primary health care bsn

8/11/2019 Primary Health Care Bsn

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PRIMARY HEALTH CARE

MIDWIFERY COURSE AUDIT

SUMMER 2014


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PRIMARY HEALTH CARE

Definition of PHC, rationale and goals

Principles and strategies

Elements of PHC


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PRIMARY HEALTH CARE

Essential health care made

universally accessible to individuals

and families in the community bymeans acceptable to them through

their full participation and at cost

that the community and country can

afford at every stage of development


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PRIMARY HEALTH CARE

CONCEPTUAL FRAMEWORK

Health is a fundamental human right

Health is both an individual and collectiveresponsibility

Health should be an equal opportunity to all

Health is an essential element of socio-economic development


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PRIMARY HEALTH CARE

FOCUS OF THE PHC APPROACH

Partnership with the community

Equitable distribution of health resources

Organized and appropriate health systeminfrastructure

Prevention of disease and promotion of health

Linked multisectorally

Emphasis on appropriate technology


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PRIMARY HEALTH CARE

FOCUS OF THE PHC APPROACH

Partnership with the community

Equitable distribution of health resources

Organized and appropriate health systeminfrastructure

Prevention of disease and promotion of health

Linked multisectorally

Emphasis on appropriate technology


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PRIMARY HEALTH CARE

PHC GOAL:

Health for all by the year 2000

- Alma-Ata, USSR

- September 6-12, 1978


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PRIMARY HEALTH CARE

LEGAL BASIS OF PHC IN THE PHILIPPINES

Letter Of Instruction 949

Health in the Hands of the People by2020


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PRIMARY HEALTH CAREDIMENSION COMMERCIALIZED HEALTH CARE PHC

GOAL Absence of disease Prevention of disease

FOCUS Sick Sick and well

SETTING Hospital-based; urban; few Health centers; rural-based;

all

PEOPLE Passive recipients Active participants

STRUCTURE Health is isolated from other sectors Heath is integrated; linkaging

PROCESS Decision-making (top-bottom) Bottom-top

TECHNOLOGY Curative; physician-dominated Promotive and preventiveAppropriate technology for

frontline health care

OUTCOME Reliance on health professionals People empowerment/self

reliance


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PRIMARY HEALTH CAREPRINCIPLE STRATEGIES

Accessibility, availability and acceptability

of health services

-Health services must be delivered where

people are

- use indigenous/resident volunteer

workers as health care providers (1:20)

- use traditional medicine with essential

drugs

Provision of quality, basic, and essential

services

- Training design and curriculum based on

community needs and priorities

- KSA on promotive, preventive, curative

and rehabilitative health care-Regular monitoring and periodic

evaluation of CHW


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Community participation -Awareness-building and consciousness

raising

- Planning, implementation, monitoring

and evaluation

-Selection of CHW

-Community-building and CO

-Formation of health committees-Establishment of a community health

worker organization

-Mass health campaign and mobilization

Self-reliance - Community generates support

-Use of local resources

-Training of community leadership andmanagement skills

- incorporation of IGP, coops, small-scale

industries


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Recognition of interrelationship between

health and development

-Convergence of health, food, nutrition,

sanitation, etc- integration of PHC into all level plans

- coordination of activities to different

sectors

Social mobilization -Establishment of effective referral system

- multisectoral and interdisciplinarylinkages

-IEC using multi-media

-Collaboration between GO and NGO

Decentralization -Re-allocation of budgetary resources

-Re-orientation of health professionals onPHC

-Advocacy for political will and support,

from the national leadership down to the

barangay


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PRIMARY HEALTH CARE

FOUR CORNERSTONES OR PILLARS OF PHC

1. Use of appropriate tecnology

2. Support mechanism made available

3. Active community participation4. Intra- and inter sectoral linakages


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PRIMARY HEALTH CAREFOUR CORNERSTONES OR PILLARS OF PHC

1. ACTIVE COMMUNITY PARTICIPATION

Community Involvement

Participation of the Community in:

Defining the health and health-related needs Identifying realistic solutions

Organizing, mobilizing its resources for health

activities

- Evaluating the results of health actions


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2. SUPPORT MECHANISM MADE AVAILABLE

a. Improvement of the following:

Working conditions of health personnel such as team

building, performance review and promotion

Planning and management skills of health personnel

at all levels

Technical skills of health personnel

C


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2. SUPPORT MECHANISM MADE AVAILABLE

b. Improvement of the referral system at all levels

c. Formation and use of an information system that

will continuously monitor the changing needs andattitudes of the community.

