1 Health is a fundamental human right 2 Health is both an individual and collective responsibility 3 Health should be an equal opportunity to all 4 Health is an essential element of socio-economic development

Primary Health Care

CONCEPTUAL FRAMEWORK

FOCUS OF THE PHC APPROACH

1 Partnership with the community 2 Equitable distribution of health resources 3 Organized and appropriate health system infrastructure 4 Prevention of disease and promotion of health 5 Linked multisectorally 6 Emphasis on appropriate technology

Legal Basis of Primary Health Care

Instruction (LOI) 949 signed on October 19, 1979 by President Ferdinand E. Marcos – One year after the First International Conference on Primary Health Care which was held in Alma Ata, USSR on September 6-12 1978, sponsored by the WHO and UNICEF

The 30th World Health Assembly adopted Resolution WHO 30:43 This resolution decided that the main social targets of governments and the WHO should be the attainment by all the people of the world by the Year 2000 a level of health that will permit them to lead a socially and economically productive life.

May 1977

International Conference in Primary Health Care was held at Alma Ata, Kazakhstan, USSR. This conference came up with ALMA ATA DECLARATION which represents a global idea about how to achieve world health.

September 12, 1978

The World Health Organization (WHO) launched the Global Strategy for Health for All.

1979

“Partnership with and Empowerment of the people”: A strategy to community health development It is a strategy aimed to provide essential health care that is: C- ommunity based A- ccesible P- art and parcel of the total socio-economic development effort of the nation A- cceptable S- ustainable at affordable cost

PHC: ALMA-ATA Conference in 1978

“Health for all Filipinos by the year __ and Health in the Hands of the People by the year __”

2000, 2020

Aims to strengthen the health care system by increasing opportunities and supporting conditions wherein people will manage their own health care.

Mission of PHC

The ultimate goal of primary health care is better health for all. WHO has identified five key elements to achieving that goal:

1 Reducing exclusion and social disparities in health (universal coverage reforms); 2 Organizing health services around people’s needs and expectations (service delivery reforms); 3 Integrating health into all sectors (public policy reforms); 4 Pursuing collaborative models of policy dialogue (leadership reforms); and 5 Increasing stakeholder participation.

Objectives of PHC

1 Improvement in the level of health care of the community 2 Favorable population growth structure 3 Reduction in the prevalence of preventable, communicable and other disease. 4 Reduction in morbidity and mortality rates especially among infants and children 5 Extension of essential health services with priority given to the underserved sectors. 6 Improvement in basic sanitation 7 Development of the capability of the community aimed at self-reliance. 8 Maximizing the contributions of other sectors for the social and economic development of the community.

4 A’s of Primary Health Care

A-ccessibility A-vailability A-cceptability A-ffordability

Principles of PHC

1 Partnership and empowerment as the core strategy 2 Focuses responsibility for health on the individual, his family and the community 3 Full participation and active involvement of the community towards the development of self-reliant people 4 Interrelationship between health and the overall political, socio-cultural and economic development of society.

FOUR CORNERSTONES OR PILLARS OF PHC

1 Active Community Participation 2 Intra and Inter-sectoral linkages 3 Use of appropriate technology 4 Support mechanism made available

8 Essential Health Services in Primary Health Care (ELEMENTS)

E – Education for Health L – Locally endemic disease control E – Expanded program for immunization M – Maternal and Child Health including responsible parenthood E – Essential drugs N – Nutrition T – Treatment of communicable and non-communicable diseases S – Safe water and sanitation

Preventive Aspect of Care of patients with Communicable Disease:

A. Health Education B. Immunization

This is one of the potent methodologies for information dissemination. It promotes the partnership of both the family members and health workers in the promotion of health as well as prevention of illness.

