Principles and Practice of Public Health Nursing 1.-1

PRINCIPLES AND
PRACTICE OF PUBLIC
HEALTH NURSING 1
MS. KIRAN AKPENE TSETSEY
PUBLIC HEALTH NURSING
• Public health nursing is a specialized field of nursing that focuses on promoting and
protecting the health of populations through education, advocacy, and the delivery
of comprehensive health services. Public health nurses work in a variety of settings,
including community health clinics, schools, public health departments, and
hospitals, and are responsible for providing a wide range of services that are
designed to improve the health outcomes of individuals and communities.
• Public health nurses are trained to identify and assess the health needs of
communities, develop and implement programs to address those needs, and
evaluate the effectiveness of those programs over time. They work collaboratively
with other healthcare professionals, community leaders, and policymakers to
identify and address health disparities, promote healthy behaviors, prevent illness
and injury, and ensure access to quality healthcare services for all.
Examples of services provided by public health nurses include vaccination, health
screenings, disease surveillance and investigation, health education and promotion,
environmental health assessments, and disaster preparedness and response.
TRENDS IN PUBLIC HEALTH NURSING IN GHANA
• Public health nursing in Ghana has undergone several changes and trends over the
years. Here are some of the current trends in public health nursing in Ghana:
• 1. Increasing focus on community-based care: There has been a shift in focus
towards community-based care, with nurses increasingly working with
communities to promote health, prevent diseases, and provide healthcare services.
• 2. Emphasis on disease prevention: Public health nursing in Ghana has
increasingly focused on disease prevention, with a particular emphasis on
communicable diseases such as malaria, HIV/AIDS, and tuberculosis.
• 3. Expansion of nursing roles: There has been an expansion of the roles of
nurses in Ghana, with many nurses taking on leadership and management
positions in healthcare organizations and government agencies.
• 4. Adoption of technology: Technology has been increasingly used in public
health nursing in Ghana, with the adoption of electronic medical records,
TRENDS IN PUBLIC HEALTH NURSIONG IN GHANA
• 5. Collaboration with other healthcare professionals: Public health nurses in

Ghana are increasingly collaborating with other healthcare professionals such as
doctors, pharmacists, and public health officers to provide comprehensive
healthcare services.
• 6. Health education and promotion: Public health nurses in Ghana are
increasingly involved in health education and promotion, with a focus on
educating individuals and communities on healthy lifestyles and disease
prevention.
• Overall, these trends in public health nursing in Ghana reflect a growing emphasis
on community-based care, disease prevention, and the adoption of technology to
improve healthcare services.
TRENDS IN PUBLIC HEALTH NURSING IN AFRICA
• Public health nursing in Africa is an essential aspect of healthcare delivery in
the continent. The nursing profession has been evolving over the years, and
several trends have emerged that are shaping the practice of public health
nursing in Africa. Here are some of the trends:
• 1. Health Promotion and Disease Prevention: Public health nursing in
Africa has shifted from a focus on treating diseases to health promotion and
disease prevention. Nurses are now working to educate individuals and
communities on healthy living practices to prevent illnesses. They also work
to identify and address social and environmental factors that contribute to
poor health outcomes.
• 2. Community-Based Care: Another trend in public health nursing in
Africa is the focus on community-based care. Nurses are now working more
closely with community members, including traditional healers, to provide
• 3. Technology: Technology has played a significant role in shaping public

health nursing in Africa. The use of mobile technology has enabled nurses to
provide health education and reach out to more people in remote areas. The use of
electronic health records has also improved healthcare service delivery by
enabling healthcare providers to access patients' medical histories and monitor
their health status.
• 4. Collaborative Practice: Public health nursing in Africa is increasingly
becoming a collaborative practice. Nurses are working with other healthcare
professionals, including physicians, pharmacists, and social workers, to deliver
comprehensive care to patients.
• 5. Advocacy: Nurses are becoming more involved in advocating for health

policies that promote health equity and address social determinants of health.
They are also advocating for their profession and working to increase the visibility
and recognition of public health nursing as a critical component of healthcare
delivery in Africa.
• Overall, these trends in public health nursing in Africa are helping to improve the
quality and accessibility of healthcare services in the continent. As the nursing
profession continues to evolve, it is expected that more innovations and trends
will emerge, further transforming the practice of public health nursing in Africa.
TRENDS IN PUBLIC HEALTH NURSING IN
THE WORLD
• Public health nursing is a specialized area of nursing practice that focuses on
promoting and protecting the health of populations through the provision of health
education, disease prevention and control, and community-based care. Over the years,
there have been several trends in public health nursing that have shaped the way
healthcare is delivered to populations across the world. Some of these trends include:
• 1. Increased Focus on Health Equity: In recent years, there has been a growing
recognition of the importance of addressing health disparities and promoting health
equity in public health nursing. This has led to the development of strategies and
interventions that aim to reduce health inequities and ensure that all populations have
access to quality healthcare.
• 2. Emphasis on Primary Care: There has been a shift towards a more
comprehensive and integrated approach to healthcare, with a focus on primary care as
a means of promoting health and preventing disease. Public health nurses are
increasingly working in primary care settings, providing a range of preventive and
clinical services to individuals and families.
TRENDS IN PUBLIC HEALTH NURSING IN
THE WORLD
• 3. Use of Technology: The use of technology has become an important trend
in public health nursing, with the emergence of telehealth, mobile Health, and
other digital health tools. These technologies have enabled public health nurses to
provide care remotely and reach underserved populations in a more efficient and
effective way.
• 4. Collaboration and Partnership: Public health nursing has become more
collaborative and partnership-based, with a focus on working with other
healthcare providers, community organizations, and government agencies to
address health issues. This approach recognizes the interconnectedness of health
and social determinants and the need for a coordinated response to address health
challenges
TRENDS IN PUBLIC HEALTH NURSING IN THE
WORLD
• 5. Disaster Preparedness: The increasing frequency and severity of natural
disasters and public health emergencies have led to a greater emphasis on disaster
preparedness in public health nursing. Public health nurses play a critical role in
emergency response, providing care to affected populations and helping to prevent
the spread of disease.
• These trends reflect the evolving nature of public health nursing and the changing
needs of populations across the world. As healthcare systems continue to face new
challenges, public health nursing will continue to adapt and evolve to meet the
needs of communities and promote the health and wellbeing of populations.
OBJECTIVES AND PRINCIPLES OF PUBLIC
HEALTH NURSING
• Public health nursing is a specialty within the nursing profession that focuses on
improving the health and well-being of entire populations through the promotion of
healthy behaviors, the prevention of disease and injury, and the management of
community health issues. The objectives and principles of public health nursing are as
follows:
• 1. Promoting health and preventing illness: Public health nurses work to prevent
health problems before they occur by promoting healthy behaviors and lifestyles. This
can include providing education and resources on nutrition, exercise, and other healthy
habits.
• 2. Identifying and managing health issues: Public health nurses are trained to
identify health problems within communities and develop plans to manage and treat
these issues. This can involve working with other healthcare providers and community
organizations to develop and implement interventions.
• 3. Educating communities: Public health nurses play an important role in educating
communities about health issues, prevention strategies, and treatment options. This can
OBJECTIVES AND PRINCIPLES OF PUBLIC
HEALTH NURSING
• 4. Advocating for vulnerable populations: Public health nurses advocate for
vulnerable populations, such as low-income individuals, minorities, and those
with limited access to healthcare. They work to ensure that these populations have
access to the resources they need to stay healthy and manage health issues.
• 5. Collaborating with other healthcare providers and organizations: Public
health nurses work closely with other healthcare providers and community
organizations to develop and implement strategies for improving population
health. This can include working with hospitals, clinics, schools, and community
groups to provide education, screenings, and other health services.
• 4. Disaster preparedness and response: Public health nurses play a critical role
in preparing for and responding to natural disasters, pandemics, and other
emergencies.
Objectives Of Public Health Nursing
• The objectives of public health nursing are to promote and protect the health of
individuals, families, and communities through a range of activities, including:
• 1. Disease prevention and health promotion: Public health nurses aim to
prevent the spread of diseases and promote health through education and
awareness campaigns, screenings, vaccinations, and other interventions.
• 2. Health surveillance and assessment: Public health nurses monitor the health
status of populations, identify health trends and problems, and assess the needs of
communities.
• 3. Case management and care coordination: Public health nurses provide care
coordination and case management services to individuals with complex health
needs, such as those with chronic diseases or disabilities.
• 4. Disaster preparedness and response: Public health nurses play a critical role
in preparing for and responding to natural disasters, pandemics, and other
emergencies.
Objectives Of Public Health Nursing
• 5. Policy development and advocacy: Public health nurses work to develop
policies and advocate for legislation that supports public health initiatives and
promotes health equity.
• 6. Research and evaluation: Public health nurses conduct research and
evaluation activities to inform public health practice and improve health
outcomes.
• Overall, the objective of public health nursing is to improve the health and well-
being of individuals and populations through evidence-based practice, community
engagement, and collaboration with other healthcare professionals and
stakeholders.
The principles of public health nursing
• 1. Client-centered care: Public health nurses prioritize the needs of their
clients and work to provide care that is tailored to their individual needs.
• 2. Community-based care: Public health nurses work within communities to
promote health and prevent illness, rather than focusing solely on individual
patients.
• 3. Prevention-oriented care: Public health nurses prioritize prevention
strategies to avoid the development of health problems before they occur.
• 4. Interdisciplinary teamwork: Public health nurses collaborate with other
healthcare providers and community organizations to develop and implement
interventions.
• 5. Cultural competence: Public health nurses are trained to work with diverse
populations and respect the cultural beliefs and practices of their clients.
QUALITIES OF THE PUBLIC HEALTH NURSE
• 1. Strong communication skills: Public health nurses need to be able to
communicate effectively with individuals and communities from diverse
backgrounds to promote health and wellness and to educate people about disease
prevention. Public health nurses must be able to effectively communicate with
patients, colleagues, and the public about health issues, health risks, and
prevention strategies.
• 2. Cultural competence: Understanding and being respectful of cultural
differences is essential for public health nurses to effectively communicate and
provide care to diverse communities. Public health nurses must be able to work
effectively with diverse populations and understand the cultural factors that
influence health behavior.
• 3. Critical thinking and problem-solving skills: Public health nurses need to be
able to assess and analyze complex health issues and develop effective strategies
to address them. Public health nurses must be able to analyze complex data and
make informed decisions about public health interventions.
• 4. Flexibility and adaptability: Public health nurses work in constantly
changing environments and need to be able to adjust to new situations and
priorities. Public health nurses must be able to adapt to changing situations and
respond quickly to emerging public health concerns. Public health nurses must be
willing to work in a variety of settings, including clinics, hospitals, schools, and
community organizations.
• 5. Compassion and empathy: Public health nurses often work with vulnerable
populations and need to be compassionate and empathetic to the needs of their
patients. Public health nurses must have a genuine concern for the health and well-
being of others and be able to provide compassionate care to patients in need.
• 6. Commitment to public health: Public health nurses are dedicated to
improving the health and well-being of their communities and need to be
committed to this mission.
• 7. Leadership skills: Public health nurses often work as part of
interdisciplinary teams and need to be able to lead and collaborate with others to
achieve their goals. Public health nurses must be able to lead teams of healthcare
professionals and work collaboratively with other stakeholders to improve public
health outcomes.
• 8. Knowledge and expertise in public health: Public health nurses require
specialized knowledge and skills related to community health, epidemiology, and
health promotion and disease prevention. Public health nurses must be committed
to life long learning and staying up-to-date on the latest research, trends, and best
practices in the field.
DUTIES OF THE PUBLIC HEALTH NURSE
• The duties of a public health nurse can vary depending on their specific role and
work setting, but some common responsibilities include:
• 1. Assessing community health needs: Public health nurses work with local
communities to assess their health needs and develop strategies to address health
problems.
• 2. Educating the community: Public health nurses educate the public about
health issues, including disease prevention, healthy behaviors, and the use of
health care services. Public health nurses educate and inform the public about
health and safety issues through community events, workshops, and presentations.
• 3. Providing direct patient care: Public health nurses may provide direct
patient care to individuals or families, especially in community settings such as
schools, clinics, or homes.
• 4. Conducting screenings and assessments: Public health nurses conduct
screenings for diseases such as tuberculosis or assess individuals for health risks
or needs.
• 5. Health promotion and disease prevention: Public health nurses work to
promote healthy behaviors and lifestyles, prevent disease through immunization
programs, and identify and address health disparities in the community.
• 6. Disease surveillance and outbreak investigation: Public health nurses monitor
disease trends and investigate outbreaks to identify the source of the outbreak
and prevent further spread.
• 7. Developing and implementing health programs: Public health nurses may
design and implement health programs or interventions aimed at improving the
health of specific populations or communities.
DUTIES OF THE PUBLIC HEALTH
NURSE
• 8. Collaborating with other health professionals: Public health nurses work closely
with other health professionals, such as doctors, social workers, and community
health workers, to provide comprehensive care to patients and communities.
• 9. Advocating for public health policies: Public health nurses may advocate for
policies or initiatives that promote health and wellness in their communities, such
as improved access to health care or increased funding for health education
programs. Public health nurses help shape public health policies at the local, state,
and national levels, advocating for the needs of the community and working to
improve health outcomes.
• 10. Disaster response and emergency preparedness: Public health nurses are often
involved in emergency response planning and preparedness efforts, helping to
ensure that communities are ready to respond to natural disasters, disease
outbreaks, and other emergencies.
• 11. Conducting research: Public health nurses may conduct research

