CHAPTER 9: PRIMARY HEALTH CARE (PHC) - GR1 Mission

May 1977 -30th World Health Assembly decided that the main health to strengthen the health care system by increasing opportunities and
target of the government and WHO is the attainment of a level of health supporting the conditions wherein people will manage their own
that would permit them to lead a socially and economically productive life health care.
by the year 2000.
Two Levels of Primary Health Care Workers
September 6-12, 1978 – First International Conference on PHC in Alma
Ata, Russia (USSR) The Alma Ata Declaration stated that PHC was the key Barangay Health Workers
to attain the “health for all” goal trained community health workers or health auxiliary volunteers or
traditional birth attendants or healers.
October 19, 1979 – Letter of Instruction (LOI) 949, the legal basis of PHC
was signed by Pres. Ferdinand E. Marcos, which adopted PHC as an Intermediate-level health workers
approach toward the design, development and implementation of include the Public Health Nurse, Rural Sanitary Inspector and midwives.
programs focusing on health development at community level.
Principles of Primary Health Care
Rationale for Adopting Primary Health Care
 Magnitude of Health Problems 1. 4 A’s = Accessibility, Availability, Affordability & Acceptability and
 Inadequate and unequal distribution of health resources Appropriateness of health services.
 Increasing cost of medical care  The health services should be present where the supposed
 Isolation of health care activities from other development recipients are. They should make use of the available resources
activities within the community, wherein the focus would be more on
health promotion and prevention of illness.
Definition of Primary Health Care
 essential health care made universally accessible to individuals 2. Community Participation
and families in the community by means acceptable to them,  heart and soul of PHC
through their full participation and at cost that the community
can afford at every stage of development. 3. People are the center, object, and subject of development.
 a practical approach to making health benefits within the reach  Thus, the success of any undertaking that aims at serving the
of all people. people is dependent on people’s participation at all levels of
 an approach to health development, which is carried out decision-making; planning, implementing, monitoring and
through a set of activities and whose ultimate aim is the evaluating. Any undertaking must also be based on the people’s
continuous improvement and maintenance of health status needs and problems (PCF, 1990).
o Part of the people’s participation is the partnership
Goal of Primary Health Care between the community and the agencies found in
the community; social mobilization and
HEALTH FOR ALL FILIPINOS by the year 2000 AND HEALTH IN THE decentralization.
HANDS OF THE PEOPLE by the year 2020. o In general, health work should start from where the
people are and building on what they have. Example:
An improved state of health and quality of life for all people Scheduling of Barangay Health Workers in the health
attained through SELF-RELIANCE. center.
 Barriers of Community Involvement
Key Strategy to Achieve the Goal:  Lack of motivation
 Attitude
Partnership with and Empowerment of the people –  Resistance to change
permeate as the core strategy in the effective provision of essential health  Dependence on the part of community people
services that are community-based, accessible, acceptable, and  Lack of managerial skills
sustainable, at a cost, which the
community and the government can afford. 4. Self-reliance
Through community participation and cohesiveness of people’s
Objectives of Primary Health Care organization they can generate support for health
care through social mobilization, networking and mobilization of local
 Improvement in the level of health care of the community resources. Leadership and management skills should be developed
 Favorable population growth structure among these people. Existence of sustained health care facilities
 Reduction in the prevalence of preventable, communicable and managed by the people is some of the major indicators that the
other disease. community is leading to self-reliance.
 Reduction in morbidity and mortality rates especially among
infants and children. 6. Recognition of interrelationship between the health and
 Extension of essential health services with priority given to the Development
underserved sectors.
 Improvement in Basic Sanitation  Health- Is not merely the absence of disease. Neither is it only
 Development of the capability of the community aimed at self- a state of physical and mental well-being. Health being a social
reliance. phenomenon recognizes the interplay of political, socio-cultural
 Maximizing the contribution of the other sectors for the social and economic factors as its determinant. Good Health
and economic development of the community. therefore, is manifested by the progressive improvements in
the living conditions and quality of life enjoyed by the
community residents (PCF)
  Development- is the quest for an improved quality of life for all. 7. Treatment of Communicable Diseases and Common Illness
Development is multidimensional. It has political, social,
cultural, institutional and environmental dimensions (Gonzales  The diseases spread through direct contact pose a great risk to
1994). Therefore, it is measured by the ability of people to those who can be infected. Tuberculosis is one of the
satisfy their basic needs. communicable diseases that continuously occupies the top ten
causes of death. Most communicable diseases are also
7. Social Mobilization preventable. The Government focuses on the prevention,
 It enhances people participation or governance, support system control and treatment of these illnesses.
provided by the Government, networking and developing
secondary leaders. 8. Supply of Essential Drugs

8. Decentralization  This focuses on the information campaign on the utilization and

acquisition of drugs.
 This ensures empowerment and that empowerment can only  In response to this campaign, the GENERIC ACT of the
be facilitated if the administrative structure provides local level Philippines was enacted. It includes the following drugs:
political structures with more substantive responsibilities for Cotrimoxazole, Paracetamol, Amoxycillin, Oresol, Nifedipine,
development initiators. This also facilities proper allocation of Rifampicin, INH (isoniazid) and Pyrazinamide, Ethambutol,
budgetary resources. Streptomycin, Albendazole, Quinine.

Elements of Primary Health Care Major Strategies of Primary Health Care

1. Education for Health 1. Elevating Health to a Comprehensive and Sustained National Effort.
 Is one of the potent methodologies for information
dissemination. It promotes the partnership of both the family  Attaining Health for all Filipinos will require expanding
members and health workers in the promotion of health as well participation in health and health-related programs whether as
as the prevention of illness. service providers or beneficiary. Empowerment to parents,
families and communities to make decisions about their health
2. Locally Endemic Disease Control is the desired outcome.
 Advocacy must be directed to National and Local policymaking
 The control of endemic disease focuses on the prevention of its to elicit support and commitment to major health concerns
occurrence to reduce morbidity rate. Example Malaria Control through legislation, budgetary, and logistical considerations.
and Schistosomiasis Control.
2. Promoting and Supporting Community Managed Health Care
3. Expanded Program on Immunization  The health in the hands of the people brings the government
closest to the people. It necessitates a process of capacity
 This program exists to control the occurrence of preventable building for communities and organizations to plan, implement
illnesses, especially of children below 6 years old. and evaluate health programs at their levels.
Immunizations for poliomyelitis, measles, tetanus, diphtheria
and other preventable diseases are given for free by the 3. Increasing Efficiencies in the Health Sector
government and ongoing program of the DOH.
 Using appropriate technology will make services and resources
4. Maternal and Child Health and Family Planning required for their delivery, effective, affordable, accessible and
culturally acceptable. The development of human resources
 The mother and child are the most delicate members of the must correspond to the actual needs of the nation and the
community. So the protection of the mother and child from policies it upholds such as PHC. The DOH will continue to
illness and other risks would ensure good health for the support and assist both public and private institutions,
community. The goal of Family Planning includes spacing of particularly in faculty development, enhancement of relevant
children and responsible parenthood. curricula and development of standard teaching materials.

5. Environmental Sanitation and Promotion of Safe Water Supply 4. Advancing Essential National Health Research

 Environmental Sanitation is defined as the study of all factors in  Essential National Health Research (ENHR) is an integrated
the man’s environment, which exercise or may exercise strategy for organizing and managing research using
deleterious effects on his well-being and survival. Water is a intersectoral, multi-disciplinary and scientific approaches to
basic need for life and one factor in man’s environment. Water health programming and delivery.
is necessary for the maintenance of a healthy lifestyle. Safe
Water and Sanitation are necessary for the basic promotion of Four Cornerstones/Pillars in Primary Health Care
health.
 Active Community Participation
6. Nutrition and Promotion of Adequate Food Supply  Intra and Inter-sectoral Linkages
 Use of Appropriate Technology
 One basic need of the family is food. And if food is properly  Support mechanism made available
prepared then one may be assured healthy family. There are
many food resources found in the communities but because of
faulty preparation and lack of knowledge regarding proper food
planning, Malnutrition is one of the problems that we have in
the country.
 Philosophy
 Philosophy that guides a public between practitioners to ralley
SIR JL – PPT: CONTINUATION communities to their health and to themselves in issue affecting
their health.

Primary care VS Primary health care History of Primary Health Care

PRIMARY CARE PRIMARY HEALTH CARE It was in 1977 when the United Nations (UN) he the World Health
First level of healthcare delivery in This is a total approach in Organization launched Health for All by the Year 2000" as a global agenda
which a generalist like a physician or a ensuring people’s health to be pursued to fully realize the dream of attaining the full potential of
nurse renders medical and nursing by fostering active peoples around the world in both social and economic terms. The
services for individuals and population community participation adoption of PHC as key strategy to achieve the global agenda ensued as
groups. and establishing stated in the Alma-a Declaration.
partnerships among all
sectors of society in Primary Health Care is defined as "essential health care based on
working for better health. practical, scientifically sound and socially acceptable methods and
It can be a government owned clinic but Bringing healthcare closer technology made universally accessible to individuals and families in the
more often than not are privately to the people is a key community through their full participation and at a cost that the
owned. feature of Primary Health
community and country can afford to maintain at every stage of their
Care.
development in the spirit of self-reliance and self-determination (WHO,
First point of contact of patients in the The essential care made
2008).
healthcare system. universally accessible to
individuals and families in
the community through Accessible healthcare is the first step making PHC a reality. Facilities for
their full preparation. health and services delivered by health professionals are situated closer
to where people are. This entails that it can be reached within 30 minutes
from households or within 5 kilometer distance Evidence supports that
when resources are accessible, peoples' health seeking behaviour
improves which in turn results to better health outcomes.

Affordable healthcare flows from the Alma: ata's declaration specifically

highlighting that reform for healthcare systems across the globe should
be within the context of financial realities of governments. This
necessitates that the expenses for healthcare should be within the
budgetary capacity of each country. Efforts to reduce out-of pocket
expense for healthcare by consumers should be prioritized by adopting
policies that will improve costs of medicines and medical procedures.

Acceptable healthcare speaks of the need to contextualized health service

in the lens of culture. Collective beliefs, values, and practices of people
shape their concept of bealth. and illness (Leininger, 1991). This in turn
predicts their health seeking behaviour. Thus, health care service and
technology must fit the culture of the community, otherwise utility may
be futile.
Understanding Primary Health Care
From Alma-ata to Astana: Leaving no one behind in the quest for
Primary health care is an overall Primary healthcare is the health
approach to providing people provision of health services,
access to basic healthcare and including diagnosis and According to the World Health Organization, the social determinants of
ultimately improve health or treatment of a health condition, health are the conditions in which people are born, grow, live, work and
communities. and support in managing long- age: These circumstances are shaped by the distribution of money, power
term healthcare, including
and resources at global, national and local levels. To address the perennial
chronic conditions like diabetes.
problem of injustice in health outcomes, member states of the United
Nations introduced Primary Health Care in 1978 during the international
conference held in Alma-ata, Kazakhstan offer a holistic approach for
Three Dimensions
achieving inclusive development by prioritizing healthcare that puts
people first on the agenda. This strategy strongly emphasizes
Goal
participatory technique and values partnership with communities to
 As a goal, primary health care seeks to ensure that all people
make health for all a reality.
regardless of age, sex, religion, ideology and race are provided
access to basic health services.
SEPTEMBER 6-12, 1978 First International Conference for PHC at Alma
Ata, USSR, Russia Once again last October 2018 this time at Astana,
Strategy
Kazakhstan to affirm declaration of Alma-ata that health is a fundamental
 As a strategy, it promotes collaboration among sectors in social
right of all people and that all should be afforded equitable healthcare
and values partnership between public and private
access. Leaders present during this global conference specified that
organizations.
'strengthening primary health care (PHC) is the most inclusive, effective
and efficient approach to enhance people's physical and mental health,
as well as social well-being, and that PHC is a cornerstone of a workforce
sustainable health system for universal health coverage (UHC) and health-  This in turn will be used to inform decision makers to formulate
related Sustainable Development Goals" (WHO, 2018). policies across all levels of governance to promote and protect
peoples' health. Thus a functional system made accessible to
the people is crucial to achieving improved health outcomes.

