DOH Health Programs.pdf

DOH Health Programs NCM 104  Collaborate with other members of the health Learning team in the implementation of programs and outcome services  Integrated Management of Childhood Illnesses (IMCI) – Overview and Case Management Process Contents...

DOH Health Programs NCM 104  Collaborate with other members of the health Learning team in the implementation of programs and outcome services  Integrated Management of Childhood Illnesses (IMCI) – Overview and Case Management Process Contents National Family Planning Program Rabies Prevention and Control Program National Tuberculosis TB Control Program Oral Health Program  Integrated Management of Childhood Illnesses (IMCI) IMCI aims to reduce childhood mortality and improve the quality of care for major childhood illnesses, especially at first-level health facilities. Overview and Case Management Process One million children under five years old die each year in less developed countries. The large majority of these deaths are from preventable causes – acute respiratory infections (mostly pneumonia), diarrhea, measles, malaria, or malnutrition. Children often die from a combination of these conditions. Why was In most developing countries, first-level facilities do not have many diagnostic tools like laboratory services or radiology IMCI equipment to diagnose multiple conditions. Due to limited supplies, human resources, and equipment, Created? healthcare providers at first-level facilities often need to refer more complicated clinical procedures to second-level facilities. The Integrated Management of Childhood Illness strategy has been introduced in an increasing number of countries in the region since 1995. The strategy was developed by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF).  Providing quality care to sick children , WHO and UNICEF developed a strategy known as Integrated Management of Childhood Illness (IMCI), an integrates case management of the most common childhood problems, especially the most important causes of death.  Just five diseases (pneumonia, diarrhea, malaria, measles and dengue hemorrhagic fever) account for nearly half of these deaths and malnutrition is often the underlying condition. Key points about IMCI guidelines Assess all young infants and Identify treatment and tell children for all common Help you classify a problem you where to treat the child causes of illness and death Objectives of IMCI Reduce death and frequency and severity of illness and disability, and Contribute to improved growth and development Who are the children covered by the IMCI protocol? INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS GUIDELINES ASSESS CLASSIFY TREAT COUNSEL PROVIDE FOLLOW-UP CARE IMCI uses simple signs to detect cases. That means detection of conditions for treatment is based on your observations. You will ASSESS all sick infants and children for: 1. Signs of serious illness that requires urgent referral 2. Signs of common health conditions 3. Nutrition status, immunization status, and other problems. You will classify each health condition using color-coded IMCI charts. You will classify based on the history given, signs the child shows, and tests as indicated. The chart also identifies treatment for the condition. The three color-coded classifications also tell you where to give these treatments: ✔ PINK: very serious condition requires urgent pre-referral treatment and referral ✔ YELLOW: serious condition needs treatment and advice in the clinic ✔ GREEN: less serious condition needs home treatment and advice  After classifying all conditions, you will review all treatments identified in each classification. Then you will develop an integrated treatment plan. TREAT If a child requires urgent referral, give essential treatment before the patient is transferred. If a child needs treatment at the clinic, you will often give the first dose in the clinic. Give immunizations if needed. You will advise caregivers on home treatment. COUNSEL A critical component of IMCI is counselling caregivers on home treatment (e.g. treating local infections, giving oral drugs), feeding and fluids, breastfeeding, and other well childcare. Then counsel the caregiver about her own health. Advise the caregiver to return for follow-up on a specific date. Teach caregivers when to return immediately if child shows signs of severe illness.  When a child returns to the clinic as requested, give follow-up care as Give required. PROVIDE FOLLOW- Re-examine conditions to see if the issues are improving, the same, or Re-examine worsening. UP CARE Use Use the full IMCI process again to check the child for new problems. Steps of the IMCI Case Management Process The following is the flow of the IMCI process: At the out-patient health facility, the health worker should routinely do basic demographic data collection, vital signs taking, and asking the mother about the child's problems. Determine whether this is an initial or a follow-up visit. The health worker then proceeds with the IMCI process by checking for general danger signs, assessing the main symptoms and other processes indicated in the chart below. Take note that for the pink box, referral facility includes district, provincial and tertiary hospitals. Once admitted, the hospital protocol is used in the management of the sick child. WHAT ARE GOOD COMMUNICAT ION SKILLS? LISTEN SIMPLIFY WORDS GIVE HER TIME BE CLEAR PRAISE ASSESS AND CLASSIFY THE SICK CHILD  What Is A General Danger Sign? A general danger sign is present if CARE WHEN URGENT REFERRAL IS REQUIRED Children with general danger signs and/or any condition with a red classification require urgent pre-referral treatment and referral. These classifications indicate very serious illness.  