Com Devt Handouts

8/12/2019 Com Devt Handouts

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FAR EASTERN UNIVERSITY

Institute of Nursing

Nursing Care Management 107A: Nursing Leadership and Management

Leadership in Community De e!opment

C"URSE #AND$"UTS

C"RE C"NCE%TS AND %RINCI%LES "F C"&&UNITY DEVEL"%&ENT

Community a social group determined by geographical boundaries and/or common values and interests

!"#$%

"ealth a complete state o& physical and mental 'ell being and not merely the absence o& disease% "ealthis also seen as being a&&ected by the social( educational( economic( and political environment!"#$%

)evelopment a multi*dimensional process involving ma+or changes in social structures( population( attitudes andnational institutions( as 'ell as the acceleration o& economic gro'th( reduction o& ine,uality anderadication o& absolute poverty% -he goal o& development is to have a better li&e -eodoro( 1.7 $%

Community )evelopment is an organi ed e&&ort o& people to improve the economic conditions o& community li&eand the capacity o& the people &or participation( sel& direction and integrated e&&orts in communitya&&airs%

t advocates the principle o& sel& help( and the voluntary participation and cooperation o& the peoplein the community% 2sually couples 'ith technical assistance &rom the government and voluntaryorgani ations%

Community development rests upon certain assumptions:

1% -he 'orth and dignity o& the individual are the basic values in democratic society

3% 4veryone has something to contribute to the li&e o& the community%

5% 6eople have the ability to learn and gro'%

% Community development provides the opportunity and the means by 'hich the 'orth o& anindividual is revealed( his/her contributions can be made and learning can ta8e place%

Characteristics o& Community )evelopment:

1% Community development is concerned 'ith all the people o& the community( rather than +ust aparticular group or segment o& the population%

3% Community development is concerned 'ith the 'hole community li&e the total need o& thecommunity%

5% Community development is concerned 'ith bringing about social change in the community%


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% Community development is concerned 'ith &inding solutions to social problems and con&licts%

9% Community development is based on the philosophy o& sel& help and participation by as manymembers o& the community as possible%

% Community development usually involves technical assistance &rom the government( or voluntaryor private organi ations( 'hether domestic or &oreign%

7% Community development is essentially interdisciplinary% t must involve pro&essional s8ills andresources &or the service o& the communities various specialties%

% Community development is concerned 'ith both tas8 goals and process goals% 4;% t is concerned 'ith achieving ob+ectives( as 'ell as strengthening the ,ualities o& participation( sel& direction andcooperation%

.% Community development involves the educational process% t is al'ays concerned 'ith teachingand learning &rom the people%

10% Community development continues over a substantial period o& time% t is not an ad hoc or crashprogram rather( it is a process%

11% Community development program should be based on &elt needs and desires as 'ell as theaspirations o& the people in the community%

13% Community development is open to any community resident 'ho 'ishes to participate directparticipation$%

Community )iagnosis

Community )iagnosis Community assessment$ * is a systematic process o& collecting( collating(synthesi ing and analy ing data to dra' a clear picture o& the community( particularly its problems%

-he community diagnosis is then derived and 'ill become the bases &or developing andimplementing community health nursing interventions and strategies%

-ypes o& Community )iagnosis:

1% Comprehensive Community )iagnosis aims to obtain a general in&ormation about thecommunity%

3% 6roblem #riented Community )iagnosis a type o& community assessment that responds to &or aparticular need%

4lements o& a comprehensive community diagnosis:

