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SAS 15: CONTROL OF COMMUNICABLE ENVIRONMENT DISEASE PART I Conditions in which the agent may exist, survive or originate COMMUNICABLE DISEASE...
SAS 15: CONTROL OF COMMUNICABLE ENVIRONMENT DISEASE PART I Conditions in which the agent may exist, survive or originate COMMUNICABLE DISEASE Comprises of the following Are illnesses caused by infectious agent or its components: toxic products that is transmitted directly or Physical indirectly to a person, animal or intermediary Temperature, weather, food host or inanimate environment sources it could either be CONTAGIOUS or Biological INFECTIOUS DISEASE Animals, insects, flora and other human beings CONTAGIOUS Socioeconomic Contagion is transmitted by direct physical Behaviour, personality, contact attitudes, cultural characteristics of people INFECTIOUS Is transmitted indirectly through contaminated CHAIN OF INFECTION food, body fluids, objects, airborne, inhalation, or through vector organisms. EPIDEMIOLOGIC TRIANGLE MODEL 3 MAJOR COMPONENTS AGENT Organism involved in the 1. Causative Agent development of disease a) Any organism capable of causing disease Agent inculde: 2. Resevior Bacteria (TB, pneumonia) a) The natural habitat where pathogen lives, Fungi (ringworm) grow and multiplies Viruses (Influenza, COVID-19) b) It can be: Rickettsiae (Rocky mountain i. Human (disease transmitted person- spotted fever) person) Protozoa (malaria) ii. Animal (diseases spread from animal Helminths (Ascariasis) to person) Arthropods (scabies) iii. Environmental (soil, water or plants HOST can harbor infectious agents) Organism that harbors and provides 3. Portal of Exits nutrition for the agent a) The path through which a pathogen leaves Factors influencing the ability of the host. the host to fight the agent causing b) This often corresponds to the area of infection infection, such as: Age i. Respiratory tract Gender ii. GI tract Socio-economic iii. Bloodborne pathogens ethnicity, 4. Modes of Transmission nutrition and immune status, a) Direct: genetic make up, i. skin to skin contact hygiene and behaviour ii. Sexual intercourse 1 iii. Droplet sprean (pertusis) SAS 16: CONTROL OF COMMUNICABLE b) Indirect: DISEASES PART II i. Airborne 1. Pathigens carried by dust or LEPROSY CONTORL PROGRAM droplet nuclei over a long distances ii. Vehicleborne 1. Through food, water, or contaminated objects iii. Vectorborne 1. Transmission by insects or animals 5. Portal of entry a) The means by which a pathogen enters a host b) Common portals inculde: Leprosy i. Respiratory tract (Hansesnosis, Hansen’s, Leontiasis) ii. GI tract Causative agent: iii. Skin or mucous membranes Mycobactrium Leprae or Hansens bacillus 6. Susceptible Host Mode of transmission: a) The individual at the end of the infection Prolonged skin to skin contact, droplet chain infection b) Susceptibility depends on genetic factors, Incubation: immune response, or overall health 5 months to 5 years c) Host defenses include: Laboratory/diagnostic test: i. Specific immunity Skin slit test 1. Antibodies developed through Signs and symptoms: infection, vaccination or maternal Early signs transfer Reddish or white change in skin color ii. Specific defenses Loss sensation of the skin lesion 1. Skin, mucousmembranes and Decrease/loss of sweating or hair immune responses. growth over the lesion Thickened and or painful nerves Ulcers that do not heal Late signs Loss of eyebrow (madarosis) Inability to close eyelods (lagopthalmos) Clawing if fingers and toes Contractures Enlargement of breat in males (gynecomastia) Chronic ulcers Prevention: BCG vaccination Avoid prolonged skin to skin contact Good personal hygiene Adequate nutrition Health education 2 MALARIA CONTROL PROGRAM Larvae-eating fish, farm animals should be kept near the house Environmental methods Cleaning and irrigating canals Screening of houses Mechanical methods Use of fly swats or traps Universal precaution Screening of blood donors SCHISTOSOMIASIS CONTROL PROGRAM Malaria Marsh fever Periodic fever King of tropical diseases Causative agent: Plasmodium falciparum Vivax Ovale Malariae Knowlesi Schistosomiasis Vector: Snail fever Female anopheles mosquito Bilharziasis Symptoms: Causative agent: Recurrent fever preceded by chills and Schistosoma profuse sweating (triad signs) Japonicum Malaise Mansoni Anemia Haematobium Laboratory / Diagnostic test: Intermediary Host: History of having been in a malaria Oncomelania quadrasi endemic area: Palawan and Mindoro Mode of transmission: Blood smear Vehicle (water, indirect (skin pores) Rapid Diagnostic Test (RDT) Diagnostic/ Laboratory test: Treatment: Cercum Ova Precipetin Test (COPT) Oral Antimalarial Drugs Kato Katz Technique Chloroquine phosphate 250mg - all Symptoms: species except P. malaire Rash at the site of inoculation Sulfadoxine 50 mg For resistant P. Enlagement of the abdomen falciparum Diarrhea Primaquine for Realpse P. vivax and Body weakness P. ovale Treatment Pyrimethamine 25 mg/tab Praziquantel (Biltricide) Quinine sulfate 300 mg/tab Oxamniquine for S. mansoni and S. Tetracycline VCI 250mg/cap Haematomium Quinidine sulafte 200mg/durules Prevenetion and Control: Parenteral `proper disposal of feces Quinine hydrochloride 300mg/ml, 2ml Proper irrigation of all stagnant doies of Quinidine gluconate 80 mg (50mg) 1 water vial Prevent exposure to contaminated water Prevention and Control Eradication of breeding places of snails Mosquito control Use of molluscicides Chemical method Use of insecticides Biological method Stream seeding Zooprophylaxis 3 SOIL TRANSMITTED HELMINTHIASIS CONTROL 8-month regimen including PROGRAM Streptomyxcin The DOH, in partnership with schools and Category III LGUs, contacts the National Deqorming Children and smear-negative cass Month (NDM) 2x a year in January and July with minimal lesions receive similar This cprogram attributes anti-helminthic drugs treatments as category 1 thriugh Mass Drug Administration to control Category IV soil-trnasmitted helminths (STH Chronic TB cases are treated with STH can impair children’s growth and second -line antibiotics development, leading to anemia, manultrition Prevention and poor school preformnces BCG vaccine Components: Provide 50% protection in newborns National School-Deworming Month Health education and Environmental (NSDM) Sanitation Targets children aged 5-18 in publics Early Diagnosis and Respiratory Isolation schools TB treament for Children Community Based Deworming Month (CBDM) Focuses on deworming preschoolers aged 1-4 and non-school-aged children in health centers. NATIONAL TUBERCULOSIS CONTROL H - Isoniazid PROGRAM R - Rifampicin