Week 14: Community Health Laws and Programs • Breastfeeding

Maternity Health Program EO 51 RA 7600

• Concerns family health First was EO 51, known as the Milk Code in 1986. And then RA
7600, known as the Rooming-in Law in 1992. This primarily
RH Law RA 10354 of 2012
mandated that a baby be roomed in with the mother
• mandates the Philippine government to immediately after birth, to promote breastfeeding.
comprehensively address the needs of Filipino
• NBS (RA 9288 2004)
citizens when it comes to responsible parenthood and
reproductive health. Done 48 hrs. up to 2 weeks

Family Planning Counseling (RH Law RA 10354 of 2012)

1. Antenatal Registration or Visits • Reduced infant death

• Reduced neonatal death
1st visit – as early as possible
• Reduced under five-year-old deaths
2nd visit – 2nd Trimester • Reduced maternal death

3rd visit – 3rd Trimester Family Planning Contraception Methods

After 3 rd trimester visit every 2 weeks until 8 months to • Bilateral Tubal Ligation (BTL)
delivery. - is a surgical procedure that involves blocking the
fallopian tubes to prevent the ovum (egg) from being
fertilized. (PERMANENT)
2. Tetanus Toxoid (EPI Law 1979 or RA 10152 of 2011) • Male Sterilization (Vasectomy)
- is a form of male birth control that cuts the supply of
Protection Duration
sperm to your semen. (PERMANENT)
TT 1 – as early as possible • Pill
• Condom
TT 2 – 4 weeks 80% protection 3 yrs
• Injectable
TT 3 – 6 months 95% protection 5 years - Effects of 3 months
• Lactation amenorrhea method (LAM)
TT 4 – 1 year 99% protection 10 years - is a way for breastfeeding to temporarily help prevent
TT 5 – 1 year 99% protection Lifetime pregnancy. It must be used correctly to work.
Lactation means your body is making breastmilk and
amenorrhea means you aren't having a monthly
period. Breastfeeding hormones may stop your body
3. Micronutrient Supplementation (RA 8976)
from releasing eggs.
Vitamin A 10,000 IU 2x a week starting at the 4th month of • Mucus / Billings Method
pregnancy - is a method in which women use their vaginal mucus
to determine their fertility.
Iron / Folic Acid 60mg / 400 tablet given daily and it starts 5
• Basal Body Temperature (BBT)
months and 2 months of postpartum
- is defined as the lowest natural, non-pathologic body
4. Clean and Safe Delivery (RA 10354) temperature recorded after a period of rest. Women
5. Health Teachings have used charting average basal body temperatures
• Birth Registration over the length of a menstrual period has been a tool
to determine if ovulation has occurred or not.
At least 30 days (PD 651 - 1975)
• Sympto-thermal method
- is a combination of methods. The two most
commonly used are the BBT method and the cervical
mucus method. The Marquette method combines
 BBT and cervical mucus tracking with use of an Toilets Facility
electronic hormonal fertility monitor. The monitor
Level 1 – Non water carriage toilet facility
detects hormones in urine to confirm fertile days.
• The Standard Days Method (SDM) Level 2 – Water carriage
- is a fertility awareness-based family planning method
- flush type = septic tank
that identifies a 12-day fertile window during which
women with regular menstrual cycles (26–32 days Level 3 – Water carriage
long) should abstain from sex or use a barrier method
to prevent pregnancy. - sewage = treatment plant

Infant and Young Child Programs RA 7719 National Blood Services Act of 1994

EO 51 – Milk Code Requirements:

RA 7600 – Rooming-in Law • Must weigh more than 45 kg (100 lbs.) for 250 ml of
donated blood
First was EO 51, known as the Milk Code in 1986. And then RA • Good health
7600, known as the Rooming-in Law in 1992. This primarily • 16 – 65 yrs old
mandated that a baby be roomed in with the mother • Below 120 / 80
immediately after birth, to promote breastfeeding.

