BSN 2105 PHO Reviewer

Batangas Province 4. Drink plenty of fluid

National Voluntary Blood Services Program
Steps in donating blood
RA 7719 – National Blood Services Act of 1994 1. Vital signs (temp, BP, Pulse rate, weight)
• An act promoting voluntary blood donation, 2. Register and honestly and complete the donor
providing for supply of safe blood, regulating registration form
blood banks and providing penalties for 3. Have blood type and hemoglobin checked
violations of thereof 4. A physician will conduct the blood donor
SECTION 4: Promotion of voluntary blood donation examination
• Public Education 5. Actual donation: amount of blood to be donated
• Promotion in Schools is 450cc usually takes 10 mins
• Professional Education 6. 5-10 mins rest and plenty fluid intake are
• Establishment of Blood Service Network necessary after donation
• Walking Blood Donors 7. Volume of fluids taken is completely replaced by
the body within 3-5 hrs
IMPORTANCE OF BLOOD DONATION
• Stimulates blood cell production WHAT TO DO after blood donation?
1. Drink plenty of fluids
• Free health check-up
2. Refrain from stooping down
• Reduce risk of heart attack and cancer
3. Refrain from doing strenuous activities like lifting
• Save lives
heavy objects, driving big vehicles or operating
• Improved mental wellbeing big machines
4. Avoid using punctured arm in lifting heavy
WHO are qualifies to donate blood? objects
• Blood should come from a voluntary non- 5. Apply pressure in punctured site and lift arm in
remunerated donor case of bleeding
• POTENTIAL DONOR 6. If there is discoloration or swelling, apply cold
o Are in good health compress for 24hrs
o Between 16-65 years old (minors req 7. If dizzy, lie down with feet elevated. Drink plenty
parent consent) of juice.
o Weight at least 110 pounds/50kgs
o Have BP between: Systolic 90-160 mmHg WHAT TYPE OF TEST are performed on donated
and Diastolic 60-100 mmHg
blood?
o Pulse Rate: between 60 and 100 b/min
with regular rhythm • Screening Test: HBsAG, HepC Virus Ab/Ag, HIV,
o Hemoglobin: at least 125g/L Syphilis, Malaria
o Must pass the physical and health
history assessment WHO RECIEVES the donated blood?
• Patients suffering from severe blood loss
Preparation before donating blood • Leukemia patients
1. Enough rest and sleep • Hemophilia patients
2. No alcohol intake 24 hrs prior • Mothers giving birth with complications
3. Something to eat prior to donation, avoid fatty • Major trauma patients
foods • Transplant patients
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• Responsible for the provision and maintenance

WHERE can you DONATE BLOOD? of safe an adequate water supply to the
• Blood service facilities: BatMC, PRC, Hospitals community
• LGUs/NGOs: mobile blood donation activities
Food Sanitation
REASONS WHY YOU CANNOT DONATE BLOOD: • Responsible for the provision of safe and
Temporal Deferral: wholesome food to consumers through proper
• Pregnancy enforcement and sanitation rules and
• Acute fever regulations and training of food operators and
• Recent alcohol intake food handlers
• Ear or body tattoo
• Surgery Waste Management
Persons not allowed to donate anytime: • Responsible for the enforcement and rules and
• cancer regulations on excreta and sewerage collections
• cardiac disease and disposal, solid waste and health care waste
• severe lung disease management.
• Hepatitis B and C
• HIV infection, AIDS, STD Vermin Control
• High risk occupation (prostitution) • Responsible for the promotion of elimination of
• Chronic Alcoholism breeding and harborage places and conducts or
guides organized control program.
BLOOD DONATION AFTER COVID-19 VACCINE
• Anyone who has been vaccinated with any Industrial Hygiene
COVID-19 vaccine MAY DONATE ANYTIME • Responsible for the enforcement of sanitation
rules and regulations of industrial establishments
TARGET BLOOD COLLECTION: 1% OF TOTAL
POPULATION ANNUALY Public Places Sanitation
Estimated population – Batangas Province 2023: • Responsible for the provision of sanitary facilities
3,261,749 = 1% = 32,617 and maintenance of the sanitary conditions in
public places like schools, public laundry, camps
ACTIVITIES and picnic grounds, bus terminals, massage
• Advocacy thru community/school/company clinics, sauna, air and sea ports, public swimming
orientation/radio guesting and bathing place, dancing schools. Dance halls,
• Batangas blood council quarterly meeting night clubs and hotels
• Provincial Sandugo Awarding
Emergency Sanitation
• Blood Olympics
• Blood donor recruitment training
• Responsible for the provision of sanitary facilities
and maintenance of sanitary conditions of the
• Mass blood donations
evacuation sites or affected areas.

Environmental Health and Sanitation Health Education

Water Sanitation

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• Responsible for the implementation of health What to do during Dengue season?

education activities including community • wash and clean properly vases or other
organizing related to environmental sanitation containers that have water at least once a week
• Put a lid on water containers to prevent
Routine Inspection mosquitos from laying their eggs on it
• Carries out routine inspection in accordance with • Use “kulambo” when sleeping or put a screen on
the standard frequency for the different fields of doors and windows to prevent mosquitos from
environmental sanitation, using the prescribed entering your home
form. You are also required to conduct non-
routine inspection from time to time or re- 4s Contra Dengue
inspection as the need arises. 1. Search and Destroy – alisin mga bagay na
maaring pagipunan ng tubig at pangitlugan ng
Vector Borne Diseases lamok tulad ng lumang gulong, lata, bote at
• Aedes Albopictus tansan. Linisin ang alulud at palitan ang tubig sa
• Aedes aegypti flower vase minsan sa isang linggo. Hindi
nangingitlog and lamok sa maduming tubig.
What time does Aedes bites? 2. Self-protection Measures – magsuot ng
mahabang pantalon o polo. Maaring
• Whole day, usually 2 hours after sunrise and 2
hours before sunset gumamit ng mosquito repellant.
3. Seek early consultation – kung may lagnat
Where does Aedes lives and grows? na ng 2 araw at may rashes sa balat,
• At dark places magpakunsulta agad sa health center o
• Have its eggs at clear and calm waters??? hospital.
4. Support to misting fogging operation when
Additional information about the mosquito called there is an impending outbreak
Aedes:
• Prefers to bite warm skin/body Hanapin at Linisin ang maaring pamugaran ng
• Prefers moving victims lamok
Gawin ang mga sumusunod:
• Usually attacks people from the back or side
• Butasan, biyakin o kaya lagyan ng lupa and mga
• Can fly up to 50-300 meters from people
lumang gulong upang hindi maipunan ng tubig
• Usually multiplies during rainy season due to • Takpan and mga drum, timba at iba pang ipunan
more places it can lay its eggs ng tubig
• Have a lifespan of 20-30 days • Palitan ang tubig sa flower vase minsan isang
linggo
Symptoms of Dengue • Linisin at alisin ang tubig sa paminggalan
• High and continuous fever lasting 2-7 days. • Itapon and iba pang bagay na maaring pag-
• Reddening of skin due to high fever ipunan ng tubig at pangitlugan ng lamok tulad ng
• Nosebleed or gum bleeds lata, bote at tansan.
• Loss of appetite • Linisin ang alulod ng bahay upang hindi
• Nausea or vomiting maipunan ng tubig
• Do no give aspirin to dengue patients
What is the D.E.N.G.U.E. Strategy?

