COMMUNITY HEALTH NURSING

Dr. Jayson A. Punzal

Basic Concepts 1973).
Community (WHO Expert Committee) • An area of human services directed toward
• A social group determined by geographic developing and enhancing the health
boundaries and/or common values or interests. capabilities of people – either singly, as
• Its members know and interact with one individuals, or collectively as groups and
another. communities (Ruth Freeman & Janet Heinrich,
• It functions within a particular social structure 1981).
• It exhibits and creates norms, values, and social
institutions. Community Client
Health Goal
Health Nursing Means
• Soundness and wholeness of human structures
and bodily and mental functions (OREM) Focus (Fields) of CHN – Natural Environment
• Dynamic fluctuating from patterns of death or • Home - Public Health Nurse
OLOF (Optimum level of functioning) (DUNN) • School - School Health Nurse
• Right of every individual (Art. 25 Sec 1 of • Workplace - Occupational Health Nurse
Universal Declaration of human Rights: Health is
a basic right of every individual) Functions of OHN/SHN:
• Determinants of Health: ✓ Health provider
✓ Income and social status ✓ Environmental manager
✓ Education ✓ Healthcare coordinator
✓ Physical environment
✓ Employment and working conditions RA 10158: Occupational Health Law (Dole)
✓ Social support network - BOSC
✓ Culture - COSH
✓ Genetics
✓ Personal behavior and coping skills 3 CHN Elements
✓ Health services 1. Public Health – population focus
✓ Gender 2. Nursing skills
3. Social assistance – unique in nursing
Nursing
• “Assisting an individual, sick or well, in the PRIMARY FOCUS OF CHN
performance of those activities contributing to Health promotion & disease prevention
health or its recovery (or to peaceful death) that
he would perform if he had the necessary GENERAL PHILOSOPHY OF CHN
strength, will, or knowledge and to do this is “Worth & dignity of a man”
such a way to help him gain independence as
rapidly as possible.” - VIRGINIA HENDERSON
Qualifications of a PHN:
(1964)
1. Bachelor of Science in Nursing
2. Registered Nurse of the Philippines
Community Health Nursing
• A direct, goal-oriented, and adaptable to the Roles and Function of CHN:
needs of the individual, the family, and
Planner/Programmer
community during health and illness (ANA,
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
Provider of Nursing Care Promote health and efficiency
Manager/Supervisor
Community Organizer Level of Clientele
Coordinator of Services • Individual
Trainer/Health Educator • Family
Health Monitor • Population Groups
Role Model • Community
Change Agent
Recorder/Reporter/Statistician Level of Prevention:
Researcher • Primary
• Secondary
Principles of CHN • Tertiary
→ ◍ P – Population focused
→ ◍ R – Recognized needs The Re-Structured Health Care Delivery System of the
→ ◍ I – Inter/intra (multidisciplinary) Philippines - PD 568 (1976)
→ ◍ N – Nursing the FAMILY as unit of service • Health Care System
→ ◍ C – Comprehensive care o An organized plan of health services
→ ◍ I - Integrated approach (Miller-Keane, 1967)
→ ◍ P – Pre-payment mechanism • Health Care Delivery
→ ◍ L – Lifespan o Rendering health care services to the
→ ◍ E – Ecology oriented people (Williams-Tungpalan, 1981)
→ ◍ S – Self-reliance (Developmental Service) • Health Care Delivery System
o The network of health facilities and
Public Health Nursing personnel which carries out the task of
rendering health care to then people
• The art and science of preventing disease,
(Williams-Tungpalan, 1981).
prolonging life, and promoting health and
• Philippine Health Care System
efficiency through organized community efforts
o A complex set of organization interacting
in sanitation of the environment, education of
to provide an array of health services
the individual on principles of personal hygiene,
(Dizon, 1977)
prevention of communicable diseases, medical
PHC Levels
and nursing services for the early diagnosis and
preventive treatment of disease, and the
development of a social machinery, so
organizing these benefits to enable every citizen
to realize his birth rights of health and longevity.

