EXPANDED PROGRAM ON IMMUNIZATION

Objective: reduce morbidity and mortality among infants and children

PD 996 – compulsory Immunization of children less than 8 years old
RA 10152 – mandatory infants and children up to 5 years old immunization act of 2011
Hep B vaccine – 1st vaccine to be given 7 + 2 vaccines

Cold Chain Management

Used to maintain the potency of the vaccine
General Policies on Cold Chain
1. Stock vaccine neatly on the shelves not on the door
2. Keep diluent on lower shelves or in the door
3. Separate different types of vaccine
4. FEFO – first to expire, first to open
5. Store measles and OPV with an ice pack in the transport boxes
6. Discard BCG vaccines after 4 hours of reconstitution
7. Discard DPT, Polio, Measles, and TT after 8 hours of reconstitution

Time frame for Storage of Vaccine

1. 6 months at the regional level

2. 3 months at the provincial level/ district level
3. 1 month at the main health centers (with refrigerators)
4. Not more than 5 days at health center/ BHU
Tetanus Toxoid Immunization Schedule for Women
When given to women of childbearing age, vaccines that contain tetanus toxoid (TT) not only protect women
against tetanus but also prevent neonatal tetanus in their newborn infants

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS

An approach was established to strengthen the provision of comprehensive and essential health packages to
the children. The strategy was developed by the:

World Health Organization (WHO) and United Nations Children’s Fund (UNICEF)
In the Philippines, IMCI was started on a pilot basis in 1996 and aims to reduce childhood mortality and
improve the quality of care for major childhood illnesses, especially at first-level health facilities.
IMCI Process

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ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC)
Aims to increase the quality of care around the time of birth and during the first few weeks of life to
eliminate preventable causes of newborn death.

EINC practices during the intrapartum period

• continuous maternal support by having a companion of choice during labor and delivery
• freedom of movement during labor
• monitoring the progress of labor using the partograph
• non-drug pain relief before offering labor anesthesia
• position of choice during labor and delivery
• spontaneous pushing in a semi-upright position
• non-routine episiotomy
• and active management of the third stage of labor (AMTSL)

Early Essential Newborn Care

• Emphasize are a sequence of 4 actions that are performed step by step

• is organized so that essential time-bound interventions are not interrupted; and
• fills a gap for a package of bundled interventions in a guideline format.

1. Immediate and thorough drying

a. For 30 sec to 1 min

b. Warms the newborn and stimulates breathing

• Within 1st 30 secs

 Call out the time of birth
 Dry the newborn thoroughly for at least 30 seconds to Remove wet cloth
 Do a quick check of breathing while drying

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Notes:
 During the 1st seconds:
 Do not ventilate unless the baby is floppy/limp and not breathing
 Do not suction unless the mouth/ nose is blocked with secretions or other material
• Within 0 – 3 minutes

Notes:
 Do not wipe off the vernix
 Do not bathe the newborn
 Do not do footprinting
 No slapping
 No hanging upside-down
 No squeezing of chest

2. Early skin-to-skin contact

a. Skin-to-skin contact between mother and newborn

b. Delayed washing for at least 6 hours prevent hypothermia, infection, and hypoglycemia
• After 30 seconds of drying
 If a newborn is breathing or crying:
 Position the newborn prone on the mother’s abdomen or chest
 Cover the newborn’s back with a dry blanket
 Cover the newborn’s head with a bonnet

Notes:
 Avoid manipulation (suctioning) that may cause trauma or infection
 Place an identification band on the ankle (not the wrist)
 Skin-to-skin contact is doable even for CS newborns

3. Properly timed cored clumping and cutting

a. Prevents anemia, protects against death due to hemorrhage in premature newborn
b. Properly timed cord clumping and cutting means waiting for the cord pulsation to stop (1-3 minutes)

•1 – 3 minutes
 Remove the first set of gloves
 After the umbilical pulsations have stopped, clamp the cord using a sterile plastic clamp or tie at 2 cm from
the umbilical base
 Clamp again at 5 cm from the base
 Cut the cord close to the plastic clamp

Notes:
 Do not milk the cord toward the baby
 Cut the cord close to the plastic clamp so that there is no need for a 2nd “trim”
 Do not apply any substance to the cord

4. Non-separation of the mother and newborn for early initiation of breastfeeding

• Provides colostrum – a substance equivalent to the baby’s first immunization for its protective properties

