CHN - Copar

[BOARDS REVIEW]
COMMUNITY HEALTH NURSING

BASIC CONCEPTS ● Art 2, Sec. 15 of the Phil. constitution
● Community → client - State and government is responsible to
● Health → goal protect the rights of every individual and instill
● Nursing → means consciousness among them
● Art. 13, Sec 11 of the Phil. constitution
LEVELS OF CLIENTELE - The government must adapt a comprehensive
● Individual and integrated health programs
● Family - All levels of health care (primary, secondary
- Usually shares a common blood relationship and tertiary facilities)
- Familys is very fluid, do not limit the definition
of family to blood relation SOCIAL DETERMINANTS OF HEALTH
- Basic unit of service ● Economic Stability
- Basic unit of the society - Employment
- Health of the family influence the health of the - Income
community - Expenses
● Community - Debt
- A group of people that shares a common - Medical bills
geographic location, interest, institutions and - Support
population/ aggregates ● Neighborhood and Physical Environment
o Population aggregates: e.g. pregnant - Housing
mothers, elderly - Transportation
- Composed of group of families - Safety
- We direct our services to the community, but - Parks
we focus our interventions to the family - Playgrounds
● Population Groups - Walkability
- A group of individuals that share common ● Education
health needs - Literacy
- Language
HEALTH - Early childhood education
● Complete physical, mental and social well-being - Vocational training
and not merely the absence of disease or infirmity - Higher education
(WHO, 1958) ● Food
● Dynamic state fluctuating patterns of death or - Hunger
OLOF (Optimum Level of Functioning) (Dun, 1961) - Access to healthy options
● Individual or group is able to realize aspirations and ● Community and Social Context
satisfy needs and change or cope with the - Social integration
environment - Support systems
● Health as resource for everyday life, not objective of - Community engagement
living - Discrimination
● Positive concept emphasize social and personal ● Health Care System
resources, and physical capabilities (WHO, 1986) - Health coverage
● Absence of disease - Provider availability
● Multifactorial - Provider linguistic and cultural competency
- Address the root cause of the problem - Quality of care
● Health Outcomes
HEALTH AS RIGHT - Mortality
- Morbidity
● Art 25, Sec. 1, Universal Declaration of Human
- Life Expectancy
Rights (GA Res. 217 A III, 1948)
- Health care expenditures
- Health is the right of every individual - Health status
regardless of age, gender or socioeconomic - Functional limitations
status
OVERARCHING GOALS:
● Attain high quality, longer lives, free of preventable
disease, disability, injury and premature death
1
● Achieve health equity, eliminate disparities, and
improve the health of all groups OCCUPATIONAL HEALTH NURSING
● Create social and physical environment that
promote good health for all ● RA 1054 - Occupational Health Act
● Promote quality of life, healthy development and - Mandate owners, lessee or operator of any
health behaviors across all life stages commercial, industrial or agricultural
establishment to furnish free emergency,
NURSING medical and dental attendance to employees
● Assisting sick or well individuals to help him gain and laborers
independence (Virginia Henderson. 1964) ● 30 employees (none)
● The focus is more on primary care services ● 1-100 within 1 km from health facility (none)
● 1-100 beyond 1 km health facility - OHN
COMMUNITY HEALTH NURSING ● 101 & 200 - OHN
● Direct, goal-oriented and adaptable to the needs of ● 201 & 300 - OHN, Physician
the individual, the family and community during ● 301 & above - OHN, physician and permanent clinic
health and illness (American Nurses Association,
1973) ● E.O 442 - Labor Code of the Philippines
● An area of human services directed toward
developing and enhancing the health capabilities - 8 hours/day for 5 days a week exclusive of time
of people (Ruth Freeman & Janet Heinrich, 1981) for meals (RA 5901)
- Either singly, as individuals or collectively as
- First aid medicines and equipment
groups and communities
o > 50 but < 200 - Full time RN except when
● General Philosophy of CHN: Community health
hazardous
nursing is based on the worth and dignity of man
o > 200 but < 300 - Full time RN, part time
(Margaret Shetland)
MD & RD
o > 300 - Full time RN, MD, RD and dental
SALIENT POINTS IN CHN
clinic, infirmary or ER hospital with 1 bed
● Goal: Promotion of OLOF through teaching and
capacity for every 100 employees
delivery of care
● Philosophy: based on the worth and dignity of man
● E.O 307 - Occupational Safety and Health Center
● Primary focus: Health Promotion
(OSHC)
● Primary Activity: Health Education
● Unit of Service: Family - Under the employees compensation
commission
COMMUNITY HEALTH NURSING FOCUSES ON THE
COMMUNITY ● Health protection
● Setting: Natural environments of people - Health risk management at work e.g. health
- Home → PHN hazard identification, risk assessment, control
- School → SHN measures, surveillance, information, training,
- Workplace → OHN monitoring, record keeping
● Fields of CHN Practice - Identify health hazards or so-called
environmental scanning
SCHOOL HEALTH NURSING - Are there slippery wet floors?
- Are they using personal protective
● RA 124 equipments
- Medical Inspection of Children in private
schools, colleges and universities in the ● Health Promotion
Philippines with students 300 or more to - Health risk assessment e.g. environment,
provide part or full time MD for annual lifestyle, employee information, assistance
medical examination program
● DepEd Order No. 43 - Redesigned Approach in PUBLIC HEALTH

School Health Nursing ● Philosophy: health and longevity as birthrights
● Activities: ● Objectives:
- Health promotion - Prevent disease
- Disease prevention and early detection - Prolong life
- Emergency care - Promote health and efficiency
- Referral ● Through organized community effort
- Health screening, case finding, health
education and nursing procedures
CRUZ, DCR | BATCH 2022 | 2
● The application of science in the context of policies PREVENTIVE APPROACH TO HEALTH
to removes inequalities in health and deliver the ● Health Promotion - activities that enhance
best health for the greatest number (WHO) resources directed at improving overall well-being
● Public health + nursing + social assistance ● Disease Prevention - activities that protect people
- Promotion of health from disease and its effects
- Improvement of the physical and social
environment PRIMARY
- Rehabilitation ● Health promotion and specific protection
- Prevention of illness and disability ● E.g. Immunization, breastfeeding
NATIONAL LEAGUE OF PH GOVERNMENT NURSES SECONDARY

STANDARDS OF PHN PRACTICE IN THE PH (2006) ● Early detection and prompt intervention
● In Public health nursing, it focuses on policies and ● E.g. Newborn screening, IMCI, hearing screen,
programs that will ensure health equity sputum microscopy, PhilPEN, feeding program
- Refers to the practice of nursing in the local,
national and city health departments which TERTIARY
include health centers and public schools ● Limitation of disability and rehabilitation
- View health as macrocosm ● Referral of a severely malnourished child
- Ensure that health as received by the
community HEALTH CARE DELIVERY SYSTEM
- A subfield of community health nursing ● Refers to the overall field of practice where health
● In community health nursing, we do not only look services are provided with and for the community
at the group or community but also at the ● Characterized by different levels of service
individuals and families. We provide direct nursing
RESTRUCTURED HEALTH CARE DELIVERY SYSTEM OF THE
care to client PH
- Is a broader as it encompasses nursing
practice in a variety of roles, which at times PRIMARY LEVEL ● Prevention
includes independent nursing practice ● Management of prevalent
conditions
● Out-patient services
STANDARDS OF CARE IN PHN
● Ambulatory clients
● Barangay health center
● Assessment ● Rural Health Unit (RHU)/ Barangay
- Status of populations Health Center
SECONDARY ● Hospitalization
● Diagnosis
LEVEL ● Early diagnosis and treatment
- Give meaning to needs ● District hospital
● Provincial hospital
● Outcome Identification
TERTIARY LEVEL ● Specialized care
- Partner to identify outcomes to status of ● Specially trained personnel
populations ● Highly departmentalized
- Set goals and objectives ● Sophisticated equipment
- Define the planning process ● Regional hospital
● National / DOH/ medical centers/
● Planning university
- Develop programs based on the identify needs

INTER-LOCAL HEALTH ZONE
● Assurance ● Defined catchment population within a defined
- Instituting implementation policies geographical area
- Policies serves as guide ● Does not only cover government health services
- Procedures involves on how we are going to but includes NGOs and private sector
implement the programs (e.g. gather the ● PPM - Public and Private Mix
weight of underweight children and monitor
every month) TWO-WAY REFERRAL SYSTEM
● Communication among facilities
● Evaluation ● Efficiency of health care delivery
- Minimize cost
- Status based on set programs
- Maximize resources
- Determine whether the outcomes have been
- Competency of care
achieved

● RA 7160 - Devolution Code PUBLIC HEALTH NURSE
- Local Government Code of 1991 ● Supervises and guides all RHMs in the municipality
- Aim: to trandorm local government unit into: ● Prepares the FHSIS quarterly and annual reports
SARAD ● Utilizes the nursing process, health education
o Self-reliant communities ● Collaborates with other members of health team
● 1:10,000
o Active partnership with the people
o Responsive to the needs of the people
RURAL HEALTH MIDWIFE
o Accountable government representatives
● Manages the BHS and supervises, and trains BHWs
o Decentralization system of health
● Provides midwifery services and executes health
decision making
care programs and activities for women, family
LOCAL GOVERNMENT CODE planning and services
● Conducts patient assessment and diagnosis for
Department of Health ● National hospital/ DOH
referral
● Chair: Health Secretary hospital/ Medical centers
● Organizes the community
Provincial Health Board ● Regional hospital ● Facilitates barangay health planning and other
● Chair: Governor ● Provincial hospital community health services
● Vice-chair: PHO District hospital ● 1:5,000
● Members: Chairman,
NGO, DOH RURAL SANITARY INSPECTOR
● Ensure a healthy physical environment in the
Municipal Health Board ● RHU (RA 1082):
municipality. Activities are advocacy, monitoring,
● Chair: Mayor 1:20,000
regulatory activities, inspections of water supply
● Vice-chair: MHO ● BHS: 1:5,000
● Members: and household conditions
Chairman, NGO,
DOH Rep. BARANGAY HEALTH WORKERS
● Serves as interface between community and the
RHU
● Appointment of the position in the health center is
● Provides basic services
the responsibility of the Mayor or the Governor
● 1:20 households
● Centralize
● Grassroots health care workers
- Top level (DOH) is the only one involved in
- Non-professionals
decision making process
- They do not have formal training
● Decentralize
- Also called as Frontline health care workers
- All levels are involved in the decision making
process
● RA 7305 - Magna Carta for Public Health Workers
● RA 1082 - 40 hours per week

- Salary Scale (RA 6758)
- For every one RHU, there should only be
- Hazard Allowance 25% of monthly salary for SG
20,000 population (1:20,000)
19, 5% (SG 20) and above
ROLES AND FUNCTIONS OF

PRIMARY HEALTH CARE
PUBLIC HEALTH WORKERS
MUNICIPAL HEALTH OFFICER (MHO) / RURAL
● Legal Basis: Letter of Instruction (LOI) 949
HEALTH PHYSICIAN (RHP)/ PHYSICIAN-IN-CHARGE
(PIC) - October 1979 by Ferdinand Marcos, 1 year after
● Administrator the First International Conference on Primary
- Prepares the municipal health plan and Health Care in Alma Ata (Russia) sponsored by
budget WHO & UNICEF
- Monitor implementation of basic health - Goal: Health for All Filipinos and Health in the
services Hands of the People by the year 2020
- Management of staff - Mission: To strengthen thea health care system
● Community physician by increasing opportunities and supporting
- Conducts epidemiological studies the conditions wherein people will manage
- Formulates health education campaign their own health care
- Prepares and implement control measures ● Essential health care made universally Accessible,
plan Available, Appropriate and Affordable to
● Medico-legal officer individual and families in the community by mean
- 1:20,000 Acceptable to them (5As)
- Accessible: Health center must be found
within 5km of the location of the barangay
- Available: health care worker USE OF HERBAL MEDICINES
- Appropriate according to the needs of the
client ● Legal Basis: RA 8423 - Traditional and Alternative
- Affordable: depending on the availability of the Medicine Act of 1997
medications, services or equipments ● Promotes use of indigenous resources
- Acceptable: must no contradict their beliefs ● Traditional Medicine
and practices - Sum total of the knowledge, skill, practices
based on the theories, beliefs and experiences
PRIMARY ELEMENTS/ COMPONENTS of indigenous to different cultures
● Environmental sanitation ● Complementary Medicine
● Control of communicable diseases - Combination of both traditional and
● Immunization conventional methods
● Health education
● Maternal and child health COMPLEMENTARY MEDICINE
● Family planning ● Acupressure - pressure on acupuncture points
● Adequate food and proper nutrition ● Acupuncture - needles to puncture and stimulate
● Provision of medical care and emergency points
treatment ● Aromatherapy - senses of smell using oils
● Treatment of locally endemic diseases ● Chiropractic - static and dynamics of locomotor
● Provision of essential drugs system
● Herbal/ Phytomedicine - plants
● RA 6675: Generic Act ● Massage - soft parts of body
● Nutritional therapy - food as medicine
● RA 7581: Price Act
● Pranic healing - balancing energy
● Reflexology - reflex points
● RA 9502: Cheaper Medicine Act
● Botika ng Barangay (BnB): essential medicines at 10 HERBAL PLANTS
cheaper price ● Acronym: LUBBY SANTA
● Compack/ Complete Treatment Pack - monthly ● Lagundi
supply of medicines for HPN and DM in BHS - Pain reliever, asthma, cough, fever, dysentery,
- Amlodipine skin diseases (dermatitis, scabies, ulcer,
- Losartan eczema), rheumatism, spasm, contusions,
- Metformin aromatic bath
- Simvastatin ● Ulasimang Bato (pepperomia)
- Lowers uric acid blood level
PHC CORNERSTONE/ PILLARS ● Bawang
● Acronym: AIUS - For HPN (more on arteriosclerosis), toothache
● Active Community Participation ● Bayabas
● Intra and inter-sectoral linkages - Toothache, antiseptic wash
- Intra: LGU ● Yerba Buena/ Herba Buena
- Inter: NGO, PO & IO - Pain reliever, for menstrual pain, arthritis pain,
● Use of appropriate technology colds, bleeding gums, fainting, for relief of
- Focus on indegenous resources insect bites and itching
● Support mechanisms made available ● Sambong (camphor)
- LGU create policies and implement the - Diuretic
programs ● Ampalaya
- DOH provide financial assistance, support - For mild NIDDM
mechanisms and develop programs ● Niyog-niyogan
- Support mechanisms: Technical and financial - Intestinal parasitism
assistance ● Tsaang-gubat (wild tea)
PRIMARY HEALTH WORKERS - For diarrhea, high in chlorine content
● Village/BHWs ● Akapulko (ringworm bush)
- Trained community health workers, health - Fungal infection
auxiliary volunteers, traditional birth
attendants, healers
THINGS TO REMEMBER
- Grassroot Levels
● Intermediate Level - professional group BONUS!
- Primary: RHM ● Boling - remove cover
- Secondary: PHN ● One kind of plant for each type of symptom
- Tertiary: Physician ● No insecticides

- Medical and midwifery scholarship program
● Use clay pot and plant part advocated
● Stop in case of untoward reactions; seek
consultation if s/sx not relieved after 2-3 doses THE OTTAWA CHARTER
● Output of the first International Conference on
Herbal medicines may be prepared by decoction, health promotion, meeting in Ottawa this 21st day
infusion (tea) or poultice of November 1986
● A call for action to achieve Health for All by the year
ASTANA DECLARATION ON PRIMARY HEALTH CARE 2000 and beyond
2018
● Celebrated the 40th year HEALTH PROMOTION
● Commences the implementation of the Astana ● Is the process of enabling people to increase
Declaration control over and to improve, their health
- Marks the change the landscape of healthcare ● A behavior motivated by the desire to increase
delivery system all over the world well-being and actualize human health potential. It
is an approach to wellness
● Key to achieving Health for all by the year 2000 and
ASTANA DECLARATION
beyond
Alma Ata Declaration (1978) → focused on health for all
↓ STRATEGIES TO HEALTH PROMOTION
Astana Declaration (2018) → strengthen PHC; realize UHC ● Build healthy public policy
↓
Held in Astana, Kazakhstan
- E.g. RA 7600 - Breastfeeding policy
↓ ● Create supportive environments
Global Conference on Primary healthcare → PHC should be - E.g. Breastfeeding stations
integrated with all tiers of healthcare to give better services →
● Strengthen community action
focus on PHCs to prevent diseases and not just fight specific
disease; strive towards UHC - Organize projects that involves participation of
↓ the community to promote health
Acknowledgement of rising threat of lifestyle and - E.g. Breastfeeding campaign programs -
non-communicable disease
educate mothers about the benefits of
breastfeeding
● Develop personal skills
DETERMINANTS OF SUCCESS OF PHC ASTANA - Teaching them skills that enhances their
DECLARATION capacity to implement health promotion
● Knowledge and Capacity Building ● Reorient health services
- Health education - Integrate the health promotion strategy in
● Human Resources for Health different health programs
- Multidisciplinary approach - E.g. Breastfeeding is integrating in EIMC
- Includes all health workers to collaborate with
the health care plan PREREQUISITES FOR HEALTH PROMOTION
● Financing ● Advocate
- Involves implementation of Universal Health - Advocating for positive health behavior
Coverage - Health education
● Technology ● Enable
- Effective, safe, affordable, sustainable, - To make decision
acceptable - Give opportunities by telling them the benefits
- The delivery of basis care services ● Mediate
- Guiding them to make decision
DOH RHR PROGRAMS - E.g. Family Planning
● Fixed term basis; special programs by the
government MILLENIUM DEVELOPMENT GOALS
● Medical Pool Placement and Utilization Program
- MDs in DOH hospitals
● Doctors to the Barrios (DTTB)
- 2 years in 4th or 5th class municipality
● Nurse Deployment Project
- 6 months renewable up to 2 years
● Rural health Midwives Placement Programs -
MW
● Rural Health Team Placement Program (RHTPP)
- Med tech and nutritionist
● 2015; 8 MDGs
● DOH Pre-services scholarship programs
● To eradicate extreme poverty and its implications

● MDGs 4,5, and 6 are specific for health
abuse, road traffic
- Goal 4: Reduce Child Mortality accidents, UHC,
o Target is 2/3 hazardous chemicals
- Goal 5: Improve Maternal Health
o Target is ¾ or 75%
OTHER SDGs RELATED TO HEALTH
- Goal 6: Combat HIV/AIDS, Malaria and other
● DOH is the principal health agency in the
diseases
Philippines
SUSTAINABLE DEVELOPMENT GOALS
● SDG 1: poverty
● SDG 2: malnutrition
● SDG 5: violence against women and girls/ sexual
reproductive health and rights
● SDG 6: safe and affordable drinking water/
sanitation and hygiene
● SDG 8: safe and secure working environment
● SDG 11: housing and basic service/ air quality. Waste
management in cities
● SDG 13: climate-related hazards and natural
disasters
DEPARTMENT OF HEALTH
● Original name: Board of Health of the Philippine

