COMMUNITY HEALTH NURSING

LEVELS OF HEALTH CARE SERVICES

3

THE PUBLIC HEALTH NURSE

5

Qualifications and Functions

6

Must be professionally qualified

and licensed to practice in the arena of public health nursing Consistent with the nursing law of 2002 (RA 9173)

Management function

in the practice of PHN Performs PSODC & Program Manager Organizes the nursing service of the local health agency Supervisory function Supervisor of the midwives and other health workers

Inherent

Nursing care function Inherent function of the nurse Based on the science of art and caring Caring for all levels of clientele toward health promotion and disease prevention Collaborating and coordinating function

Care coordinators for communities and their members Establishes linkages and collaborative relationships with other health professionals, government agencies, private sectors, NGOs peoples organizations to address health problems

Health promotion and education function

goes beyond health teachings and health information campaigns Training function Initiates the formulation of staff development and training programs for midwives and other auxiliary workers

Activities

10

Research function
Participates

in the conduct of research and utilizes research findings in her practice Disease surveillance Measure the magnitude of the problem Measure the effect of the control program

NURSING PROCEDURES
11

12

Clinic visit Patient visits the health center

Most common is BP measurement

Home visit Family-nurse contact The PHN visits the patient Bag technique Tool by which the nurse during her visit will enable her to perform a nursing procedure with ease and deftness, save time and effort Most important principle

Minimize if not prevent the spread of any infection Contain all necessary articles Cleaned very often Well protected Arrangement-most convenient

Important points to consider in the use of the bag

PUBLIC HEALTH PROGRAMS

13

PUBLIC HEALTH PROGRAMS

14

Sets of interventions put together to operationalize

policies and standards directed towards the prevention of certain public health problems

FAMILY HEALTH NON-COMMUNICABLE DISEASE PREVENTION AND CONTROL COMMUNICABLE DISEASE PREVENTION AND CONTROL ENVIRONMENTAL HEALTH AND SANITATION OTHER PRIORITY HEALTH PROGRAMS

Sentrong Sigla Herbal Medicine Health Emergency Preparedness and Response Program National Voluntary Blood Services Program Botika ng Barangay

FAMILY HEALTH
15

BASIC UNIT OF THE COMMUNITY CONCERNED WITH THE HEALTH OF THE MOTHER, UNBORN, NEWBORN, INFANT, CHILD, ADOLESCENT AND YOUTH, ADULT MEN AND WOMEN AND OLDER PERSONS

FAMILY HEALTH
16

Maternal Health Program Family Planning Program Child Health Programs

EPI
Management of Childhood Illnesses Nutrition Program Oral Health Program Adolescent Health Program Adult Men, Women Older Person Philippine Reproductive Health

FAMILY HEALTH..
17

Aims to: Improve the survival, health and well being of mothers

and the unborn

Pre-pregnancy Prenatal Natal Postnatal stages Children 0-9 years old Among Filipino adults and older persons and improve quality life Mortality from preventable causes among adolescents and young people

Reduce morbidity and mortality rates:

1. MATERNAL HEALTH PROGRAM

18

Tasked to reduce MMR by three quarters by 2015 to achieve MDG a. Antenatal Registration b. Tetanus Toxoid Immunization c. Micronutrient Supplementation d. Treatment of Diseases e. Clean and Safe Delivery

Maternal Mortality Rate (2003)

19

CAUSE Other Complications related to pregnancy occurring

in the course of labor, delivery and puerperium Hypertension complicating pregnancy, childbirth and puerperium (25%) Postpartum hemorrhage (20.3%) Pregnancy with abortive outcome (9%) Hemorrhage related to pregnancy

Strategic thrusts for 2005-2010

20

Launch and implement Basic Emergency and Obstetric

Care (BEMOC) strategy in coordination with DOH

Entails establishment of facilities that provide emergency obstetric care for every 125,000 population and which are located strategically

Improve quality of prenatal and postnatal care Pregnant women should have at least four (4) prenatal visits Reduce womens exposure to health risks Institutionalization of responsible parenthood Stakeholders must advocate for health Resource generation and allocation for health services

