COMMUNITY HEALTH NURSING I

What is a community? Development of Public Health Nursing

Period of Emperical Environmental Sanitation
"a group of people with common characteristics or 1.Florence Nightingale – clean up measures and
interests living together within a territory or control of communicable disease.
geographical boundary *place where people under
usual conditions are found 2.Lilian Wald- first American Public Health Nurse,
What is health? linked nursing motherhood, social welfare and the
public. Creation of Henry Street Settlement house,
-Health-illness continuum
through nursing sick in their homes.
-High-level wellness
Agent-host-environment Development of Public Health Nursing

-Health belief 1898- Creation of Department of Public Works,

-Evolutionary-based Education and Hygiene and Board of Health
Physicians.
-Health promotion
-WHO definition 1906-Creation of Bureau of Health

What is community health? 1912- Fajardo Act (Act No. 2156)- created Sanitary
part of paramedical and medical intervention/ Divisions. President of Sanitary Divisions took
approach which is concerned on the health of the charge 2 -3 municipalities were no physicians are
whole population available. Assigned 4 graduate nurses from PGH to
take care of mothers and their babies.
aims:
1. health promotion 1914- School nursing was rendered. Bureau of
2. disease prevention Health was renamed Philippine Health Service
Reorganization Act of 2462 created Office of
3. management of factors affecting health
General Inspection where Office of District Nursing
was under and headed by Dr. Rosario Pastor
What is nursing?
-assisting sick individuals to become healthy and 1916-1918 Ms. Perlita Clarke took charge of Public
healthy individuals achieve optimum wellness Health Nursing work. Staff composed of 1
American nurse supervisor, 1 American dietitian
Public Health Nursing: the term used before and 36 Filipino nurses working in the provinces.
for Community Health Nursing
1917- 4 graduate nurses of City of Manila were
According to Dr. C.E. Winslow, Public Health is employed to work in city schools.
a science & art of 3 P's -Prevention of Disease -
Prolonging life - Promotion of health and efficiency 1919- PHN inaugurated its pioneer work inTondo,
through organized community effort Manila where visiting nurse Ms. Balbina Basa was
assigned to do house to house visit. Red Cross
introduced Operation of puericulture centers (health
Primary Health Care
WHO: PHC was declared in the ALMA ATA centers) Ms. Camen del Rosario- First Filipino
CONFERENCE(USSR) in September 6 - 12, 1978, nurse supervisor
as a strategy to community health development.
Philippines: Adopted through LOI 949 signed by 1930- Section of Public Health Nursing was
President Marcos on October 19, 1979 with the converted into Section of Nursing
theme "Health in The Hands of the People by
2020"
 COMMUNITY HEALTH NURSING I
1941 Department of Public Health and Welfare was to government hospitals, secure funding for priority
created 6 PHN were transferred to the new dept health programs; promote development of local
under Dr. Mariano Icasiano, first City Health health systems and ensure its performance;
Officer of Manila, Ms. Vicenta Ponce as Chief strengthen capacities of health regulatory agencies
Nurse. and expand coverage of National Health
InsurancePrograms.
Dec 8 1941- WWII
2005- FOURmula one for health. Ensure speed,
1947 EO 47 of 1947, Bureau of Public Welfare was precision and effective coordination towards
transferred to Office of the President and improving the efficiency, effectiveness and equity
Department of Health was renamed with the ff of health care delivery.
setup: ✓ Health Financing
✓ Office of Secretary- Division of Accounting, ✓ Health Regulation
Drug Inspection, Nursing Service, ✓ Health Service Delivery
Laboratories, and Board Examiners (Medical,
✓Good Governance and Health
Dental, Nursing, Pharmaceutical and Optical)
✓ Bureau of Health ( health promotion and 2005-2010 National Objectives for Health
maintenance and sanitation) Vision: “Health for All Filipinos”
✓ Bureau of Quarantine Mission: Ensure accessibility and quality of
✓ Bureau of Hospitals healthcare to improve QOL of all Filipinos
✓ All City Health Departments especially the poor

May 18, 1954- R.A 1082 ( Rural Health Act) was What is Community Health Nursing?
passed and implemented. Personnel assigned to "The utilization of the nursing process in the
work in RHU’s. different levels of clientele-individuals, families,
population groups and communities, concerned with
1957 R.A 1891 ( Strengthening Health And Dental the promotion of health, prevention of disease and
Services in Rural Health Areas and Providing disability and rehabilitation." - Maglaya, et al
Funding thereto)
COMMUNITY HEALTH NURSING (CHN):
1986- Ministry of Health became DOH again. -a specialized field of nursing practice
-a science of Public Health combined with Public
1987- National Drug Policy- implementation of RA Health Nursing Skills and Social Assistance with
6675 (Generics Law of 1988) the goal of raising the level of health of the
citizenry, to raise optimum level of functioning of
1991- R.A 7160 ( Local Government Code of 1991) the citizenry (Characteristic of CHN)
– Devolution code: transfer of power from National
to LGU. Aimed to build capabilities for self- BASIC PRINCIPLES OF CHN
government and develop them fully as self-reliant ✓ The community is the patient in CHN, the family
communities. is the unit of care and there are four levels of
clientele: individual, family, population group
1993-1998 National League of Philippine (those who share common characteristics,
Government Nurses request to Secretary of DOH to developmental stages and common exposure to
create an Office of Nursing was not put into reality. health problems - e.g. children, elderly), and the
community.
1996- Primary Health Care as a strategy to attain, ✓ In CHN, the client is considered as an ACTIVE
“Health for all by the year 2000. partner
NOT PASSIVE recipient of care
1999-2004- Health Sector Reform Agenda of the
Philippines was launched. Provide Fiscal Autonomy
 COMMUNITY HEALTH NURSING I
✓ CHN practice is affected by developments in
health technology, in particular, changes in society, Communication: interaction involving 2 or more
in general persons or agencies
✓ The goal of CHN is achieved through multi-
sectoral efforts 3 Elements of Communication:
Message
✓ CHN is a part of health care system and the
Sender
larger human services system.
Receiver
ROLES OF THE PUBLIC HEALTH NURSE
PUBLIC HEALTH WORKERS (PHW)
Clinician, who is a health care provider, taking care
PHW's: are members of the health team who
of the sick people at home or in the RHU Health
are professionals namely
Educator, who aims towards health promotion and
Medical Officer (MO)-Physician
illness prevention through dissemination of correct
Public Health Nurse (PHN)- Registered Nurse
information; educating people
Rural Health Midwife (RHM)-Registered Midwife
Facilitator, who establishes multi-sectoral linkages
Dentist
by referral system
Nutritionist
Supervisor, who monitors and supervises the
Medical Technologist
performance of midwives
Pharmacist
Rural Sanitary Inspector (RSI)-must be a sanitary
TARGET POPULATION (IFC) ARE:
engineer
1. Individual
2. Family DEPARTMENT OF HEALTH
3. Community 5 MAJOR FUNCTIONS:
1. Ensure equal access to basic health services
3 Elements considered in CHN: 2. Ensure formulation of national policies for proper
* Science of Public Health (core foundation in division of labor and proper coordination of
CHN), operations among the government agency
* Public Health Nursing Skills and jurisdictions
* Social Assistance Functions 3. Ensure a minimum level of implementation
nationwide of services regarded as public health
OBJECTIVES OF PUBLIC HEALTH: CODES goods
Control of Communicable Diseases 4. Plan and establish arrangements for the public
Organization of Medical and Nursing Services health systems to achieve economies of scale
Development of Social Machineries 5. Maintain a medium of regulations and standards
Education of IFC on personal Hygiene Health - to protect consumers and guide providers
Education is the essential task of every health
worker 3 Major Functions:
Sanitation of the environment
1. LEADERSHIP in health
3 ELEMENTS IN HEALTH EDUCATION:  National policy - formulation, monitoring and
IEC evaluation
Information: to share ideas to keep population  Regulatory institution
group knowledgeable and aware  Advocates adoption of health policies, plans and
Education: change within the individual 3 Key programs
Elements of Education: 2. Enabler and Capacity Builder
Knowledge  Innovate new strategies to improve health
Attitude programs
Skills  Exercise oversight function
 Ensure highest achievable standards
 COMMUNITY HEALTH NURSING I
3. Administrator of Specific Services HEALTH CARE DELIVERY SYSTEM
 Manage selected national health facilities and "the totality of all policies, facilities,
hospitals equipment, products, human resources and services
 Administer direct services for emergent health which address the health needs, problems and
concerns concerns of the people. It is large, complex, multi-
 Administer health emergency response services level and multi-disciplinary.”

