Perpetual Help Paramedical College

Happy Homes Subdivision Tagas, Tabaco City

Note-Taking Guide for MIDWIFE Licensure Examination

PRIMARY HEALTH CARE
Lecture by: Eduard E. Gandul Jr. RM, RN, EMT-B

-------------------------------------------------------------------------------------------------------------------------------
I.DOH PROGRAM AND HEALTH CONCEPT

Department of Health (DOH)

Vision:
Mission:

National Objectives:

Improve the general health status of the population (reduce mortality and morbidity rates etc.)


Promote healthy lifestyle through healthy diet and nutrition, physical activity and fitness, personal hygiene,
mental health and less stressful life violent and risk-taking behaviour.
Promote health nutrition of families and especial population through child adolescent, and youth, adult health,
womens health, elders people health, health of indigenous people, health of migrant workers, and health of
the rural and urban poor
Promote Environment health and sustainable development through the promotion of healthy homes, school
workplaces, establishment and community.

8 Millennium Development Goals are as Follows:

DOH GOAL:

Health Sector Reform Agenda

Framework: FORMULA ONE

Health Financing-looking in resources
Health Service Development ensure the accessibility and equitability of basic essentials health care
Health regulation quality and affordability of health goods and services
Good governance enhance health performance ex. Reduce corruption

Fourmula One for Health Goals and Objectives

Over-all Goals:
The implementation of FOURmula ONE for Health is directed towards achieving the following end goals, in
consonance with the health system goals identified by the World Health Organization, the Millennium

NOTES IN PRIMARY HEALTH CARE Page 1

 Development Goals, and the Medium Term Philippine Development Plan:
Better health outcomes
More responsive health system
More equitable healthcare financing.

General Objective:

FOURmula ONE for Health is aimed at achieving critical reforms with speed, precision and effective coordination
directed at improving the quality, efficiency, effectiveness and equity of the Philippine health system in a manner that is
felt and appreciated by Filipinos, especially the poor.

Specific
Fourmula One for Health will strive, within the medium term, to:
Secure more, better and sustained financing for health
Assure the quality and affordability of health goods and services
Ensure access to and availability of essential and basic health packages
Improve performance of the health system

Basic Principles to Achieve Important in Health:

Universal access to basic health services must be ensured.

The Health and Nutrition of the vulnerable groups must be prioritized
The epidemiological shift from infection to degenerative disease must be managed.
The performance of the health sector must be enhanced.

Strategic THRUST 2005-2010

1. Launch and implement the Basic Emergency Obstetric Care or BEMOC strategy in coordination with the
DOH

2. Improve the Quality of prenatal and Post Natal Care

Pregnant woman should at least have 4 prenatal Visits:
1.
2.
3.
4.

3. Reduces woman exposure to health risks through parenthood and healthcare packages Essentials Health Services
Packages Available in the Health Care Facilities (every woman has to receive before and after pregnancy and
or delivery of a baby.
4. LGUs, NGOs and other stakeholders must advocate for health through resources generation and allocation for health
services.

DOH PROGRAM STRATEGIES

Reaching Every Barangay (REB) Strategy for Immunization

Wednesday is the Immunization Day

RHU every Wednesday
BHS Every first Wednesday, every months
Farflung Area Once every Quarter or every 4 months

Infant and Young Child Feeding

Goal: Reduce Child Mortality by 2/3 by 2015.
Objectives: to improve the health and nutritional of the infant and young children
Strategies: Promotion of Breast Feeding
Promotion of exclusive BF for 6 months- even water is given.

Key messages on IYCF

1. Initiate breastfeeding within 1 hour after birth
2. Exclusive for the first 6 months of life
3. Complemented at 6 months, excluding milk supplements
4. Extend breastfeeding up to 2 years and beyond

NOTES IN PRIMARY HEALTH CARE Page 2

 National IYCF strategy
1. Health Facilities
a. Mother-baby friendly hospitals
b. Health workers
i. Advocates
ii. Protectors
iii. Promoters of IYCF
iv. Enforcers of laws, not violators
2. Family/Community
a. Supportive family
b. Milk Code vigilantes
c. Lay/Peer counselors
d. IYCF bayanihan spirit
e. Mother-baby friendly public places
3. Working places
a. Maternity leave
b. Lactation/Breastfeeding room
c. Breastfeeding breaks
4. Industry
a. Comply with the Code
5. Schools
a. Introducing the breastfeeding culture

Laws that protects IYCF

1. EO 51, Milk Code
2. Rooming-in and Breastfeeding Act of 1992
3. RA 8976, Food Fortification Law of 2000

CONCEPTS

HEALTH- state of complete physical, mental and social well being, not merely the absence of disease or infirmity
(WHO)

PUBLIC HEALTH

The science and art __________________________________________________________________________________

__________________________________________________________________________________________________
____________________________________________________________ensure everyone a standard of living adequate
for the maintenance of health, so organize to enable every citizen to realize his birthright of health and longevity
(WINSLOW).

Science & art of:

Preventing disease

Prolonging life

Promoting health and efficiency through organized community effort.

COMMUNITY HEALTH NURSING (WHO)

-a special field nursing that combines the skills of nursing, public health and some phases of social assistance and
function as part of the total public health program _____________________________________________________
_________________________________________________________

According to Anderson Gaylord:

CHN
___________________________________________________________________________________________
____________________________________________________and it is the duty of the health department as an agent of
the people or the community to prevent unnecessary illness;

The primary focus of community health nursing is health promotion.

Community health nurses provide care necessary to meet the requirements of an individual all throughout the life cycle.
Knowledge on different fields (biological and social sciences, clinical nursing, and community health organizations) is
used.
Nursing process in community health nursing changes based on the needs of the community.

NOTES IN PRIMARY HEALTH CARE Page 3

 Abilities of a CHN

1.
2.
3.

HANLON

Public Health is dedicated to the highest levels of physical, mental and social well-being and longetivity consist with
available knowledge and resources at given time and place. It holds this goal as its contribution the most effective total
development and life of the individual and hi level of functioning through teaching s society.

JACOBSON states that CHN is a learned practise discipline with the ultimate goal __________________________
__________________________________________________________________________________________________
________________________________________________________________________________________________

RUTH FREEMAN
Special field of nursing that combines skills in of work Public health Nursing and some phases of social
assistance to further community health.
Is a service rendered by a Professional nurse with community, groups, families and individuals at homes, in health
centers, in clinics, in school, in places for the promotion of health, prevention of illness, care of the sick and rehabilitation.

EC0-SYSTEMS INFLUENCES ON OPTIMUM LEVEL OF FUNCTIONING (OLOF)

Political
Safety
Oppression
Behavior
Socio Economics Culture
Empolyment Habits
Education Mores
Ethnic Costumes
OLOF
INDIVIDAUL
FAMILY/GROUP
POPULATION Heredity
Environment COMMUNITIES Generic
Air
Endowment
Water
-Defects
Urban/rural
-strengths
Noise
Health Care -Risks:
Radiation
Delivery System Familial
Preventive Ethnic
Curative Racial
rehabilitative

NOTES IN PRIMARY HEALTH CARE Page 4

 Public Health is a core of governments attempts to improve and promote the health and welfare of their citizens.

It further presented the core business of Public Health as:

1. Disease control
2. Injury prevention
3. Health Protection immunize occupational precaution.
4. Health Public Policy it includes environment hazards in workplace, housing, food, water, etc,
5. It requires everyone to do its ex, public places has a smoking area free, sanitary permit.
6. Promotion of health and equitable health gain.

COMMUNITY HEALTH NURSING

Goal: To elevate the level health of the multitude.

Philosophy: Worth and Dignity of Man

Principles of CHN:
1. __________________________________________________________________________________________
2. __________________________________________________________________________________________
3. __________________________________________________________________________________________
4. ___________________________________________________________________________________________
5. __________________________________________________________________________________________
6. CHN nurse works as a member of the health team
7. Periodic evaluation of CHN services is an integral professional growth and CHN must provide for opportunities
for continuing staff education program.
8. The CH nurse is responsible for his own professional growth and CHN must provide opportunities for continuing
staff education program.
9. The CH nurse make use of used of community available resources
10. The CH nurse utilize existing active organizing community group
11. There must be provision for educative supervision in CHN
12. There should be accurate recording and reporting in CHN

Other related concepts:

Focus of CHN-
Clients-
Types of service-
Contacts-
Process-

POVERTY - ILLNESS CYCLE

Poverty

Poor Education
Reduce
Poor Nutrition
Productivity
Poor env. Sanitation

Prone to illness/
disability

NOTES IN PRIMARY HEALTH CARE Page 5

 INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS (pls refer to supplemental notes)

STRATEGIES TO ADDRESS SPECIFIC HEALTH PROBLEMS

Communicable Disease Prevention and Control

Communicable Diseases

Chronic Communicable Vector-borne Communicable

Diseases
Tuberculosis Malaria (MCP)
Schistosomiasis (SCP)
Leprosy (LCP) Filariasis (FCP)
H-Fever (Dengue)
1. National Tuberculosis Control Program (NTBCP)

Tuberculosis is a highly infectious, chronic respiratory disease caused by TB Bacilli. It is one of the 10 leading causes of morbidity and
mortality in the Philippines, which is also known as Kochs Disease.

