CHN and CD
Transcript of CHN and CD
-
7/25/2019 CHN and CD
1/13
Primary Health Care (PHC)Overview
May 1977 -30th World Health Assemblydecided that the main health target o thego!ernment and WH" is the attainment o ale!el o health that #o$ld %ermit them to leada socially and economically %rod$cti!e lie bythe year &000'
e%tember -1&* 197+ - ,irst nternationalConerence on PHC in Alma Ata* .$ssia (/.)he Alma Ata eclaration stated that PHC #asthe 2ey to attain the health or all4 goal
"ctober 19* 1979 - 5etter o nstr$ction (5")969* the legal basis o PHC #as signed by Pres',erdinand ' Marcos* #hich ado%ted PHC as ana%%roach to#ards the design* de!elo%mentand im%lementation o %rograms oc$sing onhealth de!elo%ment at comm$nity le!el'
Rationale for Adopting Primary Health Care
Magnit$de o Health Problems
nade8$ate and $ne8$al distrib$tion o health
reso$rces
ncreasing cost o medical care
solation o health care acti!ities rom other
de!elo%ment acti!ities
Denition of Primary Health Care
essential health care made universally
accessible to individuals and families in the
community by means acceptable to them,
through their full participation and at cost that
the community can aord at every stage of
development.
a %ractical a%%roach to ma2ing health benets
#ithin the reach o all %eo%le'
an a%%roach to health de!elo%ment* #hich is
carried o$t thro$gh a set o acti!ities and
#hose $ltimate aim is the contin$o$s
im%ro!ement and maintenance o health stat$s
Goal of Primary Health Care
HEALTH FOR ALL FILIPINOS by the year
2000 AND HEALTH IN THE HANDS OF THE
PEOPLE by the year 2020.
An im%ro!ed state o health and 8$ality o lie
or all %eo%le attained thro$gh SELF
RELIANCE'
Key Strategy to Ahie!e the Goal"
Partnership with and Empowerment of the
#$%eti!e& of Primary Health Care
m%ro!ement in the le!el o health care o the
comm$nity
,a!orable %o%$lation gro#th str$ct$re
.ed$ction in the %re!alence o %re!entable*
comm$nicable and other disease'
.ed$ction in morbidity and mortality rates
es%ecially among inants and children'
;tension o essential health ser!ices #ith
%riority gi!en to the $nderser!ed sectors'
m%ro!ement in
-
7/25/2019 CHN and CD
2/13
Part o the %eo%le@s %artici%ation is the
%artnershi% bet#een the comm$nity and the
agencies o$nd in the comm$nity social
mobili=ation and decentrali=ation'
n general* health #or2 sho$ld start rom #here
the %eo%le are and b$ilding on #hat they ha!e'
;am%le> ched$ling o
-
7/25/2019 CHN and CD
3/13
en!ironment' Water is necessary or the
maintenance o healthy liestyle' ae Water
and anitation is necessary or basic %romotion
o health'
' N5trition and Promotion of Ade65ate FoodS5pply
"ne basic need o the amily is ood' And i
ood is %ro%erly %re%ared then one may be
ass$red healthy amily' here are many ood
reso$rces o$nd in the comm$nities b$t
beca$se o a$lty %re%aration and lac2 o
2no#ledge regarding %ro%er ood %lanning*
Maln$trition is one o the %roblems that #e
ha!e in the co$ntry'
7' (reatment of Comm5nia$le Di&ea&e& andCommon Illne&&
he diseases s%read thro$gh direct contact
%ose a great ris2 to those #ho can be inected'
$berc$losis is one o the comm$nicable
diseases contin$o$sly occ$%ies the to% ten
ca$ses o death' Most comm$nicable diseases
are also %re!entable' he Do!ernment oc$ses
on the %re!ention* control and treatment o
these illnesses'
+'S5pply of E&&ential Dr5g&
his oc$ses on the inormation cam%aign on
the $tili=ation and ac8$isition o dr$gs'
n res%onse to this cam%aign* the D?.C AC
o the Phili%%ines is enacted' t incl$des the
