OVERVIEW OF THE PUBLUC HEALTH NURSING IN THE 3.

A common or shared interest that binds the members

PHILIPPINES together exists.

Public health nursing practice has been 4. It has an area with fluid boundaries within which a
influenced by the changing global and local health problem can be identified and solved
trends. These global and country health imperatives
5. It has a population aggregate concept
brought public health nursing into new frontiers and
have positioned nurses to emerge as leaders in health
promotion and advocacy.
COMMUNITY HEALTH NURSING
Public health nursing in the Philippines evolved
alongside the institutional development of the DOH, the Is the utilization of the nursing process in
government agency mandated to protect and promote different levels of clienteles in which it is concerned
people’s health and the biggest employer of health with the promotion of health and prevention of disease,
workers including public health nurses. Since 1900s, disability and rehabilitation.
nurses working in the communities were already given The Four (4) Clienteles
the title PUBLIC HEALTH NURSES.
1. Individual- a single person
These changes include:
2. Family – 2 or more persons who are joined together
1. Shift in demographic and epidemiological trends in by bonds of sharing and emotional closeness and who
diseases, including the emergence and re-emergence of identify themselves as being part of the family
new diseases and in the prevalence of risk and
protective factors; 3. Population/Group/Aggregates – a group of people
who share common characteristics, developmental
2. New technologies for health care, communication stage or common exposure to particular environmental
and information; factors, thus resulting in common health problems
3. Existing and emerging environmental hazards some 4. Community
associated with globalization;

4. Health reforms.
PHILOSOPHY OF CHN

CHN is based on the worth and dignity of Man

COMMUNITY
THE COMMUNITY HEALTH NURSE
A derived from a latin word “Comunicas” which
means a group of people. Roles of Community Health Nurses

A group of people sharing common geographic 1. Care provider – “direct” nursing care to the client
boundaries and/or common values and interests. It 2. Clinician – providing direct nursing care to the
functions within a particular socio- cultural context, disabled or sick
which means that no two communities are alike
3. Hospice Care Provider – providing nursing care to the
Characteristics of a Community dying/maintaining the dignity of the dying person.
1. It is defined by its geographic boundaries within 4. Educator – teaching the client to increase knowledge
certain identifiable characteristics
5. Counselor – listening and providing feedback
2. It is made up of institutions organized into a social spiritually
system with the institutions and organizations linked in
a complex network having a formal and informal power 6. Change agent – combining teaching and counseling
structure and a communication system
7. Advocate – working on behalf of the client leading to
self determination
8. Role model – doing what is being taught to the client. 3. Supportive

9. Health monitor – detecting deviations in normal a. Community Organization

health
b. Health Education
10. Coordinator – collaborating different resources
c. Staff development and Training of Manpower
involved
d. Research and Development
11. Organizer – ensuring maximum participation of
people

12. Manager – assuming different management DOH PUBLIC HEALTH NURSES FUNCTIONS AND
function ACTIVITIES
13. Supervisor – providing administrative support by  Management
overseeing the functions of the subordinate  Training
 Supervision
14. Trainer – providing technical support by means of
 Coordination
training
 Health Education
15. Researcher – conducting studies to improve nursing  Provision of Health and Nursing Care
services and technology

CONCEPTS RELATED TO COMMUNITY HEALTH NURSING

MAJOR FUNCTIONS AND ACTIVITIES OF THE CHN PRACTICE

1. Administration and Management Health- is a changing, evolving concept that is basic to

nursing as classically defined by WHO as “ a state of
a. Planning and Programming
complete physical, mental, and social well-being and
b. Oversee the Nursing Inputs into different not merely the absence of disease or infirmity”
programs
The Modern Concept of Health refers to
c. Monitoring optimum level of functioning of individuals, families and
communities.
e. Coordination
DOH’s health care delivery system includes
f. Resources promotive, preventive, curative and rehabilitative
g. Physical facilities aspects of care, political, behavioral, hereditary, socio-
economic and environmental factors in the eco-system
h. Logistics influences and affects the total level of functioning of
individuals, families and communities.