Objective of the Program:

To control TB by reducing the annual risk of infection (prevalence and mortality rates)

Key Policies:
Prevention
BCG vaccination under the EPI Program
Annual identification of at least 45% of its prevalence
Public health education re: PTB mode of transmission, methods of control, and importance of early diagnosis
Provide outreach services for home supervision of patients in Multi-Drug Therapy and also for preventive treatment of
contacts

Case Finding
Direct sputum microscopy for identified TB symptomatics
X-ray exam of TB symptomatics who are (-) after 2 or more sputum exam
Establishment of passive and active collection points for sputum samples of all identified TB symptomatics, as well as
validation centers to ensure the standard and quality of sputum exam
Case finding and treatment services shall be made available in the BHS/RHUs

Treatment
All TB cases must be treated for free, on ambulatory and domiciliary (home) basis, except those with acute complications
and emergencies
All sputum positive and cavitary cases shall be given priority for short course chemotherapy or SCC for 6 mos.
Standard Regimen or SR for a year or intermittent SCC for 6 mos. shall be given to all infiltrative but sputum negative.

SR: isoniazid and streptomycin sulfate

SCC: Combo pack, Multi Drug Therapy

DOTS (Direct Observed Treatment Short Course)

Regimen Type of TB Patient

New pulmonary smear (+) cases New seriously ill
Regimen I 2RIPE / 4RI pulmonary smear (-) cases w/ extensive lung lesions
New severely ill extra-pulmo TB
New pulmonary smear (+) case New seriously ill
Regimen II 2RIPES/ 1RIPE / 5RIE pulmonary smear (-) cases w/ extensive lung lesions
New severely ill extra-pulmo TB
New smear(-) but with minimal pulmonary TB on
Regimen III 2RIP / 4RI radiography as confirmed by a medical officer New
extra-pulmo TB (not serious)

NOTES IN PRIMARY HEALTH CARE Page 6

PTB TREATMENT REGIMEN

Categories: 6 SCC
Patient will be:

Rifampicin Rifampicin
2 mos. on Isoniazid + 4 mos.
Pyrazinamide Isoniazid

Indicated for patients who are

- (+) sputum smear
- seriously ill ---
- (-) sputum smear, (+) extensive lung lesion
- (+) radiographic lung lesion
- extrapulmonary cases

8 SCC
Patient will be:

Rifampicin Rifampicin Rifampicin

2 mos. on Isoniazid + 4 mos. Isoniazid + 5 mos Isoniazid
Pyrazinamide Ethabutol Ethambulol
Ethambulol
Streptomycin

Indicated for those with relapse

- failures
- others

4 SCC
Patient will be:

Rifampicin Rifampicin
2 mos. on Isoniazid + 2 mos.
Pyrazinamide Isoniazid

Indicated for PTB minimal

(-) sputum smear

3 Phases of Treating a PTB patient:

Rifampicin
1 - Intensive Phase 2 mos. on Isoniazid
Pyrazinamide
Diagnostic: Sputum Exam
if (+), proceed to
Rifampicin
2 - Maintenance Phase + 4 mos. on
Isoniazid
if still (+) TB Colonies proceed to

Rifampicin
3 - Extensive Phase up to 12 mos. on
Isoniazid
What is the purpose of SCC-MDT?
- prevent developing resistance against the three drug combinations
- shorten duration of treatment usually treatment lasts from 5-10 years. With SCC-MDT. tx can be reduced to a minimum
of 6 mos.
- eradicate and completely prevent the relapse of the disease

NOTES IN PRIMARY HEALTH CARE Page 7

Direct Observation Treatment of Short-Course Chemotherapy (DOTS)
Tutok-Gamutan

DOH Activities on NTBCP:

Part of the 23 in 93 is the integrated disease control of TB together with schistosomiasis and malaria through the
formulation of a strategic plan for infectious disease control by specific DOH units.

Health for More in 94 had Malakas na Baga, Malinaw na Mata as its strategy National Focus: TB Control Month
laboratory and drug supplies were available to local governments in 1994 aimed to accelerate case finding and
treatment

Strategies done:
Ensure that every microscopy and treatment center has the ff:
Exnal microscope
Microscopist trained within the last 3 years
A 90% agreement rate in microscopy reading between the microscopist and validator
Available NTP manual of procedures
Drugs for at least 6 months supply
Reagents, sputum cups for at least 6 months
Utilization of an itinerant team composing of at least 2 microscopists, nurse, midwife,
and a medical officer who will stay for 2 3 days in far flung communities to identify TB
and start treatment

LEPROSY CONTROL PROGRAM

LEPROSY is a chronic disease of the skin and peripheral nerves caused by Myobacterium Leprae

WHO CLASSIFICATION OF LEPROSY:

Paucibacillary (tuberculoid and indeterminate) non-infectious

Duration of Treatment: 6-9 months
Multibacillary (lepromatous and borderline) infectious
Duration of treatment: 24-30 months

Objectives of the Program:

- provide MDT to all leprosy cases within 3 years and complete the treatment of 90% of all cases out on MDT within the
prescribed period
- identify all correctible deformities and institution of appropriate intervention
- reduce the stigma attached to the disease thru IEC
- formulate research proposals on topics associated with leprosy

Key Policies:
- MDT as the core strategy for the National Leprosy Control Program
- Procurement and supply of MDT Drugs, IEC and Training Materials by CDCS
- Health education
- Supervision and Control of leprosy Control Activities
Strategies:
Prevention
- Health Education
- BCG vaccination
- Case Finding
- Validate old registered cases
- Early referral of suspected leprosy patients
- Epidemiologic investigation
Treatment
- Ambulatory
- Domiciliary chemotherapy through the use of MDT as embodied in RA 4073 which advocates home treatment

MDT Treatment Regimen

Paucibacillary Multibacillary
Supervised dose: Supervised dose:
1. Rifampicin 600 mg 1. Rifampicin 600 mg
2. Dapsone 100 mg 2. Lamprene 300 mg
Taken once/month in the clinic 3. Dapsone 100 mg
Self-administered Taken once/month in the clinic
1. Dapsone 100 mg Self-administered dose
Taken OD, daily by the patient at home 1. Lamprene 50 mg
2. Dapsone 100 mg
Take OD, daily at home

Leprosy Patients must be taught ways to prevent secondary injury caused by burns and rough sharp objects

NOTES IN PRIMARY HEALTH CARE Page 8

 Emphasize importance of sustained therapy, correct dosage, effects of drugs and the need for medical check-up from
time to time
Provide mental and emotional support to the families of leprosy patients
Refer patients as needed

Rehabilitation:
Imbibe patients participation in occupational activities
Family and community health (PD 304)
o non-segregation of leprosy patients
o counseling and guidance

Locally-endemic Disease Prevention and Control

Leptospirosis an infectious disease that affects humans and animals, is considered the most common zoonosis in the
world
Causative Agent:
S/S: -high fever -severe headache -chills -muscle aches -vomiting -may include jaundice (yellow skin and eyes) -red eyes
-abdominal pain -diarrhea

Treatment: PET - >

MALARIA
Malaria (from Medieval Italian: mala aria - "bad air"; formerly called ague or marsh fever) is an infectious disease
that is widespread in many tropical and subtropical regions.
Causative Agent: Anopheles female mosquito
Signs & Symptoms:

Treatment: Chemoprophylaxis:

Preventive Measures: (CLEAN)

C
L
E
A
N

Detection and Early Treatment of Cases

Early Recognition, Prevention, and Control of Malaria epidemics
a system which will recognize impending malaria epidemics
Early diagnosis and prompt Treatment
identification of a patient with malaria as soon as he is examined.
This may be done thru:
Clinical Microscopic
- Signs and symptoms - Mass Blood Smear Exam
- history of visit to an endemic area
In the event that an imminent epidemic occurs, the following should be done:
Mass Blood Smear Collection
Immediate confirmation and follow-up of cases
Insecticide-treatment of mosquito nets