Island
● 2030; 17 MDGs
● SDG 3 is specific for health ● Vision: Filipinos are among the healthiest people
in Southeast Asia by 2022, and Asia by 2040
● Mission: To lead the country in the development of
HEALTH MDGs DIRECT HEALTH SDG
a productive, resilient, equitable and
● MDG 4 ● SDG 3 people-centered health system (PREP)
● Reduce the under-five ● Reduce the global ● The DOH holds the overall technical authority on
mortality rate by maternal maternal health as it is a nation health policy-maker and
two-thirds mortality ratio regulatory institution
● End preventable death
● MDG 5 of newborns and
3 MAJOR ROLES IN THE HEALTH SECTOR
● Reduce the maternal children under 5yrs of
● Leadership in health
mortality ratio by age
● End current epidemics ● Enable and capacity builder
three-quarters ● Administrator of specific services
and combat
● Achieve universal
communicable
access to reproductive ● Reduce premature IMPACT OF DEVOLUTION IN THE DELIVERY OF
health mortality from HEALTH SERVICES
non-communicable
● MDG 6 diseases DOH LGUs
● Halt and reverse the ● Strengthen the
● Health governance in ● Health governance in
spread of HIV/AIDS prevention and
national level subnational level
● Achieve universal treatment of substance
abuse
access to treatment ● Overall steward and ● In-charge of delivery of
● Halve the number of
for HIV/AIDS technical authority in primary and secondary
global deaths and
● Halt and reverse the health health services
injuries from road traffic
incidence of malaria accidents
● Develop national plans, ● Prepares plans,
and other major ● Ensure universal access
technical standards, manages, implement
diseases to sexual and
guidelines local health programs
reproductive healthcare
- Standard is and services
services
universal
● Achieve UHC
- Policy is different
● Reduce deaths and
from one another
illness from hazardous
at an institutional
chemicals and air, water
level
and soil pollution and
contamination
● New: Communicable HEALTH SECTOR REFORMS
diseases, substance
● FOURmula One (2005-2010)

● Kalusugan Pangkalahatan or Aquino Health ● Advance health promotion, primary care and
Agenda (2011-2015) quality
● Duterte Health Agenda (2016-2022) ● Cover all Filipinos against financial health risk
● FOURmula 1 Plus (2017-2022) ● Harness the power of strategic HRH
● Invest in eHealth and data for decision-making
DUTERTE HEALTH AGENDA ● Enforce standards, accountability and transparency
● All for Health towards Health for All ● Value clients and patients
● “Lahat para sa Kalusugan tungo sa Kalusugan ● Elicit multi-stakeholder support for health
Para sa Lahat”
FOURMULA 1 PLUS
3 GOALS
● “The health system we aspire for”
● Financial Protection
- Filipinos, especially poor, marginalized, and
vulnerable are protected from high costs of
healthcare
● Better Health Outcomes
- Filipinos attain the best possible health
outcomes with no disparity
● Responsiveness
- Filipinos feel respected, valued and
empowered in all of their interaction with the
health system
3 GUARANTEES
● Guarantee 1: All Life Stages & Triple Burden of
Disease Figure 1: FOURmula One Plus for Health Strategy Map
- Communicable diseases: HIV/AIDS, TB. Malaria,
Diseases for Elimination, Dengue, Lepto, Ebola
STRATEGIC FRAMEWORK
● Guarantee 2: Services are delivered by networks
that are VISION Filipinos are among the healthiest people in
- Fully functional: complete equipment, Southeast Asia by 2022, Asia by 2040
medicines, health professional
- Compliant with clinical practice guidelines MISSION To lead the country in the development of
PREP system
- Practice gatekeeping
- Located close to the people: mobile clinic or
GOALS Better health outcomes, financial risk
subsidize transportation cost protection, responsiveness
- Enhanced by telemedicine
● Guarantee 3: Services are financed STRATEGIC Financing, Service Delivery, Governance and
predominantly by PhilHealth PLAN Regulation
- Philhealth as the gateway to free affordable
care “PLUS” Performance Accountability
o 100% of Filipinos are members
VALUES Integrity, Excellence and Compassion
o Formal sector premium paid through
payroll
o Non-formal sector premium paid through PILLAR OBJECTIVE PERFORMANCE
tax subsidy MEASURES
- Simplify Philhealth rules
o No balance billing for the poor/ basic FINANCING ● Sustain ● Increase in share of
investments Philhealth and
accommodation and fixed co-payment
in health government
for non-basic accommodation ● Ensure expenditures (DOH
- Philhealth as main revenue source for public equitable & LGU) in total
health care providers and efficient health
o Expand benefits to cover comprehensive use expenditures
range of services
o Contracting networks of providers within SERVICE ● Available ● Achieve adequate
DELIVERY essential health facility and
SDNs
quality HRH ratios
STRATEGY
health care ● Attain targets for
● Acronym: ACHIEVE at basic services

● People-oriented approach for delivery health
appropriate (immunization,
level rates, facility based services
deliveries, etc)
SALIENT FEATURES/ TERMS
REGULATION ● Ensure safe, ● Reduce mean MEMBERSHIP
high quality, market price of ● Automatic inclusion of every Filipino into National
and services, labs and Health Insurance Program
affordable medicines
● Simplification of PhilHealth membership into:
health ● Reduce incidence
- Direct Contributors: capacity to pay
products, of adverse health
services, events due to poor premiums, are employed and are bound by an
devices and quality product employer-employee relationship. Or are
facilities and services (e.g. self-learning, professional practitioners,
antimicrobial migrant workers, including qualified
resistance, post op dependents and lifetime members
complications, etc) - Indirect Contributors: not direct contributors
and their qualified dependents, premium
GOVERNANCE ● Strengthen ● Improve rating in
subsidized by the national government
capacity, SWS and other
coordination government trust o Point of care (POC) - shouldered by
and support surveys PhilHealth
to people ● Reduce stock-outs, - Co-payments: flat free or predetermined rate
centered improve utilization paid at point of service
SDNs of budget, and
● Leading a increase % of FINANCING SOURCE
participatory facilities with EMRs
● Pooling of funds from Sin Tax, PagCOR, PCSO
approach
premium, DOH annual appropriations, and national
government subsidy to DOH and PhilHeath
F1 PLUS (PERFORMANCE ACCOUNTABILITY) ● Population-based health services financed by
STRATEGIES DOH/ LGUs
● Transparency and Accountability - Population group as recipient paid
- Identifying performance metrics - E.g.. health promotion, disease surveillance,
- Regular monitoring and performance review vector control, Immunization, maternal health
- Publishing scorecards and performance program
reports ● Individual-based health services financed by
● Shift to result-oriented management approach PhilHealth
- Efficiency of tools, systems and processes - Can definitely be traced back to 1 recipient
- Develop and explore mechanisms to link limited effect at population level
performance to incentives - Prepayment schemes (Philhealth, private
health insurance, HMOs)
UNIVERSAL HEALTH CARE
FINANCING
● RA 11223 - Universal Health Care Act of 2019 ● 50% PAGCOR Income
● Prescribing reforms in the health care system and ● 40% PCSO Charity Fund
appropriating funds ● DOH Funding from the national budget
● PhilHealth subsidy from the national government
OBJECTIVES OF UHC ACT ● Premium contributions from PhilHealth member
● Progressively realize universal health care in the (direct contributions)
country through a systemic approach and clear
delineation of roles of key agencies and ENTITLEMENT TO BENEFITS
stakeholders towards better performance in the ● Free of charge at point of service for population
health system based health services
● Ensure that all Filipinos are guaranteed equitable ● Immediate eligibility for health benefit package
access to quality and affordable health care goods under National Health Insurance Program
and services and protected against financial risk - No Philhealth ID card required
- No co-payment for services in basic/ ward
IMPACTS OF UHC accommodation
● Integrated and comprehensive approach to ensure - Fix, regulated co-payment for non-basic
health for all Filipinos accommodation
● Access to comprehensive set of health services
without casing financial hardships POPULATION COVERAGE
● Healthy population

- Health promotion - Request for FBS or RBS or OGTT or Hgb A1C
- Disease prevention and wellness program (A-I)
● Population at risk - This can be done in patients with classic
- Risk identification symptoms or in asymptomatic adults with BMI
- Screening and early detection >25 kg/m2 and with risk factors or in
● Sick population asymptomatic adults >45yrs old with BMI>25
- Clinical primary care (diagnosis and treatment, kg/m2
continuing and coordination) ● Pharmacologic intervention
- Referral to secondary hospital - Not advisable to give routine vitamin
- Referral to tertiary hospital supplementation with antioxidants such as
- Referral to quaternary/ specialized care vitamins E & C and carotene (A-I)
● Non-pharmacologic interventions
DELIVERY OF HEALTH SERVICES - Patient intervention
● Contracting of province-wide and city-wide health o Structured health education on lifestyle
system for population-based health services by changes (alcohol and smoking)
DOH with the following minimum requirements: o Moderate weight loss
- Primary Care Provider network o Regular physical activity
- Epidemiologic surveillance system o Reduced calories, sugar and dietary fat
- Health promotion programs intake (A-III)
● Population-based health services refer to - Family-focused and community-oriented
intervention such as health promotion, disease interventions
surveillance and vector control, which have o Arrange for development and
population groups as recipients implementation of family-focused and
community-oriented intervention (A-III)
● Patient outcomes
HUMAN RESOURCES FOR HEALTH - Aware of DM type 2 and management plan
● National Human Resource Master Plan to provide (A-III)
appropriate health workforce based on population - Follow up visit: In 0-2 weeks (A-III)
health needs
● National Health Workforce Support System to VARIATIONS
assist LGUs in human health resource needs ● History and Physical examination
● Expansion of existing and new allied and - If during the first visit the patient has
health-related degree and training programs laboratory results that fit the classification of
● Return Service Agreement for all allied and DM type 2, follow the recommendation during
health-related government-funded scholars for at the second visit (A-III)
least 3 years with compensation ● Laboratory
- If the doctor has doubts about the accuracy of
REGISTRY OF HEALTH PROFESSIONAL available laboratory test, the test can be
AND WORKERS repeated for confirmation (A-III)
● The PRC and the DOH shall set up a registry of HEALTH CARE PROVIDER NETWORK
medical and allied health professionals indicating ● Healthcare Assessment
among other their current number of practitioners - Gatekeeping of the health care services
and location of practice
● The DOH and the PRC shall issue guidelines for the TYPES OF HEALTHCARE PROVIDER NETWORKS
eligibility requirements, standard competencies, PUBLIC PRIVATE
training mechanisms, and post-graduate
certification process for primary care workers To deliver population-based To deliver individual-based
and individual-based health services
CLINICAL GUIDELINES AND PATHWAYS services
FIRST VISIT
Limitation: Geographic or Limitation: Market-based
● History and Physical Examination
political boundaries forces
- Elicit symptoms of hyperglycemia
o Polyuria, polyphagia, polydipsia, nocturia Contractual agreement: public health care system may
and weight loss (A-II) contract a prove facility (and vice versa) to provide services not
- General physical examination focus on cardiac available to augment existing services within the network
renal, peripheral pulse, retinopathy,
neuropathy, skin an BMI (A-II)
- Conduct risk screening for asymptomatic and
BMI > 25kg/m2 or > 45yrs old (A-II))
● Laboratory

TIMELINE AND MILESTONES OF UHC
HEALTH AND Php 750/ month/ Max of 12 months
DATE TARGET NUTRITION household or (Php 6,000)
higher
Feb 20, 2019 UHC Law
- The cash grants shall be received by the
March 8, 2019 UHC Law took effect after 15 days mother through Land Bank cash card, OTC,
G-cash remit, Rural Banks
Sept. 8, 2019 UHC IRR took effect after 180 days - Under the provision of 4Ps, the most
responsible member of the family (usually the
July to December Pilot implementation of UHC in 33 mother) is responsible for holding the ATM
2019 accredited institutions
card or receiving the cash
● Given every month per child
2020-2022 Registration of Primary Care Providers
(PCP)
PROGRAM CONDITIONS
2022-2028 Organization of networks and ● Pregnant must avail pre/post-natal care and be
integration of local health systems attended by a trained health professional
● 0-5 children must receive regular preventive health
2029 Full implementation of UHC check-ups and vaccines
● 6-14 y/o must receive deworming pills 2x/yr
SOCIAL PROGRAMS ● 3-5 y/o children must attend daycare or preschool
PANTAWID PAMILYANG PILIPINO PROGRAM (4Ps) classes and must attend at least 85% of the time
● Rights-based and social development program of ● 6-18 y/o children must enroll in elementary or high
the national government to reduce poverty by school classes and must attend at least 85% of the
providing Conditional Cash Transfer (CCT) grants time
to extremely poor households to improve their ● Parents must attend Family Development Sessions
health, nutrition and education particularly of their (FDS) on effective parenting, husband and wife
children 0-18y/o relationships , child development, laws affecting
● In 2011, it became a law the Filipino family, gender and development and
- Extended the inclusion of qualified Filipinos home management
- Paglalatag ng Pundasyon ng Programang
● RA 11310 - Pantawid Pamilyang Program Act Pantawid Pamilya
- Paghahanda at Pangangalaga ng
- The government will provide conditional cash
Pamilyang Pilipino
transfers to qualified poor households for a
- Partisipasyon ng Pamilyang Pilipino sa
maximum period of 7 years. The National
Gawing pang Komunidad
Advisory Council, however, may recommended
a longer period under exceptional
GENERAL PRINCIPLES OF CHN
circumstances
● The Family - basic unit of service
- Qualified for the program are farmers,
● Comprehensive Care
fishermen, homeless familie, indigenous
● Developmental Service - self reliance
people, those from the informal sector and
● Pre-payment mechanism
those living in isolated and disadvantaged
- Through the taxes we pay
areas including places without electricity
● Preventive Care - primary, secondary, tertiary
- Livelihood programs and employment
● Ecology Orientation
assistance may also be availed by eligible
● Continuity of Care - throughout the lifespan
beneficiaries at the Department of Social
● Multidisciplinary Approach - intra/intersectoral
Welfare and Development
● Population Focused - greater good of majority
- Persons who will be found of falsifying their
● Consumer Involvement - allow them to make
information in the registry for conditional cash
decision for their health after we educate them
transfer may be imprisoned for a month or up
to a year, and may be fined with not less than
LEGAL BASIS OF PHN PRACTICE
Php 10,000 but not more than Php 100,000
BENEFICIARY AMOUNT DURATION ● RA 9173 Sec 28 - Philippines Nursing Act of 2002
ELEMENTARY Php 300 or higher Max of 10 months - Provide nursing care using nursing process
(max of 3 children) (Php 9,000 for 3 - Establish linkages with community resources
child) and coordination with health team
- Provide health education to IFC
SENIOR HS Php 700 or higher Max of 10 months - Teach, guide and supervise students in
nursing education programs

- Undertake nursing and HRD training and - BHW - Vitamin A, Vital Signs
research - Authority, Responsibility & Accountability
(ARA)
ROLES AND FUNCTIONS OF PUBLIC HEALTH NURSE
● Healthcare Provider EPIDEMIOLOGIST
● Healthcare Educator ● Researcher
● Leader/Manager ● Participant in epidemiologic investigations
● Advocate ● Health monitor of the community
● Counselor ● Statistician
● Researcher/ Epidemiologist - Presentation of municipal health statistics
● Community Organizer through tools such as graphs and tables
ADDITIONAL INFO
● Epidemiological Investigation
● Roles - title of the position - Secondary Prevention
● Functions - activities related to the role
- Performed during an outbreak using graphs
and tables to analyze data
ROLES OF PHN - Pie Graph: Percentage
HEALTH CARE PROVIDER - Line Graph: Relationship
● Secondary health care provider ● Recorder/ reporter: RA 3573
● Provider of direct nursing care - Diseases that require weekly monitoring:
● Health educator and change agent o Acute flaccid paralysis (AFP) polio
● Role model o Measles
● Health monitor of the individual and family o Severe acute diarrhea (SAD)
● Sick and well individuals, families and communities o Neonatal tetanus
● E.g. administering vaccine o AIDS
LEADER/MANAGER ● RA 11166 - Philippines HIV and AIDS Policy Act of

● Planner/programmer: nursing component of 2018
health plan
- Repealed the RA 8504 also known as the
- E.g. Planning of budget
Philippines AIDS Prevention and Control Act
● Coordinator of services
of 1998
- Make referrals
- Allows minors 15 - 17y/o to give their own
- Coordinate nursing services with other health
consent for taking HIV test
programs
- Any person below 15 who is pregnant, married
● Supervisor of RHM’s
or in high-risk behavior should be considered a
- Organize work force
mature minor and be allowed to give their
o Schedule of RHU personnel (RHM visits
own consent for HIV testing
BHS at least 1x/week) - Mandates HIV and AIDS education in the
o E.g. Coordinate with the physician in workplace
charge to know what are the resources - All public and private employers and
needed such as procurement of vaccines employees, including AFP and the PNP shall
- Provide technical assistance to RHM’s in be provided with basic information and
implementing instructions on HIV and AIDS, including on
o Standard case definitions confidentiality in the workplace and reduction
o Management guidelines or elimination of stigma and discrimination
● Trainer ● Diseases targeted for eradication
- Training programs of RHM’s, BHW and - Acute flaccid paralysis
traditional healers (TBA’s, herbolario, etc.) - Neonatal tetanus
● Resource person - Measles
- Property custodian of the RHU - Rabies
o E.g. cold chain officer in EPI ● Diseases that require reporting within 24hrs
- Evaluator of work performance - Acute flaccid paralysis polio
● Utilize the process of Directing - Measles
- Delegate some responsibilities to
subordinates, but it is important they are FAMILY NURSE CONTACT
oriented and trained regarding their task. We ● Home Visit
cannot delegate something beyond their task. ● Clinic Visit
- E.g. Follow-up postpartum mothers to visit the ● Telephone Contact
health center ● Group Discussion
- E.g. Midwives - BCG, Vitamin A, Deworming
● Telehealth/ telemedicine - Consider all articles belonging to the family as
contaminated - place a lining below the bag
CLINIC VISIT - The outside of the lining is considered as
● The family initiates the care contaminated, therefore touch the outer
● Resources are readily available portion because the inside portion is
● Has higher number of patients considered sterile
PHASES OF A CLINIC VISIT ● Save time and effort of nurse
PRE-CONSULTATION PHASE ● Effectiveness of care: not overshadow
● Perform nursing history taking ● Performed in variety of ways: do not spread
● Perform physical assessment infection
● Review records
● Pre-consultation lecture FAMILY AND COMMUNITY HEALTH NURSING
FAMILY HEALTH FAMILY NURSING FAMILY HEALTH
CONSULTATION PHASE CARE NURSING
● Assist client to consultation room
● Work with physician Health status of a Philosophy and Process of
● Comfort and safety of client throughout the given family at a way of interacting providing for the
given point in with families healthcare needs
procedure
time of families that are
● Confidentiality of results
within the scope
● Carry out physician’s orders of nursing
POST-CONSULTATION PHASE
● Explain physician’s orders and advice 4 CONCEPTS OF FAMILY/ APPROACHES TO FAMILY
● Give health teaching and counseling NURSING
● Refer to other agency CHARAC F. AS A F. AS A F. AS A F. AS A
● Schedule next visit TERISTIC CONTEXT/ CLIENT/ SYSTEM COMPONE
FAMILY-CENT UNIT/ NT OF
ERED/ FAMILY SOCIETY
HOME VISIT FAMILY-FOC GROUP
USED
● Professional face-to-face contact made by the
nurse to a patient of the family Focus Individual Family Individual Family as
- The nurse initiates the care of Care members members on of the
- Resources are limited and institution
- Personalized but time-consuming family s in the
society
● To provide necessary healthcare activities
How the
● To further attain an objective of the agency
individual How can
interact the
PRINCIPLES IN PLANNING FOR A HOME VISIT with one resources
● Have a purpose or objective another of the
● Make use of all available information communit
● Focus on essential needs of the Individual and y
family but prioritize needs recognized by the family contribute
towards
● Should involve the individual and family
the health
● Flexible and practical
concern of
the family
PHASES OF HOME VISIT
● Initiation - Assessment Resourc Family Individual Interactio Other
● Pre-visit - Planning es of members n institution
● In-home - Implementation care s
● Termination/Summarization - Implementation
● Post-visit - Evaluation GENERAL FUNCTIONS OF FAMILY
● Physical maintenance
BAG TECHNIQUE ● Socialization of family members
● is commonly utilized during home visit ● Allocation of resources
● Equipment: Public Health bag ● Maintenance of order
Principles: ● Division of labor
● Minimize and prevent spread of infection ● Reproduction, recruitment and release of members
- Handwashing ● Placement of members into the larger society
- Start with a well member towards the sick ● Maintenance of motivation and morale
member

