SKILLS ENRICHMENT SOCIAL DETERMINANTS OF HEALTH

PROGRAM  Conditions in which people are born grow, live and work
and age and the system put in place to deal with illness
COMMUNITY HEALTH NURSING  Shaped by the distribution of money, power, and resources
BASIC CONCEPTS 
at global, national, and local levels
Responsible for health inequities- the unfair and avoidable
COMMUNITY
differences in health status seen within and between
 Is a social group (has to be more than 1 person)
countries (WHO)
 Determined by geographic boundaries and or common
 5 domains:
values or interest
o Education access and quality
 Its member know ad interact with one another
o Health care and quality
 Its functions within a particular social structure
 It exhibits and creates norms, values, and social institutions o Neighborhood and built environment
o Norms- set of standards within community o Social and community context
HEALTH o Economic stability
 (WHO) A state of complete physical, mental. And social  Setting: natural environment of the people
well-being and not merely the absence of disease or o 3 fields of CHN practice
infirmity  Home
 (Modern Definition) Optimum level of functioning of an  School
individual, family and communities  Workplace
 Clients:
NURSING o Individual
 Assisting an individual, sock or well, in the performance of  Sick or well
those activities contributing to health or its recovery that he o Family
would perform if he had the necessary strength, will, or  Basic unit of care
knowledge and to do this in such a way as to help him gain  Most important unit in society
independence as rapidly as possible (Virginia Henderson)  Not visiting the pregnant mother but
 Direct, goal-oriented, and adaptable to the needs of the visiting the family with a pregnant
individuals. The family, and community during health and mother
illness (ANA)  Gather data from the family
as a whole
PUBLIC HEALTH o Population group/ aggregate
 The art and science of preventing disease, prolonging life,  Group of people who share
and promoting health and efficient through organized commonalities
community efforts in sanitation of the environment,  Pregnant women, seniors, adolescents
education of the individual on principles of personal o Community
hygiene, prevention of communicable diseases, medical
and nursing services for the early diagnosis and preventive PHILOSOPHY OF CHN
treatment of disease, and the development of a social  CHN is based on the worth and dignity of man (Margaret
machinery, so organizing these benefits to enable every Shetland)
citizen to realize his birthrights of health and longevity.  Components:
(Charles Winslow) o Integrity
o Health as basic human right
PUBLIC HEALTH NURSING o Quality
 Conditions that affect dignity:
 Special field of nursing that combines the skills of public o Humiliation
health, nursing and some phases pf social assistance and
o Social rejection
functions as part of a total public health program for the
o Marginalization
promotion of health, improvement the physical and social
environment and the prevention of illness and disability o Diminished self-respect
(WHO)
 Social assistances through FEATURES OF CHN
o Assessment  Preventive care
o Referrals o Most priority
o Monitor and evaluate (programs & services) o Immunization, health education, prenatal check
o Health education (primary role) up
 Population focused
o Centers to a need of a specific group
COMMUNITY HEALTH NURSING
 Multidisciplinary approach
 An area of human services directed towards developing and o Coordinate with other agencies, professionals
enhancing the health capability of people (Ruth Freeman o referrals
and Janet Heinrich)  Comprehensive care
 The utilization of the nursing process in the different levels o Look at not just the problem but also the
of clientele (individuals, families, population group and contributary factors
communities) concerned with promotion of health, o Looks for possible solutions
prevention of disease and disability and rehabilitation  Continuity of care
(Maglaya) o Follow ups, formalized partnership with
community, frequent visits
  Community based place; refused service order and payment of
o Community diagnosis to determine needs, bill
E. REFERRAL Agency to agency Service to service; by
problems, and interventions agency seldom
 Consumer involvement
o Involve client in the care PRIMARY HEALTH CARE
 Ecologically oriented  ALMA ATA declaration (1978)  LOI 949
o Services must be cost-effective and will not harm  ASTANA declaration (2018)
the environment
 Pre-payment mechanism Primary Health Care
o Free at the point of care but general population  Basic essential health care made
pays through taxes  Universally accessible to individual and families in the
 Developmental service community by
o To increase health capability so they can deal o Geographic accessibility
with their own problem o Cultural accessibility
o Financial accessibility
PRINCIPLES  Means acceptable to their though their:
 Recognized needs o Full participation
 Clearly defined objectives o At a cost affordable
 Active and organized citizen group
o Sustainable
 Available to all (social justice)
 PHC is a whole-of-society aims at ensuring the highest
 Periodic and continuous evaluation
 Family as unit of service possible level of health and wellbeing by focusing on
 Professionally prepared people’ needs and as close as feasible to people’s everyday
 Health education and counselling environment. (WHO and UNICEF)
 Member of the health team
 Service records
 Does not provide material relief
o Direct family to appropriate resource ESSENTIAL HEALTH CARE
ELEMENTS:
o refer
 Education
 Professional growth and development
 Local disease control
o Ongoing staff development program
 Essential drugs
o Needs of the evolve continuously  Maternal and child health
STANDARDS OF CARE IN PHN  Expanded program on immunization
 Standard 1: Assessment  Nutrition programs
 Standard 2: Population diagnosis and priorities  Treatment of simple ailment
 Standard 3: Outcomes identification  Sanitation, especially safe water supply
o Set together with the client
o Prioritizing Added: (after ALMA ATA declaration)
o Scoring  Mental health
o SMART  Oral health
 Standard 4: Planning  Control of ARI
o Must be responsive to needs of client and within  Control of HIV/AIDS and other STI
their resources  Occupational health
 Standard 5: Implementation  Use of traditional medicine
o Coordination
o Health education and health promotion GOAL OF PHC
o Consultation  HEALTH FOR ALL
o Regulatory activities  4 major features (pillars) of PHC
 Standard 6: Evaluation o Active community participation
o Intra & inter sectorial linkages
CHN VS INSTITUTIONAL NURSING o Support mechanisms made available
POINT OF CHN INSTITUTIONAL o Use of appropriate technology
COMPARISON NURSING  Safe
A. PATIENT  Affordable
Source Case-finding Patient’s initiative or  Feasible
referral  Convenient to use
Environment Familiar Unfamiliar
 Effective
Adjustment Made by the nurse Made by the patient
Cost Pre-paid Generally paid by the  Fulfils its purpose
patient/HMO  Simple
B. NURSING CARE  Acceptable
Period of care Case-holding Admission to  With a wide scope of technology
discharge
Direction of care Center physician, Consultant; resident RA 8423: Traditional and Alternative Medicine Act of 1997
nurse
Unit of service Family Individual Akalpuko Antifungal
Emphasis of care Prevention cure Ampalaya Diabetes Mellitus
C. TEACHING Family Patient; the family Bawang Lower blood cholesterol level, hypertension,
seldom toothache
D. DISCHARGE Moved to another Upon physician’s Caution: take on full stomach to prevent ulcer
  Stable eco-system
Guava?  Sustainable resources
Yerba Buena o Analgesic: rheumatism, menstrual  Social Justice
(peppermint) & gas pain  Equity
o Cough and colds
o Swollen gums
o Toothache
o Nausea and fainting RECOMMENDED ACTION AREAS
o Insect bites and pruritus  Build healthy public policy
o Right approached, legislations, taxations and
Lagundi o Asthma, cough, muscle pains & organizational change
fever o Relies on policy makers
o Dysentery
o Analgesic: headache, rheumatism,
 Creates supportive environment
sprain o Encourage reciprocal maintenance
o Contusions o Health promotion generates living and working
o Insect bites conditions that are safe, stimulating, satisfying
o Aromatic bath for sick patient
and enjoyable
Niyug-niyogan Anti-helminthic
(Chinese honey  Strengthen community action
suckle) o Empower people
Caution: not to be given to children below 4
Sambong Diuretic  Develop personal skills
(Camphor) o Skills to exercise more control over their own
Tsaang-gubat o Diarrhea health
(wild tree) o Has fluoride content
o Used as mouthwash to prevent
 Reorient health services
dental carries o Strong attention to health research, educ and
Ulasimang bato o Lowers uric acid training
(peperomia) o Reorientation=on on basic health services
Types of health promotion program
Preparations:  Information dissemination
 Decoction  Health appraisal0wellness assessment program
 Infusion  Lifestyle and behavior change
 Syrups  Worksite and wellness program
 Poultices  Environmental control program
 Lotions
5 priorities identified in the Jakarta declaration on leading health
 Compresses
promotion into the 21st century
Reminders on the use of herbal medicine  Promoting social responsibility for health
o Use clay pot, remove cover when boiling  Increasing community capacity and empowering the
o Wash herb well individual
 Expanding and consolidating partnerships for health
o Use only part indicated
 Increasing investment for health development
o Use one herb at a time  Securing an infrastructure for health promotion
o If no relief in 2-3 doses, refer to MD
o Watch out for allergy LEVELS OF PREVENTION

