CHAPTER 1: OVERVIEW

THE PHILIPPINE PUBLIC HEALTHCARE SCENARIO

• The national budget allocation for health care is relatively small.

• Local government units augment the national budget to an undetermined extent.

• This scenario requires strategies that will allow maximization of limited resources:

1 Health promotion 2 Disease prevention

NURSES IN PUBLIC HEALTHCARE

• practice.

• The major goal of community health nursing

 to preserve the health of the community and surrounding populations by focusing on health promotion and health maintenance of individuals, families, and groups within the community.

• The MISSION of public health is SOCIAL JUSTICE, which entitles all people to basic necessities such as adequate income and health protection and accepts collective burdens to make this possible.

CONCEPTS OF HEALTH

• The variety of characterizations of the word illustrates the difficulty in standardizing the conceptualization of health.

• Common concepts in various definitions include:

– Goal-directed/ purposeful actions, processes, responses or behaviors. – Soundness, wholeness, and/ or well-being

CONCEPTS OF COMMUNITY

• Before 1996: definitions of community focused on geographical boundaries, combined with social attributes of people.

• Later part of the decade: geographical location became a secondary characteristic in the discussion of what defines a community.

-Baldwin, et.al, 1998

DEFINING ATTRIBUTES OF COMMUNITIES

1. People

2. Place

3. Interaction

4. Common characteristics, interests or goals

TYPES OF COMMUNITIES

1. Geopolitical / Territorial community

2. Phenomenological / Functional community

DETERMINANTS OF HEALTH AND DISEASE

• Income and social status

• Education

• Physical environment

• Employment and work conditions • Social support networks

• Culture

• Genetics

• Personal behavior and coping skills • Health services

• Gender

-Maurer and Smith, 2009

-Maurer and Smith, 2009

Community/public health nursing

is the synthesis of nursing practice and public health

HEALTH PROMOTION AND DISEASE PREVENTION

• Health promotion activities enhance resources directed at improving well-being,

• Disease prevention activities protect people from disease and the effects of disease.

LEVEL OF PREVENTION

1. Primary: general health promotion and specific protection 2. Secondary: early detection and prompt intervention

3. Tertiary: reduce the effects of disease and injury, and restore individuals to their

optimal level of functioning

-Leavell and Clark, 1958

DEFINITIONS OF PUBLIC HEALTH NURSING

• Public health nursing

- defined as a field of professional practice in nursing and in public health in which technical nursing, interpersonal, analytical, and organizational skills are applied to problems of health as they affect the community.

-Freeman, 1963

- The practice of promoting and protecting the health of populations using knowledge from nursing, social, and public health sciences

-ANA/APHA, 1996

COMMUNITY-BASED NURSING

• Application of the nursing process in caring for individuals, families and groups where they live, work or go to school or as they move through the health care system

-McEwen and Pullis, 2008

POPULATION-FOCUSED APPROACH

• Focuses on the entire population

• Is based on assessment of the populations' health status

• Considers the broad determinants of health

• Emphasizes all levels of prevention

• Intervenes with communities, systems, individuals, and families

EMERGING FIELDS OF COMMUNITY HEALTH NURSING IN THE PHILIPPINES

This practice involves providing nursing care to individuals and mainly to minimize the effects of illness and

disability.

• Hospice home care: This is home care specifically rendered to the terminally ill.

• ENTREPRENURSE -- This is a project initiated by the Department of Labor and Employment (DOLE), in collaboration with the Board of Nursing of the Philippines, Department of Health, Philippine Nurses Association, and other stakeholders to promote nurse entrepreneurship.

families in their own places of residence

•

religious faiths.

: This is the practice of nursing combined They may work in either paid or unpaid positions in a variety of

Faith community nursing or parish nursing

with spiritual care.

-Minnesota Department of Health, 2003

COMPETENCY STANDARDS IN COMMUNITY HEALTH NURSING

• Safe and quality nursing care

• Management of resources and environment • Health education

• Legal responsibility

• Ethico-moral responsibility

• Personal and professional development

• Quality improvement

• Research

• Records management

• Communication

• Collaboration and Teamwork

HISTORY OF PUBLIC HEALTH NURSING IN THE PHILIPPINES

•1577: Friar Juan Clemente opened a medical dispensary in Intramuros for the indigent.

