Midterm CHN Poliran, Mharlynne Nezlou | Nur 2C

The Health Situation of the Country and a Global Glimpse (2020)

Global Burden of Disease 2020

1. Ischemic heart disease

2. Unipolar major depression
3. Road traffic injuries
4. Cerebrovascular disease
5. Chronic Obstructive Pulmonary Disease
6. Lower respiratory Infections
7. Tuberculosis
8. War
9. Diarrheal Diseases
10. Human Immunodeficiency Virus (HIV)

The national health situation as of October 24, 2019

Dengue

 On August 6, 2019, the Department of Health declared a dengue epidemic. With nearly 361, 000 dengue cases recorded
and 1, 373 deaths, the current dengue epidemic is the largest in the last ten years, or since the disease has been monitored
in the Philippines.

Dengue 2021

 With 106,630 dengue cases reported through the Philippines Integrated Disease Surveillance and Response (PIDSR)
system from 1 January to 29 June 2019, including 456 deaths, the current dengue incidence is 85% higher than in 2018, in
spite of a delayed rainy season. Whereas the Case Fatality Rate (CFR) of 0.43% as of 29 June 2019 is lower than in the same
time period in 2018 (0.55%), this is still significantly higher than the regional average of 0.22% in the Western Pacific.
 The Philippines Department of Health (DoH) declared a National Dengue Alert on 15 July 2019, urging regional DoH
offices to step up dengue surveillance, case management and outbreak response in primary health facilities and hospitals,
as well as through community and school-based health education campaigns, clean-up drives, surveillance activities, case
investigations, vector control, and logistics support for dengue control (insecticides, RDTs, medicine, etc) in line with an
Advisory on Dengue Preparedness and Outbreak Response issued earlier this year. The National Disaster Risk Reduction
Management Council (NDRRMC), raised the code blue alert, activating the national Health Cluster, led by DoH.

Current Situation

 Between 1 January to 29 June 2019, including 456 deaths were officially reported through the routine surveillance
system from the DOH, with a CFR of 0.43%.
 With a median age of 12 years, the most affected age group among dengue cases is 5-9 years (23%). Similarly, the most
affected age group among dengue deaths is 5-9 years (39%). The majority of dengue cases are male (53%), whereas the
majority of dengue deaths are female (52%).
 Most affected regions are II, IVA, V, VI, VII, VIII, IX, II, BARMM and NCR. Iloilo, Capiz, Aklan, Antique and Guimaras
provinces in Region VI declared an outbreak, with many municipalities seeking a state of calamity to access emergency
funding to mobilize additional resources.

Diphtheria

 Almost 200 cases of diphtheria were reported by the Department of Health for the period from January 1, 2019-October
5, 2019, an increase of 47% compared to the same period in 2018. A significant number of diphtheria cases were reported
in the National Capital Region, Region IV-A, and Cordillera Autonomous Region.

Diphtheria 2020
 The analysis indicates that diphtheria remains endemic in Metro Manila and that the infection is frequently fatal in
young children. Improved vaccine coverage and a sustainable supply of diphtheria antitoxin should be prioritized. 11 Mar
2020

Measles

 In February 2019, the Department of Health declared a measles outbreak in five regions in the country including Metro
ManilaFrom January 1, 2019-October 12, 2019, over 42, 400 cases were reported by the DOH. Severe complications from
measles have also claimed the lives of over 560 people. As of October 25, 2019, the reported cases of measles are declining
as well as the case fatality rate.

