Saint Dominic Savio College School of Nursing NCM 104 Community Health Nursing 1 Lecture PDF 2024-2025

SAINT DOMINIC SAVIO COLLEGE SCHOOL OF NURSING NCM 104 - COMMUNITY HEALTH NURSING 1 LECTURE S.Y. 2024-2025 RESOURCE...

SAINT DOMINIC SAVIO COLLEGE SCHOOL OF NURSING NCM 104 - COMMUNITY HEALTH NURSING 1 LECTURE S.Y. 2024-2025 RESOURCE UNIT Course title : COMMUNITY HEALTH NURSING 1 (Individual and Family) Course code : NCM 104 Course Credit : Theory: 2 UNITS (36 HOURS); RLE: SKILLS LAB- 1 UNIT (51 HOURS); Clinical -1 unit (51 hours) Placement : SECOND YEAR, FIRST YEAR Pre-requisite : NCM 101, NCM 102, NCM 103 Course Description: This course deals with concepts, principles, theories and techniques in the provision of basic care in terms of health promotion, disease prevention, restoration and maintenance and rehabilitation at the individual and family level. It includes the study of the Philippine Care Delivery System, national health situation, and the global context of public health. The learners are expected to provide safe, appropriate and holistic nursing care to individual and 1  TABLE OF CONTENTS Content Cover Page-------------------------------------------------------------------------------------------------------1 Table of Contents----------------------------------------------------------------------------------------------2 I. The Health Care Delivery System-----------------------------------------------------------------------4 A. World Health Organization 1.Millennium Development Goals-------------------------------------------------------------8 2. Sustainable Development Goals------------------------------------------------------------9 II. Philippine Department of Health----------------------------------------------------------------------10 1. Mission-Vision 2. Historical Background 3. Local Health System and devolution of Health Services 4. Classification of health facilities 5. Philippine Health Agenda 201-2022 B. Primary Health Care--------------------------------------------------------------------------------17 C. Levels of Prevention--------------------------------------------------------------------------------22 D. Universal health Care Law------------------------------------------------------------------------24 1.Legal basis 2.Background and rationale 3.Objectives and Thrusts III. DOH Programs Related to Family Health A. Expanded Program Related to family Health------------------------------------------20 B. Integrated Management of Childhood Illnesses (IMCI)-----------------------------33 C. Early Intrapartum and Newborn Care (EINC)------------------------------------------36 D. Newborn screening---------------------------------------------------------------------------37 E. BEmONC/CEmONC----------------------------------------------------------------------------40 F. MhGap--------------------------------------------------------------------------------------------41 IV.Ethical Considerations in Community Health Nursing------------------------------------------44 V. New Technologies Related to Public Health Electronic Information-----------------------44 VI. Public Health Laws--------------------------------------------------------------------------------------54 A. Magna Carta for Health Worker B. Sanitation Code C. Clean Air Act D. Generic Act E. National Health Insurance Act (PhilHealth) F. National Blood Services Act G. Laws on Notifiable Disease H. Senior Citizen Laws I. Revised Dangerous Drugs Law 2  J. Act on Cheaper Medicine K. Save the Children L. Violence Against Women M. Disaster Risk Reduction Management N. Rooming-in and Breastfeeding Act of 1992 (Milk Code) O. Responsible Parenthood and Reproductive Health Law of 2012 P. Mandatory Infants and Children Health Immunization Act of 2011 Q. Children Safety on Motorcycles Act of 2015 R. Children’s Emergency Relief and Protection Act of 2016 S. Child and Youth Welfare Code of the Philippines T. Tobacco Regulation Act of 2003 (RA 9211) U. Other Related Laws VIII. REFERENCES----------------------------------------------------------------------------------------------56 3  I. THE HEALTH CARE DELIVERY SYSTEM LEARNING OBJECTIVES: 1. Discuss how the World Health Organization affects health issues in the Philippines 2. Describe the Philippine Health Care Delivery System as to its components and sectors 3. Determine the factors that influence the health care delivery system 4. Critiquing the Philippine health care delivery system in terms of the different levels of services 5. Compare the Health care delivery system between health system, health care system 6. Monitor how the health care delivery system paradigm helps the health condition of the people 7. Link the pyramid to achieve our country’s vision, mission and goal 8. Review how the WHO affects health issues in the Philippines 9. Integrating the Millennium Development Goals and the targets of the health related MDG’s in the health care delivery system 10. Validate the Sustainable Development Goals and its effect on the people HEALTH CARE DELIVERY SYSTEM: It is the totality of all policies, infrastructures, facilities, equipment, products, human resources, and services that addresses the health needs, problems and concerns of all people. Health Care Delivery – rendering health care services to the people. Health Care Delivery System (Williams-Tungpalan, 1981) – the network of health facilities and personnel, which carries out the task of rendering health care to the people. HEALTH CARE DELIVERY SYSTEM -A nation’s health care delivery system has a tremendous impact not only on the health of its people but also on their total development, including their socioeconomic status. A discussion of the health care delivery system often involves issues of cost and challenges. Nations go through a struggle to overcome multiple forces in efforts to advance the nation’s health within the context of their financial and political situations. - Anderson and Mc Earlane (2011) emphasized the role of the following factors in shaping 21st century health that further influence health care delivery system: FACTORS THAT INFLUENCE HEALTH CARE DELIVERY SYSTEM 1. Health care reforms 2. Demographics 3. Globalization 4. Poverty and growing disparities 5. Social disintegration The health care delivery system in the Philippines beginning with the WHO as this specialized agency of the United Nations (UN) provides global leadership on health matters. In the Philippines, health services are provided by the: 4  A. Government B. Private sector- for profit and nonprofit agencies. With the latter frequently referred to as non-governmental organizations or NGOs. On the National level, direction is set by the Department of Health (DOH). By virtue of the mandate of the local Government Code (R.A. 7160), local government units (LGUs) should have an operating mechanism to meet the priority needs and service requirements of their communities. Basic health services are regarded as priority services, for which LGUs are primarily responsible. Health System Consist of all organizations, people, and actions whose primarily intent is to promote, restore, or maintain health. Health Care System – an organized plan health services (Miller_Keane, 1987). Philippine Health Care System – is a complex of organizations interacting to provide an array of health services (Dizon, 1977) Health System has 6 building blocks or components 1. Service Delivery 2. Health workforce 3. Information 4. Medical products, vaccines, and technologies 5. Financing 6. Leadership and governance or stewardship The nurse is an essential member of the health workforce in the country. For all the nurse to work efficiently within the health care delivery system, an understanding of the dynamic relationships among its components is needed. Components and Sectors of the Health Care Delivery System Services is divided into 2 sectors: a. Public b. Private Public Sector consists of: 1.National Government Agencies, the Department of Health is mandated as the lead agency for health. It has a regional office in every region and maintains specialty hospitals, regional hospitals and medical centers. It also maintains provincial health teams made up of health teams made up of DOH representatives to the local health boards and personnel involved in communicable disease control , specifically for malaria and schistosomiasis. 2.Local Government Agencies Public sector is largely financed through a tax based budgeting system at both national and local levels. In here, health care is generally given free at the point of service. Socialized user fees have been introduced in recent years for certain types of services. Financing of health services is provided by three major groups: A. Government (national and local) 5  B. Private sources C. Social health insurance The National Health Insurance Act of 1995 (R.A. 7875) created the Philippine Health Insurance Corporation (Phil Health). It is a tax-exempt government corporation attached to the DOH for policy coordination and guidance, and aims for universal health coverage of all Filipino citizen. -In the Philippines health care system is complex set of organizations interacting to provide an array of health services. (www.freewebs.com/.../...). Components of the Health Care Delivery System as mandate of the Department of Health (DOH) is to be responsible for the following: 1.formulation and development of national health policies, guidelines, standards 2.manual of operations for health services and programs; 3. issuance of rules and regulations, licenses and accreditations; 4.promulgation of national health standards, goals, priorities and indicators; 5.development of special health programs and projects and advocacy for legislation on health policies and programs. A. Paradigm National - Tertiary Health Services Medical Centers Regional Health Services - Secondary