to better understand health issues affecting their communities and to
develop new approaches to preventing or treating disease. Public
health nurses may conduct research and evaluate programs to identify
best practices and improve the effectiveness of public health
interventions.
SCOPE OF WORK OF THE PUBLIC HEALTH NURSE
• The scope of work of a public health nurse varies depending on the specific role and
setting in which they work. However, in general, the main responsibilities of a public
health nurse include:
• 1. Health promotion, disease prevention and Control: Public health nurses work to
promote healthy behaviors and prevent the spread of disease within the community.
They educate individuals and groups on health topics such as nutrition, exercise, and
disease prevention strategies. Public health nurses work to prevent the spread of
infectious diseases through education, immunization programs, and disease
surveillance. They also collaborate with other healthcare professionals to respond to
outbreaks and manage infectious diseases.
• 2. Community assessment: Public health nurses assess the health needs and resources
of the community they serve, in order to identify potential health problems and
develop interventions to address them.
• 3. Care coordination: Public health nurses often serve as a liaison between patients
and healthcare providers, helping to coordinate care and ensuring that patients
• 4. Immunization and vaccination programs: Public health nurses are often
responsible for administering immunizations and vaccinations to individuals and
groups in order to prevent the spread of disease.
• 5. Disaster preparedness and response: Public health nurses play a key role in
preparing for and responding to disasters and other emergencies, working to
ensure that the community is prepared for potential health threats and providing
care and support in times of crisis. Public health nurses work with emergency
responders and community organizations to prepare for and respond to disasters
and emergencies.
• 6. Research and evaluation: Public health nurses often conduct research and
evaluate the effectiveness of public health interventions, using data to inform
future health programs and policies.
• 7. Report writing is an essential skill for public health nurses as it allows them
to communicate important information to various stakeholders, including
healthcare providers, policymakers, and the public. Reports are crucial in the field
of public health, as they serve as a means of communication between healthcare
providers, organizations, and government agencies. Reports can be used to convey
information about public health trends, outbreaks, and disease prevention
strategies, among other things.
• The scope of work of a public health nurse in report writing includes:
•• Collecting Data: One of the primary roles of a public health nurse is to
collect data on various public health issues. This can include monitoring disease
outbreaks, tracking immunization rates, and conducting community health
assessments. The data collected is used to identify public health problems, trends,
and areas that require intervention.
The scope of work of a public health nurse in report writing continues:
•• Analyzing Data: After collecting data, the nurse must analyze it to identify
patterns, trends, and risk factors. This involves using statistical methods to
understand the data and draw conclusions about the public health issue under
investigation.
•• Reporting Findings: Once the data has been collected and analyzed, the
nurse must report their findings. This involves writing reports that are clear,
concise, and accurate. Reports may be intended for different audiences, such as
healthcare providers, government agencies, or the general public.
•• Communicating Recommendations: In addition to reporting their findings,
public health nurses must also communicate recommendations for action. This
may involve recommending strategies for disease prevention, interventions to
control outbreaks, or promoting healthy behaviors within the community.
The scope of work of a public health nurse in report writing continues:
•• Monitoring Progress: Finally, the nurse must monitor the progress of any
interventions or strategies implemented to address the public health issue. This
involves ongoing data collection, analysis, and reporting to ensure that the
interventions are effective.
• In summary, report writing is an essential part of the scope of work of a public
health nurse. It involves collecting and analyzing data, reporting findings,
communicating recommendations, and monitoring progress to improve public
health outcomes. Effective report writing requires excellent communication skills,
attention to detail, and a thorough understanding of public health concepts and
principles.
• Overall, the scope of work of a public health nurse is broad and varied, with a
focus on promoting health and preventing disease within the community. Public
health nurses play a critical role in improving the health and well-being of
communities by addressing the complex interplay of biological, environmental,
REPRODUCTIVE AND CHILD HEALTH (RCH)
• Reproductive and child health is a broad term that encompasses a range of issues
related to sexual and reproductive health, maternal and child health, and family
planning. It is an essential component of public health that focuses on ensuring
that individuals have access to information, services, and support they need to
make informed decisions about their reproductive health and to have healthy
pregnancies, safe childbirth, and healthy children.
• Some of the key areas of focus in reproductive and child health include:
• 1. Maternal health: This includes ensuring access to quality prenatal care, safe
delivery services, and postnatal care for mothers.
• 2. Family planning: This includes providing access to information, counseling,
and services related to contraception and fertility.
• 3. Child health: This includes ensuring access to preventive services, such as
vaccinations and regular check-ups, as well as treatment for common childhood
illnesses.
key areas of focus in reproductive and child health continues:
• 4. Adolescent health: This includes addressing the unique health needs and
challenges faced by adolescents, including sexual and reproductive health issues.
• 5. Sexual and reproductive health: This includes promoting safe and healthy
sexual behaviors, preventing sexually transmitted infections (STIs), and
addressing issues related to infertility, menstruation, and menopause.
• Efforts to improve reproductive and child health require a multifaceted approach
that includes improving access to healthcare services, promoting health education
and awareness, and addressing social and economic factors that impact health
outcomes.
REPRODUVTIVE HEALTH
• Reproductive health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity, in all matters related to the
reproductive system and to its functions and processes.
• Components of Reproductive Health
• The components of Reproductive Health Programmes are;
• • Safe motherhood including antenatal, safe delivery and postnatal care especially
• breast feeding, prevention of mother to child transmission of HIV (PMTCT),
infant health and women’s health;
• • Family Planning: Prevention and management of unsafe abortion and post-
abortion care;
• • Prevention and management of Reproductive tract infections (RTI), including
• Sexually Transmitted Infections (STIs), and HIV/AIDS:
• Prevention and management of infertility;
• Management of cancers of the reproductive system, including cervical, breast,
• testicular and prostate cancers;
• • Responding concerns about menopause;
• • Prevention and management of harmful traditional practices that affect the
• reproductive health of men and women such as female genital mutilation;
• • Information and counselling on human sexuality, responsible sexual behaviour,
• responsible parenthood, pre-conception care and sexual health.
• • Gender based violence and reproductive health.
The Priorities of Reproductive Health Care
• • Safe motherhood including infant health, Family Planning, STI/HIV/AIDS prevention
and management, Post Abortion Care, Prevention and management of cancers of the
reproductive system.
• SAFE MOTHERHOOD
• Safe motherhood is defined as the creation of the circumstances within which a woman
is enabled to choose whether she would become pregnant, and if she does, ensuring she
• receives care for prevention and treatment of pregnancy complications, and have
access to emergency obstetric care where necessary, as well as, care after birth, so that
she can
• avoid death or disability from complications of pregnancy and child birth.
• Goal:-The goal of the safe motherhood programme is to improve women‘s health in
• general, and especially to reduce maternal morbidity and mortality, and to contribute to
• reducing infant morbidity and mortality.
Objectives of safe Motherhood
• To:
• • Make child bearing safe for all women.
• • Contribute to the improvement of infant health
• • Promote and maintain the physical, mental and social health of the mother and baby
• by providing education on nutrition, family planning, STI prevention including
• HIV/AIDS, managing the danger signs of pregnancy, ensure rest/sleep and personal
• hygiene.
• • Help clients develop birth preparedness and complication readiness plans, detect and
• treat all complications arising during pregnancy, whether surgical, medical or
• obstetric. This is achieved through physical examination for oedema of feet;
• laboratory investigations of urine for protein; interview clients for complains such
• as headache, among others.
Objectives of safe Motherhood
To:
• Ensure delivery of full-term healthy baby with minimal stress or injury to mother
and baby. This ensures that mothers attend ANC at least 4 times; mothers take
• prescribed drugs; sleep in insecticide treated bed nets and take prophylaxis to
prevent malaria; eat well nourished diet with protein dense foods; and ensure rest.
• • Help prepare the mother to breastfeed successfully, experience normal
puerperium and take good care of the child physically, psychologically and
socially.
• • Prevent mother-to-child transmission of HIV/AIDS
• Target Groups for Safe Motherhood - The target groups are: married couples and
• individuals; adolescents; pregnant women including adolescents; women and
adolescents in their puerperium and their babies; as well as all families.
• Safe motherhood covers:
• 1. Antenatal Care: This is the care provided to pregnant women to ensure that they go
• through Antenatal, Labour, and Peurperium successfully. Ante natal care has beneficial
• impact on pregnancy and birth outcomes through early diagnosis and treatment of
• complication and treatment as well as promoting the health of the pregnant woman
• through nutrition.
• It manages current and potential risks and problems.
• It creates the opportunity for the woman to establish a delivery plan based on her needs,
• resources and circumstances.
• It creates opportunity for screening for conditions such as breast cancer, HIV and STI
• among others.
Safe motherhood
• It provides malaria prevention through chemoprophylaxis for pregnant women
with Intermittent Preventive Treatment (IPT), promotion of the use of insecticide
treated bed nets, nutrition education, iron folate supplementation, tetanus
immunization, clinical examination, laboratory investigations, VCT and PMTCT,
family planning education, education on breastfeeding and care of the newborn.
The strategy for delivery
• ANC services (Focused Antenatal Care). This is geared towards promoting
individualised, client centred comprehensive services. Focused antenatal care
places emphasis on disease detection and risk assessment.
• This strategy also improves the skills and boosts the morale and services provided
to deliver effective ANC services taking cognisance of individual needs of the
client.
• Minimum ANC visit should be four, however, the introduction of intermittent
preventive treatment of malaria in pregnancy, Direct Observation Therapy
(DOT), Prevention of mother to child transmission of HIV, voluntary
counselling and testing (VCT) for HIV has made it necessary for a lot more
visits to be made to the health facility during pregnancy.
• It also necessary to consider the following birth prepared plan during pregnancy
in order for the client and family have a sound psychological and physical state
towards delivery, which will assist in having a healthy live mother and baby.
• - Arrange who to assist with delivery and where, Transportation arrangements,
Financial resources (delivery fee and transport), Family planning goals after
delivery, Donor for blood transfusion, Breastfeeding plan, Clothing for mother
and baby.
• The ages between 20 and 35 years normally carries low risk. This group has
improved socio-economic status, chronic diseases are fewer, and the body is
adequately developed to carry pregnancy.
• . Pregnancy in women over 35 carries greater risk due to high incidence
• of chronic medical condition, increase parity that has adverse effect on the
women.
• 2. Supervised Delivery: This is a child birth conducted by trained personnel, that
is, trained midwife or trained nurse. The outcome of delivery may be; normal
birth; low birth/premature birth; still birth; maternal death; normal delivery;
caesarian section; vacuum and forceps delivery.
• 3. Post Natal Care
• The postnatal period is the period from the end of delivery to six weeks after
delivery. The purpose is to maintain the physical and psychological wellbeing of
the mother and child.
• The essential components of postnatal care are; comprehensive screening for
detection and treatment or referral of complications in both mother and child;
health education, family planning, counselling and motivation.
• There are two main routine visits that the woman makes to the postnatal clinic:
The first is within 6-7 days after delivery, and then six weeks after delivery. These
periods provide opportunities for immunization with Bacillus Calmette Guerine
(BCG) and oral polio vaccines to the babies. It is also the critical period in the
prevention of mother-to-child transmission of HIV/AIDS.
• 4. Post Abortion Care
• Abortion is the expulsion of the contents of the uterus before the fetus is
• viable, that is before the twenty-eight weeks of pregnancy. Although abortion and
• miscarriage have the same technical meaning, clients/patients sometimes think
that miscarriage is an accident and an abortion is a criminally induced process.
The nurse has to be very tactful in discussing this issue with client.
Types of Abortion
• Spontaneous Abortion: With this, the process of abortion starts on its own accord
• without any outside influence.
• ii. Threatened Abortion: Slight bleeding may occur usually during the first three
• months of pregnancy, pain does not occur nor does the cervix dilate. The bleeding
• may cease and pregnancy goes to term. Complete rest may prevent further
• bleeding.
• iii. Inevitable Abortion: The bleeding is more severe than in a threatened abortion
• and sometimes the patient collapse from blood loss. The ovum separates from the
• uterine wall and it is expelled by the contractions of the uterus. The ovum may be
• expelled completely as in a complete abortion or part of the ovum as in an
• incomplete abortion. Evacuation of the uterus is done to remove any uterine
• content.
Types of Abortion
• iv. Habitual Abortion: This is a term used when three or more consecutive
abortions
have occurred. The client becomes very anxious and need reassurance. She is
hospitalised and given appropriate treatment.
• v. Induced Abortion: The process of abortion is stimulated by the individual; this
can be therapeutic or criminal.
• vi. Therapeutic Abortion: Based on the Abortion act the Medical Officer can
perform an abortion to save the life of the woman.
• vii. Criminal Abortion: This is the unlawful expulsion of the fetus by artificial
means and is an offence punishable by law.
• viii. Septic Abortion: Criminal abortion usually ends up becoming septic where
some of the uterine content is retained. Septicaemia may set in and the patient can
Post Abortion care
• Post Abortion care is important because: It has implication for high mortality, and
• reproductive organs can be destroyed and lead to infertility.
• Health Consequences of Abortion: abortion can end in any of these condition;
Chronic pelvic pain; pelvic Inflammatory disease; tubal occlusions leading to
secondary infertility, increased risk of spontaneous abortion and death.
• Post Abortion Care: Is the counselling and clinical services offered to women who
have undergone abortion.
• Post Abortion Care is a global strategy to reduce death and suffering from
complications.
• Post Abortion Care for unsafe and spontaneous abortion comprises five elements;
• 1.Treatment 2. Counseling 3. Contraceptive and family planning services
• 4. Reproductive and other health services 5. Community and service provider
partnerships for prevention of unwanted pregnancies and unsafe abortion.
Strategies for Improving the Quality of Post
Abortion Care
• Strategies for Improving the Quality of Post Abortion Care are to:
• - Upgrade clinical care through the use of appropriate technology, paying attention
to pain management before and after the procedure
• - Ensuring adequate supply of services and medicine and promoting improved
client/provider interaction.
IMMUNIZATION
• Immunization is the process of making a person immune to a particular disease by
administering a vaccine or other agents that stimulate the body's immune system
to produce an immune response. This immune response helps the body to
recognize and fight off specific disease-causing agents, such as viruses or bacteria.
• The primary goal of immunization is to prevent the spread of infectious diseases
and protect individuals from developing serious or life-threatening illnesses.
Through immunization, individuals can build immunity against a wide range of
diseases, including measles, polio, hepatitis B, influenza, and many others.
• Immunization is generally safe and highly effective, and it has helped to
dramatically reduce the incidence of many infectious diseases worldwide. It is
typically recommended for individuals of all ages, from infants and children to
adults.
IMMUNIZATION
• IMMUNITY : Disease can occur only in a susceptible human host. The concept of
immunity is important in the understanding of resistance to diseases caused by
infectious agents.
• Immunity refers to the ability of one‘s body cells to resist infection wholly or
partially.
• It also means the insusceptibility of the body to infectious diseases and conditions.
• It also refers to the body‘s resistance to harmful agents.
TYPES OF IMMUNITY
There are two main types of immunity:
1. Innate or inborn immunity and
2. Acquired immunity
These types of immunity are sub-divided, and the variation in the degree to which
the individual reacts to infection depends on the sub-types and many other factors.
1. Innate or inborn or inherent immunity
This is the power to resist infection under normal conditions without any reaction in
the body. In other words, it is the ability of the body to resist disease independently
of antibodies or of specifically developed tissue responses.
This type of immunity is peculiar to species, race or individuals
1. Innate or inborn or inherent immunity
a. Species innate immunity – different species of animals have their different innate
immunity. Certain diseases that affect man, for example do not affect animals
innately.
For instance, poliomyelitis, measles, cholera and most other infectious diseases
which affect man do not affect animals. In the same way, certain conditions of
animals such as rinderpest and coccidiosis do not affect man for the fact that they
are different species.
b. Racial innate immunity - different races within the same species may vary in their
protection against certain diseases, and these differences are spoken of as racial
immunity. For example, sickle cell disease is found among the black race but the
white race is immune to it. Likewise, hemophilia usually occurs among the white
race. It is an inherited sex-linked recessive disorder that affects blood clotting.
• However some recent studies show that due to inter-marriages between the black
and white races, sickle cell disease has been identified in some whites.
• c. Individual innate immunity – individuals in the same species and/or race may
show variations in their immunity. These variations may be due to certain factors
such as nutrition, physical fitness, genetic make-up, age, sex and environmental
factors such as temperature, humidity and so on. For instance certain age groups
are immune to certain infections or diseases than other age groups. Adults are
immune to certain childhood conditions such as, measles, whooping cough and
poliomyelitis.
• Certain diseases affect males (hydrocele, enlarged prostate) and others affect
females (pelvic inflammatory disease, salpingitis) due to the unique anatomical
structure of both sexes. An individual whose nutrition is adequate has a higher
level of immunity than those who are not. Different environmental and
temperature changes also influence the immunity levels of individuals.
2. Acquired immunity
• This refers to the resistance developed to diseases as a result of the body‘s own
effort. With this, the body cells are stimulated to take part in the production of its
own antibodies to protect itself against the disease.
• a. Active Immunity: The antibodies produced in Active Immunity tend to be
long-lasting, which may be permanent or semi-permanent. This is achieved
through natural or artificial means.
• Naturally Active Acquired Immunity: This results from the production of
antibodies by the individual contracting a disease. When a disease occurs, the
body cells naturally try to fight the disease by producing the antibodies, thereby
developing resistance to it. Examples are that when people suffer measles or
chicken pox, the body cells try to fight the infection. By this, it produces
antibodies which remain in the body system to fight subsequent infections. Thus,
naturally active immunity is attained through infection of a disease.
ii. Artificially Active Acquired Immunity
This results from the introduction of antigens (substances which stimulate the
formation of antibodies) in to the body to effect antibody formation to fight the
disease. This is done through vaccination or immunization. Examples are all types
of vaccines such as, Measles vaccine, Diphtheria, Pertussis, Tetanus, Influenza type
B, Hepatitis B (DPT /HibHepB) vaccine, Yellow Fever vaccine and Tetanol-
Diphtheria vaccine.
b. Passive Immunity
This refers to the protection against a disease provided by the introduction of
antibodies prepared from an immune person or animal. In passive immunity, the
body cells do not take active part in the formation of the antibodies and therefore
tend to be short lived.
Passive immunity can also be natural or artificial.
i. Naturally Passive Acquired Immunity
• This is derived from the transfer of antibodies from an immune mother to the
foetus during intra-uterine life through the placenta. For instance, when a mother
is given the tetanol toxoid vaccine during pregnancy, she transfers the antibodies
to the foetus through the placenta. The baby is then born with protection from
having the disease for a short period after birth. The protection for tetanus may
last up to about 6 weeks after delivery. The baby also gets natural passive
immunity from the breast milk.
• ii. Artificially Passive Acquired Immunity
• This is obtained from the introduction of serum obtained from an immune person
or animal to prevent one exposed to the infection from getting the disease. For
instance, injection of diphtheria antitoxin, anti-rabies serum, anti tetanus serum
(ATS), anti snake bite serum (gamma globulin) when the individual has been
exposed to their specific organisms or poisons already, but symptoms of the
disease have not started
Herd Immunity
• This describes the immunity level that is present in a group of people. A
community can be said to have either a high or low herd immunity. The larger the
number of immunized people in the community the less easy is the spread of the
disease. A population with low herd immunity is one with few immune members
and consequently more susceptible to the disease, placing the entire population at
a greater risk. High herd immunity of 80% or more provides a population with
greater overall protection and this is the target for the EPI in Ghana.
Cross-immunity: refers to a situation in which a person‘s immunity to one
causative organism provides immunity to another related organism as well.
Immunization with a vaccine made from one disease-causing organism can provide
immunity to another related disease-causing organism. For instance, the vaccine
against Mycobacterium tuberculosis, that is, BCG, provides the individual with a
degree of cross-immunity to Mycobacterium leprae that causes leprosy.
VACCINES
• Vaccines – a vaccine is a suspension of antigens in a base. Vaccines are either
made from the organisms which are dead (as in DPT / HibHepB) or live but made
harmless (attenuated) as in measles, BCG and OPV, or toxoid which relates to the
toxins or poisons produced by the organism which do no damage but protect the
body.
• All antigens are weak to cause the real disease but have the ability to stimulate the
body to produce antibodies to confer immunity in the individual. Some vaccines
give permanent immunity and others semi-permanent, but long lasting protection.
Vaccines come in vials and ampoules.
Types of Vaccines
• There are three main types of vaccines:
• Live vaccines: consist of living but weakened micro-organisms (attenuated)
grown in the laboratory. Examples are Poliomyelitis, Measles and BCG vaccines.
• Dead vaccines: contain the dead micro-organisms but when introduced into the
body enable it to produce antibodies. Example is the DPT/HibHepB vaccine.
• Antitoxins: are the altered harmless toxins of an organism which when injected
into the body, cause it to make antibodies. Example is the tetanol toxoid vaccine.
THE EXPANDED PROGRAMME ON IMMUNIZATION (EPI)
• The Expanded Programme on immunization (EPI) was launched in 1974 by the