2. Multisectoral Policy and Action

 Multisectoral policy entails a functional coordination between
public and private agencies in making health for all possible.
Salunke (2017) states that "Multisectoral approach (MSA) refers
to deliberate collaboration among various stakeholder groups
(eg. government civil society, and private sector) and sector (eg.
deserved by all health, environment and economy) to jointly
achieve a policy outcome.

3. Empowered People and Communities

 Empowered people and communities pivotal to the success of
PHC since it envisiones health in the hands of the people.
Obviously it puts emphasis on health more than a righ they but
a responsibility Thus, health profession should assist
individuals, families and groups to realize that health is a
personal and social responsibility.

Determinants of success for PHC

Knowledge and Capacity Building

 Communities should actively participate in every stage of
planning and developing health programs and services Shared
leadership and participatory governance are critical in fostering
a people centered healthcare system.

Human Resources for Health

 Community health needs are varied and require not only
holistic care but multidisciplinary approach. The need for skill to
address health needs of the people is crucial to the
implementation of primary health care.

Financing
 Primary health care aims to strengthen the healthcare delivery
system by providing people access to essential health services
that will ultimately advance the well being of individuals,
Essential Public Health Services (Revised, 2020) families and the population in general.
Center for Disease Control and Prevention

1. Assess and monitor population health status, factors that influence Technology
health, and community needs and assets  To ensure that people from all enjoy the highest possible level
2. Investigate, diagnose, and address health problems and hazards of wellnes, access to available service and technology must be
affecting the population provided.Technology is defined in a general context as
3. Communicate effectively to inform and educate people about health, application of science for the benefit of communities.
factors that influence it, and how to improve it
4. Strengthen, support, and mobilize communities and partnerships to Criteria for appropriate health technology
improve health
5. Create, champion, and implement policies, plans, and laws that impact The World Health Organization defines appropriate health technology as
health methods, procedures, techniques, and equipment that are: scientifically
6. Utilize legal and regulatory actions designed to improve and protect the valid, adapted to local needs, acceptable to users, recipients and
public’s health maintainable with local resources.
7. Assure an effective system that enables equitable access to the
individual services and care needed to be healthy Health technology should be characterized by the following:
8. Build and support a diverse and skilled public health workforce
9. Improve and innovate public health functions through ongoing  Effectiveness
evaluation, research, and continuous quality improvement  Safety
10.Build and maintain a strong organizational infrastructure for public  Affordable
health.  Sustainable
 Acceptable
Elements of Primary Health Care
Essential Drugs/Medicines
1. Primary care and essential public health functions as the core of
integrated services. An important element in the effective delivery of health service is the
provision of medicines to treat endemic conditions affecting people in the
community. This will contribute to the reduction of unnecessary deaths CHIROPRACTIC A discipline of the healing arts
and improve health essential are not only regarded as life saving but can concerned with the
be used for all population groups. pathogenesis, diagnosis, therapy,
and prophylaxis of functional
Government efforts to increase people's access to this vital resource disturbances, pathomechanical
include legislative measures like the: states, pain syndromes, and
neurophysiological effects
related to the static and
 Generics Act of 1998 (RA 6675)
dynamics of the locomotor
 Price Act (RA 7581) system, especially of the spine
 Cheaper Medicine Act of 2008 (RA 9502) and pelvis.
HERBAL MEDICINE/ Finished, labeled, medicinal
According to the DOH (2018) the Generics Act of 1998, "sought to ensure PHYTOMEDICINE MASSAGE products that contain as active
adequate supply, distribution, use and acceptance of drugs and medicines ingredients aerial or
identified by their generic names. It was supported by Executive Order underground parts of the plant
(EO) 49, s. 1993, which directed the mandatory use of the Philippine or other materials or
National Drug Formulary (PNDF) as the basis for the procurement of drug combination thereof, either in
products by the government." the crude state or as plant
preparations.
Another initiative from the public sector is the implementation of the MASSAGE A method wherein the
superficial soft parts of the body
Medicines Access Program (MAP) and the Cheaper Medicine Program
are rubbed, stroked, kneaded, or
(CMP). Under these programs, the Department of Health launched
tapped for remedial, aesthetic,
ComPack and Botika ng Barangay (BnB) hygienic, or limited therapeutic
purposes.
Traditional and Alternative Health NUTRITIONAL THERAPY The use of food as medicine and
to improve health by enhancing
There are two general schools of thought in medicine, eastern and the nutritional value of food
western. Both are anchored on a well established body of knowledge; the components that reduces the
former scientific while the latter traditional. risk of a disease. It is
synonymous with nutritional
Primary Health Care advocates for the provision of health service for all. healing.
To achieve this requires that both modern and traditional knowledge go PRANIC HEALING -
hand in hand in improving people's health (WHO, 2013). Specifically, in REFLEXOLOGY The application of therapeutic
the context of developing countries where financial resources may be pressure on the body's reflex
points to enhance the body's
limited, it is imperative that people are aware of indigenous resources
natural healing mechanisms and
available to them. Thus, the WHO recognizes the significance of
balance body functions. It is
incorporating traditional and complementary interventions in achieving based on the principle that
better health outcomes for all. internal glands and organs can
be influenced by properly
In the Philippines, traditional and complementary medicine has been applying pressure to the
institutionalized through Republic Act 8423. This law created the corresponding reflex area on the
Philippine Institute of Traditional Alternative Health Care or PITAHC body.
which has the broad mandate of initiating activities to advocate, develop,
and promote use of indigenous healthcare practices in the country. Herbal Medicines
 This refers to the use of plants or derivatives from plants for the
World Health Organization (2019) defines traditional medicine as "the treatment of specific conditions.
sum total of the knowledge, skill and practices based on the theories,
beliefs and experiences indigenous to different cultures, whether In the Philippines, herbal medicines are considered as one of the most
explicable or not, used in the maintenance of health as well as in the popular modalities of complementary medicine. They are commonly sold
prevention, diagnosis, improvement or treatment of physical and mental in the local market as food supplements and are regulated by the Food
illness. " and Drug Administration (FDA).

Common Modalities of Traditional Alternative Healthcare in the Over the last decade, various researches were undertaken to discover,
Philippines investigate, and develop more herbal formulations to address the
spiraling cost of conventional medicines and the growing number of
TERMINOLOGIES DEFINITION people burdened by disease.
ACUPRESSURE A method of healing and health
promotion that uses the PREPARATION PROCEDURE
application of pressure on DECOCTION Boil the recommended part of
acupuncture points without the plant material in water.
puncturing the skin Recommended boiling time is 20
ACUPUNCTURE A method of healing using minutes.
special needles to puncture and INFUSION Plant material is soaked in hot
stimulate specific anatomical water, much like making a tea.
points on the body. Recommended period of soaking
AROMATHERAPY The art and science of the sense is 10-15 minutes
of smell whereby essential POULTICE Directly apply recommended
aromatic oils are combined and plant material on the part
then applied to the body in some affected, usually used on bruises,
form of treatment. wounds, or rashes.
 TINCTURE Mix the plant material in alcohol. -Provides to the -Involves -Forms communi
community community more partnership ty level
DOH Recommended Herbal Medicine with and participatio s with
information them, n with community -Entities
answer community on each have
-Entities seeking. on issues aspect of formed
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-Gets -Entities from relations
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/feedback with each nt to structure
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share -Entities
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Outcomes: Outcomes: Outcomes: Outcomes: Outcome
establishes Develops Visibility of Partnership s:
communica connection partnership building, Broader
tion s established trust health
channels. with building outcome
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Key Principles Of Community Engagement

 Clarity of Purpose
 Knowledge
 Relationships
 Respect for Self-Determination
 Partnership
 Diversity
CHAPTER 10: COMMUNITY ORGANIZING AND EMPOWERMENT  Community Assets
IN HEALTH  Flexibility/Sharing Control
 Commitment
Community Engagement
Community Development
The Centers for Disease Control (1997) defines community engagement
as "the process of working collaboratively with and through groups of Community Development (CD) is a concept that can be viewed as a
people affiliated by geographic proximity, special interest, or similar process and an outcome. As a process, it entails people's active
situations to address issues affecting the well-being of those people. It is participation in bringing about solutions to problems collectively
a powerful vehicle for bringing about environmental and behavioral identified.
changes that will improve the health of the community and its members.
It speaks of a state in which people enjoys better health through their own
It often involves partnerships and coalitions that help mobilize resources
efforts or to a broader sense better quality of life.
and influence systems, change relationships among partners, and serve
as catalysts for changing policies, programs, and practices.”
The International Association of Community Development in 2016 spelled
Increasing Level Of Community Involvement, Impact, Trust, And out in details that "Community Development” is a practice-based
Communication Flow profession and an academic discipline that promotes participative
democracy, sustainable development, rights, economic opportunity,
Outreach Consult Involve Collaborate Shared equality and social justice, through the organization, education and
Leadersh empowerment of people within their communities, whether these be of
ip locality, identity or interest, in urban and rural settings.”
-Some -More -Better - -Strong
community community community Community bidirectio
involvemen involvemen involvemen involvemen nal The bottom line of community development according to Morton and
t- t t t Relations
Glasgow as cited by Bezboruah (2013) can be summed up into four
Communica - hip
characteristics:
tion flows - Communica -
from one to Communica tion flows Communica -Final
the other, tion flows both ways tion flow is decision 4 characteristics of community development:
to inform bidirectiona marking
l is at  Process for implementing change
  A program of specified activities
 An outcome 1. Human Rights
 An ideology 2. Social Justice
3. Social Responsibility
Community Organizing
Models/Typology of Community Organizing
 Active community participation is critical to achieve the goals of
primary health care and that public health as a science calls for Locality Development
organized efforts. This clearly establishes the need to invoke  The classic form of community organizing is where people living
community organizing as a strategy to help achieve better in the same area that are bound by the same issues and
health outcomes, for the people and by the people. problems develop their capacities in dealing with their own
o Participation and ownership of the community is concerns. Active community participation and involvement of
fundamental to the success of health programs and all members of the community is the critical element to
as such necessitate collaboration of all members of determine the success of locality development. Traditionally,
society. health workers/professionals employ this approach when
engaging population groups.
 Community Organizing (CO) is a form of community
engagement that seeks to rally people to work together and act Social Action
on issues owned, identified, and solved thru and by the people's  This approach is therefore not limited to communities bound by
own efforts. location but more commonly involves people of the same social
class, occupation, or ideology. Movements of this nature
In the Philippine context, most authors defined community organizing as include workers in labor unions, students fighting for their rights
a people centered approach for development. Dizon (2012) cited in her , women against misogyny and discrimination , and even nurses
paper the insights and experiences of local authors in community in the country calling for better salaries and working conditions
organizing. for safe patient care.

Manalili (1990) - "Community organizing is a process that revolves around Social Planning
the people's lives, experiences, and aspirations. it is the process that is  Emphasizes a technical approach to solving social problems,
people-centered and geared towards [the] continuing capability building, solving community problems. The practice of strategic planning
self-reliance, and empowerment." applied to addressing identified social objectives. Social
planners study community needs, examine the social impacts of
Dacanay (1993) - "the process which builds/mobilizes people and other development, and design strategies to enhance and benefit the
community resources towards identifying and solving their own community.
problems, establishing people's self-awareness and capacities to stage
their own future...taking action collectively considering the bureaucratic Phases of Community Organizing
structure and restrictive institutional arrangements."
Dizon (2012) mentioned that Community Organizing goes through the
ESSENCE OF COMMUNITY ORGANIZING: F.A.C.E.S following phases namely; Social Preparation of the community, Education
and Training, Values Orientation, and Mobilization. To simplify, we will be
1. Educating the people dividing the process into 3 broad phases namely; Social Preparation,
2. mobilizing all stakeholders to address problems Social Mobilization, and Capacity Building.