RA 8976 - THE PHILIPPINE FOOD FORTIFICATION ACT OF 2000

BB Botika ng Barangay
PD 996 – EPI Law
Criteria:

• Community Organization
Environmental and Sanitation Laws
• Poor
PD 856 Sanitation Code of the Philippines • Funds (community /LGU)
• Pharmacist
Level 1 – protected well (15 – 25 households)
• BHW
250 meters away from the furthers house • Space

40 – 140 L/min Medicinal Plants

Rural Areas S = ambong – anti - urolithiasis

Level 2 – Communal Faucet System (Stand Posts) A = kapulko – skin diseases

40 – 80 L/m per day N = iyog niyogan = ascaris

100 households T = saang gubat – stomach ache

1 faucet = 4-6 households A = mpalaya - diabetes

Level 3 – NAWASA, Maynilad L = agundi – cough/asthma

Waterworks System U = lasimang bato – uric acid

B = awang – low cholesterol

Y = erba Buena – body pains

Week 15: Culture and the Community Trends in Public Health: National and Global

Culture set of beliefs, values, and assumptions about life; Trends in Community Health and Community Health Nursing
widely held among group of people; transmitted Practice (Maglaya, 2009)
intergenerationally

Values are abstract rules people apply to many life

1. Health Promotion / Healthy Lifestyle Directions &
experiences. These are personal ideas people hold on to as
Challenges
truth and are related to past experiences.
Rationale/Bases:
Beliefs are assumptions people hold as true and are not related
to learned experiences. - Rapid rise of NCD/CVD, CA, Diabetes, Kidney problem
and COPD\
What is it with Filipinos?
Challenges:
• Tiyaga
• Lakas ng loob - Health Promotion Strategy
• Tatawanan ang problema
Creative Options and Initiatives
• Bahala na
• Interventions to address challenges/ issues on
Health and Culture
poverty and health
• Self care concepts • Development of healthy settings
• “’Tanong sa mga matatanda”
• “Balanse”
• “Init-lamig” = sakit 2. Acute Care / Illness Care Increasingly Being Delivered
• Warm = healthy in Home / Community Setting