BASIC HEALTH SERVICES UNDER OPHS THREE STRATEGIES IN DELIVERING

OF DOH HEALTH SERVICES (ELEMENTS)
Education regarding Health ✓ Creation of Restructured Health Care Delivery
Local Endemic Diseases System (RHCDS) regulated by PD 568 (1976)
Expanded Program on Immunization ✓ Management Information Systems regulated by
Maternal & Child Health Services R.A. 3753: Vital Health Statistics Law
Essential drugs and Herbal plants ✓ Primary Health Care (PHC) regulated by LOI 949
Nutritional Health Services (PD 491): Creation of (1984): Legalization of Implementation of PHC in
Nutrition Council of the Phils. the Philippines
Treatment of Communicable & Non communicable
Diseases CREATION OF RHCDS
Sanitation of the environment (PD 856): Sanitary  RHO (National Health Agency) or existing
Code of the Philippines national agencies like PGH or specialized
agencies like Heart Center for Asia, NKI
Dental Health Promotion  MHO & PHO (Municipal/Provincial Health
Access to and use of hospitals as Centers of Office)
Wellness  BHS & RHU (Barangay Health Station/Rural
Mental Health Promotion Health Unit)
VISION BY 2030 (DREAM OF DOH) 3 LEVELS OF HEALTH CARE
 A Global Leader for attaining better health 1. Primary-prevention of illness or promotion
outcomes, competitive and responsive health of health
care systems, and equitable health financing 2. Secondary-curative
3. Tertiary-rehabilitative
MISSION
 To guarantee EQUITABLE, SUSTAINABLE
and QUALITY health for all Filipinos,
especially the poor and to lead the quest for
excellence in health

Principles to attain the vision of DOH

 Equity: equal health services for all-no
discrimination
 Quality: DOH is after the quality of service not
the quantity
 Philosophy of DOH: “Quality is above
quantity"
 Accessibility: DOH utilize strategies for
delivery of health services
 COMMUNITY HEALTH NURSING I
SENTRONG SIGLA MOVEMENT (SSM) was
established by DOH with LGUs having a logo of a
Sun with 8 Rays and composed of 4 Pillars:
1. Health Promotion
2. Granted Facilities
3. Technical Assistance
4. Awards: Cash, plaque, certificate

4 CONTRIBUTIONS OF PHC TO DOH &

ECONOMY:
 Training of Health Workers
 Creation of Botika sa Baryo & Botika sa Health
Referral System in Levels of the Health Care: Center
✓ Barangay Health Station (BHS) is under  Herbal Plants
the management of Rural Health Midwife (RHM)  Oresol
✓ Rural Health Unit (RHU) is under the
management or supervision of PHN. A. TRAINING OF HEALTH WORKERS
✓ Public Health Nurse (PHN) caters to 3 Levels of Training:
1:10,000 population, acts as managers in the Grassroot/Village
implementation of the policies and activities of  Includes Barangay Health Volunteers (BHV)
RHU, directly under the supervision of MHO (who and Barangay Health Workers (BHW)
acts as administrator)  Non-professionals, didn't undergo formal
training, receive no salary but are given
REFERRAL SYSTEM: incentive in the form of honorarium from
BHS →RHU→ MHO →PHO →RHO→ National the local government since 1993
Agencies Specialized Agencies Intermediate - these are professionals including the
8 members of the PHWS
CHARACTERISTICS OF PHC First Line Personnel - the specialist
Acceptable
Accessible B. CREATION OF “BOTIKA SA BARYO
Affordable & BOTIKA SA HEALTH CENTER”
Available RA 6675: Generics Act of 1988: Implementing
Sustainable  “Oplan Walang Reseta Program”-solution to the
Attainable absence of a medical officer who prescribed the
medicines so PHN are given the responsibility
UTILIZES APPROPRIATE TECHNOLOGIES to prescribe generic medicines and
USED BY PHC: ACCEFS
Affordable, accessible, acceptable, available  “Walong Wastong Gamot Program"- available
Cost wise=economical in nature generics in “Botika sa Baryo” & Health Center
Complex procedures which provide a - Father of Generics Act: Dr. Alfredo Bengzon
simple outcome
Effective
Feasibility of use=possibility of use at all times
Scope of technology is safe & secure
 COMMUNITY HEALTH NURSING I
8 COMMONLY AVAILABLE GENERICS HERBAL PLANTS
(CARIPPON)  RA 8423: Alternative Traditional Medicine Law
Co-Trimoxazole  A program where patient may opt to use
herbal plants especially for drugs that are not
 It’s a combination of 2 generics of drugs which
available in dosage form or patients has no
is antibacterial
financial means to buy the drug
 Trimethoprim (TMP)  Traditional Medicine = Use of herbal plants
 Has a bacteriostatic action that stops/
inhibits multiplication of bacteria 10 ADVOCATED HERBAL PLANTS BY DOH:
 For GUT, GIT, and URTI (TMP LUBBY SANTA
combined with SMX)
 Sulfamethoxazole (SMX)
 Has bactericidal action that kills bacteria
 For GUT, GIT, URTI, and Skin
Infections
Amoxicillin/ Ampicillin
 An antibacterial drug that comes from the
Penicillin family
 Effect is generally bacteriostatic (when source
of infection is bacterial)
 These 2 drugs provide the least sensitivity
reaction (rashes & GI) and the adverse effect of
other antibiotics is anaphylactic shock
TB DRUGS:
Rifampicin (RIF)
Isoniazid (INH) POLICIES TO ABIDE:
Pyrazinamide (PZA)  Know indications
Paracetamol  Know parts of plants with therapeutic value:
 Has an analgesic & anti-pyretic effect
Acetyl Salicylic Acid (ASA) or Aspirin is never
kept in the “Botika” because of its effects:
 Anticoagulant-highly dangerous to Dengue
patients that’s why it’s not available in roots; fruits; leaves
“Botika” and Health Center  Know official procedure/ preparation
Oresol
PROCEDURES/ PREPARATIONS:
 A management for diarrhea to prevent  DECOCTION
dehydration under the Control of Diarrheal  Gather leaves & wash thoroughly, place in a
Diseases (CDD) Program container the washed leaves then add water
Nifedipine  Let it boil without cover to vaporize/ steam
 An anti-hypertensive drug to release toxic substance and undesirable
 According to DOH, 16% of population taste
belonging to 25 years old & above in the  Use extracts for washing
community are hypertensive  POULTICE
 Done by pounding or chewing leaves used
by herbolaryo
 COMMUNITY HEALTH NURSING I
 Example: Akapulko leaves - when pounded,  It is a government mandate aiming to ensure
it releases extracts coming out from the that every Filipino shall receive affordable and
leaves that contains enzyme (serve as anti- quality health benefits. This involves providing
inflammatory) then apply on affected skin or adequate resources - health human resources,
spewed it over skin health facilities, and health financing
 For treatment of skin diseases UHC’s Three Thrusts
 INFUSION 1. Financial risk protection through expansion
 To prepare a tea (use lipton bag), keep in enrollment and benefit delivery of the
standing for 15 minutes in a cup of warm National Health Insurance Program (NHIP)
water where a brown solution is collected, 2. Improved access to quality hospitals and
pectin which serves as an adsorbent and health care facilities
astringent 3. Attainment of health-related Millennium
 JUICE/ SYRUP Development Goals (MDGs)
 To prepare a papaya juice, use ripe papaya Financial Risk Protection
& mechanically mashed then put inside a  Protection from the financial impacts of health
blender then add water care is attained by making any Filipino eligible
 To produce it into a syrup, add sugar then to enroll, to know their entitlements and
heat to dissolve sugar and mix it responsibilities, to avail of health services, and
 CREAM/ OINTMENT to be reimbursed by PhilHealth with regard to
 Start with poultice (pound leaves) to turn it health care expenditures
semi-solid Improved Access to Quality Hospitals and
 Add flour to keep preparation pasty then Health Care Facilities
make it adhere to skin lesions  Improved access to quality hospitals and health
 To make it into an ointment: add oil facilities shall be achieved in a number of
(mineral, baby or any oil - serves as creative approaches. First, the quality of
moisturizer) to the prepared cream to keep it government-owned and operated hospitals and
lubricated while being massage on the health facilities is to be upgraded to
affected area accommodate larger capacity, to attend to all
types of emergencies, and to handle non-
ORESOL communicable diseases.
Health Facility Enhancement Program (HFEP)
 Shall provide funds to improve facility
preparedness for trauma and other emergencies.
The aim of HFEP was to upgrade 20% of DOH
- retained hospitals, 46% of provincial hospitals,
46% of district hospitals, and 51% of rural
health units (RHUs) by end of 2011
ATTAINMENT OF HEALTH RELATED
MDGs
UNIVERSAL HEALTH CARE (UHC)  Further efforts and additional resources are to be
 Also referred to as KALUSUGAN applied on public health programs to reduce
PANGKALAHATAN (KP) maternal and child mortality, morbidity and
 Is the “provision to every Filipino of the highest mortality from Tuberculosis and Malaria, and
possible quality of health care that is accessible, incidence of HIV/AIDS. Localities shall be
efficient, equitably distributed, adequately prepared for the emerging disease trends, as
funded, fairly financed, and appropriately used well as the prevention and control of non-
by an informed and empowered public” communicable diseases
 The Aquino administration puts it as the
availability and accessibility of health services
and necessities for all Filipinos
 COMMUNITY HEALTH NURSING I
 The organization of Community Health Teams
(CHTs) in each priority population area is one GOAL 6: COMBAT HIV/ AIDS, MALARIA
way to achieve health-related MDGs. CHTs are AND OTHER DISEASES
groups of volunteers, who will assist families  Target: Have halted by 2015 and begun to
with their health needs and provide health reverse the spread of HIV/AIDS
information  Target: Have halted by 2015 and begun to
 RNheals nurses will be trained to become reverse the incidence of malaria and other major
trainers and supervisors to coordinate with diseases
community-level workers and CHTs. By the end
of 2011, it is targeted that there will be 20,000 GOAL 7: ENSURE ENVIRONMENTAL
CHTs and 10,000 RNheals SUSTAINABILITY
 Another effort will be the provision of necessary
services using the life cycle approach. These  Target: Integrate the principles of sustainable
services include family planning, ante-natal development into country policies and programs
care, delivery in health facilities, newborn care, and reverse the loss of environmental resources
and the Garantisadong Pambata package  Target: Halve, by 2015, the proportion of people
 Better coordination among government without sustainable access to safe drinking
agencies, such as DOH, DepEd, DSWD, and water
DILG, would also be essential for the  By 2020, to have achieved a significant
achievement of these MDGs improvement in the lives of at least 100 million
slum dwellers
MILLENIUM DEVELOPMENT GOALS
(MDGs) by WHO GOAL 8: DEVELOP A GLOBAL
PARTNERSHIP FOR DEVELOPMENT
GOAL 1: ERADICATE EXTREME POVERTY
AND HUNGER  Target: Develop further an open, rule-based,
 Target: Halve, between 1990 and 2015, the predictable, non-discriminatory trading and
proportion of people whose income is less than financial system
one dollar a day  Target: Address the special needs of the least
 Target: Halve, between 1990 and 2015, the developed countries
proportion of people who suffer from hunger  Target: Address the special needs of landlocked
countries and small island developing states
GOAL 2: ACHIEVE UNIVERSAL PRIMARY  Target: Deal comprehensively with the debt
EDUCATION problems of developing countries through
 Target: Ensure that, by 2015, children national and international measures in order to
everywhere, boys and girls alike, will be able to make debt sustainable in the long term
complete a full course of primary schooling
SUSTAINABLE DEVELOPMENT GOALS
GOAL 3: PROMOTE GENDER EQUALITY (SDGs) by WHO
AND EMPOWER WOMEN
 Target: Eliminate gender disparity in primary  Adopted by nations of the world on 25th
and secondary education preferably by 2005 and September, 2015 to be achieved till 2030
to all levels of education no later than 2015  PHHEEWE GIRRLLS CPP
1. Poverty
GOAL 4: REDUCE CHILD MORTALITY 2. Hunger
 Target: Reduce by two-thirds, between 1990 and 3. Health Care
2015, the under-five mortality rate 4. Education
5. Equality (Gender)
GOAL 5: IMPROVE MATERNAL HEALTH 6. Water
 Target: Reduce by three-quarters, between 1990 7. Energy
and 2015, the maternal mortality ratio 8. Good Jobs and Economic Growth
 COMMUNITY HEALTH NURSING I
9. Innovation and Infrastructure  The fundamental building block or
10. Reduced Inequality foundation of the Field Health Service
11. Responsible consumption and production Information System is the
12. Life below water INDIVIDUAL TREATMENT
13. Life on land RECORD
14. Sustainable cities and communities  This is a document, form or piece of
15. Climate action paper upon which is recorded the date,
16. Peace and Justice name, address of patients, presenting
17. Partnerships for the goals symptoms or complaint of the patient on
consultation and the diagnosis (if
FIELD HEALTH SERVICE INFORMATION available), treatment and date of
SYSTEM (FHSIS) treatment
 It is a network of information 2. Target Client List (TCL)
 It is intended to address the short-term needs of  Constitute the second “building block”
DOH and LGU staff with managerial or of the FHSIS and are intended to serve
supervisory functions in facilities and program several purposes:
areas  To plan and carry out patient care
 It monitors health service delivery nationwide and service delivery. Such lists will
 OBJECTIVES of FHSIS: be of considerable value to
 To provide summary data on health service midwives/nurses in monitoring
delivery and selected program service delivery to clients in general
accomplishment indicators at the barangay, and in particular to groups of patients
municipality/city, and district, provincial, identified as “targets” or “eligibles”
regional and national levels for one or another program of the
 To provide data which when combined with Department
data from other sources, can be used for  To facilitate the monitoring and
program monitoring and evaluation purposes supervision of service delivery
 To provide a standardized, facility-level data activities
base that can be accessed for more in-depth  To report services delivered
studies  To provide a clinic-level data base
 To minimize the recording and reporting which can be accessed for further
burden at the service delivery level in order studies
to allow more time for patient care and  TARGET CLIENT LISTS TO BE
promote activities MAINTAINED IN THE FHSIS
 IMPORTANCE OF FHSIS  Target Client List for Prenatal Care
 Helps local government determine public  Target Client List for Post-Partum
health priorities Care
 Basis for monitoring and evaluating health
 Target Client List of Under 1 Year
program implementation Old Children
 Basis for planning, budgeting, logistics and
 Target Client List for Family
decision making at all levels
Planning
 Source of data to detect unusual occurrence
 Target Client List for Sick Children
of a disease
 Needed to monitor health status of the  NTP TB Register
community  National Leprosy Control Program
 Helps midwives in following up clients Form 2-Central Registration Form
 Documentation of RHM/ PHN day to day
activities
 COMPONENTS OF FHSIS
1. Individual Treatment Record (ITR)
 COMMUNITY HEALTH NURSING I
3. Summary Table  THE QUARTERLY FORM
 The Summary Tables is a form with 12-  Program Report (Q1)
month columns retained at the facility  The Quarterly Form is the
(BHS) where the midwife records municipality/city health report and
monthly all relevant data. The Summary contains the three-month total of
Table is composed of: indicators categorized as maternal care,
 Health Program Accomplishment family planning, child care, dental health
this can serve as proof of and disease control
accomplishments to show LGU  Morbidity Report (Q2)
officials whenever they visit the  The PHN uses the form for the Quarterly
facility. Consolidation Report of Morbidity
 Morbidity Diseases the source of Diseases to consolidate the Monthly
ten leading causes of morbidity for Morbidity Diseases taken from the
the municipality/city. This summary Summary Table.
table will help the nurse and MHO to  THE ANNUAL FORMS (A-BHS, A1, A2 &
get the monthly trend of diseases. A3)
4. Monthly Consolidation Table (MCT)  ABHS Form is the report of midwife which
 The Consolidation Table is an essential contains data on demographic,
form in the FHSIS where the nurse at the environmental and natality.
RHU records the reported data per  The report of nurse at the RHU/MHC are the
indicator by each BHS or midwife. Annual Form 1 which is the report on vital
 This is the source document of the statistics: demographic, environmental,
nurse for the Quarterly Form. natality and mortality.
 The Consolidation Table shall serve  Annual Form 2 is the report that lists all
as the Output Table of the RHU as it diseases and their occurrence in the
already contains listing of BHS per municipality/city. The report is broken down
indicator. by age and sex.
 FHSIS REPORTING  Annual Form 3 is the report of all deaths
 These are summary data that are transmitted occurred in the municipality/city. The report
or submitted on a monthly, quarterly and on is also broken down by age and sex.
annual basis to higher level. The source of
data for this component is dependent on the  FLOW OF REPORT
records.