9 AREAS OF FAMILY ASSESSMENT ● Has the highest weight: 2
● Physical independence
MODIFIABILITY SCORE WEIGHT
● Therapeutic competence
● Knowledge of health condition EASILY MODIFIABLE 2
● Application of principles of general hygiene
● Health attitude PARTIALLY MODIFIABLE 1 2
● Emotional competence
NOT MODIFIABLE 0
● Family living
● Physical environment
● Use of community resources PREVENTIVE POTENTIAL
● Nature and magnitude of future problems that can
TYPES OF PROBLEMS IN THE COMMUNITY be minimized or totally prevented if intervention is
done. This is affected by:
FAMILY COMMUNITY
- Seriousness of the existing problem
● Wellness condition ● Health Status - Duration of the existing problems
- E.g. Breastfeeding - Morbidity, mortality - Measures that have been implemented
or fertility - Probability
● Health deficit ● Health Resources POTENTIAL SCORE WEIGHT

- Actual problem - Manpower,
HIGH 3
facilities,
financial/budget
MODERATE 2 1
● Health Threat - ● Health Related

LOW 1
predisposes the family - Political,
- E.g. Family living environmental or
near the river social SALIENCE
● Family’s perception of the problem and evaluation
● Foreseeable Crisis or
of the condition or the problem in terms of
Stress - increases
seriousness and urgency of attention needed
demand
- E.g. Death of a SALIENCE SCORE WEIGHT
family member
SERIOUS PROBLEM
2
IMMEDIATE CONCERN
CRITERIA FOR PRIORITIZING FAMILY PROBLEMS
PROBLEM NOT NEEDING
1 1
● Highest score is 5 URGENT ATTENTION
● Scoring - the higher the score the higher the NOT CONSIDERED AS A
0
priority PROBLEM
NATURE OF THE PROBLEM SCORING FORMULA

● Based on the type of family problem (wellness 𝑆𝑐𝑜𝑟𝑒 𝑜𝑓 𝑐𝑟𝑖𝑡𝑒𝑟𝑖𝑎
× 𝑤𝑒𝑖𝑔ℎ𝑡
ℎ𝑖𝑔ℎ𝑒𝑠𝑡 𝑠𝑐𝑜𝑟𝑒 𝑜𝑓 𝑡ℎ𝑒 𝑐𝑟𝑖𝑡𝑒𝑟𝑖𝑎
condition, health deficit, health threat, foreseeable
crisis)
COMMUNITY PROBLEM PRIORITIZATION
NATURE SCORE WEIGHT ● Highest score is 10
NATURE OF THE PROBLEM
WELLNESS 3
NATURE SCORE WEIGHT
HEALTH DEFICIT 3
1 HEALTH STATUS
HEALTH THREAT 2 - Increased or
3
decreased morbidity,
mortality, fertility
CRISIS 1
HEALTH DEFICIT
- Manpo
MODIFIABILITY
wer, money, 3
● The probability of success in eliminating or 1
materials,
reducing the problem by nursing interventions. institutions
This is affected by:
HEALTH THREAT
- Available technology
- Social,
- Resources of the family economic, 2
- Resources of the nurse environmental,
- Resources of the community political factors

DEPARTMENT OF HEALTH PROGRAMS
MAGNITUDE OF THE PROBLEM ● Also known as Public Health Programs
- It addresses public health concerns
MAGNITUDE SCORE WEIGHT
- Implemented by the LGUs
75-100% AFFECTED 4 - Created by DOH
50-74% AFFECTED 3 MATERNAL HEALTH PROGRAM

3
25-49% AFFECTED 2
● “Ligtas Buntis, Ligats Pagbubuntis”
<25% AFFECTED 1 ● The right to health: every woman has a right to safe
pregnancy and childbirth
● Crafted based on the maternal mortality ratio
MODIFIABILITY
- Based on the 2015 data, the maternal mortality
MODIFIABILITY SCORE WEIGHT ratio is 114:100,000
HIGH 3
CAUSES OF MATERNAL DEATH
MODERATE 2 ● Unsafe abortion - 14%
4 ● Severe bleeding - 21%
LOW 1 ● Infection - 8%
● Eclampsia - 13%
NOT MODIFIABLE 0 ● Obstructed labor - 11%
● Other direct causes - 11%
PREVENTIVE POTENTIAL ● Indirect causes - 25%
POTENTIAL SCORE WEIGHT

THREE DELAYS MODEL
HIGH 3
MODERATE 2 1
LOW 1
SOCIAL CONCERN
CONCERN SCORE WEIGHT
URGENT COMMUNITY
2
CONCERN
A PROBLEM, NOT
NEEDING URGENT 1 1
ATTENTION
NOT A COMMUNITY
0
CONCERN
PARADIGM SHIFT
PARADIGM SHIFT
EVALUATION OF NURSING CARE
● Effectiveness Risk Approach → Identifies high risk pregnancies; For referral
- Attainment of the objectives during the prenatal period; treatment; encourage them to
deliver in a healthcare facility
● Efficiency
↓
- Relates to cost, time and resources EmOC Approach → considers all pregnant women to be at risk
● Appropriateness of complications at childbirth; preventive
- The ability of the intervention to solve the
problem BASIC EMERGENCY OBSTETRIC AND NEWBORN
- E.g. Feeding program to address CARE (BEMONC) SERVICES
undernutrition ● Administer Parenteral Antibiotics
● Adequacy ● Parenteral Uterotonic drugs (oxytocin) to prevent or
- Looking at the number of interventions to treat postpartum hemorrhage
solve the problem ● Parenteral Anticonvulsants for pre-eclampsia and
- E.g. Feeding program may not be adequate to eclampsia (e.g. MgSO4)
solve undernutrition ● Manual Removal of Placenta
● Removal of retained placental products (vacuum or
DNC)
● Performed assisted Vaginal Delivery ● Established strengthened referral systems
(vacuum/forceps) - In case they encounter an emergency during
● Performed basic neonatal resuscitation with deliver (e.g. bleeding), they can refer the
bag/mask mother to a tertiary hospital (may be public or
- Performs vaginal delivery by midwife, but private)
there’s an on-call physician ● Transportation Communication
- Stakeholders, barangay officials, LCEs, NGOs
COMPREHENSIVE EMERGENCY OBSTETRIC AND - Some barangay owns a vehicle or ambulance
NEWBORN CARE (CEMONC) SERVICES to assist mothers in transportation
● 7 Functions of BEMONC Facility plus PERINATAL CARE
- Perform surgery (CS or Hysterectomy) PRENATAL/ ANTENATAL VISITS
- Give safe blood transfusion ● Home-based mother’s record
● There must be 5 EmOC facilities (at least 1 CEmoc) ● Encourage all women to deliver in the health
for every 500,000 population (WHO) facility
- At Least minimum of 4 pre-natal visits
DOMICILIARY OBSTETRICAL SERVICE: - Mothers are encouraged to deliver in a healthy
QUALIFICATIONS facility
● Full term - If the mother do not have at least 4 pre-natal
● Not a primigravida, with less than 5 pregnancies visits, they are requiring the mother to delivery
● Without coexisting disease in a hospital
● No history of complications/ abnormalities in
NO. OF VISITS WHO/ UNICEF/ PHN 2007 BOOK
present and previous pregnancies and deliveries DOH CPG 2005/
● Imminent delivery 2006
FIRST Before the 4th 1st trimester

BIRTH PLAN
month
● A birth plan is a document prepared during the
prenatal care which states the woman’s conditions SECOND Between 6th - 7th 2nd trimester
during pregnancy month
- Also check whether a mother is a Philhealth
member THIRD 8th month 3rd trimester
- Usually part of the mother baby book
● Her preferences for her place of delivery FOURTH 9th month After 8th month;
every 2 weeks
- Includes materials to be prepared for the
mother and baby during the 3rd trimester
● Choice of birth attendant
IDEAL PRENATAL CHECK UP
● Her available resources for her childbirth and
newborn baby AOG INTERVAL NO. OF VISIT
● The preparation needed should an emergency
situation arise during pregnancy, childbirth and 1st 28 weeks Every 4 weeks 7 visits
postpartum
28-36 weeks Every 2 weeks 4 visits
● As a nurse, it is our role to prepare the mother for
childbirth 36-40 weeks Every week 4 visits
CMMNC FRAMEWORK
ASSESSMENT DURING PREGNANCY
● Community Managed Maternal and Newborn ● History taking
Care Framework ● Weight and height
- Check for normal weight gain
● Availability of maternal and child health services
- If the mother is less than 149cm, the mother is
- Skilled birth attendant
considered as high risk
- Facilities
● Vital signs
- Supplies/ equipments
- Check for pre-eclampsia
- Policies/ standards
● Physical examination
- EMOC
- Check for the presence of edema: normal
● Communication and mobilization
during the 3rd trimester but NOT on the 1st or
- Birth plan
2nd trimester
- Philhealth
LABORATORY EXAMINATIONS
- Funding support
● Glucose screening 24-28 weeks if (+) DM history,
● Provide care and support
obese, recurrent vaginal infections, history of
- Partners/ spouse
unexplained fetal death, large fetus
- Family members

● Urinalysis - But in the board exam, they still utilize the 3%
- Benedict’s test in determining the amount of vial to be
o Test for sugar in the urine; test for requested for children
diabetes - Choose the nearest option
o Heat the test tube with 5cc of Benedict’s DOSE SCHEDULE DURATION OF %
Solution (blue) in the burner then add PROTECTION PROTECTION
OF THE
3-5gtts of urine (amber yellow) then heat MOTHER
again. Observe for change in color
1ST Anytime At any point Immed
COLOR INTERPRETATION RESULT
iate
BLUE (-) sugar in urine
2ND After 1 month 3 years 80%
GREEN Trace of sugar in +1 | +
urine 3RD After 6 5 years 95%
months
YELLOW Traces of sugar in +2 | ++
urine 4TH After 1 year 10 years 99%
ORANGE More traces of +3 | +++

5TH After 1 Lifetime 99%
sugar in urine
year
BRICK RED Surely diabetic +4 | ++++
MICRONUTRIENT SUPPLEMENTATION
- Acetic Acid test IRON SUPPLEMENTATION
o Test for albumin in urine; test for
pregnancy induced HPN TARGETS PREPARATIONS DOSE/ DURATION
o Collect urine in a test tube, heat it in a
PREGNANT ● Tab containing ● 1 tab 1x/day for
burner then add 3-5gttsof acetic solution MOTHERS 60mg El with 6 months or
(clear white). Observe for change in color 400mcg Folic ● 2 tabs/day if
o If it remains clea: (-) CHON or albumin in Acid 2nd or 3rd
urine trimester
o If it turns cloudy: (+) CHON = proteinuria
LACTATING ● Tab containing ● 1 tab 1x/day for
WOMEN 60mg El with 3 months or
TETANUS TOXOID DIPHTHERIA IMMUNIZATION
400mcg Folic ● 90 days
● Protects the mother and baby against tetanus acid
- Mothers: Artificial Active
- Fetus: Natural Active ● Iron Deficiency - can cause neural tube defects
● Fully Immunized Mother (FIM) - 5 TT (doses) ● Anemia - presence of pallor, N= 11g/dl
- Should be given during 2nd trimester of ● Instruct mother how to take Ferrous Sulfate and its
pregnancy because studies show may have side effects
teratogenic effect if given on the 1st trimester - Best taken with Vitamin C rich foods for better
- After 1st dose, there is an immediate absorption
protection to the mother - Preferably taken before meals, but sometimes
- After giving 2 doses, the baby is already causes gastric upset. Therefore, advised to be
protected taken after meals
● 3 doses of DPT = 2 doses of TT - Side effects: discoloration of stools, metallic
- Nowadays, tetanus toxoid is usually given with taste
diptheria - Advice mother to take iron rich foods:
● Given through IM injection at the deltoid green-leafy vegetables, red meat products
- Ask the dominant hand of the mother, and
administer it to the nondominant hand. VITAMIN A SUPPLEMENTATION
- Educate the mother about the side effects
such as local tenderness. TARGETS PREPARATIONS DOSE/ DURATION
- Apply cold compress
PREGNANT ● 10,000 IU ● 1 cap/tab
- Do not massage the site of injection MOTHERS 2x/wk (4th
● For determining the amount of TT to be requested: month until
3.5% of the (catchment) population delivery)
- Based on the recent DOH, they lower it to 3%
for mothers and 2.7% for children POSTPARTUM ● 200,000 IU ● 1 cap 1x
WOMEN (within 4

POSTPARTUM CARE
weeks after
delivery) ● Breast
● Uterus- if contracting
● Vitamin A Deficiency - can cause congenital ● Bowel
problems ● Bladder
● Do not give Vitamin A if woman is taking ● Lochia
multivitamins - Rubra, serosa, alba
- E.g. Clusivol OB ● Episiotomy
● Best source of Vitamin A ● Skin
- Plant sources (yellow fruits and vegetables) ● Homan’s Sign
- Carotene ● Emotions
- Animal Sources: retinol
● Given during the 2nd trimester because it is FAMILY PLANNING
teratogenic during the 1st trimester ● To ensure quality of life
● 10,000 IU - yellowish ● Usually done before pregnancy
● 100,000 IU - blue ● We do NOT impose what kind of family planning
● 200,000 IU - red they are going to acquire, but we only educate
them about all the options
IODINE SUPPLEMENTATION ● Decisions should be taken by both marital partners
● Only if the parents have sincere inner motivation
TARGETS PREPARATIONS DOSE/ DURATION for FP may they persist with it.
● Health workers cannot assume that their clients
CHILDREN OF ● Iodized oil ● 1 cap for 1yr
SCHOOL AGE capsule with
hold the same attitude toward FP
200mg iodine ● When a couple expresses hostility toward FP it is
both wrong to and useless for health worker to
WOMEN ● Iodized oil ● 1 cap for 1 yr insist on it
5-45YRS OLD capsule with
200mg iodine FOUR PILLARS
● Responsible Parenthood
ADULT MALES ● Iodized oil ● 1 cap for 1 yr
- No. of child desired by the parents as long as
capsule with
200mg iodine
they can provide
● Child Spacing
● Iodine deficiency - can cause congenital - At Least 3 to 5 years interval
hypothyroidism or cretinism ● Respect for Life
● Usually given to mothers in far flank areas (such as ● Informed Choice
mountains) which are iodine sources are limited
● Sources: seafoods ● RA 6365 - National Policy on Population,
- Avoid foods that inhibit the absorption of POPCOM
iodine: root crops (broccoli, cauliflower)
- Advise to use iodized salt ● PD 69 - Limit to 4 children for Tax Exemption
POSTNATAL VISITS ● LOI 47 - Schools to Integrate Family Planning

NO. OF VISITS WHO/ UNICEF/ PHN 2007 BOOK
DOH CPG 2005/ ● PD 965 - Family Planning before Marriage
2006 License
FIRST First 24 to 48 Within 3 to 5 days

hours after FAMILY PLANNING PRIORITIES
delivery ● Couples in the reproductive age: 20 to 44 years
- Based on WHO. the reproductive age is 16-49
SECOND 6 weeks after 6 weeks after years old
delivery delivery ● 3 or more children
If the mother delivered in a lying-in clinic, the ● Close interval pregnancies
mother will visit the health center after 3 to 5 days ● (+) Chronic Disease
● If the mother delivered at home, the nurse will visit
the mother at home after 24hrs of delivery, to CONCEPT OF FAMILY PLANNING
check for postpartum hemorrhage ● Decision should be taken by both marital partners
● 6 weeks - expect the uterus will return to its ● Only if the parents have sincere inner motivation
prenatal state for FP may persist with it
● Health workers cannot assume that their clients
hold the same attitudes toward FP

● When a couple expressed hostility towards FP, it is HOME-BASED PROGRAMS
both wrong to and useless for health worker to ● Neighborhood-based Play groups
insist on it ● Family Day Care Programs
● Parent Education
FP COUNSELING (GATHER) ● Home Visiting Programs
● Greet warmly and politely
AGE NO. OF VISITS
● Ask about him/herself
● Tell health center and the services provided 0 - 11 months Every month
● Help make the decision that is best for him/her
● Explain relevant information abou the sx, dx, tx 12 - 23 months Every 2 months
● Return schedule a return visit
24 - 35 months (3rd yr) Every 3 months
ROLES OF THE NURSE IN FAMILY PLANNING

36 - 47 months (4th yr) Every 6 months
● Provide counseling to increase number of
acceptors 48 - 59 months (5th yr) Once a year
● Provide packages of health services among the
● ECCD Card
reproductive age group
- Include core developmental milestones they
● Ensure availability of FP supplies and logistics to
must manifest according to age
clients
- This is usually required during the first day of
classes
SAMPLE SCENARIO ● Growth Chart
- Normal growth should be within the normal
If the mother forgot to drink her pills yesterday and
range
remember it today. How many pills will she take today?
ESSENTIAL NEWBORN CARE OR THE UNANG YAKAP
- Take only one pill and do a follow up check
● DOH Administrative Order 2009-0025
FORMULA ● Safe motherhood month: May

