COMMUNITY HEALTH NURSING • Needs a "multi-disciplinary approach" in

order to cover all the aspects.

The summit among all fields in nursing • Public Health: field of practice (requires
profession. multidimensional & multidisciplinary
approach)
✓ C - Community (client)
✓ H - Health (main goal) Social/Core Determinants of Health
✓ N - Nursing (as the strategy/means to
✓ Health services

I
achieve the goal) MEANS
✓ Employment/working conditions
w C's of dealing w/the community
impacts
✓ Education and literacy
✓ Physical environment
• Culture health ✓ Social support networks
o Madeleine Leininger: transcultural ✓ Personal health practices and coping skills
nursing ✓ Social environments
o Health values are rooted in culture. ✓ Health child development
o Determines practices/health seeking ✓ Biology and genetic endowment
behaviors. ✓ Culture
o ✓ Financial and social status
Filipino:late -> complicationso From Filipino Perspective: based on ✓ Gender
checkrp physical s/sx (absence/presence of
symptoms) Interpretation: health cannot be alienated from
• Communication social reality. (connected sya)
o nx must educate the people of the
community in terms of the new
6 Factors affecting health Health-politicsne
trends in terms of health. 1. Political - comes from the policies being
• Change implemented by the government.
o Implication: culture specific care 2. Behavioral - talks about values and culture practices,
and use of effective communication 3. Heredity rituals
promote behavioral change. • talks about genetics
o nurses must be good health • in our country; CVD, endocrine disorders,
communicators. and such.
o Sadly, here in our country, the use of 4. Environment
media is not utilized. • climate change/global warming
y Community • we need to demand climate justice.
• can lead to different diseases
A group of people with common characteristics and 5. Socioeconomic Influence - lack of job
interest. Thus, living within a territory or geographical 6. Health Care Delivery System (HCDS) -
boundary. incompetent leaders.

• The only way to move forward: to revive the ✓ Health is a shared reality: it means that we
spirit of "Bayanihan". need to look on the ecosystem at large. Thus,
• As a CHN, we want the people inside the think of human health as part of animal and
community to work towards one cause. environmental health.
(Community Organizing) ✓ One Health: the one health concept
• Community Organizers - helping them recognizes the interrelationship between
achieve a state of empowerment. animal, human and environmental health.
Health ✓ One Health consist of: animal,
environment, human
• 0
It is a state of complete physical, mental, and O
"Health is a basic human right"
social well-being, and not merely the
absence of disease and infirmity. (WHO) "Health is notonly to be well, but be able
to

• health is a "multidimensional" reality, thereby

it is not limited on physical aspects only.
to use well every werwe have."Nightingale
Implication:Holistic careCAand self-
Foster
2: CHN (1)
reliance
 CHN=Capacity Building
Nursing • we need to give them a sense of
responsibility so we want them to
• "Putting people in the best possible condition realize that our role is to facilitate
for nature to restore or to preserve health." them towards independence.
(Florence Nightingale)
• "Shared leadership"
• The unique function of the nurse is to assist ✓ Collective in scope - we believe that Health
the individual, sick, well, in the performance is a right of everyone (inclusive) *something
of those activities contributing to health or its that is covering everyone.
recovery (or to peaceful death) that he would ✓ Collaborative approach - "We work with
perform unaided. (Virginia Henderson) others", Flat hierarchy *because HEALTH is
COMMUNITY HEALTH NURSING a multi-dimensional phenomenon.
✓ Capacity building - towards independency
• Field of nursing practice that renders care to *insert Virginia Henderson’s Theory
individual, families, groups, and communities ✓ Common good - we must look for the better
focusing on health promotion and disease good of other people.
prevention through people. empowerment
Take Note:
• an area of human services directed toward
developing and enhancing the health
- - -
✓ Home visits - "we attend to the needs of the
capabilities of people-either singly, as
- family." done as needed *PRN
individuals, or collectively as groups and − (Midwives - attends during home
communities Ruth Freeman & Janeth visit, Primary Health Care Provider)
Heinrich) ✓ Clinical visitation - we want to attend more
• Empowerment - enabling people to do people. (Nurses – attends the needs of the
things on their own. majority inside the community)
o They must acquire the necessary
knowledge and skills so that they can
do things on their own PUBLIC HEALTH Stewardship
Features of Community Health Nursing
• It is the melting pot of all professions in nursing.
① Developmental in approach: as CHN, we provide • The art and science of preventing disease,
people the technology they can apply on their own an prolonging life, and promoting health and
maximize it for their health. efficiency through organized community efforts.
e n

• The application of science in the context of

② Population focused: must view health according to politics to remove inequalities in health and
the welfare of other people inside the community as deliver the best health for the greatest number.
-
well. (e.g., conducting seminars among teenagers (Our role is to enlighten the policy workers in
regarding reproductive health) terms of their decisions)
•
⑤ Driven by Social Justice: requires equality (fair
treatment)
The collective effort of improving the health of
the population.
• Organized community efforts:
④ Ecology oriented: we provide care where people
o There must be a structure that: health is
are. (Based on their natural environment) our
prioritized, public health services are
workplace is everything within the field aside from the
provided, and policies are established.
hospital setting.

Multi-disciplinary: we need to collaborate with other

Core Functions of Public Health (APA)
healthcare professionals as well. (schools, workplaces) ✓ Equity is a must
Immunication, Physical Ether ✓ Assessment - gather date, generate events
&
Preventive service: we promote preventive services
✓ Policy - generate policies
rather than treating illness/diseases. sprimary. Secon,ter
✓ Assurance - provides protection among the
Comprehensive care: our approach must be holistic community
patients:partners
Consumer involvement: we want them to
Nurse:Facilitator
participate (COPAR) client participation
Pre-paid mechanism: we should not owe our
services to the government leaders because they are
paid to do that task. (hindi sya libre)

