Records in Family Health Nursing Practice

FHSIS - Field Health Service Information System

EO 352

Is the official recording and reporting system of the Department of Health and is used by
the NSCB (National Statistical Coordination Board) to generate the statistics

Is an essential tool in monitoring the health status of the population at different levels.

It is therefore a basis for

1. Priority setting by local governments,
2. Planning and decision making at different levels (barangay, municipality, district,
provincial and national), and
3. Monitoring and evaluating health program implementation.

Facilitates detection of unusual occurrence of diseases.

It also provides a standardized, facility-level database for more in-depth studies (DOH-
IMS, 2011).

The FHSIS is composed of recording and reporting tools.

Records are facility-based that is, records are kept in the:

BHS or REGIONAL NATIONAL

PHO
RHU DOH DOH

The recording tools:

1. The Individual Treatment Record (ITR) is the building blocks of the FHSIS. The
record contains the date, name, address of the patient, presenting symptoms or
complaint of the patient on consultation, and the diagnosis ( if available).
2. Target Client Lists (TCLs) are second building block of the FHSIS. These service
records have the following purposes:
 a. To plan and carry out patient care and service delivery since midwives and
nurses use TCLs to monitor target or eligible populations for particular health
services.
b. To facilitate monitoring and supervision of service delivery activities.
c. To report services delivered, thus reducing the need to refer back to the ITRs
to accomplish reporting.
d. To provide a clinic-level database that can be accessed for further studies.

The following are the TCLs maintained in the RHUs and health centers:
a. TCL for Prenatal care
b. TCL for Postpartum care
c. TCL for Under 1-Year-Old children
d. TCL for Family Planning
e. TCL for Sick children
f. National Tuberculosis Program TB Register
g. National Leprosy Control Program Central Registration Form

3. The Summary Table is accomplished by the midwife. It is a 12 column table in

which columns correspond to the 12 months of the year. The record is kept at the
BHS and has two components: Health Program Accomplishment and
Morbidity Diseases.

Health Program Accomplishment – provides the midwife with a tool for

assessment of accomplishments and a ready source of reports
Morbidity Diseases – monthly summary of morbidity gives information on the
monthly trend of diseases and serves as a source for the 10 leading causes of
morbidity in the municipality/city.

4. The Monthly Consolidation Table (MCT) is accomplished by the nurse based on

the Summary Table. It serves as the source document for the Quarterly Form
and Output Table of the RHU or health center.

The reporting tools:

1. Monthly Forms are regularly prepared by the midwife and submitted to the
nurse who then uses the data to prepare the Quarterly Forms.
a. Program Report (M1) contains indicators categorized as maternal care, child
care, family planning and disease control. The midwife copies the data from
the Summary Table.
b. Morbidity Report (M2) contains list of all cases of disease by age and sex.
2. Quarterly Forms are usually prepared by the nurse. There should only be one
Quarterly Form for the municipality/city. In municipalities/cities with two or more
RHUs or health centers, consolidation is done under the direction of the
 Municipal/City Health Officer, Quarterly Forms are submitted to the Provincial
Health Office.
a. Program Report (Q1) contains the 3 month total of indicators categorized as
maternal care, family planning, child care, dental health, and disease control.
b. Morbidity Report (Q2) is a 3-month consolidation of Morbidity Report (M2).
3. Annual Forms
a. A-BHS is a report by the midwife that contains demographic, environmental,
and natality data.
b. Annual Form 1 (A-1) is prepared by the nurse and is the report of the RHU
or the health center. It contains demographic and environmental data, and
data on natality and mortality of the entire year.
c. Annual Form 2 (A-2) prepared by the nurse, is the yearly morbidity report by
age and sex.
d. Annual Form 3 (A-3) also prepared by the nurse, is the yearly report of all
deaths (mortality) by age and sex.

