Course description: This course deals with concepts and principles in the provision of basic health care in terms

of health promotion/maintenance and disease prevention at the individual and family level.

COURSE OUTLINE: I.Concepts of Man II.Concepts of Health and Illness a. Dimensions of wellness b. Factors affecting health and illness c. Models of health and wellness d. Stages of illness behavior e. Levels of prevention f. Health as a multi factorial phenomenon

III PRIMARY HEALTH CARE CONCEPT A. Philippine Health Care Delivery system 1. The Department of Health 1.1 Vision Mission 1.2 National Objectives for Health 1.3 Millennium Development Goals 1.4 Levels of Health Care Facilities 2. Devolution of Health Services

B. Primary Health care as an Approach to Delivery of Health Care Services 1.Definition and Concept 2.Principles and Strategies 3.E- L- E- M-E- N- T- S of PHC E- Education for health L- Locally Endemic Diseases E- Expanded Program on Immunization M- Maternal and Child Health E- Essential Drugs N- Nutrition T- Treatment of Communicable Diseases S- Safe Water and Sanitation

4. DOH Health Programs 4.1 Integrated Management of Childhood Diseases (Overview and Case Management Process) 4.2 Reproductive Health 4.3 Rabies Control program 4.4 National healthy Lifestyle Program 4.5 Oral health Program

EVALUATION: 1.Paper and Pencil Test 2.Oral Questioning 3.Seat Works 4.Outputs of group Work

REFERENCES: Fundamentals of Nursing By: Kozier, Erb, Blais, Wilkinson Public Health Nursing In The Philippines Kalusugan Para Sa Masa

ADPCN Manual

CONCEPT: THE STUDY OF MAN

Approaches to the Study of man: 1.ATOMISTIC APPROACH includes the structure of the human body and how man function. 2.HOLISTIC APPROACH includes the study of man in all aspects of his behavior and his relationship with others in his environment.

Types of Motivation to Overcome Hardships 1.Natural forces natural for man to suffer for those whom he loves and wishes to protect them from pain and sufferings. Ex. Love of parents to their children. 2. Supernatural forces one transcends pain and suffering to a higher place in the hope of non-material reward. Ex. Offering our sufferings and pain to the Lord.

SPIRITUAL VALUES OF MAN 1.FAITH is the unquestioning belief in someone or in something or the complete trust and confidence or reliance one places in a person or a thing. - it is foundation on which HOPE rests. Ex. Faith to the Lord. Faith to the surgeon and physician to prolong their lives.

2. HOPE nourishes faith; vital factor in the health care setting because it plays a part in determining the patients prognosis on illness, state of well-being and acceptance of the dying process. Ex. Patients who might otherwise have recovered died simply because they lacked hope. 3. CHARITY means love of man for his fellowmen, this love makes one do things for another without complaint.

Examples: Nurse makes the patient comfortable in bed before leaving him for that night. Stays for a few minutes to anxious patient on the eve of surgery. Charity allows the nurse to assist the patient in overcoming one crisis after another. It allows one to give up his own pleasures while serving another without even thinking of the sacrifice it entails.

ALTRUISM taking the needs of others before his/her own needs. MAN is a unique, irreplaceable individual and a one-time being in this word.
Man as a Psycho-social Being: Can be described with his uniqueness each of whom is different from any other person. Is capable of rational, logical thinking most of the time but can be irrational when provoked.

His rational side makes him merciful, kind and compassionate. His irrational nature may make him commit criminal acts against another man. (Example: crimes of passion)

MAN AS A SOCIAL BEING Is capable of relating with others. From birth, he is endowed with the capacity to know, to like, to love, to respond to, and to appreciate the uniqueness of others.

Evokes opposite responses on circumstances within the environment or within himself. Ex. From social amiability when the circumstances are right to social hostility, disliking, and hating others when circumstances are adverse. Has capacity to cope with stressful stimuli

MAN AS SPIRITUAL BEING there is unity of man in body, mind and spirit.

Two Components that assist Man in Transcendence: 1.INTELLECT - allows man to look for the truth. - gives man ability to perceive his surroundings or the forces within

or outside him, or to understand the meaning of events as they relate to him or his loved ones. 2. WILL - expresses mans own wishes , desire or longing to do what he has set his mind to do. - gives him the power of conscious and deliberate action or self control in initiating, sustaining or terminating humanactivity.

NEEDS OF MAN Need something that is essential to the emotional and physiologic health and survival of humans. A need is basic if: 1.Its absence results in illness. 2.Its presence prevents or signals health. 3.Meeting an unmet need restores health.

THE BASIC NEEDS OF MAN 1.PHYSIOLOGICAL NEEDS need for oxygen, food, fluid, sleep, sex . 2.SAFETY NEEDS both physiological and psychological safety. 3.LOVE AND BELONGING NEEDS enhances the feeling of safety.This is the need to be a member of a group.

Our feeling of structure and security is reinforced when we know where we stand in relation to others. 4. SELF-ESTEEM NEEDS - derived from the feeling that we are valued by those around us. - when people important to us express acceptance and approval. - comes from within; it is related to the assessments of our own adequacy, our performance.

5. SELF-ACTUALIZATION NEEDS the need to reach ones potential through development of ones unique capabilities. The process of self-actualization is one that continues throughout l

Qualities that indicate achievement of ones potentials: 1.Acceptance of self and others as they are. 2.Focus of interest on problems outside self. 3.Ability to be objective. 4.Feelings of happiness and affections for others.

5. Respect for all persons. 6. Ability to discriminate between good and evil. 7. Creativity as a guideline for solving problems and carrying out interests. Characteristics of Basic Human Needs: 1.Needs are universal. 2.Needs may be met in different ways. 3.Needs may be stimulated by external and internal factors. 4.Priorities maybe altered. 5.Needs maybe deferred. 6.Needs maybe interrelated.

HUMAN RIGHTS OR RIGHTS OF MAN 1. Civil and political Rights 2. economic, Social, and Cultural Rights 3. The Filipino Bill of Rights
Project for Prelims: Rights of Children and Elderly

I. CIVIL AND POLITICAL RIGHTS 1.Right to life, liberty and security of a person. 2.Right to freedom from slavery and servitude. 3.Right to freedom from torture and cruel inhuman or degrading treatment or punishment. 4.Right to recognition as a person before the law.

5. Right to equal protection of the law. 6. Right to an effective remedy for violation of human right. 7. Right to freedom from arbitrary arrest, detention or exile. 8. Right to fair trial and public hearing by an independent and impartial tribunal. 9. Right to the presumption of innocence until guilt has been proven.

10. Right to debarment from conviction for an act which was not a penal offence at the time it was committed. 11. Right to freedom from arbitrary interference with privacy, family, home or correspondence. 12. Right to freedom of movement and residence, including the right to leave the country and return to ones country.

13. Right to asylum. 14. Right to a nationality. 15. Right to contract a marriage and find a family. 16. Right to own a property. 17. Right to freedom of thought, conscience, and religion. 18. Right to freedom of opinion and expression.

19. Right to participation in the government of ones own country. 20. Right to equal access to public service in ones country.

ECONOMIC, SOCIAL AND CULTURAL RIGHTS 1.Right to social security. 2.Right to work and free choice of employment.

3. Right to equal pay for equal work. 4. Right to just and favorable remuneration ensuring the existence worthy of human dignity. 5. Right to form and join trade unions. 6. Right to rest and leisure. 7. Right to a standard of living adequate for health and well-being (including food, clothing, housing, and medical care).

8. Right to security in the event of an unemployment, sickness, disability, widowhood, old-age or other circumstances beyond ones control. 9. Right to protection of motherhood and childhood. 10. Right to education, with parents having prior right to choose their childrens type of education.

11. Right to participation in the cultural life of ones community. 12. Right to protection of the moral and material interest resulting from ones authorship of scientific, literary, or artistic productions.

THE PILIPINO PATIENTS BILL OF RIGHTS 1.The patient has the right to considerate and respectful care, irrespective of socioeconomic status. 2.The patient has a right to obtain from his physician complete information concerning his diagnosis, treatment, and prognosis in terms the patient can reasonably expect to understand.

3. The patient has the right to receive from his physician to give informed consent prior to the start of any procedure and/or treatment and the patient has the right to know the name of the person responsible for the procedures and/or treatment. 4. The patient has the right to refuse treatment/life-saving measures and to be informed of the medical consequences of his action.

5. The patient has the right to every consideration of his privacy concerning his own medical care program. Case discussion, consultation, examination, and treatment are confidential and should be conducted discretely. Those not directly involved in the care must have the permission of the patient to be present.

6. The patient has the right to expect that all communication and records pertaining to his care should be treated as confidential. 7. The patient has the right that within its capacity, a hospital must make reasonable response to the request of patients for services. When medically permissible, a patient may be transferred to another facility only after he has received complete information concerning the needs and alternatives to such transfer.

8. The patient has the right to obtain information as to any relationship of the hospital to other health care and educational institutions in so far as his care is concerned. 9. The patient has the right to be advised if the hospital proposes to engage in or perform human experimentation affecting his care or treatment. The patient has the right to refuse or participate in such research project.

10. The patient has the right to expect reasonable continuity of care; he has the right to know in advance what appointment time the physicians are available and where. He has the right to expect that the hospital will provide a mechanism whereby he is informed by his physician or a delegate of the physician of his continuing health care requirements following discharge.

11. The patient has the right to examine and receive an explanation of his bill regardless of source of payment. 12. The patient has the right to know what hospital rules and regulations apply to his conduct as a patient.

