WEEK 8 – PRIMARY HEALTH CARE standard of living adequate for the health and

wellbeing of himself and of his family, including

DISCUSSION CONTENT food, clothing, housing and medical care and
necessary social services […]”.
 What is Primary Health Care (PHC)?  It addresses the broader determinants of health
 History of Primary Health Care and focuses on the comprehensive and
 Objectives of Primary Health Care (PHC)? interrelated aspects of physical, mental and
 Principles of Primary Health Care (PHC): social health and wellbeing.
 What are the Pillars of PHC?  It provides whole-person care for health needs
 Elements/components of PHC throughout the lifespan, not just for a set of
 Why is Primary Health Care (PHC) important? specific diseases.
 What are the challenges for implementation of  Primary health care ensures people receive
PHC? comprehensive care - ranging from promotion
 What are the mitigation measures for ensuring and prevention to treatment, rehabilitation and
effective PHC? palliative care - as close as feasible to people’s
everyday environment.
WHAT IS PRIMARY HEALTH CARE (PHC)?  It addresses the broader determinants of health
 Primary health care (PHC) is and focuses on the comprehensive and
essential health care made universally interrelated aspects of physical, mental and
accessible to individuals and acceptable to them, social health and wellbeing.
through full participation and at a cost  It provides whole-person care for health needs
the community and country can afford. It is an throughout the lifespan, not just for a set of
approach to health beyond the traditional health specific diseases.
care system that focuses on health equity-  Primary health care ensures people receive
producing social policy. Primary health-care comprehensive care - ranging from promotion
(PHC) has basic essential elements and and prevention to treatment, rehabilitation and
objectives that help to attain better health palliative care - as close as feasible to people’s
services for all. everyday environment.
 Primary Health Care (PHC) is the health care  WHO has developed a cohesive definition based
that is available to all the people at the first level on three components:
of health care. 1. Meeting people’s health needs through
 According to World Health Organization (WHO), comprehensive promotive, protective,
‘Primary Health Care is a basic health care and is preventive, curative, rehabilitative, and
a whole of society approach to healthy well- palliative care throughout the life course,
being, focused on needs and priorities of strategically prioritizing key health care
individuals, families and communities.’ services aimed at individuals and families
 Primary Health Care (PHC) is a new approach to through primary care and the population
health care which integrates at the community through public health functions as the
level all the factors required for improving the central elements of integrated health
health status of the population. services;
 Primary health care is both a philosophy of 2. systematically addressing the broader
health care and an approach to providing health determinants of health (including social,
services. economic, environmental, as well as
 It addresses the expansive determining factor of people’s characteristics and behaviours)
health and ensures whole person care for health through evidence-informed public policies
demands during the course of the natural life. and actions across all sectors; and
 It is developed with the concept that the people 3. empowering individuals, families, and
of the country receive at least the basic communities to optimize their health, as
minimum health services that are essential for advocates for policies that promote and
their good health and care. protect health and well-being, as co-
 Primary health care is rooted in a commitment developers of health and social services, and
to social justice and equity and in the as self-carers and care-givers to others.
recognition of the fundamental right to the
highest attainable standard of health, as echoed HISTORY OF PRIMARY HEALTH CARE:
in Article 25 of the Universal Declaration on
Human Rights: “Everyone has the right to a
  Before 1978, globally, existing health services 5 PRINCIPLES OF PRIMARY HEALTH CARE
were failing to provide quality health care to the (PHC):
people.
 Different alternatives and ideas failed to 1. Social equity
establish a well-functioning health care system. 2. Nation-wide coverage/wider coverage
 Considering these issues, a joint WHO-UNICEF 3. Self- reliance
international conference was held in 1978 in 4. Intersectoral coordination
Alma Ata (USSR), commonly known as Alma- 5. People’s involvement (in planning and
Ata conference. implementation of programs)
 The conference included participation from
government from 134 countries and other PRINCIPLE OF PRIMARY HEALTH CARE (PHC)
different agencies.
 Equitable distribution of health care –
 The conference jointly called for
according to this principle, primary care and
a revolutionary approach to the health care.
other services to meet the main health problems
 The conference declared ‘The existing gross
in a community must be provided equally to all
inequality in the health status of people
individuals irrespective of their gender, age, and
particularly between developed and developing
caste, urban/rural, and social class.
countries as well as within countries is
 Community participation-comprehensive
politically, socially and economically
healthcare relies on adequate numbers and
unacceptable’.
distribution of trained physicians, nurses, allied
 Thus, the Alma-Ata conference called
health professions, community health workers,
for acceptance of WHO goal of ‘Health for All’
and others working as a health team and
by 2000 AD.
supported at the local and referral levels.
 Furthermore, it proclaimed Primary Health
 Multi-sectional approach-recognition
Care (PHC) as a way to achieve ‘Health for
that health cannot be improved by intervention
All’.
within just the formal health sector; other
 In this way, the concept of Primary Health
sectors are equally important in promoting the
Care (PHC) came into existence globally in
health and self-reliance of communities.
1978 from the Alma-Ata Conference.
 Use of appropriate technology- medical
technology should be provided that accessible,
OBJECTIVE OF PRIMARY HEALTH CARE (PHC):
affordable, feasible, and culturally acceptable to
 To increase the programs and services that the community.
affect the healthy growth and development of
children and youth.
 To boost participation of the community with Behind these elements lies a series of basic objectives
government and community sectors to improve that should be formulated in national policies to launch
the health of their community. and sustain primary healthcare (PHC) as part of a
 To develop community satisfaction with the comprehensive health system and coordination with
primary health care system. other sectors.
 To support and advocate for healthy public
policy within all sectors and levels of  Improvement in the level of health care of
government. the community.
 To support and encourage the implementation  Favorable population growth structure.
of provincial public health policies and  Reduction in the prevalence of preventable,
direction. communicable, and other diseases.
 To provide reasonable and timely access to  Reduction in morbidity and mortality rates
primary health care services. especially among infants and children.
 To apply the standards of accountability in  Extension of essential health services with
professional practice. priority given to the underserved sectors.
 To establish, within available resources, primary  Improvement in basic sanitation.
health care teams and networks.  Development of the capability of the community
 To support the provision of comprehensive, aimed at self-reliance.
integrated, and evidence-based primary health  Maximizing the contribution of the other sectors
care services. for the social and economic development of the
community.
  Intersectoral coordination will ensure
different sectors to collaborate and
function interdependently to meet the
health care needs of the people.
 It also refers to delivering health care
services in an integrated way.
 Therefore, the departments like
agriculture, animal husbandry, food,
industry, education, housing, public
works, communication, and other
sectors need to be involved in achieving
health for all.