•1690: Dominican Father Juan de Pergero worked towards installing a water system in San Juan del Monte (now San Juan City, Metro Manila) and Manila.

•1805: Dr. Francisco de Balmis introduced Smallpox vaccination.

•1876: The first medicos titulares were appointed and worked as provincial health

officers.

•1888: The University of Santo Tomas opens a two-year, cirujanos ministrantes course to produce male nurses and sanitary inspectors.

LEVELS OF CLIENTELE

• Individual

• Family

• Group/ Aggregate • Community

PRE-PAYMENT MECHANISM

• Community health services and community health nursing services, are generally free at the point of care.

• The services have already been pre-paid by the community/aggregate.

– Taxes cover government-provided healthcare services

– Tuition fees cover school-health services

– Consumers pay for the occupational health services of employees of a company.

• Home health care:

•1901: The Board of Health of the Philippine Islands was created through Act 157, which eventually evolved into the Department of Health (DOH)

•1912: The Fajardo Act law created sanitary divisions made up one to four municipalities.

•1905: Asociacion de Feminista Filipina founded La Gota de Leche: the first center dedicated to the service of mothers and babies

•1947: The DOH was reorganized into bureaus and the administration of city health departments was placed at bureau level.

•1954: The congress passed R.A. 1082 or the Rural Health Unit Act which provided an RHU in every municipality.

•1957: R.A. 1891 was enacted to have a more equitable distribution of health personnel.

•1958: Regional health offices were created as a result of decentralization efforts, thus creating the position: Regional Health Officer.

•1970: the Philippine health care delivery system was restructured, paving the way for the health care system that exists to this day where health services are classified into primary, secondary and tertiary levels.

1991: R.A.7160 or the Local Government Code mandated the devolution of basic services, including health services, to local government units and the establishment of a local health board in every province and city or municipality

•1999: Health Sector Reform Agenda was launched to direct government efforts towards comprehensive reforms.

•2005: FOURmula One (F1) for health was launched to provide an implementation framework to the reform agenda.

•2010: Universal Health Care was launched to provide the necessary revisions to the F1 framework.

• AIMS TO ACHIEVE THE HEALTH SYSTEM GOALS OF:

– better health outcomes,

– sustained health financing and

– a responsive health system that will provide equitable access to health care.

• It is deliberately focused on economically disadvantaged Filipinos to ensure that they are given risk protection through enrollment in PhilHealth (Philippine Health Insurance Corporation) and that they are able to access affordable and quality health services.

AGENDA

1. World Health Organization • Millennium Development Goals • Sustainable Development Goals

Health – a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Delivery – distribution; approach; to educate people regarding health

– the help of its people but also on their total development

2. Philippine Department of Health • Mission-Vision • Historical Background • Local Health System and DEVOLUTION OF HEALTH SERVICES

• Classification of Health Facilities • Philippine Health Agenda 2010-2022

INTRODUCTION

• A nation’s healthcare delivery system has a tremendous impact not only on the health of its people but also on their total development, including their socioeconomic status.

• Anderson and McFarlane (2011) emphasized the following factors in shaping 21st-century health that further influence healthcare delivery system:

1. Healthcare “reforms”

2. Demographics

3. Globalization

4. Poverty and growing disparities 5. Social Disintegration

CHAPTER 2:

HEALTH CARE DELIVERY SYSTEM

Health care delivery system

• Healthcare “reforms”

• Demographics

5 Factors

- laws that contains the needs that is complied by the people

- includes addressing the ever- increasing costs of national health care by individuals, families, and the government.

- habang tumatagal, nagbabago

- example: vaccination; health education; breastfeeding

- Particular area or its field

- Each demographic area, there’s health care delivery system

• Globalization

• Poverty and growing disparities

• Social Disintegration

Health System – consist of all organizations, people, and action whose primary intent is to:

SIX BUILDING BLOCKS OR COMPONENTS:

1. Service delivery

2. Health workforce

3. Information

4. Medical products, vaccines and technologies 5. Financing

6. Leadership and governance or stewardship.

WORLD HEALTH ORGANIZATION

• The WHO constitution came into force on April 7, 1948.