 THE MONTHLY FORM

 Program Report (M1)
 The Monthly Form contains selected
indicators categorized as maternal care,
child care, family planning and disease
control.
 Morbidity Report (M2)
 The Monthly Morbidity Disease Report
contains a list of all diseases by age and
sex. The Midwife uses the form for the
monthly consolidation report of
Morbidity Diseases and is submitted to
the PHN for quarterly consolidation.
 COMMUNITY HEALTH NURSING I
HEALTH INDICATORS FAMILY HEALTH NURSING PROCESS
A systematic approach of solving an existing
Fertility problem/meeting the needs of family
 Crude Birth Rate (CBR) - Overall total reported
births I. RAPPORT
𝑂𝑣𝑒𝑟𝑎𝑙𝑙 𝑡𝑜𝑡𝑎𝑙 𝑟𝑒𝑝𝑜𝑟𝑡𝑒𝑑 𝑏𝑖𝑟𝑡ℎ𝑠 ✓ Trust building
 𝐶𝐵𝑅 = 𝑥 1000
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 ✓ Knowing your client
✓ Adjusting to the situation and environment
Morbidity - Illnesses affecting the population group ✓ RESPECT

 Incidence Rate (IR): reported new cases II. ASSESSMENT

affecting the population group Data Gathering: tools or instruments used during
𝑁𝑒𝑤 𝑐𝑎𝑠𝑒𝑠 𝑜𝑓 𝑑𝑖𝑠𝑒𝑎𝑠𝑒 survey
 𝐼𝑅 = 𝑥 100
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 ✓ Interview
✓ Observation
 Prevalence Rate (PR): determine sum total of
new + old cases of diseases per percent ✓ Questionnaires - mostly patronized & used
population ✓ Records & Reports available
𝑁𝑒𝑤 𝑐𝑎𝑠𝑒𝑠+𝑂𝑙𝑑 𝑐𝑎𝑠𝑒𝑠
 𝑃𝑅 = 𝑥 100
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 Consolidation or Collation: collecting back the
questionnaires, tabulate and summarize
Mortality - Reports causes of deaths
 Crude Death Rate (CDR): overall total reported Validation: uses statistical approaches
death
𝑂𝑣𝑒𝑟𝑎𝑙𝑙 𝑡𝑜𝑡𝑎𝑙 𝑑𝑒𝑎𝑡ℎ𝑠
 𝐶𝐷𝑅 = 𝑥 1000
𝑃𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
Statistical Approaches:
 Maternal Mortality Rate (MMR): maternal 1. Central Tendencies: 3 M's
deaths due to maternal causes Mean = average
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑚𝑎𝑡𝑒𝑟𝑛𝑎𝑙 𝑑𝑒𝑎𝑡ℎ𝑠 Median = range (Highest - Lowest Score)
 𝑀𝑀𝑅 = 𝑥 1000
𝑅𝐿𝐵 Mode = frequency of occurrence of a variable,
used if there's too many variable occur
 Infant Mortality Rate (IMR): # of infant deaths
(0-12 months) or less than 1 year old 2. Standard Deviation: used if there are too many
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑖𝑛𝑓𝑎𝑛𝑡 𝑑𝑒𝑎𝑡ℎ𝑠
 𝐼𝑀𝑅 = 𝑥 1000 variables available to be treated which is seldom
𝑅𝐿𝐵
used in CHN
 Neonatal Mortality Rate (NMR): # of deaths
among neonates (newborn 0-28 days, < 1 √∑(𝑥 − 𝑦)
𝑆𝐷 =
month) 𝑛−1
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑛𝑒𝑜𝑛𝑎𝑡𝑎𝑙 𝑑𝑒𝑎𝑡ℎ𝑠
 𝑁𝑀𝑅 = 𝑥 1000
𝑅𝐿𝐵 Σ = summation of; x = variables available; y =mean
(given special attention); n = # of existing variables
 Swaroops Index (SI): deaths among individual
in the age group of 50 and above
𝑁𝑢𝑚𝑏𝑒𝑟 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ𝑠 (>50 𝑦𝑟𝑠 𝑜𝑙𝑑)
 𝑆𝐼 = 𝑥 100 3. Percentile (%) Method: most commonly used in
𝑇𝑜𝑡𝑎𝑙 𝑑𝑒𝑎𝑡ℎ𝑠
CHN by adding all cores then multiply by 100
 COMMUNITY HEALTH NURSING I
Presentation of Data DEFINE THE PROBLEM AFTER
1. Table/Chart IDENTIFYING IT ACCORDING TO NATURE
2. Graph (Pie, 2-Variable bar, Polygon Health Deficit (HD)
connecting results, Histograph-2 or more - If identified problem is an abnormality, illness or
variables adjacent to each other) disease, there's a gap/difference between normal
TYPOLOGY OF NURSING PROBLEMS status (ideal, desirable, expected) & actual status
A. First Level Assessment: to determine problems (the outcome/result/problem encountered on that
of family actual day)
Sources of Problems using IDB
Family: use of Initial Data Base (IDB) Health Threat (HT)
Nature: Health Deficit (HD), Health Threat (HT), - Any condition or situation which will be
Foreseeable Crisis (FC) conducive to health alteration, health interference &
health disturbance.
USE OF INITIAL DATA BASE (IDB): Foreseeable Crisis (FC) -stress points, anything
1. Family Chart Structure: which is anticipated/expected to become a problem
Nuclear -Father, mother, children
Extended (3rd generation)-Relatives staying with III. PLANNING
the family Four (4) Standard Steps:
Multi-generational extended-“apo sa tuhod” or “apo Prioritization - start if there are multiple identified
sa talampakan” problems
Dyad - Husband & wife only (childless couple) Formulation of objectives - planning a procedure
Blended -widow married another widow & have will start here if there is only one problem
children Developing strategies of action
Gay-Same sex living together Matriarchal -Mother Formulation of evaluation tools for the identified
is the decision maker strategy developed
Patriarchal -Father is the decision maker
Communal -different families forming a community CRITERIA IN IDENTIFYING THE
PROBLEM
2. Socio-economic: poverty level, educational
attainment & nature of occupation of members of
the family (sources of income)

3. Socio-cultural: different nature of religion

4. Home environment: assessment according to ES,

treatment of garbage, preparation of food,
availability of toilet, water & food sanitation,
sources of diseases Steps:
a. Decide on a score
5. Medical history: history of certain disease, family 𝑆𝑐𝑜𝑟𝑒
b. 𝐻𝑖𝑔ℎ𝑒𝑠𝑡 𝑆𝑐𝑜𝑟𝑒 x 𝑤𝑒𝑖𝑔ℎ𝑡
member with disease
c. Get the sum total of all the scores
6. Resources available in community for use by the
Interpretation:
family: Perfect score = 5, if score nearing 5 then prioritize
the problem
Criteria 1, 2 & 3 has to be assessed objectively by
5 Generalized M's in resources available in the health worker
community: Criteria 4 has to be assessed by the perception of the
Man/Manpower, Money, Machine, Materials, family
Methods
Compute for 3rd Degree Malnutrition
 COMMUNITY HEALTH NURSING I
IV. INTERVENTION 1. PREPARATORY PHASE
✓ Is the capacity to provide management A. Area of Selection
✓ Is the professional phase of nursing process -It should be DOPE Community: Depressed,
✓ Is the time when the PHN executes the standard Oppressed, Poor & Exploited, a new criteria for
function of an RN community organization
✓ Three (3) Standard Functions of RN: - “Old Criteria” → it must be a virgin community =
o Dependent-giving of medicines meaning no agency has gone there.
o Independent-monitor, assess, provide, educate -This is a dangerous situation that's why RA 7305:
o Interdependent-referrals Magna Carta for Public Workers was provided-a
PHN is to receive a hazard pay of 20-25% of
V. EVALUATION monthly salary
Three (3) Things to be evaluated: SPO B. Entry: the 1st thing to do upon entering the
1. Structure of program & activity -what articles, community is to have a courtesy call with the
equipment, supplies are utilized Barangay
2. Process utilized - steps used C. Integration/Immersion
3. Outcome of activity -results can be: -Immersion is imbibing the life situation/condition
o Desirable -to be implemented, advocated, of the community by living, eating & sleeping with
strengthen the family to be able to understand their situation
o Undesirable-to be avoided - It requires 2 Qualities of PHN:
Two (2) Aspects to be evaluated in the Outcome: Empathy & Sympathy (Integration)
D. Community Study: Diagnosis of Community-
o Quality -characteristic or kind of outcome; no
COPAR
numerical value, not measurable
-Makes use of the Nursing Process/Problem
o Quantity -from the word “quantum", with
numerical value, measurable Solving Approach
-Prioritized which among the problems identified is
to be attended 1st like in nature, magnitude,
COMMUNITY ORGANIZING -
modifiability, preventive potential, salience
PARTICIPATORY ACTION RESEARCH
(COPAR)
PRIORITIZATION OF COMMUNITY
PROBLEMS
OBJECTIVES OF COPAR
Patterns to be followed:
Indicators of Health Status/Condition:
1. Organize people
Fertility: 1 CBR = overpopulated community = HS
2. Mobilize people
Morbidity: IR (new cases) & PR (old cases) = HS
3. Work with people
Mortality: Deaths like children dying of
4. Educate people
pneumonia=HS
✓ Knowledge Health Resource(s):
✓ Attitude 5 M's-Manpower/Man, money, machinery, material
✓ Skills & methods (+) available facilities-Hospital/Clinic,
mode of transportation, market, school & movie
PHASES OF COPAR houses for recreation
1. Preparatory Health Related:
2. Organizing Categories according to 5 Aspects of Man =
3. Mobilizing PEMSS
4. Educating Physical, Physiological, Psychological
5. Collaborating Emotional
6. Phase Out Mental
Social
Spiritual
 COMMUNITY HEALTH NURSING I

Epidemic
- Greater than 50% of populations are
2. ORGANIZING PHASE susceptible or less immune individual
- Choosing potential community leaders - Greater % of the population is affected by
- Core group formation the occurring disease
- Community Assembly: Community e.g. Health worker reports that community Lanting
Organizing Participatory Action Research has an epidemic of measles affecting children less
(COPAR) than 7 years old
o Attend the assembly of the - total susceptible population: 3000
family/families - children affected by measles: 1750
o Families in the community should be
Endemic
represented, any family members can
- the disease occurs regularly, habitually,
represent his/her family as along as
constantly affecting the population group
he/she is a RESPONSIBLE (one
- 2 local endemic diseases: where causative
who also can comprehend) member
agent is available on those places
of that family
o Schistosomiasis  Samar, Leyte,
o Brgy. Captain/ chairman need not
Mindoro, Davao
necessary be the leader.
o Malaria  Palawan, Mindanao –
3. MOBILIZATION PHASE reasons why it’s prevalent
- Mobilization  let the member of the  Forested areas
community do the work. PHN should only  Surrounded by bodies of
supervise water
4. HEALTH EDUCATION Sporadic
- Adjust on the level of understanding of the - The pattern of occurrence is on & off where:
community o On  available causative agent
- Return demonstration is the best way of o Off  no available causative agent
teaching - It’s intermittent (unpredictable) in
- Focus on the KSA occurrence
- Respect of the custom and tradition - Disease occurs only if there’s a susceptible
host like in rabies
5. COLLABORATING
6. PHASE OUT

Epidemiology  the pattern of occurrences &

distribution of diseases, defects & deaths
 COMMUNITY HEALTH NURSING I
Pandemic - Opportunity to provide or extend health
- Worldwide, international, universal, global services
in occurrence like in AIDS, Hepatitis B, - Standard role of the Nurse  independent,
PTB, measles, mumps, diphtheria, dependent and interdependent
pneumonia - To be effective, come in complete uniform
o SARS is categorized by WHO as an (also bring a long umbrella with pointed end
outbreak only because out of 191 which serve as protection)
nations, 33 countries are reported to 4. Summarization
have it - Ability to put into record & report (orally)
about the outcome of the activity
Home Visit
- Is a professional contact between PHN and
the family Public Health Bag  indispensable tool that
- The services provided is an extension of the should be organize to save time & effort and to
Health Service Agency (Health Centers) prevent cross infection and contamination