5C's in CHN

✓ Client as partners - they are not just

consumers
CA 2: CHN (2)
 10 ESSENTIAL PUBLIC HEALTH SERVICES improvement of the physical and social
environment, rehabilitation, and the prevention of
The 10 Essential Public Health Services provide a illness and disability. (WHO expert committee)
framework for public health to protect and promote
the health of all people in all communities. To achieve • Almost the same as CHN, however PHN is a
equity, the Essential Public Health Services actively subspecialty of CHN.
promote policies, systems, and overall community • "PHN may be defined as a field of professional
conditions that enable optimal health for all and seek practice in nursing and in public health in which
to remove systemic and structural barriers that have technical nursing, interpersonal, analytical, and
resulted in health inequities. Such barriers include organizational skills are applied to problems of
poverty, racism, gender discrimination, ableism, and health as they affect the community. These skills
other forms of oppression. Everyone should have a are applied in connect with those of other
fair and just opportunity to achieve optimal health and persons engaged in health care, through
well-being. comprehensive nursing care of families and
other groups and through measures for
⑪ Assessment:
evaluation or control of threats to health, for
Essential Public Health Service #1: Assess and health education of the public, and for
monitor population health status, factors that mobilization of the public for health action."
influence health, and community needs and assets. • "Must keep in mind all of the fields in nursing
because PHN requires knowledge from these
Essential Public Health Service #2: Investigate, branches."
diagnose, and address health problems and hazards • it is the integration of all knowledge in the field of
affecting the population. nursing.
Policy Development: • "We need to mobilize the people so that they will
realize that the health is in their hands."
Essential Public Health Service #3: Communicate
effectively to inform and educate people about health, Public Health Nurse:
factors that influence it, and how to improve it. ✓ "The practice of promoting and protecting the
Essential Public Health Service #4: Strengthen, health of populations using knowledge from
support, and mobilize communities and partnerships nursing, social, and public health sciences."
to improve health. ✓ Includes all the part of the health team
including the community.
Essential Public Health Service #5: Create,
champion, and implement policies, plans, and laws Basic Concepts
that impact health. ✓ Levels of Clientele: Individuals, Families,
Essential Public Health Service #6: Utilize legal Groups, and Communities. (IFGC)
and regulatory actions designed to improve and ✓ Unit of service: Family (breathing ground of
protect the public’s health. health & illness)
✓ Philosophy: Worth & Dignity of Man
Assurance: (Margaret Shetland) *respect the patient's
dignity
Essential Public Health Service #7: Assure an
✓ Principle: "Greatest good for the greatest
effective system that enables equitable access to the number" (e.g., allocating resources, staffing
individual services and care needed to be healthy.
& developing of services, deployment of
Essential Public Health Service #8: Build and human services, and etc.)
support a diverse and skilled public health workforce. ✓ Primary Activity: "Health Education"
✓ We must specify the topic we will discuss. (to
Essential Public Health Service #9: Improve and implement easier)
innovate public health functions through ongoing ✓ Primary Focus: Health Promotion/Disease
evaluation, research, and continuous quality Prevention
improvement. ✓ 1st Step: Health Education
Essential Public Health Service #10: Build and Health Promotion & Disease Prevention
maintain a strong organizational infrastructure for
public health. • Health Promotion: "the process of enabling
people to increase control over and improve
PUBLIC HEALTH NURSING their health." (WHO)
• "Enabling" means the people must acquire
A special field of nursing that combines the skills of and apply it on their lives.
public health, nursing and some phases of social • Combination educational and environmental
assistance and functions as part of a total public supports for actions and conditions
health program for the promotion of health, conducive to health. (Lawrence Green)
CA 2: CHN (3)
Health Promotion Strategies (WHO) • Other roles: Health screening, case finding
(outbreak of communicable disease), health
• Build Healthy Public Policy: consistent education (e.g., teenage pregnancy) and
w/APA nursing procedures.
• Nurses can be involved in policy by showing • Elementary School Nurse - under DepEd
evidence.
• Creative Supportive Environments B. Occupational Health Nursing
• Strengthen Community Action • Focus: Health Promotion & Protection
• Develop Personal Skills (e.g., teaching • Similar to school, it is also a point of
members of the family about health convergence of different types of people.
promotion) • provides safety among workers.
• Reorient Health Services - more • Health Protection - health risk management
responsive to the needs of the people. at work (e.g., health hazard identification, risk
• Taxation: is the single most cost-effective assessment, control measures, surveillance,
measure to reduce tobacco and alcohol information, training, monitoring, record
consumption. (current law: train law) keeping.) - identify different causes of
3 Levels of Prevention disease/disturbance inside the work area.
• Health Promotion - health risk assessment
✓ Primary - teaching the importance of (e.g., environment, lifestyle, employee
vaccines against Covid-19 (acute) "risk- information, assistance program) -
reduction methods" organizing events that promotes active
o Focus: well clients lifestyle and wellness.
✓ Secondary – teaching the early s/sx of
cancer (chronic) RA 11058
o Focus: sick clients (early ➢ Act strengthening compliance with
stage/usually asymptomatic) occupational safety and health standards and
✓ Tertiary - limiting disability (rehabilitation) providing penalties for violations thereof:
o Focus: late stage/usually ➢ Classified workplaces either low-risk/high risk
symptomatic ➢ low risk example: offices, high risk example:
3 Pillars of Health Promotion factories, plants, and such.
➢ Occupational Health Nurse: considered as
✓ Good Governance – as mentioned earlier. frontliner in occupational health nursing.
✓ Healthy Cities – by formulating ➢ The number of OH nurse will depend on the
policies/guiding policy makers towards number of workers.
implementing laws that will protect its citizens
against disease/illnesses. Emerging fields of chn
✓ Health Literacy - through "Health Education" C. Correctional Nursing - provision of healthcare
thus applying it to their lives. (e.g., use of to prisoners and developing programs to ensure
infographics) their health.
D. Faith community/Parish Nursing - this is the
FIELDS OF COMMUNITY HEALTH NURSING practice of nursing combined with spiritual care.
A. School Health Nursing they may work in either paid or unpaid position
• Focus: Health Promotion & Health in a variety of religious faiths.
Screening E. EntrepreNurse/Independent Practice -
initiated by the Department of Labor and
• can be a point of convergence of diff people
w/diff vulnerabilities. Employment (DOLE), in collaboration with the
Board of Nursing of the Philippine Nurses
• we must make sure to promote health and
Association, and other stakeholders to promote
reduce risk of disease transmission through
nurse entrepreneurship.
continuous interaction of people inside.
• FCNC's - Family Care Nursing Clinics;
• Health Promotion - such as; nutrition month,
Equivalent of Health Centers but the
ensuring that the canteen doesn't serve junk
difference is that it was established by a
foods, promote the wellness of the faculty,
nurse or nurses.
school-based immunization, active case
finder especially within the nearest • Independent practicing nurse: starting
community *raising the consciousness of the your own clinic.
children in terms of health ✓ Hospice, domiciliary and
healthcare facility management
• Disease Prevention & Early Detection
✓ Public health advocacy
• Emergency Care
✓ Home health care services
• Referral

CA 2: CHN (4)
 ✓ Outsourcing public health delivery THE PH NURSE AS AN EPIDEMIOLOGIST
for LGUs, and other government
institutions. • Notes the common disease/trend inside the
✓ Medical transcription services community
✓ Health care training management • Researcher
✓ Emergency medical services • Participant in epidemiologic investigations
• Statistician: presentation of municipal health
COMMUNITY HEALTH NURSING OF PUBLIC statistics thru tools such as graphs & tables
HEALTH • Prepares and submits report
• Health monitor of the community
Population-focused - also known as ecology
orientation in PHN.

✓ Occupational Health Nursing

✓ Faith Community Nursing
✓ Correctional Nursing (People Deprived of
Liberty/PDL)
✓ School Health Nursing

Family as a unit of service: because it is where we

develop our health-seeking behaviors.

Roles of the CH/PH Nurse

• our job is "multi-faceted" role

• Has 3 main roles:
THE HEALTH CARE DELIVERY SYSTEM
1. Health Care Provider (clinician role) - uses the • It is very important to understand the HCDS
nursing process (NCP) inside the community.
• admitting patient • refers to the sum of all agencies, personnel, and
• administering IV, medication, services directed to provide health care to the
• monitoring weight population.
2. Health Educator - organizes formal/informal • Sectors: Public and Private
programs • Components: Agencies, Personnel, Services
3. Program Implementer - develop programs for
Building blocks of a successful and efficient
the population you serve. (cervical cancer
health care system
screening, smoking cessation, ensure the
compliance of the community, documents & ✓ Access to essential medicines
prepare reports) Field Health Information ✓ Health Information Systems
System ✓ Human Resources - definitely most
4. Manager - responsible & resourceful, being important (lots of infrastructures hence
efficient (does the job on a consistent basis) understaffed)
✓ Leader: influences & motivates your ✓ Financing - from the taxes paid by the
peers citizens. (must be used according primarily
✓ Supervisor on health)
✓ Trainor: provide updated information and ✓ Service delivery - referral of systems
equip them with knowledge (primary, secondary, and tertiary)
✓ Poverty Custodian: inventories, ✓ Leadership & Governance - main key
monitors supplies towards successful health care system.
✓ Environmental Manager: ensures that
the workplace/field of practice is Components
conducive to health. (Adequate lighting,
1. Agencies
ventilation, noise pollution, provision for
safety measures, waste disposal & waste It has 2 sectors namely: DOH and Local
management) Government
5. Community Organizer - helps A. DOH
people/community to develop their own skills • Lead agency for health in the country
towards achieving the desired health outcome.
• develops, initiates, and monitors health
6. Researcher/Epidemiologist - uses current
programs at the national level
data which can contribute in terms of health
promotion.
7. Advocate - of health equity & social justice.
CA 2: CHN (5)
 • Vision: Filipinos are among the • Governance
healthiest people in Southeast Asia by • Performance accountability
2022, and Asia by 2040.
• Mission: To lead the country in the NOH General Goals 2022
development of a productive, resilient, • Better health outcomes with no major
equitable, and people-centered health disparity among population groups
system. • Financial risk protection for all especially the
• Given to its mandate, it is necessary for poor, marginalized and vulnerable; and
DOH to be both a policy and regulatory
• A responsive health system which makes
body for health. Filipinos feel respected, valued, and
As a major player, the DOH is a: empowered.
• Makes aggressive decisions, set directions,
✓ Technical resource: expert resource develops policies, and implements those
person towards policy making policies towards public health.
✓ Catalyzer for health policy • Both DOH (National gov't) and Local Gov't
✓ Political sponsor and advocate for health must be collaborating.
issues on behalf of the health sector.
B. Local Government
Comprehensive Reforms in Health
• RA 7160 (devolution of tasks)
• Universal Health Care (2010-2016) - project • Primary and secondary tasks were given.
of Noynoy Aquino • Implements health programs at the
• Formula One for health (2005-2010) - by community level.
GMA • Aim: To transform local government units
• Health Sector Reform Agenda HSRA into:
(1999-2004) - signed by Joseph Estrada ✓ S – self-reliant communities
✓ Currently: FOURmula 1+ by the ✓ A - active partnership with the people
Department of Health (based on ✓ R – responsive to the needs of the
administrative order no. 2018-0014) people
✓ Strategic Framework and ✓ A - accountable government
Implementing Guideline for representatives
FOURmula One Plus for Health (F1+) ✓ D - decentralization
✓ O - n system of health decision
F1 plus for Health making.
• this outlines four pillars + 1 • Provides direct access thus promoting
• Targets the following: "bottom up" approach wherein the voice of
✓ Aims to attain goals outlined in the: the community is being heard by the
✓ PDP 2017-2022 government. (services,
✓ SDG 2030 governance/leadership, and decision-
making)
• Has 2 Sublevels:
✓ Provincial
• Local chief executive:
governor
✓ Municipal
• Local chief executive: mayor