PART II HEALTH AND ILLNESS

Definitions of terms: HEALTH is a state of complete physical, mental, and social well-being, and not merely the absence of disease. ILLNESS a. is a state in which someones needs are not sufficiently met to allow the individual to have a sense of physical and psycho-social well-being. b. is a highly personal state in which the person feels unhealthy or ill.

c. may or may not be related to a disease. An individual could have a disease and not feel ill. Ex. growth in the stomach.

DISEASE a. is an alteration in body functions resulting in the reduction of the capacity or shortening of the life-span.

b. may be described as acute or chronic, communicable, congenital, degenerative, functional, malignant, psychosomatic or idiopathic. WELLNESS a. is an integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable, within the environment where he is functioning.

b. it is a state of well-being. It means engaging in attitudes and behaviors that enhance quality of life and maximize personal potential. c. it is a choice, a way of life; a process, efficient handling of energy; integration of body, mind, and spirit, and loving acceptance of self.

c. it is an active process of becoming aware of making choices towards a higher level of wellness. Most people define and describe health as the following: 1.Being free from symptoms of disease and pain as much as possible.

2. Being able to be active and able to do what they want or must be done. 3. Being in good spirits all the time. HEALTH is a highly individual perception. Meanings and definitions of health vary considerably. An individuals definition of health may not agree with that of health professionals.

Factors That Influence an Individuals Definition of Health: 1.Developmental status 2.Social and cultural influences 3.Previous experience 4.Expectations of self 5.Perception of self

COMPONENTS OF WELLNESS: Physical Social Emotional Intellectual Spiritual Occupational Environmental

PHYSICAL The ability to carry out daily tasks, achieve fitness (e.g., pulmonary, cardiovascular, gastrointestinal), maintain adequate nutrition and proper body fat, avoid abusing drugs and alcohol or using tobacco products, and generally to practice positive life-style habits.

SOCIAL The ability to interact successfully with people and within the environment of which each person is a part, to develop and maintain intimacy with significant others, and to develop respect and tolerance for those with different opinions and beliefs.

EMOTIONAL The ability to manage stress and to express emotions appropriately. Emotional wellness involves the ability to recognize, accept, and express feelings and to accept ones limitations.

INTELLECTUAL The ability to learn and use information effectively for personal, family, and career development. Intellectual wellness involves striving for emotional growth and learning to deal with new challenges effectively.

SPIRITUAL The belief in some force (nature, science, religion, or a higher power) that serves to unite human beings and provide meaning and purpose to life. It includes a persons own morals, values, and ethics.

OCCUPATIONAL The ability to achieve a balance between work and leisure time. A persons beliefs about education, employment, and home influence personal satisfaction and relationships with others.

ENVIRONMENTAL The ability to promote health measures that improve the standard of living and quality of life in the community. This includes influences such as food, water, and air.

The seven components overlap to some extent, and factors in one component often directly affect factors in another. Example: A person who learns to control daily stress levels from a physiologic perspective is also helping to maintain the emotional stamina needed to cope with a crisis. Wellness involves working on all aspects of the model.

FACTORS AFFECTING HEALTH AND ILLNESS 1.Physical dimension 2.Emotional dimension 3.Intellectual dimension 4.Environmental dimension 5.Socio-cultural dimension 6.Spiritual dimension 7.Sexual dimension

PHYSICAL DIMENSION Genetic make-up, age, developmental level, race, and sex are all part of an individuals physical dimension and strongly influence health status and practices. Ex.1. The toddler just learning to walk is prone to fall and injure himself. 2. The young woman who has family history of breast cancer is at higher risk to develop this condition.

EMOTIONAL DIMENSIONS How the mind and body interact to affect body function and to respond to body conditions also influences health. Long-term stress affects the body systems and anxiety affects health habits; conversely, calm acceptance and relaxation can actually change body responses to illness.

Ex. 1. prior to a test, a student always has diarrhea. 2. Extremely nervous about a surgery, a man experienced severe pain following his operation. 3. Using relaxation techniques, a young woman reduces her pain during the delivery of her baby.

INTELLECTUAL DIMENSION The intellectual dimension encompasses cognitive abilities, educational background and past experiences. These influence a clients responses to teaching about health and reactions to health care during illness. They also play a major role in health behaviors.

Ex. 1. An elderly woman who has only a 3rd grade education needs teaching about a complicated diagnostic test. 2. A young college student with diabetes who is suppose to follow a diabetic diet continuously drink beer and eat pizza with friends several times a week.

ENVIRONMENTAL DIMENSION The environment has many influences on health and illness. Housing, sanitation, climate, and pollution of air, food, and water are aspects of environmental sanitation. Ex. Increased incidence of asthma and respiratory problems in large cities with smog.

SOCIOCULTURAL DIMENSION health practices and beliefs are strongly influenced by a persons economic level, life-style, family, and culture. Low-income groups are less likely to seek health care to prevent or treat illnesses; high-income groups are more prone to stress-related habits and illnesses.

Ex. 1. The adolescent who sees nothing wrong with smoking or drinking because his parents smoke and drink. 2. The person of Asian descent who uses herbal remedies and acupuncture to treat an illness.

SPIRITUAL DIMENSION Spiritual and religious beliefs and values are important components of the way the person behaves in health and illness. Ex. 1. RC require baptism for both live births and stillborn babies. 2. Jehovahs witnesses are opposed to blood transfusions.

SEXUAL DIMENSION Refers to the acceptance and the ability to achieve satisfactory expression of ones sexuality.

MODELS OF HEALTH AND WELLNESS 1.Medical/clinical model 2.Role performance model 3.World health organization definition of health 4.Health-illness continuum 5.High-level wellness 6.Needs-fulfillment model (Eudemonistic model) 7.Health belief model

MEDICAL/CLINICAL MODEL HEALTH IS THE STATE OF BEING FREE OF SIGNS OR SYMPTOMS OF DISEASE. ILLNESS IS THE PRESENCE OF SIGNS OR SYMPTOMS OF DISEASE.

ROLE PERFORMANCE MODEL HEALTH IS THE ABILITY TO PERFORM ALL THOSE ROLES WHICH ONE HAS BEEN SOCIALIZED.

WORLD HEALTH ORGANIZATION DEFINITION OF HEALTH HEALTH IS THE STATE OF COMPLETE PHYSICAL, MENTAL, EMOTIONAL, AND SOCIAL WELLBEING AND NOT MERELY THE ABSENCE OF DISEASE OR INFIRMITY.

HEALTH-ILLNESS CONTINUUM HEALTH IS A CONSTANTLY CHANGING STATE, WITH HIGH LEVEL WELLNESS AND DEATH BEING ON OPPOSITE ENDS OF A GRADUATED SCALE OR CONTINUUM.

HIGH-LEVEL WELLNESS HIGH LEVEL WELLNESS REFERS TO FUNCTIONING TO ONES MAXIMUM POTENTIAL WHILE MAINTAINING BALANCE AND PURPOSEFUL DIRECTION IN THE ENVIRONMENT.

NEEDS-FULFILLMENT MODEL (EUDOEMONISTIC MODEL) HEALTH IS A STATE IN WHICH NEEDS ARE BEING SUFFICIENTLY MET TO ALLOW AN INDIVIDUAL TO FUNCTION SUCCESSFULLY IN LIFE WITH THE ABILITY TO ACHIEVE THE HIGHEST POSSIBLE POTENTIAL.

HEALTH BELIEF MODEL THIS MODEL IS INTENDED TO PREDICT WHICH INDIVIDUALS WOULD OR WOULD NOT USE PREVENTIVE MEASURES, AS SCREENING FOR EARLY DETECTION OD DISEASE (CANCER).

COMPONENTS OF HEALTH BELIEF MODEL 1.INDIVIDUAL PERCEPTION a. perceived susceptibility (has a family history of the disease) b. perceived seriousness (concerned with the spread of the disease) c. perceived threat ( perceived susceptibility and perceived seriousness combined)

2. MODIFYING FORCES a. demographic variables (age, sex, race, ethnicity) b. socio-psychologic variables (social pressure or influence from peers or other reference groups) may encourage preventive health behaviors even when individual motivation is low. Expectations of others may motivate people. Ex. Not to drive a vehicle after drinking alcohol.

c. structural variables (presumed to influence preventive behavior are knowledge about the target disease and prior contact with it) Ex. Higher compliance rates with prescribed treatment among clients who had repeat infections and occurrence of asthma. d. cues to action (includes feelings of fatigue, uncomfortable symptoms, or thoughts about the condition of an ill person.

3. LIKELIHOOD ACTION The likelihood of a persons taking recommended preventive health actions depends on the perceived benefits of the action minus the perceived barriers to the action. Ex. of perceived benefits of the action a. Refraining from smoking to prevent lung cancer.

b. Eating nutritious food and avoiding snacks to maintain health. Ex. of perceived barriers a. Can include cost, inconvenience, unpleasantness, and life-style changes.

Other further considerations added: 1. The importance of health to the person. Ex. Special foods and vitamins, regular check-ups, participating in screening test. 2. Perceived control Ex. Not smoking Using seat belts in automobiles.

ILLNESS IT IS A STATE IN WHICH SOMEONES NEEDS ARE NOT SUFFICIENTLY MET TO ALLOW THE INDIVIDUAL TO HAVE A SENSE OF PHYSICAL AND PSYCHO-SOCIAL WELL-BEING.

