Philippine Health
Care Delivery
System
PRIMARY HEALTH CARE AND DOH
PROGRAMS
OVER ALL GOAL:
To improve the survival,
health and well-being of
mothers and unborn
through a package of
services.
MATERNAL HEALTH
PROGRAMS
STRATEGIC THRUSTS
• Launch the Basic Emergency Obstetric
Care (BEMOC)
• “e” obstetric care: 125,000 population
• Improve quality of prenatal and post natal
care
• At least 4 prenatal visits
• Reduce women’s exposure to health risk.
• Mobilizing LGUs, NGOs, stakeholders for
health for resource generation.
ESSENTIAL HEALTH SERVICE
PACKAGES AVAILABLE IN THE
HEALTH CARE FACILITIES
A. ANTENATAL
REGISTRATION: Frequency
of Visits (Community)
1ST Visit ➢As early in the pregnancy as possible,
before 4 months, or during the 1st
trimester
2nd Visit ➢During the 2nd trimester
3rd Visit ➢During the 3rd trimester
➢After 8 months of pregnancy until
Every 2 weeks delivery
BeMONC / CeMONC
• BEMONC
– 1. Administer parenteral oxytocin
– 2. Administer parenteral anticonvulsant
– 3. Administer parenteral antibiotic
– 4. Perform manual removal of placenta
– 5. Perform removal of retained products of conception
– 6. Perform assisted vaginal delivery (vacuum and
forceps delivery)
• CEMONC
– BEMONC plus:
• 1. Perform Cesarean section
• 2. Perform blood transfusion
• 3. Advance life support
POST – PARTAL
VISIT
FREQUENCY VISITATIO LOCATION
VISIT N
SCHEDULE
1st Week
First Visit Postpartum
(after 3-5 Home Visit
days)
Second Visit 6 weeks Clinic Visit
Postpartum
B. TT Immunization
(updated)
VACCINE MINIMUM % OF YEARS OF
AGE/INTERVAL PROTECTION PROTECTION
As soon as
TD 1 known pregnant NONE 0 Years
4 weeks after
TD 2 last dose 80% 3 Years
6 months after
TD 3 last dose 95% 5 Years
1 year after last
TD 4 dose 99% 10 Years
1 year after last
TD 5 dose 99% Lifetime
C. MICRONUTRIENT
SUPPLEMENTATION
(UPDATED)
VITAMIN DOSE SCHEDULE REMARKS
S/ OF GIVING
MINERAL
S
Vitamin A 10,000 IU Twice a week Do not give before the 4th
starting on month of pregnancy to
the 4th month prevent congenital
of pregnancy problems
Iron 60mg/400 ug Daily
tablet
Calcium 1200mg/day At 4 month of Avoid taking more than
(400mg/3x pregnancy the recommended dose.
day)
D. TREATMENT OF
DISEASES AND OTHER
CONDITIONS
• Post-partum Bleeding
– Uterine massage
– Ergometrine 0.2mg IM.
• Intestinal parasite Infection
– Mebendazole 500 mg at 4th – 9th month.
• Malaria
– Sulfadoxin-pyrimethamine 500 mg/tab, 3
tabs on the 2nd to 3rd trimester, not less
than one month interval.
E. CLEAN AND SAFE
DELIVERY
• Ensure clean hands; cord, surface.
• Register each birth to the civil registry.
• Birth certificate should be filled out by
the attendant at birth
• Enroll all newborns in Under Five Clinic
and issue a Growth Monitoring Chart
F. Support Breast feeding
G. Family Planning Counselling
Essential Intrapartal
and Newborn Care
Four Core Steps
I- Immediate and thorough drying
II- Skin-to-skin Contact
III- Proper Cord Clamping and Cutting
IV- Non-separation of the newborn and
mother for early initiation of breastfeeding
GOAL: To provide
universal access to family
planning information and
services.
FAMILY PLANNING
PROGRAM
R.A. no. 10354
• “Responsible Parenthood and
Reproductive Health Act of 2012”
• FOUR PILLARS
–Responsible Parenthood
–Respect for Life
–Birth Spacing
–Informed Choice.
ARTIFICIAL MODERN
FAMILY PLANNING
PILLS
• COC
– For non Breastfeeding Mothers.
– 92% - 99.7% effective.
• POP
– For breastfeeding mothers.
– 99% - 99.5% effective.
• CONCEPT:
– Helps menstruation to become regular.
– Prevent: Cancer, anemia, dysmenorrhea,
bleeding it between menstruation and other
conditions.
