GERALDINE KETH G.

SALON
 PROMOTING COMMUNITY HEALTH hospitals and other health care
services.
 2021
 Based on UNAIDS Report on the Global AIDS
 COMMUNICABLE DISEASES CONTROL –
Epidemic 2010, the Philippines is one of the
associated terms
seven countries where new cases increased by
 Infection vs. Disinfection more than 25% from 2001 to 2009.

 Contamination vs. decontamination  The most common disease outbreaks are

food-borne diseases like cholera,
Infection – invasion and multiplication of salmonellosis and shigellosis.
microorganisms (infectious agents) in the body that
result in cellular injury.  Health security threats are from newly
emerging diseases
Disinfection - destruction of pathogenic
microorganisms by processes that fail to meet the  CLASSIFICATION OF INFECTIOUS DISEASES
criteria for sterilization. Pasteurization is a form of
 Respiratory – cough, flu
disinfection. Particularly the use of heat at a
temperature (62-74 ‘C) sufficient to inactivate  Bovine (discharge) diseases- brucellosis
important pathogenic organisms in liquids such as
 Vector-borne diseases – malaria, dengue,
water or milk.
schistosomiasis

 Open lesion diseases – carbuncle, impetigo

Contamination - accidental release of hazardous contagiosa (MRSA)
biologic materials that pollute the environment and
 Eradication of small pox
place humans at risk (Turnock,2016).
 Strategy –
Decontamination – removal of hazardous biologic
materials from the skin and/or mucous membranes by  Vaccination
applying disinfectants or other forms of
disinfection(Turnock,2016).  No non-human spread or transmission

 Infectious /communicable diseases  Two remaining

 Etiology  Outcome

Pathogenic microorganisms, such as bacteria,  Total elimination or eradication

viruses, parasites or fungi.  Other Diseases for eradication:
 Zoonotic diseases are infectious measles and polio
diseases of animals that can cause  Case of measles?
disease when transmitted to humans.
 Complacency – health
DISEASE INCIDENCE education
 Philippines  Weak of herd immunity
 outbreaks of emerging infectious  Sexually transmitted (ST) diseases
diseases, including epidemic-prone
communicable diseases such as  ST Diseases, ST INFECTIONS OR VENEREAL
dengue, cholera, typhoid and DISEASE – illness that hasa significant
leptospirosis. probability of transmission between humans
by means of HUMAN SEXUAL BEAVIOR,
 Dengue especially, has become a INCLUDING VAGINAL INTERCOURSE, ORAL SEX
serious public health problem, AND ANAL SEX.
imposing a significant burden on

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 GERALDINE KETH G. SALON
 Also transmitted via use of IV drug needles  Direct transmission
after use of an infected person
 Indirect transmission
 Through childbirth or breastfeeding
 Vehicle of transfer
Promoting measures
 DISEASE TRANSMISSION
 Sexually transmitted (ST) diseases
 Illness results when the infectious agent
 CLASSIFICATION enters a person’s body and multiplies in it,
producing poisons (toxins) that damage the
1. Bacterial
body or weaken its defences against other
A. chancroid (H. ducreyi) infectious agents, or provoking an immune
response that, in trying to kill the invading
B. chlamydia (C. trachomatis) organism, damages the host.
C. Granuloma inguinale (K. granulomatis)  DISEASE TRANSMISSION
D. Gonorrhea (N. gonorrheae)  DIRECT Mode of transmission
E. Syphilis (T. pallidum directly from one person to another.
1. Fungal  Some infections can be caught from
A. Tinea crucis “jock itch” another person who has the infection;

B. Candidiasis, yeast infection  INDIRECT Mode of transmission

 Sexually transmitted (ST) diseases indirectly, from one person to another.

 CLASSIFICATION  Some infections can be caught from

infected animals or insects
3. Viral
 DISEASE TRANSMISSION
A. Viral Hepatitis
 Vehicles of transfer
B. Herpes simplex skin and mucosal lesions
 from Contaminated food, water, or
C. HIV inanimate objects
D. HPV  TERMS
E. Molluscum contagiosum Carrier:-
4. Parasites a person carrying a disease-causing
A. crab louse microorganism without becoming ill

B. Scabies but able to pass the microorganism to others.

5. Protozoal – Trichomoniasis Contact-

 Sexually transmitted (ST) diseases

 PREVENTION and promoting measures a person who has been in contact with an
infected person and who may, or may not, have
 Vaccines picked up the infection.
 Use of condoms Incubation period-
 Vaginal microbicide (Nanoxynol-9) the time it takes a disease-causing
microorganism to produce symptoms and signs of the
 Safe sex measures
disease after entering a person’s body: this period
 Epidemiology of infection

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 GERALDINE KETH G. SALON
varies in length from a few hours to many years, Host
depending on the species of microorganism.
Increasing Immunity/host resistance
Isolation period:-
Environment
the time during which a patient suffering from an
Sanitation/hygiene
infectious disease should be isolated from others.
Engineering measures
Segregation period-
Signs and symptoms of infectious disease
the time during which a patient who may be
incubating an infectious disease following infection Onset
should be segregated from others.
 Many diseases caused by bacteria and viruses
Quarantine period- begin with non-specifi c features: this stage is
often called a “flu-like prodrome” and consists
the time during which health authorities may
of some combination of:
require a suspect or infected person to be isolated
from contact with another person usually for patients ■ feeling unwell
with serious epidemic diseases, such as plague,
cholera, epidemic flu ■ poor appetite

 Epidemiological principles of disease control ■ lack of energy

Legal authority ■ mild fever

 Administrative Order No. 2007-0036 ■ aches and pains

“Guidelines on the Philippine Integrated ■ headache.
Disease Surveillance and Response (PIDSR)
Framework  The flu-like initial (prodromal ) period may last
only a few hours but could last for several
 Wo are involved? days.
 Department of Health ■ In some infections, onset is slow, whereas in others
National Epidemiology Center (e.g. bacterial meningitis) it can be dramatic.

Bureau of Quarantine ■ During the prodromal phase it is usually not possible

to make a diagnosis and nearly all patients who seem
National Center for Disease to have an ordinary viral “cold” do.
Prevention and Control
Fever
Health Emergency Management Staff
 Fever is a common feature of infectious
Center for Health Development disease. In most cases it develops as part of
the body’s defence against infection. Taking
DOH Representative
the temperature is important not only to
 Local Government Units diagnose an infection but also to follow its
course: whether or not the fever goes away is
· Provincial Health Office
often the best indicator of whether or not
· Municipal/City Health Office treatment is working.

 Philippine Health Insurance Corporation  Not all patients with fever feel unwell: a
(PhilHealth or PHIC) classic example is tuberculosis, in which fever
is present without the patient being aware of
Agent it.
Elimination of pathogens ■ Not all infectious diseases produce fever:
Personal hygiene infections, such as cholera and tetanus, which are

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 GERALDINE KETH G. SALON
caused by bacterial toxins in the bowel or in a wound,  ● of the sulfonamide family (e.g. co-
generally do not cause fever. trimoxazole);

■ Fever can have many other causes besides  ● a drug rash is usually itchy and appears on
infection: medicines, including antibiotics, are one the back and legs (in a patient lying in
example.
 bed) after the patient has been taking the
Fever can have many other causes besides drug for a few days.
infection: medicines, including antibiotics, are one
 MANAGEMENT OF INFECTIOUS
example.
DISEASES – GENERAL PRINCIPLES
■ Fever is part of the body’s mechanisms for
 Isolation of a patient with an infectious
fighting infection: do not try to lower the fever unless:
disease is time-consuming and makes caring
● the patient is distressed by fever; for the patient much more difficult.

● the fever is over 40C.  Isolation is generally required with diseases

such as tuberculosis and whooping cough that
■ Paracetamol 1000 mg orally every four
spread via droplets. By contrast, there is no
hours can be given if necessary to lower fever.
reason to isolate patients with sexually
■ NEVER give acetylsalicylic acid (Aspirin®) to transmitted infections or with infections
anyone under 18 years with fever. carried by vectors, such as malaria.

Rash  With many infections, particularly viral

infections, the patient is most likely to
Some infectious diseases produce a transmit the infection before becoming
characteristic rash from which a diagnosis can be obviously ill: isolating such a patient once
made. symptoms have appeared may not stop
What to do in a case of rash and fever transmission.

■ When examining a patient with a possible Shelter

infectious disease, examine the whole body in order  In many emergency situations, the displaced
to get a full picture of the rash and how it is population must be sheltered in temporary
distributed. settlements or camps. The selection of sites
In examining a rash, note: must be well planned to avoid risk factors for
communicable disease transmission, such as
● its pattern: round spots or irregular blotches;
overcrowding, poor hygiene, vector breeding
● its size: 1–2 mm, 1–2 cm, or several centimetres; sites and lack of adequate shelter.
● its colour: pale-pink or dark red;  Such conditions favour the transmission of
● its form: raised or flat (i.e. whether it can be felt diseases such as measles, meningitis and
when the fingers pass lightly over cholera.

the skin);  Site selection criteria

● whether, when you press it with a finger, it goes pale Settlements should avoid the major
for a time; breeding sites of local vectors, as well asmarshy areas
and flat, low-lying ground at risk of flooding.
● whether there are any pustules.
Preference should be given to gently
 A rash is often due to drugs, especially sloping, well drained sites on fertile soil with tree
antibiotics: cover,
 ● of the penicillin family (with names ending sheltered from strong winds. Local expertise
in –cillin, such as amoxycillin); and knowledge of the biology of the vectors should be
considered, such as avoiding forested hills in some

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 GERALDINE KETH G. SALON
Asian countries where vectors proliferate. If not  Environmental health
already sufficiently documented by national and local
 Areas near vector breeding sites where there
health services, the epidemiological characteristics of
is a risk of contracting malaria,
the area need to be assessed quickly.
 onchocerciasis (river blindness),
 The following criteria should be considered
schistosomiasis, trypanosomiasis, etc. should
when assessing site suitability; other criteria
may also be relevant in specific situations.  be avoided.
 Water supply  Security
 The availability of an adequate amount of safe  The site chosen should be in a safe area,
water throughout the year has sufficiently distant from national
 proved in practice to be the single most  borders and combat areas.
important criterion for site location. The
Local population
 water source should be close enough to avoid
transporting water by trucks,  The use of land for a camp can cause friction
with local farmers, herdsmen, nomads and
 pumping it over long distances or walking long landowners. Some potential sites may have
distances to collect insufficient special ritual or spiritual significance to local
people, and site selection must respect the
 quantities.
wishes of the local population. Streams or
Space rivers used for bathing and laundry may cause
pollution far downstream; water abstraction
 There must be enough space for the present
will reduce flow rates.
number of emergency-affected population,
with provision for future influxes and for  Indiscriminate defecation in the early stages
amenities such as water and sanitation may also pollute water supplies used by the
facilities, food distribution centres, storage local population.
sites, hospitals, clinics and reception centres.
 Fuel supply
 Topography and drainage
 Fuel for cooking is an essential daily
 Gently sloping sites above the flood level is requirement.
preferred in order to provide natural
 Options for fuel include wood,charcoal and
 drainage. Flat areas, depressions, swamp, kerosene. In practice, wood from surrounding
river banks and lakeshore sites forests is the most likely fuel. It is important to
liaise closely with the local forestry
 should be avoided. Windy sites are unsuitable,
department to control indiscriminate felling
as temporary shelters are
and collection.
 usually fragile.
 ENVIRONMENTAL SANITATION
Vegetation
 The aim of a sanitation programme is to
 The site area should have good vegetation develop physical barriers against the
cover if possible. Trees and plants provide transmission of disease, in order to protect
shade, help to prevent soil erosion, allow the health of the emergency-affected
recharge of the groundwater supplies and population.
help in reducing dust. It may sometimes be
 These barriers include both engineering
necessary, however, to destroy poisonous
measures and personal hygiene measures.
trees or plants, for example where
populations are accustomed to collecting  provision of latrines and the
berries or mushrooms. development of methods of waste

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 GERALDINE KETH G. SALON
disposal are essential elements of the • National and local level
programme. priorities

 These measures are only fully – Medical care to

effective, however, when radiation victims
complemented by a sanitation
– Provision of info on
education programme.
food and drinking
• Noise water contamination

• Effect of environmental noise – Implement

countermeasures, if
– Sleep related problems
necessary
– Noise induced hearing
» Sheltering
impairment/loss
» Radioprotecti
– Children are more vulnerable
ve
* For good sleep, sound level should not exceed 30 prophylaxis,
dB(A) for continuous background noise & 45 dB(A) for iodine
individual noise events prophylaxis,
body
• Main health risks of noise interference (WHO) protection,
• Pain and hearing fatigue evacuation,
personal
• Hearing impairment incldg tinnitus decontamina
• Annoyance tion

• Interference with social behavior – If necessary, request

(aggressiveness, protest, helplessness) assistance of
international
• Interference with speech communication community
• Sleep disturbance and all its consequences on – Intermediate phase
a shot-term and long-term basis
• Applicable countermeasures
• Cardiovascular effect
– Sheltering
• Performance at work and school
– Radioprotective
• Normal responses, stress follows prophylaxis
• Radiological Protection – Body protection
• Response to a nuclear accident – Decontamination of
areas
– Networking/cooperation/coordination
– Evacuation
• WHO
– Recovery phase
• International Atomic Energy
Authority – Applicable or essential
countermeasures
• Local health authorities
• Personal decontamination
• Response is divided into
• Relocation
– Early phase
• Control of access

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 GERALDINE KETH G. SALON
• Food control “The Code on Sanitation of the PHILIPPINES ”
mandates the DOH to promote and preserve public
• Decontamination of areas
health and upgrade the standard of medical
• Institutional Sanitation practice . In line with the DOH mandate , a Manual
on Hospital Management was published in 1997 and
• Healthcare Waste Management the Implementing Rules and Regulations of Chapter
• AO No. 341 – Implementing the Phil Health XVII , fuse Disposal of PD 856 was promulgated.
Promotion Program through Healthy Places OCCUPATIONAL
– Water supply A hazard found or likely to occur in the work place .
– Sanitary toilets The number of types of hazards

– Waste collection and disposal a health care worker may encounter in the routine
conduct of the healthcare delivery.
– Non pollution of the environment

– Insect and vermin control measures

Through out the world most adults and many children
• spend much of their waking hours at work . Works
Stream Pollution provide a number of economic and other benefits.
• Waste collection and disposal Working conditions for the majority of the world
• Disposal of human and animal excreta workers do not meet the minimum standards and
guidelines by set of international agencies .
• Responsibilities of Health Workers Occupational health and safety laws cover only about
10 % of the population in developing countries ,
• Health education
omitting many major hazardous industries and
• Participation in the training component occupation.

