Community Health Nursing

Integrated Management of Childhood Illness (IMCI) / Philippine Health Care Delivery System / Epidemiology / Disaster Nursing

Integrated Management of Childhood Illness (IMCI)

It is a strategy developed by the World Health Organization (WHO) and UNICEF to reduce illness and deaths among children below 5 years old through an integrated approach. It does not focus on one disease only; it evaluates the child as a whole and manages multiple childhood conditions simultaneously.

1. Reduce childhood mortality

2. Reduce illness and disability

3. Improve growth and development

4. Improve quality of care for children under 5 years old

The main goals of IMCI are?

Children aged 2 months to 5 years

Young infants: birth to 2 months

Primary targets of IMCI

Integrated Approach

Syndromic Approach

Family Involvement

Principles of IMCI

Syndromic Approach

Diagnosis is based on:

• Signs and symptoms

• Classification system

• Not solely on laboratory tests.

Improve Case Management Skills of Health Workers

Improve Health System Support

Improve Family and Community Practices

Three Major Components of IMCI

1. Unable to Drink or Breastfeed

2. Vomits Everything

3. Convulsions

4. Lethargic or Unconscious

5. Chest Indrawing

6. Stridor in Calm Child

Game Changer:

What are the 6 general danger signs of a child?

Severe illness

Game Changer:

A child with general danger signs is classified as ___ and needs immediate referral.

Red (Severe Disease)

Yellow (Moderate Disease)

Green (Mild Disease)

IMCI Classification System

GREEN CATEGORY (Mild Disease)

Meaning:

• Home management possible

Action:

• Provide home care advice

• Counsel caregiver

YELLOW CATEGORY (Moderate Disease)

Meaning:

• Requires specific treatment

Action:

• Treat at health facility

• Provide medications

• Counsel caregiver

RED CATEGORY (Severe Disease)

Meaning:

• Emergency condition

• Requires urgent referral

Examples:

• Severe pneumonia

• Severe dehydration

• Severe malnutrition

• Very sick child

Action: Refer urgently

5 years old

Game Changer:

IMCI focuses on children below ___.

Assess → Classify → Treat

Game Changer:

Main strategy for IMCI (Management Principles)

1. Pneumonia

2. Diarrhea

3. Fever

4. Ear problems

5. Malnutrition

6. Anemia

6 IMCI Major Conditions Assessed

Pneumonia Assessment

We assess about the child’s:

• Cough

• Difficulty breathing

• Fast breathing

• Chest indrawing

Severe Pneumonia (Red)

Signs:

• General danger signs

• Chest indrawing

• Stridor

Treatment:

• Urgent referral

Pneumonia (Yellow)

Signs:

• Fast breathing

Treatment:

• Antibiotics

• Follow-up

No Pneumonia (Green)

Signs:

• No fast breathing

Treatment:

• Supportive care

Diarrhea

We assess about the child’s:

• Duration of elimination

• Blood in stool

• Signs of dehydration

Severe Dehydration (Red)

Some Dehydration (Yellow)

No Dehydration (Green)

Classifications of Diarrhea

Severe Dehydration (Red)

Signs:

• Lethargy

• Sunken eyes

• Unable to drink

• Poor skin turgor

Management:

• IV fluids

• Urgent referral

Some Dehydration (Yellow)

Signs:

• Restlessness

• Thirst

• Sunken eyes

Management:

• Oral rehydration solution (ORS)

No Dehydration (Green)

Management:

• Continue feeding

• Increase fluids

Persistent Diarrhea

Diarrhea lasting 14 days or more

Dysentery

Blood in stool

Possible cause is invasive intestinal infection

Fever

We ask about the child’s:

• Temperature Duration

• Malaria risk (where applicable)

• Measles signs

• Other infections

Classifications of fever

Ear Problems

We assess the child’s:

• Ear pain

• Ear discharge

• Duration

Classifications of Ear Problems

Malnutrition

Assess:

• Weight

• Height/length

• Edema

• Feeding practices

Severe Acute Signs

• Visible severe wasting

• Bilateral pitting edema

• Weight-for-height very low

Anemia

We assess the child’s:

Palmar pallor

Classifications of Anemia

Feeding

Continue breastfeeding

Provide appropriate complementary feeding

Encourage adequate nutrition

Medication

Correct dose

Correct timing

Complete treatment course

• Child becomes sicker

• Unable to drink

• Develops fever

• Difficulty breathing

• Persistent vomiting

• Convulsions

Caregiver should return immediately if:

Exclusive Breastfeeding

Immunization

Vitamin A Supplementation

Growth Monitoring

Hand Hygiene and Sanitation

Prevention Strategies Under IMCI

Exclusive Breastfeeding

Game Changer:

• Recommended for the first 6 months of life

• Benefits are Nutrition and Immunity protection

ORS

Game Changer:

___ is the priority treatment for dehydration due to diarrhea

Caregiver

___ education is an essential component of IMCI.

IMCI

The goal is reduction of childhood mortality and morbidity.

