COMMUNITY

HEALTH
Community Health
These are group of Complete state of physical, mental and social
people that shares well-being and not merely the absence of
the common disease or infirmity (WHO)
geographic Right of every individual
Art. 25 Sec 1 of Universal Declaration of
location, institution
human Rights: Health is a basic right of
where they are
every individual.
organized into Everyone has the right to a standard of
population living adequate for the health and
aggregate concept wellbeing of himself and of his family
(age group), Dual responsibility of the government
common values or and the individuals.
interest. Art. 2, Sec. 15
The state shall protect and promote the
Levels of Clientele right to health of the people and instill
Individual health consciousness among them.
Family – focus of care (CHN) Art. 13, Sec. 11
Community – group of families; CHN The state shall adopt an integrated and
directs its services to the community comprehensive approach to health
because the client is the community
development
Population Groups – common health
needs
 Nursing Community
“Assisting an individual, sick or well,
in the performance of those
Health Nursing
activities contributing to health or direct, goal-oriented, and
its recovery (or to peaceful death) adaptable to the needs of
that he would perform if he head the individual, the family,
the necessary strength, will, or
and community during
knowledge, and to do this in such a
health and illness - ANA
way as to help him gain
(1973)
independence as rapidly as
possible.” - Virginia Henderson an area of human services
(1964) directed toward
developing and enhancing
Community Health the health capabilities of
people – either singly, as
Part of paramedical and medical
intervention/approach which is individuals, or collectively
concerned on the health of the whole as groups and
population communities. – Ruth
Aims:
Freeman & Janet Heinrich
Health promotion
Disease prevention (1981)
Management of factors affecting
health
Public Health Public Health Nursing
Philosophy—health and
longevity as birthright Public health + Nursing +
Social Assistance
Objectives:
Prevent disease 1. Promotion of health
Prolong life 2. Improvement of the physical &
Promote health and social environment
efficiency 3. Rehabilitation
Through: organized 4. Prevention of illness and
community effort disability
“The application for
science in the context of WHO Expert Committee on
politics to remove Nursing
inequalities in health and
deliver the best health for
the greatest number” –
WHO
 Milestones in history of public health
1601- Elizabeth Poor Law
1617- Sisterhood of Dames de Charite organized by St. Vincent de
Paul
1789- Baltimore Health Department
1798- Marine Hospital Service, nuns visited poor
1813- Ladies Benevolent Society of Charleston, South Carolina
founded
1836- Lutheran deaconesses provided home visits in Germany
1851- Nightingale visited Kaiserwerth, 3 months of nursing training
1855- Quarantine Board, established in New Orleans; beginning of
tuberculosis campaign in US
1859- district nursing established by William Rathbone
1860- Florence Nightingale Training School for Nurses established
in St. Thomas Hospital in London
1864- Beginning of Red Cross
 HISTORY OF PUBLIC HEALTH AND
PUBLIC HEALTH NURSING IN THE
PHILIPPINES
1577 - Franciscan FriarJuan Clemente opened medical dispensary in
Intramuros for the indigent
1690 – Dominican Father Juan de Pergero worked toward installinga water
system in San Juan del Monte and Manila
1805 – smallpox vaccination was introduced by Franciwsco de Balmis , the
personal physician of King Charles IV of Spain
1876 – first medicos titulares were appointed by the Spanish government
1888 - 2-year courses consisting of fundamental medical and dental subjects
was first offered in the University of Santo Tomas. Graduated were known as
“cirujanosministrantes” and serve as male nurses and sanitation inspectors
1901 – United States Philippines Commission, through Act 157, created the
Board of Health of the Philippine Islands with a Commisioner of the Public
Health ,as its chief executive officer (now the Departmnt of Health
Fajardo Act of 1912 – created sanitary divisions made up of one to four
municipalities. Each sanitary division had a president who had to be a
physician
 HISTORY OF PUBLIC HEALTH AND
PUBLIC HEALTH NURSING IN THE
PHILIPPINES
1915 - the Philippine General hospital began to extend public health nursing
services in the homes of patients by organizing a unit called Social and Home
Care services
Asociacion Feminista Filipina (1905) – Lagota de Leche was the first center
dedicated to the service of the mothers and babies
1947 – the Department of Health was reorganized into bureaus: quarantine,
hospitals that took charge of the municipal and charity clinics and health with
the sanitary divions under it.
1954 – Congress passed RA 1082 or the Rural Health Act that provided the
creation of RHU in every municipality
RA 1891 – enacted in 1957 amendd certain provisions in the Rural Health Act
-Created 8 categories of rural health units corresponding to the population
size of the municipalities
RA 7160 (Local Government Code) – enacted in 1991, amended that devolution of
bsic health services incuding health services, to ocal government units and
the establishment of a local health board in every province and city of
municipality
Roles of a PUBLIC HEALTH NURSE
Clinician Epidemiologist
who is a health care provider,
taking care of the sick people at
home or in the RHU

Health Educator Health Advocator

who aims towards health who speaks on behalf of the client
promotion and illness prevention
through dissemination of correct
information; educating people

Facilitator Advocator
who establishes multi-sectoral who act on behalf of the client
linkages by referral system

Supervisor Collaborator
who monitors and supervises the who working with other health
performance of midwives team member
 Health Care Delivery System
Primary Secondary Tertiary
Prevention Hospitalization Rehabilitation
Management Providers: Specialized care
of prevalent Provincial Highly trained
conditions Hospitals personnel
Out-patient District Highly
services Hospitals departmentalized
Providers: Sophisticated
Barangay equipment
Health Providers:
Station Regional Hospital
Rural National Hospitals
Health DOH national office
Units Medical Centers
Two-way Referral System University Hospital
Communication among facilities
Competent care
Efficiency of health care delivery
RITM
Least possible cost
Maximize resources
Health Sectors Department of Health
Vision: Health for all by year 2000 ands
Government Sectors Health in the Hands of the People by
Non Government 2020
Mission: In partnership with the
Sectors people, provide equity, quality and
Private Sectors access to health care esp. the

RA 7160 - Devolution Code marginalized

Local Government Code National hospitals/DOH,
office, Medical
national

Aim: to transform local Major Centers

government units into: Functions Chair: Health Secretary
Self-reliant
1. Ensure equal access to basic health
communities services
Provincial
Active partnership 2. Ensure formulation of national policies Health Board
with the people for proper division of labor and proper Regular hospitals/RHO
Provincial Hospital/PHO
Responsive coordination of operations among the
District Hospital
government government agency jurisdictions Chair: governor
3. Ensure a minimum level of
representatives Vice chair: PHO
implementation nationwide of services Members: Chairman, NGO, DOH
Accountable regarded as public health goods
government 4. Plan and establish arrangements for the
Municipal
representatives public health systems to achieve Health Board
Decentralization economies of scale RHU/BHS
Chair: Mayor
system of health 5. Maintain a medium of regulations and
Vice Chair: MHO
decision making standards to protect consumers and Members: Chairman, NGO,
guide providers DOH representative
 Department of Health
Chair: health Secretary

Provincial Health Board

Chair: Governor; Vice-Chair: Provincial
health Officer;
Members: Chairman, NGO, DOH

Municipal Health Board

Chair: Governor; Vice-Chair:
Provincial health Officer;
Members: Chairman, NGO, DOH

DOH standards, training and funding

LGU policies, implementation

 Primary Strategies to Major Strategies of
Achieve Health Goals Primary Health Care
Support for health goal Elevating Health to a Comprehensive
Assurance of health care and Sustained National Effort
Increasing investment for PHC Promoting and Supporting Community
Development of National Standard Managed Health Care
Increasing Efficiencies in the Health
Milestone in Health Sector
Care Delivery System Advancing Essential National Health
RA 1082 – RHU Act Research
RA 1891 – Strengthen Health
Services
PD 568 – Restructuring HCDS Four Cornerstones/Pillars
RA 7160 – LGU Code in Primary Health Care
1. Active Community
Elements of Primary Health Care Participation
2. Intra and Inter-
1. Education for Health 6.Nutrition and Promotion of
sectoral Linkages
2. Locally Endemic Disease Control Adequate Food Supply
3. Use of Appropriate
3.Expanded Program on 7.Treatment of
Technology
Immunization Communicable Diseases
4. Maternal and Child Health and and Common Illness 4. Support mechanism
Family Planning 8. Supply of Essential Drugs made available
5. Environmental Sanitation and
Promotion of Safe Water Supply
 Primary Health Care (PHC) Two Levels of Primary
Legal Basis—LOI 949 Health Care Workers
October 1979 by Ferdinand Marcos, 1.Barangay Health Workers – trained community
one (1) year after the First health workers or health auxiliary volunteers or
International Conference on Primary traditional birth attendants or healers.
Health Care in Alma Ata (Russia)
sponsored by WHO & UNICEF Village/BHWs—trained community health works,
Goal - Health for all Filipinos & Health in health auxiliary volunteers, traditional birth
the Hands of the People by the attendants, healers (Grassroots Levels)
Intermediate Level—Professional group
Mission - To strengthen the health care
Primary
system by increasing opportunities and
Rural Health Midwife (1:5,000)
supporting the conditions wherein Secondary
people will manage their own health care Public Health Nurse (1:20,000) – WHO
Essential health care made universally: 1:10,000
Dentists (1:50,000)
1. Accessible – to the people in the Rural Sanitary Inspector (1:20,000)
catchment of the barangay Tertiary
2. Available Municipal Health Officer -
Physician (1:20,000)
3. Appropriate – to the needs of the people
4. Affordable
2. Intermediate level health workers- include the
Acceptable – does not conflict their
Public Health Nurse, Rural Sanitary Inspector
values and beliefs in the locality year and midwives
2020.
 8 Essential Health Services
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 noncommunicable diseases

