COMMUNITY HEALTH NURSING

Prepared By: Maynard P. Agustin, RN, MSN

COMMUNITY HEALTH NURSING: AN OVERVIEW

What is a community? A group of people with common characteristics or interests living together within a territory or geographical boundary place where people under usual conditions are found

WHAT IS HEALTH? (WHO)

It is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

WHAT IS COMMUNITY HEALTH?

part of paramedical and medical intervention/ approach which is concerned on the health of the whole population aims: 1. health promotion 2. disease prevention 3. management of factors affecting health

WHAT IS NURSING?

assisting sick individuals to become healthy and healthy individuals achieve optimum wellness.

Public Health Nursing: the term used before for Community Health Nursing According to Dr. C.E. Winslow, Public Health is a science & art of 3 Ps

Prevention of Disease Prolonging life Promotion of health and efficiency through organized community effort

What is Community Health Nursing? 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. Maglaya, et al

WHAT IS COMMUNITY HEALTH NURSING (CHN)?

oa specialized field of nursing practice oa science of Public Health combined with Public Health Nursing Skills and Social Assistance with the goal of raising the level of health of the citizenry, to raise optimum level of functioning of the citizenry.

BASIC PRINCIPLES OF CHN:

The community is the patient in CHN, the family is the unit of care and there are four levels of clientele: individual, family, population group (those who share common characteristics, developmental stages and common exposure to health problems e.g. children, elderly), and the community. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE recipient of care

BASIC PRINCIPLES OF CHN:

CHN practice is affected by developments in health technology, in particular, changes in society, in general The goal of CHN is achieved through multisectoral efforts CHN is a part of health care system and the larger human services system.

ROLES OF THE PUBLIC HEALTH NURSE:

Clinician, who is a health care provider, taking care of the sick people at home or in the RHU
Health Educator, who aims towards health promotion and illness prevention through dissemination of correct information; educating people Facilitator, who establishes multi-sectoral linkages by referral system Supervisor, who monitors and supervises the performance of midwives

TARGET POPULATION (IFC) ARE: 1. I ndividual 2. F amily

3. C ommunity

3 Elements considered in CHN:

Science of Public Health (core foundation in CHN), Public Health Nursing Skills and, Social Assistance Functions

OBJECTIVES OF PUBLIC HEALTH: (CODES)

C ontrol of Communicable Diseases O rganization of Medical and Nursing Services D evelopment of Social Machineries E ducation of IFC on personal Hygiene Health E ducation is the essential task of every health workers S anitation of the environment

3 ELEMENTS IN HEALTH EDUCATION: (IEC)

I nformation: to share ideas to keep population group knowledgeable and aware E ducation: change within the individual 3 Key Elements of Education: (KSA)

K nowledge S kills A ttitude

3 ELEMENTS IN HEALTH EDUCATION: IEC

C ommunication: interaction involving 2 or more persons or agencies

3 Elements of Communication: (MSR) M essage S ender R eceiver

PUBLIC HEALTH WORKERS (PHW)

PHWs: are members of the health team who are professionals namely Medical Officer (MO)-Physician Public Health Nurse (PHN)-Registered Nurse Rural Health Midwife (RHM)-Registered Midwife Dentist Nutritionist Medical Technologist Pharmacist Rural Sanitary Inspector (RSI)-must be a sanitary engineer

DEPARTMENT OF HEALTH

DOH
is the executive department of the Philippine government responsible for ensuring access to basic public health services by all Filipinos through the provision of quality health care and the regulation of all health services and products. It is the government's over-all technical authority on health.It has its headquarters at the San Lazaro Compound, along Rizal Avenue in Manila. The department is led by the Secretary of Health, nominated by the President of the Philippines and confirmed by the Commission on Appointments. The Secretary is a member of the Cabinet. The current Secretary of Health is Enrique Ona.

