Supervision and care of women during pregnancy, labor and

COMMUNITY HEALTH NURSING: AN OVERVIEW puerperium

Performance of internal examination and delivery of babies
 Defining Community Health Nursing Suturing lacerations in the absence of a physician
Provision of first aid measures and emergency care
What is a community? Recommending herbal and symptomatic meds…etc.
- a group of people with common characteristics or interests living
together within a territory or geographical boundary In the care of the families:
- place where people under usual conditions are found
Provision of primary health care services
What is health? Developmental/Utilization of family nursing care plan in the provision
of care
1. Health-illness continuum
2. High-level wellness In the care of the communities:
3. Agent-host-environment
4. Health belief Community organizing mobilization, community development and
5. Evolutionary-based people empowerment
6. Health promotion
Case finding and epidemiological investigation
7. WHO definition
Program planning, implementation and evaluation
Influencing executive and legislative individuals or bodies concerning
What is community health?
health and development
- part of paramedical and medical intervention/approach which is
 Responsibilities of CHN
concerned on the health of the whole population
- aims:
Be a part in developing an overall health plan, its implementation and
1. health promotion
evaluation for communities
2. disease prevention
3. management of factors affecting health Provide quality nursing services to the three levels of clientele
Maintain coordination/linkages with other health team members,
What is nursing? ngo/government agencies in the provision of public health services
- assisting sick individuals to become healthy and healthy individuals Conduct researches relevant to chn services to improve provision of health
achieve optimum wellness care
Provide opportunities for professional growth and continuing education for
What is Community Health Nursing? staff development

“The utilization of the nursing process in the different levels of

clientele-individuals, families, population groups and communities, Unit 2
concerned with the promotion of health, prevention of disease and LEVELS OF CLIENTELE IN CHN
disability and rehabilitation.” - Maglaya, et al
 Individual
Goal: “To raise the level of citizenry by helping communities and
families to cope with the discontinuities in and threats to health in Basic approaches in looking at the individual:
such a way as to maximize their potential for high-level wellness 1. Atomistic
- Nisce, et al 2. Holistic

 Basic Principles of CHN Perspectives in understanding the individual:

1. The community is the patient in CHN, the family is the unit of care and 1. Biological
there are four levels of clientele: individual, family, population group a. Unified whole
(those who share common characteristics, developmental stages and b. Holon
common exposure to health problems – e.g. children, elderly), and the c. Dimorphism
community.
2. In CHN, the client is considered as an ACTIVE partner NOT PASSIVE 2. Anthropological
recipient of care
3. CHN practice is affected by developments in health technology, in a. Essentialism
particular, changes in society, in general b. Social constructionism
4. The goal of CHN is achieved through multi-sectoral efforts c. Culture
5. CHN is a part of health care system and the larger human services system.
3. Psychological
 Roles of the PUBLIC HEALTH NURSE
a. Psychosexual
Clinician, who is a health care provider, taking care of the sick people at b. Psychosocial
home or in the RHU c. Behaviorism
d. Social learning
Health Educator, who aims towards health promotion and illness
prevention through dissemination of correct information; educating people
4. Sociological
Facilitator, who establishes multi-sectoral linkages by referral system
Supervisor, who monitors and supervises the performance of midwives a. Family and kinship
b. Social groups
In the event that the Municipal Health Officer (MHO) is unable to perform his
duties/functions or is not available, the Public Health Nurse will take charge of
the MHO‟s responsibilities.
 Family
Other Specific Responsibilities of a Nurse, spelled by the implementing rules and Models:
Regulations of RA 7164 (Philippine Nursing Act of 1991) includes:
1. Developmental

Stages of Family Development

1
Stage 1 – The Beginning Family Preventive potential
Stage 2 – The Early Child-bearing Family High
Stage 3 – The Family with Preschool Children Moderate
Stage 4 – The Family with School Age Children Low
Stage 5 – The Family with Teen-agers
Stage 6 – The Family as Launching Center Modifiability
Stage 7 – The Middle-aged Family Easily modifiable
Stage 8 – The Aging Family Partially modifiable
Not modifiable
2. Structural-Functional
Salience
Initial Data Base High
Moderate
Family structure and Characteristics Low
Socio-economic and Cultural Factors
Environmental Factors Family Service and Progress Record
Health Assessment of Each Member
Value Placed on Prevention of Disease  Population Group

First Level Assessment Vulnerable Groups:

Health threats: Infants and Young Children

Conditions that are conducive to disease, accident or failure to School age
realize one‟s health potential Adolescents
Health deficits: Mothers
Instances of failure in health maintenance (disease, disability, Males
developmental lag) Old People
Stress points/ Foreseeable crisis situation:
Anticipated periods of unusual demand on the individual or Specialized Fields:
family in terms of adjustment or family resources
Community Mental Health Nursing
Second Level Assessment: A unique clinical process which includes an integration of
concepts from nursing, mental health, social psychology,
Recognition of the problem psychology, community networks, and the basic sciences
Decision on appropriate health action
Care to affected family member Occupational Health Nursing
Provision of healthy home environment The application of nursing principles and procedures in
Utilization of community resources for health care conserving the health of workers in all occupations

Problem Prioritization: School Health Nursing

The application of nursing theories and principles in the
Nature of the problem care of the school population
Health deficit
Health threat Components:
Foreseeable Crisis

Unit 3
ASSESSMENT OF COMMUNITY HEALTH NEEDS

 Community Diagnosis

- A process by which the nurse collects data about the community in order to identify factors which may influence the deaths and illnesses of the population,
to formulate a community health nursing diagnosis and develop and implement community health nursing interventions and strategies

2 Types of Community Diagnosis

Comprehensive Community Diagnosis Problem-Oriented Community Diagnosis

- aims to obtain general information about the community - type of assessment responds to a particular need

STEPS: Implementation Phase

Preparatory Phase 1. data collection

2. data organization/collation
1. site selection 3. data presentation
2. preparation of the community 4. data analysis
3. statement of the objectives 5. identification of health problems
4. determine the data to be collected 6. priority zation of health problems
5. identify methods and instruments for data collection 7. development of a health plan
6. finalize sampling design and methods 8. validation and feedback
7. make a timetable Evaluation Phase

2
 Crude Death Rate
 Biostatistics Specific Mortality Rate
Infant Mortality Rate
A. Demography Neonatal Mortality Rate
- study of population size, composition and spatial distribution as affected by Post-neonatal Mortality Rate
births, deaths and migration. Maternal Mortality Rate
Proportionate Mortality Rate
* Sources: Swaroop‟s Index
Census – complete enumeration of the population Case Fatality Rate
2 Ways of Assigning People Cause-of- Death Rate
De jure – People were assigned to the place where they usually live regardless of
where they are at the time of census Morbidity Rates
De facto – People were assigned to the place where they are physically present at
the time of census, regardless, of their usual place of residence Prevalence Rate
Incidence Rate

C. Epidemiology
COMPONENTS: - the study of distribution of disease or physiologic condition
Population size among human population s and the factors affecting such
distribution
Population composition - the study of the occurrence and distribution of health
* Age Distribution conditions such as disease, death, deformities or
* Sex Ratio disabilities on human populations
* Population Pyramid
* Median age Basic Concepts:
age below which 50% of the population fall and above which 50% of 1. Epidemiologic Triad
the population fall. The lower the median age, the younger the 2. transmission
population (high fertility, high death rates). 3. incubation period
* Age – Dependency Ratio 4. herd immunity
used as an index of age-induced economic drain on human resources

* Other characteristics: Factors affecting distribution:

- occupational groups 1. PERSON
- economic groups - intrinsic characteristics
- educational attainment 2. PLACE
- ethnic groups - extrinsic factors
3. TIME
Population Distribution - temporal patterns

* Urban-Rural Patterns of Disease Occurrence:

shows the proportion of people living in urban compared to the rural
areas Epidemic
* Crowding Index - a situation when there is a high incidence of new cases of a
indicates the ease by which a communicable disease can be specific disease in excess of the expected.
transmitted from 1 host to another susceptible host. - when the proportion of the susceptibles are high compared
* Population Density to the proportion of the immunes
determines congestion of the place Epidemic potential
B. Vital Statistics - an area becomes vulnerable to a disease upsurge due to
the application of statistical measures to vital events (births, deaths causal factors such as climatic changes, ecologic changes,
and common illnesses) that is utilized to gauge the levels of health, or socio-economic changes
illness and health services of a community. Endemic
- habitual presence of a disease in a given geographic
Fertility Rate location accounting for the low number of both immunes
and susceptibles
Crude Birth Rate e.g. Malaria is a disease endemic at Palawan.
General Fertility Rate - the causative factor of the disease is constantly available or
present to the area.
Mortality Rates Sporadic
- disease occurs every now and then affecting only a small
number of people relative to the total population
- intermittent
Pandemic
- global occurrence of a disease

Types of Epidemiological Study Designs

Descriptive VS Analytical

Provides information on patterns of

disease in terms of person, place and Test hypothesis about characteristics
causes of disease

Intervention
* Correlational * Case Reports Observational (Experimental)
studies
*Case Series * Case control * Trials
3
 * Ecologic *Cross-sectional * Cohort
surveys

Experimental VS. Non-Experimental

With manipulation Mere observation of study conditions
* Clinical Trials * Cohort
* Field Trials * Case Control
* Community Intervention Trials * Proportional-Mortality Studies
* Cross-sectional
* Ecologic

Common Epidemiologic Studies:

Retrospective Cross-sectional Prospective Cohort

Steps in EPIDEMIOLOGICAL IVESTIGATION:

1. Establish fact of presence of epidemic
2. Establish time and space relationship of the disease
3. Relate to characteristics of the group in the community
4. Correlate all data obtained

Unit 4: B. Maternal Mortality Rate

NATIONAL HEALTH SITUATION C. Life Expectancy at Birth
D. Median Age
E. Crude Rates
 Health Indices 1. Crude birth rate
I. Basic Health Indicators 2. Crude death rate
A. Nutrition
B. Disease Patterns  Health Care Delivery System
Leading Causes of Morbidity
Leading Causes of Mortality Health Care Delivery System is
“the totality of all policies, facilities, equipments, products, human
II. Other Indicators resources and services which address the health needs, problems and
concerns of the people. It is large, complex, multi-level and multi-
A. Infant Mortality Rate disciplinary.”