Rationale/ Bases:
• Belief in Mystical Causes
• Belief in Naturalistic Causes - Early hospital Discharges due to increasing cost of
• Belief in Personalistic Causes hospital care / services, insurance requirements. Etc.
- Increasing burden of chronic and palliative care
Common Superstitions - By 2010 in the USA, 70 % to 80 % illness care will be
• “laway at sinok” in home setting
• “usog” Challenges / Creative Options
• “basang buhok tulog at pagkabulag”
• “pasma” - Expertise / Competence in Specific Areas in Acute
• “pawis at pneumonia” Care in Home Setting
• “di na lalaki” - Case Management as nucleus of continuum of care
• “kulugo” with the nurse case manager as orchestrator of
services
• “asin at bahay”
- Nurse role varies from monitoring long -term needs to
managing current episode of care
- Effective use of two-way referral system
- Enhance potential of families on acute / illness on
palliative care or reduce burden
 3. Focus on Care of Population Aggregates to Promote
Healthy Transitions
3. Global Influenza Pandemic
Rationale/Basis
153 institutions in 114 countries are involved in global
Population shift leads to surveillance, response of WHO monitoring of influenza viruses
to detect potential pandemic strains.
- Increasing health problem among elders, ethnic and
marginalized group 4. Fragile and Vulnerable Settings
- Emphasis on child, adolescent, reproductive / - Protracted crises (through a combination of
women's – health challenges such as drought, famine, conflict, and
- Increasing scope, magnitude and impact of disaster population displacement) and weak health services
around the world leave people living in these areas without access to
basic care.
Challenges / Creative Options
- Strengthen health systems
- 1) Expertise / Competence on use of epidemiologic 5. Antimicrobial Resistance
Approach to care for population group - rifampicin-resistant TB (RR-TB)
- Work / Group Approach - multi-drug-resistant TB (MDR-TB)
- Expertise / competence on Disaster - fluoroquinolone antibiotics in E. coli, for treatment of
- Promoting equity to access needed health and social UTI
services - methicillin-resistant Staphylococcus aureus (MRSA)
- Use of "Human Becoming "Approach. - N. gonorrhoeae - resistance to sulphonamides,
penicillin, tetracyclines, macrolides,
fluoroquinolones, and early generation
10 Threats to Global Health (WHO, 2019) cephalosporins.
- injectable extended-spectrum cephalosporin (ESC)
1. Air Pollution and Climate Change ceftriaxone - remaining monotherapy for gonorrhea.
- Malaria has partial resistance to artemisinin and
Air pollution is greatest environmental risk to health (WHO).
resistance to a number of ACT drugs
Microscopic pollutants in air penetrate respiratory &
circulatory systems, damaging the lungs, heart & brain - Candida auris, a fungal infections has resistance to
fluconazole, amphotericin B & voriconazole as well as
Burning fossil fuels - primary cause of air pollution; major emerging caspofungin resistance.
contributor to climate change.
Leads to:
90% of these deaths are in low- and middle-income countries.
- prolonged hospital stays
with high volumes of emissions from industry, transport and
agriculture, as well as dirty cookstoves and fuels in homes. - more expensive
2. Noncommunicable Diseases - intensive care
- 70% of all deaths worldwide
- 15 million people dying prematurely, aged between - compromise surgery and chemotherapy.
30 and 69. - risky: Medical procedures, such as surgery, including
- 5 major risk factors: tobacco, physical inactivity, use of caesarean sections or hip replacements, cancer chemotherapy,
alcohol, unhealthy diets & air pollution. organ transplantation,
- Risk factors exacerbate mental health issues
- Environmental factors linked to urbanization that 6. Ebola & other high-threat pathogens
discourage people from becoming more active, such
- WHO's R&D Blueprint identifies diseases and pathogens that
as:
have potential
- fear of violence and crime in outdoor areas
- high-density traffic - watchlist priority R&D: Ebola, several other hemorrhagic
- low air quality, pollution fevers, Zika, Nipah, MERS-CoV and SARS & disease X
- lack of parks, sidewalks & sports/recreation facilities
 7. Weak Primary Health Care 9. Conduct research with an experienced researcher.
10. Engage in lifelong learning with a passion to keep
Neglect are d/t:
current with national and global developments in
- lack of resources in low- or middle-income general, and nursing and health developments in
countries particular.
- October 2018, renew commitment to primary 11. Demonstrate responsible citizenship and pride in
health care made in Alma-Ata declaration (by being a Filipino
WHO in Astana, Kazakhstan) 12. Apply techno-intelligent care systems and processes
in health care delivery.
8. Vaccine hesitancy 13. Uphold the nursing core values in the practice of the
profession.
Why people choose not to vaccinate: 14. Apply entrepreneurial skills in the delivery of nursing
- complacency care.
- inconvenience in accessing vaccines
- lack of confidence

Health workers remain most trusted advisor. Influencer of

vaccination decisions.

9. Dengue
10. HIV

Challenge:

Reaching people like sex workers, people in prison, men who

have sex with men, or transgender people

Young girls, women (aged 15-24) - high risk and account for 1
in 4 HIV infections in sub-Saharan Africa - group increasingly
affected by HIV

Nursing Competency includes core abilities that are requires

for fulfilling one’s role as a nurse

14 Nursing Competency

1. Apply knowledge of physical, social, natural and

health sciences and humanities in the practice of
nursing.
2. Perform safe, appropriate and holistic care to
individuals, families, population, groups and
community utilizing nursing process.
3. Apply guidelines and principles of evidence-based
practice in the delivery of care.
4. Practice nursing in accordance with existing laws,
legal, ethical and moral principles.
5. Communicate effectively in speaking, writing and
presenting using culturally-appropriate language.
6. Report/document client care accurately and
comprehensively.
7. Collaborate effectively with inter-, intra- and multi-
disciplinary and multicultural teams.
8. Practice beginning management and leadership skills
using system approach in the delivery of client care.
Week 16: Information Technology and Community Health EHEALTH SITUATIONS IN THE PHILIPPINES

Ehealth 1. In 2001, 2.5% had internet access

➢ Use of ICT for health ✓ In 10years, to 29% cellphone rate of

80%, 73MILLION subscribers (2009)

