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Community Health Nursing

Community

• A group if species who reside in a designated geographic are and who share common interests and bonds.

• A group of persons united by some common feature or shared interest.

Health

• A state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.

Public Health

• The art of applying science in the context of politics so as to reduce inequalities in health while ensuring the best health for the greatest number.

Community Health

• part of paramedical or medical intervention/ approach which is concerned on the health of the whole or population

Aims: • health promotion • disease prevention• management of factors affecting health

Public Health Nursing

• A special field of nursing that combines the skills of nursing, public health and some phases of social assistance for the promotion o health, the improvement of conditions in the social and physical environment, rehabilitation, prevention of illness and disability.


• The utilization of the nursing process in the different levels of clientele-individuals, families, population groups and communities, concerned with the promotion of health, prevention of disease and disability and rehabilitation.


Goal: “To raise the level of citizenry by helping communities and families to cope with the discontinuities in and threats to health in such a way as to maximize their potential for high-level wellness”.

THE PHILIPPINE HEALTHCARE DELIVERY SYSTEM

Department Of Health

• Mandated as the lead agency in health at the national level

Local Government Units

• Runs the local health system• Provincial and district hospitals• RHUs and BHSs


R.A. 7160 (1991) Local Government Code• Decentralization• LGU (implementation)• DOH (governance)

E.O. 102 (1999)• The Department of Health is the national authority on

health, providing technical and other resource assistance to local government units, people’s organization, and other members of the civic society in effectively implementing programs, projects, and services that will:

(a) Promote the health and well-being of every Filipino. (b) Prevent and control diseases among population at risks. (c) Protect individuals, families, and communities exposed. to hazards and risks that could affect their health, and (d)Treat, manage, and rehabilitate individuals affected by diseases and disability.

Roles and Functions: DOH – EO 1021. Leadership in Health-national policy and regulatory institution where LGUs and NGOs will base their direction for health

2.Enabler and Capacity Builder-innovates new strategies in health to improve effectiveness of health programs- ensures highest achievable standards of quality health care 3. Administrator of Specific Services-manage selected national health facilities that shall serve as national referral centers-administers health emergency response services


• Vision by 2030: A global leader for attaining better health outcomes, competitive and responsive health care system, and equitable health financing.

• Mission: To guarantee equitable, sustainable, and quality health for all Filipinos, especially the poor, and to lead the quest for excellence in health.


Goal: Health Sector Reform Agenda (HSRA)• Overriding goal of the DOH• Conceptualized because although there has been a

significant improvement in the health status of Filipinos for the fast 50 years some the following conditions were still seen in the population:

• slowing down in the reduction of Infant Mortality Rare (IMR)• persistence of large variations in health status across population

groups• high burden from infectious diseases• rising burden from chronic and degenerative diseases• unattended emerging health risks• burden of disease heaviest among the poor

Support mechanisms of HSRA:• Sound organizational development• Strong Policies, Systems, and procedures• Capable Human Resources• Adequate Financial Resources

Framework for Implementation: FOURmula One for HealthGoals • Better health outcomes• More responsive health systems• Equitable health care financing

The Four Elements:

• Health financing investment• Health regulationensure quality and affordability of

health goods• Health Service Delivery improve and ensure the

accessibility and availability of basic and essential care• Good governance enhance health system performance

at national and local levels

Primary Health Care

• Essential Health made universally accessible to individuals and families in the community by means acceptable to them thru their full participation and at cost that the community and country can afford at every stage of development.

• Mission: To strengthen the health care system by increase opportunities and supporting the conditions wherein people will manage their own health.

Primary Health Care

• Was declared during the First conference on Primary Health Care was held in Alma Ata, USSR on Sept. 6-12, 1978 by the WHO as a strategy for community health.