S Safe water and sanitation

 Types of Health Care Systems
Traditional Acupuncture
a. E.g. client provider Insertion of needles into selected body
parts to control pain
Non-Traditional
a. Holistic Health Centers Acupressure
Believes that time, space and encouragement can help people Finger pressure to control pain in body
find strength to deal with problems confronting them parts
Spiritual, physical and psychological care
Acts:
Pastoral counseling
Stress reduction
Kinesiology
Study of movement which applies
Parenting
Dietary conditioning principles of anatomy to movement

Faith Healing Reflexology

Believes that disease is a state of mind so one can alter his state
Systematic massage of soles of feet
of mind so he will be healed
Applies same principles as applied in
acupressure
Chiropractic
System of manipulation treatment which teaches that all
diseases are caused by impringement on spinal column and
Massage
corrected by spinal adjustment Relieves tension, enhances flexibility and
Daniel Palmer- founder creates coordination between mind and
body
R.A. 8423
Traditional and Alternative Medicine Act of 1997 (Juan Flavier)
 Medicinal Plant Preparation
DECOCTION
boiling the plant material in water for 20 min

INFUSION
plant material is soaked in hot water for 10 - 15 minutes

POULTRICE
directly apply plant material on the affected part, usually in
bruises, wounds and rashes

TINCTURE
mix the plant material in alcohol
Alternative health care modalities
PRIMARY CARE
Includes health promotion, disease prevention, health maintenance, counseling,
patient education and diagnosis and treatment of acute and chronic illness in
different health settings (American Association of Family Medicine)
 Philippine Health Care Laws
Republic Act
Republic Act 349 – Legalizes the use of human organs for surgical, medical and
scientific purposes.
Republic Act 1054 – Requires the owner, lessee or operator of any commercial,
industrial or agricultural establishment to furnish free emergency, medical and
dental assistance to his employees and laborers.
Republic Act 1080 – Civil Service Eligibility
Republic Act 1082 – Rural Health Unit Act
Republic Act 1136 – Act recognizing the Division of Tuberculosis in the DOH
Republic Act 1612 – Privilege Tax/Professional tax/omnibus tax should be paid
January 31 of each year
Republic Act 1891 – Act strengthening Health and Dental services in the rural areas
Republic Act 2382 – Philippine Medical Act which regulates the practice of medicines
in the Philippines
Republic Act 2644 – Philippine Midwifery Act
Republic Act 3573 – Law on reporting of Communicable Diseases
Republic Act 4073 – Liberalized treatment of Leprosy
Republic Act 4226 – Hospital Licensure Act requires all hospital to be licensed before
it can operative
 Philippine Health Care Laws
Republic Act
Republic Act 5181 – Act prescribing permanent residence and reciprocity as
qualifications for any examination or registration for the practice of any profession
in the Philippines
Republic Act 5821 – The Pharmacy Act
Republic Act 5901 – 40 hours work for hospital workers
Republic Act 6111 – Medicare Act
Republic Act 6365 – Established a National Policy on Population and created the
Commission on population
Republic Act 6425 – Dangerous Drug Act of 1992
Republic Act 6511 – Act to standardize the examination and registration fees charged
by the National Boards, and for other purposes.
Republic Act 6675 – Generics Act of 1988
Republic Act 6713 – Code of Conduct and Ethical Standards for Public Officials and
Employees
Republic Act 6725 – Act strengthening the prohibition on discrimination against
women with respect to terms and condition of employment
 Philippine Health Care Laws
Republic Act
Republic Act 6727 – Wage Rationalization Act
Republic Act 6758 – Standardized the salaries
Republic Act 6809 – Majority age is 18 years old
Republic Act 6972 – Day care center in every Barangay
Republic Act 7160 – Local Government Code
Republic Act 7164 – Philippine Nursing Act of 1991
Republic Act 7170 – Law that govern organ donation
Republic Act 7192 – Women in development nation building
Republic Act 7277 – Magna Carta of Disabled Persons
Republic Act 7305 – The Magna Carta of public Health Workers
Republic Act 7392 – Philippine Midwifery Act of 1992
Republic Act 7432 – Senior Citizen Act
Republic Act 7600 – Rooming In and Breastfeeding Act of 1992
Republic Act 7610 – Special protection of children against abuse, exploitation and
discrimination act
Republic Act 7624 – Drug Education Law
Republic Act 7641 – New Retirement Law
 Philippine Health Care Laws
Republic Act
Republic Act 7658 – An act prohibiting the employment of children below 15 years of
age
Republic Act 7719 – National Blood Service Act of 1994
Republic Act 7875 – National Health Insurance Act of 1995
Republic Act 7876 – Senior Citizen Center of every Barangay
Republic Act 7877 – Anti-sexual harassment Act of 1995
Republic Act 7883 – Barangay Health workers Benefits and Incentives Act of 1992
Republic Act 8042 – Migrant Workers and Overseas Filipino Act of 1995
Republic Act 8172 – Asin Law
Republic Act 8187 – Paternity Leave Act of 1995
Republic Act 8203 – Special Law on Counterfeit Drugs
Republic Act 8282 – Social Security Law of 1997 (amended RA 1161)
Republic Act 8291 – Government Service Insurance System Act of 1997 (amended PD
1146)
Republic Act 8344 – Hospital Doctors to treat emergency cases referred for
treatment
Republic Act 8423 – Philippine Institute of Traditional and Alternative Medicine
 Philippine Health Care Laws
Republic Act
Republic Act 8424 – Personal tax Exemption
Republic Act 8749 – The Philippine Clean Air Act of 1999
Republic Act 8981 – PRC Modernization Act of 2000
Republic Act 9165 – Comprehensive Dangerous Drugs Act 2002
Republic Act 9173 – Philippine Nursing Act of 2002
Republic Act 9288 – Newborn Screening Act

Presidential Decree
Presidential Decree 46 – An act making it punishable for any public officials or
employee, whether of the national or local government, to receive directly or
indirectly any gifts or valuable things
Presidential Decree 48 – Limits benefits of paid maternity leave privileges to four
children
Presidential Decree 69 – Limits the number of children to four (4) tax exemption
purposes
Presidential Decree 79 – Population Commission
Presidential Decree 147 – Declares April and May as National Immunization Day
 Philippine Health Care Laws
Presidential Decree
Presidential Decree 148 – Regulation on Woman and Child Labor Law
Presidential Decree 166 – Strengthened Family Planning program by promoting
participation of private sector in the formulation and implementation of program
planning policies.
Presidential Decree 169 – Requiring Attending Physician and/or persons treating
injuries resulting from any form of violence.
Presidential Decree 223 – Professional Regulation Commission
Presidential Decree 442 – Labor Code Promotes and protects employees self-
organization and collective bargaining rights. Provision for a 10% right differential
pay for hospital workers.
Presidential Decree 491 – Nutrition Program
Presidential Decree 539 – Declaring last week of October every as Nurse’s Week.
October 17, 1958
Presidential Decree 541 – Allowing former Filipino professionals to practice their
respective professions in the Philippines so they can provide the latent and
expertise urgently needed by the homeland
Presidential Decree 568 – Role of Public Health midwives has been expanded after
the implementation of the Restructed Health Care Delivery System (RHCDS)
 Philippine Health Care Laws
Presidential Decree
Presidential Decree 603 – Child and Youth Welfare Act / Provision on Child Adoption
Presidential Decree 626 – Employee Compensation and State Insurance Fund. Provide
benefits to person covered by SSS and GSIS for immediate injury, illness and disability.
Presidential Decree 651 – All births and deaths must be registered 30 days after delivery.
Presidential Decree 825 – Providing penalty for improper disposal garbage and other forms
of uncleanliness and for other purposes.
Presidential Decree 851 – 13th Month pay
Presidential Decree 856 – Code of Sanitation
Presidential Decree 965 – Requiring applicants for Marriage License to receive instruction
on family planning and responsible parenthood.
Presidential Decree 996 – Provides for compulsory basic immunization for children and
infants below 8 years of age.
Presidential Decree 1083 – Muslim Holidays
Presidential Decree 1359 – A law allowing applicants for Philippine citizenship to take Board
Examination pending their naturalization.
Presidential Decree 1519 – Gives medicare benefits to all government employees regardless
of status of appointment.
Presidential Decree 1636 – requires compulsory membership in the SSS and self-employed
Presidential Decree 4226 – Hospital Licensure Act
 Philippine Health Care Laws
Proclamation
Proclamation No.6 – UN’s goal of Universal Child Immunization; involved NGO’s in the
immunization program
Proclamation No. 118 – Professional regulation Week is June 16 to 22
Proclamation No. 499 – National AIDS Awareness Day
Proclamation No. 539 – Nurse’s Week – Every third week of October
Proclamation No. 1275 – Declaring the third week of October every year as “Midwifery Week”