The success of PHC will be driven by Levels of

Primary Secondary Tertiary
 Knowledge Prevention
Total population, “Late” sick;
 Human resource for health (HRH) Target well individuals, convalescent, disabled,
 Technology “Early” sick
Population families, groups & complicated case,
o High-quality, safe, effective, and affordable communities terminally ill
Early diagnosis
medicines (traditional medicines, vaccine) Specific disease & prompt
Rehabilitation
Aspects of Prevention of permanent
o Information system (high quality data to improve Prevention
prevention treatment
disability/ disability
Specific protection Prevention of
information…)PICCCCCC complication
limitation

OTTAWA CHARTER FOR HEALTH PROMOTION HEALTH CARE DELIVERY SYSTEM
 To reach a state of complete physical, mental and social
wellbeing and individual or group must be able to identify  Sustainable Development Goals
and to …PICCCC o 17 goals and 169 targets
o End poverty; no one is left behind
Health Promotion
 “The process of enabling people to increase control over & Philippine Health Care Delivery System
to improve their health”  Public Sector
Pre-requisite for Health o Tax based budget system
 Peace  Private Sector
 Shelter o Market oriented
 Education
DEPARTMENT OF HEALTH
 Food  Vision:
 Income
 o Filipinos are among the healthiest people in SEA  Health service delivery
by 2022, and Asia by 2040 (Health for All)  Good governance for health
 Mission:
o To lead the country in the development of a FOURmula 1 Plus for Health
productive, resilient, equitable and people-  Financing
centered health system for Universal Health Care  Regulation
 Strategies  Service Delivery
o Focusing on programs that will fight poverty at  Good governance
the family and community levels  Performance Accountability
o Family empowerment rather than individual
o People oriented programs Areas of Reform
 Mandate  Health Service Delivery
o Is the principal agency in the Philippines  Health Financing
o Is responsible for ensuring access to basic public  Health Regulation
health services to all Filipinos through the  Good governance for Health
provision of quality health care and regulation of  Performance Accountability
providers of health goods and services
 General functions Kalusugang Pangkalahatan
o Leader in health  Obstacles in attaining the Universal Health care
o Enabler and capacity builder o The DOH & LGU budges & the NHIP can’t
o Administrator of specific services adequately provide financial risk protection for
 Priorities for DOH assistance to LGU the poor
o Recommended by local health officials o Poor households have inadequate access to
o Areas where research on health are conducted quality out-patient & in-patient care from health
o Deserving but less developed LGU care facilities
 Given the mandate, the DOH is both a policy and o Failure of the financing & health care delivery
regulatory body for health
systems to address the needs of poor Filipinos
 Technical resource
 Catalyzer for health policy  Strategies
 Political sponsor and advocate for 1. Expanded coverage of Philhealth
health issues on behalf of the health 2. 4 Ps or Pantawid Pamilyang Pilipino Program
sector 3. Improved access to quality hospitals & health
 Problem areas in the Delivery of health Services: care facilities
o Inappropriate delivery of health services 4. Attainment of the health related MDGs
o Maldistribution of equipment & even human
PHILIPPINE HEALTH AGENDA
resource
 “All for Health Towards Health for All”
o Inadequate regulatory mechanism, high cost of
 (2017-2022)
services & medications
 Financial Protection
o Poor health care financing
o Filipinos, especially the poor, marginalized, and
Key Structured reforms in the Health Sector vulnerable are protected from high cost of health
 1979 – Adoption of PHC care
 1991 – Local Government Code of 1991  Better Health Outcomes
 1995 – National Health Insurance Act of 1995 o Filipinos attain the best possible health outcomes
 1999 – Health Sector Reform Agenda of 1999 with no disparity
 2004 – National Health Insurance Act of 2004  Responsiveness
 2005 – FOURmula One for Health (F1) o Filipinos feel respected, valued, and empower in
 2008 – Universally Accessible Cheaper and Quality all of their interaction with the health system
Medicines Act of 2008
Human Resource for Health
 2009 – Food and Drug Administration Act of 2009 (RA  MD Scholarships
9711) o Doctors to the Barrio
 2011 – UH Kalusugan Pangkalahatan (KP)  Service - + 2 years in every year of
 2013 – National Health Insurance Act of 2013 (RA 10606) cash grant
 2017 – F1 plus for Health o Doktora para sa Bayan (RA 11509)
 2019 – UHC law of 2019  RN HEALS (Health Enhancement and Local Service)
Health Sector Reform Agenda (HSRA) o NARS (Nurse Assigned in Rural Services)
 Health services delivery from local health systems,  Medical Pool Placement and Utilization Program
government hospitals & public health programs  Nurse Deployment Act (6 months in RHU and 6 months in
 Health financing hospital service)
 Health regulation  Rural Health cs program
 Rural health team placement program (Midwifery and
FOURmula 1 for Health Medical Students)
 Financing
 Regulation
RA 11310: PANTAWID PAMILYANG PILIPINO PROGRACT  Automatic inclusion of every Filipino into the NHIP
ACT (4P’S)  Financing Source:
 Eligible Beneficiaries o Pooling of funds from SIN tax, PAGCOR, PCSO,
o 0-18 years old premium, DOH annual appropriations and
o Pregnant at the time of enumeration national government subsidy to DOH and
 Conditions for Entitlements: Philhealth
o Pregnant Women o Population-based health services financed by
 Avail of pre-natal services DOH
 Give birth in a health facility o Individual-based health service financed by
 Receive post-partum and post-natal philhealth
care  Entitlement to benefits:
o 0-5 years old  Free of charge at point of service for population-based
 Receive regular health and nutrition health services
services o Immediate eligibility for health benefit package
 Undergo check-ups and vaccinations under national health insurance program
o 3-4 years old o Fix, regulated co-payment for non-basic
 Attend day care or pre-school classes
with at least 85% attendance
o 5-18 years old
 Attend elementary or secondary school HEALTH IMPACT ASSESSMENT (HIA)
Monitoring and Evaluation
classes with at least 85% attendance
 Health Technology Assessment (HTA): Criteria
o 1-14 years old
o Responsive to Magnitude, Severity & Equity
 Avail of deworming pulls twice a year
o Safety and effectiveness
o 1 Responsible Member
o Household and financial impact
 Attend monthly Family Development
Session (FDS) o Cost-effectiveness
 Program benefits o Affordability and viability
o Education Grant (Maximum of 10 months/ year)
THE RE-STRUCTURED HEALTH CARE DELIVERY
 Elementary/ Daycare: Php SYSTEM OF THE PHILIPPINES
300/child/month  Primary Level
 Junior High: Php 500/child/month o Prevention
 Senior High: Php 700/child/ month o Management of minor prevalent conditions
o Health grant: Php 750/month o Out-patient services
o Rice Subsidy o RHU; Health Centers; Private Clinics;
 Php 600/onth Puericulture Centers; OPD; BHS
 Philhealth automatic Coverage
 Secondary Level
 Priority in the availment of modalities
o Hospitalization
and interventions under DSWD’s
o Provincial/ City health Services, emergency/
sSustainable Livelihood Program (SLP)
Distric Hosptitals, Infirmaries
RA 1123: UNIVERSAL HEALTH CARE ACT 2019  Tertiary Level
Objectives: o Specialized care
 Progressively realize universal health care in the country o Specially trained personnel
through a systemic approach and clear delineation of roles o Sophisticated Equipment
of key agencies and stakeholders towards better o DOH National health Services, Regional…
performance in the health system
 Ensure that all Filipinos are guaranteed equitable access to Local Government Code (RA 7160)
quality and affordable health care goods and services and  Mandates devolution of Public Health services from
protected against financial risk. national government to local government units
 Aim of Devolution:
How Universal Health Care addresses the challenges in the health o Self-reliant communities
system?
o Active partnership with the people
 Create Functional Health Care Provider Network (HCPN)
o Responsive to the needs of the people
 Ensure Strategic and adequate financing and purchasing
o Accountable government representatives
services
o Decentralization system for health decisions
 Engage local governments to effectively manage local
health systems;  LGU is given authority
 Building capacity in terms of qualified human resources
 Seamless information system