Measles 2020

 17 September 2020- The Department of Health, supported by WHO and UNICEF will conduct the nationwide measles
and polio supplemental immunization campaign starting October 26 this year. In the Philippines, an estimated 2.4M children
under the age of five are susceptible for measles. Measles or tigdas is one of the most contagious diseases in the world.
Among those who are not immune, up to 9 out of 10 people exposed to the measles virus will contract the disease.
 The nationwide Measles Rubella-Oral Polio Vaccine Supplemental Immunization campaign will be rolled out in two
phases. Phase 1 will be conducted from 26 October to 25 November 2020 in Mindanao Regions, CAR, I, II, IV-B and V. Phase
2 will be conducted in February 2021 in Visayas Regions, NCR, III, and IV-A. DOH is conducting the campaign for children
under five years old-around 9.4M children for the measles-rubella vaccine and 6.9M children for the oral polio vaccine.
 "Despite the COVID-19 pandemic, a high-quality immunization campaign is urgently needed to stop measles
transmission and possible outbreaks. We encourage parents and caregivers to have their children immunized. The measles
vaccine is safe, effective, and free. To protect against COVID-19 infections, all health care workers have been trained and
provided with Personal Protective Equipment," Department of Health Secretary Francisco Duque says.
 In 2020, pockets of measles outbreaks are being reported in the Philippines. As of August 2020, there are around 3,500
reported measles cases with 36 deaths. Most of the cases are among children under five years old.
 Measles is a dangerous and fatal disease, with complications that can include severe diarrhea and dehydration,
pneumonia, ear and eye complications, encephalitis or swelling of the brain, or permanent disability. There is no specific
treatment for measles. The only reliable protection from measles is vaccination.
 "While measles is highly contagious, it is also a preventable disease. We must not lose the decades of progress we have
achieved in immunizing and protecting Filipino children, even in the midst of the COVID-19 pandemic. The measles vaccine
is safe and has been in use for 50 years. The benefits of vaccination greatly outweigh the risks, saving an estimated 2-3
million lives worldwide every year," WHO Representative Dr.Rabindra Abeyasinghe says.
 As a result of immunization challenges before and during the pandemic, too many children are missing out on routine
immunization in the Philippines. Among the reasons for the low coverage are fears of contracting COVID-19, a constrained
health system and rapidly spreading misinformation on vaccination.
 "We are at an especially challenging time when immunization for children is being threatened. All of us must do our part
in ensuring children in our family are immunized, and that we provide the correct information to parents, community
members and among our peers. COVID-19 is a challenge and a chance to reflect on what needs to change so that Filipino
children can survive and thrive," UNICEF Philippines Representative Oyunsaikhan Dendevnorov says.
 WHO and UNICEF are fully committed to supporting the Philippine government in the fight against measles. WHO and
UNICEF support the DOH in vaccine procurement and delivery, development of immunization guidelines and
communication materials, and building the capacity of DOH staff nationwide to plan and ensure that all eligible children are
protected through safe and effective vaccines for measles, rubella, and polio.

Measles 2021

Press Release | 23 February 2021

 The Department of Health (DOH) reports that as of 21 February 2021, 73% or 3,721.186 of nationwide targets have
been vaccinated against measles and rubella, while 72.9% or 3,483,423 against polio as part of the second phase of the
Measles-Rubella and Oral Polio Vaccination Supplemental Immunization Activity (MR-OPV SIA). The said immunization
program launched its activity last 1 February 2021, covering regions in both Luzon and Visayas and scheduled to run until 28
February 2021.
 In Luzon, the measles-rubella vaccination program in the National Capital Region has covered 71.3% or 726,006 children
aged 9-59 months-old. While Regions III and IV-A have vaccinated 826,870 (85.4%) and 913,822 (70.2%) children aged 9-59
 mos., respectively. For the polio vaccination on the other hand, 964,249 (85.1%) children aged 0-59 mos. have been
vaccinated in Region III, while 1,069,791 (70.2%) children have been vaccinated in Region IV-A.
 In Visayas, 516,748 (78.2% children in Region VI, 422,104 (60.9%) children in Region VIl, and 315,636 (68.8%) children in
Region VIll have been vaccinated against measles and rubella. While 588, 197 (76.4%) children in Region VI, 497,067 (60.9%)
children in Region VIl, and 364,119 (68.0%) children in Region VIll have been inoculated against polio.
 The DOH likewise urges all parents and guardians of children to participate in the free immunization program. "We can
decrease the prevalence of cases of measles, rubella and polio through vaccination. These vaccines have been proven to be
safe and effective for over 40 years, and parents need not have second thoughts. Above all, we can prevent unnecessary
deaths that are caused by these illnesses. This is why we have tirelessly been urging our mothers to have their children
vaccinated," Sec. Duque assured.

Poliomyelitis

 On September 19, 2019, the Department of Health confirmed the re-emergence of polio in the Philippines and declared
the National Polio outbreak. As of October 25, 2019, thirteen environmental samples and three human samples of vaccine-
derived polio virus have been confirmed. Between October 2019 and January 2020, 4.4 million children under 5 years of age
will be vaccinated through vaccination campaigns.