Injectable Hormonal
Contraceptives
• CIC: 97% - 99% effective.
– every month and not recommended to breastfeeding
mothers.
• POI: 97% - 99.7%
– every 2-3 months and can be used by breastfeeding
mothers because it will not affect milk production.
• CONCEPTS:
– helps prevent epileptic attack to women with epilepsy.
– prevent some forms of cancer and anaemia.
– Impair glucose tolerance
– Slight increase in osteoporosis risk
Progestin Sub-dermal
Implant
• Insertion of a match like tube that
slightly releases progesterone.
inserted ID in the inner portion of the
upper arm.
• CONCEPTS:
–Getting pregnant will return immediately
just after 2 weeks of removal.
SUB DERMAL IMPLANT
GENERAL CONCEPT OF
HORMONAL METHODS
ALL HORMONAL CAN CAUSE THE FF:
• Nausea and irritability.
• Menstruation is irregular.
• Weight gain.
• Headache and breast pain.
Note: All side effects are normal and
should not be a cause of alarm.
CONDOM
• A thin rubber sheath worn on a man’s erected
penis. 85% - 98% effective.
• CONCEPTS:
– worn before penetration of penis to the
vagina
– should be withdrawn before actual
ejaculation.
– put it when the penis is erected by pinching
– It helps in preventing acquiring STD’s
Intrauterine
Device
• A small, soft plastic T-shape rolled with
copper wire that is inserted in the
woman’s uterus. 99.2% - 99.4%
effective.
• CONCEPTS:
–Preventing the sperm to enter the
uterus and decreases the ability of the
sperm to fertilize the egg cells.
–Thicken the cervical mucus
–12 years duration.
IUD
Bilateral Tubal
Ligation
• Cutting or tying the fallopian tube
through surgery. 99.5% effective.
• CONCEPTS:
–Will experience post-operative pain
for 1-2 days.
–May experience awkwardness for the
first 2 days.
–Woman would still menstruate.
BTL
No-Scalpel
Vasectomy
• cutting the vas deferens through
operation.
• 99.9% effective
• CONCEPTS:
– NO PROBLEM WITH COITUS.
– Use condom or avoid sexual
intercourse for the first 3 months
after operation.
– With mild discomfort felt by the patient
for the 1st 3 days.
VASECTOMY
NATURAL FAMILY
PLANNING METHOD
Billings Ovulation
Method
• observing the mucus, 80%-
97% effective.
• CONCEPT:
–Avoid sexual intercourse if
the woman feels wet or if
mucus is stretchy, slippery
and watery.
Basal Body Temperature
(BBT)
• Know the start and end of her ovulation by taking
and monitoring her temperature.
• CONCEPTS:
– 80% - 99% effective.
➢ Temperature dips half a degree before and rises
a degree after ovulation (2oC)
– Daily BBT measurement
• Abstinence up to after 3rd day.
BBT
Sympto-Thermal
Method (STM)
✓ Three things to observe:
▪ Check for the mucus that’s coming out of her
vagina.
▪ Check her temperature.
▪ Check the position of her cervix.
• CONCEPTS:
– 98% effective if perfectly used.
– couples avoid intercourse during wet
days
– may have intercourse during the dry days
and temperature slightly increases.
Standard Days Method
(SDM)
• Rubber black necklace beads is used by
the woman to mark the beads with
different colors.
• Beads represent the different days of the
menstrual cycle.
• 88% - 95% effective.
✓Base on the following aspects:
▪ Signs and symptoms during the menstrual
cycle.
▪ Life expectancy of sperm and egg cell.
Cycle Beads
Lactating Amenorrhea
Method (LAM)
• Stops ovulation by changing the
production of hormones through
breastfeeding.
✓3 criterias:
▪ Exclusive breastfeeding every 2 hours.
▪ No menstruation
▪ Child is less than 6 months.
✓99.9% effective if perfectly used and 98%
effective if typically used.
LAM
Roles of Public Health
Nurse
• Provide Counselling
• Provide packages of health
services among reproductive
age group
• Ensure the availability of FP
supplies and logistics for the
client
Misconception about
Family Planning
Method
• Some family planning methods
causes abortion.
• Using contraceptives will render
couples sterile.
• Using contraceptive methods
will result to loss sexual desire.