• Goal: “Health for All by the year 2000”• Letter of Instruction 949 signed on

October 19, 1979 by Pres. Marcos with a theme: “Health in the Hands of the People by 2020”

Primary Health Care

It is a strategy aimed to provide essential health care that is (concept): (CAPAS)• Community-based• Accessible• Part and parcel of the total socio-

economic development effort of the nation

• Acceptable• Sustainable at an affordable cost

Primary Health Care

Elements of Primary Health Care• Education of prevailing Health Problems• Locally-endemic Disease Prevention and Control • Expanded Program of Immunization• Maternal and Child Health and Family Planning • Environmental Sanitation and Safe Water Supply • Nutrition and Food Supply • Treatment of Communicable & Non-communicable Diseases/

Conditions• Supply and Proper use of Essential Drugs and Herbal

Medicine • Dental Health Promotion • Access to and use of hospitals as Centers of Wellness• Mental Health Promotion

Primary Health Care

The Four Cornerstones/Pillars of Primary Health Care

1. Active Community Participation2. Intra and Inter-sectoral Linkages3. Use of Appropriate Technology4. Support Mechanism Made Available

Primary Health Care

8 Millennium Development Goals1. Eradicate extreme hunger and poverty2. Achieve universal primary education3. Promote gender equality and empower women4. Reduce child mortality5. Improve maternal health6. Combat HIV/AIDS, malaria and other diseases7. Ensure environmental sustainability8. Develop a global partnership for development

Vital Statistics

• The systematic study of vital events such as births, deaths, illness, marriages and divorce.

SOURCES OF DATA:• Population Census – once every 10 years• Registration of vital data – birth, death, divorce• Individual Health records and family records• Weekly Reports from Field health PersonnelCategories of Data according to Sources:• Primary data- those obtained first hand by the

investigator for the purpose of the study• Secondary data- those which are existing and obtained

by other people for purposes not necessarily those of the investigator

Vital Statistics

Methods of data Collection:• Documented Sources• Ocular Inspection• Participant Observation• Interview• Group Interview• Sample Survey• Focus Group Discussion

Vital Statistics

Crude Birth RateThe measure of one characteristic of the natural growth or increase of a population.

Number of live births during a given year x 1000 population estimated at mid year

General Fertility RateNumber of live births during a given year x 1000 female pop (15-44 y.o.) population estimated at mid-year for females age 15-44 during the same year

Vital Statistics

Crude Death RateThe measure of one mortality from all causes which may result in a decrease of population.

number of deaths from all causes during a given year x 1000 population estimated at mid year

Specific Death rateDescribes the risk of certain classes or groups to particular disease.Cause specificNumber of deaths from a specific condition during a given year population estimated at mid year x 100,000

Age SpecificNumber of deaths for a specified age group during a given year x 1000 population estimated at mid year for the specific age group

Vital Statistics

Infant Mortality RateMeasures the risk of dying during the first year of life. It is a good index of the general health condition of the community. Number of deaths under 1 year of age during the given year x 1000 LBs Number of live births during the same year Maternal Mortality RateMeasures the risk of dying from causes related to pregnancy, childbirth and puerperium.

Number of deaths from the puerperal complications during a given year number of live births during the same year x 100,000

Vital Statistics

Fetal Death RateMeasures pregnancy wastage. Death of the product of conception occurs prior to its complete expulsion, irrespective of duration of pregnancy.

Number of fetal deaths at 20 weeks of gestation (or more) during a given year x 1000 number of live births and fetal deaths during the same year Neonatal Death RateMeasures the risk of dying the 1st month of life.serves as an index of the effects of prenatal care and obstetrical management of the newborn.

Number of deaths under 28 days of age during a given year x 1000 Number of live births during the same year

Vital Statistics

Birth – Death Ratio Number of live births in a specified population x 1000 Number of deaths in the same population Case Fatality Ratio Number of deaths from a specified disease or condition Number of reported cases of the specified disease or condition

x 100,000

Vital Statistics

General Morbidity Rate

Total number of sick persons x 1000 population estimated at mid year

Prevalence Rate-measures the proportion of the population which exhibits a particular disease at a particular time; deals with NEW and OLD CASES

Number of old and new cases of a specific disease or conditionexisting at a point in time x 100,000total population at the same point in time

Vital Statistics

Incidence RateMeasures the frequency of occurrence of the phenomenon; deals with NEW CASES. number of new cases of a specific disease or condition occurring during a given period of timepopulation at risk during the same time period x 100,000

Vital Statistics

Attack rateAccurate measure of the risk of exposure.

Number of new cases of a disease in a time period x 100 population at risk during that time

Rate• The relationship between a vital event and those persons exposed to

the occurrence of said event, within a given area and during a specified time.

Ratio• Describes the relationship between 2 numerical quantities or

measures of events without taking particular considerations to the time or place.