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• D – daily monitoring of patient’s status o Courtesy to barangay officials/leaders

• E – encourage intake or oral fluids o Meeting with the barangay leaders
• N – note any dengue warning signs like persistent o Briefing of the set-up/policies in the
vomiting and bleeding barangay
• G – give paracetamol for fever and not aspirin o Briefing of the existing activities/projects
because aspirin induces bleeding o Tour the whole community
• U – use mosquito nets • Actual job training with your clinical instructor
• E – early consultation is advised for any warning • Feedback with LCE/RHU personnel before
signs leaving the health facility
What is CHIKUNGUNYA?
• Viral disease spread by mosquitos
Health Education and Promotion Services
What Is health promotion?
• Causes fever and sever joint pain
• “The process of enabling people to increase
• Shares same clinical signs with dengue and can control over and to improve their health and its
be misdiagnosed in areas where dengue is determinants”
common o Social determinants of health – non-
• occurs in Africa, Asia and Indian Subcontinent medical factors and conditions in which
people are born, grow, work, live, and
age that influence health outcome
Steps/Procedure During The Actual Job
Training
• Courtesy call to the Local Chief Executive
(Municipal)
• Courtesy call to the Chief or Hospital/Municipal
Health Officer and other personnel
• Orientation to the:
o Physical set-up of the health facility
(hospital/RHU)
o Other health personnel/organizational
set-up
o Activities of the health facility
o Behavior and attitude
o Policies/SOP of the hospital/RHU
o Follow the minimum health protocol of Universal Health Care
the health facility • Better health outcomes
• Tour the are of the health facility and other part • Financial risk protection
of the building (hospital) • Responsiveness
o Actual duty with the clinical instructor
o Case presentation to be presented to the
chief nurse and staff
o Evaluation and exit conference
(presentation of issues/concerns during
their course of duty)
• Orientation to the area of assignment
(community)

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Key Strategies Implementation of all health promotion

policies, programs, plans, and activities shall be guided
80% SECTORAL – This includes first three factors by the following strategies:
(Socioeconomic Factors, Physical Environment, Health 1. Health Governance
behavior) Protecting and enabling Filipinos to care for self 2. Healthy Settings
and community. 3. Health Literacy
20% HEALTH SECTOR – Taking care of Filipinos when
needed.

Administrative Order 2021-0063: Health Promotion

Framework Strategy 2030
• Provides framework, direction and strategies for
the planning, development, and implementation
of health promotion policies, programs and
activities for the period 2021-2030
• Focuses on promoting health and wellbeing and
reducing inequity by improving individual habits
and fostering environments conductive to health
• Provides the foundation for preventing death,
diseases, disability and health inequities at a
population level.

Health Promotion Framework Strategy

1. All Filipinos are health literate
2. Settings are health enabling
3. Public policies are supportive and protective of
health

Objectives Of Health Promotion Framework

Strategy 2030
• Provides strategic direction
• Identifies priority areas for health promotion
• Promotes and provides basic technical support
• Provides guidance on the roles and participation
of the DOH, CHDs, LGUs
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2. Relief International
3. World Health Organization
4. Lions Club

Vision
• A healthy Pilipinas where health-seeking
individuals, health-enabling setting, and health-
supporting governance are present and
achieving optimum health is possible
Mission
• To make healthy behavior the easier choice for
everyone, every time, everywhere
PARTNER INVOLVEMENT FOR BROADER REACH
Goals
AND ENGAGEMENT
• Filipinos are health literate, settings are health
1. Major Health Event Partners
enabling, and public policies are health-
Goal: strengthen, support, and widen reach of
observances/celebrations supporting
o Hosting of event and logistics support
o External financing
o Resources persons and technical
assistance
o Promotion of activity
2. Regular Health Event Partners
Goal: deload HPB/HPU with conduct of regular
health observances/celebrations
o Co-branding of society/organization
event
o Promotion of regular health event
o Dissemination of Communication
Packages
Important Stakeholders/Program Partners:
1. UNICEF Health Promotion Governance
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• DOH AO 2020-0058: Guidelines on the supporting mechanisms needed for the

transformation of the Health Promotion and integration
Communication Services (HPCS) to Health • Organizational Level (Level 2) – covers KRAs
Promotion Bureau (HPB) that are important for organization and
• AO 2020-0042: Health Promotion Framework management of integrated LHS. Other UHC
Strategy in Province wide and City-wide Health Act reforms that have effects on integration.
Systems • Functional Level (Level 3) – cover KRAs to
• DOH DM 2021-0245: Creation of P/CWHS Health monitor functionality of the integrated
Promotion Committee management support systems
• DOH DM 2021-0313: Designation of Barangay
Health Workers as Barangay-Level Health
Promotion and Education Officers (HEPOs)
• DOH-DILG JAO 2021-001: Guidelines for the
operationalization of the Health Impact
Assessment (HIA) Review Process for the
Development Projects

Health Promotion Delivery Services

• DOH DM 2021-0068: Submission of self-
appraisal checklist for P/CWHS Population-Wide
Health Promotion Programs
o This DM provides for the self-appraisal
checklist as a tool to assess existing
interventions in the seven identified
priority areas of the HPFS, and five action
areas of Ottawa Charter for Health Implementation Approach
Promotion as detailed in AO 2020-0042 • Life stage Approach
• DOH DM 2021-0244: Health Promotion Playbook o Pregnancy & Child Birth
Modules o Infancy and early years
o Childhood
Health Promotion Governance o Adolescence
• DOH DM 2021-0313: Designation of Barangay o Adulthood
Health Workers as Barangay-Level Health o Older Adult
Promotion and Education Officers (HEPOs) • Setting-Based Approach
o Healthy Communities
o Healthy Schools
o Healthy Workplace

