7/25/2019 CHN and CD

1/13

Primary Health Care (PHC)Overview

May 1977 -30th World Health Assemblydecided that the main health target o thego!ernment and WH" is the attainment o ale!el o health that #o$ld %ermit them to leada socially and economically %rod$cti!e lie bythe year &000'

e%tember -1&* 197+ - ,irst nternationalConerence on PHC in Alma Ata* .$ssia (/.)he Alma Ata eclaration stated that PHC #asthe 2ey to attain the health or all4 goal

"ctober 19* 1979 - 5etter o nstr$ction (5")969* the legal basis o PHC #as signed by Pres',erdinand ' Marcos* #hich ado%ted PHC as ana%%roach to#ards the design* de!elo%mentand im%lementation o %rograms oc$sing onhealth de!elo%ment at comm$nity le!el'

Rationale for Adopting Primary Health Care

Magnit$de o Health Problems

nade8$ate and $ne8$al distrib$tion o health

reso$rces

ncreasing cost o medical care

solation o health care acti!ities rom other

de!elo%ment acti!ities

Denition of Primary Health Care

essential health care made universally

accessible to individuals and families in the

community by means acceptable to them,

through their full participation and at cost that

the community can aord at every stage of

development.

a %ractical a%%roach to ma2ing health benets

#ithin the reach o all %eo%le'

an a%%roach to health de!elo%ment* #hich is

carried o$t thro$gh a set o acti!ities and

#hose $ltimate aim is the contin$o$s

im%ro!ement and maintenance o health stat$s

Goal of Primary Health Care

HEALTH FOR ALL FILIPINOS by the year

2000 AND HEALTH IN THE HANDS OF THE

PEOPLE by the year 2020.

An im%ro!ed state o health and 8$ality o lie

or all %eo%le attained thro$gh SELF

RELIANCE'

Key Strategy to Ahie!e the Goal"

Partnership with and Empowerment of the

#$%eti!e& of Primary Health Care

m%ro!ement in the le!el o health care o the

comm$nity

,a!orable %o%$lation gro#th str$ct$re

.ed$ction in the %re!alence o %re!entable*

comm$nicable and other disease'

.ed$ction in morbidity and mortality rates

es%ecially among inants and children'

;tension o essential health ser!ices #ith

%riority gi!en to the $nderser!ed sectors'

m%ro!ement in

7/25/2019 CHN and CD

2/13

Part o the %eo%le@s %artici%ation is the

%artnershi% bet#een the comm$nity and the

agencies o$nd in the comm$nity social

mobili=ation and decentrali=ation'

n general* health #or2 sho$ld start rom #here

the %eo%le are and b$ilding on #hat they ha!e'

;am%le> ched$ling o

7/25/2019 CHN and CD

3/13

en!ironment' Water is necessary or the

maintenance o healthy liestyle' ae Water

and anitation is necessary or basic %romotion

o health'

' N5trition and Promotion of Ade65ate FoodS5pply

"ne basic need o the amily is ood' And i

ood is %ro%erly %re%ared then one may be

ass$red healthy amily' here are many ood

reso$rces o$nd in the comm$nities b$t

beca$se o a$lty %re%aration and lac2 o

2no#ledge regarding %ro%er ood %lanning*

Maln$trition is one o the %roblems that #e

ha!e in the co$ntry'

7' (reatment of Comm5nia$le Di&ea&e& andCommon Illne&&

he diseases s%read thro$gh direct contact

%ose a great ris2 to those #ho can be inected'

$berc$losis is one o the comm$nicable

diseases contin$o$sly occ$%ies the to% ten

ca$ses o death' Most comm$nicable diseases

are also %re!entable' he Do!ernment oc$ses

on the %re!ention* control and treatment o

these illnesses'