Origin and Historical Background 1. SOCIAL 2. SOCIAL 3. CAPACITY

PREPARATION MOBILIZATION BUILDING
The term Community Organization/Community Organizing was first used  Site selection  Identifying -
by social workers in the United States during the late 1800's in reference  Entry & Potential
to their initiatives to facilitate services for immigrants and the poor Integration Leaders
(Minkler, 2012). Much of the written text dedicated to the origin of the  Social  Formation of
community organizing can be traced to historical milestones in different Investigation Core Group
parts of the world where clamor for human rights and redistribution of  Establishing
power structures where encountered. Community
 Organization
Famous personalities instrumental in shaping the philosophy and  Evaluation and
methodology of community organizing and empowerment includes Phase Out
Gandhi, Alinsky and Freire.
Social Preparation - it refers to the initial steps involved in establishing a
Similarly in the Philippines, social action and community organizing partnership with the people and identifying the needs, problems, issues
activities spawned from historical events marked by corruption and affecting the community.
abuse. The most documented community organizing initiatives occurred
during the martial law regime under the dictatorship of Ferdinand Marcos
from 1972 to early 1980's.  Site Selection - directed towards establishing an organization in
communities that will serve as a venue for people to talk about their
Church-based programs which functioned as nongovernment concerns and formulate solutions for collective action.
organizations (NGOs) were the first to engage in organizing despite o a.) formulating a criteria for selection
oppressive conditions of that period proclaiming gospel values to a o b.) performing an ocular visit
society cloaked with despair. o c.) initiating contact with the community

GIDA (geographically inaccessible disadvantaged areas) - site

Values and Assumption
preference for communities recommended by the DOH.
Community organizing is a values-based process, tracing its roots in:
 Entry and Integration - organizer meets with the local leaders of the
community. This is done to show respect and discuss the possibility FACILITATOR
of developing a partnership.  A facilitator helps client systems alter their environment.
 Social Investigation - collection of information in a systematic Community organizer helps the community to articulate
manner to generate community profile is the main feature of this their needs, clarify and identify their problems, explore
step. resolution strategies, select and apply intervention
strategies, and develop their capacities to deal with their
Social Mobilization - commonly referred to as “organizational phase” and own problems more effectively.
primarily characterized as the point in which greatest participation of the
people is encountered. Principles of Community Organizing
 Identifying Potential Leaders - leaders are prime movers in
the community and are critical to mobilization later on. 1. Go to the people, live among the people.
2. Learn, plan, and work with the people.
The criteria for selecting potential leaders in the community are as 3. Start with and build on what the people know.
follows: 4. Teach by showing, learn by doing.
5. Not piece meal but an integrated approach.
 A resident of the community in good standing 6. Not relief but release.
 Has moral ascendancy
 Influential and respected by the people Tips for Successful Community Organizing Efforts
 Currently not holding a leadership post in other
organizations like the barangay  Begin with the end in mind of helping people gain self-
 Willing to work for the community reliance.
 Value life and dignity of the people in the community;
Core Group Formation - considered as the foundation of the remember that you are dealing with human lives and not
organization. It is also referred to as an executive committee or objects.
council of leaders in indigenous communities.  Keep a mindset of working with rather than working for
the people.
Organization Building - community assembly. Initially the  Get to know people genuinely and the environment
agenda is to formulate a vision, mission, and goals of the surrounding the community including agencies,
community organization. organization, and resources .
 Show respect for the beliefs and practices of the people.
Evaluation and phase-out - The partnership between the  Maintain open communication.
organizer and the community is temporary and is expected to  Be flexible and appreciate that every person is unique and
end when desired outcomes are achieved. can contribute to the process.
 Be consistent and maintain honest communication to build
Capacity building - refers to education and training activities initiated to trust.
facilitate community’s acquisition of knowledge and skills.  Avoid judging people's behavior and understand their
 May include SWOT(strengths, weakness, opportunities context.
and threats) analysis, and SALT (self-awareness leadership  Be fair to all and avoid favoritism.
training).  Believe in the goodness of all people and show enthusiasm
when dealing with the community.
The Community Organizer  Invest in people, seize all opportunities to educate and
share knowledge and skills to the community.
Doing endless field work, coordinating with different agencies, conducting  Manage expectations and be transparent with the people.
teaching sessions , listening to people, and doing much more - describes  Maintain a professional relationship with the community.
the community organizer. To be one, entails dedication and patience in  Think of teamwork and look for opportunities to
witnessing how people can change over time from indifference to collaborate with others for the benefit of the community.
vigilance , from dependence to self-reliance.
Traditional and Participatory Research
ENABLER
 Developing communities from within requires building According to the WK Kellog Foundation, community-based participatory
people's knowledge and skills. The community organizer research (CBPR) is a "collaborative approach to research that equitably
facilitates the process in the community for a change. He involves all partners in the research process and recognizes the unique
does not carry out any work by himself but he enables the strengths that each brings. CBPR begins with a research topic of
community to do the work. Teaching communities based importance to the community, has the aim of combining knowledge with
on their needs will allow them to manage their health and action and achieving social change to improve health outcomes and
their lives on their own. eliminate health disparities."

ADVOCATE Fran Baum (2006) states that "PAR seeks to understand and improve the
 the role of the advocate is to be a representative or world by changing it. At its heart is collective, self reflective inquiry that
persuade the members of the community and prepare researchers and participants undertake, so they can understand and
them to be a representative as well as represent the issues improve upon the practices in which they participate and the situations in
to the concerned body to bring a solution to the unmet which they find themselves."
needs. Have their voice heard on issues that are important
to them. Protect and promote their rights. Have their views
and wishes genuinely considered when decisions are being
made about their lives.
Examples of Participatory Approaches to Social Investigation in
Community Organizing
 Transect Walk
 Mapping

-Resource Map- shows the sources of their livelihoods CHAPTER 11: GLOBAL HEALTH NURSING
-Health Map- highlighting households with identified problems
-Seasonal Map or Calendar- showing livelihood, various activities and
Global Health Issues
events, and disasters significant to the community
 The goal of the global health issue is to improve people's health
 Venn Diagram
and achieve health equity for all. It affects politics and the
economy on a worldwide scale and transcends national
Classic Grounded Theory (CGT) approach, transcribed narratives were
boundaries.
analyzed through constant comparison technique and open, selective,
 It necessitates international cooperation in reaction, planning,
and theoretical coding.
readiness, and care that takes into account problems with
health equity between nations. The public and commercial
The substantive theory of gaining control is the end product of the
sectors must collaborate due to the nature of these global
research entitled “Discovering the Basic Social Process of Empowerment
health concerns and the factors that affect them on an
in Health”. It also explicates the processes of empowerment in health
interprofessional and interagency level.
among relocation communities anchored on 5 key concepts namely:
(1) consciousness-raising
Global Health Issues
(2) capacity building,
(3) committing to serve,
1. Infectious disease
(4) carrying-out responsibilities
 Pandemic
(5) collaborating
 HIV/AIDS
 Malaria
Community Organizing is a powerful tool that can be used by nurses and
other public health professionals in working with people to gain their
2. Non-Communicable Diseases (NCDs)
active participation in making "health in their hands" a reality.
 Cardiovascular Diseases
 Cancer
 Diabetes

3. Malnutrition
 Undernutrition
 Overnutrition

4. Access to Healthcare
5. Maternal and Child Health
6. Mental Health

7. Environmental Health
 Climate change
 Air and water pollution

8. Antibiotic Resistance
9. Vaccine Hesitancy
10. Access to Safe Water and Sanitation
11. Tobacco and Substance Abuse
12. Neglected Tropical Diseases
13. Health Inequalities

According to the 2016 Global Burden of Disease report, deaths due to

NCDs made up 72.3% of all fatalities followed by 19.3% from
communicable, maternal, neonatal, and nutritional diseases (CMNN) and
8.4% from injuries.
  Diabetes: Both the number of deaths and years of life lost (YLLs)
CMNN rates are decreasing throughout all levels of the sociodemographic due to diabetes increased by 31.1% and 25.3%, respectively,
index. Whereas, the number of fatalities, conflicts, and acts of terrorism between 2006 and 2016.
have increased in various places.  Chronic respiratory diseases, with chronic obstructive
pulmonary disease (COPD) at the forefront, accounted for
Communicable, Maternal, and Neonatal and Nutritional Diseases 8.96% of NCD deaths in 2016, leading to 2.93 million fatalities.

The decline in mortality from HIV/Aids, malaria, tuberculosis, and INJURIES

diarrheal diseases resulted in a decline in communicable diseases as the
leading cause of death. 1. Unintentional injuries (1.80 million deaths)
 Falls
From 1.91 million deaths from HIV/AIDS in 2006 to 1.03 million deaths in  Drowning
2016, the overall rate of decline was 45.8%. These declining death rates  Mechanical forces
probably reflect the successful expansion of antiretroviral therapy and the
prevention of mother to child transmission programs. 2. Transport injuries (1.44 million deaths)

 Expansion of Antiretroviral Therapy (ART): 3. Self-harm and Interpersonal violence (1.21 million deaths)
 Prevention of Mother-to-Child Transmission (PMTCT) Programs  a. Physical Violence from forearms
 Increased Awareness and Education
 Global Partnerships and Funding 4. Exposure to forces of Nature (7,060 deaths)
 Research and Innovation
5. Conflict and Terrorism (61,900 deaths)
There was also a decrease of 20.9% (1.21 million deaths) from
tuberculosis 24.2% (1.66 million deaths) from diarrhea in 2016 Sustainable Development Goals

From 2006 to 2016, leishmaniasis (54.1%), intestinal infectious illnesses In 2015, the United Nations General Assembly adopted the Sustainable
(14.7%), measles (72.5%), and other communicable diseases all saw a Development Goals (SDGs), which aims "to ensure that all human beings
decline in the overall number of deaths. Only the neglected tropical can fulfill their potential in dignity and equality and in a healthy
disease dengue had a considerable rise in cause-specific mortality and an environment." The SDGs lay the foundations for supporting global health
81% rise in overall deaths (37,800 deaths in 2016). and international development work from 2015 to 2030. There are 17
goals and 169 target indicators that require multisectoral and multi-
All maternal and neonatal causes of death decreased globally in terms of stakeholder partnerships and involve embedding in national plans and
total deaths between 2006-2016. The largest decrease in deaths from policies and building capacity.
maternal disorders were for other maternal disorder (35,500 deaths),
maternal sepsis, and other maternal infections (19,500 deaths), and 17 interconnected global goals of the Sustainable Development Goals
maternal hemorrhage (72,400 deaths) which represented decreases of (SDGs)
27.4%, 26.7%, and 23.8% respectively.
1. No Poverty
Neonatal disorders decreased by 25.3% for total deaths, declining from 2. Zero Hunger
2.23 million deaths in 2006 to 1.73 million deaths in 2016. Deaths from 3. Good Health and Well-being
nutritional deficiencies constituted 3.49% of total deaths due to CMNN 4. Quality Education
causes, resulting in 396,100 in 2016. 5. Gender Equality
6. Clean Water and Sanitation
Protein-energy malnutrition caused the largest number of deaths for 7. Affordable and Clean Energy
nutritional deficiencies with 308,000 deaths in 2016, followed by other 8. Decent Work and Economic Growth
nutritional deficiencies, which caused 54,500 deaths. Progress toward 9. Industry, Innovation, and Infrastructure
reducing mortality rates associated with nutritional deficiencies was 10. Reduced Inequalities
similar to maternal and neonatal disorders. 11.Sustainable Cities and Communities
12. Responsible Consumption and Production
Noncommunicable Disease 13. Climate Action
14. Life Below Water
In 2016, the most significant number of deaths were due to non- 15. Life on Land
communicable diseases (NCDs). 16. Peace, Justice, and Strong Institutions
17. Partnerships for the Goals
 Cardiovascular diseases caused the most deaths in 2016, with
17.6 million fatalities, marking a 14.5% increase from 2006. The SDG 3: GOOD HEALTH AND WELL-BEING
primary culprits were ischemic heart disease and stroke, which
together accounted for over 85% of all cardiovascular disease  One goal particular to health is SDG 3, which aims to “ENSURE
deaths. HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AGES” . It
 Ischemic heart disease deaths rose by 19.0% from 7.96 million covers the unfinished MDGs and newer challenges such as NCDs,
in 2006 to 9.48 million in 2016, playing a major role in the health security, tobacco, and injuries (WHO, 2017).
overall increase in cardiovascular disease deaths.
 Neoplasms (cancers) led to 8.93 million deaths in 2016, showing OTHER SDGs RELATED TO HEALTH
a 17.8% global increase from 2006. Notably, specific cancers like
prostate, pancreatic, lung, and breast cancer saw significant  SDG 3 is linked to around 50 health-related targets across the
rises. SDGs. These SDGs include core health targets, contribute to
health and well-being and commit to "leave no one behind."
  SDG 1. Extreme poverty/ Vulnerability to economic, social & and  8) Compared to other countries in the Western Pacific Region,
environmental shocks and disasters coverage of some essential services is slightly below the
 SDG 2. Malnutrition regional average but high coverage was noted for reproductive,
 SDG 5. Violence against women and girls/ Sexual reproductive maternal, newborn and child health services and some
health and rights communicable disease prevention and control interventions
 SDG 6. Safe and affordable drinking water/ Sanitation and  9) Estimates of the financial burden for health showed that 1.4%
hygiene of the population incurred high out-of-pocket health payments
 SDG 8. Safe and secure working environment suggesting gaps in financial protection for health and
 SDG 11. Housing and basic services/ Air quality, waste catastrophic expenditures among the wealthiest quartile
management in cities  10) Major challenges remain in infectious disease prevention
 SDG 13. Climate-related hazards and natural disasters and control and in-service capacity and access