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• Within 90 minutes
 Leave the newborn in skin-to-skin contact
 Observe for feeding cues, including tonguing, licking, rooting
 Point these out to the mother and encourage her to nudge the newborn toward the breast

• Counsel on positioning
 Newborn’s neck is not flexed or twisted
 Newborn is facing the breast
 Newborn’s body is close to the mother’s body o Newborn’s whole body is supported

•Counsel on attachment and sucking o Mouth wide open

 Lower lip turned outwards

 Baby’s chin touching the breast

 Sucking is slow, deep with some pauses

Notes:
 Minimize handling by health workers
 Do not give sugar water, formula or other o Do not give bottles or pacifiers
 Do not throw away colostrum
 Weighing, bathing, eye care, examinations, injections (hepatitis B, Vitamin K) should be done after the first
full breastfeed is completed
 Postpone washing until at least 6 hours

NEWBORN SCREENING
Republic Act No. 9288 or the Newborn Screening Act of 2004

 To reduce preventable deaths of all Filipino newborns due to more common and rare congenital
disorders through timely screening and proper management
 Introduce in 1996 adopted in 2004 by the DOH
 A simple procedure to find out if a baby has a congenital metabolic disorder.
Why is it important?

 Because most babies with metabolic disorders look normal at birth. One may only know it once signs and
symptoms are already severe and irreversible. These disorders may lead to mental retardation and even
death, if untreated.
When is it done?
 It is ideally done on the 48th hour or at least 24 hours after birth. Because some disorders are not detected
if the test is done earlier than 24 hours. And the baby must be screened again after 2 weeks to obtain more
accurate results.
How is it done

 A few drops of blood are taken from the baby's heel, blotted on a special absorbent filter card, and then
sent to Newborn Screening Center (NSC). – paying for an amount, 500 – 600 pesos.
Who will collect the sample?

• Physician

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 • Nurse
• Midwife
• Medical Technologist
Where is it available?
All practicing health institutions:

• Hospitals
• Lying-in Clinics
• Health Centers
• Rural Health Units
Expanded newborn package from 6 – 28, expanded is 28 disorders which include: hemoglobinopathies
and additional metabolic disorders. Cost 1500 or 1800
When are the results available?
 Within 3 weeks after the laboratory receives and tests the samples.
A negative screen means…
 The results are normal and the baby is not suffering from any of the disorders being screened.
In case of a positive screen…

 The Newborn Screening Nurse Coordinator will immediately inform the coordinator of
the institution. The parents are recalled for confirmatory testing
BASIC EMERGENCY OBSTETRICS AND NEWBORN CARE AND COMPREHENSIVE
EMERGENCY OBSTETRICS AND NEWBORN CARE
BEmONC
Basic Emergency Obstetrics and Newborn Care
▪ Oxytocic drugs IV / IM
▪ Antibiotics IV / IM
▪ Anticonvulsants IV / IM
▪ Manual removal of placenta
▪ Manual vacuum aspiration of retained products of conception
▪ Vacuum extraction
▪ Newborn resuscitation
▪ Treatment of neonatal sepsis / infection
▪ Oxygen support
CEmONC
Comprehensive Emergency Obstetrics and Newborn Care
▪
▪ Oxytocic drugs IV / IM
▪ Antibiotics IV / IM
▪ Anticonvulsants IV / IM
▪ Manual removal of placenta
▪ Manual vacuum aspiration of retained products of conception
▪ Vacuum extraction
▪ Surgery (cesarean section)
▪ Blood transfusion
▪▪ Newborn resuscitation

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 ▪ Treatment of neonatal sepsis / infection
▪ Oxygen support
▪ Management of low birth weight or
▪ preterm newborn
▪ Other specialized newborn services
NUTRITION PROGRAM
Objectives
▪
 To decrease the morbidity and mortality rates secondary to Avitaminoses and other nutritional deficiencies
among the population mostly composed of infants and children.
Goal
▪
 The improvement of nutritional status, productivity, and quality of life of the population through the
adoption of desirable dietary practices and healthy lifestyle
 Philippine Food and Nutrition Programs- directed towards the provision of nutrition services to the
DOH’s identified priority vulnerable groups: infants, preschoolers, schoolers, women of childbearing
age (also included are the pregnant and lactating mothers) and the elderly
Coverage
 Protein-energy malnutrition (PEM)
 Vitamin A Deficiency (VAD)
 Iron Deficiency Anemia (IDA)
 Iodine Deficiency Disorders (IDD)