2. Technical

a. Patient/Family Health

b. Disaster Emergency

c. Epidemiology

d. Environmental Sanitation
DERMINANTS OF HEALTH PUBLIC HEALTH

1. Income and Social Status Dr. Winslow defined Public Health as “Science
and art of preventing disease, prolonging life,
2. Education
promoting health and efficiency through organized
3. Physical environment community effort for the sanitation of the environment,
control of communicable disease, the education of
4. Employment and working conditions individuals in personal hygiene, the organization of
5. Social support networks medical and nursing services for the early diagnosis and
preventive treatment of disease and the development
6. Culture of social machinery to ensure everyone a standard of
7. Genetics living adequate for the maintenance of health, so
organizing these benefits as enable citizen to realize his
8. Personal behavior and coping skills birthright and longevity”.
9. Health Services WHO defined PH as the “art of applying science
in the context of politics so as to reduce inequalities in
10. Gender
health while ensuring the best health for the greatest
number.
PUBLIC HEALTH NURSING

Is a synthesis of public and nursing practice. PUBLIC HEALTH NURSING

As a field of professional practice in nursing and WHO Expert Committee of Nursing – “A special field of
public health in which technical nursing, interpersonal, nursing that combines the skills of nursing, public health
analytical and organizational skills are applied to and some phrases of social assistance and functions as
problems of health as they affect the community. These part of total public health program for the promotion of
skills are applied in concert with those of other persons health, the improvement of the conditions in the social
engaged in health care, through comprehensive nursing and physical environment, rehabilitation of illness and
care of families and other groups through measures for disability.”
evaluation or control of threats to health, for health
DOH - Public Health Nursing refers to the practice of
education of the public, and for mobilization of public
nursing in national and local government health
for health action.
departments (which includes health centers and rural
WHO defines public health nursing as a special health units), and public schools. It is community health
field of nursing that combines skills of nursing and nursing practiced in the public sector.
public health nursing as a field of Nursing. Public health
Lilian Wald - Founder of Public Health Nursing
and some phases of social assistance, and functions as a
part of public health program for the promotion of - She coined the word Public Health Nursing when she
health, the improvement of conditions in the social and was director of the Henry Street Settlement in New York
physical environment, rehabilitation and prevention of City to denote a service that was available to all people.
illness and disability.
Public Health Nurse- refer to the nurses in
local/national health departments or public schools
whether their official position title is Public Health
Nurse or Nurse or School Nurse
CORE FUNCTIONS OF PUBLIC HEALTH 9. Research, development and implementation of
innovative public health solutions
 Disease control
 Injury Prevention CORE FUNCTIONS OF PUBLIC HEALTH
 Health Protection
1. Assessment
 Health public policy including those in relation
to environmental hazards such as in the 2. Policy Development
workplace, food, water
 Promotion of health and equitable health gain. 3. Assurance

Proper delivery of essential public health functions Public Health efforts focus on disease
prevention and health promotion of the population at
“A set of fundamental activities that address the the national and local levels.
determinants of health, protect a population’s health
and treat disease. These public health functions • Community health services protect the public
represent public goods, and in this respect governments from hazards such as polluted water and air,
would need to ensure the provision of these essential contaminated food and unsafe housing.
functions, but would not necessarily have to implement • Personal Health services such as immunization,
and finance them. family planning, well-baby clinic and STDs.

They prevent and manage the major Public health efforts are multidisciplinary
contributors to the burden of disease by using technical, because they require people with many different skills.
legislative, administrative, and behavior-modifying CH nurses work with team of public health
interventions or deterrents, and thereby provide an professionals: epidemiologist, local health officers and
approach for inter- sectoral action for health. This health educators.
approach stresses the importance of numerous
different public health partners. Moreover, the need for
flexible, competent state institutions to oversee these PREVENTIVE APPROACH TO HEALTH
cost-effective initiatives suggests that the institutional
capacity of states must be reinforced Public health efforts focus on health promotion and
disease prevention.

Health Promotion – are activities that enhance

ESSENTIAL PUBLIC HEALTH FUNCTIONS resources directed at improving well-being.
1. Health situation monitoring and analysis Disease Prevention – are activities that protect people
2. Epidemiological surveillance/disease prevention and from disease and the effects of disease.
control

3. Development of Policies and planning in public health Three Levels of Prevention (Leavell and Clark)
4. Strategic management of health systems and services 1. Primary Prevention – activities prevent a problem
for population health gain before it occurs (e.g. immunization against the seven
5. Regulation and enforcement to protect public health childhood illnesses)

6. Human resources development and planning in public 2. Secondary Prevention – activities provide early
health detection and intervention (e.g. screening for diabetes)