5 MAJOR FUNCTIONS:
1. Ensure equal access to basic health services 2. Ensure formulation of national policies for proper division of labor and proper coordination of operations among the government agency jurisdictions 3. Ensure a minimum level of implementation nationwide of services regarded as public health goods 4. Plan and establish arrangements for the public health systems to achieve economies of scale 5. Maintain a medium of regulations and standards to protect consumers and guide providers

BASIC HEALTH SERVICES: UNDER OPHS OF DOH (ELEMENTS DAM)

E ducation regarding Health
L ocal Endemic Diseases E xpanded Program on Immunization M aternal & Child Health Services E ssential drugs and Herbal plants N utritional Health Services (PD 491): Creation of Nutrition Council of the Phils. T reatment of Communicable & Non communicable Diseases S anitation of the environment (PD 856): Sanitary Code of the P hilippines D ental Health Promotion A ccess to and use of hospitals as Centers of Wellness M ental Health Promotion

VISION BY 2030 (DREAM OF DOH)

A Global Leader for attaining better health outcomes, competitive and responsive health care systems, 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.

Principles to Attain the Vision of DOH Equity: equal health services for all-no discrimination Quality: DOH is after the quality of service not the quantity Philosophy of DOH: Quality is above quantity Accessibility: DOH utilize strategies for delivery of health services

HEALTH CARE DELIVERY SYSTEM

The totality of all policies, facilities, equipment, products, human resources and services which address the health needs, problems and concerns of the people. It is large, complex, multi-level and multi-disciplinary.

THREE STRATEGIES IN DELIVERING HEALTH SERVICES (ELEMENTS):

oCreation of Restructured Health Care Delivery System (RHCDS) regulated by PD 568 (1976)
oManagement Information Systems regulated by R.A. 3753: Vital Health Statistics Law oPrimary Health Care (PHC) regulated by LOI 949 (1984): Legalization of Implementation of PHC in the Philippines

CREATION OF RHCDS: RHO (National Health Agency) or existing national agencies like PGH or specialized agencies like Heart Center for Asia, NKI MHO & PHO (Municipal/Provincial Health Office)

BHS & RHU (Barangay Health Station/Rural Health Unit)

3 LEVELS OF HEALTH CARE: 1. Primary-prevention of illness or promotion of health 2. Secondary-curative 3. Tertiary-rehabilitative

According to Increasing Complexity of Services Provided

According to the Type of Service

Type

Service

Type

Example

Primary

Health Promotion, Preventive Care, Continuing Care for Common Health Problems, Attention to Psychological and Social Care, Referrals
Surgery, Medical Services by Specialist Advanced, Specialized, Diagnostic, Therapeutic and Rehabilitative Care

Health Promotion and Disease Prevention

Information Dissemination

Secondary

Diagnosis and Treatment Rehabilitation

Screening

Tertiary

PT/OT

LEVELS OF PREVENTION
PRIMARY LEVEL
Health Promotion and Illness Prevention

SECONDARY LEVEL
Prevention of Complications thru early Dx and Tx When hospitalization is deemed necessary and referral is made to emergency (now district) provincial or regional or private hospitals

TERTIARY LEVEL
Prevention of Disability, etc When highlyspecialized medical care is necessary Referrals are made to hospitals and medical centers like PGH, PHC, POC, NCMH, and other Govt and private hospitals at municipal level

Provided atHealth Care/RHU BHS Main Health Center Community Hospital and Health Center Private and SemiPrivate Agencies

Referral System in Levels of the Health Care:

Barangay Health Station (BHS) is under the management of Rural Health Midwife (RHM) Rural Health Unit (RHU) is under the management or supervision of PHN Public Health Nurse (PHN) caters to 1:10,000 population, acts as managers in the implementation of the policies and activities of RHU, directly under the supervision of MHO (who acts as administrator)

REFERRAL SYSTEM:
BHS RHU MHO PHO RHO National Agencies Specialized Agencies

CHARACTERISTICS OF PHC:

Acceptable Accessible Affordable Available Sustainable Attainable

UTILIZES APPROPRIATE TECHNOLOGIES USED BY PHC: ACCEFS

A ffordable, accessible, acceptable, available C ost wise=economical in nature C omplex procedures which provide a simple outcome E ffective F easibility of use=possibility of use at all times S cope of technology is safe & secure

SENTRONG SIGLA MOVEMENT (SSM) was established by DOH with LGUs having a logo of a Sun with 8 Rays and composed of 4 Pillars:

1. 2. 3. 4.