● EINC includes the intrapartal care
No. of pills to be requested = 3.5% of the population x ● Yakap ng buhay, Yakap ng Pagmamahal
28 days
FOUR CORE STEPS IN ESSENTIAL NEWBORN CARE
EARLY CHILDHOOD CARE AND DEVELOPMENT (ENC)
(ECCD) PROGRAMS ● Immediate and thorough drying to prevent
● Previous names: Under 5 clinic programs, hypothermia
Well-baby clinic programs - Two towels are prepared. One linen is for
- Services are expanded therefore there’s a drying and the other is to cover the child when
change in the name they are in the mother’s abdomen
● Early skin-to-skin contact to reduce infection and
● RA 8980 Early Childhood Care and Development hypoglycemia
(ECCD) - Mother contains natural flora
● Properly timed cord clamping to prevent
- Refers to the full range of health, nutrition,
intraventricular hemorrhage
early education, and social services programs
- We wait for the pulsations to stop before
that provide for basic holistic needs of young
cutting
children from birth to 6 years of age, to
● Non-separation of the newborn and mother for
promote their optimum growth and
early initiation of breastfeeding
development
NEWBORN SCREENING
CENTER-BASED PROGRAMS
● Facility-based programs ● RA 9288 Newborn Screening Act of 2004
● Day Care Service (RA 6972)
- Age 3 years old staying for 1 to 2 hours ● Detect congenital metabolic disorder that may
● Public and Private Pre-schools lead to mental retardation, physical disability,
● Kindergarten motor impairment or even death if left untreated
● Community or school-based early childhood ● The blood specimen is acquired from the heel of
● Child-minding Centers the child by a nurse, midwife, medtech or
- Not available in the country physician, regardless whether the mother delivered
● Health Centers and Stations at home or in a health facility

● 28 Disorders in the NBS Package (Screened) ● Ask the mother to sign a waiver if the mother do
- From 5 to 6 to 28 disorders: the 28 disorders is not consent for newborn screening
called the Expanded Newborn Screening
Test NEWBORN SCREENING
- Screened: ● 24hr at least
o Congenital Hypothyroidism (CH) ● Trained MD, RN, midwife, medical technologist
● Using heel prick method
o Congenital adrenal hyperplasia (CAH)
- A few drops of blood are taken from the baby’s
o Galactosemia (GAL)
heel
o Phenylketonuria (PKU)
● Blotted on a special absorbent filter card
o G6PD Deficiency
● Blood is dried for 4hrs and sent to the NBS center
o Maple syrup urine disease (MSUD)
● After 7 working days, parents claim the result from
- Current 6:
their physician, nurse, midwife, or health worker
o Cystic fibrosis
● If positive (+) screen:
o Biotinidase disease
- Released within 24hrs for confirmatory testing
o Organic acid disorders
- Referred to a specialist for further
o Fatty acid oxidation disorders management
o Amino acid disorders
o Urea cycle disorders UNIVERSAL NEWBORN HEARING SCREENING
o Urea cycle disorders PROGRAM
o Hemoglobin
BASIC EXPANDED
● RA 9709: Universal Newborn Hearing Screening
and Intervention Act of 2009
PRICE 550 pesos 1500 pesos
● Early detection of congenital hearing loss and
referral for early intervention for infant
FACILITY 50 pesos 50 pesos ● Newborn Hearing Screening Reference Center at
COLLECTION FEE the National Institutes of Health
● On any healthcare practitioner who delivers, or
TOTAL 600 pesos 1550 pesos
assists in the delivery of a baby in the Philippines
COST PER 100 pesos x 6 55 pesos x 28
the obligation to inform the parents or legal
DISORDER guardian of the newborn of the availability, nature
TESTED and benefits of hearing loss screening among
newborns or infants 3 months old and below
TOTAL 600 pesos 1550 pesos
PHILHEALTH FREE 950 pesos

RARE DISEASE PROGRAM
MEMBER
● RA 10747: The Rare Diseases Act of the
Philippines
ROLES OF RHU STAFF IN NBS - An act promulgating a comprehensive policy
● Advocacy for NBS for every baby. This starts during in addressing the needs of the person with
pregnancy. Rare Disease
- The family is advised to save Php 550 ● RA 7277: Magna Carta for Disabled Persons
● Collection of samples by a trained healthcare - Under the law, the patients with rare diseases
professional (MD, RN, midwife, medtech) within at will be considered as persons with disabilities.
least 24 hours after birth when the mother has With this, they will also enjoy the rights and
initiated breastfeeding benefits of persons with disabilities (PWDs)
● Assures transport of specimen within 24hrs ● Undergo clinical trials - with consent
following collection of the sample ● As a nurse, we can inform them about the available
- Dry the card for 4 hours before transport resources provided for Rare Disease (e.g. support
- Initial results will be released within 7 days groups, NGOs
● Advice and counsel parents upon receiving the ● A Healthcare System for Rare
screening results - Department of Health (DOH) together with
- Monitor the child in case the child tested the National Institutes of Health (NIH-UP
positive in any of the disorders Manila) shall create a system for the
- If the result tested positive, we conduct a identification, management and registration
confirmatory test. of persons with rare disease
- Then if it remains positive, we refer the child to - Under this system, all rare disease patients
a specialist shall:
● It is the option of the parents to avail basic or o Be referred to a Regional Newborn
expanded newborn screening test Screening Continuity Clinic (NSCC)
o Be included in the National Rare Disease - Contains bifidus factors that promotes growth
Registry, a secured health information of the lactobacillus which inhibits the growth
system on the data on rare diseases, of pathogenic pacilli
persons with rare diseases, orphan drugs
and products. LAWS FOR BREASTFEEDING
o Have better access to a support system
through the Rare Disease Management ● RA 7600: Rooming-In and Breastfeeding Act of
Program, a comprehensive program that 1992,
encompasses diagnosis, clinical - Breastfeeding Week: August 1-7
management, genetic counseling, and
drug research development. ● EO 51: Milk Code
● The RDTWG
- As a healthcare professional, we are prohibited
- The DOH shall organized the Rare Disease
from promoting formula milk
Technical Working Group for the identification
of rare diseases, orphan drugs and orphan
● RA 10028: Expanded Breastfeeding Promotion
products
Act
● Reporting to the Registry
- Healthcare institutions and practitioners are - Lactation stations
required to report diagnosed cases and the - There must be a refrigerator for milk storage
status of patients to the Rare Disease registry.
● A Practitioner's Responsibility ● AO 2006-0012: Revised Implementing rules and
- Healthcare practitioner attending to a person regulations in the EO 51
with a rare disease as the responsibility of
● AO 2005-0014: National Policies on Infant and
informing patients and their families of
Young Child Feeding
available resources and the nearest available
specialist
● Continuing Education and Training Programs BREASTFEEDING PRACTICE
- The DOH, together with the NIH, professional ● Exclusive breastfeeding (for the first 6 months)
societies and academic institutions shall - Allows to receive ORS, drops, vitamins,
conduct continuing education, information medicines
and training programs for healthcare ● Predominant breastfeeding
practitioners on the identification, referral, and - H2O, fruit juice, ORS, vitamins, medicines
medical management of persons with rare ● Complementary feeding
disease. - Foods and liquids with breast milk
● Public Education and Information Campaign ● Bottle feeding
- The act recognizes the importance of a - Food or drink (including breast milk) from a
"culturally-sensitive public education and bottle
information campaign" on the nature of rare ● Early initiation of breastfeeding
disease in helping the public understand the - After birth within first 90 minutes of life
special needs of persons afflicted with rare ● 1st trimester
diseases, as well as their right against ridicule - Discomfort of pregnancy
and discrimination. Such campaign would ● 2nd trimester
involve participation of concerned - Accept pregnancy and baby
government agencies, professional societies ● 3rd trimester
and non-government organization - Birth preparation (labor and delivery)
BREASTFEEDING PROGRAM POSITION FOR BREASTFEEDING

ADVANTAGES OF BREASTFEEDING ● Cradle Hold
● Mother - For mothers who delivered NSD
- Oxytocin help the uterus contracts ● Football Hold
- Uterine involution - For SGA baby, twins
- Reduce incidence of breast cancer ● Side-lying position
- Promote maternal-infant bonding - Usually utilized by CS section mothers
- Form of Family planning method (LAM) ● Kangaroo position
● Baby
- Provides antibodies which contains IgA TECHNIQUE FOR BREASTFEEDING
- Contains Lactoferrin (binds with iron) ● The mother hold her breast in C-hold
- Leukocytes - To anchor the breast
- Stimulate the baby’s rooting reflex

- Clean the breast with saline or water., not with
● Sick of the - Attenuated
alcohol, betadine or soap because it causes disease (BCG, OPV, AMV,
dryness Rotavirus)
● How to get baby to latch on - Killed (P, HBV)
- Stimulate the baby’s rooting reflex - Weakened toxins
- When the baby’s mouth opens wide, put the (TT,DPT)
nipple and as much of the areola as possible
PASSIVE ● Breast milk ● Gamma globulin
into his mouth
(IgA) (6months-1yr)
● How to make baby let go of the breast without
● Placenta (IgG) ● antitoxin/
hurting the mother antiserum/
- Press down on the breast near his mouth serum
- Pull down on his chin and insert a small finger
● Active immunity
in the corner of his mouth. This will break his
- Xxposed to an antigen (bacteria, virus, fungi)
seal on the nipple
the body will develop antibodies
- Then remove him from the breast
- Provides long term protection
● Signs that the baby has latched on properly to
● Passive immunity
the breast
- The body developed antibodies
- The baby’s mouth is wide open
(immunoglobulin, antitoxin)
- Much of the mother’s areola is inside the
- Provides short term protection
baby’s mouth
● Natural
- The mother does not feel nipple pain
- Person acquired immunity through natural
o When in pain, withhold feeding on the
means
affected side. The mother may apply
● Artificial:
warm compress on the affected side
- Inoculate the antigen or antibodies coming
- For inverted nipples, we encourage the
from another individual or animal
mother to do nipple stretching or nipple
- Natural active: e.g. carrier
rolling exercise
- Natural passive: e.g. breastfeeding, through
- The baby and the mother are in tummy to
placenta
tummy position
- Artificial active: e.g. COVID-19, tetanus toxoid,
- The baby is relaxed and happy
measles
- Artificial passive: e.g. got bitten by a dog and
BREASTFEEDING CAMPAIGN
went to a bite center to acquire anti-rabies
● Storage of breast milk
shot
- At room temperature (8hrs), ref (24hrs), frozen
(1 month)
● PD No. 996
● Galactogen
- Foods that increases the production of - Sept. 16, 1976
breastmilk - Compulsory basic immunization for infant and
- Whole grains, especially oatmeal, dark, leafy children below 8y/o
greens (alfalfa, kale, spinach, broccoli), garlic,
chickpeas, nuts and seeds, especially almonds, ● RA 7846
ginger, papaya. - December 30, 1994
● Breastfeeding should be fed on demand at least - Hepa B immunization
8x/day
- Baby can be fed more than 8x/day ● RA 10152 (2011)
● Diet during lactation:(+) 550 calories, high CHON,
- Mandatory Infants and Children Health
high calcium, sufficient fluids
Immunization Act
NATIONAL IMMUNIZATION PROGRAM (NIP) 2016 ● PP 46

● Old name: Expanded Program on Immunization
● Launched by DOH, WHO & UNICEF last July 1976 - Polio eradication
● Objective: To reduce morbidity and mortality
● PP No. 6
among infant and children caused by childhood
immunizable diseases - April 3, 1996
● DOH mandated to allot Wednesday as an - UN Universal Child Immunization
Immunization day “Bakuna Wednesday”
7 PRIORITY AREAS
NATURAL ARTIFICIAL
● Diet and Exercise
ACTIVE ● Exposure ● Antigens ● Environmental health
● Carrier ● Vaccines and immunizations

● Substance use
● Sexual and reproductive health NOT CONTRAINDICATIONS
● Mental health ● Fever up to 38.5 degree Celsius
● Violence and injury prevention ● Simple or mild acute respiratory infection
● Simple diarrhea without dehydration
PROGRAM GOALS ● Malnutrition (it is indication for immunization)
● Targets at least 95% of eligible child within the
catchment area are immunized before 1 year old ROUTINE IMMUNIZATION FOR CHILDREN
- Eligibility qualifications: 1 year old and below;
children below 5 years old are susceptible in ● Infant BCG “Bacille-Calmette-Guerin”
communicable diseases because they - 0 t 11 months or 0 to 1 yr
immature organs - Anytime after birth
- Fully Immunized Child (FIC): received all before - 0.5ml ID, right upper deltoid
1y/o o Subcutaneous abscess will form if
- Completely Immunized Child (CIC): all after injected via subcutaneous: treated with
1y/o incision and drainage + local INH. Expect
● Maintenance of polio eradication the child to develop a fever. Advise the
● Elimination of measles mother to give antipyretics every 4 to 6
● Elimination of maternal and neonatal tetanus hours; Antibiotics may be prescribed
● Control of diphtheria, pertussis, hepatitis B o Indolent ulcer: does not health within 12
infection, TB meningitis and other disseminated weeks; secondary bacterial infection;
forms of TB treated with local INH
- Freeze dried then reconstituted with diluent
PRINCIPLES OF EPI - Once diluted, it must be consumed within 4 to
● Epidemiological situation - schedules are drawn on 6 hours. Discard the remaining medication if
the basis of occurrence and characteristic feature of not consumed.
the disease - Clean the site with saline
● Mass approach o DO NOT apply alcohol to the site of
● Integrated to the health services of the unit
injection
- A formation of a wheal for 30mins to 1 hour
ELEMENTS OF THE EPI
and will cause an inflammatory reaction for 2
● Target setting - all children before 1 y/o
weeks
● Cold chain logistics
- Apply warm compress on the site of injection
● IEC: Information, Education and Communication
- DO NOT expose BCG to sunlight
● Assessment and evaluation of the program overall
- Expected side effects: local inflammatory
performance
reaction/ superficial abscess/ ulcer 2 to 12
● Surveillance, studies and research
weeks after immunization (permanent scar)
- All vaccines are investigated by HTA (health
- If no side effect: repeat BCG after 2 months
technology assessment) of DOH to ensure
safety and effective ● Hepa B
SUPPLEMENTARY IMMUNIZATION ACTIVITIES (SIAs) - 1 dose

● Catch-up or speed-up campaigns for the new - 2 types: plasma derived and recombinant
vaccine to rapidly increase immunity in older age hepa b surface antigen
groups that are outside of the immunization - Target age: birth (health facility delivery within
schedule 2hrs), (home delivery - no more than 7 days)
● Intended to reduce o interrupt transmission of the - 0.5ml IM, vastus lateralis (upper outer thigh)
targeted disease with the goal of elimination or - Side effect: local tenderness - apply cold
eradication compress
- If the mother delivered at home, the mother is
CONTRAINDICATIONS asked to bring the child to the health center
● History of seizures/ convulsions - for DPT 1 within 7 days of delivery
- If the child develops convulsions once, 3 days - Doesn’t need dilution
after immunizations, administer DNT. If more
● Pentavalent
than 3 days, it's a sign of neurological
problems, DO NOT Administer the remaining - 3 doses, 4 weeks or 1 month interval
dose of DPT - Target age: 6, 10, 14 weeks
● Clinical AIDS - Infant BCG - 0.5ml IM, vastus lateralis
● Immunosuppression - Reduces chance of acquiring pneumonia,
- DO NOT give any live attenuated vaccines meningitis

- Tetanus-diphtheria booster dose at grade 1 ● Attenuated Measles Vaccine (AMV)
and grade 7 - 9 to 11 months
o In case an epidemic of measles, we
OPV IPV administer it during 6 months
o The child still has maternal antibodies
Live, weakened viruses Killed viruses
that lasts for 6 to 9 months
- 0.5ml, subcutaneous, bevel down, any arm
Oral (mucosal immunity) IM (serum immunity)
- When a child receives
(outer part of the upper arm)
OPV, the vaccine virus - Fever and measles rash lasting for 1 to 3 days
enters the child's mouth within 2 weeks after immunization (modified
and gut and replicates. measles)
The child then mounts - Vitamin A is given with Measles: 100,000 IU
immune responses in o Vitamin A enhanced the antibody
three places: (1) antibody
response to measles vaccine given at 9
response in the blood
months of age significantly, especially in
that protects against the
virus invading the boys. The effects were sustained over
nervous system and time; the children who had received
causing paralysis, (2) vitamin A with their measles vaccine were
immune response in the more protected against measles at 6-8
mouth which prevents years of age.
shedding of virus in oral - At least 85% can be prevented by
secretions and spread
immunization at this age
from those secretions
- Freeze dried then reconstituted with diluent
and (3) intestinal
immunity (also called water
gut or mucosal
immunity), which ● Measles Mumps, Rubella (MMR)
prevents shedding of the
- 12 to 15 months
virus in the stool
- 0.5ml, SC, any arm (outer part of the upper
3 doses (6, 10, 14 weeks) 1 dose (14 weeks)
arm)
2 doses (14 weeks and 9 - Vitamin A is given with MMR: 200,000IU
months) in some regions - Freeze dried then reconstituted with diluent
water
Assess immunity from Individual immunity - MR booster dose at Grade 1 and 7
person-to-person - Side effects: Fever and measles rash within 2
weeks after immunization lasting for 1 to 3
Side effects: none Swelling, fever
days
NPO for 30 mins after Apply warm compress
administration Do not massage ANTIGEN AGE DOSE SIDE EFFECTS
- If the child vomits within Give antipyretics
30 mins, a single drop is BCG At birth 0.05m Local
repeatedly given. ID inflammation
Right Scar
Very low risk for vaccine No risk for VAPPs or cVDPVs deltoid fever
associated paralytic
poliomyelitis (VAPPs) or HEPA B At birth 0.5ml Local tenderness
Circulating vaccine-derived Not given to children with IM
polioviruses (cVDPVs) allergy to streptomycin, Vastus
neomycin or polymyxin B lateralis
(inactive components of IPV)
PENTA 6, 10, 14wks 0.5ml Local tenderness
IM
Vastus
● Pneumococcal Conjugate Vaccine (PCV) lateralis
- 3 doses (6, 10, 14 weeks)
OPV 6, 10, 14wks 2gtts None
- 0.5ml via IM
Oral
- Protects children from meningitis
- Healthy children aged 2-5 y/o maybe given 1 IPV 14 wks 0.5ml Local tenderness
dose of PCV 13 or 2 doses of PCV 10 at least 8 IM Fever
weeks apart Vastus
lateralis