Expanded Program of Immunization

• Goal: morbidity and mortality reduction of immunizable diseases


PD 996 Compulsory Basic Immunization to all children before reaching 8 years oldStarted in 1976 by MOHTarget Population:A. Infants (0-12 months): BCG, DPT, OPV& Measles HBV (1996) B. School Entrants: MECS: Grade 1=7 years old DECS: Grade 1=6 yrs. old (1993) Booster of BCG

RA 7846 Compulsory HBV before 8 years old:1996PP 4 Measles Elimination Program (September & October)

1994 – 1997 “Ligtas Tigdas” (6 months-8 years)


PP 6 Universal Mother & Child Immunization Law advocated by WHO from 1996 and onwards: 5 vaccines + Tetanus ToxoidStrengthens the EPI Program1. Pregnant mothers-Tetanus Toxoid2. Children: Infants-5 vaccines School entrants-BCG booster dose3. Before EPI total immunization-5 After EPI total immunization-6 (Tetanus toxoid was included)4. OPV was given to all children under 5 years old irregardless of the # of doses & the time OPV was given

PP 147 Declaring the National Immunization Day Plus (NIDs Plus) initiated by former Sec. Flavier in 1993-1995Initially every 3rd Wednesday of January & February (1993-1995)1996 to present: Still being practiced but not every 3rd Wednesday of January & February2002: 2nd Tuesday of March & AprilAt present: depends on the Secretary


PP 773 Launched the Polio Elimination Program (PEP) 1995-2000: Zero Polio Philippines, 1. Knock Out Polio (KOP)2. Zero Polio Philippines (1996-2000)3. Patak Polio (< 5 years old)

PP 1064 AFP (Acute Flaccid Paralysis) Elimination Program-an adverse effect of Polio

PP 1066 Neonatal Tetanus Elimination Morbidity Mortality


Vaccine (# of Doses) Schedule Site and Dose

BCG-1 dose At BirthSchool Entrants (6 years old)

0.05ml ID (Deltoid)0.10ml ID (Deltoid)

DPT-3 dosesHBV-3 doses

OPV-3 doses

1st 6 wks or 1 ½ mos2nd 10 wks or 2 ½ mos3rd 14 wks or 3 ½ mos

0.5ml IM (Upper Outer Thigh)

2 drops oral

MV-1 dose 9-12 months 0.05ml SC (Outer Part Upper Arm)


Tetanus Toxoid Immunization ScheduleRoute: 0.05ml IM (Deltoid)

Primary Dose TT1 Anytime during Pregnancy (5th-6th months)

Primary Dose TT2 4 weeks after TT1 3 years immunity

1st Booster TT3 6 months after TT2 5 years immunity

2nd Booster TT4 1 year after TT3 10 years immunity

3rd Booster TT5 1 year after TT4 Lifetime immunity

Expanded Program of ImmunizationSide EffectsBCG:• Inflammation at the site (Koch’s phenomenon) - warm compress • Glandular enlargement, deep abscess, indolent ulceration - incision

and drainage and powdered INH DPT: • Inflammation at site: warm compress• Fever for a day• Abscess - incision and drainage and antiseptic (betadine)Measles: • Fever 3-5 days within a week after injection• Mild rashes

Expanded Program of ImmunizationCOLD CHAIN LogisticsA system used to maintain the potency of a vaccine from that of manufacture to the time it is given to child or pregnant woman.

Storage of vaccine should not exceed:- 6 mos. @ the Regional Level - 3 mos. @ the Provincial Level- 1 mo. @ main Health Centers (with refrigerators)- not more than 5 days @ Health Centers (using transport boxes)

Important points to remember:Arranging of stored vaccine according to:• Type• Expiration date• Duration of Storage• Number of times they have been brought out to the fieldThe vaccine stored the LONGEST AND THOSE THAT WILL EXPIRE FIRST should be distributed or used 1st

Expanded Program of Immunization• Vaccines which are opened, though not consumed,

should be discarded.• Reasons: They cannot be used for future program

because of vaccine half life (duration of potency).BCG and MV - 4 hours half lifeOther vaccine - 8 hours half life

• Use Cold Dogs for transport.