GENERAL PHILOSOPHY OF PHN

health and longevity as birth rights

OBJECTIVES OF PHN: 3 P’S

Prevent disease
Prolong life
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
R.A. 7160 – Local Government Unit Code (Devolution of GOAL OF PHC
Health Care) health for all Filipinos by the year 2000 and health in
the hands of the people by the year 2020
DOH National Health Office
National Health Board An improved state of health and quality of life for all
Head: DOH Secretary
people attained through SELF-RELIANCE
RHO / PHO
Provincial Health Board Chair: Governor
V. Chair: PHO Historical Perspective
• May 1977 -30th World Health Assembly -socially
DHO / MHO
and economically productive life by the year
Municipal Health Board Chair: Mayor
2000.
V. Chair: MHO
• September 6-12, 1978 - First International
Conference on PHC in Alma Ata, Russia
Two-way Referral System (USSR)
• Communication among facilities
• Alma Ata Declaration stated that PHC was the
• Competent care
key to attain the “HEALTH FOR ALL”
• Legal basis – LOI 949
Efficiency of health care delivery
• Least possible cost Rationale for Adopting PHC:
• Maximize resources • Magnitude of Health Problems
• Inadequate and unequal distribution of health
The RHU Team: resources
• MHO (1:20,000) • Increasing cost of medical care
• PHD (1:50,000)
• Isolation of health care activities from
• SI (1:20,000)
other development activities
• PHN (1:10,000 WHO) / (1:20,000 PHN)
• RHM (1:5,000)
Objectives of PHC
• BHW (1:10-20 families)
• HC Facility Improvement
Primary Health Care
• Favorable population growth structure
• Essential health care made universally
• Reduction in the prevalence of preventable,
communicable, and other disease.
accessible to individuals and families in the
community by means acceptable to them, • Reduction in morbidity and mortality
through their full participation and at cost that rates especially among infants and
the community can afford at every stage of children.
development.
2 Levels of PHC Workers
• Mission: to strengthen the health care system
by increasing opportunities and supporting 1. Barangay Health Workers
the conditions wherein people will manage 2. Intermediate level
their own health care.
• Key strategies: Partnership and Empowerment Principles of PHC
• Community participation
• A's
• People – centered
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
• Partnership • Intra and Inter-sectoral Linkages
• Interrelationship: H vs D • Support mechanism made available
• Social Mobilization • Appropriate Technology
• Self-reliance
• Decentralization ASTANA Health Declaration
• Global Conference on Primary Health Care from
Barriers of Community Involvement Alma-Ata towards universal health coverage and
• Lack of motivation the Sustainable Development Goals
• Lack of managerial skills • October 25-26, 2018. Astana Kazakhstan
• Attitude
• Resistance to change AHA envisions to:
• Dependence on the part of community people • Governments and societies
• • Primary health care and health services
Elements • Enabling and health-conducive environments
• Education regarding Health • Partners and stakeholders
• Local Endemic Diseases
Success is driven by:
• Expanded Program on Immunization
Knowledge and capacity-building
• Maternal & Child Health Services→ Integrated
Human resources for health
Comprehensive MCHS
Technology
• Essential drugs and Herbal plants
Financing
• Nutritional Health Services (PD 491): Creation of
Empower individuals and communities
Nutrition Council of the Phils.
Align stakeholder support to national policies,
• Treatment of Communicable & Non
strategies, and plans
communicable Diseases
• Sanitation of the environment (PD 856):
Sanitary Code of the Philippines
• Dental Health Promotion
• Access to and use of hospitals as Centers of
Wellness
• Mental Health Promotion

Major Strategies
• Elevating health to a comprehensive and
sustained national efforts. Contributions of PHC to DOH and Economy
• Promoting and supporting community managed • Training of Health Workers
health care. • Creation of Botika sa Baryo & Botika sa
• Increasing efficiencies in the health sector. Health Center
• Advancing Essential National Health Research • Herbal Plants
(ENHR). • Oresol

Pillars
• Community participation
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
HALAMANG GAMOT Purpose
As approved by DOH • Nursing care
• L – Lagundi (for Asthma) • Assess living condition
• U – Ulasimang Bato (for uric acid/gout) • Utilization of community services
• B – Bayabas (Antiseptic) • Teaching
• B – Bawang (for hypercholesteronemia / HPN) • Inter-referral system
• Y – Yerba Buena (for pain) • Establish close relationship
• S – Sambong (diuretic)
• A – Akapulko (Anti-fungal) Principles
• N – Niyog-niyogan (for Ascariasis) • Purpose
• T – Tsaang Gubat (For Diarrhea) • Planning – all Information
• A – Ampalaya (for Type 2 DM) • Priority
Nursing Considerations • Participation
• B – boiling; remove cover • Flexible
• 0 – one plant each type
• N – no insecticides Guidelines in frequency
• U – use clay pot • Needs
• S – Stop in case of untoward reaction • Acceptance
• Ability
Home Visit • Policy
• Is a PROFESSIONAL contact between • Personnel
PHN & the family • Past Services
• The services provided is an extension of the
•
Health Service Agency (Health Center) Phases
• Pre-Visit
• Objectives: • Actual Visit
o Assessment • Post-Visit
o Provision of Care Public Health Bag:
o Treatment: under RA 6675 • Indispensable tool that should be organized to
o Health Education save time & effort and to prevent cross infection
o Referral (if care fails) & contamination
• Guiding Principles in the use of Public Health
Priorities (in the care): to prevent cross contamination Bag:
• Newborn • Content-should be prepared by the one
who will make home visit
• Postpartum
• Pregnant mothers • Efficiency
• Cleaning
• Morbid cases
• The families need the assistance of the health • Contamination
center that’s why home visit was done to the • Care of Communicable Case(s)
family • Important Considerations:
• The person who makes the home visit is • Completeness
rendering services on behalf of the health center • Cleanliness
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
• Contamination

BENEDICT’S TEST

Family Health Nursing

• FAMILY as the unit of care with
• HEALTH as the goal and
• NURSING as the medium, channel or provider of
ACETIC ACID TEST care.

Family Case Load

• the no. and kind of families a nurse handles at
any given time
• variable for cases is added or dropped based on
the need for nursing care and supervision