1) MALNUTRITION REHABILITATION PROGRAM

2) MICRONUTRIENT SUPPLEMENTATION PROGRAM
 Interventions to address the health and nutritional needs of infants and children
 Garantisadong Pambata
I. Vitamin A Supplementation twice a year
II. Araw ng Sangkap Pinoy

Target Preparation Dose/Duration

Infant 100,000 IU 1 dose only

Children 200,000 IU 1 cap every 6 months

Pregnant Women 10,000 IU 1 cap/tab twice a week start at 4

months until delivery

Post-partum Women 200,000 IU 1 cap/ 1 dose within 4 weeks after

delivery
3. FOOD FORTIFICATION PROGRAM

 FORTIFICATION is the addition of a micronutrient deficient in the diet to a commonly and widely consumed
food or seasoning.
 Food fortification or enrichment is the process of adding micronutrients (essential trace elements and vitamins)
to food.

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RA 8976 – Food Fortification Law
1.Rice – iron
2.Flour – iron and Vit. A
3.Cooking oil – Vit. A
4.Sugar – Vit. A

4. NUTRITION SURVEILLANCE SYSTEM

 The Nutrition Surveillance system involves keeping a close watch on the state of nutrition and the causes of
malnutrition within a locality. This which involves periodic collection of data and analysis and
dissemination of analyzed information.

LEGAL MILESTONES:
A. PD 491 – Nutrition Act of the Philippines

▪ declares nutrition as a priority of the government

▪ creates the National Nutrition Council
▪ designated July as the Nutrition Month

B. RA 832- rice Enrichment Law

 All milled rice will have to be enriched with pre-mixed Rice

C.RA 8172- FIXED Salt

1. PD 856 Code on Sanitation Moses: Father of Sanitation

2. RA 8749 Philippine Clean Air Act
3. RA 7719 National Blood Services Act
4. RA 7875 National Health Insurance Act (PhilHealth)
5. RA 3573 Mandatory Reporting of Notifiable Diseases and Health Events of Public Concern Act
• Epidemiology – a branch of medical science that treats epidemics
• Incidence – the number of new cases occurring in a defined population during a specified period of time
• Prevalence – refers to all current cases (old & new) existing at a given point of time
• Sporadic – diseases only occur rarely and largely without a geographic focus
• Endemic diseases occur at a constant level within a population
• Epidemic describes diseases that’s widespread; affect greater number of people than is usual for the
locality or one that spreads to areas not usually associated with the disease.
• Pandemic is an epidemic of worldwide proportions.
6. RA 7305 Magna Carta for Public Health Workers
7. RA 9211 Tobacco Regulation Act of 2003
8. RA 6675 Generic Acts of 1988
9. RA 9994 Expanded Senior Citizens Act of 2010 (amending RA7432 & RA9257)
10. RA 9165 Comprehensive Dangerous Act of 2002 (repealing RA6425DangerousDrugs Act of 1972)
• Dangerous Drugs Board – the policy making and strategy formulating body in planning and formulations of policies
and programs on drug prevention and control
• Philippines Drug Enforcement Agency – under the Office of the President, serves as the implementing arm of the
Dangerous Drugs Board
11. RA 9502 Universally Accessible Cheaper and Quality Medicines Act of 2008 – intended to achieve universally
accessible and cheaper and quality medicines by pursuing an effective competition policy
12. RA 10121 An Act Strengthening the Philippine Disaster Risk Reduction and Management System providing
for the National Disaster Risk Reduction and Management Framework and Institutionalizing the National
Disaster Risk Reduction and Management Plan.
Disaster – a serious disruption of the functioning of a community
Emergency – unforeseen or sudden occurrence, esp. danger, demanding immediate action.
Disaster Management Cycle
1. Risk Reduction – mitigation/prevention; the outright avoidance of adverse impacts of hazards and related
disasters (DOST)
2. Readiness – preparedness; the knowledge and capacities developed by governments, professional response
and recovery organizations, communities, and individuals to effectively anticipate, respond to and recover from
the impact of likely, imminent, or current hazard events or conditions. (DILG)
3. Response – provision of emergency services and public assistance during or immediately after a disaster in
order to save lives (DSWD)
4. Recovery – rehabilitation (NEDA)

