The Philippine Health Care Delivery System & Primary Health Care

The Philippine health care delivery system & primary health care

Mr. John Frederick C. Udtujan, MAN, RN

PROGRAMS OF DOH

D – ental Health

O – steoporosis Prevention H – ealth Education and Community Organizing P – revention and Control of Communicable Diseases R – eproductive Health (RH) O – lder Persons Health Services G – uidelines for Nutrition R – ehabilitation and Management of Non-Communicable Diseases. A – lternative Health Care Practices (Herbal Meds/Acupressure) M – aternal and Child Health and Integrated Management of Childhood Illness (IMCI)

Primary Health Care • An essential health care made universally accessible to individuals and families in the community by means acceptable to them through their full participation and at a cost that the community and country can afford every stage of development (WHO). • CONCEPT: PHC is characterized by PARTNERSHIP & EMPOWERMENT of the people towards SELF-RELIANCE.

“accessible, acceptable and sustainable” • It is a strategy, which focuses responsibility for health on the individual, families and the communities. “full participation

and active involvement of the community”

Primary Health Care CommunityBased

Accessible

Affordable

PHC Acceptable

10/16/2013

Sustainable

4

FUNCTIONS OF PHC 1. Community-Based • Within the community, health services should be delivered to where the people are 2. Accessible • Within the reach of the people and those in far-flung areas should not be deprived of these health services by regular periodic visits by the health personnel and training of indigenous resident volunteers of the area

3. Acceptable • Serves for the people; the willingness of the people to identify and solve their problems • The people agree and are satisfied with the health care services which meet the requirements and needs of the area • Families from lower income groups are the ones mostly served

FUNCTIONS OF PHC 5. Sustainable • For these health services to be successfully utilized, maintained and continue needs the active participation and involvement of the community members. • The residents, once they have developed awareness building and knowledge on health and health-related issues, will consequently develop self-confidence and self-efficacy which are the driving forces for empowerment and self-reliance

FUNCTIONS OF PHC 6. Affordable • At a cost the people & the government can afford • Traditional herbal medicines and other alternative forms of healing must be used together with the essential drugs which are generic and are more affordable 7. Self-reliance • People could provide for their own needs

OBSTACLES TO PRIMARY HEALTH CARE • Role Complexity – the CHNurse is mandated to perform a lot of functions with its inherent responsibilities which requires the provision of a high level of nursing care. He/she needs to be skillful in both technical and communication skills. • Special

PRIMARY HEALTH CARE • GOAL: Health for all Filipinos and Health in the Hands of the People by the year 2020

Framework of PHC People Empowerment

“Health for All Filipinos by the Year 2000 and Health in the Hands of the People by 2020”

Partnership

PRINCIPLES OF PRIMARY HEALTH CARE 1. Accessibility, Acceptability, Availability, and Affordability of Health Services 2. Partnership between the community and health agencies in the provision of quality basic and essential health services 3. Community participation 4. Self-Reliance 5. Social Mobilization 6. Decentralization

PRINCIPLES OF PRIMARY HEALTH CARE 1. Accessibility, Acceptability, Availability, and Affordability of Health Services Health services are delivered where the people live and work. Indigenous residents and volunteer health workers should be given training to develop their capabilities for them to provide health care in their own locality with an ideal ration of 1 health worker for 10-20 households depending on the distance between these households. Low cost appropriate technologies should be utilized for the community to sustain combining it with traditional medicines.

PRINCIPLES OF PRIMARY HEALTH CARE 2. Partnership between the community and health agencies in the provision of quality basic and essential health services People should be the center of development not as objects. Participation is always encouraged and that community needs and priorities should be the basis for planning health services and activities.

PRINCIPLES OF PRIMARY HEALTH CARE 3. Community Participation Participation is considered the core of community organization. Community should be aware and conscious about health and development issues. Planning, implementation, monitoring, and evaluation should be done by the people, even in the selection of Community Health Workers and formation of health committees. Community Participation assumes that people have the capacity to care for their own welfare. Having a sense of ownership for one’s action ensure a sustainable development effort rather than depending on services through external or dole out activities. Partnership within the community ensures a more responsible development initiative.

PRINCIPLES OF PRIMARY HEALTH CARE 4. Self-Reliance Through community participation and cohesiveness of people’s organization, people can generate support for health care through social mobilization, networking, and mobilization of local resources. Leadership and management skills should be developed among the people. Existence of sustained and progressive income generating projects (IGPs), cooperatives, family production, and sustained health care facilities managed by the people are some of the major indicators that the community is leading into self-reliance.

PRINCIPLES OF PRIMARY HEALTH CARE 5. Social Mobilization Convincing all sectors to support and participate in community-based activities through policy, advocacy, media channels, information education campaign, organizational linkages and community mobilization, and establishment of an effective health referral system by the people.

PRINCIPLES OF PRIMARY HEALTH CARE 6. Decentralization This ensures empowerment and that empowerment can only be facilitated if the administrative structure provides local level political structures with more substantive responsibilities for development initiators. This also facilitates proper allocation of budgetary resources.

STRATEGIES • Reorientation and reorganization of the national health care system (RA 7160/Local Government Code of 1991) • Effective preparation and enabling process for health action at all levels • Mobilization of the people with the end view of providing appropriate solutions leading to self-reliance and self determination • Development and utilization of appropriate technology focusing on local indigenous resources available in and acceptable to the community • Organization of communities arising from their expressed needs increase opportunities for community participation • Development of intra-sectoral linkages with other government and private agencies • Emphasizing partnership

Primary Health Care • May 1977 - 30th World Health Assembly decided that the main health target of the government and WHO is the attainment of a level of health that would permit them to lead a socially and economically productive life by the year 2000.

Primary Health Care • September 6-12, 1978 - First International Conference on PHC held in Alma Ata, Russia (USSR). The Alma Ata Declaration stated that PHC was the key to attain the “Health for All by the year 2000” goal

Primary Health Care • October 19, 1979 - Letter of Instruction (LOI) 949, the legal basis of PHC was signed by then Pres. Ferdinand E. Marcos, which adopted PHC as an approach towards the design, development and implementation of programs focusing on health development at community level. • LOI 949 mandated the DOH to use PHC as an approach in planning and implementing health programs • LOI 949 is the “legal basis of PHC in the country” and has an underlying theme “Health in the Hands of the People by 2020”

Board Question What is the legal basis of Primary Health Care approach in the Philippines? A. Alma Ata Declaration of PHC B. Letter of Instruction No 949 C. Presidential Decree No. 147 D. Presidential Decree 996

Primary Health Care How can PHC be POSSIBLE? Control of Communicable Diseases

Offers Health Education Maternal and Child Care Provision of Medical Care and Emergency Treatment Offers “Immunization” Nutrition and Food Supply Environmental Sanitation N “Family Planning” Treatment of Locally Endemic Diseases Supply and Proper Use of Essential Drugs

Primary Health Care E L E M E N T S H O M E

Education for Health (priority) Locally endemic disease prevention and control Essential drug provision Maternal and child health and family planning Expanded program on immunization (PD 996) Nutrition (adequate food and proper nutrition) Treatment of communicable disease Safe water and environmental sanitation Hospital as a center of wellness Oral and dental health Mental health Elderly care

EDUCATION FOR HEALTH • Involves human development and is people-oriented. • It is a dynamic process of giving information and is the 1st step to improve knowledge, skills, and attitude of the people in order for them to voluntarily adopt these teachings as an entry point to human development. • As health educators, we are not here to change the behavior of the individual but rather to motivate him through information campaign for him to voluntarily adapt to these changes as he interacts with the environment.