PRIMARY HEALTH CARE


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3. APPROPRIATE TECHNOLOGY

Acceptability

Complexity

CostEffectiveness

Safety

Scope of technology

Feasibility

PRIMARY HEALTH CARE


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3. APPROPRIATE TECHNOLOGY

- ORS for diarrhea

- Herbal medicine

- Botika ng Barangay- Indigenous manpower and materials


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ELEMENTS OF PRIMARY HEALTH CARE

ESSENTIAL HEALTH SERVICES IN PRIMARYHEALTH CARE

Education for health

Locally endemic diseases

ExpandedProgram on Immunization

Maternal and Child care Program

Essential drugs

Nutrition

Treatment of communicable diseases

Sanitation

Ed i f h l h


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Education for health-the sum of activities in which health agencies

engage to influence the thinking, motivation,

judgment, and action of the people

-consists of techniques that stimulate, arouse, and

guide people to live healthfully it is the process

whereby knowledge, attitude, and practice of the

people are changed to improve individual, family,

and community.

Ed i f h l h


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Education for healthSteps in Health Education:

Creating awareness Motivation

Decision-making

Aspects of Health Education Information

Communication

Education

Ed i f h l h


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Education for healthPrinciples of Health Education

Health education considers the health status ofthe people

Health education is learning

Health education involves motivation,experience, and change in conduct and thinking

Health education should be recognized as a basic

function of health workers Health education takes place in the home, in the

school, and the community.

Ed ti f h lth


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Health education is a cooperative effort Health education meets the needs, interests and

problems of the people affected

Health education is achieved by doing. Health education is a slow and continuous

process

Health education makes use of supplementaryaids and devices

Health education utilizes community resources

Ed ti f h lth


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Health education is a creative process. Health education helps people attain health

through their own efforts

Health education makes careful evaluation of theplanning, organization, and implementation of

health education program and activities.

Ed ti f h lth


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Education for healthGeneral Aims of Health Education

To persuade people to adopt and sustainhealthful life practices

To use judiciously and wisely the health services

available to them

To make their own decisions, both individually

and collectively to improve their health status

and environment.

Ed ti f h lth


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Education for healthFactors Affecting the Attainment of Health

Education

Availability and accessibility of health services to

which the individual have trust

The economic feasibility of putting into practice

the health measures being advocated

Acceptability of the proposed health practice in

terms of their customs and traditions that an

individual observe.

Ed ti f h lth


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Education for healthQualities of a Health Educator

Knowledgeable/mastery of subject matter

Credible

Good listener

Can empathized with others

Possess teaching skills

Flexible Patience

Creative and innovative

Effective motivator

Able to rephrase and summarize Encourages group participation

Good sense of humor

Works for the joy of it

L ll d i di t l


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Locally endemic diseases control1. MALARIA CONTROL PROGRAM

2 Major Strategies of the Program

a. Vector Control- CLEAN

- Chemoprophylaxis

b. Detection & Early Treatment of Cases

Early Recognition, Prevention & Control of Malaria epidemics

Identification of a patient with malaria as soon as he isexamined.

This may be done thru: > Clinical >Microscopic

- Signs & Sx - Mass blood smearexam

- History of visit to & endemic area

Locally endemic diseases control


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Locally endemic diseases control2. SCHISTOSOMIASIS, H-FEVER, FILARIASIS CONTROL PROGRAMS

SCHISTOSOMIASIS

CONTROL PROGRAM

H-FEVER

(DENGUE)

FILARIASIS

CONTROL PROGRAM

A parasitic infection caused

by blood flukes inhabiting

the veins of their vertebral

victims transmitted thru skin

penetration causing

diarrhea, ascites,

hepatosplenomegaly

Dengue-

Acute febrile infection of

sudden onset, caused by

Aedes Aegypti, vector

mosquito

> A mosquito borne disease

caused by a tissue

nematode attacking the

lymphatic system of humans

thereby causing

elephantiasis, lymphedema

& hydrocele

Activities:

> Case Finding

> Surveillance of the disease

> Health education-

encourage use of rubber

boots for protection

> Environmental Sanitation-

proper disposal of feces

> Snail Eradication- use of

moluscides

Activities:

>Case Finding

> Early reporting of any

known case or outbreak

Activities:

>Case Finding

>Early reporting of any

known case of outbreak

Expanded Program on Immunization


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Expanded Program on ImmunizationObjective:

