1

NCM 113 – LEC health through their own efforts or to

COMMUNITY HEALTH NURSING a better quality of life.
MIDTERM REVIEWER - A practice-based profession and an
academic discipline that promotes
participative democracy, sustainable
COMMUNITY ORGANIZING
development, rights, economic
AND EMPOWERMENT IN opportunity, equality, and social
HEALTH justice, through the organization,
education and empowerment of
Community Engagement
people within the communities.
- Social movement that aims to - A set of principles that guide practice
transform current realities affecting not exclusive to a specific profession
people's health. but as a science that can be applied
- For people to walk together in the in various context.
journey of achieving health for all, by - 4 Characteristics:
all. a. A process for implementing
- The process of walking collaborates change
with and through groups of people b. A program specified activities
affiliated by geographic proximity. c. An outcome
Special interest, or similar situations d. An ideology of action
to address issues affecting the
Community Organizing
wellbeing of those people (CDC,
1997). - A form of community engagement
- As a strategy – requires a that seeks to rally people to work
systematic approach to bring people, together an act on issues owned,
structures, and resources together; identified, and solved through and by
gives premium to activities that equip the people’s efforts.
people with the necessary knowledge - As a process – It has 2 broad phases
and skills as tools for self-help as they 1. Raising the consciousness of the
deal with the problems of their people and;
community. 2. Mobilizing stakeholders to
- As a continuum – it shows a address the problem
trajectory that focuses on the active - As a method – it draws its approach
participation of all stakeholders that and techniques from the fields of
ultimately ends in shared leadership. sociology, anthropology, community
- Involvement of the people at all development, and social work.
stages is the key ingredient. - As a framework – it speaks of a
sustained and continuous process of
Community Development
enhancing capabilities and resource
- As a process – it entails people's of the community in response to their
active participation in bringing in issues and concerns.
bringing about solutions to problems - As a philosophical approach to
collectively identified. development – it aims to transform
- As an outcome – it speaks of a state the voiceless and powerless into a
in which people enjoys a better dynamic participatory and politically
responsive community.

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- A planned process to activate - Active involvement is critical to
community to use its own social determine success.
structures and any available resources to - Emphasis on self-help, fostering
accomplish community goals that are indigenous leadership and developing
decided on primarily by community an organization.
representatives ad generally consistent 2. Social Action Model
with local values (Bracht, 1999). - Involves sectors of a population that
- Philippine context: are disenfranchised and clamors for
- Co is a process that revolves around social justice.
the peoples lives, experiences, and - Not limited to communities bound by
aspirations. location.
- It is people-centered and geared - Involves people of the same social
towards continuing capability class, occupation or ideology.
building, self-reliance, and 3. Social Planning
empowerment (Manalili, 1990). - Experts driven and highly technical
- The process which build/mobilises solution to problems of society at
people and other community large.
resources towards identifying and - Government agencies from both local
solving heir own problems (Dacanay, and national levels
1993) - To solve population concerns
- In the Philippines, the most - Example: communicable disease
documented CO initiatives occurred control: grounded on epidemiological
during the events surrounding EDSA evidence and formulated based on
1. scientific literature and best available
- Values-based: evidence.
- Human rights - worth and dignity
inherent to all human beings.
- social justice – fairness in the
distribution of resources to satisfy
basic needs and to maintain dignity
as human beings.
- Social responsibility – people are part
of one community and reflected on
concern for one another.

MODELS OF COMMUNITY
ORGANIZING PHASES OF COMMUNITY
1. Locality Development ORGANIZING
- People in the same area that are
bound by the same issues and 1. Social Preparation
problems develop their capacities in - Initial steps in establishing a
dealing with their own concerns. partnership with the people and
- Commonly employed in villages, identifying needs, problems, issues.
resettlement sites or in areas a. Site selection
characterized by homogeneity of b. Entry and integration
inhabitants. c. Social investigation

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2. Social Mobilization THE HEALTHCARE DELIVERY

- The organizational phase; greatest SYSTEM
participation is encountered.
a. Identifying potential leaders
b. Core group formation World Health Organization
c. Organization building
3. Capacity building - Founded in 1948
- Education and training activities - WHO is the United Nations agency
initiated to facilitate community’s that connects nations, partners and
acquisition of knowledge and skills. people to promote health, keep the
- Can be a nurse, social worker, a world safe and serve the vulnerable.
teacher, or a volunteer. - Objective: The attainment by all
- Enabler, advocate, facilitator, change peoples of the highest possible
agent. level of health.
- Headquarters – Geneva, Switzerland
PRINCIPLES OF COMMUNITY - Has 150 country offices and 6 world
ORGANIZING regional offices:
1. Go to people, live among the people. Africa, the Americas, Eastern
2. Learn, plan, and work with the Mediterranean, Europe, Southeast
people. Asia and the Western Pacific.
3. Start with and build on what the - Philippines – a member of the
people know. Western Pacific Region
4. Teach by showing, learn by doing.
5. Not piecemeal but an integrated Core Functions:
approach. a) Providing technical leadership on
6. Not a relief but release. matters critical to health and
Community Engaged Research engaging in partnerships where joint
action is needed.
- Requires careful assessment through b) Shaping the research agenda and
research and thus calls for a stimulating the generation,
partnership approach. translation, and disseminating
- The subjects of the research (people valuable knowledge.
in the community are given c) Setting norms and promoting and
opportunity for control. monitoring their information.
- Community-based participatory d) Articulating ethical and evidence-
research (CBPR) is a collaborative based policy options.
approach to research process and e) Providing technical support,
recognizes the unique strength that catalyzing change, and building
each brings. sustainable institutional capacity.
- CBPR is commonly termed as
participatory action research (PAR) in The Millennium Development Goals (MDGs)
the Philippines and becomes part of - are eight goals with measurable
social investigation while organizing targets and clear deadlines for
communities.