• Assistance in projects like deworming of target INTERNATIONAL LABOR ORGANIZATION (ILO)

groups
Convention are intended to guide all countries in the
• Participation in ES campaigns e.g. use of promotions of workplace safety and in managing
sanitary toilets, proper garbage disposal, occupational health and safety programs.
“green” projects
The management of health care waste of the country
• Participate/conduct ES researches is driven by concerns about adverse health and
environmental effects , uncertainty regarding
• Be a role model of cleanliness in the homes
regulations , and the negative perceptions by waste
and surroundings including
handlers . Although significant progress has been
observance/practice of proper waste disposal
made on health care waste management ,
in both public and private places
two(2)studies conducted by the Department of
POLICIES AND LEGISLATION Health(DOH)namely , the Waste management
Practices Of DOH-Retained Hospitals in 1995 and the
9.1 DOH Waste Management Practices of Private and
Republic Act No.4226 Government Hospitals in Metro-Manila in
1997,indicated the need to introduced modification to
“Hospital Licensure Act” requires of all the hospitals the existing health care waste management practices.
in the country and mandates DOH to provide the
guidelines for hospital technical standards as to IMPACT OF HEALTH CARE WASTE
personnel , equipment and physical facilities. A framework for health care waste management
PRESIDENTIAL DECREE No. 856 should always consider health and occupational safety
. There are many potential hazards associated when
dealing or handling health care waste such as

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 GERALDINE KETH G. SALON
physical , chemical and biological hazards as well as The main groups of people who are at risk of
ergonomic factors. exposure to health hazards associated with health
care waste are the following:
Minimizing these hazards may entail the institution of
administrative , engineering and medical controls • Staff of the health care establishments such as
including the provision of personal protective physician , nurses , health care auxiliaries ,
equipment. and hospital maintenance personnel

Administrative control includes: • Patients in the health care establishment or

receiving home care
 Proper and regular training
• Visitors , comforters ,and caregivers to health
 Change of job schedule
care establishment
 Rotation of workers
• Personnel and workers providing support
Engineering control includes the substitution of services and allied to health care
equipment/devices , change of process to a much establishment , such as laundries , waste
safer method , the mechanization or computerization , handling and transportations.
proper upkeep and regular maintenance of
• Persons transporting hazardous health care
equipment/machine and imposition of warning
waste.
devices . Medical control includes :
• Workers and operators of waste treatment
 Written occupational health and safety
and disposal facilities ; sanitary landfill.
program
Hazards from Infectious Waste and Sharps :
 Physical examination(pre-employment and
annual Infectious waste may contain any of a great
variety of pathogenic organisms .Pathogens in
 Regular immunization
infectious waste may enter the human body by a
 Health education number of routes :

 Regular exercise  Through a puncture

 Healthy diet and continuous medical  Abrasion

monitoring and periodic examination
 Cut in the skin
 Adequate and good designed personal
 Through in the mucous membrane
protective equipment should be provided
 Inhalation
this include protection for the head , face , body,
arms ,legs and feet.  ingestion

Exposure to hazardous health care waste can result to CATEGORIES OF HEALTH CARE WASTE
disease or injury . The hazardous nature of health care
1. GENERAL WASTE : comparable to domestic
waste maybe due to one or more of the following
waste , this type of waste does not posed
characteristics :
special handling problem or hazard to human
 Contains infectious agents health or to environment . It comes mostly
from the administrative and housekeeping
 Geno-toxic
functions of health care establishment and
 Contains toxic or hazardous chemicals or may also include waste generated during
pharmaceuticals maintenance of health care premises.

 Radioactive 2. INFECTIOUS WASTE : this type of waste is

suspected to contain pathogens
 Contains sharps

PERSONS AT RISK

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 GERALDINE KETH G. SALON
3. PATHOLOGICAL WASTE : consist of body • Medical
parts , human fetus and animal carcasses ,
• Veterinary
blood and body fluids.
• Health care centers and dispensaries
4. SHARPS : include needles , syringes , scalpels ,
saws , blades , broken glass , infusion sets , • Alternative medicine
knives any other items can cause cut or
puncture • Dental

5. PHARMACEUTICAL WASTE : includes expired , • Maternity and lying-in

unused spilt and contaminated • Dialysis center
pharmaceutical products.
• Physician offices
6. GENOTOXIC WASTE : include certain cytostatic
drugs , vomit , urine , feces from patients 3.Laboratories and research center
treated with cytostatic drugs. 4.Drug Manufacturers
7. CHEMICAL WASTE : consist of discarded solid , 5.Institution
liquid and gaseous chemicals , for example
from diagnostic and experimental work.  Medical

Chemical waste is considered hazardous if it  Nursing homes

has at least one of the following properties:
 Dental
 Toxic
 Paramedics
 Corrosive
 Nursing
 Flammable
 Drug rehabilatation center
 Reactive(explosive ,water-reactive , shock
 Veterinary
sensitive)
 6.Motuary and Autopsy center
 Genotoxic (e.g cytostatic drugs)
 7.Ambulances and Emergency care
 8.WASTE WITH HIGH CONTENT HEAVY
METALS  8.Home treatment

 -consist of broken mercury and blood  9.Cosmetic ear peircing and tattoo parlors.
pressure gauges
PRINCIPLES OF WASTE MINIMIZATION
 9.PRESSURIZED CONTAINERS
1.REDUCTION AT SOURCE-
 includes pressurized cylinders , cartridges
and aerosols cans.
some reduction involves measures that either
 10.RADIOACTIVE WASTE
completely eliminate use of a materials or
 include disused sealed radiation sources , generate less waste.
liquid and gaseous materials
2.RE-USED
 contaminated with radioactivity.
Reused is not only finding another use for a
product , more importantly , reusing product over
and over again for a given function as intended .
SOURCES AND COMPOSITION OF HEALTH CARE
Promoting re-use entails the selection of reusable
WASTE
rather than disposable products whenever
1. Hospitals possible. Reuse will also entail setting reliable

2. Clinics

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 GERALDINE KETH G. SALON
standards for disinfection and sterilization of incorporate satisfactory segregation ,
equipment and material for used. treatment , collection , and disposal system”.

3.RECYCLING  DOH MEMORANDOM No. 1-A,series of 2001

Collecting waste and processing it into something  “Requiring the Department of Health Central
new . Many items in the hospitals can be Office , Centers for Health development and
recycled . Items such as organic , plastic , paper , all concerned hospitals to practice proper
glass , and metal can be recycles easily. solid waste management.

4. SEGREGATION OF WASTE DENR

Is the important step to waste management . PRESIDENTIAL DECREE N. 1586

There are several reasons to undertake waste
“ENVIROMENTAL IMPACT STATEMENT(EIS)
segregation :
SYSTEM
 Segregation minimizes the amount of waste
requires projects like construction of new
that needs to be managed as bio-hazardous or
hospital buildings or expansion of existing
hazardous waste.
hospitals to secure an Environmental
 Facilitates waste minimization by generating a Compliance Certificate(ECC)prior to
solid waste steam which can be easily , safely , construction and operation of the facility.
and cost-effectively managed through
REPUBLIC ACT No. 8749
recycling or composting.
“CLEAN AIR ACT”
 Reduces the amount of toxic substances
release to the environment through disposal Prohibits the incineration of biomedical waste
of general waste. effective JULY 17, 2003.It promotes the state-
of-the-art , environmentally sound and safe-
 Makes it easier to conduct assessments of the
burn technologies for the handling ,
quantity and composition of different waste
treatment , thermal destruction , utilization ,
streams thereby allowing health care facilities
disposal of sorted , un recycled and hazardous
to obtain baseline data , identify options ,
waste.
determine waste management cost , and
assess the effectiveness of waste minimization ADMINISTRATIVE REQUIREMENTS
strategies.
 OGANIZATION AND FUNCTIONS : appropriate
 6. COMPOSTING health care waste management practices
depend largely on the administration and
 Composting is another important strategy to
organization and require adequate legislative
minimize waste such as food discards , kitchen
and financial support as well as the active
waste , cardboard , and yard waste . Some
participation by trained and informed staff.
hospitals in other countries have also
successfully composted placenta waste.  HEALTH CARE WASTE MANAGEMENT
Sufficient land space for on-site composting COMMITTEE(HCWMC)promulgate a policy
far enough from patient care and public formalizing the commitment of the health
access area would be needed. care institution to proper management of its
waste with the goal of protecting health and
 OTHER DOH REQUIREMENTS:
environment.
 DOH Department Circular No. 156-C,series of
 HEALTH CARE WASTE MANAGEMENT PLAN : a
1993
comprehensive health care waste
 “PROVIDES GUIDELINES ON HOSPITAL WASTE management plan is the key ingredient s to a
MANAGEMENT successful waste management within a health
care facility.
 All undevolved government hospitals , clinics ,
laboratories , and research offices , shall  HEALTH AND SAFETY

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 GERALDINE KETH G. SALON
PRACTICES  IMMUNIZATION

-health care personnel should be given

immunization against infection from virus causing
 Proper training of Health workers
hepatitis B and tetanus infection.
o No training/no hiring policy should be
 RESPONSE TO INJURY AND EXPOSURE
instituted
-all staff that handles health care waste must be
o Immunization at the first day of work
trained to deal with injuries and exposures .
 Provision of personal protective Health care establishment should develop a
equipment(from head to toe) program that would prescribe the actions taken in
the event of injury or exposure to a hazardous
 Establishment of an effective occupational subtance.
health program that includes immunization ,
post exposure prophylactic treatment , and  SAFE USE OF CYTOTOXIC DRUGS
continuous medical surveillance. -in order to ensure safe use of cytotoxic drugs ,
 WORKER PROTECTION : the senior pharmacist of the health care
establishment , should be appointed to supervised
the safe management of cytotoxic waste . To
-all personnel who are directly involved in the minimize exposures , the following measures
handling of potentially hazardous health care should be observed
waste must be provided with adequate protection  Written procedures that specify safe working
from the hazards associated with it. methods for each process
 PERSONAL PROTECTIVE EQUIPMENT  Data sheets , based on the suppliers
-health care waste management program requires specification , to provide information on
that the following personnel protective potential hazards.
equipment be made available to all health care  Established procedures for emergency
personnel who collect and handle health care response in case of spillage or other
waste. occupational accident
 Hard hats with or without visor-depending on  Appropriate education and training for all
the nature of operation personnel involved in the handling of
 Facemask-depending on the nature of cytotoxic drugs.
operation  Global Warming
 Eye protector/safety goggles-depending on  El Nino phenomenon
the nature of operation
 Characterized by extreme climatic
 Overalls(coveralls)-obligatory conditions, extreme temperature with
 PERONAL HYGIENE little rainfall and, at the opposite
extreme, there is unusually heavy
-provision for washing facilities(with soap and rainfall
warm water)should be made available to
personnel.  La nina phenomenon

 SPECIAL PRECAUTIONS FOR CLEARING UP  Characterized by unusually cold ocean

SPILLAGE OF POTENTIALLY HAZARDOUS temperature in the equatorial pacific
SUBTANCES which causes increased number of
tropical storms in the pacific ocean
-the place to be cleared must be secured or
cordoned .Only authorized personnel or the A Review of the Philippine Health Care
pollution control should be allowed in the area. Delivery System

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 GERALDINE KETH G. SALON
private sources, and social health
insurance (PhilHealth per RA 7875)

• DOH

• Leader for health

• Envisions to be a global leader for attaining

better health outcomes, competitive and
responsive healthcar system and equitable
healthcare financing

• Mission: To guarantee equitable, sustainable,

and quality health for all filipinos, especially
the poor and to lead the quest for excellence
in health

• DOH

• Major roles (1) leader in health, (2) anabler

and capacity builder, (3) administrator of
specific services

• Core values reflect adherence to highest

standards of work namely:

• Integrity

• Excellence

• Compassion and respect for human

dignity

• Commitment

• Professionalism

• Teamwork

• Stewarship of the health of the people

• Philippine Healthcare Delivery System
• Levels of health care Delivery
• Centralized-decentralized (LGUs)
• A general hospital provides services for all
• Public-private mix kinds of illnesses, injuries or deformities
• PRIVATE • Level 1,2,3
– accessed by 30% of • A special hospital offers services for a specific
filipinos disease or condition, or type of patient such
– 60% o natl health as children, women…
expenditure • Other health care facilities
– Employs more than Category A. Primary care facility – first contact hc
70% of health facility that offers basic services including emergency
professionals services and provision of normal delivery services
• Financing is provided by the -With-out in-patient beds like health centers,
government (natinal and local), OPD and dental clinics

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 GERALDINE KETH G. SALON
-With in-patient beds: stay of 1-2 days before (2) Prepares FHIS quarterly and annual reports for
discharge such as infirmaries and birthing (lying-in) submission to the PHO
centers
(3) Responds to healthcare needs of individuals,
• Category B. Custodial care facility – provides families and catchment community utilizing
long-term care including basic services like the nursing process
food and shelter to patients with chronic
(4) Collaborates with other members of the
conditions requiring on-going health and
health team, Gos, NGOs, etc…
nursing care due to impairment and reduced
degree of independence in ADL, and patients Ratio of 1 PHN: 20,000 population
in need of rehabilitation
Rural Health Midwife
• Examples are custodial psychiatric facilities,
substance/drug abuse treatment and rehab Ratio of 1RHM: 5,000 population
centers, sanitaria/leprosaria, and nursing 1. Manages the BHS, supervises and trains BHWs
homes
2. Provides midwifery services and executes
• Category C. Diagnostic/Therapeutic facility – healthcare programs and activities for women
a facility for the examination of the human of reproductive age including FP
body, specimens from the human body for
diagnosis and treatment of disease; also 3. Conducts patient assessment and diagnosis
drinking water analysis for referral or further management

• Category D. Specialized out-patient facility – a 4. Performs health information, communication

facility that performs highly specialized and education activities
procedures on an out-patient basis 5. Organizes community
• The Rural Health Unit 6. Facilitates barangay health planning and other
• Primary level community health services

• Focused on promotive and preventive health Rural Sanitation Inspector

services Core Function is to ensure a health physical
• Supervise BHSs under its jurisdiction environment in the municipality which entails
advocacy, monitoring and regulatory activities such as
• Recommended ratio is 1 RHU: 20,000 inspection of water supply and unhygienic household
population conditions
• Manned by MHO, PHN, RSI, RHM, BHWs

Municipal Health Officer or Rural Health Physician BHWs –considered as the interface between the
Ratio 1 RHP: 20,000 population community and the RHU; are trained in preventive
health carewith a strong emphasis on maternal and
Core Functions: child care, FP and reproductive health, nutrition and
sanitation.
(1)Administrator of the RHU,
-Equipped with basic skills for prevention and
(2)Community physician, and
management of common diseases
(3) Medico-legal Officer of the municipality
-Assist in providing basic services at the BHS and RHU
Public Health Nurse
-accredited by the LOCAL HEALTH BOARD with a
Core functions: status of “volunteers”

(1) Supervises and guides all RHMs -ratio of 1 BHW: 20 households

• Local Health Boards

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 GERALDINE KETH G. SALON
• Chaired by the local chief executive: Provincial 4. Health Workers – deliver comprehensive services
Governor/City or Municipal Mayor and co- include all personnel from public and private facilities,
chaired by the Provincial/City/Municipal NGOs and community-based organizations.
Health Officer

• Members are Chairman of the Committee on

health of the Sanggunian, representative from
the private sector or NGO involved in health
services, and a representative of DOH.

Functions of local health boards

1. Make proposals to Sanggunian annual

budgetary allocation for the operation and
maintenance of health facilities and services
within the province/city/municipality

2. Serves as advisory committee to the

Sanggunian on health matters

3. Create committees that shall advise local

health agencies on various matters related to
health service operations

Health Referral System done within the context of

ILHZ providing a means of consolidating healtcare
efforts.

BHSs --- RHUs ----- Municipal/District Hospitals

----- Provincial Hospitals ----- Regional Centers

(primary --- secondary ---- tertiary care)

• Inter-Local Health Zone

-based on the concept of district health

system
• Health Care Frameworks
- Integrated health management and delivery
• 1980s-2023
system based on a defined administrative and • Primary Health Care
geographical area • 30th World Health Assembly (May 1977)
- Has a central or core referral hospital and a – Attainment of a level of health that
number of primary level facilities like RHUs would permit the population to lead a
socially and economically productive
and BHSs; includes all sectors
life by year 2000
Components: • Primary Health Care
• 1st International Conference on PHC (Sept
1. People = between 100,000 – 500,000; varies from 1978; Alma Ata, Russia) where the Phils is one
zone to zone of the signatories
• LOI 949 Oct 1979) adoption of PHC in the
2. Boundaries – clear boundaries between ILHZs on
Phils
accountability and responsibility of health service
Rationale for adoption:
providers
– Magnitude of health problems
3. Health facilities – work together as an integrated – Inadequate and unequal distribution of
health system health resources
– Increasing cost of health care

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– Isolation of HC from other • People are the center, object and subject of
development activities development
• Primary Health Care, defined • Self reliance
• Essential health care services made accessible
to individuals and families in the community • 8 PHC Principles
by means acceptable to them, through their • Partnership between the community and
full participation and at a cost that the health agencies in the provision of quality of
community can afford at every stage of life
development • Recognition of inter relationship between
• Vision: Health for All Filipinos by the year health and development
2000; Health in the hands of the people by the – Health: WHO model
year 2020 – Development: multidimensional –
• Primary Health Care political, social, cultural, institutional
• Mission: To strengthen the healthcare system and environmental
by increasing the opportunities and supporting It is measured by the ability of
the conditions wherein people will manage the people to satisfy their basic needs
their own healthcare
• Two levels of HCworkers • 8 PHC Principles
– BHW: trained community health • Social Mobilization
workers/health auxiliary – People participation or governance
volunteers/traditional birth with support system from the govt;
attendants/healers networking and developing secondary
– Intermediate level: PHN, RSI and leaders
midwives • Decentralization
– PHC Key Strategies – Local level political structures with
• Partnership with and Empowerment of the more substantive responsibilities for
people development
– EHCS that are community based, • Four Pillars of PHC
accessible, acceptable and • Active community participation
sustainable , at a cost which the • Intra-and inter-sectoral linkages
community and the government can • Use of appropriate technology
afford. • Support mechanism made available
• PHC Objectives • Elements of PHC
• Improvement in the level of health care of the • E – education for health
community • L – locally endemic disease control
• Favorable population growth structure • E- expanded program on immunization (EPI)
• Reduction in the prevalence of preventable, • M- maternal and child health and family
communicable and other diseases planning
• Reduction in morbidity and mortality rates • E- environmental sanitation and promotion of
especially among infants and children safe water supply
• PHC Objectives • N – nutrition and promotion of adequate food
• Extension of EHCS with priority given to the supply
underserved sectors • T – treatment of communicable diseases and
• Improvement of basic sanitation common illnesses
• Development of community capability aimed • S- Supply of essential drugs
at self-reliance • Four Major Strategies of PHC
• Maximizing the contribution of other sectors • Elevating health to a comprehensive and
for the social and economic development of sustained national effort
the community. • Promoting and supporting Community
• 8 PHC Principles Managed Health care
• 4 A’s (accessibility, affordability, acceptability • Increasing efficiencies in the health sector
and appropriateness) of health services • Advancing essential national health research
• Community Participation • Healthcare Reforms/Laws
• Basis: Ottawa Charter for Health Promotion

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– Ottawa, Canada; November,1986; disease of rapid urbanization and
organized by WHO Industrialization
– Charter signed calls for a • Health Goals to attain SDGs
commitment to health promotion to • Financial Risk Protection
achieve the goal of Health for All by • Filipinos, especially the poor are
the year 2000 and beyond protected from high cost of health care
– Defines health promotion as the • Better Health Outcomes
process of enabling people to • Filipinos attain the best possible health
increase control over, and to outcomes with no disparity
improve their health, which requires • Responsiveness
that individuals/groups must be able • Filipinos feel respected, valued, and
to identify and realize aspirations, to empowered in all of their interaction
satisfy needs, and to change or cope with the health system
with the environment • VALUES
• Ottawa Charter for Health Promotion • EQUITABLE & INCLUSIVE TO ALL
• Identified Pre-requisites to health: • TRANSPARENT & ACCOUNTABLE
– Peace • USES RESOURCES EFFICIENTLY
– Shelter • PROVIDES HIGH QUALITY SERVICES
– Education • Universal Heath Care
– Food • Fulfills the “social contract” with the people
– Income (EO No. 43, s. 2011)
– A stable ecosystem • Investing in our people, reducing
– Sustainable resources poverty and building national
– Social justice and equity competitiveness
– Ottawa Charter for Health Promotion • Advancing and protecting public
• Three (3) Basic strategies for health health
promotion • Building of capacities and creation of
1. Advocacy for health to provide for the opportunities among the poor
conditions and resources essential to health • Increasing social protection
2. Enabling all people to attain their full health • Universal Heath Care
potential • Fulfills the “social contract” with the people
3. Mediating among the different sectors of (EO No. 43, s. 2011)
society in efforts to achieve health • Investing in our people, reducing
• Healthcare Reforms/Laws poverty and building national
• Healthcare Reforms/Laws competitiveness
• Healthcare Reforms/Laws • Advancing and protecting public
• Healthcare Reforms/Laws health
• Healthcare Reforms/Laws • Building of capacities and creation of
• Universal Heath Care opportunities among the poor
• AHA under Aquino administration • Increasing social protection
• “Kalusugan Pangkalahatan” Admin Order No. • Goals of Universal Health Care
2010-0036; aims to achieve universal health • Financial Risk Protection
care for all Filipinos. • Responsive health system
• National Objectives for Health • Better health outcomes
2016-2022 • UHC: Financial Risk Protection
• “All for Health towards Health for All” • Protection against the catastrophic cost of ill
(Lahat Para sa Kalusugan! Tungo sa health through strengthening the NHIP
Kalusugan Para sa Lahat) • NHIP as prime mover in improving financial
• All Life Stages & Triple Burden of Disease risk protection, generating resources to
Pregnant, newborn, infant, child, adolescents, modernize and sustain health facilities, and
adults and elderly improve the provision of public health services
• Communicable diseases; Non- through the Millenium Development Goals
communicable including malnutrition; (MDGs)
• UHC: Responsive health system

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• Improving the quality of hospitals and other 1C Halve between, 1990 and 20015,
HC facilities the proportion of people who suffer from
• Upgrading of govt owned/operated facilities; hunger.
provision of quality services to attain MDGs • Goal…Target….Indicators…
• Attend to traumatic injuries and other types of • Goal 2 Achieve universal primary education
emergencies; manage non-communicable • Targets:
diseases and their complications 2A Ensure that, by 2015, the proportion of
• UHC: Better health outcomes people , boys and girls alike, will be able to
• Preparedness for emerging diseases, complete a full course of primary schooling.
prevention and control of communicable
diseases
• Focus on health-related MDGs on: • Goal…Target….Indicators…
• Reduction of maternal and child • Goal 3 Promote gender equality and empower
mortality women
• Morbidity and mortality from TB, Target 3A Eliminate gender disparity in
malaria, primary and secondary education preferably
• Prevalence of HIV/AIDS by 2005 and to all levels of education no later
• UHC: Strategic Thrusts: than 2015.
• Financial risk protection through expansion in
NHIP enrolment and benefit delivery • Goal…Target….Indicators…
• Improved access to quality hospitals and • Goal 4 Reduce child mortality
health care facilities Target 4A Reduce by two-thirds, between
• Attainment of health-related MDGs 1990 and 20015, the under-five mortality rate.
• DOH General Strategies: Indicator 4.1 Under five mortality rate
• Focus and engage vulnerable families, starting Indicator 4.2 Infant mortality rate
with provinces where most are found Indicator 4.3 Proportion of 1 year-old children
• Organization and mobilization of immunized against measles
Community Health Teams (CHTs)
• Partner with poverty alleviation programs like • Goal…Target….Indicators…
the National Household Tartgeting System • Goal 5 Improve maternal health
Poverty Reduction (NHTS-PR) and Target 5A Reduce by three-quarters,
Conditional Cash Transfer (CCT) between 1990 and 2015, the maternal
• Leverage LGU participation and performance mortality rate.
thru province-wide agreements Indicator 5.1 Maternal mortality ratio
• Harness private sector participation Indicator 4.2 Proportion of births attended by
• Philippines as a member of UN skilled health personnel
• Millennium Summit on September 6-8, 2000 Target 5B Achieve, by 2015,
• Commitment to the UN Millennium universal access to reproductive health
Declaration to reduce poverty and seven other Indicator 5.3 Contraceptive prevalence rate
goals by 2015 thru the MDGs Indicator 5.4 Adolescent birth rate
• Five are not strictly health issues but are Indicator 5.5a Antenatal care coverage (at least
considered as related to health being geared one visit)
towad upgrading socio-economic conditions Indicator 5.5b Unmet need for family
(health determinants) planning
• 8 Millenium Development Goals
• Goal 1. Eradicate extreme poverty and • Goal…Target….Indicators…
hunger. • Goal 6 Combat HIV/AIDS, malaria and other
• Targets: diseases
1A Halve, between 1990 and 2015, Target 6C Have halted by 2015 and
the proportion of people whose income is less begun to reverse the incidence of malaria
than one dollar and other major diseases
1B Achieve full and productive Indicator 6.6a Prevalence associated with
employment and decent work for all, including malaria
women and young people.