To reduce infant mortality and morbidity throughdecreasing the prevalence of the seven

immunizable diseases

Noteworthy campaigns:

National Immunization Days (NID)

Knock-out Polio (KOP)Garantisadong Pambata (GP)



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Expanded Program on ImmunizationThe Fully Immunized Child (FIC)

- 1 dose of BCG

- 3 doses of DPT, OPV and Hepa B

- 1 dose AMV



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Expanded Program on ImmunizationVACCINE DOSE ROUTE SITE

BCG Infants: 0.05 ml ID RIGHT deltoid

School entrants: 0.10

ml

ID LEFT deltoid

Hepa B 0.5 ml IM Vastus lateralis

DPT 0.5 ml IM Vastus lateralis

OPV 2 gtts (depends) Oral Mouth

AMV 0.5 ml SQ Outer part of upper

arm

TT 0.5 ml IM deltoid



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Expanded Program on ImmunizationVACCINE MINIMUM TIME

INTERVAL

PERCENT

PROTECTION

DURATION OF

PROTECTION

TT1 As early as pregnancy

TT2 At least 4 weeks 80 Infant: Neonatal

tetanus

Mother: 3 years

TT3 At least 6 months 95 Infant: Neonataltetanus

Mother: 5 years

TT4 At least 1 year 99 Infant: Neonatal

tetanus

Mother: 10 years

TT5 At least 1 year 99 All infants born will

be protected

Mother: lifetme



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Expanded Program on ImmunizationVACCINE SIDE EFFECTS MANAGEMENT

BCG

WHEAL

SMALL RED TENDER

SWELLING

ULCER

SCAR FORMATION

KOCHS PHENOMENON

- Acute inflammatory

reaction

No management

DEEP ABSCESS AT

VACCINATION SITE ORLYMPH NODES

I and D

INDOLENT ULCERATIONS

-Persists after 12 weeks

-Ulcer more than 10 mm

INH powder

GLANDULAR ENLARGEMENT Treat as deep abscess



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DPT FEVER

-usually one day

Antipyretic

TSB

LOCAL SORENESS

- At injection site

No treatment

3-4 days

ABSCESS

- An abscess that appear a

week or more after is due towrong technique

I and D

CONVULSIONS

-very rare; 3 months of age

Proper management

Do not continue normal

course



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POLIO Usually none

HEPATITIS B LOCAL SORENESS

Within 24 hours

MEASLES FEVER AND RASH

5-7 days after (1 week)

Antipiretics

TSB

TT PAIN, REDNESS, SWELLING

-injection site

none



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Expanded Program on ImmunizationVACCINE CONTENTS FORM CONDITIONS

WHEN EXPOSED

TO HEAT

STORAGE

TEMPERATURE

BCG Live, attenuated,bacteria

Freeze dried Destroyed 2 to 80 C

DPT D-weakened

toxin

P-killed bacteria

T-weakenedtoxin

Liquid D-by heat/freeze 2 to 80 C

OPV Live, attenuated

virus

Liquid Easily destroyed

by heat, not by

freezing

-15 to -250C

AMV Live, attenuated

virus

Freeze dried Easily destroyed

by heat, not by

freezing

-15 to -250C

Hepa B Plasma-derived Liquid Damaged by heat

or freezing

2 to 80 C

TT Weakened toxin Liquid Damaged by heat

or freezing

2 to 80 C



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Expanded Program on ImmunizationFREQUENTLY ASKED QUESTIONS:

Q: What if the child failed to return after the first

dose of the vaccine, can we still give it?

Q: Is it necessary to repeat the first dose?

Q: Up to what age can we give the immunization?

Q: Is there any contraindication to giving DPT, OPV,

and Hepa B?



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Expanded Program on ImmunizationCOLD CHAIN

- System used to maintain the potency of a vaccine

from the time of manufacture to time it is given

1. Storage of vaccines should NOT exceed:

6 months at regional

3 months at provincial

1 month at main health centers*

Not more than 5 days at health centers

2. Use of boxes/carriers in transport



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Expanded Program on ImmunizationCOLD CHAIN

3. Once opened, vaccines must be placed in a

special cold pack during sessions

4. DISCARD:

BCG vaccines after 4 hours

Others, after 8 hours


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Expanded Program on ImmunizationEligible population

Infants3%

BCG school entrants3%

Pregnant women3.5%12-59 months old*11.5%

0-59 months old** - 14.5%

15-44 y/o women***11.5%

ESSENTIAL DRUGS


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ESSENTIAL DRUGS- Essential drugs are medicinal preparations

necessary to fill the basic health needs of the

population.