SEC 3 of UHC law: Ensure that all Filipinos are guaranteed equitable
access to quality and affordable health care goods and services and  Provincial health Board/ Municipal health board
protected against financial risk.
Provisions:
 o Participant in epidemiologic investigations
 Community organizer

School Nurse
 RA 124: Mandates all schools to have a school clinic for….

Occupational Health
 Basis is the Labor Code: Health, safety & Welfare benefits
 RA 1054: An act to revise & consolidate…
 Guidelines:
o 10-50 workers: graduate first aider
o 50-200 workers:
 Two-way referral System  Hazardous – requires 1 OH nurse
 Non-Hazardous – full-time first aider
o 200-300 workers: 1 OHN, parttime MD &
dentist; 1 “e” clinic or hospital within 5 km (1
bed: 100 workers)
o > 300 workers: 1 OHN, full time MD, dentist,
infirmary or “e” clinic or hospital within 5 km
 Functions of OHN & SHN
o Health care provider
 Preventive services
 Screening for health problems
 Emergency nursing care
 Levels of Primary Health Care Workers o Environmental manager
 Monitoring environmental conditions
 Recognizing & reporting of accident &
health hazards in school/ workplace
 Healthful school living
 Application of ergonomic principles
o Health coordinator
 Making referrals to other agencies &
health personnel
 Coordination with public health nurse