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Indicator 6.6b Death rate associated with standards to promote good research
malaria practice, translation to ensure quality
Indicator 6.8a Prevalence associated with evidence is turned into products and
tuberculosis. policy; and organization to stregthen
Indicator 6.8b Death rate associated with research culture within and improve
tuberculosis. management and coordination of
Indicator 6.9a Proportion of tuberculosis cases research activities
detected under directly observed treatment, • Core Functions of WHO
short course (DOTS) • Setting the norms and standards and
Indicator 6.9b Proportion of tuberculosis promoting and monitoring their
cases cured under DOTS implementation
• Goal…Target….Indicators… • Articulating ethical and evidence-based policy
• Goal 7 ENSURE ENVIRONMENTAL actions
SUSTAINABILITY • Providing technical support, catalyzing
Target 7A Integrate the principles of change, and building sustainable institutional
sustainable development into country policies capacity
and programmes to reverse the loss of • Universal Health Care
environmental resources. • RA 11223 signed into law by Pres. R. Dutuerte
Target 7B Reduce biodiversity loss, on February 20,2019.
achieving, by year 2010, a significant • IRR was signed by Sec Duque on October 10,
reduction in the rate of loss. 2019
Target 7C Halve, by 2015, the proportion of • Conceptual framework is based on WHO’s
population without sustainable access to safe three dimensions of universal health coverage-
drinking water and improved sanitation. – Population, service and financial
• Goal…Target….Indicators… coverage
• Goal 8 Develop a global partnership for • Major reforms
development. • Organization of health system into healthcare
Target 8D Deal comprehensively wuth the provider networks composed of primary,
debt problems of developing countries thru secondary and tertiary levels of care where the
national and international measures in order to primary care facilities serve as gatekeeper and
make debt sustainable in the long term. navigator of health services within the network
Target 8F In cooperation with the private • Classification of health services into
sector, make available the benefits of new population-based and individual-based health
technologies, especially information and services
communications. • Simplification of health financing
• Philippine Health Situation Indicators mechanisms:
(DOH,NNC,POPCOM,NSCB) – population-based services will be
• Public Health Programs generally supported by tax-based
• World Health Organization financing
• Created after UN was formed in 1945 – individual-based health services
• Constitution came into force on April 7, 1948; through premium-based social health
April 7 is celebrated as World Health Day insurance scheme
• As constituted, it aims towards attainment by • Principles and Objectives of the Universal
all peoples of the highest level of health Health Care Act
(2006) 1. Adoption of integrated and comprehensive
• Core Functions of WHO approach to ensuring health literacy, healthy
• Providing leadership on matters critical to heal living and protection from hazards and risks
and engaging in partnerships where joint 2. Development of health care model that
action is needed provides comprehensive health services
• Shaping the research agenda, and stimulating without causing hardship to citizens, specially
the generation, translation and disseminating the poor and marginalized sectors
valuable knowledge • Principles and Objectives of the Universal
– Research strategies are: capacity Health Care Act
building, focus on health priorities,

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3. Pursues a whole-of- system, whole- of – known as immunization. Immunity
government, and whole-of-society approach in (protection) from immunization is similar to
developing health policies; disease immunity, however instead of
4. Adheres to a people-oriented approach receiving the disease, you get a vaccine. This
centered on people’s health needs and well- is why vaccines are such effective medicines.
being. o Majority of vaccines are administered via
• Framework of Universal Health Care needle (injection), although others are
administered via mouth (orally) or nasal spray
• 8-Point Agenda of BBM
(nasally). Immunizations, needles, shots, and
• Food security jabs are all terms used to describe
• Improved transportation vaccinations.
• Affordable and clean energy Two types of Immunization
• Health care – advance medical facilities and o administration of antibodies to an
human capital unimmunized person from an immune subject
• Education to provide temporary protection against a
• Social Services microbial agent or toxin.
• Sound Fiscal Management o this type of immunity can be conferred on
• Bureaucratic Efficiency persons who are exposed to measles, mumps,
• 8-point Agenda of DOH/Sec Herbosa whooping cough, poliomyelitis
• Every Filipino should feel healthy. o the individual’s own immune system is
• Safe, quality, and comparative service stimulated to produce antibodies and
• Technology for prompt services lymphocytes.
• Crisis ready Passive Immunization
• Disease Prevention Active Immunization
• Mental and Emotional Support 1. HERD IMMUNITY
• Rights and welfare of health workers o also known as 'population immunity’
• Protection against any Pandemic o indirect protection from an infectious disease
• Three Priority Actions that happens when a population is
immuneither through vaccination or immunity
• Ending tuberculosis
developed through previous infection.
• 95% rate of Fully Immunized Child
o WHO supports achieving 'herd immunity'
• Decreasing malnutrition to as much as 50%
through vaccination, not by allowing a disease
to spread through any segment of the
population, as this would result in unnecessary
LESSON 9 cases and deaths.
Communicable Diseases Control
REVIEW OF CONCEPTS with emphasis on
the COVID- 19 PANDEMIC

PREVENTION AND CONTROL

Individual Level
 Breaking the Infection Chain
 Healthy/Positive Lifestyle Behavior
 Primary Prevention: Health Maintenance, 1. VACCINE
Health Protection o a substance used to stimulate the production of
Public Health/Population Level antibodies and provide immunity against one
 Health Education or several diseases, prepared from the
 Advocacy of relevant health programs causative agent of a disease, its products, or a
 Isolation, Segregation, Quarantine synthetic substitute, treated to act as an antigen
 Monitoring and Surveillance without inducing the disease.
 Expanded Program of Immunization Types of vaccine
1. Live-attenuated Vaccines - Live-attenuated
Expanded Program Of Immunization vaccines inject a live version of the germ or
virus that causes a disease into the body.
IMMUNIZATION
o The procedure of administering a vaccine to a 2. Inactivated Vaccine - uses a strain of a
bacteria or virus that has been killed with heat
person in order to protect them from disease is

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or chemicals. This dead version of the virus or In 2013, global measles immunization
bacteria is then injected into the body. coverage was 84% among children aged 12–
3. Subunit, Recombinant, Conjugate, and 23 months. During 2000–2013, estimated
Polysaccharide Vaccines - use particular parts measles deaths decreased by 74% from 481
of the germ or virus. They can trigger very 000 to 124 000.
strong immune responses in the body because 1. EPI to MDG
they use a specific part of the germ. 2. Over-all Goal:
o To reduce the morbidity and mortality among
children against the most common vaccine-
What is Expanded Program on preventable diseases.
Immunization (EPI)? 1.
2. Specific Goals:
The Expanded Program on Immunization 3. 1. To immunize all infants/children against
(EPI) was established in 1976 to ensure that the most common vaccine-preventable
infants/children and mothers have access to diseases.
routinely recommended infant/childhood 4. 2. To sustain the polio-free status of the
vaccines. Philippines.
In 1986, 21.3% “fully immunized” children less 5. 3. To eliminate measles infection.
than fourteen months of age based on the EPI 6. 4. To eliminate maternal and neonatal tetanus
Comprehensive Program review 7. 5. To control diphtheria, pertussis, hepatitis b
Immunization is a global health and and German measles.
development success story, saving millions of 8. 6. To prevent extra pulmonary tuberculosis
lives every year. Vaccines reduce risks of among children.
getting a disease by working with your body’s Mandates:
natural defences to build protection. When you Republic Act No. 10152 “Mandatory Infants and
get a vaccine, your immune system responds. Children Health Immunization” Act of 2011
We now have vaccines to prevent more than 20 Signed by President Benigno Aquino III in July
life-threatening diseases, helping people of all 26, 2010. The mandatory includes basic
ages live longer, healthier lives. Immunization immunization for children under 5 including other
currently prevents 2-3 million deaths every year types that will be determined by the Secretary of
from diseases like diphtheria, tetanus, pertussis, Health.
influenza and measles. 1. What are the vaccines included in EPI?
Immunization is a key component of primary Vaccine-preventable diseases that are included in
health care and an indisputable human right. It’s the Expanded Program of Immunization:
also one of the best health investments money o Tuberculosis
can buy. Vaccines are also critical to the o Poliomyelitis
o Diphtheria
prevention and control of infectious-disease
o Tetanus
outbreaks. They underpin global health security
o Pertussis
and will be a vital tool in the battle against
o Measles
antimicrobial resistance.
o Hepatitis B
1. Significance of EPI to Public Health
Millennium Development Goal 4: Reduce TUBERCULOSIS
Child Mortality POLIOMYELITIS
1. Polio Eradication
Target : Reduce by two-thirds, between 1990
o The Philippines has sustained its polio-free
and 2015, the under-five mortality rate
status since October 2000.
o In 2013, 6.3 million children under 5 died,
o Declining Oral Polio Vaccine (OPV) third dose
compared with 12.7 million in 1990. Between
coverage since 2008 from 91% to 83%. A
1990 and 2013, under-5 mortality declined by
least 95% OPV3 coverage need to be achieved
49%, from an estimated 90 deaths per 1000
to produce the required herd immunity for
live births to 46. Despite this improvement, the
protection.
world is unlikely to achieve the MDG target of
o There is an on-going polio mass immunization
a two-thirds reduction in 1990 mortality levels
by 2015. to all children ages 6 weeks up to 59 months
o More countries are now achieving high levels old in the 10 highest risk areas for neonatal
tetanus. These areas are the following: Abra,
of immunization coverage; in 2013, 66% of
Banguet, Isabela City and Basilan, Lanao
Member States reached at least 90% coverage.

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Norte, Cotabato City, Maguindanao, Lanao 1. Conduct of Routine Immunization for
Sur, Marawi City and Sulu. Infants/Children/Women through the
o Acute Flaccid Paralysis (AFP) reporting rate Reaching Every Barangay (REB) strategy
has decreased from 1.44 in 2010 to 1.38 in
2011. Only regions III, V and VIII have The Reaching Every District (RED) plan, which
achieved the AFP rate of 2/100,000 children was adapted from the WHO-UNICEF Reaching
below 15 years old. (Source: NEC, DOH). A Every District (RED) strategy, was adopted in
decreasing AFP rate means we may not be able 2004 with the goal of improving access to routine
to find true cases of polio and may experience
immunization and reducing dropouts. Data
resurgence of polio cases
DIPHTHERIA analysis for action, re-establish outreach services,
TETANUS enhance ties between the community and service,
1. Maternal and Neonatal Tetanus Elimination supportive supervision, and resource
o 10 areas were classified as highest risk for maximization are the five components of the plan.
neonatal tetanus (NT). Figure 3 shows the 1. 2. Supplemental Immunization Activity
areas categorized as low risk, at risk and (SIA)
highest risk based on the NT surveillance, Supplementary immunization activities are used to
skilled birth attendants and facility based reach children who have not been vaccinated or
delivery and the tetanus toxoid 2+ (TT 2+) have not developed sufficient immunity after
vaccination. previous vaccinations. It can be conducted either
o Three (3) rounds of TT vaccination are national or sub-national –in selected areas.
currently on-going in the 10 highest risk areas. 3. Strengthening Vaccine-Preventable Diseases
An estimated 1,010,751 women age 15 - 40 Surveillance
year old women regardless of their TT 1. This is critical for the eradication/elimination
immunization will receive the vaccine during efforts, especially in identifying
these rounds. This is funded by the Kiwanis 2. true cases of measles and indigenous wild
International through UNICEF and World polio virus.
Health Organization. 3. 4. Procurement of adequate and potent
PERTUSSIS vaccines and needles and syringes to
MEASLES 4. all health facilities nationwide
HEPATITIS B 5. COLD
1. Measles Elimination CHAIN
o Conducted 4 rounds of mass measles o Cold chain is a system of storing, transporting
campaign: 1998, 2004, 2007 and 2011. and distributing of vaccines in the correct
o Implemented the 2-dose measles-containing temperature and way from the factory to the
vaccine (MCV) in 2009 vaccinated child.
MCV1 (monovalent o Cold chain is a corner stone of the EPI,
measles) at 9-11 months old because the vaccine loses the efficacy if
MCV2 (MMR) at 12-15 months incorrectly kept.
old. o Vaccines are sensitive to heat and freezing and
o Implemented and strengthened the laboratory Vaccines are sensitive to heat and freezing and
surveillance for confirmation of measles. must be kept at the correct temperature from
Blood samples are withdrawn from all measles must be kept at the correct temperature from
suspect to confirm the case as measles the time they are manufactured until they are
infection. the time they are manufactured until they are
o A supplemental immunization campaign for used.
measles and rubella (German measles) was
done in 2011. This was dubbed as “Iligtas sa
Tigdas ang Pinas” 15.6 million (84%) out of
the 18.5 million children ages 9 months to 8
years old were given 1 dose of the measles-
rubella (MR) vaccine between April and June
2011.
1. IMMUNIZATION SCHEDULE FOR
INFANTS
Strategies