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improving the lives of the world's mortality to at least as low as 25
poorest people. per 1,000 live births.
- To meet these goals and eradicate 3. By 2030, end the epidemics of
poverty, leaders of 189 countries AIDS, tuberculosis, malaria and
signed the historic millennium neglected tropical diseases and
declaration at the United Nations combat hepatitis, water-borne
Millennium Summit in 2000. diseases and other communicable
- Target: 2015 diseases.
4. By 2030, reduce by one third
premature mortality from non-
communicable diseases through
prevention and treatment and
promote mental health and well-
being.
5. Strengthen the prevention and
treatment of substance abuse,
including narcotic drug abuse and
harmful use of alcohol.
6. By 2020, halve the number of
global deaths and injuries from
road traffic accidents.
7. By 2030, ensure universal access
to sexual and reproductive
health-care services, including for
Sustainable Development Goals family planning, information and
education, and the integration of
reproductive health into national
strategies and programs.
8. Achieve universal health
coverage, including financial risk
protection, access to quality
essential health-care services and
access to safe, effective, quality
and affordable essential
3 – Good Health and Well-Being medicines and vaccines for all.
Targets: 9. By 2030, substantially reduce the
number of deaths and illnesses
1. By 2030, reduce the global from hazardous chemicals and
maternal mortality ratio to less air, water and soil pollution and
than 70 per 100,000 live births. contamination.
2. By 2030, end preventable deaths 10. Strengthen the implementation of
of newborns and children under 5 the World Health Organization
years of age, with all countries Framework Convention on
aiming to reduce neonatal Tobacco Control in all countries,
mortality to at least as low as 12 as appropriate.
per 1,000 live births and under-5

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11. Support the research and Mission: Guarantee equitable, sustainable
development of vaccines and and quality health for all Filipinos, especially
medicines for the communicable the poor and shall lead the quest for
and noncommunicable diseases excellence in health.
that primarily affect developing
DOH is the national authority on health. Its
countries, provide access to
role is to provide technical and resource
affordable essential medicines
assistance to concerned groups as mandated
and vaccines, and, in particular,
by EO 102.
provide access to medicines for
all. The role of the DOH in the Health Sector:
12. Substantially increase health
financing and the recruitment, 1. Leadership in health
development, training and - Serve as the national policy
retention of the health workforce regulating institution, that
in developing countries, spearheaded the sectoral planning
especially in least developed and policy formulation and
countries and small island assessment at the national and
developing States. regional level. It advocates the
13. Strengthen the capacity of all adoption of policies, plans and
countries, in particular developing programs to address national and
countries, for early warning, risk sectoral concerns.
reduction and management of 2. Enabler and Capacity Builder
national and global health risks. - Innovates new strategies in health to
improve effectiveness. The institution
oversees national health plan
The Philippine healthcare delivery programs and policies. It ensures the
system highest achievable standard of
Health Care Delivery System quality health care.
- organization of people, institutions, and 3. Administration of Specific Services
resources that deliver health care - Manage selected national health
facilities and hospital. The institution
services to meet the health needs of
also administers direct health
target populations
services for emergent health concern,
Philippines Health Care Delivery System health emergency response and
catastrophic events.
- Composed of agencies, personnel
and services divided into 2 sectors: Local Government Code of 1991 (RA 7160)
public and private.
- resulted in the devolution of health
- DOH (Department of Health) is the
services to local government units
lead agency.
(LGUs).
- Public sector – tax-based, mostly
- The municipalities are clustered into
availed for free.
inter-local health zones. Each
- Private sector – market-oriented and
interlocal health zone (ILHZ) has a
are availed for a payment.
defined population within a
Vision: DOH is the leader, staunch advocate geographical area and comprises a
and model in promoting health for all in the central referral hospital and a number
Philippines.
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of primary-level facilities such as RHU Triple Burden of Disease
and Barangay Health Station (BHS).
1. Communicable Diseases
- The purpose of ILHZ is to integrate
- HIV/AIDS, TB, COVID-19
hospital and public health system
2. NCDs
service for a holistic delivery of health
- HPN, DM, CA
services.
3. Diseases of rapid urbanization and
- Stakeholders include LGU and all civic
industrialization
organizations, DOH, PHIC, NGO’s and
- Mental Health, substance abuse
GO’s.
Universal Health Care Law (RA 11223)
The inter-local health zone
- On February 2019, President Rodrigo
▪People – one interlocal health zone has an
Duterte signed the Universal Health
ideal population size of 100k to 500k for
Care Bill into law, ushering in massive
optimum efficiency effectiveness.
reforms in the Philippine health
▪Boundaries – identified geographical sector. Among the salient features of
locations and access to referral facilities. the UHC Law are the expansion of
population, service, and financial
▪Health facilities – district or provincial
coverage through an array of health
hospital. RHU, BHS or health services
system amendments. Along with this
deciding to work together
is a planned paradigm shift to primary
▪Health workers – composed the ILHZ care, which is the core and center of
team which are the community-based all health reforms under the UHC.
organization, NGO, Volunteer health worker,
private clinic, barangay health station, rural
Level of Health Care and Referral
health unit, district hospital and DOH.
System:
1. Primary Level of care
- Devolved to the cities and
municipalities
- Provided by center physician, public
health nurses, rural health midwives,
brgy health worker, traditional
healer, Brgy health station, Rural
health unit.
2. Secondary Level of care
- given by the physician with basic
health training.
- still devolved to the cities and
municipalities.
- includes infirmaries, municipal and
district hospitals and outpatient
department of provincial hospital.
- Referral center of primary health
facilities.

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- Capable of performing minor
surgeries and perform simple
laboratory exams.
3. Tertiary Level of Care
- Rendered by specialists in health
facilities including medical centers as
well as regional and provincial
hospital specialized hospitals such as
Philippine heart center and care
facilities.
- Referral center for secondary care
facilities.
- For complicated cares and intensive.