LOCALLY ENDEMIC DISEASE CONTROL • Focuses on the prevention of the occurrence of endemic diseases because it is continuously present in the community

EXPANDED PROGRAM ON IMMUNIZATION • Exists to control the occurrence of preventable illnesses especially in children. • Immunizations on poliomyelitis, measles, tetanus, diphtheria, and other deadly but preventable diseases are given for free by the government and is an on-going program of the DOH.

MATERNAL AND CHILD HEALTH • The mother and child are the most delicate members of the community. • Therefore, the maternal and infant mortality and morbidity rates are among the indicators of health of a particular community. • The protection of the mother and child to illness and other risks would ensure a good health for the community.

ESSENTIAL DRUGS • This focuses on the information campaign on the proper utilization and acquisition of drugs. • In response to this campaign is the Generic Act of the Philippines

ESSENTIAL DRUG PROVISION • C otrixomazole • C arboceistine • A moxicillin • A mpicillin • R ifampicin • I soniazid (INH) • P yrazinamide (PZA) • P aracetamol • O resol • N ifedipine

NUTRITION • Food is one of the basic needs of the individual. • Appropriate kind of food and food preparation can contribute to a healthy state. • There are a lot of resources available in our setting but because of lack of knowledge as well as faulty preparation, it leads to malnutrition, which is one of the major health problems we have in our country.

TREATMENT OF COMMUNICABLE DISEASES • Tuberculosis, malaria, schistosomiasis, and other communicable diseases associated with poverty continue to be a serious problem with economic implications. • 75,000 Filipino babies die of preventable causes every year and that most of these preventable diseases are communicable in nature. • The government then has to focus on the prevention, control, and treatment of these diseases.

SAFE WATER & SANITATION • Access to potable water within 250 meters or 10-minute walk and sanitary toilet is a must for every family. • The government then has to see to it that policies, rules, and regulations related to this must be implemented and followed strictly. • Because this is also one of the basic needs of human beings for survival, a clean environment is necessary to promote good health.

C O M M U N I T Y

I N T R A

P A R T I C I P A T I O N

I N T E R

A N D

SEC L I N K

A P P R O P R I A T E

T E C H N O L O G Y

S U P P O R T M E C H A N I S M

Four Cornerstone of PHC (MAUS) 1. Multisectoral Linkages - Intra and inter sectoral linkages *Intra sectoral - within the health system/ facilities: Primary – RHU, LGU, HC, BHS Secondary - regional health sector Tertiary - national level headed by the DOH

Four Cornerstone of PHC 2. Active community participation and involvement  Participation is considered the core of community organization.  Community should be aware and be conscious about health and development issues.  Planning, implementation, monitoring, and evaluation should be done by the people, even in the selection of Community Health Workers and formation of health committees.  Assumes that people have the capacity to care for their own welfare.  Having a sense of ownership for one’s action ensure a sustainable development effort rather than depending on services through external or dole out activities.  Partnership with the community ensures a more responsible development initiative.

Four Cornerstone of PHC 3. Use of appropriate technology  Provide social and environmental service that is acceptable to all level and has a quality of product with the least cost.  Criteria for Selection of Technology 1. Efficacy and safety 2. Complexity and simplicity 3. The cost 4. Acceptability 5. Scope of technology 6. Visibility

Four Cornerstone of PHC 4. Support mechanism made available *The primary health care, as a nurse one must try to determine the needs of the community (ex. teach income generating program (IGP) such as basket weaving, candle making, soap making etc.)

REPUBLIC ACT NO 8423 – “Traditional and Alternative Medicine Act (TAMA) of 1997”. REPUBLIC ACT NO. 8423 - AN ACT CREATING THE PHILIPPINE INSTITUTE OF TRADITIONAL AND ALTERNATIVE HEALTH CARE (PITAHC) TO ACCELERATE THE DEVELOPMENT OF TRADITIONAL AND ALTERNATIVE HEALTH CARE IN THE PHILIPPINES, PROVIDING FOR A TRADITIONAL AND ALTERNATIVE HEALTH CARE DEVELOPMENT FUND AND FOR OTHER PURPOSES Section 1. Short Title — This Act shall be known as the “Traditional and Alternative Medicine Act (TAMA) of 1997”. Section 2. Declaration of Policy — It is hereby declared the policy of the State to improve the quality and delivery of health care services to the Filipino people through the development of traditional and alternative health care and its integration into the national health care delivery system.

REPUBLIC ACT NO 8423 – “Traditional and Alternative Medicine Act (TAMA) of 1997”.  Calls for the effective utilization of medicinal plants as an alternative for high cost medications  The law forwards the following policies 1. The indications and/or uses of plants 2. The part of the plant to be used 3. Preparation of a. Decoction – laga/boil b. Poultice – tapal (may add oil) c. Infusion – an example is tea where hot water is added and steeped for at least 24 hours d. Syrup – add sugar and for storage – lasts 3-5 days e. Oils – bawang, luya, mansanilya extract f. Ointment – with wax g. Tincture – preparation composed of water and alcohol h. Elixir based

REPUBLIC ACT NO 8423 – “Traditional and Alternative Medicine Act (TAMA) of 1997”. • It shall also be the policy of the State to seek a legally workable basis by which indigenous societies would own their knowledge of traditional medicine. When such knowledge is used by outsiders, the indigenous societies can require the permitted users to acknowledge its source and can demand a share of any financial return that may come from its authorized commercial use. • In promoting herbal medicines: • • • • •

Encourage client to backyard gardening. When using herbal medicines, advise the client never to use insecticides or pesticides Use one herbal medicine at a time When cooking the herb, use clay pot and remove the cover to prevent “over cook”. If there is a reaction to the herbal medicine, advice client to go to the nearest health center.

10 HERBAL PLANTS ADVOCATED BY THE DOH

1) Lagundi-cough, asthma, and colds 2) Ulasimang-Bato-lowers uric acid

3) Bawang-anti cholesterol 4) Bayabas- antiseptic; diarrhea 5) Yerba Buena- toothache, pain, and arthritis

6) 7) 8) 9)

Sambong- renal calculi Ampalaya- diabetes mellitus Niyog-niyogan- anti-helminthic Tsaang-Gubat- diarrhea

1. Lagundi (Vitex negundo) Other Names: 5 leavechaste tree (Eng.) Kamalan (Tag.) Limo-limo (Ilk.) Dabtan (If.) Tugas (Ceb) Molave aso (Sul) • A shrub known in English as the “5-leaved chase tree” which grows wild in vacant lots and waste land. The flowers are blue and bell-shaped and small fruits turn black when ripe. It is better to collect the leaves where are in bloom. Matured branches are planted. • Parts utilized: Leaves, flower.

1. Lagundi (Vitex negundo) – available as Ascof tablet Benefits: • Skin diseases (dermatitis, scabies, ulcer) and wounds • Headache • Asthma, pharyngitis, cough, fever • Aromatic bath for sick patients • Rheumatism, sprain, contusions, insect bites • Eczema • Dysentery (blood in the stool), colds and pain in any part of the body (influenza)

LAGUNDI

• Asthma, cough and fever- boil the chopped raw fruits or leaves in 2 glasses of water left for 15 minutes until the water left in only one glass. Strain. The following dosages of the decoction are given to age group. DRIED LEAVES FRESH LEAVES Adult 4 tbsp 6 tbsp 2-6 years old 1 tbsp 1 ½ tbsp 7-12 years old

2 tbsp

3 tbsp

• Dysentery, colds and pain in any part of the body as influenza – boil a handful of leaves and flowers in water to produce a glass full of decoction 3 times a day.