- Sulu
PCV 6, 10, 14wks 0.5ml Local tenderness
IM - Davao oriental
Vastus - Sarangani
lateralis - North cotabato
AMV 9mos 0.5ml Rashes VACCINES FOR HIGH RISK POPULATION

SQ Fever
Outer,
● Cholera Vaccine
upper arm
- Given per orem, 1.5ml
MMR 12-15mos 0.5ml Rashes - Given at a minimum age of 12 months
SQ Fever - 2 doses with 2 weeks interval
Outer, - NPO 1hr before and after because it causes
upper arm
gastric upset
- Given ONLY when there is an outbreak
● Typhoid vaccine
FOR SPECIAL POPULATION GROUPS & EXPANSION
- Given IM, single dose, 0.5ml
VACCINE AGE DOSE REMARKS - At 2yrs old with revaccination every 2-3yrs
TETANUS- Grade 1 & 0.5ml Public schools

● Japanese Encephalitis (JE) Vaccine
DIPHTHERIA 7 IM, single
(TD) For introduction in 2017
-
JE is responsible for 7.4$ to 40% of
-
MEASLES- 0.5ml
RUBELLA (MR) meningitis-encephalitis syndrome in the
SQ, single
Philippines Affecting children younger than
HUMAN 9 to 14yrs 0.5ml In 20 provinces 15yrs old
PAPILLOMAVIR old IM Parent’s consent - Given SQ at a minimum age of 9 months
US (HPV) female For 2 doses needed - Children 9 months to 17yrs of age should
(Grade 4)
with 6mos receive on primary dose followed by a booster
interval dose 12-24months after the primary dose
- Individuals 18yrs and older should receive a
PNEUMOCOCC 1st - 60 0.5ml, IM or Indigent senior
AL y/o single dose only
SC for citizens
POLYSACCHAR 2nd - single dose - Only given to affected regions
IDE VACCINE 65y/o o Central Luzon has the highest case
(PPV)
INACTIVATED
● Pamamantal
- Not a normal side effects of other vaccine,
INFLUENZA 60yrs old 0.5ml, IM therefore it is recommended to consult the
(INACTIVATED) and for single health center if there are any presence of
above dose yearly
annually rashes
ENSURING POTENCY OF BIOLOGICALS
● Maintenance of the cold chain
20 POOREST PROVINCES TO RECEIVE HPV BASED
ON NEDS 2016 TYPE OF VACCINE STORAGE
TEMPERATURE
● Luzon
- Pangasinan MOST SENSITIVE OPV -15c to -25C
- Ifugao TO HEAT Freezer
- Apayao AMV (freeze dried)
- Masbate
- Camarines sur LEAST SENSITIVE DPT, PCV, Hepa B, 2C to 8C
TO HEAT diluent Refrigerator
- Quezon
BCG, TT,
● Visayas
Pentavalent,
- Leyte Rotavirus, MMR
- Eastern & Northern Samar
- Ilo-ilo
- Negros Occidental - If vaccine is a live microorganism, they are
- Negros Oriental stored in the freezer
- Cebu ● Discarding unused biologicals
● Mindanao - Vaccine Vial Monitor (VVM): the square must
- Maguindanao be lighter than the circle
- Lanao del sur
- Zamboanga del sur
o Inner square is lighter than the outer ● Goal: Improve quality of life through better
circle. If the expiry date has not been nutrition, improved health and increase
passed, USE the vaccine productivity
o At a later time, the inner square is lighter
than the outer circle. If the expiry date has NUTRITION PROGRAM & PROJECTS
not been passed, USE the vaccine ● Nutritional assessment
o Discard point: inner square matches color - Ex. Operation Timbang
of outer circle. Do NOT use the vaccine. ● Micronutrient Supplementation
Inform your supervisor. - Ex. Vitamin A is given every 6 months
o Beyond the discard point: inner square ● Food Fortification
darker than outer circle. Do NOT use the ● Maternal and Child Health Service Packages
vaccine. Inform your supervisor ● Nutrition Information, Communication, Education
- Unopened, exposed may be put back in the ● Home, School and Community Food Production
refrigerator or freezer twice ● Food Assistance
- Discard BCG and MAV 4-6hrs after ● Livelihood Assistance
reconstitution ● Treatment of Conditions Associated with
- If we dispose of the vaccine, sterilize it first. Malnutrition
Then discard it in a biological bins - Presence of parasitism
● Shake the vial before use - Deworming is done every 6 months or 2x/year
- If after shaking the vial, there are formation of - Mebendazole is chewable; given during
sediments, or granular particles DO NOT use vacation because one of the side effects is
the vial diarrhea
● Maximum storage and transport
- RHO/PHO/DHO: 3 months each LEGISLATIONS AFFECTING THE PHILIPPINE
- Rural health unit: 1 month NUTRITION PROGRAM
- Maximum transport period (with cold packs): 5
days ● PD No. 491
- FEFO: first expiry, firs out - Declared July as the Nutrition Month and
- 3% or 2.7% in requesting vaccine for adults creation of Nation Nutrition Council
PEDIATRIC DOSE FOR COVID (5-11Y/O)
● LOI 441
Trade name Tozinameran,, COVID-19 mRNA vaccine - Integration of Nutrition Education in the
(nucleoside-modified) [Cominarty]
school curriculum
Other name Pfizer-BioNtech COVID-19 vaccine
DEWORMING
Manufacturer/s Pfizer Manufacturing Belgium ● Deworming of children aged 1 to 12 years is done
every 6 months
Vaccine platform mRNA vaccine (nucleoside modified)
AGE ALBENDAZOLE MEBENDAZOLE
400mg/tab 500mg/tab
Dose strength & Two doses of 0.2ml each (containing
administration 10micrograms/dose) 1-23 months 1/2 1
3 weeks apart
Route of Intramuscular (IM) 24-59 months 1 1

administration
Drug delivery A white to off-white frozen dispersion of COMMON INTESTINAL PARASITES

system 10 micrograms/dose
One multidose vial contains 10 doses of ● Ascaris (giant roundworm)
0.2ml after dilution
- Nutritional competition, source: soil, fecal-oral,
Storage condition Store frozen at -90C to -60C (shelf life: 6 vomit worms
months0
Once thawed, store at 2C to *c (can be ● Ancylostoma (hookworm)
used within 10 weeks)
- Blood sucker
- Heavy infestation is seen as severe anemia
NUTRITION PROGRAMS - Enters the human body by skin penetration,
● As of 2015, 33.4% of the Filipino children are affected abdominal pain
by stunting
● Enterobius (pinworm)
- Habitat is the rectum; source: finger nais

- Symptom is pruritus ani
<60% 3rd degree Referral to hospital
- Highly contagious undernutrition
(Severe)
● Taenia saginata/ solium (tapeworm)
- Longest intestinal parasite ● Height for Age
● Weight for height (BMI)
SIDE EFFECTS: - Adults
● Local sensitivity or allergy - Diagnosis of acute malnutrition
- Give antihistamine - Body mass index:
● Mild abdominal pain o BMI of 20-25 is desirable (WHO)
- Give an antispasmodic
o BMIof 18.5-22.9 is desirable (Asian Criteria)
● Diarrhea 𝑊𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑘𝑔
- Give oral rehydrating solution 𝐻𝑒𝑖𝑔ℎ𝑡 𝑖𝑛 𝑚𝑒𝑡𝑒𝑟𝑒𝑑 𝑠𝑞𝑢𝑎𝑟𝑒
● Erratic worm migration ● Mid upper arm circumference (MUAC)

- Pull out worm from mouth/ nose or from other - 1-4 year old
body orifices - Rapid screening for malnutrition, but cannot
determine the degree of malnutrition
CONTRAINDICATIONS Procedure:
● Serious illness such as that requires referral to a - Determine the midpoint between acromion
hospital and olecranon process
● Abdominal pain Interpretation:
● Diarrhea - Measure circumference at midpoint
● History of hypersensitivity to the drug - > 115mm: normal nutritional status
● Severe malnutrition - < 115mm: acute undernutrition (wasting)
● Skin fold thickness
NUTRITIONAL ASSESSMENT METHODS - Thickness of subcutaneous tissue
● A - Anthropometry o Femoral
● B - Biochemical Or Lab Exams o Abdominal
● C- Clinical Exam o Triceps
● D - Dietary History - Utilized the Harpenden Caliper
● H- Health History - Adults: Acute Malnutrition
A - ANTHROPOMETRY MALNUTRITION IN CHILDREN

● Weight for age
CATEGORY TYPE SD OF WHO
- Gomez Classification Formula CHILD GROWTH
𝐴𝑐𝑡𝑢𝑎𝑙 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡
x 100 STANDARDS
𝐸𝑥𝑝𝑒𝑐𝑡𝑒𝑑 𝑏𝑜𝑑𝑦 𝑤𝑒𝑖𝑔ℎ𝑡 MEDIA
o Determine the degree of malnutrition
o Under the age of 9 PROTEIN ENERGY Underweight - < -2 Standard
MALNUTRITION weight for age deviation (SD)
- Under 5yrs old: Operation Timbang every
(PEM)
month
- Do not use when the pt has edema
Stunting - < -2 SD
- Used in dx of height for age
o Chronic Undernutrition → stunting
o Acute (current) malnutrition Wasting - < -2 SD
● Overweight → obesity weight for height “Baggy pants”
● Underweight → wasting
Overweight - +2 SD
% INTERPRETATION MGT weight for height Associated with a
higher probability
>110% Overweight of obesity in
adulthood
91-110% Normal No management

SEVERE ACUTE In children 6-59 ● Weight for
MALNUTRITION months of age height less
76-90% 1st degree Home (SAM) than -3 SD of
undernutrition management
the WHO
(Mild)
Child Growth
Standards
61-75% 2nd degree Home
median
undernutrition management
(Moderate)

● Presence of
edema of VITAMIN A DEFICIENCY
both feet ● VAD/ Xerophthalmia
● MUAC less - Vitamin A is the precursor of rods
than 115mm ● Susceptible population: 1-4 year; usually occurs
together with PEM
For infants less ● Presence of ● Foods rich in Vitamin A
than 6 months of visible severe
- Rich source: animas sources (retinol) such as
age wasting and
liver, egg yolk and milk
edema,
together with - Best source: plant sources (carotene) such as
difficulties in dark green leafy vegetables; yellow fruits and
breastfeeding vegetables (considering socio-economic
status of family)
● Treatment
MACRONUTRIENT DEFICIENCIES
- 6 to 12 months: 100,000 IU
REFERENCE KWASHIORKOR MARASMUS - 12 months and above: 200,000 IU
- Give now, after 2 weeks and every 6 months
ETIOLOGY The word comes Greek word which
● Prevention
from Africa means means wasting
the sickness of the
- Every 6 months or 2x a year
older child when the ● Diagnosis: Vitamin A assay test
next baby in born
DEFINITION Results from severe Results from fatal IRON DEFICIENCY

CHON deficiency, CHO deficiency, ● Susceptible population: 1-4 year; usually occurs
qualitative def. quantitative def.
together with PEM
● Food rich in Iron:
HISTORY Improper weaning or Starvation or
diarrhea Malabsorption
- Rich source: plant sources
- Best sources: animal sources
AGE Toddler - age of Various age even ● Iron supplement:
weaning infants - 10-19yrs old: 60mg iron with 400mcg folic acid
(1tab/day)
- Pregnant: 60mg iron with 400mcg folic acid
DIFFERENCE KWASHIORKOR MARASMUS (1tab/day for 6 months or 2tab/day for 2nd or
3rd trimester)
WASTING Present but no Present very
- Lactating /postpartum: 60 mg iron with
obvious obvious
400mcg folic acid(1tab/day for 3 months)
APPETITE Poor Good - Older persons: 60mg iron with 400mcg folic
acid (1tab/day)
MENTAL Irritable apathetic ● Administered for 2 weeks. After 2 weeks, check if
OUTLOOK there is still the presence of Palmar Pallor.
MAJOR Edema: ascites, Wasting: skin and
FEATURE pedal bone IODINE DEFICIENCY
● Manifest poor memory
FACIAL Moon face Old man’s face ● Iodine supplement:
APPEARANCE - Children or school age: iodized oil capsule with
200mg Iodine (1 cap for 1 year)
HAIR CHANGES Sparse absent
Flag sign
depigmentation FORTIFICATION
● Addition of a nutrient to food during processing
SKIN CHANGES Flaky paint Absent ● Products without any nutrient are added with
dermatoses nutrients
desquamation ● Sangkap Pinoy Seal - placed on label of fortified
foods
WEIGHT May be normal Abnormal - 2nd or
- Yellow: Vitamin A
3rd degree
- Green: Iron
malnutrition
- Red: Iodine
MICRONUTRIENT DEFICIENCIES
● A substance found in very small amounts in the
body ( <0.005% of body weight)

● RA 8976 - Philippines Food Fortification Act of - Malaria, measles, dengue - fever
2000 o Fever: feels hot or temperature of 37.5C
- This provides for mandatory fortification of the via axilla or 38C via rectal
following products: - Ear problem - ear pain or ear discharge
o Rice with iron
o Wheat flour with vitamin A and iron ClASSIFY
o Refined sugar with vitamin A
● Severe Classification: Pink
o Cooking oil with vitamin A
- Referral to hospital + 1st dose of
● E.O 382 Pharmacological treatment
- November 7 declared as National Food

● Some/ Disease Condition: Yellow
Fortification Day
- RHU + Pharma
● RA 8172 - Asin Law - Follow up: 3 days
o Improving: continue giving the antibiotic
- Fidel Salt (fortification of Iodine Deficiency
o Did not improve/ remains the same:
Elimination)
- Iodized salt: “Patak sa asin” by secretary Flavier change the antibiotic
on December 1-5, 2003 where DOH workers go o Becomes worse: refer to the hospital
to market to check if salt sold contains iodine
● No classification: Green
by placing few drops of reagent:
o Salt color turn to blue violet → fortified - Home management
with iodine - Follow up: 5 days
o Salt color show no change → not fortified TREAT
● Based on the classification
● RA 832 - Rice Fortification FOLLOW-UP
- FVR (Fortified Vitamin Rice) by secretary
TREATMENT FOR DANGER SIGNS
Flavier order FVR, Erap Rice under Erap, Gloria
● Diazepam if convulsing now
Rice or Bigas ni Gloria under PGMA
● Complete assessment
● Give pre-referral treatment
INTEGRATED MANAGEMENT FOR
● Treat to prevent low blood sugar
CHILDHOOD ILLNESS (IMCI)
- Can breastfeed: breastfeed the child
● Distribution of deaths among children < 5 for 1990
- Cannot breastfeed but can swallow: give
and projected for 2020
expressed breastmilk or 30-50ml milk or sugar
● The main 5 killers: Acute Respiratory infection,
H2O
diarrhea, measles, malaria and nutrition
- Cannot swallow: 0ml of milk or sugar H2O by
● Perinatal conditions, other communicable diseases,
NGT
non-communicable diseases and injuries
- Not awaken or unconscious: IVF
● Objectives:
o 5ml/kg of 10% Dextrose for a few minutes
- To reduce significantly global mortality and
morbidity associated with the major causes of o 1ml/kg of 5% Dextrose in 50cc by slow IV
deaths in children push
- To contribute to health growth and ● Keep the child warm
development of children ● Refer urgently
BASIC STEPS IN IMCI MALNUTRITION

ASSESS ASSESSMENT
● Child’s problem ● Look and feel
- Ask the reason for bringing the child to the - Edema of both feet
health facility - WFH/L - Z score
● Check for general danger signs (VACU) - MUAC - for children 6 months or more
- Vomiting ● If WFH/L less than -3 z scores or MUAC less than
- Abnormally sleepy/ lethargic/ unconscious 115mm:
- Convulsion - Check for medical complication
- Unable to breastfeed, eat or drink - Danger sign, severe classification, pneumonia
● Then ask for main symptoms with chest indrawing
- Pneumonia - cough or DOB ● If no medical condition:
- Dehydration - diarrhea - Child is 6 months or older: offer RUTF (ready to
- Malnutrition - weight/age use therapeutic food) to eat
- Anemia - palmar pallor

- Child is less than 6 months: assess
12 months to 2yrs 5ml OD for 3 1.5ml
breastfeeding months
● Complicated Severe Acute Malnutrition 2 to 5 yrs 5ml 23x for 3 2ml

- Edema of both feet months
- Medical complication present

- 1st dose: Gentamicin via IM PNEUMONIA
- Feed the child if tolerated CONTROL OF ACUTE RESPIRATORY INFECTION
- Sugar water or milk (CARI)
- NGT if not tolerated ● Main symptoms: cough or DOB
- Unconscious: D5 OR D10 ● Ask how long
- Acute (Pneumonia): lasts for 3 days
● Uncomplicated Severe Acute Malnutrition - Chronic (Asthma/PTB): lasting for more than 2
- MUAC less than 115 mm weeks
- No edema and medical complication present ● Look and Listen: child must be calm
- Give oral antibiotics for 5 days - Stridor
- Chest indrawings
● Moderate Acute Malnutrition - Count RR/min
- Wheezing: if with chest indrawing, fast
- MUAC 115 - 125mm
breathing and wheeze
● Trial of Rapid Acting Bronchodilator for 3x,
● No acute Malnutrition
15-20mins apart.
- MUAC 125mm or more - 1st choice: inhaler
- Micronutrient powder is commercially - 2nd choice: oral salbutamol
prepared. If not available, continue feeding the ● Most common in the community is bacterial
child pneumonia
- Causative agent: Streptococcus Pneumoniae
ANEMIA
● Look for palmar pallor: severe or some? FAST BREATHING MEANS:
- If the palm is lighter than the back of the hand
AGE RR
● Severe Anemia
Below 2 months 60/min and above
- Severe palmar pallor
- Refer urgently to hospital 2-12 months 50/min and above
● Anemia 12 months to 5yrs 40/min and above
- Some palmar pallor

- Give iron supplement for 2 weeks MANAGEMENT OF WHEEZING (Salbutamol)
- Give mebendazole and anthelmintic for 1 y/o or ● Metered dose Inhaler (100 micrograms/puff)
older and has not had a dose in the previous 6 - Give 2 puffs → repeat up to 3x every 15 mins
months - 3cc of NSS + 1cc of Salbutamol
● Inhalation - at home, every 6 hrs
● No anemia ● Oral
- No palmar pallor AGE OR WEIGHT SUSPENSION TABLET

- If the child is less than 2 yrs old, assess the 2mg/5ml TID for 5 2mg TID for 5
days days
child’s feeding and counsel the mother
according to the feeding recommendations 2 to 11 months 2.5ml ½ tab
o If feeding problem, follow up in 5 days 5 to 9kg
o Give micronutrient Powder (MNP)
10kg and above 5ml 1 tab
AGE OR WEIGHT IRON SYRUP IRON SYRUP