FILIARIASIS
name for a group of tropical diseases caused by various thread-like parasitic round worms (nematodes) and their
larvae
larvae transmit the disease to humans through a mosquito bite
can progress to include gross enlargement of the limbs and genitalia in a condition called elephantiasis

S/S:

Asymptomatic Stage
Characterized by the presence of microfilariae in the peripheral blood
No clinical signs and symptoms of the disease
Some remain asymptomatic for years and in some instances for life

NOTES IN PRIMARY HEALTH CARE Page 9

 Acute Stage
Lymphadenitis (inflammation of lymph nodes)
Lymphangitis (inflammation of lymph vessels)
In some cases the male genitalia is affected leading to orchitis (redness, painful and tender scrotum

Chronic Stage
Hydrocoele (swelling of the scrotum)
Lyphedema (temporary swelling of the upper and lower extremities
Elephantiasis (enlargement and thickening of the skin of the lower and / or upper extremities, scrotum, breast)

Management:
No treatment can reverse elephantiasis

SCHISTOSOMIASIS parasitic disease caused by a larvae

Causative Agent:

Signs & Symptoms: (BALLIPS)

B
A
L
L
I
P
S

Treatment:

DENGUE is a mosquito-borne infection which in recent years has become a major international public health concern..
It is found in tropical and sub-tropical regions around the world, predominantly in urban and semi-urban areas.

Causative Agent: Dengue fever virus (DENV)

Mode of Transmission: Vector Borne Disease (Mosquito Bite) Aedes aegypti typically Day biting (Early morning and evening)
Aedes albopictus Known as Asian Tiger Mosquito

S/S: (VLINOSPARD)

V
Low platelet
I
N
Onset of fever
Severe headache

Pain of the muscle and joint

Abdominal pain
Rashes
D

TREATMENT:

The mainstay of treatment is supportive therapy.

CONTROL OF CARDIOVASCULAR DISEASE should be controlled on the 1st trimester, last trimester only
premature delivery

NON COMMUNICABLE DISEASE

Birth: CHD (Congenital heart Disease)

NOTES IN PRIMARY HEALTH CARE Page 10

 Adult: HPN HYPERTENSION
Type: 1
Type: 2

Middle age: CAD (Coronary Artery Disease) and IHD (Ischemic Heart Disease)

Elderly: CVA (Cerebro Vascular Accident)

Major Factors to Consider in CAD:

1. Hypertension
2. Diabetes Mellitus affect all organs
3. Serum Lipid Concentration (Inc. Cholesterol)
4. Cigarette smoking tar (causes cancer)
a. Nicotine causes spasm
Effects: Coronary Artery Spasm
Myocardial irritability
Blood coagulation

Minor Factors: increases HPN

1. Stress
2. Obesity
3. Family history and hereditary
4. Sex-more common to men at age 60 y.o

Prevention and Control:

CHN Functions:
- Health Education on:
-
-
-
-
-
-

CANCER CONTROL
Types:
- Carcinoma
- Leukemia
- Lymphoma
- Sarcoma
-
Warning Signs of Cancer:

C
A
U
T
I
O
N
U
S

RH Reproductive Health
A state of complete physical, mental and social well being merely the absences of disease or infirmity in all matters
relating the reproductive system and its functioning process.

Concepts
Married couple has the capacity to procreate
RH is the exercise of reproductive rights with responsibility,
RH includes sexual health for the purpose of enhancement of the life and personal relationship.
RH includes protection from unwanted pregnancy by access to safe and acceptable F.P method
RH includes protection from harmful procedure practices and violation
RH assures accesses to information on sexual to achieve sexual enjoyment.
NOTES IN PRIMARY HEALTH CARE Page 11
 Goals:
To archive healthy sexual development and maturation.
To achieve their reproductive intention.
To avoid illness, injury, disability, related to sexual and reproduction
To receive appropriate counselling and care of RH problem

Strategies:
Used of modern and more effective way of contraceptives
Provision of RH services in clinics and hospitals
RH cares focus on adolescent, unmarried, men, etc. Concerned high risk
Strengthen outreach and referrals
Prevent specific RH problems

Ten Elements of RH

1. MCH and nutrition

2. Family planning
3. Prevention and management of abortion complication
4. Prevention and treatment of reproductive tract infection and disease
5. Education and counselling on sexuality and sexual health
6. Breast and reproductive tract cancers and other gyne condition
7. Mens reproductive health
8. Adolescent reproductive health
9. Violence against women (VAW)
10. Prevention and treatment of infertility and sexual disorder

MATERNAL CARE

Prenatal Care

I-Physical Exam

Wt. Gain - should not exceed 2 lbs. For the first trimester and 11 lbs for the 2nd trimester and 11 lbs on the 3rd trimester.
BP - should not exceed 30 mm Hg of baseline BP
Heart Rates of Fetus
Respiratory Rates of Mothers

II Prenatal Check Up

First Trimester (1-3rd month)

Services:

1. _______________________________
2. _______________________________
3. _______________________________
4. _______________________________

Cervical Smear for high risk women with multiple partner to prevent STD
Health Teaching personal hygiene, mental health, Nutrition, exercise, avoids sick individuals, avoid taking medication
without prescription.

II- Prenatal check-up

Second Trimester (4-6th month)

Services:

NOTES IN PRIMARY HEALTH CARE Page 12

 Third Trimester (7-9th month)

Services:
1.
2.
3.
4.

Maternal High Risk Factors

1. Age----------------------
2. Parity--------------------
3. Weight-------------------
4. Height-------------------
5. Hemoglobin------------

5 High Risk Pregnancy:

1. To many -
2. Too soon -
3. Too sickly
4. Too Young
5. Too Old

Danger signs refer

-
-
-

Frequent Visit
- 1-7 months once a month
- 8th month 2x month
- 9th weekly until delivery

Minimum number of Visit

- Once / trimester with 2 prenatal visit on the 3rd trimester

Immediate Postpartum Care

Check the following:

Mother Child
1. 1.
2. 2.
3. 3.
4. 4.

Succeeding Visits:

Mother
1. Check signs of bleeding and infection
2. Check V/s. Breast Feeding practices
3. P.P counselling birth Spacing
4. Cord Care
5. Hygiene and Nutrition

Child
1. Check sucking reflex and breast feeding practice problem
2. Check umbilical Stump for signs of infection
3. Observes s/s of pathological jaundice

NOTES IN PRIMARY HEALTH CARE Page 13

 Qualified for Home Delivery
1.
2.
3.
4.

Venue of Delivery
1. Home
2. Lying In Centers or Birthing Centers (BEmONC)
3. Hospitals

Principles in Home Deliveries

3Cs
C
C
C

Breast Feeding - Iron is only Lacking

Importance of Breast feeding

B- Importance of breast Feeding

R- Essential for Child survival
E- Develop bond between mother and child
A- More superior than other milk
S- Promotes self care
T- Contraindication of Breast Feeding
F- Cracked or fissured nipple(wipe nipple w/ luke
E- warm water)
E- Galactosemia O lactose is rich in breast milk
D- Infection like AIDs, hepatitis B, Leprosy,
I- untreated TB
N- Meds that can be transmitted to mothers milk
G-

Difference of breast milk from formula milk

BREASTMILK VS FORMULA*
CHO > CHO
CHON (LACTALBUMIN) < CHON (CASEIN)
FATS = FATS
Linoleic acid content (3x) > Linoleic acid content
MINERALS < MINERALS

* the high CHON and mineral content of cows milk may overwhelm the newborns kidney, thus it still needs to be
diluted. Casein is more difficult to digest

Maternal Care
DOH policy on maternal Care
All pregnant women shall be given tetanus toxoid immunization
Iron Supplemental Shall be given the 5th month of pregnancy until 2 months post partum (100-200mg daily p.o for
210 days)
Iodized oil capsule every year to goiter infested areas
Chloroquine (150mg) 2 tablets/week, an anti-malarial drugs prophylaxis given during pregnancy for malarial
areas.

NOTES IN PRIMARY HEALTH CARE Page 14

 Grassroots Worker:
BHW- Barangay Health Workers
TBA traditional Birth Attendant (HILOT)
Record HBMR-HOME BASED MOTHERS RECORD

FAMILY PLANNING

Family Planning Program

Objectives:
A. Increase the number of mother of reproductive age participating to contribute to improvement of mother and
child health and reduction of fertility by:
Expanding the program coverage
Quality Service Provision
B. Promote Value of:
Responsible sexual behaviour
Delayed marriage
Promote safe motherhood
Child survival
Counteracting trend toward abortions

C. Strengthening
Management
Logistics
Research
Training
Important objectives
Reduce High Risk
Reduce total fertility Rate

Components:
1. Service Delivery



2. Information, Education, Communication and Motivation- sustained public awareness on responsible parenthood
and health and family welfare.
3. Training upgrade skills of health workers
4. Research and Development
5. Monitoring and supervision

FAMILY PLANNING METHOD couples decision/ whatever fits/suits with the patient.