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13. RA 9262 Violence Against Women refers to any act or a series of acts committed by any person against a
woman who is his wife, former wife, or against a woman
14. RA 11188 Save the Children: An Act providing special protection of the children in situationsofarmed conflict
and providing penalties for violations
15. RA 10028 THE EXPANDED BREASTFEEDING PROMOTION ACT OF 2009”AN ACT EXPANDING
THE PROMOTION OF BREASTFEEDING, AMENDING FOR THE PURPOSE REPUBLIC ACT NO. 7600
The Philippine Milk Code of 1986 or Executive Order 51- A LAW IMPOSING STRICT FORMULA MILK
MARKETING INTHE PHILIPPINES
16. RA 10354 Responsible Parenthood & Reproductive Health Law
4 Pillars: (1) Responsible Parenthood, (2) Respect for Life, (3) Birth Spacing, and (4) Informed Choice
Gender equality refers to the principle of equality between women and men and equal rights
Gender equity refers to the policies, instruments, programs, and actions that address the disadvantaged position
of women in society by providing preferential treatment and affirmative action.
Reproductive Health (RH) refers to the state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and
processes.
1. RA 9288 – NB Screening − Basic – 6 diseases; Expanded – 28 diseases
2. RA 11210 – Expanded Maternity Leave Act − 105 paid days (previous: 60 days) − Can extend another 15 days
without pay, 7 days can be passed to the husband
3. MDGs (2000-2015) − 4th goal – reproductive and child health →ENC, KMC (kangaroo mother care), HMB (human
milk bank) − 5th goal – maternal health → decrease Maternal DeathRateby75%
4. SDGs (2015-2030) − 3rd goal – reproductive and child health →to lessen maternal deaths by 70-100,000
5. AO 0012-2012 − Nurse can now put up a birthing clinic
17. RA 10152 Mandatory Infant & Children Health Immunization Act of 2011 - an act providing for mandatory
basic immunization services for infants and children repealing for the purpose PRESIDENTIAL DECREENO.
996.
18. RA 10666 Children Safety on Motorcycles Act of 2015 AN ACT PROVIDING FOR THE SAFETY OF
CHILDREN ABOARD MOTORCYLES - it is illegal to operate a two-wheeled motorcycle on public roads if a
child is on board ,
19. RA 10821 Children’s Emergency Relief and Protection Act of 2016- mandates national and local government
agencies to establish and implement a Comprehensive Emergency Program that will prioritize the protection of
children and pregnant and lactating mothers.
20. PD 603 Child and Youth Welfare Code of the Philippines All children shall be entitled to the rights herein set
forth without distinction as to legitimacy or illegitimacy
21. RA 7877 Anti – Sexual Harassment Act
22. RA 8423 Herbal Medicines
23. RA 3753 Civil Registrar Law
24. RA 7160 Devolution of Health Services
25. RA 6713 Code of Conduct & Ethical Standards for Public Officials &Employees
26. R.A. 1082 Rural Health Act. An Act Strengthening Health and Dental Services in the Rural Areas
Family solidarity
In sociology, solidarity is defined as the willingness of individuals to serve and promote the collective interests of a
group or of society. The word is used most often to describe a sense of unity with a political group or people who
have been deprived of their rights in some way.
Value
Is vital to the socialization skills of an individual can be developed and nurtured in the family, school and
environment, it may include obtaining knowledge, wisdom and necessary skills, using them in your home and
living out the values you acquired within the family
COMMUNICATION
Filipinos will try to express their opinions and ideas diplomatically and with humility to avoid appearing arrogant.
The tone of voice varies widely by language, dialect and region.
HELPING OTHERS AND GRATITUDE
This trait shows a sense of duty and responsibility. Filipinos know how to repay other people. When someone
helped us, were turn the favors with goodness.
RESPECT
One of the precious things’ Filipinos have is that they are respectful. Young, youth, people in all ages know how
to show respect and courtesy. Some ways to show the mare the use of “Poat Opo”, “Pagmamano” or putting the
back of an elder’s hand on your forehead, and calling our older siblings or elders Ate or Kuya.
INDEPENDENCE
Individual grows and develop focus is placed heavily on promoting independence and separation from the family
unit.