- those drugs that satisfy the health care needs of

the majority of the population; they should

therefore be available at all times in adequate

amounts and in appropriate dosage forms, at a

price the community can afford

ESSENTIAL DRUGS


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ESSENTIAL DRUGS

10 herbal plants recommended by the DOH

Lagundi Sambong

Olasimang bato AmpalayaBawang Niyog-niyogan

Bayabas Tsaang gubat

Yerba buena Akapulko

ESSENTIAL DRUGS


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ESSENTIAL DRUGSFORMS OF PREPARATION

Decoctionboiling herbal part

Poultice

Oil

TinctureOintment

Cataplasm

SyrupInfusion

ESSENTIAL DRUGS


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ESSENTIAL DRUGSGUIDELINES

1. Avoid the use of insecticides as these may leave

poison on plants.2. In the preparation of herbal medicine, use a clay pot

and remove cover while boiling at low heat.

3. Use only the part of the plant being advocated.

4. Follow accurate dose of suggested preparation.

5. Use only one kind of herbal plant for each type ofsymptoms or sickness.

6. Stop giving the herbal medication in case untowardreaction such as allergy occurs.

7. If signs and symptoms are not relieved after 2 or 3

doses of herbal medication, consult a doctor.


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ESSENTIAL DRUGS


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ESSENTIAL DRUGSHERBAL PLANT SCIENTIFIC NAME USES

YERBA BUENA Rheumatism, arthritis and

headache; cough & cold,

swollen gums, Toothache,menstrual and gas pain,

nausea and fainting, insect

bites

SAMBONG Anti-edema, diuretic, anti-

urolithiasis

AKAPULKO Anti-fungal: Tinea Flava,

ringworm, athletes foot, and

scabies

NIYOG-NIYOGAN Anthelminthic

TSAANG GUBAT Diarrhea

AMPALAYA Lower blood sugar levels

Diabetes Mellitus (Mild non-

insulin dependent)

ESSENTIAL DRUGS


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ESSENTIAL DRUGSGenerics Act of 1988

R.A. # 6675

Dangerous Drugs Act

R.A. 6425

Formally proclaims the state of promoting

the use of generic terminology in the

importation, manufacture, distribution,

marketing, promotion & advertising,

labeling, prescribing & dispensing of drugs.

Reinforces the NDP with regards to the

assurance of the

high-quality & rational drug

use.

The safe administration & transportation

of prohibited drugs is punishable by law.

2 Types of Drugs:

Prohibited Regulated


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NUTRITION PROGRAM


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NUTRITION PROGRAMCoverage:

Protein Energy Malnutrition (PEM)

Vitamin A deficiency (VAD)

Iron Deficiency Anemia (IDA)

Iodine Deficiency Disorder (IDD)

Philippine Food & Nutrition Programs

Directed to the provision of nutrition services to theDOHs identified priority vulnerable groups

NUTRITION PROGRAM


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NUTRITION PROGRAMTargeted Food Task Force

Assistance Program

Nutrition Rehabilitation Ward Akbayan sa Kalusugan (ASK

Project)

Provision of food rations ofbulgur wheat & green peas

Target population:

Pre-schoolers

Pregnant women

Lactating mothers

Every hospital must have aNurse ward, where an

adequately trained nutritionist

were assigned (RA 422)

Aimed to provide rice & cornsoya blend supplemented with

local foods.

Target pop:

6 mos- 2 years

Moderately & severely

underweight

Pre-schoolers not served by

the DSWD and DA in Regions

2,8,9,10,11,12

NUTRITION PROGRAM


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NUTRITION PROGRAM23 in 93 FORTIFIED VITAMIN RICE Health for More in 94

Buwan ng Kabataan, Pag-asa ng Bayan

National Focus: National Micronutrient Day

or Araw ng Sangkap Pinoy

-A free enrichment program aimed to

prevent deficiencies in vitamin A (blindness);

iron (anemia); iodine (goiter, mental

retardation & delayed development)

(1 cavan of rice + fistful processed, binilid

enriched with essential micronutrients)

-Aimed to distribute vitamin A supplements,

iodized oil for & seedlings of plants rich in Fe

& other minerals.