1. Permanent
A. Female BTL- Bilateral Tubal Ligation
b. Cutting or blocking two fallopian tubes (BTL)
c. 99.5% of effectiveness
B. Male (Vasectomy)-
Effective 3 months after sterilization,

B. Non Permanent
A. Pill
d. Hormones estrogen and progesterone
e. Taken daily PO
f. 92.0% to 99.7% effective
B. Male condom
a. Thin sheath of latex
b. Dual protection from STIs including HIV
c. 85% to 98% effective
C. Injectables
a. Synthetic hormone progestin which suppresses ovulation, thickens cervical mucus
b. 97.0% to 99.7% effective
D. LAM
a. Postpartum method of postponing pregnancy based on physiological infertility experienced by breast
NOTES IN PRIMARY HEALTH CARE Page 15
 feeding women
b. Effective only for a maximum of 6 months postpartum
c. 99.5% to 98% effective
E. Mucus/Billings/Ovulation
a. Abstaining from SI during fertile days
b. Can not be used by woman with unusual disease or condition that results in extraordinary vaginal
discharge that makes observation difficult
c. 80% to 97% effective
F. BBT
a. Identifying the fertile and infertile period by daily taking and recording rise in BT during and after
ovulation
b. Temp is taken 3 hours of undisturbed rest (usually morning)
c. 80% to 99% effective

G. Sympto-thermal method
a. Combination of BBT and Billing/Mucus method
b. 9% to 80% effective
H. Two day method
a. Simple fertility awareness based method
i. Cervical secretions as an indicator of fertility
ii. Checking the presence of secretions daily
b. 86% to 96.5% effective
I. Standard days method
a. Users with menstrual cycle between 26 and 32 days are counseled to abstain from SI on days 8-19 to
avoid pregnancy
b. 88% to 95% effective

Factors to Consider in Choosing Methods

1. Safety
2. Effectiveness
3. Convenience
4. Cost
5. Availability

Developmental Goals for F.P

1. Sustainable Growth
2. Alleviation of Poverty
3. Better Education
4. Improved Health and Nutritional status at the level of individual household (specially mother and children)

Principles Concerning Family Planning Program:

Improvement of family well being through population information and education and F.P methods but giving
respect to the couples right conviction based on their morale and religious beliefs

EXPANDED PROGRAM OF IMMUNIZATION (EPI)

Aims to immunize all children against the target Disease:

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

PD 996 compulsory basic immunization to 8 y.o and below

Expanded program on Immunization

Fully immunized child is ad child who has received 1 dose of BCG, 3 doses of DPT, OPV and 1 dose of AMV
before his first birthday

General principles which apply in vaccinating children

Safe and immunologically effective to administer all EPI vaccine on the same day at different sites of the body
Measles vaccine should be given as soon as the child is 9 months old
9 months 85% protection

NOTES IN PRIMARY HEALTH CARE Page 16

 1 year above 95% protection
Vaccination schedule should not be restarted from the beginning even if the interval between doses exceeded the
recommended interval by months or years
Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and vomiting are not contraindicated to
vaccination; unless the child is so sick that he needs to be hospitalized
Absolute contraindications to immunizations are:
DPT2 or DPT3 to a child who has had convulsions or shock within 3 days the previous dose
Vaccines containing the whole pertussis component should not be given to children with an evolving neurological
disease
Live vaccines like BCG must not be given to immunosuppressed due to malignant disease (child with clinical
disease), therapy with immunosuppressive agents or irradiation
Safe and effective with mild side effects after vaccination. Local reaction, fever and systemic symptoms can result
as part of the normal immune response
Giving doses of vaccine at less than the recommended 4 weeks interval may lessen the antibody response.
Lengthening the interval between doses of vaccines leads to higher antibody levels
No extra doses must be given to children who missed a dose of DPT/HB/OPV/TT
Strictly follow the principle of never, ever reconstituting the freeze dried vaccines in anything other than the
diluents supplied with them
Repeat BCG vaccination if the child does not develop a scar after the 1st injection
Use one syringe one needle per child during vaccination

Immunization Guidelines

Dont be burden by the remarks of the mothers on the inconveniences of receiving 3-4 vaccines on the same day.
Continue giving immunization according to the # of doses even if the interval exceeded by weeks, months or
years.
No contraindication in giving immunization moderate fever, cough and colds, diarrhea and malnutrition; not
unless the child is assessed by the physician to be serious enough needing hospitalization.
No BCG to child born positive to clinical AIDS.
No food 30 min. after OPV; if the child vomits after receiving OPV, give additional drop.
Contraindication of Vaccination

Acute Illness that needs hospitalization

Fever of 38.5 degree Celsius and above
Hypersensitivity to any of the vaccines

Target Eligible population:

3 % (0.03 03 3/100) for children

5 % (0.035 03 3.5/100) for pregnant mothers
Computation

Schedule:

1 months:
2 months:
3 months:

Elements of Immunization:
1. Target setting
2. Cold chains logistic management ensure that the vaccines will still be potent
3. Information, education and communication (IEC)
4. Assessment, evaluation of the program
5. Surveillance, studies and research (REB)-reading every barangay
Cold Chain System- a system that ensure the potency f the vaccines from the time of manufacture to the time it is given
to the child or pregnant.

NOTES IN PRIMARY HEALTH CARE Page 17

 Stocking of Vaccines Refrigerator

Vaccine Storage Temp

Most sensitive to heat Oral Polio (live attenuated) -15C to -25C (at the freezer)
Measles (freeze dried) -15C to -25C (at the freezer)
Least sensitive to heat DPT/Hep B +2C to +8C (in the body of the
D toxoid; wekened toxin refrigerator)
P killed bacteria
T weakened toxin
Hep B +2C to +8C (in the body of the
refrigerator)
BCG (freeze dried) +2C to +8C (in the body of the
Tetanus Toxoid refrigerator)

Tetanus Toxoid Immunization Schedule for Women

Vaccine Minimum age/interval % protected Duration of protection
TT1 Early during pregnancy 80 %
TT2 4 weeks later 80% 3 yrs for the mother
TT3 6 months later 95% 5 yrs for the mother
TT4 1 year later 99% 10 yrs for the mother : INFANT 1 YEAR
TT5 1 year later 99% Lifetime for the mother;
All infants born will be protected

NEWBORN SCREENING ACT OF 2004 R.A 9288

When:
48th to 72nd hour of life, the result are available after 7 working days from the sample are received.

WHAT METHOD USED:

HEEL PRICK METHOD

Location of Screening:
Hospitals, lying-in centers, RHU and Health Centers

Disorders to be Screened in the Newborn Screening ACT of 2004 RA 9288

1. CH (congenital hyperthyroidism)
2. CAH (Congenital Adrenal Hyperplasia)
3. GAL (Galactosemia)
4. PKU (Phenylketonuria)
5. G6PD deficiency

NUTRITION PROGRAM AND GARANTISADONG PAMBATA PROGRAM

Nutrition Program

Main Objective:
- Aims to promote protect and preserve the nutritional and health status of the Filipino population
particularly the vulnerable group such as infants, pre-schoolers, pregnant and lactating mothers.

THREE BASIC GROUPS

Go-ENERGY GIVING FOODS carbohydrates, and Fats

Types:
Source:

GROW-BODY BUILDING FOODS Protein

Source: Plants-

GROW REGULATING FOODS vitamins and minerals (fruits)

NOTES IN PRIMARY HEALTH CARE Page 18

 Nutrition Program:
- Garantisadong pambata (Apr. 10-24 2000)
- Micronutrients malnutrition

1. VAD-VIT. A DEFICEINCY
Prob:
Signs and symptoms:
Night blindness, bitots spot in the eyes-foamy white spot in the eyes
Dry, hazy rough appearing cornea
Crater like defect on cornea (late s/s) decrease result to permanent blindness
Softened, sometimes bulging cornea
- 100,000 iu- (6-11 mos in infants) 200,000 iu 12-83 mos. Vitamin A capsule
2. IDD-IODINE DEFFICINCY DISEASE (200,000 iu post partum)
Problems:
S/s: enlarged thyroid gland
Sudden wt. Loss
Tremors

Iodine deficiency Disease

Cause: inadequate intake of iodine
Management:
___________________________________________________________________________________________
__________________________________________________________________________________________

3. IDA-IRON DEFICIENCY DISEASE

Problems:
S/s:

Causes:
1.
2.