• Headache- crushed leaves may be applied on the forehead. • Rheumatism, sprain, contusion insect bitespound the leaves and apply on affected part. • Aromatic bath for sick patients - prepare leaf decoction for use in sick and newly delivered patients.

LAGUNDI

2. Ulasimang bato/Pansit-pansitan (Peperomia pellucida) Other Names: Pansit-pansitan (Tag.)  A weed, with heart-shaped leaves also known as "pansit-pansitan", grows in shady parts of the garden and yard. It is effective in fighting arthritis and gout. The leaves can be eaten fresh (about a cupful) as salad or like tea.  Parts utilized: leaves

2. Ulasimang bato / pansit-pansitan (Peperomia pellucida) Uses: • Uric acid excretion (rheumatism & gout) Preparation: • Wash leaves well. One and a half cup leaves are boiled in two glassfuls of water over lower fire. Do not cover pot. Cool and strain. Divide into three parts and drink each part three times a day after meals. • May also be eaten as salad. Wash the leaves well. Prepare one and a half cups of leaves. Divide into 3 parts and take as salad three times a day.

ULASIMANG-BATO

3. Bawang (Allium sativum) • Other Names: Garlic (Eng) Ajos (Span., Bis.) • Popularly known as "garlic", it mainly reduces cholesterol in the blood and hence, helps control blood pressure. Also a remedy for toothache • Parts utilized: garlic bulb • Preparation: 1. May be fried, roasted, soaked in vinegar for 30 minutes or blanched in boiled Water for 5 minutes. Take 2 pieces three times a day after meals. 2. For toothache: pound a small piece and apply to affected part.

3. Bawang (Allium sativum) Benefits:  BawHat: Bawang for HYPERTENSION & TOOTHACHE  Helps lower bad cholesterol levels (LDL)  Good for the heart  Remedy for arteriosclerosis  May help prevent certain types of cancer  Boosts immune system to fight infection  With anti oxidant properties  Cough and cold remedy  Relieves sore throat  Aids in treatment of tuberculosis  With anticoagulant properties

BAWANG

4. Bayabas/Guava (Psidium guajava) • A tree about 4- 5 meters high with tiny flowers with round or oval fruits that are eaten raw. Propagated through seeds. • Parts utilized: leaves • Preparation: 1. For washing wounds- may be used twice a day. 2. For diarrhea- may be taken 3-4 twice a day. 3. As gargle and to relieve toothache. Warm decoction is used for gargle. Freshly pounded leaves are used for toothache. Guava leaves are to be washed well and chopped. Boil for 15 minutes at low fire. Do not cover pot. Cool and strain before use.

4. Bayabas/Guava (Psidium guajava) Uses of Bayabas:  Diarrhea  Washing of wounds – antiseptic, astringent (kills bacteria, fungi, and ameba)  Gargle to relieve toothache  For hypertension, diabetes and asthma  Promotes menstruation

BAYABAS

5. Yerba Buena (Clinopodium douglasii) • Other Names: Peppermint mint (Eng.) Herba Buena (most dialects) • A small multi- branching aromatic herb commonly known as Peppermint. The leaves are small, elliptical ands with soothed margin. The stem creeps to ground, and develops roots. May also be propagated through cuttings.

5. Yerba Buena (Clinopodium douglasii) Preparation: 1) For pain in different parts of the body as headache, stomach ache – boil chopped leaves in two glasses of water for 15 minutes. Cool and strain. Divide decoction into two parts and drink one part every three hours. 2) Rheumatism, arthritis and headache – crush the fresh leaves squeeze sap. Massage sap on painful parts with eucalyptus. 3) Cough and colds – get about 10 fresh leaves and soak in a glass of hot water. Drink as tea. Acts as an expectorant. 4) Swollen Gums (Gingivitis) – steep 6 grams of fresh plant in a glass of boiling water for 30 minutes. Use solution as gargle.

5. Yerba Buena (Clinopodium douglasii) Clinopodium douglasii) Preparation:. 6) Menstrual and gas pain – soak a handful of leaves in a glass of boiling water. Drink infusion. It induces menstrual flow and sweating. 7) Nausea and fainting – crush leaves and apply at nostrils of patients. 8) Insect bites – crush leaves and apply juice on affected part or pound leaves until paste-like. Then rub this on affected part. 9) Pruritis- boil plant alone or with eucalyptus in water. Use decoction as wash on affected area.

5. Yerba Buena (Clinopodium douglasii) • Benefits & Treatment of: • S wollen gums • P ain • I nsect bites • T oothache • M enstrual and gas pain • A rthritis • N ausea and fainting • D iarrhea

DIARRHEA • B anana – rich in Potassium • R ice – carbohydrates • A pple – balat rich in pectin; adsorbent and astringent effect • T oast • A pple - balat (peel) • B anana - flesh • K aimito - flesh • D uhat - balat (peel) 100% pectin

CONSTIPATION • High fiber diet • Ripened Papaya

YERBA (HIERBA) BUENA

6. Sambong (Blumea balsamifera) – anti-edema diuretic, anti-lithiasis (stone) Other Names: Haliban/Camphor, Blumea camphora (Eng.) Aliminon, Alibhon, Kambihon. Lakdanbulan (Vis.) • A plant that reaches 1.5 to 3 meters high with rough hairy leaves. Young plants around mother

6. Sambong (Blumea balsamifera) Benefits: • A nti-edema • D iuretic • A nt-urolithiasis (effective in dissolving kidney stones) • Anti – diarrheic & Anti – gastralgic properties • Helps remove worms, boils • Treats dysentery, sore throat

SAMBONG

7. Ampalaya (Mamordica charantia) - for those with non-insulin diabetes mellitus, non-ketosis prone diabetes, maturity onset or juvenile diabetes. • Other Names: Balsam Apple, Balsam Pear, Bitter Gourd (Eng.) Palia (Bis.) • Known as "bitter gourd" or "bitter melon" in English, it most known as a treatment of diabetes (diabetes mellitus), for the non-insulin dependent patients. • Parts utilized: leaves

7. Ampalaya (Momordica charantia) Herbal Benefits of Ampalaya: • Good for rheumatism and gout • And diseases of the spleen and liver • Aids in lowering blood sugar levels • Helps in lowering blood pressure • Relieves headaches • Disinfects and heals wounds and burns • Can be used as a cough & fever remedy • Treatment of intestinal worms, diarrhea • Helps prevent some type of cancer • Enhance immune system to fight infection

AMPALAYA

8. Niyug-niyogan (Quisqualis indica L.) Anti-helminthic: ASCARIASIS Other Names:      

Balitadham, Pnones, Pinio, Bonor (Bis.) Bawe-bawe (Pamp.) Kasumbal, Talolong (Bik.) Tagrau, Tagulo Totoraok (Tag.) Tartarau (Ilk.) Burma creeper Chinese honey suckle (English) Parts utilized: Seeds

8. Niyug-niyogan (Quisqualis indica L.)  A vine which bears tiny fruits and grows wild in backyards. The seeds must come from mature, dried but newly opened fruits.  Propagated through stem cuttings about 20 cm. in height.  Parts utilized: Seeds  Use: Anti-helminthic – used to expel roundworms (ascariasis)  The seeds are taken 2 hours after supper.  If no worms are expelled, the dose may be repeated after one week.  Adult 8-10 seeds  7-12 years old 6-7 seeds  6-8 years old 5-6 seeds  4-5 years old 4-5 seeds  CAUTION:

NIYOG-NIYOGAN

9. Tsaang Gubat (Carmona retusa) - for those with diarrhea, stomach ache, can be used as mouthwash because it is rich in fluoride. Other Names:  Alibungog (Vis.)  Kalabonog, Maragued (Ilk)  Kalimunog, Taglokot, Talibunog, Tsa (Tag.). Malatadian (Gad.)