STAGES OF ILLNESS BEHAVIOR

1.Symptom experience
2.Assumption of the sick role

3.Medical care contact

4.Dependent client role

5.Recovery and rehabilitation

SYMPTOM EXPERIENCE The person is aware that something is wrong. A person recognizes a physical sensation of limitation in functioning but does not suspect a specific diagnosis.

Three aspects of symptom experience 1. Physical experience of symptoms Ex. Pain, increased temperature 2. Cognitive aspect ( the interpretation of the symptoms in terms that have meaning to the person 3. Emotional response (fear and anxiety)

ASSUMPTION OF THE SICK ROLE If symptoms persist and become severe, clients assume the sick role. At this point the illness becomes a social phenomenon, and sick people seek information from their families and social groups that they are indeed ill and that they be excused from normal duties and role expectations.

MEDICAL CARE CONTACT If symptoms persist despite the home remedies, it becomes more severe or require emergency care, the person is motivated to seek professional health services. In this stage the client seek expert acknowledgment of the illness as well as the treatment.

DEPENDENT CLIENT ROLE The client depends on the health care professionals for the relief of symptoms. The client accepts care, sympathy and protection from the demands and stresses of life. A client can adopt the dependent role in a health care institution, at home, or in a community setting. The client must also adjust to the disruption of a daily schedule.

RECOVERY & REHABILITATION This stage can arrive suddenly, such as when the symptoms appeared. In the case of chronic illness, the final stage may involve in an adjustment to prolonged reduction in health and functioning.

EFFECTS OF ILLNESS 1.Impact on the client a. May experience behavioral and emotional changes. b. May have changes in self-concept and body image. c. May require life-style changes. d. Ill individuals are also vulnerable to loss of autonomy, the state of being independent and self-directed without outside control.

2. Impact on the family a. Role changes b. Task reassignments and increased demands on time c. Increased stress due to anxiety about the outcome of illness for the client and conflict about the unaccustomed responsibilities. d. Financial problems e. Loneliness as a result of separation and pending loss. f. Changes in social customs.

LEVELS OF PREVENTION OF ILLNESS OR DISEASE

1.PRIMARY PREVENTION

2.SECONDARY PREVENTION
3.TERTIARY PREVENTION

PRIMARY PREVENTION * the most desirable form of prevention. * spares the client the cost, discomforts and the threat to the quality of life that illness poses, or, at least delay the onset of illness. * consists of counseling, education, and adoption of specific health practices or changes in life-style.

Two aspects of primary level of prevention:

1.Health promotion (promotive

aspect) 2.Specific protection (preventive aspect)

HEALTH PROMOTION (PROMOTIVE ASPECT) promote positive general health. * development of good healthy habits and hygiene. * proper nutrition * proper attitude towards sickness * proper and prompt utilization of available health and medical facilities.

Types of health promotion programs: 1.Information dissemination 2.Health appraisal and wellness assessment programs 3.Life-style and behavior change programs 4.Worksite wellness programs 5.Environmental control programs

SPECIFIC PROTECTION (PREVENTIVE ASPECT) the use of measures against specific disease agents like protection of the individual, or the establishment of barriers against agents in the environment. 1.Control of the means of spread of vectors. 2.Specific immunization

Behaviors Associated With Primary levels of Prevention: 1.Quit smoking 2.Avoid/limit alcohol intake 3.Exercise regularly 4.Eat well-balanced diet 5.Reduce fat & increase fiber in diet 6.Take adequate fluids 7.Avoid over exposure to sunlight 8.Maintain ideal body weight 9.Complete immunization program 10.Wear hazard devices in worksite

SECONDARY PREVENTION (CURATIVE ASPECT) - consist of organized, direct screening efforts or education of the public to promote early case finding of an individual with disease so that prompt intervention can be instituted to halt pathologic processes and limit disability.

- early diagnosis of a health problem can decrease the catastrophic effects that might otherwise result for an individual and family from advanced illness and its many complications.

Ex. 1. Public education to promote breast self examination, use of home kit to determine occult blood in stool specimens, and familiarity with the 7 cancer danger signals. 2. Screening programs for hypertension, diabetes, uterine cancer (pap smear), breast cancer (BSE and mammography), glaucoma and sexually transmitted disease.

Behaviors Associated with Secondary level of prevention: 1.Have annual physical examination 2.Regular paps test for women 3.Monthly BSE for women who are 20 years old and above 4.Sputum examination for TB 5.Annual stool test and rectal examination for clients over age 50

TERTIARY PREVENTION (REHABILITATIVE ASPECT) * begins early in the period of recovery from illness or limitations. * consists of such activities as consistent and appropriate administration of medications to optimize therapeutic effects, moving and positioning to prevent complications of immobility, and passive and active exercises to prevent disability.

Goals of tertiary prevention: 1.Continuing health supervision during rehabilitation to restore an individual to an optimal level of functioning. 2.Minimizing residual disability and helping client to learn to live productively with limitations.

Behaviors Associated with the Tertiary level of prevention: 1.self-monitoring of blood glucose among diabetics. 2.Physical therapy after CVA (stroke)/participation in cardiac rehabilitation after MI. 3.Attending self-management education for diabetics. 4.Undergoing speech therapy after laryngectomy.

MULTIFACTORIAL PHENOMENON AFFECTING HEALTH (Factors Affecting Health) 1.Political factor 2.Cultural factor 3.Heredity 4.Environmental factor 5.Socio-economic factor

POLITICAL FACTOR * involves ones leadership, how he/she rules, manages and involves other people in decision making 1.Safety the condition of being free from harm, injury or loss. Ex. Protection from exploitative working conditions. Expanding access to social security.

2. Oppression unjust or cruel exercise of authority or power. 3. Political will determination to pursue something which is in the interest of the majority. 4. Empowerment the ability of the person to do something. - creating the circumstances where people can use their faculties and abilities at the maximum level in the pursuit of common goals.

CULTURAL FACTOR relating to the representation of nonphysical traits, such as values, beliefs, attitudes and customs shared by a group of people and passed from one generation to the next. Included are: 1.Practices 2.Beliefs

Practices a customary action usually done to maintain or promote health like use of anting-anting or lucky charms. Beliefs a state or habit of mind wherein a group of people place a trust into something or a person.

HEREDITY the genetic transmission of traits from parents to offspring; genetically determined. Ex. An asthmatic parent can produce asthmatic children. People with family history of cardiovascular diseases or hypertension

ENVIRONMENTAL is the sum total of all conditions and elements that make up the surroundings and influence the development of an individual. Ex. Air pollution Water pollution Noise pollution

SOCIO-ECONOMIC FACTOR refers to the production activities, production and consumption of goods of an individual. Ex. If the income of an individual/family is enough to sustain their needs.

PART III PRIMARY HEALTH CARE

PHILIPPINE HEALTH CARE DELIVERY SYSTEM Health Care System an organized plan of services Health Care Delivery rendering health care services to the people. Health Care delivery System the network of health facilities and personnel which carries out the task of rendering health care to the people.

Phil. Health Care System is a complex set of organizations interacting to provide an array of health services. Dept. of Health (DOH) lead agency responsible for delivering health care services to the people.

The DOH shall be responsible for the following: 1.Formulation and development of national health policies, guidelines, standards and manual of operations for health services and programs. 2.Issuance of rules and regulations, licenses and accreditations.

3. Promulgation of national health standards, goals, priorities and indicators. 4. Development of special health programs and projects and advocacy for legislation on health policies and programs.

Primary Function of DOH: promotion, protection, preservation or restoration of the health of the people through the provision and delivery of health services and through the regulation and encouragement of providers of health goods and services. (E.O. No. 119)

3. Promulgation of national health standards, goals, priorities and indicators

VISION: HEALTH AS A RIGHT. HEALTH for ALL FILIPINOS by the year 2000 and Health in the Hands of the People by the Year 2020.

MISSION: The mission of DOH, in partnership with the people to ensure equity, quality and access to health care - by making services available. - by arousing community awareness. - by mobilizing resources. - by promoting the means to better health.

LEVELS OF HEALTH CARE FACILITIES: 1. Primary Level of Health Care Facilities - services offered at this level are to individuals in fair health and to patients with diseases in early symptomatic stages. Ex. RHUs, their sub-centers, clinics, malaria eradication units, and schistosomiasis control units operated by the DOH.

Ex. Puericulture centers Tuberculosis clinics and hospitals of the Phil. TB Society Private clinics operated by PMA Clinics operated by large industrial firm for their employees Community hospitals and health centers operated by Phil. Medicare Commission Other health facilities operated by voluntary religious and civic groups.

2. Secondary Level of Health Care Facilities - services offered to patients with symptomatic stages, diseases which require moderately specialized knowledge and technical resources for adequate treatment. Ex. Smaller, non-departmentalized hospitals including emergency and regional hospitals.

3. Tertiary Level of Health Care Facilities - services rendered at this level are for clients afflicted with diseases which seriously threaten the health and which require highly technical specialized knowledge, facilities and personnel to treat effectively.

Ex. of tertiary level of health care facilities are highly technological and sophisticated services offered by medical centers and large hospitals. These are the specialized national hospitals. (Heart Center of the Phil., Lung Center, Orthopedic Hospital, etc.)

TWO-WAY REFERRAL SYSTEM A two-way referral system need to be established between each level of health care facility e.g. barangay health workers reports cases to the rural health team, who in turn refer more serious cases to either the district hospital, then to the provincial, regional or to the whole health care system.