3. APPRORIATE TECHNOLOGY
 Appropriate healthcare technologies
are an important strategy for improving
the availability and accessibility of
healthcare services.
Primary health care consists of an integrative group of  It has been defined as ‘’technology that
health care professionals is scientifically sound, adaptable to local
coordinating to provide basic health care services to a needs and acceptable to those who
particular group of people or population. apply it and to whom it is applied and
These pillars are reinforcement for the delivery of safe that can be maintained by people
health care. themselves in keeping with the
WHAT ARE THE PILLARS OF PRIMARY HEALTH principle of self-reliance with the
CARE (PHC)? resources the community and country
can afford.’’
1. COMMUNITY PARTICIPATION  Appropriate technology refers to using
 Community participation is a process in cheaper, scientifically valid and
which community people are engaged acceptable equipment and techniques.
and participated in making decisions  It is also necessary to ensure that the
about their own health. technology is:
 It is a social approach to point out the  Scientifically reliable and valid
health care needs of the community  Adapted to local needs
people.  Acceptable to the community
 Community participation involves people
participation of the community people  Accessible and affordable by
from identifying the health needs of the the local resources
community, planning, organizing,
decision making and implementation of 4. SUPPORT MECHANISM MADE AVAILBALE
health programs.  Support Mechanism is vital to health
 It also ensures effective and strategic and quality of life. Support mechanism
planning and evaluation of health care in primary health care is a well-known
services. process focused to develop the quality
 In lack of community participation, the of life.
health programs cannot run smoothly  Support mechanism includes that the
and universal achievement by primary people are getting personal, physical,
health care cannot be achieved. mental, spiritual and
instrumental support to meet goals of
2. INTER-SECTORAL COORDINATION primary health care.
 Inter-sectoral coordination plays a vital  Primary health care depends on
role in performing different functions in adequate number and distribution of
attaining health services. trained physicians, nurses, community
 The involvement of specialized agency, health workers, allied health
private sectors, and public sectors is professions and others working as a
important to achieve improved health health team and supported at the local
facilities. and referral levels.
  Stronger primary health care is essential to
achieving the health-related Sustainable
ESSENTIAL ELEMENTS OF PRIMARY HEALTH Development Goals (SDGs) and universal health
CARE (PHC): coverage. It will contribute to the attainment of
other goals beyond the health goal, including
 There are 8 elements of primary health care those on poverty, hunger, education, gender
(PHC). equality, clean water and sanitation, work and
o E - Education concerning prevailing health economic growth, reducing inequality and
problems and the methods of identifying, climate action.
preventing, and controlling them.  Primary health care is well-positioned to
o L - Locally endemic disease prevention and respond to rapid economic, technological, and
control. demographic changes, all of which impact health
o E– An expanded program of immunization and well-being. A recent analysis found that
against major infectious diseases. approximately half of the gains in reducing child
o M– Maternal and child health care including mortality from 1990 to 2010 were due to factors
family planning. outside the health sector (such as, water and
o E– Essential drugs arrangement. sanitation, education, economic growth). A
o N– Nutritional food supplement, an adequate primary health care approach draws in a wide
supply of safe and basic nutrition. range of stakeholders to examine and change
o T– Treatment of communicable and non- policies to address the social, economic,
communicable diseases and the promotion of environmental and commercial determinants of
mental health. health and well-being. Treating people and
o S– Safe water and sanitation. communities as key actors in the production of
their own health and well-being is critical for
EXTENDED ELEMENTS IN THE 21 S T CENTURY understanding and responding to the
complexities of our changing world.
 Expanded options of immunizations.  Primary Health Care focuses more on quality
 Reproductive health needs. health service and cost-effectiveness.
 Provision of essential technologies for health.  Primary Health Care focuses on “Health for all”
 Health promotion.  Primary Health Care integrates preventive,
 Prevention and control of non-communicable promotive, curative, rehabilitative and
diseases. palliative health care services.
 Food safety and the provision of selected food  Primary Health Care encourages new
supplements. connection and community participation.
 It includes services that are readily accessible
WHY IS PRIMARY HEALTH CARE (PHC) and available to the community.
IMPORTANT?  Primary Health Care can be easily accessible by
all as it includes services that are simple and
efficient with respect to cost, techniques and
organization.
 Primary Health Care promotes equity and
equality.
 Primary Health Care improves safety,
performance, and accountability.
  Primary Health Care advocates on health To ensure that before graduation, all students undergo
promotion and focuses on prevention, screening the enhanced curriculum for Nursing where IMCI is
and early intervention of health disparities. integrated starting at Level II up to level IV.
 Primary Health Care is also perceived as an
integral part of country’s socio-economic IMCI AS A STRATEGY
development.
 Management of common childhood illness is
done in an integrated manner
WHAT ARE CHALLENGES FOR IMPLENTATION
 Includes preventive interventions
OF PHC?
 Adjusts curative interventions to the capacity
 Poor staffing and shortage of health personnel and function of the health systems (evidenced
 Inadequate technology and equipment based – syndromic approach)
 Poor condition of infrastructure/infrastructure  Involves the family members and the
gap, especially in the rural areas community in the health care process
 Concentrated focus on curative health services
rather than preventive and promotive health OBJECTIVES OF IMCI
care services.
 Reduce deaths and the frequency and severity of
 Challenging geographic distribution
illness and disability
 Poor quality of health care services
 Contribute to improved growth and
 Lack of financial support in health care
development
programs
 Lack of community participation
WHY IMCI?
 Poor distribution of health workers/health
workers concentrated on the urban areas.  Overlap of conditions
 Lack of intersectoral collaboration  Diagnostic tools are minimal or non-existent
 Drugs and equipment are scarce
WHAT ARE THE MITIGATING MEASURES FOR  Health workers have few opportunities to
ENSURING EFFECTIVE PHC? practice complicated clinical procedures
 Relies on history & signs & symptoms
 Encouraging community participation through
rapport building, effective communication and
COMPONENTS OF THE IMCI
sharing objectives and benefits of PHC.
 Developing quality assurance mechanisms 1. Improving case management skills of health
through the development of various indicators workers
and standards. 2. Improving the health systems to deliver IMCI
 Development of clinical guidelines including the 3. Improving family and community health
implementation of Essential drugs list practices
 Allocating resources as per the need of the
central, provincial/state and local level. TARGET AGE FOR THE IMCI STRATEGY
 Develop a planning process to define objectives
and set targets by giving priority on those  Young infants – 1 week up to 2 months
families and communities most at risk.  Older children – 2 months to five years old
 Promoting problem-orientated research in
health management system. DISEASES COVERED IN THE IMCI
 Creating pathways to give health higher priority  Pneumonia
on the agenda of district development and  Diarrhea
collaboration of health departments to perform  Dengue hemorrhagic fever
its role in health activities.  Malaria
 Develop guidelines and framework that specify  Measles
the roles and responsibilities of the provincial  Malnutrition
states.
Color Classification of Level of
INTEGRATED MANAGEMENT OF Presentation Diseases Management
CHILDHOOD ILLNESS (IMCI)
Green Mild Home care
Yellow Moderate Manage at the
GENERAL OBJECTIVE
RHU
Pink Severe Urgent referral
 in Hospital