Storage Temperature

Vaccine Form Dose/ Container Conditions when exposed to HEAT/

FREEZING

Most Sensitive to Heat

Least Sensitive to heat

-25ºC to -15ºC

FREEZER

BODY OF THE

REFRIGERATOR + 2ºC TO + 18ºC

OPV Liquid

20 dose/ special bottle or

25 dose/special bottle

Easily damaged by heat: not

destroyed by freezing

Measles Freeze dried 10 dose/vial Easily damaged by heat: not

destroyed by freezing

BCG Freeze dried 20 dose/amp

50 dose/ampDestroyed by heat,

sunlight; not destroyed by

freezingDPT LIQUID 20 dose/vial Destroyed by

freezing

Damaged by heat and freezing

Hepa-B

Tetanus Toxiod

Liqiud

Liquid

20 dose/vial Damaged by heat or freezing

Expanded Program of ImmunizationFrequently Asked Questions (FAQs) Q: What if the child failed to return after the first dose of the vaccine (D.O.H.), can we still give it? A: YES. It is a MUST to complete the doses .

Q: Is it necessary to repeat the 1st dose? A: NO. just give the REMAINING doses not given. Remember the principle: Even if the interval exceeded that of the expected interval, continue to give the doses of the vaccine.

Q: What is the eligible age for giving immunization (up to what age can we give the immunization)? A: Before the child reaches 6 years old

Q: If there has been a reported epidemic of measles, is it okay to give measles vaccine at an earlier age? A: In case of measles epidemic, we can give MEASLES as early as 6 months of age .* A booster dose of BCG shall also be given to all school entrants both in private and public schools REGARDLESS of presence of BCG scar.

Expanded Program of ImmunizationQ: What if the 2nd dose of Tetanus Toxoid was not given to the mother, when is the best time to give the dose? A: It has to be given after birth in order to protect the mother and the succeeding pregnancies.

Q: Is there any contraindication to giving DPT, OPV, Hepa-B? A: There is none, EXCEPT when the child had convulsions upon giving the 1st dose of DPT. Mothers must be warned that the incident of CONVULSION upon giving the 1st dose of DPT, MUST BE REPORTED. Q: What if the child has fever of <38.5 C, mild respiratory infections and diarrhea, should the child be given the vaccine? A: The abovementioned conditions are not to be considered as a contraindication to immunization. Thus, vaccine can still be given.

Q: What if the child Is malnourished? A: MALNUTRITION is not a contraindication, but RATHER an INDICATION for immunization since common childhood diseases are often severe to malnourished children

BreastFeeding Program

Two (2) Beneficiaries of BF Program:

1. Mother-regulated by R.A. 7600: Breastfeeding and Rooming-In Act

• Breastfeeding is an effective contraceptive method because it stimulates the anterior pituitary gland to produce prolactin hormone→ putting the female in an anovulatory stage→ there’s amenorrhea for 6 months from the time she gave birth

• Rooming-in (RI) is putting together of mother and the newborn and it stimulates the posterior pituitary gland to release oxytocin hormone→ stimulates the uterine muscle contraction that inhibits the implantation of fertilized zygote in the endometrium→ no pregnancy occurs

2. Children-regulated by EO 51: Milk Code of the Philippines• Dictum of Milk Code: Never commercialized a brand name of milk


3 Principles to make breastfeeding effective: 3 E’s• Early: start BF as early as possible→ NSD: after 30 minutes; CS: after 3-4 hours • Exclusive: for the 1st six months; never alternate BF with any

supplementary feeding• Extensive: BF can be extended to 2 years

Unique Characteristics of BF:Breast milk: EO 51-best for babiesReduced allergyEasily establishedAlways availableSafe makes/maintains soft stoolTemperature: right temperature 24°C body reference→ if to be frozen, preservation is minimum of 3 months & maximum of 6 months


Fresh alwaysEmotional bondingEconomicalDigestible: It contains lactalbumin, a protein substance.Immunity: Colostrum contains Ig A that protects baby for the 1st 3 months.Nutritious (optional)GIT diseases such as diarrhea is minimized/lessened because it is sterile.

Epidemiology

• The study of occurrences and distribution of diseases as well as the distribution and determinants of health states or events on specified population, and application of this study to the control of health problems.