Parts utilized: Leaves Benefits and Treatment of: • Stomach pains • Gastroenteritis • Intestinal motility • Dysentery • Diarrhea or Loose Bowel Movement (LBM) • Mouth gargle • Body cleanser/wash

9. Tsaang Gubat (Carmona retusa) Uses:  Diarrhea – Boil the following amount of chopped leaves in 2 glasses of water for 15 minutes or until amount of water goes down to 1 glass. Cool and strain. Dried Leaves Fresh Leaves Adult 10 tbsp. 12 tbsp. 7-12 y.o. 5 tbsp. 6 tbsp. 2-6 y.o. 2 ½ tbsp. 3 tbsp. Divide decoction into 4 parts. Let patient drink 1 part every 3 hours.  Stomachache

9. Tsaang Gubat (Carmona retusa) Uses:  Stomachace – Wash leaves and chop. Boil chopped leaves in 1 glass of water for 15 minutes. Cool and filter/strain and drink. Adult Dried Leaves Fresh Leaves Adult 2 tbsp. 3 tbsp. 7-12 y.o. 1/2 tbsp. 1 tbsp.

TSAANG GUBAT

10. Akapulko (Cassia alata) – anti-fungal: tinea flava, ringworm, scabies, Athlete’s foot. Other Names:  Bayabas-bayabasan, Kapurko, Kantada, Katandang Aso, Pakagonkin, Sonting (Tag.)  Sunting, Palo china (Bis.)  Ringworm bush or shrub (English) Parts utilized: Leaves Uses of Akapulko: • Treatment of skin diseases: Tinea infection, insects bites, ringworms, eczema, scabies and itchiness. • Internal: Expectorant for bronchitis and dyspnoea, mouthwash in stomatitis, alleviation of asthma symptoms, used as diuretic and purgative, for cough and fever, as a laxative to expel intestinal parasites and other stomach problems. A strong decoction of the leaves is an abortifacient.

10. Akapulko (Cassia alata) – antifungal: tinea flava, ringworm, scabies, Athlete’s foot. Preparation: Fresh matured leaves are pounded, Apply as soap to the affected part 1-2 times a day.

AKAPULKO

HERBALISM • A traditional medicinal or folk medicine practice based on the use of plants and plant extracts • Also known as botanical medicine, medical herbalism, herbal medicine, herbology, and phythotherapy

HERBAL MEDICINE PREPARATIONS 1. Aromatic Preparations • Have volatile oil for treatment of fever, cough, colds, itchiness, and gas pain • Include luya, bawang, sibuyas, yerba buena, oregano, manzanilla, tanglad (lemon grass), sambong, lagundi, petals of sampaguita, jasmine, and rosal. • Luya or ginger should not be taken on an empty stomach. Tincture of bawang 1:5 Add 5 Tbsp. of gin; 1 Tbsp. chopped bawang Shake 10 minutes for 1 week – good for superficial wounds

Tanglad/lemon grass – for fever Sambong – stomachache Suha/kalamansi – for fever, TSB

HERBAL MEDICINE PREPARATIONS 2. Astringents • Bitter-tasting because they contain tannin and pectin • Generally effective for diarrhea and wounds • Examples: Avocado leaves Guava leaves Kamilo leaves Duhat leaves Banana leaves

HERBAL MEDICINE PREPARATIONS 3. Bitter-Tasting Preparations Skin problems – akapulko, kalachuchi, malunggay, kakawati, makabuhay Depressants (to put hyperactive people to sleep) – dapdap, dita, makabuhay, makahiya Anti-cancer drug – tsitsirika Aches and pains – sambong, damong maria Asthma – talampugay – can cause psychosis

HERBAL MEDICINE PREPARATIONS 4. Seeds • Have fixed oils and are good anti-helminthics  Niyug-niyogan  Patola  Ipil-ipil  Betel nut or bunga  Balanyog  Squash seeds  Lanzones – do not throw peelings, instead burn it for it is a good insect repellant

HERBAL MEDICINE PREPARATIONS 5. Grass Family • Good diuretics Kugon Tubo Tanglad Pandan Pugo-pugo Buton-butones Gatas-gatas Ulasimang bato Corn hair – good for kidney stones Palay – used for hypertension

MALUNGGAY • Known as horseradish • A “backyard pharmacy” because all parts of the tree have medicinal or therapeutic value – “miracle vegetable” • Propagation is through stem cuttings and seeds and is a low maintenance plant • Contains the following: 4 times the calcium in milk 7 times the vitamin C in orange 4 times the vitamin A in carrots which is good for the eyes and effective against cancer 3 times the potassium in banana 2 times the protein in milk

MALUNGGAY • A multi-use plant, its various parts are used in a variety of ways: Leaves – food, medicine (for stomach, it is applied as a poultice) and animal feed; converted to powder and used as food supplement Trees – used as backyard hedges, alley cropping, and erosion control Flowers – food or medicine Pods – food or medicine Roots – medicine (has abortive effect) Dry and mature seeds – water purification and used as oil (has more impressive attributes/properties than olive oil) Bark/stem – medicine (laxative) and tenderizer Fruit or seed – arthritis

MALUNGGAY • Other uses: Promotes good eyesight Good for digestion Natural source of energy supplement Facilitates bowel movement Local cure for stomachache Prevents arthritis, cancer, heart, and kidney diseases Known to increase milk production

GUIDELINES ON HERBAL PLANT PREPARATION 1. Use only half the dosage prescribed for fresh parts like leaves when using dried parts. 2. Do not use stainless steel utensils when boiling decoctions. Only use earthen, enameled, glass or like utensils. 3. Decoctions lose potency after some time. Dispose of decoctions after one day. To keep fresh during the day, keep lukewarm in a flask or thermos.

GUIDELINES IN HANDLING OF MEDICINAL PLANTS 1. If possible, buy herbs that are grown organically – without pesticides. 2. Medicinal parts of plants are best harvested on sunny mornings. Avoid picking leaves, fruits, or nuts during and after heavy rainfall. 3. Leaves, fruits, flowers, or nuts must be mature before harvesting. Less medicinal substances are found on young parts. 4. After harvesting, if drying is required, it is advisable to dry the plant parts either in the oven or air-dried on screens above ground and never on concrete floors. 5. Store plant parts in sealed plastic bags or brown bottles in a cool dry place without sunlight preferably with a moisture absorbent material like charcoal. Leaves and other plant parts that are prepared properly, well-dried and stored can be used up to 6 months.

REMINDERS ON THE USE OF HERBAL PLANTS (ABONUS)

• Accurate dosage of medication – follow • Boiling at low heat: remove cover • One kind of plant for each type of sign/symptom • No insecticides – may leave poison on plants • Use clay pot and plant part being advocated • Stop in case of untoward reaction such as allergy occurs; seek medical consultation if s/sx not relieved after 2-3 doses of herbal medication

• Decoctions loose potency after some time. Dispose of decoctions after one day. To keep fresh during the day, keep lukewarm in a flask or thermos.