• April 7 has been celebrated each year as World Health Day. • Objective:

• The attainment of all peoples of the highest possible level of health.

WHO CORE FUNCTIONS:

1. Providing leadership on matters critical to health and engaging partnerships where joint action is needed.

2. Shaping the research agenda and stimulating the generation, translation, and disseminating valuable knowledge.

3. Setting norms and standards and promoting and monitoring their implementation. 4. Articulating ethical and evidence-based policy options.

5. Providing technical support, catalyzing change, and building sustainable institutional capacity.

THE MILLENNIUM DEVELOPMENT GOALS (MDG) • before, called the Millennium Summit

• September 6 to 8, 2000 – World leaders on UN General Assembly participate in Millennium Summit.

• The declaration expressed the commitment of the 191 member states, including the Philippines

• The following are the eight MDG’s and the targets corresponding to health related MDG’s 4,5, and 6:

MILLENIUM DEVELOPMENT GOALS

1. Eradicate extreme poverty and hunger.

2. Achieve universal primary education.

3. Promote gender equality and empower women.

4. Reduce child mortality.

5. Improve maternal health.

6. Combat HIV/AIDS, malaria, and other diseases. 7. Ensure environmental sustainability

8. Develop a global partnership for development

THE PHILIPPINE HEALTH CARE DELIVERY SYSTEM

4 MAIN FUNCTIONS:

1. The DOH - serves as the main governing body of health services in the country.

- All rules and regulations, policies or bylaws is coming from DOH

 17 regions in the Philippines – we have the provinces (municipal and city governments)

Promote, Restore, and

, to reduce extreme poverty and achieve seven other targets - now called the

Who are we referring? The

Millennium Development Goals (MDG’s) by the year 2015.

Maintain HEALTH

organization or the people or

the actions.

- What we do in the local level, it is the same with the global or international health care system. We do not do steps that are not in-lined

- Hindi pwede na ito ang gusting gawin ni local without approval of the national and the international government

- Example: covid vaccine; started at the higher up going to the lower up. There is a hierarchy, step by step flow

- Until now, there is poverty and growing disparities because hindi nakukuha ang tamang benepisyo in terms of health.

- But there are solutions that are being made to address theses issues

- There are different healthcare program or health care delivery system that is disintegrated. Meaning, di sila nagc-comply interms of the social just because of traditional/cultural beliefs.

 Flow: WHO – DOH – REGIONAL LEVEL – PROVINCIAL LEVEL – MUNICIPAL/ CITY LEVEL – BARANGAY

2. The private sector

• In Philippines, there is 30% private utilities

3. Financing of health services is provided by three major group

4. National Insurance Act of 1995 (R.A. 7875) (because of PhilHealth)

THE DEPARTMENT OF HEALTH (DOH)

DOH VISION

“Filipinos are among the healthiest people in Southeast Asia by 2022, and Asia by 2040”

DOH MISSION

“To lead the country in the development of a productive, resilient, equitable and people-centered health system”

In the pursuit of its vision and execution of its mission, the following has THE MAJOR ROLES:

1. Leader in health

2. Enabler and capacity builder

3. Administrator of specific services

The DOH core values reflect adherence to the highest standards of work namely: 1. Integrity

2. Excellence

3. Compassion and respect for human dignity 4. Commitment

5. Professionalism

6. Teamwork

7. Stewardship of Health

8. Political Neutrality

9. Simple living

LEVELS OF HEALTH CARE DELIVERY

Administrative order 2012-0012 (Rules and Regulations Governing the new Classification of Hospitals and Other Health Facilities in the Philippines)

▪ provides for a new classification scheme of health facilities.