Health Settings
• Healthy Communities – any level of local
Components of the LHS ML: Levels of Progress government unit where (1) the physical, social,
• Preparatory Level (Level 1) – covers KRAs political and economic factors that make up the
relating to preparatory works and other environment of the population are promotive

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and protective of health and where (2) health • Immunization

care is available and accessible • Substance Abuse
• Health Schools – any learning institution that • Mental Health
foster health and well-being of learners and • Sexual and Reproductive Health
personnel. These are learning institutions that • Violence and Injury Prevention
have met the standards to be recognized or
awarded as such Action Areas
• Healthy Workplaces • Developing Healthy Public Policies
• Creating Supportive Environment
• Developing Personal Skills
• Strenghtening Community Actions
• Reorienting Health Services

Health Promotion Playbook: Content

• Evidence Brief
• Template Policy
• Implementation Checklist
• Basic Resource Requirements
• Capacity-Building Requirements
• Communication Plan
• Monitoring and Evaluation
• Frequently Asked Questions

Campaign Architecture for Health Pilipinas

• Health Promotion Bureau (HPB)
o Health is Life
o KonsulTayo
o Sa Booster: PINASLAKAS
Health is Life!
• The Health is Life Campaign will focus on the
Health Promotion Framework Strategy’s seven
priority areas. These are the pillars upon which
health promotion efforts for improving health
outcomes will be centered.
KunsulTayo
• The KonsulTayo Campaign aims to encourage
Filipinos to get the care they need to avoid
negative health outcomes in the future. The
campaign primarily targets for the general
public to know what services are under primary
Priority Areas care and who provides these services.
• Diet and Physical Activity Sa Booster PinasLakas
• Environmental Health

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• The Sa Booster PinasLakas Campaign aims to • Ensuring that all Filipinos, especially the
sustain the success of the country’s COVID disadvantaged groups, have equitable access to
vaccination program. The campaign pushes this affordable health care
by highlighting the positive effects of • The LGUs assume primary responsibility over
vaccination in our social and economic recovery, the delivery of health services and the provision
as well as communicating the safety and efficacy of health facilities
of vaccines for us to achieve a “wall of • The DOH in coordination with LGUs, designed
immunity” against COVID. mechanisms for a comprehensive approach to
health care delivery
Partner Involvement for broader reach and
engagement
LEPROSY
Vision:
• Healthy and productive individuals towards a
“Leprosy Free Philippines”
Mission
• Sustain elimination of leprosy as a public health
Indigenous People Health Program problem thru quality comprehensive and
Indigenous People integrated health services
• Refer to a group of people sharing common
bonds of language, customs, traditions and Leprosy
other distinctive cultural traits • Since 1997, Leprosy elimination goal is attained
• A common characteristic of indigenous people is and sustained to less than 1 per 10,000
their close attachment to ancestral land, population
territory and resources. The world view that • World Leprosy Day is celebrated every last
“land is life” is deeply embedded in their Sunday of January
existence. • Leprosy control week is celebrated every last
week of February
• Indigenous people are among the poorest and
most marginalized sectors of Philippine Society
What is Leprosy?
• Indigenous Peoples’ communities can be found
in the interiors of Luzon, Mindanao and some • Leprosy is a chronic infectious disease caused by
islands in Visayas like Mangyan in Mindoro. And Mycobacterium leprae, an acid fast, rod-shared
AETAS living in the community of PUTING bacillus that mainly affects the skin, peripheral
KAHOY, ROSARIO, BATANGAS nerves, mucosa of the upper respiratory tract
and eyes
Opportunities:
Universal Health Care Did you know?
• The Aquino Health Agenda (AHA), contains the • Leprosy is also known as “Hansen’s Disease”
operational strategy called Kalusugan because it was discovered by a Norwegian
Pangkalahatan (KP), which aims to achieve physician, Dr. Gerhard Armauer Hansen in 1873
universal health care for all Filipinos • It has a very long incubation period which
• Kalusugan Pangkalahatan is directed towards ranges from 5 to 15 years
achieving better health outcomes, sustained • Leprosy is an infectious disease directly
financing, and responsive health systems transmitted from man to man

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• It is acquired through prolonged exposure to

untreated person
• Transmitted through droplet infection, such as
coughing and sneezing

Diagnosis of Leprosy
• Mainly based on clinical signs and symptoms
• Only rare instances is there a need to use
laboratory and other investigations to confirm a
diagnosis of leprosy
• Cardinal signs:
o Hypo-pigmented or reddish skin
lesion(s) with definite sensory loss
o Peripheral nerve damage, as
demonstrated by loss of sensation and
muscle weakness in the hands, feet
and/ or face
o Positive slit skin smear
• Other signs of leprosy are: Classification of Leprosy according to WHO
o Skin lesion(s) with decrease or loss of • Paucibacillary (PB) – 2 to 5 skin lesions
sweating and/or hair growth • Multibacillary (MB) – more than 5 skin lesions
o Constant redness in the eyes from
irritation and dryness
o Loss of eyebrows and eyelashes
(madarosis)
o Nasal congestion/obstruction and
frequent nosebleed
o Collapse of nose bridge
o Enlargement of breast in males
(gynecomastia)
o Mobile or stiff clawing of fingers and
toes
o Chronic ulcers, usually in the sole of the
foot, palm of the hands and fingers

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Treatment for Leprosy

• Multi-drug Therapy (MDT) – the accepted
standard treatment for Leprosy. Combination of
2 or more anti-leprosy drugs that renders a
patient to be non-infectious within one month
after starting the treatment
o Dapsone
o Rifampicin
o Clofazimine

Treatment is complete when:

• PB patient has taken 6 MDT blister packs within
6-9 months (Rifampicin and Dapsone)
• MB patient has taken 12 MDT blister packs
within 12-18 months (Rifampicin, Dapsone and
Clofazimine)