✓ RANKED 1ST IN SMS USE WORLDWIDE

➢ The use of technologies to enhance communication
and furthering goals in healthcare

2. 70% population in rural – NO OR LIMITED

ACCESS QUALITY IN PATIENT/OUTPATIENT
➢ But when using ICT or TECHNOLOGIES we must
CARESERVICES
remember the effectiveness of its use IS ALWAYS
REQUIRED KNOWLEDGE

✓ HEALTH DEMOGRAPHICS – segmented

distribution (kalat kalat ang health
➢ RECOGNIZED BY WHO (world health organization) as
facilites at kalat kalat din ang health care
cost effective way of using ICT in
providers) that’s why 13% healthcare
• HEALTH CARE SERVICES providers, 40% tertiary hospitals –
situated in non-urban areas; average
• HEALTH SURVEILLANCE travel to local health facility is 39
MINUTES (DAPAT 15 MINUTES AWAY!!!)
• HEALTH LITERATURE

• HEALTH EDUCATION & RESEARCH

3. MOBILE TECHNOLOGIES and AVAILABILITY OF
INTERNET SRVICE in country, DOH introduced
POWER OF DATA AND INFORMATION health information systems

1. CONTINUITY OF INTEROPERABILITY of care stops ✓ AIM IS TO IMPROVE ACCESS OF HEALTH

unlikely events that record gets misplaced DATA

• WHY WE USE ICT? because we need good

records
E-HEALTH IN THE COMMUNITY
• And our goal is to have ONE RECORD, ONE
1. THE UNIVERSAL HEALTH CARE and ICT
PERSON for all institutions
• Known as the KALUSUGANG
2. ILLEGIBLE HANDWRITTING poses misinterpretation
PANGKAHALATAN (KP) aims to attain effiency
of data
by using IT in all agencies of HEALTH CARE…
3. PATIENT PRIVACY is compromised according to literature and studies more than
60% health gastos are comes from our own
4. DATA ARE DIFFICULT to aggregate
pocket that’s why we have KALUSUGANG
5. ACTUAL TIME for patient care gets limited PANGKAHALATAN aims to address that

• Why? Because when your paper-records most of time THREE PRIORITY HEALTH DIRECTIONS OF KP
kinakain yung oras mo but if we apply ICT/NEW
• 1. Financial risk protection
TECHNOLOGIES it actually increase the actual time of
patient care • 2. Improved access to quality hospital and
health care facility

• 3. Attainment of health related MDG

 2. TELEMEDICINE 1. DRILL AND PRACTICE

• Have been used to delivered health • FOR EXAMPLE : you saw a picture 30-
services using electronic technology to 50times then what will happened? You will
patient at a distant place memorized whats in the picture even the
smallest details, so that is DRILL AND
PRACTICE approach
• ONE OF THE FIVE GOALS OF THE DOH’S
• GOOD AND THE BEST FOR MEMORIZATIONS
National ehealth STRATEGIC FRAMEWORK
FOR 2010 is to CAPITALIZE ON ICT (2016).
Aimed to provide better health services to
2. TUTORIAL
geographically isolated and disadvantages
areas (GIDAS), so how will they do that,
PHONES!
• The GOAL is to designed and impart
informations to the learners
FOUR ELEMENTS OF TELEMEDICINES (WHO) • INFORMATION IS GOING TO BE FEED!
1. Purpose is to provide clinical support

2. Overcome geographical barriers, connect users not 3. STIMULATIONS

in same physical locations
• The objective is to make the learner an
3. Involves use of various types of ICT actual participant in a situation
4. Goal is to improve health outcomes • this what we do in our RLE

ELECTRONIC MEDICAL RECORD (EMR) 4. INSTRUCTIONAL GAMES

➢ It is a COLLECTION OF MEDICAL INFORMATION • Increase motivation
ABOUT A PERSON that is stored on computer
• Improved psychomotor skills