Level of Prevention
1. Primary Prevention
- aims to prevent disease or injury
before it ever occurs.
- This is done by preventing exposures
to hazards that cause disease or
injury, altering unhealthy or unsafe
behaviors that can lead to disease or
injury, and increasing resistance to
disease or injury should exposure
occur.
- Examples include:
legislation and enforcement to ban or
control the use of hazardous products
(e.g. asbestos) or to mandate safe
and healthy practices (e.g. use of
seatbelts and bike helmets);
education about healthy and safe
habits (e.g. eating well, exercising
regularly, not smoking);
immunization against infectious
diseases.
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2. Secondary Prevention retrain workers for new jobs when
- aims to have early and prompt they have recovered as much as
treatment to reduce the impact of a possible; Palliative care.
disease or injury that has already
occurred.
- This is done by detecting and treating
disease or injury as soon as possible MATERNAL, CHILD, AND
to halt or slow its progress, ADOLESCENT HEALTH
encouraging personal strategies to
SERVICES
prevent reinjury or recurrence, and
Current Situation
implementing programs to return
people to their original health and DOH AO 2008-0029: Implementing Health
function to prevent long-term Reforms for the Rapid Reduction of Maternal and
problems. Neonatal Mortality – A response to the slow
- Examples include: decline in maternal and child mortality.
- regular exams and screening tests to
- Maternal Newborn Child Health and
detect disease in its earliest stages
Nutrition (MNCHN) services.
(e.g. mammograms to detect breast
- For each stage of life – prepregnancy,
cancer); daily, low-dose aspirins
and/or diet and exercise programs to pregnancy, delivery, postpartum,
prevent further heart attacks or newborn and childcare.
strokes; suitably modified work so Maternal Newborn Child Health
injured or ill workers can return safely and Nutrition (MNCHN) services
to their jobs. To ensure:

3. Tertiary Prevention - Every pregnancy is wanted, planned

- aims to rehabilitate the client or to and supported.
soften the impact of an on-going - Every pregnancy is adequately
illness or injury that has lasting managed throughout its course.
effects. - Every delivery is facility-based and
- This is done by helping people managed by skilled birth attendants
manage long-term, often-complex or skilled health professionals.
health problems and injuries (e.g. - Every mother and newborn pair
chronic diseases, permanent secures proper postpartum and
impairments) in order to improve as newborn and childhood care.
much as possible their ability to - Remarkable gains were recorded
function, their quality of life and their afterwards:
life expectancy. - FHSIS (Field Health Service
- Examples include: Information System) in 2018 showed
cardiac or stroke rehabilitation that maternal mortality rates
programs, chronic disease decreased from 209/100,000
management programs (e.g. for livebirths (1990), 162 (2006) and 74
diabetes, arthritis, depression, etc.); (2015) to 54/100,000 livebirths in
support groups that allow members 2018.
to share strategies for living well; - Despite this, women are still dying
vocational rehabilitation programs to from hemorrhage, hypertension, and
infection.
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- Other challenges were encountered - To ensure that women receive high-
on perinatal mortality (fetal deaths of quality gynecological family planning,
22 weeks or more) and infant health. prenatal, delivery and postpartum
- Weak national immunization care to achieve optimal health for the
coverage (2008). mother, fetus and infant during
- Service utilization for maternal pregnancy, childbirth and
gradually increased in 2018: increase postpartum.
in number of women with at least 4
Strategic changes in the design of
ANC (antenatal consultations which
services provided which include:
should commence in the first
trimester of pregnancy). 1. Shift in handling pregnancy clients
- Reports on women seeking prenatal risk-approach to preparing all
care only when quickening is felt pregnant women to complication at
(around 17th to 20th week AOG). childbirth.
- Facility-based delivery (FBD) and - All women are considered at risk for
skilled birth attendance (SBA) were pregnancy and childbirth
94% and 95% respectively (2018). complications.
- An indication of women’s preference - Establishment of BEmONC-CEmONC
to give birth in licensed facilities and network within the bigger Service
attended by skilled health Delivery Network (SDN).
professionals as well as the support 2. Improved quality of FP counselling
of PhilHealth provided for women and expanded service availability of
giving birth in health facilities through postpartum FP in hospitals and
its maternity and newborn care primary birthing centers.
packages and resolutions prohibiting 3. The integration of cervical cancer,
deliveries at home. syphilis, hepatitis B, and HIV
- 5% of pregnant women still give birth screening among others into the
at home assisted by traditional birth antenatal care protocols.
attendants (TBA) or hilots. - A shift from centrally-controlled
national programs to an LGU
Challenges in the delivery of maternal
governed system that delivers an
and child health services
integrated system.
1. Low utilization of Family Planning - A woman who seeks care for
Packages of PhilHealth reproductive health concerns could
2. Decrease in the number of expect a comprehensive array of
PhilHealth-accredited Maternal and services that addresses her most
Child Program facilities. critical reproductive health needs.
3. Antenatal and postpartum care lags. - MNCHN was expanded to
4. Measles and polio outbreaks and Reproductive Maternal Newborn
increase in measles-related Child Adolescent Health and Nutrition
mortalities. (RMNCAHN).
- Anchored on PhilHealth accreditation
Safe Motherhood Program
of birthing centers and individual
- A series of initiatives, practices, membership.
protocols, and service delivery - Ensures sustainable financing and
guidelines. eliminate out-ofpocket expenditures

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for antenatal, facility delivery and - Department Order 2009-0029:
postnatal care. Guidelines Governing the Payment of
- Includes systems for safe blood Training Fees relative to the
supply and stakeholder behavior attendance of Health Workers to
change through a combination of BEmONC Skills Training Course at
advocacy and interpersonal Duly Designated Centers.
communication during clinic visits. - AO 2011-0011: Establishments of
BEmONC Training Centers in
Related Policies and Laws Regional Hospitals and Medical
Centers.
- AO 2015-0020: Guidelines in the
1. Strategic Framework and
Administration of Life Saving Drugs
Implementing Guidelines for
During Maternal Care Emergencies by
FOURmula One Plus for Health (F1+).
Nurses and Midwives in Birthing
- DOH AO 2018-0014
Centers.
- Alignment of health initiatives into 4
- AO 2018-0003: National Policy on
strategic pillars: Financing,
the Prevention of Illegal and Unsafe
Regulation, Service Delivery and
Abortion and Management of
Governance plus Performance
PostAbortion Complications.
Accountability.
- AO 2016-0035: Guidelines on the
2. The National Objectives for Health
Provision of Quality Antenatal Care in
2017-2022
All Birthing Centers and Health
- A roadmap for the F1+ towards the
Facilities Providing Maternity Care
achievement of Universal Health
Services
Care.
- RA 10028: Expanded Breastfeeding
- Specifies the objectives, strategies
Promotion Act of 2009
and targets of DOH F1+ for Health.
- RA 11166: Philippine HIV and AIDS
- RA 10354 – Responsible
Policy Act of 2018
Parenthood and Reproductive Health
- Strengthening of the country’s
Act of 2012.
policy on HIV/AIDS prevention,
- RA 11148: The “Kalusugan at
treatment, care and support.
Nutrisyon ng Mag-Nanay” Act -
-Lowered the minimum age
Scaling up of the national and local
requirement from 18 yo to 15 yo in
health nutrition programs for
availing HIV testing and counselling
pregnant and lactating women,
without parental or guardian’s
adolescent girls, infants and young
consent.
children in the first 1,000 days of life.
- RA 11210: The 105-Day Expanded
Maternity Leave Law - 105 days of RMNCAHN core package of services
maternity leave with option to extend - A health systems-oriented, multi-
for an additional 30 days (without sectoral approach in strengthening
pay) and additional 15 days (solo the continuum of care for women,
mothers). children, families and communities.
- AO 2008-0029: Implementing - To enable all adolescents to make
Health Reforms to Rapidly Reduce informed choices on reproductive
Maternal and Neonatal Mortality health issues particularly about
pregnancy by creating awareness