21

Essential Health Service Packages

Prenatal Period of pregnancy visits 1st visit As early in pregnancy as possible before four months or during the first trimester 2nd visit During the 2nd trimester 3rd visit During the 3rd trimester Every two After 8th month of weeks pregnancy till delivery
ANTENATAL REGISTRATION

Micronutrient supplementation
22

Vitamins Vitamin A

Dose 10,000 IU

Iron

Schedule 2x a week starting on the 4th month of pregnancy 60mg/400 ug Daily tablet

Remarks Do not give Vitamin A before 4th month of pregnancy. It might cause congenital problems in the baby

Recommended Schedule for Post Partum Care Visits

23

1st visit

1st week post partum preferably 3-5 days

2nd visit

6 weeks post partum

2. FAMILY PLANNING PROGRAM

24

Annual Population Growth

2.36%

Population expected to double in 29 years Total fertility rate

3.5 children/woman 3 to 4 million getting pregnant/year 85% expected to progress full term 44% women got pregnant with 1st child ages 20-24 6.1% Ages 15-19 35-39 highest percentage of using contraceptives 15-19 lowest percentage

National Demographic and Health Survey (2003)

25

Married women 48.8% - use any form of contraceptive method 33.4% - modern method 15.5% - traditional method 51.1% - do not use any form of contraceptive method

Family Planning Methods

26

Female sterilization Cutting or blocking two fallopian tubes (BTL) Male sterilization Vas deferens is tied and cut or blocked through a small opening on the scrotal skin (Vasectomy) Effective 3 months after the procedure Pill Hormones estrogen and progesterone Taken daily PO Male condom Thin sheath of latex Dual protection from STIs including HIV

27

Injectables Synthetic hormone progestin which suppresses ovulation, thickens cervical mucus LAM Postpartum method of postponing pregnancy based on physiological infertility experienced by breast feeding women Effective only for a maximum of 6 months postpartum Mucus/Billings/Ovulation Abstaining from SI during fertile days Can not be used by woman with unusual disease or condition that results in extraordinary vaginal discharge that makes observation difficult

28

BBT Identifying the fertile and infertile period by daily taking and recording rise in BT during and after ovulation Temp is taken 3 hours of undisturbed rest (usually morning) Sympto-thermal method Combination of BBT and Billing/Mucus method Two day method Simple fertility awareness based method
Cervical secretions as an indicator of fertility Checking the presence of secretions daily

Standard days method Users with menstrual cycle between 26 and 32 days are counseled to abstain from SI on days 8-19 to avoid pregnancy

Misconception about Family Planning Methods

29

Some family planning methods causes abortion Abortion is termination of pregnancy; family planning prevents pregnancy

Using contraceptives will render the couples sterile Only vasectomy and BTL considered permanent methods and chosen by the couples who have completed desired family size
Using contraceptive methods will result to loss of

sexual desire

Contraceptives free the couple from unwanted pregnancies, this enhances couples sexual relationship

3. CHILD HEALTH PROGRAMS

30

Main goal is to reduce morbidity and mortality rates for children 0-9 years old

Strategic thrusts for 2005-2010

31

Pursuing the sentrong sigla initiative Apply REB strategy for immunization Intensify health education and information campaign

IMCI and BEMOC strategy

Implementation of laws and policies for the protection

of newborns

Early Childhood Development Act of 2000 Newborn Screening Act of 2004 EO 286, Bright Child Program EO 51, Milk Code Rooming-in and Breastfeeding Act

Infant and Young Child Feeding (IYCF)

32

Global Strategy for IYCF issued jointly by the WHO

and UNICEF in 2002 as endorsed by the World Health Assembly in May 2002 and the UNICEF Executive Board in September 2002

33

Strategy calls for the: Promotion of breastmilk as the ideal food for the healthy growth and development of infants Exclusive breastfeeding for the first 6 months of life Overall objective: Improve the survival of infants and young children by improving their nutritional status, G & D through optimal feeding