HOSPITAL

OTHER HEALTH FACILITIES

General • Level 1

• Level 2

• Private hospitals

• Level 3 (teaching/ training) Specialty

• Tertiary level (Has complete facilities)

A. Primary Care Facility

B. Custodial facility

C. Diagnostic/ Therapeutic facility D. Specialized outpatient facility

DOH ADMINISTRATIVE ORDER 2012-0012 CLASSIFIES OTHER HEALTH FACILITIES AS FOLLOWS:

➢ CATEGORY A: PRIMARY HEALTH CARE FACILITY

• First contact healthcare facility

• providing the basic care including emergency services and provision of normal

deliveries

• example: infirmaries; clinics

➢ CATEGORY B: CUSTODIAL CARE FACILITY

• caters about drugs; rapes; rehabilitations

➢ CATEGORY C: DIAGNOSTIC/THERAPEUTIC FACILITY • diagnostic clinics and laboratories

➢ CATEGORY D: SPECIALIZED OUTPATIENT FACILITY

• caters dialysis patients

• focused on only one treatment

THE RURAL HEALTH UNIT

• The RHU (commonly known as health center)

• primary level of health facility in our municipality

FOCUS OF RHU

• preventive and promotive healthcare services; supervision of barangay health sectors under its jurisdictions (particular area).

• Recommended ratio of RHU to catchment population is 1 RHU: 20,000 populations. the barangay level.

Better health outcomes, competitive and responsive health care system

• The MAYOR is the highest personnel in RHU.

THE RURAL HEALTH UNIT PERSONNEL

• When hospital intervention has been completed, the patient is referred back to the health center. This accounts for the term two-way referral system.

• Referrals may be internal or external

The Municipal Health Officer (MHO) or Rural Health Physician heads the health

services at the municipal level and carries out the following roles and functions: -

– it is within the health facilities

– a movement of patient from one facility to another; to

THE INTER-LOCAL HEALTH ZONE

Internal referrals

External referrals

1. Administrator of the RHU

2. Community physician

3. Medico-legal officer of the municipality. (the one who signs those dead certificates of patients who died)

➢ The revised implementing rules and regulations (IRRSs) of R.A. 7305 or the Magna Carta of Public Health Workers

- 1 health physician : 20,000 population

- 1 doctor : 20,000 population

LOCAL HEALTH BOARDS (LHB)

R.A 7160 or Local Government Code

 The police development as self-reliant communities.

 DEVOLUTION

o National government center power and authority along the various local government units.

THE FUNCTIONS OF LOCAL HEALTH BOARDS:

1. Proposing to the Sanggunian annual budgetary allocations for the operation and maintenance of health facilities and services within the province/city/municipality.

2. Serving as an advisory committee to the Sanggunian on health matters; and

3. Creating committees that shall advise local health agencies on various matters related to health service operations.

THE HEALTH REFERRAL SYSTEM

A referral is a set of activities undertaken by a health care provider or facility in response to its inability to provide the necessary health intervention to satisfy a patient’s need

• Functional Referral System.

• It usually involves movement of a patient from the health center of first contact and the hospital at first referral level.

-

transfer

• The referral system functioning within the context of the Inter-Local Health Zone (ILHZ)

• The ILHZ is based on the concept of the District Health System

- All district 1 is magkakasama; lahat ng district 2 magkakasama; etc.

- Example: Western part has 4 districts, so silang 4 ang magkakasama

- In terms of delivery system, sila munang nasa district 1 ang mag-uusap usap

bago ireffer outside, sa district 2,3, or 4, if hindi na-address sa district 1.

• An ILHZ has a defined catchment population within a defined geographical area, it has a central or core referral hospital and a number of primary level facilities such as RHUs and BHSs

Components of ILHZ:

1. People

 The number of people from zone to zone or specially taking consideration of the local government in terms of the clustering it should have between 100,000 to 500,000 people in ILHZ.

2. Boundaries

 Clear boundaries between the ILHZ.

 Establishing the accountability and responsibility in the particular area.

 Wag papakialaman kung saan siyang area. Kung sa district 1 wag papakialaman

ng district 2.

3. Health facilities

 It should have the RHU, barangay health workers, or health facilities that decide to work together as an integrate the health system regarding to the provincial hospital or provincial level serving as the central referral hospital.

4. Health workers

 Helps to deliver a comprehensive health care services.