Health Promotion Granted Facilities Technical Assistance Awards: Cash, plaque, certificate

4 CONTRIBUTIONS OF PHC TO DOH &ECONOMY: 1. Training of Health Workers 2. Creation of Botika sa Baryo & Botika sa Health Center 3. Herbal Plants 4. Oresol

A. TRAINING OF HEALTH WORKERS

3 Levels of Training: Grassroot/Village Includes Barangay Health Volunteers (BHV) and Barangay Health Workers (BHW) Non professionals, didnt undergo formal training, receive no salary but are given incentive in the form of honorarium from the local government since 1993 Intermediate - these are professionals including the 8 members of the PHWs First Line Personnel - the specialist

B. CREATION OF BOTIKA SA BARYO & BOTIKA SA HEALTH CENTER

RA 6675: Generics Act of 1988: Implementing Oplan Walang Reseta Program-solution to the absence of a medical officer who prescribed the medicines so PHN are given the responsibility to prescribe generic medicines and Walong Wastong Gamot Program- available generics in Botika sa Baryo & Health Center Father of Generics Act: Dr. Alfredo Benzon

8 COMMONLY AVAILABLE GENERICS (CARIPPON)

1. Co-Trimoxazole: Its a combination of 2 generics of drugs which is antibacterial Trimethoprim(TMP) Has a bacteriostatic action that stops/inhibits multiplication of bacteria For GUT, GIT & URTI (TMP combined with SMX) Sulfamethoxazole (SMX) Has bactericidal action that kills bacteria For GUT, GIT, URTI & Skin Infections

8 COMMONLY AVAILABLE GENERICS(CARIPPON)

2. Amoxicillin/Ampicillin

An antibacterial drug that comes from the Penicillin family Effect is generally bacteriostatic (when source of infection is bacterial) These 2 drugs provide the least sensitivity reaction (rashes & GI) and the adverse effect of other antibiotics is anaphylactic shock

COMMONLY AVAILABLE GENERICS (CARIPPON) TB DRUGS: 3. Rifampicin (RIF) - used in certain types of bacterial infections and tuberculosis. 4. Isoniazid (INH) - used alone or with other drugs to treat tuberculosis (TB) and to prevent it in people who have had contact with tuberculosis bacteria. 5. Pyrazinamide (PZA) - kills or stops the growth of certain bacteria that cause tuberculosis (TB). It is used with other drugs to treat tuberculosis

COMMONLY AVAILABLE GENERICS (CARIPPON)

6. Paracetamol

Has an analgesic & anti-pyretic effect

Acetyl Salicylic Acid (ASA) or Aspirin is never kept in the Botika because of its effects: Anticoagulant-highly dangerous to Dengue patients thats why its not available in Botika & Health Center

8 COMMONLY AVAILABLE GENERICS (CARIPPON) 7. Oresol: a management for diarrhea to prevent dehydration under the Control of Diarrheal Diseases (CDD) Program

8 COMMONLY AVAILABLE GENERICS (CARIPPON) 8. Nifedipine: An anti-hypertensive drug According to DOH, 16% of population belonging to 25 years old & above in the community are hypertensive

C. HERBAL PLANTS
RA 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

Traditional Medicine: Use of herbal plants

10 ADOVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA

Lagundi

Vitex negundo

Asthma, Leaves Cough Colds, and Fever (ASCOF) Pain and Inflammati on

Decoction Poultice

10 ADOVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA

Ulasiman g Bato Peperonia Gout Leaves pellucida Arthritis Rheumati sm Decoction Poultice