+'S5pply of E&&ential Dr5g&

his oc$ses on the inormation cam%aign on

the $tili=ation and ac8$isition o dr$gs'

n res%onse to this cam%aign* the D?.C AC

o the Phili%%ines is enacted' t incl$des the

ollo#ing dr$gs> Cotrimo;a=ole* Paracetamol*

Amo;ycillin* "resol* ?iedi%ine* .iam%icin* ?H

(isonia=id) and Pyra=inamide*thamb$tol*

tre%tomycin*Albenda=ole*E$inine

'a%or Strategie& of Primary Health Care

1' Ele!ating Health to a Comprehen&i!e andS5&tained National E2ort4

Attaining Health or all ,ili%ino #ill re8$ire

e;%anding %artici%ation in health and health

related %rograms #hether as ser!ice %ro!ider

or beneciary' m%o#erment to %arents*

amilies and comm$nities to ma2e decisions o

their health is really the desired o$tcome'

Ad!ocacy m$st be directed to ?ational and

5ocal %olicy ma2ing to elicit s$%%ort and

commitment to maBor health concerns thro$ghlegislations* b$dgetary and logistical

considerations'

comm$nities and organi=ation to %lan*

im%lement and e!al$ate health %rograms at

their le!els'

3' Inrea&ing E9ienie& in the Health Setor

/sing a%%ro%riate technology #ill ma2e

ser!ices and reso$rces re8$ired or theirdeli!ery* e:ecti!e* a:ordable* accessible and

c$lt$rally acce%table' he de!elo%ment o

h$man reso$rces m$st corres%ond to the act$al

needs o the nation and the %olicies it $%holds

s$ch as PHC' he "H #ill contin$e to s$%%ort

and assist both %$blic and %ri!ate instit$tions

%artic$larly in ac$lty de!elo%ment*

enhancement o rele!ant c$rric$la and

de!elo%ment o standard teaching materials'

6' Ad!aning E&&ential National Health

Re&earh

ssential ?ational Health .esearch (?H.) is

an integrated strategy or organi=ing and

managing research $sing intersectoral* m$lti-

disci%linary and scientic a%%roach to health

%rogramming and deli!ery'

Fo5r Corner&tone&:Pillar& in Primary Health Care

1' Acti!e Comm$nity Partici%ation

&' ntra and nter-sectoral 5in2ages

3' /se o A%%ro%riate echnology

6' $%%ort mechanism made a!ailable

Comm5nity A&&e&&ment

tat$s

tr$ct$re

Process

(ype& of Comm5nity A&&e&&ment

1' Comm5nity Diagno&i&

A %rocess by #hich the n$rse collects data

abo$t the comm$nity in order to identiy

actors #hich may inF$ence the deaths and

illnesses o the %o%$lation* to orm$late a

comm$nity health n$rsing diagnosis and

de!elo% and im%lement comm$nity health

7/25/2019 CHN and CD

4/13

aims to obtain

generalinormation abo$tthe comm$nity

ty%e o assessment

res%onds to a%artic$lar need

Step&"

Preparatory Phase

1' site selection

&' %re%aration o the comm$nity

3' statement o the obBecti!es

6' determine the data to be collected

' identiy methods and instr$ments or data

collection

' nali=e sam%ling design and methods

7' ma2e a timetable

Implementation Phase

1' data collection

&' data organi=ationGcollation

3' data %resentation

6' data analysis

' identication o health %roblems

' %rioriti=ation o health %roblems

7' de!elo%ment o a health %lan

+' !alidation and eedbac2

Evaluation Phase

,io&tati&ti&

DE'#GRAPH< - st$dy o %o%$lation si=e*

com%osition and s%atial distrib$tion as a:ected

by births* deaths and migration'

So5re&" Cen&5& com%lete en$meration o

the %o%$lation

; *ay& of A&&igning People

1' De =5re - Peo%le #ere assigned to the %lace

#here assigned to the %lace they $s$ally li!e

regardless o #here they are at the time o

cens$s'

De Fato- Peo%le #ere assigned to the %lace#here they are %hysically %resent at are at thetime o cens$s regardless* o their $s$al %laceo residence'

Median age- age belo# #hich 0I o the%o%$lation alls and abo!e #hich 0I o the%o%$lation alls' he lo#er the median age* theyo$nger the %o%$lation (high ertility* highdeath rates)'

ge ! "ependency #atio - $sed as an inde; oage-ind$ced economic drain on h$manreso$rces

