✓ An estimated 10 million (range, 8.

9–11 million)

CHN LEC
OUTLINE HIV
✓
people fell ill with TB in 2019

New HIV infections have been reduced by 40% since

the peak in 1998.
✓ In 2019, around 1.7 million people were newly
infected with HIV, more than a million fewer than in
1998.
MALARIA
✓ The malaria mortality rate has been more than halved:
from 25 deaths per 100 000 population at risk in 2000
to just 10 per 100 000 population at risk in 2019.
✓ The total number of malaria deaths worldwide fell
from 736 000 in 2000 to 409 000 in 2019.

FOUR MAJOR NCDS (CANCER,

CARDIOVASCULAR DISEASES (CVD), DIABETES
AND CHRONIC RESPIRATORY DISEASES (CRD))

✓ The greatest decline in mortality was seen as follows:

GENDER AND DEVELOPMENT
1. CRD - with a 37% decline in age-standardized rates
(ASR) for all ages
Fairness and equity demands that everyone in society whether
2. CVD and Cancer - ASR at 27% and 16% respectively
male or female has the right to the same opportunities to
3. Diabetes - with 3% increase in ASR
achieve a full and satisfying life.
POVERTY AND HEALTH
OVERVIEW OF PUBLIC HEALTH NURSING IN THE
PHILIPPINES
✓ Poverty is a major reason for the health problems.
✓ Most of the leading causes of morbidity and mortality
GLOBAL HEALTH SITUATION
are associated with factors that could be attributed to
poverty.
85%
✓ The poor have poor health because they...
116 million infants received 3 doses of
- do not have the resources to afford the basic requisites of
diptheria-tetanus-pertussis (DTP3) in 2019
health
- could not afford to buy emergency medicines if they got sick
- do not have the capacity to negotiate with the health care
system.

CULTURE INFLUENCES ON HEALTH

✓ Culture is a way of life.

✓ But culture per se, may not be the culprit for poor
health; in many instances it is poverty and inadequacy
of the health system.
✓ Many unhealthy and unsafe practices continue
particularly among poorly educated and poor people.
LIFE EXPECTANCY AND HEALTHY LIFE
✓ Although some cultural practices are harmful to
EXPECTANCY
health, certain aspects of our culture exert positive
influences on health.
• Between 2000 and 2019, global life expectancy (LE)
✓ In CHN, it should be considered as a major social
at birth increased from 66.8 years in 2000 to 73.3 years
resource.
in 2019, and healthy life expectancy (HALE)
increased from 58.3 years to 63.7 years. ENVIRONMENTAL INFLUENCES ON HEALTH
• Despite sharing similar increasing trends, LE and ✓ The environment plays a direct influence on the health
HALE among females were consistently higher than of people.
males. ✓ Exposure to chemicals and other air pollutants has
been identified as a major cause of a number of
BURDEN OF DISEASE diseases such as cancer and respiratory diseases.
✓ The state of the country’s environment is the direct
TUBERCULOSIS result of the interaction of a number of factors such as
✓ Remains as the top leading cause of death
 industrialization, government policies, poverty and an 1. Emphasis on the importance of the “greatest good for
uncaring attitude towards the environment. the greatest number”
✓ In CHN, the environment should be included in its 2. Assessing health needs, planning, implementing and
health programs. evaluating the impact of health services on population
groups
Health is defined as a state of a complete physical, mental and 3. Priority of health-promotive and disease-preventive
social well-being and not merely the absence of disease or strategies over curative interventions
infirmity (WHO, 1995) 4. Tools for measuring and analyzing community health
problems
PUBLIC HEALTH 5. Application of principles of management and
organization in the delivery of health services to the
➢ Public health is the science and art of 3Ps: community
1. Preventing disease
2. Prolonging life COMMUNITY HEALTH NURSING VS. PUBLIC
3. Promoting health and efficiency through organized HEALTH NURSING
community effort
Deliver health services to individuals, groups, and families.
COMMUNITY HEALTH
Assessing the populations health needs.
✓ focuses on the maintenance, protection, and
improvement of the health status of population groups Diagnosis is based on the needs of individuals, family, or group.
and communities
✓ part of paramedical and medical intervention/approach Diagnose and develop policy in relation to community health
which is concerned on the health of the whole needs.
population that aims to:
1. Health promotion Work to promote health and prevent illness in groups and
2. Disease prevention families with the main goal being to increase community health.
3. Management of factors affecting health For example, meeting with a group of young mothers to provide
information on immunizations.
COMMUNITY HEALTH VS. PUBLIC HEALTH Plan for the community as a whole in order to prevent disease
and disability and preserve the health of the community. For
Community health is considered a sub-discipline of public example, after an illness outbreak, the public health nurse will
health, one focused on improving the health outcomes of assess the need and develop a program for an immunization
different groups of individuals, often at the local level. clinic.

Public health is defined by the CDC Foundation as “the science Implementation is based on individual needs. For example, a
of protecting and improving the health of people and their new diabetic who is a kinesthetic learner would be taught how
communities.” to give insulin injections by practicing with an orange.
Community health workers typically support specific
geographical regions, from small rural towns to large districts Implementing the plan means the nurse ensures the resources
in urban areas. are available to all who need them within the community.

Public health workers are more concerned with preventing Evaluate whether health needs were met on the individual,
disease, prolonging life and promoting healthy behaviors that family or group level.
impact entire nations or society as a whole.
Evaluate the health status of the whole community and whether
PUBLIC HEALTH NURSING planned goals and objectives were met.

✓ Special field of nursing that combines the skills of ROLES AND FUNCTIONS OF A COMMUNITY
nursing, public health and some phases of social HEALTH NURSE
assistance and functions as part of the total public
health programme for the promotion of health, the 1. Planner/Programmer
improvement of the conditions in the social and 2. Provider of Nursing Care
physical environment, rehabilitation of illness and 3. Community Organizer
disability. (WHO Expert Committee of Nursing). 4. Coordinator of Services
5. Trainer/Health Educator
COMMUNITY HEALTH NURSING 6. Health Monitor
7. Role Model
It is a specialized field of nursing practice. Its baisc knowledge 8. Change Agent
and skills are anchored on nursing theories and important 9. Recorder/Reporter/Statistician
concepts from the science of public health such as: 10. Researcher
CLIENTS OF A COMMUNITY HEALTH NURSE targets laid out in the Sustainable Development Goals
(SDGs).
There are different levels of clientele: ✓ The SDGs underscore the key role health plays in
I - Individual assuring the world’s future, with SDG3 calling on all
F - Family stakeholders to “ensure healthy lives and promote
P - Population group well-being for all at all ages”.
C - Community ✓ Aligned with WHO’s goal of ensuring that everyone,
everywhere, can realize their right to a healthy life.
HEALTH CARE DELIVERY SYSTEM ✓ Emphasized the importance of collaboration, between
different actors working in different fields, in all
• is the totality of all policies, infrastructures, countries of the world.
facilities, equipment, products, human resources, WHO’s New General Programme of Work
and services that address the health needs,
problems and concerns of all people. ✓ Mission: Promote health, keep the world safe, serve
the vulnerable
WORLD HEALTH ORGANIZATION ✓ Targets to be achieved by 2023:
• The World Health Organization works with 194 a. 1 billion more people benefitting from universal health
Member States, across six regions, and from more than coverage
150 offices b. 1 billion more people better protected from health
• WHO Member States are grouped into 6 regions. emergencies
Each region has a regional office. c. 1 billion more people enjoying better health and well-
• WHO Africa being
• WHO Americas
• WHO Mediterranean DEPARTMENT OF HEALTH (DOH)
• WHO Europe
✓ The DOH holds the over-all technical authority on
• WHO South East Asia
health as it is a national health policy-maker and
• WHO Western Pacific regulatory institution.
✓ The DOH has three major roles in the health sector: (1)
WHO collaborates with Member States to provide on-the-
leadership in health; (2) enabler and capacity builder;
ground planning, implementing and monitoring of health
and (3) administrator of specific services. Its mandate
programmes. Today, more than half of WHO staff work in
is to develop national plans, technical standards, and
country offices.
guidelines on health. Aside from being the regulator of
all health services and products, the DOH is the
Guiding Principle
provider of special tertiary health care services and
✓ The principle that all people should enjoy the highest
technical assistance to health providers and
standard of health, regardless of race, religion,
stakeholders.
political belief, economic or social condition, has
guided WHO’s work for the past 70 years, since it was
first set up as the lead agency for international health
in the new United Nations system.

Standards

✓ WHO has brought together the world’s top health

experts to produce international reference materials
and to make recommendations to bring better health to
people throughout the world.
✓ WHO’s work has led to global standards for air and
water quality, so important in a world where pollution
is an increasing threat to our health; safe and effective
vaccines and medicines, thanks to its prequalification
programme; and height and weight charts for children,
to guide health professionals and parents in helping
young people grow up healthy and strong.
✓ WHO has also led to guidelines and advice on
preventing and treating health conditions ranging from
asthma and hepatitis to malnutrition and Zika.