Nursing Care of the Community CHAPTER 3: PRIMARY HEALTH CARE

HISTORY OF PHC

• Alma Ata Conference of Sept. 6 -12, 1978 • Alma Ata Declarations of PHC

– Health as Basic Fundamental Right

– Global Burden of Health inequalities – Economic and Social Development

– Government responsibility

• LOI 949, PHC adopted in the Philippines

Letter Of Instruction

- PHC was implemented in the Philippines through LOI 949 on 1979.

- If this happened in United nations on 1976, in the Philippines it happened 1979 in which the phil is governed by Pres. Marcos who underscored the need to promote health development in a rural areas sand integrate in all the

government activities.

HEALTH DEFINED BY THE WHO

In the PHC declaration, the WHO defined

PHC Defined

 Alma Ata Declaration:

PHC - “is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self- determination”.

• Health for all means an acceptable level of health for all the people of the world through community and individual self-reliance. This policy agenda of “health for all by the year 2000” technically, was a global strategy employed in achieving three main objectives:

(3) therapy for existing conditions.

KEY PRINCIPLES OF PHC

• Accessibility, affordability, acceptability, and availability • Support mechanisms

• Multisectoral approach

• Community participation

• Equitable distribution of health resources • Appropriate technology

Point of Comparison PHC

Primary Care

Focus Client

Family and Community

Individual

Focus of Care

PCH IS NOT PRIMARY CARE

Promotive / Preventive

Curative

Decision-Making Process

Community-centered / consultative, participative

Health Worker driven

Outcome

Self-reliance / self help

Reliance on health professional to restore/ regain health

Setting of Services

Rural-based satellite clinics, community health centers

Mostly urban based clinics and hospitals

Goal

Development and preventive care

Absence of disease

COMMUNITY HEALTH NURSING I CHAPTER 4: HOME VISIT

(2) prevention of diseases, and

◦ Home visit – is a professional, purposeful interaction that takes place in the family’s residence aimed at promoting, maintaining and restoring the health of the family members.

◦ The services provided is an extension of the health service agency (Health Center) ◦ The best opportunity to serve the actual care given by family members.

PRINCIPLES OF VISIT

◦ Must have a purpose or objectives;

HEALTH FOR ALL: UNIVERSAL GOAL OF PHC

health as “a state of complete physical,

mental and social wellbeing, and not merely the absence of disease or infirmity”

(1) promotion of healthy lifestyles,

Example; ◦Assessment

◦ Nursing care

◦ Treatment

◦ Health Education ◦ Referral

◦ Must base every available information about the patient and his family through family records.

◦ Priority should focus on the essential needs of the individual and his family.

◦ Should involve the individual and family.

◦ Plan should be flexible.

◦ Planning continuing care should involve a responsible family members.

ADVANTAGES OF HOME VISIT

◦ It allows first hand assessment of the home situation.

◦ The nurse is able to seek out previously unidentified needs.

◦ It gives the nurse an opportunity to adapt interventions according to family resources. ◦ It promotes family participation and focuses on the family as a unit.

DISADVANTAGES OF HOME VISIT

◦ The cost in terms of time and effort.

◦ There are more Distractions because the nurse is unable to control the environment. ◦ Nurses safety.

PRIORITY PATIENTS FOR HOME VISIT

◦ Newborn

◦ Postpartum

◦ Pregnant mothers ◦ Morbid Cases

PHASES OF HOME VISIT ◦ PRE – VISIT PHASE (PLANNING PHASE)

 Nurse contacts the family, determines willingness for home visit and sets appointment with them.

 A plan for the home visit is formulated this phase

 Start at the health center.

 Make a study on the status of the family.

 Statement of the problem.

 Formation of objectives. ◦ IN HOME PHASE

 The phase begins as the nurse seeks permission to enter and last until he or she leaves the family’s home. It consists of INITIATION, IMPLEMENTATION AND TERMINATION.

◦ INITIATION (SOCIALIZATION)

 First activity is to establish rapport to gain the trust of the family.

 It is customary to knock or ring the doorbell and at he same time in a reasonably loud but non threaten voice say ‘Tao po si nurse Albert po ito,

Nurse po sa Health Center?’

 On entering the home, the nurse acknowledges the family members with a

greeting and introduce s himself and the agency he represents.