"ther characteristics>

occ$%ational gro$%s economic gro$%s

ed$cational attainment

ethnic gro$%

Pop5lation Di&tri$5tion

$rban%#ural- sho#s the %ro%ortion o %eo%leli!ing in $rban com%ared to the r$ral areas

Crowding Inde& - indicates the ease by #hich acomm$nicable disease can be transmitted rom1 host to another s$sce%tible host'

Population "ensity- determines congestion othe %lace

>ital Stati&ti&

he a%%lication o statistical meas$res to !itale!ents (births* deaths and common illnesses)that is $tili=ed to ga$ge the le!els o health*illness and health ser!ices o a comm$nity'

Epidemiology

the st$dy o distrib$tion o disease or%hysiologic condition among h$man %o%$lations and the actors a:ecting s$ch distrib$tion

the st$dy o the occ$rrence and distrib$tion o

health conditions s$ch as disease* death*deormities or disabilities on h$man%o%$lations

1' Pattern& of di&ea&e o5rrene

Epidemic

A sit$ation #hen there is a high incidence one# cases o a s%ecic disease in e;cess o thee;%ected'

#hen the %ro%ortion o the s$sce%tible are highcom%ared to the %ro%ortion o the imm$nes

Epidemic potential

an area becomes !$lnerable to adisease $%s$rge d$e to ca$sal actors s$ch asclimatic changes* ecologic changes* or socio-economic changes

Endemic

habit$al %resence o a disease in a gi!engeogra%hic location acco$nting or the lo#n$mber o both imm$nes and s$sce%tibles''g'Malaria is a disease endemic at Pala#an'

he ca$sati!e actor o the disease isconstantly a!ailable or %resent to the area'

'poradic

disease occ$rs e!ery no# and then a:ectingonly a small n$mber o %eo%le relati!e to thetotal %o%$lation

7/25/2019 CHN and CD

5/13

stablish time and s%ace relationshi% o thedisease

.elate to characteristics o the gro$% in thecomm$nity

Correlate all data obtained

Role of the N5r&e

Case ,inding

Health eaching

Co$nseling

,ollo# $% !isit

Comm5nia$le Di&ea&e& ?Chroni@

Chroni

1' (5$er5lo&i&

< is a highly inectio$s chronic disease that$s$ally a:ects the l$ngs'

Ca5&ati!e Agent"Mycobacteri$m$berc$losis

Sign:Symptom&"

co$gh

aternoon e!er

#eight loss

night s#eat

blood stain s%$t$m

Pre!alene:Inidene"

ran2s si;th in the leading ca$ses o morbidity(#ith 116*&&1 cases) in the Phili%%ines

i;th leading ca$se o mortality (#ith &+07cases) in the Phili%%ines'

N5r&ing and 'edial 'anagement

Jentilation systems

/ltra!iolet lighting

Jaccines* s$ch as the bacill$s Calmette D$erin

(

7/25/2019 CHN and CD

6/13

Lepro&y Control Program

*H# Cla&&iation basis o m$lti-dr$gthera%y

Pa$cibacillaryGP< non-inectio$s ty%es' -9months o treatment'

M$ltibacillaryGM< inectio$s ty%es' &6-30months o treatment'

'5lti-dr5g therapy $se o & or more dr$gsrenders %atients non-inectio$s a #ee2 aterstarting treatment

Patients #G single s2in lesion and a negati!e slits2in smear are treated #G a single dose o ."Mregimen

,or P< le%rosy cases- .iam%icinLa%sone onay 1 then a%sone rom ay &-&+' blister%ac2s ta2en monthly #ithin a ma;' %eriod o 9mos'

All %atients #ho ha!e com%lied #G M areconsidered c$red and no longer regarded as acase o le%rosy* e!en i some se8$elae ole%rosy remain'

Re&pon&i$ilitie& of the n5r&e"

Pre!ention health ed$cation* health$l li!ingthro$gh %ro%er n$trition* ade8$ate rest* slee%and good %ersonal hygiene

Ca&ending

'anagement and treatment %re!ention osecondary inB$ries* handling o $tensils s%ecialshoes #G %added soles im%ortance os$stained thera%y* correct dosage* e:ects odr$gs and the need or medical chec2-$% romtime to time mental emotional s$%%ort