10 ADOVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA

Bayabas

Psidium quajava

Diarrhea Leaves Toothache Mouth and wound wash

Decoction

10 ADOVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA

Bawang

Allium sativum

HPN Clove/bul Toothache b

poultice

10 ADOVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA

Yerba Buena Mentha Cordifelia Same as Lagundi except Asthma Leaves Decoction Poultice

10 ADOVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA

Sambong Blumea Edema balsanifer Diuretic a Leaves Decoction

10 ADOVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA

Akapulko Cassia alata All forms of skin diseases Leaves Decoction Poultice Cream

10 ADOVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA

Niyogniyogan Quisquali s indica Intestinal Seeds Parasatis m (nematode s) Decoction Poultice Juice

10 ADOVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA

Tsaang Gubat

Carmona resuta

Diarrhea Leaves Infantile colic(kaba g) Dental carries

Decoction poultice

10 ADOVOCATED HERBAL PLANTS BY DOH: LUBBY SANTA

Ampalaya Mamordic Type II a Diabetis charantia NIDDM

Leaves

decoction

POLICIES TO ABIDE: Know indications Know parts of plants with therapeutic value: roots, fruits, leaves Know official procedure/preparation

Procedures/Preparations: Decoction Gather leaves & wash thoroughly, place in a container the washed leaves & add water Let it boil without cover to vaporize/steam to release toxic substance & undesirable taste Use extracts for washing

Procedures/Preparations:
Poultice

Done by pounding or chewing leaves used by herbolaryo Example: Akapulko leaves-when pounded, it releases extracts coming out from the leaves contains enzyme (serves as anti-inflammatory) then apply on affected skin or spewed it over skin For treatment of skin diseases

Procedures/Preparations: Infusion To prepare a tea (use lipton bag), keep standing for 15 minutes in a cup of warm water where a brown solution is collected, pectin which serves as an adsorbent and astringent

Procedures/Preparations: Juice/Syrup To prepare a papaya juice, use ripe papaya &mechanically mashed then put inside a blender& add water To produce it into a syrup, add sugar then heat to dissolve sugar & mix it

Procedures/Preparations: Cream/Ointment Start with poultice (pound leaves) to turn it semi-solid Add flour to keep preparation pasty & make it adhere to skin lesions To make it into an ointment: add oil (mineral, baby or any oil-serves as moisturizer) to the prepared cream to keep it lubricated while being massage on the affected area

D. ORESOL
Glucose 20 gms 1st significance: For reabsorption of Na Facilitates assimilation of Na 2nd significance: Provides heat and energy

NaCl

3.5 grms

For retention of water/fluid

NaHCO3

2.5 grms

Buffer content of solution Neutralizer content of solution Stimulates smooth muscle contractility especially the heart and GIT

KCL

1.5 grms

PREPARATION OF PROPER HOMEMADE ORESOL

A volume or 1 liter homemade oresol Water 1000 ml or 1 liter Sugar 8 tsp Salt 1 tsp Smaller volume or a glass homemade oresol 250 ml 2 tsp tsp or a pinch of salt= 10-12 granules of rock salt: iodized salt= tips of thumb and index finger are penetrated with salt

UNIVERSAL HEALTH CARE

UNIVERSAL HEALTH CARE (UHC), ALSO REFERRED TO AS KALUSUGAN PANGKALAHATAN (KP)

is the provision to every Filipino of the highest possible quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and empowered public

UNIVERSAL HEALTH CARE (UHC), ALSO REFERRED TO AS KALUSUGAN PANGKALAHATAN (KP)

The Aquino administration puts it as the availability and accessibility of health services and necessities for all Filipinos.

It is a government mandate aiming to ensure that every Filipino shall receive affordable and quality health benefits. This involves providing adequate resources health human resources, health facilities, and health financing.

UHCS THREE THRUSTS

1.

