
 Men—Accidents And Injuries, Liver Diseases, BPH, Prostate Malignancies
 Women—Goiter, Malignancies (Breast), DM
8. Screening And Management Of Chronic Debilitating And Infectious Diseases
9. Post Productive Care
Non-communicable Disease

 Mortality = Lifestyle Related/Chronic

1. Cardiovascular Diseases
2. Cancer
3. Chronic Obstructive Pulmonary Disease
4. Diabetes Mellitus
 Risk Factors of Disease
1. Smoking
2. Physical inactivity
3. Unhealthy diet
4. Excessive alcohol drinking
Strategies for the Control & Prevention of Non-Communicable

 Promote Physical Activity & Exercise

 Physical Activity = body movement that results in expenditure of energy
(occupational, leisure-time, routine daily activities)
 Exercise = planes, structured, repetitive aimed at improving or maintaining
physical fitness (performed activities with vigor & alertness without undue fatigue)
 Moderate intensity for 30 mins. for days
 Promote Proper Nutrition (ABC)
 Aim for physical fitness (Ideal body weight)
 Build healthy nutrition-related practices – variety of foods, breastfeed, monitoring,
eat vegetables, milk, avoid salty foods, clean and safe foods.
 Choose food sensibly
 Promote Smoke Free Environment
 Five A’s – Quitting Smoking
 Ask = smoking status
 Advise = to stop smoking, can cause death
 Assess = willingness to quit
 Assist = quitting
 Arrange follow up = monitor progress
 RA 10352 - Excise tax on alcohol and tobacco for 5 years for the Universal
Health Care program of the government
 Stress Management Techniques – 12s
1. Spirituality 7. Sports
2. Self-Awareness 8. Socials
3. Scheduling Activities 9. Sounds and Songs
4. Siesta 10. Speak to me
5. Stretching 11. Stress Debriefing
12. Smile
 6. Sensation Techniques – Massage, Spa
Applications of Epidemiology in Community Health
Epidemiology - study of the DISTRIBUTION and DETERMINANTS of health-related states or
events in specified populations, and the application of this study to the prevention and control of
health problems
Practical Applications of Epidemiology
1. Assessment of the health status of the community or community diagnosis
2. Elucidation of the natural history of disease
3. Determination of disease causation
4. Prevention and control of disease
5. Monitoring and evaluation of health interventions
6. Provision of evidence for policy formulation
Health Indicators
 Are quantitative measures usually expressed as rates, ratio, or proportions that
describe and summarize various aspects of the health status of the population.
 These are also used to determine factors that may contribute to a causation and
control of diseases, indicates priorities for resource allocation, monitors
implementation off health programs, and evaluates outcomes oh health
programs.
Types of Health Indicators and their Examples
Morbidity Indicators
 generally based on the disease specific incidence or prevalence for the common and
severe diseases such as malaria, diarrhea, and leprosy
 (P) Prevalence proportion measures the total number of existing cases of disease at a
particular point in time divided by the number of people at the point in time. Thus, if the
point in time is the time of examination, then the denominator is the number of people
examined.

 Where F is any number of the base 10 that is used as a multiplier to avoid having
decimals as the final value of the indicator.
 Incidence – measures the number of new cases, episodes, or events occurring
over a specified period of time, commonly a year within a specified population at
risk.

Factors affecting Prevalence

Incident Density Rate

 Computed using the total person-time at risk for the entire cohort as the denominator
 This indicators measures the average instantaneous rate of disease occurrence.

Mortality Indicators

 Crude Death Rate (CDR) - the rate with which mortality occurs in a given population. It
is computed as
 Specific mortality rate - shows rate of dying in a specific population groups

 Cause-of-death rate - identifies the greatest threat to the survival of the people, thereby
pointing to the need for preventing such deaths

 Infant mortality rate

 A good index of health in a community because infants are very sensitive to
adverse environmental conditions
 A high IMR means low levels of health standards that may be secondary to poor
maternal health and child health care, malnutrition.

 Neonatal mortality rate

 Postnatal mortality rate

 Maternal death - Death of a female from any cause related to or aggravated by

pregnancy or its management during pregnancy and childbirth or within 42 days of
termination of pregnancy, irrespective of the duration and the site of the pregnancy.

 Case fatality rate

  Is the proportion of cases that end up fatally.
 It gives the risk of dying among persons afflicted within particular disease.
 It is similar to an incidence proportion because it also a measure of average risk.