UNIVERSAL HEALTH COVERAGE STRENGTHENING HEALTH SYTEMS

All individuals and communities receive the healthcare services they need  A significant and purposeful effort to improve the system's
without suffering financial hardship. Such services include the full performance and should embody the intermediary objectives
spectrum of essential, quality health services from health promotion to of the national health policies, plans and strategies which are
prevention, treatment, rehabilitation, and palliative care. (WHO 2019). quality, equity, efficiency, accountability, resilience and
sustainability.
 UHC enables countries to achieve their health targets towards
other economic and development goals. DETERMINANTS OF HEALTH SYSTEM
 UHC is measured by a country's health service coverage and
financial protection.  Social and Economic Environment
 Physical Environment
SOME FACTS ABOUT THE CURRENT GLOBAL HEALTH SCENARIO  Person's individual characteristics and Behavior

At least half of the world's population still does not have full coverage of 6 BUILDING BLOCKS THAT CONTRIBUTE TO STRENGTHENING OF HEALTH
essential health services. SYSTEMS

About 100 million people are still being pushed into extreme poverty  Leadership / Governance
because they have to pay for healthcare.  Health information systems
 Person's individual characteristics and Behavior
Over 930 million people or around 12% of the world's population spend  Financing
at least 10% of their household budgets to pay for healthcare.  Health workforce
 Medical products and Technologies
HEALTH SERVICE COVERAGE AND FINANCIAL PROTECTION
 Service Delivery

UHC progress is monitored using two indicators: (1) health service

HOW HEALTH SYSTEMS STRENGTHENING CONTRIBUTE TO SDG
coverage or the proportion of population that can access essential quality
THROUGH UHC
health services and, (2) financial protection or the proportion of the
population that spends a large amount of household income on health.
WHO (2019) uses 16 essential health services in four categories as
indicators of the level and equity of coverage in countries:

 1.) Reproductive, maternal, newborn and child health (RMNCH)

which include services on family planning, antenatal and
delivery care, full child immunization and health-seeking
behavior for pneumonia.
 2) Infectious diseases covering services for tuberculosis
treatment, HIV antiretroviral treatment, hepatitis treatment,
use of insecticide-treated bed nets for malaria prevention and
adequate sanitation.
 3) Noncommunicable diseases that include services for GLOBAL HEALTH PLAYER
prevention and treatment for raised blood pressure and blood
glucose, cervical cancer screening and tobacco smoking.  A "global health player" is an organization, country, or entity
 4) Service capacity and access to basic hospital and health that actively participates in international efforts to address and
worker services, essential medicines and health security WHO improve public health on a worldwide scale.
(2019) bares some facts about the current global health
scenario: GLOBAL HEALTH PLAYERS FOR ACHIEVING THE SDG
 5) At least half of the world's population still do not have full
coverage of essential health services 1. Gavi, the Vaccine Alliance: is a public private partnership committed to
 6) About 100 million people are still being pushed into extreme saving children's lives and protecting people's health by increasing
poverty because they have to pay for health care equitable use of vaccines in lower income countries.
 7) Over 930 million people or around 12% of the world's
population spend at least 10% of their household budgets to 2. The Global Financing Facility (GFF) for Women, Children, and
pay for health care. In the Philippines, the UHC and SDG Country Adolescents- Is a multi-stakeholder partnership that supports efforts to
Profile (WHO, 2018) reports the following overall progress tackle the greatest health and nutrition issues affecting women, children
towards UHC:
and adolescents in low and lower middle income countries around the organizations, policy-making, advocacy, and active roles in their
world. workplaces.

3. The Global Fund to Fight AIDS, TB and Malaria- Is a partnership

designed to accelerate the end of AIDS, tuberculosis and malaria as CHAPTER 12: THE PHILIPPINE HEALTHCARE DELIVERY SYSTEM
epidemics.
Overview of the Health Care Delivery System
4. The Joint United Nations Programme on HIV/AIDS (UNAIDS)- Leads and
inspires the world to achieve a vision of zero new HIV infections, zero
 A nation's healthcare delivery system has a tremendous impact
discrimination and zero AIDS-related deaths.
not only on the health of its people but also on their total
development, including their socioeconomic status.
6. The United Nations Development Programme (UNDP)- is one of the
world's largest multilateral development agencies, present in over 170
Factors that Influence the Healthcare Delivery System by Anderson and
countries and territories and on the frontlines of anticipating,
McFarlane (2011)
understanding and acting on today's opportunities and risks.
(1) Healthcare "reforms"
7. The United Nations Population Fund (UNFPA)- Is the United Nations
(2) Demographics reforms"
agency working to deliver universal access to sexual and reproductive
(3) Globalization
health, including voluntary family planning and safe motherhood, and to
(4) Poverty and Growing Disparities
advance the rights and opportunities of young people.
(5) Social Disintegration

8. The United Nations Children's Fund (UNICEF)- Works with its partners
Health services are provided by the government and private sector--- for
in 190 countries and territories to promote the rights and wellbeing of
profit as well as non-profit referred to as non-governmental organizations
every child and translate that commitment into practical action.
(NGO).

9. Unitaid- Is a global development agency engaged in finding innovative

On the national level, direction is set by the Department of Health (DOH).
solutions in global health, including new ways to prevent, diagnose and
treat diseases more quickly, cheaply and effectively, in low and middle
By virtue of the mandate of Republic Act 7160, local government units
income countries.
(LGUs) employ operating mechanisms to meet their community needs
and service requirements of their communities.
11. World Bank Group- The World Bank Group supports countries efforts
to achieve universal health coverage and provide quality, affordable
Basic health services are regarded as priority services, for which LGUs are
health services to everyone regardless of their ability to pay-reducing the
primarily responsible.
financial risks associated with ill health and increasing equity.
HEALTH SYSTEM
12. The World Food Programme (WFP)- Is the leading humanitarian
organization saving lives and changing lives, delivering food assistance in
A health system consists of all organizations, people, and actions whose
emergencies and working with communities to improve nutrition and
primary intent is to promote, restore, or maintain health.
build resilience.
A health system has six building blocks or components:
13. The World Health Organization (WHO)- Provides global leadership in
public health within the United Nations system. Founded in 1948, WHO
(1) service delivery
works to promote health, keep the world safe and serve the vulnerable.
(2) health workforce
(3) information
ROLE OF NURSES IN GLOBAL HEALTH
(4) medical products, vaccines, and technologies
(5) financing
To address global health issues and reach the SDGs via universal health
(6) leadership and governance or stewardship
coverage and primary care, all healthcare professionals, especially nurses,
play vital roles in leadership, management, caregiving, research, and
The nurse is an essential member of the health workforce in the
policy advocacy. country.

 Nurses face challenges in tackling healthcare disparities, as they For the nurse to work efficiently within the health care delivery
need to grasp how social factors affect health. They should system, an understanding of the dynamic relationships among its
advocate for reducing these inequalities, assess and implement components is needed.
programs to address local and global health issues and become
advocates for human rights and global health diplomacy, which THE WORLD HEALTH ORGANIZATION
involves understanding globalization and healthcare politics.
 Nurse shortages and uneven distribution of healthcare workers When diplomats formed the United Nations (UN) in 1945, they also
are global issues. The WHO's Global Strategy aims to ensure discussed the creation of a global health organization, the World Health
everyone has access to skilled healthcare workers within a Organization (WHO) was the outcome of these discussions.
functional healthcare system, helping achieve Universal Health
Coverage and the Sustainable Development Goals. This requires The WHO constitution came into force on April 7, 1948. The Philippines is
solid policies and investments at all levels to promote good a member of the Western Pacific Region, which holds office in Manila.
health and provide job opportunities.
 Nurses can lead change in addressing global health issues, WHO carries out the following core functions (WHO, 2013b)
achieving SDGs, and implementing universal healthcare and
primary care by engaging in communities, nursing
WHO carries out the following core functions Puericulture center nurses carried out health educational activities and
home visits to follow up cases and invite clients to consult at the center.
 Founded by the Association Feminista Flipina in 1905. La Gota
Providing leadership on matters critical to health and engaging in
de Leche was the first center dedicated to the service of
partnerships where joint action is needed.
mothers and babies.
Shaping the research agenda and stimulating the generation,
In 1954, Congress passed R.A. 1082, or the Rural Health Act that provided
translation, and disseminating valuable knowledge.
for the creation of rural health units in every municipality.
The WHO strategy on research for health has five goals
In the 1970's, the Philippine Health Care Delivery System was
restructured, paving the way for the health care system that exists to this
 Capacity
day where health services are classified into primary, secondary and
 Priorities
tertiary levels.
 Standards
 Translation
To enable the local government to attain their fullest development as self-
 Organization
reliant communities and make them more effective partners in the
attainment of national goals. R.A. 7160 or the Local Government Code
Setting norms and standards and promoting and monitoring their
was enacted in 1991.
implementation.

Articulating ethical and evidencebased policy options.

 Through its Department of Ethics and Social Determinants, Components And Sector of Philippine Health Care Delivery System
WHO is involved in various issues on health ethics (WHO,
2013d). The Philippine health care delivery system is composed of agencies,
personnel and services divided in two sectors: public and private.
Providing technical support, catalyzing change, and building sustainable
institutional capacity. Public Sector

The Philippines is a member of a global system of nations interacting with  Consists of the national and local government agencies
each other at different levels and in different ways providing health services. At the national level, the Department
of Health (DOH) is mandated as the lead agency for health.
Events that happen in other countries can affect the health status of
Filipinos.  Largely financed through a tax based budgeting system at both
national and local levels. In here, health care is generally given
In contrast, cooperation and sharing of resources among nations served free at the point of service. Socialized user fees have been
as the key in the solution of many human problems and otherwise. introduced in recent years for certain types of services.

THE SUSTAINABLE DEVELOPMENT GOALS

Private Sector

The Sustainable Development Goals (SDGs) or Agenda 2030 aims to  Largely market-oriented and health care is paid through user
continue the gains achieved thru the Millennium Development Goals fees at the point of service.
(MDGs) implemented from 2000 to 2015.
 Its involvement in maintaining the people’s health includes
It takes into full account the realities of the social determinants of health providing health insurance, manufacture of medicines,
and thus shapes global and local healthcare delivery. vaccines, medical supplies, equipment, and other health and
nutrition products, research and development, human
HISTORY OF PHILIPPINE HEALTH CARE DELIVERY SYSTEM resource development and other health related services.

