Primary Health Care BSN

PRIMARY HEALTH CARE
MIDWIFERY COURSE AUDIT

SUMMER 2014
PRIMARY HEALTH CARE
Definition of PHC, rationale and goals
Principles and strategies
Elements of PHC
PRIMARY HEALTH CARE
Essential health care made
universally accessible to individuals
and families in the community by
means acceptable to them through
their full participation and at cost
that the community and country can
afford at every stage of development
PRIMARY HEALTH CARE
CONCEPTUAL FRAMEWORK
Health is a fundamental human right
Health is both an individual and collective
responsibility
Health should be an equal opportunity to all
Health is an essential element of socio-
economic development
PRIMARY HEALTH CARE
FOCUS OF THE PHC APPROACH

Partnership with the community
Equitable distribution of health resources
Organized and appropriate health system
infrastructure
Prevention of disease and promotion of health
Linked multisectorally
Emphasis on appropriate technology
PRIMARY HEALTH CARE
FOCUS OF THE PHC APPROACH

Partnership with the community
Equitable distribution of health resources
Organized and appropriate health system
infrastructure
Prevention of disease and promotion of health
Linked multisectorally
Emphasis on appropriate technology
PRIMARY HEALTH CARE
PHC GOAL:

Health for all by the year 2000

- Alma-Ata, USSR
- September 6-12, 1978
PRIMARY HEALTH CARE
LEGAL BASIS OF PHC IN THE PHILIPPINES
Letter Of Instruction 949

Health in the Hands of the People by
2020

PRIMARY HEALTH CARE
DIMENSION COMMERCIALIZED HEALTH CARE PHC
GOAL Absence of disease Prevention of disease
FOCUS Sick Sick and well
SETTING Hospital-based; urban; few Health centers; rural-based;
all
PEOPLE Passive recipients Active participants
STRUCTURE Health is isolated from other sectors Heath is integrated; linkaging
PROCESS Decision-making (top-bottom) Bottom-top
TECHNOLOGY Curative; physician-dominated Promotive and preventive
Appropriate technology for
frontline health care
OUTCOME Reliance on health professionals People empowerment/self
reliance
PRIMARY HEALTH CARE
PRINCIPLE STRATEGIES
Accessibility, availability and acceptability
of health services
-Health services must be delivered where
people are
- use indigenous/resident volunteer
workers as health care providers (1:20)
- use traditional medicine with essential
drugs
Provision of quality, basic, and essential
services
- Training design and curriculum based on
community needs and priorities
- KSA on promotive, preventive, curative
and rehabilitative health care
-Regular monitoring and periodic
evaluation of CHW
PRIMARY HEALTH CARE
Community participation -Awareness-building and consciousness
raising
- Planning, implementation, monitoring
and evaluation
-Selection of CHW
-Community-building and CO
-Formation of health committees
-Establishment of a community health
worker organization
-Mass health campaign and mobilization
Self-reliance - Community generates support
-Use of local resources
-Training of community leadership and
management skills
- incorporation of IGP, coops, small-scale
industries
PRIMARY HEALTH CARE
Recognition of interrelationship between
health and development
-Convergence of health, food, nutrition,
sanitation, etc
- integration of PHC into all level plans
- coordination of activities to different
sectors
Social mobilization -Establishment of effective referral system
- multisectoral and interdisciplinary
linkages
-IEC using multi-media
-Collaboration between GO and NGO
Decentralization -Re-allocation of budgetary resources
-Re-orientation of health professionals on
PHC
-Advocacy for political will and support,
from the national leadership down to the
barangay
PRIMARY HEALTH CARE

FOUR CORNERSTONES OR PILLARS OF PHC
1. Use of appropriate tecnology
2. Support mechanism made available
3. Active community participation
4. Intra- and inter sectoral linakages
PRIMARY HEALTH CARE
1. ACTIVE COMMUNITY PARTICIPATION
Community Involvement
Participation of the Community in:
Defining the health and health-related needs
Identifying realistic solutions
Organizing, mobilizing its resources for health
activities
- Evaluating the results of health actions
PRIMARY HEALTH CARE
2. SUPPORT MECHANISM MADE AVAILABLE
a. Improvement of the following:
Working conditions of health personnel such as team
building, performance review and promotion
Planning and management skills of health personnel
at all levels
Technical skills of health personnel