World Health Organization (WHO) and adopted by Ghana in 1978. With initial six
antigens, Ghana has progressively expanded the antigens used in the Programme
and currently has thirteen (13) vaccine preventable diseases (VPDs) on its EPI
schedule.
The table below summarizes the vaccines used in Ghana’s EPI and the diseases
protected against.
Vaccines used in Ghana’s EPI and the diseases
protected against
CAUSATIVE ORGANISM DISEASE VACCINE
Mycobacterium tuberculosis Bacillus Calmette-Guérin
Tuberculosis (TB)
(BCG) vaccine
Oral polio vaccine (OPV),
Poliovirus Poliomyelitis Inactivated polio vaccine
(IPV)
Diphtheria toxoid vaccine as a
Corynebacterium component of Pentavalent
Diphtheria
diphtheriae (DPT-HibHepB) and Td
vaccines
Tetanus toxoid vaccine as a
component of Pentavalent
Clostridium tetani
Tetanus (DPT-Hib-HepB) and Td
Vaccines used in Ghana’s EPI and the diseases protected against
Pertussis vaccine* in Pentavalent
Bordetella Pertussis or Whooping (DPTHib-HepB) vaccine
pertussis cough
Hepatitis B (HepB) vaccine (standalone)

and in Pentavalent (DPT-Hib-HepB)
Hepatitis B vaccine*
Viral hepatitis
virus
Haemophilus Pneumonia, meningitis, Hib conjugate vaccine as a component

influenzae Septicaemia etc. of Pentavalent (DPT-Hib-HepB) vaccine
type B [Hib]
Pneumonia,
Vaccines used in Ghana’s EPI andmeningitis,
the diseases
protected against other invasive
Streptococcus pneumoniae pneumococcal Diseases Pneumococcal vaccine
(IPD)
Rotavirus Rotavirus diarrhoea Rotavirus vaccine