In 1577, Franciscan Friar Juan Clemente opened a medical dispensary in LEVELS OF PUBLIC HEALTH CARE DELIVERY IN THE PHILIPPINES
Intramuros (the old walled city of Manila) for the indigent.
Primary Secondary Tertiary
 Municipal  Provincial Health  National
In 1690, Dominican Father Juan de Pergero worked toward installing a
Health Office Office Hospitals
water system in San Juan del Norte (now San Juan City, Metro Manila) and
 Rural Health  District Hospitals  National
Manila Smallpox vaccination was introduced by Dr. Francisco de Balmis,
Units  Emergency Medical
the personal physician of King Carlos IV, who came to the Philippines in  Health Hospitals Centers and
1805. Centers  Provincial National
 Baranggay Hospitals/Provincial Specialized
In 1901, the United States Philippine Commission, through Act. 57, Health Medical Centers Hospitals
created the Board of Health of the Philippine Islands, with a Stations  Regional
Commissioner of Public Health as its chief executive officer. Hospitals
/Regional
The Fajardo act of 1912 created sanitary divisions made up of one to four Medical
municipalities. Centers
 Teaching and
Meanwhile, in 1915, the Philippine General Hospital began to extend Training
Hospitals
public health nursing services in the homes of patients by organizing a
unit called Social Home Care Service, with two nurses as staff.
THE DEPARTMENT OF HEALTH communities and make them more effective partners in the attainment of
national goals. It mandates devolution of basic services from the national
The Department of Health (DOH) is the national agency mandated to government to LGUs.
lead the health sector towards assuring quality health care for all
Filipinos. RURAL HEALTH UNIT (RHU) AND ITS PERSONNEL
The DOH vision is to make Filipinos among the healthiest in Southeast
Asia by 2022 and in Asia by 2040.  Commonly known as health center.
 Primary level health facility in the community.
Its mission statement is to “Lead the country in the development of a  Focus: Preventive and promotive health services and
productive, resilient equitable, and people-centered health system” supervision of Barangay Health Station (BHS) under its
(DOH,2019). jurisdiction (DOH, 2001)

In the pursuit of its vision and execution of its mission, the DOH has the
BARANGAY HEALTH STATION (BHS)
following major roles: (1) leader in health, (2) enabler and capacity
builder and (3) administrator of specific services (DOH, 2013a).
 First-contact health care facility that offers basic services at the
The leadership role of the DOH is specifically elucidated in Executive barangay level.
Order 102, series of 1999 in terms of the following functions:  Satellite station of the RHU
 Manned by volunteer Barangay Health Worker (BHW) under
1) Panning and formulating policies of health programs and supervision of Rural Health Midwife (DOH, 2001).
services
2) Monitoring and evaluating the implementation of health MUNICIPAL HEALTH OFFICER (MHO) OR RURAL HEALTH PHYSICIAN
programs, projects, research, training, and services;
3) Advocating for health promotion and healthy lifestyles; Heads the health services at the municipal level. Their roles and functions
4) Serving as a technical authority in disease controland are:
prevention; and,  Administrator of RHU
5) Providing administrative and technical leadership in health  Community physician
care financing and implementing the National Health  Medico-legal of the municipality
Insurance Law.
1. Administrator of RHU
As enabler and capacity builder, As administrator of specific
the DOH performs the following services, the DOH is tasked to a. Prepares the municipal health plan and budget.
functions (Office of the (Office of the President, 1999): b. Monitors the implementation of basic health services.
President, 1999): c. Management of the RHU staff
1) Providing logistical support 1. Serve as administrator
to LGUS, the private sector, of selected health 2. Community physician
and other agencies in facilities at subnational a. Conducts epidemiological studies
implementing health levels that act as b. Formulates health education campaigns on disease
programs and services; referral centers for prevention.
2) Serving as the lead agency local health systems, c. Prepares and implements control measures or rehabilitation
in health and medical 2. Provide specific plans.
research; and program components
3) Protecting standards of for conditions that
3. Medico-legal officer of the municipality
excellence in the training affect large segments
and education of health of the population
care providers at all levels of 3. Develop strategies for
the health care system. responding to PUBLIC HEALTH NURSE (PHN)
emerging health
needs; and,  Supervises and guides all Rural Health Midwives (RHMs) in the
4. Provide leadership in municipality
health emergency  Prepares the Family Health Service Information System (FHSIS)
preparedness and quarterly and annual reports of the municipality for the
response services. submission to the Provincial Health Office
 Utilize nursing process in responding to health care needs
The DOH core values reflect adherence to the highest standards of  Collaborates with other members of health team, government
work, namely: agencies, private businesses, NGOs, and people's organization.

(1) Integrity RURAL SANITATION INSPECTOR

(2) Excellence
(3) Compassion and respect for human dignity Ensuring healthy physical environment in municipality. This entails
(4) Commitment advocacy, monitoring, and regulatory activities, such as inspection of
(5) Professionalism water supply and unhygienic household conditions.
(6) Teamwork, and
(7) Stewardship of the health of the people (DOH,
2018)

LOCAL HEALTH BOARDS

The Local Government Code (RA 7160) was enacted to bring about
genuine and meaningful local autonomy. This will enable local
governments to attain their fullest development as self-reliant
 4. Health Workers - Includes personnel of DOH, district or provincial
LEVELS OF HEALTH CARE, SERVICES, AND FACILITIES hospitals, rural health units, barangay health stations, private clinics,
NGOs, and community based organization.

HEALTH REFFERAL SYSTEM

Referral is a dynamic process, in which a health worker at one

level of the health system, having insufficient resources (drugs,
equipment, skills) to manage a clinical condition, seeks the help
of a better or differently resourced facility at the same or higher
level to assist in.

IMPORTANCE OF THE HEALTH REFERRAL SYSTEM:

1. Facilitating access to specialized medical services beyond the scope of

1. Primary Care Facility - A first-contact health care facility that primary care.
offers basic services. 2. Ensuring timely and appropriate referrals for patients requiring
a. Without in-patient beds (health centers, out-patient clinics, specialized treatment or consultations.
and dental clinics) 3. Enhancing the overall quality of healthcare delivery by enabling
b. With in-patient beds (infirmaries and birthing/lying-ins comprehensive and integrated care pathways.
facilities)
Functions of the Health Referral System:
2. Custodial Care Facility - A health facility that provides long-term care
Ex. Custodial psychiatric facilities, substance/drug abuse Referral Initiation: This involves the identification of patients who require
treatment and rehabilitation centers, sanitaria/leprosaria, and specialized care and initiating the referral process.
nursing homes.
Information Transfer: Ensuring the smooth transfer of patient
3. Diagnostic/Therapeutic Facility - A facility for the examination of information, including medical history, diagnostic reports, and treatment
human body, specimen diagnosis, sometimes treatment of disease, or plans, to the referred healthcare provider.
water for drinking analysis. It is categorized into:
Appointment Scheduling: Coordinating appointments between the
referring and the receiving healthcare facilities to minimize waiting times
Laboratory Facility a. Clinical laboratory for patients.
b. HIV testing laboratory
c. Blood service facility Follow-up and Feedback: Monitoring the progress of referred patients
d. Drug testing laboratory and obtaining feedback from both the patient and the receiving
e. Newborn screening healthcare provider.
laboratory
d. Laboratory for drinking water HEALTH SECTOR REFORM
analysis
Radiologic Facility (xray, CT scan, mammography,
The Philippines has been striving to improve its healthcare system to
MRI, and ultrasonography)
ensure accessibility and quality healthcare services for its citizens. Various
Nuclear Medicine Facility Utilizing application of
radioactive materials in diagnosis, reforms have been implemented to address challenges such as
treatment, or medical research. inadequate infrastructure, limited access to medical services, and
insufficient health insurance coverage.
4. Specialized Outpatient Facility - A facility that performs highly
specialized procedures on an outpatient basis. Community:
Ex. Dialysis clinic, ambulatory surgical clinic, cancer radiation  At the community level, the focus has been on strengthening
facility, and physical medicine and rehabilitation center/clinic. primary healthcare services, promoting health education, and
raising awareness about preventive care. Community health
INTER LOCAL HEALTH ZONE workers play a crucial role in disseminating information,
providing basic healthcare services, and facilitating the referral
Any form of organized arrangement for coordinating the operations of an of patients to higher-level healthcare facilities when necessary.
array and hierarchy of health providers and facilities, which typically
includes primary health providers, core referral hospital and an end BARANGAY HEALTH STATIONS (BHS)
referral hospital, jointly serving a common population within a local
geographic area under the jurisdictions of more than one local Barangay Health Stations (BHS) serve as primary healthcare centers at the
government. community level, providing basic healthcare services, maternal and child
care, and health education. The government has emphasized the
Components of Inter Local Health Zone enhancement of BHS facilities and the training of staff to improve the
quality of primary healthcare services at the grassroots level.
1. People - A health district has around 100,000 to 500,000 population
2. Boundaries - There has to be clear boundaries between ILHZs to RURAL HEALTH UNITS (RHU)
established responsibility and accountability.
3. Health Facilities - Made up of Rural Health Units, Barangay Health Rural Health Units (RHU) play a vital role in delivering comprehensive
Center that decide to work together an integrated health system. healthcare services to rural communities. These units are responsible for
providing a wide range of healthcare services, including preventive care,
maternal and child health services, and treatment for common illnesses.
Efforts have been made to strengthen RHUs by enhancing infrastructure, THE F1+ STRATEGY MAPS FOR THE UHC:
deploying skilled healthcare professionals, and expanding the scope of
services. • Financial Risk Protection: Strategies include expanding the National
Health Insurance Program, enhancing financing mechanisms, and
MUNICIPAL DISTRICT HOSPITALS: implementing measures to reduce out-of-pocket expenses.
Municipal District Hospitals serve as secondary-level healthcare facilities,
catering to the healthcare needs of the local population within a specific • Service Delivery and Accessibility: Measures involve strengthening
municipal district. These hospitals offer a broader range of medical primary healthcare services, upgrading healthcare facilities, and
services compared to RHUs and BHS, including emergency care, enhancing the capacity of secondary and tertiary hospitals.
diagnostic services, and basic surgical procedures.
Health System Improvement: Efforts encompass the development of
PROVINCIAL HOSPITALS: health policies, training of healthcare professionals, and establishment of
Provincial Hospitals function as tertiary-level healthcare institutions, a health information system for monitoring and evaluation.
offering more specialized and advanced medical services to patients
within a particular province. These hospitals are equipped with a wider
range of medical facilities and specialty departments, catering to complex CHAPTER 13: MATERNAL, CHILD, AND ADOLESCENT SERVICES
medical conditions and procedures that cannot be addressed at lower-
level healthcare facilities. THE CURRENT MATERNAL, NEWBORN, INFANT, AND NUTRITION
SITUATION
MEDICAL REGIONAL CENTERS
Medical Regional Centers serve as key referral centers within specific The Department of Health (DOH) issued administrative order 2008-0029
regions, providing specialized medical services, advanced treatments, and entitled "Implementing Health Reforms for the Rapid Reduction of
critical care facilities. These centers play a crucial role in addressing maternal and Neonatal Mortality" as a response to the slow decline in
complex medical cases, conducting specialized surgeries, and offering Maternal and child mortality in the Philippines, far beyond the millennium
comprehensive diagnostic and treatment services to patients from development goals in 2015 (DOH, 2018).
different areas within the region.
The MNCHN strategy guides the development, implementation and
INTERUNIVERSAL HEALTH CARE IN THE PHILIPPINES monitoring or evaluation of various government programs aimed at
improving the health of women, mothers, and children with the goal of
The Universal Health Care (UHC) program in the Philippines is a significant rapidly reducing maternal, and Neonatal mortality in the country.
initiative aimed at providing comprehensive and accessible healthcare
services to all citizens. This goal is to be achieved by using the integrated Maternal, Newborn,
Child Health and Nutrition (MNCHN) services for each stage of life pre-
OBJECTIVES AND VALUE OF THE LAW: pregnancy, pregnancy, delivery, postpartum, newborn, and child
care which will ensure the following results:
1. Ensuring equitable access to quality and affordable healthcare
for all citizens, including marginalized and underserved 1. Every pregnancy is wanted, planned and supported
populations. 2. Every pregnancy is adequately managed throughout its course
2. Providing financial risk protection to prevent families from 3. Every delivery is facility based and managed by skilled birth attendants
facing catastrophic health expenditures. or skilled health professionals
3. Improving overall health outcomes and well-being through 4. Every mother and newborn pair secures proper postpartum and
comprehensive and integrated healthcare services. newborn and childhood care.
4. Establishing an efficient and responsive health system that
prioritizes preventive care and health promotion. The law MATERNAL MORTALITY RATIO
reflects the value of promoting social justice by guaranteeing
access to essential healthcare services regardless of
socioeconomic background.

