HOME VISIT

ACTIVITIES

PHASES:

PREPARATORY
→ Records review
→ Formulation of plan of visit
→ Preparation of supplies to be used
→ Notification to the client

ACTUAL HOME VISIT

→ Conducting assessment
→ Determining expected outcomes
→ Setting agreements and formulating plan of care together with the family
→ Performing procedures
→ carrying-out interventions
→ summarizing responses to care
→ counseling and reinforcing needed care and setting appointment

POST-VISIT
→ Recording of data on the chart
→ Facilitating actual referrals

FACTORS TO CONSIDER

Physical, psychological or educational needs

Ability to recognize needs
The policy of a given agency
Interest, willingness and acceptance of the family
Evaluation of past services rendered
Number of health personnel involved
The family's knowledge and ability to use their resources

STEPS DURING THE ACTUAL HOME VISIT:

1. Greet the client
2. Introduce self
3. State the purpose of visit
4. Observe the patient
5. Determine health needs
6. Put the bag in the convenient place and perform the bag technique
 7. Render the nursing care needed
8. Give health teachings
9. Do the documentation
10. Make an appointment for a return visit

NURSING CARE IN THE HOME

PURPOSES:
→ To give nursing care specific to illness
→ To help the client reach or maintain a level of functioning
→ To assist terminally ill to die peacefully with dignity

HEALTH EDUCATION
GREEN: Any combination of learning experience designed to facilitate voluntary adoptions of
behaviors conducive to health
→ The process of assisting individuals, acting separately or collectively, to make informed
decisions about matters affecting the personal health and that of others
→ A process whereby knowledge, attitude and practice of people are changed to improve
individual, family and community health.
→ RATIONALE: To enhance capability of the client that would result to self-reliance
→ APPLICATION:
Takes place in any setting, such as:
▪ Health care settings
▪ Schools
▪ Communities
▪ Worksites

PROCEDURES
Confirm cases
ISOLATION TECHNIQUE
RATIONALE
→ To prevent cross-infection
PRINCIPLES (5 A)
Airing of household articles should be done
All articles used by the sick member should not be mixed with those of the others confirm
cases measles
Articles soiled with discharges should be boiled in water 30 minutes before laundering
A protected gown should be used by the caretaker within the room of the patient
All discharges should be disposed properly

BAG TECHNIQUE
DEFINITION:
A tool making use of a public health bag through which the nurse, during his home visit can perform
nursing procedures with ease and deftness, saving time and effort.
RATIONALE:
To render effective nursing care to clients and/or family members during home visit.

B- Bag and its content should be free from contamination

A- Always perform hand washing before & after
G- Gather necessary equipment to conserve time and
energy

PUBLIC HEALTH BAG

An essential and indispensable equipment of the public health nurse that contains medications and
articles.

TRADITIONAL ARRANGEMENT OF ARTICLES

FRONT (LEFT TO RIGHT):
✓ Oral thermometer
✓ Rectal thermometer

CENTER:
✓ Forceps contains
✓ Sterile dressing (os and cotton ball)
✓ Tape measure
✓ Syringe and needle

BACK (LEFT TO RIGHT):

✓ 70% alcohol
✓ 5% acetic acid
✓ Spirit of ammonia

LEFT REAR:
✓ BABY'S SCALE
✓ SCISSORS

RIGHT REAR:
✓ Test tube
✓ Test tube holder

TOP:
✓ Hand towel
✓ Soap
✓ Apron
✓ Paper lining
MODERN ARRANGEMENT OF ARTICLES
Based on the convenience of the user
→ To facilitate efficiency
→ To avoid confusion
WORK FIELD:
→ Paper lining (inner surface)
OPENING OF THE BAG:
→ Usually 2-3x
→ May vary according to the number of procedures to be done so long as it saves time and effort
and depending on the following:
o Agency's policy
o Home situation
o Principle of avoiding transfer of infection

HEAT AND ACETIC ACID TEST Preeclampsia

PURPOSE
→ To determine PROTEINURIA
PROCEDURE
→ Obtain mid-stream catch of urine sample before meal
→ Fill the test tube with 2/3 of urine sample then heat
→ Add 3-5 drops of acetic acid
→ Observe changes in the consistency of the mixture
RESULT:
→ Negative: CLEAR
→ Positive: CLOUDY

BENEDICT TEST Diabetes Mellitus

PURPOSE
→ To determine GLUCOSURIA
PROCEDURE
→ Fill the test tube with 5ml of benedict's solution then heat
→ Add 8-10 drops of mid-stream catched urine sample which is obtained before meal
→ Reheat the mixture
→ Observe changes in the color of the mixture
RESULTS
→ BLUE –NEGATIVE
→ BLUEGREEN—TRACE
→ GREEN--+
→ YELLOW--++
→ ORANGE--+++
→ BRICK RED --++++
CLINITEST
PURPOSE
→ To determine glucosuria
PROCEDURE
→ Put one (1) clinitest tablet in the test tube
→ Fill the test tube with five (5) drops of midstream catched urine sample which is obtained before
meal
→ Add 10 drops of water
→ Observe changes in the color of the mixture