National Plan of Action for 2005 2010 for IYCF

34

GOAL Reduce Child Mortality Rate by 2/3 by 2015 OBJECTIVE Improve health and nutrition status of infants and young children OUTCOME Improve exclusive and extended breast feeding and complementary feeding

35

Specific Objectives 70% of newborns are initiated to breastfeeding within one hour after birth 60% of infants are exclusively breastfed up to 6 months 90% of infants are started on complementary feeding by 6 months of age Median duration of breastfeeding is 18 months Key messages on IYCF Initiate breastfeeding within 1 hour after birth Exclusive for the first 6 months of life Complemented at 6 months, excluding milk supplements Extend breastfeeding up to 2 years and beyond

National IYCF strategy

36

Health Facilities Mother-baby friendly hospitals Health workers

Advocates Protectors Promoters of IYCF Enforcers of laws, not violators

Family/Community Supportive family Milk Code vigilantes Lay/Peer counselors IYCF bayanihan spirit Mother-baby friendly public places

37

Working places Maternity leave Lactation/Breastfeeding room Breastfeeding breaks Industry Comply with the Code

Schools Introducing the breastfeeding culture

Laws that protects IYCF

38

EO 51, Milk Code Rooming-in and Breastfeeding Act of 1992 RA 8976, Food Fortification Law of 2000

4. EXPANDED PROGRAM IMMUNIZATION

39

General principles which apply in vaccinating children

40

Safe and immunologically effective to administer all

EPI vaccine on the same day at different sites of the body Measles vaccine should be given as soon as the child is 9 months old

9 months 85% protection 1 year above 95% protection

Vaccination schedule should not be restarted from the

beginning even if the interval between doses exceeded the recommended interval by months or years Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindicated to vaccination; unless the child is so sick that he needs to be hospitalized

41

Absolute contraindications to immunizations are: DPT2 or DPT3 to a child who has had convulsions or shock within 3 days the previous dose Vaccines containing the whole pertussis component should not be given to children with an evolving neurological disease Live vaccines like BCG must not be given to immunosuppressed due to malignant disease (child with clinical disease), therapy with immunosuppressive agents or irradiation

Safe and effective with mild side effects after

vaccination. Local reaction, fever and systemic symptoms can result as part of the normal immune response

42

Giving doses of vaccine at less than the recommended 4

weeks interval may lessen the antibody response. Lengthening the interval between doses of vaccines leads to higher antibody levels No extra doses must be given to children who missed a dose of DPT/HB/OPV/TT Strictly follow the principle of never, ever reconstituting the freeze dried vaccines in anything other than the diluents supplied with them Repeat BCG vaccination if the child does not develop a scar after the 1st injection Use one syringe one needle per child during vaccination

Routine Immunization Schedule for Infants

43

A child is said to be Fully Immunized Child (FIC)

when a child receives 1 dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HB and 1 dose of measles before a childs 1st birthday

Routine Immunization
44

Vaccine

Minimum age at 1st dose

Number of doses

Minimum interval between doses

BCG
DPT OPV Hep B

Birth or anytime after birth

6 weeks 6 weeks At birth

1
3 3 3

None
4 weeks 4 weeks 6 weeks interval 1st to 2nd dose; 8 weeks from 2nd to 3rd dose None

Measles

9 months

Tetanus Toxoid Immunization Schedule for Women

45

Vaccine
TT1 TT2 TT3 TT4 TT5

Minimum age/interval Early during pregnancy 4 weeks later

6 months later 1 year later 1 year later

% protected

Duration of protection

80% 95% 99% 99%

3 yrs for the mother 5 yrs for the mother 10 yrs for the mother Lifetime for the mother; All infants born will be protected

EPI vaccines and characteristics

46

Most sensitive to heat

Oral Polio (live attenuated) Measles (freeze dried)

Least sensitive to heat

-15C to -25C (at the freezer) -15C to -25C (at the freezer) DPT/Hep B +2C to +8C (in the body of D toxoid; wekened toxin the refrigerator) P killed bacteria T weakened toxin Hep B +2C to +8C (in the body of the refrigerator) BCG (freeze dried) +2C to +8C (in the body of the refrigerator) Tetanus Toxoid