Objectives of Home Visit Guiding Principles in the use of PH bag

- Assessment 1. Content – should be prepared by the one
- Nursing Care who will make home visit
- Treatment a. Note: BP Apparatus is kepy
- Health Education separately from PHN bag
- Referral (if care fails) 2. Cleaning
a. The inner part of the bag should be
Priorities (in the care): to prevent cross clean and sterile
contamination b. Should be done every after home
1. Newborn visit
2. Post-partum c. Ever endorse the bag
3. Pregnant mothers 3. Contamination
4. Morbid cases a. The less one opens the bag, the lesser
- The families need the assistance of the chance of contamination
health center that’s why home visit was done 4. In general, the bag is opened 3x:
to the family a. Putting out materials for hand
- The person who makes the home visit is washing
rendering services on behalf of the health b. Putting out materials used for
center nursing care
c. Returning all what have been used
Phases of Home Visit 5. Care of Communicable Case  should be
1. Planning disinfected with the use of 70% isopropyl
- Starts at the health center alcohol or Lysol which should be done at the
- Makes a study on the status of the family health center and not at home
- Statement of the problem
- Formation of objective
2. Socialization
- First activity is to establish rapport and gain
the trust of the family
3. Activity
- Intervention/professional phase
 COMMUNITY HEALTH NURSING I
Strategies/Programs to Promote Health of the - Spleen  infection of spleen 
Vulnerable Sectors of the Population inflammation  enlargement of organ
DOH Endemic Disease Control Program (Splenomegaly)  abdominal distension 
I. Schistosomiasis Control Program abdominal pain of the right upper quadrant
- Policies: CHES - Blood  Anemia and weakness
o Case Finding
o Health Education Treatment
o Environmental Sanitation - Drug of choice - Praziquantel (Biltricide) 
o Snail Eradication 60mg/KBW/day
- Length of treatment: takes months to a year
Case Finding:
6 aspects or thing to know: e.g. if patient is 50 kg., 50kg x 60 mg/KBW/day =
- Disease: Schistosomiasis 3000 mg/day
- Other Name: Bilhariasis or Snail Fever
- Causative Agent: Schistosoma blood fluke Health Education  it affects mostly farmers so
education them to wear rubber boots
(parasite)
Environmental Sanitation
3 types of species: - 1st concern  Snail
- Schistosoma japonicum – endemic in the - 2nd concern  water, where snail thrives
Philippines & affecting Indonesia, China, - 3rd concern  Toitlet
Japan, Korea - Food
- Schistosoma mansoni - Garbage
Schistosoma haematobium
Snail Eradication  use molluscicides treat the
entire suspected soil with chemical solution that
Laboratory procedure:
kills snails
- Blood examination: heightened eosinophil
level indicated parasitism
II. Malaria Control Program
- Fecalysis: Kato Katz (plain stool exam that
uses a special apparatus resembling a Case Finding
feeding bottle sterilizer) - Disease: Malaria
o Procedure: - Other name: Ague
 Collect specimen - Causative agent: Plasmodium-a protozoa
 Have the test tube undergo
4 types of species:
centrifugation for 20 mins
- Plasmodium falciparum – more fatal that
 Get specimen from
affect Philippines
precipitate & swab it on glass
o Vector  Female Anopheles
slide
Mosquito (FAM)
 Observe it on microscope
- Plasmodium viax
Signs & Symptoms: - Plasmodium ovale
- CNS  High grade fever  cerebral - Plasmodium malariae
convulsion
- GIT  Nausea & vomiting, Diarrhea 
Chronic dysentery (prolonged diarrhea of
more than 2 weeks & consistency of mucoid
& bloody (with streaks of blood)
- Liver  presence of infection manifested by
jaundice & hepatomegaly
 COMMUNITY HEALTH NURSING I
Laboratory Procedure  malarial smear-extract o Perform head-to-toe assessment,
blood at the height of fever because plasmodium is abdominal exam
very active & ruptures at this period o Tetanus toxoid immunization
Signs and symptoms: o Fe supplementation: given from 5th
- 1st stage  cold: chilling sensation for 1-2 month of pregnancy to two months
hrs postpartum (100-120 mg orally/day
- 2nd stage  hot: high grade fever lasting for for 210 days)
3-4 hrs o Laboratory exam: heat-acetic acid
- 3rd stage  wet: Diaphoresis (excessive test. Benedict’s test
sweating) o Oran/dental exam
Treatment  drug of choice  Quinine - Pre-natal counseling
2 forms: - Provision of safe, deliver care
- Chloroquine (Aralen) o All birth attendants shall ensure
- Primaquine clean and safe deliveries at the
facilities (RHUs/hospitals)
If quinine is not available, ma use Silfadoxime-an o At-risk pregnancies and mothers
antibacterial drug paired with pyrinthamine must be immediately referred to the
Personal protection
nearest institution
- Sleep under a mosquito net
- Provision of quality postpartum care
- Sleep in a screened room
- Proper schedule of follow-up must be
- Sleep with long sleeve attire
followed:
- Use repellants that contain DET (diethyl
o 1st postpartum, visit for home
toluamide or toluene which has a pungent
deliveries must be done within 24
odor that drives awat mosquitoes and an
hours after delivery
irritant to mucous membrane of respiratory
o 2nd, done at least 1 week after
tract when inhaled
delivery
- Plant a neem tree using leaves
o 3rd, done 2-4 weeks thereafter
CLEAN
Attendants must be aware of the early signs,
Chemical Method  insecticide spraying at night
symptoms and complication. They should follow
Larvae eating fish  Tilapipa
the 3 CLEANS:
Environmental Sanitation & Health Education 
- CLEAN hands
insect, water, trash
Anti-mosquito soap  basil citronelli - CLEAN surface
Neem Tree  banana, gabi, eucalyptus, provide - CLEAN cord
repellent effect B. Improvement of the health personnel’s
capabilities on newborn care, midwifery thru
III. Maternal Care Program trainings
a. Note: all deliveries should be done in
Strategies:
health care facilities only
A. Provision of Regular and Quality Maternal
C. Improvement on the quality of care at the
Care Services
first referral level
- Regular and quality pre-natal care
a. Orientation, training should be done
o Hx-taking, utilization of HBMR
on the use of proper filling-up of
(Home-Based Mother’s Record) as a
HBMR card
guide in the identification of risk
b. Proper referrals/endorsements must
factors
be done for future if-ups
o PE: weight, height, BP-taking
D. Prevention of unwanted pregnancies through
family planning service
 COMMUNITY HEALTH NURSING I
E. Prevention and management of STDs Tetanus Toxoid Immunization
F. Promotion of Appropriate health practices Protection among neonatal tetanus. Both mother and
G. Upgrade reporting services child are PROTECTED against tetanus and neonatal
H. Mobilize political commitment and tetanus.
community involvement to provide support
to basic health care delivery
Maternal Health Program
Components of Pregnancy Care:
1. Antenatal Registration
2. TT immunization
3. Macronutrient and micronutrient
Supplementation
4. Early detection and management of
Micronutrient Supplementation
complications of pregnancy
Vitamin Dose Schedule Remarks
5. Clean and Safe Delivery
Vitamin 10,000 IU Twice a Do not
6. Support to Breast feeding
A week give
7. Family planning and counseling
starting on before 4th
8. STD/HIV/AIDS Prevention and management
the 4th month
9. Treatment of disease and other condition
month of
10.Oral care
pregnancy
Iron 60mg/400ug daily
Antenatal Registration
Home Based Mother Record (HBMR) serves as tablet
passport to appropriate health care. Simple card
designed to facilitate easy recording and
interpretation of comprehensive information on
health status of a women, before, during and after Treatment of Disease and other conditions
pregnancy.
Pre-natal visit Period of pregnancy
1st visit As early in pregnancy
as possible before 4
months or during 1st
trimester
2nd visit During 2nd trimester
3rd visit During 3rd trimester
Every 2 weeks After 8 months of
pregnancy till delivery
 COMMUNITY HEALTH NURSING I
Emergency Signs during Pregnancy Acetic Acid Test – test for albumin in urine; test for
- Unconscious/Convulsion Pregnancy Induced HPN.
- Profuse vaginal bleeding - Collect urine in test tube, heat it in burner
- Severe abdominal pain then add 3-5 gtts of acetic solution (clear
- Looks very ill white). Observe for change in color:
- Severe headache and visual disturbances o If it remains clear  (-) CHON or
- Severe difficulty of breathing albumin in urine
- Fever o If it turns cloudy  (+) CHON =
- Severe vomitting proteinuria
Policies
Family Planning 1. Non coercive (give freedom of choice)
- The program is anchored in the following 2. Integration of Family Planning in all
principles: Curricular Program:
o LOI 47 DECS states that Family
R – Responsible Parenthood Planning is to be integrated in all
R – Respect for Life. The 1987 Constitution states
school curricular programs, either
that the government protects the sanctity of life.