Management:
-
-
-
-
-

Forms of Malnutrition

Deficiency Diseases Nutrients

MACRO MALNUTRITION
Marasmus - -
Kwashiorkor - -

MICRO MALNUTRITION
Xeropthalmia -
Endemic Goiter - -
Pellagra -
Beriberi -
Rickets -
Scurvy -
Anemia -

NOTES IN PRIMARY HEALTH CARE Page 19

 Gross Malnutrition (Protein Caloric Def.)
1. Marasmus Balance Nurition
s/s:
Mgt:
2. Kwashiorkor
s/s:
Mgt:

Nutrition Program Component:

1. Growth Monitoring
A. Operation Timbang salter, ming scale, bar detecto (instrument used in weight taking)
B. UMAC upper mid arm circumference
1-5 years old 15 cm
cm susceptible to malnutrition
cm under weight
C. Physical Exam
D. Clinic Visit if necessary

2. Nutritional Education Information provide knowledge

-
-

3. Target Food Assistance

4. Food Production backyard gardening and livestock
5. Income generating project
6. Malnutrition ward for 3 degree
7. Macronutrient supplementation and food fortification FIDEL (fortification Iodized Deficiency elimination)
8. ASAP Araw Nang Sangkap Pinoy

Care of Premature Infant in the HOME

I. Establish and maintain good respiration mouth to nose resuscitation
II. Minimum Handling of Babies
III. Regulation of Body temperature
IV. Proper management of Feeding
V. Prevention of Infection
VI. Early Detection and Tx of Complication

Go to your Nearest Health facility for the Garantisadong Pambata package of Services:
1. Immunization
2. Vit. A supplement
3. Deworming
4. Health Information on 9 ways to save your child

9 WAYS TO SAVE YOUR CHILD

1. Skilled health Professional during pregnancy, delivery and immediate postpartum
2. Care of the New born
3. Breast feeding and complementary feeding
4. Micronutrient Supplements
5. Immunization of the infant and the mother
6. Integrated management of sick children
7. Child injury prevention control
8. Birth spacing
9. Proper personal hygiene

7 Healthy Lifestyle Habits

1. No smoking 5. Prevent hypertension
2. Dont Drink Alcohol 6. Do Physical activity
3. No to illegal Drugs 7. Manage Stress
4. Eat low fat, low salt and high fiber diet

Herbal Medicine Lecture

Lagundi
Ulasimang-Bato
Bawang

NOTES IN PRIMARY HEALTH CARE Page 20

 Bayabas
Yerba Buena
Sambong
Akapulko
Niyog-niyogan
Tsaang-gubat
Ampalaya

AKAPULKO (CASSIE, ALATA L.)

It is also known as "bayabas-bayabasan" and "ringworm bush" in English, this herbal medicine is used to treat
ringworms and skin fungal infections.

Parts utilized:
leaves
Use:
Anti-fungal: Tinea Flava, ringworm, athletes foot and scabies.
Preparation:
Fresh, matured leaves pounded. Apply as soap to the affected part 1-2 times a day.

AMPALAYA (MAMORDICA CHARANTIA)

Most known as a treatment of diabetes (diabetes mellitus), for the non-insulin dependent patients. Known as
"bitter gourd" or "bitter melon" in English, it
Parts utilized:
leaves
Use:
Lower blood sugar levels
Preparation:
Gather and wash young leaves very well. Chop. Boil 6 tablespoons in two glassfuls of water for 15 minutes under
low fire. Do not cover pot. Cool and strain. Take one third cup 3 times a day after meals. Remember that young
leaves may be blanched/ steamed and eaten glassful 2 times a day.

BAWANG (ALLIUM SATIVUM)

Popularly known as "garlic", it mainly reduces cholesterol in the blood and hence, helps control blood pressure.
Also a remedy for toothache
Parts utilized:
Garlic Bulb
Uses:
For hypertension: Toothache; to lower cholesterol levels in blood.
Preparation:
May be fried, roasted, soaked in vinegar for 30 minutes or blanched in boiled Water for 5 minutes. Take 2 pieces
three times a day after meals.
For toothache:
Pound a small piece and apply to affected part.

BAYABAS / GUAVA (PSIDIUM GUAJAVA L.)

A tree about 4- 5 meters high with tiny flowers with round or oval fruits that are eaten raw. Propagated through
seeds.
Parts utilized:
leaves
Uses:
For washing wounds- may be used twice a day.
For diarrhea- may be taken 3-4 twice a day.
As gargle and to relieve toothache. Warm decoction is used for gargle. Freshly pounded leaves are used for
toothache. Guava leaves are to be washed well and chopped. Boil for 15 minutes at low fire. Do not cover pot.
Cool and strain before use.

LAGUNDI (VITEX NEGUNDO)

A shrub known in English as the 5-leaved chase tree which grows wild in vacant lots and waste land. The
flowers are blue and bell-shaped and small fruits turn black when ripe. It is better to collect the leaves where are
in bloom. Matured branches are planted.
Parts utilized:
Leaves, flower.
Uses:

Asthma, cough and fever- boil the chopped raw fruits or leaves in 2 glasses of water left for 15 minutes until the
water left in only one glass. Strain. The following dosages of the decoction are given to age group.
NOTES IN PRIMARY HEALTH CARE Page 21
 Dysentery, colds and pain in any part of the body as influenza boil a handful of leaves and flowers in water
to produce a glass full of decoction 3 times a day.
Skin Diseases (dermatitis, scabies, ulcer, eczema) and wounds prepare a decoction of the leaves. Wash and
clean the skin/ wound with the decoction.
Headache- crushed leaves may be applied on the forehead.
Rheumatism, sprain, contusion insect bites- pound the leaves and apply on affected part.
Aromatic bath for sick patients - prepare leaf decoction for use in sick and newly delivered patients.

NIYUG- NIYOGAN (QUISQUALIS INDICA L.)

A vine known as Chinese honey suckle which bears tiny fruits and grows wild in backyards. It is effective for
the elimination of intestinal worms. The seeds must come from mature. Dried but newly opened fruits. Propagated
through stem cuttings about 20cm in height.
Parts utilized:
seeds
Uses:
An anti- helmintic used to expel round worms ascariasis. The seeds are taken 2 hours after supper. If no worms
are expelled, the dose may be repeated after one week. This is not to be given to children below four years old.
Special precautions: Follow recommended dosage. Overdose causes hiccups.

SAMBONG ( BLUMEA BALSAMIFERA)

A plant that reaches 1.5 to 3 meters high with rough hairy leaves. Young plants around mother plant may be
separated when they have three or more leaves.
English name: Blumea camphora
Parts utilized:
leaves
Uses:
Anti- edema, diuretic, anti- urolithiasis -boil chopped leaves in water for 15 minutes until one glassful remains.
Cool and strain. Divide decoction into 3 parts. Drink one part 3 times a day. Remember that sambong is not a
medicine for kidney infection.

TSAANG GUBAT (CARMONA RETUSA)

A shrub with small, shiny nice- looking leaves that grows in wild uncultivated areas and forests. Mature stems are
used for planting.
Parts utilized:
leaves
Uses:
Diarrhea boil the following amount of chopped leaves in 2 glasses of water for 15 minutes or until amount of
water goes down to 1 glass. Cool and strain. Divide decoction into 4 parts. Let patient drink 1 part every 3 hours.
Stomachache- washes leaves and chops. Boil chopped leaves in 1 glass of water for 15 minutes. Cool and filter,
strain and drink.

ULASIMANG- BATO (PEPERONIA PELLUCIDA)

A weed, with heart-shaped leaves also known as "pansit-pansitan", grows in shady parts of the garden and yard. It
is effective in fighting arthritis and gout. The leaves can be eaten fresh (about a cupful) as salad or like tea.
Parts utilized:
leaves
Use:
Lowers uric acid. (Rheumatism and gout)
Preparation:
Wash leaves well. One and a half cup leaves are boiled in two glassfuls of water over lower fire. Do not cover pot.
Cool and strain. Divide into three parts and drink each part three times a day after meals.
May also be eaten as salad. Wash the leaves well. Prepare one and a half cups of leaves. Divide into 3 parts and
take as salad three times s day.