CARE WHEN URGENT REFERRAL IS REQUIRED SICK YOUNG INFANT AGE UP TO 2 MONTHS SICK CHILD 2MONTHS UP TO 5 YEARS HOW DO YOU URGENTLY REFER THE CHILD? 1 2 3 EXPLAIN to the caregiver the need CALM the caregiver’s fears and help WRITE A REFERRAL NOTE for the for referral and get her agreement to him/her resolve any problems. caregiver to carry take the child. National FAMILY PLANNING PROGRAM  For Filipino women and men achieve their desired family size and fulfill the reproductive VISION health and rights for all through universal access to quality family planning information and services.  MISSION In line with the Department of Health FOURmula One Plus strategy and Universal Health Care framework, the National Family Planning Program is committed to provide responsive policy direction and ensure access of Filipinos to medically safe, legal, non-abortifacient, effective, and culturally acceptable modern family planning (FP) methods.  1. To increase modern Contraceptive Prevalence Rate (mCPR) among all women from 24.9% in 2017 to 30% by 2022 OBJECT IVES 2. To reduce the unmet need for modern family planning from 10.8% in 2017 to 8% by 2022 Program Components Component A: Provision of free FP Commodities that are medically safe, legal, non-abortifacient, effective and culturally acceptable to all in need of the FP service Component B: Demand Generation through Community-based Management Information System Component C: Family Planning in Hospitals and other Health Facilities Component D: Financial Security in FP  Local Government Units Civil Society Organizations Partner Non-Government Organizations Institutions Private Sector Faith-based Organizations Development Partner Policies and Laws Republic Act No. 10354: Responsible Parenthood and Reproductive Health Act of 2012 (RPRH Law) Executive Order No. 12, s. 2017: Attaining and Sustaining “Zero Unmet Need for Modern Family Planning” Through the Strict Implementation of the Responsible Parenthood and Reproductive Health Act, Providing Funds Therefor, and for other Purposes Administrative Order 2017-0005: Guidelines in Achieving Desired Family Size through Accelerated and Sustained Reduction in Unmet Need for Modern Family Planning Methods Administrative Order 2016-0005: National Policy on the Minimum Initial Service Package (MISP) for Sexual and Reproductive Health (SRH) in Emergencies and Disasters Administrative Order 2017-0002: Guidelines on the Certification of Free-Standing Family Planning Clinics Policies and Laws Department Order 2017-0345: Guidelines on the Forecasting, Procurement, Allocation and Distribution of Modern Family Planning Commodities Administrative Order 2015-0006: Inclusion of Progestin Subdermal Implant as One of the Modern Methods Recognized by the National Family Planning Program. Administrative Order 2014-0042: Guidelines on the Implementation of Mobile Outreach Services for Family Planning Department Memorandum 2015-0384: Establishment of the Family Planning Logistics Hotline Strategies, Action Points and Timeline The following main strategies to ensure universal access to FP: FP Outreach Mission – this maximizes opportunities where clients are, and FP services are delivered down to the community level. FP in hospitals – this address missed opportunities where women especially those who recently gave birth are offered with appropriate FP services. Intensive Demand generation through house-to-house visits by the community health volunteers, Family Development Sessions, Usapan sessions, among others The Department of Health (DOH) defines Informed Choice and Voluntarism (ICV) as: “A standard in the delivery of FP services, ensuring that clients freely make their own decision based on accurate and complete information on a broad range of available modern FP methods, and not by any special inducements or forms of coercion or misinterpretation.” What Is Informed Choice and Voluntarism (Icv)? 1 2 3 The quality of care in The rights of FP clients, Clients must be able to family planning (FP) especially the right to make voluntary and requires that the rights of information and choice, informed choices based FP clients are safeguarded must be honored through on accurate, balanced and by service providers at all appropriate FP counseling. complete information. times. QUALITY OF CARE IN FP: CLIENT RIGHTS AND PROVIDER NEEDS The quality of FP services can be further enhanced by safeguarding the rights of clients and by providing the needs of healthcare professionals.  Informed consent is a written voluntary decision of an FP client stating that INFORMED he/she accepts the particular method (e.g., sterilization, IUD, or implant CONSENT insertion) before undergoing the procedure.  Any minor availing of FP services must have written consent of their parents or The RPRH Act of 2012 guardians. implementing rules and Any minor who has had a previous pregnancy or is already a parent still requires parental regulations include the following consent prior to availing of FP services. provisions regarding informed Spousal consent is needed prior to undergoing permanent surgical contraceptive consent in availing FP services: methods.  