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• DOH field units thru programs & projects
(basic services & facilities)
– Elimination & control of
environmental factors in disease
transmission
– Strategies
• Water quality surveillance
• Evaluation of food establishments
• Proper solid & liquid waste management
• Sanitation of public places
• Strategies
• Sanitation management of disaster areas
• Impact assessment of environmentally critical
projects and enforcement of sanitation laws,
rules and regulations
• Water supply sanitation
• Water
– Prime necessity for existence of life
– Quality of water is one most impt
factor in public health
• Maybe a vehicle of water-
related disease transmission
• Impurities of Water
(Water is a universal Solvent)
LESSON 7 • Bacteriological – bacteria maybe parasitic,
ENVIRONMENTAL SANITATION pathogenic or both
• Definition (WHO) • Physical –suspension of floating substances;
• Control of all factors in man’s physical responsible for turbidity or cloudiness
environment which exercise or may exercise a • Chemical – dissolved or colloidal constituent;
deleterious effect on his physical account mostly for color and palatability
development, health and survival. • Impurities
• • Biological – microscopic & macroscopic plants
Factors and animal life
• Water sanitation • Radiological – may result from nuclear
• Food sanitation weapon testing and discharge of radio-
• Refuse and garbage disposal isotopes into water courses
• Excreta disposal • Water-related diseases:
• Insect and vector control • Poor sanitation contributes to water-borne
• Housing diseases which include cholera, typhoid &
• Factors infectious hepatitis
• Air pollution – Polluted water acts as a passive
• Noise vehicle for an infecting agent
• Radiological protection • Lack of water, poor personal hygiene and lack
• Institutional sanitation of proper waste disposal contribute to a large
• Stream pollution group of water-washed diseases including
• Environmental Health Service (DOH) scabies, leprosy and conjunctivitis
• Legal basis – PD 856 Sanitation Code of the • Aquatic animals in drinking water can cause
Phils, 1978 water-based diseases like guinea worms,
• Functions of EHS: urinary and rectal infections
• Promotion of healthy environmental • Diseases with water-related insect vectors
conditions & prevention of related diseases such as malaria, schistosomiasis, infectious
through appropriate sanitation strategies viral fevers (dengue) are spread by
• Conceptualization of new programs/projects mosquitoes and other insects that breed in
to contend with emerging problems water
• Implementors: • Diseases related to fecal disposal likely to be
acquired by eating raw fish and fresh-water

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shrimps, crabs and other large aquatic • Use ice if needed
organisms; ex: Paragonimiasis – endemic in • Disinfection and Treatment
Jaro, Leyte • Use of chlorine – powerful germicide, readily
• Water Supply Sanitation Program: available, cheap and easy to apply
• Approved types of water supply facilities: – Safe level: 1 ppm available chlorine
– Level I (Point Source) – Use clean container
• Protected well or a developed – Let treated water stand for at least 30
spring with an outlet but minutes before using
without a distribution system • Boiling – simple and effective emergency
– 15-25 households measure for water sterilization
– Farthest user not – At least 20 minutes, have water over
more than 250 meters the fire for at least 3 minutes after
– Yield/discharge of 40- reaching boiling point
140 L per minute • Food Sanitation
– Level II (Communal faucet system or • Application of measures that will make the
stand-posts physical environment healthful (clean and
• Concrete reservoir, piped orderly)
distribution network and • Proper food handling
communal faucets • Efficient supply of clean, potable water
– 100 households • Proper preparation/cooking
– Farthest user not • Protection of food from insect vectors and
more than 25 m rodents
– Delivers 40-80 L per • DOH programs:
capita per day • Appraisal of food establishments-
– Level III (Waterworks or individual – Inspection and approval of food
house connections) sources, containers and transport
• System with a source, vehicles
reservoir, piped distribution – Sanitary permit requirements
network and household taps compliance
• Unapproved types – not to be used for – Updated health certificates for food
drinking such as open dug wells, unimproved handlers, cooks and cook helpers
springs • Classification of food establishments
• All households shall be provided with safe and – Class A (excellent)
adequate water supply – Class B (very satisfactory)
• Yearly monitoring/surveillance – Class C (satisfactory)
– Water analysis by DOH accredited labs – Destruction or banning of food unfit
– Disinfection of water supply sources: for human consumption
required for new construction, – Training of food handlers and
repaired or improved and those found operators on food sanitation
(+) bacteriologically – Health certificate requirements for
– Container disinfection if subject to ambulant food vendors
recontamination (from unapproved – Promotion of household food
water types) sanitation and food hygiene education
• Sampling for water analysis: • Excreta Disposal
• All water samples should be submitted to the • Collection and disposal of human wastes are
lab after collection and not later than the max among the most important problems of
allow time below environmental health
– Bacteriological • Diseases closely associated with improper
• Use sterile containers; within human excreta disposal are among the
24 hours; maintain same leading causes of illness and deaths in the
temperature as its source country
• If more than 24 hrs, keep • Approved types of toilet facilities
sample in a box with ice • Level I
– Physical & chemical – Non-water carriage toilet facility as pit
• Submit within 72 hrs latrines
• Keep cool

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– Toilet facilities requiring small amount • Vectors are arthropods or other invertebrates
of water as pour-flush type which transmit infection thru biological or
• Pit latrines or sanitary pit privy mechanical means
– Dug pit cased by bamboo, wood, – Biological vector is one in whichthe
brick, hollow blocks or empty drums disease agent completes part of its life
on the sides measuring 1-2 m deepx1 cycle in the insect host e.g. mosquito
cu. m. with floor cover at top of pit, – Mechanical vector is one which
riser, seal and self-closing lid, all made transmits the disease agent physically
as “fly-tight” as possible; screened e.g. housefly
vent maybe provided; with a • Control strategies:
superstructure/shed for privacy • Physical – use physical force and devices
• Level II – on site water carriages with water • Chemical – use of rodenticides and
sealed and flush type with septic tank insecticides
• Pour-flush or water-seal latrine • Biological – limiting the growth and
– Modified pit privy with a relatively reproduction of vectors by limiting availability
simple concrete bowl the lower of food sources and harborages e.g. effect of
portion is either “P” or “S” shaped predators
trap which form a “water-seal” when • Environmental measures – maintaining the
water is added; fitted with an ordinary cleanliness of immediate premises and
concrete slab and the bowl is placed observing proper building construction and
directly over the pit maintenance to prevent access of pests into
• Level III – water carriage types connected to human dwellings
septic tanks and/or sewerage system to • Health education – e.g. importance of control
treatment plant measures
• Flush type • Considerations:
– Waste is disposed by flushing water • Construction materials used
through sewer pipes into a public – Lead based paints
sewerage system or into individual – Asbestos
disposal system (individual septic • Water supply (private water wells)
tank) • Domestic sewage
• Other types of toilet/unapproved types • Minimum standards for accomodation
• Cat-hole • Accomodation Stds
• Pail method 1. Physiological Requirements
• Chemical toilet – liquefaction of organic Thermal conditions
matter with the use of caustic chemicals • Dampness/molds
• Cesspool – reverse of a well; untreated liquid • Excessive heat/cold
wastes are run into a hole in the ground Presence of pollutants
• Sewerage Systems • Asbestos,lead
• Urban places – collected and carried by sewer • Carbon monoxide
• Radiation
pipes and are disposed of by land or into
bodies of water; some undergo treatment
processes before its discharge to bodies of
2. Psychological Requirements
water
• Space (crowding)
• Rural places
– Domestic sewage commonly • Security/access by intruders
discharged into backyards, canals • Light and noise
without treatment;
– Open drainage
– Blind drainage 3. Protection against infection
• Waste water flows thru a
• Hygiene and sanitation
system of closed pipes to an
underground pit or covered – Water supply and drainage
canal – Refuse
• Insect & Rodent Control – Pests
4. Protection against accidents/falls
• Electrical hazards

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• Fires, burns & scalding – Sheltering
• Collisions and falls (stairs) – Radioprotective
• Air Pollution prophylaxis
• Noise – Body protection
• Effect of environmental noise – Decontamination of
– Sleep related problems areas
– Noise induced hearing – Evacuation
impairment/loss – Recovery phase
– Children are more vulnerable
– Applicable or essential
* For good sleep, sound level should not countermeasures
exceed 30 dB(A) for continuous • Personal decontamination
background noise & 45 dB(A) for • Relocation
individual noise events • Control of access
• Main health risks of noise interference (WHO) • Food control
• Pain and hearing fatigue • Decontamination of areas
• Hearing impairment incldg tinnitus • Institutional Sanitation
• Annoyance • Healthcare Waste Management
• Interference with social behavior • AO No. 341 – Implementing the Phil Health
(aggressiveness, protest, helplessness) Promotion Program through Healthy Places
• Interference with speech communication – Water supply
• Sleep disturbance and all its consequences on – Sanitary toilets
a shot-term and long-term basis – Waste collection and disposal
• Cardiovascular effect – Non pollution of the environment
• Performance at work and school – Insect and vermin control measures
• Normal responses, stress follows •
• Radiological Protection Stream Pollution
• Response to a nuclear accident • Waste collection and disposal
– Networking/cooperation/coordination • Disposal of human and animal excreta
• WHO • Responsibilities of Health Workers
• International Atomic Energy • Health education
Authority • Participation in the training component
• Local health authorities • Assistance in projects like deworming of target
• Response is divided into groups
– Early phase
– National and local level priorities • Participation in ES campaigns e.g. use of
Medical care to sanitary toilets, proper garbage disposal,
radiation victims “green” projects
– Provision of info on • Participate/conduct ES researches
food and drinking
water contamination • Be a role model of cleanliness in the homes
– Implement and surroundings including
countermeasures, if observance/practice of proper waste disposal
necessary in both public and private places
» Sheltering
» Radioprotecti • 9.1 DOH
ve • Republic Act No.4226
prophylaxis, • “Hospital Licensure Act” requires of all the
iodine hospitals in the country and mandates DOH
prophylaxis,
body to provide the guidelines for hospital
protection, technical standards as to personnel ,
evacuation, equipment and physical facilities.
personal • PRESIDENTIAL DECREE No. 856
decontamina
tion • “
– If necessary, request • The Code on Sanitation of the PHILIPPINES ”
assistance of mandates the DOH to promote and preserve
international public health and upgrade the standard of
community
medical practice . In line with the DOH
– Intermediate phase
mandate , a Manual on Hospital
• Applicable countermeasures

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Management was published in 1997 and the The main groups of people who are at risk of
Implementing Rules and Regulations of exposure to health hazards associated with
Chapter XVII , fuse Disposal of PD 856 was health care waste are the following:
promulgated. • Staff of the health care establishments such as
• IMPACT OF HEALTH CARE WASTE physician , nurses , health care auxiliaries ,
A framework for health care waste and hospital maintenance personnel
management should always consider health • Patients in the health care establishment or
and occupational safety . There are many receiving home care
potential hazards associated when dealing or • Visitors , comforters ,and caregivers to health
handling health care waste such as physical , care establishment
chemical and biological hazards as well as • Personnel and workers providing support
ergonomic factors. services and allied to health care
Minimizing these hazards may entail the establishment , such as laundries , waste
institution of administrative , engineering and handling and transportations.
• Persons transporting hazardous health care
medical controls including the provision of
waste.
personal protective equipment.
• Workers and operators of waste treatment
Administrative control includes: and disposal facilities ; sanitary landfill.
 Proper and regular training • Hazards from Infectious Waste and Sharps :
 Change of job schedule Infectious waste may contain any of a great
 Rotation of workers variety of pathogenic organisms .Pathogens in
Engineering control includes the substitution
infectious waste may enter the human body
of equipment/devices , change of process to a
by a number of routes :
much safer method , the mechanization or
 Through a puncture
computerization , proper upkeep and regular  Abrasion
maintenance of equipment/machine and  Cut in the skin
imposition of warning devices . Medical  Through in the mucous membrane
control includes :  Inhalation
 Written occupational health and safety  ingestion
program Infectious waste may contain any of a great
 Physical examination(pre-employment and variety of pathogenic organisms .Pathogens in
annual infectious waste may enter the human body
 Regular immunization by a number of routes :
 Health education  Through a puncture
 Regular exercise  Abrasion
 Healthy diet and continuous medical  Cut in the skin
monitoring and periodic examination  Through in the mucous membrane
 Adequate and good designed personal  Inhalation
protective equipment should be provided  ingestion
this include protection for the head , face ,  GENERAL WASTE : comparable to domestic
body, arms ,legs and feet. waste , this type of waste does not posed
Exposure to hazardous health care waste can special handling problem or hazard to human
result to disease or injury . The hazardous health or to environment . It comes mostly
nature of health care waste maybe due to one from the administrative and housekeeping
or more of the following characteristics : functions of health care establishment and
 Contains infectious agents may also include waste generated during
 Geno-toxic maintenance of health care premises.
 Contains toxic or hazardous chemicals or  INFECTIOUS WASTE : this type of waste is
pharmaceuticals suspected to contain pathogens
 Radioactive  PATHOLOGICAL WASTE : consist of body
 Contains sharps parts , human fetus and animal carcasses ,
 PERSONS AT RISK blood and body fluids.
 SHARPS : include needles , syringes , scalpels ,
saws , blades , broken glass , infusion sets ,