Tips on Handling Medical Plants / Herbs: • If possible, buy herbs that are grown organically without pesticides. • Medicinal parts of plants are best harvested on sunny mornings. Avoid picking leaves, fruits or nuts during and after heavy rainfall. • Leaves, fruits, flowers or nuts must be mature before harvesting. Less medicinal substances are found on young parts. • After harvesting, if drying is required, it is advisable to dry the plant parts either in the oven or air-dried on screens above ground and never on concrete floors. • Store plant parts in sealed plastic bags or brown

Maternal & Child Care • GOALS • Qualified for Home Deliveries • POINTERS… 3 CLEANS • HANDS • SURFACE • CORD

Maternal & Child Care

• GOALS:

1. To ensure that every expectant & nursing mother: a. Maintains good health b. Learns the art of child care c. Achieve normal delivery d. Bears healthy children 2. That every child:

a. Grows up in a family with LOVE & SECURITY b. Live in HEALTHY surroundings c. Receives: adequate NOURISHMENT Health supervision & MEDICAL attention d. Taught elements of healthy living

Maternal & Child Care • Qualified for Home Deliveries 1. 2. 3. 4. 5.

Full term Adequate pelvis CEPHALIC presentation Imminent deliveries Abdominal enlargement appropriate for AOG

• POINTERS… 3 CLEANS CLEAN HANDS CLEAN SURFACE CLEAN CORD

Maternal & Child Care • Postpartum Visits 1. FIRST: within 24 hours 2. 2ND: at least one week after delivery 3. 3RD: two to four weeks later

LIGTAS BUNTIS CAMPAIGN • A strategy to increase the visibility of family planning as an essential public health service • To improve access of men, women, and couples to family planning and safe motherhood services

EXPANDED PROGRAM ON IMMUNIZATION (EPI) • OBJECTIVE: To reduce the morbidity and mortality among infants and children caused by the 7 childhood immunizable diseases (TB, Diphtheria, Pertussis, Tetanus, Hepatitis B, Poliomyelitis, & Measles) • ELEMENTS OF EPI: 1) T ARGET SETTING – main element Infants 0-12 months Pregnant and Post Partum Women School Entrants/ Grade 1 / 7 years old 2) I E C (information, education, communication) 3) C old chain logistics management - vaccine distribution through cold chain is designed to ensure that the vaccines were maintained under proper environmental condition until the time of administration.A ssessment and evaluation of overall performance 4) S urveillance, studies, and research

EXPANDED PROGRAM ON IMMUNIZATION • MAIN PRINCIPLE: Based on EPIDEMIOLOGICAL SITUATION • PRESIDENTIAL DECREE (PD) 996: Providing for compulsory basic immunization for infants and children below 8 years old • IMMUNIZATION SCHEDULE: Provide maximal immunity to the SEVEN EPI diseases BEFORE THE CHILD’S FIRST BIRTHDAY

EXPANDED PROGRAM ON IMMUNIZATION VACCINE

FIRST DOSE

NO. OF DOSES

BCG (Bacillus CalmetteGuerin)

AT BIRTH

1

DPT

3 DOSES GIVEN AS EARLY AS 6 WEEKS AFTER BIRTH

3

4 WEEKS IN BETWEEN DOSES

HEPA B

SIX WEEKS

3

4 WEEKS/1 MONTH

MEASLES

9 MONTHS

1

MMR

15-18 MONTHS

1

OPV (Sabin)

INTERVAL

ADMINISTRATION OF VACCINES VACCINE

DOSE

ROUTE

SITE

BCG (Bacillus CalmetteGuerin)

Initial dose AT BIRTH or anytime after birth (0-1 year): 0.05 ml Booster dose at SCHOOL ENTRY (Grade 1): 0.10 ml given to all grade school pupils regardless of the presence or absence of a BCG scar

Intradermal

Right deltoid Left deltoid

DPT

0.5 ml

Intramuscular

Deltoid

HEPA B

0.5 ml

Intramuscular

Upper outer portion of thigh

OPV (Sabin)

2-3 drops

Oral

Mouth

MEASLES

0.5 ml

Subcutaneous

Upper part of the upper arm

MMR

0.5 ml

Subcutaneous

Upper part of the upper arm

Childhood Immunizations 1. BCG  BCG is given at the earliest possible age protects against the possibility of TB infection from the other family members

2. Measles  6 months – earliest dose of measles given in case of outbreak  9months-11months- regular schedule of measles vaccine  15 months- latest dose of measles given  4-5 years old- catch up dose  At least 80%-85% of measles may be prevented

3. DPT  Early start with DPT vaccine reduces chances of severe pertussis

4. OPV  Extent of protection is increased the earlier the OPV is given

5. Hepatitis B  Early start with Hep B vaccine reduces chances of being infected and becoming a carrier

TETANUS TOXOID IMMUNIZATION SCHEDULE FOR WOMEN Vaccine

Minimum Age interval

% protected

Duration of Protection

TT1

As early as possible

0%

0

TT2

4 weeks later

80%

3 years

TT3

6 months later

95%

5 years

TT4

1year later/during next pregnancy

99%

10 years

TT5

1 year later/third pregnancy

99%

Lifetime

Immunization Guidelines 1. BCG vaccine shall be given to all school entrants regardless of the presence or absence of BCG scar. 2. Fever, local soreness, and rash are common side effects. 3. A fully immunized child (FIC) should have received 1 dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of Hepa B, and 1 dose of AMV 4. Contraindications include: a. BCG vaccine: if child has clinical AIDS b. DPT2 and DPT3 if child has convulsion or shock within 3 days of the previous dose unless the pertussis component of DPT vaccine is removed c. All serious conditions that need hospitalization

Immunization Guidelines 5. The following are not contraindications: a. Moderate fever up to 38.5 degrees Celsius, malnutrition, mild acute respiratory infection (colds/cough), simple diarrhea, and vomiting (1) Do not expose to sunlight (2) Do not apply alcohol on site of injection (3) Side effects include local inflammatory reaction, superficial abscess, ulcer with pus at times (4) If no side effects, repeat BCG after 2 months (5) Koch’s phenomenon: begins after 2-4 days like a normal reaction; no special treatment needed b. Permanent scar formation: 2-12 weeks after c. Indolent ulceration: does not heal within 12 weeks – indicates the presence of secondary infection and can be treated with local isoniazide (INH)

Immunization Guidelines 5. The following are not contraindications: d. Deep (subcutaneous) abscess – indicates wrong technique, SC route instead of ID route. Treatment includes incision and drainage and local INH. (1) Do not expose to sunlight (2) Do not apply alcohol on site of injection (3) Side effects include local inflammatory reaction, superficial abscess, ulcer with pus at times (4) If no side effects, repeat BCG after 2 months (5) Koch’s phenomenon: begins after 2-4 days like a normal reaction; no special treatment needed b. Permanent scar formation: 2-12 weeks after c. Indolent ulceration: does not heal within 12 weeks – indicates the presence of secondary infection and can be treated with local isoniazide (INH)

• Malnutrition is not a contraindication for immunizing children rather; it is an indication for immunization since common childhood diseases are often severe to malnourished children.

COLD CHAIN UNDER EPI • Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to the time it is given to child or pregnant woman. • The allowable timeframes for the storage of vaccines at different levels are: 6months- Regional Level 3months- Provincial Level/District Level 1 month-main health centers-with ref. Not more than 5days- Health centers using transport boxes.

• Most sensitive to heat: Freezer (-15 to -25 degrees C) OPV Measles • Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius) BCG DPT Hepa B TT

COLD CHAIN UNDER EPI • Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to the time it is given to child or pregnant woman.

• The allowable timeframes for the storage of vaccines at different levels are: 6months- Regional Level • 3months- Provincial Level/District Level • 1month-main health centers-with ref. • Not more than 5days- Health centers using transport boxes. • Most sensitive to heat: Freezer (-15 to -25 degrees C) • OPV • Measles • Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius) • BCG • DPT

Cold Chain Considerations • OPV and AMV are the most sensitive to HEAT with storage temperature of -15 degrees C to -25 degrees C • BCG, DPT, HBV, TT are sensitive to heat and freezing with storage temp of 2 degrees C to 8 degrees C; use of cold packs during transport

Maximum Storage and Transport Considerations 1. RHO  PHO  DHO – 3 months 2. RHU – 1 month 3. Maximum transport period if with cold packs – 5 days

UNDER FIVE CLINIC PROGRAM Overview • The first five years of life form the foundations of the child’s physical and mental growth and development. Studies have shown the mortality and morbidity are high among this age group. The Department of Health established the Under Five Clinic Program to address this problem.