Categories:

According to Increasing Complexity of According to the Type of Service

the Services Provided

Type Service Type Example

Health Promotion, Preventive Care, Health Promotion and Information Dissemination

Continuing Care for common illness Prevention
Primary health problems, attention to
psychological and social care,
referrals

Surgery, Medical services by Diagnosis and Treatment Screening

Secondary Specialists

Advanced, specialized, diagnostic,

Tertiary therapeutic & rehabilitative care Rehabilitation PT/OT

 The Health Sector

5 Major Functions:
Department of Health 1. Ensure equal access to basic health services
2. Ensure formulation of national policies for proper division of
Vision: Health for all by year 2000 ands Health in the Hands of the People by labor and proper coordination of operations among the
2020 government agency jurisdictions
3. Ensure a minimum level of implementation nationwide of
Mission: In partnership with the people, provide equity, quality and access to services regarded as public health goods
health care esp. the marginalized 4. Plan and establish arrangements for the public health systems to
achieve economies of scale
5. maintain a medium of regulations and standards to protect
consumers and guide providers

Local Government Units

4
Private Sector
-Composed of both commercial and business organizations, non-business organizations

Commercial / Business Non-commercial

Profit - oriented Orientation to social development, relief and rehabilitation,
community organizing
► Manufacturing companies ► Socio-civic groups
► Advertising agencies ► Religious organizations/foundations
► Private practitioners
► Private institutions

NGOs
assumes the following roles: FOUR QUESTIONS:
- Policy and Legislative Advocates
- Organizers, Human Rights Advocates Who are served?
- Research and Documentation Who provides the services?
- Health Resource Development Personnel Where are the services given?
- Relief and Disaster Management What is the focus of care?
- Networking

PROBLEMS
Unit 5 POLICY THRUSTS
THE NATIONAL HEALTH PLAN STRATEGIES
THRUSTS
(Acronym: PPST)
National Health Plan is a long-term directional plan for health;
the blueprint defining the country‟s health –
GOAL :

To enable the Filipino population to achieve a level of health which will allow BARRIO
Filipino to lead a socially and economically-productive life, with longer life ► Residents actively participate in attaining good health; they
expectancy, low infant mortality, low maternal mortality and less disability are PARTNERS in health care
through measures that will guarantee access of everyone to essential health care
Highlight Project: BOTIKA SA PASO CAMPAIGN
Goal : to maintain herbal plants in pots for family use
 Broad Objectives:
CITY
promote equity in health status among all segments of society ► The physical environment in the workplace, streets, and
address specific health problems of the population public places promotes health, safety, order, and
upgrade the status and transform the HCDS into a responsive, cleanliness through structural manpower support
dynamic and highly efficient, and effective one in the provision of
solutions to changing the health needs of the population Health-related Strategies: Construction of well-maintained, income-generating
promote active and sustained people‟s participation in health care public toilets; designation of a “Pook-Sakayan, Pook-Babaan”

EATING PLACE
Safe
 MAJOR HEALTH PLANS TOWARDS “HEALTH IN THE HANDS OF properly - Prepared
THE An eating place where
PEOPLE IN THE YEAR 2020” Stored
Nutritious
Transported
“23 IN 1993” foods & drinks are served.

■ refers to the 23 programs, projects, activities of the DOH for the Complies with the following sanitation standards:
year 1993, which marks the beginning of its journey towards DOH ► safe, environment-friendly
vision ► with clean restrooms
► food handlers are medically-fit and observes proper personal hygiene
► clean with adequate, well-maintained facilities

“Health for more in „94” MARKET

► adequate water supply
- activities in 1994 focused on Cancer prevention, Reproductive ► proper drainage
health, Mental health and maintenance of a safe environment ► well-maintained toilet facilities
► proper garbage and waste disposal is observed by vendors
► cleanliness maintained
5 Thrusts and Strategies ► affordable quality foods
► has a well-organized and honest market system
Multi-sectoral action & Consensus Building
Linkages & Networking WORKPLACE
Community Organizing ► Physical Environment: clean, orderly, well-ventilated, adequately-lighted,
Risk Assessment & Management smoke-free and adequately-secured which promotes and protects the safety
Capacity Building and health of the family members
► Psychosocial Environment: its management encourages professional,
personal and spiritual growth, which promotes harmonious relationships and
In lieu of “Five in „95”, DOH characterized what a… productive work
Healthy __________________ should be:

5
HOSPITAL ► Manned by a reliable and dependable licensed operators
► A “CENTER OF WELLNESS” ► With posters on health promotion and illness prevention
► Promotes preventive care
► provides clean and adequate resources, affordable and accessible services MOVIE HOUSE
► Patient-centered ► Provides rest, recreation, and wholesome entertainment
► Governed by competent health team members and personnel ► Has sanitary toilets and adequate communication facilities

HOME
► A safe, sanitary, peaceful place where God-fearing household members are
provided with the basic physical, social, economic, emotional, mental, moral
and spiritual needs by their responsible parents/guardians Unit 6
STRATEGIES AND METHODOLOGIES IN CHN:
SCHOOL
► Health instructions provided through classroom/extra-curricular activities  Strategies and Health Status Targets to Achieve Objectives
► Maintains adequate, basic health services to both pupils, teachers, and other
personnel Strategies to promote equity in health
Sample School Initiative : Little Doctor Program ► priority for the vulnerable and marginalized
- outstanding students are chosen yearly on the bases of their healthy
conditions and lifestyles Marginalized people are those who live geographically and culturally isolated
areas; are victims of poverty, armed-conflict, man-made and natural disasters
PRISON and poor environmental conditions. Vulnerable sector of the population is
► Physical Environment: clean, safe detention place with adequate facilities composed of infants (0 mo-1 yr) and children (1-4 y/o), women or
► Psychosocial Environment: services address the mental, spiritual, physical, reproductive age (15-44 y/o), youth and adolescents and the elderly (65 and
social and economic needs of inmates; has an atmosphere that actively above).
promotes JUSTICE, PEACE, REHABILITATION and a HEALTHY
LIFESTYLE ► primary Health Care as the Key Approach

PORT 1. Health Promotion

► Physical Environment: clean, spacious, and secure, with public waiting
areas, passenger terminals, safe drinking water, sanitary food shops and public Levels of Health Promotion:
toilets; conveniently and economically-accessible 1. individual wellness
► NOT a FRONT for gambling, smuggling, prostitution, and other vices 2. family wellness
3. community wellness
HOTEL/MOTEL 4. environmental wellness
► Physical Environment: clean, safe, pleasant place; conforms with a set of 5. societal wellness
guidelines and standards; provides comfort and security
2. Disease Prevention
RESORT
► Clean, safe, affordable resort Primary Level of Disease Prevention
► Provides recreation, rest, relaxation and wholesome entertainment Through people
► Promotes and maintains favorable environmental and health conditions Environmental control
STREET
► Well-maintained roads and public waiting areas Secondary Level of Disease Prevention
► Well-marked traffic signs and pedestrian crossing lane and visible street
names Screening Methods:
► Clean and obstruction-free sidewalks * mass screening
► With minimal traffic problems * case-finding
► With adequate strict law enforcement * contact-tracing
Project: Pook-Tawiran (Kapag ikaw ay nahuli, walang sisihan) * multi-phasic screening
Goal : To promote and reorient people especially erring pedestrians on the use * surveillance
of pedestrian crossings
Characteristics of an ideal screening test:
VEHICLE sensitivity
► Clean, safe, comfortable, smoke-free, well-ventilated, in good running specificity
condition

Tertiary Level of Disease Prevention

3 Levels of Prevention

PRIMARY LEVEL SECONDARY LEVEL TERTIARY LEVEL

Health Promotion and Illness Prevention of Complications thru Early Prevention of Disability, etc.
Prevention Dx and Tx

Provided at – ► When hospitalization is deemed ► When highly-specialized medical

► Health care/RHU necessary and referral is made to care is necessary
► Brgy. Health Stations emergency (now district), ► referrals are made to hospitals and
►Main Health Center provincial or regional or private medical center such as PGH,
►Community Hospital and Health hospitals PHC, POC, National Center for
Center Mental Health, and other gov‟t
►Private and Semi-private private hospitals at the municipal
agencies level

3. Community Organizing

6
Levels of Awareness:

Political socialization

Political mobilization

Interest aggregation

Interest articulation

Culture of silence/passivity

4. Primary Health Care

PHC was declared in the ALMA ATA CONFERENCE in 1978, as a strategy to community health development. It is a strategy aimed to provide essential health care
that is:
Community-based
Accessible
Part and parcel of the total socio-economic development effort of the nation
Acceptable
Sustainable at an affordable cost.

Framework
People‟s Empowerment and Partnership is the
Key Strategy to achieve the goal, “Health For all Filipinos by the year 2000
And Health in the Hands of the People by the year 2020”

WHAT DOES ESSENTIAL HEALTH CARE IN PHC MEANS?

It stands for: Education of prevailing Health Problems

Locally-endemic Disease Prevention and Control
Expanded Program of Immunization
Maternal and Child Health and Family Planning
Environmental Sanitation and Safe Water Supply
Nutrition and Food Supply
Treatment of Communicable & Non-communicable Diseases/ Conditions
Supply and Proper use of Essential Drugs and Herbal Medicine
Dental Health Promotion
Access to and use of hospitals as Centers of Wellness
Mental Health Promotion

Acronym: ELEMENTS + DAM

Pillars (major elements):

A. Multi-sectoral approach
Intersectoral linkages
Intrasectoral linkages
B. Community Participation
C. Appropriate Technology
- method used to provide a socially and environmentally acceptable level of service or quality product at the least economic cost.

Criteria: Feasible
Acceptable, Affordable
Complex
Effective
Safe
Scope-wise

Herbal Medicine:
aromatic
astringent –tasting
bitter-tasting
seeds
grass family
10 MEDICINAL PLANTS:

Lagundi Sambong
Olasimang-Bato Ampalaya
Bawang Niyog-niyogan
Bayabas Tsaang gubat
Yerba-buena Akapulko
(Acronym: LOBBY SANTA)

In “23 in „93”, the utilization of the 10 Herbal Plants was aggressively prescribed through community wide implementation of projects such as herbal garden in
communities

7
RA 8423: utilization of medicinal plants as alternative for high cost medications.
Policies:
1. The indications/uses of plants
2. The part of the plant to be used
3. Preparation of
a. Decoction e. oils
b. Poultice f. ointment
c. Infusion g. tincture
d. Syrup h. Elixir

D. Support mechanism made available

TYPES OF PRIMARY HEALTH WORKERS

Village/Grassroots Health Workers Intermediate Level Health Personnel of First-Line

Hospitals
Trained Community General Medical Physicians with
E Health worker; health auxiliary Practitioners specialty area
X volunteer; Traditional Birth Public Health Nurses Nurses
Attendant Midwives Dentists
C ► Initial link, 1st contact of the ► 1st source of ► Establish close contact with the
H community professional health care village and intermediate level
A ► Work in liaison w/ the local ► Attend to health problems health workers to promote the
R health service workers beyond the competence of continuity of acre from hospital to
A ►Provide elementary curative village health workers community to home
C preventive health care measures ► Provide support to the frontline ► Provide back-up health services for
T health workers in terms of cases requiring hospital or diagnostic
E supervision, training, referral facilities not available in health care
R services and supplies thru
I linkages with other sectors
S
T
I
C
S

Unit 7 At the time of delivery, no licensed health personnel

STRATEGIES AND METHODOLOGIES IN CHN trained on maternal care, is available
Strategies/Programs to Promote Health of the Vulnerable Sectors of the A pregnant mother lives on an area where there is no
Population licensed health personnel trained on maternal care