Side Effects:
• Rifampicin – may cause slightly reddish
discoloration of urine within a few hours after
intake: patient may experience body malaise,
joins and muscle pains
• Clofazimine – gastric irritation; skin
discoloration (disappears a few months after
stopping treatment)
• Dapsone – side effects are rare some patients
may develop allergic reactions causing itchy
rashes and exfoliative dermatitis

Contraindications to MDT:
• Cases with sever liver and kidney disease
• Severe hypersensitivity to any of the MDT drugs
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• Severe anemia

Prevention:
• BCG Immunization
• Avoid prolonged exposure to person with
leprosy
• Consult a health personnel if you think you have
symptom/s of leprosy

Batangas Province Leprosy Control Program

Activities Who can be affected by Tuberculosis?
• “Kilatis Kutis” • Affects all ages most common among the
• Home Visit productive years 15-55, affects men more than
• Slit Skin Smear women
• Orientation on Leprosy Control Program for • EVERYONE can be affected and with higher
municipal Health Officers, Public Health Nurse, chances:
Rural Health Midwives, DepEd Nurses and o Child
Barangay Health Workers o Senior citizen
• Local Program Coordinators’ Meeting on o Urban poor
Program Updates, Revised Recordings and o Male 40 yrs old
Reporting Forms o Smoker
o Contact of TB patient
National Tuberculosis Program (NTP) o Comorbity like:
▪ HIV
What is Tuberculosis? ▪ Diabetes
• Caused by a bacteria, Mycobacterium ▪ Cancer
Tuberculosis ▪ End stage renal disease
• Discovered by Robert Koch in March 24, 1882
• Opportunistic
• Very sensitive to direct sunlight (can be killed in
5 mins), may survive in the dark for year
• Can be destroyed in 20 mins at 60 degrees and 5
mins at 70 degrees Celsius

Current Status: (DOH) Philippines

• TB is 6th in mortality and morbidity
• 1 million Filipinos (1% of the National Population)
have active TB disease. Many do not even know
that they have TB

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• About 26,000 Filipinos die from TB annually, tool for systematic screening in health facilities
which translates to 70 deaths per day amongst all consults
• Ask for the following signs and symptoms
lasting for 2 weeks or more
o Cough
o Unexplained weight loss
o Night sweat
o Unexplained fever

Diagnosis Policies
• A Rapid Diagnostic Test (RDT), such as Xpert
MTB/Rif test, shall be the primary diagnostic
tool for PTB and EPTB in adults and children
• All presumptive TB patients who are at high
risk for MDR-TB shall be referred for XPERT
National Tuberculosis Program Manual of MTB/RIF Testing, If not accessible, a sputum
Procedures 6th Edition transport system shall be referred to the
Focused on the technical approach to patient care nearest health facility with DR-TB Services
• Cascade of Care for screening
o Screening • For presumptive EPTB cases, the body fluid
o Diagnosis or biopsy samples that are appropriate for
o Treatment Xpert MTB/RIF Testing shall be obtained
o Preventive Treatment
• Emphasis on patient-centered care Procedures
• Presumptive TB must be identified and
Screening Policies diagnosed through bacteriologic confirmation
1. Systematic Screening shall be implemented in all health o Collection of the necessary specimens
facilities for testing
• Identification of presumptive TB o Performing the tests (GeneXpert, Smear,
Microscopy, TrueNAT, TB LAMP)
• In target group
o Making diagnosis based on the results
• Using examinations or other procedures (cxr,
o But not if bacteriologic testing is
symptoms)
negative or not available/accessible,
• Intensified Case Finding (ICF) physician shall decide on clinical
o If done in health facilities (e.g., Cxr diagnosis based on best clinical
vouchers) judgement
• Active Case Finding (ACF)
o If done in the community using Diagnosis Policies
mobile Cxr
• Tuberculin Skin Test (TST) – an adjuvant when
• Enhanced Case Finding (ECF) there is doubt to make clinical diagnosis of TB in
o House to house visits using symptom children
screening
o Either 5-TU or 2-TU strength are
2. Symptom screening using any of the four cardinal regarded as similar in producing
signs and symptoms shall be the primary screening induration indicative of TB infection
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o For children, PLHIV and MDR TB risk drugs according to national standards of quality as
groups, trained health workers shall do set by the FDA.
the testing and reading 4. Treatment adherence shall be ensured through
o POSTIVE TST patient-centered approaches. Treatment support
▪ An induration of at least 10mm shall be provided by health workers, community
regardless of BCG vaccination volunteers, or family members.
▪ Or 5 mm in 5. Treatment response shall be monitored through
immunocompromised children ( follow-up SM and clinical assessment.
severely malnourished) 6. All adverse drug reactions (ADR) shall be reported
• All laboratories providing TB diagnostic test using the official reporting form of the Food and Drug
whether public or private, shall participate in the Administration (FDA) and managed accordingly.
Quality Assurance (QA) system of the NTP 7. TB Patients aged 15 years old and above shall be
• A TB Medical Advisory Committee (TB MAC) shall offered Provider-initiated HIV counselling and testing
be established at least per region to provide according to the phased implementation of the TB-
clinical expertise and guidance in the diagnosis of HIV collaboration.
clinically-diagnosed Drug-resistant TB and 8. TB patients aged 25 years old and above shall be
management of difficult TB and DR TB cases screened for diabetes

Patient-Centered Approach to TB Care Policies

• Throughout the continuum of TB care, Health
Workers (HCWs) shall Respect patient autonomy
and support self-efficacy.
• The patient’s physical comfort, safety, and
wellness shall be maximized by providing
evidence-based integrated care for TB and other
comorbidities
• Psycho-emotional support and protection from
social isolation or discrimination shall be
provided to all TB patients
• The impact of poverty and food insecurity on TB
diagnosis and treatment shall be recognized and
addressed by linking TB patients to social
protection measures

Treatment Policies
1. All diagnosed DSTB cases shall be provided with
appropriate anti-TB treatment within 5 working days Registration Groups of TB Patients
from collection of sputum. • New – never had treatment for TB or has taken
2. Standard treatment for DSTB shall be given based on anti-TB drugs for less than 1 month
results of Xpert MTB/Rif. If Xpert MTB/Rif Test or any • Retreatment – has been treated before with
other DST is not done, history of treatment will be anti-TB drugs for at least 1 month. This includes
used as basis for the regimen. the ff:
3. Quality of anti-TB drugs shall be ensured by ordering o Relapse – previously treated for TB and
from a sour with a track record of producing first-line declared cured or treatment complete,
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but is presently diagnosed with active TB

disease
o Treatment after failure – previously
treated for TB but failed most recent
course based on a positive SM follow-up
at 5 months or later; or, a clinically-
diagnosed TB patient who does not show
clinical improvement anytime during
treatment Treatment Regimens for Latent TB Infections
o Treatment after lost to follow-up –
previously treated for TB but lost to
follow-up for at least 2 months in most
recent course
o Previous treatment outcome unknown
– previously treated in the most recent
course is unknown