YERBA BUENA (CLINOPODIUM DOUGLASII)

A small multi- branching aromatic herb commonly known as Peppermint. The leaves are small, elliptical ands
with soothed margin. The stem creeps to ground, and develops roots. May also be propagated through cuttings.
Parts utilized:
leaves, sap of plant
Uses:
For pain in different parts of the body as headache, stomach ache boil chopped leaves in two glasses of water
for 15 minutes. Cool and strain. Divide decoction into two parts and drink one part every three hours.
Rheumatism, arthritis and headache crush the fresh leaves squeeze sap. Massage sap on painful parts with
eucalyptus.
Cough and colds get about 10 fresh leaves and soak in a glass of hot water. Drink as tea. Acts as an
expectorant.
NOTES IN PRIMARY HEALTH CARE Page 22
 Swollen Gums steep 6 grams of fresh plant in a glass of boiling water for 30 minutes. Use solution as gargle.
Toothaches cut fresh plant and squeeze sap. Soak a piece of cotton in the sap and insert this in aching tooth
cavity. Mouth should be rinsed by gargling salt solution before inserting the cotton. To prepare salt solution add 5
grams of table salt to one glass of water.
Menstrual and gas pain soak a handful of leaves in a glass of boiling water. Drink infusion. It induces
menstrual flow and sweating.
Nausea and fainting crush leaves and apply at nostrils of patients.
Insect bites crush leaves and apply juice on affected part or pound leaves until paste-like. Then rub this on
affected part.
Pruritis- boil plant alone or with eucalyptus in water. Use decoction as wash on affected area.

MENTAL HEALTH/STRESS MANAGEMENT LECTURE

Lusog Isip 97 Program:

Stress a state where ones coping is not enough to maintain a balance of equilibrium; a state of body disequilibrium.

Sources of Stress:
1.
2.
3.
4. Organizational Problems a. Functionalism c. Low Morale
b. Lack of communication d. Burn out Feeling

ABC OF STRESS MANAGEMENT

A Awareness of being aware of things that makes you stress
B - Balance in using Strategies
- Change stressor, Physical reaction
- Diet, Goal setting, exercise
C Control of feeling to cope with stress

12S

1. Spirituality 7. Sounds, Songs

2. Siesta a break 8. Stress debriefing
3. 9. Speak to me
4. 10. Self Awareness
5. 11. Social
6. 12. Sports

Pointers to Mental Health:

1. Maintain Good Physical Health
2. Undergo Annual physical Check-ups
3. Develop and maintain a wholesome lifestyle
4. Avoid smoking and excessive alcohol intake
5. Have realistic goals in life
6. Have a friend whom you can confide and ventilate you problem
7. Dont live in the past and avoid worrying about the future
8. Live one day at a time
9. Avoid excessive physical, mental and emotional stress
10. Develop and sustain solid spiritual values

NOTES IN PRIMARY HEALTH CARE Page 23

 BOTIKA NG BARANGAY
GOAL:
To promote equity in health by insuring the availability and accessibility of affordable safe and effective quality
essential drugs to all, with priority for marginalized, underserved, critical and hard to reach areas.

LIST OF OVER THE COUNTER (OTC) DRUG PREPARATION FOR BOTICA NG BARANGAY (BnB)
1. ANALGESICS/ANTIPYRETICS 13. SOLUTION CORRECTION WATER AND
2. ANTACIDS ELECTROLYTE
3. ANTIHELMINTICS 14. LAXATIVE/CATHARTICS
4. ANTI-HISTAMIN 15. ANTI-SCABIES
5. NON-STEROIDAL ANTI-INFLAMATORY 16. ANTI-ANEMIC
6. (NSAIDs) 17. ANTIFUNGAL
7. ANTI-VERTIGO 18. VITAMINS
8. BRONCHODILATORS 19. VITAINS AND MINERALS
9. DIURRETICS 20. MINERALS
10. ANTITUSSIVE 21. ANTI-INFECTIVES
11. NASAL DECONGESTANT 22. MEDICATION FOR CHRONIC DISEASE
12. ANTI MOTILITY 23. TOPICAL NASAL DECONGESTANT
24. DISENFECTANTS

*Community Organizing Participatory Action Research (COPAR) Please refer to your supplemental notes

COMMUNITY DIAGNOSING

Community
Is a group of people sharing common geographical boundaries and common values and interest. It functions
within a particular sociocultural environment. A physical environment so coping and behaviour varies.

Signs of Healthy Community

1. Awareness that we are community
2. Conservation of natural resources
3. Recognition and respect of subgroups
4. Participation in subgroups in community affairs
5. Preparation for crisis management
6. Ability to solve problems
7. Open communication
8. Resources available to all
9. Settling of dispute though legal mechanism
10. Participation of citizens in decision making
11. Wellness in High Degree among the members

COMMUNITY DIAGNOSING

1. Preparation for community diagnosis

2. Data gathering
Spot Map
Key information
Interview
Community survey
Records review
3. Data Presentation
4. Problem Identifications
1st and 2nd level assessment; problem prioritization
5. Preparation of actions

Community Diagnosis:

Descriptive research
Profile general picture of comm., a direct health indicator
Process by which the people in the connection & Health team assess the community. Health problems & needs as
bases for Health programs development.
A learning process for the comm. to identify their own H problems & needs
A profile that deposits the Health problems & potentials of the community

NOTES IN PRIMARY HEALTH CARE Page 24

 2 Types of Community Dx

1. Comprehensive- provides the general health profile of the comm.

2. Specific or problem oriented- yields a comprehensive profile of a particular H problem.

Steps:

Preparatory Phase

Site selection: Location of 1st criteria

a. Poor community because they are vulnerable to disease, a health problem
b. Free from other agency
1. Preparation of the community
2. Statement of obj- dependent of comm. Dx
3. Identify methods & instruments for data collection

1. Method of Survey: Questionnaire

Census (100%) : Most ideal, enumeratx of data conducted 6 mos.

Sample Survey : Most practical study representative of a comm.
Size matters in terms of validity

2. Interview method

Instrument- interview guide/ schedule

a. Records review
Instrument: checklist
b. Ocular inspection/ observation
Instrument: checklist
c. Participant observation
3. Finalize sampling design & methods

a. Probability: Equal chances- random- ( simple, stratified, cluster)

b. Non- probability: Everyone will not have equal chances
4. Make a timetable

Implementation Phase
1. Data collection-uses instruments
2. Data organization/ collation
3. Data Presentation (narrative, tubular, graphical)
4. Data Analysis
Median age decrease young population
Preferred Pop. older populationlonger life span, less people dying
5. Identification of health problems
6. Prioritization of health problems
7. Development of a health plan
8. Validation and feedback- presentation of results
Evaluation Phase
1. Process evaluation
2. Product evaluation

FAMILY NURSING CARE PLAN (NURSING PROCESS)

Family
The fundamental units of any society, composed of father, mother and children related by blood or marriage.

NOTES IN PRIMARY HEALTH CARE Page 25

 Types of Family by Structure:
1. NUCLEAR-
2. EXTENDED-
3. SINGLE PARENT-
4. BLENDED/RECONSTITUTED-a combination of two families with children from both families and
sometimes children of the newly married couple. It is also a remarriage with children from previous
marriage.
5. COMPOUND-one man/woman with several spouses
6. COMMUNAL-more than one monogamous couple sharing resources
7. COHABITING/LIVE-IN-unmarried couple living together
8. DYADhusband and wife or other couple living alone without children
9. GAY/LESBIAN-homosexual couple living together with or without children
10. NO-KIN- a group of at least two people sharing a relationship and exchange support who have no legal or
blood tie to each other
11. FOSTER- substitute family for children whose parents are unable to care for them

Types of Family by Structure

1. PATRIARCHAL full authority on the father or any male member of the family e.g. eldest son, grandfather
2. MATRIARCHAL full authority of the mother or any female member of the family, e.g. eldest sister, grandmother
3. EGALITARIAN- husband and wife exercise a more or less amount of authority, father and mother decides
4. DEMOCRATIC everybody is involve in decision making
5. AUTHOCRATIC- only the father or the mother has the power with complete control over the family(Strict policey)
6. LAISSEZ-FAIRE- full autonomy
7. MATRICENTRIC- the mother decides/takes charge in absence of the father (e.g. father is working overseas)
8. PATRICENTIC- the father decides/ takes charge in absence of the mother