Types of family
1. Nuclear
2. Extended
3. Three generational
4. Dyad
5. Single - Parent
6. Step - Parent
7. Blended or reconstituted
8. Single adult living alone
9. Cohabiting/ Living –in
10. No- kin
11. Compound
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
12. Gay ✓ Values, Habits, Practices on Health
13. Commune Promotion, Maintenance and Disease
Prevention
Stages of Family Cycle
1. Newly married couple Typology of Nursing Problems in Family Nursing Practice
2. Childbearing First-level Assessment
3. Preschool age I. Presence of Wellness Condition – stated as Potential
4. School age or Readiness
5. Teenage II. Presence of Health Threats
6. Launching III. Presence of Health Deficits
7. Middle-aged (empty nest –retirement) IV. Presence of stress Points/ Foreseeable Crisis
8. Period from retirement to Death of both Situations
spouses Second-level Assessment
• Focus on determining family’s capacity to perform
Family Health Tasks the health tasks
✓ Recognizing interruptions of health or • Statements on family health nursing problem:
development a. Inability to recognize the presence of the
✓ Seeking health care condition or problem
✓ Managing health and non-health crises b. Inability to make decisions with respect to
✓ Providing nursing care to the sick, disabled, taking appropriate health action
and dependent member of the family
c. Inability to provide adequate nursing care
✓ Maintaining a home environment conducive
to the sick, disabled, dependent or
to good health and personal development
✓ Maintaining a reciprocal relationship with vulnerable member of the family
the community and health institutions d. Inability to provide a home environment
conducive to health maintenance or
Family Nursing Problem personal development
• Arises when the family cannot effectively e. Failure to utilize community resources for
perform its health tasks health care
Scale for Ranking Health Conditions and Problems
Nurses Role according to priorities
1. Health monitor
2. Care provider
3. Coordinator
4. Facilitator
5. Teacher
6. Counselor

Family Data Base

✓ Family structure, Characteristics, and Dynamics
✓ Socio-economic and Cultural Characteristics
✓ Home and Environment
✓ Health Status of each Family Member
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
Family Coping Index • Basic function of HCW
• Objective is to approximate the nursing needs • All settings
of a particular family • Cooperative effort
• It is the coping capacity and not the underlying • Slow and continuous process
problem that is being rated • Supplemental aids
• It is designed to record family rather than • Community resources
individual coping capacity.
• Community involvement
• Family Coping Index is measured with
• Evaluation
the following scores:
o 1-no competence Expanded Program on Immunization (EPI) / National
o 3-moderate competence Immunization Program (NIP)
o 5-complete competence • Established in 1976
• Area of Assessment
o Physical independence GOAL of EPI / NIP
o Therapeutic Competence Reduce morbidity and mortality among children
o Knowledge of Health Condition among 6 vaccine-prevented diseases:
o Application of the Principles of ✓ TB
General Hygiene ✓ Poliomyelitis
o Health Attitudes ✓ Diphtheria
o Emotional Competence ✓ Tetanus
o Family Living ✓ Pertussis
o Physical Environment ✓ Measles
o Use of Community Facilities
Legal Basis
Health Education • PD 996 – compulsory immunization for children
• The process of changing undesirable knowledge, <8 years old
skills and attitude, knowledge or idea for • RA 10152 –repeated PD 996 (2011) children up
personal, family, and community health to 5 years
• TEACHING: the process of giving the • RA 7846 – HBV for children <8 y/o
information; expressing the needed thoughts • PP 46 – Polio eradication project
• PP 1066 – Neonatal tetanus elimination
Elements: IEC • PP 4 –Measles eradication (Ligtas Tigdas)
➢ INFORMATION: the contents of the
health teaching
➢ EDUCATION: change in knowledge, skills,
and attitude
➢ COMMUNICATION: teaching strategy

Principles
• Health status
• Improve personal habits and attitudes
• Involves motivation, experience, and change
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
Immunity Schedule

Additional Vaccines

General Principle Maintaining Efficacy

• Epidemiology • Cold chain
• Target Setting • Maximum storage
• Infants = total pop x 2.7% • RHO/PHO/DHO = 3 mos each
• Children (12-59 mos.) = total pop x 10.8 % • RHU = 1 mo
• Pregnant women = total pop x 3.5% • Maximum transport period = 5 days
• Mass Approach • FEFO
• Discarding unused biologicals
Elements • VVM
1. Target setting – all children before 1 y/o • BCG and AMV – 6 h
2. Cold chain logistics • Unused portion – 4 weeks
3. IEC
4. Assessment and Evaluation of the
program overall performance
5. Surveillance, studies, and research