ollo#ing dr$gs> Cotrimo;a=ole* Paracetamol*
Amo;ycillin* "resol* ?iedi%ine* .iam%icin* ?H
(isonia=id) and Pyra=inamide*thamb$tol*
tre%tomycin*Albenda=ole*E$inine
'a%or Strategie& of Primary Health Care
1' Ele!ating Health to a Comprehen&i!e andS5&tained National E2ort4
Attaining Health or all ,ili%ino #ill re8$ire
e;%anding %artici%ation in health and health
related %rograms #hether as ser!ice %ro!ider
or beneciary' m%o#erment to %arents*
amilies and comm$nities to ma2e decisions o
their health is really the desired o$tcome'
Ad!ocacy m$st be directed to ?ational and
5ocal %olicy ma2ing to elicit s$%%ort and
commitment to maBor health concerns thro$ghlegislations* b$dgetary and logistical
considerations'
comm$nities and organi=ation to %lan*
im%lement and e!al$ate health %rograms at
their le!els'
3' Inrea&ing E9ienie& in the Health Setor
/sing a%%ro%riate technology #ill ma2e
ser!ices and reso$rces re8$ired or theirdeli!ery* e:ecti!e* a:ordable* accessible and
c$lt$rally acce%table' he de!elo%ment o
h$man reso$rces m$st corres%ond to the act$al
needs o the nation and the %olicies it $%holds
s$ch as PHC' he "H #ill contin$e to s$%%ort
and assist both %$blic and %ri!ate instit$tions
%artic$larly in ac$lty de!elo%ment*
enhancement o rele!ant c$rric$la and
de!elo%ment o standard teaching materials'
6' Ad!aning E&&ential National Health
Re&earh
ssential ?ational Health .esearch (?H.) is
an integrated strategy or organi=ing and
managing research $sing intersectoral* m$lti-
disci%linary and scientic a%%roach to health
%rogramming and deli!ery'
Fo5r Corner&tone&:Pillar& in Primary Health Care
1' Acti!e Comm$nity Partici%ation
&' ntra and nter-sectoral 5in2ages
3' /se o A%%ro%riate echnology
6' $%%ort mechanism made a!ailable
Comm5nity A&&e&&ment
tat$s
tr$ct$re
Process
(ype& of Comm5nity A&&e&&ment
1' Comm5nity Diagno&i&
A %rocess by #hich the n$rse collects data
abo$t the comm$nity in order to identiy
actors #hich may inF$ence the deaths and
illnesses o the %o%$lation* to orm$late a
comm$nity health n$rsing diagnosis and
de!elo% and im%lement comm$nity health
-
7/25/2019 CHN and CD
4/13
aims to obtain
generalinormation abo$tthe comm$nity
ty%e o assessment
res%onds to a%artic$lar need
Step&"
Preparatory Phase
1' site selection
&' %re%aration o the comm$nity
3' statement o the obBecti!es
6' determine the data to be collected
' identiy methods and instr$ments or data
collection
' nali=e sam%ling design and methods
7' ma2e a timetable
Implementation Phase
1' data collection
&' data organi=ationGcollation
3' data %resentation
6' data analysis
' identication o health %roblems
' %rioriti=ation o health %roblems
7' de!elo%ment o a health %lan
+' !alidation and eedbac2
Evaluation Phase
,io&tati&ti&
DE'#GRAPH< - st$dy o %o%$lation si=e*
com%osition and s%atial distrib$tion as a:ected
by births* deaths and migration'
So5re&" Cen&5& com%lete en$meration o
the %o%$lation
; *ay& of A&&igning People
1' De =5re - Peo%le #ere assigned to the %lace
#here assigned to the %lace they $s$ally li!e
regardless o #here they are at the time o
cens$s'
De Fato- Peo%le #ere assigned to the %lace#here they are %hysically %resent at are at thetime o cens$s regardless* o their $s$al %laceo residence'
Median age- age belo# #hich 0I o the%o%$lation alls and abo!e #hich 0I o the%o%$lation alls' he lo#er the median age* theyo$nger the %o%$lation (high ertility* highdeath rates)'
ge ! "ependency #atio - $sed as an inde; oage-ind$ced economic drain on h$manreso$rces
"ther characteristics>