Assigning LTBI Outcome

a. Complete – completed the prescribed duration
of treatment and remains well or asymptomatic
b. Lost to follow up – interrupted TB preventive
treatment for two (2) consecutive months or
more
c. Died – dies for any reason during treatment
d. Failed – developed active TB disease anytime
while on TPT
e. Not evaluated – transferred to another health
facility but whose treatment outcome is not
TB Preventive Treatment Policies known; include here discontinued by physician
• TB contacts (1,2), PLHIV (3), and TB risk groups (4) because patient cannot tolerate (severe ADR)
should be evaluated for eligibility to receive TB
preventive treatment.
Universal Health Program
• Tuberculin skin test (TST) or interferon-gamma
release assays (IGRA) shall not be required prior to
RA. No. 11223 – Universal Health Care Act
initiation of TPT preventive treatment in the
General Provisions
following eligible individuals:
• an act instituting universal health care for all
• People living with HIV
Filipinos, prescribing reforms in the healthcare
• Children less than 5 years old, HH contacts of
system, and appropriating funds therefor
BCTB
Universal Health Care (UHC) Act.
• Individuals aged y years and older, HH contacts of
BCTB, with other TB risk factors
Declaration of Principles and Policies
• TST (or IGRA) shall be performed in other individuals
• A framework that fosters a whole-of system,
prior to TPT (5-TU or 2-TU)
whole-of-government, and whole-of society
approach in the development, implementation,

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monitoring, and evaluation of health policies, • health care professional who may be doctor of
programs and plans and; medicine or any other allied professional duly
• A people-oriented approach for the delivery of licensed to practice in the Philippines
health services that is centered on people’s • community-based health care organization,
needs and well-being, and cognizant in the which is an association of members of
differences of culture, values, and beliefs. community for the purpose of improving the
health status of that community
Two types of coverage • pharmacies or drug outlets, labs, and diagnostic
• Population Coverage – all Filipino citizens are clinics
automatically included into the National Health
Insurance Program (PhilHealth). Health care provider network
• Service coverage – every Filipino shall be granted • group of primary to tertiary care providers,
immediate eligibility and access to preventive, whether public or private, offering people
curative, rehabilitative, and palliative care, can centered and comprehensive care in an
either be delivered through population-based or integrated and coordinated manner
individual-based services. (Ways on how health
services can be delivered).
o Population-based health services –
Interventions such as health promotion,
disease surveillance, and vector control,
have populations or groups as recipients.
(pang-malawakan ang approach)
o Individual-based health services – services
that can be accessed remotely that can be
definitively traced back to 1 recipient; has PRIMARY CARE
limited effect on population level and does • initial contact, accessible, continuous,
not alter underlying cause of illness. (pang- comprehensive, and coordinated care.
isahang approach)
PRIMARY CARE PROVIDER
o
• health care worker
Financial Coverage
PRIMARY CARE COMPETENCIES: INDIVIDUAL-
• Population-based health services – financed by
BASED
National Government; free of charge for all Filipinos
• first contact care, comprehensive care, providing
(DOH, LGU)
continuing care; coordinating care and managing
• Individual-based health services – financed
patient records
primarily through prepayment mechanisms such as
health insurance, private health insurance, and HMO POPULATION-BASED
plans; ensure predictability of health expenditures • promoting health, implementing
(PhiliHealth, private insurance, HMO) public/population health.
FIRST CONTACT CARE
Definition of terms • ability to provide health services with a time
Health care provider frame appropriate to the urgency of the health
• health facility which may be public or private, problem.
devoted primarily to the provision of services for COMPREHENSIVE PRIMARY CARE
health promotion • ability to provide range of health services meet
common needs across all life stages. -it guides
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 BSN 2105 PHO Reviewer

patients to improve primary care efficiency, o Behavior and attitude

quality, and access. o Policies/SOP of the hospital/RHU
CONTINUING CARE o Follow the minimum health protocol of the
• ability to provide a sustained partnership with health facility
the patient in the management of his/her III. Tour to the area of the health facility and
condition. other parts of the building (Hospital)
• The patient is well-informed about the treatment o Actual duty with the CIinical Instructor
plan and it is not simply implemented without o Case presentation to be presented to the
the patient being aware. Chief Nurse and Staff
COORDINATING CARE o Evaluation and exit conference (Presentation
• ability to transfer and share responsibility across of the issues/concerns during their course of
disciplines and levels of care. -to transfer which duty)
is based from the primary care provider network,
secondary care, tertiary care, and to apex IV. Orientation to the area of assignment
hospital. (community)
MANAGING PATIENT RECORDS o Courtesy to the Barangay Officials/ Leader
• ability to ensure coordination of care through o Meeting with Barangay Leaders
accurate and timely integration of medical o Briefing of the set-up/policies in the
records in the health care provider network barangay
PROMOTING HEALTH o Briefing of the existing activities/projects
• ability to identify and implement programs o Tour the whole community
policies and other health promotion V.
interventions that are empowering participatory, o Actual job training with your clinical
holistic, inter-sectoral, equitable, sustainable, instructor.
and multi-strategic in nature. o Feedback with the LCE/LCU personnel before
IMPLEMENTING PUBLIC/POPULATION HEALTH leaving the health facility
• ability to implement public health/population
health services as mandated by DOH. Rabies Prevention and Protection Control
Program
Steps Procedure During the Actual Job Training
LGU Hospitals RABIES
I. • Ang Pilipinas - ay isa sa mga bansa na may
o Courtesy call to the Local Chief Executive mataas na kaso ng rabis.
(Municipal setting) • 200 - 400 Pilipino - ang namamatay dahil sa
o Courtesy call to the Chief of rabies taun-taon
Hospital/Municipal Health Officer and other
personnel (Hospital setting) Ano ang Rabies?
• Ay sakit sa utak na dulot ng Rabies Virus.
II. Orientation to the: • Ito ay isang mapanganib na sakit na
o Physical set-up of the health facility nakakamatay.
(hospital/ RHU) • Nalilipat sa tao sa pamamagitan ng:
o Other health personnel/organizational set- o Kagat ng hayop na may rabis,
up karaniwan ay aso
o Activities of the health facility
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o Nalagyan ng laway ng hayop na may • Takot sa tubig at hangin.