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knives any other items can cause cut or  9.Cosmetic ear peircing and tattoo parlors.
puncture
 PHARMACEUTICAL WASTE : includes expired ,
unused spilt and contaminated
pharmaceutical products.
 GENOTOXIC WASTE : include certain cytostatic
drugs , vomit , urine , feces from patients
treated with cytostatic drugs.
 CHEMICAL WASTE : consist of discarded solid ,
liquid and gaseous chemicals , for example
from diagnostic and experimental work.
Chemical waste is considered hazardous if it 4.
has at least one of the following properties: SEGREGATION OF WASTE
 Toxic Is the important step to waste management .
 Corrosive
There are several reasons to undertake waste
 Flammable
segregation :
 Reactive(explosive ,water-reactive , shock
 Segregation minimizes the amount of waste
sensitive)
that needs to be managed as bio-hazardous or
 Genotoxic (e.g cytostatic drugs)
hazardous waste.
 8.WASTE WITH HIGH CONTENT HEAVY
 Facilitates waste minimization by generating a
METALS
solid waste steam which can be easily , safely ,
 -consist of broken mercury and blood
and cost-effectively managed through
pressure gauges
recycling or composting.
 9.PRESSURIZED CONTAINERS
 Reduces the amount of toxic substances
 includes pressurized cylinders , cartridges
release to the environment through disposal
and aerosols cans.
of general waste.
 10.RADIOACTIVE WASTE
 Makes it easier to conduct assessments of the
 include disused sealed radiation sources ,
quantity and composition of different waste
liquid and gaseous materials
streams thereby allowing health care facilities
 contaminated with radioactivity.
to obtain baseline data , identify options ,
 SOURCES AND COMPOSITION OF HEALTH
determine waste management cost , and
CARE WASTE
assess the effectiveness of waste minimization
1. Hospitals
strategies.
2. Clinics
 6. COMPOSTING
• Medical
 Composting is another important strategy to
• Veterinary
minimize waste such as food discards , kitchen
• Health care centers and dispensaries
waste , cardboard , and yard waste . Some
• Alternative medicine
hospitals in other countries have also
• Dental
successfully composted placenta waste.
• Maternity and lying-in
Sufficient land space for on-site composting
• Dialysis center
far enough from patient care and public
• Physician offices
access area would be needed.
3.Laboratories and research center
 OTHER DOH REQUIREMENTS:
4.Drug Manufacturers
 DOH Department Circular No. 156-C,series of
5.Institution
1993
 Medical  “PROVIDES GUIDELINES ON HOSPITAL WASTE
 Nursing homes MANAGEMENT
 Dental  All undevolved government hospitals , clinics ,
 Paramedics laboratories , and research offices , shall
 Nursing incorporate satisfactory segregation ,
 Drug rehabilatation center treatment , collection , and disposal system”.
 Veterinary  DOH MEMORANDOM No. 1-A,series of 2001
 6.Motuary and Autopsy center  “Requiring the Department of Health Central
 7.Ambulances and Emergency care Office , Centers for Health development and
 8.Home treatment

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all concerned hospitals to practice proper care waste must be provided with adequate
solid waste management. protection from the hazards associated with
 DENR it.
 PRESIDENTIAL DECREE N. 1586 • PERSONAL PROTECTIVE EQUIPMENT
 “ENVIROMENTAL IMPACT STATEMENT(EIS) • -health care waste management program
SYSTEM requires that the following personnel
 requires projects like construction of new protective equipment be made available to all
hospital buildings or expansion of existing health care personnel who collect and handle
hospitals to secure an Environmental health care waste.
Compliance Certificate(ECC)prior to • Hard hats with or without visor-depending on
construction and operation of the facility. the nature of operation
 REPUBLIC ACT No. 8749 • Facemask-depending on the nature of
 “CLEAN AIR ACT” operation
 Prohibits the incineration of biomedical waste • Eye protector/safety goggles-depending on
effective JULY 17, 2003.It promotes the state- the nature of operation
of-the-art , environmentally sound and safe- • Overalls(coveralls)-obligatory
burn technologies for the handling , • PERONAL HYGIENE
treatment , thermal destruction , utilization , • -provision for washing facilities(with soap and
disposal of sorted , un recycled and hazardous warm water)should be made available to
waste. personnel.
 ADMINISTRATIVE REQUIREMENTS • SPECIAL PRECAUTIONS FOR CLEARING UP
 OGANIZATION AND FUNCTIONS : appropriate SPILLAGE OF POTENTIALLY HAZARDOUS
health care waste management practices SUBTANCES
depend largely on the administration and • -the place to be cleared must be secured or
organization and require adequate legislative cordoned .Only authorized personnel or the
and financial support as well as the active pollution control should be allowed in the
participation by trained and informed staff. area.
 HEALTH CARE WASTE MANAGEMENT • IMMUNIZATION
COMMITTEE(HCWMC)promulgate a policy • -health care personnel should be given
formalizing the commitment of the health immunization against infection from virus
care institution to proper management of its causing hepatitis B and tetanus infection.
waste with the goal of protecting health and • RESPONSE TO INJURY AND EXPOSURE
environment. • -all staff that handles health care waste must
 HEALTH CARE WASTE MANAGEMENT PLAN : a be trained to deal with injuries and
comprehensive health care waste exposures . Health care establishment should
management plan is the key ingredient s to a develop a program that would prescribe the
successful waste management within a health actions taken in the event of injury or
care facility. exposure to a hazardous subtance.
• SAFE USE OF CYTOTOXIC DRUGS
• HEALTH AND SAFETY • -in order to ensure safe use of cytotoxic
• PRACTICES drugs , the senior pharmacist of the health
• Proper training of Health workers care establishment , should be appointed to
• No training/no hiring policy should be supervised the safe management of cytotoxic
instituted waste . To minimize exposures , the following
• Immunization at the first day of work measures should be observed
• Provision of personal protective • Written procedures that specify safe working
equipment(from head to toe) methods for each process
• Establishment of an effective occupational • Data sheets , based on the suppliers
health program that includes immunization , specification , to provide information on
post exposure prophylactic treatment , and potential hazards.
continuous medical surveillance. • Established procedures for emergency
• WORKER PROTECTION : response in case of spillage or other
• occupational accident
• -all personnel who are directly involved in
the handling of potentially hazardous health

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• Appropriate education and training for all that has occurred in the course of
personnel involved in the handling of civilization.
cytotoxic drugs. 5. Middle Childhood (Ages 6-8):
• Imagination – In middle childhood,
• Global Warming the sense of an inner subjective self
• El Nino phenomenon develops for the first time, and this
– Characterized by extreme climatic
self is alive with images taken in from
conditions, extreme temperature with
the outer world, and brought up from
little rainfall and, at the opposite
extreme, there is unusually heavy the depths of the unconscious. This
rainfall imagination serves as a source of
• La nina phenomenon creative inspiration in later life for
– Characterized by unusually cold ocean artists, writers, scientists, and anyone
temperature in the equatorial pacific else who finds their days and nights
which causes increased number of enriched for having nurtured a deep
tropical storms in the pacific oceaN’ inner life.
LESSON 10 6. Late Childhood (Ages 9-11):
• Public Health Programs Ingenuity – Older children have
From Womb to Tomb acquired a wide range of social and
• The Twelve Stages of the Human Life Cycle technical skills that enable them to
1. Pre birth: Potential – The child come up with marvelous strategies
who has not yet been born could and inventive solutions for dealing
become anything – a Michelangelo, a with the increasing pressures that
Shakespeare, a Martin Luther King – society places on them. This principle
and thus holds for all of humanity the of ingenuity lives on in that part of
principle of what we all may yet ourselves that ever seeks new ways to
become in our lives. solve practical problems and cope
2. Birth: Hope – When a child is born, with everyday responsibilities.
it instills in its parents and other 7. Adolescence (Ages 12-20):
caregivers a sense of optimism; a Passion – The biological event of
sense that this new life may bring puberty unleashes a powerful set of
something new and special into the changes in the adolescent body that
world. Hence, the newborn reflect themselves in a teenager’s
represents the sense of hope that we sexual, emotional, cultural, and/or
all nourish inside of ourselves to make spiritual passion. Adolescence
the world a better place. passion thus represents a significant
3. Infancy (Ages 0-3): Vitality – The touchstone for anyone who is seeking
infant is a vibrant and seemingly to reconnect with their deepest inner
unlimited source of energy. Babies zeal for life.
thus represent the inner dynamo of 8. Early Adulthood (Ages 20-35):
humanity, ever fueling the fires of the Enterprise – It takes enterprise for
human life cycle with new channels of young adults to accomplish their
psychic power. many responsibilities, including
4. Early Childhood (Ages 3-6): finding a home and mate, establishing
Playfulness – When young children a family or circle of friends, and/or
play, they recreate the world anew. getting a good job. This principle of
They take what is and combine it with enterprise thus serves us at any stage
the what is possible to fashion events of life when we need to go out into
that have never been seen before in the world and make our mark.
the history of the world. As such, 9. Midlife (Ages 35-50):
they embody the principle of Contemplation – After many years in
innovation and transformation that young adulthood of following
underlies every single creative act

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society’s scripts for creating a life, – Reduction of morbidity and mortality
people in midlife often take a break and
from worldly responsibilities to reflect Improvement of quality of life
upon the deeper meaning of their Functions
lives, the better to forge ahead with Formulates or develops policies,
new understanding. This element of standards abd guidelines for public
contemplation represents an health services
important resource that we can all Provides technical assistance in public
draw upon to deepen and enrich our health programs or project planning,
lives at any age. implementation and evaluation.
10. Mature Adulthood (Ages 50-80): • Programs
Benevolence – Those in mature 1. Maternal and Child Health
adulthood have raised families, a. Infant and Young Child Feeding (IYCF)
established themselves in their work b. EPI
c. PEM Prevention and Control
life, and become contributors to the
d. Micronutrient Supplementation
betterment of society through
e. Food Fortification
volunteerism, mentorships, and other f. Soil- Transmitted Helminthiasis (STH)
forms of philanthropy. All of g. NBS
humanity benefits from their h. Growth Monitoring and Promotion
benevolence. Moreover, we all can i. Oral Health
learn from their example to give more j. IMCI
of ourselves to others. k. Safe Motherhood/Maternal Care (First
11. Late Adulthood (Age 80+): 1000 Days)
Wisdom – Those with long lives have l. Adolescent Health
acquired a rich repository of m. Early Childhood Care and
experiences that they can use to help Development
guide others. Elders thus represent n. Child Injury Prevention and Control
2. Women’s and Men’s Health
the source of wisdom that exists in
includes Family Planning,
each of us, helping us to avoid the
Reproductive Health; Men’s Health;
mistakes of the past while reaping the
Women and Children in Special Need
benefits of life’s lessons.
for Protection; and Health and
12. Death & Dying: Life – Those in
Development of Older Persons
our lives who are dying, or who have
• Child Health Programs
died, teach us about the value of
• Goal – That every child grows up in a family
living. They remind us not to take our
with love and security, lives in healthy
lives for granted, but to live each surroundings, receives adequate nourishment,
moment of life to its fullest, and to health supervision and medical attention, and
remember that our own small lives is taught the elements of healthy living.
form of a part of a greater whole. • Objectives – to reduce significantly global
• Family Health Office mortality and morbidity associated with the
• Purpose - tasked to operationalize family major causes of deaths in children and to
health programs which focus on the health of contribute to healthy growth and
the mother and the unborn child, infant, child, development of children.
adolescent and youth, adult men and women • Child 21 as Strategic Framework – quality of
and older persons life of Filipino Children in 2025 wherein a
• Aims. healthy Filipino child is-
– Improvement of the survival, health – Wanted, planned and conceived by
and well being of mothers and the healthy parents
unborn through packages of health – Carried to term by a healthy mother
services covering pre-pregnancy, – Born into a loving, caring, stable
prenatal, natal and post natal stages family capable of providing for his/her
basic needs

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– Delivered safely by a trained MICRONUTRIENTS DUE TO WEAKNESS IN
attendant PROCUREMENT, ALLOCATION AND
– Screened for congenital defects DISTRIBUTION
shortly after birth; if defects are – Pockets of low immunization coverage
found, interventions to correct these attributed to irregular supply of
defects are implemented at the vaccines as a result of inadequate
appropriate time funds
– Exclusively breastfed fr at least 6 • Specific Objectives
months, and continued breastfeeding • Reduce mortality
up to two years • Infants 0-1 year--- to 17
– Introduced to complementary foods deaths per 1,000 live births
at about 6 months of age, and • Children 1-4 years--- to 33.6%
gradually to a balanced, nutritious per 1,000 live births
diet; • Adolescents and youths by
– Protected from the consequences of 50%
protein-calorie and micronutrient • Risk Reduction Objectives
deficiencies through good nutrition – Increase
and access to fortified foods and • Percentage of fully immunized
iodized salt children to 90%
– Provided with safe, clean and hygienic • Percentage of infants given
surroundings free from accidents timely and proper
– Properly cared for at home when sick complementary feeding at 6
and brought to a health facility for months to 70%
appropriate management when • Percentage of mothers and
needed caregivers who know and
– Offered equal access to good quality practice home management f
curative, preventive and promotive childhood illnesses to 80%
health care services as a member of • Health care-seeking behavior
the Filipino society of adolescents to 50%
– Regularly monitored for proper – Reduce the prevalence of protein-
growth and development, and energy malnutrition among school-
provided with adequate psychosocial age children
and mental stimulation • Services and Protection Objectives
– Screened for disabilities and – Ensure 90% of infants and children are
developmental delays in early provided with essential health care
childhood; if disabilities are found, package
interventions are implemented to – Increase the percentage of health
enable the child to enjoy a life of facilities with available stocks of
dignity at the highest level of function vaccines and essential drugs and
available micronutrients to 80%
– Protected from discrimination, – Increase the percentage of schools
exploitation and abuse implementing school-based health
– Afforded the opportunity to reach and nutrition programs to 80%
his/her full potential as adult – Increase the percentage of health
• Gaps and challenges in Children’s Health facilities providing basic health
• Local health units not adequately informed services including counseling for
about the frameworks (Child 21 and Children’s adolescents and youths to 70%
Health 2025; need to disseminate for it to • Programs: Garantisadong Pambata
serve as template for local planning on • Started in 1999 to address low coverage on
children’s health immunization and micronutrient
• Need to update and reiterate policies on supplementation
children’s health particularly: immunization, • Package of health services to children below
micronutrient supplementation and IMCI 6 years old and even school-aged children
• PROBLEMS WITH AVAILABILITY OF VACCINES now offered whole year round (previously in
AND ESSENTIAL DRUGS AND April and October only)