Program Objectives and Goals • Monitor growth and development of the child until 5 years of age. • Identify factors that may hinder the growth and development of the child.

UNDER FIVE CLINIC PROGRAM Activities and Strategies • Regular height and weight determination/ monitoring until 5 years old. 0-1 year old=monthly 1 year old and above =quarterly • Recording of immunization, vitamins supplementation, deworming and feeding. • Provision of IEC materials (ex. Posters, charts, and toys) that promote and enhance child’s proper growth and development. • Provision of a safe and learning – oriented environment for the child. • Monitoring and Evaluation.

ENVIRONMENTAL HEALTH & SANITATION Environmental Health Inter-Agency Committee on Environmental Health Laws & Policies that Affect Environmental Health & Sanitation Water Supply Sanitation Program Proper Excreta Disposal Program Solid Waste Management/Garbage Disposal Vector Control Program Food Sanitation Program Environmental Quality Proper Housing Other Environmental Health Services Climate Change

ENVIRONMENTAL HEALTH & SANITATION OVERVIEW • Environmental Sanitation is still a health problem in the country. • Diarrheal diseases ranked second in the leading causes of morbidity among the general population. • Other sanitation related diseases : tuberculosis, intestinal parasitism, schistossomiasis, malaria, infectious hepatitis, filariasis and dengue hemorrhagic fever. • The DOH through the Environmental Health Services (EHS) unit is authorized to act on all issues and concerns in environment and health including the very comprehensive Sanitation Code of the Philippines (PD 856, 1978).

ENVIRONMENTAL HEALTH & SANITATION Environmental Health • A branch of public health that deals with the study of preventing illnesses by managing the environment and changing people’s behavior to reduce exposure to biological and non-biological agents of disease and injury. Environmental Sanitation • Study of all factors in man’s physical environment, which may exercise a deleterious effect on his health, well-being, and survival

ENVIRONMENTAL HEALTH & SANITATION Environmental Sanitation • Study of all factors in man’s physical environment, which may exercise a deleterious effect on his health, well-being, and survival • Environmental factors: 1. Water supply sanitation 11. Stream pollution 2. Proper excreta disposal 3. Solid waste management (refuse and garbage disposal) 4. Insect vector and rodent control 5. Food sanitation 6. Air pollution 7. Proper housing 8. Noise 9. Radiological protection 10. Institutional sanitation

INTER-AGENCY COMMITTEE ON ENVIRONMENTAL HEALTH EO 489 • Inter-Agency Committee on Environmental Health (IACEH) was formed and is composed of 11 members chaired by the secretary of DOH, with secretary of DENR as vice-chair. Committee members come from DPWH, DILG, DA, DTI, DOTC, DOST, DOLE, NEDA, and Public Information Agency. • Functions of IACEH: 1. Formulate policies and guidelines and develop programs for environmental health protection 2. Coordinate, monitor, and evaluate EH program and development projects 3. Undertake information dissemination and education campaigns on EH programs 4. Coordinate, assist, and/or support the conduct of research and relevant activities for environmental maintenance and protection

ENVIRONMENTAL HEALTH & SANITATION Laws & Policies Affecting Environmental Health & Sanitation 1. Senate Resolution 676 2. RA 6969 3. RA 8749 4. RA 9003 5. RA 9275 6. PD 856

INTER-AGENCY COMMITTEE ON ENVIRONMENTAL HEALTH Senate Resolution 676 • Stockholm Convention on Persistent Organic Pollutants (POPs) in May 2001 where the Phils. was a signatory was ratified by the Senate on Feb. 2, 2004 • Bans the use of POPs in households and industries. • POPs consists of the so-called “Dirty Dozen” of pesticides, industrial chemicals, and unintentional products of burning which are: 1. Pesticides – aldrin and dieldrin, endrin, chlordane, heptachlor, DDT, hexachlorobenzene, mirex, and toxaphene 2. Industrial chemicals – polychlorinated biphenyls and hexachlorobenzene 3. Unintentional by-products of burning – dioxins and furans (caused by burning plastics)

INTER-AGENCY COMMITTEE ON ENVIRONMENTAL HEALTH RA 6969 • Toxic Substances & Nuclear Waste Control Act of 1990 • Regulates the importation, use, movement, treatment, and disposal of toxic chemicals and hazardous and nuclear wastes in the Philippines

INTER-AGENCY COMMITTEE ON ENVIRONMENTAL HEALTH RA 8749 • Clean Air act of 1999 • Provides a comprehensive air pollution management and control program to achieve and maintain healthy air. 1. Section 20 bans the use of incineration for municipal, bio-medical and hazardous wastes but allows the traditional method of small-scale community burning. 2. All motor vehicles are required to pass the smoke emission test prior to registration. 3. Phasing out leaded gasoline by the end of the year 2000. 4. Lowering of the sulfur content of all automotive diesel fuels. 5. Decreasing the aromatic and benzene levels in unleaded gasoline. 6. Banning of smoking in public places including public transport in order to prevent indoor pollution due to second-hand smoke

INTER-AGENCY COMMITTEE ON ENVIRONMENTAL HEALTH RA 9003 • Ecological Solid Waste Management Act of 2000 • Declares the adoption of a systematic, comprehensive, and ecological solid waste management program as a policy of the state using the community-based approach and mandating waste diversion through composting and recycling.

INTER-AGENCY COMMITTEE ON ENVIRONMENTAL HEALTH RA 9275 • Clean Water Act of 2004 • Aims to establish wastewater treatment facilities that will clean waste water before it is released into the bodies of water like rivers and seas. • Requires LGUs to form Water Management Areas that will manage waste water in their respective areas

INTER-AGENCY COMMITTEE ON ENVIRONMENTAL HEALTH Supplemental Implementing Rules & Regulations (IRR) of Chapter II of Sanitation Code of the Philippines • Water refilling stations should regularly monitor their drinking water quality using the following schedules: 1. Monthly for bacteriological quality 2. Every 6 months for physical and chemical properties 3. Annually for biological quality and radiologic properties when the need arises • All water analysis procedures done only in DOH-accredited laboratories • The water quality should follow the Philippine National Standards for Drinking Water (PNSDW).