Method effectiveness is the typical or average likelihood of pregnancy Method for all users of a particular method regardless of whether they have used this method correctly and consistently. Effectiveness It also refers to the lowest likelihood of pregnancy when the method is used correctly and consistently as reported in reliable studies. Advantages and Disadvantages Clients have varying perceptions on the advantages and disadvantages of each method. The information provided to the client must therefore be adapted to his/her requirements and current conditions. For instance, taking a pill daily may be preferred by some while tedious for others. Some may prefer injectables or IUDs despite the temporary discomfort associated with these methods. Side Effects and Complications The appropriate disclosure of the It also boosts user satisfaction side effects of a particular and motivation for continued method helps the client arrive use. at an informed decision. Use of the Chosen Method The information about the use of A useful approach is to ask the certain methods should be correct client to repeat the instructions to and clear because many failure avoid misunderstandings. cases result from errors in usage. This part of client education must include the following: How the method is used and when to start What to do if any side effects, problems, or bothersome symptoms are noted What are the danger signs that should prompt immediate consultation? What special strategies to use to reduce errors of usage (e.g., developing techniques to remember taking the pill daily) What to do when errors do occur (e.g., forgotten pill)  The client must be informed when to return for follow-up, resupply, or assessment and management of symptoms. When to return The FP service provider should encourage the client to return any time and for any reason Education on the Prevention of Sexually Transmitted Infections (ST Is) Educating clients on the prevention of STIs has become an emergent need and hence an integral part of counseling because of the increase in the number of STI cases globally. The ABCDE of safe sex should also be emphasized. OBJECT IVES OF FP CLIENT ASSESSMENT Client assessment is aimed at the following objectives: To determine the health status of a client, particularly his/her eligibility for contraceptive use To gather data about the client’s health through medical history taking, physical examination (PE), and laboratory examination, if needed. To determine if the client is in good health or needs further management, close follow-up, and/or referral. Physical examination PE ensures the safe use of an FP method and thus ensures the client’s safety. A thorough PE also helps the service provider in the following circumstances: Identification of any health problems that may warrant the provision of FP/RH care Evaluation of client’s health status while he/she is using an FP method to monitor any changes that call for precautions on the use of the method Confirmation of conditions suspected or noted during the client history taking Laboratory examinations A service provider should be familiar In some cases, findings during the Laboratory tests are not required for all with these tests and their interpretation, history taking or PE may require clients but should be performed as should know when to request them, and confirmation through laboratory tests. needed. should understand how these tests can help manage the client’s condition Applicability of various procedures or tests Some examinations or procedures should be performed before providing a contraceptive method. Clients with known medical problems or other special conditions may need additional examinations or tests before being considered as candidates for a particular contraceptive method. RABIES PREVENT ION AND CONTROL PROGRAM Rabies is endemic in the Philippines and remains to be a public health concern. It has a fatality rate of almost 100%, being the most fatal among infectious diseases, rabies too, is 100% preventable. At least one-third of these deaths occur in children aged 15 years old and below. Republic Act No. 9482 also called the Anti-Rabies Act of 2007, which mandated the creation of a National Rabies Prevention and Control Program (NRPCP). This is an intersectoral initiative that aimed to strengthen the country’s national rabies prevention and control program. National Rabies Prevention and Control Committee (NRPCC) serves as its implementing body and is composed of representatives from the Department of Health (DOH). PARTNER INSTITUTIONS As of December 2018, there were 613 animal treatment bite centers in the Philippines that give free anti-rabies shots. Vision Rabies Free Philippines by 2030  To end human deaths from dog-mediated GOAL rabies by 2027  is a human infection that occurs after a transdermal bite or scratch by an infected Rabies animal, like dogs and cats. Rabies, can be transmitted when infectious material, usually saliva, comes into direct contact with a victim’s fresh skin lesions. The average incubation period of human rabies is between 1-3 months but may vary from 1 week to 1 year, dependent upon factors such as the location of virus entry and viral load. Initial symptoms of rabies include a fever with pain and unusual or unexplained tingling, pricking, or burning sensation (paraesthesia) at the wound site. As the virus spreads to the central nervous system, progressive and fatal inflammation of the brain and spinal cord develops.  