Working towards the Sustainable Development Goals

✓ WHO works alongside a host of health and
development partners to achieve the health-related
 Health Sector Reform Agenda in 1999 - Supported the
development and strengthening of local health systems,
facilitated the fiscal autonomy of government hospitals,
increased funding for priority public health programs and
expanded NHIP coverage.

FOURmula One (F1) for Health - Sought to fill the remaining

gaps in the health system not addressed by previous reforms by
leveraging central government funds to promote inter-LGU
collaboration in attaining desired health outcomes.

Universal Health Care (UHC) or Kalusugan Pangkalahatan

- A policy goal, leading to the expansion of SHI coverage
mainly due to sin taxes earmarked for health, the introduction
of no-balance billing (NBB) scheme for indigents, and
intensified support to health facility construction and
enhancement.

CHALLENGES AND IMPLICATIONS

• Mixed health outcomes

• Disjointed health system
• High out-of-pocket expenditure

CLASSIFICATION OF HEALTH FACILITIES

66 hospitals - The DOH directly supervises and controls the

management and
operations of these hospitals. Majority of these facilities are
Level 3 Hospitals (56%).
Health Service Delivery
✓ The Philippines has a mixed public-private healthcare 4 specialty hospitals - Four specialty hospitals attached to the
system that operates within a fragmented environment. DOH operating as Government-Owned and -Controlled
✓ Both the national government and LGUs manage the Corporations (GOCC) namely, National Kidney and Transplant
delivery of promotive, preventive, curative and Institute, Philippine Heart Center, Philippine Children’s
rehabilitative health services. Medical Center and Lung Center of the Philippines
✓ The DOH supervises the government corporate
hospitals, specialty and regional hospitals while the CLASSIFICATION OF HOSPITAL (ACCORDING TO
Department of National Defense (DND) runs the FUNCTIONAL CAPACITY)
military hospitals. Both agencies provide tertiary care.
✓ At the local level, the provincial governments manage General - a hospital that provides services for all kinds of
district and provincial hospitals. Meanwhile, illnesses, diseases, injuries or
municipal governments provide primary care deformities. A general hospital shall provide medical and
including preventive and promotive health services surgical care to the sick and uninjured, maternity, newborn and
and other public health programs through the RHUs, child care. It shall be equipped with the service capabilities
health centers and BHSs, which are the first point of needed to support board certified/eligible medical specialists
contact for government-provided health services, and other licensed physicians rendering services in, but not
(Dayrit, et al., 2018). limited to, the following:
a. Clinical Services (Family Medicine, Pediatrics,
Health Financing Internal Medicine, Obstetrics and Gynecology,
✓ PhilHealth serves as the national social health Surgery)
insurance agency which purchases services from b. Emergency Services
public and private providers on behalf of its members. c. Outpatient Services
Health Governance and Regulation d. Ancillary and Support Services such as, clinical
✓ The enactment of LGC in 1991 led to dual governance laboratory, imaging facility and pharmacy
in health, with the DOH governing at the national level
and the LGUs at the subnational level. Specialty - a hospital that specializes in a particular disease or
✓ The DOH serves as the over-all steward and technical condition or in one type of
authority on health being the national health policy- patient. A specialized hospital may be devoted to treatment of
maker and regulatory institution. any of the following:
a. Treatment of a particular type of illness or for a
particular condition requiring a range of treatment
 b. Treatment of patients suffering from diseases of a 1978
particular organ or group of organs
- Health, which is a state of complete physical, mental,
LEVEL OF HOSPITAL and social wellbeing, and not merely the absence of
- defined as the service capabilities of hospitals disease or infirmity, is a fundamental human right and
reflected in the 2020 license to operate. that the attainment of the highest possible level of
- These service capabilities can be classified into the health is a most important world-wide social goal
following categories. whose realization requires the action of many other
social and economic sectors in addition to the health
sector.
— Alma-Ata Declaration, 1978
2018

- Forty years later, global leaders ratified the

Declaration of Astana at the Global Conference on
Primary Health Care which took place in Astana,
Kazakhstan in October 2018

PHILIPPINE SETTING
CLASSIFICATION OF HOSPITAL (ACCORDING TO
OWNERSHIP) ✓ The 1992 implementation of the devolution of health
care to the local governments and the 1999 health
Government - created by law, may be under DOH, DND, DOJ, sector reform have brought about changes in the health
PNP, LGU, SUCs, GOCC and others care delivery system.
✓ The revitalization of primary health care is a policy
Private - may be a single proprietorship, partnership, issue to be addressed by national government, local
corporation, cooperative, foundation, religious, non- government, civil society groups and even the private
government and others business sector, in the present set-up of a devolved
health care system.
CLASSIFICATION OF HOSPITAL (ACCORDING TO
TRAUMA CAPABILITY) PHILIPPINE SETTING: HISTORICAL TIMELINE
Trauma-Capable Facilty - DOH licensed hospital designated 1978 – The Pilot Year
as a trauma center
✓ The 1978 Alma Ata Declaration definitely spurred
Trauma-Receiving Facilty - DOH licensed hospital within the changes in the Philippine health sector through
trauma service area which receives trauma patients for transport primary health care approach.
to the point of care or trauma center ✓ The public health system experienced innovative and
pioneering changes when the Marcos administration
PRIMARY HEALTH CARE (PHC) adopted the national plan and strategy for PHC
implementation.
- ...essential health care based on practical, ✓ Pilot provinces in each of twelve (12) regions in the
scientifically sound and socially acceptable methods country were selected according to certain criteria,
made universally accessible to individuals and namely: health needs of the population, lack of
families in the community through their full people's access to health services at the regional
participation and at a cost that the community can center, poor peace and order condition.
afford to maintain at every stage of their development
in the spirit of self reliance and self determination 1981 - Second Stage- Pre-Devolution: Institutionalization of
PHC
Brief History of PHC
1977 ✓ The government moved the PHC from pilot stage to
institutionalization nationwide, until the ouster of
✓ WHO members, International Conference on Primary President Ferdinand Marcos in 1986.
Health Care in Alma Ata, Kazakhstan ✓ Initially under Pres. Marcos, the Ministry of Health
✓ Resolution - 20th Word Health Assembly marshaled local government involvement and
✓ “the main social targets of governments and WHO in community participation. This stage was sustained by
the coming decades should be the attainment by all the new government of President Corazon Aquino in
citizens of the world by year 2000 of a level of health 1986 as the Department of Health pursued the policy
that will permit them to lead a socially and of engaging non-government organizations and
economically productive life” volunteer community/barangay health workers in
innovative health programs.
 ✓ Village drugstores (Botika ng Barangay) were set up recognized pioneers in primary health care and
to make medicines affordable and accessible to the experts in community processes.
poor and low income population. 3. Existence of models and best practices in PHC
experience, including the legacies of trained
1991 – Third Stage Devolution primary health care-oriented health professionals
and community workers and of processes in
✓ The Congress passed the Local Government Code and organizing and mobilizing for community based
the government began the process of devolution in and community managed health interventions.
1992 that changed the system of health service 4. Enactment of relevant laws, i.e., National Health
delivery, the role and functions of-national Insurance Act, the Generics Act, and the National
government (Department of Health), and the Drug Act.
responsibilities of local government units.
✓ The process of transition to the devolved set up that
started in 1992 created some difficulties for the
Department of Health. The responsibilities over health
service delivery were transferred from national
government to local government.
✓ The hospitals came under the jurisdiction and
management of the provincial government, the rural
health clinics under the charge of the municipality/city
government, and the barangay health stations by the
respective barangays within the municipality/city.
Health personnel were also devolved from the national
level to the local government units in different parts of
the country. UNIVERSAL TARGET
✓ The national government, through the Department of
Health, took the view that PHC is an approach, a ✓ Health for all by the year 2000 (HFA 2000)
strategy for application in health programs; that it is ✓ Does not mean that nobody will get sick anymore
not a program to be implemented by specific ✓ Concept was left for every country to define and
offices/units as it was in the pre-devolution years. interpret in consideration of the:
✓ In 1996, the DOH affirmed its policy of Primary ➢ Health status
Health Care for Community Health Development, ➢ Morbidity
within the framework of devolution. It asserted the ➢ Mortality
principle of "health in the hands of the people" that ➢ State of development of a health care system
can be done through various community processes
✓ In different parts of the country, the NGOs played a PHC Goals
crucial role in the Department of Health's Partnership
for Community Health Development (PCHD) by using ✓ To achieve Health for All that is:
their expertise in community organizing, ➢ Accessible to everyone
empowerment and mobilization for primary health ➢ Acceptable and affordable to everyone
care. ➢ Based in the community or workplace
1999 – Fourth Stage Devolution Essential Health Services in Primary Health Care
✓ The Department of Health embarked on the process of E – Education for Health
health sector reform. Specifically, the Health Sector L – Locally endemic disease control
Reform Agenda (HSRA) aimed to address the problem E – Expanded program for immunization
of fragmentation of the public health system during the M –Maternal and Child Health including
period of transition when health care services had just responsible parenthood
been devolved from national to local government; as E – Essential drugs
well as to improve the system for health care services. N – Nutrition
✓ The Department of Health began with initial pilot sites T – Treatment of communicable and non-
and later expanded the implementation of the Health communicable diseases
Sector Reform Agenda (HSRA). S - Safe water and sanitation
✓ The continuing adherence to PHC can be gleaned from
the following structures, policies and activities: Essential Elements/Services of PHC
1. Formal inclusion of barangay health workers as a 1. Education concerning prevailing health problems and
category in the classification of health workers in the methods of preventing and controlling them
the public health system and formulation of 2. Promotion of food supply and proper nutrition
policies on their rights and privileges. 3. An adequate supply of safe water and basic sanitations
2. Continuing cooperation and support from NGOs 4. Maternal and child health care, including family
in government programs and projects, as planning
 5. 5. Immunization against the major infectious diseases - 2) Improved access to quality hospitals and health care
6. 6. Prevention and control of locally endemic diseases facilities; and
7. 7. Appropriate treatment of common diseases and - 3) Attainment of health-related Millennium
injuries Development Goals (MDGs).
8. 8. Provision of essential drugs
RA 11223: Universal Health Care Act
Guiding Principles
The policy of the State to protect and promote the right to health
1. Equitable distribution of health services of all Filipinos and install health consciousness among them.
✓ Based on need Towards this end, the State shall adopt:
✓ Services to the majority a. An integrated and comprehensive approach to ensure
2. Active community participation and involvement in the that all Filipinos are health literate, provided with
planning, implementation and evaluation of health services healthy living conditions and protected from hazards
✓ Active partners in the health development process and risks that could affect their health;
✓ Not as passive recipients of health services b. A health care model that provides all Filipinos access
3. The use of appropriate technology in the delivery of to a comprehensive set of quality and cost-effective,
health services promotive, preventive, curative, rehabilitative and
✓ Includes facilities, equipment, methods, techniques, palliative health services without causing financial
procedures, supplies and materials hardship, and prioritizes the needs of the population
✓ Scientifically sound, affordable and within the who cannot afford such services;
community’s ability and resources to use, maintain, c. c. A framework that fosters a whole-of-system, whole-
and manage of-government, and whole-of-society approach in the
e.g. Water sealed toilets not appropriate in areas with water development, implementation, monitoring and
supply problems evaluation of health policies, programs, and plans; and
4. Focus on health promotion and disease prevention d. d. A people-oriented approach for the delivery of
✓ Shift of health care system priorities health services that is centered on people’s needs and
✓ From hospitals and curative care to health promotion well-being, and cognizant of the differences in culture,
and disease prevention values, and beliefs.
5. A multi-sectoral approach to community health
development Universal Health Care Act: OBJECTIVES
✓ Agriculture, industry, education, mass media, religion, ✓ Progressively realize universal health care in the
culture and politics country through a systematic approach and clear
✓ Role and contribution are recognized and utilized delineation of roles of key agencies and stakeholders
towards better performance in the health system; and
LEVELS OF PREVENTION ✓ Ensure that all Filipinos are guaranteed equitable
access to quality and affordable health care goods and
services, and protected against financial risk.