2.

3.

Financial risk protection through expansion in enrollment and benefit delivery of the National Health Insurance Program (NHIP) Improved access to quality hospitals and health care facilities; and Attainment of health-related Millennium Development Goals (MDGs).

KALUSUGAN PANGKALAHATAN STRATEGIC THRUSTS

Achieve healthrelated Millenium Development Goals targets Improve access to quality health care facilities

Improve financial risk protection through improvements in NHIP benefit delivery

Improve health status of Filipinos

FINANCIAL RISK PROTECTION

Protection from the financial impacts of health care is attained by making any Filipino eligible to enroll, to know their entitlements and responsibilities, to avail of health services, and to be reimbursed by PhilHealth with regard to health care expenditures.

IMPROVED ACCESS TO QUALITY HOSPITALS AND HEALTH CARE FACILITIES

Improved access to quality hospitals and health facilities shall be achieved in a number of creative approaches. First, the quality of government-owned and operated hospitals and health facilities is to be upgraded to accommodate larger capacity, to attend to all types of emergencies, and to handle non- communicable diseases.

The Health Facility Enhancement Program (HFEP) shall provide funds to improve facility preparedness for trauma and other emergencies. The aim of HFEP was to upgrade 20% of DOH- retained hospitals, 46% of provincial hospitals, 46% of district hospitals, and 51% of rural health units(RHUs) by end of 2011.

ATTAINMENT OF HEALTH-RELATED MDGS

Further efforts and additional resources are to be applied on public health programs to reduce maternal and child mortality, morbidity and mortality from Tuberculosis and Malaria, and incidence of HIV/AIDS. Localities shall be prepared for the emerging disease trends, as well as the prevention and control of noncommunicable diseases. The organization of Community Health Teams (CHTs) in each priority population area is one way to achieve health-related MDGs. CHTs are groups of volunteers, who will assist families with their health needs, provide health information, and

ATTAINMENT OF HEALTH-RELATED MDGS

RNheals nurses will be trained to become trainers and supervisors to coordinate with community-level workers and CHTs. By the end of 2011, it is targeted that there will be 20,000 CHTs and 10,000 RNheals. Another effort will be the provision of necessary services using the life cycle approach. These services include family planning, ante-natal care, delivery in health facilities, newborn care, and the Garantisadong Pambata package. Better coordination among government agencies, such as DOH, DepEd, DSWD, and DILG, would also be essential for the achievement of these MDGs.

MILLENIUM DEVELOPMENT GOALS (MDGS)

GOAL 1: ERADICATE EXTREME POVERTY AND HUNGER

Target : Halve, between 1990 and 2015, the proportion of people whose income is less than one dollar a day Target : Halve, between 1990 and 2015, the proportion of people who suffer from hunger

GOAL 2: ACHIEVE UNIVERSAL PRIMARYEDUCATION Target : Ensure that, by 2015, children everywhere, boys and girls alike, will be able to complete a full course of primary schooling

GOAL 3: PROMOTE GENDER EQUALITY AND EMPOWER WOMEN

Target : Eliminate gender disparity in primary and secondary education preferably by 2005 and to all levels of education no later than 2015

GOAL 4: REDUCE CHILD MORTALITY

Target : Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate

GOAL 5: IMPROVE MATERNAL HEALTH

Target : Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio

GOAL 6: COMBAT HIV/AIDS, MALARIA AND OTHER DISEASES

Target : Have halted by 2015 and begun to reverse the spread of HIV/AIDS
Target : Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

GOAL 7: ENSURE ENVIRONMENTAL SUSTAINABILITY

Target : Integrate the principles of sustainable development into country policies and programmes and reverse the loss of environmental resources Target : Halve, by 2015, the proportion of people without sustainable access to safe drinking water Target: By 2020, to have achieved a significant improvement in the lives of at least 100 million slum dwellers