Letter Of Instruction
LOI 47 – Directs all school of medicine, nursing, midwifery and allied medical professions
and social work to prepare, plan and implement integration of family planning in their
curriculum to require their graduate to take the licensing examination.
LOI 949 – Act on health and health related activities must be integrated with other activities
of the overall national development program. Primary Health Care (10-19-79)
LOI 1000 – Government agencies should be given preference to members of the accredited
professional organization when hiring.
 Philippine Health Care Laws
Executive Order
Executive Order 51 – The Milk Code
Executive Order 174 – National Drug Policy on Availability, Affordability, Safe, Effective
and Good Quality drugs to all
Executive Order 180 – Government Workers Collective Bargaining Rights Guidelines on
the right to Organize of government employee.
Executive Order 203 – List of regular holidays and special holidays
Executive Order 209 – The Family Code (amended by RA 6809)
Executive Order 226 – Command responsibility
Executive Order 503 – Provides for the rules and regulations implementing the transfer
of personnel, assets, liabilities and records of national agencies whose functions are to
be devoted to the local government units.
Executive Order 857 – Compulsory Dollar Remittance Law

Other
Administrative Order 114 – Revised/updated the roles and functions of the Municipal
Health Officers, Public Health Nurses and Rural Midwives
ILO Convention 149 – Provides the improvement of life and work conditions of nursing
personnel.
Health Promotion
Is the process of enabling people to increase control over, and to improve
their health
A behavior motivated by the desire to increase well-being and actualize
human health potential. It is an approach to wellness

Disease prevention
activities protect people from disease and effects of disease

Leavell and Clark’s Three Levels of Prevention

Primary prevention
relates to activities directed at preventing a problem before it occurs by altering
susceptibility or reducing exposure for susceptible individuals.

Secondary prevention
early detection and prompt intervention during the period of early disease
pathogenesis

Tertiary prevention
targets populations that have experienced disease or injury and focuses on
limitations of disability and rehabilitation
 Ottawa Charter Prerequisites for Health
Output of the first
international conference on Advocate
health promotion, meeting in Enable the community of health education
Mediate – facilitate decision making process
Ottawa this 21st day of
November, 1986
A call for action to achieve
health for all by the year
2000 and beyond
1. Building healthy public
policies – Breastfeeding
Law, Rooming-in
2. Create a supportive
environment
3. Strengthen community
action
4. Develop personal skills
5. Reorient health services
 Millennium Development Goals
The 3 day summit held on 6–8 September, 200 @ NY was the largest ever gathering of
world leader.
They agreed to achieve a set of concrete, measurable
The millennium development goals are the world’s time-bound and quantified
targets

mdgmonitor.org
Goal 1: Eradicate Goal 4: Reduce Child
extreme poverty and Mortality
hunger Reduce by 2/3 the mortality rate
Goal 7: Ensure
among children under 5
Reduce by half the proportion of people environmental
living on less than a dollar a day Under 5 mortality rate
Infant mortality rate
sustainability
Proportion of population below $1/day Integrate the principles
Proportion of 1 year old
Poverty gap ratio of sustainable
children immunized against
Share of poorest quintile in national development into
measles
consumption country politics and
Goal 2: Achieve Universal Goal 5: Improve Maternal programs; reverse loss
Primary Education Health of environmental
resources
Ensure that all boys and girls complete a Reduce by 3⁄4 the maternal
NGPs – 1.5 billion trees
full course of primary schooling mortality ratio
Net enrollment ratio in primary Maternal mortality ratio
education Proportion of births attended Goal 8: A global
Proportion of pupils starting grade 1 by skilled health personnel partnership for
who reach lest grade of primary Achieve by 2015, universal development
Literacy rate of 15–24 year–olds, access to reproductive health Integrate the principles
women and men of sustainable
Goal 3: Promote Gender Goal 6: Combat development into
Equality and Empower HIV/AIDS, malaria, and country politics and
Women other diseases programs; reverse loss
Eliminate gender disparity in primary and Halt and begin to reverse the of environmental
secondary education preferable by 2005, and at spread of HIV/AIDS resources
all levels by 2015 Achieve by 2010, universal access NGPs – 1.5 billion trees
Ratios of girls to boys in primary, secondary to treatment for HIV/AIDS for all
and tertiary education
those who need it
Share of women in wage employment in the
Halt and begin to reverse the
non-agricultural sector
incidence
Proportion of seats held by women in
national parliament
FOURmula One for Health as Implementation Framework
Goals:
Better health outcomes
More responsive health system
Equitable health care financing
Four Thrusts:
Financing (increased, better and sustained)
Regulation (assured quality & affordability)
Service Delivery (access & availability)
Good Governance (improves performance)

Sentrong Sigla Movement

Goal - Quality Health
Objective - Better and more effective collaboration between the DoH and LGUs
DOH - Technical and financial assistance
LGUs - Developers of health systems and implementer
Pillars
Quality assurance – ongoing process of improving health care services
Grants and technical assistance
Awards – Sentrong Sigla Movement seal
Health promotion – health education

Aquino Health Agenda

Achieving universal health care (UHC) for all Filipinos
Kalusugan Pangkalahatan (KP)
AO No. 2010-0036
Objective:
To achieve universal healthcare
Home Visit Bag Technique
Professional face to face A tool making use of
public health bag
contact made by the nurse to
through which the
Public health bag
the family
Purpose: nurse, during his/her
home visit, can perform
To provide necessary
nursing procedures with
health care activities
ease and deftness,
To further attain an saving time and effort
objective of the agency with the end in view of
rendering effective
nursing care.
Principles in Planning for
a Home Visit: Principles
1. Have a purpose or objective 1.Minimize & Prevent spread of
2. Make use of all available infection
All articles from the family are
information
considered as contaminated
3. Focus on essential needs of the
Well to Sick
individual and Hold the lining on the outside
family but prioritize needs Clean technique
recognized by the 2. Save time & effort of nurse
family 3. Effectiveness of care—not
4. Should involve the individual overshadow
4. Performed in variety of ways—
and family
do not spread infection
5. Flexible and practical
 Types of Problems in the Community
Family Community
Wellness Condition Health Status

Health Deficit Health Resources

(facilities, manpower)

Health Threat Health Related

(political, environmental,
social, economical)
Foreseeable Crisis or
Stress

Evaluation of Nursing Care

Effectiveness Measures attainment of objectives

Efficiency Cost, time, and resources

Appropriateness the ability of the intervention to solve the problem

Comprehensiveness or the number of solutions to solve the

Adequacy problems
Community Organizing
Is a continuous process of educating the community to develop its capacity to
assess and analyze the situation (which usually involves the process of
consciousness raising), plan and implement interventions (mobilization), and
evaluate them.
Is a process of educating and mobilizing members of the community to enable
them to resolve community problems. It is a means to build the community’s
capacity to work for the common good in general and health goals.