INTER-AGENCY COMMITTEE ON ENVIRONMENTAL HEALTH PD 856 • Supplemental IRR on Chapter XVII on Sewage Collection and Disposal and Excreta Disposal and Drainage of the Sanitation Code of the Philippines regulates and provides proper guidelines for LGUs and establishments involved in the desludging, collection, handling, and transport and disposal of domestic sludge from cesspools, communal septic tanks, domestic sewage treatments plantas/facilities and seepage from household septic tanks

ENVIRONMENTAL HEALTH & SANITATION Environmental & Occupational Health Office (EOHO) • This is under the National Center for Disease Prevention & Control Program of the DOH • Responsible for: a. Promotion of healthy environmental conditions b. Prevention of environmental related diseases through appropriate sanitation strategies like: (1) Water quality surveillance (2) Evaluation of food establishments (3) Proper solid and liquid waste management (4) Sanitation of public places (5) Sanitation management of disaster areas (6) Impact assessment of environmentally critical projects (7) Enforcement of sanitation laws, rules, regulations, & standards

ENVIRONMENTAL HEALTH & SANITATION Environmental & Occupational Health Office (EOHO) • Has 2 divisions: 1. Water & Sanitation Division 2. Health Care Waste & Toxic/Hazardous Division • Programs/projects: 1. Water for Life 2. Hospital Waste Management 3. Urban Health and National Projects 4. Pasig River Rehabilitation Program

ENVIRONMENTAL HEALTH & SANITATION Presidential Proclamation 856 • Sanitation Code of the Philippines WATER SUPPLY SANITATION PROGRAM Approved Types of Water Supply • Level I: Point Source • Level II: Communal Faucet System/Stand-Post • Level III: Waterworks System/Individual House Connections

ENVIRONMENTAL HEALTH & SANITATION Level I: Point Source Type • Protected well or developed spring with an outlet • Without distribution system • Adaptable for rural areas where the houses are thinly scattered • 15-25 households • Must not be more than 250 meters from the farthest user • Yield/discharge: 40-140 liters per minute

ENVIRONMENTAL HEALTH & SANITATION Level II: Communal Faucet System/Stand-Post Type 1. Source 2. Reservoir 3. Piped distribution network 4. Communal faucet Not more than 25 m away: farthest 40-80 liters/capital/day Average: 100 households 4-6 households/faucet For rural areas where houses are clustered densely to justify a simple piped system

ENVIRONMENTAL HEALTH & SANITATION Level III: Waterworks System/Individual House Connections 1. 2. 3. 4.

Source Reservoir Piped distribution network Household taps Requires minimum disinfection For densely populated urban areas

ENVIRONMENTAL HEALTH & SANITATION Access to Safe & Potable Drinking Water • Certification of potability of an existing water source is issued by the Secretary of the DOH or his duly authorized representative.

ENVIRONMENTAL HEALTH & SANITATION Water Supply & Sanitation-related Diseases • Food- and water-borne diseases such as cholera and typhoid fever, are some of the leading causes of morbidity and mortality in the Phils. • Cholera – manifests 1st as diarrhea but can lead to dehydration and even death if not treated swiftly • Typhoid – accompanied by sustained high fever, headaches, weakness and constipation or abdominal discomfort

ENVIRONMENTAL HEALTH & SANITATION Water Purification • FILTRATION

eliminates sediments

• CHLORINATION

kills microorganisms

• FLUORIDATION

fortification

• BOILING

5-10 minutes from boiling point *Drinking water should be replaced every 24 hours.

Unapproved Types of Water Supply: doubtful sources like • OPEN DUG WELL • UNIMPROVED SPRING • WELLS that need priming The community must exert effort to convert approved type of water supply

ENVIRONMENTAL HEALTH & SANITATION Water Quality Monitoring Surveillance Disinfection of Water Supply • Newly constructed water facility • Repaired/improved water facility • Water sources found to be (+) bacteriologically by lab analysis • Container disinfection of drinking water collected from water facilities subject to contamination like: a. Open dug wells b. Unimproved springs c. Surface water

ENVIRONMENTAL HEALTH & SANITATION Household Water Treatment 1. Boiling • Heating water to boiling point to destroy pathogens 2. Chemical coagulation • Use of aluminum sulfate (tawas) to coagulate suspended materials in water 3. Filtration • Use of sand, piece of cloth, or any other material for filter to remove suspended materials from water

ENVIRONMENTAL HEALTH & SANITATION Household Water Treatment 4. Chlorination • Adding chlorine to water to kill pathogens a. Buy commercial chlorine solution (6%-10% sodium hypochlorite) b. Prepare Chlorine Stock Solution by adding 1 tsp. of commercial chlorine solution to 1 L of water c. Disinfect drinking water by adding 3 teaspoonfuls of chlorine stock solution to 4 liters of water 5. Softening – boiling or adding certain chemicals to reduce calcium and magnesium salts which cause water to be “hard”

ENVIRONMENTAL HEALTH & SANITATION Waterworks/Water System • Well sites: approval • Comply to sanitary requirements • Supply of safe and potable water • Adequate pressure and volume in the water system distribution line

ENVIRONMENTAL HEALTH & SANITATION Proper Excreta & Sewage Disposal Program Approved Types: Toilet Facilities LEVEL 1 1. Non-water carriage toilet facility • Water is not needed to wash the waste into the receiving space • Pit latrines • Reed odorless earth closet 2. Toilets requiring small amount of water • Pour flush toilets • Aqua privies

ENVIRONMENTAL HEALTH & SANITATION Approved Types: Toilet Facilities LEVEL 2 1. Water-sealed 2. Flush type with septic vault/tank disposal facilities LEVEL 3 1. Water-carriage type of facilities connected to septic tanks and/or to sewerage system connected to treatment plants

ENVIRONMENTAL HEALTH & SANITATION Terminologies related to Excreta Disposal Management: • • • •

• • • •

Pail system – a pail or a box is used; “balot” system included Open Pit Privy – a pit covered by a platform with an uncovered hole Closed Pit Privy – a pit covered by a platform with a covered hole Bored-hole Latrine – a deep but relatively narrow hole made with a boring equipment Overhung Latrine – the toilet house is constructed over a body of water Antipolo-type – elevated toilet house; the shallow pit is extended upwards Water-sealed latrine – a water-sealed toilet bowl is placed over a pit privy Flushed-type – waste is disposed by flushing water through pipes (sewer) into a sewerage system or septic tank

ENVIRONMENTAL HEALTH & SANITATION Terminologies related to Solid Waste Management/Garbage Disposal: • Hog feeding – left-over food/waste is used as hog feed • Open dumping – garbage is piled in a dumping place with no soil covering • Open burning – garbage is piled then later burned in the open air • Burial in pit – garbage is placed in a pit and covered when filled up; with no intention to use as fertilizer • Composting – biodegradable materials or garbage are converted into compost or soil conditioner • Collection – garbage is collected regularly by a facility for proper disposal

ENVIRONMENTAL HEALTH & SANITATION Vector Control Program • Focuses on sustainable preventive and vector control measures against the malaria parasite and mosquito vector. • Objective: to reduce the source of infection in the human population by reducing/eliminating man-vector contact and reducing the density of mosquito vector population. • Vector-borne diseases include malaria, dengue fever, and dengue hemorrhagic fever.

ENVIRONMENTAL HEALTH & SANITATION Vector Control Measures 1. Insecticide treatment of mosquito nets - where the mosquito net is soaked in insecticide and allowed to dry and used as a protective measure against mosquitoes when a person sleeps whether at night or even when he takes a nap during the day. 2. House spraying of insecticide on surfaces whether indoor or outdoor 3. On-stream seeding – involves the construction of bio-ponds for larvivorous fish propagated by the LGUs and their corresponding communities especially in malaria-endemic areas 4. On-stream clearing – involves removing vegetation overhang in order to expose the stream to sunlight rendering it unsuitable for vector propagation

ENVIRONMENTAL HEALTH & SANITATION Policies of the Food Sanitation Program 1. Inspection/approval of food sources, containers, & transport vehicles 2. Sanitary permit for all food establishments 3. Health Certificate for food handlers, cooks, and cook-helpers which include monitoring for the presence of intestinal parasites (ascaris, amoeba, E. coli) and bacterial infection (typhoid, cholera, dysentery, salmonella infection) 4. Banning of food unfit for human consumption like “double-dead meat” or “botcha” which are being dumped/sold in some markets 5. DOH Administrative Order No. 1-2006 requires all laboratories to use Formalin Ether Concentration Technique (FECT) instead of the direct fecal smear in the stool analysis of food handlers. This will enable the labs to identify infected food handlers and treat them before they are allowed to work in food establishments