CHN PROCESS

I. Assessment
1. Data gathering- first level of assessment
2. initial data(Health Threat, Health Deficit, Foreseeable Crisis, Wellness Deficit)
a. Health Threat- conditions conducive to disease, accidents or failure to realize ones health potential
- healthy people
- Ex. Family hx of illness- hereditary like DM, HPN
nutritional problems- eating salty foods
personal behavior- smoking, self-medication, sexual practices, drugs, excessive drinking
inherent personality char- short temperedness, short attn span
short cross infectx
poor home env't.
lack/inadequate immunization
hazards- fire, falls, or accidents
family size beyond what resources can provide
b. Health Deficits- instances of failure in health maintenance ( disease, disability, devtl lag)
3 Types:
a. Disease/ illness- URTI, marasmus, scabies, edema
b. Disabilities- blindness, polio, colorblindness, deafness
c. Developmental Problems like mental retardatx, gigantism, hormonal, dwarfism

c. Stress Points/ Foreseeable Crisis Situations

- anticipated periods of unusual demand on individual or family in terms of adjustment or family resources
( nature situations)
Ex. Entrance in school
adolescents (circumcision, menarche, puberty
courtship (falling in love, breaking up)
marriage, pregnancy, abortion, puerperium
death, unemployment, transfer or relocation, graduation, board exam
3. Collect data and analyze
4. Identity of health needs

II. PLANNING
1. Prioritize the problem
a. Nature of conditions-wellness state, health treat, health deficits and foreseable crisis
b. Modifiability of the problem-probability of success in improving conditions
c. Preventive potentials-refers to probability of minimizing/preventive future problem
Salience
-refers to family perception and evaluation of the problem in terms of serious and urgency of attention needed.

NOTES IN PRIMARY HEALTH CARE Page 26

 Modifiability:
- Current knowledge, technology and intervention
- Resources of the family
- Resources of the nurse
Preventive Potentials
- Gravity and severity
- Duration of the problem
- Current management
- Exposure to any risk group

2. Statement of goals and objectives (smart)

III. IMPLEMENTATION
Guide in the selection of nursing intervention:
1. Analyze with the family current situation and determine choices and possibilities based on lived experiences of
meanings and concerns
2. Development / enhance familys competencies as thinker, doer and feeler
3. Focus on the interventions to help perform the health tasks
4. Catalyst behaviour changes through motivation and support

Types of nursing interventions:

Supplemental doing things for the patient
Facilitative- removing barriers for care
Developmental-improving family capabilities

IV. EVALUATION

HOME VISIT / BAG TECHNIQUE

Home Visit
Definition: a professional face to face contact made by PHN or RHM to the patient or the family to provide necessary
health care to further the objective of the agency.

Phases of Home visit

I. Socialization Phase II. Working Phase III. Evaluation Phase

1. introducing your name 1. Teaching 1. Record Data Findings
2.Greetings 2. Return demonstration of the mother 2. Schedule another Visit
3. your purpose of home visit 3. Final Instruction

Principles of Home Visit

1. Home visit should have a purpose and objective
2. Planning a home visit make use of available information about the client from records and other professional
providing care
3. Planning a home visit takes into consideration identified needs and clients taking into priority recognized needs
the family itself.
4. Planning continuing care should involve the clients family
Planning should be flexible and practical

Principles of Home Visit: should be from the cleanest to the dirtiest case eg Newborn, Postpartum to morbid case.

Advantage of Home Visit

1. The PHN or RHM see the family in their natural setting
2. The PHN or RHM can identify the presence of CD in the community
3. H.V establish a working and social relationship between the family and the health center staff.

Disadvantages of Home Visit

1. Time consuming in the party of the health Personnel.
2. H.V disrupt the family activities for the day
3. Some family are not comfortable of the health personnels presence at their home

NOTES IN PRIMARY HEALTH CARE Page 27

 Clinic Visit
Patient visits the Health Center to avail of the services thereto offered by the primarily for the consultation on matters that
allied them physically.

Phases
Phase I: Pre Consultation/ Conference Phase II: Consultation / Conference Phase III: Post Conference
1. Pt. Records 1. Rx is Given 1. Schedule of the next visit
2. V/S 2. Treatment and Prevention 2. referral
3. Assessment
4. Record findings

Advantages of Clinic Visit:

1. Make the health Personnel Available to more patient
2. Save time and effort of the health personnel
3. Materials and equipment needed for care are readily available
4. Record are available

Community Assembly

Phase I: Planning and Preparation Phase II: Assembly Phase III: Evaluation
1. Setting Objectives 1. Presentation of Data and 1. Assessment and result
2. Organizing Community leaders Survey 2. Referral/coordination/networking
and Community 2. Program Presentation 3. Follow-up
3. Program Planning 3. Open forum/ consultation
4. Giving of Assignments and 4. socialization
Task
5. Invitations (Brgy. Captain,
principal, etc)

Bag Technique

-steps which are carried out by the nurse to facilitate the performance of nursing procedures with ease and deftness
-a tool making use of the public health bag through which the nurse during the visit can perform nursing procedures with
ease and deftness, saving time and effort at the end in view of rendering effective nursing care.

Public Health Bag- essential and indispensable equipment of the Public Health Nurse

Principles: Should minimize if not totally prevent the spread of infection; should save time and effort
Special Consideration: HAND WASHING

Contents of the Bag: BP apparatus and stethoscope are carried separately; medicines also include-
Betadine, 70% alcohol, Benedicts solution
Place waste paper bag outside the work area to prevent contamination of the work area

Remember the :

Bag -and its contents must be protected from any possible contamination

Always wash your hands to prevent the spread of infection

Gather all necessary articles and supplies to answer emergency needs.

Note: Blood Pressure apparatus and stethoscope are carried separately.

Consider the following principles:

1. prevention of contamination
- place waste paper bag outside the work areas
2. protection of the caregiver
- clean and alcoholize all articles after use
3. make articles readily accessible
- place the articles in one corner of the work area

NOTES IN PRIMARY HEALTH CARE Page 28

 4. make follow-up care
- set the date and the time for the next visit

VITAL STATISTICS LECTURES

Vital Statistics - refers to birth, deaths, population, illness, marriages, divorce

The application of statistical measures to vital events (births, deaths and common illnesses) that is utilized to gauge the
levels of health, illness and health services of a community.

Source of Data:
- Municipal Treasurer
- Civil Register General
- City Health Officer

Types of Record:
- Birth record - record of live birth and fetal death
- Mortality Record records of deaths, date and causes
- Morbidity Record CD and important Chronic Disease
- Reportable Disease

6 Quarentinable Diseases:

1. Small Pox
2. Cholera
3. Plague
4. Yellow Fever
5. Typhoid
6. Relapsing fever

TYPES OF VITAL STATISTICS

FERTILITY RATE

1. Crude Birth Rate

Total # of livebirths in a given calendar year X 1000

Estimated population as of July 1 of the same given year

2. General Fertility Rate

Total # of livebirths in a given calendar year X 1000

Total number of reproductive age

MORTALITY RATE

1. Crude Death Rate

_Total # of death in a given calendar year_ X 1000

Estimated population as of July 1 of the same calendar year

2. Infant Mortality Rate

Total # of death below 1 yr in a given calendar year X 1000

Estimated population as of July 1 of the same calendar year

3. Maternal Mortality Rate

Total # of death among all maternal cases in a given calendar year X 1000
Estimated population as of July 1 of the same calendar year

NOTES IN PRIMARY HEALTH CARE Page 29

 EPIDEMIOLOGY

Study of frequency of disease

Study of distribution of disease or physiologic condition among human pop & the factors affecting
such distribution.
Distribution means the frequency of diseases & physiologic condition in terms of who gets sick where & when.

Basic Concepts:

1. Epidemiologic Triad: Agent- Host- env't

2. Transmission of CD: Common vehicle, source- serial- transfer- propagated from host to host

3. Incubation period: Entry of pathogens w/ enough infections load , up to appearance of the 1st s/sx

4. Herb Immunity: % of immune pop- some indiv are immune

Dengue- aedes daytime C
Arthropod Malaria anopheles- nighttime L
E
A
Neem tree
Types of Immunity:

1. Passive: Quick to come, quick to go

Natural- in water, breast feeding
Artificial- serum globulin, antiserum, antitoxin

2. Active: Slow to come, slow to go

Natural active- getting the dse itself
Artificial- tetanus toxoid

Preg 1 --- 4th month --------------------------TT1

--- 8th month (before delivery) ---- TT2
Preg 2 --------------------------------------------- TT3 ( 1st booster dose)
Preg 3 -------------------------------------------- TT4 (2nd booster dose)
Preg 4 -----------------------------------------------TT5 (3rd booster dose)

Factors Affecting Distribution of Disease:

1. Person- exposure, susceptibility or response to agents.

- Influenced by intrinsic characteristic
- Genetic/ family, prior immunologic experience
- Age, sex, ethnic grp, physiologic status
- Human behavior---most significant---can be modified

Some identified increase risk grps.