2. DIARRHEA

FOCUSED ASSESSMENT

A. DANGER SIGNS
1. Vomits everything
2. Seizure / convulsions > 38.5C & above
3. Sleepiness
4. Sucking / drinking inability

CHECK FOR GENERAL DANGER SIGNS

 Ask:
- Is the child not able to breastfeed or
drink?
- Does the child vomit everything?
- Has the child had convulsions?
 Look:
- See if the child is abnormally sleepy of
difficult to awaken?
If YES……

B. MAIN SYMPTOMS
1. Cough or DOB
2. Diarrhea
3. Fever
4. Ear Problem

1. COUGH OR DOB

3.FEVER

a. Malaria
 7. If no sign → tourniquet test if fever is
present → 3 days

4.EAR PROBLEMS

b. Measles

C. NUTRITIONAL STATUS

1. NUTRITION

c. Dengue
 If there is Dengue Risk
1. Bleeding gums
2. Black vomitus or stool
2. IMMUNIZATION
3. Persistent abdominal pain
3. VITAMIN A
4. Persistent vomiting
5. Skin petechiae SUPPLEMENTATON
6. Slow capillary refill
WEEK 10 : IMMUNIZATION

Note: A fully Immunized Child (FIC) is a child

that has received all of the following

a. One dose of BCG at birth or anytime

before reaching 12 months
b. 3 dose each of Pentavalent, OPV and
Hepa B as long as the 3rd dose is given
before the child reaches 12 months of
age.
c. One dose of anti-measles vaccine before
reaching 12 months.

Table 13.7 Recommended dose of calcim

supplementation
TARGETS PREPARATION DOSE/
DURATION
Pregnant 1.0-2.0 g Three divided
Women element doses
calcium
Table 13.4 Recommended dose of iron and folic
acid supplementation
TARGET PREPARATION DOSE/
DURATION
Pregnant 60 mg 1 tab/day for 6
Women elemental iron months or 2
with 400 mcg tabs/day if
folic acid prenatal
consultation
starts on the 2nd
and 3rd trimester
of pregnancy
Lactating 60 mg 1 tab/day for 3
Women elemental iron months or 90
with 400 mcg days
folic acid

Table 13.5 Recommended dose of vitamin A for

women
TARGET PREPARATION DOSE/
DURATION
Pregnant 10,000 IU 1 cap 2x/wk
Women (4months until
delivery)
Postpartum 200,000 IU 1cap once after
women delivery (may
be given within
4 weeks

Table 13.6 Recommended dose of iodine

supplementation
TARGET PREPARATION DOSE/
DURATION
Children of 200 mg of 1 cap per year
school age iodized oil
capsule
Women 15-25 200 mg iodized 1 cap per year
years old oil capsule
Adult males 200 mg iodized 1 cap per year
oild capsule

Table 13.17 Recommended dose for deworming

children
Age Albendazole Mebendazole
 400 mg/tab 500mg/tab
12-23 months ½ tab 1 tab
24-59 months 1 tab 1 tab

Table 13.18 Common adverse effects of

deworming and corresponding management
Adverse Effects Management
Local sensitivity or Give antihistamine
allergic reaction
Mild abdominal pain Give antispasmodic
Diarrhea Give ORS
Erratic worm migration Pull put worms from
mouth or nose or from
other body orifices
WEEK 11: EPIDEMIOLOGY:
COMMUNICABLE DISEASE