- DOH Programs related to family health

A. Expanded Program of Immunization (EPI)
B. Integrated management of childhood illnesses (IMCI)
C. Early Intrapartal and Newborn Care (EEINC)
D. Newborn screening
E. BEmONC/CEmONC
F. Nutrition
G. MhGaP
H. Other related programs

DOH Programs related to Family Health

I. Expanded Program of Immunization (EPI)
https://doh.gov.ph/expanded-program-on-immunization

I. Rationale

The Expanded Program on Immunization (EPI) was established in 1976 to ensure that
infants/children and mothers have access to routinely recommended infant/childhood vaccines.
Six vaccine-preventable diseases were initially included in the EPI: tuberculosis, poliomyelitis,
diphtheria, tetanus, pertussis and measles. In 1986, 21.3% “fully immunized” children less than
fourteen months of age based on the EPI Comprehensive Program review.

Over-all Goal:

To reduce the morbidity and mortality among children against the most common vaccine-
preventable diseases.

Specific Goals:

1. To immunize all infants/children against the most common vaccine-preventable diseases.

2. To sustain the polio-free status of the Philippines.

3. To eliminate measles infection.

4. To eliminate maternal and neonatal tetanus

5. To control diphtheria, pertussis, hepatitis b and German measles.

6. To prevent extra pulmonary tuberculosis among children.

J. Integrated management of childhood illnesses (IMCI)
https://doh.gov.ph/integrated-management-of-childhood-illness

One million children under five years old die each year in less developed countries. Just five
diseases (pneumonia, diarrhea, malaria, measles and dengue hemorrhagic fever) account for
nearly half of these deaths and malnutrition is often the underlying condition. Effective and
affordable interventions to address these common conditions exist but they do not yet reach the
populations most in need, the young and impoverish.

The Integrated Management of Childhood Illness strategy has been introduced in an

increasing number of countries in the region since 1995. IMCI is a major strategy for child
survival, healthy growth and development and is based on the combined delivery of essential
interventions at community, health facility and health systems levels. IMCI includes elements of
prevention as well as curative and addresses the most common conditions that affect young
children. The strategy was developed by the World Health Organization (WHO) and United
Nations Children’s Fund (UNICEF).

In the Philippines, IMCI was started on a pilot basis in 1996, thereafter more health
workers and hospital staff were capacitated to implement the strategy at the frontline level.

Objectives of IMCI

 Reduce death and frequency and severity of illness and disability, and
 Contribute to improved growth and development

Components of IMCI

 Improving case management skills of health workers

11-day Basic Course for RHMs, PHNs and MOHs

5 - day Facilitators course

5 – day Follow-up course for IMCI Supervisors

 Improving over-all health systems

 Improving family and community health practices

Rationale for an integrated approach in the management of sick children

 Majority of these deaths are caused by 5 preventable and treatable conditions
namely: pneumonia, diarrhea, malaria, measles and malnutrition. Three (3) out of four
(4) episodes of childhood illness are caused by these five conditions

Most children have more than one illness at one time. This overlap means that a single
diagnosis may not be possible or appropriate.

Who are the children covered by the IMCI protocol?

Sick children birth up to 2 months (Sick Young Infant)

Sick children 2 months up to 5 years old (Sick child)

Strategies/Principles of IMCI

 All sick children aged 2 months up to 5 years are examined for GENERAL
DANGER signs and all Sick Young Infants Birth up to 2 months are examined
for VERY SEVERE DISEASE AND LOCAL BACTERIAL INFECTION. These signs
indicate immediate referral or admission to hospital
 The children and infants are then assessed for main symptoms. For sick children,
the main symptoms include: cough or difficulty breathing, diarrhea, fever and ear
infection. For sick young infants, local bacterial infection, diarrhea and jaundice. All
sick children are routinely assessed for nutritional, immunization and
deworming status and for other problems
 Only a limited number of clinical signs are used
 A combination of individual signs leads to a child’s classification within one or more
symptom groups rather than a diagnosis.
 IMCI management procedures use limited number of essential drugs and encourage
active participation of caretakers in the treatment of children
 Counseling of caretakers on home care, correct feeding and giving of fluids, and when
to return to clinic is an essential component of IMCI

BASIS FOR CLASSIFYING THE CHILD’S ILLNESS (please see enclosed portion of the IMCI
Chartbooklet) The child’s illness is classified based on a color-coded triage system:

PINK- indicates urgent hospital referral or admission

YELLOW- indicates initiation of specific Outpatient Treatment

GREEN – indicates supportive home care

Steps of the IMCI Case management Process

The following is the flow of the iMCI process. At the out-patient health facility, the health
worker should routinely do basic demographic data collection, vital signs taking, and asking the
mother about the child's problems. Determine whether this is an initial or a follow-up visit. The
health worker then proceeds with the IMCI process by checking for general danger signs,
assessing the main symptoms and other processes indicated in the chart below.