DEMOGRAPHY AND EPIDEMIOLOGY

Epidemiology
o upon” “people” “study”
o The study of the occurrence and distribution of health-
1 midwife: 1000 population related states or events un specified populations, including
Quality Health Care Service in Primary Care… the study of the determinants influencing such states, and
Indicator of Quality: Competency of Health Care Providers the application of this knowledge to control the health
ROLES OF THE PUBLIC HEALTH NURSE problems
 Health care Provider
o Provider of direction nursing care Functions of Epidemiology
 Health Educator
 Historically study the occurrence of disease in the
o Provider of direct care & change agent
population
o Role model
 Diagnose community health problems
o Health monitoring
 Estimate individual risks and chances
 Manager  Help complete the clinical picture and natural history of the
o Planner/ programmers disease
o Coordinator of services
o Supervision of RHMs
o Trainer
o Property custodian of RHU Classification of epidemiology
 Descriptive
o Evaluator of work performance
o Seeks to answer the questions:
 Epidemiologist  What is the outcome
o Health monitor of the community  Who are affected
 Statistician  Where are they
 Presentation of municipal health  When do events occur
statistics thru tools such as graphs & o Seeks to describe the occurrence of a disease in
tables terms of person, place, and time
o Researcher  Analytical
 o Seeks to answer the following questions  De jure- assigned at the usual
 How does it occur place of residence
 Why are some affected more than  De facto- where the person is
others physically present at the time
o Focuses on investigation of causes and of census
associations o Survey
 Interventional/experimental  Carried out on a smaller scale, dealing
o Seeks to study the effectiveness of new only with a sample of the total
method/treatment of disease population (20%)
 Evaluation  Ex: block
o Seeks to measure the effectiveness of different  Urban- bounded by 3-4
health programs streets
 Ecological approach  Rural- about 40-80 houses
o Seeks to understand the etiology (origin or causal  2 types of community diagnosis
factor) of disease, the broad consideration of  `comprehensive
many levels of potential determinants  Problem-based
MODELS AS BASIS IN EPIDEMIIOLOGY o Experiment
 Person-Place-Time Model  Study of cause-and-effect relationship
o Person: “Who” factors, such as demographic between and among variables through
characteristics, health and disease status manipulation of the study factors
o Place: “Where” factors, such as geographic  Secondary
location, climate and environmental conditions, o Registry of vital events
and political and social environment  RA 3753- Civil Registry Law
o Time: “When” factors, such as time of day, week,  PD 651- Birth Registration
Law
or month and secular trends over months and
 Certificate of live birth
years
 Signed by buirth attendant,
o Example: Epidemiologic Triangle must be filed within 30
 Wheel model of Human-Environment Interaction days///////
o Agent  Death certificate
o Host  Signed by the physician; in
 Environment doctor-less places, the mayor
USES OF EPIDEMIOLOGY IN DISEASE PREVENTION  Must be filed within 48 hours from
 Primary prevention time of death
o Research studies on health promotion activity  Death registry is almost complete
that has positive effects health mortality data is the most accurate
o Specific protection measure that reduces the PICCCCC
incidence of a particular disease  Piccccccc
 Secondary o Records & Reports
o Interventions that provide for early retreatment o Publications
and cure of disease  Thru print/ online
o Epidemiological data and clinical trials o Informal Sources
determining effective treatments  Ex. by barangay chairman, midwives
 Tertiary o
o Focus on limitation of disability and the TIME RELATED PATTERNS OF DISEASE OCCURENCE
rehabilitation of those with irreversible diseases  Short-time fluctuation of an epidemic
o Examine risk factor affecting function o Common-source epidemics – simultaneous
o Suggest optimal strategies in the care of patients exposure of a large number of susceptible to a
with chronic advanced disease common infectious agent.
 Establishing causality
 Point source, if the exposure is singular
o Identify etiological factors of disease to
and all of the affected individuals
encourage
o Identify the most effective prevention activiris develop the disease over a single
o Develop treatment modalities exposure and incubation course.
 Screening o …
o Identify riusk factors and diseases in their earliest  Cyclical variation
stages o Recurrent fluctuations of disease that may exhibit
 Surveillance cycles lasting for certain periods
o Mechanism for the ongoing o Ex. Seasonal disease
collection….piccccccccccc  Secular variation
Types of data according to source  Changes in disease frequency over a period of many years
 Primary DEMOGRAPHY
o census  Population size
 An official and periodic enumeration of o # of people in the given area and the given size
population; data gathering about 100% o Census
of the population
 Population Composition
 2 ways of assigning people:
o Age, sex, occupation, educational level
  Population Distribution Patterns of Distribution of Disease:
o Number in space  Geographic
 Population: Age, sex, occupation, lifestyle
Measuring population growth  Time
 Natural increase
o = (no. of births – no. of deaths) Herd Immunity
 Rate of Natural Increase  General level of immunity of a population against a
o Rate of natural increase = crude birth rate – crude particular disease
death rate Types of Graphs
Population Composition  Line
 Age & Sex Composition – population pyramid  Bar
 Sex Composition – sex ratio  Area Diagram, component bar graph, pie chart
o Ex: (No. of males/ total population) x 100  Scattered diagram
 Age Composition
o Median age – divides the population into 2 equal
parts
o Dependency ratio VITAL STATISTICS
 (Population aged <15 years + > 65)/  Salient numbers in public health
(population aged 15-64 years) x 100  Provides public health experts important trends, changes,
impact and prevalence of diseases
Population Distribution  Useful in program development
 Urban-rural distribution  General Pointers:
 Crowding index – number of persons in a household o Numerator – description
divided by the number of rooms used for sleeping o Denominator – Population susceptible
o Know the factor to use
 Population density – number of people living in a given
o Total population synonyms:
land area
 Average population
Epidemiologic investigation  Midyear population
 To identify the source/ delineate etiology of an epidemic  Estimated population
Common Frequency Measures are:
 Establishing the epidemic – compare: present number of
 Rates
cases of a disease usual number of cases in the past at this
 Ratio
time of the year  PICC
 Appraisal of facts – describing the epidemic according to Vital Statistics tools
o Person  Measure of Birth/ Fertility
o Place o Crude Birth Rate
o Time – onset o General/ Total Fertility rate
 Formulating the hypothesis – making an “educated  Measures of Morbidity
guess” resource of epidemic o Prevalence rate
 Testing the hypothesis – performing diagnostic tests to o Incidence Rate
determine actual source o Attack Rate
o Ex. Culture food sample, coliform test Contact  Measures of Mortality
o Crude-Death Rate
tracing
o Cause-Specific Death Rate
 Conclusion and recommendations
o Age- Specific
Types of Epidemics according to Onset o Proportionate- Mortality
 Point/ common source epidemic – common vehicle; sudden o Swaroop’s Index
onset o Case-Fatality
 Propagated o Maternal-Mortality
o Person-to-person propagated o Infant
o Neonatal
 Person-to-person contact needed
Fertility rate
o Vector-propagated
 Will give an idea of the growth range of a population
 Vector population  Affected baby fertility, marriage patterns & practices, sex
 size is the single most & age composition, birth registration practice
important factor in  MWRA or MCRA (Married women of Reproductive Age)
determining no. of cases o Crude Birth Rate (CBR)
 Number of live births occurring among
Patterns of Disease Occurrence: the population of a given geographical
 Sporadic – occasional occurrence affecting a small number area during a given year
of people  No. of registered live births/ total
 Endemic – cases are present all year round population x 1000
 Epidemic – an unexpected increase in the number of cases o General/ Total Fertility Rate (TFR)
of a disease in the community  Number of live births per 1,000 women
 Pandemic – an epidemic in the world… of reproductive age (15-45) per year
  More refined way to measure fertility o Small or Large, Similar or Diverse (age, gender,
than crude birth rate because FR race, occupation, socioeconomic status)
accounts for the % of women aged 15-  Place
45 In a population o Geographical boundaries
 o Geopolitical (Spatial) – by boundary (natural or
Morbidity rate manmade)
 Any departure, subjective or objective, from a state of o Phenomenological (functional)- members
physiological or psychological well-being feelings of belongingness or membership
 Prevalence Rate  Social Interaction
 Prevalence Proportion- a measure of existing disease (old o Understand each other
and new cases in a population time) Functions of a Community
o No. of existing cases divided by the current  To determine the use of space for living and other purposes
population  To make available the means for production and
 Point Prevalence – describe the number of people with the distribution of necessary goods and services
disease at a specific point in time  To protect and conserve the health, life, resources &
 Period Prevalence – represent the number of existing cases property of individuals
 To educate and acculturate newcomers
Incidence Rate  To transmit information, ideas & beliefs
 The basis for leading causes of morbidity  To provide opportunities for interaction between
 Occurrence of new cases of a disease or condition in a individuals & groups
community over a given period relative to the size of the Types of Community
population at risk  Urban
Attack Rate  Rural
 Document the number of new cases of a disease in those  Sub-urban
exposed to the disease. Principles of Community Health Nursing
Mortality Rates  Focus on the community as the unit of care
 Crude mortality rate  Give priority on community needs
 The proportion of a population who die from any cause  Work with the community as an equal partner of the health
during the period team
 Cause-specific death rate  In selecting appropriate activities, focus on primary
o Mortality rate from a specified cause for a prevention
population  Promote a healthful physical and psychosocial environment
 Age Specific  Reach out to all who may benefit from a specific service
o Number of deaths among persons of given age  Promote optimum use of resources
group per midyear population of that age group  Collaborate with others working in the community
 Case Fatality rate and survival rate Community as Client
o Reflects the killing power of a disease  Focus is on the collective or common good of the
o The higher the CFR = more fatal the disease population instead of on individual health
o The more fatal the disease = the lesser the  When focusing on the community as client, direct clinical
survival rate care can be a part of population-focused community health
 Swaroop’s index practice
o The proportion of deaths aged 50 years and above
is determined by Swaroop’s Index Ethical Concepts
o The higher the Swaroop’s Index, the greater the  Utilitarianism
proportion of the deaths who were able to reach  Distributive Justice
the age of at least 50 years. Meaning, more  Social Justice
people grew old before they died. Characteristics of a Healthy Community
 Maternal-mortality rate  A shared sense of being a community based on history and
o Measures the number of deaths due to diseases values
related to pregnancy, delivery, puerperium  A general feeling of control and empowerment over matters
o It is an index of the obstetrical care needed and that affect the community as a whole
received by the women in a community  Existing structures that allow subgroups within the
 Infant-mortality rate community to participate in decision making in community
o Measures the risk of dying during the 1st year of matters
 The ability to cope with change, solve problems and
life.
manage conflicts within the community through acceptable
o Neonatal Mortality Rate (NMR): 0-28 days
means
o Early Neonatal (Hebdomadal) Mortality Rate
 Open channels of communication and cooperation among
(ENHMR): 0-7 days the members of the community
 Peri-natal mortality rate  Equitable and efficient use of community resources, with
o The number of fetal deaths past 22 (or 28) the view toward sustaining natural resources
completed weeks of pregnancy plus the number Application of the Nursing Process in the Community
of deaths among live-born children up to 7  Application of the Nursing Process in the Community
completed days of life Health Care: STEPS
CARE OF THE COMMUNITY o Establishing a professional relationship with the
Community Attributes: community
 People/ Population o Community diagnosis
o The most important component of the community
o Program planning
 o Implementation of the program plan  Numerical
o Evaluation of the health program  Descriptive
Community Assessment o Data Presentation
 Characteristics of the Population  Descriptive data: narrative
o Demography: Population size, composition &  Numerical data: tables or graphs
distribution in space, density  Types of Graphs:
o Vital Statistics: Fertility, Morbidity, Mortality o Line
o Patterns of Migration o Bar/ pictograph
o Psychological characteristics: Sense of belonging, o Histogram/
responsiveness to health efforts frequency polygon
o Quality of families that make up the community o Proportional/