Recording and Reporting

• FIC – Fully Immunized child
• CIC – Completely Immunized Child
• CPAB – Child Protected At Birth
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
Contraindications OPV
1. Hx of seizures/convulsions- for DPT1 ✓ No feeding for 30 minutes after
2. Clinical AIDS - infant BCG ✓ Side effects of measles vaccination
3. Immunosuppression ✓ Fever and measles rash w/in 2 wks. after
immunization lasting for 1-3 days
NOT contraindications: ✓ Side effect of HBV & tetanus toxoid
1. Fever up to 38.5 ºC ✓ Local tenderness
2. Simple or mild acute respiratory infection
3. Simple diarrhea without dehydration Disposal of Syringes and Needles:
4. Malnutrition (it is indication for immunization) • Immediately after use: discard in puncture
proof containers
Nursing Considerations • Final disposal: dispose in a pit and burn. This
BCG will not destroy the metallic needle but will
✓ Do not expose BCG to sunlight. render them sterile.
✓ Do not apply alcohol to the site of injection.
✓ Expected side-effect: local inflammatory Epidemiology
reaction/superficial abscess/ulcer 2 wks. → • It is the pattern of occurrences & distribution of
12 wks. after immunization (permanent scar) diseases, defects & deaths
✓ No side-effect: Repeat BCG after 2 mos.
✓ Koch’s phenomenon Functions of the Nurse
o begins after 2-4 days →like a normal • Implement public health surveillance
reaction • Monitor local health personnel
o no special treatment • Assist other personnel in outbreak surveillance
✓ Indolent ulcer • Assist in rapid surveys and surveillance during
o does not heal w/in 12 weeks disaster
o secondary bacterial infection • Assist during survey and program evaluation
o Tx: local INH • Assist in training, preparing annual report and
✓ Deep (subcutaneous) abscess financial plan
o wrong technique • Inventory and maintenance of ESU
o Tx: I & D + local INH
Epidemic
PENTA/DPT • Greater than 50% of populations are susceptible or
✓ Shake well less immune individual
✓ Do not massage the site of injection. • Greater % of the population is affected by the
occurring disease
✓ Side effects
o fever w/in 24 hours after immunization
o local tenderness for 3 to 5 days Endemic
o tenderness on the 2nd week = wrong • The disease occurs regularly, habitually,
technique (subcutaneous injection), constantly affecting the population group
may need I & D • 2 Local Endemic Diseases: where causative
agent is available on those places
➢ Schistosomiasis: Samar, Leyte,
Mindoro, Davao
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
➢ Malaria: Palawan & Mindanao – o 100,000 at the Population of the
reasons why it’s prevalent Philippines; # of cases in the
○ Forested areas Philippines
○ Surrounded by bodies of water
Health Indicators Fertility
Sporadic Crude Birth Rate (CBR) - Overall total reported
• The pattern of occurrence is on & off where: births
• On = available causative agent
• Off = not available causative agent Morbidity - Illnesses affecting the population group
Incidence Rate (IR)-reported new cases affecting
• It’s intermittent (unpredictable) in occurrence
the population group
• Disease occurs only if there’s a susceptible host like in
Prevalence Rate (PR)-determine sum total ofnew
rabies
+ old cases of diseases per percent population
Pandemic
• Worldwide, international, universal, global in Mortality-Reports causes of deaths
occurrence like in AIDS, Covid-19, Hepatitis B, Crude Death Rate (CDR)-overall total reported
PTB, measles, mumps, diphtheria, pneumonia death
• SARS is categorized by WHO as an OUTBREAK only Maternal Mortality Rate (MMR)-maternal deaths
because out of 191 nations, 33 countries are due to maternal causes
reported to have it. Infant Mortality Rate (IMR)-# of infant deaths (0-
12 months) or less than 1 year old
Epidemiological Investigation Neonatal Mortality Rate (NMR)-# of deaths
• When, where, how, who; the entirety of the among neonates (newborn 0-28 days, < 1
disease process month)
Swaroop’s Index (SI)-deaths among individual in
• Considered as a secondary prevention because it
the age group of 50 and above
aims to control and cure the problem

VITAL STATISTICS
• Systematic approach of obtaining,
organizing, and analyzing numerical facts so
that the conclusion may be drawn from
them.
• Systematic study of vital events.
• Statistics from NSO
• LCR – births and deaths
• Application of statistical techniques to
vital events Functions of the Nurse
• It describes status of health of the community • Collects data
• Reflects the effectiveness of • Tabulates data
the services/programs • Analyses and interprets data
• Identifies the health needs of the community • Evaluates data
o 100: for percentages • Recommends redirection and/or strengthening
o 1000: at the Community Level of specific areas of health programs as needed
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
Field Health Service Information System (FHSIS) COPAR
• It is a network of information Community Organizing Participatory Action Research
• It is intended to address the short-term needs
of DOH and LGU staff with managerial or ● Is a sustained and continuous process of
supervisory functions in facilities and program educating and mobilizing the people to solve
areas. their own problems
• It monitors health service delivery nationwide. ● Working WITH the people and not for the
• To provide a standardized, facility-level data people continuous and sustained process
base that can be accessed for more in-depth of:
studies. ● Educating the people
• To minimize the recording and reporting burden ● Working with people
at the service delivery level to allow more time for ● Mobilizing the people
patient care and promote activities.
Importance:
Importance • generate community participation
• Helps local government determine public health • management of a development programs
priorities. • community participation and involvement
• Basis for monitoring and evaluating
health program implementation. Principles:
• Basis for planning, budgeting, logistics ➢ Change
and decision making at all levels. ➢ Poor
• Source of data to detect unusual occurrence of a ➢ Self-reliance
disease.
Process:
• Needed to monitor health status of the
• A progressive cycle of action-reflection -action
community.
• Consciousness-raising
• Helps midwives in following up clients.
• COPAR is participatory and mass-based
• Documentation of RHM/PHN day to
• Group-centered and not leader-oriented
day activities.
Approaches to development:
Components
• Welfare approach
✓ Individual Treatment Record (ITR)
✓ Target Client List (TCL) • Modernization approach
✓ Summary Table • Transformatory approach
✓ Output Reports
Phases:
Reporting 1. Pre-entry
• These are summary data that are transmitted or • Formulation of institutional goals,
submitted on a monthly, quarterly and on annual objectives and targets for the program
basis to higher level. The source of data for this • Revision of curriculum
component is dependent on the records. • Training of faculty if CO-PAR
• Coordinate participation of other departments
within the institution
• Community consultations/dialogues
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
• Designing a plan for community development
• Designing criteria for the selection of site 3. Community Diagnosis / Study
• Criteria for site selection: • Selection of the research team
1. Depressed and underserved • Training on data collection methods and
2. Poor techniques, development of tools
3. Exploited • Planning for the actual data gathering
4. Struggling • Data gathering
5. No serious peace and order problem • Training on data validation
6. Willingness to be organized • Community validation
7. Needing health assistance • Presentation of CDX and recommendation
8. Counter-part of the community • Prioritization of community needs/problems for
(support, commitment, action
resources)
9. Accessible to transport and 4. Community Organization / Capability Building
communication • More formal structures
• Site selection • Procedures of planning, implementing, and
• Preliminary social investigation (PSI) evaluating community activities
• Networking with local government units (LGU’s), • Developing AKS in managing their
NGOs and other departments own concerns/programs
• Community meetings to draw up guidelines for
2. Entry the organization of CHO
• Courtesy call • Election of officers
• Establish a rapport • Development of management systems and
• Imbibe their lifestyle procedures,
• Immerse yourself • Team building/Action-reflection-action sessions
• Live with them • Working out legal requirements for CHO
• Reside on the area • Organization of working committees/task
• Sensitization of the community/information groups
campaign • Training of CHO officers/community leaders
• Continuing social investigation
• Core Group (CG) formation
5. Community Action
• Characteristics of a potential leader:
• Organization and training of CHWs
a. Respected community members
b. Responsible/committed • PIME of health services and community
c. Willing to work for the desired change development projects
d. Has good communication skills • Resource Mobilization
e. Has wide “influence” on elite/poor • 5 M’S
community members • Manpower
• Coordination/consultation with • Machine
other community organizations • Materials
• Self-awareness and Leadership Training (SALT) • Method
• Money
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
• Space UNIVERSAL HEALTH CARE
• Setting up of linkages/network referral systems R.A. 11223
• The policy of the State to protect and promote
6. Sustenance and Strengthening the right to health of all Filipinos
• Formulation and ratification of constitution and
bylaws Salient Features
• Identification and development of secondary ✓ Population
leaders ✓ Service
• Institutionalization of financing scheme ✓ Financial coverage
• Development and implementation of
viable management systems
• Transfer of community organizers roles
and responsibilities and documents
• Subsequent follow-up