A% )emographic variables

1% -otal population( geographical distribution and population density%

3% Age and se; composition

5%


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1% >ocial ndicators

a% Communication net'or8s

b% -ransportation system

c% 4ducational level

d% "ousing conditions

3% 4conomic ndicators

a% 6overty level income

b% 2nemployment and underemployment rate

c% 6roportion o& salary and 'age earners to active population

d% #ccupation common in the community

5% 4nvironmental ndicators

a% 6hysical( geographical( topographical characteristics o& the community

b% !ater supply

c% !aste disposal

d% Air( 'ater and land pollution

% Cultural &actors

a% 4thnicity( social class( language( religion( race( political orientation

b% Cultural belie&s and practices that a&&ects health

c% Concepts about health and illness

C% "ealth and illness pattern

1% Leading cause o& mortality

3% Leading cause o& morbidity

5% Leading cause o& in&ant mortality

% Leading cause o& maternal mortality

9% Leading cause o& hospital admission

)% "ealth ?esources

1% Manpo'er resources

3% Material resources

4% 6olitical/Leadership patterns

1% 6o'er structures


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3% Attitudes o& the people to'ards authority

5% Conditions/events that cause social con&lict

% 6ractices/approaches e&&ective in setting issues and concerns

Steps in Condu'ting Community Diagnosis(

1% )etermine the ob+ectives

3% )e&ining the study population

5% )etermining the data to be collected

% Collecting the data

9% )eveloping the instrument survey ,uestionnaire( intervie' guide( observation chec8list$

% Actual data gathering

7% )ata collation

% )ata presentation

.% )ata analysis

10% denti&ying the community health nursing problems

a% "ealth status problem mortality( morbidity( &ertility$

b% "ealth resource problem manpo'er( money( material$

c% "ealth*related problem social( economic( environmental and political$

11% 6riority setting

a% Nature o& the problem presented health status( health resource and health related problem$

b% Magnitude o& the problem re&ers to the severity o& the problems 'hich can be measured in termso& the proportion o& the population a&&ected by the problem%

c% Modi&iability o& the problem the probability o& reducing( controlling( or eradicating the problem

d% 6reventive potential the probability o& controlling or reducing the e&&ects posed by the problem%

e% >ocial concern perception o& the population or the community as they are a&&ected by theproblem%

"ealth 6roblem is a situation 'hich inter&eres 'ith the promotion and/or maintenance o& health andrecovery &rom illness or in+ury%

-ypology o& Nursing 6roblems in @amily Nursing 6ractice

@irst Level Assessment


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% 6resence o& !ellness Condition stated as 6otential or ?eadiness a clinical nursing +udgmentabout a client in transition &rom a speci&ic level o& 'ellness or capability to higher level NAN)A3001$%

% 6resence o& "ealth -hreats conditions that are conducive to disease( accident or &ailure toreali e one s health potential%

% 6resence o& "ealth )e&icits instances o& &ailure in health maintenance%

B% 6resence o& >tress 6oints/@oreseeable Crisis >ituations anticipated period o& unusual demandon the individual or &amily in terms o& ad+ustment/&amily resources%

@amily Nursing 6roblem stated as the &amily s &ailure to per&orm ade,uately speci&ic health tas8s toenhance the 'ellness state or manage the health problem%

-ypes o& @amily Nursing 6roblems:

1% nability to recogni e the presence o& the condition/problem

3% nability to ma8e decisions 'ith respect to ta8ing appropriate action

5% nability to provide nursing care to the sic8( disabled or dependent member o& the &amily

% nability to provide a home environment 'hich is conducive to health maintenance and personaldevelopment

9% @ailure to utili e community resources &or health care

6rioriti ing "ealth 6roblems:

>cale &or ?an8ing @amily "ealth Conditions and 6roblems According to 6riorities =aylon andMaglaya( 1..0$% -his tool aim to ob+ectively set priorities among the problems identi&ied%

@our criteria &or determining priorities among health conditions:

1% Nature o& the condition/problem categori ed into 'ellness state/potential( health threats( healthde&icit and &oreseeable crisis%

3% Modi&iability o& the condition/problem re&ers to the probability o& success in enhancing the 'ellness state( improving the condition( minimi ing( alleviating or totally eradicating the problemthrough intervention%

5% 6reventive potential * re&ers to the nature and magnitude o& &uture problems that can be minimi edor totally prevented i& intervention is done on the problem under consideration%