 Environmental Conditions component bar
o Geographic characteristics: location of the graph/pie chart
community, quality of soil, topography, climate o Scattered diagram
& seasonal changes
o Rural, urban or semi-rural o Data Analysis
o Housing conditions  Establishing trends & patterns
o Water supply  Comparing data with standard values
o Waste disposal  Determining interrelationship of data &
o Flora & Fauna significance of problems
 Social System  Recognizing implications of findings
o Economy on the health status of the community
o Education o Identify Community Health Nursing Problems
o Religion  Health Status Problem
o Politics 
o Transportation System  Health resource Problem
o Communication System  Community resources to
solve the problem (ex.
o Health Care System
Manpower, money,
Community Diagnosis
machinery)
 Determining the health status of the community
 Health-related problem
 Types of Community Diagnosis (CDX)
 Presence of social, economic,
o Comprehensive
environmental, political
o Problem-oriented
factors that can aggravate the
 Comprehensive Community Diagnosis …
o Demographic Variables o Priority Setting & Scoring
o Socio-economic, environmental & Cultural o PIC: Nature of the Problem
Variables o PIC: Magnitude of the Problem
o Health & illness patterns
o PIC: Modifiability of the Problem
o Health Resources
o PIC: Preventive Potential
o Political/ leadership patterns
o PIC: Social Concern
 Power structures in the community
PLANNING FOR CHN PROGRAMS & SERVICES
 Attitude of the people toward authority
Planning should be:
 Conditions/ events/ issues that cause
 Futuristic
social conflict/ upheavals
 Change-oriented
 Practices/ approaches that are effective
 Continuous & dynamic process
in settling issues & concerns
 Flexible
 The Process:
 Systematic process
o Determine the objectives
Factors that may affect planning
o Define the study population:  Existing health policies & legislations
 Comprehensive – random-sampling  Level of technology in the area
 Problem-oriented – Purposive sampling  Economic resources
o Determine the data to be collected  Presence of programs and institutions supportive or maybe
o Choose data collection method in conflict with proposed programs
 Ex. Survey, observation, interview,  Other sectors with different orientation in viewing solutions
review of records, participant’s to community health problems
observation  PIC: Models and Frameworks for Community Health Care
o Develop the instrument  Planned Approach to Community
 Survey questionnaire
 Interview guide Five critical elements or phases
 Observation checklist o Mobilizing the community
o Actual Data Collection o Collecting and organizing data
o Data Collation o Choosing health priorities
 Putting together gathered data based on o Developing a comprehensive intervention plan
category o Evaluating PATCH
 Categories were EXCLUSIVE &
EXHAUSTIVE IMPLEMENTATION OF THE PROGRAM
 Types:
  Action phase Importance of COPAR
 Nurses as facilitators, not a leader nor a member  An important tool for community development and people
Evaluation empowerment
 Quantitative, qualitative  Prepares people to eventually take over the management of
 Approaches: development programs in the future
o Structure evaluation
 Maximizes community participation and involvement
 Involves looking into the manpower
and physical resources of the agency  Community resources are mobilized for community
responsible for community health services
interventions  Offers alternative solutions to health problems that may not
o Process evaluation require modern medical interventions
 Examining the manner by which
assessment, diagnosis, planning, Objectives:
implementation, and evaluation were  To help the people harness their human material resources
undertaken to pursue programs and projects which will enhance
o Outcome evaluation community development
 Determining the degree of attainment  To help the people understand their own situation and
of goals and objectives develop awareness of their potential through the process of
o Impact Evaluation action-reflection-action
 Program effectiveness in achieving its
ultimate goal
Principles of COPAR
COMMUNITY DEVELOPMENT  People, especially the most oppressed, exploited, and
An organized effort of the people to improve the conditions of deprived sectors are open to change, have the capacity to
community life and the capacity of the people for participation, self- change and are able to bring about change
direction and integrated efforts in community….  COPAR should be based on the interests of the poorest
Approaches to ComDev: sectors of society
 Social Welfare/ Dole Out Approach
 COPAR should lead to self-reliant community and society
 Modernization Approach
 COPAR leaders are identified and are tested through action
 Participatory Approach rather than appointed or selected by some
Community Organizing Methods used in COPAR
 A sustained process of educating & mobilizing the people  Action-reflection-action
so that they will be able to identify & solve their own
 Consciousness-raising
problem
 Participatory and mass-based
 A process whereby the community members develop the
 Group-centered and not leader-oriented
capability to assess their health needs and problems, plan &
implementation of health initiatives by the people Steps in COPAR
(Maglaya, 2007)  Pre-entry phase
1. Site or Area Selection
Basic Values in Community Organizing
 Activity = conduct an ocular survey
 Human Rights
 Criteria for site selection
 Social Justice
 Population size
 Social Responsibility
o (at least 100
Core Principles in Community Organizing families)
 People-oriented  Socio-economic status
 Participative o (Economically
 Democratic marginalized
 Developmental sector)
 Process-oriented  Peace & order situation
o Safe, no conflict
Goals of Community Organizing (social/ political)
 People empowerment  Accessibility of the site
 Building relatively permanent structures and people’s o Proximity of the
organizations area from base area
 Improved quality of life  Willingness of people to be
organized
Participatory Action Research (PAR)
o No strong
 Is a community directed process of gathering and analyzing
resistance
information or an issue for the process of taking actions and
 Inadequacy of health services
making changes
in the area
COMMUNITY ORGANIZING PARTICIPATORY ACTION o Lack resources,
RESEARCH (COPAR) poor environment
 Sustained, continuous sanitation
  Identify a contact person & a host 9. Follow-up/ Extension/ Expansion
family
 Methodology: ESSENTIAL HEALTH PACKAGES
Special Population group
 Inquire & coordinate with
 Adolescent
government & private
agencies  Adult Men and Women
 Ocular inspection  Older persons
 Collection of data from  Vulnerable population
secondary sources Services:
 Informal interview  For Women
 Entry phase o Breast self-examination
2. Courtesy call o Clinical Breast examination
 Gaining endorsement from local o Mammogram
leaders
o Pelvic examination and Papanicolaou Smear
 Forging partnerships with concerned
(Papsmear)
agencies/ authorities
o Digital rectal examination
3. Integration
o Bone density
 Establishing rapport
 Imbibing community way of life  For Men
 Clarify objectives & limitations o Gender linked behavior:
4. Community Study/ Social Investigation  Tobacco use
 Assessment: community survey,  Substance use
collation & interpretation of data  Poor preventive health
 Preliminary List of health & Health-  Lack of other emotional channels
related Problems
 Community Profiling
Health and Wellness Program for Senior Citizen in the Philippines
 Focus: Determine community problems
 RA 9257 (The expanded Senior Citizens Act of 2003), RA
together with the people
9994 (Expanded Senior Citizen Act of 2010)
 Design: Participatory Action Research
 Program Accomplishments/ Status
 Methodology: Community Diagnosis
o Provision of influenza and pneumococcal vaccine
 Organization Building phase
 Influenza/ Flu vaccine -annually
5. Spotting of Potential Leaders
 Pneumococcal Vaccine – every 5 years
 Belongs to EMS
o Wellness camp for senior citizens
 Well-respected member of the
community o Elderly Filipino week (Walk for Life Celebration
 Good moral standing
Vulnerable Populations
 Non-formal leader
 Persons with Disabilities (PWD)
 Desirous of change and is willing to
o Deafness or difficulty hearing
work for change
o Blindness or difficulty seeing
 Must be able to communicate
o Difficulty concentrating, remembering, or
effectively
6. Core group formation making decisions due to physical, mental, or
 Training of potential leaders emotional issues among those 5 years and older
 Laying down foundations for a strong o Difficulty walking, climbing stairs, dressing, or
community organization bathing among those 5 years and older
 Form the ACTION team o RA 7277: Magna Carta for Disabled persons
 Should represent the different sectors in  Application of the Primary Health Care
the community approach in rehabilitation for persons
 Should have the “CAN DO” attitude with disabilities
 May undergo S.A.L.T. thru S.W.O.T.  Adolescent & Youth Health Development Program
7. Social Mobilization/ Community Organizing (AYHP)
 Groundwork “motivate the people” o 10-24 years old
 Planning in a community assembly o Prepare adolescent to be responsible citizen
 Mobilization = implementation of plans during adulthood
 Program implementation o PIC: VULNERABLE YOUNG FILIPINOS
 Focus: Health, Education, Livelihood, o Adolescent Health Issues:
Physical Environment, Socio-spiritual  Early pregnancy & childbirth
formation  HIV
 Sustenance & Strengthening Phase  Malnutrition
8. Evaluation & Phase Out  Mental Health
 Effectiveness  Tobacco use
 Efficiency  Harmful use of alcohol
 Appropriateness  Drug addition
 Adequacy  Violence
  Injuries
o Factors affecting Adolescent health Issues
 Lack of life skills
 Lack of access to health services
 Lack of safe & supportive environment
o Characteristics of Adolescent-Friendly Health
Services
 Accessible (able to obtain)
 Acceptable (met expectation)
 Appropriate
 Equitable
 Effective (positive contribution)
o PIC: Required Quality of Adolescent Health
Service Provision
o Adolescent Health Services
 Management of illness
 Counselling substance abuse, sexuality
& reproductive tract infections (RTIs)
 Nutrition & Diet counselling
 Mental health
FAMILY
 Family planning & responsible sexual
o TYPES
behavior
o Nuclear
 Dental Health
o Multi-generational/extended
Health Package for Adult Men & Women  Nuclear + relatives
 Management of illness  Can offer help and advice
 Closer bond outside nuclear
 Counselling substance abuse, sexuality & RTIs
 May have conflict and lack of privacy,
 Nutrition and diet counseling many guests
 Mental health o Single-parent/incomplete
 Family planning & responsible sexual behavior  Either death or separation
 Dental care o Blended
 Screening & management of lifestyle related and other  Children or parents from other
degenerative diseases marriages
o Men- accidents & injuries, liver disease, BPH, o Compound
prostate malignancies  Muslims
o Women- goiter malignancies, DM  More than 1 wife
o Communal
 Group of ppl living together who share
Elderly Health program the same religion, beliefs etc
 Challenges of an Elderly  Dominican priests
o Cohabitation
o Maintaining …
 Live in partners
 Legal Basis  Living together but not married
o RA 9257: Expanded Senior Citizen Act of 2003  Can be ended simply by ending on both
o RA 7432: An act to maximize the contribution of parties
senior citizens to nation building, grant benefits o Foster
& special privileges & for other services  Adopting
o Proclamation 470: 1st week of October every year  Orphans feel safer and secured
as “Elderly Filipino Week”  Not permanent
 Health Services  Hard to live with strangers
o Homosexual
o Management of illness
 Same-sex
o Counselling substance abuse, sexuality & RTIs  Not legally accepted in PH
o Nutrition and diet counseling  Provides loving, caring and helpful
o Mental health environment
o Family planning & responsible sexual behavior  No male/female role or role confusion
o Dental care o Family as a client
o Screening & management of lifestyle related and o Sum of individual family members
other degenerative diseases o Family ads a system
o Screening & management of chronic, debilitating, o Whole is more than the sum of its part
o Interactions between family becomes the focus
infectious disease
 How they cope, deal with emotions etc
o Post-productive care
 Interrelated concerns
Anti-Violence against Women & Children Act of 2004
Advocacy Wheel
Reasons for having the family as the basic unit of service
 Steps of the nursing process in the care of the family
o Family is the natural and fundamental unit of any society or
critical resource o Assessment
o The family is a group generates, or events, tolerations and o The status of the family as a client
corrects within its membership o Ability to maintain itself as a system and
o Health problems of family members are interlocking functioning unit
o Illness of one affects the rest of the family o Ability to maintain wellness, prevent, control or
o The family is the most frequent locus of health decision resolve problems
o Center of decision-making o Data gathering methods
o The family is an effective and available channel for much  Observation
of the CHN effort  Physical examination
o The family provides a crucial environmental force  Interview
o Through its interaction with a larger social system,  Records review
validates and influences health efforts  Laboratory/ diagnostic test
o Priority setting of family health
o Formulation of FNCP
Family Tasks (in general) o Implementation of FNCP
o Evaluation of FNCP
o Physical maintenance
o Socialization of family
o Maintenance of order
o Allocation of resources
o Division of labor
o Recruitment, reproduction & release of members
o Placement of members into society
o Maintenance of motivation and morale