2 local health boards:

• Provincial health boards (prov hospital,

district hospital)
✓ chairman: Governor
✓ vice chairman: PHO
• Municipal health boards (RHU, BHS)
✓ chairman: Mayor
✓ vice chairman: MHO
• Generate more funding to support health
care reforms Notes:
• Service delivery (ensuring that health
• Rural Health Units = health centers in urban
services are provided at all levels)
area
• Regulation (government is proactive in o RHU - caters cluster of barangays
controlling health) (the more, the better)
CA 2: CHN (6)
 • BHS - facility located in a barangay (midwife DOH Recommendation for HRH and Health
= Primary Health Worker) Facilities Ratio to Population (NOH, 2018)
• If applying as BHW; apply to the barangay
✓ 1 RHU/HC physician: 20k population
chairman.
✓ 1 public health nurse: 10k population
✓ 1 public health midwife: 5k population
COMPOSITION OF LOCAL HEALTH BOARDS
✓ 1 public health dentist: 50, 000 population
• There must be a partnership between *constant
national and local gov't ✓ 1 BHS: 5k population
• Local Health Boards: provides budget
Services:
allocation.
• Chairperson: mayor or governor • Primary: out-patient services
• Vice-Chairperson: municipal health officer or • Secondary:
provincial health officer ✓ in-patient services
• Members: ✓ basic hospitalization
✓ chairman of the health committee of • Tertiary:
sangguniang ✓ in patient services
pambayan/panlalawigan ✓ specialized care
✓ NGO representative ✓ critical care
✓ DOH representative
Note:
PERSONNEL OF THE HCDS ✓ To ensure that our health care system
Categories of health workers: remains efficient, two-way referral system is
implemented. tertiary to primary *vice versa
• BHW/VHW: volunteers, TBA, traditional = minimizes expenditures.
healers ✓ Increased Competency of Specialized Care:
• Intermediate Health Workers: MD's, PHN, any patient can avail those health care needs
etc in basic facilities.
• Basic PHC team (3): MHO (physician),
Summary: (Primary) -- BHS → RHU (Secondary) →
PHN, RHM (midwife) (+ dentist, sanitary
district/emergency hospitals → provincial hospitals
inspector, BHW)
(Tertiary) → regional hospitals & national hospitals
• Basic RHU team (6): include those 3
university hospitals, and medical centers.
additional professions
• Nurses: are deployed every RHU

THE RURAL HEALTH UNIT TEAM PRIMARY HEALTH CARE

• BHW - Can cater 10-20 families (neighborhood) • An overall strategy that addresses the health
• Auxiliary personnel, volunteer, village, needs of the population.
grassroots, traditional healer • Considered as philosophy/goal that is meant to
• RHM (midwife) *primary - Can cater 5000 achieve health for all.
people (barangay) • Different from primary care: provision of care
• PHN *secondary HW (rural sanitary inspector from the point of contact.
RSI, Nutritionist, Medtech) - 1 nurse = 10,000
Primary Health Care: Historical Perspective
people
• MHO (physician) - 1 doctor = 20,000 people ✓ 1977: 20th world assembly of the WHO and
• DOH - Can provide fundings/any resources to the HFA (health for all) 2000 movement
local government for continuation of their (health for all by the year 2000)
projects. ✓ 1978: Alma Ata Conference and Declaration
• Doctors to the Barrios/DTB – A project of the ✓ PHC identified as key strategy in achieving
DOH that provides services to areas that has a the HFA by the year 2000 goal
limited in terms of health services. ✓ 1979: the Philippines adopting PHC through
• NDP (nurse deployment project) - A nurse will LOI 949
apply to DOH thus working in a local gov't ✓ 2018: Astana Declaration reaffirming
institution. (contractual/job order) *The DOH can commitment to PHC globally and commit to
also deploy several professions such as UHC.
midwives, dentist, and such depending in the
Definition (Primary Health Care)
need of the community.
"Essential health care based on practical,
scientifically sound and socially acceptable methods
and technology made universally accessible to

CA 2: CHN (7)
individuals and families in the community through ✓ Acceptable - choose what's the best among
their full participation and at a cost the community and the citizen.
the country can afford to maintain at every stage of
their development in the spirit of self-reliance and PRIMARY HEALTH CARE: CORNERSTONES
self-determination." • Active Community Participation
• We want to enable people to do things on • Inter (consists of other sectors) and Intra-
their own thus manage their own health. sectoral (coming from the same sector e.g.,
• Is an approach to health and well-being nurse-physician) linkages
centered on the needs and circumstances of • Use of Appropriate Technology - to be
individuals, families, and communities and efficient, use of other resources
addresses comprehensive and interrelated • Support System made available - looking
physical, mental, and social health and well- on a wider perspective
being. (WHO, 2019) -our approach must Use of Appropriate technology
include the overall society.
• Use of herbal medicines (RA 8423)
Notes:
• The nurse can use these herbal medicines if
• PHC: goal, philosophy, strategy & approach western medicine is not available inside the
• Definition: essential healthcare made community.
universally accessible to the people by • SANTA LUBBY:
means acceptable to them. ✓ Sambong (blumea camphora) – renal
calculi
Elements of Primary Health Care ✓ Akapulko (bayabas-
bayabasan/ringworm bush) –
✓ E - education on health (promote health literacy)
ringworm and skin fungal infection
✓ L - local disease control (address what are the
✓ Niyog-niyogan (Chinese honey
health needs of a community) *endemic
suckle) – anti-helminthic
conditions such as TB, pneumonia and such.
✓ Tsaang gubat – anti-diarrheal
✓ E - essential drugs (there must be a continuous
✓ Ampalaya (Bitter gourd) – Diabetes
supply)
Mellitus
✓ M - maternal & child health (safe motherhood,
✓ Lagundi (5 leved chaste tree) –
prenatal visits, under five care)
cough, asthma, and colds
✓ E - expanded program on immunization (under
✓ Ulasimang Bato (pansit-pansitan) –
five projects; BCG, pneumococcal, MMR, oral
lowers uric acid, arthritis, and gout
polio)
✓ Bayabas (guava) – antiseptic,
✓ N - nutrition
diarrhea
✓ T - treatment of simple ailments
✓ Bawang (garlic) – anti-cholesterol,
✓ S - sanitation
lowers blood pressure
Determinants of success for PHC (WHO) ✓ Yerba Buena (peppermint) –
toothache, pain, and arthritis
• Knowledge and capacity building (training
and health education sessions) Nursing Considerations
• Human resources for health (HRH)
• Boiling - remove cover & use clay pot = to
(communicate w/the local gov't)
ensure that ingredients of the herb is not
• Financing
oxidized.
• Technology (tools, instruments, aids towards
• One kind of plant for each type of
healthcare) - vaccines, testing kits, and such.
symptoms
Criteria for Appropriate Technology • No pesticides
• Use only the part recommended (e.g.,
• HTAC (health technology assessment Bayabas = leaves only)
community) created by WHO • Stop in case of untoward reactions - seek
o to ensure the health of the general consultation if s/sx not relieved after 2-3
public by reviewing prior to doses
implementation.
✓ Effective - achieving the desired effects
(must present data for reviewing)
✓ Safe - no side effects (benefits outweighs the
risks) *minimal risk
✓ Affordable – accessible to all especially
among less-privileged.
✓ Sustainable