Measles vaccine as a compon
Measles virus Measles of Measles-Rubella vaccine
Rubella & Rubella vaccine as a compon
Congenital Measles-Rubella vaccine
Rubella virus
Rubella Syndrome
Yellow fever virus Yellow fever Yellow fever vaccine
Neisseria meningitidis Conjugate Meningococcal
Meningococcal
NOTE:
• Diphtheria, pertussis and tetanus vaccines are combined as DPT; and as
Pentavalent with the addition of HepB and Hib as used in Ghana; †IPD: Invasive
pneumococcal diseases; Vitamin A deficiency is not a VPD and Vit. A is NOT a
vaccine.
• The Recommended Schedule Of Immunization Considers:
 which immunizations are necessary
 the age of starting the immunization
 the order in which they are given
 the route of administration
 the doses and intervals
The Expanded Program on Immunization (EPI)
• 1. It costs money to organize, administer, provide vaccines, manage
the ―cold chain system, transportation and other equipment.
• 2. Information on the need for immunization must reach every one in
the country.
• 3. Health education on immunization must be organized as a priority,
using many different methods of communication.
• 4. Personnel must be trained and be available to administer and carry
out the vaccination and maintain proper care of the vaccines and
equipment.
• 5. Immunization needs to be provided within the reach of all.
• 6. There should be no import taxes or restrictions on vaccines and
equipment.
•.
TETANUS TOXOID(TT), NOW TETANUS- DIPHTHERIA(TD)
Modes of Rendering Immunization Services
• 1. Static or fixed facilities (Health Centres and Clinics) where immunizations are
given everyday or on weekly basis.
• 2. Outreach points where immunization is given at specific periods of the month
by clinic staff who visit those points. These sessions are usually run on monthly
basis.
• 3. Mobile teams also travel to areas that are difficult to reach for regular
immunization services.
• 4. Intensive programmes such as Mass, National Immunization Days (NIDs) and
Child Health Days (CHD‘s) where all children under 5 years are immunized.
• 5. House- to-house immunization in CHPS zones.
• 6. Immunizations are also given in institutions like Day - Care Centres and during
School hygiene inspection
• Before any immunization session, the following tasks need to be performed:
• i. Determine the number of children to be immunized in a month.
• ii. Determine how often to conduct the immunizations.
• iii. Determine the catchment areas that need to be covered within a month.
• iv. Determine a day that would be convenient for the clients.
ADMINISTRATION OF VACCINES
• Common Vaccines (Antigens)
• Vaccines are put in small containers known as vials or ampoules.
• 1) BCG (Bacillus Calmette Guerin) Vaccine
• It is a live attenuated vaccine. It was first produced by two French scientists called
Calmette and Guerin. It protects against tuberculosis (TB).
• Age: it is given from birth to one year.
• Route of Administration: intradermal in the right upper arm on the deltoid
muscles. Dosage: 0.05ml to children 0 -11 months.
• Reaction of BCG: After injecting a small, red, tender area appears(patch) this may
develop into nodule and leave a scar, this may burst (ulcerate), after some weeks it
heals and leaves a scar. The nurse must counsel the mother not to massage or
apply anything onto the site
How to Reconstitute BCG Vaccine
• - It is in powdered form
• - It is a live vaccine and frozen dry
• - It is reconstituted by adding 1ml of diluent into the powder
• - It is destroyed by heat, sunlight and detergent.
• - To protect the vaccine it is put in dark brown containers (vials) since it easily
looses its potency
• - It is damaged by using spirit and disinfectants in cleaning the site after injection
• Administration of BCG Vaccine
• How to position the baby:
• - let the mother hold the baby and free its right arm from the clothes
• - hold the baby‘s arm with your left hand while you inject with the right hand.
To Load the BCG Syringe
• Fix the needle onto the syringe very firmly
• Draw a little more than 0.05ml of reconstituted vaccine into the syringe
• Put the vaccine back into the ice pack. Point the needle upwards and expel any air
bubbles and extra vaccines till you get 0.05ml left in the syringe
• Clean the skin with cotton wool swabs (wet with boiled cool water).
• Hold the child‘s arm with your left hand so that your left hand comes under the
arm, your thumb and fingers reaching around the arm and stretching the skin
tightly.
• Hold the syringe in your right hand with the bevel (cut-end) facing up towards
you.
• Lay the syringe and needle almost flat along the child‘s arm, while you try to pick
the skin, to avoid getting deeper in to the skin.
+
• Insert the tip of the needle just under the skin, with the bevel facing you, enclosing
the bevel (the cut side of the needle) and a little bit more of the needle.
• Keep the needle flat along the skin so that it only goes with the top layer of the
skin.
• Put your thumb over the needle end of the syringe to hold it in position
• Inject 0.05ml of the vaccine and withdraw the needle without touching the site.
• Note: If you inject BCG correctly, there will be flat patch at the site, which
disappears and forms a nodule and a scar in a few weeks time.
Oral Polio Vaccine (OPV)
• It is administered to protect against poliomyelitis (infantile paralysis). It is a live
attenuated vaccine containing 3 types of sabin strain (1, 2, 3).
• Age: it is given at birth and before 2 weeks. The polio at birth is not the first dose,
but considered as polio “O”. The 1st dose is given at 6 weeks, 2nd dose at 10
weeks and 3rd dose at14 weeks.
• Interval: All the 3 doses are given at 4 weeks intervals.
• Dosage: two to three drops according to the manufacturer‘s instruction.
• Route: oral - dropped at back of the tongue.
Administration of OPV
• Find out from the mother whether the child has been given polio before.
• Collect the Child‘s Health Record Booklet and check if the child is due.
• Explain the procedure to the mother.
• Make sure the mother understands what the vaccine is meant for.
• Ask mother to place the child on her laps.
• Open the vaccine carrier and remove the vaccine, remove the top and fix it with a
pipette.
• Use your left hand to open the mouth of the child by pressing the lower jaw
gently.
• Squeeze two or three drops of the vaccine (according to the literature) at the back
of the tongue.
Administration of OPV CONTINUED
• Instruct mother to allow baby to swallow,
• Wash your hands with soap and water and dry with a clean towel.
• Record the immunization into the Child Health Record Booklet and clinic register,
and tally in the immunization tally book.
• Give other immunizations if due
• Congratulate the mother for bringing the child.
• Remind the mother of the next dose.
DPT/ HibHepB (Five-in One Vaccine or Pentavalent)
• This is made up of five vaccines (Diphtheria, Pertusis, Tetanus, Haemophilus
influenza B, Hepatitis B), and given as a triple-dose vaccine.
• Age: it is given at 6 weeks
• Interval: 4 weeks (1st dose at 6 weeks, 2nd dose at 10 weeks and 3rd dose at 14
weeks)
• Dosage: 0.5ml
• Route: intramuscularly at the left medio-lateral thigh.
• Reaction / side effect: slight rise in temperature.
• Management: give 0.5mls of syrup paracetamol 3 times daily for 3 days. After
three days if temperature persists, send the child to the hospital for investigation
for any possible illness.
Administration of DPT / Hib-HepB Vaccine
• Welcome the mother, offer a seat and create rapport.
• Find out from the mother if the child has been given DPT/HibHepB vaccine.
• Collect the child’s health record booklet and check the vaccines given to
make sure the child is due.
• Explain procedure to the mother
• Make sure the mother understands what the vaccine is meant for by asking
for feedback.
• Discuss with mother how to manage any possible fever at home
• Position the baby on the lap of the mother, and face the child‘s left thigh.
• Wash hands with soap and water and dry them.
• Remove the vaccine
• Pick a sterile solo-shot syringe and needle, and draw the correct dosage of
DPT/HibHepB
• Pick the cotton wool swab with soiled cooled water, and clean the site
Administration of DPT / Hib-HepB Vaccine CONT.
• Ask mother to hold child firmly.
• Hold the muscle at the outer part of the left thigh firmly with your left hand, a
dimple or depression will appear. Gently push the needle into the dimple at an
angle of 90 degrees
• Withdraw the piston slightly to check if the needle is not in a vein (if it is,
withdraw the needle with the vaccine, discard and use another one).
• If there is no blood in the vaccine gently push the vaccine into the muscle
• Apply a swab with a little pressure to prevent any bleeding, while withdrawing the
needle.
• Remind mother of the next dose and thank her for bringing the child
Measles Vaccine
• The vaccine is a live- attenuated vaccine which comes in vials. It is reconstituted
with 5mls of diluent.
• Dosage: 0.5mls
• Dose: It is given twice.
• Age: 9 months and 18 months
• Route of Administration: it is given either deep subcutaneous or intramuscular at
the upper left arm (deltoid muscle).
• Storage: it is stored between 0 degree and 8 degrees.
• Management: tell mother that this does not give rise in temperature, but if there is
high temperature, they should see the medical officer for treatment of any possible
illness.
Yellow Fever Vaccine
• It is a live- attenuated vaccine also destroyed by heat and sunlight.
• Age: 9 months
• Storage: in a temperature of 2- 8 degrees
• Dosage: 0.5mls
• Interval: 10 years
• Route of administration: either subcutaneous or intramuscular at the right upper
arm into the deltoid muscle.
Administration of Measles or Yellow Fever Vaccine
• Explain procedure to mother and make sure she understands by asking for
feedback.
• Sit the baby on the mothers lap
• Tuck baby‘s right arm away, around the body
• Mother‘s left arm goes round the baby to support the head, her left hand holds the
baby‘s left shoulder, her right arm holds the baby‘s leg out of the way, and her
right hand holds the baby‘s left hand.
• Wash hands well with soap and water and dry them
• Draw the correct dosage of the vaccine, 0.5ml
• Pinch up the muscle of the outer part of the child‘s upper arm with your fingers
• Clean the site with a wet cotton swab
• Push the needle into the pinched- up muscle
• Hold the syringe with your left hand firmly and use the right to withdraw the
piston to check for blood. Withdraw the needle if there is blood, discard and use
another sterile syringe and needle.
• If no blood press the piston with your thumb to inject the vaccine and remove the
• needle applying slight pressure on the site with a swab
• Thank the mother for coming
THE COLD CHAIN SYSTEM
• The cold chain is a system that ensures that vaccines are kept in a potent state
during transportation from the manufacturer to the people to be immunized or
recipients. It consists of transportation links during which adequate refrigeration is
ensured.
• A break at any level of the cold chain would destroy the potency of the vaccines.
Once vaccines lose their potency they cannot be rejuvenated through refrigeration
or any other means.
• The Cold Chain System:
• Manufacturer
• Manufacturer: The manufacturer produces the vaccine and sends telex to the
airport of the receiving country. The telex contains the quantity of vaccines that
are coming to the country, the type, the date and time the vaccines will reach the
airport.
Airport
• Airport (Ghana) Central store

• Regional store
• District store
• Sub-district store
• Recipient (Clinic)
Vaccines are carried in special planes with refrigerators. The national cold chain
staff is supposed to be at the airport before the plane arrives with cold vans.
Central or National Cold Store : Vaccines are carried in cooling vans from the
airport to the central cold store (national level), at the correct temperature. The
vaccines are kept in special cooling rooms built purposely to store vaccines at the
correct temperatures.
Regional Cold Store
• Vaccines are carried in cooling vans from national cold store to the regional cold
store at their correct temperatures in deep freezers and refrigerators.
District Cold Store
Cold boxes are used to carry vaccines from the regional cold store to the district
cold store. At the district, they are kept in big deep freezers and big refrigerators
according to their required temperatures with deep freezers, refrigerators, cold
boxes and vaccine carriers.
Sub-district or Health Centre Store
Vaccines are carried from the district store to the health centre in vaccine carriers.
They are stored in refrigerators, cold boxes, freezers, and vaccine carriers at the
sub-district.
• Recipient
• Vaccines are carried in vaccine carriers from the health centre store to the recipient
on the field. Vaccines when reconstituted or removed from the carrier are placed in
ice cubes to maintain the potency before it is given to the recipient.
Cold Chain Equipment
Freezer / refrigerator
Deep freezers
RCW 42 EK
Cold box
Vaccine carrier
RWC vaccine carrier
VACCINE CARRIERS AND COLD BOXES
TEMPERATURES FOR STORING VACCINES
• The coldness and hotness of something is what defines temperature. The
instrument used for measuring temperature is called thermometer.
• All temperatures below 0 degree are negative (-) and freezing.
• Temperature above 0 degree are positive (+) range. Currently vaccines are stored
between +2 centigrade to +8 degrees (+2 to +8 degree Celsius).
ADVERSE EVENT FOLLOWING IMMUNIZATION (AEFI)
• Adverse Event Following Immunization (AEFI) is any untoward medical