7. Turnover/Phase Out
• Transfer of community organizers roles
and responsibilities and documents
• Subsequent follow-up

Critical Steps:
Duterte Health Agenda:
1. Integration - immersion
All for Health Towards Health for ALL
2. Social Investigation – community study
3. Tentative Program Planning – social issue/CO
4. Groundwork – going around
5. The Meeting – ratify (collective power
and confidence)
6. Role Play – acting out/anticipation
7. Mobilization or action – actual experience
8. Evaluation – reviewing of steps
9. Reflection – deeper on-going concerns
10. Organization – success

GOAL OF COPAR
to attain community development a better-quality life
✓ Basic needs are met
✓ Equal rights
✓ Self-reliance
✓ Active participation
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
Key Strategies:
▪ Certification/Recognition Program - CRP
▪ Continuous Quality Improvement – CQI

Sentrong Sigla Movement

GOAL OF SSM
Quality Health
• Objectives: Better and more effective collaboration
between DOH and LGUs

Pillars:
▪ quality assurance
▪ grants and technical assistance
▪ awards
▪ health promotion

Millenium Development Goals

National Objectives for Health (NOH)

• Serves as the medium-term roadmap of the
Philippines towards achieving universal
healthcare (UHC)
• It specifies the objectives, strategies and targets of
the Department of Health (DOH) FOURmula One
Plus for Health (F1 Plus for Health) Sustainable Development Goals

Pillars of F1 Plus
- Financing
- Service delivery
- Regulation
- Governance
- Performance accountability

QUALITY ASSURANCE PROGRAM

GOAL OF QAP
To make DOH and LGUs active partners in providing
quality health services.
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
6. EO #51- Milk Code
7. RA 7846- Hep B Immunization for infants &
children < 8 yrs old
8. PP #46- Re-affirming Universal Child &
Mother Immunization;
9. Polio Eradication Project of the
Philippines
10. RA 8172- ASIN Law (Iodization of salt)