 Observes environment for his own safety and its as the family directs him to

sit.

 Establish rapport by initiating a short conversation.

States the purpose of the visit the source of information.

◦ IMPLEMENTATION (ACTIVITY)

◦ INTERVENTION / PROFESSIONAL PHASE

 Involves the application of the nursing process assessment, provision on direct nursing needed and evaluation

 Opportunity to provide or extend health.

 Standard role of the nurse; INDEPENDENT, DEPENDENT AND

INTERDEPENDENT.

 To be effective come in complete uniform (also bring a long umbrella with

pointed end which serves as a protection)

◦ TERMINATION (SUMMARIZATION)

 Consist of summarizing with the family events during the home visit and setting subsequent home visit or another form nurse contact.

 Use this time to record findings, such as of the family members and body weight.

◦ POST - VISIT PHASE

 Takes place when nurse has returned to the health facility.

 It involves documentation of the visit.

CHAPTER 5:

PUBLIC HEALTH BAG

◦ Note: BP apparatus is kept separately from PHN BAG.

◦ Line the table / flat surface with paper/ washable protector on which the bag and all of the articles to be used are placed.

◦ The inner part of the bag should be clean and sterile.

◦ Wash your hands before and after physical assessment and physical care of each family member.

PUBLIC HEALTH BAG

◦ Bring out only the articles needed.

◦ The less one opens the bag, the lesser chance of contamination.

◦ In general, the bag is open 3x;

◦ Putting out materials for hand washing

◦ Putting out materials use for nursing care.

◦ Putting all what been used.

◦ Do not put any of the family’s articles on your paper lining/ washable protector. ◦ Wash your articles before putting them back into your bag

◦ Confine the contaminated surface by folding the contaminated side inward

◦ Wash the inner clothing of the bag as necessary.

THE BAG TECHNIQUE

◦ Care of Communicable Case(s):

◦ Should be disinfected with the use of 70% isopropyl alcohol or Lysol which should be done at the health center and not at home.

◦ PHN BAG

 Frequently called the PHN BAG

 is an indispensable tool that should be organized to save time and effort and

to prevent cross infection and contamination.

 Serves as a reminder of one need for hand hygiene and other measures to

prevent the spread of infection

PUBLIC HEALTH BAG

◦ NURSING BAG USUALLY HAS THE FOLLOWING CONTENTS;

◦ Articles for infection control

◦ Articles for assessment of family members.

◦ Note that the stethoscope and sphygmomanometer are carried separately. ◦ Articles for nursing care.

◦ Sterile items

◦ Clean articles ◦ Pieces of paper

THE BAG TECHNIQUE

 is performed before and after handling a client in the home to prevent transmission of infection to and from the client.

 helps the nurse in infection control.

 allows the nurse to give care efficiently.

 It saves time and effort by ensuring that the articles needed for nursing care

are available.

 should not take away the nurse’s focus on the patient and the family.

 maybe performed in different ways, principle of asepsis are of the essence

and should be practiced.

◦ Remember to proceed from ‘clean to contaminated’

◦ The bag and its content should be well protected from contact with any article in the patient home.

◦ FOR INFECTION CONTROL THE ACTIVITIES SHOULD BE PRACTICED DURING

HOME VISITS;

◦ FOR INFECTION CONTROL THE ACTIVITIES SHOULD BE PRACTICED DURING HOME VISIT:

◦ Contents should be prepared by the one who will make home visit.

IMMUNITY

CHAPTER 6:

EXPANDED ROGRAM ON IMMUNIZATION (EPI)

HISTORY OF VACCINE DEVELOPMENT

◦ In May 1776, Jenner found a young dairy maid Sarah Nelmes who had fresh cowpox lesions on her hand.

◦ On May 14, using matter from Sarah’s lesions he inoculated an eight year old boy, James Phipps, who had never had smallpox.

◦ Phipps became slightly ill over the course of the next 9 days but was well on the 10th day

◦ On July 1 Jenner inoculated one boy again, this time with smallpox matter. No disease developed; protection was complete

TYPES OF VACCINE:

 LIVE ATTENUATED VACCINE

- Attenuated ( weaken) form of the “ wild” virus or bacterium.