The Phil. Health Care Delivery System is composed of two sectors: 1.Public sector - largely finance through a taxedbased budgeting system at both national and local levels. - health care is generally given free at the point of service.

2. Private sector (for profit and nonprofit providers) - is largely market-oriented. - health care is paid through user fee at the point of service.

The public sector consist of the national and local government agencies providing health services. a.National level DOH is mandated as the lead agency in health. b.Local level regional field office, regional hospitals and medical centers, provincial health teams made up of DOH representatives to the local health board, and personnel involved in communicable disease control.

Example of communicable disease control: Malaria control unit Schistosomiasis control unit The DOH as the governments lead agency in delivering health services has 5 central offices under which are key service units and programs. The main field units are the regional health offices (14 offices). Under each regional office are the provincial health offices, which in turn supervise district offices and RHUs.

1976 Rural Health units and Barangay Health Stations were established. October 10, 1991 RA 7160 Local Government Code of 1991 (otherwise known as the DEVOLUTION) was enacted. The health offices from the provincial to the municipal levels became the responsibilities of the LGUs. (Devolution of health services began on January, 1993)

Aims of the Local Government Code: To transform local government units into self-reliant communities and active partners in the attainment of national goals through a more responsive and accountable local government structure instituted through a system of DECENTRALIZATION.

With the devolution of health services, the local health system is now run by LGUs. The provincial and district hospitals are under the provincial government while the city/municipal government manages the RHUs and the BHSs. The local chief executive is the chairperson for the local health board, whose function is mainly to serve as advisory body to the local executive and the sangunian on health-related matters.

Roles of the DOH: 1.Ensuring the equal access to basic health services. 2.Ensuring the formulation of national policies for proper division of labor and proper coordination of operations among government agency jurisdictions.

3. Ensuring a minimum level of implementation of nationwide services regarded as public health goods. 4. Planning and establishing arrangements for the public health system to achieve economies of scale. 5. Maintaining a modicum of regulations and standards to protect consumers and guide providers.

NATIONAL HEALTH PLAN is the blue print which is followed by the DOH. It defines the countrys health problems, policy thrusts, strategies and targets.

The National Objectives for Health 1.Improve the general health status of the population. - reduce infant mortality rate - reduce child mortality rate - reduce maternal mortality rate - reduce total fertility rate - increase the life expectancy and quality of life

2. Reduce morbidity, mortality, disability and complications. 3. Eliminate the following diseases as public health problems: Schistosomiasis, malaria, filiariasis, leprosy, rabies, vaccine preventable diseases, vitamin A dificiency, and iodine deficiency disorders.

4. Eradicate poliomyelitis 5. Promote healthy lifestyle -promote healthy diet & nutrition -promote physical activity & fitness -promote personal hygiene -promote mental health & less stressful life -prevent smoking & substance abuse -prevent violent and risk-taking behaviors.

6. Promote the health and nutrition of families and special populations -neonatal & infant health -childrens health -adolescent & youth health -adult health -womens health -health of older people -health of indigenous people -health of overseas Filipino workers -health of rural & urban poor

7. Promote environmental health and sustainable development. -healthy homes -healthy workplace and establishments -healthy schools -healthy communities, towns and cities

Improve the general health status of the population. - reduce infant mortality rate, child mortality rate, maternal mortality rate, total fertility rate, and increase the life expectancy and the quality of life years.

MORBIDITY refers to statistics of diseases. MORTALITY refers to statistics of death. Morbidity and mortality indicate the state of health of the community and the success or failure of the health programs.

Infant Mortality Rate (IMR) this measures the risk of dying during the first year of life. - it is a good index of the general health condition of a community since it reflects the changes in the environmental and medical conditions of a community.

High Infant Mortality Rate (IMR) is noted among infants of mothers with: a. no education b. aged below 20 years and above 40 years. High IMR is noted among the following infants: a. male infants b. small or very small infants c. birth order number 7 and above.

Two most common causes of infant death: 1.Respiratory conditions of the fetus and newborn. 2.Pneumonia Other causes of infant death: congenital anomalies, diarrheal diseases, birth injuries & difficult labor, septicemia, meningitis, avitaminosis & other nutritional defficiences, measles.

Maternal Mortality Rate (MMR) measures the risk of dying related to pregnancy, childbirth, and puerperium. - it is an index of the obstetrical care needed and received by the women in the community and one of the important indicators of the nations health.

Causes of maternal death: 1.Postpartum hemorrhage 2.Sepsis 3.Obstructed labor 4.Complications from abortions Most of these causes can be prevented through quality maternal care.

Fetal Death rate (FDR) measures pregnancy wastage. Death of the product of conception occurs prior to its complete expulsion irrespective of the duration of pregnancy. Neonatal Death Rate (NDR) measures the risk of dying during the first month of life.

NDR may serve as an index of the effects of prenatal care and obstetrical management of the newborn. Crude Death Rate (CDR) is a measure of one mortality from all causes which may result in a decrease in population.

Reasons for the reduction in mortality: 1.Discovery of new, effective medicines. 2.Improved agriculture and transportation. 3.Vaccination and immunization. 4.Expansion of the delivery of health and nutrition services. 5.Improvement in safe water supply. 6.Other public health measures.

There are more male deaths than female deaths, accounting for a death sex ratio of 147 males per 100 females dying. Reasons for this: 1. women possess an inherent sexlinked resistance to some type of lifethreatening diseases. 2. men are engaged in more hazardous work than females. 3. unhealthy lifestyle of some males.

Total Fertility Rate (TFR) refers to the average number of births that a woman would have at the end of her productive life (15yrs. 45 yrs.) Life Expectancy at Birth refers to the life span. From 1946 up to the present there is rising life expectancy.

Implications of rising life expectancy 1.More people will reach old age and this means a higher proportion of elderly in the general population. 2.There will be increase in the occurrence of degenerative diseases and disabilities associated with an aging population. 3.There is a need to increase health & socio-economic inputs for programs for elderly.

Public health systems are operating within a context of ongoing changes, which exert a number of pressures on public health system. These changes includes: 1.Shifts in the demographic and epidemiological trends in diseases, including the emergence and reemergence of new diseases.

2. New technologies for health care, communication and information. 3. Existing and emerging environmental hazards some associated with globalization. 4. Health reforms. In response to the above trends, the global community , represented by the US Gen. Assembly, decided to adopt a common vision of poverty reduction and sustainable development in Sept 2000.

The vision is exemplified by the Millenium development Goals (MDGs) which is based on the fundamental values of freedom, equality, solidarity, tolerance, health, respect of nature, and shared responsibility.

Millenium Development Goals: 1.Eradicate extreme poverty and hunger. 2.Achieve universal primary education. 3.Promote gender equality and empower women. 4.Reduce child mortality. 5.Improve maternal health. 6.Combat HIV/AIDS, malaria and other diseases. 7.Ensure environmental sustainability. 8.Develop a global partnership for development.

Currently there are various country initiatives to implement a more costeffective health care services. The Health Sector Reform Agenda (HSRA) implemented through FOURmula ONE for Health and operationalized in the National Objectives for Health 2005 to 2010 spells out the program imperatives of the health sector. All these are in line with the MDGs.

Health Sector Reform Agenda (HSRA) launched last 1999 to improve the performance of the health sector and to address the inequities and inefficiencies in the delivery and financing of health services.

Health Sector Reform - is the overriding goal of the DOH. Support mechanisms will be through sound organizational development, strong policies, systems and procedures, capable human resources and adequate financial resources.

FOURmula ONE for Health this is the framework for the implementation of HSRA. Goals of FOURmula ONE for Health: 1.Better health outcomes. 2.More responsive health systems. 3.Equitable health care financing.

The 4 elements of FOURmula One for Health: 1. Health financing the goal of this health reform is to foster greater, better and sustained investments in health. The Phil. Health Insurance Corporation, through the National Health Insurance Program & the DOH through sector wide policy support will lead this component jointly.

2. Health regulation the goal is to ensure the quality and affordability of health goods and services. 3. Health service delivery the goal is to improve & ensure the accessibility and availability of basic and essential health in both public and private facilities and services. 4. Good governance the goal is to enhance health system performance at the national & local levels.

Primary Strategies to Achieve Health Goals 1.Increasing investment for primary health care. 2.Development of national standards and objectives for health. 3.Assurance of the health care. 4.Support to local health system development. 5.Support for frontline health workers.

Basic Principles to Achieve Improvement in Health 1. Universal access to basic health services must be ensured. 2. The health & nutrition of vulnerable groups must be prioritized. 3. The epidemiological shift from infection to degenerative diseases must be managed. 4. The performance of the health sector must be enhanced.

PRIMARY HEALTH CARE AS AN APPROACH TO DELIVERY OF HEALTH CARE SERVICES

Definition of PHC (by WHO) defined as essential care based on scientifically sound and socially acceptable methods and technology made universally accessible to individuals, families and communities through their full participation at a cost they can afford at any stage of development.

Goals of PHC: - Self-reliance (the ability to stand on their own; self-sufficiency. - Health for all Filipinos by the year 2000 and Health in the hands of the People by the year 2020.

History of PHC: PHC was declared during the First International Conference on primary health Care held in Alma Ata, Kazakstan on September 6 12, 1978 by WHO. (This is known as the birth of Primary health Care.) Goal Health for all by the year 2000.

The conference came up with the Alma Ata Declaration, which represents a global idea, a new vision on how to achieve world health. The declaration stated that PHC is the key to attaining the health-for-all goal.