Core Packages
PUBLIC HEALTH PROGRAMS ❑ Pre-pregnancy package
(Selected Population Groups) ❑ Pregnancy or prenatal package
❑ Delivery or care during labor package
❑ Post partum package
THE MATERNAL HEALTH PROGRAM ❑ Newborn care package
GOAL OF MHP ❑ Childcare package
Improve the survival, health, and well-being of mothers
and unborn through a PACKAGE OF SERVICES for the Delivery Package
pre-pregnancy, pre natal, natal and post natal stages.
- Skilled birth attendant/ skilled
health professional-assisted
Underlying cause of maternal deaths: delivery
✓ Delay in taking critical actions - Facility-based delivery
✓ Delay in seeking care - Use of partograph
✓ Delay in making referrals - Proper management of pregnancy,
✓ Delay in providing appropriate medical delivery, and newborn complications
management - Access to BEmONC or CEmONC services
- Rooming-in/Breastfeeding
Strategic Thrusts:
❑ Launch and implement BEMONC 6 BEmONC Functions
❑ Improve the quality of prenatal and postnatal ◦ Parenteral antibiotics
care
◦ Parenteral oxytocic drugs
❑ Reduce women’s exposure to health risks
◦ Parenteral anticonvulsants
❑ LGUs, NGOs and other stakeholder’s advocacy
◦ Manual removal of placenta
Legal Basis:
◦ Removal of retained products
◦ Assisted vaginal delivery, vacuum
1. PD 996– Immunization <8 years of age
extraction and forceps delivery
2. PD 965– marriage license
3. PD 603- The Child and Youth Welfare Code
CEmONC 6 + BT and CS
4. PP No.6- Implementation of Universal Child
Immunization
Domiciliary Obstetrical Service Qualification
5. RA 7600- The Rooming-In and Breast-feeding
- Full term
Act of 1992
- Not a primigravid and with <5 pregnancies
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
- No history of complications/abnormalities • Albendazole 400mg or Mebendazole 500mg
in present and previous pregnancies tablet-children older than 2 years old
- W/o co-existing disease
- Imminent delivery Nursing Considerations:
- 18-35 years of age, No CS • To be taken in full stomach
• Not advised if the child is known to have any of
Postpartum Package the following
❑ Birth registration ✓ Serious illness, such as an illness that
❑ Breastfeeding & NBS require referral to a hospital
❑ Vit. A. Supplementation ✓ Abdominal pain
❑ Family planning counseling ✓ Diarrhea
❑ Maternal nutrition and lactation ✓ History of hypersensitivity to the drug
❑ Postpartum care every day ✓ Severe malnutrition
❑ 1st visit- 1st week PP
❑ 2nd visit- 6 weeks PP Adverse Effects:
✓ Local sensitivity of allergy
Newborn Care Package ✓ Mild abdominal pain
❑ EINC ✓ Diarrhea-give oral rehydration
❑ Newborn Screening (RA 9288) ✓ Erratic worm migration
o Congenital Hypothyroidism
THE PHILIPPINE NUTRITION PROGRAM
o Congenital Adrenal Hyperplasia
Conditions Associated with Malnutrition
o Galactosemia
• Infections
o Phenylketonuria
o Glucos-6-phosphate • Intestinal Parasitism
dehydrogenase deficiency
o Maple syrup urine 3 Major Micronutrient Deficiencies:
❑ Universal Hearing Screening (RA 9709) • Vitamin A Deficiency
• Signs of Vitamin A Deficiency
Childcare Package (Xerophthalmia)
❑ Infant and Young Child Feeding • Night blindness
o EO 51 – Milk Code • Photophobia
o RA 10028 – Expanded Breastfeeding Act • Conjunctival xerosis
o RA 7600 – Rooming-in (NSD/CS) • Bitot’s spot
• Corneal opacity
o RA 8976 – Food Fortification Act
• Keratomalacia to irreversible
o RA 8172 – ASIN Law
blindness
o AO 36, S. 2010 – GP
• Iron Deficiency Anemia
• Palmar pallor
Deworming
• Deworming of children aged 1-12 years is done
• Iodine Deficiency Disorder
every 6 months • Signs of Cretinism:
• Albendazole 200 mg or half tablet or • Growth stunting
Mebendazole 500 mg –children 12-24 months • Pasty skin
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
• Protruding abdomen INTEGRATED MANAGEMENT OF CHILDHOOD
• Deaf mutism ILLNESS (IMCI)
• Management of common childhood illness
Nutritional assessment methods: isdone in an integrated manner
1. Anthropometry • Can be used by doctors, nurses and other
health care professionals who see sick infants
2. Biochemical examination
and children aged 1 week to 5 years
3. Clinical examination
4. Dietary history
Benefits:
5. Health history
✓ Addresses major child health problems
✓ Promotes prevention as well as cure
PEM: Kwashiorkor vs Marasmus
✓ Improves health worker performance and their
quality of care.
Strategies in prevention & management of
micronutrient deficiencies ✓ Reduce under-five mortality and improve
1. Supplementation – administration of a nutritional status, if implemented well
concentrated source of a nutrient ✓ IMCI is worth the investment, as it costs up to
➢ VAD prevention: six times less per child correctly managed than
• Preschoolers (12-83 months): 200,000 current care
IU q 6 mos ✓ Cost-effective
• Postpartum: 200,000 IU w/in 1 mo ✓ Improves inequity in global health care.
after delivery of each child
➢ VAD treatment: days 1 & 2, after 2 wks FeSO4 Principles:
supplement (prev): • All sick children aged up to 5 years – examine
• Infants (6-11 mos): 0.7 mg./kg. body for general danger signs
wt/day • All sick young infants – examine for very severe
• Preschoolers (12-59 mos): 1 mg./kg. disease.
body wt/day • Assess for main symptoms
• Pregnant & postpartum: 100-200 mg. o For older children, the main
OD from 5th mo of pregnancy to 2 mos symptoms include: cough or difficulty
postpartum breathing, diarrhea, fever and ear
➢ FeSO4 supplement (tx): infection.
• 0-59 mos: 3-6 mg./kg. body wt/day o For young children, local
➢ Iodine (potassium iodate) capsule: bacterial infection, diarrhea and
jaundice.
• Pregnant women & children in endemic
o Routine assessment –
areas (0-59 mos): 1 cap 200 mg. once a
nutrition, immunization,
year
deworming, etc.
• Limited number of clinical signs
2. Fortification addition of a nutrient to food during
processing
• A combination of individual signs leads to
a child’s classification within one or more
a. Sangkap Pinoy Seal – placed on label of
symptom groups rather than a diagnosis.
fortified foods
b. Iodized salt • Use limited number of essential drugs and
encourage active participation of caretakers in
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
the treatment of children 6. Anemia
• Counseling (home care) - feeding and giving of 7. HIV/AIDS
fluids, follow-up
IMCI Skin Problems
Process: ASSESS – CLASSIFY – TREAT – COUNSEL & 1. Prurigo – papular itching rash
FOLLOW UP 2. Tinea – ringworm
ASSESS a child by checking first for danger signs: 3. Scabies
✓ Severe vomiting/vomits everything 4. Chickenpox
✓ Convulsion 5. Herpes Zoster
✓ Abnormally sleepy/unconsciousness 6. Impetigo
✓ Not able to drink or breastfeed 7. Molluscum Contagiosum
CLASSIFY a child’s illness using color-coded triage system: 8. Warts
✓ Pink 9. Sebbhorrea
✓ Yellow 10. Fixed-drug reactions
✓ Green 11. Eczema
TREATments for the child. 12. Steven Johnson Syndrome
✓ If the child needs urgent referral, give essential
treatment before the patient is transferred; if
RA 10354: REPRODUCTIVE HEALTH
the child needs treatment at home, develop an
• Guarantees universal access to methods on
integrated plan for the child and give the first
contraception, fertility control, sexual education,
dose of drugs in the clinic.
and maternal care.
✓ Immunize the child if needed
COUNSEL the mother
✓ Providing health education to clients promotes
health and avoid risk of infection. These are
important for parents/caregivers especially who
lack knowledge on health practices and risks
factors that contribute to disease ailments.
✓ Give FOLLOW-UP care