Community organizing and community health nursing practice have common

goals: People empowerment, development of self-reliant community, and
improved quality of life. As a result, they become the health care professionals’
partners in health care delivery and overall community development

Community development
entails a process of assessment of the current situation, the identification of
needs, deciding on appropriate courses of actions or response, mobilization of
resources to address these needs, and monitoring and evaluation by the people.
CORE PRINCIPLES IN COMMUNITY ORGANIZING

Community organizing
is people-centered

Community organizing
is participative

Community organizing
is democratic

Community organizing
is developmental

Community organizing
is process-oriented
 PHASES OF COMMUNITY ORGANIZING
Pre-entry
Involves preparation one the part of the organizer and choosing a community for partnership.
Preparation includes knowing the goals of the community organizing activity or experience. It also necessary to delineate criteria or
guidelines for site selection.
Making a list of sources of information and possible facility resources, both government and private, is recommended.
For the novice organizers, preparation includes a study or review of the basic concepts of community organizing.
Proper selection of possible barriers, threats, strengths, and opportunities at this stage is an important determinant of the overall
outcome of community organizing.
Communities may be identified through different means:
Initial data gathered through an ocular survey
Review of records of a health facility
Review of the barangay/municipality profile
Referrals from other communities or institutions or through a series of meetings
Consultation from the local government units (LGUs) or rivate institutions.
An ocular survey done at this stage.
Courtesy call to the Mayor

Entry into the community

Entry into the community formalizes the start of the organizing process. This is the stage where the organizer gets to know the
community and the community likewise gets to know the organizer.
An important point to remember this phase is to make courtesy call to local formal leaders (barangay chairperson, council members)
Equally crucial but often overlooked is a visit to informal leaders recognized in the community, like elders, local health workers,
traditional healers, church leaders, and local neighborhood association leaders
Manalili describe two
Considerations in the entry phase strategies for gaining
The community organizer’s responsibility to clearly introduce themselves entry into a community
and their institution to the community. Padrino – a patron, usually barangay or some other
A clear explanation of the vision and mission, goals, programs, and activities local government official. The padrino, in an effort to
must be given in all initial meetings and contacts with the community. boost the organizer’s image, tends to preset the
Preparation for the initial visit includes gathering basic information on intended project output, thereby creating false hopes.
socioeconomic conditions, traditions including religious practices, overall Bongga – as the easiest way to catch the attention and
physical environment, general health resources. gain the “approval” of the community. This strategy
the community organizer must keep in mind that the goal of the process is to exploits the people’s weaknesses and usually involves
build up the confidence and capacities of people doles-out, such free medicines
Basic Emergency Obstetric
Care (Bemoc) Services Perinatal Care
Are upgraded enhanced BHS, RHU, lying-in
clinics or birthing homes, District and Community
Prenatal/ Antenatal visits
hospitals that provide. Home-based mother’s records
Encourage all women to deliver in
6 Basic Obstetric Functions the health facility
Administer Parenteral antibiotics
Parenteral Uterotonic drugs (Oxytocin)
Parenteral Anticonvulsants Pre-natal Check-up
Manual Removal of Placenta Age
Removal of Retained Placental Products LMP
Perform assisted vaginal delivery Family history
Fundic Height
Comprehensive Emergency Leopold’s Manuever
Obstetric Care (CEmoc) Services Blood Pressure
Are end-referral facilities capable of managing Tetamus
complicated deliveries and newborn ToxoidImmunization
emergencies Laboratory Tests
It should be able to perform 6 basic OB CBC – Anemia
functions as well as to provide Glucose Tolerance Test
CS services – 24 to 28th week AOG– if
Blood banking and transfusion services with hx of DM
Blood Typing – ABO Rh
Incompatibility
UA – Proteinuria, UTI,
STIs
Leopold’s Maneuver Void first
Position: supine or dorsal recumbent
Palm not fingertips
Provide privacy

1st Maneuver (Upper pole) 2nd Maneuver

(sides of
Fundal grip – find out what is maternal
occupying the uterus
abdomen)
Fetal presentation Umbilical grip
Fetal back

3rd Maneuver
(Lower pole) 4th Maneuver
(presenting part
Paulick grip evaluation)
Assess for fetal engagement Pelvic grip
Floating or engaged Fetal position
Primi: 2 weeks before labor Fetal attitude
(engagement)
Multi: during labor
Nutrition Program
Goal: Improve quality of life through better nutrition, improved health and increased productivity

Nutritional Programs
Nutritional assessment
Micronutrient supplementation
Food fortification
Maternal and child health service packages
Nutrition information communication, education
Home, school and community food production
Food assistance
Livelihood assistance
Treatment of conditions associated with malnutrition

Legislations Affecting the Philippine Nutrition Program

PD No. 491
declared July as the Nutrition Month and creation of National Nutrition Council

LOI 441
Integration of Nutrition Education in the school curriculum
Tetanus Toxoids Vitamin A Supplementation
Mother - Artificial Active Plant sources: Carotene
Baby – Natural Passive Animal sources: Retinol
Mother is protected after 1 dose Vit A Deficiency – can cause congenital
Baby is protected after 2 doses problems
IM – 0.5 mL – deltoid Do not give Vit. A if woman is taking
multivitamins
2nd trimester – teratogenic
Blue – 100,000 IU

Micronutrient Supplementation
Iron Deficiency – can cause neural tube defects Iodine Supplementation
Anemia – presence of pallor, N = 11g/dl Iodine deficiency – can cause congenital
hypothyroidism or cretinism
Iron Supplementation Sources: seafood
Avoid goitrogenic foods – cabbage,
broccoli, potato, peanuts, cauliflower -
inhibit the absorption of iodine in the body
Post-Partum Care Sleep Essential component of chronic
Breast disease prevention and health
Uterus promotion
Bowel
Bladder
Lochia – rubra,
serosa, alba
Episiotomy
Skin
Homan’s Sign
Emotions

Sleep Hygiene
Avoid caffeine and nicotine close to bedtime
Avoid alcohol as it can cause sleep disruptions
Retire and get up at the same time everyday
Exercise regularly but finish all exercise and vigorous activity at least 3 hours
before bedtime
Establish a regular relaxing bedtime routine (a warm bath, reading a book)
Create a dark, quiet, cool sleep environment
As much as circumstances allow, have comfortable beddings
Use the bed for sleep only. Do not read, listen to music or watch TV in bed
Avoid large meals before bedtime
Smoking Cessation an important step in achieving optimum
health

Steps to Quit Smoking

Make decision to quit.
Set a date to quit and choose a plan
Deal with withdrawal through. Avoid temptation
Staying off tobacco is a lifelong process. Remind yourself of the reasons why
you quit

Alcohol Consumption Health authorities have defined moderation as not more than 2
drinks a day for the average sized man and not more than 1
drink a day for the average size woman

Heavy Drinking consuming more than 2 drinks/day on average for men and more
than 1 drink per day for women

Binge drinking drinking 5 or more drinks on a single occasion for men / 4 or

more drinks on a single occasion for women

Excessive Drinking can take the form of heavy drinking/ binge drinking/ both
 The 10 Nutritional Guidelines for Filipinos
1.Eat variety of foods everyday 7.Consume milk and milk
2.Breast feed infants products and other calcium
exclusively from birth to 4-6 rich foods such as small fish
months and give appropriate and dark leafy vegetables
foods while continuing everyday
breastfeeding 8.Use iodized salt but avoid
3.Maintain children’s normal intake of excessive intake of
growth through proper diet salty foods
and monitor their growth 9.Eat clean and safe food
regularly 10.For a healthy lifestyle and
4.Consume fish, lean meat, good nutrition, exercise
poultry or dried beans regularly, do not smoke and
5. Eat more vegetables, fruits avoid drinking alcoholic
beverages
and root crops
6.Eat foods cooked in
edible/cooking oil daily
Common Intestinal Parasites Nutritional Methods of Assessment
Ascaris (giant roundworm) A – anthropometry
Nutritional competition B – biochemical or lab exams
Source: Soil, fecal-oral C – clinical exam
Vomit worms D – dietary history
Ancylostomiasis/Hookworm H – health history
Blood sucker Anthropometry
Heavy infestation is Weight for age
seen as severe anemia Under 5 - Operation Timbang
Enters the human body Not used when patient has edema
by skin penetration, abd. Used in diagnosis of:
Acute (current) malnutrition
Pain
Overweight – obesity
Enterobius (pinworm) Underweight – wasting
Habitat is the rectum Height for age
Major symptom is
pruritis ani Body mass index
Normal 18-24
Highly contagious
Source: fingernails Mid Upper Arm Circumference
Only for children under 5 years old (1-4
Taenia saginata/ solium years old)
(tapeworm) Rapid screening for malnutrition
The longest intestinal parasite
(average adult length is about 15 to
Skin Fold Thickness
25 meters)
 Macronutrient Deficiencies
Kwashiorkor Marasmus
Qualitative Deficiency Quantitative Deficiency
Manifestations: Protein, Carbohydrates, Fats
Edema Manifestations:
Ascites Muscle Wasting
Irritable Normal hair and skin
Alternating black or black hair – Flag Sign – Skin and bones
discoloration of hair Weight between 2nd to
Skin desquamation 3rd degree malnutrition
Normal weight – edema
Micronutrient
a substance found in very small amounts in the body (<0.005% of body weight

Major Micronutrient Deficiency in the Philippines

Vitamin A deficiency
Iron deficiency anemia
Iodine deficiency disorders

Vitamin A Deficiency (VAD)

Xerophthalmia - Night Blindness
Susceptible population: 1-4 year; usually occurs together with PEM
Deficiency: irreversible blindness
Foods rich in vitamin A
Richest: liver, egg yolk and milk; contain retinol
Best (considering socio-economic status of family): dark green leafy
vegetables, yellow fruits and vegetables; contain carotene