Provincial / City Health Services Provincial / City Hospitals - Primary Emergency / District Hospitals Rural Health Unit Community Hospitals and Health Centers Private Practitioners / Puericulture Center Barangay Health Station FIGURE 1. THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM (Community Health Nursing Services in the Philippine Department of Health, 2000) 6  The pyramid is a graphic representation of our country’s vision and goal to achieve Health for all Filipinos and Health in the Hands of the People by the year 2020, with the mission to ensure accessibility and quality of life of all Filipinos, especially the poor. A. WHO - World Health Organization The WHO constitution came into force on April 7,1948. So April 7 has been celebrated each year as World Health Organization Day. The headquarters is in Geneva, Switzerland. The Philippine is a member of the Western Pacific Region which holds office in Manila. -The DOH serves as the main governing body of health services in the country. Specialized agency of the United Nation provides global leadership on health matters. -The WHO constitution came into force on April 7, 1948. Since then, April 7 has been celebrated each year as -World Health Day (WHO, 2013a). With its headquarters in Geneva, Switzerland, WHO has 147 country offices and 6 world regional offices for Africa, the Americas, Eastern Mediterranean, Europe, Southeast Asia, and the Western Pacific. -The Philippines is a member of the Western Pacific Region, which holds office in Manila (WHO, 2007b). -The WHO constitution states that its objective is the attainment by all peoples of the highest possible level of health (WHO, 2006). Core Functions: 1. Providing leadership on matters critical to health and engaging in partnerships where joint action is needed. 2. Shaping the research agenda and stimulating the generation, translation and disseminating valuable knowledge WHO strategy on research has 5 goals; 1.Capacity in reference to capacity building to strengthen national health research systems 2.Priorities to focus research on priority health needs particularly in low-and middle income countries 3.Standards to promote good research practice and enable the greater sharing of research evidence tools, and materials 4. Translation to ensure that quality evidence is turned into products and policy 5.Organization to strengthen the research culture within WHO and improve the management and coordination of WHO research activities 3. Setting norms and standards and promoting and monitoring their implemnetations. 4. Articulating ethical and evidence based policy options. 5. Proving technical support, catalyzing change, and building sustainable institutional capacity In the past decade, WHO has worked as a partner of the Philippine DOH in the development and provision of services towards the attainment of health-related Millennium Development Goals (MDGs). 7  1. THE MILLENEUM DEVELOPMENT GOALS September 6-8, 2000- Millennium Summit. World leaders in the UN assembly participated. United Nations Millennium Declaration. The world leaders recognized their collective responsibility to uphold the principles of human dignity, equality, and equity at the global level. The declaration expressed the commitment of the member states is to reduce poverty and achieve the 7 other targets. Now called Millennium Development Goals (MDGs) by the year 2015. MILLENNIUM DEVELOPMENT GOALS 1. Eradicate extreme poverty and hunger 2. Achieve universal primary education 3. Promote gender equality and empower women 4. Reduce child mortality 5. Improve maternal health 6. Combat HIV/AID, malaria and other diseases 7. Ensure environmental sustainability 8. Develop a global partnership for development 2. SUSTAINABLE DEVELOPMENT GOALS -Known as the Global Goals are a universal are a collection of 17 global goals set by the United Nations Assembly in 2015 for the year 2030. The SDGs are part of Resolution 701 of the United Nations General Assembly 8 -They are the blueprint to achieve a better and more sustainable future for all. They address the global challenges we face, including those related to poverty, inequality, climate, environmental degradation, prosperity, and peace and justice. -The goals interconnect and in order to leave no one behind, it is important that we achieved each goal and target by 2030 17 GLOBAL GOALS (SUSTANAINABLE GOALS) 1. No poverty-end poverty in all its forms everywhere 2. Zero hunger-food security n improved nutrition 1 3. Good health and well being 7 4. Quality Education 5. Gender equality 6. Clear water and sanitation 7. Affordable and Clean energy 8. Decent Work and economic growth 9. Industry, Innovation, and infrastructure 10. Reduces inequalities 11. Sustainable cities and communities 12. Responsible consumption and production 13. Climate action 14. Life below water 15. Life on land 16. Peace justice and strong institution 17. Partnership for the goals 9 II. THE PHILIPPINE DEPARTMENT OF HEALTH LEARNING OBJECTIVES: 1. Explain how the Department of Health (DOH) provides health leadership in the Philippines 2. Evaluate the major role of the Department of Health 3. Review about the vision and mission of the DOH 4. Critiquing the local health system and devolution of health services 5. Comparing the different classification of health facilities 6. Analyze the Philippine Health Care Agenda A. Philippine Department of Health 1. Mission and Vision 2. Historical background 3. Local Health System and Devolution of Health Services 4. Classification of Health Facilities (DOH AO -0012A) 5. Philippine Health Agenda 2010-2022 -The Department of Health (DOH) is the national agency mandated to lead the health sector towards assuring quality health care to all Filipinos. -Vision: is to make “Filipinos among the healthiest in Southeast Asia by 2022and in Asia by 2040” Mission: To” Lead the country in the development of a productive, resilient, equitable, and people centered health system” Major Roles: 1. Leader in health 2. Enabler and capacity builder 3. Administrator of specific services The leadership role of the DOH is specifically elucidated in Executive Order 102. series of 1999 in terms of the following functions: 1. Planning and formulating policies of health programs and services 2. Monitoring and evaluating the implementation of health programs , projects, research training, and services 3. Advocating for health promotion and healthy lifestyles 4. Serving as a technical authority in disease control and prevention 10  5. Providing administrative and technical leadership in health care financing and implementing the National Health Insurance Law FUNCTIONS OF THE DOH, As enabler and capacity builder: 1. Providing logistically support to LGUs the private sector, and other agencies in implementing health programs and services 2. Serving as the lead agency in health and medical research 3. Protecting standards of excellence in the training and education of health care system As administrator of specific services, the DOH is tasked to: 1. Serve as administrator of selected health facilities at subnational levels that act as referral centers for local health systems, that is, tertiary and special hospitals, reference laboratories, training centers, centers for health promotion, centers for disease control and prevention and regulatory offices 2. Provide specific program components for conditions that affect large segments of the population, such as TB, malaria, schistosomiasis, HIV/AIDS and micronutrient deficiencies 3. Develop strategies for responding to emerging health needs 4. Provide leadership in health emergency preparedness and response services Including referral and networking systems for trauma, injuries and catastrophic events. The DOH core values reflect adherence to the higher standards of work: 1. Integrity 2. Excellence 3. Commitment 4. Professionalism 5. Teamwork 6. Stewardship of the people -The DOH shall do this by seeking all ways to establish performance standards for health human resources; health facilities and institutions; health products and health services that will produce the best health systems for the country. This, in pursuit of its constitutional mandate to safeguard and promote health for all Filipinos regardless of creed, status, or gender with special considerations for the poor and the vulnerable who will require assistance 2. Historical Background Pre-Spanish and Spanish period (before 1898) -Traditional health care practices especially the use of herbs and rituals for healing were widely practiced during these periods. -The western concept of public health services in the country is traced to the first dispensary for indigent patients of Manila ran by a Franciscan friar that was began in 1577. -In 1876 Medicos Titulares, equivalent to provincial health officers were already existing in 1888, a Superior Board of Health and Charity was created by the Spaniards which established a hospital system and a board of vaccination among others. 11 June 23, 1898 Shortly after the proclamation of the Philippine independence from Spain, the Department of Public Works, Education and Hygiene was created by virtue of a decree signed by President Emilio Aguinaldo. September 29, 1898 General Orders No. 15 established the Board of Health for the City of Manila. July 1,1901 A Board of Health for the Philippine Islands was created through Act No. 157. This also functioned as the local health board of manila. It truly became an Insular Board of Health when Act Nos 307,308 dated Dec. 2, 1901, established the Provincial and Municipal Boards respectively completing the health organization in accordance with the territorial division of the islands. October 26, 1905 The Insular Board of Health proved to be inefficient operationally so it was abolished and was replaced by the Bureau under the Department of Interior through Act No. 1407. Act No. 1487 in 1906 replaced the provincial boards of health with district health officers. 