POPULATION-BASED HEALTH SERVICES

-refer to interventions such as health promotion, disease
surveillance, and vector control, which have population groups
as recipents
Province-wide and city-wide health systems shall have the
following minimum components:
1. Primary care provider network with patient records
accessible throughout the health system
2. Accurate, sensitive, and timely epidemiologic
surveillance systems
UNIVERSAL HEALTH CARE 3. Proactive and effective health promotion programs or
- Universal health coverage means that all people have campaigns
access to the health services they need, when and
where they need them, without financial hardship. It INDIVIDUAL-BASED HEALTH SERVICES
includes the full range of essential health services, -refer to services which can be accessed within a health facility
from health promotion to prevention, treatment, or remotely that can be definitely traced back to one (1)
rehabilitation, and palliative care. recipient, has limited effect at a population level and does not
alter the underlying cause of illness such as ambulatory and
UHC’s Three Thrusts inpatient care, medicines, laboratory tests and procedures,
- To attain UHC, three strategic thrusts are to be among others
pursued, namely:
- 1) Financial risk protection through expansion in INTEGRATION OF LOCAL HEALTH SYSTEMS
enrollment and benefit delivery of the National Health Integration of Local Health Systems into Province-wide and
Insurance Program (NHIP); City-wide Health System (P/CWHS)
 ✓ The DOH, DILG, PhilHealth and the LGUs shall RA No. 7846
endeavor to integrate health systems into P/CWHS.
✓ The Provincial and City Healths Boards shall oversee
An Act requiring compulsory immunization against
and coordinate the integration of health services for
P/CWHS, to be composed of municipal and Hepatitis B for infants and children below eight years old,
component city health systems, and city-wide health amending for the purpose Presidential Decree No. 996,
systems in highly urbanized and independent December 30, 1994.
component cities, respectively.
DOH AO No. 39, s. 2003
KEY ACTIVITIES OF THE DOH FOR UHC ACT
1. Engagement of the 58 UHC Integration Sites
2. Development of 59 Operational Guidelines and (April 21, 2003) guided the nationwide implementation
Policies of the EPI.
3. Capacity building through E-Learning Modules
*UHC Integration Sites referes to LGUs that expressed their RA No. 10152
commitment to integrate local health systems into province-
wide and city-wide health systems.
Mandatory Infants and Children Health Immunization
Act of 2011Signed by President Benigno Aquino III in July
26, 2010. The mandatory includes basic immunization for
EPI (Expanded Program on Immunization) children under 5 including other types that will be
determined by the Secretary of Health.
The Expanded Program on Immunization
(EPI) was established in 1976 to ensure that infants/children Supporting Data and Statistics
and mothers have access to routinely recommended
infant/childhood vaccines. Six vaccinepreventable diseases
POLIOMYELITIS- The Philippines has sustained its polio-
were initially included in the EPI: tuberculosis, poliomyelitis,
diphtheria, tetanus, pertussis and measles. free status since October 2000.

The Fundamental Law of the Land Measles Elimination Conducted 4 rounds of mass
measles campaign: 1998, 2004, 2007 and 2011. 2-dose
the 1987 Philippine Constitution – says that “…to make measles-containing vaccine (MCV) was implemented in
essential goods, health and other social services available 2009 MCV1 (monovalent measles) at 9-11 months old
to all people at affordable cost… There shall be priority MCV2 (MMR) at 12-15 months old.
for the needs of the underprivileged, sick, elderly,
disabled, women, and children” (Article XIII, Section 11,
1987)

Presidential Decree (PD) No. 996

(September 16, 1976) provides for compulsory basic

immunization for infants and children below eight years
old.

Presidential Proclamation No. 6

Implementing the Expanded Program on Immunization

(EPI), in response to the United Nation’s goal of universal Maternal and Neonatal Tetanus Elimination
child immunization by 1990.
10 areas were classified as highest risk for neonatal
Proclamation No. 46 tetanus (NT). These areas are the following: Abra,
Banguet, Isabela City and Basilan, Lanao Norte, Cotabato
(September 16, 1992) reaffirmed the Philippines’ City, Maguindanao, Lanao Sur, Marawi City and Sulu.
commitment to universal goal of eradicating polio by
2000 through child and mother immunization. Hepatitis B Control

The goal of Hepatitis B control is to lower the chronic

hepatitis B infection rate, as defined by HBsAg
prevalence, to less than 1% in five-year-olds born after
routine vaccination began with a 100% Hepatitis B at PARTNER INSTITUTION
birth immunization.
INTERNATIONAL HEALTH PARTNERS

-Global Alliance for Vaccines and Immunization (GAVI)

-Coalition for Epidemic Preparedness Innovations (CEPI)
-Centers for Disease Control and Prevention (CDCP)
-United Nations Children’s Fund (UNICEF)
-World Health Organization (WHO)