METHODOLOGIES

EPIDEMIOLOGY
→ Study of occurrence of disease and factors affecting disease distribution
→ Considered as the backbone of prevention of diseases
CONCERNED WITH:
→ Disease prevention
→ Disease occurrence
→ Disease distribution

PREVENTION AND CONTROL

LEVELS OF PREVENTION
1. PRIMARY PREVENTION
Client: Well
Scope:
- Healthy lifestyle
- Specific protection
- Elimination of risk factors (primordial)

2. SECONDARY PREVENTION
Client: Early sick
Scope:
- Early detection
- Prompt treatment
- Prevention of complications

3. TERTIARY PREVENTION
Client: Late Sick
Scope:
- Health restoration and maintenance disease
- Rehabilitation
- Prevention of further disabilities or permanent damage
OCCURRENCE
→ Imbalance between the FORCE OF INFECTION and FORCE OF RESISTANCE
→ Multi-causal theory (ecologic triad/epidemiologic triangle) as the force of infection

→ Immunity as the FORCE OF RESISTANCE

PATHOGENECITY occurs if the force of infection is increased as compared to the force of resistance
1. Pre-pathogenic
2. Pathogenic
a. Incubation
b. Prodromal
c. Peak/acme or period of infection
d. Convalescence

DISTRIBUTION
CHAIN OF INFECTION:
1. Causative agent
2. Reservoir
3. Portal of exit
4. Mode of transmission
5. Portal of entry
6. Susceptible host
PATTERNS
1. Sporadic
2. Endemic
3. Epidemic
4. Pandemic

EPIDEMIOLOGICAL APPROACH
→ Identification and verification of the diagnosis
→ Determine the case whether:
TRUE POSITIVE: a sign or symptom manifested is correct identified
FALSE NEGATIVE: a sign or symptom manifested is not identified correctly
TRUE NEGATIVE: a sign or symptom not manifested is correctly identified
FALSE POSITIVE: a sign or symptom not manifested is not identified correctly

→ SENSITIVITY: pick-up most cases and avoid false negatives

= X 100
→ SPECIFICITY: exclude non-cases or avoid false positives
= X 100
DESCRIPTION OF THE DISEASE
1. Characteristics of PLACE

2. Characteristics of PERSON

HERD IMMUNITY:
The state of resistance or level of immunity of a population group to a particular disease at a
given time

EPIDEMIC: high level of susceptibility and low level of immunity

ENDEMIC: low level of susceptibility and low level of immunity
SPORADIC: low level of susceptibility and high level of immunity

EXPOSURE OR CONTACT RATE:

This represents the opportunities for progressive transfer or transmission of an infectious agent
to a new host

CHANCE: this is the probability of contact between the source of infection and the susceptible
individual

3. Characteristics of TIME

SHORT-TIME FLUCTUATIONS (EPIDEMIC):

→ Changes in disease frequency in very short time
→ Types of epidemic:
1. POINT-SOURCE EPIDEMIC
2. PROPAGATED EPIDEMIC

CYCLIC VARIATION:
Recurrent fluctuations of disease which may exhibit cycles lasting for certain periods
SECULAR VARIATION: long-term (decade) changes in disease frequency

EPIDEMIOLOGICAL INVESTIGATION STEPS:

1. Establish presence of epidemic
2. Appraisal of facts
3. Formulate hypothesis
4. Test the hypothesis
5. Make conclusions and recommendations

NATIONAL EPIDEMIC SENTINEL SURVEILLANCE SYSTEM (NESS)

→ Hospital-based information system that monitors the occurrence of infectious diseases with
outbreak potential
→ Serves a supplemental information system of the DOH
OBJECTIVES:
1. To provide early warning on occurrence of outbreaks
2. To provide rapid, accurate and timely information so that preventive and control measures
can be instituted

SURVEILLANCE:
CLINICAL DIAGNOSIS
1. Dengue hemorrhagic fever
2. Diphtheria
 3. Measles
4. Meningococcal disease
5. Neonatal tetanus
6. Non-neonatal tetanus
7. Pertussis
8. Rabies
9. Leptospirosis
10. Acute flaccid paralysis (poliomyelitis)

LABORATORY DIAGNOSIS
1. Cholera
2. Hepatitis a
3. Hepatitis b
4. Malaria
5. Typhoid fever

VITAL STATISTICS
Study of vital events
→ BIRTH
→ MARRIAGE
→ SEPARATION/DIVORCE
→ DISEASE/ILLNESS
→ DEATH
Serve as INDICES OF THE HEALTH CONDITIONS of a community or population group and provide
valuable clues as to the nature of health services or actions needed

POPULATION - an aggregate or group of people under study

RATE - a figure that describes the probability of occurrence of some event

MID-YEAR POPULATION - The population of the area understudy as of july 1 of a calendar year.
Assuming that births, deaths and migration are equally distributed throughout the year
-------CAN REPRESENT THE POPULATION FOR THE WHOLE YEAR.