Poliomyelitis 2021

 COVID-19 and vaccine hesitancy did not stop the Philippines from stamping out a polio outbreak in a 16-month drive
that ended June 2021, a feat commended by WHO and UNICEF.
 The outbreak came almost two decades after the Philippines was declared polio-free, the last case of wild poliovirus
infection having been reported in 1993.
 At least 17 children were infected since the start of the outbreak in September 2019 but there have been no new cases
since February 2020, according to health authorities.
 "The decision [that the polio outbreak is over] came as the virus has not been detected in a child or in the environment
in the past 16 months," said the 11 June joint-media release by WHO and UNICEF Philippines
 All cases in the latest outbreak were attributed to the vaccine-derived poliovirus type 2, a rare form of the disease that
spreads from oral vaccination in areas with low sanitation and poor coverage.
 Wild poliovirus types 2 and 3 were declared eradicated in 2015 and 2019, and South-East Asia was declared free of
poliovirus by WHO in 2014. However, some regions have seen a rise in type 2 vaccine-derived poliovirus cases.
 Owing to the global eradication of wild poliovirus type 2 in 2015, available oral polio vaccines did not offer any
protection against the type 2 virus and WHO had to provide specific vaccines for a supplemental immunization campaign.

The health issues in the Philippines

1. Physical activity and nutrition

2. Overweight and obesity
3. Tobacco
4. Substance abuse
5. HIV-AIDS
6. Mental health
7. Injury and violence
8. Environmental quality
9. Immunization
10. Access to health care

Leading Causes of Morbidity in the Philippines 2019

1. Acute respiratory infection

2. Acute lower respiratory tract infection and pneumonia
3. Bronchitis / bronchiolitis
4. Hypertension.
5. Acute watery diarrhea
6. Influenza
7. Urinary tract infection (UTI)
8. TB respiratory
9. Injuries
10. Diseases of the heart

Leading Causes of Mortality in the Philippines 2019

1. Malignant neoplasms
2. Accidents
3. Pneumonia
4. Tuberculosis, all forms
5. Chronic lower respiratory diseases
6. Diabetes mellitus
7. Certain conditions originating in the perinatal period
8. Nephritis, nephrotic syndrome, and nephrosis

4 chronic respiratory disease

1. Stenosis- narrowing
2. Thrombosis – clotting
3. Embolism – blockage
4. Hemorrhage – ruptures

The five leading causes of infant mortality

1. Birth defects
2. Preterm birth and low birth weight
3. Maternal pregnancy complications
4. Sudden infant death syndrome
5. Injuries (suffocation)
6. Leading causes of maternal mortality
7. Postpartum hemorrhage
8. Eclampsia
9. Obstructed labor
10. Sepsis

THEORIES RELATED TO HEALTH PROMOTION/HEALTH EDUCATION

PENDER'S HEALTH PROMOTION THEORY

1. Nola J. Pender, PhD, RN, FAAN.

2. Professor Emerita School of Nursing, University of Michigan
3. Distinguished Professor, Loyola University Michigan
 She became interested in health promotion because very early in her nursing career she observed that health
professionals intervened only after people developed acute or chronic diseases and experienced compromised lives.
 Attention was devoted to treating them after the fact.
 She further said that this reactive approach did not reflect the philosophical beliefs of our predecessors in nursing which
focused on maintaining conditions of healthy interaction between self and the environment.
 Her doctoral preparation in psychology and cognitive processes furthered her interest in people's ability to take
responsibility, make reasoned discussions and engage in competent self-care.

BANDURA'S SELF EFFICACY THEORY

 Albert Bandura, believes that those with high self-efficacy expectancies can achieve what one sets out to do; they are
healthier, more effective, and generally more successful than those with low self-efficacy expectancies.
 He demonstrates how belief in one's capabilities affects development and psychosocial functioning during the course of
life, underscoring provocative applications of this work to issues In education, health among others.

HEALTH BELIEF MODEL

 Godfrey M. Hochbaum originally proposed the model in 1958 as a theoretical model of preventive health behavior.
 Rosenstock in (1966) developed and coined the team "Health Belief Model". This was further modified by Becker in
1974.
 Is based on the premise that the world of the perceiver determined what he or she will do.
 It suggests that whether or not a person changes their behavior, will be influenced by an evaluation of its feasibility and
its benefits weighed against its costs. The belief influences behavior.