7. Health promotion, social participation and 3. Tertiary Prevention – activities correct a disease state
empowerment. and prevent it from further deteriorating (e.g. insulin
administration at home)
8. Ensuring the quality of personal and population
based health services
FAMILY The Filipino Family has 3 main points of interaction

-Is the basic unit of society, a primary entity of health  Husband-wife Relations
care or institution responsible for the physical,  Parent-Child Relations
emotional and social support of its member.  Sibling Relations
- It’s foundation is marriage, the group which ensures 3. Single-parent family – has only one parent, mother or
continuity through its reproductive function and father.
socialization.
4. Dual-earner family – two working parents with or
- is a group of persons united by ties of marriage, blood, without children
birth or adoption (according to Burgess and Locke)
5. Step/blended/remarried/reconstituted – two adults
- is composed of two or more people who are at least one of whom are remarried following divorce or
emotionally involved with each other and live in close death of spouse and at least one of them has children
geographical proximity (Friedman, 1981) from a prior marriage.
Two Types 6. Binuclear – child is a member of two nuclear families
1. Family of Orientation – the family into which they are 7. Cohabitating – man and woman are married or “trial
born, and where one is reared or socialized. marriage”
2. Family of Procreation – the one created when they 8. Gay/Lesbian – same sex in relationship living together
marry or form a significant and lasting bond with
another adult. 9. Grandparent-headed – grandparent is the head of the
household
 Family role – is an expected set of behaviors
associated with a particular family position that 10. Foster Families – at least one adult and one or more
can be formal or informal. foster children placed by a court system
 The Filipino families look up to the father as the 11. Communal family – as orphanage
head of the family in authority and his wisdom
is respected.
 “Patriarchalism” is the solid foundation of DUVALLS’S DEVELOPMENTALS STAGES
family solidarity and survival.
1. Beginning Family - covers the start of the marriage to
the birth of the first child, including establishment of a
FAMILY STRUCTURES new household and the beginning of the nuclear family.

Refers to the characteristics and demographics (age, • Establishing a mutually satisfying marriage
sex, name) of individual members who make up family o Relating harmoniously to kin
units (stanhope & lancaster, 2004). o Make decisions regarding parenthood
Traditional Structures 2. Childbearing Family – begins with the birth of the first
1. Nuclear or conjugal family – consists of the husband, child and lasts until the child is 30 months of age
a wife and their children (natural or adopted) who live • Integrate infants into the family unit.
in a common household. o Accommodate to new parenting and grand
2. The extended or consanguineous family- is a form of parenting roles.
combining nuclear families into larger units through the o Renegotiating marital relationship
parent-child relation. It is composed of 2 or more
residential units of three or more generations affiliated
through grandchildren.
3. Family with Pre-school Children- covers the years o Deal with disabilities and deaths of older
from the time the oldest child is 2 and a half years old generations
until the youngest child is 5 years old
8. Aging Family – lasts from the retirement of one or
 Adapting to critical needs and interest of pre- both members of the couple through the death of one
school children of the spouses, ending with the death of the remaining
 Meeting the needs of additional children while spouse
continuing to meet those of the first born
• Shift from work role to leisure and semi-
 Coping with parental energy depletion and lack
retirement or full retirement
of privacy.
• Maintaining couple and individual functioning
4. Family with School-Aged Children – from which the while adapting to the aging process
oldest child is 6 years of age until the child turns 13 • Prepare for own death and dealing with the loss
years of age of spouse, and/ or siblings, and other peers.

• Encouraging the child’s educational

achievement
FAMILY FUNCTIONS
• Meeting the physical health needs of all family
members 1. Affective
• Maintaining a satisfying marital relationship
2. Socialization and Social Placement
5. Family with Teenagers – begins when the oldest child
3. Reproduction
is 13 years of age and ends when the youngest child is
20 years of age or leaves home. 4. Economic
• Balancing teenager’s freedom with 5. Health Care and Physical Necessities
responsibility as they mature and emancipate
from the family
• * Parents refocus on midlife marital and career RATIONALE FOR CONSIDERING THE FAMILY AS THE
issues UNIT OF CARE IN CHN
• * Parents begin a shift toward concern for the
older generation 1. The family is considered as the natural and
fundamental unit of society
6. Launching Center Family – covers between the time
the first child leaves home and the last child leaves 2. The family as a group generates, prevents, tolerates
home and corrects health problems within its membership.