➢ EMR replaces the paper version of patient’s

medical history (in KALUSUGANG 5. EXAMINATIONS
PANGKAHALATAN KP is very importatant
because we need to data so that the
government could pay that particular
institution --- KUNG WALANG DATA HINDI
KA BABAYARAN NG GOBYERNO)

E-LEARNING

➢ Intended to increase the knowledge of the learners

➢ THE USE OF ELECTRONIC TOOLS to aid teaching

E-HEALTH PROJECTS IN PHILIPPINES USED IN COMMUNITY
➢ Can be done synchoronously (happen in real
HEALTH PRACTICE
time/LIVE) and asynchronously (NOT LIVE, it is
recorded) 1. ELECTRONIC HEALTH SERVICE INFORMATION
SYSTEM (E-FHSIS)
FIVE ELEMENTS IN E-LEARNING
Type : Health Information System • Created elearning videos for TB, STROKE,
BIRDFLU and CHILDPOISONING

• Contains data about demographics,

environmental data and also dito 4. SYNCHRONIZED PATIENT ALERT VIA SMS (SPASMS)
pumapasok yung report ng vital statistics
Type: Alert System
ilan yung napanganak and ilan yung
namatay

• Develop by DOH ONLINE VERSION OF FHSIS • Add on to WAH (WIRELESS ACCESS SYSTEM)
where FHSIS can be uploaded data
• Reminder for patient on due for FF-UP
• SO THIS THE ORDER OF DATA KUNG SAN
NAGMULA AND THEN PINAPASA-PASA (the
process flow of E-FHSIS) 5. SURVEILLANCE IN POST EXTREME EMERGENCIES
• 1. RHU/HU (ITR, TCL, M1 – means MONTHLY AND DISASTERS (SPEED)
REPORTS) Type: Disaster Management And SMS Reporting
• 2.Municipality, Component and Charted • Early warning detection
City
• Lessen workload
• 3. PROVINCIAL
• Sends INAs (IMMEDIATE NOTIFICATION
• 4. REGIONAL ALERT) so they can respond agad
• 5. NATIONAL • LEGAL FRAMEWORK

- REPUBLIC ACT 10121 : PHILIPPINE

2. ELECTRONIC INTEGRATED MANAGEMENT OF DISASTER RISK REDUCTION AND MGT
CHILDHOOD ILLNESS (E-IMCI) ACT OF 2010

Type : E-Learning 6. RXBOX

Type: Telemedicine

• Developed in 2009 by ATENEO INNOVATION

CENTER • Multi-component device comprising:
• Electronic version of IMCI - BP MONITOR
• Accessible in mobile device - PULSE OXYMETER

- ECG

3. NATIONAL TELEHEALTH CENTER (NTHC_ LEARNING - FETAL HEART RATE MONITOR

VIDEOS
- MATERNAL TOCOMETER AND
Type : E-Learning TEMPERATURE SENSOR

• Funded by USAID (UNITED STATE AGENCY • Provide better access to life-saving health
FOR INTERNATIONAL DEVELOPMENT) care service in isolated and disadvantages
area
• DEVELOPED BY UP MLA-NTHC
 • THE FIRST RXBOX was funded by DOST- • Developed by sergworks, a local software
PCHRD (DEPARTMENT OF SCIENCE AND company in DAVAO
TECHNOLOGY – PHIL COUNCIL FOR HEALTH
RESEARCH) and develop by UP-MIA EEIE
(proudly ph made) 9. SECURE HEALTH INFORMATION NETWORK
EXCHANGE (SHINE) – look a like SEGRIS

Type: Electronic Medical Record And SMS Reporting

• SINCE 2014, total of 143 units of RXBOX had

been deployed in the country • THE 4 Rs (the innovative features of SHINE)

- RECORDING

• ANONG MAGANDA SA RXBOX? - REMINDING

-improved local referral system by facilitating - REFERRING

teleconsultations (audio-video conferences)
- REPORTING
- reduced overall cause if healthcare

10. WIRELESS ACCESS FOR HEALTH (WAH)

• IT IS A TELEMEDICINE DEVICE
TYPE : Electronic Medical Record And Health Information
- Capturing medical signals through System
built-in medical sensors