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and providing access to information, B. Family Planning
education, support, services and - The program which enables couples
necessary treatment pertaining to and individuals to.
reproductive health. - decide freely and responsibly the
1. Known appropriate clinical case number and spacing of their children.
management services including - To have access to full range of safe,
emergency obstetric and newborn affordable and effective,
care. nonabortifacient modern natural and
2. Known cost-effective public health artificial FP methods.
measures capable of reducing - Target modern contraceptive
exposure to and severity of risks for Prevalence Rate (mCPR) is 65% of
maternal and newborn deaths that married women.
are routinely being provided by LGUs. - 4 pillars of FP
1. Responsible parenthood
2. Child spacing – 3-5 years
MCNHN Service Delivery Network
3. Respect for life – abortion is
(SDN)
considered illegal
- Refers to the network of facilities and
4. Informed choice
providers within the province-wide or
city-wide health system offering the 2. Maternal-newborn Helath
MNCHN core package of services in A. Pregnancy services
an integrated and coordinated
manner. - Provision of iron and folate
- Includes the communication and supplementation.
transportation system. - counselling and provision of FP methods,

1. Reproductive Health - Prevention and management of infection

- RA 10354: Responsible Parenthood and lifestyle-related diseases.
and Reproductive Health (RPRH) Law B. Antenatal Care Services
in 2013.
- Life-span approach: reproductive - RA 11148: Kalusugan at Nutrisyon ng Mag-
health is a concern that affects Nanay Act.
different age brackets.
- To scale up the national and local nutrition
- Client-centered approach (not
programs for maternal, neonatal child health
program-focused): provision of
and nutrition.
services the client needs.
A. Responsible Parenthood - In the first 1000 days.
- The will and ability of a parent to
1. Pregnancy Tracking and Enrollment to
respond to the needs and aspirations
Antenatal Care (ANC)
of the family and children.
- A shared responsibility between - To scale up the national and local nutrition
parents programs for maternal, neonatal child health
- Determine and achieve the desired and nutrition.
number of children.
- Spacing and timing of their children. - Tracking is done by the BHWs.
- Awareness of their reproductive
health rights.

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Antenatal care services (first 270 days) D. Postpartal services

1. Pregnancy Tracking and enrollment - 1 st visit – within 24 hours

to Antenatal Care (ANC) - 2 nd visit – within 1 week
- Health History - Micronutrient supplementation
- Prenatal Assessment - Birth registration
- Birth preparation and Emergency - Lactation support and counselling
Plans - Nutrition assessment
2. DT immunization
E. Birth and Newborn (28 days)
3. Consumption of iodized salt
4. Micro- and macronutrient Ao 2005-0014
supplementation - For iron deficiency
anemia, Vit A deficiency, Iodine - Early initiation of breastfeeding
deficiency disorder and Calcium - Exclusive breastfeeding for the first 6
supplementation months
5. Early identification and Management - Expanded bf for 2 years and beyond
of Nutritionally at-Risk Pregnant - Appropriate complementary feeding
Client. - Micronutrient supplementation
6. Counselling on maternal nutrition, - Universal salt iodization
breastfeeding and rooming-in, - Food fortification
appropriate infant and young child F. Expanded NBS test and hearing screening
feeding practices. test.
7. Assessment of risk for parasitism
8. Provision of oral services 3. National Immunization Program
9. Counselling on proper handwashing, Goals:
environmental sanitation and - To immunize all infants against
personal hygiene. vaccine preventable diseases
10. Counselling on nutrition, smoking - To sustain polio-free status
cessation and adoption of healthy Philippines
lifestyle practices. - To eliminate measles infections
11. PHIC enrollment and linkage with - To eliminate maternal and neonatal
health workers. tetanus
C. Intrapartal services - To control Diphtheria, Pertussis,
Hepatitis B infection and German
- facility-based delivery to ensure safe Measles
labor, availability of intrapartum - To prevent extrapulmonary TB
interventions and to safeguard the among children
welfare of women and newborns.
- A network of public and private 4.Child Health Services
healthcare providers. Nutrition program - complementary
- BEmONC-capable facility – to be feeding, micronutrient supplementation,
reached within 30 minutes from food fortification, deworming program.
home. - IMCI
- CEmONC-capable facility within an
hour from each BEmONC-capable
facility.

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5. Adolescent Health - The most common causes of these
- Adolescent Health and Development two diseases are atherosclerosis and
Program (AHDP) Strategic Directions hypertension.
for 2018-2022. - Hypertension or high blood
- To guide the improvements of health pressure is defined as a systolic
status of adolescents, enabling them blood pressure equal to or above
to enjoy their right to health. 140mm Hg or a diastolic blood
- Strategies: health education and pressure equal to or above 90mm Hg.
promotion, life skills building and - Atherosclerosis is a disease of the
medical service provision. blood vessels characterized by the
- Encourage the use of adolescent deposition of fats and cholesterol
sexual and reproductive health within the walls of the artery (WHO,
(ASRH) services. 2011).
- Uncontrolled hypertension and
atherosclerosis lead to heart attack,
stroke, kidney damage, and a host of
complications (Stanhope &
CONTROL OF NON-
Lancaster, 2010).
COMMUNICABLE DISEASES
- Common risk factors: Unhealthy
diet/eating, Smoking, Sedentary
Non-communicable Disease (NCDs) lifestyle/physical inactivity, Excessive
alcohol consumption, Viruses, and
- A medical condition that is
Radiation.
noninfectious and non-transmissible,
a communicable disease is caused by Classification of Blood Pressure
an infectious agent and is transmitted
from one person to another.
- Most often, NCDs are referred as
“chronic diseases” due to their long
duration, signs and symptoms lasting
for more than 6 months.
- NCDs are also referred to as
“lifestyle-related diseases” usually by
having unhealthy lifestyle. Prevention of Cardiovascular and
Cerebrovascular Disease
CARDIOVASCULAR AND Screening. Identification of unrecognized
CEREBROVASCULAR DISEASES disease by the application of test,
- Cardiovascular disease (also called examination, or other procedures that can be
heart disease) - general term used to applied rapidly to help identify an individual’s
refer to diseases that involve the chances of becoming ill (WHO, 2011).
heart or blood vessels (arteries,
capillaries, and veins). For hypertension- involves the monitoring
- Cerebrovascular disease or stroke - is of blood pressure, WHO recommends the use
a group of brain dysfunction related of aneroid devices such as
to diseases of the blood vessels sphygmomanometers that are calibrated
supplying the brain. every 6 months.