MALARIA
  Causative Agent: Plasmodium  Treatment: Diethylcarbamazine citrate
falciparum, vivax, ovale, malariae (Hetrazan)
(Protozoa)  Prevention and Control: Eradication of
 Signs and Symptoms: Recurrent fever vectors
preceded by chills and profuse sweating,
malaise, anemia TYPHOID FEVER
 Mode of Transmission: Vector (female
 Causative Agent: Salmonella typhosa
Anopheles mosquito)
 Mode of Transmission: ingestion of
 Incubation Period: 7 days or longer
contaminated food or water with feces or
 Laboratory/Diagnostic Examination
urine of infected individuals
1. History of having been in a malaria
 Incubation Period: 7 to 14 days
endemic area: Palawan and Mindoro.
 Signs and Symptoms:
2. Blood smear Treatment:
1. Prodromal: headache, fever,
1. Chloroquine phosphate 250 mg--
ancrexia, lethargy, diarrhea,
all species except P. malariae
vomiting, abdominal pain
2. Sulfadoxine 50 mg-For resistant
2. 2. Fastigial: ladder-like curve of
P. falciparum
temperature, rose spots on trunks,
3. Primaquine-For relapse P. vivax
splenomegaly
and P. ovale
3. Defervescence: fever gradually
4. Pyrimethamine 25 mg/tab
subsides, onset of complications such
5. Quinine sulfate 300 mg/tab
as hemorrhage, peritonitis
6. Tetracycline HCl 250 mg/cap
Convalescence or Recovery stage
7. Quinidine sulfate 200 mg/durules
 Laboratory/Diagnostic Examination:
 Prevention and Control
Typhidot test
1. Mosquito control
 Treatment: Chloramphenicol
2. Chemical methods-use of insecticides
 Prevention and Control: sanitary
3. Biological methods-stream seeding
disposal of feces, practice hand washing,
4. Zooprophylaxis-larvae-eating fish,
avoid feces, fomites, flies, food, fluids (5
farm animals should be kept near the
Fs) that carry the infection,
house
immunization with Typhoid vaccine 0.5
5. Environmental methods-cleaning
ml per IM single dose at any age from 2
irrigating canals
years old up.
6. Protective screening of windows and
 Nursing Care: practice enteric
doors of houses
precaution and observe character of
7. Educational methods
stool for signs of bleeding
8. Mechanical methods-use of fly swats
or traps
DYSENTERY
9. Universal precaution
10. Screening of blood donors  Causative Agent: Shigella dysenteriae
 Mode of Transmission: ingestion of
FILARIASIS contaminated food or water
 Signs and Symptoms: High grade
 Causative Agent: Wuchereria
fever, colicky abdominal pain with
bancrofti, Brugia malayi
tenderness, diarrhea with straining,
 Mode of Transmission: Bite of
bloody mucoid stool
mosquito
 Incubation Period: 3-4 days
 Incubation Period: 8 to 16 months
 Laboratory/ Diagnostic Examination:
 Vector: Aedes poecilus, Culex
Stool examination
quinquefasciatus
 Treatment: Co-trimoxazole,
 Signs and Symptoms: chills, fever,
Chloramphenicol
myalgia, lymphangitis with gradual
 Prevention and Control: Safe water
thickening of the skin (commonly
supply, Handwashing
affecting limbs, scrotum) resulting in
 Nursing Care: monitor intake and
elephantiasis and hydrocele
output and observe for signs of
 Laboratory/Diagnostic Examination:
dehydration, rehydration by increasing
Circulating filarial antigen (CFA)-finger
fluid intake or drink Oresol.
prick
CHOLERA Communicability Period: 2 days
before to 4 days after onset of parotitis
 Causative Agent: Vibrio cholerae (El but range can be 7 days before to 15
Tor) days after onset.
 Mode of Transmission: ingestion of  Signs and Symptoms: acute onset of
contaminated food, water, or milk fever, painful swelling of the salivary or
 Incubation Period: 1 to 3 days parotid glands, headache; complications
 Signs and Symptoms: rapid explosive range from meningo-encephalitis to
watery stool and vomiting permanent hearing impairment and
 Laboratory/Diagnostic Examination: orchitis in post pubescent males, but
Stool Exam Treatment: Tetracycline, rarely sterility
Furazolidone  Laboratory/Diagnostic Examination:
 Prevention and Control: Boiling and isolation of virus from oral and throat
chlorination of water, sanitary disposal of spray, urine and cerebrospinal fluid
human waste, administer vaccine per Treatment: Supportive care
orem with a dosage of 1.5 ml at a  Prevention and Control: Mumps
minimum age of 12 months for 2 doses vaccine (MMR vaccine) given at 9 and 12
with 2 weeks interval months
 Nursing Care: Increase fluid intake,  *Nursing Care: apply warm and cold
administer oral rehydrating solutions compress for pain on affected area, strict
isolation, use of mask when handling
MEASLES patient, terminal disinfection, provide
oral care, and provide soft to semi-solid
 Causative Agent: Morbili virus that
food
belongs to the family paramyxoviridae
 Mode of Transmission: Airborne
RUBELLA OR GERMAN MEASLES
 Incubation Period: 8 to 20 days,
average of 10 days  Causative Agent: Rubella togaviridae
 Signs and Symptoms: acute onset of virus family
fever, rhinitis, conjuctivitis, bronchitis,  Mode of Transmission: Droplet and
excessive lacrimation, Koplik's spots direct contact with nasopharyngeal
(clustered white lesions) on the buccal secretions of infected person
mucosa, stomatitis, maculo papular  Incubation Period: 10 to 21 days
rashes that begin on the face and Signs and Symptoms: fever, headache,
become generalized; can progress into malaise, maculopapular rash, enlarged
severe complications, including post auricular occipital and posterior
pneumonia, encephalitis and death cervical lymphadenopathy, sore throat,
 Laboratory/Diagnostic Examination: rhinitis, conjunctivitis, bronchitis,
tissue culture of naso-pharyngeal forchheimer's spot (small red spots) on
secretions and serological testing the soft palate
 Treatment: supportive care, antibiotic if  Laboratory/Diagnostic Examination:
with complications like pneumonia serological testing Treatment: supportive
 Prevention and Control: administer care but for exposed pregnant woman in
measles vaccine (MMR vaccine) at the 1" trimester or 2nd trimester, serum
age of 9 and 12 months immune globulin is administered to
 *Nursing Care: administer antipyretic, protect the fetus.
provide eye, nasal and oral care, strict  Prevention and Control: Rubella
isolation, increase fluid intake. vaccine (MMR vaccine) at the age of 9
and 12 months
MUMPS  Nursing Care: administer antipyretic,
increase fluid intake, bed rest
 Causative Agent: Mumps virus from
paramyxovirus
CHICKEN POX
 Mode of Transmission: airborne or
droplets, or direct contact with saliva or  Causative Agent: Varicella Zoster Virus
infected person  Mode of Transmission: Direct and
 Incubation Period: 16 to 18 days, indirect contact with droplets from
range of 14 to 25 days respiratory passages or vesicle fluid
  Signs and Symptoms: Body malaise,  Prevention and Control: Proper
fever, itchy vesiculo-pustular lesions first disposal of feces, avoid using feces as
appearing on the chest and trunk fertilizer, handwashing, and proper
spreading to extremities washing of vegetables before
 Incubation Period: 14 to 16 days, consumption.
range 2 to 3 weeks Treatment:
Supportive care, anti-viral drugs ENTEROBIASIS
 Prevention and Control: Immunization