 Population Indicators - Include not only the population growth indicators but also other
population dynamics that can affect the age-sex structure of the population and vice
versa
 Crude Birth Rate
 Measures how fast people are added to the population through births.
 Measure of population growth.

*A CBR greater than or equal to 45/1,000 live births implies high fertility while a level less
than or equal to 20/1,000 live births implies low fertility

 General Fertility Rate - Is a more specific rate than CBR since births are related to the
segment of the population deemed to be capable of giving birth, that is, the women in
the reproductive age groups
  Population Pyramid - A graphical representation of the age-sex composition of the
population that should also be examined during the assessment of the health status of
the community.

 Disease Registry
 Is a compilation of information about a particular disease.
 The aim of disease registry is to include all cases of the disease in the registry
without duplication
Diseases Surveillance Systems in the Philippines
 Notifiable Disease Reporting System ( NDRS)
 Field Health Service Information System (FHSIS)
 National epidemiology Sentinel Surveillance System ( NESSS)
 Expanded Program on Immunization Surveillance System (IPE Surveillance)
 HIV/AIDS Registry
Stages in the Natural History of Disease and the Levels of Prevention
RN HEALS (Registered Nurses for Health Enhancement and Local Service)
 During Arroyo Regime—NARS (Nurses Assigned in Rural Service)
 Part of the mitigation program of the Arroyo administration
 Originally for 6 months
 3 months—Community
 3 months—Hospital
 Aquino - RN HEALS
 Now - NDP (Nurse Deployment Project)
 Is a training and deployment project, jointly implemented by the DSWD, the DOH, and
the PRC-BON, DOLE, PNA designed to mobilize unemployment 10,000 registered
nurses to the 1,221 poorest municipalities of the country and to improve the delivery of
health care services
 Nurses will be mobilized n their hometowns as warriors for wellness to do the 3 I’s:
1. Initiate primary health, school nutrition, maternal health programs, first line diagnosis
2. Inform about environmental sanitation practices and also do health surveillance;
3. Immunize children and mothers
 They shall likewise serve identifies CCT and BemONC identified areas
Delivery mechanisms
 Nurses will be deployed at an average of 5/town in the 1,211 poorest municipalities, for
12 months tour of duty. Another batch will be deployed for the second half of the year.
These nurses will undergo training and development for competency enhancement in
accordance with the training program designated by the PRC-BON in collaboration with
the DOH
 While on training, nurses will be given a stipend of P18,000/month. This translates to
about P366.00 per day for 40o training/workweek. As these nurses are already in their
hometowns, transportation expenses will no longer be a problem
 The stipend of P18,000.00 may be increase if the host LGUs will offer a counterpart of
say P2,000.00 LGUs may provide Philhealth coverage to nurse-trainees. Corporations
may chip in by providing shirts, insurance, vitamins, etc., making the project a national
enterprise with private equity
 A certificate of completion/competency shall be issued jointly by the DOLE, DOH and
PRC after an assessment of the gained competencies of nurse trainees.
Project Entrepre-Nurse
 Concept of nurse entrepreneurship
 An initiative of DOLE, in collaboration with BON-PRC, DOH, PNA, UPCN, OHNAP and
other government and non-government entities, and academic institutions to promote
nurse entrepreneurship in the Philippines
Forms of nurse entrepreneurship
 Hospice, domiciliary and health care facility management
 Public health advocacy
 Home health care services
  Outsourcing public health delivery for LGUs, NGAs and other government institutions
 Medical transcription services
 Health care training management
 Emergency medical services
 Tourism health care services
 Wellness and fitness management for private companies
 Outsourcing health services for private establishments
Community Organizing Participatory Action Research
Community Organizing - A development approach that aims to transform the apathetic
individualistic, and voiceless poor into dynamic, participatory & politically responsive community
Basic Values in Community Organizing

 Human rights
 Social Justice
 Social Responsibility
 Apostolate Work of the Church
Approaches in Community Organizing