Signs of Vitamin A deficiency

Night blindness
Photophobia
Conjunctival xerosis
Bitot’s spot
Corneal opacity
Keratomalacia - can cause irreversible blindess
Iron Deficiency Anemia Iodine Deficiency Disorder
(IDA)
Susceptible population: pregnant Susceptible population - Pregnant
women and infants women
Foods rich in Fe Most serious effect - mental
Liver and other internal organs retardation (cretinism) in the baby if
Egg yolk the mother does not have enough
Dark green leafy vegetables supple of Iodine during pregnancy
Major sign of IDA: Palmar Pallor 200mg capsule once a year
(Color of the palm darker than the Other Signs of Cretinism
color of the skin) Growth stunting
Management: Pasty Skin
150mg/5mL = 14 days Protruding Abdomen
Below 4 months—2.5 mL Foods rich in Iodine: sea foods
4–12 months—4 mL Iodine in vegetables and fruits
1–3 yrs.—5ml depends on the soil on which they
3–5 yrs.—10 mL are grown
Taken once a day for 3 months Goitrogens – substances that
interfere with iodine use; found in
cabbage, turnips, mustard, red
skin of peanuts, cauliflower,
broccoli, Brussels sprouts,
cassava
Fortification Addition of a nutrient to food during processing

Sangkap Pinoy Seal placed on label fortified foods

Philippine Food Fortification Act of 2000
RA 8976 This provides for mandatory fortification of the
following products:
Rice with iron
Wheat flour with Vit. A and Iron
Refined Sugar with Vit. A
Cooking Oil with Vit. A

RA 8172 “Asin” Law

EO 382 November 7 declared National Food Fortification Day

Yellow—Vitamin A
Green—Iron
Purple—Iodine
Family Planning Program Reproductive Health Program (Responsible Parenthood
Program)
Ideal: Prior to marriage
Four Pillars
Responsible Parenthood They can have as many child as they want provided that
they can support their needs
PD 965
mandates all couples prior to marriage must attend
family planning seminar
done at the local municipal office

Child Spacing at least 3 to 5 years interval

Respect for life anti-abortion

Informed Choice The right of every couple to be knowledgeable of the

different family planning methods, its advantages and
disadvantages
All health care workers must inform them of its
contraindications
Before they can teach, must attend a training seminar (PD
791)
 Family Planning Priorities Couples in the reproductive age: 20 to 44 years
3 or more children
Close interval pregnancies
(+) chronic disease

Family Planning Counseling Greet – warmly and politely

Ask – about him/herself
Tell – health center and the services provided
Help – make the decision that is best for him/her
Explain – relevant information about the signs, diagnos
treatment
Return – schedule a return visit

Early Childhood Care and

Development (ECCD)
RA 8980 Refers to the full range of health, nutrition, early education and social services programs that
provide for the basic holistic needs of young children from birth to 6 years of age, to promote
their optimum growth and development

Center-based Programs Home-based Programs

Day-care Service (RA 6972) Neighborhood-based play groups
Public and Private Pre-schools Supervised by the barangay captain
Kindergarten Family day care programs
Community or school-based early childhood Supervised by the public schools
Child-minding centers Parent education
Health centers and stations Home visiting Programs
Essential Intrapartal Newborn Care – Unang Yakap
DOH Administrative Order 2009 – 0025
Four Core Steps in EINC
Immediate and thorough drying
2 towels
Early skin to skin contact
To prevent hyperthermia
Properly timed clamping and cutting of the cord
To prevent intraventricular hemorrhages and anemia
Non-separation of the newborn and the mother thru initiation of early breastfeeding
Within 90 minutes after birth

Newborn Screening
RA 9288—Newborn Screening Act of 2004
Detect congenital metabolic disorder that may lead to mental retardation or even death if left
untreated

6 diseases Congenital Adrenal Hyperplasia

Congenital Hypothyroidism
PKU
Galactosemia
G6PD
Maple Syrup Purine Disease
Recommended Advocacy
Get specimen after 48 – 72 hours after education of the mother about the benefits of
birth because PKU cannot be detected as Newborn Screening Test (as early as pregnancy
early as 24 hours stage) and ask to prepare said amount
Universal Newborn Hearing Screening Program
RA 9709 Universal Newborn Hearing Screening and Intervention Act of 2009
Early detection of congenital hearing loss and referral for early interventions for infants
(under 3 months of age)
Newborn Hearing Screening Reference Center at the National Institute of Health
BAAH Test – to detect initially whether the child has hearing loss

Breastfeeding Campaign The first step to raising a bright child

Promoting Breastfeeding
Rooming in and Breastfeeding Act of 1992
RA 7600 Breastfeeding week: August 1-7

EO 51 Milk Code
Avoid formula milk
Do not give incentives who use formula milk

Expanded Breastfeeding Promotion Act of the Philippines

RA 10028 Promotes that each facilities (if they have female employees) should have a
breastfeeding station
Must include refrigerators
AO 2006 Revised Implementing Rules and regulations in the EO 51
– 0012
AO 2005- National Policies on Infant
0014
 Breastfeeding Practices
Exclusive Breastfeeding Practices
Allows ORS, drops, syrups (vitamins, minerals, medicines)

Predominant Breastfeeding
May also have water and water-based drinks, fruit juice, ritual fluids and ORS – drops or
syrups such as vitamins, minerals and medicines

Complementary Feeding
Interval of 1 week to check for food allergies
Giving the infant foods and liquids along with breast milk
When breast milk is no longer sufficient to nutritional requirements

Bottle feeding
Child is given food or drink (including breast milk) from a bottle with a nipple

Early Initiation of breastfeeding

Initiating breastfeeding of the newborn after birth within 90 minutes of life in
accordance to the essential newborn care protocol
Positions How to get baby “latch on”
The mother holds her breast in a C-hold
position
To anchor the breast
Stimulate the baby’s rooting reflex
Striking the cheek of the child
Stimulate the sucking reflex using the nipple
When the baby’s mouth opens wide, put the
nipple and as much of the areola as possible
into his mouth
Chin and breast must be in contact

Signs that the baby has latched

on properly to the breast
The baby’s mouth is widely open
The baby and the mother are into tummy-to-
tummy
position
Much of the areola is inside the baby’s mouth
The mother does not feel nipple pain
Baby is relaxed and happy
Breastfeeding Campaign Unique Characteristics of
Storage of breast milk Breastmilk
If at room temp – 8 B – best for baby
hours
R – reduced allergic
If refrigerated – 24
hours reaction
If frozen – 1 month E – economical
Galactogen A – always available
Malunggay
S – safe
(mammolactin)
Soups, Broths,
T – temperature always right
Shellfish F – fresh always
Breastfeeding should E – emotional bonding
be fed on demand – at E – easily established
least 8x a day
No coffee, alcohol,
D – digestible
drugs, smoking I – immunity
If taken coffee, N – nutritious
withhold feeding G – GIT disorder decreased
after 24 hours
 Expanded Program on
Immunization
PD No. 996 (Sept. 16, 1976)
Natural Artificial Providing for compulsory basic immunization
for infants and children below 8
Active Exposure Antigens 6 vaccines
Carrier Attenuated –
Sick of the BCG, OPV,
disease AMV,
Rotavirus RA 10152
Killed – P. HBV
Weakened toxins Inclusion of new vaccines
Mandatory Infants and Children Health
Immunization Act of 2011
Breast milk Prepared by 11 vaccines
Passive
(IgA) Laboratories
Placenta (IgG)
RA 7846 (Dec. 30, 1994)
Hep. B immunization
Launched by DOH, WHO, & UNICEF last July 7 vaccines
1976
Objective - reduce morbidity and mortality
among infants and children caused by the 6 PP No. 6 (April 3, 1996)
childhood immunizable diseases Implementing a United Nations goal on
Universal Child Immunization by 1990
Principles of EPI
Epidemiological Situation
Schedules are drawn on the basis of
occurrence and characteristic feature of the
disease Elements of EPI
Applicable to children below 8 Target setting—all children before 1 year
Goal is to complete vaccines before 1 year (“Fully old
Immunized Child”) Cold chain logistics
If achieved after 1 year—“Completely Immunized” PHN—Cold chain officer
Mass approach Vaccines must be stored in a cold
Integrated to the health services of the unit place
Freezer (–15–25oC) - OPV & Measles
Refrigerator Compartment (2–8oC)
- BCG & DPT
BCG—Light sensitive
Measles/MMR—Heat sensitive
Information, Education, and
Communication (IEC)
Assessment and evaluation of the
program overall performance
Target: 95% every month
Surveillance, studies and research
Supplementary Immunization
Activities (SIAs)
“Catch up” or “speed up” campaigns for the
new vaccine to rapidly increase immunity
in older age groups that are outside of the Schedule for Immunization
immunization schedule
Intended to reduce or interrupt
transmission of the targeted disease with
the goal of elimination or eradication