 Causative Agent: Enterobius
(Varivax) for 2 doses at 12 to 18 months
vermicularis or the human pinworm or
 Nursing Care: Antipyretic for fever,
seatworm
strict Isolation, handwashing, trim
 Mode of Transmission: Vehicle-
fingernails, daily bath
ingestion of contaminated food
 Incubation Period: 4 to 6 hours
POLIOMYELITIS
 Signs and Symptoms: perianal itching
 Causative Agent: Legio debilitans or disturbed sleep and nervousness,
polio virus irritability
 Mode of Transmission: Fecal-oral,  Laboratory/ Diagnostic Examination:
droplet scotch tape swab test in the perianal
 Incubation Period: 7 to 21 days Types region
and  Treatment: Mebendazole single dose
 Signs and Symptoms: repeated at 2nd week for effectivity
1. Abortive-fever, sore throat, low-  Prevention and Control: personal
lumbar backache/cervical stiffness on hygiene, handwashing, keeping
anteflexion of spine fingernails short
2. Non-paralytic-recurrence of fever,
poker spine, tightness and spasm of ANCYLOSTOSOMIASIS
hamstring hypersensitiveness of the
 Causative Agent: Ancylostoma
skin, deep reflexes are exaggerated
duodenale
3. Paralytic-with paralysis depending on
 Mode of Transmission: contact
part affected
 Incubation Period: 4 to 6 weeks
 Laboratory/Diagnostic Examination:
 Signs and Symptoms: dermatitis,
Blood and throat culture, stool
abdominal pain, anemia, mentally and
examination, lumbar tap
physically underdeveloped
 Treatment: Symptomatic and
 Laboratory/Diagnostic Examination:
supportive
Stool examination
 Prevention and Control: Proper
 Treatment: Mebendazole
disposal of fecal waste, hand washing,
 Prevention and Control: avoid walking
proper preparation of food, and
barefooted, and practice personal
iminunization of oral polio vaccine given
hygiene
for 3 doses starting at the age of 6
weeks with a dosage of 2 drops
SCHISTOMIASIS
 Nursing Care: enteric isolation, bed
rest, passive range of motion exercises  Causative Agent: Schistosoma
japonicum, S. mansoni, S. haematobium
ASCARIASIS  Vector: Oncomelania quadrasi (snail)
 Incubation Period: 2 months
 Causative Agent: Ascaris lumbricoides
 Mode of Transmission: indirect
(round worm)
contact
 Mode of Transmission: fecal-oral
 Signs and Symptoms: Rash at site of
 Incubation Period: 8 weeks
inoculation, enlargement of the
 Laboratory/Diagnostic Examination:
abdomen, diarrhea, body weakness
Stool examination
 Laboratory/Diagnostic Examination:
 Signs and Symptoms: abdominal pain,
Stool examination
and passing out of worms
 Treatment: Praziquantel (Biltricide),
 Treatment: Mebendazole or
Oxamniquine for S. mansoni and S.
Albendazole
haematobium
 Prevention and Control:
 1. Proper disposal of feces and urine 2. Encourage family to provide care and
2. Proper irrigation of all stagnant bodies company
of water 3. Darken room and observe silence.
3. Prevent exposure to contaminated 4. Give food if patient is hungry
water (wearing of rubber boots). 5. Keep water out of sight.
4. Eradication of breeding places of 6. Observe universal precaution, which
snails. are essentially wearing gloves.
5. Use of molluscides. 7. Wash hands frequently.
8. Remove oral and nasal secretions.
ZOONOSES 9. Dispose contaminated materials.
10. Perform terminal disinfection.
 WHO (2019) defines zoonoses as
 Post-exposure treatment for rabies
diseases and infections that are naturally
(for dog bites)
transmitted between vertebrate animals
1. Wash wound with soap and water
and humans. A zoonotic agent may be a
and seek consultation
bacterium, a virus, a fungus or other
2. Administer Anti-tetanus
communicable disease agent.
serum/tetanus anti toxin and suture
if severe wounds
RABIES
3. Observe dog for 10 days, if possible
 Causative Agent: Rhabdovirus for signs of rabies
 Mode of Transmission: Bite of rabid A. Recommended vaccines that provide
animal active immunity that is infiltrated in and
 Source: Saliva of infected animal or around the wound for the first dose of
human the vaccine.
 Incubation Period: 20 to 90 days for 1. PVCV (purified vero cell vaccine) =
humans, 1 week to 7.5 months for dogs 01 ml
 Signs and Symptoms: 2. PDEV (purified duck embryo vaccine)
A. Dog-at first withdrawn, change in = 0.2 ml
mood, shows nervousness and
apprehension, unusual salivation,  Site of Administration of Vaccine
paralysis starts on hind legs  Multisite Intramuscular (IM)
spreading towards entire body, Schedule (2-1-1)
death
Schedule/ Site and Route/ Dose
B. Human
1. Incubation period-flu-like Day 0/ Deltoid IM/ 2 doses
symptoms
2. Prodromal stage-headache, pain Day 7, 21/ Deltoid IM/ 1 dose
and numbness sensation at the
2-Site Intradermal Regimen
site of bite. depression, penile
erection or spontaneous  Schedule/Site and Route/Dose
ejaculation for males
3. Acute neurologic phase Day 0 / Deltoid, ID / 2 doses
a. Spastic-anxiety, confusion,
Day 3 / Deltoid, ID / 2 doses
insomnia
b. Dementia-intense Day 7 / Deltoid, ID / 2 doses
excitement, difficulty in
breathing, swallowing, Day 30 / Deltoid, ID / 2 doses
drooling, hydrophobia
c. Paralytic-flaccid ascending B. Recommended immunoglobulins that
symmetric paralysis, coma, provide passive immunity administered
death IM route distant from the site of vaccine
 Laboratory/Diagnostic Examination: inoculation. The vaccine is given for a
Post mortem direct fluorescent antibody single dose a Day 0 based on the weight
staining test of the individual. It is administered at the
 Nursing Management: deltoid or anterolateral region.
1. Isolate patient. 1. Equine rabies = KBW x 0.2 ml
2. Human rabies = KBW x 0.133 ml
 the body from the neck down to the feet
 Prevention and Control: Pre-exposure and toes.
prophylactic treatment is given for high-  Prevention and Control: Laundry and
risk individuals like laboratory iron soiled clothes, practice personal
technicians, and veterinarians hygiene, terminal disinfection
 *Nursing Care: Contact isolation
LEPTOSPIROSIS
ANTHRAX
 Causative Agent: Leptospira
interrogans (bacteria)  Causative Agent: Bacillus anthracis
 Mode of Transmission: Inoculation  Mode of transmission and Signs and
into broken skin, mucous membrane or Symptoms:
ingestion of contaminated food and 1. Cutaneous (skin) anthrax-handling
water with urine of animals sick animals or contaminated animal
 Source of Infection: urine of rodents, wool, hair, hides, or bone meal
pet animals, and farm animals products.
 Incubation Period: 7 to 13 days 2. Inhalational anthrax-breathing
 Signs and Symptoms anthrax spores into the
1. Sepsis Stage-High fever, 4 to 7 days, lungs/woolsorter's disease
calf pain, abdominal pain 3. Gastrointestinal anthrax-meat
2. Immune/Toxic Stage products that contain anthrax
a. Anicteric Stage-disorientation Gastrointestinal anthrax is difficult to
b. Icteric Stage-jaundice diagnose. It can produce sores in the
3. Convalescence-symptoms will mouth and throat. A person who has
disappear but relapse may occur 4th eaten contaminated products may
5th weeks feel throat pain or have difficulty
swallowing.
 Laboratory/Diagnostic Examination:  Laboratory/Diagnostic Examination:
1. Blood/Urine culture done on the 1" Gram staining (+)
week  Treatment: Formaldehyde,
2. Leptospira Agglutination test (LAT) fluoroquinolones, ciprofloxacin
done on the 2nd to 3rd week  Prevention and Control: BioThrax,
 Treatment: Penicillin or Tetracycline, although it is commonly called Anthrax
Doxycycline Vaccine Adsorbed (AVA)
 Prevention and Control: Eradication
of rodents, avoid wading in flood water SEXUALLY TRANSMITTED INFECTIONS
 Nursing Care: symptomatic care, (STI)
increase fluid intake
 4Cs in Syndromic Case Management
for STI:
SCABIES
1. Compliance of clients in the
 Causative Agent: Itch mite, Sarcoptes treatment, prevention and successful
scabiei recommendation for preventing
 Mode of Transmission: prolong skin to recurrence of disease
skin contact with infected humans or 2. Counseling and education on the
indirect contact with infested linens or nature of the disease, signs and
clothing symptoms, management, and
 Incubation Period: 4 to 8 weeks prevention
 Signs and Symptoms: itchy papulo- 3. Contact tracing facilitates the
vesicular eruptions on warm folds and process of partner treatment to
areas of friction of the body prevent the spread of the disease
 Laboratory/Diagnostic Examination: 4. Condom use and promoting them to
scraping the skin off burrow, ink test, risk individuals to reduce the chance
mineral oil or fluorescence tetracycline of acquiring the disease.
test
 Treatment: permethrin cream or GONORRHEA
scabicide lotion applied to all areas of
 Causative Agent: Neisseria
gonorrhoeae
  Mode of Transmission: Sexual contact  Laboratory/Diagnostic Examination:
 Incubation Period: 2 10 7 days Culture & Nucleic acid amplification test
 Signs and Symptoms: Thick purulent (NAAT) of urine or swab samples
urethral discharge frequency of urination  Treatment: Doxycycline, Azithromycin
among females, burning urination single dose
among males/ females  Prevention and Control: safe sexual p
 Laboratory/Diagnostic Examination: test pregnant women practices,
Culture of specimen in cervix-female,
Gram stain-male GENITALS HERPES
 Treatment: Ceftriaxone
 Causative Agent: Herpes simplex virus
 Prevention and Control: for adults
(HSV) types 1 and 2
avoid contact with secretions, practice
 Mode of Transmission: direct contact
monogamous sexual contact, for
with infected skin and mucous
newborn babies of infected women who
membranes, childbirth
gave birth via vaginal delivery apply
 Incubation Period: 2 to 12 days
Crede's prophylaxis through
 Period of Communicability: during
administration of tetracycline eye
and up to 7 weeks after primary lesions
ointment
appear
 Signs and Symptoms: localized
SPYHILIS
vesicular lesions at area of contact but
 Causative Agent: Treponema pallidum may spread to surrounding tissues or
 Mode of Transmission: Sexual contact disseminated in body
 Incubation Period: 10-90 days  Laboratory/Diagnostic Examination:
 Types and Signs and Symptoms:  serological test, isolation of virus from
1. Primary-chancre that appears within lesions or tissues, biopsy specimens
3 weeks at area of contact  Treatment: antiviral agents
2. Secondary-condylomata, throat,  Prevention and Control: safe sexual
mucous patches of the mouth, practices, cesarean delivery if lesions
macupapular rash sore are present during late pregnancy
3. Tertiary-gumma formation,
cardiovascular and nervous system GENITAL WARTS
involvement
 Causative Agent: Human Papilloma
 Laboratory/Diagnostic Examination:
Virus with 100 types
Darkfield illumination test, venereal
 Mode of Transmission: direct contact
disease research laboratory (VDRL) test,
with infected skin and mucous
Fluorescent treponemal antibody test
membranes, childbirth
 Treatment: Penicillin tetracycline,
 Incubation Period: 2 to 3 months,
erythromycin
range 1 to 20 months
 Prevention and Control: Practice
 Period of Communicability: as long as
monogamy, Sex education
lesions persist
 Signs and Symptoms: circumscribed
CHLAMYDIA
lesions in cervix, vulva, anus, penis,
 Causative Agent: Chlamydia vagina, oropharynx that may be varying
trachomatis in sizes
 Mode of Transmission: sexual contact,  Laboratory/Diagnostic Examination:
or contact with exudates from mucous visualization of lesion, excision and
membranes, childbirth histological exam of lesion
 Incubation period: 7-14 days  Treatment: removal of warts by
 Signs and Symptoms: urethritis with freezing with liquid nitrogen
purulent discharge from anterior urethra  Prevention and Control: HPV vaccine
(males), mucopurulent cervicitis often for individuals 11-12 years old, and safe
asymptomatic (females) that may lead sexual practices
to endometritis, salphingitis and pelvic
peritonitis HUMAN IMMUNODEFICIENCY VIRUS/
ACQUIRED IMMUNO DEFICIENCY
SYNDROME
 Causative Agent: HIV 1 and 2 c. Follow correct and consistent use
 Mode of Transmission: Sexual contact, of condoms.
blood transfusion, contaminated 3. Mother-to-child transmission. For
syringes, needles, nipper, blades, direct HIV+ mothers, consult with health
contact of open wounds/ mucous workers to have access to care,
membranes with contaminated blood, treatment, and support to services
body fluids, semen, and vaginal during pregnancy, labor and delivery,
discharges and postpartum.
 Incubation Period: varies from 3-6 4. PrEP or Pre-Exposure Prophylaxis for
months to many years (8-10 yrs.) people with a high risk of acquiring
 Signs and Symptoms HIV by taking the drug Truvada
1. Clinical stage 1-persistent
generalized lymphadenopathy HIV/AIDS CONTROL AND PREVENTION
2. Clinical stage II-weight loss of <10% ACT OF 2018 (REPUBLIC ACT 11166)
of body weight, minor
mucocutaneous manifestations,  Signed into law by the President on
herpes zoster within the last five December 2018 almost twenty years
years, recurrent upper respiratory since the first law for AIDS (RA 8504 of
tract infections 1998) was implemented in the
3. Clinical stage III-weight loss >10% of Philippines
body weight, unexplained chronic
Salient Features:
diarrhea for > 1month, unexplained
prolonged fever for >1 month, oral  Intensified campaign on prevention and
candidiasis, oral hairy leukoplakia, control of HIV/AIDS specifically on sexual
pulmonary tuberculosis within the transmission
past year, severe bacterial infections  Expanded access to diagnosis and
4. Clinical stage IV-pneumocystic carini treatment for HIV/AIDS
pnemonia, toxoplasmosis of brain,  Inclusion of HIV/AIDS treatment in the
herpes simplex virus infection, Universal Health Care platform of the
kaposis sarcoma, Extrapulmonary country thru PhilHealth
tuberculosis, lymphoma  Penalty for discrimination of People
Living with HIV (PLHIV)
 Acquired immunodeficiency syndrome  Minors can undergo testing for HIV
(AIDS) is a term which applies to the without parental or guardian consent (In
most advanced stages of HIV infection. It 2018, 62% of new cases are among
is defined by the occurrence of any of youth population according to WHO)
more than 20 opportunistic infections or
HIV-related cancers (WHO, 2018). EMERGING INFECTIOUS DISEASES