Reha$ilitation-ma2es %atients ca%able* acti!eand sel-res%ecting member o society'

Comm5nia$le Di&ea&e ?>etor ,orne@

Lepto&piro&i& ?*eil& di&ea&e@

An inectio$s disease that a:ects h$mans andanimals* is considered the most common=oonosis in the #orld

Ca5&ati!e Agent" 5e%tos%ira interrogans

Sign:Symptom&"

High e!er

Chills

Jomiting

.ed eyes

iarrhea e!ere headache

m$scle aches

may incl$de Ba$ndice (yello# s2in and eyes)

abdominal %ain

(reatment"

PE( - N Penicillins* Erythromycin* (etracycline

'alaria

Malaria (rom Medie!al talian> mala aria - Obad

airO ormerly called ag$e or marsh e!er) is aninectio$s disease that is #ides%read in manytro%ical and s$btro%ical regions'

Ca5&ati!e Agent" Ano%heles emale

S#eats %ro$sely

Ele!ated tem%erat$re

(reatment"

Chemo%ro%hyla;is chloro8$ine ta2en at#ee2ly inter!al* starting rom 1-& #ee2s beoreentering the endemic area'

Anti-malarial dr$gs s$lado;ine* 8$inines$late* tetracycline* 8$inidine

nsecticide treatment o mos8$ito nets* ho$ses%raying* stream seeding and clearing*s$stainable %re!enti!e and !ector control meas

Pre!enti!e 'ea&5re&" ?CLEAN@

Chemically treated mos8$ito nets

Lar!ae eating sh

En!ironmental clean $%

Anti mos8$ito soa%Glotion

Neem treesGe$caly%t$s tree

Filaria&i&

name or a gro$% o tro%ical diseases ca$sedby !ario$s thread-li2e %arasitic ro$nd #orms(nematodes) and their lar!ae

lar!ae transmit the disease to h$mans thro$gha mos8$ito bite

can %rogress to incl$de gross enlargement othe limbs and genitalia in a condition calledele%hantiasis

Sign:Symptom&"

symptomatic 'tage

Characteri=ed by the %resence o microlariaein the %eri%heral blood

?o clinical signs and sym%toms o the disease

ome remain asym%tomatic or years and insome instances or lie

cute 'tage

5ym%hadenitis (inFammation o lym%h nodes)

5ym%hangitis (inFammation o lym%h !essels)

n some cases the male genitalia is a:ectedleading to orchitis (redness* %ain$l and tenderscrot$m)

Chronic 'tage

Hydrocoele (s#elling o the scrot$m)

5y%hedema (tem%orary s#elling o the $%%er

and lo#er e;tremities

le%hantiasis (enlargement and thic2ening othe s2in o the lo#er and G or $%%er e;tremities*scrot$m* breast)

'anagement"

iethylcarbama=ine citrate or Hetra=an

!ermectin*

Albenda=olethe

?o treatment can re!erse ele%hantiasis

Shi&to&omia&i&

%arasitic disease ca$sed by a lar!ae

Ca5&ati!e Agent" chistosoma intercalat$m*

7/25/2019 CHN and CD

7/13

InFammation o li!er s%leen

Pallor

Sei=$re

Pre!enti!e mea&5re&

health ed$cation regarding mode o

transmission and methods o %rotection %ro%erdis%osal o eces and $rine im%ro!ement oirrigation and agric$lt$re %ractices

Control o %atient* contacts and the immediateen!ironment

(reatment"

iethylcarbama=e%ine citrate (C) or

Pra=i8$antel (dr$g o choice)

Deng5e

?D/ is a mos8$ito-borne inection #hich inrecent years has become a maBor international%$blic health concern''

t is o$nd in tro%ical and s$b-tro%ical regions

aro$nd the #orld* %redominantly in $rban andsemi-$rban areas'