1912 Ant No. 2156 known as the Fajardo Act, consolidated the municipalities into sanitary divisions and established what is known as the Health Fund for travel and salaries. 1915 Act No. 2468 transformed the Bureau of Health into a commissioned service called the Philippine Health Service. August 2, 1916 The passage of the Jones Law also known as the Philippine Autonomy Act, provided the highlight in the struggle of the Filipinos for Independence from the American rule 1932 Because of the need to better coordinated public health and welfare services, Act No. 4007 known as the Reorganization Act of 1932, reverted back the Philippine Service into the Bureau of Health, and combined the Bureau of Public Welfare under the Office of the Commissioner of the Health and Public Welfare 1935-1945 The Philippine Commonwealth and the Japanese Occupation May 31, 1939 Commonwealth Act No. 430 created the Department of Public Health and Welfare but the full implementation was only completed through Executive Order No. 317, January 7,1941. Dr. Jose Fabella became the first Department Secretary of Health and Public Welfare in 1941. 1942 During the period of the Japanese occupation, various reorganization and issuances for the health and welfare of the people were instituted and lasted until the Americans came in 1945 and liberated the Philippines. October 4, 1947 Executive Order No. 94 provided for the post war reorganization of the Department of Health and public Welfare. 12  This resulted in the split of the Department with transfer of the Bureau of Public Welfare (which became the Social Welfare administration) and the Philippine General Hospital to the Office of the President. Another was created between the curative and preventive services through the creation of the Bureau of Hospitals which took over the curative services. Preventive care services remained under the Bureau of Health. This order also established the Nursing Service Division under the Office of the Secretary. January 1, 1951 The office of the President of the Sanitary District was converted into a Public health Unit, carrying out 7 basic health services: Maternal and child health, environmental health, communicable disease control, vital statistics, medical care, health education and public health nursing. This was carried out in 81 selected provinces. It directly resulted in the passage of the Rural health Act of 1954 (RA 1082). This Act created more rural health unites and crated posts for municipal health officers among other provisions. February 20,1958 Executive Order No. 288 provided for what is described as the” most sweeping” reorganization in the history of the department at that period. 1970 The Restructured Health Care Delivery System was conceptualized. It classified health services into primary, secondary, and tertiary levels of care. Under this concept the public health nurse to population ratio ws 1:20,000 June 2,1978 With proclamation of martial law in the country, Presidential Decree 1397 renamed the Department of Health to the Ministry of Health. Secretary Gatmaitan became the first Minister of Health. DECEMBER 2,1982 Executive Order No. 851 signed be the President Ferdinand E. Marcos reorganized the Ministry of Health as an integrated health care delivery system through the creation of the Integrated Provincial Health Office which combines public health and hospital operations under the Provincial Health Officers. April 13, 1987 Executive Order No.119 “Reorganizing the Ministry of Health “by President Corazon C. Aquino saw a major change in the structure of the ministry. It transformed the Ministry of Health back to the Department of Health. EO 119 clustered agencies and programs under the Office for Public Health Services, Office for Hospital and Facilities Services. The Field Offices were composed of the Regional Health officers and National Health facilities. The latter was composed of National Medical centers, the Special Research Centers and Hospitals. Five Deputy minister positions were also created. October 10,1991 Republic Act 7160 known as the Local Government Code provided for the decentralization of the entire government. This brought about a major shift in the role and functions of the Department of Health. 13 Under this law, all structures personnel and budgetary allocations from the provincial health level down to the barangays were devolved to the local government units (LGUs) to facilitate health service delivery. May 24, 1999 Executive Order No. 102 “and Operations of the Department of Health” by President Joseph E. Estrada granted the DOH to proceed with its Rationalization and Streamlining Plan which prescribed the current organizational, staffing and resource structure consistent with its new mandate, roles and functions post devolution. EO 102 Mandates the Department of Health to provide assistance to local government units, people’s organization and other members of civic society in effectively implementing programs, projects and services that will promote the health and well-being of every Filipino; prevent and control diseases among population at risks, protect individuals, families and communities exposed to hazards and risks that could affect their health and treat , manage and rehabilitate individuals affected diseases and disability. 1994-2004 Development of the Health Sector Reform Agenda which describes the major strategies, organizational and policy changes and public investments needed to improve the way health care is delivered, regulated and financed. 2005 ongoing Development of a plan to rationalize the bureaucracy in an attempt to scale down including the Department of Health. 3.Local Health System and Devolution of Health Service In 1991 the Philippines Government introduced a major devolution of national government services, which included the first wave of health sector reform, through the introduction of the Local Government Code of 1991. The Code devolved basic services for agriculture extension, forest management, health services, barangay (township) roads and social welfare to Local Government Units. In 1992, the Philippines Government devolved the management and delivery of health services from the National Department of Health to locally elected provincial, city and municipal governments. Aim: The aim of this review is to (i) Provide a background to the introduction of devolution to the health system in the Philippines and to (ii) Describe the impact of devolution on the structure and functioning of the health system in defined locations. A major shift took place in 1991 with the passage of the Local Government Code also known as Republic Act 7160. Under this law, all structures, personnel and budgetary allocations from the 14 provincial health level down to the barangays were devolved to the local government unis to facilitate health service delivery. Devolution made local government executives responsible to operate local health care services. New Centers of authority for local health services emerged. These consist of provincial, city, municipal governments, including an autonomous regional government and a metropolitan authority. Each center controls a portion of the health system as part of its political and administrative mandate. Now, provincial governments operate the hospital system, Provincial and District Hospitals, while city/municipal governments operate the Health Centers, Rural health Units and barangay health stations. With the devolution of health services, the local health system is now run by Local Government Units (LGUs). The provincial and district hospitals are under the provincial government while the city/ municipal government manages the health centers/ rural health units and barangay health stations. In every province, city or municipality, there is a local health board chaired by the local chief executive. Its function is mainly to serve as advisory body to the local executive and the sangguniang or local legislative council on health related matters. 4.Classification of Health Facilities (DOH AO -012A) -DOH issued Administrative Order 2012-0012 that provides for a new classification of health facility. -DOH Administrative Order 2012-0012(Rules and Regulations Governing the New Classification of Hospitals and Other Health Facilities in the Philippines). Hospitals Other Health Facilities General A. Primary Care facility Level 1 B. Custodial Care Facility Level2 C. Diagnostic/Therapeutic Level 3 Facility (teaching/training) Specialty D. Specialized Outpatient Facility Category A. Primary Health Care Facility The first -contact health care facility that offers basic services including emergency services and provision for normal deliveries 1. Without in-patient beds like health centers, outpatient clinics, and dental clinics 2. With in-patient beds- a short stay facility where the patient spends on the average of one or two days before discharge. Examples are infirmaries and birthing (lying in) facilities Category B Custodial Care Facility A health facility that provides long term care, including basic services like food and shelter, to patients with chronic conditions requiring ongoing health and nursing care due to impairment and a reduced degree of independence in activities of daily living and patients in need of rehabilitation 15 Examples: are custodial psychiatric facilities, substance. drug abuse treatment and rehabilitation centers, sanitaria/ leprosaria and nursing homes Category C Diagnostic /therapeutic facility A facility for the human body, specimens from the human body for the diagnosis, sometimes treatment of disease, or water for drinking water analysis. The test covers the pre analytical, analytical and post analytical: 1. Laboratory facility such as but not limited to the