CA 2: CHN (8)
 Universal Health • Funding
✓ Includes a big amount of funding for
Care/Coverage (UHC) scholarships for those who are
taking degree-related to medical
• Astana Declaration sciences. (condition = RSA)
• All people having access to quality health ✓ 50% PAGCOR, 40% PCSO, which
services* w/o suffering the financial hardship includes budget from national
associated with paying for care. gov't/congress.
• All people (population coverage)
• Having access to quality health services (service Take note: UHC = under principle of social justice
coverage) (equity) thereby all individuals must have access to it.
• Without suffering financial hardship associated
w/paying for care (financial risk protection) TOOLS IN CHN PRACTICE
• Including: prevention, promotion, treatment,
rehabilitation and palliation. ✓ Community Organizing
✓ Health Education
RA 11223 (National Policy) ✓ Family-Nurse Contacts
✓ Bag Technique
➢ Guarantees that all Filipinos are eligible for basic
✓ Epidemiology
care.
✓ FHSIS
➢ There's a limitation because we cannot cater all
the services.
➢ No deposits to be required upon admission. 1. Community Organizing
➢ Signed into law February 2019, IRR Oct 2019 Primary Health Care: Cornerstones
Type of Service
• Active Community Participation - most
• Individual-based/Population-based important
(newborn screening, cervical Ca screening) • Inter-intra sectoral linkages - w/the help of
✓ Population based: corresponds other professions towards achieving goal.
w/the projects of the DOH • Use of Appropriate Technology - must
(immunization, nutrition) provide safe care
✓ Individual-based: context of • Support Systems made available - w/the
hospital admission (during the pt's support of the local & national gov't
hospital admission)
Community Organizing
• Eligibility & Membership
✓ direct/indirect contributors • Is a sustained and continuous process of
✓ Direct: under formal economies educating and mobilizing people to solve
✓ Indirect: children, senior citizens, an their own problems.
• Organization of Local Health Systems • Is a process whereby the community
✓ Province-wide and City-wide members develop the capability to assess
✓ Province-wide: combined their health needs and problems, plan, and
w/municipal network implement actions to solve these problems,
✓ City-wide: integrated hospitals = *put up and sustain organizational structures
ensures coverage from anyone who which will support and monitor
would like to avail their services implementation of health initiatives by the
• Health promotion & HRH (Human people.
Resource for Health) • C: Capacity Building = we want the people
✓ Ensuring that health promotion to understand the problem and the solution is
activities are carried through national in their which requires teamwork.
& local authorities.
✓ Human resources for health will be Participatory Action Research
also given emphasis.
• Is a community directed process of gathering
✓ Salaries will be standardized
and analyzing information or an issue for the
regardless of the classification of
process of taking and making changes.
LGUs.
• "The community itself is the one doing the
✓ salary according to the category of a
collection, analysis, and planning to those
municipality: depends on the income
problems."
of the LGU.
✓ HRH = provides opportunity for • A process of empowering the powerless in
nurses. (Requires training for society
certification)

CA 2: CHN (9)
 COPAR 3 phases:

A continuous and sustained process of educating the • Social Preparation: Pre-entry to Social
people to understand and develop their critical Investigation
awareness of their existing condition, working with • Social Mobilization: Movement of the
the people collectively and efficiently on their people
immediate and long-term problems, and mobilizing • Capacity Building: Must be present during
the people to develop their capability and readiness the beginning and end of the COPAR.
to respond and take action on their immediate needs
towards solving their long-term problems. Pre-entry/Site Selection
Values ❖ Establishing a criteria for selection
❖ 100 or more families
✓ Human rights: everybody deserves a better
❖ Economically marginalized
life
❖ Accessible location
✓ Social Justice: respect each other's rights
❖ Peace and Order situation: conducting ocular
✓ Social responsibility: requires teamwork
visits
The FACE of COPAR
Entry and Integration
Focus = people must acquire "Self-Reliance"
❖ Gaining endorsement from local leaders
Aim = Community Development: everyone will ❖ Formalizing partnerships with concerned
benefit w/respect to human rights and social justice. agencies/authorities
❖ Establishing rapport with the people
Concept = TEAM work because it is for the benefit of (establish contract setting: within your
all members. capacity to avoid high expectations)
❖ Imbibing community way of life
Element = Participation *Very Important Aspect!!!
❖ Spending time with the community.
Strategies: Teaching, Training, Transfer of
Social Investigation/Community Study
technology = helping people to acquire skills
necessary for addressing each of their health ❖ Focus: determine community problems
problems. together with people.
Steps of Community Organizing Participatory Methodology: Community Diagnosis
Research
• Is a process of gathering, collating,
I. Pre-Entry: looking for a community processing, and analyzing data to determine
• Conducts ocular inspection community problems.
II. Entry and Integration: engaging w/the • Two types:
community ✓ Comprehensive: used in the
• Gaining the community's trust & beginning and end of community dx
cooperation. (used for evaluating outcomes from
• Establishing a smooth relationship within its previous state)
the members of the community. ✓ Problem Oriented: used on
III. Social Investigation/Community Study particular area only
IV. Spotting of Potential Leaders: Some • Tool/Instrument: Survey/Interview (must
members of the community that has an initiative be valid & reliable = must match the
towards giving his/her service to the community. objective)
V. Core Group Formation
• Establish the foundation of group- NEEDED DATA
formation
Demographics
• Calling for an assembly
• Age & Sex
VI. Community Organizing/Social Mobilization
• Religion
• Implementing initiatives towards solving
• Civil Status
problems
VII. Evaluation and Phase Out Socio-economic Indices
• It is important to remind the members of • Education & Occupation
the community regarding this phase.
• We are not their "Messiah" thus, we are Health Status
just "facilitators" that provides guidance Environmental Condition
for them to work with their problems.
• Ventilation
• Waste management

CA 2: CHN (10)
 SPOTTING OF POTENTIAL LEADERS
2. Health Education
Criteria in Selecting a Community Leader:
• Process of creating learning situations that
• Belongs to the economically marginalized will favorable
sector • Influence the people to change their
• Well-respected member of the community behavior.
• good moral standing • Helping people make informed choices about
• Non-formal leader (no current position to do their health.
the tasks efficiently) • "Educating people towards Health Literacy"
• Independent function of health professionals.
Core Group Formation • Applicable in any situation, but the focus is on
❖ Executive Committee (EXECOM): Elders the learning needs of the patient.
❖ They can start "tasking" or organizing in • Goal: Modify Risk Behavior
subcommittees. • Purposes:
❖ They try to solicit participation. ✓ Promote Health
✓ Prevent Disease
Evaluation, Turn-over and Phase-out ✓ Restore Health
❖ Once the organization is capable of running • Aspects: IEC (information → education →
the community on their own. communication = desired outcome/s)
❖ May use metric measures and several HEALTH LITERACY
parameters to determine if the goals were
met. "Health literacy implies the achievement of a level of
knowledge, personal skills, and confidence to take
Arnstein's Ladder of Public Participation action to improve personal and community health by
changing personal lifestyles and living conditions.
Thus, health literacy means more than being able to
read pamphlets and make appointments. By
improving people's access to health information and
their capacity to use it effectively, health literacy is
critical to empowerment. (WHO)

• "It is more beyond acquiring knowledge, thus

utilizing it."