occ$%ational gro$%s economic gro$%s
ed$cational attainment
ethnic gro$%
Pop5lation Di&tri$5tion
$rban%#ural- sho#s the %ro%ortion o %eo%leli!ing in $rban com%ared to the r$ral areas
Crowding Inde& - indicates the ease by #hich acomm$nicable disease can be transmitted rom1 host to another s$sce%tible host'
Population "ensity- determines congestion othe %lace
>ital Stati&ti&
he a%%lication o statistical meas$res to !itale!ents (births* deaths and common illnesses)that is $tili=ed to ga$ge the le!els o health*illness and health ser!ices o a comm$nity'
Epidemiology
the st$dy o distrib$tion o disease or%hysiologic condition among h$man %o%$lations and the actors a:ecting s$ch distrib$tion
the st$dy o the occ$rrence and distrib$tion o
health conditions s$ch as disease* death*deormities or disabilities on h$man%o%$lations
1' Pattern& of di&ea&e o5rrene
Epidemic
A sit$ation #hen there is a high incidence one# cases o a s%ecic disease in e;cess o thee;%ected'
#hen the %ro%ortion o the s$sce%tible are highcom%ared to the %ro%ortion o the imm$nes
Epidemic potential
an area becomes !$lnerable to adisease $%s$rge d$e to ca$sal actors s$ch asclimatic changes* ecologic changes* or socio-economic changes
Endemic
habit$al %resence o a disease in a gi!engeogra%hic location acco$nting or the lo#n$mber o both imm$nes and s$sce%tibles''g'Malaria is a disease endemic at Pala#an'
he ca$sati!e actor o the disease isconstantly a!ailable or %resent to the area'
'poradic
disease occ$rs e!ery no# and then a:ectingonly a small n$mber o %eo%le relati!e to thetotal %o%$lation
-
7/25/2019 CHN and CD
5/13
stablish time and s%ace relationshi% o thedisease
.elate to characteristics o the gro$% in thecomm$nity
Correlate all data obtained
Role of the N5r&e
Case ,inding
Health eaching
Co$nseling
,ollo# $% !isit
Comm5nia$le Di&ea&e& ?Chroni@
Chroni
1' (5$er5lo&i&
< is a highly inectio$s chronic disease that$s$ally a:ects the l$ngs'
Ca5&ati!e Agent"Mycobacteri$m$berc$losis
Sign:Symptom&"
co$gh
aternoon e!er
#eight loss
night s#eat
blood stain s%$t$m
Pre!alene:Inidene"
ran2s si;th in the leading ca$ses o morbidity(#ith 116*&&1 cases) in the Phili%%ines
i;th leading ca$se o mortality (#ith &+07cases) in the Phili%%ines'
N5r&ing and 'edial 'anagement
Jentilation systems
/ltra!iolet lighting
Jaccines* s$ch as the bacill$s Calmette D$erin
(
-
7/25/2019 CHN and CD
6/13
Lepro&y Control Program
*H# Cla&&iation basis o m$lti-dr$gthera%y
Pa$cibacillaryGP< non-inectio$s ty%es' -9months o treatment'
M$ltibacillaryGM< inectio$s ty%es' &6-30months o treatment'
'5lti-dr5g therapy $se o & or more dr$gsrenders %atients non-inectio$s a #ee2 aterstarting treatment
Patients #G single s2in lesion and a negati!e slits2in smear are treated #G a single dose o ."Mregimen
,or P< le%rosy cases- .iam%icinLa%sone onay 1 then a%sone rom ay &-&+' blister%ac2s ta2en monthly #ithin a ma;' %eriod o 9mos'
All %atients #ho ha!e com%lied #G M areconsidered c$red and no longer regarded as acase o le%rosy* e!en i some se8$elae ole%rosy remain'
Re&pon&i$ilitie& of the n5r&e"
Pre!ention health ed$cation* health$l li!ingthro$gh %ro%er n$trition* ade8$ate rest* slee%and good %ersonal hygiene
Ca&ending
'anagement and treatment %re!ention osecondary inB$ries* handling o $tensils s%ecialshoes #G %added soles im%ortance os$stained thera%y* correct dosage* e:ects odr$gs and the need or medical chec2-$% romtime to time mental emotional s$%%ort
Reha$ilitation-ma2es %atients ca%able* acti!eand sel-res%ecting member o society'