Tuberculosis E - Ethambutol Phtisis, Consumption, Koch’s disease S - Streptomycin Causative agent: Roles and Responsibilities of the nurse in Mycobacterium Africanum the NTP (National TB PRogram) and DOTS Mycobacterium bovis (Direct Observed Treatment Short-course / Mycobacterium canettii Tutok Gamutan) Strategy Mycobacterium tuberculosis (humans) Administrator Mode of transmission: Health educator Airborne droplets Case manager and coordinator Incubation time: Community coordinator 4-6 weeks Treatment partner Signs and Symptoms Advocate Fever, night sweats Weight loss LAWS FOR COMMUNICABLE DISEASE Persistent cough CONTROL Diagnostic / laboratory test: RA No. 3573 Direct sputum Smear Microscopy : Reporting of communicable disease Determines TB presence on the Category I (Immediately Notifiable number of acid-fast bacilli (AFB) Acute flaccid paralysis detected Adverse event following immunization Anthrax Paralytic shellfish poisoning Severe Acute Respiratory Syndrome (SARS) Category II (Weekly Notifiable) Acute bloody diarrhea Acute encephalitis syndrome Treatment Regimen Acute viral hepatitis Category I Cholera New-smear-positive TB Dengue Treated with 6-month regimen of Diphtheria Isoniazid (H), Rifampicin ( R), Influenza-like illness Pyrazinamide (Z), Ethambutol ( E) Leptopirosis Category II Malaria Treatment failure, relapse, or return RA No. 4073 after defeault (RAD), treated with an Liberalizing treatment of leprosy 4 RA No. 1136 SAS 17: NURSING CARE OF CLIENT WITH NON- TB law of 1954 COMMUNICABLE DISEASES PART I Establishment of TB law Memorandum Circular No. 98-155 GOALS OF DOH (Department of Health) Prioritizes TB control in public health A Philippines free from the avoidable burden of programs NCDs Pronounces the NTCP as the highest priority Public Health Program of the RISK FACTORS FOR NON-COMMUNICABLE LGUs DISEASES AO No. 24 series of 1996 1. Physical Inactivity The NTCP adopted DOTS in the a) Less than the recommended 5x of management of TB 30minutes of moderate activity per week or less than 3x of 20 minutes of vigorous activity per week or equivalent b) Key determinant of energy expenditure, fundamental to energy balance and weight control 2. Cigarette Smoking a) Increases risk of lung and other cancers, heart diseases, and stroke 3. Unhealthy Eating a) High fat, sugar and salt consumption contribute to obesity, HTN, and cholesterol issues 4. Excessive Alcohol Drinking a) Affects the GI system, liver, cardiovascular health and increases cancer risk 5. Viruses a) Certain viruses are associated with cancers 6. Radiation a) Both UV and ionizing radiation can lead to DNA damage, increasing cancer risk 7. Drug Abuse a) Certain drugs like cocaine can result in cardiovascular complications, including heart attack and strokes 8. Chemicals and Environmental Agents a) Found in processed foods, smoke, and industrial pollutants, many are carcinogenic NURSING FUUNCTIONS AND RESPONSIBILITIES The role of Public Health Nurse in NCD prevention and control HEALTH ADVOCATE Promotes active community participation in NCD prevention and control through advocacy work. PHN helps the people towards optimal degree of independence in decision-making and in asserting their right to safer and better community. Informing the people about the rightness of the cause Thoroughly discussing with the people the nature of the alternatives their content and consequences. 5 Supporting people’s right to make a choice SAS 18: CONTROL OF NON-COMMUNICABLE and to act on the choice DISEASES PART II Influencing public opiniion HEALTH EDUCATOR CARDIOVASCULAR and CEREBROVASCULAR Is an essential tool to chieve community helath DISEASE A health educator is concerned with non- Cardiovascular communicable disease prevention and control, Also known as heart disease, diseases health education focuses on establishing or that involves the heart or blood vessels including changes in personal and group Cerebrovascular attitudes and behaviour that promote healthier Also known as stroke, a group of brain living. dysfunction related to disease of the blood Inform the people vessels supplying to the brain Motivate the people Atherosclerosis and Hypertension are the Guide people into action most common cause of these 2 diseases HEALTH CARE PROVIDER The PHN is a care provider to individuals, Classification of Blood Pressure families, and community rendering primary, secondary and tertiary health care services in any setting including the community. As a care provider, emphasis of care is on health promotion and disease prevention focusing on promotion of rational diet and physical activity and cessation of smoking and alcohol drinking. Classification of LDL, Total and HDL COMMUNITY ORGANIZER Cholesterol (mg/L) As an organizer, the ultimate goal of the PHN is community health development and empowerment of the people. This is achieved by: Raising the level of awareness of the community regarding non-communicable disease, its causes, prevention and control Organizing and mobilizing the community in taking action for the reduction of risk factors Influencing executive and legislative bodies to create and enforce policies that favor a healthy environment CANCER HEALTH TRAINER Leading cause of death with over 50,000 cases The PHN provides technical assistance in the in the Philippines assessment of the skills of auxiliary health Most common types: workers in NCD prevention and control program Breast cancer (Women) RESEARCHERS Lung cancer (Men) Researcher is an integral part of primary health Carcinogen care approach to non-communicable disease Substances that cause some cells to prevention and control program undergo genetic mutation It is inextricably related to community health Screening fo rcancer involves early detection of practice since It provides the theoritical bases the warning signals of cancer for developing appropriate and responsive !!!!WARNING SIGNS OF CANCER!!!! intervention programs and strategies. 