MORBITY AND MORTALITY RATES - indicate the state of community and the success or failure of
health work

MEASURES OF FERTILITY/NATALITY
CRUDE BIRTH RATE (CBR) - A measure of one characteristic of the natural growth or increase
population. By subtracting the crude death rate from it
GENERAL FERTILITY RATE (GFR) - Specific measure of fertility because the denominator makes use of
the number of women of childbearing age

Number of live births during a year

GFR = __________________________________________ x 1000

Midyear female POP (15-49) in the same year

MEASURES OF MORBIDITY

INCIDENCE RATE (IR)

Measures the of the of occurrence frequency phenomenon (NEW CASES ONLY) during a given period
and is usually used in the study of acute diseases

Number of new Cases

IR = ___________________________________________ x 100

Total population in the specified period

PREVALENCE RATE (PR)

The total number of current cases, OLD AND NEW, of a specified disease at a certain point in time (or a
specific date) per 100, 1000, 10,000 or 100,000 people at risk and is used in the study of chronic
diseases

Number of new and preexisting cases over a specified period

PR = _____________________________________________________________x 100

Total population in the specified period

MEASURES OF MORTALITY

CRUDE DEATH RATE (CDR)

A measure one mortality from all causes which result in a decrease of population

Number of death per year

CDR = ________________________________ x 1000

Total population

SWAROOP'S INDEX
→ It gives the percentage of all deaths which occur in persons 50 years and above and it directly
proportional to the health status of a population
→ Meaning a high index implies that life expectancy long and less people are drying at an early age
(before 50 years)

Number of deaths (individual more than 50 years old)

SI = ____________________________________________________________x 100

Total deaths
CASE FATALITY RATE
Index of killing power of a disease as expressed in terms of percentage

Number of death due to disease X

CFR = __________________________________________ x 100

Number of cases of disease

MATERNAL MORTALITY RATE (MMR)

An index of the obstetrical care needed and received by women in a community which measures the
risk of dying from causes related to pregnancy, childbirth, and puerperium within 90 days.

Number of resident maternal death

MMR = ______________________________________________x 100,000 or 1000

Number of resident live births

INFANT MORTALITY RATE (IMR)

The most sensitive index of the general health condition of a community since it reflects the changes in
the environment and medical condition of a community which the risk of dying during the 1 st year of life

Number of deaths of children less than one year of age in a year

IMR = __________________________________________________________________________x 1000

Number of live births in the same year

NEONATAL MORTALITY RATE (NMR)

Serves as an index of the effects of prenatal care and obstetrical management f the newborn which
measures the risk of dying during the 1st month of life.

Number of infant deaths under 8 days of age

NMR = ____________________________________________________x 1,000 live births (during a year)

Number of live births

FETAL DEATH RATE (FDR)

Measures pregnancy include abortions and still births which is generally attributed to prenatal causes
and are therefore influenced more by endogenous than environmental factors.

FDR (per 1,000 live births plus fetal deaths) =

Number of Fetal deaths after20 weeks or more gestation x 1,000
number of live births + number of fetal deaths
after 2o weeks or more gestation
DEVELOPMEN TAL APPROACHES
PRIMARY HEALTH CARE
WHO-essential health care made universally accessible and available to individuals and
families in the community by means acceptable to them through their full participation and at a cost
that the community can afford at every stage of development

FOUR A'S OF PRIMARY HEALTH CARE

A VAILABLE
A CCESSIBLE
A CCEPTABLE
A FFORDABLE
TYPES OF PHC WORKERS:

VILLAGE OR BARANGAY HEALTH WORKERS

→ Trained Community Health Workers or Health Auxiliary Volunteers or a Traditional Birth
Attendants or Healers.

INTERMEDIATE LEVEL HEALTH WORKERS

→ These comprise the professional of general medical practitioners which also include Public
Health Nurses, Rural Sanitary Inspectors, and Midwives.

RATIO OF MANPOWER TO POPULATION:

→ Physician (1:20,000)
→ Nurse (1:20,000)
→ Midwife (1:5,000)
→ Sanitary Inspector (1:20,000)
→ Medical Technologist (1:20,000)
→ Dentist (1:50,000)

LEVELS OF HEALTH CARE SERVICES

Provides a structure for the Hierarchical Referral System for better utilization of scarce Rural Health
Unit, Health Resources.