PRIMARY HEALTH CARE
2. SUPPORT MECHANISM MADE AVAILABLE
b. Improvement of the referral system at all levels
c. Formation and use of an information system that
will continuously monitor the changing needs and
attitudes of the community.
PRIMARY HEALTH CARE
3. APPROPRIATE TECHNOLOGY
Acceptability
Complexity
Cost
Effectiveness
Safety
Scope of technology
Feasibility
PRIMARY HEALTH CARE
3. APPROPRIATE TECHNOLOGY
- ORS for diarrhea
- Herbal medicine
- Botika ng Barangay
- Indigenous manpower and materials
PRIMARY HEALTH CARE
4. INTRA- AND INTER-SECTORAL LINKAGE
Local Governments
Education
Agriculture
Public works
Population control
Social welfare
ELEMENTS OF PRIMARY HEALTH CARE
ESSENTIAL HEALTH SERVICES IN PRIMARY
HEALTH CARE
Education for health
Locally endemic diseases
Expanded Program on Immunization
Maternal and Child care Program
Essential drugs
Nutrition
Treatment of communicable diseases
Sanitation
-the sum of activities in which health agencies
engage to influence the thinking, motivation,
judgment, and action of the people
-consists of techniques that stimulate, arouse, and
guide people to live healthfully it is the process
whereby knowledge, attitude, and practice of the
people are changed to improve individual, family,
and community.
Steps in Health Education:
Creating awareness
Motivation
Decision-making
Aspects of Health Education
Information
Communication
Education
Principles of Health Education
Health education considers the health status of
the people
Health education is learning
Health education involves motivation,
experience, and change in conduct and thinking
Health education should be recognized as a basic
function of health workers
Health education takes place in the home, in the
school, and the community.
Health education is a cooperative effort
Health education meets the needs, interests and
problems of the people affected
Health education is achieved by doing.
Health education is a slow and continuous
process
Health education makes use of supplementary
aids and devices
Health education utilizes community resources
Health education is a creative process.
Health education helps people attain health
through their own efforts
Health education makes careful evaluation of the
planning, organization, and implementation of
health education program and activities.
General Aims of Health Education
To persuade people to adopt and sustain
healthful life practices
To use judiciously and wisely the health services
available to them
To make their own decisions, both individually
and collectively to improve their health status
and environment.

Factors Affecting the Attainment of Health
Education
Availability and accessibility of health services to
which the individual have trust
The economic feasibility of putting into practice
the health measures being advocated
Acceptability of the proposed health practice in
terms of their customs and traditions that an
individual observe.

Qualities of a Health Educator
Knowledgeable/mastery of subject matter
Credible
Good listener
Can empathized with others
Possess teaching skills
Flexible
Patience
Creative and innovative
Effective motivator
Able to rephrase and summarize
Encourages group participation
Good sense of humor
Works for the joy of it
Locally endemic diseases control
1. MALARIA CONTROL PROGRAM
2 Major Strategies of the Program
a. Vector Control
- CLEAN
- Chemoprophylaxis

b. Detection & Early Treatment of Cases
Early Recognition, Prevention & Control of Malaria epidemics

Identification of a patient with malaria as soon as he is
examined.
This may be done thru:
> Clinical >Microscopic
- Signs & Sx - Mass blood smear
exam
- History of visit to & endemic area
Locally endemic diseases control
2. SCHISTOSOMIASIS, H-FEVER, FILARIASIS CONTROL PROGRAMS

SCHISTOSOMIASIS
CONTROL PROGRAM
H-FEVER
(DENGUE)
FILARIASIS
CONTROL PROGRAM
A parasitic infection caused
by blood flukes inhabiting
the veins of their vertebral
victims transmitted thru skin
penetration causing
diarrhea, ascites,
hepatosplenomegaly
Dengue-
Acute febrile infection of
sudden onset, caused by
Aedes Aegypti, vector
mosquito
> A mosquito borne disease
caused by a tissue
nematode attacking the
lymphatic system of humans
thereby causing
elephantiasis, lymphedema
& hydrocele
Activities:
> Case Finding
> Surveillance of the disease
> Health education-
encourage use of rubber
boots for protection
> Environmental Sanitation-
proper disposal of feces
> Snail Eradication- use of
moluscides
Activities:

>Case Finding
> Early reporting of any
known case or outbreak
Activities:

>Case Finding
>Early reporting of any
known case of outbreak
Objective:
To reduce infant mortality and morbidity through
decreasing the prevalence of the seven
immunizable diseases

Noteworthy campaigns:
National Immunization Days (NID)
Knock-out Polio (KOP)
Garantisadong Pambata (GP)
The Fully Immunized Child (FIC)