• Concerned not only with deaths and illnesses, but with positive health states and means to improve health

• Is considered as the backbone of preventing disease

2 Main Areas of Investigation:• distribution of disease• search for determinants (causes) of disease and its

observed distributions

EpidemiologyUses of Epidemiology (Morris):• Study the history of the health population and rise and fall of

diseases• Diagnose health of the community and condition of people to

measure distribution and dimension of illness in terms of:-incidence -prevalence-disability-mortality• Study the work of health services with a view of improving them• Estimate risk of disease, accident, defects, and chances of avoiding

them• Identify syndromes by describing the distribution and association of

clinical phenomena• Complete the clinical picture of chronic disease• Search for causes of health and disease by comparing the

experience of groups

EpidemiologyThe Epidemiologic Triangle• A change in any of the components will alter an existing

equilibrium to increase or decrease the frequency of the disease.

Classifications of Agents, Hosts, and Environmental Factors which determine the occurrence Disease in Human Population1. Agents of Disease2. Host Factors (Intrinsic Factors)3. Environmental Factors

EpidemiologyPatterns of Occurrence and DistributionENDEMIC• The habitual presence of a disease in a given geographic location

accounting for the low number of immunes and susceptible.• causative factor of the disease is constantly available or present in

the areaEPIDEMIC• A situation when there is a high incidence of new cases of a specific

disease in excess of the expected.• when the proportion of the susceptible are high compared to the

proportion of the immunePANDEMIC • global occurrence of a diseaseSPORADIC• A disease occurs every now and then affecting only a small number

of people relative to the total population.

EpidemiologyOutline of Plan for Epidemiological Investigation1. Establish fact of presence of epidemic2. Establish time and space relationship of the disease3. Relations to characteristic of the group of community4. Correlation of all data obtained Epidemiology and Surveillance Units• established in regional and some local office as support to the public

health system• responsible for providing timely and accurate information on

diseases in the locality• responsibilities include:1. surveillance of infectious diseases2. assisting LGUs in investigation of outbreaks3. developing information package4. providing technical assistance

EpidemiologyPublic Health Surveillance• An ongoing systemic collection, analysis, interpretation, and dissemination of health

data.• considered information loops or cycles involving health care providers, public health

agencies, and the publicInformation Loop:1. Cases of disease occur2. Cases are reported by health care providers to health agencies3. Information about cases is relayed to those responsible for disease prevention4. Feedback of surveillance information is received by health providers, health agencies, and the public

Surveillance• an continuous collection and analysis of data of cases and death• public health nurse function as a researcher in disease surveillance Objectives:• measures magnitude of the problem• measures effect of the control program

EpidemiologyNational Epidemic Sentinel Surveillance System (NESSS)• hospital based information system that monitors the occurrence of infectious

disease with outbreak potential• supplemental information system of the DOH Objectives:• Provide early warning on occurrence of outbreaks• Provide program managers, policy makers, and public administrators, rapid,

accurate and timely information do that inventive control measures can be instituted

NESSS shows:• Trends of cases across time• Demographic characteristics of cases• Estimates case fatality ratio• Clustering of cases in a geographical area• Formulate hypothesis for disease causation

Environmental SanitationIt is defined as the study of all factors in man’s physical environment, which may exercise a deleterious effect on his health, well-being and survival.Goal:To eradicate and control environmental factors in disease transmission through the provision of basic services and facilities to all households.

Components• Water Supply Sanitation Program• Proper Excreta and Sewage Disposal Program• Insect and Rodent Control• Food and Sanitation Program• Hospital Waste Management Program• Strategies on Health Risk Minimization

Environmental and Occupational Health Office (EOHO)

Water Supply Sanitation Program3 Types of Approved Water Supply and Facilities

Level IPoint Source

Level IICommunal faucet system or stand posts

Level IIIWaterworks system or individual house connections Level III

Protected well or developed spring with an outlet but with out a distribution systemRural areasServes around 15 to 25 householdsOutreach: not more than 250 meters from the farthest userYield or discharge: 40 to 140 liters per minute

A protected well or a developed spring with an outlet but without a distribution system for rural areas where houses are thinly scattered.

Source of reservoir, A piped distribution network, communal faucetsRural areas that are clustered denselynot more than 25 meters from the farthest userdeliver 40 to 80 liters per day to 100 householdsone faucet per 4 to 6 households A system composed of a source, a reservoir, a piped distribution network and communal faucets located at not more than 25 meters from the farthest house in rural areas where houses are clustered densely.

source, reservoir, a piped distributor network and households tapurban areas where population is dense

A system with a source, a reservoir, a piped distributor network and household taps that is suited for densely populated urban areas.