- Mothers, infants, and young children
- School children, old people, contacts
- People far from medical assistance
- People in areas with endemic dse
- People at certain times

Attack Rate- incidence of illness among exposed pop

Number of cases x 100
Pop at Risk

2. Place
- Extrinsic factors, existence of etiologic factors & exposure & susceptibility of human host,
influenced by extrinsic factors.

3. Time
- Temporal patterns- fluctuations of incidence

a. Short term- fluctuations

NOTES IN PRIMARY HEALTH CARE Page 30

 - Time of day
- Days of the week

b. Cyclic pattern- regular pattern

Seasonal cyclicity annual cyclicity
Secular cyclicity every other year typhoid, measles

Patterns of Disease Occurrence:

Epidemic
A situation when there is a high incidence of new cases of a specific dse in excess of the expected.
When the proportion of the susceptible are high compared to the proportion of the immunes.

Ex. 20-30 diseases that you dont know

Current number of cases exceeds the usual expectancy.

Endemic
Habitual presence of a disease in a given geographic location accounting for the low number
of both immunes & susceptible.
Causative factor is constantly available or present to the area
Ex. Malaria, constant

Sporadic

Disease occurs every now & then affecting only a small number of people relative to the total pop
Intermittent
On & off

Pandemic
Global occurrence of a disease, bigger population
- Patient epidemic- easily the person can identify the cause

Common Epidemiologic Studies:

Retrospective (Past) Cross- Sectional (Present) Prospective Cohort (future)

Case Control study Prevalence study- old & new cases - Incidence or new cases
-Show an association bet. - Get prevalence of disease (Lung CA)
the risk factor & disease - Get prevalence of risk factor (smoking)

*Independent variable (Cause) - The one to be manipulated

*Dependent (Effect) - Will always be the interest of the researcher

MORBIDITY RATE

1. Prevalence Rate

Total # of new & old cases in a given calendar year X 100

Estimated population as of July 1 of the same calendar year

2. Incidence Rate

Total # of new cases in a given calendar year_ X 100

Estimated population as of July 1 of the same calendar year

3. Attack Rate
Total # of person who are exposed to the disease X 100
Estimated population as of July 1 of the same calendar year

NOTES IN PRIMARY HEALTH CARE Page 31

 PRIMARY Health Care/Rural Health Care Delivery System (RHCD)

Primary Health Care (PHC)

An essential health care based on practical, scientifically sound and social acceptable methods and technology
made universally accessible and families in the community through their full participation at a cost that the community
can afford to maintain at every stage of their development in the spirit of self reliance and self determination
(WHO/UNICEF 78)
Primary health care was declared during the First International Conference on PHC held in Alma Ata USSR on
September 6 12, 1978 by WHO with a goal of Health for All by the year 2000
Primary Health Care was adopted in the Philippines through LOI 949 signed by Pres. Marcos on October 19,
1979 and has an underlying theme of Health in the hands of the People by 2020

PHC was declared in the ALMA ATA CONFERENCE in 1978, as a strategy to community health development. It is a
strategy aimed to provide essential health care that is:
Community-based
Accessible
Part and parcel of the total socio-economic development effort of the nation
Acceptable
Sustainable at an affordable cost.
Framework

Peoples Empowerment and Partnership is the Key Strategy to achieve the goal, Health For all Filipinos by the
year 2000 And Health in the Hands of the People by the year 2020
Levels of Care
WHAT DOES ESSENTIAL HEALTH CARE IN PHC MEANS?
It stands for: 2-way referral
Education of prevailing Health Problems system
Locally-endemic Disease Prevention and Control Goal Tertiary Level
Rehab
Expanded Program of Immunization -National
Health services
Maternal and Child Health and Family Planning Medical and
Training centers
Environmental Sanitation and Safe Water Supply -Regional Medical Centers
Nutrition and Food Supply Secondary
Treatment of Communicable & Non-communicable Diseases/ Conditions Level
Supply and Proper use of Essential Drugs and Herbal Medicine Goal: Curative
-Provincial / City Hospital
Dental Health Promotion -Provincial / City Health Services
Access to and use of hospitals as Centers of Wellness -Emergency / District Hospital Primary
Mental Health Promotion Level
Goal: Promotion of Health and Prevention
Acronym: ELEMENTS + DAM Of Illness
-Rural Health Unit, Barangay Health Station
-Community Hospital and Health Center
-Private Practitioner, Puericulture Center
Pillars (major elements):
A. Multi-sectoral approach
Intersectoral linkages
Intrasectoral linkages
B. Community
C. Appropriate Technology
- method used to provide a socially and environmentally acceptable level
of service or quality product at the least economic cost.

Levels of Health Care Providers

Criteria: Feasible
Acceptable, Affordable
Complex Tertiary Level
Effective
Safe MHO
Scope-wise Secondary

PHN
Primary
RHM
BHM
SI
NOTES IN PRIMARY HEALTH CARE Page 32
 Concept of PHC is characterized by;
Partnership and empowerment of the people
PHC is a strategy
which focuses responsibility for health on the individual, his family and the community
PHC includes full participation and active involvement of the community
towards the development of self-reliant people, capable of achieving an acceptable level of health
and well being
PHC recognizes the interrelationship between health and the overall political, socio-cultural and
economic development of society

Four cornerstones/Pillars in PHC

1. Active community participation

2. Intra and Inter-sectoral linkages
3. Use of appropriate technology
4. Support mechanisms made available

Two levels of PHC workers

1. Village or Barangay Health Workers

2. Intermediate Level Health Workers
a. General medical practitioners
b. PHN
c. RSI
d. RHM

Supervisory Function of the PHN

3. The PHN supervises midwifes within her catchment area
4. The PHN formulates a supervisory plan
5. Identifies the factors that affect the midwives performances and job satisfaction
6. Defines standards of the performances
7. Set achievable performance targets and defines criteria for evaluation
8. Formulates objectives and strategies to meet the midwives needs for supervision.
9. Conduct supervisory visits.
10. Monitor and evaluates midwives and nursing auxiliary performances in the implementation of public health
programs.
11. Utilize public health monitoring and evaluation tools.
12. Reviews clinic records and reports, validates their accuracy and completeness and compares actual
performances.
13. Utilize results of monitoring and evaluation strengthens supervisory.
14. Documents Findings during monitoring and evaluation

RURAL HEALTH MIDWIVE

QUALIFICATION OF A RURAL HEALTH MIDWIFE (RHM)

Graduate of an accredited School of Midwifery and Passed the Midwifery Board Examination
ROLES OF RURAL HEALTH MIDWIFE IN COMMUNITY WORK
Guide help the people achieve their goal
Enabler- facilitates the community organization process
Expert provides technical skills and advice
Therapist clarifies issues and bring diverse group together

DUTIES AND RESPONSIBILTY OF AN RHM

1. Works with the PHN in Planning and Evaluating Health Services at the barangay level
- Participates in determining health needs of the community
- Assists in planning and organizing the clinic in his/her barangay station
- Prepares monthly scheduled of activities in coordination with the physicians, nurse, sanitary inspectors and
other health workers
2. Plans for activities in the clinic Barangay Health Station (BHS) follow-ups in homes and clinic visits in the
community.
- Participate in the periodic evaluation of health services in the barangay.
3. Provides midwifery services in the barangay.
- Gives direct care to normal childbearing woman as well as normal infants

NOTES IN PRIMARY HEALTH CARE Page 33

 - Refer to physicians and / or nurse and appropriate agencies any postpartum women and newborn infant with
suspected abnormalities and problems.
4. Carries out medical nursing functions as authorize by the department of health
5. Conduct clinics which includes:
- Obtaining clinical history
- Performing simple routines physical and laboratory examinations
- Administering emergency and therapeutic measures based on the standing procedures.
6. Refer cases needing further diagnostics and management by the nurse or the physicians and other agencies.
7. Keeps accurate record f medical and nursing care rendered in the clinic homes and community
8. Mobilizes community for health actions
9. Carries out health education and information education communication activities.
- Conduct individuals and group teachings utilizes IEC materials
- Request and distributes IEC materials to other government and non-government units
10. Monitor and supervises health and health related activities within the catchment area
- Guides volunteer health workers and / or trainees assigned to Barangay Health Station
- Accomplishes required records and forms of activities
- Prepares and submits report of activities and needs for supplies
- Participates as facilitator in the training of volunteer health workers and community leaders/members

NOTES IN PRIMARY HEALTH CARE Page 34