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• Highlights health-promoting behaviors that increased from 13.2% to 20% among
parents, caregivers, teachers, leaders and children 4-5 months of age
children themselves can do in their respective • 0-2 years old
spheres of influence • Conduct child growth and development
• Services include immunization for measles, monitoring
tetanus, polio, hepatitis and TB; Vitamin A • Identify and manage cases
supplementation; deworming – Severe acute malnutrition
• Newborn Screening Program – Common childhood illnesses
• To find out if the newborn has a congenital • Provide oral health services to pregnant
metabolic disorder that may lead to mental mothers and childhood.
retardation and even death if left untreated; • Lactating mothers
signs and symptoms of which are manifested • Counselling and lactation management
when the ill effects are already irreversible support
• Ideally done on the 48th hour or at least 24 – Exclusive breast feeding: 6 months to
hors from birth; if done earlier than 24 hours, 2 years
baby must be screened again after 2 weeks for – Dietary supplementation for
more accurate results; prick method of blood nutritionally-at-risk lactating mothers
collection from baby’s heel – Community-based mother support
• Babies with positive NBS results should be groups and peer counsellors
referred at once to nearest hospital/specialist – Lactation support in the workplace
for confirmatory testing and further • BF/Lactation Stations
management • Lactation breaks
• Metabolic Disorders targeted by NB • Access to safe drinking water and sanitary
Screening; causes and consequence if left toilet facilities
untreated • Counselling on handwashing, ES, and personal
– Congenital Hypothyroidism (CH) – hygiene
stunted growth and mental • Counsel/encourage utilization of reproductive
retardation health and FP services
– Congenital Adrenal Hyperplasia (CA) – • Provide social welfare support to families esp
may die within 7-14 days nutritionally vulnerable households to
– Galactosemia (GAL) –accumulation of improve access to health and nutrition
excessive galactose which may result services
in liver damage, brain damage and • Scale up stunting-prevention activities.
cataracts • Improve nutrition of women of reproductive
– Phenylketonuria (PKU) – accumulation age and support optimal breastfeeding and
of excess phenylalanine causes brain complementary feeding practices.
damage • Enhanced Child Growth Strategy
– Glucose-6-Phosphate Dehydrogenase – Community based intervention that
Deficiency (G6PG Def) – hemolytic aims to improve the health and
anemia resulting from exposure to nutritional status of children through
certain drugs, foods and chemicals improved caring and seeking
• Infant and Young Child Feeding behaviors. It operates through health
Situationer: and nutrition posts established
Malnutrition common in through out the country
children with • Mother and Baby-Friendly Hospital Initiative
– 4 out of 10 children 0-10 years old are (MBFHI)
underweight – Main strategy to transform all
– Low vitamin A serum levels with hospitals with maternity and newborn
increasing vitamin A deficiency due to services into facilities which fully
decreasing Vitamin A protect, promote and support
supplementation coverage from breastfeeding and rooming-in
97% in 1993 to 78% in 1997 practices
– Breastfeeding rate is 78% (rural- 92%, – Field health personnel has to provide
urban – 84%); exclusive breastfeeding antenatal assistance and
breastfeeding counseling to pregnant

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and lactating mothers as well as to – Improving the health system
the breastfeeding support groups in – Improving family and community
the community practices
• MBFHI Guidelines Even integrates nutrition,
1. Counsel pregnant women on the merits of immunization, vitamin
breastfeeding starting at the first encounter, supplementation and counseling of
and reinforced with every subsequent visit mothers
2. Prescribe non-human milk only when there IMCI Strategy include
are valid medical reasons and with 1. Focused Assessment of danger
information on the inherent hazards and risks
signs, major symptoms, nutritional
of non-human milk
status, immunization status
3. Strongly advocate for the adoption of
essential newborn care, rooming-in and 2. Classification of diseases into
breastfeeding standards as mandated by law urgent referral, specific treatment and
• MBFHI guidelines also prohibit physicians home management
from: 3. Treatment includes identifying the
1. Accepting gifts or any sort of treatment, treating, counseling and
material/financial inducements from follow-up, and counseling the care
manufacturers of breastmilk substitutes and takers and follow-up
other products covered by the Milk Code • Methods in Managing Childhood Illnesses
2. Accepting samples of non-human milk or through the IMCI Color Coded System
similar products unless approved by DOH, nor • IMCI strategy – focuses on the well-being of
giving out samples or gifts of any sort from the whole child; aims to reduce death, illness
milk companies to pregnant women, mothers, and disability and to promote improved
and members of their families growth and development among children
3. Displaying, promoting or distributing non- under 5 years old using the preventive and
human milk and other breastmilk substitutes curative aspects of care that are implemented
in their offices or clinics by families, communities and health facilities
• Legal Basis • Nutrition Program
– Milk Code of the Phils (EO. No. 51) • Common nutritional deficiencies are
– Rooming-in and Breastfeeding Act of deficiencies in Vitamin A, Iron, Iodine
1992 (RA 7600) Phil Nutrition Program
– National Policies on Young Feeding Goal– Improve quality of life among
(AO No. 2005-0014) Filipinos through better nutrition,
– New Policies and Protocol on Essential improved health and increased
Newborn Care (AO No. 2009-0025)
productivity
• Immunization Guidelines
Objectives
1.BCG vaccine shall be given to all
a. Reduction in the proportion of Filipino
school entrants regardless of the
households with intake below 100% of the
presence or absence of BCG scar
dietary energy requirement from 53.2% to
2. Fever, local soreness and rash are 44%
common side effects b. Reduction of the following –
3. A fully immunized child (FIC) should -Underweight among
have received 1 dose of BCG, 3 doses schoolchildren
of OPV, 3 doses of DPT, 3 doses of -Stunting among pre-school
Hepa B, and 1 dose of AMV (for children
chicken pox) -Chronic energy deficiency
• Integrated Management of Childhood among pregnant women
Illnesses -Iron deficiency among
• Approach to strengthen the provision of
children 6 moths to 5 years old and
essential and comprehensive health package
pregnant and lactating mothers
to children
• Components - Prevalence of overweight,
– Improving health workers’ skills obesity and non-communicable
diseases

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- Prevalence of iron deficiency Refer also to “Ten Nutritional
disorder among lactating mothers Guidelines for Filipinos”
- Prevalence of low birth Desirable contribution of major
weight babies macronutrients to total energy intake
Elimination of moderate to severe should be”
iron deficiency disorder among school Carbohydrates --- 55-70%
children and pregnant women Fat ------------------ 20-30%
Strategies include food-based Protein ------------- 10-15%
interventions for sustained • Home, School and Community Food
improvements in the nutritional Production
status, life cycle approach with 1. Establishment of kitchens and gardens in
strategic attention to 0-3 years old homes, schools and communities as additional
children, adolescent females and sources of food
pregnant/lactating mothers; effective 2. Establishment of demonstration centers and
plant nurseries
complementation of nutrition
3. Distribution of planting materials
interventions with other services; and
• Food Assistance
geographical focus to needier areas 1. Center-based feeding for wasted or
• Expanded Program on Immunization children with stunted growth and
• Immunizable Childhood Illnesses and schedule
pregnant women with history of
Tuberculosis
giving birth to low birth weight babies
BCG – initial dose at birth or
2. Rice distribution is done in schools
0-1 year; booster dose upon school
thru LGUs
entry regardless of the
• Livelihood Assistance
presence/absence of scar
– provision of credit and livelihood
Measles, Mumps – single dose at 9-12 opportunities to poor households
months; at least 80% of measles can with malnourished children
be prevented • Oral Health
Hepatitis B – first dose within 24 Vision – A lifetime of oral health and
hours to 48 hours after birth; booster no tooth decay for the next
of 3 doses given as early as 6 weeks generation.
after birth with at least 4 weeks Strategies include
interval between doses social mobilization (“Sang
Diptheria, Pertussis and Tetanus; Milyong Sepilyo”; coordination and
Poliomyelitis partnership with sectoral groups;
DPT -3 doses given as early as networking; capacity building and
6 weeks after birth with at least 4 work value formation; and
weeks interval between doses • Aims of dental health program
Oral Polio - 3 doses given as 1. Emphasize the importance of oral health in
early as 6 weeks after birth with at relation to total body health
least 4 weeks interval between doses 2. Increase pubic awareness on the prevention
– Nutrition programs and projects of common dental diseases: tooth decay or
• Micronutrient Supplementation through dental caries and periodontal diseases (gum
1. Twice -a- year distribution of Vit A capsules diseases)
during Araw ng Sangkap Pinoy, GP or Child 3. Solicit 1M new toothbrushes
Health Week to 6-71 nonth-old pre-schoolers • Direct services include dental health
on a nation-wide basis promotion and advocacy; dental preventive
2. Iron def prevention and treatment thru iron program, dental curative program; oral
supplements to specific target groups habilitation and rehabilitation program
Food Fortification Act of 2000 on the • Support services include dental health
following staples: flour, cooking oil, planning, training program, dental research
rice, salt; processed foods (voluntary) program, monitoring and evaluation
• Prevention of dental problems:

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– Regular visits to the dentist (as soon Phil PEN – provision of
as the first tooth erupts) for early medicines for non-communicable
diagnosis and preventive care diseases of hypertension and
– Eating a well-balanced diet and diabetes mellitus
minimizing eating sugary foods Establishment Diabetes and
– Use of fluorides and sealants and Hypertensive support groups or Clubs
good plaque control thru regular
at the community level
tooth brushing and flossing
Violence against Women (VAW)
• Gum diseases can be prevented by:
– Regular visits to the dentist for early program include Gender and
detection and treatment Development activities
– Regular and proper tooth-brushing • Care of Older Persons
and healthy lifestyle such as • Elderly population – 60 years old and above
avoidance of tobacco smoking, drugs Goal: A longer disability free life
and alcohol Guidelines in providing health care
– Orally Fit Child program for under-six services for older persons consider
Filipinos with following package of the following
activities: 1. Rights of older persons
1. Oral examination and prophylaxis 2. Traditions, beliefs an values as well as health
2. Sodium fluoride mouth rinsing practices
3. Supervised tooth brushing drill 3. Holistic care – focus on developmental tasks
4. Pit and fissure sealant application; atraumatic 4. Care for older persons is multi-disciplinary
restorative treatment and IEC • UN principles for older persons
-the program integrates its activities 1. Independence – be able to reside at home for
with the Maternal and Child Health as lng as possible
Program. Nutrition Program and 2. Participation – be able to remain integrated in
Garantisadong Pambata (GP) society
• Essential Youth and Adolescent Health 3. Care – be able to enjoy human rights and
Program fundamental freedom
• Addresses these concerns- 4. Self-fulfillment – be able to pursue
– Management of illness opportunities for full development of
– Counseling on substance abuse, potential
sexuality and reproductive tract 5. Dignity – be free from exploitation and
infections including HIV/AIDS physical and mental abuse; be treated fairly
– Nutrition and diet counseling regardless of age, gender, racial or ethnic
– Mental health background, disability or other status
– Family Planning and responsible • Privileges of Senior Citizens
sexual behavior 1. 20% discount and exemption of
– Dental care value-added tax on sale of goods and
– Health of Adult Men and Women services (medicines, medical and
• Essential Health Care Package for Adult Men dental fees, transport fare, services in
and Women hotels/restaurants, admission fees in
1. Management of illness theaters and other places of leisure
2. Counseling on substance abuse, (Note;: also applies to Persons with
sexuality and reproductive tract Disabilities)
infection 2. Mandatory PhilHealth coverage –
3. Nutrition and diet counseling free medical and dental service and
4. Mental health laboratory fees in govt facilities
5. Dental care 3. Monthly stipend of Php500.00 ,
6. Screening and management of Php1,500 for indigents; free
lifestyle related and other vaccination against influenza virus and
degenerative diseases pneumococcal disease
Current Strategies: 4. 5% discount on water bills
(consumption of less than 30