ENVIRONMENTAL HEALTH & SANITATION Policies of the Food Sanitation Program • Training of food handlers and operators on food sanitation • Rating and classification of food establishments Class A - Excellent Class B - Very Satisfactory Class C - Satisfactory

• Compliance of requirements as to the issuance of health certificates for ambulant food vendors • Promotion & monitoring of household food sanitation and food hygiene education

ENVIRONMENTAL HEALTH & SANITATION Hospital Waste Management Program • Disposal of infectious, pathological and other wastes from hospital which combine them with the municipal or domestic wastes pose health hazards to the people. • Hospitals shall dispose their hazardous wastes thru incinerators or disinfectants to prevent transmission of nosocomial diseases

ENVIRONMENTAL HEALTH & SANITATION Program on Health Risk Minimization due to Environmental Pollution • Prevention of serious environmental hazards resulting from urban growth and industrialization • Policies on health protection measures • Researches on effects of GLOBAL WARMING to health (depletion of the stratosphere ozone layer which increases ultraviolet radiation, climate change and other conditions)

ENVIRONMENTAL HEALTH & SANITATION Nursing Responsibilities and Activities: • Health Education – IEC by conducting community assemblies and bench conferences. • The Occupational Health Nurse, School Health Nurse and other Nursing staff shall impart the need for an effective and efficient environmental sanitation in their places of work and in school. • Actively participate in the training component of the service like in Food Handler’s Class, and attend training/workshops related to environmental health. • Assist in the deworming activities for the school children and targeted groups.

ENVIRONMENTAL HEALTH & SANITATION Nursing Responsibilities and Activities: • Effectively and efficiently coordinate programs/projects/activities with other government and non-government agencies. • Act as an advocate or facilitator to families in the community in matters of program/projects/activities on environmental health in coordination with other members of Rural Health Unit (RHU) especially the Rural Sanitary Inspectors. • Actively participate in environmental sanitation campaigns and projects in the community. Ex. Sanitary toilet campaign drive for proper garbage disposal, beautification of home garden, parks drainage and other projects. • Be a role model for others in the community to emulate terms of cleanliness in the home and surrounding.

ENVIRONMENTAL HEALTH & SANITATION

Policies of the Food Sanitation Program • Inspection/approval of all food sources, containers, & transport vehicles • Sanitary permit • Health Certificate for food handlers, cooks, and cook-helpers which include monitoring as to the presence of intestinal parasites (acaris, amoeba, E. coli, among others) and bacterial infection • Banning of food unfit for human consumption • Household sanitation

ENVIRONMENTAL HEALTH & SANITATION

Hospital Waste Management Program • Prepare and implement Hospital Waste Management Program (HWM) • Use of appropriate technology & indigenous materials • Training of personnel • Admin: PUBLIC INFORMATION CAMPAIGN

SENTRONG SIGLA MOVEMENT (SSM) • 1998 – DOH embarked in a Quality Assurance Program (QAP) with the goal of making DOH and LGU as active partners in providing quality health services • 1999 – QAP was renamed to Sentrong Sigla Movement (SSM) or Centers of Vitality Movement (SS Phase 1) • 2001 – Effort to raise quality of health was intensified, leading to SS Phase 2 • SS PHASE 1 – Sentrong Sigla Movement (SSM) • SS PHASE 2 – Expansion of the concern for quality beyond DOH-LGU interaction level into the entire health sector • Sentrong Sigla Certification – the certification strategy of SSM that has remained an important strategy in the accreditation approach of the broader Philippine Quality in Health Program (QIP)

SENTRONG SIGLA MOVEMENT (SSM) • GOAL: Improvement of the Quality of Services provided by HEALTH CENTERS • AIM: To promote availability of quality services in health centers and hospitals and to make these services accessible to every Filipino • MAIN COMPONENT: CERTIFICATION RECOGNITION PROGRAM • FOUR PILLARS: 1. QUALITY ASSURANCE PILLAR 2. GRANTS & TECHNICAL ASSISTANCE 3. HEALTH PROMOTION 4. AWARDS

SENTRONG SIGLA MOVEMENT (SSM) • LEVEL & SCOPE OF CERTIFICATION: 1. Basic SS Certification – minimum input, process, & output standards for integrated public health services for 4 core public health programs, facility systems, regulatory functions, and basic curative services 2. Specialty Awards – 2nd level quality standards for selected 4 core public health programs 3. Awards for Excellence – highest level quality standards for maintaining Level 2 standards for the 4 core public health programs and level 2 facility systems for at least 3 consecutive years

SENTRONG SIGLA MOVEMENT (SSM) • SS Certification validity of certification is every 2 years. 1. Facilities which did not progress to a higher level of certification but maintained current certification are: a. given stickers to confirm the renewal of the validity of seal b. no other incentives given for mere renewal of SS status 2. Facilities that slide back; seal will not be removed but not issued an SS sticker

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) • Respiratory Infection Control • Control of Diarrheal Diseases • Ear Problems • Malnutrition & Anemia

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) 1. Respiratory Infection Control – COLOR SYSTEM • PINK ROW: Severe classification; needs immediate attention & referral • YELLOW ROW: needs appropriate antibiotic/other treatment • GREEN ROW: no need for specific medical treatment such as antibiotics

INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (IMCI) 3. EAR PROBLEMS – COLOR SYSTEM • PINK ROW: Mastoiditis • YELLOW ROW: Acute ear infection, Chronic ear infection • GREEN ROW: No ear infection

FIELD HEALTH SERVICES & INFORMATION SYSTEM (FHSIS) • TREATMENT RECORD: fundamental building block or foundation of the Field Health Services and Information System • TARGET/CLIENT LIST: second building block • The FHSIS Report Forms are to be submitted by the reporting units identified in the upper portion of the page • REPORTING UNIT: defined as any DOH health care facility that renders public care-related health services • BARANGAY HEALTH STATION: lowest level of reporting unit

VITAL STATISTICS • Vital Statistics is the systematic study of vital events such as birth, illnesses, marriages, divorce, and deaths • Births and deaths are registered in the Office of the Local Civil Registrar • RATE: shows the relationship between a vital event and those persons exposed to the occurrence of the said event, within a given area and during a specified unit of time • RATIO: relationship between 2 numerical quantities or measures of events without taking particular considerations to time and place

VITAL STATISTICS • CRUDE/GENERAL RATES: rates referred to the total living population • SPECIFIC RATE: limits the occurrence of event to the portion of the population definitely exposed to it • INFANT MORTALITY RATE: a good index of the general health condition of the community

VITAL STATISTICS PRESENTATION OF DATA: • Line or Curve Graphs: show peaks, valleys, and seasonal trends over a period of time, e.g. births, deaths • Bar Graphs: each bar represents or expresses a quantity in terms of rates or percentages of a particular observation, e.g. causes of illness and deaths • Area Diagrams: (Pie chart) show the relative importance of parts to the whole

VITAL STATISTICS EPIDEMIOLOGY: • Epidemiology: concerned with the study of the factors that influence the occurrence and distribution of diseases, defects, disabilities, or death • It concerns the factors of causation • It is the backbone of disease prevention • Nurse’s Roles: 1. Maintains surveillance of the occurrence of notifiable disease 2. Casefinding and collection of laboratory specimens 3. Isolation precautions 4. Organize, coordinate, and conduct community health education campaign

VITAL STATISTICS DEMOGRAPHY: • Demography is the study of the population • Statistics on population and the characteristics such as age and sex, distribution are obtained from NSO

That’s all for This Morning..

Thank YOU! シ