3. Family-Nurse Contacts
✓ Clinic visit
✓ Home visit
• We want to empower the community and allow ✓ Telephone contact/Telehealth
them to take full control with their lives. ✓ Written communication
• Citizen Control: the phase where the community ✓ Group conference
reaches the full control on their lives. CLINIC VISIT
• not fixated on a certain level, sometimes it goes
up/down. (Depending on the community) • Refers to the Health Center/RHU
• Made accessible to the population
COPAR SYNTHESIS:
• Provision of medical and nursing services at
• Input: to Organize (organizing people) → the health facility made available and
Process Organizing (Organized people) → accessible to the community.
Output: Organization (organized people) • Advantages:
• Venue for people to work together. o Fosters family initiative: allows the
family to decide.
• Recognizing the problem thus realizing the
o Allows the nurse to maximize her
solution is in their hands
service to the community:
• Example: "Doctor Quack 2x” game =
• Has 3 Phases:
realizing that the people can solve the
o Pre-consultation: assess & admit
problem!"
o Consultation: assist
• Medical mission: doing an outreach (one
o Post-consultation: administer &
time, big time only) over communities that
advice
don't have access for health services.
• Disadvantage: Care in unfamiliar
environment (esp. among children)

CA 2: CHN (11)
Activities: 5 A’s (assessment, admission, assisting, Criteria in Determining Priority problems of the
administration, and advice) family (applicable only in Philippine setting)

HOME VISIT Nature of the problem (identify if: health threat,

health deficit, or foreseeable crisis, wellness state)
• Defined as a professional "face to face" contact
for the purpose of providing care. ✓ Health Threat: can be a condition that
• "Bring the best of the profession" causes the risk of having disease
• made by the nurse with the patient or his family (environmental, sanitation, personal)
for the purpose of providing health care services ✓ Health deficit: presence of disease/illness
or further attain an agency's objective. ✓ Foreseeable crisis/Stress point: an
• Considerations: Purpose, Planning, anticipated period of unusual demand on the
Participatory family, in terms of resources or adjustment.
• Advantage: ✓ Wellness state: none of the three, there is a
o Offers first-hand assessment of the home potential to promote health.
environment Criteria in Determining Priority Problems of the
o Care given at familiar environment Family
• Disadvantage: Time consuming & limited
service • Nature of the problem
• Modifiability of the problem: "yung kaya agad
Purposes of Home Visit
tugunan" *more practical to address
1. Give nursing care to sick, postpartum mother, • Preventive potential: mostly are "Health
newborn Threat"
2. Find living conditions of the patient/family. • Salience: awareness and perception of the
3. Provide health education to IF (infant feeding) family to the problem.
4. Supervise home sanitation and Health practices
FNCP
5. Detect, prevent, & report presence of comm
disease. • Goal: must address the first level of problem
6. Establish relationship between health agencies (often used as a statement of health status
& public for the promotion of public health. change) ex: improved weight
Principles in Planning for a Home Visit • Objectives: equipping them w/capacity in
providing care (specific)
1. Have purpose or objective
2. Make use of all available information 4. Bag Technique
3. Focus on essential needs of the individual and • A tool making use of a public health bag that
family but allows the nurse to perform procedures with
4. Prioritize needs recognized by the family ease and deftness, therefore saving time and
5. Should involve the individual & family effort.
6. The plan should be FLEXIBLE. • Systematic way of using the PH bag
Steps in Home Visit: • We are not doing Home Deliveries (HD) until
now to decrease the risk of maternal and
• It is very important to secure consent prior to child mortality rate.
a procedure.
• Assessment: start w/the healthy member to Main consideration: Prevent Spread of Infection
avoid cross-contamination Principles: 5C's
• observe aseptic technique
• end: make a summary and secure an Cleanliness
appointment for a follow up. (Preferably
• The bag must not below the knees
clinical visit)
• Facing you, not the patient (CHN Bag)
FAMILY ASSESSMENT: DURING A HOME • Safe distance between you and the bag
VISIT • Handwashing
• Limiting the number of times opening the
2 Levels of Assessment: bag.

• First: health problems Convenience

• Second: analyze these problems in light of
doing tasks • Making sure that the materials are at ease of
✓ identify concerns with the family access.
✓ prioritize problems Complete: Make sure that all the necessary
✓ formulate plan of action materials are inside.

CA 2: CHN (12)
Contents are organized: In a way that you know Sources of Demographic Data
where the instruments are located.
1. Census - An official periodic enumeration of
Coordinated actions: Provides coordinated actions population; data gathering about 100% of the
(less time consuming). population. (not done annually because it is total
enumeration)
• Starting 2010: done every 5 years
5. Epidemiology • 2 ways:
• Backbone of prevention o De Jure - place of usual residence.
• Study of patterns of occurrence and distribution o De Facto - where people are
of diseases as it affects the population physically present at the time of the
• Study of distribution and determinants of health- census.
related states or events in specified populations, Importance of census:
and the application of this study to the prevention
and control of health problem. ✓ Determines funding
• Goal: prevent disease spread ✓ Creation of districts, barangays,
• Strategy: Information dissemination
• Tool: research 2. Registry of Vital Events
• RA 3753 - Civil registry law
Uses of Epidemiology in CHN: • RA 10625 - Philippine Statistical Act of
2013 *main repository of vital events in
✓ Identify etiology/origin of disease
our country
✓ Determine natural history of disease (course
and outcome) - determines the trajectory of • PD 651 - Birth registration law
the disease a. Certificate of Live Birth - signed
✓ Determine population characteristics: by the by birth attendant; must be filed
use demographics within 30 days. (leads to inaccurate
✓ Evaluate success of health recording/age declaration due to
programs/interventions delayed submission)
b. Death Certificate - signed by a
Branches of Epidemiology: physician; in doctor-less places, the
mayor.
1. Descriptive epidemiology - concerned with ✓ must be filed within 48 hrs
disease frequency and distribution. (Hypothesis from the occurrence of
only which will lead to analytical for confirmation) death.
2. Analytical epidemiology - analysis of the ✓ death registry is almost
causes or determinants of disease (pt that will complete --> mortality data
undergo antigen testing for COVID 19 to confirm most accurate data/best
presenting s/sx) reflection of health status
3. Intervention/Experimental epidemiology - of a population.
study of effectiveness of new methods of
prevention/treatment of disease. (testing VITAL STATISTICS
through the use of several interventions)
• from Latin "Vita" meaning LIFE
✓ Real time/Real world studies: research
• Statistics = measurement
that are held outside which may interfere
• Measures quality of health and life
the findings of the study due to
• Quantitative analysis of events that may
uncontrolled variables.
increase or decrease the population
4. Evaluation epidemiology - measurement of
the effectiveness of different health programs. • Includes: birth, death, marriage, divorce,
annulment, legal separation, adoption,
Types of Epidemiologic Data: legitimation,

• Demographic Data - census, surveys, vital INDICATORS OF COMMUNITY HEALTH

records, civil registry
Morbidity
o Refers to the characteristics of the
population • Statistics of disease
• Vital Statistics Data - BR, DR, and Marriage • Incidence
• Environmental Data - Physical and Social • Prevalence
• Health Service Data - rules out the use of
health services within an area. Mortality (basis for the quality of health = legal
record)
Note: "Science must govern our actions" hence
there must be evidence behind each of our actions. • Statistics of death

CA 2: CHN (13)
Infant Mortality Rate - How many infants die for • Secretary of Health shall have the authority
every 1,000 who are born. to declare epidemics of national and/or
international concern.
• Reflects survival (from intrauterine to
• Reporting must be done by health
extrauterine), estimating life expectancy (low
professionals, facilities, and both GO/NGOs.
infant mortality = long life expectancy)
• Formula: Notes:
✓ # Of deaths under 1y/o in a given
year / # Of live births in the same • National Declaration: vested to DOH
year x 1000 = IMR • Established protocols as part of disease
response (minimum public health standards)
Swaroop's Index - for the old • Established the legal basis of quarantine and
isolation protocol and non-cooperation. (Rule
• Percentage of the total deaths that are aged
IX s.1)
50 years and older.
• Determines longevity Prohibited Acts (Under RA 11332)
• Inversely proportional w/IMR
• Formula: • Unauthorized disclosure of private and
✓ Total # of deaths aged 50 & older in confidential information pertaining to a
a year/ Total # of death in the same patient's medical condition.
year x 100 = N • Tampering of records relating to notifiable
diseases or health events of public health
PATTERNS OF OCCURRENCE OF DISEASE concern, which includes identification
(FREQUENCY) documents or passes and other similar
documents for the movement of cargoes and
• Sporadic - on and off occurrence of disease; passage of persons.
occurrence of 1 or several unrelated cases of a
• Intentionally providing misinformation by
disease in the community. (isolated)
deliberately providing false or misleading
• Endemic/Communicable or Local Diseases - information/details in the required official
cases of the disease are persistently or forms
constantly present in the community; cases are
• Non-cooperation of:
present all year round. (pneumonia, diarrhea,
✓ agencies, organizations to report,
filariasis)
respond
• Epidemic - an unexpected increase in the ✓ identified cases to provide
number of cases of a disease in the community. information, comply with quarantine
• Pandemic - an epidemic of word-wide or • Discrimination of persons infected
continental proportions. (A wide spread of a w/notifiable disease
disease)
• Penalties: Fine/Imprisonment
✓ It has 6 levels: 1,2,3,4,5,6*sustained
human to human transmission Category 1 (within 24 hours)
(worldwide)
The following diseases/syndromes shall be
Types of Epidemics: categorized as immediately notifiable:

• Common source: point/continuous source ✓ Acute flaccid paralysis

✓ Point: sudden increase then sudden drop ✓ Adverse event ff immunization;
✓ Continuous: as long as the source is ✓ Anthrax
present, it will rise. ✓ COVID 19
• Propagated: human to human ✓ Hand-Foot-and Mouth Disease
• Seasonal: in our country, our season is only wet ✓ Human Avian Influenza
& dry ✓ Measles
• Cyclical: follows an interval (e.g., within 6 ✓ Meningococcal disease
months, 6 years, and etc.) ✓ Middle East Resp syndrome
• Epidemic of NCD's: behaviors and choices in
Category 2 (weekly/every Friday)
life (additional)
• Facilities within the area covered by the
RA 11332 - Act aims to prevent Epidemics thru
health centers must submit report of these
Mandatory Reporting of Notifiable Diseases and
diseases every Friday. (local/endemic
Health Events of Public Health Concern.
diseases)
• Provided a list of nationally notifiable • Not considered as "public alarm".
diseases and health events of public health
concern with their corresponding case
definitions.
CA 2: CHN (14)
Field Health Service Information System (FHSIS) Health in SDG 3

• It is the official system of the DOH and • Maternal mortality

designated national health statistics as per • Newborn and child mortality
EO 352. • Communicable diseases (aids, tb, malaria,
• 2 Components: NCDs, waterborne diseases)
• NCDs and mental health
Recording Tools:
• Substance abuse
✓ facility-based documents with more detailed • Road traffic accidents
data and contains day to day activities of the • Reproductive health
health workers. • Universal health coverage
✓ must be accurate, timely, and "neutral". *No • Environmental health (chemicals, air, water,
presence of bias and soil pollution)
Individual Treatment Record (ITR): name, date of 4 Means of Implementation:
birth, address of the pt, chief complaint, assessment
data, prescriptions, treatments, and procedures done ✓ Tobacco control
to pt. ✓ Vaccines and medicines
✓ Health financing and workforce
Take Note: Documentation is vital on public ✓ Global health security
health.

Target Client List (TCL): contains the list of names Non-Communicable Disease
of people who are eligible for a particular health
programs/services. (e.g., family planning services) • Leading cause of death: CAD

Summary Table (ST): "S" record that reflects the Risk Factors
accomplishments of a single barangay regardless of ✓ Physical inactivity
health services catered to the community. ✓ Unhealthy diet/poor nutrition
• Has 2 components: ✓ Smoking and alcohol*
✓ mortality report ✓ Hypercholesterolemia
✓ morbidity report: being tallied at the ✓ Obesity
end of the day in terms of the leading ✓ Increased blood glucose
cause of disease. Prevention Strategies
Monthly Consolidation Table (MCT): reflects to the Promote physical activity & exercise
whole municipality/RHU reports that caters a cluster
of barangays. (combination of all STs) • Physical Activity = (enjoyable) washing
dishes, sweeping floor, cleaning the house,
FHSIS Reporting Tools: these are summary data gardening, walking.
that are transmitted or submitted on a weekly,
• Exercise = (strenous) aerobics, walking or
monthly, quarterly and on annual basis to the next
jogging at least 3x/week.
level.
Promote proper nutrition (ABC)
E (electronic) FHSIS - data that can be easily
accessed by the health professionals immediately. • Aim for the ideal body weight (IBW)
• Build health nutrition-related practices
(increase fiber intake, low salt, sugar, & fat
Community and Public Health intake)
• C - choose foods wisely! (calorie count,
Nursing interpreting nutrition table)
• Agenda 2030: SDGs (started on 2016 which NCD Prevention Strategies (3PS)
ends in 2030)
• SDGs: successor of MDG ✓ Promote Smoke-Free Environment
• Consist of 17 goals which are directed to health- ✓ Stress management
related aspects of life.
Healthy Lifestyle! (BEAT)
• Core of SDGs: Good Health and Well-Being:
ensures healthy lives and promote well-being for B - be Active
all ages. E - eat right
A - always smile
T - time to end vices

CA 2: CHN (15)
Use of Infographics & Social media: as a platform • condition: must attend monthly health
to influence other individual with regards to promoting programs in return of cash transfer.
health.

FACILITATE SMOKING CESSATION (4 A'S)

Ask - smoking status

Environmental Sanitation
Advise - to stop smoking, can cause death • Study of all factors in man's physical
environment which may exercise a deleterious
Assist - "formulate" quit plan
effect on his safety and well-being.
Arrange follow-up - to monitor progress • "to study how these environmental factors
affects health, and develop programs to control
RA 9211 (Tobacco Regulation Act of 2003)
disease-related to them."
Prohibited Acts: • Areas:
✓ Water sanitation
• Smoking in public cases ✓ Food sanitation
• Sale of tobacco products to persons below ✓ Waste management
18 years of age
• All forms of tobacco advertising in mass SANITATION RELATED LAWS
media and regulates other forms of tobacco
PD 856 - Sanitation Code *most comprehensive
promotions.
• The law requires a printed warning on PD 825 - Anti-Littering Law
cigarette packages.
RA 8749 - Clean Air Act (emission testing, prohibits
RA 10351 1st SIN Tax Law: to reduce the access of the use LED in gasoline)
people to tobacco
RA 9275 - Clean Water Act
RA 10643 Graphics Health Warning Law: can be
seen on cigarette packs. RA 9003 - Solid Waste Management Act

EO 26 RA 10611 - Food Safety Act

• Nationwide smoking band RA 11311: free internet service, clean sanitary

facilities, adequate ventilation, and lactation stations
• Implemented July 2017
required in transport terminals.
TRAIN LAW
Water Sanitation: meant to ensure that water supply
• Tax reform for acceleration and inclusion is safe for human consumption.
• Increase excise taxes to fund universal
Prohibitions of the Code of Sanitation on Water
healthcare services
Supply
• Tobacco and alcohol
• Sugar beverage tax • Washing and bathing within a radius of 25
meters from any well or other source of
RA 11346 (SIN Tax)
drinking water.
• Raises cigarette tax from 35 php to 45 php • Construction of artesians, deep, or shallow
well within 25 meters from any source of
“ComPack” pollution (including septic tanks and
sewerage systems)
• Part of Medicine Access Program (MAP)
• Drilling a well within 50-meter distance from
• Offers complete package of medicines for
a cemetery.
certain diseases.
• Conditions: people must be enrolled for Methods of Water Analysis to Determine
them to include to the TCL. Portability
• Requires reporting monthly in combine with
physical examination. • Physical - examination of water for its
appearance, odor and taste; can be done by
RA 1131 anybody.
• Chemical - test for chemical attributes of
• An act institutionalizing the Pantawid water, such as pH and presence of Cl, Fe
Pamilya Pilipino Program
• Bacteriological - test for the presence of
• Section 2: the state shall promote a just and indicator organisms, such as Coliforms;
dynamic social order thereby uplifting its when water is Coliform +, it is contaminated
citizens and marginalized sectors from by human excreta.
poverty.

CA 2: CHN (16)
 HOUSEHOLD TREATMENT OF WATER II. Separate Raw from Cooked Food
• Separate raw meat, poultry, and seafood
• Boiling from other foods.
• Filtration • Use separate equipment and utensils,
• Chemical disinfection - chlorine is the most such as knives, cutting boards, for
frequently used, although it is not effective in handling raw food.
destroying amoeba. • Store food in containers to avoid contact
TREATMENT OF WATER PUBLIC SUPPLY between raw and prepared food.
III. Cook food thoroughly
Sedimentation • Cook food thoroughly, especially meat,
poultry, eggs, and seafood.
Flocculation/Coagulation - the addition of a
• Bring food, like soups and stews to boiling
coagulant (alum to form flocs that will settle at the
to make sure that they have reached
bottom.
70’C. For meat and poultry, make sure
Aeration - water is sprinkled into the air to allow water that juices are clear, not pink. Ideally, use
to absorb oxygen to improve its palatability. a thermometer.
• Reheat cooked food thoroughly.
Filtration IV. Keep Food at Safe Temperatures
Disinfection with Chlorine – a residual of at least • Do not leave cooked food at room
0.1 ppm in tap water is desirable. temperature for more than 2 hours.
• Refrigerate promptly all cooked and
Fluoridation – to prevent dental carries in the perishable food (preferably below 5’C).
population drinking the water; must not exceed 1.5 • Keep cooked food piping hot (more than
ppm to prevent dental fluorosis (fluorine toxicity) 60’C) prior to serving.
• Do not store food too long even in the
APPROVED TYPES OF WATER FACILITIES
refrigerator.
(UNDER PD 856)
• Do not thaw frozen food at room
Level 1 (point source) temperature.
V. Use Safe Water and Raw Materials
• a protected well or spring • Use safe water or treat it to make it safe.
• no disruption system • Select fresh & wholesome food.
• adaptable for rural areas • Choose food processed for safety such as
• within 250m from the farthest use pasteurized milk.
Level 2 (communal faucet or stand post) • Wash fruits and vegetables, especially if
eaten raw.
• Composed of a source reservoir, a piped • Do not use food beyond its expiry date.
distribution network and communal faucets
• Located not more than 25 m from the farthest What to Do in Case of Suspected Food-Borne
house Illness?