PHC was adopted in the Philippines through LOI 949 (by Pres. Marcos) on October 19, 1979 and has an underlying theme of Health in the Hands of the People BY 2020. LOI 949 mandated the then Ministry of Health to adopt PHC as an approach towards design, development, & implementation of programs, which focus health development at the community level. (Legal bases for PHC)

Feb. 23 24, 2006 recent PHC summit showcased the various community managed health activities that has successfully placed health in the hands of the people in this country, and is a testimony that indeed the concepts of PHC as an approach to health works and has virtually changed the landscape for health care services in the country.

Concept of PHC: 1. PHC characterized by partnership and empowerment of the people shall permeate as the core strategy in the effective provision of essential health services that are community based, accessible, acceptable and sustainable at a cost, which the community and the government can afford.

2. It is a strategy, which focuses responsibility for health on the individual, his family and the community. 3. It includes the full participation and active involvement of the community towards the development of self-reliant people, capable of achieving an acceptable level of health and well-being.

4. It also recognizes the interrelationship between health and the overall political, socio cultural and economic development of society.

Principles and Strategies of PHC: 1.Accessibility, Availability, Affordability and Acceptability of health services. Strategies: a. Health services delivered where the people are. b. Use of indigenous/resident volunteer health worker with a ratio of 1 worker per 10 20 households. c. Use of traditional medicine with essential drugs.

2. Provisions of quality, basic and essential health services. Strategies: a. Training design curriculum based on community needs and priorities. b. AKS developed are on promotive, preventive, curative and rehabilitative health care. c. Regular monitoring & periodic evaluation of comm. Health worker performance by the comm. Health staff.

3. Community participation. Strategies: a. Awareness building and consciousness raising on health and health-related issues. b. Planning, implementation, monitoring & evaluation done through small group meetings (10 20 household clusters). c. selection of community health workers by the community.

d. Formation of health committees. e. Establishment of a community health organization at the parish and municipal level. f. Mass health campaigns and mobilization to combat health problems.

4. Self-reliance Strategies: Comm. Generates support (cash, labor) for health program. a. Use of local resources (human, financial, material). b. Training of comm. In leadership & management skills. c. Incorporation of income generating projects, cooperatives & small scale industries.

5. Recognition of the interrelationship of health and development. Strategies: a. Convergence of health, food, nutrition, water, sanitation and population services. b. Integration of PHC into national, regional, provincial, municipal & barangay devt. plan. c. Coordination of activities with economic planning, education, agriculture, industry, housing, public works, communication and social services.

6. Social mobilization Strategies: a. Establishment of an effective referral system. b. multi- sectoral and interdisciplinary linkage. c. Information, education, communication support using multi media. d. Collaboration between the government and non-government org.

7. Decentralization Strategies: a. Reallocation of budgetary resources. b. Reorientation of health professionals on PHC. c. advocacy for political will & support from the national leadership down to the barangay level.

Four Cornerstone / Pillars of PHC: 1.Active community participation. 2.Intra and inter- sectoral linkages. 3.Use of appropriate technology. 4.Support mechanism made available.

Types of Primary Health Workers 1. Village or Barangay health workers (V/ BHWs) this refers to trained community health workers or health auxiliary volunteer or a traditional birth attendant or healer. 2. Intermediate Level health Workers refers to general medical practitioners or their assistants, PHN, Rural Sanitary Inspectors and midwives.

ELEMENTS / Components of PHC E Education for health L Locally endemic diseases E Expanded program on immunization M Maternal & child health care E Essential drugs N Nutrition T Treatment of communicable diseases S Safe water and sanitation

Education for Health - Sum of activities in which health agencies engage to influence the thinking, motivation, judgment and action of the people. - Consists of techniques that stimulate, arouse and guide people to live healthfully. - process whereby knowledge, attitude and practice of the people are changed to improve individual, family and community.

Steps in health Education: 1.Creating awareness 2.Motivation 3.Decision-making action Aspects of health education: 1.Information provision of knowledge 2.Communication exchange of information 3.Education change in AKS

Principles of Health Education: 1.HE considers the health status of the population. 2.HE is learning. 3.HE involves motivation, experience and change in conduct and thinking. 4.HE should be recognized as a basic function of health workers. 5.HE takes place in the home, school and in the community. 6.HE is a cooperative effort.

7. HE meets the needs, interests and problems of the people affected. 8. HE is achieved by doing. 9. HE is a slow and continuous process. 10. HE makes use of supplementary aids and devices. 11. HE utilizes community resources. 12. HE is a creative process. 13. HE helps people to attain health through their own efforts. 14. HE makes careful evaluation of the planning, org. & implementation of HE programs and activities.

HE Teaching Methods & Strategies: 1.Interviewing 2. Counseling 3. Lecture discussion 4. Open forum 5. Workshop 6. Case study 7. Role play 8. Symposium 9. Group work buzz session 10. Community assembly 11. Nominal group technique (NGT) 12. Laboratory training

13. Use of IEC (information, education and communication) materials as leaflets, brochure, comics, handouts, flyers. 14. Use of publications. 15. Use of audio-visual aids, bulletin boards, billboards, posters, streamers, radio, TV, projectors, multimedia presentations 16. Use of other IEC support as fans, umbrellas, t-shirts, bookmarks, bags, hats, pens, key chains, folders & kits.

General Aims of HE: 1.To persuade people to adopt and sustain healthful life practices. 2.To use judiciously & wisely the health services available to them. 3.To make their own decisions, both individually and collectively to improve their health status and environment.

Qualities of a Good Health Educator 1.Knowledgeable / mastery of subject matter 2.Credible 3.Good listener 4.Can emphasize with others 5.Possess teaching skills 6.Flexible 7.Patience

8. Creative and innovative 9. Effective motivator 10. Able to rephrase & summarize 11. Encourages group participation 12. Good sense of humor 13.Works for the joy of it

Locally Endemic Diseases The nature of this public health program: 1. to prevent the transmission of endemic diseases through vector control. 2. detection and early treatment to reduce case and prevent deaths.

MALARIA - A systemic protozoan infection with fever, chills, sweats and headaches. - produced by intraethrocytic parasites of the genus Plasmodium which produces malaria in humans: P. Falciparum, P. Vivax, P. Ovale, & P. Malariae - Transmitted through a bite of an infected female anopheles mosquito.

Signs and Symptoms of Malaria: 1.Recurrent chills 2.Fever 3.Profuse sweating 4.Anemia 5.Malaise 6.Hepatomegaly 7.Spleenomegaly

Early Diagnosis & Prompt Treatment of Malaria: Early diagnosis is the identification of a patient with malaria as soon as he/she is seen through clinical or microscopic method. Clinical method is based on s/s of the patient and the history of his/her having visited a malaria-endemic area.

Microscopic method is based on

the examination of the blood smear of the patient through a microscope. These methods of identifying of cases is done by the Medical Technologist or Microscopist at the main Health center where there are microscopy facilities during regular consultations.

Protective and Preventive Measures: C chemically treated mosquito nets. L larvae-eating fish (stream seeding) E environmental clean up for stagnant water, cutting of vegetation overhanging along stream banks (stream clearing) A anti- mosquito soap, lotion, coils, insecticides N neem tree or other plants which are mosquito repellant.

Other preventive measures: 1.Wearing of clothing that covers arms and legs in the evening. 2.Avoiding outdoor night activities from 9 pm to 3 am. 3.Zoo prophylaxis tying of domestic animals like carabao, cow, pig, etc. near human dwellings to deviate mosquito bites from man to these animals.

Early Recognition Prevention and Control Malaria Epidemics refer to the establishment of a system that will immediately recognize an impending malaria epidemic. Malaria Epidemic is a situation where there is an incidence of new malaria cases is in excess of the expected.

Epidemic potential is a situation wherein an area is vulnerable to malaria case upsurge due to causal factors such as climatic changes, ecological changes or socio-economic changes. For chemoprophylaxis only chloroquine drug should be given to be taken at weekly intervals, starting from 1 -2 weeks before entering the endemic area. In pregnant women it is given throughout the duration of pregnancy.

DENGUE HEMORRHAGIC FEVER (H FEVER) An acute febrile infection of sudden onset with clinical manifestation of 3 stages: 1. First 4 days (febrile or invasive stage) - starts abruptly as high fever, abdominal pain and headache; later flushing which may be accompanied by vomiting, conjunctival infection and epistaxis.

2. 4th 7th day (Toxic or hemorrhagic stage) lowering of temperature, severe abdominal pain, vomiting and frequent bleeding from the gastrointestinal tract in the form of hematemesis or melena. Unstable BP, narrow pulse pressure and shock. Death may occur. Tourniquet test which may be positive on the 3rd day may become negative due to low or vasomotor collapse.

3. 7th 10th day (convalescent or recovery stage) generalized flushing with interventing areas of blanching appetite regained and BP already stable. Classification: 1.Severe, frank type 2.Moderate 3.mild

Method of Prevention and Control a.The infected individual, contacts and environment: * Recognition of the disease. * Isolation of patient (screening or sleeping under the mosquito net). * Epidemiological investigation * Case finding and reporting. * Health education

b. Control measures: * Eliminate vector by: 1. Changing water & scrubbing sides of lower vases once a week. 2. Destroy breeding places of mosquito by cleaning surroundings. 3. Proper disposal of rubber tires, empty bottles and cans. 4. Keep water containers covered. * Avoid too many hanging clothes inside the house. * residual spraying with insecticides.