GOAL: To reduce
morbidity and
mortality of Children
(0-9 y/o)
CHILD HEALTH
PROGRAMS
R. A. No. 7610
• “AN ACT PROVIDING FOR
STRONGER DETERRENCE AND
SPECIAL PROTECTION AGAINST
CHILD ABUSE, EXPLOITATION
AND DISCRIMINATION,
PROVIDING PENALTIES FOR
ITS VIOLATION AND FOR
OTHER PURPOSES.”
CHILD HEALTH
PROGRAMS IN
HEALTH FACILITIES
• Infant and Young child feeding
• Newborn Screening
• EPI
• Management of Childhood Illnesses
• Micronutrients Supplementation
• Dental Health
• Early Child Development
• Child Health Injuries
GOAL: Reduce child
mortality rate by 2/3
by 2015
Infant and Young
Child Feeding
KEY MESSAGES
• Initiate breastfeeding within 1
hour after birth
• Exclusive for the first 6 months of
life.
• Complemented at 6 months with
appropriate foods, excluding milk
supplements.
• Extend breastfeeding up to two
years and beyond.
Benefits of
Breastfeeding
• B- Best for baby and mommy
• R- Reduces incidence of allergies
• E- Economical, no waste
• A- Antibodies
• S- Sterile and pure
• T- Temperature is always ideal
• F- Fresh milk never spoils
• E- Easy to prepare and digest
• E- Eradicates feeding difficulties
• D- Develops mother and child bonding
• I- Immediately available
• N- Nutritionally optimal
• G- Gastroenteritis greatly reduced
GOOD LATCH ON DURING
BREASTFEEDING
“CALMS”
C- Chin must touch the breast
A- Areola is more visible above
than below
L- Lower lip turned outward
M- Mouth wide open
GUIDELINES IN
COMPLIMENTARY
FEEDING
•P- Properly fed
•A- Adequate
•S- Safe
•T- Timely
LAWS AFFECTING
IYCF
•EO 51 – Milk Code
•RA 7600: Rooming-in Act of
1992.
•RA 10028: New Rooming-in
Act.
•RA 8976: Food Fortification
Law
NEWBORN SCREENING
LEGAL BASIS!!!
• Republic Act. No. 9288
otherwise known as Newborn
Screening Act of 2004
Newborn Screening
• Simple procedure to find out if
baby has a congenital metabolic
disorder.
• Ideally done on the 48th hour or
at least 24 hours from birth.
• First week October: “Newborn
Screening Week”
GOAL
• To reduce preventable
deaths of all Filipino
newborns due to more
common and rare congenital
disorders through timely
screening and proper
management.
METHOD OF SCRENNING
• Heel prick method
–Drops of blood are
taken from the
baby's heel and
blotted on a
special absorbent
filter card.
–Dried for 4
hours.
Key CONCEPTS!!!
• RESULTS: 7 working days to 3
weeks
• (-) result = normal
• (+) result = Recall of patients for
confirmatory testing.
• Done by an MD, RN, RM, RMT
• Available in participating health
institutions (hospitals, lying-ins,
RHUs, and Health Centers).
SCREENED DISORDERS
EPI/NIP
LAWS ABOUT
IMMUNIZATION
• PD 996: Compulsory immunization for
children under 8 years old.
• RA 10152: Mandatory Infants and
Children Health Immunization Act of 2011
• PD 147: National Immunization Day:
Wednesday
• RA 7846: Compulsory Hepatitis B
vaccination
• EO 663: Bakuna ang Una sa Sanggol at
Ina
Basic Concepts of EPI
(PD 996)
• Primary target: infants and
newborns (0-12 months)
• Most important principle is
based on epidemiologic
situation
• Aims to increase immunity
against diseases
Four Major
Strategies: MNOP
•Measles-free by 2008
•Neonatal tetanus free by
2008
•At least 90% FIC (Fully
Immunized Child)
•Polio-free maintenance
PRINCIPLE OF
EPI/NIP
• Mass approach
• Absolute contraindication: Convulsion,
Severe infection, Immunocompromised
• Vaccination should not be restarted from
the beginning.
• 1 syringe: 1 Child
• Basic health service
• Epidemiologic situation
• Safe to give all EPI vaccines on the same
day at different sites of body
Population Group
• Mandatory basic immunization
shall be given for infants and
children up to five (5) years
of age.
ELEMENTS OF EPI
(TICAS)
• Target Setting
• Information, Communication,
Education
• Cold Chain Management
• Assessment and Evaluation of
Programs
• Surveillance, Research and
Studies
Cold Chain
Management
• Rationale: To preserve the potency of
vaccines.