Infants

(0–12 months)

Health Priorities:

• Growth and development monitoring

• Immunization

• Nutrition (breastfeeding)

• Infection prevention

Infant care

Game Changer:

___ focuses on Nutrition, Immunization, Growth monitoring, and Safety

Children

(1–9 years or preschool/school-age)

Health Priorities:

• Nutrition

• Immunization completion

• School readiness

• Injury prevention

Children Care

Game Changer:

___ are managed using IMCI Guidelines/Approach.

Adolescent care

Game Changer:

___ (10-19 years old) require counseling, education, and risk prevention.

Pregnant women

(Maternal Care)

Health Priorities:

• Safe pregnancy

• Fetal monitoring

• Prevention of complications

Maternal care

Game Changer:

___ focuses on safe pregnancy and early detection of complications

Elderly care

Game Changer:

___ focuses on maintaining independence and quality of life.

Clinic visit

A ___ is a structured interaction between nurse and client in a health facility to provide care and health services.

Clinic visit focuses on structured assessment and health service delivery.

1. Reception of Patient

2. Assessment

3. Nursing Intervention

4. Documentation

5. Follow-up Planning

Steps in Clinic Visit

Home visit

A ___ is a planned nursing visit to the client’s home to provide care, assess environment, and deliver health teaching.

Objectives:

• Assess home environment

• Provide nursing care

• Strengthen family relationships

• Promote health education

1. Preparation Phase

2. Entry Phase

3. In-Home Phase

4. Termination Phase

5. Documentation

Phases of Home Visit

Home visit

Game Changer:

___ evaluates real living conditions and family dynamics.

Bag Technique

Itis a systematic procedure used by public health nurses during home visits to prevent infection and maintain efficiency using a specially prepared nursing bag.

• Clean hand towel

• Soap

• Thermometer

• Alcohol/spirit lamp

• Sterile supplies

• Cotton balls

• Medicines

• Record book

Contents of Nursing Bag

1. Prepare materials

2. Place bag on clean surface

3. Perform hand hygiene

4. Remove only needed items

5. Perform nursing care

6. Dispose waste properly

7. Return items properly

8. Close and secure bag

Game Changer:

Bag technique is about asepsis, organization, and infection control.

What are the steps in bag technique?

Infection Control (Prevent contamination)

Clean to Dirty Principle (Clean items first, Dirty items last)

Hand Hygiene (Before and after procedures)

Proper Bag Placement (Keep on surface, not floor or bed)

Avoid Contamination (Don’t touch inside if unnecessary)

Principles of bag technique

Philippine Health Care Delivery System

The ___ is the organized network of health services, facilities, professionals, and programs that provide healthcare to the Filipino population.

Local Government Units (LGUs)

Game Changer:

The Philippine health system follows a decentralized structure, where local health services are mainly managed by ___.

Department of Health (DOH)

Local Government Units (LGUs)

Health Facilities (Private health sector)

Public Health Care System (Structure)

Local Government Code of 1991

Under the ___, health services were devolved to LGUs.

LGUs manage:

• Provincial hospitals

• City health offices

• Rural Health Units

• Barangay Health Stations

Primary Health Care (PHC)

Secondary Health Care

Tertiary Health Care

Levels of Health Care Delivery

Primary health care

Game Changer:

___ = first contact and prevention.

Services:

• Immunization

• Maternal and child health

• Nutrition programs

• Health education

• Family planning

• Basic treatment

Rural Health Unit (RHU)

Barangay Health Station (BHS)

Facilities under primary care

Secondary health care

Specialized care provided by physicians and specialists.

Facilities:

• District hospitals

• Provincial hospitals

Services:

• Emergency care

• Specialist consultation

• Diagnostic procedures

Example: Patient referred from RHU to hospital.

Tertiary health care

Highly specialized and advanced medical care.

Facilities:

• Medical centers

• Specialty hospitals

Services:

• Complex surgeries

• Intensive care

• Advanced diagnostics

Referral system

A system where patients are transferred from one healthcare level to another for appropriate care.

Barangay Health Station

⬇

Rural Health Unit

⬇

District/Provincial Hospital

⬇

Tertiary Hospital

Referral Flow

Department of Health

The ___ is the national government agency responsible for leading the health sector and ensuring access to quality healthcare.

Vision: A leader in health development toward a healthier Filipino society.