Domestic dog rabies remains the predominant contributor to rabies incidence throughout the world. Components of the program as mandated by RA 9482 (Anti-Rabies Act of 2007) Mass Dog Vaccination This is the most effective measure to control canine rabies. The Department of Agriculture takes the lead in mass dog vaccination campaigns and provision of animal rabies vaccine. Post-Exposure Prophylaxis (PEP) and Pre-Exposure (PrEP) Post Exposure Prophylaxis (PEP) – antirabies prophylaxis should be administered after an exposure (such as bite, scratch, lick, etc). Pre-Exposure Prophylaxis (PrEP) – vaccination should be given to individuals who are at high risk of getting rabies  Components of the program as mandated by RA 9482 (Anti-Rabies Act of 2007) Health Promotion Celebration of Rabies Awareness Month under Executive Order No. 84, March is Rabies Awareness Month Celebration of World Rabies Day - September 28 has been declared as World Rabies Day Development of IEC Materials Massive Health Information Campaign using Tri-Media Integration of Rabies Program into the School Curriculum POLICIES AND LAWS Anti-Rabies Act of 2007 (Republic Act 9482) An Act Providing for the Control and Elimination of Human and Animal Rabies, Prescribing penalties for Violation Batas Pambansa Bilang 97: An Act Providing for the Compulsory Immunization of Livestock, Poultry and other Animals against Dangerous Communicable Diseases. Executive Order No. 84: Declaring March as the Rabies Awareness Month, Rationalizing the Control Measures for the Prevention and Eradication of Rabies and Appropriating Funds. Memorandum of Agreement on Interagency Implementation of the NRPCP: Signed in May 1991 by the Secretaries of Agriculture (DA), Health (DOH), Local Government (DILG) and Education, Culture and Sports, now, Department of Education POLICIES AND LAWS Joint DA, DOH, DepEd, DILG Administrative Order No. 01 Series of 2008: Implementing Rules and Regulations Implementing Republic Act 9482 An Act Providing for the Control and Elimination of Human and Animal Rabies, Prescribing Penalties for Violation Thereof and Appropriating Funds Administrative Order No. 2014-0012 entitled New Guidelines on the Management of Rabies Exposures Administrative Order No. 2018-0013 entitled Revised Guidelines on the Management of Rabies Exposures Joint Department Administrative Order No. 01 entitled Guidelines for Declaring Areas as Rabies-Free Zones National Tuberulosis Control Program VISION A Tuberculosis-free Philippines Zero deaths, disease, and suffering due to tuberculosis  ✓Long Term Goal (2035): Reduce TB burden by decreasing TB mortality by 95% and TB incidence by 90%. GOAL ✓Medium Term Goals (2022): Reduce TB burden by: Decreasing the number of TB deaths by 50% from 22,000 to 11,000 Decreasing TB incidence rate by 15% from 554/100,000 to 470/100,000 Reduce catastrophic costs incurred by TB-affected households from 35% to 0%. At least 90% of patients are satisfied with the services of the DOTS facilities. OBJECTIVES: Specific objectives by 2022 Improve the utilization of TB care and prevention services by patients and communities. Reduce catastrophic cost of TB-affected households accessing DOTS facilities to 0%. Ensure adequate and competent human resources for TB elimination efforts. Improve the use of TB data for effective TB elimination efforts. Enhance quality of all TB care and prevention services. Increase to at least 90% of DOTS facilities that are providing expanded integrated patient centered TB care and prevention services. Enhance the political stewardship through high-level political commitment of national government agencies and LGUs to implement localized TB elimination plan in coordination with different sectors. Tuberculosis TB most commonly affects the lungs, it is called Pulmonary Tuberculosis Pulmonary tuberculosis (PTB) is a chronic respiratory disease common among crowded and poorly ventilated areas. Who is most at risk? Tuberculosis mostly affects adults in their most productive years. However, all age groups are at risk. People who are infected with HIV are 19 times more likely to develop active TB. People with undernutrition are 3 times more at risk. Alcohol use disorder and tobacco smoking increase the risk of TB disease by a factor of 3.3 and 1.6 respectively Global impact of TB In 2018, the largest number of new TB cases occurred in the South-East Asian region, with 44% of new cases, followed by the African region, with 24% of new cases and the Western Pacific with 18%. Eight countries accounted for two thirds of the new TB cases: India, China, Indonesia, Philippines, Pakistan, Nigeria, Bangladesh and South Africa. Symptoms and Diagnosis Rapid test Xpert MTB/RIF has expanded substantially since 2010, when WHO first recommended its use. The test simultaneously detects TB and resistance to rifampicin, the most important TB medicine. Diagnosis can be made within 2 hours and the test is now recommended by WHO as the initial diagnostic test in all persons with signs and symptoms of TB. Treatment TB is a treatable and curable disease. Active, drug-susceptible TB disease is treated with a standard 6-month course of 4 antimicrobial drugs that are provided with information and support to the patient by a health worker or trained volunteer. Without such support, treatment adherence is more difficult. Classification based on history of previous treatment 1. New Case- A patient who has never had treatment for TB or who has taken anti-TB drugs for less than one (