- 1 dose of BCG
- 3 doses of DPT, OPV and Hepa B
- 1 dose AMV
VACCINE DOSE ROUTE SITE
BCG Infants: 0.05 ml ID RIGHT deltoid
School entrants: 0.10
ml
ID LEFT deltoid
Hepa B 0.5 ml IM Vastus lateralis
DPT 0.5 ml IM Vastus lateralis
OPV 2 gtts (depends) Oral Mouth
AMV 0.5 ml SQ Outer part of upper
arm
TT 0.5 ml IM deltoid
VACCINE MINIMUM TIME
INTERVAL
PERCENT
PROTECTION
DURATION OF
PROTECTION
TT1 As early as pregnancy
TT2 At least 4 weeks 80 Infant: Neonatal
tetanus
Mother: 3 years
TT3 At least 6 months 95 Infant: Neonatal
tetanus
Mother: 5 years
TT4 At least 1 year 99 Infant: Neonatal
tetanus
Mother: 10 years
TT5 At least 1 year 99 All infants born will
be protected
Mother: lifetme
VACCINE SIDE EFFECTS MANAGEMENT
BCG
WHEAL

SMALL RED TENDER
SWELLING

ULCER

SCAR FORMATION
KOCHS PHENOMENON
- Acute inflammatory
reaction
No management
DEEP ABSCESS AT
VACCINATION SITE OR
LYMPH NODES
I and D
INDOLENT ULCERATIONS
-Persists after 12 weeks
-Ulcer more than 10 mm
INH powder
GLANDULAR ENLARGEMENT

Treat as deep abscess
DPT FEVER
-usually one day
Antipyretic
TSB
LOCAL SORENESS
- At injection site
No treatment
3-4 days
ABSCESS
- An abscess that appear a
week or more after is due to
wrong technique
I and D
CONVULSIONS
-very rare; 3 months of age
Proper management
Do not continue normal
course
POLIO Usually none
HEPATITIS B LOCAL SORENESS
Within 24 hours
MEASLES FEVER AND RASH
5-7 days after (1 week)
Antipiretics
TSB

TT PAIN, REDNESS, SWELLING
-injection site
none
VACCINE CONTENTS FORM CONDITIONS
WHEN EXPOSED
TO HEAT
STORAGE
TEMPERATURE
BCG Live, attenuated,
bacteria
Freeze dried Destroyed 2 to 8
0
C
DPT D-weakened
toxin
P-killed bacteria
T-weakened
toxin
Liquid D-by heat/freeze 2 to 8
0
C
OPV Live, attenuated
virus
Liquid Easily destroyed
by heat, not by
freezing
-15 to -25
0C

AMV Live, attenuated
virus
Freeze dried Easily destroyed
by heat, not by
freezing
-15 to -25
0C

Hepa B Plasma-derived Liquid Damaged by heat
or freezing
2 to 8
0
C
TT Weakened toxin Liquid Damaged by heat
or freezing
2 to 8
0
C
FREQUENTLY ASKED QUESTIONS:
Q: What if the child failed to return after the first
dose of the vaccine, can we still give it?

Q: Is it necessary to repeat the first dose?

Q: Up to what age can we give the immunization?

Q: Is there any contraindication to giving DPT, OPV,
and Hepa B?
COLD CHAIN
- System used to maintain the potency of a vaccine
from the time of manufacture to time it is given
1. Storage of vaccines should NOT exceed:
6 months at regional
3 months at provincial
1 month at main health centers*
Not more than 5 days at health centers

2. Use of boxes/carriers in transport
COLD CHAIN

3. Once opened, vaccines must be placed in a
special cold pack during sessions

4. DISCARD:
BCG vaccines after 4 hours
Others, after 8 hours
TARGET SETTING
-involves the calculation of the eligible population
for immunization services

Eligible Population
- consists of any grp of people targeted for specific
immunizations d/t susceptibility to one or several
of the EPI diseases.
Eligible population

Infants 3%
BCG school entrants 3%
Pregnant women 3.5%
12-59 months old* 11.5%
0-59 months old** - 14.5%
15-44 y/o women*** 11.5%

ESSENTIAL DRUGS
- Essential drugs are medicinal preparations
necessary to fill the basic health needs of the
population.