30mg Iron/5ml FeSO4
15mg/0.6ml MANAGEMENT OF PNEUMONIA
Low birth weight 0.3ml OD 2-6
infants less than months
● Severe Pneumonia or Very Severe Disease
2.5kg - Any general danger sign: Stridor in calm child
- Give first dose of an appropriate antibiotic
6 to 12 months 0.6 2-3x for 3 - Refer urgently to the hospital
months

- IM antibiotic for children being referred ● Main symptom: At Least 3 loose watery stools
urgently: ● Ask
o Gentamicin: 7.5mg/kg - How long?
o Benzylpenicillin: 50,000 units/kg - Blood in the stool?
● Look and feel
● Pneumonia - Abnormally sleepy or difficult to awaken
- Chest indrawing or fast breathing - Restless and irritable
- Give oral Amoxicillin (for 5 days) → change to - Sunken eyes
cotrimoxazole if not improving for 3 days - Not able to drink
- If wheezing (or disappeared after rapidly - Pinch the skin
acting acting bronchodilator) give an inhaled ● If it is caused by a pathogenic agent, antibiotic is
bronchodilator for 5 days given
- If chest indrawing in HIV exposed/ infected ● In diarrhea, we need 2 signs for us to classify
child: give first dose of amoxicillin and refer
- Soothe the throat and relieve the cough with a CLASSIFICATION OF DIARRHEA
safe remedy ACUTE (less than 14 days)
o Safe remedy: calamansi or breast milk ● Severe dehydration
● Some dehydration
(except codeine cough syrups or nasal
● No dehydration
decongestants)
- If coughing for more than 14 days or recurrent
CHRONIC (14 days or more)
wheeze, refer for possible TB or asthma
● Severe persistent (with dehydration)
assessment
● Persistent (no dehydration)
- Advise mother when to return immediately
o Return immediately: fast breathing, fever,
DYSENTERY
not breathing
● Blood in stool
- Follow up in 3 days
CHOLERA
● Cough or cold
● Rice watery stools
- No signs of pneumonia or very severe disease
- If wheezing (or disappeared after rapidly CLASSIFICATION OF ACUTE DIARRHEA
acting bronchodilator) give an inhaled SEVERE DEHYDRATION
bronchodilator for 5 days Look for at least 2 of the following signs:
- Soothe the throat and relieve the cough with a ● Abnormally sleepy or difficult to awaken
safe remedy ● Sunken eyes
o Safe remedy: calamansi or breast milk ● Not able to drink or drinking poorly
(except codeine cough syrups or nasal ● Skin pinch goes back very slowly
decongestants)
- If coughing for more than 14 days or recurrent SOME DEHYDRATION
wheeze, refer for possible TB or asthma Look for at least 2 of the following signs:
assessment ● Restless, irritable
- Advise mother when to return immediately ● Sunken eyes
o Return immediately: fast breathing, fever, ● Drinks eagerly, thirsty
not breathing ● Skin pinch goes back slowly
- Follow up in 5 days if not improve
NO DEHYDRATION
ORAL ANTIBIOTIC ● Not enough signs
● First line: amoxicillin for 5 days, BID
AGE AMOUNT OF AMOXICILLIN CLASSIFICATION OF CHRONIC DIARRHEA
100mg/5ml SEVERE PERSISTENT DIARRHEA
● If the age of the child is less than 2 months, with
2 to 6 months 1.5ml
chronic diarrhea
● Dehydration present or less than 2 months with
6 to 12 months 2.5ml
chronic diarrhea
12 months to 3yrs 3.5ml
PERSISTENT DIARRHEA
3 to 5yrs 5ml ● No dehydration
CONTROL OF DIARRHEA DISEASES (CDD)

● Leading cause of morbidity is diarrhea

MANAGEMENT OF CHRONIC DIARRHEA
2 to 5yrs 12 to <19kg 960-1600
● Severe Persistent Diarrhea

PLAN C
- Treat dehydration
- Give vitamin A if not give in the last 30 days
● Severe dehydration
- Refer to the hospital
- Plan C + Vitamin A AGE FIRST GIVE THEN GIVE
30ml/kg in 70ml/kg in
● Persistent Diarrhea
Infants under 1 yr 1 hour 5 hours
- Advise feeding
- Give Vitamin A if not given in the last 30 days Children 1yr and 30 mins 2 and ½ hours
- Give zinc supplements for 14 days above
- Follow up in 5 days
● Give IV Fluid immediately: Plain LR or PNSS
- Advise when to return
- If IVF is not available, give ORS by mouth if
- Plan A + Vitamin A
tolerated
- If the child cannot swallow, give ORS via NGT
MANAGEMENT OF ACUTE DIARRHEA
- If no health facility, use NGT
PLAN A
● If any of the above steps is not possible, bring child
immediately to the hospital for IVF or NGT
● No dehydration
treatment
● Managed at home ● If the age of the child is 2 yrs old or there is an
epidemic of cholera, give antibiotics
4 RULES (X2B5)
● Give extra fluid and food ANTIBIOTICS
- Every after loose stools
- Soup, rice water, buko juice or ORS ● Dysentery
o Below 2yrs old: 50 to 100ml
- Cirpofloxacin 15mg/kg for 3 days BID
o 2 to yrs old: 100 to 200ml
● Zinc supplement for 14 days
● Cholera
- 2 to 6 months: 10mg/day
- 6 months to 5yrs old: 20mg/day - Cotrimoxazole or Furazolidone for 3 days BID
● Continue breastfeeding REMEMBER
● Follow up in 5 days if not improving
Pneumonia
PLAN B - 1 pink + 1 yellow = pink
Diarrhea
● Some Dehydration - 1 pink + 1 yellow = yellow
● Managed in RHU
NOTE: : If the baby vomits the oresol twice, stop giving
● Give reformulated ORS in the first 4hrs
oresol and bring the baby back to the health center
- Amount of ORS = wt. in kg x 75ml/kg of BW
o Consumed in the health center
- Home made oresol: 1 LH + 1 tsp NaCl + 4 tsp
sugar (1:1:4)
SUMMARY: PHARMA
● For under 6 months: give 100-200ml in the first
4hrs ● For convulsions: diazepam
● Advise mother to continue to breastfeeding ● Anemia: FeSO4
● After 4hrs → continue feeding and give zinc ● Dysentery: Criprofloxacin
● If mother must leave before treatment → explain 4 ● Cholera: Cotrimoxazole /Furazolidone
rules ● Antihelminthic: Mebendazole/Albendazole
- At home: Continue Plan A ● Wheezing: Salbumtamol (Bronchodilator)
● Follow up in 5 day if not improving ● Chronic Diarrhea (Severe Persistent / Persistent):
AGE WEIGHT AMOUNT (ML) IN Vitamin A
4HRS ● ORS + Zinc (Plan B +A): Dehydration
- ORS: 1 liter water, 1 tsp salt, 4 tsp sugar
Below 4 months < 6kg 200-450 - Sugar water = 200ml water + 4 tsp sugar
- PLR, NSS
4 to 12 months 6 to <10kg 450-800
● Prevent low blood sugar: D5 or D10
12 months to 2yrs 10 to <12kg 800-960

- Awareness of available services
SUMMARY: FOLLOW UP
- Able and willing to obtain services
● Malnutrition
- Complicated severe acute: refer FACTORS AFFECTING ADOLESCENT HEALTH ISSUES
- Uncomplicated severe acute: 5 days ● Lack of life skills
- Moderate acute: 30 days ● Lack of access to health services
- No malnutrition: 5 days ● Lack of safe and supportive environment
● Anemia
- Severe anemia: refer
- Anemia: 14 days ADOLESCENT HEALTH SERVICES
- No anemia: 5 days ● Adolescent sexual and reproductive health
● Pneumonia - 15 to 24 years old
- Severe: refer - Highest adolescent fertility rates
- Pneumonia: 3 days ● HPV vaccination
- Cough or colds: 5 days - Grade 4 (9-14y/o) public schools
● Dehydration ● Violence against women and children
- Acute ● Weekly Iron and Folic acid supplementation (WIFA)
o Severe dehydration: refer ● Assessment of health, nutritionally at risk and
o Some dehydration: 5 days provision of RTU supp;ementary food for
o No dehydration: 5 days adolescent female
- Chronic ● Antihelminthic drugs for deworming
o Severe persistent: refer ● Micronutrient supplementation
o Persistent: 5 days ● Promotion of consumption of iodized salt and
foods fortified with micronutrients
● Age-appropriate immunization
ADOLESCENT HEALTH
● Oral health
● 10-19y/o (WHO)
● Counseling on personal hygiene and
environmental sanitation
ADOLESCENT HEALTH ISSUES
● Referral for management for menstruation
● Early pregnancy and childbirth - 30% of births
irregularities, complicated illness including
● HIV
malnutrition
● Malnutrition
● Counseling on proper nutrition, mental health,
● Mental health
avoidance of risk-taking behaviors, smoking
● Tobacco use
cessation, adoption of healthy lifestyle practices
● Harmful use of alcohol - starts at 13-15y/o
and family health
● Violence
● Injuries
RELATED LAWS AND POLICIES FOR ADOLESCENT
ADOLESCENT HEALTH AND DEVELOPMENT
HEALTH PROGRAMS
PROGRAM (AHDP) 2018-2022
● Vision: A country with well informed, empowered,
● Proc. 99 - Second week of December as Linggo
responsible, and healthy adolescent who are
ng Kabataan
leaders in society
● Mision: Ensure that all adolescents have access to ● DepEd Order 0031, 2018
comprehensive health care and services in an
adolescent-friendly environment - Guidelines on the Implementation of the
comprehensive sexuality education (CSE) on
STRATEGIES the development of an age-appropriate and
● Health education and promotion developmentally-appropriate curriculum on
● Like skills building reproductive health and gender-based
● Medical service provision violence
● RA 11166 - Phil HIV and AIDS Policy Act

GAPS IN ADOLESCENT HEALTH SERVICE PROVISION
● Facility / provider - Repeals RA 8504 (Phil AIDS Prev and Control
- Available services Act) on the access of adolescents to HIV
- Appealing and respectful services from 21 y/o to 15-17 y/o for HIV testing
- Non judgment and considerate - Allows below 15 y/o that is pregnant or
- Appropriate delivery engaged in high-risk behavior for HIV testing
● Community and counseling with assistance of licensed
- Support the provision of service social worker or health worker
● Adolescents

ADULT MEN AND WOMEN HEALTH PROGRAM ● Life Expectancy:
● Management of Illness - Male = 64.10 y/o
● Counseling substance abuse, sexuality and - Females = 70.10y/o
reproductive tract infections (RTI) ● Mortality - CVD, cancer
● Nutrition and diet counseling ● Morbidity - Influenza, pneumonia, TB (infectious)
● Mental health
● Family planning and responsible sexual behavior BENEFITS OF SENIOR CITIZEN
● Dental care
● Screening and management of lifestyle related and ● RA 7432
other degenerative diseases - An act to maximize the contribution of senior
● Men - accidents and injuries, liver disease, BPH, citizens (60y/o) to nation building, grant
prostate malignancies benefits and special privileges and
● Women - goiter, malignancies (breast), DM opportunities
OLDER ADULTS HEALTH PROGRAM ● RA 9257

● Global Aging Population
- According to DOH, at least 7% of the - Expanded Senior Citizen Act
population is older adult to be considered as
- Seniors to render services to the community
aging population
- By the year 2050, 24% will be coming from the
● RA 9994
older adult
- Potential Support Ratio: ratio between older - Amended 7432 to include additional services
adult and below 60yrs old
● Aged 60 years and older ● RA 7876
- 1 billion (2017) - Senior Citizens Center Act
- 1.4 billion (2030) - Access to vital facilities in the community in all
- 2.1 billion (2050) cities and municipalities
● Young-old (65-74yrs)
● Middle-old (75-84yrs) ● RA 10645
● Old-old (85 yrs and older) - Mandatory Philheth coverage for ALL senior
citizens
RESPONSE TO AGING POPULATION
● United Nations International Plan of Action on ● Proc. 470
Aging (2002)
- 1st week of October every year as “Elderly
● WHO Active Aging: Policy Framework (2002;
Filipino Week”
Strategy and action plan on aging and heath
(2016-20202)
BENEFITS OF SENIOR CITIZEN
● Philippines Plan of action for Senior Citizens
● 20% discount on:
(2012-2016)
- Medical related privileges: medicine, medical
- Vision is to have a society for all ages where
supplies, accessories and equipment, medical
the senior citizens are empowered to achieve
and dental services, PF of physician and
active aging
license health workers providing home health
- It has 3 priority directions or major areas:
services
o Senior citizens and development
- Transportation: air, sea, land (MRT, LRT, PNR,
o Advancing health and well-being into old
buses, jeepneys, taxi, shuttle services)
age
- Hotels, restaurants, recreational facilities,
o Ensuring enabling and supportive
places of leisure: hotels, restaurants, theaters,
environments
cinemas, concert halls, circuses, leisure and
amusement
OLDER ADULTS IN THE PHILIPPINES
- Recreation centers: fees, charges and rental for
● Article XV, Sec. 4 of the 1986 Philippine
sports facilities and equipment
Constitution which states “The family has the duty
- Funeral services: funeral and burial expenses
to care for its elderly members although the state
include casket or urn, embalming, cremation
may do so through programs of social security”
cost and other services
- Utility discount: grant 5% discount relative to
● Expanded Senior Citizen Act
the monthly use of water and electricity,
- Senior citizens center were also established in provided that the meter is registered under
the Philippines pursuant to RA 7876, the name of the senior citizen residing therein
otherwise known as the Senior Citizen Center and does not exceed 100kWh and 30m
Act of the Philippines ● Exemptions
- Tax Exemptions: payment of individual income VIOLENCE AGAINST WOMEN AND CHILDREN
tax of those who are considered to be
minimum wage earners ● RA 9262 - Anti Violence against Women and
- Training fee: for socio-economic programs their Children Act of 2004
conducted by private and government
agencies subject to the guidelines issued by
DTI, DOLE, DA, TESDA and DOST-TRC
- Freebies: medical, dental services and
vaccinations
● Government Assistance
- Social Pension: indigent entitled to monthly
stipend to Php 500 to augment subsistence
and medical needs
- Mandatory PhilHealth Coverage
- Social Safety Nets: shall include but not
limited to food, medicines and financial
assistance for house repair to cushion effects
of economic, disaster and calamity shocks
- Death benefit: minimum of Php 2,000 shall be
given to the nearest surviving relative who ESSENTIAL HEALTH SERVICE PACKAGE FOR VAW
took care of the deceased senior citizen ● Identification of Survivors of intimate partner
● Others violence
- Express lanes: private, banking, commercial - Allow them to state or verbalize what happen
and government establishments and their emotions with consent
- Education: provision of scholarships, grants, - Don't pressure her, give her time
financial aids, subsidies and other incentives - Document
- Benefits for retirees: continuance of same ● Written information in the health facility
benefits by GSIS, SSS and PAGIBIG as enjoyed ● Identification of women suffering intimate partner
those in active service violence
- Privileges on special discounts in special ● Provide information regarding available services
programs ● First line of support
- Being non-judgemental
HEALTH SERVICES FOR OLDER ADULTS - Ask about history of violence
● Management of Illness - Referral
● Counseling substance abuse, sexuality and - Mandatory reporting is not recommended
reproductive tract infections (RTI) ● Care of injuries and urgent medical issues
● Nutrition and diet counseling - History taking is standard but avoid redundant
● Mental health questions
● Family planning and responsible sexual behavior - Explain and obtain informed consent for
● Dental care medical examination, treatment, forensic
● Screening and management of lifestyle related and evidence collection, release of information
other degenerative diseases - Emergency treatment
● Screening and management of chronic debilitating PERSONS WITH DISABILITIES (PWDs)
and infectious diseases NATIONAL HEALTH PROGRAM FOR PERSONS WITH
● Post productive care DISABILITIES (PWD)
● Individuals who have impairments, activity
FACILITIES FOR ADULTS IN THE PHILIPPINES limitation or restrictions on participation
● National center for Geriatric Health (Manila) - Disability: impairments, activity limitations and
● Golden Acres Home for the Aged (Govt) participation restrictions
● Mountain Crest Residential Care (Cavite) - Impairment: problem in body function (e.g.
● Kanlungan ni Maria deaf, mute)
● Blessed family Home Care Facility (QC) - Activity limitations: difficulty in executing a
task or action
- Participation restriction: problem experiences
with regard to involvement in life situations
ISSUES AMONG PWD

● Poor health outcomes
● Low educational outcomes
● Less economic participation

● Higher rates of poverty - Portion of the burden relating to impact of
● Increased dependency mental health problems to person other than
● Restricted participation than people without the individual directly affected
disability - Felt by families and relatives of mentally ill
● Hidden burden
BARRIERS TO SERVICE - Stigma and violations of human rights
● Inadequate policies and standards - Rejection, shame suffered by mentally ill
● Negative attitudes of people ● Future burden
● Lack of provision of services - Burden in the future resulting from the aging
● Poor service delivery of the population, increasing social problems
● Inadequate funding and unrest inherited from the existing burden
● Lack of accessibility
● Lack of involvement RA 11036 MENTAL HEALTH ACT
● Lack of data and evidence on disability ● An Act Establishing a National Mental Health
Policy for the purpose of enhancing the delivery of
MAGNA CARTA integrated mental health services, promoting and
protecting the rights of persons utilizing psychiatric
● RA 7277 - Magna carta for Disabled Persons neurological and psychosocial health services
● National Health Program for PWD ● June 1, 2018
● Medical rehab Centers in provincial hospitals
● Comprehensive, integrated and affordable health MENTAL HEALTH FACILITY
services ● Establishment or any unit of an establishment
which has as its primary function of provision of
CATEGORIES OF PWD mental health services
● Psychosocial behavioral disabilities ● Mental health services at all levels in the national
● Chronic illness and disabilities health system
● Learning disabilities
● Mental disabilities MENTAL HEALTH SERVICES AT COMMUNITY LEVEL
● Visual disability ● Basic mental health services at all LGUs down to
● Orthopedic /moving the barangay
● Communication deficits ● Community resilience and psychosocial well-being
training in all barangays, including the availability
HEALTH AND WELLNESS PROGRAM FOR PWDs of mental health and psychosocial support services
● Vision: a country where all persons with disabilities, during and after natural disasters and other
including their children and families have full calamities
access to inclusive health and rehabilitation ● Training and capacity-building programs for local
services mental health workers in coordination with mental
● Mission: promote highest attainable standards of health facilities and departments of psychiatry in
health and wellness for PWDs by fostering general or university hospitals
multisectoral approach towards a disability ● Support services for families and co-workers of
inclusive health agenda mental health services
● Dissemination of mental health information and
MENTAL HEALTH PROGRAMS promotion of mental health awareness among the
MENTAL HEALTH IN THE PHILIPPINES general population
● 1 in 5 Filipinos suffer from mental disorders
● 3.3% of total population has depression and 3.1% SUPPORTED DECISION MAKING
has anxiety ● A service use may designate up to 3 persons or
● 2,558 cases of Filipinos resorting to suicide (WHO, supporters, including the legal representative for
2012) supported decision making
- Access the service user’s medical information
4 FACETS OF MENTAL HEALTH PROBLEMS AS - Consult with the service user vis-a-vis any
PUBLIC HEALTH PROBLEM proposed treatment or therapy
● Defined burden - Be present during appointments and
- Burden of currently affecting persons with consultations with mental health
mental disorders professionals, workers and other service
- Quality of life indicators, Disability adjusted life providers during the course of treatment or
years (DALY) therapy
● Undefined burden ● Deinstitutionalization