PRIMARY FACILITIES - Rural Health Unit Barangay Health Station, Health Center, Puericulture
Center, Private Clinic, Community Hospital

SECONDARY FACILITIES - District Hospital, Provincial Hospital

TERTIARY FACILITIES - Private Clinic, Regional Hospital, National Hospital, National Health
Training Institution, Specialized Hospital, Medical Center

ELEMENTS/COMPONENTS OF PHC:
1. Health Education
2. Environmental Sanitation
3. Maternal And Child Health And Family Planning
4. Immunization
5. Adequate Food And Proper Nutrition
6. Provision Of Medical Care & Emergency Treatment
7. Treatment Of Locally Endemic Diseases
 8. Control Of Communicable Diseases
9. Provision Of Essential Drugs

THE LOCAL HEALTH SYSTEM

LEGAL BASIS:
RA 7160 OR LGC OF 1991

DEVOLUTION OF HEALTH SERVICES:

Political (Decentralization) And Administrative (Deconcentration) Mandate For Local Health Care
Services Operation By Local Government Executives

CONTEXT: Local Autonomy

AUTHORITY: Local Health Board

FRAMEWORK: Inter Local Government Unit (ILGU) Partnership through the creation of Inter Local
Health System
→ Clustering municipalities into inter local health zone (ILHZ)

COMPOSITION:
1. PEOPLE - 100,000 to 500,000 population per health district
2. BOUNDARIES - determinant of accountability and responsibility, geographical location and
access to referral facilities
3. HEALTH FACILITIES - working together as a integrated health system
CENTRAL REFERRAL HOSPITAL (PROVINCIAL/DISTRICT HOSPITAL)
o Managed by the provincial government
PRIMARY LEVEL FACILITIES (RHU, BHS, HEALTH CENTERS)
o Managed By The City Or Municipal Government
4. HEALTH WORKERS - forming the ILHZ team to plan joint strategies for district health care

PUBLIC HEALTH PROGRAMS

MATERNAL HEALTH PROGRAM

OVERALL GOAL:
To improve the survival, health and well-being of mothers and unborn through a package of services
for the pre-pregnancy, prenatal, natal and post-natal stages.

ESSENTIAL HEALTH SERVICE PACKAGES:

1. ANTENATAL REGISTRATION
 2. MICRONUTRIENT SUPPLEMENTATION

3. TREATMENT OF DISEASES AND OTHER CONDITIONS

4. CLEAN AND SAFE DELIVERY
5. HEALTH TEACHINGS
o Birth registration
o Importance of breastfeeding
o Newborn screening within 48 hours up to 2 weeks after birth
o Schedule when to return for consultation for POST-PARTUM VISITS
▪ 1ST VISIT - 1st week postpartum preferably 3- 5 days
▪ 2ND VISIT - 6 weeks postpartum
6. SUPPORT TO BREASTFEEDING
7. FAMILY PLANNING COUNSELING
o Proper spacing of birth (3 TO 5 YEARS INTERVAL)

EMERGENCY OBSTETRIC AND NEWBORN CARE (EMONC)

CAUSES OF MATERNAL MORTALITY:

→ Pregnancy-Induced Hypertension Post-Partum Hemorrhage
→ Obstructed Labor
→ Infection
→ Unsafe Abortion
→ Indirect Causes Like Malaria, Hiv, Anemia

GOAL:
To Reduce Maternal Mortality
STRATEGIES:

FAMILY PLANNING:
To ensure that every birth is wanted, reducing unwanted pregnancies

SKILLED CARE BY A HEALTH PROFESSIONAL WITH MIDWIFERY SKILLS:

To ensure safe motherhood

EMONC:
To ensure timely access to care for women experiencing complications

BASIC EMONC (BEMONC)

→ Performed in a health center without the need for an operating room
FUNCTIONS:
→ Administration Of Parenteral Antibiotics
→ Administration Of Anticonvulsants
→ Assisted vaginal delivery, with forceps of preferably with vacuum extractor
→ Manual removal of placenta
→ administration of oxytoxics
→ Removal of retained products
→ Imminent breech delivery
→ Administration of corticosteroids
→ Essential newborn care

COMPREHENSIVE EMONC (CEMONC)

→ Performed in a provincial hospital; requires an operating room
FUNCTIONS (ABC)
→ All bemonc functions
→ Blood transfusion
→ Caesarean section
→
GOAL: Reduce child mortality rate by 2/3 by 2015

EMONC FACILITIES
→ FOUR BEMOC facilities for every 500,000 people
→ ONE CEMOC facility for every 500,000 people
→ Each facility must have a trained staff and a functional operating room, and must be able to
administer anesthesia blood transfusion

FAMILY PLANNING
OVERALL GOAL:
To provide universal access to family planning information and services wherever and whenever
these are needed.