6 Lifestyle Related Factors CHRONIC OBSTRUCTIVE PULMONARY DISESASE (COPD) Disease of the lungs in which the airways narrow over time It is a major cause of chronic morbidity and 3. Promote a Smoke Free Environment mortality throughout the world a) Smoking is major risk factor for developing COPD involves progressive lung diseases like cardiovascular and cerebrovascular Bronchitis and Emphysema disease Smoking is a major risk factor, causing structural damage to the lungs Quick reference guide for treating tobacco use Complications include respiratory failure and and Dependence cardiovascular disease DIABETES DM is one of the leading cause of disability in persons over 45. more than half of diabetic persons will die of CAD CAD tends to occur at an earlier age and with greater severity in persons with diabetes STRESS MANAGEMENT Symptoms: 12 Stress Management Techniques Increased urination 1. Spirituality Thirst (polydipsia) 2. Self-awareness Hunger (polyphagia) 3. Scheduling: Time Management Weight loss 4. Siesta (Nap) Vision changes and fatigue 5. Stretching Diagnostics 6. Sensation techniques Fasting Blood Sugar 7. Sportts 77.0 mmol/L 8. Socials Or 126 mg/dL 9. Sounds and songs 10. Speak to me NON-COMMUNICABLE DISEASES PREVENTION 11. Stress debriefing 1. Promote Physical Activity and Exercises 12. Smile a) Refers to any bodily movement produced by skeletal muscles that results in expenditure LAWS AFFECTING CONTROL OF NON- of energy and includes occupational, COMMUNICABLE DISEASES leisure-time and routine daily activities EO 958 2. Promote Healthy Diet National Healthy Lifestyle Advocacy a) Strategies for a healthier lifestyle include: campaign i. Choosing smaller portions of low-fat RA 1054 foods Free emergency medical and dental ii. Engaging in daily physical activity for treatment for employees at least 30 minutes RA 9211 iii. Avoid eating meals in front of the Tobacco Regulation Act of 2003 television RA 6425 iv. Keeping track of food intake and Penalties for violations of the Dangerous physical activity Drug Act RA 9165 Comprehensive Dangerous Drug Act RA 8423 Traditional and Alternative Medicine Act AO 179 Series of 2004 Guidelines for the implementation of the National Prevention Blindness Program 7 Department Personnel No. 2005-0547 SAS 19: HEALTH DEVELOPMENT PROGRAMS Creation of Program Management FOR ADULT AND OLDER PERSON, Committee for the National Blindness PREVENTION OF BLINDNESS Program Proc. No. 40 A. MENTAL HEALTH PROGRAM Declaring the Month of August as Sight a) Mental health is a key component of Saving Month overall health and is essential to achieving RA 7277 the Sustainable Development Goals Magna Carta for Disable Persons (SDGs) b) A comprehensive Mental Health Program includes promotive, preventive, treatment, and rehabilitative services for all individuals, with a focus on those at risk or suffering from Mental, Neurological, and Substance use (MNS) disorders c) VISION i. A society that promotes the well-being of all Filipinos, supported by transformative multi-sectoral partnerships, comprehensive mental health policies and programs, and a responsive service delivery network. d) MISSION i. To promote over-all wellness of all Filipinos, preventing and treating mental, psychosocial and neurologic disorders, reducing substance abuse and other forms of addiction, and reduce burden of disease by improving access to quality care and recovery in order to attain the highest possible level of health to participate fully in society. e) OBJECTIVES i. To promote participatory governance and leadership in mental health ii. To strengthen coverage of mental health services through multi-sectoral partnership to provide high quality service aiming at best patient experience in a responsive service delivery network iii. To harness capacities of LGUs and organized groups to implement promotive and preventive interventions on mental health iv. To leverage quality data and research evidence for mental health v. To set standards for compliance in different aspects of services f) PROGRAM COMPONENTS i. Wellness of Daily Living 1. Incorporates health, social, and poverty reduction programs 2. Includes family wellness, healthy lifestyle promotion, and disease prevention 3. Supports school and workplace health and wellness programs 8 ii. Extreme Life Experiences The “Pinggang Pinoy” can be used side by 1. Mental Health and side with the existing Daily Nutritional Guide Psychosocial Support (MHPSS) (DNG) Pyramid for Filipinos but it will not during disasters (personal and replace it. community-wide) According to FNRI, Pinggang Pinoy is a iii. Mental Disorders quick and easy guide on how much to eat per 1. Provision of services at the mealtime, while the DNG Pyramid shows at a primary level for assessment, glance the whole day food intake treatment and engagement recommendation. iv. Neurologic Disorders 1. Includes services for individuals C. HEALTH AND WELLNESS PROGRAM FOR with neurologic conditions SENIOR CITIZEN v. Substance Abuse and Addiction Description 1. Servives for substance use In support of the RA 9257 (The Expanded disorders Senior Citizens Act of 2003) and the RA 2. Enhancement of mental health 9994 (Expanded Senior Citizen Act of 2010), facilities under the Health the Department of Health issued Facilities Enhancement Administrative Orders for health Program (HFEP) implementors to undertake and promote g) POLICIES AND LAWS the health and wellness of senior citizens DOH Administrative Order No. 8 series of as well as to alleviate the conditions of 2001 older persons who are encountering The National Mental Health Policy degenerative diseases. DOH Administrative Order No. 2016-0039 focused service delivery packages Revised Operational Framework for a and integrated continuum of quality Comprehensive National Mental Health care, Program patient-centered and environment Republic Act No. 11036 standard to ensure safety and Mental Health Act accessibility for senior citizens, equitable health financing, h) Calendar of Activities capacitated health providers in the i. September 10 - World Suicide implementation of health programs for Prevention Day senior citizens, ii. October 10 -World Mental Health Day data base management, and iii. 2nd Week of October - National strengthened coordination and Mental Week collaboration with other stakeholders involved in the implementation of B. PINGGANG PINOY programs for senior citizens. Vision A country where all Filipino senior citizens are able to live an improved quality of life through a healthy and productive aging. Mission Implementation of a well-designed program that shall promote the health and wellness of senior citizens and improve their quality of life in partnership with other stakeholders and sectors. Objectives To ensure better health for senior citizens through the provision of focused service Pinggang Pinoy delivery packages and integrated continuum of is a new, easy to understand food guide quality care in various settings. that uses a familiar food plate model to To develop patient-centered and environment convey the right food group proportions on standards to ensure safety and accessibility of a per-meal basis, to meet the body’s all health facilities for the senior citizens. energy and nutrient needs of Filipino To achieve equitable health financing to adults. develop, implement, sustain, monitor and Pinggang Pinoy serves as visual tool to help continuously improve quality health programs Filipinos adopt healthy eating habits at meal accessible to senior citizens. times by delivering effective dietary and healthy lifestyle messages. 