• Releasing young adults into lives of their own 3. The health problems of family members are
with appropriate rituals and assistance interlocking
• Maintaining a supportive home base 4. The family is the most frequent locus of health
• Building a new life together as a couple decisions and actions in personal care
7. Middle-Aged Family- refers to the years from the 5. The family is an effective and available channel for
time the last child leaves home to the retirement or much of the community health nursing efforts
death of one of the spouses
6. The Family provides a crucial environmental force
• Reinvest in couple identity with concurrent
development of the independent interest. 7. The family through its interaction with the larger
social system validates and influences health efforts
o Maintaining ties with older and younger
generations
o Realign relationships to include in-laws and
grandchildren
CHARACTERISTICS OF FAMILY AS A PATIENT 4. To develop the individual’s and/or family’s
competence to cope with their health problems.
1. The family is a product of time and place
5. To contribute to the personal and social development
2. The family develops its own life style
of the family through and varied health activities.
3. The family operates as a whole/group

4. The family accommodates to needs of the individual

METHODS OF FAMILY-NURSE CONTACT

1. Home Visit
BASIC REQUIREMENTS FOR FAMILY SURVIVAL,
2. Clinic Visit
CONTINUITY OF GROWTH
3. Group Conference
1. Reproduction
4. Telephone Contact
2. Physical Maintenance of Family Members
5. Written communication
3. Socialization of offspring into functioning adults,
capable of assuming adult family roles of husband-
father, wife-mother
HOME VISIT
4. Allocation of resources and division of duties and
- is a professional face to face contact made by a nurse
responsibilities
to the client or family to provide necessary health care
5. Maintenance of order within the family and between activities and to further attain an objective of the health
the family and outsiders agency.

6. Maintenance of family morale and motivation to Purpose of Home Visit

carry out family task
1. To give nursing care to the sick, to a post-partum
7. Development of methods for orderly recruiting and mother and newborn, with a view of teaching a
releasing of group members responsible family member on how to give subsequent
care.

2. To find out home living condition of the client and

FAMILY NURSE CONTACT
family in order to fit a health teaching needs.
- Is an activity with or in behalf of a particular family or
3. To teach health practices, prevention of disease and
individual. It is a crucial approach in delivering
correction of defect for better living.
community health nursing service for the family
through home visit, clinic visit, group conference, 4. To detect, help prevent the spread of communicable
telephone contact or written communication. disease.

5. To establish close relationship between the health

agencies and the public for the promotion of public
OBJECTIVES OF FAMILY NURSE CONTACT
health
1. To assess the health needs and problems of the
6. To make use of the referral system and use of
family utilizing a multidisciplinary approach.
community services.
2. To ensure family’s understanding and acceptance of
their problems.

3. To provide the needed support and assistance to the

family.
ARRANGEMENT OF HOME VISIT 2. Appraise needs of total family and individual
members. Consider:
1. Nursing care to post-natal cases
a) Recognized needs – health problems observed
2. Health supervision to visit pre-natal cases and infants
by the family
3. Visit to clients suffering from communicable diseases b) Unrecognized needs – health problems
observed by the health personnel

3. Review new or forgotten content materials related to

COMPONENTS OF HOME VISIT the health needs of the family.
1. Planning 4. Contact health and social agencies, which have
2. Implementation provided services to the family as recorded

Phases of Approach 5. Decide on methods and materials to be used. The

tools which will facilitate effective contact with the
a) Socialization Phase family.
b) Working/Professional Phase
6. Consider other possible ways of meeting family’s
c. Summary Phase needs.
3. Evaluation

Steps in Home Visit

PRINCIPLES IN PLANNING FOR A HOME VISIT 1. Greet the client or the family member according to
1. A home visit should have a purpose or objective. the time of the day and introduce yourself.

2. Planning for a home visit should make use of all 2. Explain the purpose of home visit; allow the client or
available information about the client and his family the hostess to feel at ease before proceeding further.
through family records, information from health center 3. Inquire about the health and welfare of the client and
personnel and other existing agencies that have given other family members. Ask about any health and
services to the particular family. health-related problems.
3. Planning for a visit should revolve around the 4. Look for a place to put your PHN bag; on the table or
essential needs of the individual and his family but chair six feet away from bedside, but since some homes
priority should be given to those needs recognized by have limited area any convenient.
the family itself.
5. If nursing care will be given, proceed to get articles
4. Planning of a continuing care should involve the needed from the PHN bag observing proper bag
individual and his family technique. Give necessary care or demonstration.
5. Planning should be flexible and practical. It should be 6. Perform Physical assessment and nursing care
able to meet the needs of the family members other needed. If more than one member of the family is for
than those planned. health supervision and care, start with the well member
to avoid transfer of infection.