F1+ STRATEGY MAPS

F1+ Strategy Maps is a term that may refer to an advanced version of

strategy mapping, signifying an enhanced approach to strategic planning
and execution.

MATERNAL SERVICE UTILIZATION

Challenges in the delivery of maternal and child health services include the objectives, strategies, and targets of DOH F1+ for health Important laws
following: relevant to the RNMCAHN strategy.
1. Low utilization of Family Planning Packages of Phil Heath. This
low utilization may arise from confusion between patients and 1. Republic Act No 10354: responsible parenthood and Reproductive
providers brought about by differing interpretations in the Health Act of 2012
implementation of the guidelines;
2. Decrease in the number of Phil Health-accredited Maternal 2. Republic Act No 11148: The "kalusugan at Nutrisiyon ng mag nanay Act"
and Child program (MCP) facilities; which scales up the the national and local health nutrition programs for
3. Antenatal and postpartum care services lag; and, pregnant and lactating women, adolescent girls infants, and young
4. Measles and polio outbreaks and increase in measles- related children in the first 1000 days.
mortalities
3. Republic Act No. 11210: the "105 Day expanded Maternity leave law"
SAFE MOTHERHOOD PROGRAM which increase the maternity leave period to 105 Days for all workers
which an option to extend for an additional 30 days without pay and an
The Philippines faces unique challenges in aligning its health system with additional 15 days for solo mothers.
the needs of its inhabitants, primarily because of the country's geography
and income distribution. 4. Administrative Order 2008-0029: Implementing Health Reforms to
Rapidly Reduce Maternal and Neonatal Mortality.
The Philippine government place health, in general and maternal health
on its high political agenda of form. 5. Department Order 2009-0084: Guidelines Governing the payment
Of training fees Relative to the attendance of health workers to Basic
In 2006 recognizing that "good maternal health services can also Emergency obstetric and Newborn Care skills training Course at Duly
strengthen the entire health system" Designated training centers

The Philippine Department of Health launched the innovative women's 6. Administrative Order 2011-0011: Establishment of basic Emergency
health and safe motherhood project 2 (WHAMP2) obstetric and Newborn Care training in Regional Hospital and medical
 This project funded in part by the world bank, shifted the centers.
emphasis from identifying and treating high risk pregnancies to
preparing all women for potential obstetric complications. 7. Administrative Order 2015-0020: Guidelines in the administration of
life savings Drugs During maternal care emergencies by Nurses and
It is a fast-tracked system-wide reform in maternal health in selected Midwives in Birthing centers.
provinces through a set of interventions:
• Sector governance 8. Administrative 2016-0035 Guidelines on the provision of Quality
• Infrastructure and essential medical products and equipment Antenatal Care in all birthing Centers and Health Facilities providing
• Human resource development Maternity Care services.
• Financing
• Service delivery 9. Administrative Order 2018-0003 National Policy on the prevention
National Policy on the prevention of illegal and unsafe of Abortion and
SAFE MOTHERHOOD PROGRAM management of post-Abortion Complications

Safe motherhood encompasses a series of initiatives, practices, protocols, 10. Administrative Order (AO) 2016-0035 the national policy on the
and service delivery guidelines it designed to ensure women receive high prevision of Quality Antenatal Care in Birthing centers and Health
quality gynecological family planning, prenatal delivery and postpartum Facilities providing Maternal Care services.
care to achieve optimal health for the mother, fetus and infant during
pregnancy, childbirth and postpartum. 11. Republic Act No. 10028: Expanded Breastfeeding promotion Act of
2009
NATIONAL SAFE MOTHERHOOD PROGRAM
12. Republic Act No. 11166 Philippines HIV and AIDS Policy Act of 2018
Brought about a strategic change in the design of the services provided which strengthens the countrys Policy on HIV/AIDS prevention,
which includes: treatment, Care, and support. It also lowered the minimum age
requirement (from 18 to 15 years old) unavailing HIV testing and
1. Shifts in handling pregnant clients from risk approach to preparing counseling without prenatal or guardian consent.
all pregnant women to complications at childbirth.
2. Improved quality of family planning counselling and expansive THE RMNCAHN CORE PACKAGES
service availability of postpartum family planning in hospitals and
primary birthing centers The MNCHN program takes a health system-oriented, multisectoral
3. The integration of cervical cancer, syphilis, hepatitis B, and HIV approach in strengthening the continuum of care for women, children,
screening among others into the antenatal care protocols. families, and communities. The main objective of this core package is to
enable all adolescent to make informed choices on reproductive health
REALATED POLICIES AND LAW issues, particularly about pregnancy, by creating awereness and providing
access to information, education, support services, and necessary
The DOH issued administrative order (AO) 2018-0014 entitled. Strategic treatments in the field of reproductive health.
framework and implementing guidelines. For FOURmula. One plus for
Health (FI+) it aligned health initiatives into FOUR STRATEGIC PILLARS; The core package of services referto a package of services for women,
Financing, Regulation, Service Delivery, Governance. It also added a cross mother's and children covering the spectrum of (1) known appropriate
cutting initiative for performance accountability. The national objectives clinical case management services including emergency obstetrics and
for health 2017- 2022 a roadmap for the F1+ towards the achievement of newborn care in preventing direct causes of maternal and neonatal
universal Health Care, was formulated and issued. It specifies the deaths which are or will be within the capacity of the health system to
routinely provide; and (2) known cost-effective public health measure RESPONSIBLE PARENTHOOD
capable of reducing exposure to and the severity of risk for Maternal and
newborn deaths that are routinely being provided by LGUs. It refers to the will and ability of a parent to respond to needs and
aspirations of the family and children. It is likewise a shared responsibility
MNCHN Service Delivery Network refers to the network of facilities and between parents to determine and achieve the desired number of
providers within the province-wide or city-wide health system offering the children, spacing and timing of their children according to their own
MNCHN core package of services in an integrated and coordinated family asiprations, taking into account psychological preparedness, health
manner. It includes the communication and transportations system status, socio cultural and economic convictions (Congress of the
supporting this network. Philippines, 2012).

HEALTH PROVIDERS ARE PART OF THE MNCHN SERVICE DELIVERY For couples to practice responsible parenthood, they should be
NETWORK aware of their 13 sexual reproductive health rights (DOH, 2019)

1. Community level service providers or community health teams 13 SEXUAL REPRODUCTIVE HEALTH RIGHTS
(CHT) comprise of out patient departments, Baranggay Health
Station, Rural Health Units and Private Clinics which are 1. The Right To Life
manned by community health volunteers and led by the 2. The Right To The Liberty And Security Of The Persons
midwife. 3. The Right To Equality, And To Be Free From All The
2. BEmONC-capable facility maybe a Barangay Health Station. Discrimination
Lying-in, or birthing home that provides the parenteral 4. The Right To Privacy
administration of oxytocin (3rd stage), loading anticonvulsant, 5. The Right To Freedom Of Thought
initial dose of antibiotics, assisted imminent breech deliveries; 6. The Right To Information And Education
removal of retained products and placenta; and emergency 7. The Right To Choose Whether Or Not To Marry And To Find And
newborn intervention such as resuscitation, sepsis, and oxygen Plan A Family
treatment. BEmONCcapable capable facilities may also 8. The Right To Decide Whether Or When To Have Children
transfuse blood products, if needed. 9. The Right To Health Care And Health Protection
3. CEmONC-capable facilities provide all services rendered in 10. The Right To The Benefits Of Scientific Progress
BEmONC facilities with the addition of cesarean section, blood 11. The Right To Freedom Of Assembly And Political Participation
banking and transfusion, highly specialized obstetrics 12. The Right To Be Free From Torture And Ill-Treatment
intervention, management of low birth weight and preterm 13. The Right To Develoment
babies, and other newborn specialized services. Intrauterine
device insertion, vasectomy, and bilateral tubal ligation are ADOLESCENT HEALTH
likewise performed in these facilities. An itinerant team
composed of a physician, a nurse and a midwife is in-charge for ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH
the outreach service. One CeMxNC facility caters to at least
500,000 population. The DOH with the technical support of UNICEF, developed the Adolescent
Health and Development Program (AHDP) Strategic Directions for 2018-
REPRODUCTIVE HEALTH 2022 to guide the improvement of health status of adolescents, enabling
them to enjoy their right to health through the following strategies:
According to the World Health Organization (WHO 2008),
reproductive health is state of complete physical, mental and social  health education and promotion
well-being and not merely the absence of infirmity in all matters  life skills building
relating to reproductive system and to its function and processes.  medical service provision
Reproductive health is based on right access appropriate health care
services which enables women to go safely through pregnancy and In line with this, health facilities need to be provided with capable and
child birth and provides couples with the best chance of having adequate human resource and essential equipment, commodities, drugs
health infants. and supplies to ensure delivery of adolescent-friendly health services.

The Magna Carta of Women (RA 9710), which was enacted 2009, The AHDP aims to: Improve the health status of adolescents and enable
stipulated that, “the state shall, at all times, provide for a them to filly enjoy their rights to health.
comprehensive, culture sensitive, and gender responsive health
services and programs covering all stages of a women’s life cycle and The mission of AHDP is to: ensure that all adolescents have access to
which adresses the major causes of women’s morbidity and comprehensive health care and services in an adolescent-friendly
mortality.” This law states that in provision of comprehensive health environment.
services , due respect shall be accorded to women’s religious
convictions, and the right of women to protection from hazardous The AHDP envisions: A country with well-informed, empowered,
drugs, devices, intervention, and substances. Its also stated that the responsible and healthy adolescents who are leaders in society.
full range of reproductive health services shall be ensured by the
government (Congress of the philippines, 2009). 1. Adolescent Sexual and Reproductive Health

Republic act 10354, also known as the Responsible Parenthood and  Adolescent fertility rate
Reproductive Health (RPRH) Law signed by Benigno Aquino II on  The proportion of women who have had a birth or are pregnant
January 17 2013 is an act with the declaration that state recognizes with the first child
and guarantees the human rights to sustainable human  The number of babies born to adolescent parents
development, health, education, and information, and the right to  The number of newly diagnosed HIV positive cases among the
choose and make decisions and in accordance with one’s religious 15-24-year age group
convictions, ethics, cultural beliefs, and demands of responsible  The number of teens who began childbearing in 2018 remains
parenthood. high at 425,000.
2. Human papillomavirus vaccination 1. House Bill 4742: “An Act Providing for National Policy in
Preventing Teenage Pregnancies, Institutionalizing Social
 To help protect adolescents from cervical, vaginal and ulnar Protection for Teenage Parents, and Providing Funds”
cancers associated with human papillomavirus (HPV) infection, 2. Senate Bill 1888: “An Act Providing for National Policy in
which is sexually transmitted. Preventing Teenage Pregnancies, Institutionalizing Social
Protection for Teenage Parents, and Providing Funds Thereof”
 The DOH, with DepEd, held a nationwide HPV immunization for was approved on Third Reading on December 10, 2018 and was
Grade 4 female learners aged 9-14 years old in public schools in sent to the House of Representatives requesting for
selected provinces and cities. concurrence on December 13, 2018.