 Maternal Care Program ► Provision of quality postpartum care

Proper schedule of follow-up must be followed:
Strategies:
- 1st postpartum visit for home deliveries must be
A. Provision of Regular and Quality Maternal Care Services
done within 24 hours after delivery
► regular and quality pre-natal care
- 2nd, done at least 1 week after delivery
- hx-taking, utilization of HBMR (Home-Based
- 3rd, done 2-4 weeks thereafter
Mother‟s Record) as a guide in the identification of
risk factors
Attendants must be aware of the early signs, symptoms and
- PE: weight, height, BP-taking
complications. They should follow the 3 CLEANS:
- Perform head-to-toe assessment, abdominal exam
CLEAN Hands
- Tetanus Toxoid Immunization
CLEAN Surface
- Fe supplementation: given from 5th mo. of pregnancy
CLEAN Cord
to two months postpartum (100-120 mg orally/day
for 210 days)
B. Improvement of the health personnel‟s capabilities on newborn care,
- Laboratory exam: Heat-acetic acid test. Benedict‟s
midwifery thru trainings. Trainings for “hilots” must also be conducted.
test
- Oral/Dental exam
C. Improvement on the quality of care at the First Referral Level
► Orientation, training should be done on the use of proper
► Pre-natal counseling
filling-up of HBMR card
► Proper referrals/endorsements must be done for future If-
► Provision of safe, delivery care
ups
- all birth attendants shall ensure clean and safe
deliveries at home or at the faciltiies
D. Prevention of unwanted pregnancies through family planning services
(RHUs/hospitals)
- at-risk pregnancies and mothers must be immediately
E. Prevention and management of STDs
referred to the nearest institution
- untrained TBA‟s who actively practice must be
F. Promotion of Appropriate health practices
identified, trained and supervised by a personnel of
the nearest BHS/RHU trained on maternal care.
G. Upgrade reporting services
Q: When is a “trained hilot” allowed to attend to home
H. Mobilize political commitment and community involvement to
deliveries?
provide
A: when ---
8
 Support to basic health care delivery Hepa B: 0.5 ml intramuscular
OPV: 2 drops per orem
Measles: 0.5 ml subcutaneous
 Family Planning Program
Tetanus toxoid: 0.5 ml intramuscular
Methods of Family Planning:
I. Spacing Side Effects:
A. Hormonal - Oral Contraceptives
Injectables BCG: inflammation at the site (Koch‟s phenomenon) – warm compress
Inplants Glandular enlargement, deep abscess, indolent ulceration: insicision
B. Barrier - IUD and drainage and powered INH
Condom DPT: inflammation at site: warm compress; fever for a day; abscess: incision and
Diaphragm, Cervical cap drainage and antiseptic(betadine
C. Biologic - Lactation-Amenorrhea Method Measles: fever 3-5 days within a week after injection; mild rashes
D. Natural - Basal Body Temperature (BBT)
Sympto-thermal Frequently Asked Questions (FAQs)
Cervical Mucus Q: What if the child failed to return after the first dose of the vaccine (D.O.H.),
II. Permanent (surgical/irreversible) can we still give it?
A. Tubal Ligation - done in women; a 15 min. surgical A: YES. It is a MUST to complete the doses
procedure in which the fallopian
tubes are tied and cut to prevent Q: Is it necessary to repeat the 1st dose?
passage of sperms A: NO. just give the REMAINING doses not given.
B. Vasectomy - done in men, was deferens is tied Remember the principle:
and cut to block passage of sperm Even if the interval exceeded that of the expected interval, continue to give
the doses of the vaccine.
DOH Effort : National Family Planning Program in 23 in „93

EO 119 gave a legal mandate to the program from UN Declaration of Q: What is the eligible age for giving immunization (up to what age can we
Human Rights, which considers Family Planning as a basic human give the immunization)?
right. A: Before the child reaches 6 years old
Goal: Universal access to family planning information and
services Q: If there has been a reported epidemic of measles, is it okay to give measles
Policies: vaccine at an earlier age?
- to improve family welfare with main focus on: A: In case of measles epidemic, we can give MEASLES as early as 6 months of
i. woman‟s health age
ii. safe motherhood
iii. child survival * a booster dose of BCG shall also be given to all school entrants both in
- to promote family solidarity and responsible private and public schools REGARDLESS of presence of BCG scar.
parenthood
Q: What if the 2nd dose of Tetanus Toxoid was not given to the mother, when is
In “Health for more in „94” the best time to give the dose?
DOH effort: Buwan ng Masayang Pamilya A: It has to be given after birth in order to protect the mother and the
National Focus: Alay sa Pamilya II succeeding pregnancies.
- an activity that promotes the National Family Planning
Program Q: Is there any contraindication to giving DPT, OPV, Hepa-B?
(Other Event: Pneumonia Prevention Week) A: There is none, EXCEPT when the child had convulsions upon giving the 1 st
dose of DPT. Mothers must be warned that the incident of CONVULSION
3 FACTORS CONTRIBUTING TO PREGNANCY RELATED ILLNESS upon giving the 1st dose of DPT, MUST BE REPORTED
AND DEATH AMONG MOTHERS AND INFANTS
Q: What if the child has fever of <38.5 C, mild respiratory infections and
1. too early pregnancy diarrhea, should the child be given the vaccine?
2. pregnancy before age 20 or after age 35 A: The abovementioned conditions are not to be considered as a
3. pregnancy after the 4th baby contraindication to immunization. Thus, vaccine can still be given.

 Expanded Program on Immunization Q: What if the child Is malnourished?

A: MALNUTRITION is not a contraindication, but RATHER an INDICATION
for immunization since common childhood diseases are often severe to
Goal: morbidity and mortality reduction of immunizable diseases
malnourished children.
Schedule:
COLD CHAIN
At birth: BCG
► A system used to maintain the potency of a vaccine from that of
1 ½ months: First doses of DPT, Hep B, OPV
manufacture to the time it is given to child or pregnant woman.
2 ½ months: Second doses of DPT, Hep B, OPV
3 ½ months: Third doses of DPT, Hep B, OPV
Principles:
Tetanus Toxoid:
I. Storage
First Pregnancy: TT1- 5th to 6th mo of pregnancy, after 4 weeks TT2 (3 years
immunity)
Storage of vaccine should not exceed:
Second Pregnancy: TT3 (1st booster dose) – 5th to 6th (5 years immunity)
Third Pregnancy: TT4 (2nd booster dose) – 5th to 6th (10 years immunity)
- 6 mos. @ the Regional Level
Fourth Pregnancy: TT5 (3rd booster dose) – 5th to 6th (life-long long immunity)
- 3 mos. @ the Provincial Level/District Level
- 1 mo. @ Main Health Centers (with refrigerators)
Administration:
- not more than 5 days @ Health Centers (using transport boxes)
BCG: (infants) 0.05 ml intradermal
Important points to remember:
(school entrants) 0.10 ml intradermal
DPT: 0.5 ml intramuscular
► Arranging of stored vaccine according to :
9
 ■ Duration of Storage
■ Type ■ # of times they have been brought out to the field
■ Expiration date

Storage Temperature Vaccine Form Dose/Container Conditions when

exposed to
heat/freezing

Most Sensitive - 15 C to – 25 C 20 dose/special bottle or 25 Easily damaged by

to Heat FREEZER OPV Liquid dose/special bottle heat; not destroyed by
freezing

10 dose/vial

Measles Freeze
dried 20 dose/amp Destroyed by heat,
50 dose/amp sunlight; not destroyed
BCG Freeze by freezing
BODY OF THE dried
REFRIGERATOR + 2C TO Destroyed by freezing;
+ 18 C heat

D Damaged by heat
L
Damaged by heat and
I 20 dose/vial freezing
P
Q

U
T Damaged by heat or
I freezing

Hepa-B Liquid 20 dose/vial

Least Sensitive
to heat Tetanus Liquid
Toxoid

► The vaccine stored the LONGEST AND THOSE THAT WILL EXPIRE FIRST should be distributed or used 1 st.
► It is MUST to mark ampules / vials with an “X” mark each time they are carried to the field, because if a VACCINE IS NOT USED on the third trip, it must
already BE DISCARDED.

II. Transport

use cold dogs

III. Handling

Once opened or reconstituted, vaccines must be placed in a special cold pack during immunization sessions.
Vaccine Half life
BCG 4 hours
DPT
Polio
Measles 8 hours
Tetanus Toxoid
Hepa-B

DOH STRATEGIES:

- “23 in „93”
National Immunization Day Slogan: “Ceasefire for Children: Support National Immunization Day!
Concept: “No shooting of bullets, only shooting of vaccines”
Project included: Polio Eradication Project
Goal of the project to immunize 9m. children with OPV to completely eradicate polio by 1995
Disease Eradication: Measles, Rabies, Polio, Neonatal Tetanus
Formalization of plans for an improved Biologic Production Service is done to develop self-sufficiency in vaccine production decreasing dependence on
imported vaccines.

- “Health for more in „94”

Buwan ng Oplan Alis Disease II
Goals: to completely eradicate or control childhood killer diseases that are immunizable
To promote a healthy lifestyle that will decrease every Filipino‟s risk of having a heart disease, most especially those belonging to 35 years and above.
10
 LEGAL MILESTONES:
PD 996 – Compulsary, Basic Immunization for children 8 years old and below (0-8 y/o), thus covers 2 age groups - infants
School entrants
PP # 6 – “Universal Law on Immunization” strengthens the EPI
PP # 147 – “National Immunization Day”; every organized Patak Center will cater to 1,000 population (1:1000 population). The team will be composed of:
◊ 1 organizer
◊ 1 vaccinator
◊ 1 recorder
◊ 1 health educator
◊ 1 sanitary inspector
PP # 46 – Launched the POLIO CONTROL PROGRAM OF THE PHILIPPINES

Polio Eradication Knock-out Polio Zero-Polio Philippines

Project (PEP) (KOP) (‟95-‟00)

AC # 63-A – included Hepa-B as an immunizable disease (EPI Program of the DOH)

AC # 242 – Hepa –B must be given with DPT, OPV (3 doses)
TARGET-SETTING
- involves the calculation of the eligible population. “Eligible population consists of any group of people targeted for specific immunizations due to their
susceptibility to one or several of the EPI diseases.”

3 Population with which the EPI is concerned.

Infants
School Entrants
Pregnant Women

For infants, target-setting should be based on the 3% of the total population, while for pregnant women, it must be based on the 3.5% of the total population.

infants

Eligible Population = total population x 0.03

school entrants

x 0.035 pregnant women

To compute for the vaccines

I. Determine Annual Dose-doses required in a year for complete coverage

AD = EP x # of doses to consider that immunization is complete

II. Determine Wastage Allowance

Wastage Dose = Annual Dose x % wastage allowance

III. Combine complete coverage needs with wastage allowance

Annual doses = annual doses (no wastage) + wastage doses with wastage

IV. Determine # of ampules or vials needed per year

Amp: vials = annual doses/doses per ampule (per year)

V. Determine 3 of ampules/vials needed per month

Amp: vials = annual amp: vials/12 months (per month)

Solve: Total population = 6000, determine DPT vaccine to be used for infants.

SURVEILLANCE

 Under Fives Care Program

UFC Program (Under Five Care Program)

A package of child health-related services focused to the 0-59 months old children to assure their wellness and survival

A. Growth and Health Monitoring

Growth Monitoring Chart (GMC)
A standard tool used in health centers to record vital information related to child growth and development, to assess signs of malnutrition.
Sallen “Ming Scale”, Bar and Detect type scales are being used
All newborns must be enrolled for UFCP

B. Oresol Therapy

Diarrhea (Unusual frequency of bowel movements more than 3x/day) (Marked change in the amount of stool)
(Increase in stool liquidity)

3 CLASSIFICATIONS:
11
 Mild - 5 - 10 unformed stools/24 hours
Moderate - 10 - 15 unformed stools/24 hours
Severe - > 15 unformed stools/24 hours with associated
signs/symptoms

Dehydration
ORS, assess after 4 – 6 hours

Management of Moderate and Severe Dehydration

Intravenous fluids
If NOT possible, assess if the child can drink (give ORS and refer for IV)
If cannot drink ( give fluids via NGT)
If no NGT, refer immediately!