• Most Sensitive to Heat:
➢-15 to -25 (Freezer)
➢Measles and OPV
• Least Sensitive to Heat:
➢ +2 to +8 (Body of Refrigerator)
➢TT, DPT, Hep. B, BCG.
VACCINE STORAGE
REGIONAL – 6 MOS
PROVINCIAL- 3 MOS
HEALTH CENTER- 1 MONTH
TRANSPORT BOX- 5 DAYS
FIFO/FEFO
Concept
• First IN/Expiry, First OUT
• Vaccines that are taken out in
the Health Center but not used
should be marked with “X”.
• Temperature Monitoring:
= 1st: AM
= 2nd: Before leaving the BHS.
Vaccine Summary
Table
Vaccine Type Dose Route Site # First Dose
Dose / Interval
BCG Live 0.0 ID RDA 1 At Birth
Attenuated 5
Vaccine
HEP B. Inactivated 0.5 IM RVL 1 At Birth
vaccine
OPV Live 0.5 ORA Mouth 3 6th, 10th,
Attenuated L 14th
Vaccine
PENTA Inactivated 0.5 IM RVL 3 6th, 10th,
Vaccine 14th
Vaccine Summary
Table
Vaccine Type Dose Route Site # First Dose
Dose / Interval
PCV Inactivated 0.5 IM RVL 3 6th, 10th,
Vaccine 14th week
IPV Inactivated 0.5 IM LVL 2 14th week
Vaccine 9th month
MMR Live- 0.5 SQ DA 2 9th month
attenuated 12th
Vaccine month
TD Inactivated 0.5 IM DA 2 Grade 1
Vaccine Grade 7
HPV Inactivated 0.5 IM DA 1 9 – 12
Virus years old
IMMUNIZATION
ACTIVITIES
• MR SIA + OPV
➢Provision of Measles containing vaccines
(MR/MMR) to children ages 6-59 months
regardless of the vaccination status with
one month interval from the last vaccine
received.
➢OPV for ages 6 weeks to 59 months.
• SBI
➢Provision of Measles containing vaccine and
TT to Grade 1 and Grade 7 Pupil.
GOAL: To improve
quality of life of
Filipinos through
better nutrition,
improved health and
increased
productivity.
NUTRITION
PROGRAM
Presidential
Decree 491 of 1974
• CREATING A NATIONAL
NUTRITION COUNCIL AND FOR
OTHER PURPOSES
KEY CONCEPT!!!
• Micronutrient Supplementation
–“Araw ng Sangkap Pinoy”: GP or
Child Health Weeks
•Vitamin A supplementation (April
and October)
•Approach adopted to provide
supplements to 6-71months old
preschoolers.
–Flouride: by water and toothpaste
IODINE
SUPPLEMENTATION
• TARGET POPULATION:
–Women 15-45 yrs old.
–Children of school age
–Adult Males
• PREPARATION:
–Iodized oil capsule with 200mg
iodine.
• DOSE:
–I capsule for 1 year.
PROGRAM
• Food Fortification Act of 2000 (RA
8976)
•Flour with iron and Vit. A
•Cooking oil with Vit. A
•Sugar with Vit. A
•Rice with iron
–Voluntary fortification of processed
foods - “sangkap Pinoy Seal”
–Household utilization of iodized salt
PROGRAM
• Essential Maternal and Child Health
Services Package
– Child to survival, development, protection
and participation through:
•Breastfeeding
•Complementary feeding
•Micronutrient supplementation
• Nutrition Information, Communication and
Education
• Home, School and Community Food
Production
PROGRAM
• Food Assistance
– Center-based complementary feeding
for wasted/stunted children and
pregnant women with low birthweight.
–Rice distribution in the school
–Food discounts through the
“Tindahan Natin Program”
• Livelihood Assistance
WATER
SUPPLY AND
SANITATION
PROGRAM
ENVIRONMENTAL
AND SANITATION
PROGRAM
DOH policies
• Approved types of water facility.
• Unapproved type of water facility.
• Access to safe and potable drinking
water.
• Water quality and monitoring
surveillance.
• Waterworks/water system and well
construction.
APPROVED
WATER SUPPLIES
• Level I: Point source
– Protected well and developed
springs with/without outlet
distribution.
–Serves 15 to 25 households.
– 250 meters from the furthest
house.
– Serves 40 to 140 liters.
APPROVED
WATER SUPPLIES
• Level II: Communal Faucet System
or Stand-Posts
–A source reservoir with piped
distribution networks and communal
Faucet.