occurrence which follows immunization and which does not necessarily have a
causal relationship with the usage of the vaccine.” The adverse event may be any
unfavorable or unintended sign, abnormal laboratory finding, symptom, or
disease. Reported adverse events can either be true adverse events, i.e., resulting
from the vaccine or immunization process – or coincidental events that are not due
to the vaccine or immunization process but are temporally associated with
immunization.
• Regarding the causes of AEFI, it could stem from the five broad categories of
AEFI as per the World Health Organization (WHO) classification. These are
vaccine-product related reaction; vaccine quality defect-reaction; immunization-
related reaction; immunization-anxiety related reaction and coincidental
reaction/event.
Some Possible Reasons for Defaulting Immunization
• Low motivation of parents due to lack of understanding of the importance of
immunization
• Fear of side effects on the child
• Poor access to immunization services (long distances)
• Long waiting time at the facility
• Some health workers charging for what should be free
• Lack of reliable services staff are not present to immunize when they are supposed
to
• Unpleasant attitudes of some health staff
• Disappointment from non-availability of vaccines and other essential supplies
Transportation of Vaccines from the Health Centre to the
Clinic
• Pick up your vaccine carrier and check for cracks.
• clean the carrier and make sure the lid is well fitted.
• Take the required ice packs at the appropriate temperature.
• Estimate and take only the quantity needed.
• Take polio BCG, measles, yellow fever, DPT/HibHebB, which are live vaccines
first, and cover with foil.
• Put other vaccines like tetanus toxoid vaccines on the foil and cover with another
foil.
• Put the diluents on top of the foil.
• Take the shortest and fastest possible route to the clinic.
• Put vaccine carrier under a shade always.
Transportation of Vaccines from the Health Centre to the
Clinic
• The vaccine carrier should be opened only when necessary.
• Remove vaccines needed at a time.
• If the Geostyle type of vaccine carrier is used, put the vaccine needed at a time in
the perforation in the foam.
• The lid of carrier must be securely tight after opening.
THE VACCINE VIAL MONITOR (VVM)
• A vaccine vial monitor (VVM) is a label containing a heat-sensitive material
which is placed on a vaccine vial to register cumulative heat exposure over time.
The combined effects of time and temperature cause the inner square of the VVM
to darken, gradually and irreversibly.
• A direct relationship exists between the rate of colour change and temperature:
• The lower the temperature, the slower the colour changes.
• The higher the temperature, the faster the colour changes.
• The VVM is a circle with a small square inside it. It can be printed on a product
label, attached to the cap of a vaccine vial or tube, or attached to the neck of the
ampoule.
• At the starting point, the inner square is a lighter colour than the outer circle.
From then on, until the temperature and /or duration of heat reaches a level
known to degrade the vaccine.
• Beyond acceptable limits, the inner square remains lighter than the outer
circle.
• At the discard point, the inner square is the same colour as the outer circle.
This shows that the vial has been exposed to an unacceptable level of heat
and the vaccine degraded beyond acceptable limits.
• The inner square will continue to darken with heat exposure until it is
much darker than the outer circle. Whenever the inner square matches or is
darker than the outer circle, the vial must be discarded.
VACCINE VIAL MONITOR
Using the safety box
• All used sharps are discarded in a safety box immediately after use.
• If possible, use 15-litre safety boxes for vaccination campaigns
• Do not go beyond the safety box’s maximum syringe capacity. Do not fill beyond the
maximum line shown.
• Do not handle the safety boxes unnecessarily, shake them, or compress them.
• Store them in a safe place, out of reach of the public, while they wait to be transported
for disposal.
• The personnel that handle the safety boxes should always wear thick gloves (at the
vaccination site, during transport to the disposal site and at the disposal site).
• They should never be carried in someone’s arms.
THE SAFETY BOX
PHYSICAL EXAMINATION UNDER THE SCOPE
OF WORK OF THE PUBLIC HEALTH NURSE
• Physical examination is an important component of the scope of work of a public
health nurse. As part of their duties, public health nurses conduct physical
assessments to identify health problems, assess the overall health status of
individuals, and develop appropriate care plans.
• A physical examination is a medical examination that is performed by a healthcare
provider to evaluate a person's overall health status.
• HEAD TO TOE PHYSICAL EXAMINATION
• Performing a head-to-toe physical examination is an important part of a
comprehensive health assessment. The following is a general guide of what to
look for in each area of the body:
HEAD:
 Inspect the scalp for any lesions or abnormalities
• Examine the face for symmetry and any abnormalities, such as asymmetry or
drooping
• Check the eyes for visual acuity, pupillary response, and redness or discharge
• Examine the ears for any signs of infection or hearing loss
• Inspect the nose for any discharge, swelling, or tenderness
• Check the mouth and throat for any abnormalities, such as redness, swelling, or
lesions
• NECK:
• Check for any masses or lymph nodes
• Palpate the thyroid gland for any nodules or enlargement
• Assess range of motion and strength
• CHEST:
• Inspect the chest for any deformities or abnormalities
• Palpate for any masses or tenderness
• Auscultate the heart for any murmurs, rubs, or gallops
• Auscultate the lungs for any wheezing, crackles, or diminished breath
sounds
• ABDOMEN:
• Inspect the abdomen for any scars, distention, or masses
• Palpate the abdomen for any tenderness, organ enlargement, or masses
• Auscultate the abdomen for bowel sounds
• EXTREMITIES:
• Check for any deformities or abnormalities
• Palpate for any swelling or tenderness
• BACK:
• Inspect the back for any deformities or abnormalities
• Palpate for any masses or tenderness
• SKIN:
• Inspect the skin for any lesions, rashes, or abnormalities
• Check for any moles or other growths that may be suspicious for skin cancer
• Overall, it is important to perform a thorough physical examination, paying close
attention to any abnormalities or changes in the patient's health status. It is also
important to document any findings in the patient's medical record for future reference.
Physical Examination
• Physical examination is carried out on clients on the first contact, using all senses.
This is
• performed on:
•  The new born baby.
•  When a baby is brought to the clinic for the first time.
•  When the baby is sick.
•  The pregnant woman on each visit.
•  The woman, when labour sets in.
•  The woman, after delivery.
•  During the first visit in the puerperal period.
•  During the second visit in the puerperal period.
•  When a woman is to be put on a family planning methods.
•  During home visit, when you are seeing clients of all ages and both sexes.
•  It is also carried out on the pupils/students during school hygiene inspection
• PHYSICAL EXAMINATION OF THE CHILD FROM HEAD TO TOE
• Head: Examine the head of the child, which should be proportional to the body.
When it is bigger or smaller it is abnormal (hydrocephaly or Anencephaly
respectively).
• Hair; A newly born baby‘s hair should be black curly and shinny.
• Scalp: Examine scalp for cleanliness, rashes or sore
• Fontanelle the anterior is diamond in shape and it should admit 2-3fingers and
pulsates. It closes at 18 months. The posterior fontanelle is triangular in shape and
admits 2 fingers. It closes at 6 weeeks
• Eye; Examine the eye for blood stain which may be due to delivery this will
disappear by itself. Observe for any purulent discharge. This is an indication for
gonococci eye infection. Baby should be referred for immediate treatment
• Ear; Examine for cleanliness, excessive wax, and position of ear. Lower set ears
may demote kidney problems.
• Nose; Examine the nose for cleanliness, runny or blocked nose, or any deformity.
• Mouth: Examine for cleanliness, coated tongue, false teeth, cleft palate, and tongue tie.
• Inspect the mouth for oral thrush and advice on proper cleaning of the mouth
• Neck: Examine for any swelling, rashes or any other deformity
• Umbilical Cord: Inspect umbilical cord for proper healing of stump. If there is hernia
• refer. Examine if the cord is healed, dry or offensive, and refer.
• Breast: For abnormal position and extra nipple and refer. There may be milk in the breast
for the first weeks; this is due to the effect of maternal hormones .This disappears by itself.
• Skin: The skin of a new born baby is pink and smooth. Examine for rashes, boils, septic
spots, wrinkles (mostly found in premature babies).
• Buttocks: Separate the buttocks and inspect to see if the anus is well perforated. Inspect
• for rashes or sore.
• Genital Organs: Examine the males to see if the testes have descended into
scrotum.
• The urethral orifice should be one and well perforated. In the female examine to
see if
• The labia have been well separated.
• Limbs: Examine both upper and the lower limbs for equality, fingers and toes for
extra
• digits, webbed fingers sores or rashes.
• Chest: Observe for the shape of the chest and pattern of respiration.
• Vertebral Column: Run your fingers along the vertebral axis to inspect for any
dimpling
• or hole into the spinal cord, check for spinal bifida. Inspect also for sore or skin
rashes at the back.
PHYSICAL EXAMINATION OF A BABY
1. Explain procedure to mother and wash hands/apply alcohol rub to the hands
2. Ask mother to place baby on her lap for physical examination
3. Observe the size and shape of the head
4. Feel the skull for anterior and posterior fontanelles, and observe for any
abnormalities
5. Open baby’s eyes gently with the thumb and index finger and examine
the eyes
6. Examine the nose, mouth and the ears
7. Examine the neck for enlarged lymph nodes
8. Examine the armpit, upper limbs and nails
9. Test for reflexes ( at least one)
PHYSICAL EXAMINATION OF A BABY
10. Examine the skin for any rashes and muscle tone
11. Examine the trunk and abdomen
12. Observe umbilicus for any rashes and muscle tone
13. Examine the groins for swelling, vulva for discharges, scrotum for
cleanliness and undescended testes
14. Examine the lower limbs and nails
15. Turn child and examines the back, buttocks and anal area for any
abnormalities
16. Assist mother to dress up baby, discusse findings with mother and refers
if necessary
17. Apply alcohol rub to hands, record and report/document findings
THE COMMUNITY
• The World Health Organization (1974) has defined the community as being a
social group determined by geographic boundaries and / or common values and
interests. Its definition states that community members know and interact with one
another, that the community functions within a social structure, and that the
community creates norms, values and social institutions.
• A place or geographical area where a group of people lives and shares a common
interest and aspirations and have social network of relationships at the local level
• A group of people with well-defined demographic characteristics and power
structure also form a community. E.g. Villages, Towns and Other residential areas
• On the other hand, people who do not live in the same neighbourhood but share
common characteristics in terms of goals, etc could be described as communities.
E.g.,youths, Ethnic minorities, Drug addicts, Handicapped person
• The community within the framework of CHPS is described as:
•  A place or geographical area where a group of people live and share
• common interest and aspirations, and have social network of relationship at the local
• level.
•  A group of people with well defined demographic characteristics and power
• structures.
•  A cluster of villages or divisions of a larger settlement or town with a travelling
distance of 5 to 10 kilometres across and a populations of 3000 to 5000 people
altogether. This means that if three or four villages, or a single one, or as a
• division of a larger community in a geographical area provide a total of 3000 to 5000
people and the distance to be carried by the community health officer riding in
• between 5 to 10 then, that is one community in which the principles and practices of
• CHPS will and a CHO located (MOH, 2003).
Types of Communities
• 1. Rural community refers to a population of less than 5000 residing in the same
• geographical area. They share the same needs have common health problems,
same culture, beliefs, who are more united and have the informal way of
instruction. The elders and old people are able to direct and correct any one in the
community.
• 2. Urban community has a population of 5000 or more, who have different
• ethnic groups and have different ideas, beliefs, taboos and culture. However, their
• needs and problems could be the same or different.
• 3. Traditional communities are old and established settlements of people with
• certain common identifiable traits. In the traditional community ethnic characteristics
• such as clans, families’ ties, religion and occupation among others, are found to be
• common. Important natural bounds such as common leadership, language, traditions
• and customs hold members of this type of community together. These characteristics
• could provide useful criteria for segmenting such as communities into recognizable
• and practical units to facilitate mobilization for sustained development activities. On
• the other hand, the belief and customs of some of such traditional community could
• hinder the work of health workers as such beliefs and customary practice may conflict
• with convectional acceptable health practices. Most rural towns and villages in Ghana
• are typical traditional communities (MOH, 2002).
• 4. Solidarity community is where people are seen to be living in a common
• territory because of common heritage such as nationality, ethnicity, religion or
• language. Since they often define themselves as belonging to that group and
• emotionally loyal to it, the possibility of their working as a community to promote
their own health and well-being is high. On the other hand, if they object to a type
of health information because it contradicts their belief systems, it could hinder
the promotion of health programmes.
• 5. Neighbourhood community is another territorially bound conception of the
• community, which could be recognized and used to promote community
mobilization.
• This develops as people live in areas together for a period of time and in the
process develop familiarity out of which strong loyalty may grow. Examples of
such communities are the workers‘ estates, residential settlements, Zongos, and
so on.
• Furthermore, neighbourhood integration may not be totally based on loyalty and
• personalities, but on share interest and common problems such as unsanitary
surroundings, poor water and sanitation facilities and outbreak of common
illnesses, which may call for attention from all. Moreover, neighbourhood
communities when properly identified and recognized through a problem focus,
can effectively serve as manageable units which could be organised for
effective and sustainable participation in health service delivery.
Features of a Community
• a. Political structure - communities have their own structures around which
political activities are organized. It is extremely important for the preventive nurse
to know and understand these structures and how they function in order to be used
to win the community members.
• b. Traditional leadership structures – these are identified positions, roles and
responsibilities of the paramount chief, divisional chiefs, queen mothers, elders,
spiritual leaders which are tapped in the discharge of health services.
• c. Formal political structures - Identify the formal or governmental structures that
• exist in the community, which include the office of the district chief executive, the
• district assembly unit committee, and so on. These structures can be involved in
• planning, implementing and evaluating health related activities.
• The community/Public health nurse who is charged with the care of community
members, in order to effectively perform this role has to identify their desired
Community Entry
• It is the process of initiating, nurturing and sustaining a desirable relationship with
the purpose of securing and sustaining the community’s interest in all aspect of a
programme (M.O.H. Manual 1999).
• Community entry refers to the process, principles and technique of community
mobilization and participation. This involves recognizing the community, its
leadership and people and adopting the most appropriate process in meeting,
interacting and working with them.
• Thus, Community entry is the process of gathering data about the people the
community/Public health nurse will be working with so that he or she can be
accepted to carry out his or her tasks.
•
Contact persons
• Heads of families
• Heads of schools or teachers
• Religious leaders
• District Assembly members
• Village / town development committee members
• Unit committee members
• Youth leaders
• Women’s group leaders
• The water and sanitation committee
• Diseases surveillance volunteers
• Traditional birth attendants and
Meeting with community leadership
• In Ghana, traditional leadership lies in the hands of a hierarchy of persons ranging
from the paramount chiefs through town/village chief, clan/lineage heads to
family heads. At each of these levels of leadership, communities have their own
schedule and plans of carrying out development activities. There is therefore the
need to recognize the position and roles of the community leaders in order that the
most suitable ways could be developed in seeking their co-operation and support
for implementation of programmes.
• In organising meetings with chiefs and their elders, it is important to schedule
meeting times to suit the traditional leaders. The following guidelines of meetings
with chiefs should be followed when meeting with community leadership:
•  Meet the paramount chief first and discuss the new health programme with him.
Allow him time to discuss your proposals with his sub-chiefs and elders.
•  Meet the chiefs of selected communities and discuss the programme with them.
Meeting with community leadership
• Meet the chiefs, their elders, and the community as a whole and discuss the
• programme at the sub-district level and subsequent community meetings.
• During the meetings with chiefs, you should first greet and introduce yourself to
the chief, elders and other leaders. Inform them of your mission and ask for their
permission and advice to get started.
• They can tell you some of the problems, what they think about health service in
the area and what the community has been doing about health. You can get the
ideas from contact persons or groups in the community whose support can
facilitate your work.
Critical Action for the Community Entry
• Know the community
• Identify the community leaders
• Identify the contact persons
• Conduct meetings with the community leaders
• Let the community leaders and the people know you and your missions
• Brief leaders on the purpose of your visit
• Seek approval and support for your programme, study and be conversant with
• the customs, and the traditions of the people
Community Study
• The Public/Community health nurse after gaining entrance into the
community survey to find herself approved to work in the
community.
• Community survey is a systematic study designed to collect data on
a community‘s functioning, data on a specific segment of the
population, data on a particular component of the health care
delivery systems or data on health needs of the entire community
may be collected when conducting a survey. However, the scope
varies depending on the purpose and the financial and work force
resources available. It is important to define specifically the reason
for doing a survey because this process can be costly and time-
consuming
Community survey
• Purpose: Surveys are commonly conducted in the