following: a. Clinical laboratory b. HIV testing laboratory c. Blood service facility d. Drug testing laboratory e. Newborn screening lab. f. Laboratory for drinking water analysis 2. Radiologic facility providing services such as X-ray, CT scan, mammography, MRI, and ultrasonography 3. Nuclear medicine facility- a facility regulated by the Philippine Nuclear Research Institute utilizing applications of radioactive materials in diagnosis, treatment or medical research, with the exception of the use of sealed radiation sources in radiotherapy as in internal radiation therapy Category D Specialized outpatient facility A facility that performs highly specialized procedures on an outpatient basis Examples are dialysis clinic, ambulatory surgical clinic, cancer chemotherapeutic center/ clinic cancer radiation facility and physical medicine and rehabilitation center/ clinic. NEW CLASSIFICATION OF GENERAL HOSPITALS HOSPITALS LEVEL 1 LEVEL 2 LEVEL 3 Clinical services for Consulting Level 1 plus: Level 2 plus: in patient specialists in: Departmentalized Teaching /training Medicine clinical service with accredited Pediatrics residency training Obstetrics- program in four Gynecology major clinical srevices Surgery Emergency and out Respiratory unit patient services Physical medicine and Isolation facilities General ICU rehabilitation unit Surgical /maternity High risk pregnancy facilities unit Ambulatory surgical Dental Facility NICU clinic 16  Dialysis clinic Ancillary services Secondary clinical Tertiary clinical Tertiary clinical laboratory laboratory laboratory with Blood station histopathology First level X-ray Second level X-ray Blood bank Pharmacy with mobile unit Third level 5.PHILIPPINE HEALTH AGENDA 2010-2022 (LINKS will be given) In order to attain health-related sustainable development goals, the A.C.H.I.E.V.E. strategy is followed: A- Advance quality, health promotion and primary care C- Cover all Filipinos against health-related financial risk H- Harness the power of strategic HRH development I- Invest in eHealth and data for decision-making E- Enforce standards, accountability and transparency V- Value all clients and patients, especially the poor, marginalized, and vulnerable E- Elicit multi-sectoral and multi-stakeholder support for health With the Philippine Health Agenda 2016-2022, we will all ACHIEVE a health system with the values of Equity, Quality, Efficiency, Transparency, Accountability, Sustainability, Resilience towards “Lahat Para sa Kalusugan! Tungo sa Kalusugan Para sa Lahat”. C. PRIMARY HEALTH CARE (PHC) LEARNING OBJECTIVES 1. Define Primary Health Care 2. Outline the historical background of PHC 3. Enumerate the key principles of PHC 4. Enumerate the 5 As of PHC 5. Differentiate between the multisectoral, intersectoral linkages 6. Relate the application of the PHC key principles in the implementation of public health programs B. Primary Health Care (PHC) 1. Brief History 2. Legal Basis 3. Definition 4. Goals 5. Elements 6. Principles and Strategies 17 1. Brief History: The core strategy is the effective provision of essential health services. PHC was declared during the First International Conference on Primary Health Care held in Alma Ata, USSR on September 6-12 1978 by WHO and UNICEF. Together they expressed the need for concerted efforts by all governments and health and development workers for the protection and promotion of health of all the people. 2.Legal Basis of PHC in the Philippines Letter of instruction (LOI) 949 signed by Pres. Marcos on October 19, 1979. Making the Philippines the first country in Asia to embark on meeting the challenge of PHC. It must be noted that even prior to LOI 949, which provided impetus to the then Ministry of Health, there were several health workers, nongovernmental organizations (NGOs) and church organizations offering community-based health programs In the rural areas of Visayas and Mindanao, applying the spirit of PHC even before it was formally adopted by the government. The Alma ATA Declaration on Primary Health Care emerged from this conference. The Alma Ata conference made the following declarations: 1. Health is a basic fundamental right 2. There exists global burden of health inequalities among populations 3. Economic and social development is of basic importance for the full attainment of health for all 4. Governments have a responsibility for the health of their people. -Basic to the PHC declaration is the common view that health “is a state of complete, physical, mental, and social well-being, and not merely the absence of disease or infirmary “ -Viewing health from holistic perspective, beyond just physical and mental maladies, the WHO has put equal emphasis on the social dimensions of health, that wellness can be achieved by considering different factors that interdependently influence the health of the population, such as the environment, education, social services and politics/ leadership. -A healthy population has the capability to contribute more to its development. By emphasizing the people’s right to health, the government is driven to increase investment on health care. The WHO recommends governments to allocate 5% of the gross national product (GNP) to health services from 2005 t 2007 was only 3.3 % of the GNP -PHC as a service delivery policy of the DOH permeates all strategies and thrusts of government health programs from the national to the local and community levels --PHC is a complete turn-about from disease-oriented, curative, hospital based, and urban centered health care to preventive, people centered, and community-based health care. 18 3.The WHO defined PHC: -Essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost that the community and country can afford at every stage of development. -According to Alma Ata Declaration, PHC “is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost to maintain at every stage of their development in the spirit of self-reliance and self- determination” It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work and constitutes the first element of a continuing health care process. Mission of PHC: is to strengthen health care systems by providing and supporting conditions where people manage their own health and ultimately realize the goal of health in their own hands. It advocates for a healthcare system characterized by 5A’s. 5 A’s (4As) a. Accessible- The WHO guideline states that for these health care facilities to be considered accessible, they must be within 30 minutes from households or within 5 kilometers distance. the communities. BHSs are facilities intended to provide accessible health services at the community level. Facilities for health and services delivered by health professionals are situated closer to where people are. b. Appropriate -connotes the use of technology based on expressed needs of the people that are not only scientifically proven effective but at the same time safe. This guarantees that communities are provided service designed to specifically address their needs employing local/indigenous resources that can be sustained overtime e. Availability- is a question of whether the basic health services require by the people are offered in the health care facilities or is provided on a regular and organized manner. Available health care refers to ensuring that essential services are provided to people in communities across all strata of society. Further, the effective and efficient utilization of resources by c. Affordable- health care flows from the Alma Ata declaration specifically. It is not only in consideration of the individual or family’s capacity to pay for basic health services. This necessitates that the expenses for health care should be within the budgetary capacity of each country. Efforts to reduce out of pocket expense for health care by consumers should be prioritized by adopting the policies that will improve costs of medicines and medical procedures. Moreover, the concept of affordable health care requires that both private and public healthcare systems avail of technology for a reasonable price so that budget for health services can be maximized to benefit people. Particularly for public health services, it is also a matter of whether the community or government can afford these services. One of the factors the WHO considers in determining affordability of health care is the out of pocket expenses for health care. 19 This is the actual cost to the family for health services in any coverage of insurance. In the Philippines, the government health insurance is covered through Phil health. There are other health insurance policies offered by private companies or health management organization. d. Acceptable- means that the health care offered in in consonance with the prevailing culture and traditions of the population. The healthcare service and technology must fit the culture of the community; otherwise utility may be futile. Thus concept is cited by Leininger who developed the sunrise model of transcultural nursing. She states that it is imperative that nurses deliver culturally congruent care to genuinely promote participation of clientele on managing their own health. organizations and governments is a critical element of sustaining health care available to the people. Main Objectives: 1. Promotion of healthy lifestyles, 2. Prevention of diseases 3. Therapy for existing conditions President Marcos signed the LOI 949 that has an underlying theme” Health in the Hands of the People by 2020” 4.GOALS Health for All by the year 2000 Health for all means an acceptable level of health for all the people of the world through community and individual self-reliance and self determination This policy agenda of “health for all by the year 2000” technically was a global strategy employed for achieving their main objectives. 5. 