rabis ang sariwang sugat o gasgas. • Nagiging mabangis o mabagsik.
• 100% na nakakamatay ang madapuan ng • Tumatakbo ng walang direksyon.
Rabies ngunit 100% maiiwasan sa • Nangangat ng kahit anong bagay.
pamamagitan ng pagbabakuna. • Naglalaway ng labis.
• Maaring makapasok ang virus sa katawan • Hindi makakain at o makainom ng tubig
sa pamamagitan ng:
o kagat o kalmot ng aso, pusa, at 3 kategorya ng Kagat
unggoy. • Category I
o O kaya paglaway nito sa sugat o o Nalawayan ng hayop ang balat na
“mucus membranes” ng tao walang sugat o gasgas (intact skin).
• Virus—Nervous System—Central Nervous o Walang bakunang kailangan maliban
System (Brain). kung nais magpalagay ng proteksyon
• Ang sintomas ay karaniwang lumalabas sa laban sa rabies bago pa makagat (Pre-
loob ng 20-90 days. exposure Prophylaxis).
• Sa di-pangkaraniwang pangyayari ay • Category II
lumalabas pagkatapos ng 4 na araw o mayroong gasgas, mababaw ang kagat
hanggang 7 na taon dahil sa: na hindi dumugo at minor scratches
o Dami ng virus (virus load) o kadalasang nasa parte ng binti.
o Lakas ng virus (virus strain) o kailangan nito ng ACTIVE VACCINE gaya
o Dami ng kagat (degree of exposure) ng PVRV o PCECV.
o Lugar ng kagat sa katawan • Category III
(Localization of exposure) o Kagat o kalmot na nagdugo at lahat ng
kagat o kalmot mula sa leeg pataas pati
2 URI NG RABIES VIRUS na ang nadilaan na “mucus membrane”.
1. Furious type o Kailangan nito ng ACTIVE (PVRV/PCECV)
• 80% ay biktima. at PASSIVE (RIG) VACCINES.
• Mga symptomas:
o pagkatakot sa hangin DOH POLICIES
(aerophobia) • Day 0, 3, 7 & 28 are free
o pagkatakot sa tubig • Only PCEC ( Rabipur) & PVRV (Verorab) so far
(hydrophobia), have approval for ID use
o nawawala sa sarili.
• All animal bite patients must be referred to
2. Dumb type
ABTCs for proper bite management
• 20% ay biktima.
• Symptomas:
Mga dapat at hindi dapat gawin
o pagkaparalisado ng buong
Things to do:
katawan (paralysis).
• Wash with soap and water for not more than 10
mins.
MGA PALATANDAAN NG TAONG MAY RABIES • Make a schedule for consultation and
• Sakit ng ulo at lagnat. vaccination to nearest Animal Bite Treatment
• Pananakit o pamamanhid sa parteng kinagat. Center
• Nahihibang at nalulumpo. • Lock up and tie up the animals
• Paninigas ng laman (muscle spasm). Things not to do:

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• Don’t put garlic, rocks, and others. I. Infant and Young Child Feeding Program
• Do not bleed the wound. (IYCF)
• Don’t go to “tandok o albularyo”. 1) It covers the enforcement of E.O 51 or
• Do not kill and release the animals. commonly known as the MILK CODE.
• E.O 51 (MILK CODE)
Mga paalala para makaiwas sa Rabies: o It regulates the marketing of infant field
• Be a responsible pet owner—make sure to formula, other milk products, and
always vaccinate your pets annually, lock them beverages, as well as feeding bottles and
up, and tie them if possible. needs.
• If bitten, make a schedule for a consultation and o This program also covers the
vaccination at the nearest Animal Bite Treatment enforcement of RA 10028 or the
Center. Expanded Exclusive BreastFeeding in the
• Always remind the children to report if they are Workplace Law.
bitten by the dog or cats. • RA 10028 (Expanded Exclusive BreastFeeding in
the Workplace Law)
Nutrition Services o The policy adopts rooming-in and
establishment of lactation stations in the
MISSION
workplace to encourage, protect, and
• To manage and organize efforts of government,
support the practice of breastfeeding.
private sector, and other stakeholders at all levels
o Enforcement of RA 11148 popularly
in addressing malnutrition of Batangueños
known as the Kalusugan at Nutrisyon ng
through:
Mag Nanay Act or First 1000 Days.
o Policy and program formulation and
• RA 11148 (Kalusugan at Nutrisyon ng MagNanay
coordination;
Act or First 1000 Days)
o Capacity development;
o It is an act scaling at the national and
o Promotion of good nutrition;
local health and nutrition programs
o Resource generation and mobilization;
through a strengthened integrated
o Advocacy;
strategy for maternal, neonatal, child
o Partnership and alliance building
health, and nutrition in the first 1000
VISION
days of life
• The family, community & health providers that o Proper introduction of complementary
work together to make the attainment of good feeding (Timely, Adequate, Safe &
nutrition and optimum health, a way of every Properly Fed).
Filipino. o Home fortification of complementary
o The Philippine Plan of Action for foods through the use of multiple
Nutrition lays on the target direction & micronutrient powder.
priority action to achieve nutrition
II. INTEGRATED MANAGEMENT OF ACUTE
targets that are in turn based on the
MALNUTRITION
nutrition situations.
A. OPERATION TIMBANG (CHILD GROWTH
STANDARD/ CGS)
THE NUTRITION SERVICES ARE SUBDIVIDED INTO 2
o Mass weighing of 0-59 months old
CATEGORIES: children every 1st quarter of the year.
A. SPECIFIC PROGRAMS That would be the baseline data for
o address immediate causes of intervention.
malnutrition.
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o Rationale for Use: It Is the "single o NORMAL: ≥125 mm (>12.5 cm)