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BP should be recorded twice daily in the VLDL (very-low-density lipoproteins)
morning and evening, for several days before
- Another type of bad cholesterol
a diagnosis of HPN can be made. The person
produced in the liver, and contains a
assumes a seating position during the BP
high amount of triglycerides.
monitoring.
- Triglycerides are a type of fat-most
Screening for Elevated Cholesterol common type of fat in the body. They
come from foods, especially butter,
- Involves taking a blood sample to
oils, and other fats sources, and from
determine the total serum
extra calories.
cholesterol, low density lipoprotein
(LDL), and high-density lipoprotein Guidelines for triglycerides
(HDL).
- Prior to testing, the individual should
withhold food or drinks for at least 8
hours to ensure accuracy of results.
- In all adults aged 20 years or older, a
fasting lipoprotein profile should be
obtained once every 5 years (NCEP,
CANCER
2001).
- One of the most common causes of
- Research indicates that elevated LDL
death worldwide. According to WHO
cholesterol is a major cause of
(2010), over 12 million people are
cardiovascular diseases (NCEP,
diagnosed with cancer every year. In
2001).
the Philippines, 50,000 cancer cases
- LDL cholesterol is known as bad
have been recorded, and this number
cholesterol because it increases the
is estimated to increase by 5% every
likelihood of the formation of plaque
year; 16% of these recorded deaths
that can block blood flow in the
are due to breast cancer.
arteries.
- Breast cancer was the leading cancer
- HDL is known as the good cholesterol
killer in both men and women (15%)
because it clears the excess LDL in
in 2010 and ranked first among
the arteries, the higher the HDL, the
women (28%).
better is the health of the individual.
- Lung cancer was the second leading
- Total cholesterol is the sum total of
cause of cancer deaths for both sexes
all the cholesterol (LDL, HDL, and
combined (14%) in 2010. In males
other cholesterol- triglycerides)
(22%), and in females (6%).
Classification of LDL, Total, and HDL - Cancer or malignant neoplasm is a
Cholesterol (mg/dl), (NCEP, 2001) group of various diseases involving
unregulated cell growth (Newton,
2009).
- In cancer, the cell divide, grow
uncontrollably forming malignant
tumors, and invade parts of the body.
- Substances that cause some cells to
undergo genetic mutations are called
carcinogens.

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- Although the body is capable of DIABETES
repairing these mutations, there are - It is a group of metabolic disease in
still lifestyle-related factors involved which the individual has high blood
in causation of cancer: cigarette sugar because the pancreas does not
smoking, unhealthy diet, alcohol produce enough insulin or the cells do
drinking, physical inactivity, and not respond to the insulin produced.
overweight/obesity. - Insulin is a hormone that regulates
blood sugar.
Screening for Cancer
- Hyperglycemia or high blood sugar is
- Involves the early detection of the a common effect of diabetes.
warning signals of cancer developed
Signs and symptoms of Diabetes
by the American Cancer Society
(Allender, 2010). - Increased frequency and amount of
- Use of the mnemonic device: urination (polyuria),
CAUTION US - Increased thirst (polydipsia),
- Constant hunger (polyphagia),
C – Change in bowel or bladder habits
- Weight loss,
A – A sore throat that does not heal - Vision changes, and
- Fatigue
U – Unusual bleeding or discharge
Complications associated with diabetes
T – Thickening or lump in breast
- Heart disease, neuropathies,
I – Indigestion or difficulty of swallowing amputations, and dental disease.
O – Obvious change in a wart or mole - Lifestyle- related factors: unhealthy
diet, overweight, and obesity.
N – Nagging cough or hoarseness
Current guidelines of the WHO (2005) for
U – Unexplained anemia the diagnosis of diabetes:
S – Sudden weight loss - Fasting blood sugar (FBS) of less than
7.0 mmol/l (126mg/dl) or 2-hour
CHRONIC OBSTRUCTIVE
PULMONARY DISEASE (COPD) blood sugar test of more than 11.1
- COPD is a disease of the lungs in mmol/l (200mg/dl).
which airways narrow over time. It - Mmol/l stands for millimoles per liter
includes chronic bronchitis, Laws Affecting Control of Non-
chronic asthma, and asthma. communicable Diseases
- It is estimated that 7% of deaths
worldwide are due to chronic
respiratory diseases (WHO, 2010).
- Smoking is a strong risk factor for
COPD, and statistics shows that 15%
of cigarette smokers develop COPD.
Second-hand smoke and pollution
aggravate the problem.