Take note that for the pink box, referral facility includes district, provincial and tertiary
hospitals. Once admitted, the hospital protocol is used in the management of the sick child.
K. Early Intrapartal and Newborn Care (EEINC)

As discussed in MCN 107

L. Newborn screening
https://doh.gov.ph/newborn-screening

I. TITLE: Newborn Screening Program

2. DESCRIPTION: Newborn screening (NBS) is an essential public health strategy that
enables the early detection and management of several congenital disorders, which if
left untreated, may lead to mental retardation and/or death. Early diagnosis and initiation
of treatment, along with appropriate long-term care help ensure normal growth and
development of the affected individual. It has been an integral part of routine newborn
care in most developed countries for five decades, either as a health directive or
mandated by law. In the Philippines, it is a service available since 1996.

A. Program Objectives: By 2030, all Filipino newborns are screened; Strengthen quality of
service and intensify monitoring and evaluation of NBS implementation; Sustainable financial
scheme; Strengthen patient management

Target Population: Filipino newborns

B. Area of Coverage: Nationwide

C. Partner Institutions: The following institutions/units and bodies are the primary partners of
DOH-Family Health Office at the national level to ensure that appropriate policies, standards,
logistics and technical assistance are available to all implementing units.:

a. National Technical Working Group on Newborn Screening Program (NTWG- NBS)

b. National Institutes of Health (NIH)
c. NIH-Newborn Screening Reference Center (NIH-NSRC)
d. DOH Epidemiology Bureau (EB)
e. DOH Health Facilities and Services Regulatory Bureau (HFSRB)
f. DOH Health Facility Development Bureau (HFDB)
g. DOH National Center for Health Promotion (NCHP)
h. NIH - Institute of Human Genetics (NIH-IHG)
i. Department of the Interior and Local Government (DILG)
j. Council for the Welfare of Children (CWC)
k. Philippine Health Insurance Corporation (PhilHealth)

D. Policies and Laws: RA 9288 or the Newborn Screening Act of 2004 and DOH AO No. 2014-
0045 or the Guidelines on the Implementation of the Expanded Newborn Screening Program

3. Strategies, Action Points and Highlights

1. Ensuring Efficient Operations, Systems and Networks Management

This shall be upgraded to reach areas that need access to newborn care. This includes
construction and/or renovation of well-planned and equipped infrastructures to ensure quality
service among patients and to engage more health facilities to offer NBS services (human
resource for health-trained and capacitated)

2. Expanding Package of Services and Delivery Network

In the next ten years, the program aims to shift fully into expanded newborn screening.
Enrollment of new facilities and sustaining the operations of existing facilities is critical in
increasing the coverage of service delivery. Strategic actions to increase the uptake of ENBS
are critical to ensure nationwide implementation, which involves strong promotion, advocacy
and cooperation of the newborn screening facilities.

3. Enhancing Health Promotion and Advocacy

This requires a developed and well-coordinated comprehensive health promotion and

communication plan targeting different audiences to increase awareness and uptake on
expanded newborn screening. It shall also focus on information campaign by strengthening
communication strategies using different media platforms.

4. Optimizing Health Information Management Systems for Expanded Newborn

Screening

This aims to optimize current investments on health management information systems by

adopting interoperable, consensus-based, evidence—driven and standards-based vocabularies
and system that maximize the use of electronic health record systems that will automatically
process and send information and reports to (a) PhilHealth for verification of claims for NBS,
and (b) the NBS registry for program planning and research purposes, among others.