LOCAL HEALTH PARTNERS

Introduction to New Vaccines
-Department of Health (DOH)
As of 2012, Rotavirus and Pneumococcal vaccines were
-Department of Education (DepEd)
introduced in the national immunization program.
-Department of Social Welfare and Development (DSWD)
Immunization are prioritized among the infants of
- Department of the Budget and Management (DBM)
families listed in the National Housing and Targeting
-Material Management Division (MMD)
System (NHTS) for Poverty Reduction nationwide.
-Research Institute for Tropical Medicine (RITM)
- Food and Drug Administration (FDA)
PROGRAM COMPONENTS: GOALS AND OBJECTIVES
STRATEGIES AND ACTIVITIES
Important components of management of EPI
1. Expand the package of quality immunization
1. cold chain maintenance
services and scale up coverage
2. record keeping and evaluation
2. Generate clients demand and multisectoral
3. uniform vaccination coverage standards 12:01 PM
support for immunization services
4. communication with the public through various media.
3. Strengthen surveillance and response
4. Build-up supervision, monitoring and evaluation
The ultimate Objective of EPI
5. Institute supportive governance, financing and
regulatory measures
To reduce the morbidity of the diseases for which vaccine
is available.
EPI ACTIVITIES
SPECIFIC GOALS
• 1976 BCG first administered among school
entrants DPT introduced in priority areas
1. To immunize all infants/children against the most
• 1979 BCG and DPT provided nationwide; OPV
common vaccinepreventable diseases.
and tetanus toxoid (TT) for pregnant women
2. To sustain the polio-free status of the Philippines.
provided in high risk areas
3. To eliminate measles infection.
4. To eliminate maternal and neonatal tetanus • 1983 MV provided nationwide 2005 Hepatitis B
5. To control diphtheria, pertussis, hepatitis b and provided nationwide
German measles. • 2012 PENTA administered Nationwide Rotavirus
6. To prevent extra pulmonary tuberculosis among vaccine provided among children in indigent
children. families Anti-Influenza Vaccine and PPV 23
provided for indigent senior citizens
TARGET CLIENTS • 2016 Switch from tOPV to bOPV IPV provision
expanded to 6 regions Td and MR vaccines
provided in all public schools HPV vaccination
expanded to 48 provinces
• 2017 MV was replaced with MMR TT vaccine for
CBAW was replaced with Td Anti-Influenza
Vaccine and PPV 23 provided for all senior citizen
at ages 60 to 65 year
EPI STRATEGIES AND ACTIVITIES (MIMAROPA) IMCI

S1. Conduct of Routine Immunization for WHAT IS IMCI?

Infants/Children/Women through the Reaching Every
Barangay (REB) or Reaching Every Purok (REP) strategy. IMCI is an integrated approach to child health that
focuses on the well-being of the whole child.
S2. Supplemental Immunization Activity (SIA): It is a major strategy for child survival, healthy growth
• 1998- Ligtas Tigdas 2004- Ligtas Tigdas (follow - and development and is based on the combined delivery
up of 1998) of essential interventions at community, health facility
• 2007- Knockout Tigdas (sequel of 1998 and 2004) and health systems levels.
• 2011- Iligtas sa Tigdas and Pinas/Mr Sia)
• 2014- Measles Rubella- Oral Polio Vaccine (MR It is a case management process and strategy for first-
OPV) level facility such as a health center to achieve a
• 2015- School-Based Adolescent Imm. Activity significant reduction in the number of deaths from
(SBAI communicable diseases in children under five.
• S3. Strengthening Vaccine – Preventable Disease
Surveillance IMCI includes elements of prevention as well as curative
and addresses the most common conditions that affect
young children.

IMCI POLICIES AND LAWS

IMCI aims to reduce death, illness and disability, and to

promote improved growth and development among
infants and children aged less than 5 years. IMCI includes
both preventive and therapeutic elements that are
implemented by families and communities as well as by
health workers in facilities.

RA 11148
This Act covers those who are nutritionally-at-risk,
especially pregnant and lactating women, particularly
teenage mothers, women of reproductive age,
adolescent girls, and all Filipino children who are newly
born up to age twenty-four (24) months.

RA 10821
Republic Act (RA) 10821 or the Children's Emergency
Relief and Protection Act sets a standard of
accountability to children in terms of protection and
provision of their needs before, during, and after a
disaster.

REPUBLIC ACT No. 10028

An act expanding the promotion of breastfeeding,
amending for the purpose republic act no. 7600,
otherwise known as "an act providing incentives to all
government and private health institutions with
rooming-in and breastfeeding practices and for other
purposes"

Revised Implementing Rules And Regulations of

Executive Order No. 51,
Otherwise Known as The "Milk Code", Relevant STRATEGIES AND PRINCIPLES
International Agreements, Penalizing Violations Thereof,
and for Other Purposes 1. Ask the mother what is the problem of the child.
2. All sick children aged 2 months up to 5 years are
Components of IMCI examined for GENERAL DANGER SIGNS (GDS):
-A general danger signs is present if the child is/has:
➢ Improving case management skills of health C-onvulsions
workers U-nable to feed, drink or breastfeed
V-omits everything
11-day Basic Course for RHMs, PHNs A-bnormally sleepy/difficult to awaken (lethargic
and MOHs or unconscious)
5 - day Facilitators course Remember: 1 Danger Sign =Severe Classification
5 – day Follow-up course for IMCI
Supervisors • -All Sick Young Infants Birth up to 2 months are
➢ Improving over-all health systems. examined for VERY SEVERE DISEASE AND LOCAL
➢ Improving family and community health BACTERIAL INFECTION. These signs indicate
practices immediate referral or admission to hospital
• -The children and infants are then assessed for
OBJECTIVES OF IMCI main symptoms. For sick children, the main
symptoms include: cough or difficulty
Reduce death and frequency and severity of illness and breathing, diarrhea, fever and ear infection. For
disability, and sick young infants, local bacterial infection,
Contribute to improved growth and development diarrhea and jaundice.
• All sick children are routinely assessed for
TARGET CLIENTS nutritional, immunization and deworming status
and for other problems
Sick children birth up to 2 months • Only a limited number of clinical signs are used
(Sick Infant) • A combination of individual signs leads to a
Sick children 2 months up to 5 years old (Sick Child) child’s classification within one or more
symptom groups rather than a diagnosis.
IMCI PARTNER INSTITUTIONS • IMCI management procedures use limited
number of essential drugs and encourage active
National/Government participation of caretakers in the treatment of
• -Department of Interior Local Government ( children
DILG) • Counselling of caretakers on home care, correct
• -Public Information Agency feeding and giving of fluids, and when to return
• Local/Youth/CSOs, NGOs to clinic is an essential component of IMCI
• -Local Government Units (LGUs)
THE IMCI CASE MANAGEMENT PROCESS
International Partners
• -World Health Organization (WHO) 1. Assess and classify
• -United Nations Children’s Funds -taking a history and doing a physical
• -Save the Children examination
-making a decision on the severity of the illness.
BASIS FOR CLASSIFYING THE CHILD’S ILLNESS 2. Identify appropriate treatment
-the charts recommend appropriate treatment
PINK- indicates urgent hospital referral or admission for each classification.
YELLOW- indicates initiation of specific Outpatient 3. Treat/refer
Treatment -giving treatment in health center, prescribing
GREEN – indicates supportive home care drugs or either treatments to be given at home,
and also teaching the mother how to carry out the
treatments.
4. Counsel
 -includes assessing how the child is fed and 1. Guide health workers and medical practitioners in
telling her about the foods and fluids to give the child and providing evidenced-based essential newborn
when to bring back to the health center. care.
5. Follow-up • This is to ensure that newborn babies receive the
describe what to do when a child returns to the best and quality newborn care that is based on
health center by arrangemnet for a follow-up visit. evidences and studies, and also to reduce the risk
for complications such as hypothermia and
UNANG YAKAP: sepsis.
2. Define the roles and responsibilities of the
ESSENTIAL different DOH Offices and other agencies in the
implementation of the Newborn Protocol.
NEWBORN CARE • This goal is included in the Administrative Order
(PROTOCOL FOR No. 2009-0025. It aims to define the roles and
responsibilities of the people and agencies that
NEWLIFE) are connected with the implementation of EINC
to provide a safe, organized and evidenced-based
protocol to ensure the quality care for newborn.
I. INTRODUCTION One of its main goals is to promote evidence-based care
eliminating stereotyped newborn care practices such as
• What is EINC? unnecessary suctioning and bathing instead of carrying
Essential Intrapartum Newborn Care is a package out a step-by-step time bound intervention and to achieve
of evidenced based practices recommended by the United Nations Millennium Development Goal 4 of
the DOH, PhilHealth and WHO as the standard of Reducing Under 5 Child Mortality (through reduction of
care by all births by skilled attendants in all neonatal deaths).
Government and Private Settings
• Unang Yakap
• EINC is a series of time-bound and evidence- Unang Yakap is a simple and evidence-based
based interventions for newborn babies and interventions that may help in ensuring the survival of
their mothers that ensure the best care for all newborns and young infant. This compasses
them, when it was developed and further interventions such as ensuring warmth, breastfeeding,
studies was made, WHO supported the love and safety and infection control.
Philippine government in promoting safe and
effective health care for mothers and babies • The most important outcome of Unang Yakap is
including the development and the promotion of breastfeeding. Since the baby is
implementation of the EINC protocols. placed closely to the mother’s breast he becomes
familiar with the breast as the source of food.
• Development of EINC According to Dr Teresita “Tetchie” Cadiz Brion,
from an interview with UNICEF, the most
• The ENC Protocol was developed by the
important outcome of Unang Yakap is the
Newborn Care Technical Working Group
promotion of breastfeeding. Since the baby is
(TWG)
placed closely to the mother’s breast he becomes
• The TWG conducted a systematic search and
familiar with the breast as the source of food. She
critical appraisal of foreign and local medical
highlighted the importance of collaboration
and allied health literature on practices in the
between and continuous training of all the health
immediate newborn period.
workers and volunteers involved in the care of
• An evidence-based draft was then developed
mothers and newborns. Even doctors who are
and reviewed by the Department of Health
non-first liners from other specialties were
(DOH)
trained for additional support.
• Organizations like UN, UNICEF, UNFPA
and POGS reviewed the draft.