- Discourage patients to be admitted in mental ● Socials
health facility wherein there is a controlled ● Sounds and songs
environment ● Speak to me
- Be present in the community in order to adjust ● Stress debriefing
and cope with stress ● Smile
INTEGRATED COMMUNITY BASED WHO PEN

NON-COMMUNICABLE DISEASE PREVENTION & ● WHO Package of Essential Non-Communicable
CONTROL PROGRAM Disease Interventions
● Mortality - Lifestyle Related/Chronic ● Enable early detection and management of
- Cardiovascular Diseases cardiovascular disease, diabetes, chronic respiratory
- Cancer diseases and cancer to prevent life threatening
- COPD complications
- DM - Ex. heart attacks, stroke, kidney failure,
● Risk Factors of Diseases amputations, blindness
- Smoking
- Physical Inactivity PACKAGE OF ESSENTIAL NCD INTERVENTIONS -PEN
- Unhealthy diet CVD
- Excessive alcohol drinking ● Primary prevention of heart attack and strokes
● Acute myocardial infarction
STRATEGIES FOR THE CONTROL & PREVENTION OF ● Secondary prevention: post MI
NON-COMMUNICABLE ● Secondary prevention: post stroke
● “Mag HL tayo Program” → healthy lifestyle ● Secondary prevention: rheumatic heart disease
● Promote physical activity and exercise
- Physical activity: body movement that results DIABETES MELLITUS
in expenditure of energy (occupational, ● Type 1 DM
leisure-time, routine daily activities) ● Type 2 DM
o E.g. washing the dishes, walking ● Prevention of foot complications through
- Exercise: planned, structured, repetitive aimed examination and monitoring
at improving or maintaining physical fitness ● Prevention of onset and delay in progression of
(performed activities with vigor and alertness chronic kidney disease
without undue fatigue) ● Prevention of onset and delay in progression of
o Moderate intensity for 30 mins for 5 days diabetic retinopathy
o E.g. Zumba, weightlifting, jogging ● Prevention of onset and delay in progression of
● Prompt proper nutrition (ABC) neuropathy
- A: aim for physical fitness (ideal body weight)
- B: build healthy nutrition-related practices CHRONIC OBSTRUCTIVE LUNG DISEASES
- C: choose foods sensibly ● Bronchial asthma
● Promote smoke free environment (5A’s to ● Prevent exacerbation of COPD and disease
quitting smoking) progression
- Ask smoking status
o “Ilang sticks per day?” CANCER
- Advise to stop smoking, can cause death ● Early diagnosis
o Educate them about the adverse effects
- Assess willingness to quit NCD CARE
- Assist quitting ● Package of Essential Noncommunicable (PEN)
- Arrange follow up monitor progress Disease interventions for primary health care in
- RA 10352 Excise Tax on Alcohol and Tobacco low-resource settings:
for 5 years for the Universal Health Care - Prevention
program of the government - Treatment
- Rehabilitation
12 STRESS MANAGEMENT TECHNIQUES - Palliative care
● Spirituality PRIMARY HEALTH CARE CENTER
● Self-awareness STAFF TEAM & ROLES
● Scheduling activities
PHYSICIAN ● Receives NCD referrals from
● Siesta
nurse
● Stretching
● Physically examines pt
● Sensation techniques ● Prescribed medications and
- E.g. Spa promote adherence
● Sports

the continuing education of health care
NURSE ● Conduct risk assessment and
screening providers, all in the interests of advancing the
● Measure height and weight health of individuals and their communities
● Perform UA and blood sugars, if (WHO)
needed
● Healthy lifestyle counseling ● eLearning
OTHERS ● Dietitian
- The use of electronic tools aid in teaching
● Smoking cessation specialist - Instructional videos, informational text blasts,
● Health educator interactive simulations
ENVIRONMENTAL SANITATION
PHILPEN
● Is the control of factors in man’s physical
● Philippine Package of Essential Noncommunicable
environment that maybe deleterious to man’s
disease intervention
well-being
● The program covers the following areas
● AO No. 2012-0029
- Water Sanitation
- An adaptation of the WHO guidelines in - Food Sanitation
managing non-communicable diseases in low - Waste Management
resource setting such as thing country
● PD 825 - Anti-littering Act
RISK FACTORS
● Age > 40 yrs old ● PD 856 - Code on Sanitation
● Smokers
● Waist circumference of ● RA 9003 - Ecological Solid Waste Management
- > 90cm in women Act
- > 100cm in men
● Known hypertension ● RA 8749 - Clean Air Act
● Known DM - Prevents burning as a way of waste disposal
● History of premature CVD in first degree relatives
● History of DM or kidney disease in first degree ● RA 9275 - Clean Water Act
relatives
- Separate disposal system for human waste
o E.g. Septic tank
TELEMEDICINE
● PP 1101 - November as Clean Air Month

● Information Communication Technology (ICT)
- A diverse set of technological tools and 9 ENVIRONMENTAL HEALTH INDICATORS

resources used to communicate, create, ● Households with access to improved or saafer
disseminate, store and manage information water-stratified to Level I, II and III
(Blurton, 2002) ● Households with sanitary toilets
● Households with satisfactory disposal of solid waste
- Example technologies:
● Households with complete basic sanitation
o Computers
facilities
o The Internet
● Food establishments
o Television
● Food establishments with sanitary permit (PD 522)
o Mobile phones
- Acquired from the municipal hall
● Food handlers
● eHealth
● Food handlers with health certificates
- Is the use of ICT for health (WHO, 2012) - Acquired from the municipal hall
- Must submit a stool for fecalysis
● Electronic Medical Records
- Comprehensive patient records that are stored WATER SANITATION
and accessed from computer or server WATER FACILITIES
- Community health information tracking LEVEL DESCRIPTION
system (CHITS) of the UP Manila
I (Point source) ● A protected well or spring with
● Telemedicine outlet
● No distribution system - source
- Using ICT for exchange of valid information for
● Adaptable for rural areas, 15-25
diagnosis, treatment and prevention of disease household
and injuries, research and evaluation and for

● Within 250m from the farthest II ● On site toilet of the water
user carriage type with water-sealed
(flush type) with septic tank
II ● Sourcer + reservoir + piped
distribution III ● Water carriage type connected
● Within 25m from the farthest to sewerage system to
house treatment plant
● 100 households
● E.g. poso
FACTORS COVERED BY SANITATION CODE
III ● Sourcer + reservoir + piped ● Toilet
distribution + household tap ● Two consideration in constructing toilets:
● Suited for urban areas - Construct at a distance of 25:30m from
● Undergoes treatment at water identified sources of water like deep well,
facility
faucet, etc.
● Recommended because it
- Construct at a level lower than the source of
ensures safety of consumers
water
WATER TREATMENT IN A LEVEL II WATER SUPPLY SOLID WASTE MANAGEMENT

SYSTEM ● Need for sorting/ waste segregation
● Sedimentation ● Reuse - all solid and semi-solid except human
- Settles at the bottom excreta
● Flocculation or coagulation - Garbage: biodegradable wastes
- E.g. alum or tawas - Rubbish / trash: non biodegradable wastes
● Filtration
- E.g. sand, gravel SOLID WASTES
● Chlorination ● Municipal wastes - non hazardous household
● Aeration commercial and institutional waste, street
- Used after chlorination sweepings, debris
- This is used to improve the taste and smell of ● Healthcare Wastes (Biomedical Waste)
the water - Infections: contain bacteria, viruses, paratise,
● Fluoridation fungal
- Pathological: tissues, organs, body parts,
PROHIBITIONS OF THE CODE OF SANITATION ON human fet
WATER SUPPLY - Pharmaceutical: drug, vaccines, sera
● Washing and bathing within a radius of 25m from - Chemical: from lab, housekeeping, disinfectant
any well or other source of drinking water - Sharps: cause cuts, puncture
● Construction of artesians, deep or shallow well - Radioactive: liquids or gaseous materials
within 25m from any source of pollution ● Industrial Wastes
- Including septic tanks and sewage systems - Agricultural and mining
● Drilling a well within 50m distance from a ● Hazardous Wastes
cemetery - Toxic, corrosive acids, explosions, cytostatic
● Construction of dwellings within the catchment drugs, genotoxic drugs
area of protected spring water source
WASTE SEGREGATION
TOILET FACILITIES ● Black or colorless
LEVEL DESCRIPTION - Non-hazardous, non-biodegradable wastes
● Green
I ● Non-water carriage toilet - Non-hazardous biodegradable wastes
- Ex. Pit latrine
● Yellow with biohazard symbol
● Toilet facilities requiring small
- Pathological / anatomical wastes
amount of water to wash the
waste into the receiving space - E.g. cotton ball used to clean the shoes
- Ex. pour flush toilet & aqua ● Yellow with black band
privy - Pharmaceutical, cytotoxic or chemical wastes
● Other type 1: (label separately)
- Trench latrine/ temporary ● Yellow bag that can be autoclaved
toilet - Infectious wastes
- Chemical toilet
● Orange with radioactive symbol
- Cathole
- Radioactive wastes

METHODS OF SOLID WASTE MANAGEMENT AGE COMPOSITION
● Recycling - other names: ● Dependency ratio
- Total recycling 𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑔𝑒𝑑 <15 𝑦𝑟𝑠 + > 65𝑦𝑟𝑠 𝑎𝑛𝑑 𝑎𝑏𝑜𝑣𝑒
𝑥 100
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑎𝑔𝑒𝑑 15−64𝑦𝑟𝑠 𝑜𝑙𝑑
- Waste recovery method
- Zero waste management
- Volume reduction method FIELD HEALTH SERVICES AND INFORMATION
● Sanitary land-fill SYSTEM (FHSIS)
● Incineration ● Reproductive age
● Open dumping - Ability to conceive
● 3Rs: Reduce, reuse & recycle ● Productive age
- Ability to work
FOOD SAFETY - Below 18yrs old can work with consent of the
● The food establishment must have a sanitary parent
permit from the city or municipality that has ● Individual / family health record
jurisdiction over the business - Building blocks of information in the
● No person shall be employed in any food healthcare system
establishment without a health certificate properly ● Target/ client list
issued by city/ municipal health officer - Used in monitoring compliance to treatment
● No person shall be allowed to work on food - E.g. list of patients undergoing TB treatment
handling while he/ she is afflicted with a ● Tally report
communicable disease, including boils, infected - Prepared by RHU
wounds, respiratory infections, diarrhea and - E.g. tally of the morbidity case
gastrointestinal upset ● Output report
- Collation of tally reports
4 Rs
● Right source PROCESS
● Right preparation
● Right cooking Tally report (RHU)
● Right storage ↑
Output report (PHO)
↓
VITAL STATISTICS Regional Health Office
● Demography - the study of a population ↓
National office, DOH
● Demographic data:
- Population size
- Population composition TYPES OF DATA ACCORDING TO SOURCE
- Distribution of population in space PRIMARY
● Census:
MEASURING POPULATION GROWTH - An official and periodic enumeration of
● Natural increase population
- How many is added - Data gathering about 100% of the population
- No. of births - no. of deaths - Done every 5 years between June to July
● Rate of natural increase - De jure: place of usual residence
- Speed of increase - De facto: where people are physically present
- Crude birth rate - crude death rate at the time of census
o Crude birth rate: total number of births/ ● Experiment
total number of population
o Crude death rate: total number of deaths/ SECONDARY
total number of population ● Registry of vital events
- Ex. Philippines data, 2003 - Birth certificates
o 25.2/ 1000 population - 5.72/ 1000 o May be signed by midwife or nurse
population → 19.48/ 1000 → 1.95% o Must be filed within 30 days and
submitted to the municipal hall
POPULATION COMPOSITION o Filed by the mother and signed by the
SEX COMPOSTITON birth attendant
● Sex ratio (M:F) o In the hospital, the hospital files the birth
SR =
𝑇𝑜𝑡𝑎𝑙 𝑛𝑜. 𝑜𝑓 𝑚𝑎𝑙𝑒𝑠
𝑥 100 certificate
𝑇𝑜𝑡𝑎𝑙 𝑛𝑜. 𝑜𝑓 𝑓𝑒𝑚𝑎𝑙𝑒𝑠
- Death certificate
- 100 - equal males and females
o Must be filed within 48hrs from the
- > 100 - more males
occurrence of death
- < 100 - more females

o Death registry is almost complete → SWAROOP’S INDEX
mortality data most accurate data/ best 𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑎𝑚𝑜𝑛𝑔 50𝑦𝑟𝑠 𝑜𝑙𝑑 𝑎𝑛𝑑 𝑎𝑏𝑜𝑣𝑒
𝑥 100
𝑇𝑜𝑡𝑎𝑙 𝑛𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠
reflection of health status of a population
● High swaroop’s index means there is a good
o Signed by physician or mayor
indication that the health status of the population
o If signed by mayor - unknown cause of
death MATERNAL MORTALITY RATE
o Submitted to the municipal where the 𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑𝑢𝑒 𝑡𝑜 𝑝𝑟𝑒𝑔𝑛𝑎𝑛𝑐𝑦, 𝑙𝑎𝑏𝑜𝑟, 𝑎𝑛𝑑 𝑝𝑢𝑒𝑟𝑝𝑒𝑟𝑖𝑢𝑚
𝑥 1000
person died 𝑁𝑜. 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
- RA 3753: Civil Registry Law INFANT MORTALITY RATE

𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑎𝑔𝑒𝑑 11 𝑚𝑜𝑛𝑡ℎ𝑠 𝑎𝑛𝑑 𝑏𝑒𝑙𝑜𝑤
𝑁𝑜. 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
𝑥 1000
- PD 651: Birth Registration Law
● Records and reports NEONATAL MORTALITY RATE
𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑎𝑔𝑒𝑑 28 𝑑𝑎𝑦𝑠 𝑎𝑛𝑑 𝑏𝑒𝑙𝑜𝑤
● Publications 𝑁𝑜. 𝑜𝑓 𝑟𝑒𝑔𝑖𝑠𝑡𝑒𝑟𝑒𝑑 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
𝑥 1000
● Informal sources
NARS
FERTILITY RATES ● Nurses Assigned in Rural Service
● Percentage distribution - 100 ● Joining hands against global crisis
● Small population of the barangay - 10000 ● President Arroyo announced during her speech in
● Whole country/ large population - 100,000 the Multi-Sectoral Jobs Summit at the Heroes Hall
in Malacañang the launch of the Nurses Assigned
CRUDE BIRTH RATE in Rural Areas (NARS) program.
𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
𝑥 1000 ● Those who will be hired under the program will
each receive P8,000 from the national government
aside from a P2,000 stipend given by local
GENERAL/ TOTAL FERTILITY RATE
governments to rural nurses.
𝑁𝑜. 𝑜𝑓 𝑓𝑒𝑚𝑎𝑙𝑒𝑠 𝑜𝑓 𝑟𝑒𝑝𝑟𝑜𝑑𝑢𝑐𝑡𝑖𝑣𝑒 𝑎𝑔𝑒
𝑥 1000
RN HEALS
● Registered Nurses for Health Enhancement And
MORBIDITY RATES
Local Service
PREVALENCE RATE
𝑇𝑜𝑡𝑎𝑙 𝑐𝑎𝑠𝑒𝑠 (𝑜𝑙𝑑+𝑛𝑒𝑤) 𝑜 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑑𝑖𝑠𝑒𝑎𝑠𝑒𝑠 ● By PNoy
𝑥 100
𝐸𝑠𝑡𝑖𝑚𝑎𝑡𝑒𝑑 𝑚𝑖𝑑 𝑦𝑒𝑎𝑟 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 ● Currently the RN Heals nurses received a monthly
allowance of P8,000 from the DOH, the agency
INCIDENCE RATE according to Sec. Ona could receive a monthly
𝑁𝑜. 𝑜𝑓 𝑛𝑒𝑤 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑑𝑖𝑠𝑒𝑎𝑠𝑒𝑠
𝑥 100, 000 compensation of P16,000, if they will be hired or
regularized
MORTALITY RATES
CRUDE DEATH RATE NDP MECHANISMS
𝑇𝑜𝑡𝑎𝑙 𝑛𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 ● The nurse shall be hired with a Nurse 1, salary grade
𝑥 1000
11, monthly salary of P18,549 (2018)/ grade 15 P31,765
(2019)
AGE-SPECIFIC DEATH RATE ● Contract is for 6 months that can be renewed
𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑖𝑛 𝑎𝑛 𝑎𝑔𝑒 𝑔𝑟𝑜𝑢𝑝
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑜𝑓 𝑎𝑔𝑒 𝑔𝑟𝑜𝑢𝑝
𝑥 100, 000 based on satisfactory performance for a maximum
of 2 years.
● Nurses who completed the project shall be:
SEX-SPECIFIC DEATH RATE
𝑁𝑜. 𝑜𝑓 𝑚𝑎𝑙𝑒/ 𝑓𝑒𝑚𝑎𝑙𝑒 𝑑𝑒𝑎𝑡ℎ𝑠
awarded with a Certificate of Employment
𝑁𝑜. 𝑜𝑓 𝑚𝑎𝑙𝑒𝑠/ 𝑓𝑒𝑚𝑎𝑙𝑒𝑠
𝑥 100, 000
COMMUNITY ORGANIZING
CAUSE-SPECIFIC MORTALITY RATE ● Community Development
𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑𝑢𝑒 𝑡𝑜 𝑎 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑐𝑎𝑢𝑠𝑒
𝑥 100, 000 - An organized effort of people to improve the
conditions of the community life and the
capacity of the people for participation, self
PROPORTIONATE MORTALITY RATE
𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ 𝑓𝑟𝑜𝑚 𝑎 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑐𝑎𝑢𝑠𝑒/𝑎𝑔𝑒 𝑎𝑡 𝑎 𝑔𝑖𝑣𝑒𝑛 𝑦𝑒𝑎𝑟 direction, and integrated efforts in community
𝑥 1000
𝑇𝑜𝑡𝑎𝑙 𝑛𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 affairs in which development is accomplished
by the people
CASE FATALITY RATE
𝑁𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 𝑑𝑢𝑒 𝑡𝑜 𝑎 𝑠𝑝𝑒𝑐𝑖𝑓𝑖𝑐 𝑐𝑎𝑢𝑠𝑒
𝑁𝑜. 𝑜𝑓 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑡ℎ𝑒 𝑑𝑖𝑠𝑒𝑎𝑠𝑒
𝑥 100 APPROACHES TO COMMUNITY DEVELOPMENT
● Case fatality rate - killing power of the disease ● Social welfare/ Dole-out