baccalaureates or non baccalaureates,
Abortion is not a family planning method.
B – Birth Spacing  refers to interval between enrolled separately as one unit
pregnancies (which is ideally 3 years) 3. Multi-Sectoral Approach: establish
I – Informed Choice that is upholding and ensuring relationship with other agencies which can
the rights of couples to determined. either be:
o Intrasectoral
Goals: o Intersectoral-Local or International
A. Safe Pregnancy (WHO, Uniced, USAID, Japhiego)
- Right age to be pregnant = 20 – 35 years
old, not less than 20 and not more than 25
METHODOLOGIES
- Right interval of pregnancy = once in 2 or 3
Biological
years A. Basal Body Temperature (BTT)
- Home Base Mother’s Record (HBMR) = the - Get the temperature early morning before
record used for care of mothers in CHN. waking up which should be monitored daily
Laboratory Examinations: at the same time
Benedict’s Test – test for sugar in the urine; test for - There should be a sudden drop of
diabetes. temperature between 0.3 – 0.6 deg. C
- Heat test tube with 5 cc of Benedict’s followed by an increase of temperature by
solution (blue) in the burner then add 3-5 0.3 – 0.6 deg. C which means that the
gtts of urine (amber yellow) then heat again. woman is fertile.
Observe for the change in color: B. Sympto-thermal
o Blue  (-) sugar in urine C. Cervical Mucus Test
o Green  trace of sugar in urine; +1 - Billing’s method by Dr. Billing
or + - Spinnbarkheit 9came from a German word
o Yellow  traces of sugar in urine; +2 Spinner which means to play with the
or ++ cervical mucus with the finger) or Wet &
o Orange  more traces of sugar in Dry Method:
urine; +3 or +++ o Wet Cervical Mucus (Fertile) 
o Brick Red  surely diabetic; +4 or abundant, stretchy & transparent
++++
 COMMUNITY HEALTH NURSING I
o Dry Cervical Mucus (Safe & Not  Upper inner arm because it
Fertile)  whitish, pasty & adhesive is nearest to the brain
D. Calendar (Rhythm)  External oblique
- Deleted already since 1998 because it’s not  Thigh
recommended for irregular cycle of  Gluteal muscles
menstruation B. Mechanical
- Menstrual cycle should be regular, obtain 4- o IUD  up to 10 years protection
6 month cycle o Cervical cap & Diaphragm
E. Lactation Amenorrhea Method (LAM):  Prevent the sperm to pass the
RA 7600-Breastfeeding & Rooming in cervix
Law  Works better with spermicide
- DOH organized Maternal & Child Family  Wore 30 minutes coitus and
Health Institute (MCFHI) with the following keep up to 6 after coitus
members: o Condom  most effective way to
o All government hospitals prevent STD’S / STI’s
o Private hospitals (volunteer) C. Behavioral
- Normal involution (uterus goes back to o Abstinence
normal) of the uterus: after 45 days or 5-6 o Withdrawal
weeks or 1 ½ months if not breastfeeding D. Permanent
- Frozen breast milk is to be put out of the o Vasectomy (reversible)  since year
freezer 2 hours before feeding (Body of Ref: 200 in the Philippines
2-3 days / Freezer: 3-4 months) o BLT
- Left over milk should be discarded & should
not be re-preserved or re-frozen because it NUTRITIONAL HEALTH SERVICES
is already contaminated Policies:
Temporary I. Nutritional Surveillance (NS)  to
A. Chemical determine victims of malnutrition
o Oral Pills (Logentrol)  has low A. Anthropometric Measurement  study of
dose of estrogen & progesterone that measurements of human dimensions
inhibits ovulation a. Age of weight  if weight is not
o Parenteral  Depot appropriate with the age:
Medroxyprogesterone Acetate i. Stunting  growth
(DMPA)/ Depoprovera – inhibits retardation
ovulation making women ii. Wasting  connoted
amenorrheic malnutrition
b. Age for height  if height is not
1991, DMPA was found to be causing cancer of the appropriate with the age:
cervix c. Weight for height
1994, DMPA is given IM 4x a tear every 3 months
(90 days interval)
o Implants  Norplant-it inhibits
ovulation effective for 5 years but
seldom advocated for use it is
usually expensive; the client buys the
device (consists of 5 capsules) &
have it implanted at the health center
by minor surgical incision in:
 COMMUNITY HEALTH NURSING I
Rule Male Female Goiter: Iodine Deficiency Disease (endemic in
Every height of uphill)
110 lbs 105 lbs. - Target age group: 0 -59 months
5ft.
Every - Give 1 capsule (200 mg) of potassium iodate
increment of an in oil once a year
+6 +5
inch above 5 ft.
ADD For a child< <5 years old, empty contents of capsule
Every in a cup with warm water because he can’t tolerate
decrement of it
-6 -5 - Adverse effect of iodine deficiency disease
an inch below 5
ft. SUBTRACT that must be avoided:
o Mental retardation-intelligence
d. Skin Folds Test-pinch  the quotient: idiot, moron & imbecile
external oblique muscle with your o Growth retardation-cretinism (pedia)
palm & dwarfism (adult)
i. Normal  1 inch
Macronutrient Malnutrition  available in large
ii. Overweight  >1 inch amount in the body 9Protein Energy Malnutrition or
e. Middle Upper Arm Circumference PEM)
(MUAC)  used in children below - Kwashiorkor  protein deficiency
5 years old by measuring the middle - Marasmus  carbohydrate deficiency
upper arm with a tape measure (energy giving food)
i. Normal  13 cm. and above
ii. Malnutrition  <13cm
B. Biochemical Method
Micronutrient Malnutrition  available in small
amount in the body VADAG:
Vitamin A Deficiency:
- Deficiency: Xerophtalmia-opacity of cornea
leading to night blindness
o Infants (6-12 months)  give
100,000 i.u.
o Pre-schoolers (12-83 months) 
give 200,000 i.u.
o Post partum  give 200,000 i.u.
- Never give Vitamin A to infants less than 6
months & pregnant women because it is
toxic
Anemia: Iron Deficiency Anemia II. Food Production
- Target age group: 0-59 months (less than 5 - Fortification-products without any nutrient
years) are added with nutrients
- Give 3-6 mg/kbw/day - RA 8172 (Asin Law)  Fidel Salt
- Always give the maximum 9Fortification of Iodine Deficiency
Elimination) = iodized salt – “Patak sa
Example: child weighs 8 kg. Asin” by Secretary elavier on December 1-5,
 8x6 = 48mg/day for the 1st 3 months then 2003 where DOH workers go to marker to
monitor, if still anemic, continue giving but check if salt sold contains iodine by placing
compute again 6mg/kbw. few drops of reagent:
 COMMUNITY HEALTH NURSING I
o If salt color turns to blue violet 
fortified with ioding Sangkap Pinoy
o If salt color show no change  not - Or micronutrients
fortified with iodine - Are vitamins and minerals required by the
- RA 832 (Rice Fortification)  FVR bod in very small quantities. These are
(Fortified Vitamin Rice) by Secreatry essential in maintaining a strong, healthy,
Elavier under FVR, Erap Rice under Erap, and active body; sharp mind; and for women
Gloria Rice or “Bigas ni Gloria” under to bear healthy children
PGMA - Vitamin A, iron and iodine, which cannot be
synthesized by the human body, and
therefore must be provided through the diet
CHILD Health Programs
1. Infant and Young ChildFeeding Sentrong Sigla Movement
2. Newborn screening - Is a joint effort of the DOH and the LGUs
3. Expanded Program on Immunization - It aims at promoting availability of quality
4. Management of ChildhoodIllnesses health services in health centers and
5. Micronutrient Supplementation hospitals and at making these services
6. Dental Health accessible to every Filipino
7. Early ChildDevelopment
- Its main component is the certification and
8. Child Health Injuries
recognition program that develops and
Food Fortification Program promotes standards for health facilities
Fortification  the addition of a micronutrient
deficient in the diet to a commonly and widely
consumed food or seasoning
E.g. The use of FIDEL salt
Fortification for Iodine Deficiency Elimination
 COMMUNITY HEALTH NURSING I
Republic Act 10028 or the Expanded Breastfeeding Early identification and timely intervention
Promotion Act of 2009 can lead to significant reduction of
RA7600 (or the “Rooming-in and Breastfeeding Act morbidity, mortality, and associated
of 1992) disabilities in affected infants. NBS in the
EO 51: Milk Code of the Philippines Philippines started in June 1996 and was
Benefits of Breastfeeding integrated into the public health delivery
- Bonding
system with the enactment of the Newborn
- Resistance
Screening Act of 2004 (Republic Act 9288).
- Economical
- Currently, PHIC is funding the basic
- Allergy free screening of six disorders for P550 for its
- Safe members. The expanded newborn screening
- Time saving costs P1500 and remains as an option to
- Family Planning parents, wherein PhP 550 is covered by
- Energy Giving PHIC and the remaining PhP 950 as an out
- Error Free Formula of pocket expense of the family.
- Digestible - RA 9288 or the Newborn Screening Act of
- Inexhaustible supply 2004 and DOH AO No. 2014-0045 or the
- No vitamins needed Guidelines on the Implementation of the
- Guaranteed Expanded Newborn Screening Program