Environmental SanitationUnapproved type of water facility:• Open dug wells• Unimproved springs• Wells that need priming Disinfection of water supply sources is required on the following:• Newly constructed water supply facilities• Water supply facility that has been repaired or improved• Found to be positive bacteriologically by lab analysis• Open dug wells• Unimproved springs• Surface water

Proper Excreta and Sewage Disposal System

Level 1 Level 2 Level 3

Non-water carriage toilet facility:- Pit latrines- Reed Odorless Earth Closet - Bored-hole- Compost- Ventilated improved pit Toilets requiring small amount of water to wash waste into receiving space: - Pour flush- Aqua-privies

On site toilet facilities of the water carriage type with water sealed and flushed type with septic vault/tank disposal facilities.

Water carriage types of toilet facilities connected to septic tanks and/or to sewerage system to treatment plant.

Environmental SanitationProper Solid Waste Management

- refers to satisfactory methods of storage collection and final disposal of solid wastes.

Household Community

Burial -Deposited in 1m x 1m deep pits covered with soil, located 25m away from water supply.

Open BurningAnimal feedingCompostingGrinding and disposal sewer

Sanitary landfill or controlled tipping Excavation of soil deposition of refuse and compacting with a solid cover of 2 feet. Incineration

Environmental SanitationFood Sanitation Program

Policies:• Food establishment are subject to inspection (approved of all food

sources containers and transport vehicles).• Comply with sanitary permit requirement• Comply with updated health certificates for food handlers, helpers,

cooks• All ambulant vendors must submit a health certificate to determine

present of intestinal parasite and bacterial infection.DOH AO #1 • Requires all laboratories to use Formalin Ether Concentration Technique (

FECT ) instead of the direct fecal smear in the analysis of stools of foodhandlers.

• This will enable laboratories to identify food handlers with parasitic infection and treat them before they are allowed to work in food establishment.

• All ambulant vendors must submit a health certificate to determine present of intestinal parasite and bacterial infection.

Environmental SanitationFood establishment shall be rated and classified as:• Class A- Excellent• Class B- Very Satisfactory• Class C- Satisfactory 3 Points of Contamination• Place of production processing and source of

supply• Transportation and storage• Retail and distribution points

Environmental SanitationFour Rights in Food Safety

Right Source:• Always buy fresh meat, fish, fruits & vegetables.• Always look for the expiry dates of processed foods and avoid buying the

expired ones.• Avoid buying canned foods with dents, bulges, deformation , broken seals

and improperly seams.• Use water only from clean and safe sources.• When in doubt of the water source, boil water for 2 minutes.

Right Preparation:• Avoid contact between raw foods and cooked foods.• Always buy pasteurized milk and fruit juices.• Wash vegetables well if to be eaten raw such as lettuce, cucumber,

tomatoes & carrots.• Always wash hands and kitchen utensils before and after preparing food.• Sweep kitchen floors to remove food droppings and prevent the harbor of

rats & insects.

Environmental SanitationRight Cooking:• Cook food thoroughly. Temperature on all parts of the food should reach 70 degrees centigrade.• Eat cooked food immediately.• Wash hands thoroughly before and after eating.

Right Storage:• All cooked foods should be left at room temperature for NOT more than two hours to prevent multiplication of bacteria.• Store cooked foods carefully. Be sure to use tightly sealed containers for storing food.• Be sure to store food under hot conditions (at least or above 60 degrees centigrade) or in cold conditions (below or equal to 10 degrees centigrade). This is vital if you plan to store food for more than four to five hours.• Foods for infants should not be stored at all. It should always be freshly prepared.• Do not overburden the refrigerator by filling it with too large quantities of warm food.• Reheat stored food before eating. Food should be reheated to at least 70 degrees centigrade. Rule in Food Safety: “When in doubt, throw it out!”

Environmental SanitationHospital Waste Management

Goal: To prevent the risk of contraction nosocomial infection from type disposal of infectious; pathological and other wastes from hospital.

Policies:• All newly constructed/ authorized and existing government and private

hospitals shall prepare and implement a Hospital Waste Management ( HMW ) as a requirement for registration and renewal of licenses.

• Use of appropriate technology and indigenous resources• Training of all hospital personnel• Public information campaign on health and environmental hazard shall

be the responsibility of the hospital administration.