Comm5nia$le Di&ea&e ?>etor ,orne@
Lepto&piro&i& ?*eil& di&ea&e@
An inectio$s disease that a:ects h$mans andanimals* is considered the most common=oonosis in the #orld
Ca5&ati!e Agent" 5e%tos%ira interrogans
Sign:Symptom&"
High e!er
Chills
Jomiting
.ed eyes
iarrhea e!ere headache
m$scle aches
may incl$de Ba$ndice (yello# s2in and eyes)
abdominal %ain
(reatment"
PE( - N Penicillins* Erythromycin* (etracycline
'alaria
Malaria (rom Medie!al talian> mala aria - Obad
airO ormerly called ag$e or marsh e!er) is aninectio$s disease that is #ides%read in manytro%ical and s$btro%ical regions'
Ca5&ati!e Agent" Ano%heles emale
S#eats %ro$sely
Ele!ated tem%erat$re
(reatment"
Chemo%ro%hyla;is chloro8$ine ta2en at#ee2ly inter!al* starting rom 1-& #ee2s beoreentering the endemic area'
Anti-malarial dr$gs s$lado;ine* 8$inines$late* tetracycline* 8$inidine
nsecticide treatment o mos8$ito nets* ho$ses%raying* stream seeding and clearing*s$stainable %re!enti!e and !ector control meas
Pre!enti!e 'ea&5re&" ?CLEAN@
Chemically treated mos8$ito nets
Lar!ae eating sh
En!ironmental clean $%
Anti mos8$ito soa%Glotion
Neem treesGe$caly%t$s tree
Filaria&i&
name or a gro$% o tro%ical diseases ca$sedby !ario$s thread-li2e %arasitic ro$nd #orms(nematodes) and their lar!ae
lar!ae transmit the disease to h$mans thro$gha mos8$ito bite
can %rogress to incl$de gross enlargement othe limbs and genitalia in a condition calledele%hantiasis
Sign:Symptom&"
symptomatic 'tage
Characteri=ed by the %resence o microlariaein the %eri%heral blood
?o clinical signs and sym%toms o the disease
ome remain asym%tomatic or years and insome instances or lie
cute 'tage
5ym%hadenitis (inFammation o lym%h nodes)
5ym%hangitis (inFammation o lym%h !essels)
n some cases the male genitalia is a:ectedleading to orchitis (redness* %ain$l and tenderscrot$m)
Chronic 'tage
Hydrocoele (s#elling o the scrot$m)
5y%hedema (tem%orary s#elling o the $%%er
and lo#er e;tremities
le%hantiasis (enlargement and thic2ening othe s2in o the lo#er and G or $%%er e;tremities*scrot$m* breast)
'anagement"
iethylcarbama=ine citrate or Hetra=an
!ermectin*
Albenda=olethe
?o treatment can re!erse ele%hantiasis
Shi&to&omia&i&
%arasitic disease ca$sed by a lar!ae
Ca5&ati!e Agent" chistosoma intercalat$m*
-
7/25/2019 CHN and CD
7/13
InFammation o li!er s%leen
Pallor
Sei=$re
Pre!enti!e mea&5re&
health ed$cation regarding mode o
transmission and methods o %rotection %ro%erdis%osal o eces and $rine im%ro!ement oirrigation and agric$lt$re %ractices
Control o %atient* contacts and the immediateen!ironment
(reatment"
iethylcarbama=e%ine citrate (C) or
Pra=i8$antel (dr$g o choice)
Deng5e
?D/ is a mos8$ito-borne inection #hich inrecent years has become a maBor international%$blic health concern''
t is o$nd in tro%ical and s$b-tro%ical regions
aro$nd the #orld* %redominantly in $rban andsemi-$rban areas'
Sign:Symptom&" ?>LIN#SPARD@
>omiting
Lo# %latelet
Na$sea
#nset o e!er
Se!ere headache
Pain o the m$scle and Boint
Abdominal %ain
Rashes
Diarrhea
(reatment"
he mainstay o treatment is s$%%orti!ethera%y'
ntra!eno$s F$ids
A %latelet trans$sion
Alternati!e 'ediine
.A +6&3
&3 ? 93
Her$al 'ediine ?L,,< SAN(A@
Her$al
'ediine
SES
5ag$ndi
( Jite;?eg$ndo)SHARED
S2in diseases
Headache*Asthma*e!er*co$ghcoldsRhe$matismEc=emaDysentery
/lasimang
-
7/25/2019 CHN and CD
8/13
. pillar&"
E$ality ass$rance
Drants technical assistance
Health %romotion
A#ard
Comm5nity #rgani7ing PartiipatoryAtion Re&earh
Comm5nity #rgani7ing
A contin$o$s and s$stained %rocess o
/CA?D H P"P5*
C.CA5 AWA.?