AIMS TO REDUCE:
→ Infant Deaths
→ Neonatal Deaths
→ Under-Five Deaths
→ Maternal Deaths
OBJECTIVES
Addresses the need to help couples and individuals achieved their DESIRED FAMILY SIZE WITHIN THE
CONTEXT OF RESPONSIBLE PARENTHOOD

ENSURE THAT QUALITY FP SERVICES ARE AVAILABLE in DOH retained hospitals, LGU managed
health facilities, NGOS and private sector.

FAMILY PLANNING METHODS:

NATURAL METHODS

1. LACTATING AMENORRHEA METHOD/ LAM

→ Temporary introductory postpartum method of postponing pregnancy based on
physiological infertility experienced by breastfeeding women.
→ ADVANTAGES
→ LAM is universally available to all postpartum breastfeeding women
→ No other FP commodities required
→ It contributes to improve maternal and child health and nutrition
→ DISADVANTAGES
→ Short term FP method which is effective only for a maximum of 6 months
→ The effectiveness of lam may decrease if a mother and child are separated for
extended periods
→ Full Or Nearly Full Bf May Be Difficult To Maintain Up To 6 Months
2. BASAL BODY TEMPERATURE
→ Identifies the fertile and infertile period of a woman's cycle by daily taking and
recording of the rise in body temperature during and after ovulation.
→ BEFORE OVULATION: decreases 0.5°f
→ DURING OVULATION: Increases 1.0°F
3. STANDARD DAYS METHOD
→ Couples use color coded cycle beads to mark the fertile and infertile days of the
menstrual cycle.
→ ADVANTAGES
→ No health-related side effects associated with its use
→ Increases self-awareness and knowledge of human reproduction
→ Can be used either to avoid or achieve pregnancy
→ Enhances respect self-discipline, mutual
→ Can be integrated in health and family planning services
→ DISADVANTAGE
→ Cannot be used by women who usually have menstrual cycle between 26 and 32
days long
ARTIFICIAL METHODS

1. FEMALE STERILIZATION
→ Also known as BILATERAL TUBAL LIGATION
→ Safe and simple surgical procedure which provides permanent contraception for
women who do not want more children.
→ Involves cutting or blocking of two fallopian tubes
→ ADVANTAGES
→ Permanent method of contraception
→ Does not interfere with sex
→ Results in increased enjoyment
→ No effect on breastfeeding sexual
→ No known long term side effects health risks
→ DISADVANTAGES
→ Uncommon complications of surgery:
o Infection or bleeding
o Increase risk for ectopic pregnancy
o Requires physical examination
o Reversal surgery is difficult
o Do not protect against sexually transmitted diseases

2. MALE STERILIZATION
→ Also known as VASECTOMY
→ Permanent method wherein the vas deferens is tied and cut or blocked through a
small opening on the scrotal skin.
→ ADVANTAGES
→ Very Effective In 3 Months After The Procedure
→ Permanent, Safe, Simple And Easy To Perform
→ Can Be Performed In A Clinic
→ Person Will Not Lose His Sexual Ability And Ejaculation
→ DISADVANTAGES
→ May be uncomfortable due to slight pain and swelling 2-3 days after the procedure
→ Reversibility is difficult and expensive
→ Bleeding may result in hematoma formation
 3. PILL
→ Contains HORMONES PROGESTERONE - ESTROGEN and
→ ADVANTAGES
→ Safe as proven through extensive studies
→ Convenient and easy to use
→ Reduces gynecologic symptoms such as painful menses and endometriosis
→ Does not interfere with sexual intercourse
→ DISADVANTAGES
→ Often not used correctly and consistently lowering its effectiveness
→ Has side effects such as nausea, dizziness or breast tenderness
→ Can suppress lactation

4. MALE CONDOM
→ Thin sheath of latex rubber made to fit on a man's erect penis to prevent the passage of
sperm cells and sexually transmitted disease into the vagina.
→ ADVANTAGES
→ Safe and has no hormonal effect
→ Protects against microorganisms during intercourse
→ Encourages male participation in family planning
→ DISADVANTAGES
→ May cause allergy for people who are sensitive to latex or lubricant
→ May decrease sensation, making sex less enjoyable

5. INJECTABLES
→ Contain synthetic hormone, progestin which suppresses ovulation, thickens cervical
mucus and changes uterine lining
→ ADVANTAGES
→ Reversible
→ No need for daily intake
→ Does not interfere with sexual intercourse
→ Has no estrogen-related side effects

MISCONCEPTIONS ABOUT FAMILY PLANNING

→ Causes abortion
→ Will render couples sterile
→ Will result to loss of sexual desire

ROLES OF PUBLIC HEALTH NURSE ON FP PROGRAM

→ Provide counseling
→ Provide packages of health services
→ \ensure the availability of fp supplies and logistics

CHILD HEALTH PROGRAM

GOAL: To reduce morbidity and mortality rates (for children 0-9 yrs)