Diarrhea Management at Home

3 F‟s
Fluids Frequent Feeding Fast Referral
► Oresol ► Continue If child doesn‟t get better in 3 days,
Rehydration breastfeeding or if danger signs develop – refer
Therapy ► With children over patient
►Encourage/ensure intake of any fruit 6 mos.: Danger Signs:
juices, “am lugaw” homemade soup Cereals/ starchy ► Fever
foods mixed with ► Sunken fontanel
meat or fish and ► Sunken eyeball
vegetables ► Frequent watery stool
► Mashed banana or any fresh ► Repeated vomiting
fruit ► Blood in stool
► Feed the child at ► Poor intake of meals
least 6x/day ► Weakness
► After diarrhea
episode, feed 1
extra meal/day for
2 weeks

ORS :
1 pack
1 L of water
Contains:
glucose for Na absorption
NaCI for fluid retention
NaHCO3 to serve as a buffer system
KCL for smooth muscle contraction

Home-made Oresol:
1 L of water: or 1 glass of water
8 tsp. of sugar: 2 tsp. of sugar
1 tsp. of salt 1 pinch of salt
Remember:
Infant must be given ¼ - ½ cup every after LBM
Child must be given ½ - 1 cup every after LBM
Adult must be given 1 or more cup every after LBM

Measures on Diarrhea Prevention:

- Breastfeed infants
- Provide appropriate supplemental feeding
- Handwashing
- Utilize clean and potable water
- Clean toilet and observe proper feces disposal
- Immunize the child with measles
* No antibiotics must be given to a diarrheic patient except in infectious diarrhea (e.g. cholera)

C. Breastfeeding

Unique Characteristics of Breast milk:

B Fresh
Reduced allergic reaction Emotional bonding
Economical Easily established
Always available Digestible
Safe/maintains the stool soft Immunity
Temperature always right Nutritious
GIT disorders are decreased

Difference of breast milk from formula milk

BREASTMILK VS FORMULA*
12
 CHO > CHO
CHON (LACTALBUMIN) < CHON (CASEIN)
FATS = FATS
Linoleic acid content (3x) > Linoleic acid content
MINERALS < MINERALS

* the high CHON and mineral content of cow‟s milk may overwhelm the newborn‟s kidney, thus it still needs to be diluted. Casein is more difficult to digest.

LEGAL MILESTONES:
EO 51 MILK CODE OF THE PHILIPPINES
RA 7600 MOTHER-CHILD FRIENDLY HOSPITAL
- part of “23 in ‟93 which aims to sustain breastfeeding efforts immediately after delivery

D. Immunization (see EPI)

E. Care of Acute Respiratory Tract Infections (CARI)

Goal: treatment of pneumonia

Assessment:
History:
Age, cough (since when), fever (since when), stop feeding?, convulsions?

Physical Examination:
Assess for fast breathing:
RR of 60/min (below 2 months)
50/min (2months to 1 year)
40/min (1 to 5 years)
stridor, wheeze
level of consciousness
stop feeding
malnutrition

Standard ARI / PNEUMONIA Case Management (EO 110-E s, 1991)

○ Cotrimoxazole adult tabs

Injectable penicillin should be regularly available in
IM gentamycin DOH facilities
IM chloramphenicol

○ No DOH fund shall be used to regularly provide cough medicines except only for the following emergency conditions.
- Single ingredient cough suppressant for severe pertussis
- Single antihistamine fro confirmed allergic conditions such as allergic rhinitis

○ O2 and flow meters must be regularly available in all government hospitals, with O2 delivered properly according to Standard ARI/Pneumonia Case
Management

○ Children found to have Severe Pneumonia, Very Severe Pneumonia, wheezing, otitis media, streptococcal sore throat should be referred to Municipal
Health Officer (MHO) or hospital physicians for proper management according to the referral scheme

Unit 8
STRATEGIES TO ADDRESS SPECIFIC HEALTH PROBLEMS
 Communicable Disease Prevention and Control

Communicable Diseases

Chronic Communicable Vector-borne Communicable

Diseases
► Tuberculosis ► Malaria (MCP)
Schistosomiasis (SCP)
► Leprosy (LCP) ► Filariasis (FCP)
► H-Fever (Dengue)

1. National Tuberculosis Control Program (NTBCP)

“Tuberculosis is a highly infectious, chronic respiratory disease caused by TB Bacilli. It is one of the 10 leading causes of morbidity and mortality in the Philippines,
which is also known as “Koch‟s Disease.”

Objective of the Program:

To control TB by reducing the annual risk of infection (prevalence and mortality rates)

Key Policies:

13
Prevention
○ BCG vaccination under the EPI Program
○ Annual identification of at least 45% of its prevalence
○ Public health education re: PTB mode of transmission, methods of control, and importance of early diagnosis
○ Provide outreach services for home supervision of patients in Multi-Drug Therapy and also for preventive treatment of contacts

Case Finding
○ Direct sputum microscopy for identified TB symptomatics
○ X-ray exam of TB symptomatics who are (-) after 2 or more sputum exam
○ Establishment of passive and active collection points for sputum samples of all identified TB symptomatics, as well as validation centers to ensure the
standard and quality of sputum exam
○ Case finding and treatment services shall be made available in the BHS/RHUs

Treatment
○ All TB cases must be treated for free, on ambulatory and domiciliary (home) basis, except those with acute complications and emergencies
○ All sputum positive and cavitary cases shall be given priority for short course chemotherapy or SCC for 6 mos.
○ Standard Regimen or SR for a year or intermittent SCC for 6 mos. shall be given to all infiltrative but sputum negative.

SR: isoniazid and streptomycin sulfate

SCC: Combo pack, Multi Drug Therapy

PTB TREATMENT REGIMEN

Categories:
6 SCC
Patient will be:

Rifampicin Rifampicin
2 mos. on Isoniazid + 4 mos.
Pyrazinamide Isoniazid

Indicated for patients who are

- (+) sputum smear
- seriously ill ---
- (-) sputum smear, (+) extensive lung lesion
- (+) radiographic lung lesion
- extrapulmonary cases

8 SCC
Patient will be:

Rifampicin Rifampicin Rifampicin

2 mos. on Isoniazid + 4 mos. Isoniazid + 5 mos Isoniazid
Pyrazinamide Ethabutol Ethambulol
Ethambulol
Streptomycin

Indicated for those with relapse

- failures
- others

4 SCC
Patient will be:

Rifampicin Rifampicin
2 mos. on Isoniazid + 2 mos.
Pyrazinamide Isoniazid

Indicated for PTB minimal

(-) sputum smear

3 Phases of Treating a PTB patient:

Rifampicin
1 - Intensive Phase 2 mos. on Isoniazid
Pyrazinamide
Diagnostic: Sputum Exam
if (+), proceed to
Rifampicin
2 - Maintenance Phase + 4 mos. on
Isoniazid
if still (+) TB Colonies proceed to

Rifampicin
3 - Extensive Phase up to 12 mos. on
14
 Isoniazid

What is the purpose of SCC-MDT?

- prevent developing resistance against the three drug combinations
- shorten duration of treatment usually treatment lasts from 5-10 years. With SCC-MDT. tx can be reduced to a minimum of 6 mos.
- eradicate and completely prevent the relapse of the disease

Direct Observation Treatment of Short-Course Chemotherapy (DOTS)

“Tutok-Gamutan”

DOH Activities on NTBCP:

Part of the “23 in „93” is the integrated disease control of TB together with schistosomiasis and malaria through the formulation of a strategic plan for
infectious disease control by specific DOH units.

“Health for More in „94” had “Malakas na Baga, Malinaw na Mata” as its strategy National Focus: TB Control Month
► laboratory and drug supplies were available to local governments in 1994 aimed to accelerate case finding and treatment

Strategies done:
Ensure that every microscopy and treatment center has the ff:
 Exnal microscope
 Microscopist trained within the last 3 years
 A 90% agreement rate in microscopy reading between the microscopist and validator
 Available NTP manual of procedures
 Drugs for at least 6 months supply
 Reagents, sputum cups for at least 6 months
 Utilization of an itinerant team composing of at least 2 microscopists, nurse, midwife, and a medical officer
who will stay for 2 – 3 days in far flung communities to identify TB and start treatment

2. Leprosy Control Program

LEPROSY is a chronic disease of the skin and peripheral nerves caused by Myobacterium Leprae

WHO CLASSIFICATION OF LEPROSY:

Paucibacillary (tuberculoid and indeterminate) – non-infectious

Duration of Treatment: 6-9 months
Multibacillary (lepromatous and borderline) – infectious
Duration of treatment: 24-30 months

Objectives of the Program:

- provide MDT to all leprosy cases within 3 years and complete the treatment of 90% of all cases out on MDT within the prescribed period
- identify all correctible deformities and institution of appropriate intervention
- reduce the stigma attached to the disease thru IEC
- formulate research proposals on topics associated with leprosy

Key Policies:
- MDT as the core strategy for the National Leprosy Control Program
- Procurement and supply of MDT Drugs, IEC and Training Materials by CDCS
- Health education
- Supervision and Control of leprosy Control Activities

Strategies:
Prevention
- Health Education
- BCG vaccination
- Case Finding
- Validate old registered cases
- Early referral of suspected leprosy patients
- Epidemiologic investigation
Treatment
- Ambulatory
- Domiciliary chemotherapy through the use of MDT as embodied in RA 4073 which advocates home treatment
MDT Treatment Regimen
Paucibacillary Multibacillary
Supervised dose: Supervised dose:
Rifampicin 600 mg Rifampicin 600 mg
Dapsone 100 mg Lamprene 300 mg
Taken once/month in the clinic Dapsone 100 mg
Self-administered Taken once/month in the
clinic
Dapsone 100 mg Self-administered dose
Taken OD, daily by the patient at home Lamprene 50 mg
Dapsone 100 mg
Take OD, daily at home
Leprosy Patients must be taught ways to prevent secondary injury caused by burns and rough sharp objects
Emphasize importance of sustained therapy, correct dosage, effects of drugs and the need for medical check-up from time to time
15
 Provide mental and emotional support to the families of leprosy patients
Refer patients as needed

Rehabilitation:
Imbibe patient‟s participation in occupational activities
Family and community health (PD 304)
o non-segregation of leprosy patients
o counseling and guidance

 Locally-endemic Disease Prevention and Control

1. Malaria Control Program

Malaria a vector-borne disease caused by female Anopheles mosquito causing symptoms such a fever, sweating, intermittent chills, anemia, and splenomegaly.

2 Major Strategies of the Program

I - Vector-Control
Highlight
In “24 in „94”
Project: “Kalusugan ng Kalikasan, Kalusugan ng Mamamayan”
National Focus: Awareness and prevention of mosquito borne disease day
Community Action Campaign Acronym CLEAN
Chemically treated mosquito nets
Larva-eating fish
Environmental clean-up of stagnant water
Anti-mosquito soap
Neem trees
● Chemoprophylaxis – Chloroquine 1-2 weeks before entering an area then continuous until 4-6 weeks after leaving the area
2 - Detection and Early Treatment of Cases
● Early Recognition, Prevention, and Control of Malaria epidemics
a system which will recognize impending malaria epidemics
● Early diagnosis and prompt Treatment
identification of a patient with malaria as soon as he is examined.

This may be done thru:

► Clinical ► Microscopic
- Signs and symptoms - Mass Blood Smear Exam
- history of visit to an endemic area
In the event that an imminent epidemic occurs, the following should be done:
Mass Blood Smear Collection
Immediate confirmation and follow-up of cases
Insecticide-treatment of mosquito nets

2. Schistosomiasis, H-fever and Filariasis Control Programs

DOH measures to prevent and control in “24 in „94”

Project: “Kalusugan ng Kalikasan, Kalusugan ng Mamamayan”
National focus: Awareness and prevention of mosquito borne diseases day
Community Action Campaign Acronym: CLEAN

SCHISTOSOMIASIS CONTROL PROGRAM H-FEVER (DENGUE) FILARIASIS CONTROL PROGRAM

16
Schistosomiasis – a parasitic infection caused by blood flukes Dengue – acute febrile infection ►A mosquito borne disease caused by a tissue nematode
inhabiting the veins of their vertebral victims transmitted thru skin of sudden onset, caused by Aedes attacking the lymphatic system of humans thereby
penetration causing diarrhea, ascites, hepatosplenomegaly. Aegypti, vector mosquito causing elephanthiasis, lymphedema, and hydrocele
►started in 1957 as an operational research of the malaria.
Activities: Activities: Eradication Service Three Filaria Control were
Case Fx: Surveillance of the disease Case Fx established and later on integrated with the Regional
Health Education – encourage use of rubber boots for protection Early reporting of any known Health Offices
Environmental sanitation – proper disposal of feces case or outbreak
Snail Eradication – use of moluscides
Activities:
Case fx
Early reporting of any known case of outbreak

 Prevention, Control and Rehabilitation of Non-communicable Diseases

1. Philippine Cancer Control Program

AO 89-A s. 1990
provided the Guidelines for the Philippine Cancer Control Program specifying its program policy, components, implementing guidelines and
timetable.
6 Pillars:
Public Information and Health Education
Cancer Prevention and Early Detection
Cancer Epidemiology and Research
Cancer Treatment
Cancer Pain Relief

In Cancer Nursing, the aim of management is to relieve physical, mental and spiritual distress.
Vital Task of the nurse: To help the patient maintain his dignity and integrity

Cancer care is multidisciplinary.