5 key elements The WHO has identified 5 key elements to achieving the goal “health for all” 1. Reducing exclusion and social disparities in health (universal coverage) 2. Organizing health services around people’s needs and expectations (health service reforms) 3. Integrating health into all sectors (public policy reforms) 4, Pursuing collaborative models of policy dialogue (leadership reforms) 5. Increasing stakeholder participation 8 essential health services in PHC -Health education -Immunization -Essential Medicines -Mother and Child Health services -Endemic disease control and management -Nutrition -Treatment of simple conditions -Sanitation and access to safe water supply 20 ELEMENTS OF PHC 1.Primary care and essential public health functions as the core of integrated services 2.MUltisectoral policy and actions 3. Empowered people and communities 6. Principles of PHC AND STRATEGIES 1. Accessibility, affordability, acceptability and availability 2. Support mechanism 3. Multisectoral approach 4. Community participation 5. Equitable distribution of health resources 6. Appropriate technology Health programs according to the 4As 1. Botika ng Bayan and the Botika ng barangay 2. Ligtas sa Tigdas ang Pinas” mass measles immunization campaign. Children aged 9 months to below 8 years old. The two were vaccinated against measles and rubella 3 major entities 1. People themselves 2. The government 3. Private sector like NGOs and socio-civic and faith groups. Multisectoral approach As health and disease are outcomes of multiple interrelated factors, PHC requires communication, cooperation and collaboration within and among various sectors. A. Intrasectoral Linkages B. Intersectoral linkages 1. Intrasectoral linkages It refers to communication, cooperation and collaboration within the health sector: among the members of the health team and among health agencies. This is exemplified by team approach utilized by the personnel of a health center in dealing with health conditions and problems. The two-way referral system, is necessary so that clients get the needed and desired care. The two-way referral system ensures competent care, maximum use of availability of resources and continuity of care 2.Intersectoral linkages -One of the major criticisms against the traditional perspective in development is that the tools for analysis and strategies used are primarily economic in orientation. 21 -The idea that the population Is sick because they are poor implies that illness or health is a result of economic gains or the lack thereof. -Intersectoral linkages encompasses that communication, cooperation and collaboration between the health sector and other sectors of society like education, public works, agriculture, and local government officials. -Example Rabies prevention and control program. It requires collaborative effort among the Department of Health (DOH), DA, DepEd and LGUs. The DOH provides immunization or victims of animal bites. The DA provides outreach rabies immunization for dogs, while Dep ED and the LGUs are in charge of information campaign in schools and communities. -One of the major criticisms against the traditional perspective in development is that the tools for analysis and strategies used are primarily economic in orientation. It encompass the communication, cooperation and collaboration between the health sector and other sectors of society like education, public works, agriculture and local government officials. Community Participation A key to understanding the concept of PHC puts emphasis on how it is defined: that health is achieved through self-reliance and self-determination and that individuals, families and communities are not considered as recipients of care but active participants in achieving their health goals. -Community participation is an educational and empowering process in which people in partnership with those who are able to assist them, identify the problems and the needs and increasingly assume responsibilities themselves to plan, manage, control and assess the collective actions that are proved necessary. Equitable distribution of health resources 2 programs 1. Doctor to the Barrios (DTTB) is the deployment of doctors to municipalities tat are without doctors. DTTB volunteers are fielded to manage the RHU or health centers in unserved, economically depressed fifth or 6th class municipalities for 2 years. 2. Registered Nurses Health Enhancement and Local Service (RN HEALS) -It is a training and deployment programs for unemployed nurses. They are volunteers are deployed to unserved, economically depressed municipalities for 1 year to address the inadequate nursing workforce in rural communities and health facilities. D. LEVELS OF PREVENTION LEARNING OBJECTIVES: 1. Classify the three levels of prevention 22  2. Compare the Universal health care law to the present health situation in the Philippines 3. Differentiating the 8 things the citizen to expect for the health care 4. Relate the strategic thrusts of Universal Health Care to the current health situation and the goal and objectives of Universal Health Care -Medical Care focuses on disease management -Cure public health efforts focus on health promotion and disease prevention -Health Promotion activities enhance resources directed at improving well-being. -Disease prevention activities protect people from disease and the effects of disease. 3 levels of prevention 1. Primary Prevention 2. Secondary Prevention 3. Tertiary Prevention PRIMARY PREVENTION Relates to activities directed to preventing a problem before it occurs for susceptible BY altering susceptibility or reducing exposure for susceptible individuals. 2 Elements 1. General health promotion 2. Specific protection Example: Promotion of good nutrition, provision of adequate shelter and encouraging regular exercise Health promotion efforts enhance resiliency and protective factors and target essentially well populations. Examples of these include good nutrition , provision of adequate shelter and encouraging regular exercise Specific protection efforts -Reduce or eliminate risk factors and include such measures as immunization, and water purification Primary level disease Prevention -directed towards individuals who are at Risk of developing a disease or those who are in the pre-pathogenic stage; deals with the removal of risk factors of specific protection of individuals against these risk factors Example; immunization, food supplementation, and malaria chemoprophylaxis. SECONDARY PREVENTION -Refers to early detection and prompt intervention during the period of early disease pathogenesis. -It was implemented after a problem has just begun but before signs and symptoms appear and target those populations who have risk factors Example: Mammography, Blood pressure screening, newborn screening and mass sputum examination for pulmonary tuberculosis 23 Secondary prevention is also directed toward prompt intervention to prevent worsening conditions of the affected population. -This includes measures during the early stage of disease to prevent complications. -Teaching how to Oresol to her child suffering from diarrhea to prevent dehydration and administering vitamin A capsules to children with measles are examples. TERTIARY PREVENTION -Targets population that have experienced disease or injury and focuses on limitation of disability and rehabilitation. -Aims of tertiary prevention are to reduce the effects of disease and injury and to restore individuals to their optimal level of functioning. Examples: Teaching how to perform insulin injection techniques and disease management to a patient with diabetes, referring a patient with spinal injury for occupational and physical therapy and leading a support group for cancer patients who have undergone cancer treatment such as surgery, chemotherapy and radiation therapy. E. UNIVERSAL HEALTH CARE -Filipinos will begin benefiting from the Universal Health Care (UHC) Act this year, with every citizen entitled to health coverage that will lower out of pocket health expenses. -The passage of the law was considered a landmark for the Duterte administration as lawmakers who championed the bill gathered in Malacañang for a special ceremony last February 20. It was there that President Rodrigo Duterte affixed his signature on the long- awaited law. -The passage of Republic Act No 11223 was no easy feat. It was hailed as path-breaking as it set the direction for the reform of the health care sector in the Philippines. -The World Health Organization earlier urged the Philippine government to make a “real investment” in health care, as it would save lives. -But ensuring universal health care for all Filipinos does not come cheap. The following are the 8 things the citizen to expect 1. ALL Filipinos are covered Every single Filipino citizen is automatically enrolled into the newly-created National Health Insurance Program (NHIP). The program classified membership into two types: 1. Direct contributors – those who pay Phil Health premiums, are employed and bound by an "employer-employee relationship," self-earning, professional practitioners, and migrant workers. Members’ qualified dependents and lifetime members are also included. 2. Indirect contributors – those not considered as direct contributors, along with their qualified dependents, whose health premiums are subsidized by the government -All Filipinos will be granted “immediate eligibility” and access to the full spectrum of health care which includes preventive, promotive, curative, rehabilitative, and palliative care. This can be expected for medical, dental, mental, and emergency health services. 