GOAL 8: DEVELOP A GLOBAL PARTNERSHIP FOR DEVELOPMENT

Target : Develop further an open, rule-based, predictable, non- discriminatory trading and financial system Target: Address the special needs of the least developed countries Target: Address the special needs of landlocked countries and small island developing States Target: Deal comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term

To implement the KP thrusts and interventions, the DOH will adopt the following general strategies:
1.Focus and engage vulnerable families, starting with provinces where most are found; 2.Partner with poverty alleviation programs like the National Household Targeting System-Poverty Reduction (NHTS- PR) and Conditional Cash Transfer (CCT); 3.Leverage LGU participation and performance through province-wide agreements; and 4.Harness private sector participation

FIELD HEALTH SERVICE INFORMATION SYSTEM (FHSIS)

FIELD HEALTH SERVICE INFORMATION SYSTEM (FHSIS)

It is a network of information. It is intended to address the short term needs of DOH and LGU staff with managerial or supervisory functions in facilities and program areas. It monitors health service delivery nationwide.

OBJECTIVES OF FHSIS

To provide summary data on health service delivery and selected program accomplishment indicators at the barangay, municipality/ city, and district, provincial, regional and national levels. To provide data which when combined with data from other sources, can be used for program monitoring and evaluation purposes. To provide a standardized, facility-level data base that can be accessed for more in-depth studies. To minimize the recording and reporting burden at the service delivery level in order to allow more time for patient care and promote activities.

IMPORTANCE OF FHSIS

Helps local government determine public health priorities. Basis for monitoring and evaluating health program implementation Basis for planning, budgeting, logistics and decision making at all levels. Source of data to detect unusual occurrence of a disease. Needed to monitor health status of the community Helps midwives in following up clients. Documentation of RHM/PHN day to day activities.

COMPONENTS OF FHSIS
1. 2. 3. 4.

Individual Treatment Record (ITR) Target Client List (TCL) Summary Table The Monthly Consolidation Table (MCT)

INDIVIDUAL TREATMENT RECORD (ITR)

The fundamental building block or foundation of the Field Health Service Information System is the INDIVIDUAL TREATMENT RECORD This is a document, form or piece of paper upon which is recorded the date, name, address of patient, presenting symptoms or complaint of the patient on consultation and the diagnosis (if available), treatment and date of treatment.

TARGET CLIENT LIST (TCL)

The Target Client Lists constitute the second building block of the FHSIS and are intended to serve several purposes First is to plan and carry out patient care and service delivery. Such lists will be of considerable value to midwives/nurses in monitoring service delivery to clients in general and in particular to groups of patients identified as targets or eligibles for one or another program of the Department

TARGET CLIENT LIST (TCL)

The second purpose of Target Client Lists is to facilitate the monitoring and supervision of service delivery activities. The third purpose is to report services delivered.

The fourth purpose of the Target Client Lists is to provide a clinic-level data base which can be accessed for further studies

TARGET CLIENT LISTS TO BE MAINTAINED IN THE FHSIS

1. 2. 3. 4. 5. 6. 7.

Target Client List for Prenatal Care Target Client List for Post-Partum Care Target Client List of Under 1 Year Old Children Target Client List for Family Planning Target Client List for Sick Children NTP TB Register National Leprosy Control Program Form 2-Central Registration Form

SUMMARY TABLE

The Summary Tables is a form with 12-month columns retained at the facility (BHS) where the midwife records monthly all relevant data. The Summary Table is composed of:

1. Health Program Accomplishment this can serve as proof of accomplishments to show LGU officials whenever they visit the facility.
2. Morbidity Diseases the source of ten leading causes of morbidity for the municipality/city. This summary table will help the nurse and MHO to get the monthly trend of diseases.

THE MONTHLY CONSOLIDATION TABLE (MCT)

The Consolidation Table is an essential form in the FHSIS where the nurse at the RHU records the reported data per indicator by each BHS or midwife. This is the source document of the nurse for the Quarterly Form. The Consolidation Table shall serve as the Output Table of the RHU as it already contains listing of BHS per indicator.