Who are to be prioritized for health supervision?

Newly diagnosed cases
Post-op case/discharge
Indigent cases needing continuity of hospital care
Terminal cases

DOH Strategies:
In Health for More in ‟94,
► “Kayang-kaya ang Cancer”
National Focus: Cancer Awareness and Prevention Day
“Araw ng Pag-iwas sa Kanser”
Cancer Project: Public information and health education on Cancer
Cancer information desk nationwide
► “Kalusugan ng Kababaihan, Kalusugan ng Bayan”
Women are encourage to undergo the following screening procedures regularly
- Breast Self-Examination
- Regular Pap Smear
Nationwide demonstration on how to correctly do self breast-examination
Information dissemination also on Urinary Tract Infection, Sexually Transmitted Diseases, AIDS

2. Smoking Control Program

Health hazards of smoking:

Lung Cancer
Cardiovascular diseases
Chronic Obstructive Pulmonary Diseases
Cancer of other body organs

Program objective:
decrease the prevalence of smoking-related diseases and subsequent premature deaths

Program components:
Information and Education on Campaign and Social Mobilization
Policy Development and Legislation
Training of Counselors in Smoking Cessation Clinics for Specialty Hospitals
Resource Management and Monitoring

Strategies:
National Anti-Smoking Campaign
o World No Tobacco Day
o National No Smoking Month
o Yosi Kadiri Campaign
17
 Support comprehensive bill on Tobacco Advertising
“Warning labels be written on tobacco products and ads in compliance
with the consumer code of „92

3. Renal Disease

In “23 in „93”
Preventive Cardiology and Nephrology
► Enhance public awareness thru health education regarding healthy lifestyles
► Improve access to basic health services

“Health for More in „94”

“Buwan ng Buhay na Bato”
► Requires urinalysis of ALL children entering Grade I so as to detect childhood kidney infections, which may lead to Renal Failure
► Encourage adult Filipino to undergo urinalysis once a year

4. Cataract

In accordance with the Prevention of Blindness Program,

“Malakas na Baga, Malinaw na Mata”
National Focus: Cataracts Screening Week at DOH Centers
OPLAN: Sagip-Mata
► Eye Surgery for cataract and squint operations for cross-eyed children

 Nutrition and Adequate Food Supply

Goal:

The improvement of nutritional status, productivity and quality of life of the population through adoption of desirable dietary practices and healthy lifestyle.

Coverage:

Philippine Food and Nutrition Programs

directed to the provision of nutrition services to the DOH‟s identified priority vulnerable groups: infants, pre-schoolers, schoolers, women of child bearing age (also
included are the pregnant and lactating mothers) and the elderly

Objectives: to decrease the morbidity and mortality rates secondary to Avitaminoses and other nutritional deficiencies among the population mostly composed of
infants and children.

1. Malnutrition Rehabilitation Program

Targeted Food Task Force Assistance Nutrition Rehabilitation Ward Akbayan sa Kalusugan (ASK Project)
Program (TFAP)
Provision of food rations of bulgur wheat Every hospital must have a Nurse ward, Aimed to provide rice and corn soya blend
and green peas. where an adequately trained nutritionist supplemented with local foods.
Target population: were assigned (RA 422) Target population:
Preschoolers 6 mos. – 2 yrs.
Pregnant women moderately and severely underweight
Lactating mothers preschoolers not served by the DSWD and
DA in Regions 2, 8, 9, 10, 11, 12.

2. Micronutrient Supplementation Program

“23 in „93” “Health for More in „94”

Fortified Vitamin Rice “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 - aimed to distribute vitamin A supplements, iodized oil for
vitamin A (blindness); iron (Anemia); Iodine (goiter, mental mothers and seedlings of plants rich in Fe and other minerals
retardation and delayed development)
(1 cavan of rice + fistful processed, binilid enriched with
essential micronutrients)

3. Food Fortification Program

Fortification is the addition of a micronutrient deficient in the diet to a commonly and widely consumed food or seasoning. It involves:
Incorporation of Monosodium Glutamate (MSG) with Vitamin A to reduce clinical signs of Xereopthalmia
The use of FIDEL salt in lieu with the National Salt Iodization Program

Fortification for
Iodine
Deficiency
ELimination

18
4. Nutrition Surveillance System
- a system of keeping close watch on the state of nutrition and the causes of malnutrition within a locality, which involves periodic collection of data and analysis and
dissemination of analyzed information

Tools utilized are anthropometric measurements:

Weight for age measures degree and presence of wasting or stunting

Height for age measures the presence of stunting

< 90% of standard → stunting or past chronic malnutrition

Weight for height determines the presence of muscle wasting

Male Rule Female

+ 6 For every increment of an inch above 5 +5
feet
105 – 110 lbs. For a height of 5 feet 100 – 105 lbs.
-6 For every decrement of an inch below 5 -5
feet

1. Compute for the Ideal Body Weight

if height = 5 feet and 6 inches

actual weight = 115 lbs.
sex = Female
5 feet = 105 lbs.
6 inches = 30 lbs.
IBW = 135 lbs.

2. Determine the degree of malnutrition

Actual Body Weight
a. Degree of Malnutrition = _________________ x 100%

Ideal Body Weight

Thus;

Actual Body Weight (115)

a. Degree of Malnutrition = ____________________ x 100%

Ideal Body Weight (135)

= 85-18%
► 1st degree Malnutrition

Degrees of Malnutrition

110% and above - obese

90 –109 % - normal
75 – 89 % - 1st degree
60 – 75 % - 2nd
rd
60% and below - 3

skinfold measurement
indicates amount of body fat with the use of fat-caliper
sites: triceps, biceps, subscapular, suprailiac

MUAC
estimates lean body mass or skeletal muscle reserves

Legal Milestones:
PD 491 – Nutrition Act of the Philippines

- declares Nutrition as a priority of the government

- creates the National Nutrition Council
- designates duly as the Nutrition Month

RA 832 – Rice Enrichment Law

“all milled rice have to be enriched with premix Rice”
government‟s nutrition program

RA 8172 – FIDEL Salt

 Supply and Use of Essential Drugs

19
Essential drugs are medicinal preparations necessary to fill the basic health needs of the population.

National Drug Formulary contains the list of essential drugs

“23 in „93” “Health for More in „94”

Philippine National Drug Policy National Focus Generics information Campaign Month
Objective: to promote access to – “Walong Wastong Gamot na Maabot”
High-quality
Effective - supports the Generics Act of 1998 through aggressive
Essential information campaigns on rational drug use, to provide
Low-cost consumers options for les expensive drugs with the use of
Safe Drugs and pharmaceuticals generic labeling and prescribing.
ACRONYM HEELS
4 Pillars: Pilot Program OPLAN WALANG RESETA
1. Assurance of safe, effective and useful drugs Several prescription drugs were made available without a MD‟s
2. Rational drug use prescription
- the practice of using only the necessary, appropriate and
effective drugs in treating an illness
3. developing greater self-reliance in basic production thru DOH
herbal processing plants
4. tailored drug procurement

Legal Milestones

Generics Act of 1998 Dangerous Drugs Act

RA 6675 RA 6425
“Formally proclaims the state policy of promoting the use of “The safe, administration and transportation of prohibited drugs
generic terminology in the importation, manufacture, is punishable by law”
distribution, marketing, promotion and advertising, labeling, 2 Types of Drugs
prescribing and dispensing of drugs.” Prohibited Regulated
“Reinforces the NDP with regards to the assurance of high- LSD Benzodazepines
quality and rational drug use” Eucaine Barbiturates
Cocaine/codeine
Opiates

 Environmental Sanitation

Environmental Sanitation is defined as the study of all factors in man‟s physical environment, which may exercise a deleterious effect on his health, well-
being and survival.

Goal:
to eradicate and control environmental factors in disease transmission through the provision of basic services and facilities to all households.

Components:

Water Supply Sanitation Program

Proper Excreta and Sewage Disposal Program
Insect and Rodent Control
Food and Sanitation Program
Hospital Waste Management Program
Strategies on Health risk immunization

1. Water Supply Sanitation Program

3 Types of Approved Water Supply and Facilities

Level I Level II Level III

Point Source Communal faucet system or stand posts Waterworks system or individual house
connections
A protected well or a developed spring A system composed of a source, a A system with a source, a reservoir, a
with an outlet but without a distribution reservoir, a piped distribution network and piped distributor network and household
system for rural areas where houses are communal faucets, located at not more taps that is suited for densely populated
thinly scattered. than 25 meters from the farthest house in urban areas.
rural areas where houses are clustered
densely.
Water must pass the National Standards for Drinking Water set by the DOH

2. Proper Excreta and Sewage Disposal System

3 Types of Approved Toilet Facilities

20
Level 1 Level 2 Level 3
Non-water carriage toilet facility: On site toilet facilities of the water Water carriage types of toilet facilities
- Pit latrines carriage type with water sealed and connected to septic tanks an/or to
- Reed Odorless Earth Closet flushed type with septic vault/tank sewerage system to treatment plant.
- Bored-hole disposal facilities.
- Compost
- Ventilated improved pit

Toilets requiring small amount of water to

wash waste into receiving space
- Pour flush
- Aqua privies

Rural Areas – “Blind drainage” type of wastewater collection and disposal facilities shall be emphasized until such time that sewer facilities and off-site treatment
facilities are available.