E – Education for Health

Preventive Aspect of Care of patients with Communicable Disease:

A. Health Education B. Immunization

The control of endemic disease focuses on the prevention of its occurrence to reduce morbidity rate. Give Example:

L – Locally endemic disease control Examples 1 Malaria Control 2 Schistosomiasis Control 3 H-Fever 4 Filariasis Control

Preventive Aspect of Care of patients with Communicable Disease:

A. Health Education B. Immunization

MALARIA CONTROL PROGRAM 2 Major Strategies of the Program

1 Vector Control - CLEAN - Chemoprophylaxis 2 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 - Signs & Sx - History of visit to & endemic area >Microscopic - Mass blood smear exam

Preventive Aspect of Care of patients with Communicable Disease:

A. Health Education B. Immunization

A parasitic infection caused by blood flukes inhabiting the veins of their vertebral victims transmitted thru skin penetration causing diarrhea, ascites, hepatosplenomegaly

SCHISTOSOMIASIS CONTROL PROGRAM

Acute febrile infection of sudden onset, caused by Aedes Aegypti, vector mosquito

H-FEVER (DENGUE)

A mosquito borne disease caused by a tissue nematode attacking the lymphatic system of humans thereby causing elephantiasis, lymphedema & hydrocele

FILARIASIS CONTROL PROGRAM

This program exists to control the occurrence of preventable illnesses especially of children below 6 years old. Immunizations on poliomyelitis, measles, tetanus, diphtheria and other preventable disease are given for free by the government and ongoing program of the DOH

E – Expanded program for immunization

The objective of E – Expanded program for immunization is to reduce __ and __ through decreasing the prevalence of the six immunizable diseases which are __

1 infant mortality, morbidity 2 TB, Poliomyelitis, Diphtheria, Tetanus, Pertussis and Measles

E – Expanded program for immunization Noteworthy Campaigns:

1 National Immunization Days (NID) 2 Knock-out Polio (KOP) 3 Garantisadong Pambata (GP)

System used to maintain the potency of a vaccine from the time of manufacture to time it is given

COLD CHAIN

In Cold Chain 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

Cold Chain System

1 Storage of vaccines should NOT exceed: __ 2 Use of boxes/carriers in transport 3 Once opened, vaccines must be placed in a special cold pack during sessions 4 DISCARD: BCG: After 4 hours, Others: After 8 hours

1 The mother and child are the most delicate members of the community. So the protection of the mother and child to illness and other risks would ensure good health for the community. 2 Its goal includes spacing of children and responsible parenthood. 3 Maternal and Child Health Programs: __

1 M – Maternal and Child Health including responsible parenthood 2 Family Planning 3 Maternal Health Program Child Health Program Family Planning Program

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

E - Essential drugs

1 One basic need of the family is food. And if food is properly prepared then one may be assured healthy family. Faulty preparation and lack of knowledge regarding proper food planning. 2 __ is one of the problems that we have in the country.

1 N – Nutrition 2 Malnutrition

Goal & Objectives of nutrition program

1 Goal: The improvement of nutritional status, productivity and quality of life of the population through the adoption of desirable dietary practices and healthy lifestyle 2 Objectives: To decrease the morbidity and mortality rates secondary to avitaminoses and other nutritional deficiencies among the population mostly composed of infants and children

Is the government’s response to the growing micronutrient malnutrition that has been prevalent in the Philippines for the past several years Examples: __

FOOD FORTIFICATION PROGRAM Examples: Vitamin A, Iron, Iodine Sangkap Pinoy FIDEL salt

1 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 2 Tools utilized are Anthropometric measurements:

1 NUTRITION SURVEILLANCE SYSTEM 2 -Weight for Age -Height for Age -Weight for Height -BMI

1 The diseases spread through direct contact pose a great risk to those who can be infected. 2 __ is one of the communicable diseases continuously occupies the top ten causes of death.

1 T – Treatment of communicable and non-communicable diseases 2 Tuberculosis

1 is an illness caused by an infectious agent that is transmitted directly or indirectly to a well person through a vector or an inanimate object. 2 is an individual who harbors the organism and is capable of transmitting it to a susceptible host without showing manifestations of the disease. 3 is a term given to a disease that is easily transmitted from one person to another through direct or indirect means. 4 is a person, animal or a plant on which parasite depends for its survival 5 is transmitted not only by ordinary contact but requires direct inoculation of the organism through a break on the skin or mucous membrane.