INDIVIDUAL PERCEPTIONS

PERCEIVED SUSCEPTIBILITY

 pertains to whether the person feels susceptible or vulnerable to the negative consequences of the illness. A family
history of a certain disorder, such as diabetes or heart disease, may make the individual feel at risk.

PERCEIVED SERIOUSNESS OR SEVERITY

 are perceived threats that the person has in relation to the severity of the illness or its sequelae. The greater the
perceived severity, the more likely the person is to adhere to self-care practices or adopt recommended actions.

MODIFYING FACTORS:

DEMOGRAPHIC VARIABLES

1. Age
2. Gender
3. race
4. ethnicity

SOCIO-PSYCHOLOGIC VARIABLES

 social pressure or influence from peers or other reference groups may encourage preventive health behaviors even
when individual motivation is low.

STRUCTURAL VARIABLE

 Knowledge about the target disease and prior contact with it are structural variables that are presumed to influence
preventive behavior.

CUES TO ACTION

 This can either be internal or external. Internal cues include feelings of fatigue, uncomfortable symptoms, or thoughts
about the condition of an ill person who is close.

EXTERNAL CUES:

1. Mass media campaigns

2. Advice from others
3. Reminder postcard from physician or dentist
4. Illness of family member or friend
5. Newspaper or magazine article

 The likelihood of a person's taking recommended preventive health action depends on the perceived benefits of the
action minus the perceived barriers to the action.

PERCEIVED BENEFITS OF THE ACTION/TREATMENT

 pertains to whether the person believes that the action/treatment will make a difference in the outcome of the disease.
The patient needs to believe that the benefits of the action/treatment outweigh the "cost" of performing it in order to
promote health care.
PERCEIVED BARRIERS TO ACTION

 refers to the perceived barriers that the person must overcome in order to follow the health recommendation. It
includes, but not limited to financial cost, inconvenience, unpleasantness, and lifestyle changes. Others include knowledge,
attitudes and practices.

C. LEVELS OF PREVENTION

1. Primary
2. Secondary
3. Tertiary

PRIMARY PREVENTION

 Health Promotion and Illness Prevention

Primary Prevention Programs for the Promotion of health:

 Adequate and proper nutrition

 Weight control and exercise
 Stress reduction

Primary Prevention Programs for Illness Prevention:

 Immunizations
 Identifying risk factors for illnesses
 Environmental sanitation

SECONDARY PREVENTION

 Diagnosis and Treatment

The purpose is early detection of disease through:

 Screening those at risk of developing certain conditions

o dental exam, BP taking, blood chemistry mammogram, self-breast exam, HIV testing

TERTIARY PREVENTION

 Rehabilitation, Health Restoration and Palliative Care

o The goal of tertiary prevention is to help people move to their previous level of health.

REHABILITATIVE CARE

 emphasizes the importance of assisting clients to function adequately in the physical, mental, social, economic, and
vocational areas of their lives.

PALLIATIVE CARE

 is for those people who cannot return to their original health conditions.
 is providing comfort and treatment for symptoms.

END-OF-LIFE CARE

 may be conducted in many settings like the home.

MODULE 4: PRIMARY HEALTH CARE

PRIMARY HEALTH CARE APPROACH'

 In September 1978, the World Health Organization (WHO) and United Nations International Children's Emergency Fund
(UNICEF) held a historical international conference on primary health care in Alma-Ata, then the capital of Kazakhstan. The
conference focused on the
importance of primary health care in national health services as well as its principles and organizational models and prospects
of international cooperation in this area. The conference adopted the Alma-Ata Declaration, which defined primary health
care as the key to achieving the goal of "health for all by the year 2000".