% >alience re&ers to the &amily s perception and evaluation o& the problem in terms o& seriousnessand urgency o& attention needed or &amily readiness%

>trategies in 6eople 6articipation:

1% A'areness*building and consciousness*raising on health and health related issues


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3% 6lanning( implementation( monitoring and evaluation through small group meetings 10*13household clusters$

5% >election o& community health 'or8ers by the community

% Community*building and community organi ing

9% @ormation o& health committees

% 4stablishment o& community health 'or8er organi ation at the parish or municipal level

7% Mass health campaign and mobili ation to combat health problems%

6rograms &or basic "ealth >ervices:

%RI&ARY #EALT# CARE

6rimary "ealth Care is a practical approach to the e&&ective provision o& health

services that are community based, accessible, acceptable and

sustainable at cost 'hich the community and the government can a&&ord%

?ationale &or the need &or 6"C in the 6hilippines

1% Magnitude o& health problems3% nade,uate and une,ual distribution o& health services5% ncreasing cost o& medical care% solation o& health care activities &rom other development activities

Characteristics o& 6"C

1% Community based3% Accessible ustainable% Acceptable9% >el& reliance% nterrelated to socio*economic


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So'ia! because it is directed to the improvement o& the ,uality o& li&e and the e;tension o&ma;imum health bene&its to all( particularly to the underserved segment o& the population%

De e!opment + because it vie's the community as moving progressively to'ards socio*economicprosperity 'ith the ultimate goal o& sel&*reliance%

D-he healthier the population( the more productive the community becomes and the moreimprovements in the living conditions and the ,uality o& li&e en+oyed by the people%

6rinciples #@ 6"C

1% 4,uitable distribution3% @ocus on prevention5% Multisectoral approach% >cope o& technology

9% @easibility

) M4N> #N -?A) - #NAL 6"C

#@ CA?4 -he sic8 -he 'ell and the early sic8

>4-- N< @#?>4?B C4>

2rban based inhospital( clinics( andhomes%Accessible only to &e'

?ural based in satellite clinics%Community health centers areaccessible to all

64#6L4 6assive recipients o&health care

Active participants in healthdevelopment and preventivehealth%

>-?2C-2?4 "ealth isolated &romother sectors

"ealth is an integral part o& thesocio economic developmentsystem

6?#C4>> )ecision ma8ing &romtop*do'n

)ecision ma8ing &rom bottom*top

-4C"N#L#< Curative servicesbased on modernmedicines/sophisticatedtechnology)octor dominated

6romotive and preventive servicesblending traditional medicines 'ithmodern medicinesAcceptance o& indigenouspractitionerApprotech &or &ront*line care

"UTC"&E ?eliance on healthpro&essionals

Local sel& reliance>ocial and economically productive>el& help


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4lements o& 6rimary "ealth Care

4 4ducation &or "ealth

L Locally 4ndemic )isease Control

4 4;panded program on mmuni ation

M Maternal E Child "ealth

4 4ssential )rugs

N Nutrition

- -reatment o& Communicable )iseases

> >a&e !ater and >anitation

@unctions o& the Nurse in the 6rimary "ealth Care

1% "ealth Care 6rovider 6romotion o& health and prevention o& disease%3% 6rogram 6lanner Assess problems( plan action &or community development5% >upervisor/ -rainer Conducts training needs analysis% Community #rgani er 4stablishes mechanism &or ma;imum participation o& community &or

health action%9% >chool Nurse 4ducation &or "ealth%

ntersectoral Lin8age

)ep4) ) L< )#>- )#L4 N4)A


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)6!" 66Com N"A )>!)

ntrasectoral Lin8age

5 rd

)"

3 nd

M"

1 st

M)( 6"N/Mid'i&e( ="!