3. Elimination of Violence Against Women and Children

CHAPTER 13: FAMILY PLANNING AND INTEGRATED MANAGEMENT OF
 According to World Economic Forum, The Philippines ranked CHILDHOOD ILLNESS
8th among 149 countries in the 2018 Global Gender Gap by
continuing to narrow the gender gap between men and Continuation:
women.
FAMILY PLANNING
 To date, the Philippines has closed 80% of its overall gender
gap.  A program that enables couples and individuals to decide freely
and responsibly the number and spacing of their children and
4. Weekly Iron and Folic Acid (WIFA) supplementation.
to have the information and means to do so, and to have a full
5. Assessment of health and nutrition status and identification of range of safe, affordable, effective, non-abortifacient modern
nutritionally-at-risk adolescent girls, as well as provision of ready to use natural, and artificial methods of family planning pregnancy.
therapeutic food for nutritionally-at-risk adolescent female, as  in the Philippines responsible parenthood and family planning
appropriate. are enacted and enforced by RA 10354 (Responsible
Parenthood and Reproductive Health Act of 2012).
6. Provision of age-appropriate immunization based on the latest DOH
guidelines FOUR PILLARS

7. Provision of oral health including oral health assessment 1. Responsible Parenthood

8. Provision of anti-helminthic drugs for deworming  The couple has the right to determine the number of children
they want to have, provided they can support their needs and
9. Counseling on proper hand washing, environmental situation and provide a better life for them.
personal hygiene
2. Child Spacing
10. Provision of micronutrient supplements according to the guidelines of
the DOH, in partnership with the Department of Education (DepEd)  A birth interval of 3 to 5 years is encouraged to prepare the
mother ' s uterus for a new pregnancy and more time for the
11. Promotion of consumption of iodized salt and foods fortified with couple and other children to establish a strong relationship or
micronutrients that may be deemed necessary. bond.
12. Referral to appropriate health facilities to manage menstruation 3. Respect for Life
irregularities or abnormalities that contribute to anemia and blood loss,
and to manage complicated illnesses including moderate and severe  Abortion is considered illegal based on Philippine Law and
acute malnutrition culture.
 It is mandated that the preservation of life of the fetus be
13. Counselling on proper nutrition, mental health, avoidance of risk- observed regardless of his or her condition. The 1987
taking behaviors, smoking cessation, adoption of healthy lifestyle
Constitution protects the life of the unborn from the moment
practices, and family health.
of conception.
RELATED LAWS AND POLICIES 4. Informed Choice
Department of Education (DepEd) Order No. 2018-0031: “Policy
 The couple has the right to determine the kind of family
Guidelines on the Implementation of Comprehensive Sexuality
planning method/s based on their religious beliefs, culture, and
Education.” ethical values subject to conformity with the universally
Republic Act (RA) No. 11166: “Philippine HIV and AIDS Policy Act.” This recognized international human rights. It is the responsibility of
law signed on December 20, 2018 repeals the 21-year-old RA no. 8504: the nurse to discuss full information regarding options,
Philippines AIDS Prevention and Control Act of 1998. advantages, and disadvantages of each method.

Administrative Order No. 2013-0013: National Policy and Strategic BENEFITS:

Framework on Adolescent Health and Development.
Benefits to the mother:
Administrative Order No. 2017-0012: Guidelines on the Adoption of
-Enables her to regain her health after delivery
Baseline Primary Health Care Guarantees for All Filipinos Proclamation 99
-Prevents pregnancy-related health risks
Series of 1992: “Linggo ng Kabataan” held every second week of
-Gives enough time and opportunity to love and provide attention to her
December
husband and children
House Bill Number 4742 and 1888 in Congress has been filed to prevent -Gives more time for her family and own personal advancement
educational institutions from suspending, expelling and dismissing -When suffering from illness, give enough time for treatment and
pregnant students. recovery
Benefits to children
-Reduces infant mortality Female Condom
-Healthy mothers produce healthy children -Will get the attention, - Sheaths, or linings, that fit loosely inside a woman's vagina,
security, love and care they deserve made of thin, transparent soft plastic film.
 -90% with correct and consistent use 79% if commonly used
Benefits to the father
-Lightens the burden and responsibility in supporting his family Male Sterilization: Vasectomy
-Enables him to give his children their basic needs  -Permanent contraception to block or cut the vas deferens
tubes that carry sperm from the testicles
METHODS:  ->99% after 3 months semen evaluation 97% to 98% with no
In most developing countries, like the Philippines, several women of semen evaluation
reproductive age who wish to avoid pregnancy do not use modern
approaches because of the following reasons: Female Sterilization: Tubal Ligation
 -Permanent contraception to block or cut the fallopian tubes
1. Limited choice of methods;  ->99%
2. limited access to contraception,
3. fear or experience of side effects; Emergency contraception pills
4. cultural or religious opposition;  -(ulipristal acetate 30 mg or levonorgestrel 1.5 mg)
5. poor quality of available services;  -Pills taken to prevent pregnancy up to 5 days after unprotected
6. users and providers bias; and, sex
7. gender-based barriers  -if all 100 women used progestin-only emergency
contraception, one would likely become pregnant
Combined Oral Contraceptive (COC)
 -Contains two hormones (estrogen and progestogen) Standard Days Method or SDM
 ->99% with correct and consistent use 92 % if commonly used  -Women track their fertile periods (usually days 8 to 19 of each
26 to 32-day cycle) using cycle beads or other aids
Progesterone-only Pills (POP)  -95 % with correct and consistent use 88% if commonly used
 -Contains only progestogen
 -AKA mini pill PREGNANCY SERVICES
 99% with correct and consistent use 90 % to 97% if
commonly used PRE-PREGNANCY
Implants
 -Small, flexible rods or capsules placed under the skin of the Pre-pregnancy services include:
upper arm; contains progestogen hormone only 1. the provision of iron and folate supplementation
 ->99% 2. counseling and provision of Family Planning (FP) methods
3. prevention and management of infection lifestyle-related
Progesterone-only Injectables diseases (provided by both the DOH and Local Government
 -Injected into the muscle or under the skin every 2 or 3 months, Units (LGUs))
depending on product
 ->99% with correct and consistent use 97% if commonly used Pre-pregnancy services highlight the provision of modern FP methods to
reduce unplanned pregnancies and unmet needs of women and
Monthly injectables or combined injectable contraceptives (CIC) adolescents that can expose them to unnecessary risks from pregnancy
 -Injected monthly into the muscle, contains estrogen and and childbirth.
progestogen
 ->99% with correct and consistent use 97 % if commonly used Unplanned pregnancies are also associated with poorer health outcomes
for both mother and newborn. Effective provision of FP services can
Combined contraceptive patch and combined contraceptive vaginal ring potentially reduce maternal mortality by around 44%
(CVR)
 -Continuously releases 2 hormones-a progestin and an 1. Micronutrient supplementation
estrogen- directly through the skin (patch) or from the ring: 2. Iron and Folate: 60 mg elemental iron with 100 microgram folic
 -The patch and the CVR are new and research on effectiveness acid tablet daily for 3-6 months
is limited 3. lodized oil capsule with 200 mg iodine capsule for 1 year
 Effectiveness studies report that it may be more effective than (women ages 15-45
the COCs, both as commonly and consistent or correct use. 4. Promotion of the use of iodized salt
5. Nutrition counselling
Intrauterine Device (IUD): Copper Containing 6. Promotion of healthy lifestyle including advice relative to
 -Small flexible plastic device containing copper sleeves or wire smoking cessation, healthy diet, regular exercise and
that is inserted into the uterus moderation alcohol intake
 ->99% 7. Advice on family planning and provision of family planning
services
Intrauterine Device (IUD): Levonorgestrel 8. Prevention and management of lifestyle and diabetes like
- A T-shaped plastic device inserted into the uterus that steadily diseases related cardiovascular diseases health services
releases small amounts of levonorgestrel each day 9. Counselling, prevention, and management of infection
 ->99% including Sexually Transmitted Infections (STIs) and HIV/AIDS
Male Condoms 10. Adolescent health services
 Sheaths or coverings that fit over a man's erect penis 11. Deworming women of reproductive age to reduce other causes
 -98% with correct and consistent use 85% if commonly used of iron deficiency anemia
12. Provision of oral health services
 welfare of women and newborns . The establishment of a
ANTENATAL CARE network of public and private healthcare providers of
emergency obstetric and newborn care is integral to safe
 Republic Act 11148, known as "Kalusugan at Nutrition ng Mag- intrapartum interventions.
Nanay Act" , focuses on scaling up the national and local  The network is configured to include birthing centers capable of
nutrition programs through a strengthened integrated strategy providing BEmONC and a referral hospital that can provide
for maternal, and neonatal child health and nutrition in the first CEMONC . Ideally , a BEmONC - capable facility should be
one thousand (1,000) days of life. The program includes health reached within 30 minutes from homes using the most common
and nutrition services provided at different life stages mode of transportation , while a CEmONC should be reached
 This visit is important because it helps reduce maternal and within an hour from each BEmONC - capable facility
perinatal morbidity and mortality both directly, through
detection and treatment of pregnancyrelated complications, HEALTH SERVICES:
and identification indirectly, of women and girls at increased
risk of developing complications during labor and delivery. 1. Antenatal Corticosteroids
 ANC ensures referral to a appropriate level of care. Its
components prevention include risk identification, and These medications are given to all pregnant women who are at risk for
management of pregnancy-related or concurrent diseases, and preterm delivery (labor within 24-34 weeks AOG) or has any of the
health education and health promotion. following prior to term:
 The tracking o pregnancies in the community by barangay
health workers (BHWs) is one of the factors that influence  Antenatal hemorrhage or bleeding
women to seek ANC consultation. BHWs provide both  Hypertension
navigation and basic service delivery functions, assist pregnant  Preterm rupture of membranes
women in developing birth plans, and help families facilitate
access to critical health services Two corticosteroids are given : Betamethasone 12 mg Intramuscularly
 "Bantay Buntis, " a practice at the regional level by organized every 24 hours for 2 doses or Dexamethasone 6 mg ( 1.50 mL )
communities with indigenous people, ensure pregnant women Intramuscularly every 12 hours for 4 doses . It must be noted that even a
avail of professional assistance throughout pregnancy, delivery single dose of these corticosteroids is highly beneficial and must be
and postpartum. This service extends to ensuring the provision readily available in the Emergency Room , Delivery Room , Out Patient
of basic health services to newborns up to their childhood. Department , and ward.

VISIT: 2. Essential Intrapartal Newborn Care ( EINC ) ( DOH , 2011)