Cold Chain Equipments

47

Cold Room Freezer Refrigerator

Transport Box
Vaccine Carrier Thermometers Cold chain monitor Ice packs Temperature monitoring chart Safety collector boxes

Administration of Vaccines
48

VACCINE

DOSE

ROUTE

SITE

BCG
DPT OPV Measles Hep B

.05 ml
.5 ml 2 gtts .5 ml .5 ml

ID
IM PO SC IM

Right Deltoid
Thigh Mouth Upper arm Thigh

T.Toxoid

.5 ml

IM

Deltoid

5. Management of Childhood Illnesses

49

ASSESSING THE PATIENT CLASSIFYING THE DISEASE PINK SEVERE DANGER SIGNS - HOSPITAL YELLOW MODERATE MAJOR SYMPTOMS OUT PATIENT HEALTH GREEN MILD OTHER SIGNS HOME TREATMENT

TREATING THE PATIENT

COUNSELING THE PATIENT

T HE IN T EG R AT ED CA SE MA N AG E ME N T P ROCESS
OUTPATIENT HEALTH FACILITY

Check for DANGER SIGNS 1. Convulsions, 2. Lethargy/Unconsciousness, 3. Inability to drink/Breastfeed, 4. Vomiting Assess MAIN SYMPTOMS 1. Cough/Difficulty Breathing, 2. Diarrhea, 3. Fever, 4. Ear Problems Assess NUTRITION and IMMUNIZATION STATUS and POTENTIAL FEEDING PROBLEMS Check for OTHER PROBLEMS
CLASSIFY CONDITIONS and IDENTIFY TREATMENT ACTIONS According to Color-Coded Treatment Charts

PINK
OUTPATIENT HEALTH FACILITY Urgent Referral Pre-referral Treatments Advise Parents Refer Child

YELLOW Treatment at Outpatient Health Facility

OUTPATIENT HEALTH FACILITY Treat Local Infection Give Oral Drugs Advise and Teach Caretaker Follow-up

GREEN
Home Management

PINK
REFERRAL FACILITY Urgent Referral Emergency Triage and Treatment (ETAT) Diagnosis Treatment Monitoring and Follow-up

HOME Caretaker is counselled on how to: Give oral drugs Treat local infections at home Continue feeding When to return immediately Follow-up

50

6. Nutrition Program
51

Common nutritional deficiencies Vitamin A Iron iodine

Nutrition Programs and Projects

52

Micronutrient Supplementation Araw ng Sangkap Pinoy (Garantisadong Pambata)

Twice a year distribution of Vit. A capsule to children 6 71 mos

Food Fortification Program (RA 8976) Addition of essential nutrients to a widely consumed food product Mandatory fortification of staples namely;
Flour

with Iron and Vitamin A Cooking oil and refined sugar with Vitamin A

Voluntary fortification of processed foods through sangkap pinoy seal

Nutrition Programs and Projects

53

Essential Maternal and Child Health Service Package Breast feeding Complementary feeding Micronutrient Supplementation Nutrition information, communication and

education Home, School and Community Food Production Food Assistance Livelihood Assistance

Nutritional guidelines for micronutrient supplementation

54

TARGET Infants 6 11 months

PREP 100,000 IU

DOSE 1 dose only

REMARKS 1 cap given anytime during 611 mos but usually given 1t 9 mos during the measles immunixation

Children 12 71 months

200,000 IU

1 cap every 6 months

Universal Supplementation of Vitamin A

Supplementation for pregnant and post partum women

55

TARGETS Pregnant

PREP 10,000 IU

DOSE 1 cap 2x week

DURATION 4th month till delivery

REMARKS Should not be given who are already taking pre-natal vitamins that also contain Vit. A

Post-partum

200,000 IU

1 cap

One dose only within 4 weeks after delivery

Vit. A of 200,000 IU should not be given to pregnant women

6. Oral Health Program

56

Classifications of oral intervention

PREVENTIVE Oral examination Oral hygiene Pit and fissure sealant Flouride utilization program CURATIVE Permanent filling Gum treatment Atraumatic restorative treatment Temporary filling Extraction Drainage of localized oral abscess PROMOTIVE SERVICES Health education

REPRODUCTIVE HEALTH
57

A state of complete physical, mental and social

well-being and not merely the absence of disease or infirmity in all matters relating to the reproductive system and to its functions and processes.