community/public health nursing practice because, existing
data from census, vital statistics and morbidity records are
inadequate to substantiate a need from the development of a
particular health programme
•  Again, a survey can be carried out to discover the main
health needs of the community. Accurate base line
information of the community is obtained before solutions
are put in place. Then a re-survey is done after a period so
that estimation of progress can be ascertained.
Community survey
•  Discover those individuals and families with the greatest health
needs such as:
• - Children under five
• - Pregnant and lactating mothers
• - Those with serious chronic illnesses such as TB, Leprosy, AIDS
• - The physically and mentally disabled, the elderly
• - Any group, family or individual who is socially out cast or very poor
Build relationship and create trust.
•  Teach and sensitize people by creating awareness on how problems
can be solved.
COMMUNITY SURVEY:
Helps the health workers to plan and work effectively.
 Help health workers to schedule their work to cover the target
populations.
 Identify resources that can be utilized to support the people.
 Ensure community mobilization and participation.
Uses of Data
• Data obtained from a survey provide the foundation for more

extensive investigation of health needs in the community.
Researches frequently conducted after surveys are completed to
explore the potential cause-effect relationship between deferring
community phenomena.
• The community profile can help the health workers decide where to
put health education effort by letting the community know special
needs of special people like children, the elderly, families with
young children, the disabled and the poor. It is also needed to
provide evidence to convince others of the need for special
programmes and why they have to support such programmes.
Community survey
• The community profile can help the health workers decide where
to put health education effort by letting the community know
special needs of special people like children, the elderly, families
with young children, the disabled and the poor. It is also needed
to provide evidence to convince others of the need for special
programmes and why they have to support such programmes.
Types of Surveys that can be undertaken
1.Comprehensive survey: This is the type of survey where every

home is visited and questions are asked concerning the needs of all
family members. The main advantage is that all individuals at risk
can be discovered and comprehensive care given. However, the
disadvantage is that it is time consuming.
2. Sample surveys: With this type of survey, selected houses are
visited. For instance, the nurse can decide to enter every fifth house.
Sample survey is used when the community to be studied is a large
one.
3. Mixed surveys: This is using both the comprehensive and sample
survey approaches. For instance, for socio-economic data, selected
homes can be visited, but for nutritional status, all children under two
years will be visited and weighed or arm circumference measured.
Types of Surveys that can be undertaken
• 4. Pilot survey : Small scale surveys carried out at the start of a project,
either to estimate the needs of the people or an approximate census or
to pre-test a survey technique
Who should undertake community survey?
 Project and community members
Health committee members can also undertake community survey.
The project officer
 The community health workers and community members as in the
participatory leaders approach
 Student community/public health nurses - This is evident when student
nurses are expected to identify at least one problem in the community
and research into.
When to undertake community survey
 Community survey is carried out when the community is ready to
participate, this will make the work of project officer or nurse easier
 When there are enough resources to make movement and
documentation possible
 At the times of the day and a time of the year when most people are at
home and not too busy with other activities
 During Pre-survey activities
How to carry out a survey
 Arrange the day in advance, inform the people so that they can get
themselves ready and support the programme
 Work in pairs if possible
 There are variety of ways which a community can use to survey it
needs,
 Personal interviews
 Telephone interview
 Written questionnaires
 Focused group discussions
 Mapping and diagramming
•  Semi- structured interviews
•  Sorting out and ranking
•  Transect walk and observation
•  Time line, schedules and seasonal calendars
•  Matrices (GHS/MOH manual 2002)
Community Profile
• The term community profile is the process by which the

community/public health nurse systematically obtains information to
understand the community in which he/ she plans to work.
• The profile is a handy documentation or the main characteristics of the
community so identified for the implementation of CHPS. The
document informs health workers of what the community is, what it has
and what it does not have in terms of health and other social structures
for health promotion in the community
• The main features described in typical community profile are listed
below;
• The name of the community
•  The name of the zone in which community is located
•  The name of the sub-district in which the community is located
•  Name of villages/ settlements making up the community
•  Brief definition of the landscape and vegetation
•  Population of the community
•  Main customs and beliefs of the people
•  Predominant religious groupings
•  Economic activities – sources of income
•  Economic facilities – markets , shops etc
•  Forms of transportations
• Forms of communication
• Water facilities
• Sanitation facilities
• Housing – nature and pattern of housing
• Schools and other educational facilities
• Health facilities – hospital, clinics, health posts chemist shops,
traditional healers
• and TBAs home etc.
• Disease patterns - most common causes of illness, most frequently
diagnosed
• diseases, special and unusual health problems
• Sickness and health behaviour;
• who people see for health when sick
• what people diagnose diseases
• what roles the traditional healers and TBA play in health delivery
Community population register
• The community population register represents another important tool

for the implementation of CHPS. It provides a record of the
characteristics of individual members of the community, as well as, a
summary of basic demographic information on the community
members.
• The community register is a tool for effective planning of health
services. It helps the health workers keep track of births and deaths in
the community, as well as, migration into and out of the community. It
also helps health workers to quickly determine the immunisation status
of the children and women as well as the contraceptive status of the
• women and men
• A sample of the community population register used by the Ministry of
Health is presented below. It is meant to provide information on the
following
• household identification particulars
• particulars of births and nationality
• immunization records
• disability records
• migration records
• occupation records
• and particulars on death
• Title page – community population register
SAMPLE OF A COMMUNITY POPULATION REGISTER
MINISRY OF HEALTH
COMMUNITY POPULATION REGISTER

TOWN / VILLAGE / SECTION
………………………………………………..
DISTRICT
………………………………………………………………………
REGION
………………………………………………………………………..
FROM ………………… TO …………………
(DATE ) (DATE )
Community Needs Assessment and Diagnoses
The community health nurse gathers data with the view of breaking it
down to identify the needs of the community members and help address
these needs.
Objectives
- Identify the various types of needs of a community
- Describe the process of assessing and prioritising the primary health
care needs of a community
- Diagnose the community‘s problem
Needs: The concept of needs describes the situations or circumstances in
which something is lacking, or necessary requiring some course of action
to provide satisfaction. Needs must be well defined and must be specific.
Types of Needs
• Felt Needs: These are what people feel for, or their wants. They may
only be the feelings of the individual people, or wants shared by groups
of people in the community. These may therefore be either an
individual or community assessment of the present situation,
discovering what is lacking and realising the potential for change.
Felt needs may be expressed informally within the community. They may
be influenced by the beliefs of the people on the extent and nature of the
health problems, their causes and possibilities for prevention and cure.
These are further influenced by the people‘s previous experience, their
culture, education, understanding of epidemiology
• Expressed needs: These are the needs that have been moved from the
level of being felt to that of being brought to the attention of authorities
at various levels (expressed by requests, complaints petitions). These
needs may have been presented to authorities in writing or verbally.
• Organizational Determined Needs: These are products of decisions
emanating from external organizations to the community.
Organizational determined needs are what external organizations such
as the Ministry of Health, Department of Community Development
among others have decided to be the community needs, which may not
• necessarily reflect the felt needs of the people. These needs are
determined from out side the community.
• Health Systems Needs: These are needs or problems related to the
health systems. It may include policies emanating from inside or
outside the health sector, which have negative effects on the population
and prevent it from utilizing the health services in full. It may also
include the negative attitudes of health workers, which range from
favouritism to extorting money from users.
• User needs: Fears about what happens in the facility, people‘s
perception about diseases, illness, treatment, and modern public health
practices which prevent them from utilizing the facility. If people are
well informed about what happens at health facilities, the bridge will be
closed.
• Community needs: These can arise from the rules and laws governing
the community.
• Some of these needs such as taboos, beliefs and cultural practices may
be detrimental to health. For example, female genital mutilation which
affects the health of females, is a major community needs to those who
practice it.
NEEDS ASSESMENT
Is the process of finding out, and prioritizing the local problems of a

community, identifying the environmental, and socio-cultural factors
influencing such problems, and structuring the resources available in the
community to solve the problems.
Community needs assessment: A systematic process of involving data
collection and analysis to arrive at a diagnosis with the full participation
of community members.
The importance of assessing the needs of a community in terms of
health could be judged from the following:
• It enables health workers and their partners to gather and disseminate
information on health and well being of the community
• promotes the collection of appropriate information for effective
programmes
• It helps to raise awareness of key issues confronting the people in the
• community and among the partners on community based health service
delivery
• Community participation in assessing health needs creates the
foundation for the people‘s active involvement in the implementation of
future health programmes.
Purpose of Community Needs Assessment
• The purpose of community needs assessment is essential for the