Sign:Symptom&" ?>LIN#SPARD@

>omiting

Lo# %latelet

Na$sea

#nset o e!er

Se!ere headache

Pain o the m$scle and Boint

Abdominal %ain

Rashes

Diarrhea

(reatment"

he mainstay o treatment is s$%%orti!ethera%y'

ntra!eno$s F$ids

A %latelet trans$sion

Alternati!e 'ediine

.A +6&3

&3 ? 93

Her$al 'ediine ?L,,< SAN(A@

Her$al

'ediine

SES

5ag$ndi

( Jite;?eg$ndo)SHARED

S2in diseases

Headache*Asthma*e!er*co$ghcoldsRhe$matismEc=emaDysentery

/lasimang

7/25/2019 CHN and CD

8/13

. pillar&"

E$ality ass$rance

Drants technical assistance

Health %romotion

A#ard

Comm5nity #rgani7ing PartiipatoryAtion Re&earh

Comm5nity #rgani7ing

A contin$o$s and s$stained %rocess o

/CA?D H P"P5*

C.CA5 AWA.?

M"

7/25/2019 CHN and CD

9/13

Color Coding

PINK?RGEN( REFERRAL@

C"/DH ". C"5

co$ghing more than more th

days* reer or assessment

oothe the throat and relie!e th

co$gh #ith a sae remedy

Ad!ise mother #hen to ret$rn

immediately

,ollo# $% in days i not im%ro

7/25/2019 CHN and CD

10/13

7/25/2019 CHN and CD

11/13

La)& A2eting CHN Implementation

RA . - Clean Air Act (&000)

RA .;J angero$s r$g Act> sale*

administration and distrib$tion o %rohibited

dr$gs is %$nishable by la#

RA B

RA ;; Phili%%ines Medical Act> dene the

%ractice o medicine in the Phili%%ines

RA B; .$ral Health Act> em%loyment o

more %hysicians* n$rses* mid#i!es #ho #ill li!e

in the r$ral areas to hel% raise the health

condition'

RA J - .e%orting o Comm$nicable isease

RA J Deneric Act> %romotes* re8$ires and

ens$res the %rod$ction o an ade8$ate s$%%ly*

distrib$tion* and $se o dr$gs identied by their

generic names'

RA J

RA J

RA .

RA J Magna Carta or P$blic Health

Wor2ers (a%%ro!ed by Pres' Cora=on C'

A8$ino)> aims to %romote and im%ro!e thesocial and economic #ell being o health

#or2ers* their li!ing and conditions'

RA B 5ocal Do!ernment Code>

res%onsibility or the deli!ery o basic ser!ices

o the national go!ernment

Priniple& of EPI

1' %idemiological sit$ation

&' Mass a%%roach

3'

7/25/2019 CHN and CD

12/13

DP(?DiphtheriaPert5&&i&(etan5&@

-#ea2enedto;in

P-2illedbacteria

li8$id-0'ml

3 M

#P> ?#ralPolio>aine@

#ea2ened!ir$s

li8$id-&dro%s

3 "ral

Hepatiti&,

Plasmaderi!ati!e

5i8$id-0'ml

3 M

'ea&le& Wea2ened!ir$s

,ree=edried-0'ml

1 $bc$taneo$s

Shed5le of >aine&

>aine

Age atB&t do&e

Inter!al$et)een

do&e

Protetion

,CG At birth #ee2s 6#ee2s he e;tent o%rotection against

%olio is increasedthe earlier "PJ isgi!en'

Hepa,

birth birth*th#ee2*16th#ee2

An early start oHe%atitis < red$ces

the chance o beinginected andbecoming a carrier'

'ea&le&

9m0s'-11m0s'

At least +I omeasles can be%re!ented byimm$ni=ation at thisage'

months earliest dose o measles gi!en in

case o o$tbrea2

9months-11months- reg$lar sched$le o

measles !accine

1 months- latest dose o measles gi!en

6- years old- catch $% dose

F5lly Imm5ni7ed Child ?FIC@- less than 1&

months old child #ith com%lete imm$ni=ations

o P* "PJ*

o months- .egional 5e!el

o 3months- Pro!incial 5e!elGistrict 5e!el

o 1month-main health centers-#ith re'

o ?ot more than days- Health centers

$sing trans%ort bo;es'

7/25/2019 CHN and CD

13/13

'o&t &en&iti!e to heat",ree=er (-1 to -&

degrees C)

o "PJ

o Measles

Sen&iti!e to heat and free7ing(body o re'

L& to L+ degrees Celsi$s)

o