9 To enhance the capacity of health providers Republic Act No. 9994 – and other stakeholders including senior citizens “An Act Granting Additional Benefits and group in the implementation of health programs Privileges to Senior Citizens, Further for senior citizens. Amending Republic Act no. 7432” Program Components 1. The Policy, Standards and Regulation Strategies, action Points and Timeline component 1. Participatory Governance for health through the a) shall develop a unified patient-centered life course and supportive environment standards to 2. Strengthened Service Delivery for older ensure safety and accessibility of senior populations citizens to all health facilities and to 3. Advocacy and Promotion of healthy aging promote healthy ageing in order to prevent 4. Evidence-based Decision Making functional decline among senior citizens. 2. The Health Financing component Program Accomplishments/ Status a) shall promote health financing schemes 1. Provision of influenza and pneumococcal vaccine and other funding support in all concerned 2. Wellness camp for senior citizens government agencies and private 3. Elderly Filipino week (Walk for Life) Celebration stakeholders to provide programs that are accessible to senior citizens. Calendar of Activities 3. The Service Delivery component Presidential Proclamation No. 470, series of a) shall ensure access of senior citizens to 1994 declares the First Week of October of essential geriatric health services including every year as Elderly Filipino Week (Linggong preventive, promotive, treatment, and Katandaang Pilipino) Celebration rehabilitation services from the national to the local level. PREVENTION OF BLINDNESS PROGRAM 4. The Human Resources for Health component Government Mandates and Policies: a) shall capacitate the health care providers Administrative Order No. 179 s.2004: in both national and local government to Guidelines for the Implementation of be able to effectively provide technical the National Prevention of Blindness assistance and implement the program for Program Department Personnel Order senior citizens. No. 2005-0547: Creation of Program 5. The Health Information component Management Committee for the a) shall establish an information management National Prevention of Blindness system and maintain a repository of data. Program 6. The Governance for Health component Subcommittees: Refractive Error/Low a) shall coordinate and collaborate with the Vision, Childhood Blindness, Cataract local government units and other Proclamation No. 40 declaring the month stakeholders to ensure an effective and of August every year as “Sight Saving efficient delivery of health services at the Month” hospital and community level. Visual 20/20 Policies and Laws Aim Madrid International Plan of Action on Aging develop a sustainable comprehensive Regional Framework for Action on Aging and health care system that will ensure the health in the Western Pacific 2014-2019 best possible vision for all, thus improving The 1987 Philippine Constitution their quality of life. Aquino Health Agenda Vision: Philippine Plan of Action for Senior Citizens All Filipinos enjoy the right to sight by year (2012-2016) 2020 Republic Act No. 9257 – Mission: “An Act Granting Additional Benefits and The DOH, Local Health Unit (LGU) Privileges to Senior Citizens amending for partners and stakeholders commit to: the purpose of 1. Strengthen partnership among and with Republic Act no. 7432, otherwise known stakeholder to eliminate avoidable blindness in the as “An Act to Maximize the Contribution of Philippines; Senior Citizens to Nation Building, Grant 2. Empower communities to take proactive roles in benefits and Special Privileges and for the promotion of eye health and prevention of Other Purposes” blindness; 3. Provide access to quality eye care services for all; and 10 4. Work towards poverty alleviation through ensure that services are available at the preservation and restoration of sight to indigent local level. Filipinos. b) This shall include public-private and public- public partnership aimed at building Goal: coalition and networks for the delivery of Reduce the prevalence of avoidable appropriate eye health care services at blindness in the Philippines through the affordable cost especially to the indigent provision of quality eye care. sector. 3 components: 5. Supervision, Monitoring and Evaluation Cost effective disease control a) The Program shall be coordinated by a interventions, human resource national program coordinator from the development, and infrastructure Degenerative Disease Office of the development National Center for Disease Prevention Visual Impairment and Control (NCDPC), Department of Low vision – Health (DOH). visual acuity of less than 6/18, but equal b) The national program coordinator shall to or better than 3/60, or a corresponding oversee the implementation of program visual field loss to less than 20 degrees in plans and activities with the assistance of the better eye with best possible correction the regional coordinators from the Centers Blindness – for Health Development. visual acuity of less than 3/60, or a 6. Research and Development corresponding visual field loss to less than a) The program shall encourage the conduct 10 degrees in the better eye with best of researches for purposes of developing possible correction. local competence in eye health care and Interventions/Strategies employed or for other purposes that may be necessary. Implementation by the DOH b) The development and dissemination of 1. Advocacy and Health Education clinical practice guidelines for eye health a) This includes patient information and shall form part of the research agenda of education, public information and the program. education and intersectoral collaborationon 7. Service Delivery eye health promotion and the nature and a) Service delivery for the prevention of extent of visual impairments particularly its Blindness Program shall be covered by the risk factors and complications and the principle of best practice. need/urgency of early diagnosis and b) This means primary eye prevention management. concentrating on health education, 2. Capability Building advocacy and primary eye interventions; a) This component shall focus on ensuring Secondary prevention; screening/early the capability of national and local detection/basic management/ counseling, government health