• Goals and Objectives

 II. INTERVENTIONS AND - Put ties tightly around the cord at 2 em
and 5 em from the newborn's abdomen.
PROCESSES
- Cut between ties with sterile instrument.
- Observe for oozing blood.
• Introduction
After cord clamping, ensure 10 IU Oxytocin 1M is given
Standard essential newborn care practices and guidelines to the mother.
are organized by time, beginning at the time of perineal
bulging until one week of life. In EINC, interventions are 4. non-separation of the newborn from the mother
given emphasis that should be provided from birth of the for early breastfeeding initiation and rooming-in
newborn until the first 6 hours of life ‘til the first week of - Leave the newborn on the mother's chest
life. in skin-to-skin contact. Health workers
should not touch the newborn unless
• This is to ensure and prevent risks and there is a medical indication.
complications for newborns. In the - Observe the newborn. Advice the mother
Administrative Order 2009-0025, it mentioned to start feeding the newborn once the
the Ensure Quality Provision of Time-bound newborn shows feeding cues (e.g.
Intervention where the aspect of newborn care in opening of mouth, tonguing, licking,
the Philippines has not met the International rooting). Make verbal suggestions to the
Standards, and should be re-learned and re-taught mother to encourage her newborn to
by all healthcare providers. That is why they move toward the breast e.g. nudging.
formulated the four-time bound interventions of - Counsel on positioning and attachment.
EINC. When the newborn is ready, advise the
• 4-Time Bounded Interventions mother to position and attach her
1. Immediate thorough drying – newborn.
- Use a clean, dry cloth to thoroughly dry - Advise the mother not to throwaway the
the newborn by wiping the eyes, face, colostrum.
head, front and back, arms and legs.
- Do a quick check of newborn's breathing 4.2. Objective: To prevent ophthalmia neonatorum
while drying through proper eye care
- Do not put the newborn on a cold or wet - Administer erythromycin or tetracycline
surface. ointment or 2.5% povidone-iodine drops
- Do not bathe the newborn earlier than 6 to both eyes after the newborn has
hours of life. located the breast.
2. early skin-to-skin contact – - Do not wash away the eye antimicrobial.
- Place the newborn prone on the mother's
abdomen or chest, skin-to-skin. • Non-intermediate Interventions
- Cover the newborn's back with a blanket 1. Give Vitamin K prophylaxis
and head with a bonnet. - Inject a single dose of Vitamin K 1 mg
- Do not separate the newborn from the 1M (if parents decline intramuscular
mother, as long as the newborn does not injections, offer oral vitamin K as a 2nd
exhibit severe chest in-drawing, gasping line).
or apnea and the mother does not need 2. Inject Hepatitis Band BCG vaccinations
urgent medical/surgical stabilization e.g. - Inject hepatitis B vaccine 1M and BCG
emergency hysterectomy. intradermally.
- Do not wipe off vernix if present. 3. Examine the newborn. Check for birth
3. properly-timed clamping and cutting of the cord injuries, malformations or defects.
after 1 to 3 minutes - Look for possible birth injury and/or
- Clamp and cut the cord after cord malformations.
pulsations have stopped (typically at 1 to 4. Cord Care
3 minutes). Do not milk the cord towards - Explain to the mother that she should
the newborn. seek care if the umbilicus is red or
draining pus.
 - Teach the mother to treat local umbilical Additionally, it is important to get baby
infection three times a day. back in a skin to skin position
• Discontinued Newborn Care Practices in the immediately after to minimize effects
Delivery Room from the cold.

1. Manipulation such as routine suctioning of

secretions if the baby is crying and breathing • Significance of EINC and Unang Yakap
normally. - Dr. Teresita Brion explained that “The
- Doing so may cause trauma or introduce Unang Yakap or Essential Intrapartum
infection. Newborn Care was really conceptualized
2. Putting the newborn on a cold or wet surface. in order to have early initiation of
- The reason why this is discontinued it’s breastfeeding. So how early is early? As
because of the risk and possibility for the early as delivery. The newborn is placed
newborn to acquire hypothermia that’s strategically on the mother’s breast so he
why it was mentioned in the 4-Time will be able to feed immediately when he
bounded interventions that immediate is hungry. What’s good about Unang
thorough drying is essential and is the Yakap is that it respects the readiness of
first step to newborn care. the baby to breastfeed as manifested by
3. Wiping or removal of vernix caseosa if feeding cues”.
present III. DATA AND STUDIES
- Vernix caseosa is a white, creamy,
naturally occurring biofilm covering the 1. First Slide
skin of the fetus during the last trimester (read the slide first)
of pregnancy. Vernix coating on the - In the Philippines, an estimated 82 000 of
neonatal skin protects the newborn skin 2.4 million children die annually before
and facilitates extra-uterine adaptation of their fifth birthday with half occurring
skin in the first postnatal week if not among newborns. While post-neonatal
washed away after birth. deaths decreased between 1990 and
4. Foot printing 2005, neonatal mortality did not.
- In the first few minutes following 2. Second Slide
delivery, the newborn’s feet are pressed (read slide first)
into a common inkpad and later pressed - As what was mentioned, 82,000 of 2.4
onto an identification sheet. Not only is million children dies annually before
this practice is usually done by untrained their fifth birthday, this decreased from
personnel with variable results, but more 52 per 1000 livebirths in 1998 to 32 per
importantly also increases the risk of 1000 livebirths in 2003, the problem is
cross-contamination among the babies. that neonatal deaths decrease slowly. As
In 1988, the American Academy of a response, the Philippines Department
Pedicatrics (AAP) and the American of Health (DOH), World Health
College of Obstetricians and Organization (WHO) and partners
Gynecologists (ACOG) stated that developed and adopted a systems
“individual hospitals may want to approach to improve newborn care
continue the practice of footprinting or practices.
fingerprinting, but universal use of this 3. Third Slide
practice is no longer recommended.” (read slide first)
5. Bathing earlier than 6 hours of life - These are the most common reasons for
- The minimum time recommended falls neonatal deaths according to the analysis
between 6-8 hours after birth (WHO, and data of DOH.
AWHONN, Save the Children). It is o Birth Asphyxia - happens when a baby's
suggested that the bath be done with the brain and other organs do not get enough
parents involved so that they can learn oxygen and nutrients before, during or
the process and limit separation. right after birth. This can happen without
 anyone knowing. Without oxygen and packages: Infant and Young Child
nutrients, cells cannot work properly. Feeding (IYCF), Integrated
o Complications of Prematurity - Management of Childhood Illnesses
Premature births can happen suddenly, (IMCI), Expanded Program on
with no known cause. Sometimes Immunization (EPI), etc.
providers have to induce (start) labor • Laws and Administrative Orders in line
early for medical reasons. Women can with the Implementation of EINC
also go into premature labor due to: protocol
- Chronic health conditions, such as • Maternal, Newborn and Child Health
diabetes or infections. Nutrition (MNCHN) Strategy (In line
- Drug or alcohol abuse. with the DOH Administrative Order
- Multiple pregnancies, such as twins 2008-0029
or triplets. - Administrative Order 2008-0029
- Preeclampsia (high blood pressure entitled: “Implementing Health
during pregnancy). Reforms for the. Rapid Reduction of
• Severe Infection – with the initiation of Maternal and Neonatal Mortality”,
skin-to-skin contact of the newborn and requires that “every birth delivery
mother, this will prevent infection and should be done by skilled birth
increases colonization with protective attendants”. Thus, it may be manned
bacterial flora. by a physician – obstetrician –
4. Fourth and Fifth Slide gynecologist, pediatrician, family
(self-explanatory) medicine specialist, general
practitioner, midwife and/or a nurse.
The MNCH strategy was acquired by
the DOH and used it’s service
delivery team for implementation of
the EINC Protocol.
IV. POLICIES AND LAWS • Mother-Baby Friendly Hospital Initiative
• Implementing Mechanism (MBFHI) and Infant and Young Child
- The signing of the Administrative Feeding Strategy and Republic Act
Order 2009-0025 last Dec. 1, 2009 10028
institutionalizes policies and - Mother-Baby Friendly Hospital
guidelines for government and Initiative - What is the main purpose
private health facilities to adopt the of Baby-Friendly Hospital Initiative?
essential newborn care protocol. The Baby-friendly Hospital Initiative
Advocacy and dissemination for a is a global effort to implement
have been done since its launch. practices that protect, promote and
Scale-up implementation in all health support breastfeeding. It aims to
facilities and social marketing are ensure that all maternity facilities
both in the pipeline to ensure that the become centres of breastfeeding
policy is implemented all over the support.
country. - Infant and Young Child Feeding
- The Teams are strategically Strategy - What is the aim of infant
dispersed throughout the Province to and young child feeding? The aim of
ensure timely access to obstetric and this strategy is to improve – through
newborn emergency care by optimal feeding – the nutritional
mothers. The Teams shall provide status, growth and development,
the full maternal and newborn care, health, and thus the survival of
family planning, adolescent infants and young children.
reproductive health and STI and HIV - RA 10028 - "An act providing
service packages to the general incentives to all government and
population as well child survival private health institutions with
 rooming-in and breastfeeding - Congenital Adrenal Hyperplasia
practices and for other purposes". (CAH)
- Moreover, the connection of these - Phenylketonuria (PKU)
laws and policies with the EINC - Galactosemia (GAL)
protocol is to promote breastfeeding - Glucose-6-Phosphate
and proper nutrition for children as Dehydrogenase (G6PD) Deficiency
early as right after birth. That is why - Maple Syrup Urine Disease
early skin-to-skin contact is initiated (MSUD)
in the 4-time bounded interventions
to promote latching and nudging on CONDITIONS THAT NBS TESTS:
to the mother’s breast.