CONCEPTS
58

1. 2. 3.

4.

5.

6. 7.

A married couple has the capability to reproduce/procreate. RH is the exercise of reproductive right with responsibility (e.q. it is the freedom to when and how to do so) Includes sexual health for the purpose of enhancement of life and personal relations (sexual health means protection from STD, from harmful reproductive practices and violence, control and freedom over sexual relations. Means safe pregnancy and delivery. The right of access to appropriate health information and services to enable woman to go through pregnancy and childbirth safely. Includes protection from unwanted pregnancy by having access to safe and acceptable methods of family planning of their choice. Includes protection from harmful reproductive practices and violence. Assures access to information on sexuality to achieve sexual enjoyment.

VISION
59

Reproductive health practice as a way of life for

every man and woman throughout life.

GOALS
60

To achieve healthy sexual development and

maturation Achieve their reproductive intention Avoid illness/diseases, injuries, disabilities related to sexuality and reproduction Receive appropriate counseling and care of RH problems
Every pregnancy should be intended Every birth should be healthy Every sex act should be free of coercion and infection Achieve a desired family size

STRATEGIES
61

Increase and improve the use of more effective or modern contraceptive methods. Increase the type of methods offered available in the program Provision of care; treatment and rehabilitation for RH, if possible in all facilities (clinic & hospital) RH care provision should be focused on adolescent, men and unmarried and other displaced people with RH problems. Strengthen outreach activities and the referral system Prevent specific RH problems through information dissemination and counseling of clients with RH problems.

TEN ELEMENTS OF RH
62

Maternal and Child Health Nutrition Family planning Prevention and Management of Abortion Complications Prevention and Treatment of RTI including STDs, HIV and AIDS Education and Counseling on Sexuality and Sexual Health Breast and Reproductive Tract Cancers and other Gynecological conditions Mens Reproductive Health Adolescent Reproductive Health Violence against Women (VAW) Prevention and Treatment of Infertility and Sexual Disorder

Factors/Determinants of Reproductive Health

63

1.
1. 2. 3. 4.

Socio-economic conditions
Poverty Nutrition Living condition Family environment

Family surroundings influence the familys knowledge, attitudes and practices (KAP) Many still adhere to superstitious beliefs in terms of health practices among the elders and tend to pass it on to the next generation. Decision of other members may prevail even against the will of the concerned individual.

2.

Status of women

64

Destined to bear and raise children

Reducing their mobility and access to education, employment and other activities related to personal development.

Number and short spacing of pregnancies can contribute to health or mental/physical burden or deterioration. Women should be given equal right in;
Education Making decision

to have or not to have children for their health and well-being

Health protection Right to be free from torture and ill treatment Right to participate in the political arena.

3.

Social and Gender Issues

65

4.

Biological, Cultural and Psycho-Social Factors

Biological

Refers to the individual (knowledge of his her reproductive organ and its functions)

Culture
Countrys norms, practices of RH. Care provider need to know the cultural values and orientation of their clients.

MATERNAL & CHILD HEALTH NURSING

REFER TO MOTHER & CHILD RELATIONSHIP TO ONE ANOTHER & CONSIDERATION OF THE ENTIRE FAMILY AS WELL AS THE CULTURE AND SOCIO-ECONOMIC ENVIRONMENT AS FRAMEWORK OF THE PATIENT.

66

GOALS
67

Promote the health and well-being of the young

people who are potential parents & help them develop the right approach to family life and the place of the family in the community. Guidance in parent craft and in problems associated with infertility and family planning. Care of the pregnant woman, her safe delivery, postnatal care & examination and the care for lactation. Insure that every expectant and nursing mother maintains good health, learn the art of child care, has a normal delivery & bears healthy children.