Contributions
• Improving case management skills of health
workers
• Improving the health system to deliver IMCI
• Improving family and community
health practices
Family Planning
IMCI Illness (2 mos up to 5 Years) Legal Bases
1. Pneumonia • Executive Order 119
2. Dehydration • R. A. 6365
3. Febrile Disease • P.D. No. 79
4. Ear Infection • P.D. No. 965
5. Malnutrition
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
Four Pillars: PANTAWID PAMILYANG PILIPINO PROGRAM (4PS
• Responsible parenthood (PD 965) PROGRAM)
• Respect for Life Purpose:
• Informed choice (PD 79) • CCT focuses on the poverty reduction and social
• Birth spacing development strategy of the national
Priorities: government that provides conditional cash
• Couples in the reproductive age: 20 to 44 years grants to improve their health, nutrition and
(Reproductive age is 16-49; we don’t encourage 16 education particularly of children aged 0-18 to
or 49 to give birth) extremely poor households.
• 3 or more children Conditions:
• Pregnant women must avail pre-and post-natal
• Close interval pregnancies
care and be attended by a trained health
• With chronic disease
professional
Counselling
• Parents must attend Family Development
• Greet: warmly and politely Sessions (FDS) on effective parenting, husband
• Ask: about him/herself and wife relationships, child development, laws
• Tell: health center and the services provided affecting the Filipino family, gender and
• Help: make the decision that is best for him/her development and home management.
• Explain: relevant information about the signs, • 0–5-year-old children must receive regular
diagnosis, & treatment preventive health check-ups and vaccines
• Return: schedule a return visit • 3–5-year-old children must attend day care or
Roles of the RN pre-school classes at least 85% of the time.
• Counselor & educator • 6–18-year-old children must enroll in
• The nurse should give the correct the elementary or high school and must attend at
information about contraceptive methods least 85% of the time.
according to woman’s practice • 6–14-year-old children must receive deworming
• The nurse should provide individualized family pills twice a year
planning information
• Ensure confidentiality at all times Cash Transfer
• P6,000 /yr or P500 mo per household for health
Considerations and nutrition expenses
• Safety • P3,000/school year (10 months) or
• Protection from sexually transmitted disease P300/month/child for educational expenses.
• Effectiveness Maximum of 3 children
• Acceptability • A household with 3 qualified children receives a
• Convenience subsidy of P1,400/month during the school year
or P15,000 annually as long as they comply with
• Education needed
the conditionality.
• Benefits
• Side effects PhilPEN: Philippine Package of Essential
• Spontaneity Non-Communicable Disease Intervention (AO No. 2012-
• Availability 0029)
• Expense WHO PEN
• Religious & personal beliefs 1. Prevention of Heart Attacks, Strokes and
Kidney Disease through Integrated
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
Management of Diabetes and cause your blood glucose level to go too low,
Hypertension carry sugar or sweets with you
2. Health Education and Counseling • If feasible, have your eyes checked every year
3. Asthma and COPD • Avoid walking barefoot or without socks
4. Breast and Cervical Cancer • Wash feet in lukewarm water and dry well
5. Self-care especially between the toes
• Do not cut calluses or corns, nor use chemical
Objectives: agents on them
• It aims to promote the use of Phil PEN • Look at your feet every day and if you see a
protocol to diagnose and manage non- problem or an injury go to your health worker
communicable diseases.
ENVIRONMENTAL HEALTH
Specific Objectives: • All physical, chemical and biological factors
1. Provide cost-effective alternatives in external to a person, and all related behavior,
diagnosing non-communicable diseases but excluding those natural environments that
at its early stage using a risk assessment cannot be reasonably modified (WHO).
approach.
2. Assure access to basic diagnostics and Legislations:
medicines. - P.D. 825: Anti-littering Act
3. Develop a unified reporting system from - P.D. 856: Sanitation Code
which will be culled data relevant for - RA 8749: Clean Air Act
both DOH and PhilHealth, in line with - RA 9003: Ecological Solid Waste Management
monitoring quality and benefit Act
utilization
- RA 9275: Clean Water Act
- RA 1061: Food Safety Act of 2013 Program
Application of 1P
• age > 40 years
Components:
• smokers
• Drinking water supply,
• waist circumference ( ≥ 90 cm in women
• Sanitation (excreta, sewage and septage
≥100 cm in men)
management)
• known hypertension
• known DM • Zero open defacation program (ZODP)
• history of premature CVD in first degree • Food sanitation
relatives • Air pollution (indoor and ambient)
• history of DM or kidney disease in first degree • Chemical Safety
relatives • WASH (Water, Sanitation & Hygiene)
in emergency situation
Advice to Patients and Family • Climate change for health and health impact
• Avoid table salt and reduce salty foods such as assessment (HIA)
pickles, salty fish, fast food, processed food,
canned food, and stock cubes Environmental Sanitation
• Have your blood glucose level, blood • The control of all factors in man’s physical
pressure, and urine checked regularly environment, which may exercise a
• Advice Specific for Diabetes deleterious effect on his well -being & survival
• If you are on any diabetes medication that may