3. Proper Solid Waste Management

- refers to satisfactory methods of storage, collection and final disposal of solid wastes

2 Major Components:
Garbage
Those having a tendency to decay and give off foul odor
Rubbish
Broken glass, bottles, papers

Zero Solid Waste Management featured in “23 in „93”

2 Ways of Excreta Disposal

Household Community
○ Burial ○ Sanitary landfill or controlled tipping
► Deposited in 1m x 1m deep pits covered with soil, ► Excavation of soil deposition of refuse and compacting with a
located 25 m. away from water supply solid cover of 2 feet

○ Open burning ○ Incineration

Animal feeding
Composting
Grinding and disposal sewer

4. Food Sanitation Program

These include the following:
Policies: Anti-smoke Beching Campaign and Air pollution Campaign
Food establishment are subject to inspection (approved of all food Zero Solid Waste Management
sources containers and transport vehicles) Toxic, Chemical and Hazardous Waste Management
Comply with sanitary permit requirement Red Tide Control and Monitoring
Comply with updated health certificates for food handlers, helpers, Integrated Pest Management and Sustainable Agriculture
cooks Pasig River Rehabilitation Management
All ambulant vendors must submit a health certificate to determine
present of intestinal parasite and bacterial infection 7. Education of prevailing health problems

3 Points of Contamination accepted activity at all levels of public health used as a means of
Place of production processing and source of supply improving the health of the people through techniques which may
Transportation and storage influence peoples thought motivation, judgment and action.
Retail and distribution points
Three aspects of health education:
5. Hospital Waste Management
Information – provision of knowledge
Goal: Communication – exchange of information
To prevent the risk of contraction contracting nosocomial infection Education – change in knowledge, attitudes and skills
from type disposal of infectious, pathological and other wastes
from hospital

In 23 in ‟93, hospitals were developed to be “Centers Sequence of steps in health education:

of Wellness” addressing the need for preventive
programs against smoking, cancer and other Creating awareness
communicable diseases. This is further pushed through Creating motivation
with the concept of “Ospital Pinoy Style: Sentro ng Decision making action
Kalusugan” in Health for More in ‟94 its major aim is
to continue upgrading the curative as well as basic
services in hospitals, which are available to all  HIV/STI Prevention and Control
communities. One of its challenges is the
implementation of Hospital Waste Management Operational Strategies:
program as a requirement to operate
Promotion of health/health education
6. Programs related to health-risk minimization secondary to Diseases detection
environmental pollution
21
 Treatment program - the emotional adjustment the person achieve in
Contact tracing which he can live with reasonable comfort,
Clinical services functioning acceptably in the community where
she lives
Program components:
- involves the promotion of a healthy state of mind
Case-finding among the whole population through
Case management developing positive outlook in life
Training strengthening coping mechanisms
Monitoring
Reporting system Vulnerable group to the development of Mental Illness:
Operations research
Streetchildren
Victims of Torture or violence
Ministry circular #2 s. 1986 includes AIDS as a Internal refugees
notifiable disease Victims of aimed conflict
AO#57 –As 1989 provides the policies for the Victims of natural and man-made disasters
prevention and control of HIV/AIDS in the
Philippines. Components of Mental Health Program

A. Stress Management and Crisis Intervention

National AIDS Program, featured in 23 in „93 B. Drugs and Alcohol Abuse Rehabilitation
► Aimed to establish Surveillance C. Treatment and Rehabilitation of Mentally-Ill Patients
program to determine groups at D. Special Project for Vulnerable Groups
increased risk of acquiring AIDS
► Create a Philippine National DOH Events:
AIDS Council which define “Buwan ng Kabataan, Pag-asa ng Bayan”,
policies advocacy, strategies, featured in Health for More in ‟94
issues, and public health National Focus: National Mental Health Week:
education for AIDS prevention “Linggo ng Lusog-Isip”
Rationale:
Stresses in the environment of children such as times of
 Mental Heath disasters and national calamities, disintegration of the
values, structure and functions of the family and
- a state of well-being where a person can realize urbanization, migration, drugs and physical and sexual
his or her own abilities, to cope with the normal abuse and poverty have direct effects on physical and
stresses of life and work productively mental health.

METHODS OF EXCRETA DISPOSAL Pour-flushed latrines

- two types of pour-flush latrines:
FOUR CATEGORIES OF EXCRETA DISPOSAL METHODS: a. a modification of the unimproved pit latrine in which the squatting
I. With Transport and Water plate is made with a 25 mm water seal
Sewerage System Approximately 1-2 liters of water are poured in by hand to push
- consists of a cistern-flush toilet connected to a network of underground the excreta into the pit. This type of PF latrines is especially
sewers suitable where water is used for anal cleansing.
- main advantages are the excellent health benefits and convenience it b. a completely displaced pit, which is connected, to a pour-flush
provides bowl by a short length of 100m pipe, which discharges into the
- main disadvantages are its large water requirement and its very high adjacent pit
construction and maintenance costs This type of PF latrines can be installed inside the house since it is
free of odor and insect problems and is displaced from the pit.
When the pit is full, a new one is dug and the latrine is connected
II. No Transport and With Water to it.
Cistern-flush toilet connected to a septic tank
- conventional septic tank is a rectangular chamber located just below Sewered pour-flush latrines
ground level - an improvement of the sewered aqua privy system
- one to three days retention time in the tank, the solids settle at the - has 5 parts: a PF with vent pipe and inspection chamber, a small
bottom for anaerobic digestion compartment septic tank, a network of small bore sewers and a sewage
- enough sludge accumulates that the tank must be desludged every 1 to 5 facility system
years
- effluent is usually disposal of in subsurface drain fields, where it Vault Latrines
undergoes secondary treatment utilizing aerobic bacteria to stabilize - similar to PF toilets except that the vault is sealed and emptied by a
further organic matter in the effluent vacuum pump at regular intervals of two to six weeks
Aqua privy - adjacent houses can also share called cesspool
- septic privy, consists of a squatting plate above a septic tank, which
discharges its effluent to an adjacent soak-away
- squatting plate has an integral drop-pipe submerged at least 4 inches to
the water in the tank to form a simple water seal III. With transport and no water
- tank normally requires desludging when about two-thirds full or every Bucket Latrine
two to three years - consists of a squatting plate and a metal bucket located in a small vault
- variation on the conventional design is the sullage aqua privy with a immediately below the squatting plate
sink located either inside the toilet or immediately adjacent to it and is
connected to the tank so that sullage is regularly flushed into the aqua IV. No transport and no water
privy Pit latrines
22
 - most commonly observed in rural area Double vault composting (DVC) are the most common type of
- has three components: the pit, a squatting plate and the super-structure composting toilets. They are two adjacent vaults, one of which is used
- types of pit include until it is about three-fourths, when it is filled with earth and sealed to
a. “Antipolo type”, a pit type of toilet provided with concrete floor absorb odors and moisture. The composting process is anaerobic and
and an elevated seat with a cover requires several months to make it safe.
b. Ventilated Improved Pit or VIP, pit with a vent pipe
c. Reed Odourless Earth Closet or ROEC, a pit completely Indiscriminate disposal into fields or bodies of water
displaced from the superstructure and connected to the squatting - violates all sanitation principles nevertheless
plate by a curved chute. - types include:
If nearby groundwater is used for drinking, pit latrines should not be a. over-hung latrines
placed within thirty meters of the wall. If the soil is fissured, the b. “wrap and throw”
pollution is more extensive and the distance should be increased. c. cat-hole
Advantages: costs are low and their potential for health benefits is
high. MOST COMMON METHODS OF EXCRETA DISPOSAL IN THE
PHILIPPINES:
Bored hole or bore-hole latrine 1. Flush toilet (water sealed)
- consists of relatively deep holes bored into the earth by mechanical or
manual earth-boring equipment 2. Pour flush toilet (water sealed)
- holes are about 10-18 inches in diameter and usually 15-35 feet deep. 3. Sanitary Pit Privy (in places where water is scarce)
The hole is provided to facilitate squatting. Two types of bored-hole
latrines are: THINGS TO CONSIDER IN CONSTRUCTING A TOILET FACILITY:
Wet Type - when the hole penetrates ground water table or other
strata. 1. At least 25 meters away from water sources at a
Dry Type - when he hole does not reach ground water table; fills lower elevation
up at a faster rate then than the wet type. 2. It should be within your financial capability

This bored latrine is not recommended for it is too small and cannot be
3. It should be approved by the local health authorities
ventilated. It has a short lifetime (1-2 years) and an unacceptable level
CARE AND MAINTENANCE OF YOUR TOILET FACILITY:
of fly and odor nuisance. Contamination of underground drinking
water sources is to be watched for with this type of latrine, especially 1. Water must be provided at all times.
the wet type. 2. Use toilet paper
Compost Latrine
- two basic type of compost latrines: 3. Use lysol once a month for odor removal
Continuous composters - developed from a Swedish design known as 4. Clean the bowl by muriatic acid to remove the stains.
“multrum”. Composting pit is immediately below the squatting plate,
has sloping floor with inverted U or V-shaped channels suspended
5. Avoid depositing solid objects on the bowl to prevent
clogging
above it to promote aerobic conditions in the chamber. If the
temperature in the composting chamber is raised by bacterial activity to 6. Always check your toilet if it‟s clean
above 50C all pathogens in the excreta will be destroyed. 7. Use plunger when clogging occurs. Don‟t use sticks
or rods to avoid the breakage of the trap or the bowl.
3 Types of Approved Toilet Facilities

Level 1 Level 2 Level 3

Non-water carriage toilet facility: On site toilet facilities of the water Water carriage types of toilet facilities
- Pit latrines carriage type with water sealed and connected to septic tanks an/or to
- Reed Odorless Earth Closet flushed type with septic vault/tank sewerage system to treatment plant.
- Bored-hole disposal facilities.
- Compost
- Ventilated improved pit

Toilets requiring small amount of water to

wash waste into receiving space
- Pour flush
- Aqua privies

WATER SANITATION 4. Turbidity - causes of water turbidity are failure of water treatment
facilities, failure to flush thoroughly distribution and service piping,
WATER QUALITY corrosion of piping and other water supply facilities and abnormal growth
of bacteria and plankton
1. Water temperature - the water temperature of raw water changes with the
seasons and with ambient air temperatures. Compared to raw water 5. pH (alkalinity) - the alkalinity of water declines gradually during the rainy
temperature, the temperature of water from service taps fluctuates much less season and ascends gradually during the draught season.
due to meteorological conditions.

2. Color - the color of raw water maybe yellowish brown due to the decay
6. Residual Chlorine - the residual chlorine in supply water resists
recontamination. The residual chlorine of tap water should range from 0.2 -
products or organic compounds while supply water may have a reddish 0.5 mg./L
yellow color because of rust formation and scales produced by iron bacteria.

3. Odor - supply water smells slightly of residual chlorine. Foreign

7. Algae and Plankton - algae and plankton are abundant during warm
seasons. They clog sand filters and sometimes flow through filter and
substances suspend or dissolved in water sometimes cause other odors. discolor supply water.

WATER QUALITY STANDARDS

23
I. Standard Value for Bacteriological Quality
Source and Mode of Supply Bacteria S.V. (no./100 ml)
A. all drinking water supplies E. coli or thermotolerant
fecal coliform bacteria 0
B. treated water entering the distribution system
same as above 0
C. treated water in distributed system
same as above 0

II. S.V. for Biological Organism - permissible limit is 10 counts per ml.

III. S.V. for Physical and Chemical Quality (health significance)

Antimony - .005
Arsenic - .01
Barium - .7
Boron - .3
Camium - .003
Chromium - .05
Cyanide - .07
Flouride - 1.0
Lead - .01
Mercury - .001
Nitrate as NO3 - 50
Nitrite as NO2 - 3
Selenium - .01

IV. Chemical of no health significance at concentration normally found in Step 2 - The “coagulants” are injected to the water to make the dissolved
drinking water:
mineral and dirt lump together. The lumps either float or sink.
ASBESTOS, SILVER AND TIN - in accordance with the findings of The water then passes through machines called “flocculators”
the WHO, the Department of Health does not prescribe any standard that remove the dirt that floats and then through large pools
values for these compounds since they are not hazardous to human called “settling basins” to remove dirt that sinks.
health at concentration normally found in drinking water.
Step 3 - Finally, the water flows through several filter beds that act like
THE STANDARD PROCESS OF WATER TREATMENT very fine strainers, each one finer than the next, to remove
microscopic impurities. After even the smallest impurities have
been removed, the water is again injected with Chlorine gas to
1. Screening- raw water enter the plant through screens that prevent the entry kill any microbes or germs that may contaminate the water
of foreign objects such as grass, leaves and tree limbs and other large before it reaches your taps.
floatables. The screens thus protect the rapid mixer and flocculators from
damage. BALARA TREATMENT PLANT