Mission: To guarantee equitable, sustainable, and quality health services for all Filipinos.

Vision and Mission of DOH

National Immunization Program (NIP)

Maternal and Child Health Program

Family Planning Program

National Tuberculosis Control Program (NTP)

HIV/AIDS Prevention Program

National Dengue Prevention Program

Universal Health Care (UHC)

Major DOH Programs

National Immunization Program (NIP)

Program Goal: Prevent vaccine-preventable diseases.

Provides:

• BCG

• Hepatitis B

• Pentavalent vaccine

• OPV/IPV

• Measles-containing vaccine

Maternal and Child Health Program

Program Focus:

• Safe pregnancy

• Skilled birth attendance

• Newborn care

Family Planning Program

Program focus:

• Counseling

• Contraceptive services

• Reproductive health education

National Tuberculosis Control Program (NTP)

Program focus: DOTS (Directly Observed Treatment Short-course)

Components:

• Early detection

• Standard treatment

• Treatment adherence

HIV/AIDS Prevention Program

Program Focus:

• Prevention

• Testing

• Treatment access

• Education

National Dengue Prevention Program

Program Focus:

• Mosquito control

• Community participation

• Early detection

Universal Health Care (UHC)

Under Universal Health Care Act

Program Goal: Provide all Filipinos access to:

• Quality healthcare

• Financial protection

• Integrated health services

Primary Health Care (PHC)

Essential healthcare made universally accessible to individuals and families through community participation.

Equitable Distribution

Community Participation

Appropriate Technology

Intersectoral Coordination

Game Changer:

Principles of Primary Health Care

Health Care Provider

Health Educator

Community Organizer

Coordinator

Disease Surveillance Worker

Roles of Public Health Nurse (PHN)

DOH

Game Changer:

___ = national authority for health policies and programs.

RHU

Game Changer:

___ serves municipalities; BHS serves barangays

Universal Health Care (UHC)

All Filipinos have access to quality and affordable health services without causing financial hardship. It ensures that everyone receives the healthcare they need when and where they need it without suffering financial burden.

Universal Health Care Act of 2019

Established the Philippine UHC program.

Purpose:

• Reform the Philippine healthcare system

• Expand access to healthcare

• Strengthen primary care

• Provide financial protection

Better Health Outcomes

Financial Protection

Responsive Health System

Goals of Universal Health Care

Population Coverage

Service Coverage

Financial Protection

Key Components of UHC

Primary Care Strengthening

Integrated Health Care Provider Networks

Automatic PhilHealth Membership

Health Information Systems

Major Strategies of UHC

Health Promotion

Disease Prevention

Primary Health Care

Patient Advocacy

Game Changer:

Public health nurses contribute to UHC through?

Sustainable Development Goals (SDGs)

The __ are a set of 17 global goals adopted by the United Nations in 2015 to achieve a better and more sustainable future by 2030.

Health

Game Changer:

___ is directly connected to many SDGs, especially SDG 3: Good Health and Well-being.

SDG 3

Game Changer:

Most important health-related SDG for nurses

SDG 1 – No Poverty
SDG 2 – Zero Hunger
SDG 3 – Good Health and Well-being
SDG 4 – Quality Education
SDG 5 – Gender Equality
SDG 6 – Clean Water and Sanitation
SDG 7 – Affordable and Clean Energy
SDG 8 – Decent Work and Economic Growth
SDG 9 – Industry, Innovation, and Infrastructure
SDG 10 – Reduced Inequalities
SDG 11 – Sustainable Cities and Communities
SDG 12 – Responsible Consumption and Production
SDG 13 – Climate Action
SDG 14 – Life Below Water
SDG 15 – Life on Land
SDG 16 – Peace, Justice, and Strong Institutions
SDG 17 – Partnerships for the Goals

The 17 Sustainable Development Goals

SDG 2 (Zero Hunger), SDG 3 (Health), and SDG 6 (Water and Sanitation)

SDGs that are highly relevant to community nursing.

Good Health and Well-being

Universal Health Care

• Improves access to health services - Reduces health inequalities - Improves population health

It supports SDG 3

What is SDG 3?

Primary Health Care (PHC)

It is an approach to healthcare that makes essential health services universally accessible to individuals and families in the community through their full participation and at a cost the community can afford.

PHC

It focuses on health promotion, disease prevention, community participation, and addressing the basic health needs of the population. (acronym)

Alma-Ata Declaration (1978)

The International Conference on Primary Health Care held in Alma-Ata, Kazakhstan emphasized that:

Health is a fundamental human right. It promoted Health for all, Community participation, and Accessible healthcare

PHC

It was adopted as the foundation of community health nursing.