facilities in delivering referral and/or definitive care and tertiary the appropriate eye health care services prevention: especially to the indigent sector of the population. CATARACT b) Program shall provide training for Cataract, the opacification of the normally clear coordinators at regional and provincial lens of the eye, is the most common cause of levels; will ensure the availability of and blindness worldwide. access to training programs by program ERRORS OF REFRACTION implementers. Errors of refraction is the most common cause 3. Information Management of visual impairment in the country (prevalence a) The program shall develop an information is 2.06% in the population). Errors of refraction management system for purposes of are corrected either with spectacle glasses, reporting and recording. As far as contact lenses or surgery. practicable, this system shall consider and The services to address the problem of EOR will build on any existing mechanism. are provided mainly by optometrists. However, b) The system shall be national in scope, the provision of the eyeglasses or lenses (who although the mechanism shall consider the should provide, how is it provided, etc.) has to regional and local needs and capabilities. be addressed. 4. Networking, Partnership Building and CHILDHOOD BLINDNESS Resource Mobilization The prevalence of blindness among children a) An important component of the program is (up to age 19) is 0.06% while the prevalence of networking and partnership building to 11 visual impairment in the same age group is SAS 20: RESEARCH IN COMMUNITY HEALTH 0.43%. NURSING PART I The problem of childhood blindness is the highly specialized services that are needed to RESEARCH IN COMMUNITY HEALTH diagnose and treat it. Research is an important activity in public However, screening of children for any sign of health but it is misconceived to be primarily an visual impairment can be done by pediatricians, activity of professional researchers and school clinics and health workers. academicians. FOOD FORTIFICATION IN RELATION TO Although it is not commonly included in the VITAMIN A PHN’s statement of duties and responsibilities, Vitamin A, Vitamin A Deficiency (VAD) and research is nonetheless included in the scope its Consequences of functions of the nurses as defined by the Vitamin A - an essential nutrient as retinol Nursing Law. needed by the body for normal sight, growth, Research in community health serves a number reproduction and immune competence of purposes, among which are: Vitamin A deficiency - a condition (1) improve our understanding of clients characterized by depleted liver stores & low and their specific contexts; blood levels of vitamin A due to prolonged (2)provide data needed for program and insufficient dietary intake of Vit. A followed by policy development and evaluation; poor absorption or utilization of Vit. A in the (3)improve the delivery of health services body and implementation of existing programs; VAD affects children’s proper growth, (4) improve cost-effectiveness of programs; resistance to infection, and chances of survival and, (23 to 35% increased child mortality), severe (5) project a good image of nurses. deficiency results to blindness, night blindness Research also contributes to what is called and Bitot’s spot evidence-based practice. The practices were passed on and were considered as gospel truth UNIVERSAL HEALTH CARE AND EYESIGHT in the past should be examined and tested In line with the Universal Health Care (UHC) through research. Law, the Department of Health (DOH) is gearing toward providing comprehensive eye PARTICIPATORY COMMUNITY HEALTH care services, integrating eye care within local Participatory action research (PAR) health systems, and responding to emerging differs from most other approaches to eye diseases such as diabetic retinopathy and public health research because it is based glaucoma. on: Primary care provider network that will be reflection, institutionalized under UHC data collection, and Accessibility Action that aims to improve health Referral to ophthalmic units, comprehensive and reduce health inequities through eye centers, and national ophthalmic specialty involving the people who, in turn, take centers. actions to improve their own health. Definition of PAR It is a combination of participatory and action research. Participatory Research team and community members are equal partners Involves selecting issues related to the community: dependence; oppression; other inequities that need evaluation Action Reveals strategies that can address social issues Community needs are evaluated and action is taken with the purpose of social change PAR seeks to understand and improve the world by changing it. It is a collective, self- reflective inquiry that researchers and participants undertake. 12 Its purpose is to understand and improve their SAS 21: RESEARCH IN COMMUNITY HEALTH practices. The reflective process is directly NURSING linked to action, influenced by understanding of FIELD HEALTH SERVICES AND INFORMATION history, culture, and local context and SYSTEM (FHSIS) embedded in social relationships. Objectives: The process of PAR aims to empower and lead To provide summary of data on health services to people increase control over their lives delivery and selected program accomplished indicators at the barangay, municipality, district, Difference of PAR from conventional research provincial, regional and national levels. 1. Purpose - enable action To provide data which when combined with a) Action is achieved through a reflective data from other sources, can be used for cycle program monitoring and evaluation purposes. i. Participants collect and analyse data, To provide a standardized, facility level data then determine what action should base that can be accessed for more in-depth follow. studies. ii. The resultant action is then further To ensure that the data reported to the FHSIS researched and an iterative reflective are useful and accurate and are disseminated cycle perpetuates data collection, in a timely and easy to use fashion. reflection, and action as in a To minimize the recording and reporting burden corkscrew action. at the service delivery level in order to allow 2. Attention - power relationships more time for patient care and primitive a) Advocating for power to be deliberately activities. shared between the researcher and the researched. Components b) The researched cease to be objects and Family Treatment Record become partners in the whole research Target Client List process: including selecting the research Reporting Forms topic, data collection, and analysis and