PROGRAMS:
→ Infant And Young Child Feeding
→ Newborn Screening
→ Expanded program on immunization
→ Management of childhood illnesses
 → Micronutrient supplementation
→ Dental health
→ Early child development

INFANT AND YOUNG CHILD FEEDING (IYCF)

GOAL: Reduce child mortality rate by 2/3 by 2015

OBJECTIVE: To improve health and nutrition status of infants and young children

OUTCOME: To improve exclusive and extended breast feeding and complementary feeding

KEY MESSAGES ON INFANT AND YOUNG CHILD FEEDING

→ Initiate breastfeeding within 1 hour after birth
→ Exclusive for the first 6 months of life
→ Complemented at 6 months with appropriate food
→ Extend breast feeding up to 2 years and beyond

EXCLUSIVE BREASTFEEDING means giving a baby only breast milk, and no other liquids or solids, not
even water.

COMPLEMENTARY FEEDING - after six months of age, all babies require other foods to complement
breast milk.
Complementary foods should be:
→ Timely
→ Adequate
→ Safe
→ Properly fed

LAWS PROTECTING INFANT AND YOUNG CHILD FEEDING

MILK CODE (EO 51)
→ Products covered by milk code consist of breast milk substitutes, including infant formula;
other milk products, foods and bottle-fed beverages, including complementary foods
ROOMING-IN AND BREASTFEEDING ACT OF 1992 (RA7600)
→ To promote rooming-in and to encourage, protect and support the practice of breastfeeding.
→ Compliance to the law is ensured through one of the 10 steps to mother baby friendly
hospitals wherein the mother and the baby should be together for 24 hours
FOOD FORTIFICATION LAW (RA 8976)
→ The law requires mandatory food fortification of staple foods - RICE, FLOUR, EDIBLE OIL AND
SUGAR and a voluntary food fortification of processed food or food products.

EXPANDED PROGRAM ON IMMUNIZATION (EPI)

GOAL: To reduce morbidity and mortality related to childhood immunizable diseases

LEGAL BASES:
→ PD 996: Compulsory Immunization Law
→ RA 7846: Hepatitis B Vaccination
→ PP 1066: Tetanus Elimination
→ PP 773: Knock-Out Polio
→ RA 10152: Mandatory Infants And Children Health Immunization Act

SCHEDULE AND DOSES:

DOSAGE, ROUTE AND SITE:

PRINCIPLES:
→ It is safe and immunologically effective to administer all epi vaccines on the same day at
different sites of the body
→ Measles vaccine should be given as soon as the child is 9 months old. If the child is living in an
endemic area, give the vaccine as early as 6 months.
→ Vaccination schedule should not be restarted
→ Giving doses less than the recommended interval may lessen the antibody response
→ No extra doses must be given to children/mother who missed a dose of DPT HEPA-B/ OPV/TT
→ Strictly follow the principle of never, ever reconstituting the freeze-dried vaccines other than the
diluents supplied with them
→ One syringe, one needle per child during vaccination

FALSE CONTRAINDICATIONS:
→ Malnutrition
→ Low grade fever
→ Mild respiratory infections like cough and cold
→ Simple diarrhea simple vomiting

ABSOLUTE CONTRAINDICATIONS:
✓ DPT 2 or DPT3 to a child who has had convulsions or shock within 3 days the previous dose.
✓ Patients with neurologic disease should not be given vaccines containing whole cell pertussis
✓ Live vaccines like BCG vaccine must not give into individuals who are be immunosuppressed
due to a malignant disease

NUTRITION PROGRAM
GOAL: To improve quality of life of Filipinos through better nutrition, improved health, and increased
productivity.

COMMON NUTRITIONAL DEFICIENCIES

→ VITAMIN A
→ IRON
→ LODINE

PROGRAMS AND PROJECTS:

→ Micronutrient supplementation
→ Food fortification
→ Essential maternal and child health service package
→ Nutrition information, communication, and education
→ Home, school, production
→ Food assistance
→ Livelihood assistance
REPRODUCTIVE HEALTH
LEGAL BASES
→ RA 10354: Philippine Reproductive Health Act
→ PD 956: Family Planning And Responsive Parenthood

OVERALL GOAL: Better Quality Life Among Filipinos

MAIN OBJECTIVES:
→ Reducing maternal mortality rate
→ Reducing child mortality
→ Halting and reversing spread of HIV/AIDS
→ Increasing access to reproductive health information and services

FOCUS: Reproductive Health Of Both Men And Women

ELEMENTS:
→ Family Planning
→ Maternal Child And Health Nutrition Prevention And Management Of Reproductive Tract
Infection
→ Adolescent Reproductive Health
→ Prevention and management of abortions and its complications
→ Prevention and management of breast and reproductive tract cancers and other gynecological
conditions
→ Education and counseling on sexuality and sexual health
→ Men's reproductive health and involvement
→ Violence against women and children
→ Prevention and management of infertility and sexual dysfunction