community/public health nurse to have an understanding of the
community dynamics since health action occurs in the community.
Every community has patterns of functioning or community dynamics
which either contribute to, or detract from its state of health.
The community/public health nurse must have knowledge of these
patterns in order to anticipate community responses to health actions and
to influence the directions of health programming.
• Community assessment helps health workers to identify cultural
differences in relation to consumer interests, strengths, weaknesses,
concerns and motivations
It further helps health workers in the analysing processes through which
community beliefs, values and attitudes are transmitted
It helps health workers to individualize health-planning activities for
their community to make it community oriented to help achieve positive
results. This is because tradition in each community varies. Programmes
appropriate for one community or for a group within community may be
effective in meeting the needs of other community populations.
• Moreover, experiences from one community setting cannot always be
generalised to another because health needs and resources are not
consistent from one community to another.
• It promotes the collection of appropriate information for effective
programme planning
• It helps to raise awareness of the key issues confronting the people in
the community and among the partners in the community based health
services delivery (MOH/GHS manual 2002).
• It has been realizedthat community participation in assessing health
needs, rather creates the basis for the community members’ active
participation in the implementation of future health programmes.
PRIMARY HEALTH CARE (PHC)
• The concept was formulated (expressed) by 134 nations who met in 1978 at
Alma Ata (Russia) conference by the World Health Organization and United
Nation Children Fund (UNICEF). It aimed at providing health service to the
people at their door step. It also aimed at providing an acceptable level of
health delivery for all people of the world by the year 2000.
• Before 1978, globally, existing health services were failing to provide
quality health care to the people.
• Different alternatives and ideas failed to establish a well-functioning health
care system.
• Considering these issues, a joint WHO-UNICEF international conference
was held in 1978 in Alma Ata (USSR), commonly known as Alma-Ata
conference.
• The conference included participation from government from 134 countries
PRIMARY HEALTH CARE (PHC)
• The conference jointly called for a revolutionary approach to the health

care. The conference declared ‘The existing gross inequality in the
health status of people particularly between developed and developing
countries as well as within countries is politically, socially and
economically unacceptable’. Thus, the Alma-Ata conference called for
acceptance of WHO goal of ‘Health for All’ by 2000 AD.
• Furthermore, it proclaimed Primary Health Care (PHC) as a way to
achieve ‘Health for All’.
• In this way, the concept of Primary Health Care (PHC) came into
existence globally in 1978 from the Alma-Ata Conference.
Definition of Primary Health Care
• Primary Health Care (PHC) is the health care that is available to all the
people at the first level of health care.
• According to World Health Organization (WHO), ‘Primary Health Care is a
basic health care and is a whole of society approach to healthy well-being,
focused on needs and priorities of individuals, families and communities.’
• Primary Health Care (PHC) is a new approach to health care which
integrates at the community level all the factors required for improving the
health status of the population.
• Primary health care is both a philosophy of health care and an approach to
providing health services.
• It addresses the expansive determining factor of health and ensures whole
person care for health demands during the course of the natural/normal life.
• It is developed with the concept that the people of the country receive at
least the basic minimum health services that are essential for their good
health and care.
• Primary Health Care is essential health care which is made universally
accessible to individuals and families in the community by means
acceptable to them through their full participation, and at a cost that the
community and country can afford. It forms the nucleus (central part) of
the country’s health system.
• PHC therefore addresses the health problems in the community
providing promotion, preventive, curative and rehabilitative services
accordingly.
Terms in the Definition of Primary Health Care
Essential: Health service is important or peculiar to meet the health
1.
needs of the people

2. Accessible: Bringing the health service very near or at easy reach
to the people in the community
3. Universal: Health service is provided to everyone, that is, all
nations, races, ages and sexes.
4. Acceptable: The service provided should be acceptable and used.
The health worker should be sensitive to the reaction of the people in
order to assess the acceptability of the services.
5. Available: The service must be easy to get or available for every
individual to access.
6. Affordable: The nation, community, family and the individual
Reasons for Primary Health Care in Ghana
• Health delivery in the country has developed and continued to improve, even
before the advent of orthodox health services till the present. It was realized
that even scientific health care then could not address most of the health
problems it was purported to address due to the reasons stated below.
• 1. Emphasis was placed on construction of health facilities rather than
provision of health service
• 2. There was the training of sophisticated health personnel, such as doctors,
nurses, pharmacists, technologists, and so on, most of which were designed to
work in the hospitals in the urban areas at the disadvantage of the rural areas
• 3. Inadequate and inequitable distribution of the health staff and equipment in
the health institutions
• 4. Health services were more curative than preventive and had failed to
decrease the unnecessary deaths of children under one year, and also failed to
control endemic diseases.
• There was lack of community involvement and participation in their
own health care
• 7. Lack of collaboration with the other sectors e.g., health related
agencies and other ministries.
Main Objectives of Primary Health Care
• By the year 2000, the following objective were to be achieved
1. To prevent or treat conditions which cause unnecessary ill health,
disabilities and death in the community
2. To increase community participation as much as possible in the health
care delivery
ELEMENTS/COMPONENTS OF PRIMARY HEALTH CARE
1. Health Education on Prevailing Problems and Prevention
The health Education is geared towards the eradication of endemic
but preventable problems, which include those related to food
supply and consumption such as Protein-Calorie Malnutrition,
sanitation problems, as well as problems related to reproductive
and child health issues. Health education related to disease
prevention and general health promotion in individuals, families
and the community. Topics were selected for teaching and the
• message prepared. Simple health education materials prepared to
facilitate the process of understanding the topics.
2. Promotion of Food Supply and Proper Nutrition
This aims at encouraging individuals in the community to improve on
their farming habits in order to increase the yield on the same farm in
order to suffice the ever increasing population. Individuals and groups
were to be taught and supported to rear domestic animals for family
consumption. In addition, modern techniques of farming and cheaper
yielding crops were introduced, as well as, other actions to improve food
security.
3. Promotion of Environmental Hygiene
Most of the preventable health problems and conditions were related to
insanitary environments. As such, necessary to educate the community
members on the need for adequate supply of good drinking water,
proper ventilation, good housing and good refuse disposal methods.
• 4. Maternal and Child Health, and Family Planning
• The health problems include high maternal mortality and high infant
mortality, as well as, morbidity rates. Birth intervals were also short
resulting in large family sizes with attendant problems. Measures put
in place to reduce these problems included:
• Screening for risk factors and giving the necessary care, health
education on how to care for the child, as well as, education on family
planning and provision of the various family planning methods.
Prevention and Control of local Endemic Disease.
5.
Most of the endemic diseases include malaria, malnutrition, diarrhoeal diseases

and neonatal tetanus. They are prevented by the use of chemoprophylaxis, case
finding, and early treatment, as well as the use of oral rehydration therapy to
control diarrhoea. Immunization Against Communicable Diseases; this is achieved
by the immunization against the killer disease of childhood. In addition to that, the
appropriate immunizations were also given during outbreaks of communicable
diseases. Mothers are educated on the importance of immunizations and also how
to give first aid management to sick children in the home.
6. Provision of Essential Drugs
Common drugs were to be made available at all times for the treatment of
common diseases and ailments. The Traditional Birth Attendants and Community
Health Workers are trained to administer simple drugs for conditions like
malnutrition. Food deficiencies, malaria, diarrhoea, worm infestation and first aid
management for injuries
7. Appropriate Treatment of Common Diseases, Rehabilitation and
prevention of accidents, including Mental health
• This lays emphasis on the use of local procedures, herds, equipment and
facilities to combat most endemic conditions instead of relying on foreign
drugs. These measures include the preparation of ORS, use of local
preparations like strained rice water fluid, coconut juice, water from
boiled kenkey and any such fluid, for the management of
• diarrhoea. Malnutrition is also treated by using local foodstuff for
complementary feeding. Prolonged breast feeding was also to be
encouraged.
8.The activities of mental health included primary, secondary and tertiary
prevention with emphasis on practice in the community rather than
practice in institutional setting. The primary prevention activities focused
on the prevention of mental and emotional disorders
These included mental health education and mental health
counseling.Secondary acti vities aimed at preventing mental illness from
developing in people at risk. Tertiary prevention of mental illness is more
specific and addresses the care and management of clients who
experience serious or long-term psychiatric problems.
LEVELS OF PRIMARY HEALTH CARE
• Level A- Community level
• Level B- Health Centre level
• Level C- District level
• Level A - Community Level
• The staff of level A is selected by the community members with the
help of the district and sub district health teams. They were resident in
the communities, and trained to improve on their knowledge and skills
they already have. Continuous training in the form of refresher courses
were organized for them, and continuing technical supervision provided
by the Ministry of Health. They were trained in the preventive,
promotive and therapeutic procedures.
Staff of Level A
• Trained Traditional Birth Attendant (TBA)

• Community Clinic Attendant (CCA) or Village Health Workers
(V.H.W)
• Community Based Distributors
• Duties of the Traditional Birth Attendant (TBA)
• 1. Management of pregnancy and labour
• 2. Counsel on personal and environmental hygiene, nutrition, care of
babies and family planning.
• 3. They practice aseptic techniques to prevent infections
• 4. They keep records for the services given and report to level B
• 5. Early referral of cases beyond their control to level B.
Duties of the Community Clinic Attendant (CCA)
1. He administer correct doses of approval drugs
2. He recognizes serious cases and refer to level B
3. He treats minor illnesses
4. He educates the community on environmental sanitation
5. Organizes and mobilizes the community for communal labour
• Function of the Community Based Distributor (CBD)
• The function is basically the distribution of contraceptives to the
community.
Level B- Health Centre
This is the immediate referral point for level A. it is headed by the

medical assistant.
Staff of Level B
1. Medical assistant is the leader
2. The community health nurse - midwife
3. Enrolled nurse – midwife
4. Disease control assistant
5. Nutrition assistant
6. Supporting staff
Function of Level B
1. Trainning and technical supervision of level A
2. Diagnoses and treatment of diseases and injuries
3. Vaccination of children and pregnant women
4. Supervision of pregnancy and delivery, identification of high risks and refer
5. Trainning of level A staff
6. Collection of data from both levels B and A, and collating to level C
7. Control of communicable diseases
8. Ensuring food, water and environmental protection
9. Acting as liaison between level C and A
10. Level B serves as a point of contact with MOH
11. It serves as first referral point for level A
Level C or the District Level
• The district level is the highest level of the primary health care system.
• Staff of Level C
1. District Director of the Health Services
2. The District Public Health Nurse
3. The District Disease Control Officer
4. Hospital Secretary.
5. Other members
• Functions of Level C
• Most of their activities are supervisory and: Planning budgeting and
general management of the district health service
• Supervision of level B staff
• Provision of technical expertise
PRINCIPLES OF PRIMARY HEALTH CARE
• Social equity
• Nation-wide coverage/wider coverage
• Self- reliance
• Intersectoral coordination
Challenges for Implementation of PHC
• Poor staffing and shortage of health personnel

• Inadequate technology and equipment
• Poor condition of infrastructure/infrastructure gap, especially in the rural areas
• Concentrated focus on curative health services rather than preventive and
promotive health care services.
• Challenging geographic distribution
• Poor quality of health care services
• Lack of financial support in health care programs
• Lack of community participation
• Poor distribution of health workers/health workers concentrated on the urban
areas.
• Lack of intersectoral collaboration
• There was a top - down health care delivery. This means the hospitals
catered for only 30% of the total population in the cities and towns,
and the rural people which form 70% were neglected
CHANNELS FOR PROVIDING CARE FOR ALL AGE
COHORTS: STEPS IN USING HOLISTIC ASSESS
• Age cohorts are commonly used to group individuals based on their
birth year or a specific range of birth years. These cohorts help
researchers, demographers, marketers, and policymakers understand
and analyze different generations or age groups and their unique
characteristics, experiences, and behaviors.
• While there can be slight variations in defining the age ranges for each
cohort, here are the commonly recognized age cohorts:
• 1. Silent Generation:
• Birth Years: 1928-1945
• Characteristics: Experienced World War II and the post-war era. Known
for traditional values, loyalty, and respect for authority.
2. Baby Boomers:
• Characteristics: Witnessed significant social changes and economic
growth. Known for being optimistic, idealistic, and influential in
shaping cultural and political movements.
3. Generation X:
• Characteristics: Grew up in a time of economic and technological
changes. Known for being independent, adaptable, and balancing work
and family life.
TOTAL FAMILY CARE
1. Traditional Definition: Family is a social unit consisting of two or more