Output Reports deciding what action should happen as a result of the research findings. Treatment Record 3. People – active participants The fundamental building block or foundation of a) Most health research involves people, the Field Health Service Information System is even if only as passive participants, as the Treatment Record. ‘‘subjects’’ or ‘‘respondents’’. This is the document, form or pieces of paper b) PAR advocates that those being upon which the presenting symptoms or researched should be involved in the complaints of the patient on consultation and process actively. the diagnosis (If available), treatment and date i. The degree to which this is possible in of treatment is recorded. health research will differ as will the This recorded will be maintained as part of the willingness of people to be involved in system or records at each research BHS/BHC/RHU/MHC, or hospital outpatient by facility on all patients seen. The treatment record and its entire system filling may vary from program to program and place to place. Likewise, immunization recording, weighing, etc., may be recorded on the child growth and development chart card which is also part of the family record/folder. Other programs have their own resident treatment records such as Tuberculosis, Leprosy and Schistosomiasis. However, these records will be described later. If in the facility, there is no formal treatment record for individual patient’s visits/ consultation, one must be created. This record may be simple as the following example prepared on plain bond paper. 13 Target/Client Lists Tally/Reporting Forms The target/Client Lists constitute the second FHSIS Reports constitute the only mechanism “building block” of the FHSIS and are intended through which data are routinely transmitted to serve four purpose: from one facility to another in the revised FHSIS. 1. To plan and carry out patient care and service The majority of FHSIS reports are prepared and delivery. Such lists will be of considerable value to submitted either monthly or quarterly. One midwives/nurses in monitoring service delivery to report is prepared weekly, several annually, clients in general, and in particular to groups of and in some instance, every few minutes as patients identified as “targets” or “eligible” for one relevant events occur, e.g. maternal and another program of the Department. neonatal deaths. 2. To facilitate the monitoring and supervision for List of FHSIS Reports and Forms services. 3. To provide a clinic-level data base which accessed for further studies, e.g. follow up and special prospective studies, record surveys, etc. the introduction of standardized Target/Client Lists maintained in hard-bound cover is designed to result in permanent records of facility health care delivery activities which can be served as a facility level data base. The complete set of Target/Client Lists will be collected periodically at the end of each year of every two years and stored in a central location (such as the Provincial Health Office) to facilitate the maintenance of such a data base. For service activities which do not have target client lists, space is provided in reporting forms to tally such activities. EXAMPLE: One important difference between the Target/Client Lists in the revised FHSIS and the “Master Lists” utilized previously is that the Target/Client List will no longer be transmitted from the clinic. Data from the Target/Client Lists will be transmitted monthly/quarterly through the use of FHSIS Reporting Forms, but the Lists from one facility to another will be discontinued in the FHSIS. The target/Client Lists to be maintained in the revised FHSIS are as follows: Output Reports Output Reports or Table will be produced at the PHO (or alternate date processing site in the province) from the data reported in the RHU/MHC and up through the DOH system to the Regional Health Office. The objective in designing the output formats is to make the reports useful for monitoring/ management purposes at each level of DOH Management. 14 Figure 10 – FHSIS components (MHC) where it is expected to report health services provided to the RHU or MHC catchment area which is usually the Poblacion and nearby barangays. Records, Reports and Patient Flow The use of the system or records and reports is As all report forms submitted to the PHO will be relatively simple. entered and processed using a microcomputer, All information related to the client/patients it is important that reporting units be properly history, complaint, diagnosis, services and/or identified on the FHSIS Report Forms and the treatment is contained in three documents or proper codes indicated. In this connection, all records: possible reporting health units- Barangay (1) The individual treatment record. Health Station (BHSs) up to Regional Medical (2) The Target/Client List (TCL) for the center were assigned corresponding codes. several public health programs, and (3) The tally sheet/report forms which have a dual purpose that is totally events as they occur and the purpose of reporting periodically to higher levels. Geographic Coding The FHSIS Report forms are to be submitted by the reporting units identified in the upper portion of the page of each Report Form. A reporting unit is defined as any DOH Health care facility that renders/delivers public care- related services to targeted beneficiaries. The lowest level of reporting unit is the Barangay Health Station (BHS), where it expected to report health services provided to its defined catchment area. A BHS can be considered a reporting unit if the following conditions are satisfied: It renders/delivers health services to a defined catchment area which may be composed of one or more barangays. A midwife renders regular services to the area. In cases where the midwife of the area is in prolonged leave of absence or refined but a replacement is expected, the BHS still remains a reporting unit. Health services may be provided for any physical structure designated for the purposes i.e. a BHS building, a barangay hall or a place of residence. The catchment area served is not a service area of any RHU. For instance, Poblacion in most cases is the catchment area served by the RHU. It should not include satellite BHS which are visited by the midwife but part of the catchment of the “Mother BHS”. The next level of reporting unit is the Rural Health Unit (RHU) or Main Health Center 15 SAS 22: LAWS AFFECTING THE PUBLIC HEALTH **Section 9: Discrimination Prohibited** AND PRACTICE OF COMMUNITY HEALTH No discrimination based on gender, religion, NURSING PART I ethnicity, or political beliefs. RA 7305 (Magna Carta of Public Health Workers) **Section 10: No Understaffing/Overloading of Health Staff** **Section 1: Title** Proper staffing is required to ensure quality The Act is officially called the "Magna Carta of health care. Health students may only assist for Public Health Workers." educational purposes. **Section 2: Declaration of Policy** **Section 11: Administrative Charges** The State promotes health consciousness to Administrative charges are handled by a support government health programs. committee with representatives from health The Act aims to: organizations. 