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for physical fitness, Build a healthy
base of nutrition practices, and
Choose foods sensibly.
- Achieving fitness involves having an
ideal body weight, by assessing the
body mass index (BMI) and waist
Health Programs on the
circumference (WC).
Control/Prevention of NCDs
- BMI is calculated as weight in
kilograms divided by body height in
Promote physical activity and exercise. meters squared.
- WC is used to assess central fat
Physical Activity Guideline (2008):
distribution and the degree of
Four Levels
abdominal obesity (Chan, 1994).
1. Inactive/light - walking slowly
- International Classification of
around the home, store, or office,
Overweight and Obesity by BMI
sitting using computer, working
at desk, performing light work
such as making bed, washing
dishes, ironing, preparing food,
doing arts and crafts, playing
cards.
2. Medium/moderate - walking
briskly, cleaning, sweeping the
floors, vacuuming carpet, Promote a smoke-free environment.
washing car, doing carpentry,
playing badminton, basketball Stress management
shooting, bicycling on flat - Inevitable human experience in a
surfaces, ballroom dancing, rapidly changing society.
fishing, playing golf, swimming - Selye (1936) defined stress as “the
leisurely. nonspecific response of the body to
3. High/Vigorous - running, hiking, any demand on it.”
jogging, shoveling sand, carrying - Managing and preventing stress:
heavy loads, farming, digging biofeedback, meditation, breathing
ditches, participating in relaxation exercise, and massage.
basketball games, playing soccer, - BIOFEEDBACK – a technique you
playing tennis singles, playing can use to learn to control some of
competitive volleyball at the gym your body’s functions, such as your
or beach. heart rate.
Promote healthy diet and Nutrition - You’re connected to electrical sensors
that help you receive information
- Good nutrition is a primary about your body. This feedback helps
determinant of good health. you make subtle changes in your
- Healthy diet is a cornerstone of good body, such as relaxing certain
health. muscles, to achieve the results you
- To achieve healthy diet and nutrition, want, such as reducing pain.
it is recommended to follow the ABCs
of good nutrition (USDA, 2013): Aim
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Package of essential non-communicable of persons utilizing psychiatric,
(PEN) disease Interventions neurologic and psychosocial health
- A prioritized set of cost-effective services in the Philippines.
interventions that can be delivered to
an acceptable quality of care even in
resource-poor settings. Care of the Ageing Population
- Early detection and management of - The country’s population is aging as
cardiovascular diseases, diabetes, per the UN’s standard: a society is
chronic respiratory diseases and considered aging if 7% of the total
cancer to prevent life threatening population comprises 60 years old or
complications. older (more women than men).
- Older adults are more at risk for
developing disabilities, chronic
MENTAL HEALTH diseases and communicable diseases
- An integral part of every individual. due to aging.
- WHO (2001): A state of social well- - Expanded Senior Citizen Act of
being in which every individual 2003 (RA 9257): grants additional
realizes his/her own potential (self- privileges such as the provision on
image), can cope with normal employment, free skills training and
stresses (resiliency), can work education, among others.
productively and fruitfully - Expanded Senior Citizens Act of
(productivity and creativity), and is 2010 (RA 9994): Twenty Percent
able to make a contribution to his/her (20%) Discount and VAT Exemption
community (sense of purpose).

Mental Health or Mental Disorder

- Illness experienced by a person that CONTROL OF COMMUNICABLE

interferes with his/her thinking, DISEASES
feeling or social activities and even
daily functioning.
- Produces a negative effect on one’s Communicable Diseases
life or the lives of the family.
- Illnesses caused by an infectious
Mental health Problem agent or its toxic products
transmitted directly or indirectly to a
- Does not hamper functioning person, animal, or intermediary host
- Temporarily experienced as a or inanimate environment.
reaction to life stressors - Among the top ten leading causes of
- Less severe and shorter in duration morbidity.
- May lead to mental illness/disorder

Mental Health Law

- RA11036
- An act establishing the national
mental health policy for the purpose
of enhancing the delivery of
integrated mental health services,
promoting and protecting the rights
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10. Rubella
11. Chicken Pox
12. Poliomyelitis
13. Ascariasis
14. Enterobiasis
15. Schistosomiasis
16. Rabies
17. Leptospirosis
18. Scabies
Functions of a PHN 19. Gonorrhea
20. Syphilis
1. Report to local authorities any known 21. Chlamydia
case of notifiable disease as required 22. Genital Herpes
by law (RA 11332). 23. Genital warts
2. Refer any known case of notifiable 24. HIV/AIDs
disease to the nearest health facility. 25. SARS
3. Initiate health education drive 26. MERS-COV
directed towards prevention of 27. Avian flu
outbreaks in communities. 28. HFMD
4. Assist in the diagnosis of potential 29. COVID-19
cases of communicable disease based
on signs and symptoms.
5. Conduct epidemiological
ENVIRONMENTAL HEALTH
investigations together with the
- Environmental health comprises
public health team during an
those aspects of human health,
outbreak.
including quality of life, that are
TUBERCULOSIS determined by physical, chemical,
- National Tuberculosis Control biological, social, and psychosocial
Program (NTO) - TB-free Philippines factors in the environment.
- To manage the overall program in the - Theory and practice of assessing,
control of TB. correcting, controlling, and
- Adopted the directly observed preventing those factors in the
treatment short course (DOTS) – environment that can potentially
believed to be the most effective affect adversely the health of present
strategy in controlling TB. and future generations (WHO, 1993).

Other communicable diseases

Environmental Health Indicator
1. Leprosy 1. Households with access to improved
2. Dengue or safe water.
3. Malaria 2. Households with sanitary toilets
4. Filariasis 3. Households with satisfactory disposal
5. Typhoid Fever of solid waste
6. Dysentery 4. Households with complete basic
7. Cholera sanitation facilities
8. Measles 5. Food establishments
9. Mumps

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6. Food establishments with sanitary - This level of facility requires minimum
permits treatment of disinfection.
7. Food handlers
Households with sanitary toilets
8. Food handlers with health certificates
- Refers to households with their own
flush toilets connected to septic tanks
Households with access to improves or and/or sewerage system or any
safe water supply- stratified to level I, II, other, approved treatment system,
and III sanitary pit latrine, or ventilated
- Refers to those covered by or have improved pit latrine.
access to any of the three levels of - The national target for this
safe water sources that conforms to component is 91% (96% for urban
the national standards for drinking and 86% for rural areas).
water.
Households with complete basic sanitation
Level I (Point Source) facilities
- Refers to those that satisfy the
- Refers to a protected well (shallow or
presence of the following basic
deep well), improved dug well,
sanitation elements, namely, 1)
developed spring or rainwater cistern
access to safe water, 2) availability of
with an outlet but without a distribution
a sanitary toilet, and 3) satisfactory
system.
system of garbage disposal.
- This is generally adaptable for rural
Food establishments
areas where houses are thinly scattered.
- refer to those where food or drinks
Level II (Communal faucet system or are manufactured, processed, stored,
standpost) sold, or served, including those that
are located in vessels.
-Refers to a system composed of a
source, a reservoir, a piped distribution Sanitary Permit - Written certification of the
network, and a communal faucet located city or municipal health officer or sanitary
not more than 25 meters from the engineer that the establishment complies
farthest house. with the existing minimum sanitation
requirements upon inspection conducted in
-This system is generally suitable for rural
accordance with PDs Nos. 522 and 856 and
and urban areas where houses are
local ordinances.
clustered densely enough to justify a
simple piped water system. Food handlers
- Refer to persons who handle, store,
Level III (waterworks system)
prepare, or serve any food item,
-Refers to a system with a source, drink, or ice, or who come in contact
transmission pipes, a reservoir, and a with any eating or cooking utensil or
piped distribution network for household food vending machine
taps.
Health certificate – written certification,
- It is generally suited for densely using the prescribed form, and issued by the
populated areas. municipal or city health officer to a person
after passing the required physical and
medical examinations and immunizations.