CORE PRINCIPLES:
→ Rights-Based
→ Culturally Oriented
→ Gender Responsive

ENVIRONMENTAL HEALTH AND SANITATION

ENVIRONMENTAL HEALTH
It is a branch of public health that deals with the study of preventing illnesses by managing the
environment and changing people's behavior to reduce exposure to biological and non-biological
agents of disease or injury

LEGAL BASES:
→ PD 856: Sanitation Code Of The Philippines
→ PD 825: Garbage Disposal Law
→ RA 6969: Toxic Substances And Hazardous And Nuclear Waste Control Act Of 1990
→ RA 9003: Ecological Management Act Of 2000
→ RA 8749: Clean Air Act Of 1999 Solid
→ RA 9275: Clean Water Act Of 2004
ENVIRONMENTAL SANITATION WASTE
→ Study of all factors in man's physical environment, which may exercise a deleterious effect on
his health well-being and survival
→ The DOH through the environmental and occupational health office (EOHO)
→ is responsible for the promotion of healthy environmental conditions and prevention of
environmental related diseases through appropriate sanitation strategies.

GOAL: To eradicate and control environmental factors in disease transmission through the provision
of basic services and facilities to all households.

COMPONENTS:
→ Water sanitation
→ Food sanitation
→ Reuse and garbage disposal
→ Excreta disposal
→ Insect vector and rodent control
→ Air pollution
→ Noise
→ Radiologic protection institutional sanitation

WATER SANITATION
1. APPROVED TYPES OF WATER SUPPLY FACILITIES

LEVEL I (POINT SOURCE)

✓ Protected well or developed spring with an outlet but without a distribution
system
✓ Serves around 15 to 25 households
✓ Outreach must not be more than 250 meters from the farthest user
✓ yield or discharge is generally from 40 to 140 liters per minute.
✓ Generally adaptable for rural areas where the houses are thinly scattered

LEVEL II (COMMUNAL FAUCET SYSTEM OR STAND-POSTS)

✓ System Composed Of A Source Of Reservoir, A Piped Distribution Network
And Communal Faucets
✓ Located Not More Than 25 Meters From The Farthest House
✓ Designed To Deliver 40-80 Liters Of Water Per Capita Per Day
✓ Average Households: 100
✓ One Faucet Per 4 To 6 Households
✓ Suitable For Rural Areas Where Houses Are Clustered Densely To Justify A
Simple piped System

LEVEL III (WATER WORKS SYSTEM OR INDIVIDUAL HOUSE CONNECTIONS)

✓ NAWASA, MAYNILAD

2. UNAPPROVED TYPE OF WATER FACILITY

✓ OPEN DUG WELLS
✓ UNIMPROVED SPRINGS
✓ WELLS THAT NEED PRIMING

3. ACCESS TO SAFE AND POTABLE DRINKING WATER

 4. WATER QUALITY AND MONITORING SURVEILLANCE
→ Disinfection Of Water Supply Sources Is Required On The Following:
→ Newly Constructed Water Supply Facilities
→ Water Supply Facility That Has Been Repaired/Improved
5. WATERWORKS/ WATER SYSTEM AND WELL CONSTRUCTION
→ Well sites shall require the prior approval of the secretary of health or his duly authorized
representative
→ Well construction shall comply with sanitary requirements of the department of health
→ Water supply system shall supply safe and potable water in adequate quantity

PROPER EXCRETA AND SEWAGE DISPOSAL

FOOD SANITATION
Food establishments shall be appraised as to the following sanitary conditions:
→ Inspection/ approval of all food sources, containers, transport vehicles
→ Compliance to sanitary permit requirements for all food establishments
→ Provision of updated health certificate for food handlers, cooks and cook helper
o DOH'S ADMINISTRATIVE ORDER NO. 1, S.2006, requires all laboratories to use
formalin ether concentration technique (FECT) instead of the direct fecal smear in the
analysis of stools of food handlers.
→ Food Establishments Shall Be Rated As Follows:
o CLASS A – Excellent
o CLASS B - Very Satisfactory
o CLASS C - Satisfactory
→ Four Rights In Food Safety
o RIGHT SOURCE
▪ Always buy fresh meat, fish fruits & vegetables look at the expiry dates of
processed food
▪ Avoid buying canned goods with dents, bulges, deformation, broken seals and
improper seams
▪ Boil water for at least 2 minutes (running boiling)
o RIGHT PREPARATION
▪ Avoid Contact Between Raw Food And Cooked Food
▪ Always Buy Pasteurized Milk And Fruit Juices
▪ Wash Vegetables Well If To Be Eaten Raw Such As Lettuce, Cucumber, Tomatoes
& Carrots
▪ Wash Hands And Kitchen Utensils Before And After Preparing Foods.
▪ Sweep Kitchen Floors To Remove Food Droppings
 o RIGHT 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
o RIGHT STORAGE
▪ All cooked food should be left at room temperature for not more than two hours
▪ Use tightly sealed containers for storing food
▪ Store food under hot conditions (at least or above 60°c) or in cold conditions
(below or equal to 10°c) if you plan to store it for more than 4 to 5 hours.
▪ Do not overburden the refrigerator by filling it with too large quantities of warm
food.
▪ Food should be reheated to at least 70 degrees centigrade.