GUIDELINES IN PLANNING FOR A HOME VISIT 7. Give the necessary health teaching and advice based
on the client’s need and condition. If client is weak or
1. Study records, referrals from other agency and too indisposed condition, you may teach the family
available information. Look into the size of the family, member since they are with the client most of the time.
the members, and the types of family health problems
encountered. 8. Clean the articles used. Wash hands, remove apron
and fold, place in the bag.
9. Record findings and nursing services done. DECLARATION OF WHO

10. Set an appointment for a follow up home visit or “HEALTH FOR ALL BY THE YEAR 2000”
clinic visit, and leave specific instructions if necessary on
Objectives of PHC
how to ensure nursing care to the sick family member.
1. To develop and maximize people’s potential and self-
11. When you gain the family’s trust and confidence,
reliance of the community for the improvement of their
you may look into more detailed aspect of the
own health;
household and other health problems/concerns.
2. To maximize the contribution of other sectors to
health;
PRIMARY HEALTH CARE
3. To maximize the extension of effective health care
HISTORY services to the periphery

-September 6-12, marks the International Conference of PHC encompasses the concepts of:
PHC. A total of 134 member states of the WHO
- Active involvement
participated in the Alma-Ata Conference in Russia. The
joint efforts of the two International agencies WHO and - Multi-sectoral linkages
UNICEF, that sponsored the conference, contributed
much to correct serious gaps and deficiencies in the - Appropriate Technology
existing health services. The existence of the Alma-Ata - Support Mechanism
Declaration on PHC made PHC the major thrust, which
brings a global ideal and new vision about :
PHC as defined by DOH is an approach to health
development which is carried through a set of activities
HOW TO ACHIEVE WORLD HEALTH and whose ultimate aim is continuous improvement and
The Alma-Ata conference defined PHC as the maintenance of the health status of the community. The
essential health care based on practical, scientifically community will define its own programs of activities to
sound and socially acceptable methods and technology solve them, in partnership
made universally accessible to individuals and families The collective impact of community health
in the community through their full participation and at nurses in PHC concept embraces the provision of basic
a cost that the community and country can afford to essential services
maintain at every stage of their development in the
spirit of self-reliance and self-determination. -Promotive

-Preventive

RATIONALE FOR THE DEVELOPMENT OF PHC -Curative

1. Magnitude of Health Problems -Rehabilitative

2. Inadequate and unequal distribution of health

resources PRIMARY HEALTH CARE PARADIGM
3. Increasing cost of medical care Made accessible, attainable, sustainable and affordable
4. Isolation of Health care activities from other to the people towards a....
development Various Health Services -> High Level of Health -> Self
Reliance
PRIMARY HEALTH CARE GOAL: HEALTH IN THE HANDS OF THE PEOPLE BY THE
YEAR 2020
 Is an approach of organizing the community
thru involvement and participation by the use DOH Ten Guiding Principles:
of community resources, indigenous
1. Equating health in the hands of the people with PHC
technologies and linkages in attaining self-
reliance and development. 2. Advocacy or promotive and preventive health care
 Is a community-based approach to make basic among NGOs, LGUs and other government agencies and
needs accessible and effective to the people all other health partners.
through partnership among government, non-
government and community to achieve self- 3. People empowerment and participation
reliance 4. Periphery as a bias
 Is an approach whereby essential health
services are made available, acceptable, 5. Population Management
accessible, affordable and sustainable thorough 6. Development and promotion of Philippine medicine
active community participation, utilizing
appropriate technology supported by intra/inter 7. Mobilization of “pesos for health”
– sectoral collaboration leading to self-reliance
8. Partnership with organized groups
and social transformation
 Is a partnership approach to community 9. Peace building and
development thru services which are
10. Positioning for performance
community-based, affordable, accessible,
sustainable thru community participation, inter-
sectoral linkages towards self-reliance as
knowledge response to the interrelated needs BASIC CONCEPTS OF PHC
of the community 1. Health is related to social structures. Health problems
are brought about by economic, political and cultural
problems and vice-versa.
MISSION AND GOALS
2. Health and development are interrelated.
Mission:
3. People’s participation is essential
To strengthen the health care system by increasing
opportunities and supporting the conditions wherein 4. Community organizing is the core in PHC
people will manage their own health care. 5. Use appropriate technology. Making use of available
Key Strategy to Achieve the Goal: resources is a step to self-reliance and making the
community aware of its potential and resources bring
Partnership with and empowerment of the people. about self-appreciation
Health for All by the Year 2000: 4 Basic Points:

1. Use of technology that is scientifically and socially PRINCIPLES OF PHC

acceptable as well as economically sound.
1. People as the Center of Development
2. Political efforts to improve health, thus improving
people’s economic and social status. 2. Concern for Equity – Depressed, deprived and
underserved (DDU) individuals, families and
3. Cooperation of the health sector with other sectors communities are high in the agenda of the DOH
such as education, agriculture, industry and media
3. Respect for area-based knowledge and capacities
4. Community and individual participation.
4. Social accountability to the community DOH’S TEN HERBAL MEDICINES

5. Devolution a an opportunity for Empowerment 1. Ampalaya

6. Balancing Promotive/Preventive care and 2. Bawang

Curative/Rehabilitative care 3. Bayabas

7. Continuing concern for strengthening the capacity of 4. Lagundi

PHC
5. Akapulko
8. Paradigm shift as a requirement of PHC
6. Niyug-Niyogan

7. Sambong
MAJOR ELEMENTS
8. Tsaang Gubat
1. Use of appropriate technology
9. Ulasimang Bato/pansit-pansitan
2. Multi-sectoral approach to health
10. Yerba Buena
3. Community Participation
Reminders on the Use of Herbal Medicines:
4. Social Mobilization
1. Avoid the use of insecticides on plants

2. Use clay pot and remove the cover while boiling at

PRIMARY HEALTH CARE- HOME ELEMENTS ESSENTIAL low heat in cooking the herbal medicine
SERVICES
3. Use one kind of herbal plant as needed and prepare
Hospital as a Center of Wellness as instructed.

Oral and Dental Health 4. If ailments are not relieved, or if there is an untoward
reaction, stop giving the herbal medicine and consult a
Mental Health
doctor.
Elderly Care
LEVELS OF PHC WORKERS

CLASSIFIED INTO 3 LEVELS

Education for Health
1. Village or Grassroot Health workers – are trained
Local Endemic Diseases Prevention & Control community worker or health auxiliary volunteers,
traditional birth attendants or healers work in liaison
Expanded Program on Immunization with the local health services.
Maternal and Child Health/Family Planning 2. Intermediate Level of Health Workers- are the
Essential Drugs Provision/Herbal Medicines professional health care- general medical practitioners
or resident, public health nurse, midwife and sanitary
Nutrition inspectors.
Treatment of Communicable Diseases 3. Health Personnel of the 1st line Hospital Facility- are
Safe Water and Sanitation back-up services for cases that require hospitalization or
diagnostic facilities not available in the health center.
They are specialist, nurses, dentist, pharmacists and
other health professionals.
FUNCTIONS OF THE NURSE IN PHC INTEGRATED MANAGEMENT of CHILDHOOD ILLNESS
(IMCI)
1. Promotive

• Assessment of the healthcare needs of

individuals, families and communities INTRODUCTION
• Educating people towards high level of wellness
•Every year more than 10 million children die in
• Promoting safety, hygiene, nutrition, sanitation
developing countries before they reach their fifth
and healthy lifestyle
birthday.
• Mobilizing and organizing the people towards
self-reliance • Seven in 10 of these deaths are due to acute
respiratory infections (mostly pneumonia), diarrhoea ,
2. Preventive
measles, malaria, or malnutrition and often to a
• Identifying existing health threats, health combination of these illnesses
deficits and foreseeable crisis
Surveys of the management of sick children in
• Mobilizing the community to eliminate health
most developing countries reveal that
threats and health deficits
• Implementing DOH Programs • Many children are not properly assessed and
• Managing and supervising health care projects treated and that their parents are poorly
advised.
3. Curative
• Diagnostic supports such as radiology and
• Utilizing traditional/alternative healing laboratory services are minimal or non-existent.
modalities for minor illnesses • Drugs and equipment are scarce.
• Identifying cases that require serious • Projections based on the 1996 analysis. The
medical/surgical attention global burden of disease indicate that common
• Detecting and treating early various illnesses childhood illnesses will continue to be major
• Educating the public about the disease process contributors to child deaths through the year
2020 unless greater efforts are made to control
4. Rehabilitative
them.
• Restoring optimum functioning of individuals or • This assumption makes a strong case for
families after a health crisis introducing new strategies to significantly
• Ensuring the productivity of every individual to reduce child mortality and improve child health
attain wellness and development.
• Preventing the recurrence of conditions that • WHO and UNICEF developed a strategy known
lead to illness or crisis as Integrated Management of Childhood Illness
(IMCI).