 Social Welfare/Dole-out
 The intermediate and/or spontaneous response to ameliorate the
manifestation of poverty, especially on the personal level
 Assumes that poverty is GOD-given
 The poor should accept their condition since they will receive their just
reward in heaven
 Believes that poverty is caused by bad luck and natural disaster
 Modernization/Project Development
 Considered a national strategy which adopts the western mode of
technological development
 Believes that poverty is due to lack of education
 Participatory Action Approach - The process of empowering/ transforming the
poor and the oppressed sectors of society so that they can pursue more just and
human society
Participatory Action Research
 An investigation on problems and issues concerning life and environment of the
underprivileged by way of research collaboration (PCPD 1990)
 Participatory action research (PAR) is an approach to research that aims at promoting
change among the participants. Members of the group being studied participate as
partners in all phases of the research, including design, data collection, analysis and
dissemination (Brown et. al. 2008)
COPAR
 Community Organizing Participatory Action Research (COPAR) is a community
development approach that allows the community (participatory) to systematically
analyze the situation (research), plan solution, and implement projects/programs (action)
 utilizing the process of community organizing. It is essentially a research project done by
the community that leads to actions that improve conditions in the community (Famorca,
2013)
 It is done to educate the people and develop their critical awareness of their present
condition
 It helps the community to develop and enhances its resources to the fullest thus making
the community self-reliant
Principles
1. Change = Development
2. Poor
3. People-centered
4. Participative
5. Democratic
6. Developmental
7. Process-oriented
8. Self-reliance = high degree of self-awareness among people
Critical Steps (Activities in COPAR)
1. Integration – Immersion
2. Social Investigation – collection of data about the community
3. Tentative Program Planning – community organizer (plan on how to do
community organizing)
4. Groundworking – solicit the participation of the community
5. The Meeting
6. Role Play
7. Mobilization or Action – action phase
8. Evaluation
9. Reflection
10. Organization
Objectives

 To help people harness their human material resources

 To help people understand their own situations and develop awareness (process
of action-reflection-action)
Phases

 Phase I – Pre-entry phase/Preparatory

 Site/Area/Community Selection
 Criteria of Potential Site
 Socio-economically depressed
 Inaccessible health services
 Poor community health status
 Relative peace and order situation
 Acceptance of the program by the community
 Not currently served by similar agencies/organizations
  At least 100-200 families
 Courtesy Call to local government unit/ barangay level
 Mayor down to Barangay
 Safety of organizers
 Community Consultation/Dialogue/Preliminary
 Social Investigation
 Community organizers prepare
 Phase 2 – Entry phase/Integration/Immersion/Preparatory
 Integration/Immersion/Sensitization of the community/Information Campaigns
 Establish rapport and assess the needs of the community
 Guidelines in Integration:
1. Recognize local authorities – Courtesy Call
2. Adapt the lifestyle of the community
3. Choose a modest dwelling
4. Avoid expectation from the people
5. Be clear with your objectives & limitation
6. Participate in the production process
7. Participate in social activities
 Social Investigations/Community
 Profiling/Community survey (Demographic, Geographic, Socio-cultural,
Economic Indices, Environmental, Health Indices, Physical/Infrastructure
resources)
 Subjective – Interview or Participatory Observation
 Objective – Community Survey Tool
 Community Diagnosis/Research/Analysis
 Graphs
o Bar - for comparison
o Pie - Percentage distribution
o Line - Trend
o Scatter – correlate variables
 Phase 3 – Organization/Building Phase/Activity Phase
 Social preparation through community assembly
 Spotting potential leaders
 Criteria for Selection of Potential Leaders:
1. Belong to the poor sectors and classes and is directly engaged in
production
2. Well respected by members of the community and has relatively wide
influence
3. Desirous of change and is willing to work for change
4. Must be able to communicate effectively
 Core group formation – SALT
 Formation of Organization/ Committee
 Planning/Designing Phase (SMART)
 Specific
 Measurable
 Attainable
 Realistic
  Time-bound
 5 Areas of Community Life (HELPS)
 Health
 Education
 Livelihood
 Physical Environment
 Socio-spiritual
 Mobilization/Implementation/Action
 Training potential leaders
 Phase 4 – Sustenance and Strengthening Phase/Maintenance
 Evaluation/Reassessment
 Criteria: Effectivity, Efficiency, Appropriateness, Adequacy
 3 Types of Evaluation
o Process – evaluate how the program was implemented
o Impact – how the program affects the people in the community –
interview
o Outcome – evaluate if the lives of the community members
improved
 Linkaging /Establishing partnership
 Methods of Establishing Partnership

 Phase 5 – Phase Out/Exit Phase

 Documentation
 Follow-up/Expansion
 Must be done once a year