M"
-
7/25/2019 CHN and CD
9/13
Color Coding
PINK?RGEN( REFERRAL@
C"/DH ". C"5
co$ghing more than more th
days* reer or assessment
oothe the throat and relie!e th
co$gh #ith a sae remedy
Ad!ise mother #hen to ret$rn
immediately
,ollo# $% in days i not im%ro
-
7/25/2019 CHN and CD
10/13
-
7/25/2019 CHN and CD
11/13
La)& A2eting CHN Implementation
RA . - Clean Air Act (&000)
RA .;J angero$s r$g Act> sale*
administration and distrib$tion o %rohibited
dr$gs is %$nishable by la#
RA B
RA ;; Phili%%ines Medical Act> dene the
%ractice o medicine in the Phili%%ines
RA B; .$ral Health Act> em%loyment o
more %hysicians* n$rses* mid#i!es #ho #ill li!e
in the r$ral areas to hel% raise the health
condition'
RA J - .e%orting o Comm$nicable isease
RA J Deneric Act> %romotes* re8$ires and
ens$res the %rod$ction o an ade8$ate s$%%ly*
distrib$tion* and $se o dr$gs identied by their
generic names'
RA J
RA J
RA .
RA J Magna Carta or P$blic Health
Wor2ers (a%%ro!ed by Pres' Cora=on C'
A8$ino)> aims to %romote and im%ro!e thesocial and economic #ell being o health
#or2ers* their li!ing and conditions'
RA B 5ocal Do!ernment Code>
res%onsibility or the deli!ery o basic ser!ices
o the national go!ernment
Priniple& of EPI
1' %idemiological sit$ation
&' Mass a%%roach
3'
-
7/25/2019 CHN and CD
12/13
DP(?DiphtheriaPert5&&i&(etan5&@
-#ea2enedto;in
P-2illedbacteria
li8$id-0'ml
3 M
#P> ?#ralPolio>aine@
#ea2ened!ir$s
li8$id-&dro%s
3 "ral
Hepatiti&,
Plasmaderi!ati!e
5i8$id-0'ml
3 M
'ea&le& Wea2ened!ir$s
,ree=edried-0'ml
1 $bc$taneo$s
Shed5le of >aine&
>aine
Age atB&t do&e
Inter!al$et)een
do&e
Protetion
,CG At birth #ee2s 6#ee2s he e;tent o%rotection against
%olio is increasedthe earlier "PJ isgi!en'
Hepa,
birth birth*th#ee2*16th#ee2
An early start oHe%atitis < red$ces
the chance o beinginected andbecoming a carrier'
'ea&le&
9m0s'-11m0s'
At least +I omeasles can be%re!ented byimm$ni=ation at thisage'
months earliest dose o measles gi!en in
case o o$tbrea2
9months-11months- reg$lar sched$le o
measles !accine
1 months- latest dose o measles gi!en
6- years old- catch $% dose
F5lly Imm5ni7ed Child ?FIC@- less than 1&
months old child #ith com%lete imm$ni=ations
o P* "PJ*
o months- .egional 5e!el
o 3months- Pro!incial 5e!elGistrict 5e!el
o 1month-main health centers-#ith re'
o ?ot more than days- Health centers
$sing trans%ort bo;es'
-
7/25/2019 CHN and CD
13/13
'o&t &en&iti!e to heat",ree=er (-1 to -&
degrees C)
o "PJ
o Measles
Sen&iti!e to heat and free7ing(body o re'
L& to L+ degrees Celsi$s)
o