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
Water Sanitation Approved types of water facilities
• Water quality – refers to water supply’s Level Descri
availability, volume, mineral content levels, ption
I (point A protected well or spring; No distribution system;
toxic chemical pollution and pathogenic source) Adaptable for rural areas; Within 250 m from the
microorganism levels farthest user
• Water Analysis to determine potability:
o Physical - examination of water for II (Communal Composed of a source reservoir, a piped
faucet or distribution network & communal faucet;
its appearance, odor and taste; can be stand post) Located not more than 25m from the farthest
done by anybody house
o Chemical - test for chemical III Suited for urban areas; Each household has a tap;
attributes of water, such as pH and (waterworks Water undergoes treatment at the water facility
presence of Cl-, Fe, lead, mercury system/individ
u al household
o Bacteriological/Microbial quality - to
connection)
test for the presence of indicator
organisms such as coliforms; when
Household treatment of water
water is coliform +, it is
• Boiling
contaminated by human excreta
• Filtration
o Radiological quality – tests through
• Chemical disinfection – chlorine
parameters of gross alpha activity,
gross beta and radon
Treatment of Public Water Supply
• Types of water examinations required for
1. Sedimentation
drinking water
2. Flocculation/coagulation
a. Initial examination – physical,
3. Aeration
chemical, bacteriological
4. Filtration
examinations of water & possible
5. Disinfection with Chlorine
radioactive contamination
6. Fluoridation
b. Periodic examination – interval shall
not be longer than 6 months; general
Waste Management
systematic chemical examination
Solid Waste Classification
shall be conducted every 12 months
1. Municipal waste
or often
2. Industrial waste
c. Water examination shall be
3. Hazardous waste
performed only in private or
4. Hospital/Biomedical waste
government laboratories duly
accredited by the Department
Methods of solid waste management
• Recommended Schedule for Testing:
• Recycling -
o ✔ Level 1 – every 3 months
o Total recycling
o ✔ Level 2 – every other month o Waste recovery method
o ✔ Level 3 - frequent sampling for o Zero waste management
every 5000 population o Volume reduction method
• Unapproved Type of Water Facilities • Sanitary Landfill
o Water coming from doubtful sources • Incineration
o Unimproved springs, well that needs • Open dumping
priming
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
Hospital Waste Management public use
• COLOR CODING: 3. School-a toilet facility located in a school
o Black: non-biodegradable essentially for the use of students
o Green: biodegradable 4. Household-a toilet facility being used by an
o Yellow: hazardous waste individual household
o Orange: Radioactive
Pest Control Methods
Human Waste Management • Mosquito-control project
Approved type of toilet facilities o Chemically treated mosquito net
1. Level 1 –Non-water carriage toilet; toilet o Larvae eating fish
facilities requiring small amount of o Environmental sanitation
water to wash waste into the receiving o Anti-mosquito soap (soap with basil
space or citronella)
2. Level 2 – On-site toilet of water carriage type o Neem and other aromatic plants
with water seal (flush-type) with septic
tank FOOD SAFETY
3. Level 3 – Water carriage type connected to a • availability, accessibility and relative cost of
sewerage system to treatment plant healthy food free of contamination by harmful
4. Any disposal device and approved type pit pesticide and bacteria
privy approved by the secretary of his
duly authorized representative Food Sanitation Program
1. Inspection of all food sources, containers &
Unapproved/Unsanitary type of toilet facilities transport vehicles
• Open pit privy 2. Compliance to sanitary permit
• Overhung 3. Health certificate for food handlers, cooks,
helpers
Criteria for Acceptable Excreta Disposal Facilities 4. Banning of food unfit for consumption
1. Sanitary 5. Training of food handlers & operators
2. Simple, cheap & easy to construct with local 6. Ambulatory food vendors health certificate
materials 7. Household food sanitation
3. Easy to maintain
4. With adequate protection against the 4 Rights of Food Safety
elements & provides desirable privacy • Right source
5. Acceptable to users • Right preparation
6. Construction of septic anks for toilets should • Right cooking
have a minimum distance of 25 meters • Right storage
from any water sources to avoid
contamination Nursing Responsibilities & Activities in Environmental
Health Initiatives
Level of toilet use 1. Health Education
1. Communal – a toilet facility shared by two or 2. Actively participate in the training
more households component of the service
2. Public – a toilet facility located at public places 3. Assist in the deworming activities
like market, bus station, etc. Intended for 4. Coordinators of programs/projects/activities
 COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal
with other government & non-
government agencies
5. Health Advocate or facilitator
6. Actively participate in environmental
sanitation campaigns and projects
7. Role model in terms of cleanliness in the
home and surroundings
8. Participate in research/studies to be
conducted in their respective areas of
assignment
9. Helps in the implementation and
interpretation of PD 856
10. Assist in disaster management
COMMUNITY HEALTH NURSING
Dr. Jayson A. Punzal