- those drugs that satisfy the health care needs of
the majority of the population; they should
therefore be available at all times in adequate
amounts and in appropriate dosage forms, at a
price the community can afford

ESSENTIAL DRUGS

10 herbal plants recommended by the DOH

Lagundi Sambong
Olasimang bato Ampalaya
Bawang Niyog-niyogan
Bayabas Tsaang gubat
Yerba buena Akapulko
ESSENTIAL DRUGS
FORMS OF PREPARATION
Decoction boiling herbal part
Poultice
Oil
Tincture
Ointment
Cataplasm
Syrup
Infusion

ESSENTIAL DRUGS
GUIDELINES
1. Avoid the use of insecticides as these may leave
poison on plants.
2. In the preparation of herbal medicine, use a clay pot
and remove cover while boiling at low heat.
3. Use only the part of the plant being advocated.
4. Follow accurate dose of suggested preparation.
5. Use only one kind of herbal plant for each type of
symptoms or sickness.
6. Stop giving the herbal medication in case untoward
reaction such as allergy occurs.
7. If signs and symptoms are not relieved after 2 or 3
doses of herbal medication, consult a doctor.
ESSENTIAL DRUGS
HERBAL PLANT SCIENTIFIC NAME USES
LAGUNDI Vitex negundo Asthma. cough and fever;
Dysentery, colds and pain in
any part of the body as in
influenza; Skin diseases
(dermatitis, scabies, ulcer,
eczema) and wounds;
Headache, Rheumatism,
sprain, contusion, insect
bites; Aromatic bath for sick
patient
OLASIMANG BATO Lowers uric acid
BAYABAS washing wounds , diarrhea,
as gargle and to relieve
toothache.
BAWANG hypertension; Toothache;
lower cholesterol levels in
blood
ESSENTIAL DRUGS
HERBAL PLANT SCIENTIFIC NAME USES
YERBA BUENA Rheumatism, arthritis and
headache; cough & cold,
swollen gums, Toothache,
menstrual and gas pain,
nausea and fainting, insect
bites
SAMBONG Anti-edema, diuretic, anti-
urolithiasis
AKAPULKO Anti-fungal: Tinea Flava,
ringworm, athletes foot, and
scabies
NIYOG-NIYOGAN Anthelminthic
TSAANG GUBAT Diarrhea
AMPALAYA Lower blood sugar levels
Diabetes Mellitus (Mild non-
insulin dependent)
ESSENTIAL DRUGS
Generics Act of 1988
R.A. # 6675
Dangerous Drugs Act
R.A. 6425
Formally proclaims the state of promoting
the use of generic terminology in the
importation, manufacture, distribution,
marketing, promotion & advertising,
labeling, prescribing & dispensing of drugs.

Reinforces the NDP with regards to the
assurance of the
high-quality & rational drug
use.
The safe administration & transportation
of prohibited drugs is punishable by law.

2 Types of Drugs:

Prohibited Regulated

NUTRITION PROGRAM
GOAL:
The improvement of nutritional status, productivity
and quality of life of the population through the
adoption of desirable dietary practices and healthy
lifestyle

OBJECTIVES:
To decrease the morbidity and mortality rates
secondary to avitaminoses and other nutritional
deficiencies among the population mostly
composed of infants and children
NUTRITION PROGRAM
Coverage:
Protein Energy Malnutrition (PEM)
Vitamin A deficiency (VAD)
Iron Deficiency Anemia (IDA)
Iodine Deficiency Disorder (IDD)

Philippine Food & Nutrition Programs
Directed to the provision of nutrition services to the
DOHs identified priority vulnerable groups
NUTRITION PROGRAM
Targeted Food Task Force
Assistance Program
Nutrition Rehabilitation Ward Akbayan sa Kalusugan (ASK
Project)
Provision of food rations of
bulgur wheat & green peas

Target population:
Pre-schoolers
Pregnant women
Lactating mothers
Every hospital must have a
Nurse ward, where an
adequately trained nutritionist
were assigned (RA 422)
Aimed to provide rice & corn
soya blend supplemented with
local foods.

Target pop:
6 mos- 2 years
Moderately & severely
underweight
Pre-schoolers not served by
the DSWD and DA in Regions
2,8,9,10,11,12
NUTRITION PROGRAM
23 in 93 FORTIFIED VITAMIN RICE Health for More in 94
Buwan ng Kabataan, Pag-asa ng Bayan
National Focus: National Micronutrient Day
or Araw ng Sangkap Pinoy

-A free enrichment program aimed to
prevent deficiencies in vitamin A (blindness);
iron (anemia); iodine (goiter, mental
retardation & delayed development)