NUTRITION PROGRAM


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NUTRITION PROGRAM3. FOOD FORTIFICATION PROGRAM

- Is the governments response to the growing

micronutrient malnutrition that has been

prevalent in the Philippines for the past several

years

- Vitamin A, Iron, Iodine

- Sangkap Pinoy

- FIDEL salt

NUTRITION PROGRAM


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NUTRITION PROGRAM4. NUTRITION SURVEILLANCE SYSTEM

- A system of keeping close watch on the state of

nutrition & the causes of malnutrition w/n a

locality, w/ involves periodic collection of data &

analysis & dissemination of analyzed information

- Tools utilized are Anthropometric measurements:

A. Weight for Age

B. Height for Age

C. Weight for Height

D. BMI

NUTRITION PROGRAM


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NUTRITION PROGRAMTYPES OF NUTRITIONAL DEFICIENCIES

A. PROTEIN ENERGY MALNUTRITION (PEM)

1. MARASMUS

Very thin, no fat, muscle wasting

Prominent ribs

Very poor wt gain

Loose & wrinkled skin

Enlarged abdomen

Anxious, always hungry

Old Mans Face

NUTRITION PROGRAM


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NUTRITION PROGRAMTYPES OF NUTRITIONAL DEFICIENCIES

A. PROTEIN ENERGY MALNUTRITION (PEM)

2. KWASHIORKOR

- Very thin, fails to grow - Swollen legs, feet, arms & hands

- Light colored, weak hair - Doesnt want to eat

- Moon-shaped, Unhappy face - Dark spots on skin

- Enlarged abdomen - Skin sores & skin is peeling

- Muscle wasting - Apathetic

NUTRITION PROGRAM


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U O OGTYPES OF NUTRITIONAL DEFICIENCIES

B. VITAMIN A DEFICIENCY

Causes:

-Low intake of Vitamin A rich food

- Low intake of protein- Illnesses like measles, diarrhea

Consequences:

Blindness

1. Night blindness

2. Nutritional blindness

NUTRITION PROGRAM


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UNIVERSAL SUPPLEMENTATION OF VITAMIN A

INFANTS PRESCHOOLERS PREGNANT WOMEN POSTPARTUM

MOTHERS

100,000 IU

One dose only

200,000 IU

One capsule every 6

months

10,000 IU twice a

week starting at the

4thmonth of

pregnancy*

200, 000 IU within

four weeks after

delivery

NUTRITION PROGRAM


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C. IRON DEFICIENCY ANEMIA (IDA)

- Not enough hemoglobin in the RBC because of

lack of Fe

CAUSES:

- Low intake of iron-rich foods

- Blood loss

- Poor absorption- Increased demands

NUTRITION PROGRAM


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C. IRON DEFICIENCY ANEMIA (IDA)

TREATMENT AND PREVENTION:

-provision of iron with folic acid

- pregnant: Once a day for 180 days

- Lactating women: once a day for 90 days


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NUTRITION PROGRAM


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D. IODINE DEFICIENCY DISORDERS (IDD)

TREATMENT:

- Women 15-45 y/o, School age children, adult

males:

- to take one iodized capsule with 200mg iodine

every year

SANITATION


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Environmental Sanitation

- Is defined as the study of all factors in mans

physical environment, w/c may exercise a

deleterious effect on his health, well-being and

survival.

Goal:

To eradicate & control environmental factors in

disease transmission through the provision of

basic services & facilities to all households

SANITATION


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3 types of approved water supply facilities

Level 1

Point Source

Level II

Communal Faucet System/

Stand Posts

Level III

Waterworks System/

Individual House

Connections

A protected well of adeveloped sprung with an

outlet but w/o a

distribution system for rural

areas where houses are

thinly scattered.

A system composed of asource, a reservoir, a piped

distribution network &

communal faucets, located

at not more than 25 meters

from the farthest house in

rural areas where housesare clustered densely.

A system with a source, areservoir, a piped

distributor network &

household taps that is

suited for densely

populated urban areas.

SANITATION


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3 types of approved toilet facilities

Level 1 Level II Level III

Non- water carriage toilet

facility:

Pit Latrines

Reed Odorless Earth Closet

Bored-Hole

Compost

Ventilated improved pit

Toilets requiring small

amount of water to washwaste into receiving space

-Pour flush, Aqua Privies

A system composed of a

source, a reservoir, a piped

distribution network &

communal faucets, located

at not more than 25 meters

from the farthest house in

rural areas where houses

are clustered densely.

A system with a source, a

reservoir, a piped

distributor network &

household taps that is

suited for densely

populated urban areas.

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