 Laboratory/Diagnostic Examination:
1. Enzyme Linked Immuno Sorbent SEVERE ACUTE RESPIRATORY
Assay (ELISA)-presumptive test SYNDROME (SARS)
2. Western blot-confirmatory test  Causative Agent: Human Corona Virus
 Treatment: Antiretroviral drugs that  Mode of Transmission:
suppress the virus Airborne/Droplet
 Prevention and Control:  Incubation period: 2-10 days
1. Blood and blood products  Signs and Symptoms: Prodromal-high
a. Screen blood donors. fever, chill, malaise, myalgia, headache,
b. Observe universal precaution. diarrhea
c. Refrain from using contaminated Respiratory-dry non-productive cough
needles and syringes.  Laboratory/Diagnostic Examination:
2. Sexual transmission real time Polymerase Chain
a. Abstain from promiscuous sexual Reaction (PCR) of genome fragments or
contact. cultured virus (respiratory, stool, urine),
b. Be faithful to your partner and X-ray (infiltration)
practice monogamous sexual
contact.
  Prevention and Control: identification  Treatment: neuraminidase inhibitor like
and isolation of patients, 10 days home oseltamivir and zanamivir can reduce
quarantine for exposed individuals the duration of viral replication and
improve prospects of survival
MERS-COV  Prevention and Control: Hand
washing, respiratory hygiene, avoid
 Causative Agent: Middle East close contact with sick people
Respiratory Syndrome Corona Virus
(zoonotic virus)
HAND, FOOT, AND MOUTH DISEASE
 Mode of Transmission: direct or
(HFMD)
indirect contact with camels, bats, goats,
cow  Causative Agent: Enterovirus or
 Incubation Period: 14 days Coxsackievirus
 Signs and Symptoms: fever, cough,  Mode of Transmission: direct contact,
shortness of breath, Pneumonia droplet, contact with fecal matter of an
(common but not always present), GI infected person
(diarrhea), nausea and vomiting, kidney  Incubation Period: 1 to 3 days from
failure contact
 Laboratory/Diagnostic Examination:  Signs and Symptoms: common among
Polymerase Chain Reaction Testing children under five years old, flu like
(PCR-RT) with presence of antibodies in manifestations, fever, sore throat,
blood 10 days after onset of symptoms eruption of mouth sores (red spots and
 Treatment: supportive Prevention and blisters), skin rash over palms of the
Control: avoid contact with animals or hands and on the soles of the feet
sick animals especially DM, Renal failure,  Laboratory/Diagnostic Examination:
lung disease, immunocompromised, throat swab and stool exam
hand washing before and after touching  Treatment: Supportive care,
animals, avoid consumption of raw or symptomatic management, increase
undercooked animal products (high risk), fluid intake
seek immediate medical attention if an  Prevention and Control: Hand
acute respiratory illness with fever hygiene, avoid touching eyes, nose, and
appears 14 days returning from travel mouth