NEWBORN SCREENING PROGRAM

TESTS FOR NEWBORN SCREENING

- Blood Test or Heel Stick
- Hearing Screen
- Pulse Oximetry
CLAIMING OF RESULTS NEWBORN PACKAGE

- Results can be claimed from the

health facility where ENBS was
availed. Normal ENBS results are
available by 7-14 working days
from the time samples are received at
the NSC.
- Positive ENBS results are relayed to
the parents immediately by the health
facility. Please ensure that the
address and the phone number you
will provide to the health facility are
ELIGIBILITY CONDITIONS FOR NEWBORNT
correct.
TO AVAIL NCP
DISORDERS INCLUDED IN NEWBORN
- Either of the parents are eligible to
SCREENING TEST
avail the benefits, newborns
- Congenital having qualified dependents are
- Hypothyroidism (CH) also eligible
 - They were born in accredited Target Population:
facilities that perform deliveries,
All Filipino newborns
such as hospitals and birthing
homes Area of Coverage:
- Services were availed upon
delivery Nationwide

REQUIREMENT FOR HEALTH CARE INSTITUTION The following institutions/units and bodies are the
TO REIMBURSE WITH NCP primary partners of DOH-Family Health Office at the
national level to ensure that appropriate policies,
- HCI are accredited to facilities standards, logistics and technical assistance are
that can perform deliveries available to all implementing units:
- The new born is eligible to claim
for NCP. A. National Technical Working Group on Newborn
- The newborn is attended by an Screening Program (NTWG- NBS)
accredited health care professional B. National Institutes of Health (NIH)
- Essential new born care and new
born screening were given to the C. NIH-Newborn Screening Reference Center (NIH-
new born prior to discharge NSRC)

NBS CAN BE PERFORMED IN: D. DOH Epidemiology Bureau (EB)

- Hospital E. DOH Health Facilities and Services Regulatory Bureau

- Lying-in (paanakan) (HFSRB)
- Health center F. DOH Health Facility Development Bureau (HFDB)
- Private Clinic
G. DOH National Center for Health Promotion (NCHP)
GOAL AND OBJECTIVE
H. NIH - Institute of Human Genetics (NIH-IHG)
- Program Objectives: By 2030,
all Filipino newborns are screened; I. Department of the Interior and Local Government
Strengthen quality of service and (DILG)
intensify monitoring and evaluation
K. Council for the Welfare of Children (CWC)
of NBS implementation; Sustainable
financial scheme; Strengthen patient L. Philippine Health Insurance Corporation (PhilHealth)
management
STRATEGIES AND ACTIVITIES
Policies and Laws:
RA 9288 or the Newborn Screening Act of 2004 and DOH
AO No. 2014-0045 or the Guidelines on the
Implementation of the Expanded Newborn Screening
Program
 a. Establishment of Safe Blood Supply
Network with support from the
National Voluntary Blood Program
b. Behavior Change Interventions in
collaboration with the Health
Promotion and Communication
Service
c. Sustainable financing of maternal -
newborn services and commodities
through locally initiated revenue
● National Safe Motherhood Program (NSMP) generation and retention activities
including PhilHealth accreditation
Focus on making pregnancy and childbirth safer
and enrolment.
and sought to change fundamental societal dynamics that
influence decision making on matters related to Component B
pregnancy and childbirth while it tries to bring quality
emergency obstetrics and newborn care facilities nearest 1. Operational and Regulatory Guidelines
to homes. this move ensures that those most in need of a. Identification and profiling of current
quality health care by competent doctors, nurses and FP users and identification of potential
midwives have easy access to such care. FP clients and those with unmet need
for FP
Program Description in Relation to Family Health b. Mainstreaming FP in the regions with
➢ In many families, the responsibility of family high unmet need for FP
health falls mainly to the mother. Establishing c. Development and dissemination of
core knowledge base and support systems that Information, Education
facilitate the delivery of quality maternal and Communication materials
newborn health services to the families of the
country. d. Advocacy and social mobilization for
FP
Mothers, Pregnant Women, and Children
● 2. Network of Training Providers
Program Components
a. 31 Training Centers that provide
Component A BEmONC Skills Training
➢ This component supports LGUs in b. 3. Monitoring, Evaluation, Research,
establishing and mobilizing the service and Dissemination with support from
delivery network of public and private the Epidemiology Bureau and Health
providers to enable them to deliver the Policy Development and Planning
integrated maternal-newborn service package. Bureau
In each province and city, the following shall
continue to be undertaken: c. Monitoring and Supervision of Private
Midwife Clinics in cooperation with
1. Establishment of critical capacities to provide PRC Board of Midwifery and
quality maternal-newborn services through Professional Midwifery
the organization and operation of a network of Organizations.
Service Delivery Teams.
d. Maternal Death Reporting and Review
2. In collaboration with the Centers for health System in collaboration with
Development and relevant national offices: Provincial and City Review Teams
Establishment of Reliable Sustainable Support
Systems for Maternal-Newborn Service
Delivery through such initiatives as:
 e. Annual Program Implementation 6. Administrative Order 2018-0003: National Policy
Reviews with Provincial Health on the Prevention of Illegal and Unsafe Abortion and
Officers and Regional Coordinators Management of Post-Abortion Complications
Goals/ Objectives Strategies
The Program contributes to the national goal of improving Strategic change in the design of safe motherhood
women’s health and well-being by: services:
1. Collaborating with Local Government Units in ✓ a shift in emphasis from the risk approach
establishing sustainable, cost-effective that identifies high-risk pregnancies during
approach of delivering health services that the prenatal period to an approach that
ensure access of disadvantaged women to prepares all pregnant women for the
acceptable and high quality maternal and complications at childbirth
newborn health services and enable them to
✓ improved quality of family planning
safely give birth in health facilities near their
counseling and expanded services availability
homes.
of post-partum family planning in hospitals
2. Establishing core knowledge base and support and primary birthing centers
systems that facilitate the delivery of quality
✓ the integration of cervical cancer, syphilis,
maternal and newborn health services in the
hepatitis B and HIV screening among others
country.
into the antenatal care protocols
Policies and Laws
An integrated package of women’s health and safe
Republic Act No. 10354: Responsible Parenthood and motherhood services:
Reproductive Health Law (RPRH Act of 2012)
✓ This service delivery strategy is
1. Administrative Order 2008-0029: focused on maximizing synergies among key
Implementing Health Reforms to Rapidly services that influence maternal and newborn
Reduce Maternal and Neonatal Mortality health and on ensuring a continuum of care
across levels of the referral system. At the
2. Department Order 2009-0084: Guidelines
ground level, this implies that a woman who
Governing the Payment of Training Fees
seeks care from a public health provider for
relative to the Attendance of Health Workers
reproductive health concerns, could expect to
to Basic Emergency Obstetric and Newborn
be given a comprehensive array of services
Care Skills Training Course at Duly
that addresses her most critical reproductive
Designated Training Centers
health needs.
3. Administrative Order 2011-0011:
“New normal” adaptive plan
Establishment of Basic Emergency Obstetric
and Newborn Care Training Centers in To improve the services for pregnant women, Dr.
Regional Hospitals and Medical Centers Danila said that they are implementing a “new
normal” adaptive plan.
Republic Act No. 10354: Responsible Parenthood and
Reproductive Health Law (RPRH Act of 2012) This plan includes:
4. Administrative Order 2015-0020: Guidelines in the • strengthening the health system response
Administration of Life Saving Drugs During Maternal within the Health Care Provided Network
Care Emergencies by Nurses and Midwives in while maintaining the BEmONC - CEmONC
Birthing Centers configuration;
5. Administrative Order 2016-0035: Guidelines on the • ensure continuous provision of maternal
Provision of Quality Antenatal Care in All Birthing health services;
Centers and Health Facilities Providing Maternity
• maximize teleconsulting and teleprescription
Care Services
platforms for antenatal and postpartum care;
and
 • all other activities such as BEmONC training A. Breastfeeding Practices (IYCF)
and conduct of death reviews as well as safe
motherhood shall be conducted online. 1. Exclusive Breastfeeding for the first six months

NUTRITION PROGRAMS 2. Extended breastfeeding up to three years.