(1 cavan of rice + fistful processed, binilid
enriched with essential micronutrients)
-Aimed to distribute vitamin A supplements,
iodized oil for & seedlings of plants rich in Fe
& other minerals.
NUTRITION PROGRAM
3. FOOD FORTIFICATION PROGRAM
- Is the governments response to the growing
micronutrient malnutrition that has been
prevalent in the Philippines for the past several
years
- Vitamin A, Iron, Iodine
- Sangkap Pinoy
- FIDEL salt
NUTRITION PROGRAM
4. NUTRITION SURVEILLANCE SYSTEM
- A system of keeping close watch on the state of
nutrition & the causes of malnutrition w/n a
locality, w/ involves periodic collection of data &
analysis & dissemination of analyzed information
- Tools utilized are Anthropometric measurements:
A. Weight for Age
B. Height for Age
C. Weight for Height
D. BMI

NUTRITION PROGRAM
TYPES OF NUTRITIONAL DEFICIENCIES
A. PROTEIN ENERGY MALNUTRITION (PEM)
1. MARASMUS
Very thin, no fat, muscle wasting
Prominent ribs
Very poor wt gain
Loose & wrinkled skin
Enlarged abdomen
Anxious, always hungry
Old Mans Face
NUTRITION PROGRAM
A. PROTEIN ENERGY MALNUTRITION (PEM)
2. KWASHIORKOR
- Very thin, fails to grow - Swollen legs, feet, arms & hands
- Light colored, weak hair - Doesnt want to eat
- Moon-shaped, Unhappy face - Dark spots on skin
- Enlarged abdomen - Skin sores & skin is peeling
- Muscle wasting - Apathetic
NUTRITION PROGRAM
B. VITAMIN A DEFICIENCY
Causes:
-Low intake of Vitamin A rich food
- Low intake of protein
- Illnesses like measles, diarrhea
Consequences:
Blindness
1. Night blindness
2. Nutritional blindness
NUTRITION PROGRAM
UNIVERSAL SUPPLEMENTATION OF VITAMIN A
INFANTS PRESCHOOLERS PREGNANT WOMEN POSTPARTUM
MOTHERS
100,000 IU
One dose only
200,000 IU
One capsule every 6
months
10,000 IU twice a
week starting at the
4
th
month of
pregnancy*
200, 000 IU within
four weeks after
delivery
NUTRITION PROGRAM
C. IRON DEFICIENCY ANEMIA (IDA)
- Not enough hemoglobin in the RBC because of
lack of Fe

CAUSES:
- Low intake of iron-rich foods
- Blood loss
- Poor absorption
- Increased demands
NUTRITION PROGRAM
C. IRON DEFICIENCY ANEMIA (IDA)
TREATMENT AND PREVENTION:
-provision of iron with folic acid
- pregnant: Once a day for 180 days
- Lactating women: once a day for 90 days
NUTRITION PROGRAM
D. IODINE DEFICIENCY DISORDERS (IDD)
- Abnormalities d/t low iodine intake.
CAUSES:
- Low intake of iodine-rich foods
- Goitrogens and other environmental factors

CONSEQUENCES:
Fetus abortion/miscarriage/abnormalities/still
Infants cretinism/delayed walking/motor activities
Children poor academic performance
Adults mental impairment/poor working capacity
NUTRITION PROGRAM
D. IODINE DEFICIENCY DISORDERS (IDD)
TREATMENT:
- Women 15-45 y/o, School age children, adult
males:
- to take one iodized capsule with 200mg iodine
every year
SANITATION
Environmental Sanitation
- Is defined as the study of all factors in mans
physical environment, w/c may exercise a
deleterious effect on his health, well-being and
survival.

Goal:
To eradicate & control environmental factors in
disease transmission through the provision of
basic services & facilities to all households

SANITATION
3 types of approved water supply facilities

Level 1
Point Source
Level II
Communal Faucet System/
Stand Posts
Level III
Waterworks System/
Individual House
Connections
A protected well of a
developed sprung with an
outlet but w/o a
distribution system for rural
areas where houses are
thinly scattered.
A system composed of a
source, a reservoir, a piped
distribution network &
communal faucets, located
at not more than 25 meters
from the farthest house in
rural areas where houses
are clustered densely.
A system with a source, a
reservoir, a piped
distributor network &
household taps that is
suited for densely
populated urban areas.
SANITATION
3 types of approved toilet facilities

Level 1 Level II Level III
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
A system composed of a
source, a reservoir, a piped
distribution network &
communal faucets, located
at not more than 25 meters
from the farthest house in
rural areas where houses
are clustered densely.
A system with a source, a
reservoir, a piped
distributor network &
household taps that is
suited for densely
populated urban areas.

Primary Health Care BSN

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PRIMARY HEALTH CARE

MIDWIFERY COURSE AUDIT

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