HEALTH EMERGENCY PREPAREDNESS AND RESPONSE PROGRAM

GOAL: promoting health emergency preparedness among the general public and strengthening the
health sector capability and response to emergencies and disaster.

LEGAL MANDATE

PRESIDENTIAL DECREE NO. 1566 (1978) - Strengthening The Philippine Disaster Control Capability
And Establishing The National Disaster On Community Program Preparedness.

REPUBLIC ACT NO. 7160 (LOCAL GOV'T CODE OF 1991) -transfer of responsibilities from the national
to the local govemment units (LGUS)

DISASTER AND HEALTH EMERGENCY MANAGEMENT

DISASTER: it is a serious disruption of the functioning of a society, causing widespread human,

material or environmental losses which exceed the ability of the affected society to cope, using only its
own resources.

CLASSIFICATION OF DISASTER ACCORDING TO ITS CAUSE

1. Natural Disaster
2. Human Generated/Man-Made

EMERGENCY
→ Requires an immediate response
→ It is the responsibility of all
→ It should be woven into the community and administrative levels
→ It should concentrate on process and people rather than documentation

MAIN OBJECTIVE:
Decrease mortality, morbidity and prevent disability hazards any phenomenon, which has the potential
to cause disruption or damage to humans and their environment.
GENERAL PRINCIPLES
→ FIRST PRIORITY: protection of the people who are at risk
→ SECOND PRIORITY: protection of critical resources and systems communities
depend.
→ Disaster management must be an integral function of national development plans and
objectives
→ Disaster management relies upon an understanding of hazard risks
→ Capabilities must be developed prior to the impact of a hazard
→ Disaster management must be based upon interdisciplinary collaboration

MAJOR RISKS TO BE CONSIDERED

1. NATURAL RISKS
E.g. flood, earthquake, cyclones
2. TECHNOLOGICAL RISKS
Chemical, Radiological, Other Events Caused By The Failure Of The Socio- Technical
Systems
3. EPIDEMICS
4. SOCIETAL RISKS
Caused by social exclusion, extreme poverty and group violence.

NATIONAL VOLUNTARY BLOOD SERVICES PROGRAM

LEGAL BASIS

RA 7719: Blood Services Act Of 1994

VISION: Envision a network of modernized national and regional blood centers operating on a fully
voluntary, non-remunerated blood donation system

MISSION
✓ Ensure adequate, safe and accessible blood supply by:
o Promoting voluntary blood donation
o Establishing new blood service facilities
o Organizing association of blood donors and training medical practitioners on national
blood use

OBJECTIVES
→ To promote and encourage voluntary blood donation by the citizenry and to instill public
consciousness of the principle that blood donation is a humanitarian act.
→ To provide adequate, safe, affordable and equitable distribution of supply of blood and blood
products.
→ To mobilize all sectors of the community to participate in mechanisms for voluntary and non-
profit collection of blood.

REQUIREMENTS BEFORE DONATING:

→ Weigh more than 45 kg (100 lbs) for 250 ml of donated blood; 50 kg (110 lbs) for 450 ml of
donated blood
→ Be in good health
→ Be aged 16-65 years (for ages 16 & 17, parental consent is needed)
→ Systolic bp = 90-160 mm hg
→ Diastolic 60-100 mm hg
→ Hemoglobin at least 12.5g/dl
CONTRAINDICATIONS
→ Diabetes
→ Cancer
→ Hyperthyroidism
→ Cardiovascular Diseases
→ Severe Psychiatric Disorder
→ Epilepsy/Convulsions
→ Severe Bronchitis
→ Aids/ Syphilis And Other Sti (Past & Present)
→ Malaria
→ Kidney And Liver Disease
→ Prolonged Bleeding
→ Use Of Prohibited Drugs

BLOOD EXTRACTED FOR DONATION

→ WHOLE BLOOD AND RED CELL CONCENTRATES
o Shelf-life to 5 week
→ PLASMA
o Can be stored frozen for 12 months

CONSIDERATIONS AFTER BLOOD DONATION :

→ Leave the adhesive dressing on your arm for at least 3 hours but not more than twelve (12)
hours.
→ Bruising or discoloration may occur and will disappear in a few days
→ Avoid carrying heavy objects with your donating arm.
→ Do not smoke for the next 2 hours
→ Avoid alcohol intake for the next 12 hours.
→ Eat regular meals and increase fluid intake following your donation.