Characteristics of a Healthy Family

o Communication well and listen to all members

o Valued respect
o Has sense of trust
o Plays together and humor is present
o Privacy of the members is honored by the family
o Open its boundaries to admit and seek help with problems
o Shares leisure time together
o Has shared sense of responsibilities
o Members interact with each other and a balance in
interaction is noted among members

Family Health Tasks

Level 1 Assessment: Family Data Base
o Recognizing interruptions of health or development such as
illness or child’s failure to thrive o Family structure, characteristics & dynamics
o Seeking health care o Members of the household & relationship to the
o Managing health and non-health crises head of the family
o Providing nursing care to the sick, disabled or dependent o Demographic data
members of the family o Place of residence of each member
o Maintaining a home environment conducive to good health o Type of family structure
and personal development o Dominant family member
o Maintaining a reciprocal relationship with the community o General family relationship/ dynamic
and its institution
o Socio-economic & cultural characteristics
Family Health Care o Income and expenses
 Occupation, place of work and income
o Utilizes nursing process  Adequacy of i8come
o Family Nursing Care Plan  Decision maker about money
o Action-oriented o Educational attainment
o Systematic process o Ethnic background and religious affiliation
o Relates to the future o Significant others
o Based upon identified health problems o Relationship of the family to the larger
o Means to an end, not an end itself community
o
NURSING PROCESS AS APPLIED IN THE CARE OF o Home and environment
FAMILY o Housing
 Adequacy
  Sleeping arrangement  readiness for enhanced capability
 Breeding places of vectors
 Accident hazards  Areas:
 Food storage and cookies facilities o Healthy lifestyle
 Water supply o Health
 Toilet supply maintenance/
 Garbage/refuse disposal management
 Drainage system o Parenting
 Ventilation: o Breastfeeding
Total window opening x 100%
Total space area o Spiritual wellbeing
o Health Deficit
 20 & above= fair  Illness
 18-19= satisfactory  Failure to develop according to normal
 17 & below= poor
 Overcrowding: state
 Disability
o Kind of neighborhood
o Social facilities o Health Threat
o Health facilities  In the family members themselves
o Communication facilities  Biological
o Transportation facilities  Lifestyle
o Health status of each member
 In the family environment
o Medical & nursing history or past significant
 Physical
illnesses or beliefs and practices
 Social
o Nutritional assessment
 Anthropometric data
o Foreseeable Crisis/ Stress Point
 Weight
 Stress point if the crisis is incidental
 Height
 Bagyo, death of loved one,
 Etc  When one member is undergoing
 Dietary history maturational crisis, there is
 Eating habits and practices  Unusual demand for …..
o Developmental assessment of infants, toddlers
and preschoolers Second Level Assessment
o Values and practices on health promotion/maintenance &
disease prevention o Identifying Health Tasks
o Immunization status o Inability to recognize the presence of the problem
o Healthy lifestyle practices due to …
o Adequacy of o Inability to make decision with respect to taking
 Sleep and rest appropriate health action due to …
 Exercise/activities o Inability to provide adequate nursing care to the
 Protective measures sick, disabled, dependent or vulnerable member
 Relaxation and stress mgt of the family due to ….
o Use of promotive-preventive services o Inability to provide a home environment
conducive to health maintenance and personal
Level 2 Assessment: Family Health Tasks development due to …
o Inability to utilized community for health care
o Perception of the problem due to …
o Decisions made and appropriateness, if none, reasons;
actions taken and results, in none, reasons o Family Coping Index
o effects of decisions and actions on other family members o To provide a basis for estimating the nursing
needs of a particular family
Data Analysis o A family nursing need is present when
 Has a health problem wherein they are
o Sorting of data for broad categories unable to cope
o Clustering of related cues  There is a reasonable likelihood that
o Distinguishing relevant from irrelevant data nursing will make a difference in their
o Identifying patterns ability to cope
o Comparing patterns with normal or standards of health, o Scale:
family functioning and assumption of health tasks  1- totally unable to cope
o Interpreting results of comparison  3- partially able to cope
 5- able to cope
Typology of family nursing problem  No problem- if particular category is
o First level assessment not relevant
o Recognizing the presence of health problems
o Classification o Criteria
o Wellness Condition  Physical independence
 Potential for enhanced capability  Therapeutic competence
  Knowledge of health condition  Objectives/purpose
 Application of principles of general  Available family’s
hygiene information
 Health attitudes  Family’s recognized needs
 Emotional competence  Flexible and practical
 Family living
 Physical environment o Activity or implementation
 Use of community resources  Approaches
Planning  Social phase
 Professional phase
o Priority setting
 Summarization
o Criteria
 Outline verbally
 Nature of the problem
 Write summary
 Modifiability of the condition
o Summary
 Salience
o Bag Technique
 Scoring
o Formulating goals and objectives o Minimizes or totally prevent spread of infection
 SMART o Saves time and effort
Interventions/ Implementations o Effective care
o Types o Done in variety of ways
o Supplemental o Evaluation
o Facilitative o Input
o Developmental o Process
o Categories o Outcome
o Promotive
o Preventive Field Health Services and Information System (FHSIS)
o Curative
o Recording and reporting system in the Public Health
o Rehabilitative
System
Evaluation
o Provide summary data on health service delivery and
o Dimension
attainment of the objectives of public health programs
o Effectiveness
o Pride a standardized, facility-level data base
o Efficiency
o Minimize the recording and reporting burden at the service
o Appropriateness
delivery level in order to allow more time for patient care
o Adequacy
and promotive activities
Family-Nurse Contact
o Least costly Focus of FHSIS
o Development and self-direction of family
o Feasible to available nursing time and the total community o Maternal and child health care
needs o EPI
o Consistent with the community habits and expectations o Control of Diarrheal Diseases (CDD)
o Nutrition
FAMILY HOME VISIT o Family planning
o Tuberculosis, malaria, schistosomiasis, and leprosy control
Home Visit
o Dental health
o Advantages o Environmental health
o Accurate appraisal of family condition
Components
o Teaching in actual situation
o Discover new health problems
o Individual/ family health record
o Ease in sharing problems
o Foundation or building block
o Personalized service
o Target/client list
o Disadvantages
o Monitoring compliance to treatment
o Time-consuming
o For long term treatment
o Home distractions
o Tally report/ summary table
o No sharing with other family
o Reporting and transmitting of information to the
o Determinants in selecting a family in home visit
health center
o Severity of needs o Monthly consolidation Table (MCT)/ Output Table
o Family’s acceptance
o Politic of a given agency
o Availability of other health agencies
o Evaluation of past services
o Recognition of family’s needs
o Phases
o Planning
 Principles in planning a home visit
 o The exercise of reproductive right is with
responsibility
o Includes health for the purpose of enhancement
of life and personal relations
o Means safe pregnancy and delivery
o Include protection from unwanted pregnancy
o Includes protection from harmful reproductive
practices and violence
o Access to information on sexuality to achieve
sexual enjoyment
o Strategies
o Effective and more contraceptive methods
o Care, treatment and rehabilitation
o Adolescent, men, unmarried are focused
o Outreach activities and referral system
o Primary prevention