AVIAN FLU CORONAVIRUS DIESEA 2019 (COVID-

19)
 Causative Agent: A(H5N1) virus and
A(H7N9) virus  Causative Agent: Severe Acute
 Mode of Transmission: direct or Respiratory Syndrome Coronavirus 2
indirect exposure to infected live or dead (SARS-CoV-2)
poultry or contaminated environments,  Mode of Transmission: Droplet when a
such as live bird markets. Slaughtering, person speaks, coughs, sneezes, and
defeathering, handling carcasses of when you are in close contact (less than
infected poultry, and preparing poultry 1 meter away) with a symptomatic
for consumption WHO(2019). patient or by contact with contaminated
 Incubation Period: 2 to 5 days and objects.
ranging up to 17 days for A(H5N1) and 1  Incubation Period: 5-6 days (average)
to 10 days for A(H7N9) up-to 14 days
 Signs and Symptoms: mild upper  Signs and Symptoms: Mainly fever,
respiratory infection (fever and cough) to sore throat, tiredness, nasal congestion,
rapid progression to severe pneumonia, dry cough and at times diarrhea. Severe
acute respiratory distress syndrome, cases exhibit acute shortness of
shock and even death. Gastrointestinal breathing
symptoms such as nausea, vomiting and  Laboratory/Diagnostic Examination:
diarrhea have been reported more Reverse Transcription Polymerase Chain
frequently in A(H5N1) infection. Reaction (RT-PCR)
 Laboratory/Diagnostic Examination:  Treatment: No specific treatment yet
Polymerase Chain Reaction (PCR) tests (under investigation as of this writing)
  Prevention and Control: Hand C. A patient with severe acute respiratory
hygiene, respiratory etiquette, avoid infection (fever and at least one
touching face and mouth, observe sign/symptom of respiratory disease
social/physical distancing (at least 1 (e.g., cough, shortness breath) AND
meter or 3 feet away), and wearing of requiring hospitalization AND with no
face mask (optional) other etiology that fully explains the
 Coronavirus Disease 2019, abbreviated clinical presentation.
as COVID-19, is an acute respiratory
infection caused by a new coronavirus PROBABLE CASE
which was first identified in Wuhan,
China. Formerly, this disease was  A suspect case for whom testing for
referred to as 2019 novel coronavirus or COVID-19 is inconclusive.
2019-nCoV (World Health Organization,  Inconclusive being the result of the test
2020). Although it belongs to a large reported by the laboratory
family of viruses, the etiological agent is
associated with the coronavirus that CONFIRMED CASE
caused an outbreak of severe acute
 A person with laboratory confirmation of
respiratory syndrome (SARS) in 2002-
COVID-19 infection, irrespective of
2003.
clinical signs and symptoms.
 Possibly a zoonotic disease, COVID-19 is
considered to have begun from wildlife
WEEK 12: THE FIELD HEALTH SERVICE
species being sold at the Huanan
INFORMATION SYSTEM (FHSIS)
Wholesale Seafood Market in Wuhan. On
January 2020, China has confirmed that  The Field Health Service Information
person-to-person transmission from this System (FHSIS) is a major component of
virus is possible via droplets and fomites the network information sources
during close unprotected contact (WHO- developed by the Department of Health
China Joint Commission, 2020). Although (DOH)to enable it to better manage in
fecal shedding has also been identified nationwide health service delivery
from some patients, its primary role and activities.
significance for COVID-19 transmission  The FHSIS is intended to address the
remains to be determined. short term data needs of DOH staff with
 The disease causes symptoms 2 14 days managerial/ supervisory functions in
after exposure and may range from mild DOH facilities and in each of the
to severe forms of fever, cough, and program areas.
shortness of breath (Centers for Disease
Control 2020). The case definition for WHAT IS THE FIELD HEALTH SEVICE
COVID-19 from the World Health INFORMATION (FHSIS)?
Organization (situation report 49) are as
 It is a network of information.
follows:
 It is intended to address the short term
needs of DOH and LGU staff with
SUSPECT CASE managerial or supervisory functions in
A. A patient with acute respiratory illness facilities and program areas.
(fever and at least one sign/symptom of  It monitor health service delivery
respiratory disease (e.g., cough, nationwide.
shortness of breath), AND with no other
etiology that fully explains the clinical WHAT ARE THE OBJECTIVES FIRLS
presentation AND a history of travel to or HEALTH SERVICE IFORMATION SYSTEM
residence in a country/area or territory (FHSIS)?
reporting local transmission of COVID-19
1. To provide summary data on health
disease during the 14 days prior to
service delivery and selected program
symptom onset; or
accomplishment indicators at the
B. A patient with any acute respiratory
barangay, municipality, district,
illness AND having been in contact with
provincial, regional and national levels.
a confirmed or probable COVID-19 case
2. To provide data which when combined
(see definition of contact) in the last 14
with data from other sources, can be
days prior to onset of symptoms; or
 used for program monitoring and bond paper which bares the following
evaluation purposes. information: date, name, address of
3. To provide a standardized, facility-level patient, height, weight, chief complaint
data base which can be accessed for and presenting signs and symptom, the
more in-depth studies. diagnosis (if available), treatment and
4. To minimize the recording and reporting date of treatment of each family
burden at the service delivery level in member who consulted in the health
order to allow more time for patient care center.
and promotive activities.
SAMPLE OF ITR:
COMPONENTS OF THE FHSISI

RECORDING TOOLS
1. Individual/Family Treatment Records;
2. Target/Client Lists;
3. Reporting Forms; and
4. Output Reports,

IMPORTANCE OF THE FHSIS

 Helps local government determine public

health priorities.
 Basis for monitoring and evaluating
health program implementation.
 Basis for planning, budgeting, logistics,
and decision making at all levels.
 Source of data to detect unusual
occurrence of a disease.
 Needed to monitor health status of the
community.
 Helps midwives in following up clients.
 Documentation of RHM/PHN day to day
activities.

THE FHSIS HAS ITS FOCUS THE

PROGRAMS OF THE DOH PUBLIC
SERVICES (PHS), NAMELY:

 Maternal and Child (MCH);

 Expanded Program on Immunization
(EPI);
 Control of Diarrheal Diseases (CDD);
 Nutrition;
 Family Planning ;
 Maternal Care;
 The Tuberculosis, Malaria,
Schistosomiasis, and Leprosy Control
progress;
 Dental Health
 Environmental Health

A. RECORDING AND REPORTING

TOOLS
1. Individual Treatment Record (ITR)
This tool serves as the foundation or
primary building block of FHSIS. It is a
basic patient consultation record or a
 2. Target/Client Lists
 The Target/Client Lists is the
second “building block” of the
FHSIS and are intended to serve
several purposes.

PURPOSE:

 It helps nurse/midwife plan and carry out

patient care and service delivery. It
reflects the list of “target” or eligible
clients for a particular health program
 It facilitates the monitoring and
supervision of service delivery activities.
 It reports services delivered.
 It provide a clinic-level data for
population- based further studies/
research

THE TCL TO BE MAINTAINED IN THE

FHSIS VERSION 2008 ARE AS
FOLLOWS:
 Target Client List for Prenatal Care
 Target Client List for Post-Partum Care
 Target Client List of Under 1 Year Old
Children
 Target Client List for Family Planning
 Target Client List for Sick Children
 NTP TB Register (same as program)
 National Leprosy Control Program Form
2-Central Registration Form (same as
program)
 3.2MORBIDITY DISEASE
 The midwife in the BHS accomplish this
table on a monthly basis.
 This summary table can also be the
source of ten leading causes of morbidity
for the municipality/city.
 This summary table will help the nurse
and MHO to get the monthly trend
disease.

4. THE MONTHLY CONSOLIDATION

TABLE (MCT)
 The Consolidation Table is an essential
form in the FHSIS where the nurse at the
RHU records the reported data per
indicator by each PHN or midwife.
 The Consolidation Table shall serve as
the Output Table of the RHU as it already
3. SUMMARY TABLE contains listing of BHS per indicator by
 The Summary Table is a form with each barangay health station.
12-month columns filled up on a  This is the source document of the nurse
monthly basis to a tally the number for the Quarterly form.
of clients in the barangay health
facilities in terms of health program
accomplishments and morbidity/
diseases.
 The Summary Table is composed of :
(1) Health Program Accomplishment
(2) Morbidity Disease

3.1HEALTH PROGRAM
ACCOMPLISHMENT
 The midwife records on this
summary table all the data that
are found in the TCL.
 This summary table is an easy
source of data for reports being
prepared by the midwife.
 This also serves as the data
source for any survey, special
study, or research that may
include the facility.
 Most importantly, this can serve
as a tool for the midwife to assess
her own accomplishments.
C.FLOW REPORT