Philosophy
68

Pregnancy, labor & delivery & the puerperium are part of

the continuum of the total life cycle. MCN is family centered. Community centered Based from nursing theories Protects the rights of all family members Uses optimum level of independent functioning Personal, cultural & religious attitudes & beliefs influence the meaning of pregnancy for individuals Challenging role for the nurse & a major factor in promoting high level wellness in families.

Phases of Health Care in MCN

69

Health promotion educating client to e aware

of healthy living through teaching & role modeling. Health maintenance intervening to maintain health when risk of illness is present. Health rehabilitation preventing further complication from an illness, bringing ill client back to normal state of wellness; helping client accept inevitable death.

Components of Pregnancy Care

70

Preventive/Examination services;
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

WEIGHT HEIGHT BP FUNDIC HEIGHT FHT LEOPOLDS MANEUVER TTI DIET MANAGEMENT DANGER SIGNS OF PREGNANCY BREASTFEEDING POSTPARTUM CARE

Standard physical examination per visit shall include the ff.

71

Weight Height BP Eyes Skin Abdominal examination

Fundic ht. Fetal position & presentation FHT

Presence of edema (face, hands & lower extremities) Breast Neck for thyroid gland enlargement.

Basic prenatal service delivery at the hospitals should include the ff.
72

History PE Tx of disease TTI Fe supplementation Health education Lab. Exam Oral dental exam. Proper referral to the next higher level when applicable

Following are qualified for home delivery

73

Full term Less than 5 pregnancies Cephalic presentation Without existing diseases No hx of complications No hx of difficult labor & prolonged labor. No previous CS Imminent deliveries No PROM Adequate pelvis Abdominal enlargement is appropriate for age of gestation

ENVIRONMENTAL SANITATION
74

Study of all factors in mans physical environment,

which may exercise a deleterious effect on his health, well-being and survival
Major Environmental Health and Sanitation Programs
Health and Sanitation

Water Supply Sanitation Program

Proper Excreta and Sewage Disposal Program Food Sanitation Program Hospital Waste Management Program Program on Health Risk due to Environmental

Pollution

Following Factors
75

Water sanitation Food sanitation Refuse and garbage

Air pollution Noise Radiological protection Institutional sanitation Stream pollution

disposal Excreta disposal Insect vector and rodent control Housing

Approved types of water supply facilities

76

LEVEL I (Point Source) LEVEL II (Communal Faucet System or Stand-Posts) LEVEL III (Waterworks system or Individual Hose

connections)

Approved types of toilet facilities

77

LEVEL I (non-water carriage toilet facility) Pit latrines LEVEL II Water-sealed and flush type LEVEL III Water carriage types connected to septic tanks and/or to sewerage system to treatment plant

Food Sanitation Program

78

Policies Inspection/approval of all food sources, containers, transport vehicles Compliance to sanitary requirements Provision of updated health certificate Formalin Ether Concentration Technique (FECT) (DOH AO no. 1 2006)

Four Rights in Food Safety

79

Right Source Right Preparation Right Cooking

Right Storage

Recent national and international environmental laws

80

RA 6969 (Toxic Substances and Hazardous and

Nuclear Waste Control Act of 1990) RA 8749 (Clean air Act of 1999) RA 9003 ((Ecological Solid Waste Management Act of 2000) RA 9275 (Clean Water Act of 2004) PD 856 (Sanitation Code of the Philippines)

LAWS AFFECTING PUBLIC HEALTH

81

REPUBLIC ACT
82

Republic Act 9288 - Newborn Screening

An Act Promulgating A Comprehensive Policy and A National System For Ensuring Newborn Screening

Republic Act 9165 - Dangerous Drugs Act of 2002

An Act Instituting the Comprehensive Dangerous Drugs Act of 2002, repealing republic act no. 6425, otherwise known as the Dangerous Drugs Act of 1972, as amended, providing funds therefor and for other purposes

Republic Act 9257 - Expanded Senior Citizens Act of

2003

An Act Granting Additional Benefits and Privileges to Senior Citizens Amending for the Purpose Republic Act No. 7432 Otherwise Known As "An Act To Maximize the Contribution of Senior Citizens to Nation Building, Grant Benefits and Special Privileges and for other Purposes"

83

Republic Act 7883 - Barangay Health Workers

Benefits and Incentives Acts of 1995

An Act Granting Benefits and Incentives to Accredit Barangay Health Workers and for Other Purposes.