–Not more than 25 meters away.
– Average of 100 households, with 4 to
6 household per faucet.
–40 to 80 liters per day.
APPROVED
WATER SUPPLIES
• Level III: Waterworks System
or Individual Household
Connections.
–Source, reservoir, piped
distribution network and
household taps.
–In densely populated urban areas.
–Requires minimum treatment and
disinfection.
UNAPPROVED
WATER SUPPLIES
•Doubtful sources.
•Ex. Dug wells, Unimproved
springs, wells that need
priming.
PROPER EXCRETA
AND SEWAGE
DISPOSAL
PROGRAM
ENVIRONMENTAL
AND SANITATION
PROGRAM
APPROVED TYPE
OF TOILET
FACILITIES
• LEVEL I: Non – water carriage
toilet facility.
• No water is necessary.
• Ex. Pit Latrines, Reed odorless
earth closet.
• Use small amount of water.
• Ex. Pour flush toilet and Aqua
Privies.
APPROVED TYPE
OF TOILET
FACILITIES
• LEVEL II: Water Carriage type
with water sealed and flush
type with septic vault/tank
disposal facilities.
APPROVED TYPE
OF TOILET
FACILITIES
•LEVEL II: Water Carriage
type connected to septic
tank/sewerage system to
treatment plan.
GOAL: To reduce the
prevalence rate of dental
caries and periodontal
diseases from 92% in 1998
to 85% and from 78% in
1998 to 60% by end of 2010
among general population
ORAL HEALTH
PROGRAM
R.A. no. 9484
•“Philippine Dental Act of
2007”
KEY CONCEPT!!!
• Increase proportion of orally fit children
under 6 years old to 80% by 2010
• Control oral health risks among young people
• Improve oral health of pregnant by 20%
and older persons by 10% every year until
2010
• Dental check-up as soon as the first tooth
appears and every 6 months thereafter.
• 3 Classification of oral interventions:
Preventive, Curative and Promotive
services.
GOAL: Promoting Health
Emergency preparedness
among the general public
and strengthening the
health sector capability and
response to emergencies
and disasters.
HEALTH EMERGENCY
PREPAREDNESS AND
RESPONSE PROGRAM
Republic Act No.
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,
APPROPRIATING FUNDS THEREFOR AND
FOR OTHER PURPOSES.”
Key Concepts!!!
• Based on Administrative Order no. 6 Bs of
1999 of the DOH that institutionalized the
Health emergency Preparedness and Response
Program within the department.
• P.D. No. 1566 (1978): Strengthening the
Philippine Disaster Control Capability and
Establishing the National Program on
Community Disaster Preparedness.
– Creation of the National Disaster Coordinating
Council.
– Creation of the Multi-level Organizations.
– Funding for a 2% reserve for calamities.
Classification of Disaster
according to its CAUSE
• Natural Disaster
–Force nature
• Human generated/man
made disaster
–Transportation disaster
–Technological disaster.
Classification of Disaster
according to ONSET
•Acute Disaster
–Sudden impact events.
•Chronic Disaster
–Slow creeping disaster.
FACTORS TO DISASTER
OCCURRENCE AND
SEVERITY
•Human Vulnerability from
poverty and social
inequality.
•Environmental degradation
resulting from poor land use.
•Rapid population growth
especially among the poor.
EMPHASIS OF DISASTER
PREPAREDNESS
PROGRAM
• Protection of people at risk is First Priority and
Protection of resources and system is 2nd Priority.
• Major risks includes: Natural risks, Technological
risks, Epidemics and Societal risks such as extreme
poverty.
• Emergency preparedness is everybody’s
responsibility and should not done in isolation .
• Main objective of Emergency preparedness is to
decrease mortality/morbidity and disability
prevention.
• Should concentrate on process and people rather
than documentation.
PRINCIPLES OF DISASTER
MANAGEMENT
• Protection of people at risk is First Priority.
• Protection of resources and system is 2nd Priority.
• Disaster management is an integral function of
national development plans and objectives.
• Disaster management relies upon an
understanding of hazard risks.
• Capabilities must be developed prior to the impact
of a hazard.
• Disaster management must be based upon
interdisciplinary collaboration.
• Disaster management will be effective with
commitment, knowledge and capabilities.
Purposes of Disaster
Plan
• To provide policy for effective
response.
• Identify hospital capability to handle
mass casualty.
• Identify responsibilities of individuals
and departments in the event of
disaster.
• Identify standard operating guidelines
for emergency activities and