Environmental SanitationHEALTH RISK MINIMIZATION• Anti- smoking Belching Campaign and Air Pollution

Campaign• Zero Solid Waste Management• Toxic, chemical, and Hazardous Waste Management• Red Tide Control and Monitoring• Integrated Post Management and Sustainable

Agriculture• Pasig River Rehabilitation Management

Environmental SanitationHospital Waste Management

Goal: To prevent the risk of contraction nosocomial infection from type disposal of infectious; pathological and other wastes from hospital.

Policies:• All newly constructed/ authorized and existing government and private

hospitals shall prepare and implement a Hospital Waste Management ( HMW ) as a requirement for registration and renewal of licenses.

• Use of appropriate technology and indigenous resources• Training of all hospital personnel• Public information campaign on health and environmental hazard shall

be the responsibility of the hospital administration.

Non-Communicable DiseasesIntegrated Community Based Non- Communicable Disease Prevention and Control Program

Goal: To reduce the toll of morbidity, disability, and premature deaths due to chronic, non- communicable lifestyle- related diseases.

Leading Lifestyle- Related Causes of Morbidity1.Cardiovascular Diseases2.Cancer3.COPD4.Diabetes Mellitus

Non-Communicable DiseasesLeading Lifestyle Related Causes of Mortality

1. Heart and Vascular System Disease2. Cancers3. COPD4. Accidents5. Diabetes6. Kidney Problems

Health Promotion • Major strategy for the prevention of the emergence of risk factors Healthy Lifestyle

• a way of life that promotes and protects well-being• includes practices that promote health such as: healthy diet and

nutrition, regular and adequate physical activity and leisure, avoidance of substances that can be abused, adequate stress management and relaxation, safe sex, immunization

Non-Communicable DiseasesObjectives: 1. Analyze the social, economic, political, and behavioral determinants of NCD2. Reduce exposure of individuals and population to major determinants of NCD while preventing emergence of preventable common risk factors.3. Strengthen health care for people with NCD through health sector reforms and cost- effective interventions

Approaches Used in Non-Communicable Disease Prevention and Control:1. Comprehensive Approach Focused on Primary Prevention2. Community-Based Approach3. Integrated Approach

Non-Communicable DiseasesKey Intervention Strategies

1. Establishing program direction and infrastructure2. Changing environments3. Changing lifestyle4. Reorienting health services

Role of the Public Health Nurse in NCD Prevention and Control

1. Health advocate2. Health educator3. Health care provider4. Community Organizer5. Health Trainer6. Researcher

Non-Communicable DiseasesRole of the Public Health Nurse in Risk Assessment and Screening:

1. Educate as many people and in every opportunity2. Educate people on how to prevent the NCD risk factors3. Every client, not only the patient seeking consultation, should be assessed for the presence of risk factors4. Train other health workers on performing risk factor assessment

When risk factors are present:1. Advise retesting if needed2. Explain the significance of the finding3. Educate on how to modify risk factors and promote positive lifestyle change4. Monitor and follow up5. Refer for confirmation of diagnosis

Herbal MedicineRA 8423: Alternative Traditional Medicine Law

• A program where patient may opt to use herbal plants especially for drugs that are not available in dosage form or patients has no financial means to buy the drug.

10 Advocated Herbal Plants by DOH: LUBBY SANTA

Plant Name Scientific Name

Indications Plant Part Used

Preparation

Lagundi Vitex negundo

Asthma, cough, colds & fever (ASCOF)Pain and inflammation

Leaves DecoctionPoultice

Ulasimang Bato

Peperonia pellucida

GoutArthritisRheumatism


Bayabas Psidium quajava

DiarrheaToothacheMouth and wound wash

Leaves Decoction

Bawang Allium sativum

HPNToothache

Clove/Bulb Poultice

Yerta Buena Mentha cordifelia

Same as Lagundi except asthma


Sambong Blumea balsanifera

EdemaDiuretic

Leaves Decoction

Akapulko Cassia alata All forms of skin diseases

Leaves DecoctionPoulticeCream

Niyog niyogan Quisqualis indica

Intestinal Parasitism(Nematodes)

Seeds DecoctionPoulticeJuice

Tsaang Gubat Carmona resuta

DiarrheaInfantile colic (Kabag)Dental caries


Ampalaya Mamordica charantia

Type II Diabetes (NIDDM)

Leaves Decoction

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