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Solid Waste Management procedures (hazardous chemical
-Republic Act 9003 otherwise known as the wastes).
“Ecological Solid Waste Management Act of e. Sharps - biomedical wastes that could
2000” and the DOH Manual on Healthcare cause cuts or puncture wounds
Waste Management of 2011- solid waste (needles, broken glass, and scalpel
classification: blades).
f. Radioactive wastes - sealed radiation
Municipal waste - refers to all discarded
sources typically used in cancer
nonhazardous household commercial and
treatments, liquid, and gaseous
institutional waste, street sweepings, and
materials contaminated with
construction debris.
radioactivity, and excreta of patients
Health care waste – (or biomedical wastes)- who underwent radionuclide
refers to the refuse that is generated in the diagnostic and therapeutic
diagnosis, treatment, or immunization of applications, and related
human beings or animals together with those paraphernalia and tap water
related to the production or research of the washings.
same. This can be classified as follows:
Industrial Waste - refers to the refuse that
a. Infectious waste- refer to those arise from production and from agricultural,
suspected to contain bacterial, viral, and mining industries.
parasitic, or fungal pathogens in
Hazardous waste - substances that pose
sufficient concentration so as to
either an immediate or long-term substantial
cause a disease in susceptible hosts.
danger to human because of possessing any
-Laboratory cultures, contaminated
of the following properties: toxic, corrosive
wastes from clients with infectious
such as acids, flammable, reactive such as
disease, and any other dressing,
explosives, and genotoxic such as cytostatic
swabs, instruments, or materials that
drugs.
have been in contact with infected
persons or animals.
b. Pathological wastes- refer to tissues,
Color Coding of Hospital Waste Bins
organs, body parts, human fetuses,
(Manual on Healthcare Waste Management,
animal carcasses, and blood and
DOH 2011, 3rd ed)
body fluids.
c. Pharmaceutical wastes – include Black or colorless: Nonhazardous and non-
pharmaceutical products such as biodegradable wastes
drugs, vaccines, and sera that are no
longer required and need to be Green: Non-hazardous biodegradable
disposed of appropriately. wastes
- Items used in handling of Yellow with biohazard symbol:
pharmaceuticals such as bottles or Pathological/anatomical wastes
boxes with residues, gloves, masks,
connecting tubes, and drug vials are Yellow with black band: Pharmaceutical,
included in this category. cytotoxic, or chemical wastes (labeled
d. Chemical wastes - varied states of separately).
chemical matter from clinical or Yellow bag that can be autoclaved:
laboratory activities, environmental Infectious wastes
work, housekeeping, and disinfecting
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Orange with radioactive symbol: 2. Chemical and physical quality tested
Radioactive wastes through the parameters of pH,
chemical specific levels, color, odor,
turbidity, hardness, and total
Solid Waste Management dissolved solids.
- Segregate wastes and to be - Drinking water
transported accordingly. - pH range is 6.5-8.5
- Recyclable wastes such as metals, - Neutral point is pH 7
plastics, paper, and glass can be sent - Less than 7 are acidic
to a materials recovery facility to - Greater than 7 are alkaline
generate recycled raw materials for - Natural waters can be of lower pH,
producers. ex. Acid rain
- Biodegradable and organic wastes - Higher pH in limestone areas
can be sent to a composting unit for 3. Radiological quality tested through
processing and subsequent the parameters of gross alpha
agricultural use. activity, gross beta, and radon.
- Residual wastes should be dumped - Gross alpha radiation is a type of
into the sanitary landfill. energy released when certain
- Various waste processors: shredders, radioactive elements decay or break
biological reactors, and thermal down. For example, uranium and
processors. Incinerators are not thorium are two radioactive elements
acceptable (emit toxic and poisonous found naturally in the Earth’s crust.
fumes). Over billion of years, these elements
slowly change form and produce
RA 9003 has declared the following as decay products such as radium and
prohibited acts: polomium. During this change
- Open burning of solid wastes process, energy is released. As a
- Open dumping result, gross alpha radiation can be
- Burying in flood-prone areas found in drinking water.
- Squatting in landfills Health Concerns - Are gross alpha radiation,
- Operation of landfills on any uranium and radium harmful to our health???
groundwater reservoir, or watershed
- Construction of any establishment - May cause health effects overtime,
within 200 meters from a dump or radium increases the risk of bone
landfill cancer; uranium increases the risk of
kidney damage.
Water Sanitation
- General requirements of safe drinking Republic Act 9275 - National Law on water
water (DOH Administrative Order No. quality management, otherwise known as
2007-0012, otherwise known as the the Philippine Clean Water Act of 2004
Philippine National Standards for
- Directed the DENR to act as the lead
Drinking Water of 2007).
agency in the implementation and
1. Microbial quality tested through the
enforcement of this law.
parameters of total coliform, fecal
- Directed the DOH to be primarily
coliform, and heterotrophic (groups
responsible for the promulgation,
of microorganisms such as yeast,
moulds, and bacteria) plate count.
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 22
revision, and enforcement of drinking than 50% of most harmful bacteria
water quality standards. and settling of suspended solids.
- DOH has produced the Implementing - Repetition of settlement in another
Rules and Regulations (IRR) of the container or pot increases the
Code of Sanitation of the Philippines effectiveness of the process, as water
(PD 856) Chapter II: Water Supply is made to settle for longer periods.
3. Filtration – done by utilizing filters to
Provision in the IRR of the PD 856
block particles while allowing water to
1. Washing and bathing within a radius pass through. Filters include clean
of 25 meters from any well or other cloth, sand and ceramics.
source of drinking water is prohibited.
Disinfection Process
2. No artesians, deep or shallow well
shall be constructed within 25 meters 1. Boiling - considered as a very
from any source of pollution effective method for water
(including septic tanks and sewerage disinfection. The water should
systems). Drilling wells within 50- brought to a ‘rolling boil” and keep in
meters distance from a cemetery is that state for at least 1 minute at sea
also prohibited. level.
3. No radioactive source or material - -At higher altitudes, the water should
shall be stored within a radius of 25 be kept in a rolling boil state at least
meters from any well or source of 3 minutes.
drinking water unless the radioactive - This process causes the water to
source is adequately and safely change taste, this can be improved
enclosed by proper shielding. by performing aeration after the
4. No dwellings shall be constructed water has been cooled.
within the catchment area of a 2. Chemical Disinfection - using various
protected spring water source, and it chemicals but the most widely used
shall be off limits to people and remains to be chlorine as it can kill all
animals. viruses and bacteria.
- Follow the manufacturer’s
instructions on their use.
Emergency Water Treatment - Limitation of chlorine- some species
of protozoa and helminthes have
been seen to be resistant to
Pretreatment Process chlorination.
1. Aeration - done to remove volatile 3. Solar Disinfection (SODIS) -
substances, reduce carbon dioxide ultraviolet rays from the sun destroy
content, and oxidize dissolved harmful organisms in water.
minerals in preparation for - Done by filling transparent plastic
sedimentation and filtration. containers 1 to 2 liters in size with
- Rapidly shake a container that is clear water, and exposing them to
partially full of water for about 5 direct sunlight for about 5 hours. If
minutes. the skies are cloudy the water
2. Settlement – allowing water to stand containers are exposed for two
undisturbed in the dark for a day. consecutive days.
This process causes death to more