24 -Filipinos will also be enrolled with a primary health care provider of their choice. The primary care provider is the health worker they can go and seek treatment from for health concerns. They will also serve as the person in charge of referring and coordinating with other health centers if patients need further treatment. -Citizens will not need to present any Phil Health ID to avail of these benefits. Meanwhile, poor Filipinos or those who are located in geographically isolated areas will also be given priority when ensuring access to health services. 2. It is not completely free -Contrary to what some people may think, UHC does not mean every single health expense will be made free. -The law outlines that basic services accommodations will be covered by Phil Health. -As a patient, that means that if you’re admitted in a hospital you can expect regular meals, a bed in a shared room with fan ventilation, and a shared toilet and bath to be covered. -All are also entitled to an “essential health benefit package,” which includes primary care, medicines, diagnostic, and laboratory tests. It also includes preventive, curative, and rehabilitative services. It will no longer be free when one wants to stay in a hospital room offering private accommodation, air conditioning, telephone, television, and meal choices, among others. -Meanwhile, public and private hospitals are expected to allocate a certain portion of their beds as basic accommodations in the following amounts: -Government hospitals – at least 90% of beds -Specialty hospitals – at least 70% of beds -Private hospitals – at least 10% of beds -As long as a patient avail of these basic accommodations, it will be covered by Phil Health whether in a public or private hospital. -The law also states that if patients need to pay for extra expenses, their “co-payment” – or what is paid on top of basic services – should be regulated by the DOH in public hospitals. This means that you should know what to expect in terms of bills, as opposed to being shocked after treatment. -Aside from this, current case rates or packages Phil Health has crafted for certain diseases will remain. But together with the DOH, Phil Health is expected to work towards including more needs a person may have for a disease in its case rates. -The two agencies are also expected to craft and implement outpatient benefit services to be covered by the National Health Insurance Programs within 2 years after the law takes effect. 3. Phil Health will become the “national purchaser” of health goods and services -This means that Phil Health will be in charge of paying health care providers like hospitals and clinics for services given to Filipinos. This is already a job Phi lHealth carries out but the universal health care law wants to pool more funds so it can cover all Filipinos and eventually, more services. -Allocating more funds to Phil Health will also strengthen its negotiating power with health care providers, which will foreseeably improve the quality of services and lower health costs. 25 -Funds for Phil Health will be sourced from the following: Philippine Amusement and Gaming Corporation – 50% of national government’s share -Philippine Charity Sweepstakes Office (PCSO) – 40% of its charity fund, net of document stamp tax payments, and mandatory PCSO contributions -Premium contributions of direct contributory members -By giving Phil Health more funds, a goal of the UHC is to make Phil Health the national purchaser of medicines. -This can lower the cost of medicines as these will be bought in bulk. Another goal is to have quality of health services improve as Phil Health can set as a requirement for payment and contracting, standards for health care providers. 4. DOH will still be in charge of “population-based” health services -While Phil Health, along with other private health insurance companies, is expected to cover services for individuals, the DOH is still in charge of delivering health services that cover entire populations. -Think of these as programs for disease surveillance, health promotion campaigns, and mass immunization campaigns. -The DOH will do this by contracting public health care providers in cities and provinces. 5. Health systems will become city-wide and province-wide -Provinces and highly urbanized cities will now be in charge of overseeing health services in areas as opposed to the current set-up where municipalities are tasked with managing their own health centers. -The DOH will need to work with the Department of the Interior and Local Government (DILG) to have province- and city-wide health systems or networks in about two years after the law takes effect. -For this, one can imagine as an example, Rizal overseeing its province-wide health care network of clinics and hospitals compared to each municipality in Rizal taking care of its own health center alone. Similarly, highly urbanized cities like Cebu or Makati will oversee their own health care network compared to single barangays being in charge of a health center. -Having access to health networks province-wide can address the problem of inadequate access to health services due to lack of funds in barangays or municipalities. -Provincial and city health boards will be in charge of pooling and managing a special health fund to finance and improve health services for residents. PhilHealth’s income will also be channeled to this special health fund. 6. Return service in the public health sector -Graduates of health and health-related courses who received government-funded scholarships will be required to work in the public health sector for at least 3 full years. This will address the need for health workers across the country. -They will be paid by and under the supervision of the DOH. Those who serve for an extra two years will also be given incentives, which will be determined by the DOH. -Meanwhile, graduates of health courses in state universities and colleges and private schools are encouraged to work in the public sector. 26 7. A “Health Technology and Assessment Council” (HTAC) will be created -Another important feature of the law is the creation of the HTAC – a group of health experts who will be responsible for evaluating latest health developments and recommending their use to DOH and Phil Health. -The HTAC will be responsible for assessing the safety and effectiveness of health technology, devices, medicines, vaccines, health procedures, and other health-related advances developed to solve health problems. -Reviewing the social, economic, and ethical issues when using these technologies or programs is also required. -The HTAC will be attached to the DOH for the first 5 years after the law is implemented. After this, it will become an independent body attached to the Department of Science and Technology. 8. Health information will be collected Both public and private hospitals and health insurers will be required to maintain a health information system that will contain electronic health records, prescription logs, and “human resource information.” This system will be developed and funded by DOH and Phil Health. It will also be subject to patient confidentiality rules and data privacy laws. – 1. LEGAL BASIS (Kalusugan Pangkalahatan) also called the Aquino Health Agenda is the latest in a series of continuing efforts of the government to bring about sector reforms. Was launched through Administrative Order 2010-0036 The implementing rules and regulation of republic Act 11223 (UHC law) was signed in October 2019 and specified a timeline of transition for the health care system in the country that will cover a period of six years. Integration of local health systems into province-wide and citywide health systems will help address the issue of fragmentation and above all ensure a uniform delivery of health care to populations. All municipalities health offices will be placed under the province-wide health system. Twi division will be created under this structure, one for health service delivery and other for health system support UHC was built upon the strategies of two previous platforms of reform: 1, The initial Health sector reform agenda (1999-2004) 2. FOURmula One (F1) for heath (2005-2010) 2.BACKGROUND AND RATIONALE Rationale: Health sector reforms are intended to bring about equity in health care delivery. Survey data show that this has not been achieved as of yet, despite health sector reforms since 1999. A DOH and Phil Health review highlighted the need to improve health-related financial risk protection among Filipinos. 27 More importantly, Phil Health benefit delivery was found to be the lowest among the target population-the poorest quintile. The concern on inequitable access to health resources has not been resolved. Neglect of public hospitals and health facilities due to inadequate health budgets has been observed. As of October 2010, a total of 892 RHUs and 99 government hospitals had yet to qualify for accreditation by Phil Health. Data show that the poorest of the population are the main users of government health facilities. This means that the deterioration and poor quality of many government health facilities is particularly disadvantageous to the poor who needs the services the most. Finally, renewed efforts to achieve health related MDGs are in order. The MDG 4 target is to reduce maternal mortality rate from 209 maternal deaths /100,000 live births in 2990 to 52 deaths per 100,000 live births by 2015. OBJECTIVES AND THRUSTS Objective: To provide all Filipinos access to comprehensive and cost effective health care that covers all spectrum of services. These include promotive, preventive, curative, rehabilitative, and palliative care. Goals: 1. Better health outcomes 2. Sustained health financing 3. A responsive health system by ensuring that all Filipinos, especially the disadvantaged group, have equitable access to affordable health care. STRATEGIC THRUSTS 1. Financial risk protection through expansion in NHIPP enrollment and benefit delivery’ 2. Improves access to quality hospitals and health care facilities 3. Attainment of the health related MDGs STRATEGIC INSTRUMENTS 1. Health financing- instrument to increase resources for health that will be effectively allocated and utilized to improve the financial protection of the poor and the vulnerable sectors 2. Service delivery- instrument to transforms the health service delivery structure to address variations in health services utilization and health outcomes across socioeconomic variables. 