Newborn Screening
Republic Act 9288
- Newborn screening (NBS) is a public health
program aimed at the early identification of
infants who are affected by certain
genetic/metabolic/infectious conditions.
 COMMUNITY HEALTH NURSING I
5. Absolute contraindication
- DPT or DPT3to a child who has had convulsions
or shock 3 days the previous dose. (Pertusis content
contraindicated to children with progressing neuro
disease)
- Live vaccines (BCG) should not be given to
individuals who are immunosuppressed d/t
malignancy, therapy with immunosuppresive agents
or irradiation
6. Mild side effects after vaccination is okay!
- Fever
PD 996 (Compulsory Basic Immunization for - Local Reaction
Infants and Children below 8 yrs. Old) 7. Giving doses of a vaccine at less than 4 weeks
- BCG interval may lessen the antibody response.
Lengthening the interval between the doses of
- DPT
vaccine leads to higher antibody levels.
- OPV
8. NO EXTRA dose must be given to
- AMV children/mother who missed dose of
- MMR DPT/HB/OPV/TT. Vaccination must be continued
- Other basic immunization for infants asD as if no time had elapsed.
9. Strictly followed the principle, NEVER, EVER
reconstitute the freeze dried vaccines in anything
other than diluent supplied with them.
RA 10152 An Act Providing Basic Immunization
10. Use one syringe one needle per child during
Services for Infants and
vaccination.
Children, Repealing for The Purpose Presidential
Decree 996.
- TB
- DPT
- Polio
- Measles
- Mumps
- Rubella
- Hepa B
- HIB
- Such other vaccines as may be determined
by DOH