1. Improve the well-being and working conditions of health workers. **Section 12: Safeguards in Disciplinary 2. Enhance their skills for better service. Procedures** 3. Encourage qualified individuals to join and stay Health workers have rights to fair disciplinary in public health service. proceedings, including written notice of charges and the right to defend themselves. **Section 3: Definition of Health Workers** Includes all persons working in health-related **Section 13: Duties and Obligations** roles in government-run hospitals, clinics, and - Health workers must perform their duties with health units. dignity, respect for life, and without discrimination. **Section 4: Recruitment and Qualification** Recruitment policies follow Civil Service **Section 14: Code of Conduct** Commission (CSC) standards. - A Code of Conduct for public health workers Temporary appointments (up to 12 months) will be developed within six months. may be issued if no qualified candidate is available. **Section 15: Normal Hours of Work** - Normal work hours are 8 hours per day or 40 **Section 5: Performance Evaluation and Merit hours per week. Promotion** - Health workers on "On Call" status are entitled A career development plan for public health to 50% of their regular pay. workers includes promotion and performance evaluation. **Section 16: Overtime Work** Promotions follow CSC rules, and employees - Overtime pay is provided when workers are are regularly informed about their performance. required to work beyond normal hours. **Section 6: Transfer or Geographical **Section 17: Work During Rest Days and Reassignment** Holidays** Health workers can only be transferred for - Additional compensation is provided for work public interest, and they must be informed in on rest days or holidays. writing. They can appeal unjust transfers to the CSC, **Section 18: Night-Shift Differential** and reassignment expenses are covered by the - Health workers receive an additional 10% of government. their regular wage for night shifts. **Section 7: Married Public Health Workers** **Section 19: Salaries** Efforts should be made to employ married - Salary progression is based on satisfactory couples in the same municipality but in different performance, and local health workers must be offices. paid equivalent to national health workers. **Section 8: Security of Tenure** **Section 20: Additional Compensation** Public health workers can only be dismissed for - Health workers receive allowances for hazard lawful reasons after due process. If unjustly duty, subsistence, laundry, longevity, and dismissed, they are entitled to reinstatement remote assignments. with back pay. 16 **Section 21: Hazard Allowance** - **Sec. 42 (Effectivity)**: - Health workers in high-risk areas or during The Act takes effect 15 days after publication in emergencies receive a hazard allowance. at least two national newspapers. **Approved**: March 26, 1992. **Section 31: Right to Self-Organization** - Health workers can join unions but cannot **RA 9173 (Philippine Nursing Act of 2002)** strike while on duty. - **Article I (Title)**: Known as the "Philippine Nursing Act of 2002." **Section 32: Freedom from Interference or Coercion** - **Article II (Policy Declaration)**: - It is illegal to interfere with a worker’s right to The State is responsible for protecting and join a union or organization. improving the nursing profession by ensuring quality education, humane working conditions, **Section 33: Consultation with Health Workers’ and better career opportunities for nurses. Organizations** - The government consults health worker **Article III (Organization of the Board of organizations when developing policies. Nursing)** - **Sec. 3 (Creation of the Board)**: **Section 34: Health Human Resource A Professional Regulatory Board of Nursing is Development** established, with one Chairperson and six - The Department of Health will conduct studies members, appointed by the President from the to improve working conditions, training, and recommendations of the Professional staffing. Regulation Commission. - **Sec. 4 (Board Qualifications)**: **Section 35: Rules and Regulations** Board members must be Filipino citizens, - The Secretary of Health will create rules for registered nurses with a master’s degree, and implementing the Act, effective 30 days after have at least 10 years of professional publication. experience. - **Sec. 6 (Term of Office)**: **Section 36: Prohibition Against Double Board members serve for 3 years and may be Recovery** reappointed. - Health workers can choose between benefits - **Sec. 9 (Powers and Duties of the Board)**: from different laws, but they cannot receive Includes conducting licensure exams, enforcing double benefits. quality standards, resolving complaints, and creating a Code of Ethics for nurses. **Sec. 37 (Prohibition Against Elimination/Diminution)**: **Article IV (Examination and Registration)** Current benefits for public health workers - **Sec. 12 (Licensure Exam)**: cannot be reduced by this Act. Nurses must pass a written exam set by the Board. - **Sec. 38 (Budgetary Estimates)**: - **Sec. 14 (Scope of Exam)**: The Department of Health must submit an The exam scope is determined by the Board, annual budget to implement the law over 5 based on nursing curriculum objectives and years, with a total budget of P964,664,000. related disciplines. - **Sec. 17 (Issuance of License)**: - **Sec. 39 (Penal Provision)**: Upon passing the exam, nurses receive a Anyone who interferes with the rights of public Certificate of Registration and a Professional health workers or violates the law can be fined Identification Card. at least P20,000 or imprisoned for up to one year. Public officials can also be disqualified **Article V (Nursing Education)** from office. - **Sec. 25 (Nursing Education Program)**: Nursing education must provide a sound - **Sec. 40 (Separability Clause)**: foundation for nursing practice, adhering to the If any part of the Act is deemed invalid, the rest Commission on Higher Education’s standards. remains in force - **Sec. 27 (Faculty Qualifications)**: Faculty members must be registered nurses - **Sec. 41 (Repealing Clause)**: with clinical experience and hold a master’s Laws inconsistent with this Act are repealed or degree. amended. 