2. Rapid Mixing - during this process, rapid mixers uniformly disperse the The water that comes from La Mesa Dam reaches the Balara
chemicals (alum and/or polyelectrolytes) throughout the raw water. These Treatment Plant with a turbidity of 24 NTU, which is not potable.
chemicals are coagulants, which react with undesirable, tiny suspended
solids in the raw water, causing the latter to form clusters. In Balara Filtration Plant I, the treatment employed is Standard Water
Treatment that involves 5 main processes: pre-chlorination, coagulation,
sedimentation, filtration and chlorination.
3. Flocculation - the water then enters the flocculation basins when it is gently
agitated. This agitation causes the small clusters of suspended solids to Pre-chlorination - the raw water coming straight from the dam is first treated
collide with and stick to each other and form into large particles called with chlorine to get rid of germs.
“flocs”/
Coagulation - aluminum sulfate - coagulant is added to raw water. The process
4. Sedimentation - the flocculated water then enters the settling basin of he involved rapid circling, moderate and slow circling motion that
plant, where the floc particles get heavier and settle to the bottom of the enhances the combination of coagulants to the water. It is done to
basin. The settled floc materials, called “sludge” are periodically removed allow the impurities of water to clamp together forming “flocs”.
from the basin bottom.
Sedimentation - the flocculated water then enters the settling basin. After
clumping, the flocs gain weight allowing them to settle at the bottom
5. Filtration - purification of the water is done at this stage by gravity. The
of the basin. 7-8 NTU.
water is filtered through dual-media filters, which consist of a layer of
anthracite coal on top of a layer of sand. They trap the flocs as water flows
Rapid Sand Filtration - at this stage the water from sedimentation basin enters
down through them
the filter beds. In Balara Filter I, there are 10 dual-media filters which
consists of 4 layers - anthracite crust gravel at the top layer, the silica
6. Post Treatment - chlorine is added to disinfect the water. sand followed by course sand layer and lastly the support gravel.
Drain pipes are situated at the bottom.
MANILA WATER FILTRATION SYSTEM
Chlorination - the next step is the addition of chlorine to the filtered water. In
Step 1 - Raw water coming straight from the dams carries soil, dirt and Balara Filter I, there is a separate building for chlorination.
dissolved minerals. The raw water is first treated with chlorine
to get rid of any germs.
24
 Balara Filtration I was constructed to obey the law of gravity. It 4. Radiological Characteristics
produces 470 million liters of water per day. - radiological impurities in the water result from nuclear weapons
testing and discharge of isotopes and other radioactive contaminants
WATER SANITATION into the water.

SOURCES OF WATER SUPPLY: HOUSEHOLD METHODS OF WATER PURIFICATION

1. SURFACE WATER
A. BOILING
five minutes will be the minimum time suitable for low level locations
- derived from streams, brooks, ponds or rivers
but an additional 1minute will be added for every 1000 meters
- subject to seasonal availability
additional elevation (water will boil at a higher temperature at higher
- contaminated by domestic, agricultural, and industrial wastes
altitudes).
water that would be used for drinking should be boiled 15 minutes to
2. GROUNDWATER kill all vegetative bacteria, most viruses and fungi.
- this is the largest source of water
- be obtained from wells of springs
- are biologically pure with regards to bacteria, algae, protozoa and
B. SEDIMENTATION
viruses the process wherein he impurities are allowed to settle at the bottom of
- constant temperature and chemical properties a clear clean container, avoiding the creation of turbulence.
- water qualities vary based on geology and depth faucet must be at the upper 2/3rds or at the middle third of the
sedmentation container
not sufficient to render water safe for drinking, so that additional
a. Well chlorination or boiling should be done.
(a structure dug, driven, bored, or drilled into the ground to
secure water)
C. FLOCCULATION AND SEDIMENTATION
dug and driven - soft ground/sand and gravel, for the use of aluminum sulfate crystals (tawas) to form precipitates of the
wells with depth of less than 100 feet impurities found in the turbid water and allowing these precipitates to
deep wells - depth of more than a 100 feet, and may settle at the bottom of the container.
also be called artesian wells usual dose: 10-50 mg./L of water
bored and drilled - hard, rocky grounds, with depths caution: not to be applied if container has a faucet at the lower end,
of more than 100s or even thousands of feet. faucet should be at least 10 cm above the bottom of the container to
avoid drinking of precipitates.
b. Spring
(groundwater seepage created when the level of underground water D. AERATION
comes in contact with the surface usually on the side of a hill or the transferring of water from one container to another or by stirring
mountain) the water to create a turbulence
used when the taste, color, or iron content of water becomes
objectionable
3. RAINWATER
caution: can be a source of contamination of water
- good source of water supply in areas with a fairly distributed rainfall
throughout the year
- basically free from impurities E. FILTRATION
- may be contaminated by air pollution, e.g., acid rain process done before boiling or disinfecting.
the following are the common household filters:
The public water supply system:
1. collection works (dams, reservoirs, and pumps)
1. cloth filters. Muslin cloth or cotton shirt is used in rural areas
that is put on top of earthen containers (banga)
2. transportation works (conduits, aqueducts, and main transmission pipes)
3. treatment works (chemical dosing plants, mixing and flocculation tanks, 2. sand filters. Use of an earthen pot of 60 cms diameter and 75 cm
disinfecting equipment) high giving a capacity of 1 liter per minute. Filter is make up of
4. distribution works (mains and laterals, reservoir and pumping machinery) a layer of small stones (pea size) and 50 cm deep of fine sand.
3. Intermittent water filter. Use of a galvanized iron drum, fitted
CHARACTERISTICS OF WATER with tap. The filter is consists of layers of gravel, charcoal, sand
1. Physical Characteristics and gravel. Addition of a few drops of chlorine is advised.
- turbidity, color, taste and odor 4. Carbon filters. Maybe granulated or solid carbon blocks.
Turbidity is caused by the impurities in suspension and the turbidity
of water is measured in Nephelometric Turbidity Units (NTUs) by a
turbidity meter. F. CHEMICAL DISINFECTION
Color is caused by the presence of substances in water. 1. Chlorination
2. Chemical Characteristics Add 2 teaspoons of 10% stock solution (40 mg or 2 ½
- pH or alkalinity (6.5 - 8.5), hardness (soap consuming power) and tablespoons of calcium hypochlorite) per liter of water and
content of total solids, chloride and iron. let stand for 30 minutes.
3. Biological Characteristics
- the presence of bacteria, viruses, parasites and other microscopic 2. Iodination
plant and animal life such as plankton, insect and crustaceans, 2 drops of the tincture of iodine is added to 1 liter of water.
larvae and algae. the solution is allowed to stand for 30 minutes.

Water Supply Sanitation Program of

the Department of Health
(ENVIRONMENTAL HEALTH SERVICE)

Approved types of water supply facilities

25
 Level I Level II Level III
Point Source Communal faucet system or stand posts Waterworks system or individual house
connections
A protected well or a developed spring A system composed of a source, a A system with a source, a reservoir, a
with an outlet but without a distribution reservoir, a piped distribution network and piped distributor network and household
system for rural areas where houses are communal faucets, located at not more taps that is suited for densely populated
thinly scattered; serves around 15 to 25 than 25 meters from the farthest house in urban areas.
households and its outreach must not be rural areas where houses are clustered
more than 250 m from the farthest user densely; serves an average of 100
households.
Water must pass the National Standards for Drinking Water set by the DOH

Sampling for Water Examination

1. sample should be representative

2. Rubbish refers to waste materials such as bottles, broken glass, tin can,
waste papers, discarded textile materials, porcelain wares, pieces of metal
2. sufficient amount (120 ml for bacteriological examination and 2 liters for and other wrapping materials.
complete physico-chemical examination
3. prevent contamination of collected water:
a. water containers for sample 3. Ashes are left over from burning of wood and coal. Ashes may become a
- clear bottle for biological tests nuisance because of the dust associated with them.
- sterile bottle for bacteriological tests
- chemically clean container rinsed three times of the water to be 4. Stable manure is animal manure collected from stables.
sampled for chemical tests
b. clean/sterile covers
c. airspace in bottles for biological tests 5. Dead animals like dead dogs, cats, rats, pigs, and chickens that are killed
d. no samples near the river banks or too far from draw off, bottle by cars and trucks on streets and public highways. They include small and
directed to the current large animals that died from disease.
e. flame faucets and run water to waste for 2 –3 minutes before
collection 6. Street sweeping includes dust, manure, leaves, cigarette buts, waste papers
f. run pump for 5 minutes before collection and other materials that are swept from streets.
4. place proper labels and tags
- name of sample collection
- date, hour, and location
7. Night soil is human waste normally wrapped and thrown into sidewalks and
streets. This also includes human waste from pail system of toilets.
- type of examination requested
- water temperature
- other details (treatment, weather, water level, stream flow, etc. 8. Yard cuttings includes leaves, branches, grass and other similar materials
produced during cleaning of gardens and after storms.
DEFINITION AND CHARACTERISTICS OF SOLID WASTE
The amount of refuse produced is affected by many factors such as
climate, season of the year, industries present, economic condition of the family
and geographical location of the community.
A. Sources

1. Household Waste - these are wastes generated in or discharged from

household including shops but excluding commercial activities METHODS OF SOLID WASTE DISPOSAL AND MANAGEMENT

2. Commercial Waste - restaurants, stationery shops, grocery shops or any

commercial activity are the main sources of commercial waste. Storage of Solid Waste

The common waste containers used for storage in households are

3. Market Waste - only refers to waste generated in or discharged from plastics, supermarket bags, cartons, steel drums (100-120 liters capacity) plastic
markets both for whole sale and retailing containers, kaings, rice sacks, wooden or bamboo boxes, 20 liter cans, dust bins
made of tires, plastic and metal buckets. However, for the majority of large waste
4. Institutional Waste - these are wastes generated in government, state generators such as shopping centers, hotels, factories, etc. directly contract
enterprise and private firm office. private waste collection and haulage companies. The containers used by the
companies measure 1 cubic meters. Depending on the collection company
contracted compactor containers are used for storage.
5. Street Sweeping Waste - these are wastes generated by the street sweeping
cleansing service.
Market Waste
6. River Waste - includes all the wastes generated by the river and creek
cleansing On public markets usually there are containers beside the road. There
are containers that are equipped with a compacting mechanism and measure
7. Medical Waste - these are wastes generated in hospitals. about 1 m x 1.5 m x 2 m. market sweepers bring waste in to this containers using
other containers of various sizes. When the containers are full, a contractor
personnel is in charge of keeping the area clean by occasionally washing the area
with disinfectant to avoid odor and flies. Waste segregation is also done on site
B. Components of Solid Waste recyclable items are separated and sold. Bulky wastes are removed by the
operators because they damage the compacting mechanism.
Refuse is a general term applied to solid and semi-solid waste materials other
than human excreta. Waste material in refused may be divided into: Another scenario in public markets is that their wastes are centralized
in an open space about 100 sq. meters. Market sweepers sweep the alleys and the
1. Garbage refers to left over vegetable, animal and fish material from kitchen stallholders clean their own place. Some stallholders have their own waste
and food establishments. These materials have the tendency to decay containers while the rest rely on the sweeper‟s containers. The market sweepers
giving off foul odors and sometimes serve as food for flies and rats. use a pushcart to carry waste to the parking lot that also serves as the station

26
where the truck loads the waste. Since waste is left spread over a wide area the
collector uses a loader to load waste into an open dump truck. The collection system adopted by each LGU is similar. In residential
and commercial areas, door to door collection, curb collection, and bell collection
As for private markets usually there are two stations where garbage is are the collection systems mainly adopted. The collection systems adopted for
brought, a wet vault (waste from fish and meat section) and a dry vault (waste large waste generators such as markets and business offices are the container
from vegetables and dry goods). It‟s been observed that there is greater number collection system and the station collection system. The latter entails the
of sweepers for private markets. Flushing of a different section every night, each construction of a special yard, used as a waste, for waste disposal, storage and
section is flushed twice a week with water to thoroughly clean it. It was learned collection.
that there is a separate collection for dry and wet wastes by contractors. Market
sweepers use steel buggies to bring the garbage to the vaults and there are also
trash receptacles found along the alleys of the market. Aside from market Door to Door Collection. Containers are set out from the premises and set back
sweeping there are also related activities like pest control and fumigating after emptied by collection workers or by residents themselves.
services. Wastes from the vaults are loaded onto a dump truck manually with
spades. Curb Collection. Each household is responsible for placing the containers by
the curb on the collection day and for returning them when emptied to
In Manila, there also exist a “talipapa” which is small market usually their storage location.
occupying the whole length of a street or a group of street vendors selling goods
similar to those found in markets. Street sweepers and stallholders pile waste on Bell Collection. The collector calls out to the residents to discharge their waste
the center traffic island or at the nearest street corner where private collectors upon arrival of the collection vehicle at a given collection point.
pick it up. Stallholders are responsible for the own stall‟s cleanliness. There is no
organized body that manages solid waste in the street market. As talipapa Container Collection. This is mainly for large generation sources discharging
occupies the whole length of the street are multiple waste piles on the traffic waste regardless of the collection schedule.
island and corners. These are manually loaded onto the truck using spades or
plastic trays. Station Collection. This is mainly for large generation sources discharging
waste at a designated point without containers.