Level 3 (waterworks systems/individual household ✓ Preserve the evidence. If a portion of the

connection) *highest level suspected food is available, wrap it securely
with a “danger” label and freeze it.
• Suited for urban areas ✓ Seek treatment as necessary, if symptoms
• Each household has a tap water undergoes persist or are severe (i.e., bloody diarrhea,
treatment at the water facility. excessive nausea and vomiting, or high
temperature), immediately consult a doctor.
Food Safety: The assurance that food will not cause ✓ Report the incidence to the local health
harm to the consumer when it is prepared and eaten department.
according to
RULES ON FOOD SAFETY (COMMUNITY)
DOH: 5 Keys to Safer Food
➢ The food establishment must have a sanitary
I. Keep Clean permit from the city or municipality that has
• Wash your hands before handling food jurisdiction over the business.
and often during food preparation. ➢ No person shall be employed in any food
• Wash your hands after going to the toilet. establishment without a health certificate
• Wash and sanitize all surfaces and properly issued by the city/municipal health
equipment used for food preparation. officer.
• Protect kitchen areas and food from ➢ Validity of health certificates: every 1 year
insects, pests, and other animals. (pwede din 6 months due to "endo")

CA 2: CHN (17)
➢ Health certificates must be also filed within the 2. Sanitary landfill
area you are applying. (e.g., manila-manila) – • Uses the principle of burying the refuse
because you are serving for the residents inside • Involves a collection system and a land fill
that area. area.
➢ No person shall be allowed to work on food • Ideally the sanitary land fill should have a
handling while he/she is afflicted with a plastic lining to prevent seepage which
communicable disease, including boils, infected ends in leachate and contamination of
wounds, respiratory infections, diarrhea, and water tables.
gastrointestinal upset. 3. Incineration: Burning
• RA 8749: Clean Air Act
RULES ON FOOD SAFETY
• Prohibition of incineration after 3 years of
➢ After proper washing, the utensils are then the promulgation (January 2001) which
subjected to one of the ff bactericidal treatments: means by January 2004, burning or
➢ Immersion for at least half a minute in clean hot incineration is prohibited.
water (77'C) 4. Open dumping (not acceptable)
➢ Immersion for at least one minute in lukewarm
water containing 55-100 ppm of chlorine solution Criteria for Acceptable Excreta Disposal Facilities
Sanitary
Waste Management
• Simple, cheap and easy to construct with
• Is collection, transport, processing, recycling of local materials
disposal of waste material. This term usually • Easy to maintain
relates to materials produced by human activity • With adequate protection against the
and is generally undertaken to reduce effect on elements and provides desirable privacy
health, the environment and aesthetics. • Acceptable to the users.
• Practice of waste management may differ in
Approved Types of Toilet Facilities
developing nation to under developing nation,
urban to rural area, and residential to industrial Level 1
setup.
• Non-water carriage toilet - ex. pit latrine
Definition of Terms • Toilet facilities requiring small amount of
water to wash the waste into the receiving
• Refuse - all solid and semisolid wastes
space; ex. pour flush toilet * aqua privy
except human excreta
(usually yung may “black hole” lang)
• Garbage - biodegradable waste
• Rubbish – unwanted or useless materials Level 2: On site toilet of the water carriage type with
water-sealed (flush type) with septic tank.
Prohibited Acts on Solid Waste Management (RA
9003) Level 3: Water carriage type connected to sewerage
system to treatment plant.
• Open burning of solid wastes
• Open dumping
• Burying in flood-prone areas MATERNAL AND CHILD HEALTH
• Squatting in landfills
• Operation of landfills on any aquifer, • Main cause of maternal death: pregnancy and
groundwater reservoir or watershed childbirth
• Goal: to ensure safe pregnancy among all
WASTE MANAGEMENT: COLOR CODING pregnant women.
✓ Green – Biodegradable • WHO recommendation: at least 4 routine
✓ Yellow - Infections & Pathological waste antenatal visits
✓ Black - Non biodegradable
PRENATAL CARE/ANTENATAL VISITS
✓ Orange - Radiologic waste
(MINIMUM OF 4)
✓ Red – Sharps
• Home-based mother's record
Methods of Refuse Disposal
• Encourage all women to deliver in the health
1. Waste recover/zero-waste technology as facility
total recycling • Currently: A pregnant mother must have at least
• Composting 8 visits
• Recycling of Factory returnable
SAFE MOTHERHOOD
• The most viable method
• Sanitary Assessment: age of pregnancy, height, weight,
• Needs to educate people the right way GPTPAL, LMP, AOG, and Lab/Diagnostic tests
CA 2: CHN (18)
5 too’s (remember) Micronutrient Supplementation
• Too young • Prevent anemia and Neural tube defects
• Too many: if the mother reaches >5 number • Pallor - anemia, Normal -11g/dl
of pregnancies
• Too old Targets Preparations Dose/Duration
Pregnant Tab containing 1 tab 1x/day for 6
• Too close Women 60mg EI w/ 400 mos. Or 2
• Too sick mcg Folic Acid tabs/day if 2nd or
3rd trimester
Provision of Immunization: Lactating Tab containing 1 tab 1x/day for 3
Women 60 mg El w/ 400 mos. Or 90 days
Tetanus Diphtheria (TD) Immunization mcg Folic Acid

• Protection against tetanus

• Preferably given at the 4th month of Vit. A Deficiency (VAD)
pregnancy • Vit. A - can cause congenital problems if
• Fully Immunized Mother (FIM) = 5 shots given early
• Having TD will benefit both mother and baby • Do not give Vit. A if woman is taking
in case the baby reacted to pentavalent multivitamins.
vaccine.
Targets Preparations Dose/Duration
Schedule of Tetanus Diphtheria for Pregnant Pregnant 10,000 IU 1 cap/tab
Women (instruct mothers for early consultation) Women 2x/week (4th
month until
• Nulliparous: at least 2 doses before delivery delivery)
(pwede na din 1) Lactating 200,000 IU 1 Cap 1x (within
Women 4 weeks after
• 2 weeks before expected date of delivery
delivery)
• Minimum of 3, but ideally 5.
• Effectivity: not determined, less than a year
Iodine Supplementation
st
1 Dose: any time in pregnancy
Targets Preparations Dose/Duration
2nd Dose: 1 month after the 1st dose Children or Iodized oil 1 cap for 1 year
School Age capsule with
✓ Length of protection: 3 years 200mg Iodine
Women 15- Iodized oil 1 cap for 1 year
3rd Dose: 6 months after the 2nd dose 45 years old capsule with
200mg Iodine
✓ Length of protection: 5 years
Adult Males Iodized oil 1 cap for 1 year
th
4 Dose: 1 year after the 3rd dose capsule with
200mg Iodine
✓ Length of protection: 10 years

5th Dose: 1 year after the 4th dose THE EINC PRACTICES DURING
✓ Length of protection: Lifetime INTRAPARTUM PERIOD
Notes on TD for Pregnant Women • Continuous maternal support, by a companion of
her choice, during labor and delivery.
• If2nd dose is given at least 2 weeks before
delivery = assurance of full protection against • Mobility during labor – the mother is still mobile,
neonatal tetanus within reason, during this stage.
• 2nd dose is given even if mother has already • Position of choice during labor and delivery
pregnancies. • Non-drug pain relief, before offering labor
• 3rd dose of DPT in infancy = 1st dose of anesthesia.
Tetanus Toxoid. • Spontaneous pushing in a semi-upright position.
• Episiotomy will not be done, unless necessary
• Active management of third stage of labor
(AMTSL)
• Monitoring the progress of labor with the use of
partograph.