ROLE OF THE NURSE IN PHC

1. Facilitative

2. Developmental

3. Supplemental

4. Supportive

5. Clinician
WHAT IS IMCI? IMCI

• IMCI is a strategy for reducing mortality and morbidity • WHO and UNICEF used updated technical findings to
associated with major causes of childhood illness. describe management of these illnesses in a set of
integrated guidelines for each illness.
• The strategy includes preventive and curative
interventions, which aim to improve practices both in • These guidelines have been adapted to each country
the health facilities and at home

• It is an integrated approach to child health that

WHY IS IMCI BETTER THAN SINGLE-CONDITION
focuses on the well-being of the whole child
APPROACHES?

• Children brought for medical treatment in the

INTERVENTIONS CURRENTLY INCLUDED IN THE IMCI developing world are often suffering from more than
STRATEGY one condition

HOME • This overlap means that a single diagnosis may not be

possible or appropriate and treatment may be
Promotion of growth (Preventive measures)
complicated by the need to combine therapy for several
o Community/home-based interventions to conditions.
improve Nutrition
• An integrated approach to managing sick children is,
o Insecticide-impregnated bed nets
therefore, indicated as is the need for child health
Response to sickness (curative care) programs to go beyond single diseases and address the
overall health of a child.
o Early case management
o Appropriate care-seeking “Looking to the Child as a Whole”.
o Compliance with treatment

HEALTH FACILITY
OVERALL GOAL
Promotion of growth (Preventive measures)
The overall goal of IMCI is to:
o Vaccinations
1) Reduce the mortality and morbidity in under five
o Complementary feeding
children in relation to the major killers
o Breastfeeding counselling
o Micronutrient supplementation • Diarrhea
• Acute respiratory infections especially
Response to sickness (curative care)
Pneuomonia
o Case management of: ARI, diarrhea, • Malaria
measles, malaria, malnutrition, other • Measles
serious infection • Malnutrition Lead to more than 70% of child
o Iron treatment mortality and morbidity
o Antihelminthic treatment
2) To promote improved growth and development of
children.
IMCI COMPONENTS • Routine vaccination

Implementation of the IMCI strategy in • Regular growth monitoring.

countries involves the following three components
• Early care seeking.
1. Improvement of health worker skills
• Compliance to provider advice
2. Improvement of health systems
3. Improvement of family and community • Home care of sick children
practices in relation to child health
• Recognition of severe illness
These three components are complementary. They all
need to be functioning well to fully benefit the child. • Proper waste disposal.

•Antenatal care

IMCI COMPONENT 1: IMPROVES HEALTH WORKER • TT for pregnant ladies.

SKILLS • Proper nutrition for pregnant ladies.
• Case management guidelines

•Training of health providers (Doctors, Medical VOLUNTEERS WERE TRAINED ON KEY FAMILY
Assistants & Nurses) who look after sick infants and PRACTICES AND COMMUNICATION SKILLS.
children up to 5 years (pre-service and in-service)

• Follow-up after training BENEFITS OF IMCI

• Addresses major child health problems – The strategy

IMCI COMPONENT 2: IMPROVES HEALTH SYSTEMS addresses the most important causes of childhood
death and illness
• Targets first level health facilities
• Promotes prevention as well as cure – In addition to
• Organization of work its focus on treatment, IMCI also provides the
opportunity for important preventive interventions such
• Availability of drugs and supplies
as immunization and improved infant and child
• Monitoring and supervision nutrition, including breastfeeding