Primary health çare (PHC) is defined as:

 "essential health care based on practical, scientifically sound and socially acceptable methods and technology made
universally accessible to individuals and families in the community through, their full participation and at a cost that the
community and the country can afford to maintain at every stage of their development in the spirit of self. determination"
 The International Coreference on Primary Health Care (PHC) in Alma-Ata, Kazakhstan, in September 6-12, 1978, brought
together 134 countries and 67 international organizations (China was notably absent). The conference defined and granted
international recognition to the concept of primary health care (PHC) as a strategy to reach the goal of Health for All in 2000
 Primary health care promoted the progressive strengthening of units of services and WEAR of local capacities (which in
many countries would be called the primary care level) and FACE MASK that subsequently would serve as a basis for new
approaches to social policies.
 It was a new approach to health gare that came into existence following this' Organaina and the DiAlma Ata in 1978
organized by the World Health Primary health care was accepted by the member countries of WHO as the key to , achieving
the goal of Health for all.
 Primary health care is essential health care made universally accessible to individuals and families in the community by
means acceptable to them, through their full participation and at a cost that the community and country can afford. It forms
an integral part both of the country's health system of which it is the nucleus and of the overall social and economic
development of the community

Components of PHC

o The Declaration of Alma Ata outlined essential components of primary health care such as principles of.
1. Equitable distribution
2. Community participation
3. Intersectoral coordination

1. Equitable distribution
 Health services must be shared equally by all people irrespective of their ability, to pay and all (rich or poor, urban or
rural) must have access to health services. Primary health care aims to address the current imbalance in health care by
shifting the center of gravity from cities where a majority of the health budget is spent to rural areas where a majority of
people live in most countries
2. Community. participation
 There must be a continuing effort to secure meaningful involvement of the community in the planning, implementation
and maintenance of health services, beside maximum reliance on local resources such as manpower, money and materials.
3. Intersectoral coordination
 Primary health care involves in addition to the health sector, all related sectors and aspects of national and community
development, in particular agriculture, animal husbandry, food, industry, education, housing, public works, communication
and other sectors.

4 Cornerstones in primary health Care

1. Active community participation

2. Intra and Inter-sectoral linkages
3. Use of appropriate Technology
4. Support Mechanism made Available.

The Health Care Delivery System

 The health care delivery system is the totality of all policies, infrastructures, facilities, equipment, products, human
resources, and services that address the health needs, problems and concerns of all people.
 The framework which traces how the services will reach the people.

Major Players
 2 sectors which composed the HCDS
1. Public sector
2. Private sector

Elements of PHC

E - education for health

L- locally endemic disease control

E - expanded program of immunization

M- maternal and child health

E - essential drugs

N-nutrition

T- treatment of communicable disease

S- safe water and sanitation

 The legal basis of the implementation of Primary Health Care in the Philippines
 Letter of Instruction (LOl) 949.
 Public Sector-largely financed through a tax-based budgeting system at both national and local levels and where health
care is generally given free at the point of service
 Private sector-largely market-oriented and where health care is paid through user fees at the point of service.

Levels of Primary Health Care Workers

 Village or Barangay Health Workers-This refers to trained community health workers or health auxiliary volunteer or a
traditional birth attendant or healer.
 Intermediate level health workers-this may be composed of the general medical practitioners or their assistants, public
health nurse, rural sanitary inspector and midwives.

Levels of Primary Health Care and Referral System

1. Primary Level of Care

 this is devolved to the cities and municipalities.
 the care provided by center physicians, public health nurses, rural health midwives, barangay health workers, traditional
healers and others at the barangay health stations and rural health units.
 Usually the first level contact between the community members and the other levels of health care facility.

2. Secondary Level of Care

 This is given by physicians with basic health training-
 " This is usually given in health facilities that are either privately owned or government operated such as Infirmaries,
municipal and district hospitals, and outpatient departments of provincial hospitals.
 They are capable of performing minor surgeries and perform some simple laboratory examinations.
3. Tertiary Level of Care
 This is rendered by specialists in health facilities including medical centers as well as regional and provincial hospitals,
and specialized hospitals such as the Philippine Heart Center.
 This facility is the referral center for the secondary care facilities.
 They catered complicated cases and those requiring intensive care.

Levels of Health Care Facilities

Primary Level Facilities
1. Barangay Health Stations
2. Rural Health Unit
3. Community Hospitals and Health Centers
4. Private practitioners
5. Puericulture Centers

Secondary Level Facilities

1. Emergency/District Hospitals
2. Provincial City Health Services
3. Provincial/ City Hospitals

Tertiary Level Facilities

1. Regional Health Services

2. Regional Medical Centers and Training Hospitals
3. National Health Services
4. Medical Centers
5. Teaching and Training Hospitals