PUBLIC HEALTH PROJECTS AND PROGRAMS o Program components

o Safe motherhood
Major Public Health Projects & Programs o Family planning
o Sexually-transmitted infections
o Reproductive health and maternal services
o Gender-based violence
o Early child care services
o Control of communicable diseases
o Global indicators
o Control of non-communicable diseases
o Fertility rate
o Environmental health services
o Life expectancy
o Peri-natal mortality
Legal Basis
o Low birth weight
o RA 9710- Magna Carta for Women o Maternal mortality
o Provide for comprehensive health service that
Reproductive Health Law (RA 10354)
addresses causes of women’s morbidity and
o An act providing for a national policy on responsible
mortality
parenthood and reproductive health
o Ra 10354- Responsible Parenthood & Reproductive o Elements
Health Act of 2012 o Family planning information services
o Recognize and guarantees the human rights to o Maternal, infant, and child health and nutrition
sustainable human development, health, including breastfeeding
education and information, and the right to o Prescription of abortion and management of
choose and make decisions in accordance with abortion complication
one’s religious conviction, ethics, cultural beliefs o Adolescent & youth RH guidance and counseling
and demands of responsible parenthood o Prevention, treatment and management of RTIs,
HIV, AIDS and other STIs
Reproductive Health o Elimination of VAWC and other forms of sexual
and gender-based violence
o A state of complete, physical, mental and social wellbeing o ……..
and not merely the absence of infirmity in all matters
relating to reductive system and to its function and o Services provided in all public health facilities
processes at all stages of life o Fertility awareness & family planning
o Vision: information system
o Reproductive health practice as a way of life for o Interpersonal communication and counseling
every man and woman throughout life services
o Goal o Provision of modern family planning methods
o Achieve reproductive healthy sexual o Infertility services
development and maturation o Referral services where necessary
o To achieve reproductive intention o Other family planning information and services
o To avoid illness/disease, injuries related to as deemed relevant by the DOH
sexuality and reproduction
o To receive appropriate counselling and are The Philippine Family Program Planning
o Objective o Principles
o Reducing maternal mortality rate o Responsible parenthood
o Reducing child mortality rate o Birth spacing
o Halting and reversing spread of AIDS/HIV o Respect for life
infection o Informed choice
o Increasing access to rh information and services o Legal basis
o Concepts o E0 119- recognizes that family planning is a basic
o A married couple ha the capability to procreate human right
 o RA 6365- national policy on population and o The human ovum is susceptible to fertilization only for 18
created the Commission of Population to 24 hours
o PD 79- revised population act, defines the o The sperm deposited in the vagina are capable of fertilizing
objective, duties and function of the POPCOM, the ovum for no more than 72 hours
empowers nurses and midwives to provide o Present methods of determining ovulation are inexact by
acceptable methods of contraceptives about 48 hours
o PD 965- requires applicants for marriage license
to receive instructions of family planning Contraindications to Hormonal Method

Major Program Policies o Undiagnosed vaginal bleeding

o Improvement of family welfare with main focus on o Thromboembolic disorders
women’s health, safe motherhood and child survival o Pregnancy
o Freedom of choice o Liver disease
o Right to full information o Coronary artery or CVA disease
o Right to choose o Heavy cigarette smoking
o Right to quality care
o Right to sustain decisions Pill Danger Signs
o Promotion of family solidarity and responsible parenthood
o Abdominal pain
Family Planning Priorities o Chest pain or shortness of breath
o Headache
o Couples with mothers between ages 20-44 o Eye problems (blurred or loss of vision)
o Couples with 3 or more children or pregnancies at close o Severe leg pain (calf or thigh)
intervals
o Couples with mothers suffering from chronic disease in Common Side Effects of Intra Uterine Device
which pregnancy is contraindicated
o Increased menstrual flow
Concepts of Family Planning o Increased menstrual cramping
o Spotting
o Decisions should be taken by both marital partners
o Only if the parents have sincere inner motivation for FP IUD Danger Signs
may persists with it
o Health workers cannot assume that their clients hold the o Period late or skipped period
dame attitude toward FP o Abdominal pain
o When a couple expresses hostility toward FP, it is both o Increased temperature, chills
wrong to and useless for health workers to insist on it o Noticeable vaginal discharge; foul-smelling discharge
o Spotting, bleeding heavy periods & clots
3 Major High Risk Factors in Pregnancy
MATERNAL, NEWBORN, CHILD HEALTH AND
o Getting pregnant too quickly NUTRITION
o Getting pregnant before age 20 after 35 year o DOH administrative order 2008-2009
o Getting pregnant after the 4th baby o Strategy
o Every pregnancy is wanted, planned, supported
Modern Methods of Family Planning (MFP) o Every pregnancy is adequately managed
throughout its course
Modern Natural Methods o Every delivery is facility-based and managed by
o Billings ovulation or cervical mucus method
skilled birth attendants/ skilled health
o Basal body temperature professionals
o Symptom-thermal method o Every mother and newborn pair secures proper
o Standard days method post-partum and newborn care with smooth
o Lactational amenorrhea method transitions to the women’s health care package
o Any other method deemed to be safe, and effective by the for the mother and child survival package for the
DOH newborn