1 Communicable Disease 2 Carrier 3 Contagious Disease 4 Host 5 Infectious Disease

1 is the separation from other persons of an individual suffering from a communicable disease. 2 is the limitation of freedom of movement of persons or animals which have been exposed to communicable disease for a period of time equivalent to the longest incubation period of illness. 3 is the act of watching. 4 are diseases that occur occasionally and irregularly with no specific pattern. 5 are diseases that occur in a greater number than what is expected in a specific area over a specific time. 6 is an epidemic that affects several countries or continents

1 Isolation 2 Quarantine 3 Surveillance 4 Sporadic diseases 5 Epidemic diseases 6 Pandemic diseases

1 are those diseases that are present in a population or community at times involving few people during specific periods.

1 Endemic diseases

1 is any microbe capable of producing a disease. E.g. bacteria, spirochete, virus, fungi. Etc. 2 refers to the environment and objects on which an organism survives and multiplies. 3 is the path or way in which the organism leaves the reservoir. E.g. RS, GUT, GIT, skin and mm. 4 is the means by which the infectious agent passes through from the portal of exit of the reservoir to the susceptible host. This is the easiest link to break the chain of infection 5 is the venue where the organism gains entrance into the susceptible host. 6 the human body has many defenses against the entry and multiplication of organism.

1 CAUSATIVE agent 2 RESERVOIR of Infection 3 Portal of EXIT 4 Mode of TRANSMISSION 5 PORTAL of Entry 6 SUSCEPTIBLE host

MODES OF TRANSMISSION

1 Contact Transmission 2 Air-borne transmission 3 Vehicle transmission 4 Vector-borne transmission

Preventive Aspect of Care of patients with Communicable Disease:

A. Health Education B. Immunization

1 is the introduction of specific protective antibodies in a susceptible person or animal, or the production of cellular immunity in such person or animal 2 is a condition of being secure against any particular disease.

1 Immunization 2 Immunity

Immunization 1 acquired through placental transfer 2 acquired through immunization and or recovery from a certain disease 3 acquired through the administration of antitoxin, antiserum, and gamma-globulins 4 acquired through the administration of vaccine and toxoid

1 Natural Passive (NATURAL) 2 Natural Active (NATURAL) 3 Artificial Passive 4 Artificial Active

Types of antigen:

1 Inactivated (killed organism) - not long lasting, multiple dose needed and booster dose is needed 2 Attenuated (live organism) - single dose needed and has long lasting immunity

Is defined as the study of all factors in man’s physical environment, w/c may exercise a deleterious effect on his health, well-being and survival.

Environmental Sanitation

S – Safe water and sanitation goal

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

1 BCG dose, route, site 2 HEPA B & DPT dose, route, site 3 OPV dose, route, site 4 AMV dose, route, site 5 TT dose, route, site

1) Infant: 0.05ml (ID, Right deltoid) School entrants: 0.10ml (ID, Left deltoid) 2) Both 0.5ml (IM, Vastus lateralis) 3) 2 gtts (Oral, Mouth) 4) 0.5ml (SQ, Outer part of upper arm) 5) 0.5ml (IM, Deltoid)

1) TT1 (Min time interval, percent protection & duration of protection) 2) TT2 (Min time interval, percent protection & duration of protection) 3) TT3 (Min time interval, percent protection & duration of protection) 4) TT4 (Min time interval, percent protection & duration of protection) 5) TT5 (Min time interval, percent protection & duration of protection)

1 as early as pregnancy 2 at least 4 weeks, 80%, Infant: Neonatal tetanus Mother: 3 years 3 at least 6 months, 95% Infant: Neonatal tetanus Mother: 5 years 4 at least 1 year, 99% Infant: Neonatal tetanus Mother: 10 years 5 at least 1 year, 99%, all infants protected, mother protected lifetime

1 NUTRITION PROGRAM coverage:

1 Protein Energy Malnutrition (PEM) 2 Vitamin A deficiency (VAD) 3 Iron Deficiency Anemia (IDA) 4 Iodine Deficiency Disorder (IDD)

Directed to the provision of nutrition services to the DOH’s identified priority vulnerable groups

Philippine Food & Nutrition Programs

NUTRITION PROGRAMS

1 Targeted Food Task Force Assistance Program 2 Nutrition Rehabilitation Ward 3 Akbayan sa Kalusugan (ASK Project) 4 “23 in 93” FORTIFIED VITAMIN RICE 5 “Health for More in ‘94” “Buwan ng Kabataan, Pag-asa ng Bayan’ National Focus: National Micronutrient Day or “Araw ng Sangkap Pinoy”