- Long term immunity. Only needs 1-2 doses

- Immune response is similar to natural infection

 INACTIVATED VACCINE

- Giving of microorganism killed through heat and chemical methods

- Antibodies cannot replicate and that’s why you generally require 3-5

doses including boosters

- To remind the body to produce antibodies

◦ Established in 1976 by the World Health Organization (WHO) to ensure that infants/ children and mothers have access to routinely recommended infant/ childhood vaccines

◦ Six vaccine preventable disease where initially included in the EPI tuberculosis, poliomyelitis, Diptheria, tetanus, pertussis and measles.

◦ In 2002, WHO estimated that 1.4 million of deaths among child 5 years where due to diseases that could have been prevented by routine vaccinations.

◦ EPI IN THE PHILIPPINES

- Began in 1976

◦ PD NO. 996 – providing for compulsory

◦ Basic immunization for infants and children below 8 years old

FREE VACCINES: BCG, DPT, OPV AND MEASLES

◦ Done Through;

◦ Routine Immunization for infants/ children/ Women through the reaching every

 Condition of being protected against a particular disease. 2 TYPES of IMMUNITY:

◦ NATURAL/INNATE – Body’s inborn system to protect itself and fight infections ◦ ADAPTIVE – Develops as a result of exposure to disease causing organism so that

next time the body meet it again it can defend itself.

◦ ANTIGEN (Ag) – Substance that causes the body to produce specific antibodies.

◦ ANTIBODY (Ab) – Substance that is produced by the immune system and defends the body against infections.

◦ ACTIVE IMMUNITY

◦ NATURAL ACQUIRED ACTIVE IMMUNITY

◦ Resulting from infection. EX. COVID 19 infection create COVID 19 ANTIBODIES

◦ ARTIFICIALLY ACQUIRED ACTIVE IMMUNITY

◦ Injection of Antigen ( Vaccine attenuated, killed, toxoid, recombinant DNA )

◦ Giving a copy of the microorganism will triger the immune system to produce antibodies against the real microorganism to prevent infection.

◦ PASSIVE IMMUNITY

 Naturally acquired passive immunity

 Transplacental or via colostrum

 Antibodies gained by the mother either thru

◦ ARTIFICIALLY ACQUIRED PASSIVE IMMUNITY

 Injection of antibody ( anti serum immunoglobulin )

◦ IMMUNIZATION

◦ Beneficial and cost – effective disease prevention measure

◦ Process of inducing immunity against a specific disease through vaccines

◦ Protection is usually long term if not life time

◦ PASSIVE (Administration of antibody containing preparations) or ACTIVE

(stimulation of the immune system)

barangay (REB) strategy.

◦ Supplemental Immunization Activity (SIA)

◦ Strengthening Vaccine – Preventable Diseases surveillance

GOALS OF EPI;

◦ To immunize all infants/ children against the most common vaccine. ◦ To sustain the polio – free status of the Philippines

◦ To eliminate measles infection.

◦ To eliminate maternal and neonatal tetanus

◦ To control Diptheria, pertussis, Hepatitis B and German measles.

◦ To prevent extra pulmonary tuberculosis among children.

➢BACILLUS CALMETE- GUERIN (BCG)- TB antigen injection given on the right deltoid at birth. (for prevention of TB meningitis, lungs and brain.)

➢HEPATITIS B VACCINE – Intramuscular injection for protection against Hepatitis B Infection.

➢ORAL POLIO VACCINE (OPV) – given through the mouth in 3 doses ( 6, 10 & 14 wks.) for prevention of Polio

➢ROTAVIRUS VACCINE – for prevention of childhood diarrhea caused by the Rotavirusgiven through the mouth in 2 doses

➢PENTAVALENT VACCINE – 5-1 VACCINE COMPOSED OF:

➢1. DIPTHERIA – respiratory disease caused by Corynebacterium Diptheriae.