PHNursing Responsibilities: 1. Report immediately to the Municipal Health Office any known case outbreak. 2. Refer immediately to the nearest hospital, cases that exhibit symptoms of hemorrhage from any part of the body no matter how slight.

3. Conduct a strong HE program directed towards environmental sanitation particularly destruction of all known breeding places of mosquitoes. 4. Assist in the diagnosis of suspect based on the signs and symptoms. For those without signs of hemorrhage, the nurse can perform the tourniquet test. 5. Conduct epidemiologic investigations as a means of contacting families, case finding & individual as well as comm. Health education.

FILARIASIS - is a chronic parasitic infection caused by nematode parasites known as Wuchereria Bancrofti, Brugia Malayi, and/or Brugia Timori which is transmitted through bites from an infected female mosquito (Aedes Poecilius) that bites at night.

The life span of an adult parasites is about 10 years (but a 40 yr. life span has been reported.) Incubation period ranges from 8 16 month (starts from the entry of the infected larvae to the development of clinical manifestations).

Asymptomatic Stage Characterized by the presence of microfilariae in the blood. No clinical S/S of the disease. Some remains asymptomatic for years but in some instances for life. Other progress to acute and chronic stages. Microfilariae increases with age and then levels off. Men have higher microfilariae rate than women.

Acute Stage Starts when there are already manifestations such as: 1. Lymphadenitis (inflammation of the lymph nodes). 2. Lymphpangitis (inflammation of lymph vessels). 3. In some cases, the male genitalia is affected leading to furonculitis, epidydimitis, or orchitis (redness, painful and tender scrotum).

Chronic Stage Develop 10 15 years from the onset of the first attack. Immigrants from areas where filariasis is not endemic tend to develop this stage more often and much sooner (1to 2 years) than do the indigenous population of the endemic areas.

Chronic Signs and Symptoms Hydrocoele (swelling of the scrotum) Lymph edema (temporary swelling of the upper and lower extremities) Elephantiasis (enlargement and thickening of the skin of lower and/or upper extremities, scrotum, breast)

Diagnosis: Physical examination is done in the main health center or during scheduled survey bites in the community. History taking Observation of the major and minor signs and symptoms.

Laboratory Examinations: Nocturnal Blood Examination (NBE) blood are taken from the patient at the patients residence or in the hospital after 8pm. Immuno chromatographic Test (ICT) it is the rapid assessment method. It is an antigen test that can be done at daytime.

Treatment: Emphasize the importance of compliance to the prescribed regimen. Inform the community of the objective of treatment which is to reduce and interrupt transmission of infection. Diethylcarbamazine Citrate (DEC) or Hetrazan is the drug given to patients with clinical manifestation and/or microfilariae.

Mass Treatment Distribution of medicine to all population (Hetrazan) Endemic and infected or not infected with filariasis in established endemic areas. The dosage is 6 mg/kg body weight taken as a single dose per year.

Supportive Care for Filariasis Advised to observe personal hygiene by washing the affected areas with soap and water at least 2x a day. Take prescribed antibiotics or antifungal for super infection.

Prevention and Control a.Measures aimed to control the vector: 1. Environmental sanitation such as proper drainage and cleanliness of the surroundings. 2. Spraying with insecticides.

b. Measures aimed to protect the individual & families in the endemic areas: 1. Use of mosquito nets. 2. Use of long sleeves, long pants and socks. 3. Application of insect repellants 4. Screening of houses. 5. health education.

SCHISTOSOMIASIS (Bilhariasis or Snail Fever) caused by a blood fluke, Schistoma Japonicum that is transmitted by a tiny snail Oncomelia Quadrasi. There is high prevalence of schistosomiasis in Region 5 (Bicol), Region 8 (Samar and Leyte and Region 11 (Davao).

Signs and Symptoms: Diarrhea Bloody stools Enlargement of the abdomen Spleenomegaly Weakness Anemia Inflamed liver (hepatomegaly)

Methods of Control: a.Preventive measures 1. educate the public in endemic areas regarding mode of transmission and methods of protection. 2. Dispose of feces and urine so that the viable eggs will not reach bodies of fresh water containing intermediate snail host.

3. Reduce snail habitats by removing vegetation or by draining and filling. 4. Treat snail-breeding site with molluscides. 5. Prevent exposure to contaminated water (use rubber boots). 6. Provide water for drinking, bathing and washing clothes from sources free of circariae or treatment to kill them. 7.Travelers visiting endemic areas should be advised of the risks and informed about preventive measures.

b. Control of Patients, Contacts and the Immediate Environment: 1. Report to local health authority in selected endemic areas. 2. Concurrent disinfection: Sanitary disposal of feces and urine. 3. Examine contacts for infection from a common source.

4. Examine for schistosomiasis and treat all who are infected, especially those with moderate to heavy intensities of egg passage; pay particular attention to children. 5. Motivate people in these areas to have annual stool examination. PRAZIQUANTEL (Biltricide) is the drug of choice against the infectious agents.

LEPTOSPIROSIS (Weils disease, Mud Fever, Trench Fever, Flood Fever, Spiroketal Jaundice, Japanese Seven Days Fever) A disease caused by bacteria called leptospires, called Leptospira interrogans. Rat is the main host.

Mode of Transmission: Through contact of the skin, especially open wounds with water, moist soil and vegetation contaminated with urine of the infected host. Leptospires are present in the blood and cerebro spinal fluid (CSF).

Signs and Symptoms: Fever Headache Nausea Vomiting Cough Chest pain Presence of leptospires in the blood and cerebro spinal fluid.

Prevention and Control: Improved education of people who are at risk (e.g. farmers, miners). Use of protective clothing, boots and gloves especially by workers with occupational hazards. Community-wide rat eradication. Segregate domestic animals from mans living, working & recreation areas.

Contprevention & control Isolation of patients and concurrent disinfection of soiled articles. Report all cases of leptospirosis. Investigation of contacts and source of infection. Chemoprophylaxis in groups at high risk of infected host.

LEPROSY It is a chronic mildly communicable disease that mainly affects the skin, the peripheral nerves, the eyes and the mucosa of the upper respiratory tract. Mycobacterium leprae The infectious agent which is detected by (SSS) Slit Skin Smear.

Early Signs and Symptoms: Change in skin color either reddish or white. Loss of sensation of the skin. Decrease/loss of sweating and hair growth over the lesion. Thickened and/or painful nerves. Muscles weakness or paralysis of extremities. Nasal obstruction or bleeding. Ulcers that do not heal.

Late Signs and Symptoms: Loss of eyebrow Madarosis. Inability to close eyelids Lagopthalmos. Clawing of the fingers and toes. Contractures Sinking of the nosebridge. Enlargement of the breast in males Gynecomastia Chronic ulcers.

Method of Transmission: 1.Airborne - inhalation of droplet / spray from coughing and sneezing of untreated leprosy patient. 2.Prolonged skin-to-skin contact Children especially 12 years and below are more susceptible.

Prevention: Avoidance of prolonged skin-to-skin contact especially with lepromatous case. Children should avoid contact with active, untreated leprosy case. BCG vaccination. Adequate nutrition. Health education.

R.A. 4073 liberalizes the treatment of leprosy which advocates home treatment. Treatment: Multi-drug Therapy (MDT) Is the use of 2 or more drugs for the treatment of leprosy. It is proven effective and renders patients non-infectious a week after starting treatment. It makes home treatment possible.

EXPANDED PROGRAM ON IMMUNIZATION This program aims to control the occurrence of preventable illnesses especially of children. The 7 vaccine preventable diseases are: tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, measles, and hepatitis.

IMMUNIZATION is the process by which vaccines are introduced into the body before infection sets in. Vaccines are administered to induce immunity thereby causing the recipients immune system to react to the vaccine that produces antibodies to fight infection.

PRINCIPLES OF EPI: 1. The program is based on the epidemiological situation; the immunization schedules are based on the occurrence and characteristics of the epidemiological features of the disease.

2. The whole community is the target of the EPI & not a single person, therefore immunization is based on the mass approach. 3. Immunization is a basic health service and such it is integrated into the health services being provided by the RHU.

ELEMENTS OF EPI: 1.Target setting 2.Cold chain logistic management 3.Information, education and communication 4.Assessment and evaluation of the programs overall performance. 5.Surveillance studies and research

THE FOUR MAJOR STRATEGIES: 1. Sustaining high routine FIC (Fully Immunized Child) coverage of at least 90% in all provinces and cities. 2. Sustaining the polio free country for global certification. 3. Eliminating measles by 2008. 4. Eliminating neonatal tetanus by 2008.

Legal Basis / Existing policies: 1.Presidential Decree No. 996 (Sept. 16,1976) Providing for compulsory basic immunization for infants and children below 8 yrs. Of age. 2.Presidential Proclamation No. 6 (April 3, 1986) Implementing a UN goal on Universal Child Immunization by 1990.

3. Presidential Proclamation No.46 (Sept. 16, 1992) Reaffirming the commitment of the Phil. To the Universal Child and Mother Immunization goal of the World health Assembly. 4. Pres. Proclamation No. 147 (March 3, 1993) Declaring April 21 and May 19, 1993 and every Wednesday of January and February thereafter for 2 years as National Immunization Days (NIDs).

5. R.A. 7846 (Dec.30, 1994) An act requiring compulsory immunization against Hepatitis B for infants and children below 8 years old. 6. Pres. Proclamation 773 (March 28, 1996) Declaring April 21 and may 19,1996 and every 3rd Wed. of April and May from 1996 to 2000 as Knock Out Polio Days.