international standard that represents o MAM: 115 to 124 (11.5 cm to 12.4 cm)
the best description of physiological o SAM: <11.5 cm
growth for all children under 5 years of 3. Testing for Edema (bilateral pitting edema)
age and establishes the breastfed infant *apply normal thumb pressure for at least 3
as the normative model for growth and seconds
development" o NORMAL: NONE
o Indices: o MAM: NONE
▪ Weight-for-age o SAM: PRESENT
▪ Weight-for-length/height 4. Testing Appetite
▪ Length/height-for-age o To determine if the child is OTC (out-
• Target: patient therapeutic care) or ITC (in-
o Total Population X patient therapeutic care)
o .10714% of the population Some child is for OTC if:
a) The child takes 3-4 mouthful or more of
• Weight Measurement Tools the RUTF (ready to use therapeutic food)
o Dial Type Weighing Scale b) No medical complication
o Detecto Physician’s Scale ▪ severe vomiting
o Salter Type Weight Scale ▪ fever
o Infant Weight Scale ▪ hypothermia
▪ anemia
• Height Measurement Tools ▪ superficial infection
▪ very weak alertness
o Detecto
▪ dehydration
o Microtoise
▪ abnormal respiration rate: ( ≥50
o Infantometer
resp/min for 6-12 months / ≥40
o WHO Height Board Prototype
resp/min for 1- 5 y/o / ≥30
resp/min over 5 y/o)
• Mother and Child Book of 0-5 y/o children
o If the child rejects RUTF and has the
o it is used for monitoring growth,
presence of one or more medical
vaccination record, and promotion.
complications, he is automatically for
ITC.
• Child Growth Standard Revised Reference
Table for 0-5 y/o children III. NATIONAL DIETARY SUPPLEMENTATION
o used for identifying the additional status
PROGRAM
• Provision of nutritious foods during meals or
B. MANAGEMENT OF SEVERE ACUTE
snacks to fill the calories, protein and
MALNUTRITION (SAM) micronutrient inadequacy in the diet.
The 3 Indices used in active case finding are: Dietary Supplementation is given during:
1. Weight for Height Z-score a) Routine food supplementation for
o NORMAL: -2 and above undernourished children 6-59 months
o MODERATE (MAM): <-2 to -3 old & underweight pregnant
o SEVERE (SAM): <-3 2 b) Supplementary feeding during
2. MUAC (mid-upper arm circumference) *always emergencies
use left arm c) Nutritionally at-risk pregnant women
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o Pregnant Mothers (prevention of pre-

IV. NATIONAL NUTRITION PROMOTION PROGRAM edampsia in pregnant women,
FOR BEHAVIOR CHANGE particularly among those at higher risk of
A. PABASA SA NUTRITION developing gestational hypertension)
o A participative, circular gathering of 10- o Given on the 20th day of pregnancy until
12 mothers birth 3 tablets a day (1.25g calcium
o Class informally discussing health & carbonate/tablet)
nutrition D. Micronutrient powder (MNP)
B. MOTHERS CLASS E. Micronutrient syrup
o Pinggang Pinoy (healthy food plate for o For identified malnourished children 6-
Filipino) 59 months
o 10 Kumainments F. Integrated Helminth Control Program
o food pyramid o Mass deworming done every 6 months
C. DIETARY COUNSELING ▪ January & July – Community
o Provision of specialized & modified diet ▪ March & September – School
to cases like diabetes, hypertension, etc. children
D. HEALTHY LIFESTYLE LECTURES Target:
o Dietary management of • 12-59 mons. old children
noncommunicable diseases. • 5-19 years old children
E. RADIO PLUGGING / GUESTING Drug Dosage
• Mebendazole – 500mg single dose (1-19 years
V. MICRONUTRIENT SUPPLEMENTATION old)
(MSP) • Abendazole – 200mg (12-23 mons old) 400mg
A. Vitamin A Supplementation (2-19 years old)

VI. MANDATORY FOOD FORTIFICATION

A. Monitoring of mandatory food fortification of
staples.
B. Monitoring of storage, ports, food
establishment, outlets point of production, and
imported salt.
C. Market-to-market salt testing

B. Iron Supplementation
VII. NUTRITION IN EMERGENCIES
o Pregnant Mothers
A. Nutritional Assessment (Identification of SAM)
▪ 1 tablet once a day as soon as
B. Food ration for mass supplementary feeding
pregnancy is determined. A total
C. Multiple micronutrient powder
of 180 tablets.
D. Vitamin & Mineral supplementation E. Nutrition
o Lactating and post-partum mothers:
education (IYCL- exclusive breastfeeding)
▪ Give 1 tablet once a day for 90
E. Establishment of LACTATION STATION in
days.
evacuation centers
o Female adolescence (10-19y/o)
▪ Give 1 tablet once a week for 6
VIII. OVERWEIGHT AND OBESITY MANAGEMENT
months.
C. Calcium Carbonate AND PREVENTION PROGRAM

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A. promotion and healthy lifestyle in community, • implies that people are able to have responsible,
school, and workplace safe, consensual, and satisfying sex life and have
B. media campaign on increased consumption of the capability to reproduce and freedom to
fruits, vegetables and root crops decide if, when, and how often to do so
C. Wellness programs like Zumba and any exercise • men and women attain equal relationships
program & diet lectures/counseling related to sexual relations and reproduction.

NUTRITION-SENSITIVE PROGRAMS (ADDRESS

REPUBLIC ACT 10354 “Responsible Parenthood and
UNDERLYING CAUSES OF MALNUTRITION)
Reproductive Health Act of 2012”
A. NUTRITION SUPPORTIVE PROGRAMS
o Immunization
• provide a national policy on responsible
parenthood and reproductive health
o Food and agriculture systems, programs,
and projects that impact on food supply, • aims to empower the Filipino people, especially
o social protection programs like the women and youth, through informed choice and
conditional cash transfer & health age and development-appropriate education
insurance for 4Ps. • guarantees access to info, facilities and services
o Deployment of at least 1 Barangay most especially for the poor by ensuring stable
Nutrition Scholar (BNS) per barangay to and sustainable reproductive health programs
monitor the Nutritional Status of the are in place through partnerships between
barangay especially the 0-59 mons, national and local gov in collaboration w/ civil
preschool children and strengthen the society organizations, basic sectors, academe
implementation of Barangay Nutrition and private sector
Program (Presidential Decree 1569
B. CAPACITY DEVELOPMENT/ BUILDING ACTIVITIES 12 ELEMENTS OF RPRH
o Trainings/workshops 1. Family planning information and services
o Technical Support/ Mentorships o All information and services must be
o Lobbying to elected officials and available, and if not, there has to be a
lawmakers for budget allocation and concrete delivery network like in the
nutrition laws adoption forging context of UHC, which provides the
partnerships with other offices and information as to where the clients
organizations. should be referred to in case a specific
C. MONITORING AND EVALUATION information or service is unavailable.
o To determine and measure of the 2. Maternal, infant and child health & nutrition
progress made for nutrition including breastfeeding
interventions & whether the nutrition o Both the mother and the child (while still
related goals or expected outcomes are in the womb), is considered a risk (risk
being met. pregnancy). With this, PHO deviates
from the risk approach to Emergency
RESPONSIBLE PARENTHOOD AND Management Obstretic and Newborn
Care (EMONC) approach. RHU and
REPRODUCTIVE HEALTH (RPRH)
district hospitals are into traning related
to this.
REPRODUCTIVE HEALTH o This element also includes the idea, “All
• state of complete well-being in matters relating pregnancy should be planned and
to one’s sexual and reproductive life supported.”
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o It also promotes the intensification of violence among women and children.