Maternal and Child "ealth


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6atients should be re&erred to medical/hospital care(

#r should be &ollo'ed up care&ully by the rural health unit city health clinic or puericulture center 'here they should be seen &re,uently by the physician%

5% 6atients 'ith mild complications

6atients should be evaluated thoroughly to evaluate the needs &or &ollo' ups%

Nursing Care during 6regnancy:

All ?"2 should have a masterlist o& pregnant 'omen in their respective areas%

All pregnant 'omen must be motivated to submit themselves &or pre*natal visits%

-he "ome =ased Mother s ?ecord "=M?$ used in prenatal care as guide in the identi&ication o&ris8 &actors( danger signs( and to be able to do appropriate measures%

-here should be at least 5 pre*natal visits during pregnancy:

@irst prenatal should be made as early as possible( during the &irst trimester%

>econd visit during the second trimester%

-he third and the subse,uent visit during the third trimester

More &re,uent visits should be done &or those at ris8/'ith complications

>tandard prenatal physical e;amination per visit shall include the &ollo'ing:

!eight( height and blood pressure

4;amination o& the con+unctiva( palms o& the hands &or pallor

Abdominal e;amination &undic height( &etal position( &etal presentation and &etal heart tones%

@ace( hands and lo'er e;tremities &or edema

=reast e;amination

-hyroid gland enlargement goiter$

-he basic prenatal service delivery at the hospitals/?"2 should include the &ollo'ing:

"istory ta8ing

6hysical e;amination

-reatment o& disease

-etanus to;oid immuni ation accdg to !"#$


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ron supplementation 9 th month o& pregnancy up to 3 months postpartum$ 100*300mg p%o%( #) &or310 days%

Laboratory e;amination

#ral/dental e;amination

"ealth education

Ante %artum Ris, Fa'tors(

a% Age less than 1 or above 59

b% !ith babies or more multi*gravida$

c% =elo' 1 9 cm or . tall

d% "aving one or more o& the &ollo'ing

6revious C>

5 consecutive miscarriage or stillbirth

6ost*partum hemorrhage

e% Medical conditions

-=

"eart disease

)M

* sa&e

- to help mother loose 'eight

@ &ull o& bene&it both to the mother and child


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4 enhances &eeling o& rela;ation

4 environmentally sa&e

) does not your baby s stool &oul smelling

increase bone density

N * natural

< good nutrition &or your baby is assured

Ne) .orn S'reening

is the process o& testing ne'born babies &or treatable genetic( endocrinologic ( metabolic andhematologic diseases%

Ne'born screening has been adopted by most countries around the 'orld( though the lists o&screened diseases vary 'idely( any'here &rom 1 disorder to more than 100 disorders%

)isease ,uali&ication

Common considerations in determining 'hether to screen &or disorders:

1% A disease that can be missed clinically at birth

3 % A h i g h e n o u g h & r e , u e n c y i n t h e p o p u l a t i o n

5% A delay in diagnosis 'ill induce irreversible damages to the baby

% A simple and reasonably reliable test e;ists

9% A treatment or intervention that ma8es a di&&erence i& the disease is detected early

Ne'born >creening 6rogram in the 6hilippines

-he &ollo'ing tests are mandated in the ?%A% .3 or Ne'born >creening programo& 300 %Ne'born screening is available in practicing health institutions hospitals( lying*ins( ?ural"ealth 2nits and "ealth Centers$ 'ith cooperation 'ith )#" % & babies are delivered at home(babies may be brought to the nearest institution o&&ering ne'born screening% "o'ever( no' thereis also a simple method by 'hich the Ne'born >creening can be made possible even at home%-he urine sample o& ne'born can be absorbed on &ilter paper and sent to laboratories 'hich mayrun the test% -he reports are simple enough to be understood by the parents% A negative screenmean that the result o& the test is normal and the baby is not su&&ering &rom any o& the disordersbeing screened% n case o& a positive screen( the N=> nurse coordinator 'ill immediately in&ormthe coordinator o& the institution 'here the sample 'as collected &or recall o& patients &orcon&irmatory testing% =abies 'ith positive results should be re&erred at once to the nearest hospitalor specialist &or con&irmatory test and &urther management% >hould there be no specialist in thearea( the N=> secretariat o&&ice 'ill assist its attending physician%