1. The first antenatal visit should be done as soon as possible once A. Dilatation Stage
pregnancy is suspected.
2. The second and third visits, on the other hand, should be done Recommended NOT recommended
during the 2ndcand 3rd trimester, respectively. a . Admit only when the patient is a . Routine perineal shaving on
3. After the 8th month of pregnancy, mothers should have their in active phase . admission
prenatal visits every two weeks until the baby is delivered. b . Continuous maternal support b . Routine enema
c . Upright position during first c . Routine NPO
THE PRENATAL VISIT ACTIVITIES: stage of labor d . Routine IVF
d . Routine use of WHO e . Routine vaginal douching
partograph to monitor progress f . Routine amniotomy g . Routine
1. Health History
of labor e . Limit total number of oxytocin augmentation
2. Prenatal Assessment the physical examination
IE to 5 or less
3. Birth Preparation and Emergency Plans
4. Micro and macro nutrient supplementation B. Fetal Expulsion Stage
5. Early Identification and Management of Nutritionally at-Risk
Pregnant Client.
Recommended NOT recommended
6. Counselling on breastfeeding and rooming-in, appropriate
a . Upright position during a . Perineal massage or "plantsa"
infant and young child feeding practices.
delivery b . Fundal pressure obima
7. Assessment of risk for parasitism and provision of anti- b . Double gloving c . Placental Expulsion Stage
helminthic (parasiticides) medicines c . Selective episiotomy
8. Provision of oral health services including oral health
assessment proper handwashing C. Placental Expulsion Stage
9. Counselling on environmental sanitation and personal hygiene Active Management of Third Stage of Labor ( AMTSL )
10. Counselling on nutrition, smoking cessation, and adoption of
healthy lifestyle practices a . Give oxytocin within 1 minute after delivery of the baby cord
11. Philippine Health Insurance Corporation (PhilHealth) traction with countertraction on uterus
enrollment and linkages to facility and community-based health b . Controlled
and nutrition workers and volunteers c . Uterine massage after placenta is delivered
12. Social welfare support
13. Maternity protection during pregnancy D. Immediate Postpartum or Recovery Period
14. Counselling and support to parents and caregivers
Recommended NOT recommended
a . Use of dyad monitoring sheet a . Perineal massage or "plantsa"
b . Routine inspection of the birth b . Fundal pressure obima
INTRAPARTAL SERVICES canal for lacerations c . Placental Expulsion Stage
 The DOH advocates facility - based delivery to ensure safe labor c. Inspect placenta for
, availability of intrapartum interventions and to safeguard the completeness
 d . Early resumption of feeding 3 . Cover baby with dry cloth & uterus , continuing until placenta
e . Massaging the uterus the baby’s head with a bonnet is delivered .
f . Prophylactic antibiotics for 4 . Exclude a second baby by 2 . Massage the uterus until firm
women with a 3rd or 4th degree palpating the abdomen in
perineal tear simb preparation for giving oxytocin .
g . Early postpartum discharge 5 . Remove first gloves and
decontaminate them properly
E. Immediate Essential Care of the Newborn 6 . Palpate the umbilical cord to
check for pulsations
Recommended NOT recommended 7 . After pulsation stopped ,
clamp the cord using plastic
Four Core Steps DO NOT :
clamp/ cord tie 2 cm from base
a . Immediate and thorough a . Ventilate UNLESS the baby is
8 . Place instrument / metal
drying floppy /limp and not breathing
clamp 5 cm from the base
b . Skin - to - skin contact b . Suction UNLESS the mouth /
9 . Cut near plastic clamp ( not
c . Properly timed cord clamping nose are blocked with secretions
midway )
d . Nonseparation of newborn or other material
from mother c . Wipe off vernix
for early breastfeeding I. Inspect the lower vagina and perineum for lacerations / tears and repair
d . Bathe the newborn
e . Get footprint lacerations /tears as necessary
f . Slap J. Examine the placenta for completeness and abnormalities
g . Hang upside - down K. Clean the mother : flush the perineum and apply perineal pad / napkin/
h . Squeeze chest cloth
i . Milk the cord towards the baby L. Inspect the lower vagina and perineum for lacerations / tears and repair
j . Use abdominal binder or lacerations / tears as necessary
"bigkis" M. Check the baby's color and breathing
N. Check that the mother is comfortable , and if uterus is contracted
Essential Intrapartum and Newborn Care ( EINC ) Protocol O . Dispose of the placenta in a leak - proof container or plastic bag
instruments before cleaning ; decontaminate 2nd pair of gloves before
A. Admission B. In the Labor Room disposal
1 . Obtain the health history 1 . Encourage woman into her P. Decontaminate
2 . Perform health assessment position of Q. Advise mother to maintain skin - to - skin contact .
3 . If woman is in the active choice while in labor . ovilit R. Baby should be prone on mother's chest / in between the breasts with
phase , admit patient 2 . Ask mother if she wishes to eat head turned to one side
/ drink or void with mother S . Time band : 15-90 minutes
inform her of progress of labor ,
give reassurance , and
encouragement 1 . Advise mother to observe 7 . Advise optional / delayed
3 . Communicate with feeding cues and cite example of bathing of baby (explain the
4 . IV fluid and NPO only when feeding cues rationale )
indicated 2 . Support mother, instruct her 8 . Advise breastfeeding per
5 . Use WHO Partograph to on positioning demand
monitor labor 3. Support FIRST FULL 9 . In the first hour : check the
BREASTFEED . baby's breathing and skin color
C. Woman in the DR D. Preparing for delivery
4 . Continue uterine massage 10 . Check mother’s vital signs
1 . Prepare dos decontamination 1 . Wash hands thoroughly
5 . Do eye care and examine , and massage uterus every 15
solution ( 5 % Innam chlorine observing the WHO 1-2-3-4-5
measure weight , inject vitamin K minutes
bleach + 9 parts water = 0.5 % Procedure
, Hep B 1010 vaccine , BCG 11 . In the second hour : check
vagoll 12 chlorine solution ) 2 . Check resuscitation area and
vaccine ( simultaneously mother baby dyad every 30
2 . Ensure room temperature at equipment
explaining the purpose of each minutes to 1 hour .
25-28 eodegrees Celsius and 3 . Arrange all instruments in
intervention ) 12 . Complete all records
eliminate air drafts linear fashion
6 . Transport to room TOGETHE
3 . Ask woman if she is 4 . In a separate sequence , after
comfortable in ward the semi - the first breastfeed.
Continuation:
upright position  4.1 : Eye ointment
4 . Ensure the woman’s privacy (  4.2 . Stethoscope ( to
proper draping ) symbolize PE ) 3. Adherence to couple 's birth , breastfeeding or and rooming - in plans
5 . Remove all jewelry  4.3 . Vitamin K 4. Provision of mother - friendly practices during labor and delivery in line
 4.4 . Hepatitis B Vaccine with viband in compliance with Mother and broBaby - Friendly Health
 4.5 . BCG Vaccine ( plus Facility Initiative , Republic Act No. 10028 , otherwise known Tumas
cotton balls) " Expanded Breastfeeding Promotion of 2009. " Executive Order No. 51 or
5 . Wash hands and put on 2 pairs the " Milk no Code", and other related administrative issuance of the DOH
of mil bolle sterile gloves on maternal and newborn care
aseptically . ( if same o grite 5. Monitoring of the progress of labor and the well - being of both the
worker handles perineum and mother and the fetus and provision of interventions to any br health issue
cord that may arise
G. 1 minute to 3 minutes H. Perform the remaining steps 6. Identification of high - risk newborns that will be delivered
of
AMTSL:
CHILDHEALTH SERVICES
1 . Remove wet cloth 1 . Wait for strong uterine
2 . Place baby on the mother's contractions
abdomen / chest for skin - to - then apply controlled traction •NUTRITION PROGRAM
skin contact and counter - traction on the -The goal of this program is to improve quality of life through better
nutrition, improve health and productivity.
 3. FOOD FORTIFICATION
LAW AND POLICIES THAT REGULATE NUTRITIONAL PROGRAM OF THE - it is the addition of micronutrients to food during production and
PHILIPPINES preparation.
•RA8172 "Asin Law" -primarily aims to help contribute in
eliminating iodine deficiency in the population thru the use of 4. DEWORMING PROGRAM
iodized salt in food preparation. - deworming of children ages 1 to 12 years old is done every 6 months to
•PD No. 491 -declared July as the Nutrition Month and created help reduce risk of developing malnutrition among children.
National Nutrition Council.
•EQ 382- declared December 7 as National Food Fortification Before the administration of any anti-helminths medication, nurses
Day. should assess for the following:
•Letter of Instruction 441 - mandates the integration of 1. serious illness
nutrition education in the school curriculum. 2. abdominal pain
•RA 8976 - provides mandatory fortification of; 3. diarrhea
-Rice with Iron 4. history of hypersensitivity
-Wheat flour with Vitamin A and Iron 5. severe malnutrition
-Refined sugar with Vitamin A
-Cooking oil with vitamin
Integrated Management of Childhood Illnesses (IMCI)
4 COMPONENTS OF NUTRITION PROGRAM
IMCI is a process can be used by doctors, nurses and other health care
1.COMPLEMENTARY FEEDING professionals who see sick infants and children age 1 week up to 5 years
 From the age of 6 months an infants’ need for energyand old. It is a case management process for a first-level facility such as clinics,
nutrients starts to exceed what is provided by breastmilk and a health center, rural health units or an outpatient department of the
complementary feeding becomes necessary to fill the energy hospital.
and nutrient gap (WHO, 2009).
 Ensuring that their nutritional needs are met requires that The complete IMCI case process management process:
complementary food may be:
A. ASSESS - A child must be assessed first for danger signs, Asking
o Timely questions about common conditions, examining the child and check
o Adequate nutrition and immunization status and checking the child for other
o Safe problems.
o Properly fed
B. CLASSIFY - A child’s illness is categorized using color-coded triage
2. MICRONUTRIENT SUPPLEMENTATION system.
 The provision of supplies for the micronutrient
supplementation program assist the local government units in  PINK- Urgent prereferral treatment and referral.
augmenting micronutrient supplies for vulnerable populations.  YELLOW- Specific medical treatment and advice.
 Supplementation is the administration of concentrated source  GREEN- Simple advice on home management.
of a nutrient, either singly or in combination.

THE MAJOR MICRONUTRIENT DEFICIENCIES IN THE PHILIPPINES ARE C. IDENTIFY - After classifying all conditions, specific treatment for the
THE FOLLOWING: child should be decided.

1. Vitamin A Deficiency (VAD) or Xeropthalmia D. TREATMENT - Provide practical management instructions, including
- this condition diminishes a person's ability to fight infection which teaching the mother or caregiver how to give oral drugs, how to feed and
contributes to maternal morality and other poor outcomes of pregnancy. give fluids during illness, and how to treat local infections at home. Ask
the caregiver to return for follow-up on specific date and teach her how
Signs and Symptoms of XEROPTHALMIA: to recognize signs that indicate the child should return immediately to the
1. Night blindness health facility.
2. Photophobia
3. Conjunctional Serosis E. COUNSEL- Assess feeding, including assessment of breastfeeding
4. Bitot's spot practices and counsel to solve any feeding problem found. Then counsel
5. Corneal opacity the mother about her own health.
6. Corneal ulceration
F. FOLLOW-UP CARE - When a child is brought back to the clinic as
2. Iron Deficiency Anemia requested, give follow-up care and if necessary, reassess the child for new
- Anemia is defined as children whit 5 years old and pregnant women with problem.
hemoglobin value less than 10 g/L.
The principles of integrated care:
3. Iodine Deficiency Disorder (IDD)
-the most serious effect of IDD is poor mental health and development. 1. All sick children must be examined for “general danger sign” which
The child may develop mental retardation if the mother does not have indicate the need for immediate referral or admission to the hospital.
enough supply of iodine during pregnancy.
a. All sick children must be routinely assessed for major
--- continuation symptoms:
 For children age 2 months up to 5 years old: cough,
difficulty of breathing, diarrhea, fever, ear problem.
  For children 1 week up to 2 months old: Bacterial 16. Provision of locally available grown crops, vegetables and fruits for
infection and diarrhea. complementary feeding and dietary supplementation
 Must be routinely assessed for nutritional and
immunization status, feeding problems and other 17. Protection against child abuse, injuries and accidents including
potential problems. provision of first aid, counselling and proper referrals.
b. Only a limited number of carefully selected clinical signs are
used, based on evidence of their sensitivity and specificity to
detect disease.
c. A combination of individual signs leads to a child’s
classifications rather than diagnosis. ( The classifications are
color-coded)
d. The IMCI guidelines address most, but not all, of the major
reasons a sick child is brought to the clinic.
e. IMCI management procedures use a limited number of
essential drugs and encourage active participation of caretakers
in the treatment of children.
f. An essential component of the counseling of caretakers about
home management including counseling about feeding, fluid
and when to return to the health facility.

2. Timely introduction of safe, appropriate and nutrient-dense quality

complementary food with continued sustained breastfeeding for all
infants from 6 months up to 2 years old.

3. Provision of nutrition counseling on complementary food preparation

and feeding on mothers and caregiver.

4. Dietary supplementation of age-appropriate and nutrient-dense quality

complementary food.

5. Growth and development monitoring and promotion of children at

health facilities and at home.

6. Provision of routine immunization base on the latest DOH guidelines.

7. Provision of micronutrient supplements deemed necessary.

8. Management of common childhood illness based on WHO and DOH

guidelines.

9. Management of moderate and severe acute malnutrition using national

guidelines and proper referral to higher level health facilities as
appropriate for treatment and management, especially those with
serious medical
conditions.

10. Provision of oral health services including application of fluoride

varnish to prevent dental caries.

11. Provision of anti-helminthic tablets for children one to two years old
as appropriate.

12. Availability of portable source of water, counselling of household

members on handwashing, environmental sanitation, and personal
hygiene and support for sanitation needs of household to reduce food,
water and vector-borne disease.

13. Counselling and support to parents and caregiver for responsive care,
and early stimulation for early childhood development, and referral on
cases of developmental delays in children and other disabilities for early
prevention, treatment and rehabilitation.

14. Social welfare support to improve access to health and nutrition

services.

15. Support for home kitchen gardens wherever feasible