Dental Health Program

Principles - Vision  A lifetime of oral health and no
1. Safe and immunologically effective to
tooth decay for the next generation
administer all EPI on the same day at different site
- Strategies:
2. Measles vaccine should be given as soon as the
child is 9 months old, regardless of whether other o Social mobilization
vaccines will be given on that day.(85%) o Coordination and partnership with
3. Moderate fever, malnutrition, mild respiratory sectoral groups
infection, cough, diarrhea and vomiting are NOT o Networking
contraindication. o Capacity building and work value
4.Vaccination sched should NOT be restarted from formation
the beginning even if the interval years between
doses exceed the recommended interval per month
 COMMUNITY HEALTH NURSING I
Sang Milyong Sepilyo  Modified refrigerator
- Project for social mobilization o Freezer compartment
- Aim: o Body
o Emphasize the importance of oral  Top- OPV, AMV
health in relation to total body health  Middle- BCG, DPT, Hep B, TT,
o Increase public awareness on the Diluent
prevention of common dental  Lower- Bottles/ ice packs with water
diseases
o Solicit one million new toothbrushes HOW TO MAINTAIN COLD CHAIN
Stocking of Vaccines in the Transport Box
from concerned citizens
Vaccine Carrier
Elements of EPI (SACIT)  Make sure you have enough ice packs
- Surveillance, studies and research o Transport box- 24 pcs
- Assessment and evaluation of the program’s o Vaccine carrier- 4 pcs
overall performance  Place OPV, AMV in contact with frozen ice
- Cold chain logistic management packs
- Information, education and communication  Wrap DPT, Hep B, TT with paper
- Target setting  Place BCG in between AMV, OPV and
wrapped vaccines
Principles & Legal Basis
- Based on Epidemiological Situation What to do with opened vials of vaccines?
- Mass Approach I. Continue to use opened vials in the subsequent
- Basic health service (it’s integrate into the sessions if all these conditions are met:
health system) 1) Expiry date has not passed
- P.D. 996 – compulsory basic immunization 2) Vaccines are stored appropriately (+2 to 8
for infants and children below 8 years old ⁰C)
3) Sterile procedures have been fully observed
Discard Point of OPV using the VVM
4) Opened vial has not been contaminated
Constant Temperature, Length of Time VVM
Day and Night Reaches “Discard NOTE: Discard opened BCG and MV after 6 hours
Point” of reconstitution. Opened vials of DPT, Hep B, TT
At room temperature + 8 days can still be used for 4 weeks provided condition 1-4.
25⁰C II. Discard an opened vial immediately if any of
At room temperature + 20 days the following conditions apply:
20⁰C 1) Sterile procedures have not been fully
At room temperature + 180 days observed
4⁰C 2) + suspicion of contamination of the opened
At room temperature - Over 2 years vial
20⁰C
3) + visible evidence of contamination of the
opened vial (e.g. change in appearance or
Proper stocking of Vaccines (refrigerator)
 Neatly arrange the vaccines (segregated by presence of floating particles)
type) 4) If the label has come off, or
5) If the VVM has reached discard point
 Domestic refrigerator
o Freezer compartment -OPV, AMV a) the inner square matches, or
o Body - BCG, DPT, Hep B, TT, Diluent b) is darker than the circle
6) Reconstituted vaccines (BCG, AMV) after
6 hours of reconstitution
 COMMUNITY HEALTH NURSING I
What is thermal shock?
 It is the process of damage to the vaccine
resulting from the usage of diluent that is at too
high a temperature (above +8⁰C)
 It results in the death of some or all of the
essential live organisms in the vaccine.
How to read a vaccine vial monitor
 The inner circle is lighter than the outer circle. If
the expiry date has not passed, USE the vaccine.
 As time passes the inner square is still lighter
than the outer circle. If the expiry date has not
passed, USE the vaccine
 Discard point: the color of the inner square
matches that of the outer circle, DO NOT USE
the vaccine.
 Beyond the discard point: inner square is darker
than the outer circle, DO NOT USE the vaccine.
Sizes of Syringe and Needle to Use during
Vaccination
DPT, MV use 2-3 mL syringe with
and TT 25 or 30 mm 23 or 25 gauge
needle
BCG use 1 mL tuberculin syringe with
10 mm 26 gauge needle STEPS TO CALCULATING HEP B
In mixing use 5 or 10 mL syringe with REQUIREMENT
vaccines 18 gauge needle 1) Identify the important data for computation
Eligible Population (EP) of infants
“First Expiry and First Out” EP= Total Population (TP) x 3%
 A “first expiry and first out” (FEFO) vaccine Wastage Multiplier: 1.2
system is practiced to assure that all vaccines National:
are utilized before its expiry date. Proper Reserve stock: 25%
arrangement of vaccines and/or labeling of Reserve stock multiplier: 1.25
expiry dates are done to identify those close to Region/province/city:
expiring. Reserve stock: 12.5%
Reserve Stock Multiplier: 1.125
 Vaccine temperature is monitored twice a day
Municipality:
(early in the morning and in the afternoon) in all
Reserve stock: 12.5%
health facilities and plotted to monitor break in Reserve Stock Multiplier: 1.1
the cold chain. 2) Formula
Target Setting  Hep B requirements of
Wastage Factor: (constant) National/Provincial/city level
DPT= 1.67 =EP x no. of doses x wastage multiplier x
OPV= 1.67 reserve stock multiplier
Measles= 2
BCG= 2.5
HepB= 1.10
Tetox= 1.67
 COMMUNITY HEALTH NURSING I
 Hep B requirements of lower level b) inadequate antibody production response to
= EP x no. of doses x wastage multiplier x children in that area
reserve stock multiplier c) risk of hematoma formation
d) potential injury to the sciatic nerve
Which of the following is NOT an element of EPI
a) Information, Education, and Which of the following is an inappropriate nursing
Communication intervention about Hepatitis B vaccine?
b) Surveillance, studies and research a) Shouldn’t be given intradermal
c) Target setting b) Should be given in the anterolateral thigh
d) Vaccine safety muscle
c) Should do shake test to determine if the
The law which requires compulsory basic vaccine has been damaged by heat
immunization for infants and children below 8 years d) Shouldn’t be frozen to preserve its potency
old.
a) R.A. 7846 Which of the following is appropriate?
b) P.D. 996 a) No mother/child should be discharged from
c) R.A. 8746 the hospital without providing the mother
d) P.D. 966 the required Hepatitis B vaccine.
b) Provision of birth dose of Hepatitis B
Which of the following does not belong to the 7 vaccine to infants weighing equal to or more
target EPI diseases? than 1000 grams at birth.
a) Diphtheria c) Infants attended at birth by midwives shall
b) Tuberculosis be given the combination of Hepatitis B
c) Diabetes vaccine within 24 hours after birth.
d) Tetanus d) If birth is attended by TBA outside regular
health facilities, the midwife will give
It is a highly communicable infectious disease of
immunization during house visit within 7
children with paroxysm of coughing that reach a
peak of violence ending in a long-drawn inspiration days after delivery
that produces a characteristic “whoop”. It assure that all vaccines are utilized before its
a) Emphysema expiry date?
b) Pertussis a) vaccine vial monitoring
b) FEFO system
c) Tuberculosis
c) cold chain management
d) Bronchial asthma
d) ECCD monitoring
Which of the following is a fully immunized child? Which of the following is an example of relative
a) a 7 month child who has received 1 MV, 1 contraindication to immunization?
a) Melena, a newborn baby of a mother with
BCG, 1 Hep B, 3 DPT and 3 OPV
b) an 18 month old child who had just AIDS, about to be given BCG
completed his 1 BCG, 1 Hep B, 1 MV, 3 b) Shigella, a Eurasian child who develops
DPT and 3 OPV convulsion within 3 days of givin DPT, and
c) a 1 year old child who had just completed is due to receive DPT2
his 1 BCG, 1 Hep B, 1 MV, 3 DPT and 3 c) Bordatella, a 6 week infant-relative of the
OPV nurse, who has active neurologic disease
d) none of the above d) Rubella, a 14 week infant, admitted to the
hospital due to fever and chills.
Hepatisis B vaccine should not be given in the
buttocks because of: Which of the following follows the standard
a) gluteal muscle irritation and pain protocol on immunization?
 COMMUNITY HEALTH NURSING I
a) Open a vial of vaccine eve if only one In storing diluents, which of the following is
eligible child or pregnant woman is present appropriate?
for immunization. a) middle portion of the body of a modified
b) Distribute health information materials on refrigerator
family planning b) lower body of a domestic refrigerator
c) Conduct health education among mothers c) freezer compartment of both the domestic or
with high risk infants only modified refrigerator
d) Use on sterile needle and one syringe for d) top body of a modified refrigerator
each type of vaccine for all patients In storing AMV, which of the following is
appropriate?
During administration of DPT, MV, and TT, what a) middle portion of the body of a modified
syringe size is appropriate? refrigerator
a) 1 ml syringe b) lower body of a domestic refrigerator
b) 5 ml syringe c) freezer compartment of both the domestic or
c) 2-3 ml syringe modified refrigerator
d) none of the above d) top body of a modified refrigerator