Modern Artificial Methods and Health Products MCHN Core Packages

o Oral contraceptives pills
o Condoms o Pre-pregnancy
o Injectables o Provision of iron and folate supplementation
o Intrauterine devices (IUDs) o Advice on family planning and healthy lifestyle
o No scalpel vasectomy (NSV) o Provision of family planning services, prevention
o Bilateral tubal ligation (BTL) and management of infection and lifestyle-related
o Sub-dermal implants diseases
o Any other method deemed to be safe, and effective by the
DOH o Pregnancy
o First prenatal visit at first trimester
Principle of Natural Planning o At least 4 prenatal visits throughout the course of
pregnancy
  To detect and manage danger signs and
complications o To ensure that every expectant and nursing mother
 Provision of iron and folate maintains good health, learns the art of child care, has a
supplementation for 3 months normal delivery & bears healthy children
 Iodine supplementation o That every child, wherever possible lives and grows up in a
 2 tetanus toxoid immunization family unit with love & security, in healthy surroundings,
 Counselling on healthy lifestyle and receives adequate nourishment, health supervision &
breastfeeding, prevention and efficient medical attention and is taught the elements of
management if infection as well as oral healthy living
health services
o Delivery The Paradigm Shift
 Skilled birth attendance/skilled health
professional-assisted delivery and Strategic Thrusts
facility-based deliveries
 Use of partograph o Launch & implement BEMONC & CEMONC strategies
 Proper management of o Improve the quality of pre-natal & post-natal care
pregnancy and delivery o Reduce women’s exposure to health risks (family planning
complications and newborn & RH)
complications o Advocacy for health services for the mother and the unborn
 Access to BEmONC or resource generation among LGUs, NGOs, and other
CEmONC services stakeholders
o Post-partum
 Visit within 72 hours and on the 7 th day Basic Emergency Obstetric Care Strategy (BEMONC)
postpartum to check conditions such as
bleeding or infections o Establishment of facilities for every 125,000 population
 Vitamin A supplements to the mother o Services:
 Counselling on family planning and o Parenteral (IV or IM) antibiotics
other available services, maternal o Parenteral oxytocic
nutrition and lactation counseling o Parenteral sedatives or anti-convulsant drugs
 Postnatal visit of the newborn together
o Manual removal of placenta
with her visit
o Assisted vaginal delivery with forceps
MCHN Service Delivery Network

o Community level service providers (CHT) Comprehensive Emergency Obstetric & Newborn Care
(CEMONC)
o Navigation function
o Basic service delivery function
o All BEMONC functions +
o 2 basic emergency obstetrics and newborn care (BEmONC)
o Capability for blood transfusion
o Capable network of facilities and providers
o Capability for cesarian section
o Comprehensive emergency obstetric and newborn care
(CEmONC) WHO guidelines:
o Capable facility or network of facilities o For every 50,000 population should have at least 5
EMONC facility with at least 1 CEMONC

Aspects of Maternal Health Care

o Pre-natal care
o Care during labor
o Post-partum care

Essential Maternal Services

o Pre-natal schedule
o All pregnant women should have at least 4 ante-
Legislations affecting Maternal Services natal care

o EO 209- the Family Code of the Philippines Pre-natal Visits Period of Pregnancy
1st visit As early as possible
o RA 6365- law that created the Population Commission
2nd visit 2nd trimester
o PD 791- empowers nurses and midwives to dispense and 3rd visit 3rd trimester
administer acceptable methods of family planning Every week On the 9th month
o PD 965- requires applicants for a marriage license to
receive instructions on family planning o Recognition & management of pregnancy-related
o RA 9262- law on anti-violence against women and children complications
o RA 9173- sets the basis for the nurse practice on MCH o Tetanus toxoid immunization
o Micronutrient supplementation
Goals
 o Prevention & treatment of diseases and other conditions o +300 calories beginning from the 2nd trimester
associated with pregnancy
o Thyroid gland examination by palpitation
Assessment during Pregnancy
o Anemia
o History taking o Laboratory work ups
o Family o Pallor in conjunctiva and palm
o Menstrual
o OB (LMP, AOG, EDC) Tetanus Toxoid Immunization
o Weight and height o Dose: 0.5 ml
o Vital signs (especially BP) o Route: intramuscular
o Physical examination o Site: deltoid muscle
o Lab exams
# of Dose Schedule Length of Protection
Recognition & Management of Pregnancy-Related Complications 1st Anytime in pregnancy
2nd 1 month after 1st dose 3 years
o Pre-eclampsia 3rd 6 months after 2nd dose 5 years
o Anemia 4th 1 year after 3rd dose 10 years
5th 1 year after 4th dose Lifetime
o Syphilis
o HIV status Notes on Tetanus Toxoid for Pregnant Women
o DM o If 2nd dose is given at least 2 week before delivery=
o Others assurance of full protection against neonatal tetanus
o No fetal movement o 2nd dose is given even if mother has already delivered for
o Ruptured membranes and no labor protection of future pregnancies
o Fever or burning urination o 3 doses of DPT in infancy = 1st 2 doses of tetanus toxoid
o Vaginal discharge
o Signs suggesting HIV infection Micronutrient Supplementation
o Smoking, alcohol or drug abuse
o Cough or breathing difficulty Vitamin A
o Taking anti-TB drugs o 10, 000 IU- 1 capsule 2x/wk from the 4th month of
Components of Pre-natal Care by DOH pregnancy
o 200,000 IU- 1 capsule within 4 wks after delivery
o BP and Edema- most sensitive screening for PIH
(pregnancy-induced hypertension) 60 mg Elemental Iron with 400 ug Folic Acid
o During pregnancy
Systolic Diastolic Classification o 1 tablet OD x 6 months or 180 days
<130 <85 Normal o 2 tablets OD if pre-natal consultations start in the
130-139 85-89 High normal
140-159 90-99 Stage 1: mild
2nd or 3rd trimester
160-179 100-109 Stage 2: moderate o For lactating women
180-209 110-119 Stage 3: severe o 1 tablet OD x 3 months or 90 days
>209 >120 Stage 4: very severe
Potassium Iodide 200 mg Capsule
o Once a year for pregnant women
o Leopold’s Maneuver
o To determine number of fetus, fetal lie, fetal Prevention & Treatment of Disease and Other Conditions
position and presentation Associated with Pregnancy

o Fundic Height Identify of “high-risk” pre-natal

o Measure after the 20th week o Age: <15 years and >35 years
o Good estimate of the AOG in weeks o Parity: >5 pregnancies
o In HBMR, estimates are: o Weight: <95 lbs, assessed monthly
 5th month= 20 cm o Height: <4’10
 6th month= 21-24 cm o Hgb count: <8.5 grams
 7th month= 25-28 cm o Symptoms of HPN disorders
 8th month= 29-30 cm o Poor OB history
 9th month= 30-34 cm o Associated medical conditions
o Vaginal bleeding: premature rupture of BOW
o Fetal Heart Rate
o Counted for 1 full minute on the 5th month & Clean and Safe Delivery
during subsequent visits o Delivery in a birthing facility (LIC, hospital)
o Normal rate is 120-160 bpm o Domiciliary obstetrical service

o Tetanus toxoid Qualifications for Domiciliary Obstetrical Services

o AO 15 s. 1995: TT should be given to women o Full term
o Not a primigravida with <5 pregnancies
o Dietary advice and information o Without co-existing disease
 o No history of complications/ abnormalities in present &
previous pregnancies & deliveries
o Imminent delivery

Essential Intra-partum and Newborn Care

o Continuous maternal support
o Mobility during labor
o Position of choice
o Non-drug pain relief
o Spontaneous pushing in a semi-upright position
o Episiotomy will not be done, unless necessary
o Active management of 3rd stage of labor (AMTSL)
o Monitoring the progress of labor with the use of partograph

4 Principles:
o Immediate and thorough drying of the newborn
o Early skin to skin contact between mother and newborn
o Properly timed cord clamping and cutting
o Unang yakap of the mother and her newborn for early
breastfeeding initation
o