• Referral pathways and systems • Improves health worker performance and their quality
of care.
• Health information systems
• IMCI improves health worker performance and their
quality of care.
IMCI COMPONENT 3: IMPROVES FAMILY AND
• IMCI can reduce under-five mortality and improve
COMMUNITY PRACTICES
nutritional status, if implemented well;
To improve the knowledge, attitude and practices of
• IMCI is worth the investment, as it costs up to six
families mainly the mothers regarding Key Family
times less per child correctly managed than current care
practices which include:
• Cost-effective Inappropriate management of
• Exclusive Breastfeeding
childhood illness wastes scarce resources. Although
• Complementary feeding increased investment will be needed initially for training
and reorganization, the IMCI strategy will result in cost
• Cont. feeding during illness. savings.
• Using of iodized salt
• Improves equity – Nearly all children in the developed WHY NOT USE THE PROCESS FOR CHILDREN AGE 5
world have ready access to simple and affordable YEARS OR MORE?
preventive and curative care. Millions of children in the
The case management process is designed for children <
developing world, however, do not have access to this
5yrs of age, although much of the advise on treatment
same life-saving care. The IMCI strategy addresses this
of pneumonia, diarrhea, malaria, measles and
inequity in global health care.
malnutrition, is also applicable to older children, the
ASSESSMENT AND CLASSIFICATION of older children
would differ. For example;
THE IMCI CASE MANAGEMENT PROCESS
• The cut off rate for determining fast breathing would
DISEASES COVERED BY IMCI
be different because normal breathing rates are slower
1-Diarrhea in older children.

2-Acute respiratory infections • Chest in drawing is not a reliable sign of severe

pneumonia as children get older and the bones of the
3-Malaria chest become more firm.
4-Measles • In addition, certain treatment recommendations or
5-Malnutrition advice to mothers on feeding would differ for >5yrs old.

*Lead to more than 70% of child mortality and THE CASE MANAGEMENT PROCESS
morbidity The case management of a sick child brought to
a first-level health facility includes a number of
important elements
DISEASES NOT COVERED BY IMCI
1. Assessment of the child or young infant
•The IMCI guidelines address the most important but 2. Classification the illness
NOT ALL of the major reasons a sick child or an infant is 3. Identification the treatment
brought to the clinic with. 4. Referral, treatment or counselling of the child's
caretaker (depending on the identified
classification(s)
DISEASES NOT COVERED BY IMCI 5. Follow up care
• IMCI encourages the health provider to assess
problems not included in IMCI charts. These are
considered under the box: ASSESS OTHER PROBLEMS

AGE GROUPS COVERED BY IMCI

• IMCI guidelines recommend case management

procedures based on two age categories:

o Children age 2 months up to 5 years.

o Young infants age up to 2 months
ASSESS THE SICK YOUNG INFANT, AGE UP TO 2 MONTHS ASK THE MOTHER WHAT THE CHILD’S PROBLEMS ARE?

• Name of the Infant • Determine if this is an Initial or Follow Up visit for this
problem
• Age
• If Follow Up visit, use the follow up instruction on
• Weight
TREAT THE CHILD CHART
• Temperature
• If Initial visit, assess the child as follows:
• Infant’s Problems
Check for General Danger Signs
• Initial or Follow Up Visit
ASK and check LOOK
• Check for possible bacterial infection
· Is the child able to drink or breast- feed?
• Check for the presence of Jaundice
· Does the child vomit everything?
• Check for diarrhoea
· Has he had convulsions? (during present illness)
• Check for feeding problem or low weight
· See if the child is lethargic or unconscious
• Check for immunization
· See if the child is convulsing now
• Assess other problems
• Check for nutrition, immunization, vitamin A
supplementation and feeding problems

ASSESS THE SICK CHILD, AGE 2 MONTHS UP TO 5 YEARS • Assess other problems

• Name of the Child

• Age CLASSIFICATION THE ILLNESS

• Weight The classification tables on the assess and classify have

3 ROWS. COLOR of the row helps to IDENTIFY RAPIDLY
• Temperature whether the child has a SERIOUS DISEASE requiring
• Child’s Problems URGENT ATTENTION.

• Initial or Follow Up Visit Each row is colored either:

Check for general danger signs for all sick children: • RED – means the child has a severe classification and
needs urgent attention and referral or admission for
1- Unable to drink or breastfeed inpatient care.
2-Vomits every thing • YELLOW – means the child needs a specific medical
3- Has the child had convulsions? treatment such as an appropriate antibiotic, an oral
anti-malarial or other treatment. Also teaches the
4- Unconscious, lethargic mother how to give oral drugs or to treat local
infections at home
5- Is the child convulsing now
• GREEN – not given a specific medical treatment such
CHECK for GENERAL DANGER SIGNS in ALL SICK
as antibiotics or other treatments.
Children