Contraindications Not Contraindications

History of Fever up to 28.5 C
seizures/convulsions Simple or mild
for DPT 1 acute respiratory
If convulsions last infection
for 3 days—DT Simple diarrhea
If convulsions > 3 without
days—Do not give dehydration
succeeding doses Malnutrition (it is
Clinical AIDS—Infant indication for
BCG immunization)
Immunosuppression
Infant BCG Hepatitis B Vaccine
0–11 months or 0-1 years 3 doses, 2 types (Plasma derived and
At birth recombinant Hep B surface antigen)
0.05 mL (dose)—ID, right upper deltoid Target age:
Freeze dried then reconstituted with diluent HBV 1
At birth (Health Facility)
School Entrance BCG For more than 7 days (home)
When the child enters Grade 1 with or without HBV 2 & HBV
3—6 weeks
scar in the right arm then still go on with the
14 weeks
vaccination except if he is repeating grade 1
Pentavelent
0.1 mL
6, 10, 14 weeks
Effects
0.5 m, IM, Vastus Lateralis
Wheal lasts for 30 minutes to 1 hour
Effects:
Inflammatory response lasts from 2 weeks - No fever
12 weeks Local tenderness Do not massage; apply
Scar cold compress
Administer warm compress on the site of
injection Pentavalent
Fever DPT, Hib, Hep. B
Antipyretic every 4o 3 doses, 4 weeks or 1 month interval
Target age—6, 10, 14
SQ Abscess - Marble-like mass present on the
0.5 mL, IM, vastus lateralis (upper outer thigh)
site of injection
Reduces chance of acquiring pneumonia and
With persistent fever
meningitis
Management—I/D
Effects:
Fever, Antipyretic q4
Local tenderness , do not massage site
 OPV Measles
Against Poliomyelitis 9–11 months
Pathognomonic—Tightening and spasms of In cases of epidemics—can be given at 6 months
Hamstring 0.5 mL, subcutaneous, any arm (outer part of the
3 doses, 4 weeks/1 month upper arm, preferably left)
Target population—same as above, eligibility until Fever and measles rash lasting for 1–3 days within
Grade 6 (12 years) 2 weeks after immunization (modified measles)
2–3 drops, oral route Vitamin A is given with measles—100,000 IU (Blue) -
Color—clear pink or pale orange liquid boost immune system
Keep Philippines Polio Free At least 85% can be prevent by immunization at
Effects: this age
Vomiting—if after 30 minutes, do not re- Freeze dried then reconstituted with diluent water
administer Effects:
Do not feed child for 30 minutes Fever – Antipyretic every 4o
Rashes within 2 weeks and lasts for 3 days –
Rotavirus subside naturally
2 doses, 8 weeks interval
Target age: 6 and 14 weeks
1.5 mL, PO
Measles, Mumps, Rubella (MMR)
12–15 months
1st – 6 to 15 weeks
Mumps - enlargement front and below the ear
2nd – not more than 32 weeks
0.5 mL, SC, any arm (deltoid)
Reduces chance of acquiring diarrhea
Vitamin A is given with MMR, 200,000 IU (red)
Effects:
Freeze dried then reconstituted with diluent water
Soft stool
Dispose diapers – virus is there
Wash cloth diapers separately BGC, AMV, MMR
OPV - Rotarix - Pentavalent Diluted – cold temperature
Must be consumed within 4 to 6 hrs
Integrated Management Color Codes - Classification
for Childhood Illnesses and Management
Basic Steps in IMCI
Pink Severe Classification
Management - Referral to
Assess hospital + Pharma (1st Dose)
a. Child’s problem – interview the mother
b. Check for general danger signs
Some/Disease Condition
Ask Yellow Management - RHU + Pharma (3 days)
Able to drink or breastfeed?
Vomit everything? Follow-up - 2 days
Had convulsions? If after 2 days, the child gets
Look better - continue antibiotic
Abnormally sleepy or difficult to awaken If after 2 days, the child doesn’t
c. Then ask for main symptoms improve -change to 2nd line
antibiotic
Classify If after 2 days, the child gets worse
Severe (Pink) – refer
Some/Disease (Yellow)
No (Green) Green No Classification
Management - Home
Treat Follow-up - 5 days

Follow-up
C
l
a
s
s
i
f
i
c
a
t
i
o
n
Management of Anemia
 Control of Acute Respiratory Infections
Assess Main Symptoms - cough/difficulty breathing
Ask how long: acute (pneumonia), chronic (asthma)

Look and Listen: child must be calm

Stridor
Chest indrawing
Count RR/min
Wheeze
If with chest indrawing, fast breathing and wheeze
Trial of rapid acting bronchodilator for 3x 15 –20 mins apart.
1st choice – Inhaler
2nd choice – Oral salbutamol

Very severe pneumonia or severe pneumonia

Any general danger sign
Chest in-drawing or
Stridor (noisy inspiration) in a calm child

Pneumonia Fast breathing

Intramuscular Antibiotic for children being referred urgently
Gentamicin (7.5 mg/kg)
Benzyl penicillin (50 000 units/kg)
Pneumonia
Amoxicillin – 1st line BID
Clotrimoxazole – 2nd line BID
Soothe throat of child
Calamansi
Breastmilk
Don’t give: codeine, cough syrup, nasal syrup
IMCI: 3 weeks for TB
Not taking any antibiotic but have cough for 30 days:TB
Not IMCI: 2 weeks for TB
Oral Antibiotic
First line: Amoxicillin for 3 days, BID
If 250/5ml
Less than 2 months = 2.5 ml
2-12 months = 5 ml
12 months to 5 years = 10 ml
 Control of Acute Respiratory Infections
Dysentery/ Shigelosis Assessment
EA: Shigella disentiriae
Main symptoms—Diarrhea
Source: Feces
Ask
2-3 times of loose watery stools (diarrhea for children)
How long?
MOT: contaminated food, water and by hand to mouth
Blood in stools?
transfer of contaminated materials
Dysentery
IP: 1 day
Cholera
Sx: Bloody mucoid stool
Look and feel
Damage mucosa lining -- becomes necrotic -- fibrin
Abnormally sleepy or
difficult to awaken
Cholera Restless and irritable
EA: Vibrio el tor (rod-shaped)/ coma (roung-shaped) Sunken eyes
Source: Vomitus, feces Not able to drink
Mot: Contaminated food and water Pinch the skin (skin
IP: Few hours to 5 days turgor)
POC: 7 to 14 days
Sx: Rice watery stool

Classify
Severe dehydration - 2 of the following signs Some dehydration - 2 of the No dehydration
Abnormally sleepy or difficult to awaken following symptoms Not enough signs
Sunken eyes• Not able to drink or Restless, irritable
drinking poorly Sunken eyes
Skin pinch goes back very slowly (>2 secs) Drinks eagerly, thirsty
Skin pinch goes back slowly
Classification of Chronic Diarrhea
If lasts for 14 days or more
Severe persistent diarrhea
Plan B - Some
Dehydration
Dehydration present
1.Give reformulate ORS within the first 4o
Persistent diarrhea
Amount of ORS = weight in kg x 75mL/kg BW
No dehydration
Homemade Oresol
Blood in stool - Dysentery
1L water + 1 tsp. salt + 4 tsp. sugar
Rice water stool – Cholera
1 glass of water + 1 pinch of salt + 1 tsp. of
sugar
* If the child is less than 2 mos w/ diarrhea lasting for 14
For under 6 months—give 100–200 mL in the
days or more = SEVERE PERSISTENT DIARRHEA
first 4
2. Advise mother to continue breastfeeding

Management 3. After 4o - continue feeding and give zinc

If mother must leave before treatment -
Plan A - No explain 4 rules of home mgt
dehydration (XZB5) 4. Follow-up - 5 days if not improving
4 rules
1. Give extra fluid and food (soup, rice water, Plan C - Severe
or buko juice or ORS) every after loose stool Dehydration
Below 2 yrs. = 50–100 mL 1. Give IVF immediately - LRS or NSS
2–5 yrs. = 100–200 mL 2. If no health facility, use NGT
2. Zinc Supplements for 14 days 3. Or if the child can drink, give ORS by mouth
2 - 6 months = 10 mg/day 4. If any of the above steps not possible, bring
6 months - 5 yrs. = 20mg/day child immediately to the hospital for IVF or NGT
3. Continue breastfeeding treatment
4. Follow-up in 5 days if not improving 5. Give antibiotic if 2 years older or cholera
epidemic
Severe Persistent Diarrhea ORS
(less than 2 months and with
chronic diarrhea) 1 L water + 1tsp NaCL + 4 tsp. sugar
Treat dehydration
Sugar water
Give Vitamin A if not given last 30 days
200 mL H20 + 4 tsp sugar
Refer to hospital

Follow-up
Persistent Diarrhea Antibiotics – 2 days
Advise feeding Bronchodilator (Salbutamol) – 2 days
Give Vitamin A if not given last 30 days Very low weight - 30 days
Give Zinc supplements for 14 days Anemia – 14 days
Follow-up - 5 days No DHN, Anemia, Pneumonia, not very
Advise when to return low weight – 5 days