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SERVICE
One of the most popular qualities Filipinos have is that they are very hospitable
TRUST
is the belief and confidence in the integrity, reliability and fairness of a person or organization and an essential human
value that quantifies and defines our interdependence in relationships with others
Truth – factual, not relying on perception.
Reliable – consistency, walking the talk, accountability
Understanding – fueled by empathy.
Sincerity – coming from the heart as an example of true caring about another person.
Time – developed over a series of moments with proven reliability
FILIPINO FAMILY CULTURE AND TRADITION
A tradition is the transmission of customs or beliefs from generation to generation.
BAYANIHAN
It is the spirit of communal unity or effort to achieve a particular objective.
SUPERSTITION
In the Philippines, superstitious beliefs have grown throughout the country. These beliefs have come from the
different sayings and beliefs of our ancestors that aim to prevent danger from happening or to make a person
refrain from doing something in particular. It is the spirit of communal unity or effort to achieve a particular
objective.
BALIKBAYAN BOXES
Some Filipinos leave the Philippines to live and work abroad. A balikbayan box is a box of items sent by the
balikbayan to their family in the Philippines.
EATING WITH HANDS (KAMAYAN)
In addition to the use of the fork and spoon, eating with your hands or kamayan is another common Filipino
tradition
The importance of information
• The healthcare of our clients is largely
dependent on information.
• Every action taken depends on previous
information and knowledge.
The science of type of care (nursing)
 The “science of care” refers to the scientific foundations of the profession that provides healthcare.
 Science helps determine the body of knowledge, language, and focus of that profession.
 Scientific rationale or evidence provides a foundation for decision-making within that profession.
Patient or client
 Information on the client is required for his/her individual care.
 The assessment process consists of gathering information.
 The use of technology can assist in collecting this information.
 Information on the client can be found in the patient record, the patient’s history, lab results.
 Information on the client changes and grows over time

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Provider
❖ Information about the provider of care helps determine the type of assessment and the focus of care given.
❖ The provider can be an individual professional such as a nurse, a physician, or a physiotherapist.
❖ The provider can also be the facility in which care is provided such as a public health unit, or a hospital.
Outcomes
❖ The outcome of treatment and care now requires more attention than ever.
❖ There is a growing interest in ensuring that care results in quality outcomes in a cost-efficient manner.
❖ Outcomes can be difficult to measure.
❖ Technology can assist in measuring because it can enhance gathering, analysis and dissemination of
outcomes.
Process and systems for delivery of care
❖ Information about the process and systems for delivery of care assists in deciding on the type and the amount of
care required.
❖ This is the tracking on interventions and the process used for each intervention.
❖ Information about each of these areas have an impact on the type and the amount of care given.
Information must be:
▪ accurate
▪ timely
▪ accessible
▪ understandable
The structure of information
 Delivered in conversation, handwritten notes, stored in a computer.
 Regardless of the form, the same basic principles apply to the structure and the use of information.
 Words are often used interchangeably to describe information.

Data: discrete entities objectively described, without interpretation or context.

Information has five rights:

✓Right information

✓Right person

✓Right time

✓Right place

✓Right amount

⚫ NURSING CORE VALUES AS A COMMUNITY HEALTH NURSE

CORE VALUES Mission

The National League for Nursing promotes excellence in nursing education to build a strong and diverse nursing
workforce to advance the health of our nation and the global community.

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CORE VALUES
CARING:
promoting health, healing, and hope in response to the human condition
INTEGRITY:
respecting the dignity and moral wholeness of every person without conditions or limitation;
DIVERSITY:
affirming the uniqueness of and differences among persons, ideas, values,and ethnicities.
EXCELLENCE:
co-creating and implementing transformative strategies with daring ingenuity.
CARING
A culture of caring, as a fundamental part of the nursing profession, characterizes our concern and consideration
for the whole person, our commitment to the common good,and our outreach to those who are vulnerable.
INTEGRITY:
Is acting in accordance with an appropriate code of ethics and accepted standards of practice.

Health-Related Entrepreneurial Activities in Community Settings

Public Health Entrepreneurs are:
• Change agent of population health
• Pioneer of well-being that benefits the well-being of the humanity
• Offered sustained improvement in the health of populations in the face of need
• Need to shift resources from approaches that have produced low value in the areas of higher productivity and
yield
• Involve collaboration with and accountability to the constituency served and the outcomes created
PUBLIC HEALTH ENTREPRENEURSHIP
The opportunistic creation and implementation of catalytic innovations intended to offer sustained improvement in
the health of population in the face of need without being limited by resources currently in hand involving
collaboration with and accountability to the constituency served and the outcomes created.
Success is measured by:
1. Improved health income
2. Change in social environment
3. Sustainable programming
The scope of public health entrepreneurship
1. Life insurance companies
2. Large scales companies/factories
3. Public health insurance/ benefits schemes
4. Health product production establishments
5. Public health consultancy agencies
6. Fitness centers

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