1 Provision of food rations of bulgur wheat & green peas 2 Target population: _

1 Targeted Food Task Force Assistance Program 2 Pre-schoolers Pregnant women Lactating mothers

Every hospital must have a Nurse ward, where an adequately trained nutritionist were assigned (RA 422)

Nutrition Rehabilitation Ward

1 Aimed to provide rice & corn soya blend supplemented with local foods. 2 Target population: __

1 Akbayan sa Kalusugan (ASK Project) 2 -6 mos- 2 years -Moderately & severely underweight -Pre-schoolers not served by the DSWD and DA in Regions 2,8,9,10,11,12

1 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)

“23 in 93” FORTIFIED VITAMIN RICE

-Aimed to distribute vitamin A supplements, iodized oil for & seedlings of plants rich in Fe & other minerals.

“Health for More in ‘94” “Buwan ng Kabataan, Pag-asa ng Bayan’ National Focus: National Micronutrient Day or “Araw ng Sangkap Pinoy”

TYPES OF NUTRITIONAL DEFICIENCIES

1 PROTEIN ENERGY MALNUTRITION (PEM) 2 VITAMIN A DEFICIENCY 3 IRON DEFICIENCY ANEMIA (IDA) 4 IODINE DEFICIENCY DISORDERS (IDD)

1 Abnormalities due to low iodine intake. 2 Consequences: __ 3 Treatment: __

1 IODINE DEFICIENCY DISORDERS (IDD) 2 Fetus – abortion/miscarriage/abnormalities/still Infants – cretinism/delayed walking/motor activities Children – poor academic performance Adults – mental impairment/poor working capacity 3 to take one iodized capsule with 200mg iodine every year

PROTEIN ENERGY MALNUTRITION (PEM) Types

1 MARASMUS 2 KWASHIORKOR

1 Abnormalities due to low iodine intake. 2 Consequences: __ 3 Treatment: __

"OLD MAN'S FACE" Very thin, no fat, muscle wasting Prominent ribs Very poor wt gain Loose & wrinkled skin Enlarged abdomen Anxious, always hungry

MARASMUS

1 Abnormalities due to low iodine intake. 2 Consequences: __ 3 Treatment: __

Very thin, fails to grow - Swollen legs, feet, arms & hands - Light colored, weak hair - Doesn’t want to eat - Moon-shaped, Unhappy face - Dark spots on skin - Enlarged abdomen - Skin sores & skin is peeling - Muscle wasting - Apathetic

KWASHIORKOR

1 Low intake of Vitamin A rich food Low intake of protein Illnesses like measles, diarrhea 2 Consequences: __

1 VITAMIN A DEFICIENCY 2 Night blindness Nutritional blindness

UNIVERSAL SUPPLEMENTATION OF VITAMIN A 1 INFANTS 2 PRESCHOOLERS 3 PREGNANT WOMEN 4 POSTPARTUM MOTHERS

1) 100,000 IU One dose only 2) 200,000 IU One capsule every 6 months 3) 10,000 IU twice a week starting at the 4th month of pregnancy* 4) 200, 000 IU within four weeks after delivery

1 Not enough hemoglobin in the RBC because of lack of Fe 2 Treatment and prevention: __

1 IRON DEFICIENCY ANEMIA (IDA) 2 provision of iron with folic acid pregnant: Once a day for 180 days Lactating women once a day for 90 days

1 Abnormalities due to low iodine intake. 2 Consequences: __ 3 Treatment: __

A complete medical system that has been used to diagnose, treat and prevent illnesses for more than 2,000 years.

Traditional Chinese Medicine / ORIENTAL MEDICINE

It is based on the belief that qi (the body's vital energy) flows along meridians (channels) in the body and keeps a person’s spiritual, emotional, mental, and physical health in balance.

Yin and yang

1 Traditional Chinese medicine has been use more than __ and becoming popular in recent years across the world. A unique system therapy to diagnose and cure the diseases. 2 __ are used in drug discovery, dietary and functional food elements

1) 2000 years 2 Herbal medicine products