Antibiotics Soothe throat

Dysentery - Ciprofloxacin for 3 days, BID Calamansi except codeine, cough syrup
(15 mg/kgBW) and decongestant
Cholera - Tetracycline (250mg) or
Erythromycin (250mg) BID for 3 days

Vitamin A
Severe malnutrition, Very low weight,
severe dehydration, pneumonia, severe
persistent diarrhea, persistent diarrhea

IV fluids
– D5W & D10W (prevent low blood sugar),
PLRS and PNSS (Severe DHN)
Prevention and Management Adult Men and
of Abortion Complications Women Health
(PMAC) Abortion Program
As a public health issue Characteristics 1. Management of Illness
As a human rights issue
of Adolescent-
friendly Health 2. Counseling Substance Abuse,
As a resource issue Services (WHO) Sexuality and
Accessible Reproductive Tract Infections (RTI)
Adolescent (10-19 y/o) 3. Nutrition and Diet Counseling
Health Program Adolescent Acceptable
Health Issues Appropriate 4. Mental Health
Early pregnancy & childbirth – Equitable 5. Family Planning and Responsible
30% of births Effective Sexual Behavior
HIV 6. Dental Care
Adolescent
Malnutrition Health Services 7. Screening and Management of
Mental Health Lifestyle Related and
1. Management of
Tobacco use other Degenerative Diseases
Illness
Harmful use of alcohol – starts Men - Accidents And Injuries, Liver
2. Counseling
at 13 – 15 y/o Diseases, BPH, Prostate
substance abuse,
Violence Malignancies
sexuality and
Injuries Women - Goiter, Malignancies
Reproductive Tract
Infections (RTI) (Breast), DM
Factors Affecting
Adolescent Health 3. Nutrition and
Issues Diet Counseling Elderly Health Program
1. Lack of Like Skills 4. Mental Health 6.8% of the 92.1 population (2010)
2. Lack of Access to health 5. Family Planning Ageing index = 20.3% (2010) or 60 y/o & above: 15 y/o =
services and Responsible 1:5
Life Expectancy:
3. Lack of Safe and Supportive Sexual Behavior
Males = 64.10 y/o
environment 6. Dental Care
Females = 70.10 y/o
Mortality = CVD, Cancer
Morbidity = Influenza, Pneumonia, TB (Infectious)
Challenges of an Elderly Elderly Health Services
1. Maintaining health and fitness
2. Maintaining social networks and activities
1. Management of Illness
3. Feelings of sadness and loss 2. Counseling substance abuse, sexuality
4. Ensuring financial security and Reproductive Tract Infections (RTI)
5. Decrease in mobility 3. Nutrition and Diet Counseling
6. Increase reliance on others 4. Mental Health
5. Family planning and Responsible Sexual
Behavior
Elderly Population 6. Dental Care
RA 9257 Expanded Senior Citizen Act of 2003 7. Screening And Management Of Lifestyle
Related And Other Degenerative Diseases
RA 7432 An Act to Maximize the Contribution Men—Accidents And Injuries, Liver
of Senior Citizens to Nation Building, Diseases, BPH, Prostate Malignancies
Grant Benefits and Special Privileges Women—Goiter, Malignancies (Breast),
and for other purposes DM
Proc. 470 1st week of October every year as 8. Screening And Management Of Chronic
“Elderly Filipino Week”
Debilitating And Infectious Diseases
9. Post Productive Care
Facilities for the Elderly
National Center for Geriatric Health (Manila)
Golden acres Home for the Aged (Gov’t)
Mountain Crest Residential Care (Cavite)
Kanlungan ni Maria
Blessed Family Home Care Facility (QC)
Non-Communicable Disease Promote Proper Nutrition (ABC)
Mortality = Lifestyle Related/Chronic Aim for physical fitness (Ideal body weight)
1. Cardiovascular Diseases Build healthy nutrition-related practices – variety of
2. Cancer foods, breastfeed, monitoring, eat vegetables, milk,
3. Chronic Obstructive Pulmonary Disease avoid salty foods, clean and safe foods.
4. Diabetes Mellitus Choose food sensibly

Risk Factors of Disease Promote Smoke Free Environment

1. Smoking
Five A’s – Quitting Smoking
2. Physical inactivity
Ask = smoking status
3. Unhealthy diet Advise = to stop smoking, can cause death
4. Excessive alcohol drinking Assess = willingness to quit
Assist = quitting
Arrange follow up = monitor progress
Strategies for the Control & RA 10352 - Excise tax on alcohol and tobacco for 5 years
Prevention of Non-Communicable for the Universal Health Care program of the
government
Promote Physical Activity & Exercise
Stress Management Techniques – 12s
Physical Activity = body movement that
1. Spirituality 7. Sports
results in expenditure of energy
2. Self-Awareness 8. Socials
(occupational, leisure-time, routine daily
activities) 3. Scheduling Activities 9. Sounds and Songs
Exercise = planes, structured, repetitive 4. Siesta 10. Speak to me
aimed at improving or maintaining 5. Stretching 11. Stress Debriefing
physical fitness (performed activities with 6. Sensation Techniques – 12. Smile
vigor & alertness without undue fatigue) Massage, Spa
Moderate intensity for 30 mins. for days
 APPLICATIONS OF EPIDEMIOLOGY IN COMMUNITY HEALTH

EPIDEMIOLOGY study of the DISTRIBUTION and DETERMINANTS of health-related states or

events in specified populations, and the application of this study to the
prevention and control of health problems

PRACTICAL APPLICATIONS OF EPIDEMIOLOGY

1.Assessment of the health status of the community or community diagnosis
2.Elucidation of the natural history of disease
3.Determination of disease causation
4.Prevention and control of disease
5.Monitoring and evaluation of health interventions
6.Provision of evidence for policy formulation

Health indicators Are quantitative measures usually expressed as rates, ratio, or proportions
that describe and summarize various aspects of the health status of the
population.
These are also used to determine factors that may contribute to a causation
and control of diseases, indicates priorities for resource allocation, monitors
implementation off health programs, and evaluates outcomes oh health
programs.
TYPES OF HEALTH INDICATORS AND THEIR EXAMPLES
MORBIDITY INDICATORS generally based on the disease specific incidence or prevalence for the
common and severe diseases such as malaria, diarrhea, and leprosy

(P) Prevalence proportion measures the total number of existing cases

of disease at a particular point in time divided by the number of people
at the point in time. Thus, if the point in time is the time of examination,
then the denominator is the number of people examined.

P = number of existing cases of a disease at a particular point in time x F

Number of people examined at that point in time

Where F is any number of the base 10 that is used as a multiplier to

avoid having decimals as the final value of the indicator.
Incidence – measures the number of new cases, episodes, or events
occurring over a specified period of time, commonly a year within a
specified population at risk.

FACTORS AFFECTING PREVALENCE

INCIDENT DENSITY RATE Computed using the total person-time at risk for the entire cohort as
the denominator
This indicators measures the average instantaneous rate of disease
occurrence.

ID = number of new cases that develop during the period x F

Sum of person-time at risk

MORTALITY INDICATORS
Crude death rate (CDR) the rate with which mortality occurs in a given population. It is computed as

Number of deaths in a calendar year

CDR = x 1000
Midyear population

Specific mortality rate shows rate of dying in a specific population groups

SMR = number of deaths in a specified group in a calendar year

x F
Midyear population of the same specified group
Cause-of-death rate identifies the greatest threat to the survival of the people, thereby pointing
to the need for preventing such deaths

CODR = number of deaths from a certain cause in a calendar year x F

Midyear population
Infant mortality rate A good index of health in a community because infants are very sensitive
to adverse environmental conditions
A high IMR means low levels of health standards that may be secondary to
poor maternal health and child health care, malnutrition.

IMR = deaths under 1 year of age in a calendar year

Number of live births in the same year
x 1,000
Neonatal mortality rate
number of deaths among those under 28 days of
NMR = age in a calendar year
x 1,000
Number of live births in the same year
Postnatal mortality rate
PNMR = number of deaths
age to less than
among those under 28 days of
1 year of age in a calendar
year
Number of live births in the same year
x 1,000
Maternal death Death of a female from any cause related to or aggravated by pregnancy or its
management during pregnancy and childbirth or within 42 days of termination of
pregnancy, irrespective of the duration and the site of the pregnancy.

MMR = number of deaths due to pregnancy, delivery,

puerperium in a calendar year
x 100
Number of live births in the same year
Case fatality rate Is the proportion of cases that end up fatally.
It gives the risk of dying among persons afflicted within particular
disease.
It is similar to an incidence proportion because it also a measure of
average risk.

CFR = number of deaths from a specified cause

Number of cases of the same disease
x 100
POPULATION INDICATORS Include not only the population growth indicators but also other
population dynamics that can affect the age-sex structure of the
population and vice versa

Crude birth rate Measures how fast people are added to the population through births.
Measure of population growth.