- Stores data in EMR and transmits

• Augmented the existing CHITS by
health info via internet to clinical
specialist in PGH for expert advice connecting health center in BROADBAND
internet access
7. BUDDYWORKS
• Implemented in 2010 in Tarlac
Type: Telemedicine And Elearning

11. COMMUNITY HEALTH INFORMATION TRACKING

• This is just to find a MEDICAL SPECIALIST SYSTEM
that can help you
• Developed in 2004 by DR.HERMAN
• Allow those in GIGA to send referrals to TOLENTINO by UP MLA
medical specialist of UP-PGH via SMS and
EMAIL • First CHITS was began in PASAY HEALTH
CENTER then applied in more than 48
• Implemented in 2004 by UP MIA NTHC health centers

• DATA BASE OF THE COMMUNITY

8. SERGWORKS RURAL HEALTH INFORMATION TAKE NOTE : CHITS STAND ALONE BUT IF ITS CONNECTED TO
SHYSTEM (SEGRIS) THE INTERNET THE ITS CALLED WAH
Type: Electronic Medical Record (we use this in community)

FACTORS AFFECTING E-HEALTH IN THE PHILIPPINES

1. LIMITED health budget

2. Emergence of free and open source software

➢ “open source” make source code free,

available for everyone, cut cost in
developing software

3. Decentralized government

➢ Diverse and unrelated e-health projects all

over country

4. Target users are unfamiliar with technology

➢ Requires training of personnel on basic

computer skills , use of software and
maintenance of equipment limited health
budget ‘

5. Surplus of “DIGITAL NATIVE” registered nurses

➢ A person who grew up and familiar with

digital technologies

➢ RN HEALS (REGISTERED NURSES FOR

ENHANCEMENT AND LOCAL SYSTEMS)
provide nurses in a underserved, remote
are for one year
Week 17: Nursing Core Values as a CHN • To minimize employment opportunities
• To utilize the country’s unemployed human for the
delivery of public health services
Importance in Nursing

• Knowledge
• Skills
• Attitude Project Entreprenurse Options

Core Values Academic Sector Job Opportunities or Job options

Values we hold which form the foundation on which we - Teachers/professors, Clinical instructors
perform work and conduct ourselves. for nurses. Academic research
assistants, field coordinators
• Principles (what you are believed in)
• Culture (manifestation of human intellect) Health Sector Job Opportunities or Job Options
• Ethical (relates to your moral principles right and
- Part time RHU/hospital nurses,
wrong)
Manage/operate birthing centers,
• Excellence (quality of being outstanding)
Manage/operate care homes for elderly,
What Core Values should we have in CHN? differently abled persons and other
patients needing chronic care.
• Caring - Part-time or full-time private nurses (in
Promoting health, healing and hope in response to the human the homes of the patients who can
condition afford to pay. Medical representatives
for drug stores/companies, Medical
• Diversity Research Consultants/Assistants,
Technical Assistants,
Affirming the uniqueness of and differences among persons,
Consultants/Providers.
ideas, values and ethnicities.
Business Sector Opportunities or Job Options
• Integrity
Transcription services (international) and engage in other non-
Respecting the dignity and moral wholeness of every person
nursing related enterprise.
without conditions or limitation.
You can do…
• Excellence
• Review Centers
Co-creating and implementing transformative strategies with
• Hospice, Domiciliary, Health Care Facilities
daring ingenuity.
• Public Health Advocacies
• Home Health Services
• Emergency Medical Services
“Entreprenurse”
• Wellness/Fitness Management
Health-related Entrepreneurial Activities in the Community
You get paid by…
Setting
• Senators and Congressman
An initiative of DOLE in collaboration with BON-PRC, DOH, PNA,
• Requiring Long Term Care
UPCN, OHNAP other government and non-government entities
• Government Units
and academic institutions to promote nurse entrepreneurship
in the Philippines. • Health Maintenance Organizations
• Elderly (Home for the Aged)
Legal Basis: RA 9173 • Local and Foreign Donors
• PhilHealth
The aim: Project Entreprenurse

• To reduce the cost of health care