When injecting BCG to your infants, which of the SAMPLE COMPUTATION PROBLEM
following needle sizes is most appropriate? Given: Tagbilaran City, with a total population
a) 26 gauge needle of 1,000,000 for 2007. Compute for the annual
b) 23 gauge needle requirements for Hepatitis B.
c) 19 gauge needle Compute for the eligible population (infants)
d) 18 gauge needle 1,000,000 x 0.03
= 30,000 infants
Upon inspection of the vaccine vial monitor, you Calculate for the annual needs (in doses)
noticed that the inner square is darker than the outer 30,000 x 3 doses x 1.2 (WM) x 1.125 (RSM)
circle. Which of the following is correct? = 121,500 doses
a) it has reached the discard point, do not use Calculate for the annual needs (in vials)
121, 500 doses/ 10 doses per vial
b) it is already expired, do not use
= 12,150 vials
c) it is already beyond discard point, do not use
d) it is already expired, do not use if already
opened ENVIRONMENTAL SANITATION
 refers to all factors available in the environment
In storing OPV, which of the following is affecting the health of the individual or
appropriate? population
a) middle portion of the body of a modified
 regulated by PD 856: Comprehensive Sanitation
refrigerator
Code of the Philippines
b) lower body of a domestic refrigerator
c) freezer compartment of both the domestic or
ENVIRONMENTAL HEALTH SERVICES
modified refrigerator (EHS) OF DOH IS RESPONSIBLE FOR
d) top body of a modified refrigerator  Promotion of healthy environmental conditions
and prevention of environmental related
diseases through appropriate sanitation
strategies
 Promotion & implementation of sanitation
programs through the Department of Health
Field Health Units
 COMMUNITY HEALTH NURSING I
 Conceptualization of new programs/projects to  Fluoridation: adding fluoride to prevent dental
contend with emerging environmentally related caries (primary significance) & whitens enamel
health problems of teeth ( 2nd significance)
COMPONENTS:  Aeration: exposing drinking water in air to
 Water Supply Sanitation Program strengthen taste within 24 hours which is
 Proper Excreta and Sewage Disposal usually used in uphill areas where there’s less
Program or no pollution
 Insect And Rodent Control
 Food and Sanitation Program 3 TYPES OF APPROVED WATER SUPPLY
 Hospital Waste Management Program AND FACILITIES
Level I -Point Source
1. WATER SUPPLY SANITATION A protected well or a developed spring with an
PROGRAM outlet but without a distribution system for rural
 Potable areas where houses are thinly scattered.
 Free from any particles that might cause Level II Communal faucet system or stand posts
illness to a individual A system composed of a source, a reservoir, a piped
distribution network and communal faucets, located
Ways to Make Water Potable:
at not more than 25 meters from the farthest house
 Boiling: minimum of 3 minutes to maximum of
in rural areas where houses are clustered densely.
10 minutes for drinking Level III Waterworks system or individual house
 Sterilization: 30 minutes after the water starts connections
to boil A system with a source, a reservoir, a piped
 Filtration: makes use of filter paper or cotton distributor network and household taps that is suited
cloth to separate solid particle from liquid if for densely populated urban areas.
water comes from river
 Coagulation/Flocculation: uses aluminum 2. PROPER EXCRETA AND SEWAGE
crystal (tawas) that collects or absorbs particles DISPOSAL SYSTEM
from liquid part & becomes slimy 3 TYPES OF APPROVED TOILET
 In 1 gallon of water, drop tawas (the size FACILITIES
Level 1
of magi cubes) & allow to sstand for 608
Non-water carriage toilet facility:
hours
- Pit latrines
 Initially, water appears to be cloudy then
- Reed Odorless Earth Closet
after 6-8 hours of standing, the water
- Bored-hole
becomes clear
- Compost
 Chlorination: uses 100% pure concentrated
Toilets requiring small amount of water to wash
chlorine bought from botika or given free by waste into receiving space
health centers - Pour flush
 To prepare stock solution (SS): in 1 liter - Aqua privies
drinking water, add 1 tablespoon of Pit latrines
concentrated chlorine which is potent for  most commonly observed in rural area
3-4 months  has three components: the pit, a squatting plate
 To prepare the chlorinated water: in 2 ½ and the super-structure
gallons of drinking water (10,000 ml=10
liters), add 1 tablespoon from the prepared
stock solution & let it stand for 30 minutes
to react with water
 COMMUNITY HEALTH NURSING I
types of pit include CARE AND MAINTENANCE OF YOUR
 “Antipolo type”, a pit type of toilet TOILET FACILITY:
provided with concrete floor and an elevated  Water must be provided at all times.
seat with a cover  Use toilet paper
 Ventilated Improved Pit or VIP, pit with a  Use lysol once a month for odor removal
vent pipe  Clean the bowl by muriatic acid to remove the
 Reed Odourless Earth Closet or ROEC, a stains.
pit completely displaced from the  Avoid depositing solid objects on the bowl to
superstructure and connected to the prevent clogging
squatting plate by a curved chute.  Always check your toilet if it’s clean
Bored Hole Latrine  Use plunger when clogging occurs. Don’t use
 consists of relatively deep holes bored into the sticks or rods to avoid the breakage of the trap
earth by mechanical or manual earth-boring or the bowl.
equipment 3. PROPER SOLID WASTE MANAGEMENT
 holes are about 10-18 inches in diameter and refers to satisfactory methods of storage, collection
usually 15-35 feet deep. The hole is provided to and final disposal of solid wastes
facilitate squatting. SOURCES OF SOLID WASTE
Two types of bored-hole latrines are:  Household Waste - these are wastes generated
 Wet Type - when the hole penetrates ground in or discharged from household including
water table or other strata. shops but excluding commercial activities
 Dry Type - when the hole does not reach  Commercial Waste - restaurants, stationery
ground water table; fills up at a faster rate shops, grocery shops or any commercial
than the wet type. activity are the main sources of commercial
waste.
Level 2
On site toilet facilities of the water carriage type  Market Waste - only refers to waste generated
with water sealed and flushed type with septic in or discharged from markets both for whole
vault/tank disposal facilities. sale and retailing
Level 3  Institutional Waste - these are wastes
Water carriage types of toilet facilities connected to generated in government, state enterprise and
septic tanks an/or to sewerage system to treatment private firm office.
plant.  Street Sweeping Waste - these are wastes
THINGS TO CONSIDER IN CONSTRUCTING generated by the street sweeping cleansing
A TOILET service.
FACILITY:
 River Waste - includes all the wastes
 At least 25 meters away from water sources at a
generated by the river and creek cleansing
lower elevation
 Medical Waste - these are wastes generated in
 It should be within your financial capability
hospitals.
 It should be approved by the local health
authorities COMPONENTS OF SOLID WASTE
 Garbage refers to left over vegetable, animal
and fish material from kitchen and food
establishments. These materials have the
tendency to decay giving off foul odors and
sometimes serve as food for flies and rats.
 COMMUNITY HEALTH NURSING I
 Rubbish refers to waste materials such as Community
bottles, broken glass, tin can, waste papers,  Sanitary landfill or controlled tipping
discarded textile materials, porcelain wares, o Excavation of soil deposition of refuse and
pieces of metal and other wrapping materials. compacting with a solid cover of 2 feet
 Ashes are left over from burning of wood and  Incineration
coal. Ashes may become a nuisance because o Ecological Solid Waste Management: RA
of the dust associated with them. 9003- the use of incinerator approved in
 Stable manure is animal manure collected 2000 but was implemented in 2003 because
from stables. of lack of funding to purchase
 Dead animals like dead dogs, cats, rats, pigs,
and chickens that are killed by cars and trucks 4. FOOD SANITATION PROGRAM
on streets and public highways. They include POLICIES:
small and large animals that died from disease.  Food establishment are subject to inspection
 Street sweeping includes dust, manure, leaves, (approved of all food sources containers and
cigarette buts, waste papers and other transport vehicles)
materials that are swept from streets.  Comply with sanitary permit requirement
 Night soil is human waste normally wrapped  Comply with updated health certificates for food
and thrown into sidewalks and streets. This handlers, helpers, cooks
also includes human waste from pail system of  All ambulant vendors must submit a health
toilets. certificate to determine present of intestinal
 Yard cuttings includes leaves, branches, grass parasite and bacterial infection
and other 3 POINTS OF CONTAMINATION
SANITARY WAYS OF TREATING  Place of production processing and source of
GARBAGE: supply
 Segregation-separating biodegradable from  Transportation and storage
non-biodegradable  Retail and distribution points
 Collection-adherence to the proper collection
time→ the City of Manila coordinates with 5. HOSPITAL WASTE MANAGEMENT
Leonel Waste Management (a private firm RA 4226-Hospital Licensure Act monitors the
which collects garbage) where the truck driver hospital license & proper management of wastes as
coordinates with the Barangay Chairman on well as renewal of license to operate
GOAL: To prevent the risk of contraction
the time they will collect garbage so don’t
contracting nosocomial infection from type disposal
bring out garbage before the collection time
of infectious, pathological and other wastes from
WAYS OF DISPOSAL hospital
Household COLOR CODING OF BIN TO KEEP WASTE:
 Burial ► Deposited in 1m x 1m deep pits  Green: wet waste
covered with soil, located 25 m. away from  Black: dry waste
water supply  Yellow: infectious/pathological waste like
 Open burning blood, sputum, urine, feces & gauze
 Animal feeding  Orange: toxic/hazardous waste
 Composting
 Grinding and disposal sewer