➢2. PERTUSIS – also known as “whooping cough” caused by Bordetella pertussis

➢3. TETANUS – causes muscles spasm and caused by Clostridium Tetani bacteria

➢4. Hib – meningitis vaccine of children caused by Haemophilus influenza

➢5. HEPATITIS B VACCINE

MEASLES VACCINE – given at 9 months for prevention of measles

➢MMR – 3 in 1 VACCINE – for prevention of Mumps, Measles and Rubella (German Measles)

▪ MEASLES: Morbillivirus ▪ MUMPS: Rubulavirus

▪ RUBELLA: Rubellavirus

◦ CONTENT OF EPI VACCINE ◦ ➢BCG – live attenuated bacteria

➢OPV AND MEASLES - – live attenuated virus

➢DIPTHERIA AND TT – weakened bacterial toxins

➢PERTUSIS – killed/ inactivated bacteria

➢HEPA B – derived from plasma ( plasma deviratives ) DNA recombinants ◦ CONTRAINDICATIONS;

◦ 1. Severe illness ◦ 2. Allergy

◦ BCG – BACILLUS CALMETTE GUERIN

◦ DPT – DIPTHERIA, PERTUSIS, TETANUS

◦ OPV – ORAL POLIO VACCINE

◦ HIB – HAEMOPHILUS INFLUENZA TYPE B

◦ PCV – PNEUMOCOCCAL CONJUGATE VACCINE ◦ MMR – MEASLES, MUMPS, RUBELLA

DESCRIPTION OF EPI VACCINES

◦ 3. Immunosuppression

◦ HERB IMMUNITY – immunized individuals provide indirect protection to susceptible members of a population

◦ TARGETS FOR IMMUNIZATION PROGRAM: ◦ A. INFANT – 12 MONTHS OLD

◦ B. SCHOOL ENTRANTS – 6-7 YEARS OLD ◦ PREGNANT MOTHER

▪ INFANTS; ▪1BCG ▪ 3 DPT

▪ 3 HEPA B

▪ 1 MEASLES ▪ 3 OPV

▪ SCHOOL ENTRANTS: ( 1booster dose of BCG 6-7 years old

▪ PREGNANT MOTHERS: 5 Tetanus toxoid

◦ COLD CHAIN SYSTEM;

➢Keeping/ transporting the vaccine in cold temperatures to maintain potency of the vaccine

➢The system used for storing vaccines in good condition

➢Also known as vaccine supply chain or immunization supply chain ➢REFRIGARATOR;

➢FREEZER ( - 15degrees to – 25 degrees celcius )- OPV & MEASLES

➢BODY ( 2 Degrees to 8 Degrees celcius) – DPT, HEPA B, BCG 7 TT

➢2 most sensitive to heat vaccine; OPV AND MEASLES

➢2 Least sensitive to heat vaccine; BCG & TT

◦ RA 10152: Mandatory Basic Immunization services for infants and children repealing PPD 996

◦ Free infants and children up to five ( 5 ) years of age

◦ Haemophilus Influenza Type b ( Hib ) Pneumonia and meningitis ◦ DDT- HEPA B- HIB : Pentavalent vaccine

◦ ROTAVIRUS VACCINE ( ORAL) ; Diarrhea

◦ PNEUMOCOCCAL VACCINE (PCV): Pneumonia

◦ PRINCIPLES IN VACCINATION ◦

◦ 1. No BCG to a child born positive with HIV or AIDS

◦ 2. DPT2 AND DPT3 is not given to a child who has had convulsions or shock within 3 days the previous dose but you can give DT.

◦ 3. Moderate fever, malnutrition, mild respiratory infection, cough, diarrhea and mild vomiting aren’t contraindication to vaccination.

◦ 4. Safe to administer all EPI vaccines on the same day at different sites of the body.

◦ 5. No food 30 minutes after giving OPV

◦ 6. Assess the child for allergy to egg before giving measles vaccines.

◦ 7. Measles vaccine should be given as soon as the child is 9 months old regardless of whether other vaccines will be given on that day

◦ 8. Vaccination schedule should not be restarted from the beginning even if the interval between doses exceeded.

◦ 9. Repeat BCG vaccination if the child does not develop a scar after the first injection. ◦ 10. Use one syringe, one needle per child during vaccination.

◦ 11. A child with diarrhea who is due for OPV should receive a dose of OPV during the visit but do not count the dose