17 SAS 23: LAWS AFFECTING THE PUBLIC HEALTH - **Sec. 34: Incentives and Benefits** AND PRACTICE OF COMMUNITY HEALTH An incentive system for nurses will be NURSING PART II established, including free hospital care, scholarships, and non-cash benefits. **Article VI: Nursing Practice** - **Sec. 28: Scope of Nursing** **Article VIII: Penal and Miscellaneous Nurses provide services to individuals, Provisions** families, and communities in any health care - **Sec. 35: Prohibitions in Nursing Practice** setting, from conception to old age. They focus Fines or imprisonment for unauthorized on health promotion and illness prevention. practice of nursing, misuse of certificates, false Nurses collaborate with the health team for representation as a nurse, or illegal review curative, preventive, rehabilitative care, and classes. Also, penalties for violating minimum peaceful death if recovery isn't possible. base pay and benefit provisions. Key Duties: Utilize the **nursing process** for care, **Article IX: Final Provisions** including innovative techniques, health - **Sec. 36: Enforcement** teachings, and medication administration. The **Commission** and **Board** are **Collaborate** with community resources responsible for enforcing this Act. and health teams. Provide **health education** and - **Sec. 37: Appropriations** **supervise** students in nursing programs. Funding for implementing this Act must be Engage in **research** and **health included in the **Annual General Appropriations human resource development**. Act**. **Sec. 29: Qualifications for Nursing Service - **Sec. 38: Rules and Regulations** Administrators** The Board will formulate rules within **90 A **supervisory** or **managerial** nursing days** of this Act’s effectivity. role requires being a registered nurse with experience in nursing service administration - **Sec. 39-41: Miscellaneous** and additional educational qualifications. Repeals previous laws inconsistent with this Chief Nurses in primary hospitals or public Act. Takes effect **15 days** after publication in health agencies may require a master’s degree the **Official Gazette** or any newspaper of in nursing or public health. general circulation. **Article VII: Health Human Resource Production, **Laws Affecting Public Health and Community Utilization, and Development** Nursing Practice** - **Sec. 30: Studies for Nursing Manpower** 1. **R.A. 7160** – The Board and associated agencies will a) Local Government Code: Decentralizes conduct studies on nursing manpower needs powers to local government units (LGUs), and development. creating **Local Health Boards (LHBs)** responsible for health budget allocations. **Sec. 31: Comprehensive Nursing Specialty Program** 2. **R.A. 2382** – A program to enhance specialty skills (critical a) Philippine Medical Act: Defines the care, oncology, etc.) must be formulated. practice of medicine. Beneficiaries must serve in a Philippine hospital for **at least 2 years**. 3. **R.A. 1082** – a) Rural Health Act: Establishes **Rural - **Sec. 32: Salary** Health Units** to improve health in rural Nurses in public health institutions must areas. receive a salary not below **Salary Grade 15**. 4. **R.A. 6425** – - **Sec. 33: Funding for Specialty Program** a) Dangerous Drugs Act: Regulates the sale Funding for training will be sourced from and transportation of prohibited drugs. **PCSO** and **PAGCOR**, with criteria set by the **Department of Health**. 5. **P.D. No. 996** – a) Requires compulsory **immunization** for children under 8. 6. **P.D. No. 825** – a) Penalizes improper garbage disposal. 18 7. **R.A. 6758** – 18. **RA 11148: The First 1,000 Days Law** a) Standardizes salaries for government Focuses on improving maternal and child employees, including nurses. health and nutrition, especially during the critical first 1,000 days of life (from conception 8. **R.A. 6713** – to the child’s second birthday). a) Code of Conduct for Public Officials: Ensures **high ethical standards** and 19. **RA 7600: Rooming-in and Breastfeeding accountability. Act** Requires that newborns stay with their mothers 9. **R.A. 7875** – in health facilities after birth to promote a) National Health Insurance Act: Establishes breastfeeding, thereby enhancing mother-infant national health insurance. bonding and health outcomes. 10. **R.A. 7432** – 20. **RA 8976: Food Fortification Law** a) Senior Citizens Act: Provides benefits for Mandates the fortification of staple foods with senior citizens. essential vitamins and minerals to combat malnutrition. 11. **R.A. 9994** – a) Adds privileges for senior citizens. 21. **RA 8980: Early Childhood Care and Development (ECCD) Act** 12. **R.A. 7719** – Provides a comprehensive policy on early a) National Blood Services Act: Promotes childhood development, with a focus on health, voluntary blood donation. nutrition, and learning for children under 6 years of age. 13. **R.A. 8172** – a) Salt Iodization Act: Promotes the use of 22. **AO No. 2006-0015: Hepatitis B iodized salt (ASIN Law). Immunization for Infants** - Sets guidelines for ensuring that all infants receive 14. **RA 7277: Magna Carta for Persons with the Hepatitis B vaccine to reduce liver disease and Disabilities (PWDs)** cancer risks later in life. - This law ensures the inclusion and empowerment of PWDs in society, focusing on their rehabilitation, 23. **RA 7846: Compulsory Hepatitis B self-development, and integration into mainstream Immunization** activities. Nurses play a vital role in ensuring Mandates the vaccination of all infants against accessible health care for PWDs Hepatitis B, which is critical for reducing the incidence of liver cancer and other related 15. **AO No. 2005-0014: National Policies on diseases. Infant and Young Child Feeding** The policy promotes optimal breastfeeding practices, emphasizing: **Breastfeeding within 1 hour of birth.** **Exclusive breastfeeding for the first 6 months.** **Introduction of complementary foods while continuing breastfeeding up to 2 years or beyond.** 16. **EO 51: Philippine Code of Marketing of Breastmilk Substitutes** This executive order regulates the marketing of breast milk substitutes to ensure that mothers are not discouraged from breastfeeding. 17. **RA 10028: Expanded Breastfeeding Promotion Act** Promotes and supports breastfeeding in the workplace, requiring the establishment of lactation stations and break times for breastfeeding mothers. 19