7. Pres. Proclamation No. 1066 (Aug. 26,1997) Declaring a national neonatal tetanus elimination campaign starting 1997. 8. Pres. Proclamation No. 1064 (Aug. 27,1997) Enjoining all sectors of society to participate in the Acute Flaccid Paralysis (AFP) surveillance component of polio eradication campaign of the Philippines.

9. Pres. Proclamation No.4 (July 29, 1998) Declaring the period from Sept.16 to Oct. 14, 1998 as the Ligtas Tigdas Month launching the Phil. Measles Elimination Campaign.

Circular No. 14 of 1965 requires health examination and immunization of all prospective Gr. I pupils against smallpox, diptheria and TB as a prerequisite for enrollment. BCG immunization shall be given to all school entrants both in public and private school regardless of the presence or absence of BCG scar.

Every WEDNESDAY is designated as immunization day and is adopted in all parts of the country. In a barangay health station immunization is done monthly while in far flung areas it is done quarterly. However, some areas adopted local practices to provide everyday vaccination in their areas to cover all targets.

FEFO Vaccine (First Expiry First Out) is practiced to assure that all vaccines are utilized before its expiry date. FIC Fully Immunized Child refers to a child who receives complete immunization ( 1 dose of BCG, 3 doses of DPT, 3 doses of OPV, 3 doses of HB & 1 dose of Measles vaccine) before his/her 1st birthday.

MATERNAL AND CHILD CARE The mother and the child are the most delicate members of the community. Therefore, the maternal and infant mortality and morbidity rates are among the indicators of health of a particular community. So the protection of the mother and child to illness and other risks would ensure a good health to the community.

GOALS: 1.To ensure that each expectant mother and nursing mother maintains good health, learns the art of child care, has a normal delivery, and bears healthy children. 2.That every child should live and grows up in a family unit with love and security, in healthy surroundings, receive adequate nourishment, health supervision, and efficient medical attention, and is taught the elements of healthy living.

The Phil. Is tasked to reduce the maternal mortality ratio by 3 quarters by 2015 to achieve its mellineum development goal. This means a MMR of 112/100,000 live births in 2010 and 80/100,000 live births by 2015. 1987 to1993 - 209/ 100,000 live births 1998 172/ 100,000 live births

Underlying Causes of Maternal Deaths: 1.Delay in seeking care. 2.Delay in making referral. 3.Delay in providing appropriate medical management. Other Contributing factors: 1.Closely spaced births. 2.Frequent pregnancies.

3. Poor detection and management of high risk pregnancies. 4. Poor access to health facilities brought about by geographical distance and cost of transportation. 5. Health care and health staff who lack competence in handling obstetrical emergencies.

Overall Goal of the Program: - to improve the survival health, and well-being of mothers and unborn through a package of services for the pre-pregnancy, prenatal, natal, and post natal.

The Strategic Thrusts for 2005 2010 includes: 1.BEMOC strategy in coordination with DOH (Basic Emergency Obstetric Care). a. Entails the establishment of facilities that provide emergency obstetric care for every 125,000 population & which are located strategically.

b. Calls for families and communities to plan for childbirth. c. Upgrading of technical capabilities of local health providers. 2. Improve the quality of prenatal and postnatal care. a. At least 4 prenatal visits with time for adequate evaluation & management of diseases & conditions that may put the pregnancy at risk.

b. Post partum care after a miscarriage or unsafe abortion. 3. Reduce womens exposure to health risks through the institutionalization of responsible parenthood and provision of appropriate health care package to all women of reproductive age: a. Below 18 yrs. Old & over 35 years of age.

b. Women with low educational and financial resources. c. Women with unmanaged chronic illness. c. Women who had just given birth in the last 18 months. 4. LGUs, NGOs and other stakeholders must advocate for health through resource generation & allocation for health services to be provided for the mother and the unborn.

To address the problem: - Packages of health services are provided to the clients before and after pregnancy or delivery of a baby. Essential Health Service Packages Available in the Health Care facilities: 1.Antenatal registration. a.1st visit as early in pregnancy as possible before 4 months or during the 1st trimester.

b. 2nd visit - during the 2nd trimester c. 3rd visit - during the 3rd trimester d. Every 2 weeks - after 8th month of pregnancy till delivery. 2. Tetanus Toxoid Immunization. - given to protect newborns from neonatal tetanus. - both mother and child are protected against tetanus and neonatal tetanus.

FIM (Fully Immunized Mother) one who has received 2 doses of Tetanus Toxoid vaccination one month before delivery to protect the baby from neonatal tetanus and 3 booster dose shots to complete the 5 doses following the recommended schedule which provides full protection for both mother and child.

Tetanus Toxoid Immunization Schedule for Women

Note: If a woman received DPT in

infancy ( 3 doses of DPT in infancy ), this should be considered as TT1 and TT2. The succeeding doses will be TT3 and so forth. 3. Micronutrient Supplementation this is vital for pregnant women to prevent anemia, vitamin A deficiency, and other nutritional disorders. a. Vit. A 10,000 IU given 2x a week starting on the 4th month of pregnancy.

Do not give Vitamin A before the 4th month. It might cause congenital problems in the baby. b. Iron 60 mg / ug tablet given daily. 4. Treatment of Disease and other Conditions. There are other conditions that might occur among pregnant women which may endanger her health and complication could occur.

Follow first aid treatment: 1.Difficulty of breathing - clear airway - place in her best position - refer to hospital with BEMOC capabilities 2. Unconscious - keep on her back arms at the side

 tilt head backwards (unless trauma is suspected. lift chin to open airway clear secretions from throat give IVF to prevent or correct shock. (Do not give IVF if you are not trained to do so.) Monitor BP, RR and shortness of breath q 15 minutes. Monitor fluid given. Discontinue if puffiness develop.

Note: Do not give oral rehydration to a woman who is unconscious or has convulsions. 3. Post-partum bleeding - massage uterus and expel clots. - massage fundus in a circular motion.

5. Clean and Safe Delivery The presence of a skilled birth attendant will: 1.Ensure hygiene during labor and delivery. 2.Prove safe & non traumatic care 3.Recognize complications 4.Manage and refer the woman to a higher level of care when necessary.

Home deliveries for normal pregnancies attended by licensed personnel shall be encouraged. TBAs may be allowed to attend home deliveries in the following circumstances: 1.In areas where there are no licensed health personnel on maternal care. 2.When, at time of delivery, such personnel is not available.

The following are qualified for home deliveries: 1.Full term 2.Less than 5 pregnancies 3.Cephalic presentation 4.Without existing disease 5.No history of complications like hemorrhage during previous deliveries.

6. No history of difficult delivery and prolonged labor. 7. No previous CS operation 8. Imminent deliveries ( those who are about to deliver and can no longer reach the nearest health facility in time of delivery. 9. No premature rupture of membranes

10. In case of imminent deliveries by risk mothers they should be referred to the appropriate level health facility if the risk remains after delivery but the risk condition has disappeared then no referral is needed. 11. Adequate pelvis 12. Abdominal enlargement is appropriate for AOG.

Pointers for home delivery: observe and follow strictly the three cleans to prevent infection 1. Clean hands 2. Clean surface 3. Clean cord Safe Delivery attendant must be aware of early signs of complication to be able to refer properly and timely.

Guide for home Delivery 1.For registered patients: a. Time when regular pains started. b. Whether bag of water has ruptured. c. presence or absence of vaginal discharge, bleeding, etc

d. Whether the mother has moved her bowels or urinated. e. Fetal movements are felt by mother or not. f. Unusual symptoms (bleeding, headache, spots before eyes. 2. For Unregistered patients get the same information as those for registered patients. - get medical and obstetrical history.

Preparation for Delivery: a.First Stage 1.Wash hands with soap and water, prepare room and bed; set up things needed for del. 2.Explain to the mother the course of labor and reasons for the procedure. 3.Palpate abdomen to determine presentation.

4. Listen to fetal heartbeat. 5. Take BP, temperature and pulse. 6.Examine for presence of edema 7. Examine vulva to determine if there is a show, bleeding or bulging. 8. Note interval, duration and intensity of uterine contractions. 9. Empty bladder when full.

10. Put Kelly pad or newspaper under the buttocks of mother. 11. Give enema if indicated. 12. If a mother has not taken a bath, scrub from waist to knee with soap and water. 13. Give soft diet during early labor.

b. Second Stage: 1. Cleanse vulva with soap and water/ mild disinfectant. 2. Put on mask and scrub hands with clean brush in soap and water. 3. Put on clean gown or apron. 4. Wear sterile rubber gloves. 5. Set up sterile area.

6. Line Kelly pad with clean towel. 7. As the head crowns encourage the mother to bear down slowly to avoid sudden expulsion of the head to prevent extensive laceration of the perineum. 8. Protect perineum; do not press the head of the fetus to avoid injury to the brain.

9. Grease hand on either side between extended fingers and palms of hands. Feel to determine if the cord is around the neck. If it is loose, slip it over the shoulder or head. If it is tight, clamp it with clamps and cut in between. Wipe nose and mouth with dry gauze. 10. As the head restitutes and rotates, give steady, gentle downward pull to allow the anterior shoulder to go under symphysis pubis.