3. Policy, standards and regulation-instrument to ensure equitable across to health services essential medicine and technologies of assured quality availability and safety. 4. Governance for health- instrument to establish the mechanism foe efficiency, transparency, and accountability and prevent opportunities for fraud. 5. Human resources for health- instrument to ensure that all Filipinos have access to professional health care providers capable of meeting their health needs at the appropriate level of care. 6. Health Information- instrument to establish a modern information system that shall: a. Provide evidence for policy and program development 28 b. Support for immediate and efficient provision of health care and management of province- wide health system - Filipinos will begin benefiting from the Universal Health Care (UHC) Act this year, with every citizen entitled to health coverage that will lower out-of pocket health expenses. -The passage of the law was considered a landmark for the Duterte administration as lawmakers who championed the bill gathered in Malacañang for a special ceremony last February 20. It was there that President Rodrigo Duterte affixed his signature on the long- awaited law. -The passage of Republic Act No 11223 was no easy feat. It was hailed as path-breaking as it set the direction for the reform of the health care sector in the Philippines. -The World Health Organization earlier urged the Philippine government to make a “real investment” in health care, as it would save lives. Source of funding -Revenue of government from Sin Tax Reform Law (RA 10351) -50% of PAGCOR income 40% of PCSO Charity Fund -DOH funding from the national budget -PhilHealth subsidy from the national and government Premium contributions from PhilHealth members (Direct contributors) III. DOH PROGRAMS RELATED TO FAMILY LEARNING OBJECTIVES: 1. Monitoring the six vaccines available in the community and its effect to the health of the children 2. Describe the current situation of the maternal and child health situation I the Philippines 3. Recognize the role of the nurse and midwifes in the delivery of services A.EXPANDED PROGRAM OF IMMUNIZATION Expanded Program of Immunization (EPI) -The EPI was established in 1976 to ensure infants/children and mothers have access to routinely recommended infant/childhood vaccines. 29 Six vaccines preventable diseases were initially included in the EPI: 1. Tb 2. Poliomyelitis 3. Diphtheria 4. Tetanus 5. Pertussis 6. Measles Tetanus Toxoid (TT, t, Td) Goals: -To achieve the overall EPI goal of reducing the morbidity and mortality among children against the most common vaccine-preventable diseases. Laws mandate protecting children through immunizations to the DOH and LGUs 1. PD No. 996- providing compulsory basic immunization for infants and children below8 years old 2. R.A. 7846 of 1994- Inclusion of Hepatitis B immunization for infants and children below 8 years old. 3.R.A. 10152-Mandatory Infants and Children Health Immunization Act of 2011, for children up to 5 years old and inclusion of new vaccines like Hepatitis B, Mumps, Rubella, Haemophilus influenza, type B (Hib) 4.Presidential Proclamation No.6 of 1996-Implementing a United Nations Goal on Universal Immunity by1990 and designating Wednesday as Immunization Day. It also provided from Specific Goals of the Program 1.To immunize all infancy/children against the most common vaccine –preventable diseases 2. To sustain the polio-free status of the Philippines 3. To eliminate measles infection. Presidential Proclamation No. 4, s. 1998 launched the measles Elimination campaign 4. To eliminate maternal and neonatal tetanus. Presidential Proclamation No. 1066, s. 1997 declared a national neonatal tetanus elimination campaign starting 1997 5. To control diphtheria, pertussis, hepatitis B and German Measles 6. To prevent extrapulmonary TB among children. -Immunization is an essential health intervention for eligible children and women, and this service is available in all health facilities and institutions providing health services for women and children nationwide. -Wednesday is the designated immunization day in government health facilities unless otherwise revised by local traditions, customs and other exceptions. In 2012, two new vaccines were introduced as part of EPI: 1. Rotavirus vaccine 30 Rotavirus infects the large intestines. It is the most common cause of severe diarrhea in infants and children. Children between the ages of 6 and 24 months are at greatest risk for developing severe Rotavirus infection. 2. Hib vaccine Hib bacterium responsible for serious illnesses, such as meningitis and pneumonia with almost all cases younger than 5 years with those between 4 and 18 months of age especially vulnerable. Maintaining the potency of EPI vaccines -Maintain the Cold Chain: The cold chain is a system for ensuring the potency of a vaccine from the time of manufacture to the tie it is given to an eligible client. The person directly responsible for cold chain management at each level is called the Cold Chain Officer. At the RHU/health center, the public health nurse acts as the Cold Cain Officer. This means that the nurse is in charge of maintaining the cold chain equipment and supplies, such as the freezer/refrigerator, transport box vaccine bags/carriers, cold chain monitors, thermometers and cold packs. The nurse implements an emergency plan in the event of an electrical breakdown or power failure. EPI vaccines and the special diluents have the following cold chain requirements: 1. OPV: -15 t0 -25 C. OPV has to be stored in the freezer. In the vaccine bag, OPV is placed in contact with cold packs 2. All other vaccines, including measles vaccine, Pentavalent, hepatitis B, DPT, Tetanus toxoid, MMR and Rotavirus vaccine, have to be stored in refrigerator at a temperature of +_2 to +8 These vaccines should be stocked neatly on the shelves of the refrigerator shelves. 3. Hepatitis B vaccine, Pentavalent vaccine, Rotavirus vaccine and TT are damaged by freezing, so they should not be stored in the freezer. Wrap the containers of these vaccine with paper before putting them in the vaccine bag with cold packs. 4. Keep diluents cold by storing them in the refrigerator in the lower or door shelves GENERAL Considerations to Maintain Potency 1.Remind the caregivers of children to comply with the prescribed schedule of routine immunization and to bring with them the immunization record of the chikd for every clinic visit 2.Previous doses does not have to be repeated regardless of interval 3. Eligible age for Prevalent vaccines-up to 5 years 4. Booster doses are not really necessary 5.Vaccines may be given on the same day at different sites 6.When administering several vaccines on the same leg, it should be at least 2.5-5 cm apart 7.Is several vaccines will be administered start with OPV, Rotavirus then other vaccines 8.Observe “First Expiry and first out” in utilizing vaccines 31 9.Use cotton in cleaning the injection site, If with alcohol, area should be thoroughly dry before injecting the vaccine 10.BCG, AMV, MMR have special diluents and should be discarded 6 hours after reconstitution or after clinic hours 11.Protect BCG from sunlight and ROTAVIRUS from light 12.Inform caregivers of children for immunization about common side effects and how to deal with it 13.Reusable vaccines such as OPV, Pentavalent, Hepatitis B, and Tetanus Toxoid may last for maximum of 4 weeks. 14. Comply with recommended duration of storage and transport. AT the health center/RHU with a refrigerator, the duration of storage should not exceed one month. Using transport boxes, vaccines can be kept only up to a maximum of 5 days 15. Take note is the vaccine container has a vaccine vial monitor (VVM) and act accordingly. The VVM is a round disc of heat sensitive material placed on a vaccine vial to register cumulative heat exposure direct relationship exists between rate of color change and temperature, the slower the color change; the higher the temperature the faster the color change.. -A multidose vial may be opened for one or 32 clients if the health worker feels that a client cannot come back for the scheduled immunization session. -Multidose liquid vaccines, such as OPV, Pentavalent vaccine, hepatitis B vaccine and the TT from which one or more doses have been taken following standard sterile procedures may be used in the next immunization sessions for up to a maximum of 4 weeks, provided that all of the following conditions are met: a. The expiry date has not passed b. The vials has not been contaminated c. The vials has been stored under appropriate cold chain conditions. d. The VVM on the vial, if attached, has not reached the discard point. Absolute Contraindications: DO NOT GIVE: 1. Pentavalent vaccine/DPT to children over 5 years of age 2. Pentavalent vaccine /DPT to a child with recurrent convulsions or another active neurological disease of the central nervous system Absolute Contraindications: DO NOT GIVE: 3. Pentavalent vaccine 2 or 3 /DPT 2 or 3 to a child who has had convulsions or shock within 3 days of the most recent dose. 4. Rotavirus vaccine when the child has a history of hypersensitivity to a previous dose of the vaccine, intussusceptions or intestinal malformations, or acute gastroenteritis. 