FHSIS REPORTING
These are summary data that are transmitted or submitted on a monthly, quarterly and on annual basis to higher level. The source of data for this component is dependent on the records.

THE MONTHLY FORM

Program Report (M1) The Monthly Form contains selected indicators categorized as maternal care, child care, family planning and disease control.

Morbidity Report (M2) The Monthly Morbidity Disease Report contains a list of all diseases by age and sex. The Midwife uses the form for the monthly consolidation report of Morbidity Diseases and is submitted to the PHN for quarterly consolidation.

THE QUARTERLY FORM

Program Report (Q1) The Quarterly Form is the municipality/city health report and contains the three-month total of indicators categorized as maternal care, family planning, child care, dental health and disease control Morbidity Report (Q2) The PHN uses the form for the Quarterly Consolidation Report of Morbidity Diseases to consolidate the Monthly Morbidity Diseases taken from the Summary Table.

THE ANNUAL FORMS (A-BHS, A1, A2 & A3)

ABHS Form is the report of midwife which contains data on demographic, environmental and natality. The report of nurse at the RHU/MHC are the Annual Form 1 which is the report on vital statistics: demographic, environmental, natality and mortality. Annual Form 2 is the report that lists all diseases and their occurrence in the municipality/city. The report is broken down by age and sex. Annual Form 3 is the report of all deaths occurred in the municipality/city. The report is also broken down by age and sex.

FLOW OF REPORT
OFFICE PERSON BHS Midwife RECORDIN G TOOLS ITR TCL ST FORMS Monthly Form (M1 & M2) A-BHS Form Annually FREQUEN CY Monthly SCHEDULE OF SUBMISSION Every 2nd week of the succeeding month Every 2nd week of Jan. Every 3rd week of the 1st month of succeeding quarter Every 3rd week of Jan.

RHU

PHN

ST MCT

Quarterly Form (Q1 & Q2)

Quarterly

Annual forms - A1 - A2 - A3

HEALTH INDICATORS

VITAL STATISTICS

Tool in estimating the extent or magnitude of health needs and problems in the community

Fertility - is the number of children born per couple, person or population

Crude Birth Rate (CBR) - Overall total reported births General Fertility Rate (GFR) - the expected number of children born per woman in her child-bearing years Morbidity - Illnesses affecting the population group Incidence Rate (IR)-reported new cases affecting the population group Prevalence Rate (PR)-determine sum total of new + old cases of diseases per percent population

Mortality-Reports causes of deaths

Crude Death Rate (CDR)-overall total reported death Maternal Mortality Rate (MMR)-maternal deaths due to maternal causes Infant Mortality Rate (IMR) -# of infant deaths (0-12 months) or less than 1 year old Neonatal Mortality Rate (NMR) -# of deaths among neonates (newborn 0-28 days, < 1 month) Swaroops Index (SI) -deaths among individual in the age group of 50 and above Specific Death Rate (SDR) - # of deaths in a

CRUDE BIRTH RATE

CBR = Overall Total Reported Births X 1000 Population

GENERAL FERTILITY RATE

GFR = # of live births x 1000 midyear population of women, 15-44 years of age

INCIDENCE RATE
IR = New Cases of Disease Population X 100

PREVALENCE RATE
PR = New Cases + Old Cases Population X 100

CRUDE DEATH RATE

CDR = Overall Total deaths Population X 1000

MATERNAL MORTALITY RATE

MMR = # of Maternal Deaths RLB X 1000

INFANT MORTALITY RATE

IMR = # of Infant Deaths RLB X 1000

NEONATAL MORTALITY RATE

NMR = # of neonatal Deaths X 1000 RLB

SWAROOPS INDEX

SI = # of Deaths (Individual > 50 Years Old) X 100 Total Deaths

SPECIFIC DEATH RATE

SDR = # of deaths in a specified group X 1000
midyear pop o the same specified group