Primary Health Facilities: Only non-high risk

pregnant woman can be catered. (If high risk, do a
referral!)

CA 2: CHN (19)
 POSTNATAL VISITS (Minimum of 2) hemorrhage in premature newborns. Properly
timed cord clamping means waiting for the cord
Number of WHO/UNICEF/DOH PHN 2007
pulsations to stop (between 1-3 mins)
Visits CPG 2005/2006 Book
First First 24-48 hours Within 3-5 ✓ Non-separation of newborn and mother for
after delivery days early breastfeeding – protects infants from
Second 6 weeks after 6 weeks after dying from infection. The first feed provides
delivery delivery colostrum, a substance equivalent to the babies’
first immunization due to its protective
RA 11148: Kalusugan at Nutrisyon ng Mag-Nanay properties.
Act
RA 9288 - promotes early detection to prevent
• Caters nutritional support, counselling, and unnecessary deaths and mental retardation among
immunization. infants
First 1000 Days: is the period of rapid growth where • "Newborn Screening Act of 2004"
nutrient deficiencies can have long term • Detects congenital metabolic disorders that
consequences. Good nutrition during this period can may lead to mental retardation or even death
help maximize the child’s ability to grow, learn and if left untreated.
develop that has profound effect in his/her future • Expanded NBS offers 2 packages, basic 6
health, well-being and success later on in adulthood. and additional 22 for a total of 28 diseases.
The quality of nutrition during the first 1000 days can
have a significant impact on the achievement of 6 DISORDERS IN THE NBS PACKAGE
national and global development goals.
Screened Effect if “Not” Effect if
CHILD HEALTH PROGRAMS Screened “Screened”
and “Treated”
Essential Newborn Care: "Unang Yakap" Congenital Severe Mental Normal
Hypothyroidism Retardation
• Launched during: December 1, 2009 (CH)
Congenital Death Alive and
• AO 2009-0025 - adopting policies and
Adrenal Normal
guidelines on essential newborn care Hyperplasia
• Focus: MDG 4 (CAH)
• 4 Time-Bound interventions: Performed in Galactosemia Death or Alive and
the first 90 minutes of life (GAL) Cataracts Normal
Phenylketonuria Severe Mental Normal
(PKU) Retardation
G6PD Severe Normal
Deficiency Anemia,
Kernicterus
Maple Syrup Death Normal
Urine Disease

NEWBORN SCREENING

• 48-72 hrs or 2-3 days of life (ideal),24 hrs

(maybe), and After 24 hours. (ex: born yesterday
at 8 am, the baby will be viable for NBS at 8:01
am today)
• Trained MD, RN, Midwife, Medical Technologist

1. Using heel prick method, a few drops of

blood are taken from the baby’s heel.
2. Blotted on a special absorbent filter card/
3. Blood is dried for 4hrs and sent to the NBS
4 TIME-BOUND INTERVENTIONS center.
4. After 7 working days, parents claim the
✓ Immediate and thorough drying of the results from their physician, nurse, midwife,
newborn – for 30 seconds to one minute as it or health worker.
warms the newborn and stimulates breathing.
✓ Early skin to skin contact – between the If (+) positive screen:
mother and newborn and delayed for at least 6
hours to prevent hypothermia, infection, and • Released within 24 hours for confirmatory
testing.
hypoglycemia.
✓ Properly-timed cord clamping and cutting – • Referred to a specialist for further
prevents anemia and protects against brain management.
CA 2: CHN (20)
 Roles of RHU staff in NBS Types of Immunity

✓ Advocacy for NBS of every baby. This starts • Natural: most are considered active except
during pregnancy. The family is advised to save "vertical transmission" mother-baby
600 php. • Passive: contains antibodies.
✓ Collection of samples
✓ Assures Transport of specimen within 24 hours
Natural Artificial
following collection of the sample. Active Exposure Antigens
✓ Advice and counsel parents upon receiving the Carrier Attenuated-BCG, OPV,
screening results. Sick of the AMV
disease Killed – DPT, HBV
Newborn Hearing Screening Test Weakened toxins – TT
Passive Breast milk Gamma globulin (6 mos-
• Legal Basis: RA 9709 (IgA) 1yr)
• Focus: Prevention and detection of hearing Placenta Antitoxin/Antiserum/Serum
(IgG)
defects among neonates.
• Otoacoustic Emission Test (OAE) – done one
day after the infant is born. Expanded Program on Immunization
Breastfeeding “TSEK” • RA 10152
• Mandatory and Basic Immunization of Infants
• Women should go for full and exclusive
and Children
breastfeeding. (within 6 months, no other than
• PD 996 repealed already
breastmilk!)
• Covered Population: Under 5 years of age
• Breastfeeding: T – tama, S – sapat, EK –
eksklusibo Objective of the expanded program on
• Launched: February 23, 2011 immunization
• Target: new/expectant mothers in urban areas
• Encourages mothers to exclusively breastfeed • To reduce morbidity and mortality rates
their babies from birth up to 6 months. among infants and children from six
• Exclusive breastfeeding means that for the first childhood immunizable disease.
6 months from birth, nothing except breast milk o TB, Poliomyelitis, Diphtheria,
will be given to babies. Tetanus, Pertussis, and Measles.

Benefits of Breastfeeding Principles

• Offers protection/Immunity • It is based on epidemiological situation

• Offers complete nourishment (1st 6 months) • It is basic health service
• It is mass in approach (to achieve HERD
Recommendations IMMUNITY)

• Frequency: 8x in 24 hours (minimum) Element: TICAS

✓ 6 during day and 2 before bed
• Feed as long as the baby wants. • Target setting: 1 y/o and below (reduces
IMR)
• At 6 months, start supplementary feeding but
breastfeeding should be continued until 2 • Information, education, and
years of age or beyond. communication = render Health Education
• Take note: Malunggay = Enhances lactation • Cold chain logistic management
• Assessment and Evaluation - patient must
National Immunization Program be free from contraindications, vaccines
must be monitored for its efficacy.
Immunization • Surveillance and Research - continuous
process
• Process of conferring artificial immunity.
MAINTAINING POTENCY OF BIOLOGICALS
Immunity
Type of Storage
• Acquired specific resistance usually Vaccine Temperature
attributed to the presence of antibodies. Most Sensitive OPV -15’C to -25’C
• Active immunity is better than passive type to heat AMV (freeze Freezer
because it produces a secondary immune dried)
response which leads to the formation of Less sensitive DPT 2’C to 8’C
to heat Hepatitis B Refrigerator
memory cells which acts faster and stronger BCG
and lasts for a lifetime. TT

CA 2: CHN (21)
Duration of Storage

Beginning of the shift & end of the shift: monitor the

temp.

• RHU - 1 month
• Provincial Health Office - 1 month
• Regional Health Office - 3 months

Contraindications

• Fever above 38°C - not unless it reaches this

specific temp or above
• Conditions requiring hospitalization
(severe) - e.g., severe pneumonia
• Immunosuppression - if the patient is
immunocompromised. REMEMBER:
✓ weak IS + weakened antigen =
disease • Causes fever after 24 hours: Pentavalent
✓ weakened antigen + strong IS = • Can cause seizure: Penta (watch out!)
resistance • Fully immunized: child receive all before 1
year of age
Strategies • Completely immunized: after 1 year of age
• Conduct routine immunization for • VIT A: causes night blindness (decreased)
infants/children/women through the reaching • Fe: anemia (decreased)
every barangay (REB) strategy • Iodine: mental retardation (decreased)
• Supplemental Immunization Activity (SIA)
- school-based immunizations
• Strengthening Vaccine-Preventable
Diseases Surveillance

ROUTINE IMMUNIZATION

• BCG and Newborn HBV (4 times ideally, min of

3 doses): given 1st 7 days in life
• Pentavaccine (5 in 1 shot/DPTHH)
✓ DPT
✓ Hepatitis B
✓ HIb
• OPV and IPV
• PCV
• MMR (given at 9 months & 12 months)

CA 2: CHN (22)