Street Sweeping
Disposal of Solid Wastes
Many of solid waste can also be found on streets. That is why street
cleaning activities are very useful. There are local governments that use a In the homes, particularly in the rural areas, solid wastes may be
mechanical sweeper (vacuum truck) for they found it to be faster and more disposed of satisfactorily in the following ways:
effective in cleaning the streets. The sweeping crew consists of the driver and a
helper with a broom. The helper walked by the side of the truck, manually 1. Burial. In the method solid waste produced by members of the household
sweeping the sidewalk litter. The work of the helper is to sweep the waste into each day are deposited in pits (1m x 1m deep) and covered with soil and
the path of the truck. Occasionally, the helper picked-up wastes and threw it to preferably with a pit cover at the end of the day, to prevent excavation of
within reach of the truck. The helper also sees to it that the path is clear of buried materials by animals. The pit should be located at least 25 meters
obstructions such as large stones, timber, etc. When truck makes U-turn in some away from any well used for waster supply. Another pit is dug when the
buy streets, the helper controls the traffic. Sporadically, the sweeper had to miss old one is filled up. Individual households can use the pit or a communal
portions of the road because of parked vehicles. pit can be dug for use by a group of households.
There are also street sweeping activities handled by the MMDA.
Usually it is along the busy major thoroughfares. Street sweepers are assigned to 2. Open Burning. This is uncontrolled burning which is usually done for
certain places with corresponding distance coverage and depending of the yard and street sweeping. It may be allowed in rural areas where it will not
condition of the place whether it‟s a very busy street or not. The waste collected worsen already existing air pollution.
was loaded into a dump truck collecting garbage in the area.
3. Feeding to Animals. Leftover food can be used for feeding of pigs,
chicken, and other livestock. Care should be taken to maintain sanitation in
River Cleansing these areas.

One of the agencies responsible in cleaning and collection of waste

from Pasig River is the MMDA. River cleansing is undertaken by 5 member 4. Composting. Composting may be aerobic (with oxygen) or anaerobic
teams who operate motorboats each with a waste capacity of 1.5 cubic meters. (without oxygen) in nature.
Of the collected river waste, 80% were plastic items and the rest were cans, wood
sacks, and pieces of bamboo and water lilies. Three of the personnel were a. Aerobic. In aerobic composting, air is placed into a pile of solid waste
assigned to put the waste on the black to drain while other members loaded the material by frequent turning (every few days) or by the use of
waste directly onto the boat. Large volumes of the waste were observed in the mechanical air pumps with necessary pumping system. A temperature
waterways resulting from two trips, they are able to collect 1.5 cubic meters from of 60-70 degrees is reached during the process that destroys most
an area of only 10 sq. meters. Deterioration of river waste quality due to organisms that cause disease in man. The compost takes a few weeks
indiscriminate dumping of garbage was obvious. to mature depending upon the temperature and frequency of turning.
The compost material is used as soil conditioner and fertilizer.
On the other hand, the DPWH is currently implementing the Bantay
Estero Program. The program is aimed at promoting and maintaining the
b. Anaerobic. Anaerobic composting is done simply by burying organic
material, especially manure and yard cuttings, which subsequently
cleanliness of the different estuaries in Metro Manila. For the operation, the crew
covered with soil and allowed to decompose anaerobically for a
were provided 2 dump trucks (3 and 4 cubic meters loading capacities), ropes,
relatively longer time (few months) than aerobic composting.
“banyeras”, spades and a bamboo raft. The bamboo raft once lowered into the
creek serves as a platform and waste piled up on the raft. The banyeras serve as a
bucket for lifting up waste from below. 5. Grinding and Disposal Sewer. There are commercially available
machines called “garbage grinders”. Which are attached to kitchen sinks.
Local Government Units are also responsible for cleansing and Leftover food, including small bones, are ground into small particles and
collection of waste. They are bancas for transporting personnel and a floating washed down onto the wastewater pipes and finally into the septic tank or
platform (2.5m x 6m) that can accommodate 50 sacks of waste. Sometimes they public sewage collection system. This method is common in developed
place chicken wire (4” mesh, 50 cm deep) across an area of approximately 200 countries.
sq. meters. Wastes trapped and collected in the river consists of wood, plastic,
paper, cans, sacks and other non-biodegradable waste.
As for the large scale, the MMDA and Local Government Units
dispose solid waste through the following ways:
Collection System
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1. Sanitary Landfill. Sanitary landfill consists of excavating the soil.
Depositing the refuse and compacting with a solid cover of (61-91 cms.). 1. Methane - marsh gas; a natural gas produced by decomposition of organic
These are done by mechanized equipment such as bulldozers and cranes. matter in marshes and mines. It is colorless, odorless, and inflammable.
This was developed to correct the defects of open dumping in some Methane is a constituent of illuminating and cooking gas and may cause
communities. asphyxia when inhaled in high concentrations. Methane is a chief
component of firedamp, the combustible gas occurring naturally in coal
2. Dumping on Land. This is the most frequently used method being one of mines and forming explosive mixtures with air. In chemical use, it is an
the cheapest if dumping places are available. The dumped refuse is usually important source of hydrogen and a wide variety of organic compounds.
burned to reduce the volume and minimize flies. Its most frequent defect is
the lack of adequate soil cover so that flies and rats usually abound in refuse
dumps. 2. Sulfur Dioxide - SO, antioxidant pharmaceutical aid, a colorless gas
obtained by burning sulfur in oxygen. It is a moderately powerful
3. Incineration. Incineration refers to controlled burning, with extremely germicide in the presence of nature. Dry sulfur dioxide is effective in
high temperatures, of the combustible portions of solid wastes. Because of killing mosquitoes, fleas, flies, rats and other vermin. It is toxic when
air pollution problems involved with burning, the design of incinerators is a inhaled and causes irritation of the eyes, nose, throat and lungs.
specialized technology particularly in the urban communities.
C. Penetration of leachate and other hazardous substances would affect the
4. Reduction and Salvage. In some places, garbage is finally disposed of by water supply of the area. Effects on plants by water pollution by leachate
applying pressure to remove oils, grease and fats. The salvaged oils are may also occur.
used for commercial purposes. This may be done in large slaughter and
meatpacking plants where there is plenty of animal fat in the left over
materials. D. Organic waste material tends to decay, giving off foul odors.
E. Scattered waste material presents unsightly conditions or “eye-sores” to the
community.
HEALTH HAZARDS FO IMPROPER SOLID WASTE MANAGEMENT
F. Piles of waste material pose fire hazards.
REFUSE STORAGE COLLECTION AND DISPOSAL

Basic Health Principle and Public Health Reasons

ALTERNATIVES TO SOLID WASTE MANAGEMENT
A method should be provided for the adequate and the satisfactory
storage of all solid and semi-solid wastes (other than body wastes) accumulating A. Utilizing appropriate technologies for solid waste management
in the home or in the community and for collection and sanitary disposal of such
wastes. Following are the principal public health reasons for the proper disposal 1. Resource recovery - is the sorting, collection and marketing of
of refuse: recyclable materials by organized individuals (called eco-aides) form
domestic and commercial establishments.
A. Piles of waste material provide living and breeding places for flies and
other insects and rats which are carriers of disease. Recyclable items such are glass, metals and paper are brought by
manufacturing plants for processing to produce goods. Eco-aides are
provided with the equipment and supplies needed in the project
1. Mosquitoes - transmit agents of disease such as malaria, filariasis, yellow
operations and a redemption center is constructed for storage
fever, and dengue. Pestiferous mosquitoes cause an annoyance and
purposes. This project aims to provide a more decent means of living
discomfort to the people.
for scavengers (beneficiaries of the project) and minimized their
expenses to filth of dumping sites and heaps of refuse in the streets
2. Rodents - are potential carriers of human and animal diseases. They are where they thrive:
infected with fleas, ticks, mites, and biting lice which can transmit diseases Here are some of the suggested implementation strategies:
such as bubonic plague, pneumonic plague, tularemia, scrub typhus,
leptospirosis, salmonellosis, rickettsial pox, rabies and capillariasis. Rats
annoy people, steal or contaminate food and leave infected places reeking of
 Data gathering in selected site - for assessing the garbage
composition of solid waste generated.
the fecal wastes and urine.

3. Flies - certain species have certain habit. Some species attack and eat
 Household information drive - information should be
disseminated to gain active participation of residents.
scavenging larvae. Some adult flies suck blood, their bites causing possible
irritations to both man and domestic animals (stable fly). Flies directly
attack and damage plants. Some act as disease vectors either by polluting  Training Orientation - of eco-aides to the project and on the
food after coming in contact with feces, contaminating mucus membrane job supervision to improve scavenging procedures to minimized
after landing on festering sores, or by injecting saliva (blood sucking hazards to health and developed positive attitudes toward health
species). Dysentery, typhoid fever, cholera, infantile diarrhea, and other their work.
intestinal infections are the most common diseases houseflies transmit.
Other disease houseflies are associated with tuberculosis, small pox, other  Resource/materials needed - pushcarts, sweepers, t-shirts,
skin infections, and disease of the eyes. Flies breed in places that are pants, baskets, hats, gloves, weighing scale and seed money
frequently filthy. Flesh-feeding species breed mainly in carrion and infect must also be provided.
the flesh of man and domestic animals. Flies are produced in almost any
organic material under conditions suitable for their development.
 Marketing - it is needed in order to solicit the assistance of
support funds like the livelihood support fund.
4. Cockroaches - are capable of spreading germs mechanically. They are
objectionable pests in the household and in food establishments. Roaches
spoil food with their mere presence, leaving behind roachy odors and
 Monitoring and education - these include accounting of
monthly sale of recyclable materials and operative costs by
particles of filth. project staff under the supervision of Environmental
Management Bureau.

B. Gases such as methane, sulfur dioxide, etc., produced from burning,

incineration, and other garbage disposal methods

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2. Biogas Production - biogas production involves the production of
methane, which is a flammable gas through bacterial decomposition
of organic matter, vegetation and animal manure in a biogas digester.

The gas produce may be also used for cooking and lighting mantle
lamp. The residue of biogas production can be used as fertilizers,
hence decreasing a large extent of the usual household expenses.

Families with backyard piggery and/or poultry raising projects are

the target beneficiaries.

3. Recycling - one important activity in the management of solid waste

management is recycling. There is varied definition of recycling but
in its technical sense, it refers to the reproduction of waste top new
materials and products.

“Re-use” is another term used for waste reduction but does not
require the product to undergo any process and it mostly retains its
original form to be used again. In most cases when we talked about
recycling, re-use is also included.

With our present situation of solid waste management, there is really

a need to recycle for reasons such as it reduces waste, conserves and
effectively uses natural resources, raises consumer consciousness of
life style and spearheads a shift towards sustainable economic
growth.

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