CBR = number of registered live births in a year x 1,000

Midyear population
A CBR greater than or equal to 45/1,000 live births implies high fertility while a level less than or equal to
20/1,000 live births implies low fertility

Is a more specific rate than CBR since births are related to the segment
General fertility rate of the population deemed to be capable of giving birth, that is, the
women in the reproductive age groups

CBR = number of registered live births in a year

x 1,000
Midyear population of women 15-44 years of age
Population pyramid A graphical representation of the age-sex composition of the population
that should also be examined during the assessment of the health status
of the community.

SOURCES OF HEALTH DATA

Disease registry Is a compilation of information about a particular disease.

The aim of disease registry is to include all cases of the disease in the
registry without duplication

DISEASES SURVEILLANCE SYSTEMS IN THE PHILIPPINES

Notifiable Disease Reporting System ( NDRS)
Field Health Service Information System (FHSIS)
National epidemiology Sentinel Surveillance System ( NESSS)
Expanded Program on Immunization Surveillance System (IPE Surveillance)
HIV/AIDS Registry
STAGES IN THE NATURAL HOSTORY OF DISEASE AND THE LEVELS OF PREVENTION
RN HEALS (Registered Nurses for Health Enhancement and Local Service)
During Arroyo Regime—NARS (Nurses Assigned in Rural Service)
Part of the mitigation program of the Arroyo administration
Originally for 6 months
3 months—Community
3 months—Hospital
Aquino - RN HEALS
Now - NDP (Nurse Deployment Project)
Is a training and deployment project, jointly implemented by the DSWD, the DOH, and the PRC-BON, DOLE,
PNA designed to mobilize unemployment 10,000 registered nurses to the 1,221 poorest municipalities of the
country and to improve the delivery of health care services

Nurses will be mobilized n their hometowns as warriors for wellness to do the 3 I’s:
1. Initiate primary health, school nutrition, maternal health programs, first line diagnosis
2. Inform about environmental sanitation practices and also do health surveillance;
3. Immunize children and mothers
They shall likewise serve identifies CCT and BemONC identified areas
Delivery Mechanisms
Nurses will be deployed at an average of 5/town in the The stipend of P18,000.00 may be increase if the host
1,211 poorest municipalities, for 12 months tour of duty. LGUs will offer a counterpart of say P2,000.00 LGUs
Another batch will be deployed for the second half of may provide Philhealth coverage to nurse-trainees.
the year. These nurses will undergo training and Corporations may chip in by providing shirts,
development for competency enhancement in insurance, vitamins, etc., making the project a
accordance with the training program designated by national enterprise with private equity
the PRC-BON in collaboration with the DOH A certificate of completion/competency shall be
While on training, nurses will be given a stipend of
issued jointly by the DOLE, DOH and PRC after an
P18,000/month. This translates to about P366.00 per day
assessment of the gained competencies of nurse
for 40o training/workweek. As these nurses are already
trainees.
in their hometowns, transportation expenses will no
longer be a problem
 Concept of nurse entrepreneurship
Project Entrepre-Nurse An initiative of DOLE, in collaboration with BON-PRC, DOH, PNA, UPCN,
OHNAP and other government and non-government entities, and
academic institutions to promote nurse entrepreneurship in the
Philippines
Forms of nurse entrepreneurship
Hospice, domiciliary and health care facility management
Public health advocacy
Home health care services
Outsourcing public health delivery for LGUs, NGAs and other government institutions
Medical transcription services
Health care training management
Emergency medical services
Tourism health care services
Wellness and fitness management for private companies
Outsourcing health services for private establishments

COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH

Community Organizing A development approach that aims to transform the apathetic,
individualistic, and voiceless poor into dynamic, participatory &
politically responsive community

Basic Values in Community Organizing

Human rights
Social Justice
Social Responsibility
Apostolate Work of the Church
Approaches in Community Organizing
The intermediate and/or spontaneous response to ameliorate the
Social Welfare/Dole-out manifestation of poverty, especially on the personal level
Assumes that poverty is GOD-given
The poor should accept their condition since they will receive their
just reward in heaven
Believes that poverty is caused by bad luck and natural disaster

Modernization/Project Development Considered a national strategy which adopts the

western mode of technological development
Believes that poverty is due to lack of education

Participatory Action Approach The process of empowering/ transforming the poor and the
oppressed sectors of society so that they can pursue more just
and human society

Participatory Action Research COPAR

An investigation on problems and Community Organizing Participatory Action Research
issues concerning life and (COPAR) is a community development approach that allows
environment of the underprivileged by the community (participatory) to systematically analyze the
way of research collaboration (PCPD situation (research), plan solution, and implement
1990) projects/programs (action) utilizing the process of
Participatory action research (PAR) is community organizing. It is essentially a research project
an approach to research that aims at done by the community that leads to actions that improve
promoting change among the conditions in the community (Famorca, 2013)
participants. Members of the group It is done to educate the people and develop their critical
being studied participate as partners awareness of their present condition
in all phases of the research, including It helps the community to develop and enhances its
design, data collection, analysis and resources to the fullest thus making the community self-
dissemination (Brown et. al. 2008) reliant
Principles
1. Change = Development
2. Poor
3. People-centered
4. Participative
5. Democratic
6. Developmental
8. Process-oriented
9. Self-reliance = high degree of self-awareness among people

Critical Steps (Activities in COPAR)

1. Integration – Immersion
2. Social Investigation – collection of data about the community
3. Tentative Program Planning – community organizer (plan on how to do community
organizing)
4. Groundworking – solicit the participation of the community
5. The Meeting
6. Role Play
7. Mobilization or Action – action phase
8. Evaluation
9. Reflection
10. Organization
Objectives
To help people harness their human material resources
To help people understand their own situations and develop awareness (process of
action-reflection-action)

Phases
Phase 1 - Pre-entry phase/Preparatory Phase 2 - Entry phase/ Integration/
Immersion/Preparatory
Site/Area/Community Selection Integration/Immersion/Sensitization of the
Criteria of Potential Site community/Information Campaigns
Socio-economically depressed Establish rapport and assess the needs of the community
Inaccessible health services Guidelines in Integration:
Poor community health status 1. Recognize local authorities – Courtesy Call
Relative peace and order 2. Adapt the lifestyle of the community
3. Choose a modest dwelling
situation
4. Avoid expectation from the people
Acceptance of the program by
5. Be clear with your objectives & limitation
the community 6. Participate in the production process
Not currently served by similar 7. Participate in social activities
agencies/organizations Social Investigations/Community
At least 100-200 families Profiling/Community survey (Demographic, Geographic, Socio-
Courtesy Call to local government cultural, Economic Indices, Environmental, Health Indices,
unit/ barangay level Physical/Infrastructure resources)
Mayor down to Barangay Subjective – Interview or Participatory Observation
Objective – Community Survey Tool
Safety of organizers
Community Diagnosis/Research/Analysis
Community Graphs
Consultation/Dialogue/Preliminary Bar - for comparison
Social Investigation Pie - Percentage distribution
Community organizers prepare Line - Trend
Scatter – correlate variables
Phase 3 - Organization/Building Phase/ Phase 4 - Sustenance and
Activity Phase Strengthening Phase/Maintenance
Social preparation through community assembly Evaluation/Reassessment
Spotting potential leaders Criteria: Effectivity, Efficiency, Appropriateness, Adequacy
3 Types of Evaluation
Criteria for Selection of Potential Leaders: Process – evaluate how the program was implemented
1. Belong to the poor sectors and Impact – how the program affects the people in the
classes and is directly engaged in production community – interview
2. Well respected by members of the community and has Outcome – evaluate if the lives of the community
relatively wide influence members improved
3. Desirous of change and is willing to work for change Linkaging /Establishing partnership
4. Must be able to communicate effectively
Methods of Establishing Partnership
Core group formation – SALT
Self-Awareness and Leadership Training
Program)
Formation of Organization/ Committee
Planning/Designing Phase (SMART)
Specific
Measurable Phase 5 - Phase Out/ Exit Phase
Attainable Documentation
Realistic Follow-up/Expansion
Time-bound Must be done once a year
5 Areas of Community Life (HELPS)
Health
Education
Livelihood
Physical Environment
Socio-spiritual
Mobilization/Implementation/Action
Training potential leaders
I can do all things through Christ
who strengthens me.
PHILIPPIANS 4:13

Good luck future RN!

References
Chilton, S. & Bain, H. (2018). A Textbook of Community Nursing. 2nd edition. Routledge
JSV (2020). Community Health Nursing. Retrieved from https://drive.google.com/drive/u/0/my-
drive
RNPedia (2021). Community Health Nursing (Notes). Retrieved from
https://www.rnpedia.com/nursing-notes/community-health-nursing-notes/

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