breastfeeding programs. And based on studies and statistics,
3. Proscription of abortion & management of almost all the perpetrators come from
abortion complications their own family
o With the RPRH law, all the individuals o There is an established Women and
must be informed of the complications Children Protection Unit (WCPU) at
related to abortion and the necessary Batangas Medical Center that is open
and legal actions to take during an 24/7. And soon after the training, there
encounter with an abortion case. will be a Women and Children Protection
o The service delivery network in the Desk at all the 12 district hospitals.
province provides the information as to o The law mandates that there should be a
how and where to take those individuals Women and Children Protection Desk at
in corresponding facilities. the barangay level.
4. Adolescent & youth reproductive health 7. Education and counselling on sexuality and
guidance and counselling reproductive health
o With the increasing number of teenage o This is part of an educational campaign
pregnancies, there has been a massive of the Health Education and Promotion
campaign of youth and adolescent Unit.
reproductive health guidance and o There has to be leaflets and materials
counselling. It involves programs in available for the people’s awareness of
convergence with schools and health their rights to sexuality and reproductive
development programs. health.
o Adolescents may reach out their sexual 8. Treatment of breast and reproductive tract
and reproductive health needs, and cancers and other gynecological conditions and
other services in the teen health kiosk disorders
school-based and teen health kiosk RHU- o With the mandate of DOH, the detection
based. of reproductive tract cancers is done in a
5. Prevention, treatment and management of much new approach like the visual
reproductive tract infections, HIV and AIDS and inspection with acetic acid (a training is
other sexually transmittable infections conducted for this).
o Anything that concerns HIV, AIDS, and 9. Male responsibility & involvement and men’s
other STIs, there are treatment hubs at reproductive health
Batangas Medical Center and one in Lipa. o This element is not included before, but
o For other treatments like reproductive for equality purposes, it is incorporated
health infections and STI, most RHU and as well since male reproductive health is
hospitals are also catering these types of as important as female reproductive
infections. They also prescribe and do health.
the necessary laboratories for such. 10. Prevention, treatment and management of
6. Elimination of violence against women and infertility and sexual dysfunction
children and other forms of sexual and gender o It involves assessing the clients and
based violence providing them with information or
o Part of the elements of RPRH is to create referring them to infertility and sexual
a safe space for women and children. dysfunction clinics.
During pandemic, there has been a
significant increase of rape cases and

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11. Age- and development – appropriate RH • National and local government cooperation in
education for adolescents in formal & non implementation
formal educational settings • Participation of the Private sector, Academe,
o Batangas had implemented the Basic Sector, and Civil Society Organizations
reproductive health education program • Continuous monitoring & review of programs
among adolescents in collaboration with
private partners and donations from
FAMILY PLANNING METHOD
other stakeholders.
12. Mental health aspect of RH care
o In the context of RPRH, there should be
a healthy and positive attitude and
perspective towards reproductive health
care.

FAMILY PLANNING METHODS

▪ Fertility Based Awareness (FAB) Methods
▪ Lactational Amenorrhea Method (LAM)
▪ Pills (COC, POP) Oral Care
▪ Injectable (CIC, POI)
▪ Barrier method Dental Program Health Care Guarantees for All Life
▪ Intrauterine Device (IUD) Stages
▪ Bilateral Tubal Ligation (BTL) PREGNANCY
▪ No Scalpel Vasectomy (NSV) • Oral Health Examination and appropriate
interventions
4 PILLARS OF RPRH • Provision of oral care services as needed.
• The right to make free and informed decisions • Community Health and Nutrition Education:
• The provision of effective and quality RH care a) Non exposure to cigarette smoke and
services unhealthy food
• The provision of truthful information and b) Healthy diet (reducing saturated fat
education on RH content)
• The preferential access to the poor and the c) Physical activity
marginalized
BENEFITS OF RA 10354 POST-PARTUM
Improved access to services thru:
• Community Health and Nutrition education:
• Enhanced Service Delivery Networks (SDN) a) Non exposure to cigarette smoke and
through facility mapping & population matching
unhealthy food;
w/ the facilities
b) Proper tooth brushing and oral hygiene
• Provision of mobile health clinics in
geographically isolated & disadvantaged areas
NEONATE
(GIDAs)
• Instruct PARENTS on infant’s oral care.
• Improved PhilHealth coverage of RH services
• Ensured supply of RH commodities particularly in
Infant: 0-12 months
the procurement & distribution of FP supplies
• Hiring & training of skilled health professionals • Oral Health

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• Oral Health Examination and Services (Fluoride,

Varnish, etc.)

School- age: 5-9 years old

• Oral Health Examination
• Fluoride, Varnish, Glass Ionomer
• Provision of oral care services as needed
• Lifestyle modifications:
a) Healthy diet (reducing saturated fat
content)
b) Physical activity
• Safe of salty and sweetened food and sugary
beverages

Adult Women: 20-60 years old

• Community Health and Nutrition Education
• Oral Health Education
• Composite filling materials
• Prophylaxis paste
• Smoking and alcohol use (alcohol cessation,
alcohol consumption)

Elderly Men Above 60 years old

• Oral Health Examination
• Counseling (physical activity, substance use,
smoking, diet and nutrition)

Elderly Women Above 60 years old

• Oral Examination

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