- refers to a program that is B. Complementary Feeding Practices (IYCF)

implemented through a 1. Appropriate complementary feeding
collaborative effort from multiple
sectors . C. Micronutrient Supplementation
- to improve people's nutritional
1. Universal Vitamin A supplementation
status, and reduce maternal and
child mortality and stunting 2. Iron Supplementation

Presidential Decree 491 of 1974 or the Nutrition Act of D. Universal Salt Iodization
the Philippines created the National Nutrition Council
E. Food Fortification
(NNC) to supervise, coordinate and evaluate the
implementation of the national nutrition program which F. Mother Baby Friendly Health Initiative (MBFHI)
shall be implemented by all agencies and
instrumentalities of both the government and the private G. Philippine Integrated Management of Acute
sector concerned with improving the nutrition of our Malnutrition (PIMAM)
people. H. Home, school and Community Food production
Presidential Decree no. 1569 I. FOOD ASSISTANCE
strengthens the Barangay Nutrition Program by PROGRAM GOALS AND OBJECTIVES
providing for a Barangay Nutrition Scholar (BNS) in every
barangay to assist in the coordination and To improve quality of life of Filipinos through better
implementation of nutrition programs, projects and nutrition, improved health and increased productivity
activities in the barangay level 1. Reduction in the proportion of Filipino
Letter of Instruction 441 of 1976 Instructs various households with intake below 100% of the
departments of government to address malnutrition. dietary energy requirement from 53.2% to
This issuance authorizes the Department of the Interior 44.0%.
and Local Government (DILG) to establish functioning 2. Reduction in:
nutrition committees at different administrative levels A. Underweight among pre school children
(barangay, municipality, city, province, and region) to B. Stunting among pre school children
coo. C. Chronic energy deficiency among pregnant
women
The Local Government Code of 1991 (Republic Act 7160)
mandates local government units to exercise their D. Iron deficiency among children 6 months to five years
powers and discharge their functions as are necessary old, pregnant and lactating mothers
and appropriate for the effective provision of basic E. Prevalence of overweight, obesity and non-
services including child welfare and nutrition services. communicable diseases
PROGRAM DESCRIPTION IN RELATION TO FAMILY F. Reduction in the prevalence of iron deficiency disorder
HEALTH among lactating mothers
These programs tend to target children, women of G. Elimination of moderate and severe IDD among school
childbearing age, and pregnant or lactating women. children and pregnant women
These groups are especially vulnerable to the
detrimental effects of malnutrition. H. Reduction in the prevalence of low birth weight

PROGRAM COMPONENTS TARGET POPULATION/ CLIENT

Infants, 0-11 months Young Children, 1 year up to 3 years - Through a comprehensive mental health program that
old Adolescent females (Grades 7-10, ALS, Out of School) includes a wide range of promotive, preventive,
Pregnant/Lactating women treatment and rehabilitative services; that is for all
individuals across the life course especially those at risk
PARTNER INSTITUTIONS
of and suffering from Mental, Neurological, and
National Nutrition Council, Other Govt. Agencies, Substance Use (MNS disorders; integrated in various
Academe, NGOs, LGUs treatment settings from community to facility that is
implemented from the national to the barangay level;
STRATEGIES and backed with institutional support mechanisms from
Nutritional planning different government agencies and CSOs, we hope to
attain the highest possible level of health for the nation
- This involves political commitment by the government because there is no Universal Health Care without
Nutritional planning involves formulation of a nutrition mental health.
policy and overall long-term planning.
1. To promote participatory governance and leadership
Direct nutrition and health interventions in mental health
- Improved health care system Direct nutrition and 2. To strengthen coverage of mental health services
health interventions Infections like malaria, measles and through multi-sectoral partnership to provide high
diarrhea. quality service aiming at best patient experience in a
Nutrition education People can be educated on: responsive service delivery network

- The nutritional quality of common foods 3. To harness capacities of LGUs and organized groups to
implement promotive and preventive interventions on
- Importance and nutritional quality of locally available mental health
and culturally accepted foods
4. To leverage quality data and research evidence for
- Importance of exclusive breastfeeding for six months to mental health
two years
5. To set standards for compliance in different aspects of
- Damage caused by irrational beliefs and cultural services
practices of feeding 1
PROGRAM COMPONENTS
Early detection of malnutrition and intervention
- Wellness of Daily Living
- Intervention must occur during pregnancy and first - Extreme Life Experience
three years of life. - Mental Disorder
- Neurologic Disorders
A well recorded growth chart can detect malnutrition
- Substance Abuse and other Forms of
very early. Nutritional deficiency must be evaluated and
Addiction
taken care of. If growth chart is not maintained,
anthropometric indices can be measured and used for STRATEGY
evaluation of nutrition.
- GOVERNANCE
Nutrition supplementation - SERVICE COVERAGE
- ADVOCACY
Calories, proteins and micronutrients like iron, vitamin A
- EVIDENCE
and zinc are supplemented.
- REGULATION

MENTAL HEALTH PROGRAM

POLICIES AND LAWS

DOH Administrative Order No. 8 series of 2001 The

National Mental Health Policy

- The National Mental Health Policy sets to achieve

quality mental health care through the development of
efficient and effective structures, systems, and Environmental Health
mechanisms that will ensure equitable, accessible, According to WHO(2016), Environmental health
affordable, appropriate, efficient and effective delivery addresses all the physical, chemical, and biological
to all its stakeholders by qualified, competent, factors external to a person, and all the related factors
compassionate; and ethical mental health care impacting behaviors. It encompasses the assessment and
professionals and service providers. Implementation control of those environmental factors that can
shall be pursued through a Mental Health Program potentially affect health.
strategy prioritizing the promotion of mental health,
protection of the rights and freedoms of persons with Concerned with preventing illness through managing the
mental diseases and the reduction of the burden and environment and by changing people's behaviour to
consequences of mental ill- health, mental and brain reduce exposure to biological and non-biological agents
disorders and disabilities. of disease and injury. Concerned primarily with effects of
the environment to the health of the people.
Republic Act No. 11036
8 Environmental Factors that Affect Health
- An Act Establishing a National Mental Health Policy for
the Purpose of Enhancing the Delivery of Integrated 1. Chemicals
Mental Health Services, Promoting and Protecting the
2. Air pollution
Rights of Persons Utilizing Psychosocial Health Services,
Appropriating Funds Therefor and Other Purposes. 3. Climate change and natural disasters

DOH Administrative Order No. 2016-0039 Revised 4. Diseases caused by microbes

Operational Framework for a Comprehensive National
5. Lack of access to health care
Mental Health Program
6. Infrastructure issues
- Through Revised Operational Framework for a
comprehensive mental health program, the Department 7. Poor water quality
of Health shall promote and facilitate the conduct of
research, monitoring and evaluation that generates 8. Global environmental issues
relevant and timely information for sound program Five Major Subdiscipline of Environmental Health
planning and implementation, policy formulation,
service development and financial risk protection. The Environmental Epidemiology
same issuance intends to establish interconnectedness, This field seeks to understand how various external risk
collaboration and linkages and other partnership factors may predispose to or protect against disease,
mechanisms between and among different government illness, injury, developmental abnormalities, or death.
agencies.
Toxicology