Republic Act 6675 - Generics Act of 1988 An Act to Promote, Require and Ensure the Production Of An Adequate Supply, Distribution, Use And Acceptance Of Drugs And Medicines Identified By Their Generic Names

Republic Act 4226 - Hospital Licensure Act An Act Requiring the Licensure of all Hospitals in the Philippines and Authorizing the Bureau of Medical Services to Serve as the Licensing Agency

84

Republic Act 3573

Declared that all communicable diseases should be reported to the nearest health station An Act Promoting Voluntary Blood Donation, Providing For An Adequate Supply Of Safe Blood Regulating Blood Banks And Providing Penal Ties For Violation Thereof

Republic Act 7719 - National Blood Services Act of 1994

Republic Act 7875 - National Health Insurance Act of

1995

An Act Instituting A National Health Insurance Program For All Filipinos And Establishing The Philippine Health Insurance Corporation For The Purpose

85

Republic Act 8504 - Prevention and Control of 1988 Promulgating Policies And Prescribing Measures For The Prevention And Control Of Hiv/Aids In The Philippines, Instituting A Nationwide HIV/Aids Information And Educational Program, Establishing A Comprehensive Hiv/Aids Monitoring System, Strengthening The Philippine National Aids Council, And For Other Purposes Republic Act 8423 - Traditional and Alternative Medicine Act

(TAMA of 1997)

An Act creating the PHILIPPINE INSTITUTE OF TRADITIONAL AND ALTERNATIVE HEALTH CARE (PITAHC) to accelerate the development of traditional and alternative health care in the Philippines, providing for a TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND and for other purposes

Republic Act 8749 - Philippine Clean Air Act of 1999 An Act Providing For A Comprehensive Air Pollution Control Policy And For Other Purposes

86

Republic Act 8344 - An Act Prohibiting the Demand

of Deposits or Advance Payments

An Act Prohibiting The Demand Of Deposits Or Advance Payments For The Confinement Or Treatment Of Patients In Hospitals And Medical Clinics In Certain Cases

Republic Act 8976 Philippine Food Fortification Act of 2000

87

Republic Act 6713 Code of conduct and Ethical Standards for Public Officials and Employees

Republic Act 7160 Responsibility for the delivery of basic services and facilities of the national government has been transferred to the local government Republic Act 7305 Magna Carta for Public Health Workers Aims to promote and improve the social and economic wellbeing of health workers

EXECUTIVE ORDER
88

Executive Order No. 663 Implementing the the National Commitment for "Bakuna ang Una Sa Sanggol At Ina", Attaining World Health Organization's goals to Eliminate Measles and Neonatal Tetanus, Eradicate Polio, Control Hepatitis B and Other Vaccine-Preventable Diseases Executive Order No. 102 Redirecting the Functions and Operations of the Department of Health. Executive Order No. 51 Adopting a National Code of Marketing of Breastmilk Supplements and related products, penalizing violations thereof, and for other purposes.

PRESIDENTIAL DECREE
89

Presidential Decree No. 856

Code on Sanitation of the Philippines Prescribing Sanitation Requirements for the Operation of Establishments and Facilities for the Protection and Convenience of the Travelling Public Requiring the Registration of Births and Deaths in the Philippines which occurred from January 1, 1974 and thereafter Providing for Compulsory Basic Immunization for Infants and children below eight years of age

Presidential Decree No. 522

Presidential Decree No. 651

Presidential Decree No. 996

90

Presidential Decree No. 965 A Decree Requiring Applicant for Marriage License to Receive Instructions on Family Planning and Responsible Parenthood

Presidential Decree No. 384 Amending Republic Act Numbered 4073, entitled an An Act Further Liberalizing the Treatment of Leprosy by Amending and Repealing certain Sections of the Revised Administrative Code