- The immediate and / or spontaneous response ● Courtesy Call to GU/ Barangay level
to ameliorate the manifestation of poverty, - To get the approval of the leaders from LGUs
especially on the personal level ● Community consultations / dialogues
- Assumes poverty is God given - Converse with the key persons of the
- The poor should accept their condition since community (e.g. barangay captain, nurse)
they will receive their just reward in heaven - Establish rapport
- Believes that poverty is caused by bad luck - Gather data
and natural disaster
- Not advocated in community organizing CRITERIA FOR POTENTIAL SITE: SIPRAN
o Causes dependence ● Socio-economically depressed
- Only acceptable during times of disaster ● Inaccessible health services
o E.g. distribute groceries, feed the ● Poor community health status
community ● Relative peace and order situation
● Modernization / Project Development ● Acceptance of the program by the community
- Poverty is caused by lack of education ● Not currently served by similar agencies/
- Considered a national strategy which adopts organizations
the western mode of technological
development ENTRY PHASE / PREPARATORY
- E.g. training, seminars ● Sensitization of the community / Integration/
● Participatory Action Immersion/ Information Campaigns
- Process of empowering/ transforming the poor - Prepares the people in the community
and the oppressed sectors of society so that - Sensitization: establish rapport in the
they can pursue more just and humane community by living in the community for 2
society weeks
- Poverty is due to lack of cooperation ● Social investigations/ Community Profiling
- Key Solution: Cooperation and collaboration (Demographic, Geography, Socio-cultural,
o To develop self-reliance Economic Indices, Environmental, Health Indices,
Physical/Infrastructure Resources)
PARTICIPATORY ACTION RESEARCH - Draw a clear picture of the community and
● Participatory action research (PAR) is an approach involve barangay health workers
to research that aims at promoting change among ● Community Diagnosis/Research/Analysis
the participants.
● Members of the group being studied participate as GUIDELINES IN INTEGRATION
partners in all phases of the research, including ● Recognize local authorities
design, data collection, analysis, and dissemination ● Adapt the lifestyle of the community
● Work with the people, not for the people ● Choose a modest dwelling
● Continuous and sustained process of: ● Avoid expectation from the people.
- Educating the people to understand and ● Be clear with your objectives & limitations
develop their critical consciousness of their ● Participate in the production process
existing conditions ● Participate in social activities
- Working with people to work collectively and
efficiently ORGANIZATION BUILDING/IMPLEMENTATION
- Mobilizing the people to develop their ● Social Preparation through community assembly
capability and readiness to respond to take - Presents the problems
action on their immediate needs towards - Political leaders are prohibited because of
solving their long term problems political motives
● Spotting Potential leaders
PRINCIPLES OF COPAR ● Core group Formation (SALT)
● People, especially the most oppressed, exploited: - SALT: Self awareness Leadership Training
and deprived sectors are open to change, have the ● Formation of Organization/CommitteE
capacity to change, and are able to bring about ● Planning Phase (SMART)
change. ● Mobilization/Implementation/ Action
● COPAR should be based on the interests of the - They are responsible in implementing the
poorest sectors of society.. programs, we only facilitate and guide them
● COPAR should lead to a self-reliant community and
society. CRITERIA FOR SELECTION OF POTENTIAL LEADERS
● Belong to the poor sectors and classes and is
PHASES directly engaged in production
PRE - ENTRY PHASE / PREPARATORY ● Well respected by members of the community and
● Site / Area/ Community Selection has relatively wide influence

● Desirous of change and is willing to work for
change
● Must be able to communicate effectively
SUSTENANCE AND STRENGTHENING /

MAINTENANCE PHASE
● Evaluation
- Criteria: Effectivity, Efficiency, Appropriateness,
Adequacy
- Evaluates how the programs was
implemented
- Impact evaluation
o How does the program affect the lives of
the family
o Qualitative study
● Linkaging
- Arrange partnerships, organize activities that
will entail participation of NGOs
- Organizing activities in partnership with
government and non-government
organizations
METHODS OF ESTABLISHING PARTNERSHIP
NETWORKING ● Exchanging information about the

organizational goals and objectives,
services or facilities
● It provides awareness of the
organization’s capabilities to
accomplish the networks goals and
objective
COORDINATION ● Modifying the organizations

activities responsive to the needs of
the community
COOPERATION ● Sharing information and resources

to accommodate the organization’s
agenda
COLLABORATION ● Assisting organization to enhance

their capacities in performing their
tasks and quality of services
COALITION ● Forming partnership between the

organization and the members of
the community
PHASE OUT/EXIT
● Documentation
- Document of all activities done
- Basis evaluation overall organizing program
● Follow- up expansion
- Is the program sustainable?
NOTE: All members must be involved in the

preparation/identification, implementation and
evaluation of the programs
● Terminal Goal: We want them to develop
self-reliant
● Principles: Change, self-reliance, benefit the poor
sectors of the society

IMCI STRATEGY
SICK CHILD AGE 2 MONTHS TO 5 YEARS OLD
ASSESS CLASSIFY IDENTIFY TREATMENT
GENERAL DANGER SIGNS
Check for General Danger Signs ● Any general danger sign VERY SEVERE DISEASE ● Give diazepam if convulsing now
● A child with any general danger ● Quickly complete the assessment
sign needs URGENT attention; ● Give any pre-referral treatment
● Complete the assessment and any immediately
pre-referral treatment immediately ● Treat to prevent low blood sugar
so referral is not delayed. ● Keep the child warm
Ask: ● Refer URGENTLY
● Is the child able to drink or
breastfeed?
● Does the child vomit everything?
● Has the child had convulsions?
Look
● See if the child is lethargic or
unconscious.
● Is the child convulsing now?
PNEUMONIA
Ask ● Any general danger sign or SEVERE PNEUMONIA OR VERY ● Give first dose of an appropriate
● Does the child have cough or ● Stridor in calm child. SEVERE DISEASE antibiotic
difficulty of breathing ● Refer URGENTLY to hospital
● If yes, how long
● Chest indrawing or PNEUMONIA ● Give oral Amoxicillin for 5 days*** If
Look, listen and feel: ● Fast breathing. wheezing (or disappeared after
● Count the breaths in one minute. rapidly acting bronchodilator) give
● Look for chest CHILD indrawing an inhaled bronchodilator for 5 days
● Listen for stridor: child must be ● If chest indrawing in an HIV
calm exposed/infected child, give the first
● Look and listen for wheezing. dose of amoxicillin and refer.

● If wheezing with either fast ● Soothe the throat and relieve the
breathing or chest indrawing: Give a cough with a safe remedy
trial of rapid acting inhaled ● If coughing for more than 14 days or
bronchodilator for up to three times recurrent wheeze, refer for possible
15-20 minutes apart. TB or asthma assessment
● Count the breaths and look for ● Advise mother when to return
chest indrawing again, and then immediately
classify. ● Follow-up in 3 days
- 2 months to 12months: Fast
breathing is: 50 breaths per ● No signs of pneumonia or very COUGH OR COLD ● If wheezing (or disappeared after
minute or more severe disease rapidly acting bronchodilator) give
- 12 months to 5 years: 40 an inhaled bronchodilator for 5 days
breaths per minute or more ● Soothe the throat and relieve the
cough with a safe remedy
● If coughing for more than 14 days or
recurrent wheezing, refer for
possible TB or asthma assessment
● Advise mother when to return
immediately
● Follow-up in 5 days if not improving
DEHYDRATION
Ask Two of the following signs: SEVERE DEHYDRATION ● If child has no other severe
● Does the child have diarrhea? ● Lethargic or unconscious classification: Give fluid for severe
● If yes, ask for how long? Is there ● Sunken eyes dehydration (Plan C) OR
blood in the stool ● Not able to drink or drinking poorly ● If child also has another severe
● Skin pinch goes back very slowly. classification: Refer URGENTLY to
Look and feel hospital with mother giving
● Look at the child's general frequent sips of ORS on the way
condition. ● Advise the mother to continue
- Is the child: Lethargic or breastfeeding
unconscious? ● If child is 2 years or older and there
- Restless and irritable? is cholera in your area, give
● Look for sunken eyes. Offer the child antibiotic for cholera
fluid.
- Is the child: Not able to drink or Two of the following signs: SOME DEHYDRATION ● Give fluid, zinc supplements, and
drinking poorly? ● Restless, irritable food for some dehydration (Plan B)
- Drinking eagerly, thirsty? ● Sunken eyes Drinks eagerly, thirsty

● Pinch the skin of the abdomen. ● Skin pinch goes back slowly. ● If child also has a severe
- Does it go back: Very slowly classification: Refer URGENTLY to
(longer than 2 seconds)? hospital with mother giving
frequent sips of ORS on the way
● Advise the mother to continue
breastfeeding
immediately
● Not enough signs to classify as NO DEHYDRATION ● Give fluid, zinc supplements, and
some or severe dehydration food to treat diarrhea at home (Plan
A)
immediately
● If diarrhea is 14 days or more ● Dehydration present SEVERE PERSISTENT DIARRHEA ● Treat dehydration before referral
unless the child has another severe
classification
● Refer to hospital
● No dehydration present PERSISTENT DIARRHEA ● Advise the mother on feeding a

child who has PERSISTENT
DIARRHEA
● Give multivitamins and minerals
(including zinc) for 14 days
● Follow-up in 5 days
● If blood in the stool ● Blood in stool DYSENTERY ● Give ciprofloxacin for 3 days
MALARIA
Ask ● Any general danger sign or \Stiff VERY SEVERE FEBRILE DISEASE ● Give first dose of artesunate or
● Does the child have a fever? neck. quinine for severe malaria
● If yes: Decide Malaria Risk: high or ● Give first dose of an appropriate
low antibiotic
● Then ask: For how long?

- If more than 7 days, has fever ● Treat the child to prevent low blood
been present every day? sugar
- Has the child had measles ● Refer URGENTLY to hospital
within the last 3 months?
● Malaria test POSITIVE MALARIA ● Give recommended first line oral
Look and feel antimalarial
● Look or feel for a stiff neck. ● Give appropriate antibiotic
● Look for a runny nose. treatment for an identified bacterial
● Look for any bacterial cause of fever cause of fever
● Look for signs of MEASLES. ● Advise mother when to return
● Generalized rash and immediately
● One of these: cough, runny nose, or ● Follow-up in 3 days if fever persists
red eyes. ● If fever is present every day for more
than 7 days, refer for assessment
Do a malaria test:
● In all fever cases if High malaria risk. ● Malaria test NEGATIVE FEVER ● Give appropriate antibiotic
● Low malaria risk if no obvious cause ● Other cases of fever PRESENT NO MALARIA treatment for an identified bacterial
of fever present. cause of fever
immediately
● Follow-up in 3 days if fever persists
● If fever is present every day for more
● No Malaria Risk and No Travel to ● Any general danger sign VERY SEVERE FEBRILE DISEASE ● Give the first dose of an appropriate
Malaria Risk Area ● Stiff neck. antibiotic.
● Treat the child to prevent low blood
sugar.
● Refer URGENTLY to the hospital.
● No general danger signs FEVER ● Give appropriate antibiotic

● No stiff neck. treatment for any identified
bacterial cause of fever
immediately
● Follow-up in 2 days if fever persists
● If fever is present every day for more

● There is presence of measles now or ● Any general danger sign or SEVERE COMPLICATED MEASLES ● Give Vitamin A treatment
last 3 months ● Clouding of cornea or ● Give first dose of an appropriate
● Deep or extensive mouth ulcers. antibiotic
● If clouding of the cornea or pus
draining from the eye, apply
tetracycline eye ointment
● Refer URGENTLY to hospital
● Pus draining from the eye or MEASLES WITH EYE OR MOUTH ● Give Vitamin A treatment
● Mouth ulcers. COMPLICATIONS ● If pus draining from the eye, treat
eye infection with tetracycline eye
ointment
● If mouth ulcers, treat with gentian
violet
● Measles now or within the last 3 MEASLES ● Give Vitamin A treatment

months.
EAR PROBLEM
Ask ● Tender swelling behind the ear. MASTOIDITIS ● Give first dose of an appropriate
● Does the child have an ear antibiotic
problem? ● Give first dose of paracetamol for
● If yes, ask: Is there ear pain? Is there pain
ear discharge? ● Refer URGENTLY to hospital
● If yes, for how long?
● Pus is seen draining from the ear ACUTE/ CHRONIC EAR INFECTION ● Give an antibiotic for 5 days Give
Look and feel: and discharge is reported for less paracetamol for pain
● Look for pus draining from the ear. than 14 days, or ● Dry the ear by wicking Follow-up in
● Feel for tender swelling behind the ● Ear pain. 5 days
ear. ● Pus is seen draining from the ear ● Dry the ear by wicking Treat with
and discharge is reported for 14 topical quinolone ear drops for 14
days or more. days
● No ear pain and No pus seen NO EAR INFECTION ● No treatment

draining from the ear.

MALNUTRITION
● Look for signs of acute malnutrition ● Edema of both feet or COMPLICATED SEVERE ACUTE ● Give first dose appropriate antibiotic
● Look for edema of both feet ● WFH/L less than -3 z-scores or MALNUTRITION ● Treat the child to prevent low blood
● Determine WFH/L __ z-score MUAC less than 115mm and any one sugar
● Measure MUAC __ min in a child 6 of the following: ● Keep the child warm
months or older - Medical complication present ● Refer urgently to the hospital
● If WFH/L less than -3 z-scores or - Not able to finish RUTF
MUAC less than 115mm then: - Breastfeeding problem
● Check for any medical complication
present: ● WFH/L less than -3 z-scores or UNCOMPLICATED SEVERE ACUTE ● Give oral antibiotic for 5 days
- Any general danger signs ● MUAC less than 115mm and MALNUTRITION ● Give ready to use therapeutic food
- Any severe classification ● Able to finish RUTF for a child aged 6 months and
- Pneumonia with chest above
indrawing ● Counsel the mother on how to feed
● If no medical complications present: the child
- Child is 5 month or older, offer ● Assess for possible TB infection
RUTF to eat ● Advise mother when to return
o Is the child not able to immediately
finish the RUTF portion? ● Follow up in 7 days
o Able to finish RUTF potion
- Child is less than 6 months, ● WFH/L between -3 z-scores and -2 MODERATE ACUTE MALNUTRITION ● Assess the child’s feeding and
assess breastfeeding z-scores or counsel the mother on feeding
● MUAC 115mm to 125mm recommendations
● If feeding problem, follow up in 7
days
● Assess for possible TB infection
immediately
● Follow up in 30 days
● WFH/L-2 z-scores or more or NO ACUTE MALNUTRITION ● If child is less than 2 years old, assess
● MUAC 125 mm or more the child’s feeding and counsel the
mother on feeding according to the
feeding recommendations
● If feeding problem, follow up in 7
days

ANEMIA
Look ● Severe palmar pallor SEVERE ANEMIA ● Refer URGENTLY to hospital

● Look for palmar pallor. ● If a child has severe acute
- Is it: Severe palmar pallor? malnutrition and is receiving RUTF,
- Some palmar pallor? DO NOT give iron because there is
already an adequate amount of iron
in RUTF
● Some pallor ANEMIA ● Give iron

● Give mebendazole if child is 1 year or
older and has not had a dose in the
previous 6 months
immediately
● No anemia NO ANEMIA ● If child is less than 2 years old, assess

the child's feeding and counsel the
mother according to the feeding
recommendations If feeding
problem
HIV INFECTION
● Use this chart if the child is not ● Positive virological test in child or CONFIRMED HIV INFECTION ● Initiate ART treatment and HIV care
enrolled in HIV care ● Positive serological test in a child 18 ● Give cotrimoxazole prophylaxis
months or older ● Assess the child’s feeding and
Ask provide appropriate counseling to
● Has the mother or child had an HIV the mother
test ● Advise the mother on home care
● If yes: decide HIV status ● Asses or refer for TB assessment and
- Mother: positive or negative INH preventive therapy
- Child: ● Follow up regularly as per national
o Serological test positive or guidelines
negative ]

o Serological test positive or NOTE: Give cotrimoxazole prophylaxis to
negative al HIV infected and HIV exposed
● If the mother is HIV positive and children until confirmed negative after
child is negative or unknown, ask: cessation of breastfeeding
- Was the child breathing at the
time or 6 weeks before the ● Mother HIV-positive and negative HIV EXPOSED ● Give cotrimoxazole prophylaxis
test? virolgovail test in a breastfeeding ● Start or continue ARV prophylaxis
- Is the child breastfeeding now? child or only stopped less than 6 as recommended
- If breastfeeding, ask: is the weeks ago or ● Do virological test to confirm HIV
mother and child on ARV ● Mother HIV-positive, child not yet status
prophylaxis tested or ● Assess the child’s feeding and
● If no, then test: ● Positive serological test in a child provide appropriate counseling to
- Mother and child status less than 18 months old the mother
unknown: test the mother ● Advise the mother on home care
- Mother HIV positive and child ● Follow-up regularly as per national
status unknown: test the child guidelines
●
● Negative HIV test in mother or child HIV INFECTION UNLIKELY ● Treat, counsel and follow-up
existing infections

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[BOARDS REVIEW]

COMMUNITY HEALTH NURSING

● DepEd Order No. 43 - Redesigned Approach in PUBLIC HEALTH

NATIONAL LEAGUE OF PH GOVERNMENT NURSES SECONDARY

- Develop programs based on the identify needs

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● RA 1082 - 40 hours per week

ROLES AND FUNCTIONS OF

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● Original name: Board of Health of the Philippine

CRUZ, DCR | BATCH 2022 | 7

CRUZ, DCR | BATCH 2022 | 8

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CRUZ, DCR | BATCH 2022 | 10

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LEADER/MANAGER ● RA 11166 - Philippines HIV and AIDS Policy Act of

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● DOH Administrative Order 2009-0025

FORMULA ● Safe motherhood month: May

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PHILHEALTH FREE 950 pesos

BREASTFEEDING PROGRAM POSITION FOR BREASTFEEDING

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NATIONAL IMMUNIZATION PROGRAM (NIP) 2016 ● PP 46

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SUPPLEMENTARY IMMUNIZATION ACTIVITIES (SIAs) - 1 dose

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AMV 9mos 0.5ml Rashes VACCINES FOR HIGH RISK POPULATION

TETANUS- Grade 1 & 0.5ml Public schools

Route of Intramuscular (IM) 24-59 months 1 1

Drug delivery A white to off-white frozen dispersion of COMMON INTESTINAL PARASITES

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91-110% Normal No management

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- November 7 declared as National Food

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● Complicated Severe Acute Malnutrition 2 to 5 yrs 5ml 23x for 3 2ml

- Medical complication present