Uses the power of science to predict what, and how

chemicals may cause harm and then shares that
information to protect public health.
HIV/STI PROGRAM
Laws and Policies
· Philippine HIV and AIDS Policy Act of 2018
(Republic Act 11166) An Act Strengthening the
Philippine Comprehensive Policy on Human
Immunodeficiency Virus (HIV) and Acquired
Immune Deficiency Syndrome (AIDS)
Prevention, Treatment, Care, and Support, and,
Reconstituting the Philippine National Aids
Council (PNAC), Repealing for the Purpose
Republic Act No. 8504, Otherwise Known as
The "Philippine Aids Prevention and Control Act
of 1998"
· The 1987 Philippine Constitution ((RA 11223)
The 1987 Philippine Constitution declares that it
is the policy of the State to protect and promote
the right to health of the people and instill health
consciousness among them.
· Philippine AIDS Prevention and Control Act
of 1998 (Republic Act No. 8504)
· An act promulgating policies and prescribing
measures for the prevention and control of
HIV/AIDS in the Philippines, instituting a
nationwide HIV/AIDS information and
educational program, establishing a
comprehensive HIV/AIDS monitoring system,
strengthening the Philippine National Aids
Council, and for other purposes.
· Section 504 of the Rehabilitation Act of 1973
and the Americans with Disabilities Act of
1990 (ADA)
· An act that guarantees equal opportunity for
individuals with disabilities in public
accommodations, employment, transportation,
State and local government services, and
telecommunications. People with HIV, both
symptomatic and asymptomatic, are protected
 by the ADA. The ADA also protects persons Contain the prevalence of HIV/AIDS among the high risk
who are discriminated against because they or more in less than 3%
have a record of or are regarded as having
Reduce the Incidence of gonorrhea among the high-risk
HIV, or have a known association or
vulnerable population. Reduce the transmission of STIs
relationship with an individual who has HIV.
in the general population among the vulnerable group
· Under the Philippine HIV and AIDS Policy Act, by 12% or less. And condom use rate at least to high risk
all private employers and employees shall be sex by 80%.
regularly provided with standardized basic
Target Clients
information and instruction on HIV and AIDS,
including topics on confidentiality in the Some of the recognized key populations
workplace and the reduction or elimination of for HIV risk in the Philippines
stigma and discrimination. include:
Program Description in relation to family health Men who have sex with men (MSM), Transgender
people,
- It provides initiatives to promote safety in terms of
health and did not engage in HIV/STI Female sex workers (FSW), Youth, and overseas workers
It prevents HIV/STI to be transmitted Partner Organizations/Agencies:
It creates a culture nor group to expand the awareness of The following organizations/agencies take part in
what truly HIV/STI means achieving the goal of the National HIV/STI
Prevention Program:
It improves the quality of every family members life It
provides the safest place where they belong in · Department of Interior and Local Government
(DILG)
It builds relationships with others and at the same time
they can be accompanied each and everyone to what · Philippine National AIDS Council (PNAC)
outcomes it befall when HIV/STI was transmitted
· Research Institute for Tropical Medicine (RITM)
Program Components
· STI/AIDS Cooperative Central Laboratory
- Sexual and reproductive health (SCCL)
services HIV testing and counseling
- Mental health Family planning · World Health Organization (WHO)
- National safe motherhood Sanitation · United States Agency for International
- Diseases and infections Development (USAID)
- Health Promotion and
Communication on HIV and STI · Pinoy Plus Association
prevention and care services · AIDS Society of the Philippines (ASP)
- Sustainable HIV responses
· Positive Action Foundation Philippines, Inc.
Program Goals and Objectives (PAFPI)
Goals: · Action for Health Initiatives (ACHIEVES)
Contain the transmission of HIV/AIDS and other · Affiliation Against AIDS in Mindanao
reproductive tract Infections and mitigate their impact. (ALAGAD-Mindanao)
Objectives: · AIDS Watch Council (AWAC)
Contain the Prevalence of HIV/AIDS among the general · Family Planning Organization of the Philippines
population less than one year (1) per 100,000 population (FPOP)
by the end of 2010.
Contain the prevalence of HIV/AIDS among pregnant
women ages 15-24 years.
Strategies and Activities The goal of the WCPP is to increase the
number of VAWC cases appropriately managed in health
With regard to the prevention and fight against stigma and
facilities. To achieve this goal, the WCPP should focus on
discrimination, the following are the strategies and
the primary prevention and response through
interventions:
establishment and ensuring the functionality of WCPUs,
1. Availability of free voluntary HIV Counseling and strengthening management structures, capability building
Testing Service; of public health workers and hospital staff, health
promotion and advocacy.
2.100% Condom Use Program (CUP) especially for
entertainment establishments; Types of Services

3. Peer education and outreach;

4Rs (Recognition, Reporting, Recording and Referral)
4. Multi-sectoral coordination through Philippine
National AIDS Council (PNAC); The 4Rs refer to recognizing, reporting,
recording, and referring of women and children abuse.
5. Empowerment of communities; The Online 4Rs training is open to any person, parent, and
6. Community assemblies and for a to reduce member representing any agency or institution interested
stigma; in or involved in dealing with children and women who
are suspected victims of abuse or any form of domestic
7. Augmentation of resources of social Hygiene violence or gender-based violence.
Clinics; and
Laypersons, parents, teachers,
8. Procured male condoms distributed as education counsellors, health professionals, social workers, law
materials during outreach. practitioners, police officers, citizens interested and
dealing with children and women abuse who complete
The Women and Children Protection
this training should be able to:
Program (WCPP) provides technical and management
support to ensure that Women and Children Protection Multidisciplinary Team Training (MDT) on Handling
Units (WCPUs) are established and operational as Violence Against Women and Children for
mandated under Section 40 of Republic Act 9262. This Frontliners in the Community
program aims to provide medical assistance to violence
against women and their children (VAWC) survivors and The MDT is especially designed for
increase cases appropriately managed in health facilities. medical practitioners, social workers, and PNP officers
To achieve this, the WCPP focuses on the primary whose career paths focus on women and children
prevention and response through establishing and protection work. This is composed of four online modules
ensuring the functionality of WCPUs, strengthening for women and children protection unit (WCPU)
management structures, capability building of public practitioners and program managers. The modules are
health workers and hospital staff, health promotion, and also ladderized such that the first serves as prerequisite to
advocacy. the next until the completion of all the four.

Vision: Licensed professionals like physicians,

social workers, guidance counsellors, and officers of the
A gender-fair and violence-free Philippine National Police who have completed MDT
community where women and their children are Training are expected to:
empowered.
Enhanced Training on Handling Violence Against
Mission: Women and Children (EnTHAWC) for Hospitals
Improved strategy towards a violence- It is a 2-and-a-half-day training course
free community through more systematic primary that utilizes lectures and workshops. The lectures provide
prevention, accessible and effective response system and the child protection foundation of the learners, while the
strengthened functional mechanisms for coordination, workshops provide an opportunity for the learners to
planning, implementation, monitoring, and evaluation apply the concepts they have learned through small group
and reporting. case discussions. The training typically involves social
workers, police officers and medical practitioners, since it
Goal/Objectives
emphasizes the importance of the multi-disciplinary d. Dating partner or former dating
approach in handling cases of abuse within the partner
community.
• Classifies VAWC as a public crime
Other laws include:
National/Government
• Presidential Decree No. 603, otherwise known as
• Department of the Interior and Local Government the Child and Youth Welfare Code and issued in
December 1974, legally defines special
• Department of Social Welfare and Development
categories of youths, including youthful
• Philippine Commission on Women offenders, and directs the Ministry of Social
Services and Development (MSSD) to provide
• Council for the Welfare of Children comprehensive services to assist in youth
International Partners development.

• World Health Organization Department of Social Welfare and Development (DSWD)

• United Nations International Children’s Community-based Services Section (CBSS)

Emergency Fund Legarda, Manila
• United States Agency for International Tel. Nos.: 733-0014 to 18 local 116 / 488-2861
Development
The Signal for Help (or the Violence at
• United Nations Population Fund Home Signal for Help) is a single-handed gesture that
Local/Youth/CSOs, NGOs can be used over a video call or in person by an individual
to alert others that they feel threatened and need help.
• UP-College of Public Health Originally, the signal was created as a tool to combat the
rise in domestic violence cases around the world linked to
• Social Watch Philippines
self-isolation measures that were related to the COVID-
Partner Organizations 19 pandemic.

One in four Filipino women age 15-49 The signal is performed by holding one
hand up with the thumb tucked into the palm, then folding
has experienced physical, emotional or sexual violence by the four other fingers down, symbolically trapping the
their husband or partner. It is indeed alarming that despite thumb by the rest of the fingers. It was designed
efforts to address the concern, VAW persists. intentionally as a single continuous hand movement,
PREVENTION AND RESPONSE rather than a sign held in one position, so it could be made
easily visible.
Integrated Laws
and Policies
The Anti-Violence Against Women and their Children ETHICAL CONSIDERATIONS IN CHN
Act of 2004 (RA 9262)
• Seeks to address the prevalence of violence
against women and their children (VAWC) by
their intimate partners like:
a. Husband or ex-husband
b. Live-in partner of former live-in
partner
c. Boyfriend/girlfriend or ex-
boyfriend/ex-girlfriend
NEW TECHNOLOGIES RELATED TO PUBLIC
HEALTH