5. Strengthen Monitoring and Evaluation

Program monitoring and evaluation of procedures and systems, both for laboratory and
administrative units shall be undertaken to ensure smooth implementation of the program.
Periodic review of and tools should be done including quality assurance assessment.

6. Establishing Sustainable Financing Scheme

The DOH, as the lead agency of the NBS program shall allocate funds for the set-up of new
strategically located newborn screening centers. The National Comprehensive Newborn
Screening System (NCNBSS) also ensures funding for researches relevant to the
implementation of newborn screening at the national level that maybe utilized for policy
recommendations The Philippine Health Insurance Corporation (PHIC) also ensures full
coverage of expanded newborn screening, while LGUs and other stakeholders and partners are
empowered to provide ways or means to make the NBS accessible and affordable, particularly
on the economically depressed areas.
M. BEmONC/CEmONC

N. Nutrition
O. MhGaP
 INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI)

IMCI clinical guidelines are meant to be used by the health worker in the management of sick children
from age 1 wk up to 5 yrs. they are based on expert clinical opinion and research results. Using an
integrated approach, the IMCI protocol guides the health worker in ((WHO, 2005):

 Assessing signs that indicates severe disease;

 Assessing a child’s nutrition, immunization, and feeding;
 Teaching parents hoe to take care for a child at home;
 Counseling parents to solve feeding problems; and
 Advising parents about when to return to a health facility.

The entire IMCI case management process involves the following elements (WHO, 2005);

1. ASSESS a child by checking first for danger signs (or possible bacterial infection in a young
infant), asking questions about common conditions, examining a child, and checking nutrition
and immunization status. Assessment includes checking the child for other health problems.
2. CLASSIFY a child’s illness using a color-coded triage system.
3. IDENTIFY specific treatments for the child.
- If the child requires urgent referral, give essential treatment before the patient is transferred.
- If a child needs treatment at home, develop an integrated treatment plan for the child and give
the first dose of drugs in the clinic.
- If the child should be immunized, give immunizations.
4. Provide practical TREATMENT instructions, including teaching the mother or caretaker on how
to give oral drugs, how to feed and give fluids during illness, and how to treat local infections at
home.
5. Assess feeding, including assessment of breastfeeding practices, and COUNSEL to solve any
feeding problems found. And counsel the mother about her own health.
6. When a child is brought back to the clinic as requested, GIVE FOLLOW UP CARE and, if
necessary, reassess the child for new problems.

MATERNAL, NEWBORN AND CHILD HEALTH AND NUTRITION (MNCHN) Service Delivery Network

- It is important that different health care providers within the locality are organized into a well-
coordinated MNCHN service delivery network to meet the varying needs of the populations and
ensure the continuum of care.
- The MNCHN network can be province or city-wide network of public and private health care
facilities and providers capable of giving MNCHN services, including basic and comprehensive
emergency obstetric and essential newborn care. It also includes the communication and
transportation system supporting this network (DOH, 2011).
- There are three levels of care in the MNCHN service delivery network;
 Community level service providers or the community health team (CHT) gives primary
health care services. These include out-patient clinics such as RHU’s, BHS’s, and private
 clinics as well as their professional health staff and volunteer health workers, such as
barangay health workers and traditional birth attendants.
 A BEmONC- capable facility or provider can perform the following six signal obstetric
functions (DOH,2011);
 parenteral administration of oxytocin in the third stage of labor;
 parenteral administration of loading dose of anticonvulsants;
 parenteral administration of initial dose of antibiotics;
 performance of assisted deliveries (imminent breech delivery);
 removal of retained products of conception ;and
 manual removal of retained placenta

A BEmONC-capable facility is also able to provide emergency newborn interventions,

which, at the least, include the following (DOH, 2011);

 newborn resuscitation
 treatment of neonatal sepsis/infection
 oxygen support
 A CEmONC-capable facility or provider can perform the six signal obstetric functions as in
BEmONC, as well as provide caesarean delivery services, blood banking and transfusion
services, and other highly specialized obstetric interventions. It is also capable of providing
neonatal emergency interventions for BEmONC plus management of low birth weight or
preterm newborn and other specialized newborn services (DOH,2011)