5. BCG to a child who has signs and symptoms of AIDS or other immune deficiency conditions or who are immunosuppressed. EPI Recording and Reporting 32 1. Fully immunized children (FIC) are those who were given BCG, 3 doses of OPV, 3 doses of DPT and hepatitis B or 3 doses of Pentavalent vaccine and 1 dose of anti-measles vaccine before reaching 1year of age 2. Completely Immunized Children refer to children who completed their immunization schedule at the age of 12-23 months. 3. A child protected at birth (CPAB) is a term used to describe a child whose mother has received a. 2 doses of TT during this pregnancy provided that the 2nd dose was given at least a month prior to delivery b. at least 3 doses of TT any time prior to pregnancy with this child The vaccine vial monitor Inner square lighter than outer ring. If the expiry date has not been passed. Use the vaccine / AT a later time: Inner square still lighter than outer ring. If the expiry date has not been passed, USE the vaccine / Discard point: Inner square matches color of outer ring. DO NOT use the vaccine X Beyond the discard point: Inner square darker than outer ring. DO NOT use the vaccine X d a r k Management of Childhood Illnesses (IMCI) B. Integrated k k k k k 33 l l IMCI: INTEGRATED MANAGEMENT FOR CHILDREN ILLNESS -IMCI is an integrated approach to child health that focuses on the well-being of the whole child. -IMCI aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age. -IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities. The strategy includes three main components: 1.Improving case management skills of health-care staff 2.Improving overall health systems 3. Improving family and community health practices -In health facilities, the IMCI strategy promotes the accurate identification of childhood illnesses in outpatient settings, ensures appropriate combined treatment of all major illnesses, strengthens the counselling of caretakers, and speeds up the referral of severely ill children. In the home setting, it promotes appropriate care seeking behaviors, improved nutrition and preventative care, and the correct implementation of prescribed care. https://www.who.int/maternal_child_adolescent/topics/child/imci/en/ The case management process is presented on 2 different sets of charts 1. One for children aged 2 months up to 5 years 2. Children aged 1 week up to 2 months “Up to 5 years means the child has not yet reached his 5th bday. A. Integrated Management of Childhood Illnesses (IMCI) The WHO /UNICEF initiated the IMCI strategy offers simple and effective methods for child survival, healthy growth, and development and is based on the combined delivery of essential interventions at community, health facility and health systems level. The top 3 leading cause of mortality among children aged 1-4 years 1. Pneumonia 2. Accidents 3. Diarrhea and gastroenteritis The IMCI protocol guides the health worker in: IMCI clinical guidelines are meant to be used by the health worker in the management of sick children from age 1 week up to 5 years. They are based on expert clinical opinion and research results. Using an integrate approach. 34 a. Assessing signs that indicate severe disease b. Assessing a child’s nutrition immunization and feeding c. Teaching parents how to care for a child at home d. Counseling parents to solve feeding problems e. Advising parents about when to return to a health facility Elements of IMCI 1. Assess child by checking first for danger signs, asking questions about common conditions examining the child, and checking nutrition and immunization status. Assessment includes checking the child for other health problems. 2. Classify a child’s illnesses using a color-coded triage system. Many children have more than one condition. 3. After classifying all conditions, IDENTIFY specific treatments for the child if a child requires urgent referral, give essential treatment before the patient is transferred. If a child needs treatment at home, develop an integrated treatment plan for the child and give the first dose of drugs in the clinic. If a child should be immunized give immunizations. 4. Provide practical treatment instructions, including teaching the mother or caretaker on how to give oral drugs, how to feed and give fluids during illness and how to treat local infections at home. Ask the mother or caretaker to return for follow up on a specific ate and teach her how to recognize signs that indicate that the child should return immediately to the health facility 6. When a child is brought back to the clinic as requested, give follow up card and if necessary , reassess the child for new problems 5. Assess feeding, including assessment of breastfeeding practices and counsel to solve any feeding problems found. Each illness is classified according to whether it requires: 1. Urgent prereferral treatment and referral (Pink) 2. Specific medical treatment and advice (yellow) 3. Simple advice on home management (Green) For IMCI management of this child, the health worker uses the chart for the sick child. The child who is younger than 2 months is considered a young infant. Case management of the young infant is different, so the health worker uses the chart for the sick young infant. The next step is to ask about the child’s or young infant’s problem, then ask if this is an initial visit for the problem. If this is an initial visit, the health worker follows the guidelines for an initial visit. A child or young infant on a follow up visit is given follow up case according to guidelines. (REFER TO THE IMCI CHART) INTEGRATED MANAGEMENT OF CHILDREN'S DISEASE -IMCI was first developed in 1992 by the United Children's Emergency Fund (UNICEF) and the World Health Organization (WHO), with the aim of prevention of early detection and treatment of the leading cause of childhood deaths. The IMCI initiative adopted a broad, cross cutting approach recognizing that in most morbidity or mortality cases, more than one underlying cause contributes to the illness of the child. 35 -IMCI attempts to combine the lessons learned from disease-specific control programs over the past 15 years into an effective approach for managing the sick child. -It focuses on the treatment, IMCI also emphasized prevention of illness through education on the importance of immunization, micronutrient supplementation and improved nutrition- especially oral rehydration therapy (ORT), breastfeeding and infant feeding. -IMCI seeks to reduce childhood mortality and morbidity by improving family and community practices for the home management of illness and improving case management of skills of health workers in the bigger health system. -IMCI is implemented by working with local governments and ministries of health to plan and adapt the principles of this approach to participate circumstances. IMCI was introduced in the Philippines in 1995 as strategy to reduce child death and promote growth and development. C. EARLY ESSENTIAL AND NEWBORN CARE (EINC) (EMNC) LEARNING OBJECTIVES: 1. Perform immediate assessment of an example pregnant client shown in video in labor 2. Classify the Essential Maternal Newborn Care (EMNC) 3. Perform the proper steps in the actual delivery of newborn using the online video presentation /link 4. To deliver time-bound core intervention in the immediate period after the delivery of the newborn 5. Monitor during labor process with the use of partograph using video presentation 6. Practice how to deliver the baby and placenta correctly and aseptically using available material at home 7. Provide immediate care of the newborn using the online video and checklist 8. Perform thorough assessment of the actual postpartum client and her 9. Evaluate the outcomes of care provided to the client Recommended EINC practices in the care of the newborn are evidence-based measures that are vital for the survival and the quality care of the newborn (DOH, 2011b). 1. Interventions within the first 90 minutes include the following (DOH, 2011b): -Immediate and thorough drying, which does not only protect the newborn from cold stress and hypothermia, but also stimulates breathing. This is recommended as the immediate first action for all newborns, regardless of gestational age or birth weight. 36 -Skin-to-skin contact between mother and newborn does not only provide warmth and an opportunity for bonding. It plays a part in protection of the newborn against infection and hypoglycemia. Studies have shown that skin-to-skin contact at birth helps in stabilizing the baby and promotes successful breastfeeding by facilitating colostrum feeding. -Cord clamping 1-3 minutes after birth is recommended. The customary cord clamping immediately after birth is not a recommended practice in EINC because evidence shows that delaying cord clamping by 1-3 minutes allows placental transfusion at birth. This increases the newborn’s blood volume and iron reserves, and eventually reduces the likelihood of iron deficiency anemia in infancy. Studies have also shown that delayed cord clamping provides significant benefits to preterm infants by reducing the need for blood transfusions and lowering the incidence of brain hemorrhages. -Early initiation of breastfeeding means breastfeeding within an hour after birth as recommended by WHO. This practice brings about gains for both the mother and the newborn. In developing countries, early initiation of breastfeeding has been shown to reduce infant deaths attributed to diarrhea and lower respiratory tract infections. Benefits to the mother include stimulation of oxytocin secretion resulting in uterine contraction. -Nonseparation of baby from the mother (DOH, 2011j), also known as rooming-in if the childbirth is in a hospital or a similar health facility, promotes bonding and allows the mother to breastfeed her baby on demand. 2. Essential newborn care after 90 minutes to 6 hours (DOH, 2011j): -Vitamin K prophylaxis; -Hepatitis B and BCG vaccination; -Examination of the baby for birth injuries, malformations, or defects; and -Additional care for a small baby (a baby with a birth weight