individuals who are connected by blood, marriage, or adoption. In this
definition, a family typically includes parents and their children, as well as
extended relatives such as grandparents, aunts, uncles, and cousins.
2. Legal Definition: In a legal sense, family refers to a group of individuals
who are related by blood, marriage, or adoption and who are recognized as
having certain legal rights and obligations towards each other. This can
include rights related to inheritance, child custody, and spousal support,
among others.
3. Functional Definition: Family can also be defined based on the roles and
functions performed by its members. In this sense, a family consists of
individuals who live together and provide mutual support, care, and emotional
connection. This definition recognizes that families can be formed through
various means, such as cohabitation, fostering, or chosen family relationships.
4. Cultural Definition: The concept of family can vary across different cultures and
societies. Some cultures may have broader definitions of family that include close
friends or community members, while others may have more rigid definitions
based solely on biological relationships.
1. Nuclear/Conjugal Family: A nuclear family consists of a married couple
(typically heterosexual) and their biological or adopted children. Its primary
function is to provide care, support, and socialization for the children while
maintaining a stable and loving environment. The family into which one is born
is called the family of origin or orientation. When one matures, marries and gets
children, he becomes a member of a second nuclear family called a family of
procreation.
2. Extended/Consanguine Family: An extended family includes additional
relatives beyond the nuclear family, such as grandparents, aunts, uncles, and
cousins. This family type often emphasizes strong intergenerational bonds,
support, and sharing of resources.
3. Single-Parent Family: A single-parent family is headed by one parent who may
be divorced, separated, widowed, or choosing to raise a child alone. The primary
caregiver assumes multiple roles and responsibilities, providing emotional and
4. Blended Family: A blended family results from the merging of two separate
families through remarriage or partnership. It involves stepparents, stepchildren,
and half-siblings. The main function is to establish new relationships, manage
family dynamics, and foster integration and cohesion among members.
5. Same-Sex Parent Family: A same-sex parent family consists of couples of the
same gender raising children, either through adoption, surrogacy, or previous
relationships. The functions and dynamics are similar to those of a nuclear or
blended family, focusing on providing a nurturing and supportive environment
for the children.
6. Foster Family: Foster families provide temporary care for children who
cannot live with their biological parents due to various reasons, such as abuse,
neglect, or parental incarceration. The primary function is to offer a safe and
stable environment for the child's well-being, while working towards family
reunification or alternative permanent arrangements.
• Adoptive Family: Adoptive families provide permanent homes for
children who are legally adopted. Their function is to offer love,
support, and stability to the adopted child, creating a sense of belonging
and meeting their emotional and physical needs.
Total Family Care
• Total Family Care is a term that typically refers to a comprehensive approach to
healthcare that aims to address the needs of an entire family unit. It emphasizes
providing medical care and support for individuals of all ages, from infants to
elderly family members.
• In a Total Family Care model, healthcare providers recognize the
interconnectedness of family members' health and well-being. They consider the
family's medical history, lifestyle factors, and environmental influences when
diagnosing and treating conditions. The goal is to promote the overall health of
the family as a unit and improve the quality of life for each individual member.
• 1. Primary Care: A family doctor or pediatrician serves as the primary healthcare
provider for all family members, offering routine check-ups, vaccinations,
screenings, and treatment for common illnesses.
• 2. Preventive Care: This focuses on disease prevention through regular health
assessments, screenings, and counseling. It may involve promoting healthy
lifestyles, nutrition guidance, and exercise recommendations for the entire family.
• 3. Chronic Disease Management: Total Family Care addresses the management of
chronic conditions, such as diabetes, hypertension, or asthma, for all affected family
members. Healthcare providers work together to develop personalized care plans
and coordinate treatments.
• 4. Behavioral and Mental Health Support: Total Family Care acknowledges the
importance of mental and emotional well-being. Providers may offer counseling,
therapy, or referrals to mental health specialists when needed for individuals or the
family as a whole.
• 5. Care Coordination: Effective communication and collaboration among healthcare
providers, specialists, and other professionals are crucial in Total Family Care. This
ensures that each family member receives appropriate and coordinated care.
• 6. Health Education: Educating the family about healthy behaviors, disease
prevention, and self-care practices is an integral part of Total Family Care.
Providers may offer workshops, classes, or educational materials to promote health
literacy.
REFERRAL
• A referral typically refers to the act of recommending or directing someone to

a person, organization, or service that can provide assistance or fulfill a
specific need. It is a way to connect individuals with the appropriate resources
or expertise they require.
• WHAT IS REFERRAL IN PUBLIC HEALTH NURSING
• In the context of public health nursing, a referral typically refers to the process
of directing individuals or groups to appropriate healthcare services or
resources beyond what can be provided directly by the public health nurse.
Referrals are made when individuals require specialized care or interventions
that fall outside the scope of public health nursing practice.
• Public health nurses often work in community settings and focus on
promoting and protecting the health of populations. While they provide a wide
range of primary healthcare services, there are situations where individuals
may require more specialized care from other healthcare providers or
facilities.
Referrals in public health nursing can be made for various reasons,
including:
1. Medical specialists: If a public health nurse identifies a client with a
specific health condition that requires the expertise of a medical specialist,
they may refer the individual to a physician, pediatrician, cardiologist, or
other relevant specialists.
2. Mental health services: When individuals require mental health support
or therapy beyond what the public health nurse can provide, a referral to a
mental health professional, such as a psychologist or psychiatrist, may be
made.
3. Social services: Public health nurses often work closely with social
workers and may refer individuals to them for assistance with social issues
such as housing, financial support, or access to community resources.
• 4. Rehabilitation services: If an individual requires rehabilitative care,
such as physical therapy, occupational therapy, or speech therapy, a
referral can be made to a rehabilitation specialist or a rehabilitation
facility.
• 5. Support groups or community programs: Public health nurses may
refer individuals to support groups, community programs, or
organizations that provide specific services or resources related to their
health needs, such as smoking cessation programs, weight management
groups, or parenting classes.
COMMUNITY BASED PLANNING AND SERVICES (CHPS)
Community Based Health Planning and Services (CHPS) is a national

strategy forimplementing the community-based service delivery by
reorienting and relocating Primary health care from sub-district health
centres to convenient locations in the communities. It is a process of
health care provision in which health workers and community members
are actively engaged as partners in the delivery of primary health care
and family planning services. It involves full community participation in
the delivery of care through Community Health Officers, Community
Health Committees and Community Health Volunteers. It relocates
Community Health Officers in communities and further mobilizes and
re-orients the district level of the Ministry of Health, and District
Assemblies to support the initiative at the district level. The programme
has been accepted by the Ministry of Health after a four-year field trial at
the Navrongo health research centre.
CHPS
The programme seeks to mobilize community residents and resources to:
• improve access to services
• improve efficiency and responsiveness to client needs
• develop effective intersectoral collaboration. is a process that emphasizes
• preventive health care and education through effective communication
and community
• mobilization. It involves:
1. A situation analysis of health care delivery within a given community.
2. Community consultation on health needs and prioritization of such
needs.
3. Identifying and mobilizing resources both within and outside the
Community Based Health Planning and Services
4. Designing a culturally appropriate service delivery package.
5. providing health and family planning services to the community members on an
individual and household basis and Conducting early diagnosis and treatment of
common ailments and timely referral of serious cases.
The Frontline Actors in the CHPS process
1. Community Health Nurses, Midwives, Enrolled Nurses and Field

Technicians: These are health workers who have been reoriented in
outreach services delivery, community entry and mobilization, antenatal
and delivery, as well as disease control activities. They are redesignated
as community health officers (CHOs) and live in the communities to
provide health care and family planning services.
2. Community Health Volunteers : They are community members
selected to carry out the dissemination of basic health and family
planning information and services within communities and compound
with the CHOs
3. Community Health Committees: They manage and guide the health
volunteers and also provide traditional authorization and advocacy to the
process.
4. District Health Management Teams (DHMTs) and Sub-district Health
Teams (SDHTs): Provide logistic, training, monitoring and supervisory
support.
SCHOOL HEALTH SERVICES IN GHANA
• School health services are a coordinated set of procedures and actions

undertaken with the view to protect the health and promote the living
conditions among pupils, students and school personnel.
• School health services constitute those school activities directly
concerned with the present health status of the school child.
• It is important to give special attention to children of school going age
because:
1. They form a sizeable group of the population and in the period where
they begin life as independent beings, who often need help to adjust. The
period is also filled with dramatic changes and needs.
2. The academic performance of school children greatly depends on the
functioning of special organs like the eyes and ears, and therefore their
proper functioning need to be assessed.
3. School children are normally exposed to health hazards, injuries,
social and psychological problems. These need to be managed so that the
child can enjoy health hroughout their school age and adult years.
4. The health of school children and the type of educational programme
in which they participate are independent. Their health therefore needs to
be supervised while in the school.
5. The children can do their best only if their health will permit them to
participate to the
extent that the school programme requires.
• A school programme should have or should be adapted to the
physiological and emotional health needs or levels as well as the
intellectual level of the child.
7. School health services reinforce the efforts of the parents and the
family physicians in promoting the health and well being of the children.
8. The school setting provides a vantage point from which to observe and
assess the health of children.
9. Those children who deviate from the expected normal range of the
health status or behaviour are readily apparent to teachers and nurses.
10. School children are still learning and forming habits, therefore it will
be helpful to correct them early and teach them healthful habits that will
help them develop well.
Reasons for the flow chart
• It makes the work easier.
• It relaxes clients.
• It reduces waiting time.
• Clients become conversant with proceedings.
• It ensures quality work.
Child Welfare Clinic
• It a service provided under the umbrella of reproductive and child health services.
It is organised for the supervision and monitoring of the growth and development
of children from birth to five years, for prompt action to be taken when there is
deviation. During this clinic session, the weights of the children are checked,
physical examination is done from head to toe, vaccinations are also carried out,
and the mothers counselled accordingly.
• Objectives of Child Welfare Clinic (CWC)
• 1. To promote and maintain the health of the child by counselling mothers on the
care of their babies.
• 2. To prevent diseases in children by giving them specific immunizations.
• 3. To extend health care to a lot of children. This is achieved through out reach, as
well as CHPS (Community based Health Planning and services).
Objectives of child Welfare Clinic cont.
• 4. To supervise the growth and development of children.
• 5. To detect and refer any abnormality
• 6. To promote good nutrition for proper growth and development.
• 7. To reduce infant morbidity and mortality.
• 8. To treat minor ailments.
• 9. To space birth intervals
cont.
1. To demonstrate preparation of complementary feeds.
2. To educate mothers on family planning.
3. To educate mothers on personal and environmental hygiene.
4. To immunize children against the childhood preventable diseases.
5. To monitor growth and development of children.
The orderly manner in which activities at a clinic are carried out is termed CLINIC
FLOW.
FLOW CHART: Is a type of diagram that represents a workflow or process.
ORGANISATION AND MANAGEMENT
OF COMMUNITY BASED CLINICS.
• A clinic is an organized institution where people go for medical services, a place
where medical care is given to both the sick and the healthy individual.
• Types of clinics
• Clinics are named according to the type of health care they render. Examples of
clinics are:
• Child welfare clinic.
• Post natal clinic
• Family planning clinic
• Eye clinic.
• Antenatal clinic, among others.

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PRINCIPLES AND

• 5. Collaboration with other healthcare professionals: Public health nurses in

• 3. Technology: Technology has played a significant role in shaping public

• 5. Advocacy: Nurses are becoming more involved in advocating for health

• 11. Conducting research: Public health nurses may conduct research

• The Expanded Programme on immunization (EPI) was launched in 1974 by the

Hepatitis B (HepB) vaccine (standalone)

Haemophilus Pneumonia, meningitis, Hib conjugate vaccine as a component

Rotavirus Rotavirus diarrhoea Rotavirus vaccine

• Airport (Ghana) Central store

• Adverse Event Following Immunization (AEFI) is any untoward medical

• Purpose: Surveys are commonly conducted in the

• Data obtained from a survey provide the foundation for more

1.Comprehensive survey: This is the type of survey where every

• The term community profile is the process by which the

• The community population register represents another important tool

COMMUNITY POPULATION REGISTER

Is the process of finding out, and prioritizing the local problems of a

• The purpose of community needs assessment is essential for the

• The conference jointly called for a revolutionary approach to the health

needs of the people

Most of the endemic diseases include malaria, malnutrition, diarrhoeal diseases

• Trained Traditional Birth Attendant (TBA)

This is the immediate referral point for level A. it is headed by the

• Poor staffing and shortage of health personnel

1. Traditional Definition: Family is a social unit consisting of two or more

• A referral typically refers to the act of recommending or directing someone to

Community Based Health Planning and Services (CHPS) is a national

1. Community Health Nurses, Midwives, Enrolled Nurses and Field

• School health services are a coordinated set of procedures and actions

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