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cu.meters)and electric bills traditional birth attendants or “hilots” (DOH,
( consumption of less than 100 kw) 2008)
5. Educational assistance for those – Contributes to the three delays that
who shall meet school admission lead to maternal and neonatal deaths
requirements • Delay in identification of
Valid IDs to be issued by the Office of complications
Senior Citizens Affairs (OSCA) of • Delay in referral
respective LGUs • Delay in the management of
complications
Implications
• Require skilled health professionals
• Well-equipped facilities
• Current Situation
Identified Risk Factors (DOH, 2008)
1. mistimed, unplanned, unwanted and
unsupported pregnancy
2. Not securing adequate care during pregnancy
3. Delivering without skilled birth attendance
and not having access to emergency obstetric
and neonatal care
4. Not having proper postpartum and postnatal
• Maternal, Newborn, and Child Health and care for the mother and the newborn
Nutrition • Child Health Statistics
• Maternal Health Statistics • IMR AND UNDER-5 MR on target
• High mortality rate – 162/100,000 LB in 2006; – Infant mortality rate of 14.15/1,000 LB
slow decline from 209/100,000 in 1990 (2015) from 42.44 in 1990
• Majority of leading causes directly result from – Under-five mortality of 20.4/1,000
pregnancy complications during labor, LB(2015) from 61.1 in 1990
delivery, and post-partum period • However, FNRI estimates 20.6% prevalence of
– Hypertension underweight among under-five children in
– Postpartum hemorrhage 2013
– Severe infections • Child Health Statistics
– Other medical problems arising from • Leading causes of infant mortality, 2006
• Poor birth spacing – Bacterial sepsis of newborn
• Maternal nutrition – Respiratory distress of newborn
• Unsafe abortions – Pneumonia
• Presence of concurrent – Diseases related to short gestation
infections (TB), malaria and and LBW, not elsewhere classified
STI; Lifestyle diseases like – Congenital malformation of the heart
diabetes and hypertension – Congenital pneumonia
– Neonatal Health Statistics – Neonatal aspiration syndrome
• Occur during the first week of life primarly – Other congenital malformation
caused by – Intrauterine hypoxia and birth
– Asphyxia asphyxia
– Prematurity – Diarrhea and gastroenteritis of
– Severe infections presumed infectious origin
– Congenital anomalies – MNCHN PROGRAM PACKAGE
– Newborn tetanus • LEGAL BASIS: 1987 Philippine Constitution
• Current Situation “ The state shall adopt an integrated
• More than 59% of births take place at home and comprehensive approach to
of which more than 25% are attended by health development…. There shall be

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priority for the needs of the – Pregnancy
underprivileged sick, elderly, disabled, – Childbirth
women and children.” – Postpartum
Magna Carta for Women – Newborn
- fully addressed the issues – Childhood periods
related to health of women • FOUR KEY STRATEGIES (2011-2016)
• MATERNAL HEALTH 2nd Establishment of a service delivery
Overall Aim network at all levels of care to provide
To improve survival as well as the package of services and
promote and maintain the optimal interventions
health of women and their fetuses 3rd Organized use of instruments for
and/or newborn through a package of health systems development to bring
services throughout the pre- all localities to create and sustain their
pregnancy, prenatal, natal and service delivery networks
postnatal stages. 4th Rapid build-up of institutional
Philosophy capacities of DOH and PhilHealth
Pregnancy, labor, delivery and being lead agencies that provide
puerperium are part of the total life support to local planning and
cycle; it is family centered. Mental development through appropriate
and child health is based on the standards, capacity build-p of
philosophy of mother and child implementers and financing
relationship in consideration of the mechanisms.
entire family, culture, abd socio- • Intermediate (Results)Targets
economic environment. 1. Every pregnancy is wanted, planned, and
• MATERNAL HEALTH supported.
Goals 2. Every pregnancy is adequately managed
To ensure that every expectat throughout its course.
and nursing mother maintains good 3. Every delivery is facility-based and managed
health; learns the art of child care; by skilled birth attendants or skilled health
undergoes normal delivery; and bears professionals.
healthy children. 4. Every mother-and-newborn pair secures
Stratgic Thrusts in 2005-2010 proper postpartum and newborn care with
Launch and implment the smooth transitions to the women’s health
Basic Emergency Obstetric Care care package for the mother and child survival
(BEmONC) Strategy. This calls for package for the newborn.
families and communitie to plan for • Core Package of Services
childbirth and upgrad technical • Characterized by a paradigm shift from the
capabilities of local health providers risk approach that focuses on identifying
LGUs must establish one pregnant women at risk of such complications
STRATEGICALLY LOCATED BEmONC to one that considers all pregnant women at
facility per 125,00 population, in risk of such complications
coordination with DOH • consists of interventions for each life stage:
. – Pre-pregnancy
• FOUR KEY STRATEGIES – Pregnancy
1st Ensuring universal access to and – Delivery
utilization of an MNCHN core – Postpartum
package of services and interventions – Newborn
for women of reproductive age and – Childhood periods
newborns at different stages of the • Core Package of Services
life cycle Pre-pregnancy package
– Prepregnancy 1. Nutrition

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1. Nutritional counseling 2. Prevention and management of
2. Promotion of use of iodized complications of pregnancy
salt 3. Birth planning and promotion of
3. Provision of micronutrient facility-based delivery
supplements: -Use of home-based mother’s record
1. Iron and folate (HBMR) – contains the history of
2. Vitamin A present and past pregnancies;
2. Core Package of Services findings and measures od TBA, BHW
Pre-pregnancy package or health professionals
2. Promotion of healthy lifestyle • Core Package of Services
3. Advice on family planning and Childbirth Package
provision of FP services 1. Skilled birth attendance/killed healt
4. Prevention and management of professional-assisted delivery and
lifestyle related diseases facility-based delivery including use of
1. Prevention and management of partograph
infection 2. Proper management of pregnancy
2. Counseling on STI/HIV/AIDS,nutrition, and delivery complications and
persnal hygiene, and consequences of newborn complications
abortion 1. Implementation of EINC
3. Core Package of Services “Unang Yakap” during
Pre-pregnancy package intrapartum period
7. Adolescent health services 1. Continuous maternal
8. Provision of oral health services support by having a
• Core Package of Services companion of choice
Prenatal Package during labor and
1. Pre-natal visits delivery
– at least 4 visits throughout the 2. Freedom of
course of pregnancy movement during
- prenatal assessment which includes labor
weight and bp monitoring, 3. Monitoring progress
measurment of fundic heightagainst of labor using the
the age g gestation, feta heart beat partograph
and fetal movement, dx exams Partograph is a graphic recording of
1. Micronutrient supplementation the progress of labor and significant
1. Iron and folate conditions of the mother and the
2. Vitamin A fetus
3. Elemental iodine • Core Package of Services
2. Tetanus Toxoid immunization Childbirth Package
3. Promotion of exclusive breastfeeding, 4. non-drug pain relief
newborn screening, and infant before offering labor anesthesia
immunization 5. position of choice during
4. Counseling on healthy lifestyle with labor and delivery
focus on smoking cessation, healthy 6. spontaneous pushing in a
diet and nutrition, regular exercise, semi-upright position
STI and HIV prevention, and oral 7. hand hygiene
health 8. non-routine episiotomy
• Core Package of Services 9. active management of the
Prenatal package third stage of labor
1. Early detection and management of 3. Access to basic emergency obstetric
complications of pregnancy and newborn care (BEmONC) or

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comprehensive emergency obstetric 3. Examination of the baby for birth
and newborn care (CEmONC) services injuries, malformations, or defects
• Core Package of Services 4. Additional car for small babies
Postpartum Package ( birthweight of below 2,500 g or twin
1. Postpartum visits: wthin 72 hours and • Core Package of Services
on the 7th day postpartum check for Newborn care Package
conditions such as bleeding or C. PRIOR TO DISCHARGE/
infections AFTER 90 minutes to 6 hours
2. Micronutrient supplementation 1. Unrestricted breastfeeding support, or
1. Iron and folate per demand day and night
2. Vitamin A 2. Ensure warmth of the baby:
3. Counseling on nutrition, child care, 3. Washing and bathing
family planning, and other available 4. Look for danger signs and start
services resuscitation if necessary
4. Core Package of Services 5. Look for signs of jaundice and local
Newborn care Package infection
- recommended EINC 6. Perform newborn screening
practices are evidence-based 7. Provide instructions on discharge
measures that are vital for the survival 8. Core Package of Services
and the quality care of the newborn Child Care Package
A. WITHIN THE FIRST 90 MINUTES: 1. Immunization
1. Immediate and thorough drying done 2. Nutrition
regardless of gestational age or birth 1. Exclusive breastfeeding up to
1. Protect NBs from cold stress 6 months
and hypothermia (vernix 2. Sustained breastfeeding up to
caseosa); stimulates breathing 24 months with
2. Skin-to-skin contact between mother complementary feeding
and newborn for warmth and 3. Micronutrient
opportunity for bonding supplementation
3. Cord clamping recommended 1-3 3. Integrated Management of Childhood
minutes after birth or until pulsation Illnesses
stops to allow placental transfusion at 4. Injury Prevention
birth; increases blood volume and 5. Oral health
iron stores; reduces need for blood 6. Insecticide-treated nets for mothers
transfusion and lowers incidence of and children in malaria-endemic
brain hemorrhage areas
4. Early initiation of breastfeeding within 7. Core Package of Services
an hour after birth – shown to reduce MNCHN service delivery network –
infant deaths attributed to diarrhea province-wide or city-wide network of
and lower respiratory tract infections public and private health care facilities
5. Non-separation of baby from the or providers capable of giving MNCHN
mother “rooming-in” – promotes services
bonding and allows the mother to Three levels of care in the MNCHN
breastfed her baby on demand service delivery network:
• Core Package of Services 1. Community level service providers
Newborn care Package or community health team which
B. AFTER 90 MINUTES TO 6 include out-patient clinics such as
HOURS: RHUs, BHSs, and private clinics and its
1. Vitamin K prophylaxis health workers --- primary health care
2. Hepatitis B and BCG vaccination services
• Core Package of Services

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Community Heath Team plays two highly specialized obstetric
basic functions: interventions; also providing neonatal
Navigation – informing families of emergency interventions as in
health risks and assisting families in BEmONC plus management of low
health risks and needs assessment; birth weight/pre-term and other
assisting families to develop and use specialized NB services
health plans; and facilitating access by In an area with at least 500,000
families to critical health services population , one CEmONC capable
(emergency transport, facility is required (WHO)
communication, outreach services
and financing sources • Related Laws and Administrative Issuances
Basic service delivery functions – RA 9710 Magna Carta for Women
advocating for birth spacing and (2009) – provision of a
counseling on FP services; tracking comprehensive, culture-sensitive, and
and master listing of pregnant gender-responsive health services and
women, women of reproductive age, programs covering all stages of a
and children below 1 year of age; woman’s life cycle and which
early detection and referral of high- addresses the major causes of
risk pregnancies; and reporting women’s mortality and morbidity
maternal and neonatal deaths. RA 10354 Responsible Parenthood
• Core Package of Services and Reproductive Health Act of 2012 -
Three levels of care in the MNCHN - recognizes and guarantees human
service delivery network: rights to sustainable human
2. A BEmONC-capable facility or development, health, education and
provider can perform the following six information and the right to choose
signal obstetric functions: and make decisions in accordance
1. Parenteral administration with one’s religious convictions,
of medications (oxytocin in 3rd stage of ethics, cultural beliefs, and demands
labor, loading dose of anticonvulsants, of responsible parenthood
initial-dose of antibiotics; • Related Laws and Administrative Issuances
2. Performance of assisted Ten Elements of Reproductive Health
deliveries (imminent breech delivery); Care (DOH, 2006)
3. Removal of retained 1. Family Planning
products of conception; 2. Maternal and child health and
4. Manual removal of retained nutrition
placenta; 3. Prevention and control of
- also emergency newborn reproductive tract infections, STIs, and
interventions – at least HIV/AIDS
a. newborn resuscitation; 4. Adolescent reproductive health
b. treatment of neonatal 5. Prevention and management of
sepsis/infection ;and abortions and its complications
c. oxygen support 6. Prevention and management of
breast and reproductive tract cancers
• Core Package of Services and other gynecological conditions
Three levels of care in the MNCHN 7. 7. Education and counseling on
service delivery network: sexuality and sexual health
3. A CEmONC-capable facility or 8. Men’ s reproductive health and
provider can perform the following six involvement
signal obstetric functions as in 9. Prevention and management of
BEmONC PLUS aesarean delivery violence against women and children
services, blood transfusion and other

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10. Prevention and treatment of infertility pregnancy and improve her well-
and sexual dysfunction being, the health of the child, and the
11. Related Laws and Administrative relationship between husband and
Issuances wife and between parents and
AO 50-A, s. 2001 National Family children
Planning Policy which asserts that 4. Informed Choice – couples and
family planning as a health individuals are fully informed on the
intervention shall be made available different modern FP methods; use of
to all men and women of reproductive FP choice in accordance with their
age (15-44 years old). FP is a means to religious, ethical values and cultural
prevent high-risk pregnancies brought backgrounds subject to conformity
about by the following conditions: with universally recognized
1. Being too young (less than 18 years international human rights.
old) or too old (over 34 years old)
2. Having had to many (4 or more)
pregnancies
3. Having closely spaced (too close)
pregnancies (less than 36 months);
and
4. Being too ill or unhealthy/too sick or
having an existing disease or disorder
like iron deficiency anemia
• Related Laws and Administrative Issuances
AO 132, s. 2004 DOH National FP
Program in recognition of modern
NFP metods acknowledged by
international authorities and NFP
service providers and that have been
subjected to extensive testing to
ascertain their efficacy and scientific
validity ; include fertility awareness-
based (FAB)methods and lactational
amenorrhea method
AO 2012-0009 on the national
strategy toward reducing unmet need
for modern family planning as means
of achieving MDGs on maternal health
synchronized with other MNCH/public
health programs such as
Garantisadong Pambata
• Related Laws and Administrative Issuances
Four Pillars of PFPP (DOH, 2006)
1. Responsible Parenthood – the will and
ability to respond to the needs and
aspirations of the family.
2. Respect for Life. FP aims to prevent
abortions, thereby saving lives of both
women and children
3. Birth Spacing – proper spacing of 3-5
years from a recent pregnancy
enables a woman to recover from

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