Slowly give upward lift to allow the shoulder to slide over the perineum. 11. After the trunk and legs are born, lay the baby on his / her right with a clean receiver on the abdomen of the mother if he/she breathes readily. If not, with face downward, hold up by the feet, remove mucus from the throat with care.

c. Third Stage: I. The mother: 1. Place placenta in the basin against the perineum and lay maternal end of the cord with the clamp in the basin. 2. Do not interfere with the delivery of the placenta. When signs of the separation are present, apply fundal pressure

3. Signs of placental separation: - lengthening of the cord - gushing of blood - raising of the fundus 2 fingers above globular in shape. 4. note the amount of blood loss. 5. Watch out for hemorrhage at least 1 hour after delivery.

6. Instruct family members to watch mother for signs of hemorrhage at least 2 hours after the nurse or midwife has the house after delivery. 7. Encourage family planning. II The Baby: 1. As soon as the baby is breathing normally and pulsation of the cord ceases, clamp the cord with 2 clamps and cut between them.

2. Wipe eyes of baby with cotton and instill ophthalmic ointment. 3. Place baby in receiving blanket and have helper keep him warm in a safe place. 4. Examine baby for trauma and malformation. 5. Take and record weight, length, temperature and general appearance. 6. Dress cord asseptically.

7. Spread the Vernix Caseosa. 8. Put dress of baby and keep warm. 9. Fill up birth certificate. APGAR Scoring evaluation of the infants condition at birth. It is done at 1 minute and 5 minutes after delivery.

Breastfeeding a.Benefits to the infants: 1. Provides nutritional complete food for the young infant. 2. Strengthens the infants immune system preventing many infections. 3. Reduces the infants exposure to infection.

4. Rehydrates and provides essential nutrients to a sick child, especially to those suffering from diarrheal diseases. 5. Increases IQ points. b. Benefits to the mother: 1. Reduces a womans risk for excessive blood loss after birth. 2. Provides a natural method of delaying pregnancies.

3. reduces the risk of ovarian and breast cancers and osteoporosis. c. Benefits to household and community: 1. Conserve funds 2. saves medical cost to families and government.

ESSENTIAL DRUGS This program focuses on the information campaign on the proper utilization and acquisition of drugs. R.A. 6675 (Generics Act of 1988) is an act to promote, require, and ensure the production of adequate supply, distribution, use and acceptance of drugs and

medicine identified by their generic names. Medicines are prescribed in generics. GMA 50 (Gamot na Mura, Abot kaya) is a project to ensure that affordable, high quality, safe and effective drugs and medicines are always available, especially to the poor.

Strategies that GMA 50 will employ: a.Short-term 1.Continue the importation of high quality, safe, effective and affordable drugs and medicines for as long as the prices in the country remain high. 2.Expand, as appropriate the list of drugs and medicines for importation 3.Increase the number of outlets.

b. Medium and long-term strategies 1. Promote the use of Generic drugs and medicines. 2. Ensure continuous supply of high quality, safe, effective and affordable drugs and medicines, whether imported or locally manufactured.

NUTRITION PROGRAM addresses the problem of malnutrition among mothers and children. - it focuses on deficiencies in iron, iodine, and vitamin. The health stations serve as distribution centers where the micronutrients can be given.

Goal of the Program : to improve quality of life of the Filipinos through better nutrition, improved health, and increased productivity. Objectives: 1.To increase the food and dietary energy intake of the average Fil. 2.To prevent nutritional deficiency diseases and nutrition-related chronic degenerative diseases. 3.To promote healthy well-balanced

Programs and Projects: 1.Micronutrient Supplementation is one of the interventions to address the health and nutritional needs of infants and children and improve their growth and survival. a. Twice a year distribution of Vitamin A capsules through Araw ng Sangkap Pinoy

Araw ng sangkap Pinoy is known as Garantisadong Pambata is the approach adopted to provide micronutrient supplements to 6 7 years old pre schoolers on a nationwide scale. - is a campaign to support various health programs to reduce childhood illnesses & deaths by promoting positive child care

- giving vitamin A capsule supplement to all 12 59 months old children. - distribution of iron supplements to infants and pregnant mothers. - promotion of positive child care behaviors: 1. exclusive breastfeeding of infants 0 to 6 months.

2. feeding infant micronutrient rich complementary foods starting 6 months old. 3. using iodized salt daily 4. buying and eating fortified foods 5. brushing of teeth properly and regularly. 6. no smoking in front of pre schoolers.

2. Food Fortification addition of essential nutrients to a widely consumed food products. Food Fortification Act of 2000 provides for the mandatory fortification of staples: flour with iron and vitamin, cooking oil and refined sugar with vitamin A, and rice with iron, and the voluntary fortification of processed foods through the Sangkap Pinoy Seal.

ASIN LAW encourages families to use iodized salt every day for seasoning or in cooking. - utilization of iodized salt in the household to decrease the Iodine Deficiency Disorders (IDD). 3. Essential maternal and child health service package: a. breast feeding b. complementary feeding

c. micronutrient supplementation 4. Nutrition information, communication, and education this includes the promotion to nutritional guidelines for Filipinos and other nutrition key messages and training of health workers. 5. Home, school and community food production: - establishment of kitchens.

 gardens in homes, schools and in communities ( to serve as source of additional food for the homes and establishment of demonstration centers and nurseries). distribution of planting materials. 6. Food assistance includes center based complimentary feeding for wasted/ stunted children and pregnant women with delivering low in birth weight. (Done in schools.)

This includes: - rice distribution done in school(LGU) - food discounts provided through Tindahan Natin Program. 7. Livelihood assistance is done by provision of credit and livelihood opportunities to poor households especially those with malnourished children through linkage with lending and financial institutions.

TREATMENT OF COMMUNICABLE DISEASES - CDs are often the most often leading causes of illnesses in the country today. - the young and the elderly are most vulnerable to CDs. - has numerous economic, psychological,disabling and disfiguring effects to afflicted ind.

Objectives: 1. To provide knowledge about the nature of various CDs, the etiology, mode of transmission, signs and symptoms, incubation period, period of communicability, treatment, prevention and control as embodied in the policies and standards of public health programs developed by DOH.

2. The role of PHN in the prevention and control of these diseases. R.A. No. 3573 declared that all CDs shall be reported to the nearest health station, and that any person be inoculated, administered or injected with prophylactic preparations. No person shall refuse or hinder / obstruct these protective measures deemed advisable by the Secretary of Health or authorized representative.

SAFE WATER AND SANITATION Environmental Health is a branch of public health that deals with the study of preventing illnesses by managing the environment and changing peoples behavior to reduce exposure to biological and non-biological agents of disease and injury.

This definition by John Tomarro suggests that environmental health deal with disease agents, people and the environment. Ex. The people in the community by cleaning their environment and destroying the breeding sites of mosquitoes prevents mosquitoborne diseases from spreading in the community.

Environmental Sanitation is defined as the study of all factors in mans physical environment, which may exercise a deleterious effect on his health well-being and survival. Included in these factors are: 1.Water sanitation 2.Food sanitation 3.Refuse and garbage disposal

4. Excreta disposal 5. Insect vector and rodents control 6. Housing 7. Air pollution 8. Noise 9. Radiological Protection 10. Institutional sanitation 11. Stream pollution

Environmental and Occupational health Office (EOHO) is responsible for the promotion of healthy environmental conditions and prevention of environmental related diseases through appropriate sanitation strategies. - this is under the National Center for Disease Prevention and Control Program of the DOH.

- promotes and provides technical assistance on sanitation programs which is geared towards the elimination and control of environmental factors in disease transmission in all households. - responsible for conceptualizing new programs or projects to contend with emerging environmentally related problems.

Major Environmental health and Sanitation Programs: 1.Water supply sanitation program 2.Proper excreta and sewage disposal program 3.Food sanitation program 4.Hospital waste management program

5. Program on Health risk minimization due to environmental pollution P.D. 856 code of sanitation P.D. 825 provides penalty for improper disposal of garbage and other forms of uncleanliness. R.A. 6969 Toxic Substances and Hazardous and Nuclear Waste Control Act of 1990

- Regulates the importation, use, movement, treatment and disposal of toxic chemicals and hazardous and nuclear waste in the Philippines. R.A. 8749 Clean Air Act of 1999 provides comprehensive air pollution management and control program to achieve and maintain healthy air.

R.A. 9003 Ecological Solid Waste Management Act of 2000 declares the adaption of a systematic, comprehensive, and ecological solid waste management program as a policy of the state. (Composting and recycling) R.A. 9275 Clean Water Act of 2004.

- this law aims to establish wastewater treatment facilities that will clean wastewater before releasing into the bodies of water like the rivers and seas. Safe water and sanitation access to a potable water is within 250 meters or 10-minute walk from toilets. - sanitary toilets is a must for every family.

Nursing responsibilities: 1.Health education 2.Actively participate in the training component of the service like in the food handlers class, and attend training workshops related to environmental health. 3.Assist in the deworming activities for the school children and targeted groups.

4. Effectively and efficiently coordinate programs/ projects/ activities with other government and non-government agencies. 5. Act as advocate or facilitator to families in the community in matters of program/ projects/ activities on environmental health in coordination with other members of RHU especially the sanitary inspectors.

6. Actively participate in environmental sanitation campaigns and projects in the community. 7.Be a role model for others in the community to emulate in terms of cleanliness in the home and surroundings. 8. Participate in research/ studies to be conducted in their respective areas of assignments.

9. Help in the interpretation and implementation of P.D. 856 commonly known as the Sanitation Code of the Philippines. 10. Assist in the Disaster management, which will be implemented at all levels.