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Water Storage and Consumption Pollutants: ozone-depleting substances,
chlorofluorocarbons, particulate matters
1. Wide-necked containers with tight-
that refer to any material that exists in a
fitting lids are best for water storage
finely divided form as a liquid or solid
as they are easy to clean between
other than water, greenhouse gases that
use.
can induce global warming such as:
2. Hands and utensils may come in
carbon dioxide, methane, and oxides of
contact with water, educate people
nitrogen, chlorofluorocarbons, and fuel
about proper washing techniques is
components such as aromatics, benzene,
of high importance.
and sulfur.

2. Stratosphere - where the ozone layer

Air Purity
is found. It has an inverted vertical-
- Air Pollutant (DENR, Administrative
temperature profile, it gets warmer
Order (AO) 2000-81- any matter in
as you increase altitude.
the atmosphere other than the
- Communities with airports –this is the
natural concentrations of oxygen,
layer where most airplanes fly and
nitrogen, water vapor, carbon
emit most of the products of jet fuel
dioxide, and inert gases that may be
combustion.
detrimental to health or the
- Emission (AO 2000-81), as any
environment.
measurable pollutant gas or
Layers of the Atmosphere unwanted sound from a known
source, which is passed into the
1. Troposphere – 1 st 11 kilometers of atmosphere.
the atmosphere from the earth where
we live in. Sources of Air Pollution
- Temperature profile is warmest at
- Clean Air Act has identified 2 major
sea level and coolest at higher
sources of air pollution:
altitudes.
1. Mobile source- refers to any
- PHNurses serving mountainous
vehicle/machine propelled by or
communities should keep in mind
through oxidation or reduction
that these communities are generally
reactions, including combustion
exposed to cooler weather –as the air
of carbon-based or other fuel,
gets cooler, the less water vapor it is
constructed and operated
able to carry- rise of respiratory
principally for the conveyance of
infections as the moist “mucociliary
persons or the transportation of
blanket” protection of the airways
property or goods, that emit air
could be interrupted by the dry air.
pollutants as a reaction product.
- The troposphere near sea level has a
2. Stationary source- refers to any
typical composition of gases that
building or fixed structure,
support healthy human life.
facility, or installation that emits
- In general, it is thought to be 78%
or may emit any air pollutant.
nitrogen, 21% oxygen, and 1% other
gases (carbon dioxide, argon, and
water vapor).
- As the altitude increases, oxygen
percentages decrease.

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Programs Initiated to Address Air - Naturalistic control: A pest control
Pollution method that utilizes nature and
nature’s systems without disturbing
- Bantay Tsimineya Program - monitors
the balance of nature.
point-source air pollution from
- Biological and genetic control: Utilizes
industries.
living predators, parasites, and other
- Bantay Tambutso Program and
natural enemies of the pest species to
Standard Setting - adopted Euro-II
reduce or eliminate the pest
emission standards for motorized
populations.
vehicles. This program penalizes
- Mechanical and physical control:
vehicle owners who fail to meet the
Utilizes mechanical devices such as
set-standards.
rodent traps, fly traps, mosquito
- Improved Fuel Quality Program -
traps, air curtain, and ultraviolet light.
phased out leaded gasoline, and
- Chemical control: Utilizes
regulated the sulfur, benzene, and
rodenticides, insecticides, larvicides,
aromatic content of fuel.
and pesticides.
- National Research and Development
- Integrated control: Use of pesticides,
Program for the Prevention and
environmental sanitation measures
Control of Air Pollution (DENR-EMB
and natural, as well as mechanical
and DOST).
and biological control methods.

Vermin and Vector Control

Vermin - a group of insects or small animals
such as flies, mosquitoes, cockroaches, fleas,
lice, bedbugs, mice, and rats which are
vectors of diseases.

Vector - any organism that transmits

infection by inoculation into the skin or
mucous membrane by biting; or by deposit
of infective materials on the skin, food, or
other objects; or by biological reproduction
within the organism.

Vermin Control and Disinfestation Methods

(DOH)

- Environmental sanitation control: The

maintenance of cleanliness of the
immediate premises and proper
building construction and
maintenance so as to prevent access
of pests into human dwellings. Clean-
up drives are aimed at altering or
eliminating the breeding sites of
vectors.

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