)isorders >creened: "eel 6ric8 Method &or the ne'born screening

FC" Congenital hypothyroidism $ * is a condition o& thyroid hormone de&iciency present at birth%Appro;imately 1 in 000 ne'born in&ants has a severe de&iciency o& thyroid &unction( 'hile even
http://en.wikipedia.org/wiki/Genetic_disorderhttp://en.wikipedia.org/wiki/Endocrinologyhttp://en.wikipedia.org/wiki/Inborn_error_of_metabolismhttp://en.wikipedia.org/wiki/Hematologyhttp://en.wikipedia.org/w/index.php?title=R.A._9288&action=edit&redlink=1http://en.wikipedia.org/wiki/DOHhttp://en.wikipedia.org/wiki/Neonatal_heel_prickhttp://en.wikipedia.org/wiki/Congenital_hypothyroidismhttp://en.wikipedia.org/wiki/Congenital_hypothyroidismhttp://en.wikipedia.org/wiki/Genetic_disorderhttp://en.wikipedia.org/wiki/Endocrinologyhttp://en.wikipedia.org/wiki/Inborn_error_of_metabolismhttp://en.wikipedia.org/wiki/Hematologyhttp://en.wikipedia.org/w/index.php?title=R.A._9288&action=edit&redlink=1http://en.wikipedia.org/wiki/DOHhttp://en.wikipedia.org/wiki/Neonatal_heel_prickhttp://en.wikipedia.org/wiki/Congenital_hypothyroidism


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more have mild or partial degrees% & untreated &or several months a&ter birth( severe congenitalhypothyroidism can lead to gro'th &ailure and permanent mental retardation% -reatment consists o&a daily dose o& thyroid hormone thyro;ine$ by mouth% =ecause the treatment is simple( e&&ective(and ine;pensive( nearly all o& the developed 'orld practices ne'born screening to detect and treatcongenital hypothyroidism in the &irst 'ee8s o& li&e%

CA" Congenital adrenal hyperplasia$ * re&ers to any o& several autosomalrecessive diseasesresulting &rom mutations o& genes &or en ymes mediating thebiochemical steps o& production o&cortisol &rom cholesterol by the adrenal glands steroidogenesis$% Most o& these conditions involvee;cessive or de&icientproduction o& se; steroids and can alter development o& primary orsecondary se;characteristics in some a&&ected in&ants( children( or adults% Appro;imately .9Go&cases o& CA" are due to 31*hydro;ylase de&iciency%


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?" includes se;ual health &or the purpose o& enhancement o& li&e and personal relations%

?" mean sa&e pregnancy and delivery

?" includes protection &rom un'anted pregnancy by having access to appropriate healthin&ormation and services to enable 'oman to go to through pregnancy and child birth sa&ely%

?" includes protection &rom un'anted pregnancy by having access to sa&e and acceptablemethods o& &amily planning o& their choice

?" include protection &rom harm&ul reproductive practice and violence

?" assures access to in&ormation on se;uality to achieve se;ual en+oyment%

4lements o& ?"

Maternal and Child "ealth and Nutrition

@amily 6lanning

6revention and Management o& Abortion Complications

6revention and -reatment o& ?eproductive -ract n&ections ?- $including >-)( " B and A )>

4ducation and Counseling on >e;uality and >e;ual "ealth

=reast and ?eproductive -ract Cancers and other


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Integrated Management of Childhood Illness (IMCI)

#b+ectives and ituation

?egional Accomplishments

About the K"ealthy Children:


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nitiative

6ro+ects.a',ground

Integrated Management of Childhood Illness (IMCI) is a strategy &ormulated by the !orld"ealth #rgani ation !"#$ and the 2nited Nations ChildrenHs @und 2N C4@$( presented in1.. as the principal strategy to improve child health% t &ocuses on the care o& children under&ive( not only in terms o& their overall health status but also on the diseases that mayoccasionally a&&ect them% -hus( it reduces missed opportunities &or early detection andtreatment o& diseases that can escape the notice o& both parents and health 'or8ers( 'ith theconse,uent ris8 o& the illness becoming 'orse and complications arising% n addition( MCincorporates a strong component o& prevention and health promotion as an integral part o&care% -hus( among other bene&its( it helps increase vaccination coverage and improve8no'ledge and home*care practices &or children under &ive( subse,uently contributing togro'th and healthy development%

MC implementation involves the participation o& the community( the health*service sectorand the &amily% -his is carried out in three 'ays:

1% mproving the per&ormance o& health 'or8ers &or in the prevention and treatment o& childhooddiseases%

3% mproving the organi ation and operation o& health services so they provide ,uality care%

5% mproving &amily and community care practices%

MC is a strategy that integrates all available measures &or disease prevention and healthproblems during childhood( &or their early detection and e&&ective treatment( and &or promotinghealthy habits 'ithin the &amily and community%

MC can be applied by both health 'or8ers and other people responsible &or the care o& boysand girls under &ive years o& age( i%e% their parents and those 'ho care &or them%

MC o&&ers the 8no'ledge and abilities to se,uentially evaluate and integrate the status o&child health and( in this 'ay( detect the diseases or problems &re,uently a&&ecting it accordingto the epidemiological patterns o& the respective location% =ased on this evaluation( MCgives clear instructions on disease classi&ication and problems( establishing the treatment thatshould be administered &or each one% -he strategy also provides instructions on ho' tocontrol the progress o& treatment( in order to identi&y the need &or applying preventionmeasures as 'ell as ho' to in&orm and educate parents on disease prevention and childhealth promotion%

#n this basis( MC is currently regarded as the most e&&icient strategy &or reducing the burdeno& disease and disability among the population in this age group% t main goal is to contribute

to healthy gro'th and development during the &irst &ive years o& li&e%

"-/e'ti es and *oa!s 0 MC has three ob+ectives$

1% ?educing in&ant mortality%3% ?educing the incidence and seriousness o& illnesses and health problems that a&&ect boys

and girls%
http://www.paho.org/english/hcp/hct/imci/goal2002-about.htmhttp://www.paho.org/english/hcp/hct/imci/imci-aiepi.htm#proyectos%23proyectoshttp://www.paho.org/english/hcp/hct/imci/goal2002-about.htmhttp://www.paho.org/english/hcp/hct/imci/imci-aiepi.htm#proyectos%23proyectos


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5% mproving gro'th and development during the &irst &ive years o& a childHs li&e%

n the ?egion o& the Americas( 6A"# has proposed a speci&ic goal &or the implementationand strengthening o& the MC strategy% -he Healthy Children: Goal 2002 initiative 'aslaunched in 1...% t proposes to reduce the number o& deaths o& children under &ive in theAmerican hemisphere by 100(000 during the period 1...*3003%

Content

n its initial version( the central &ocus o& the MC strategy 'as a basic set o& communicablediseases and the nutritional status o& children under &ive% 6rogressively( ho'ever( the strategyhas been being e;panded and is currently &inali ing the preparation o& complementarysymptoms encompassing the ma+ority o& health problems and diseases that a&&ect childrenunder &ive years o& age% -hus( MC includes the &ollo'ing:

1 months to 2 years 3 )ee, to 1 months

Non*speci&ic signs o& serious

illness% Cough or di&&iculty breathing%

)iarrhea:

o )ehydration%

o 6ersistent diarrhea%

o )ysentery%

@ever:

o Malaria%

o Measlies%

Malnutrition and anemia%

Baccination status%

Nonspeci&ic >igns o& seriousdisease%

)iarrea:

o )ehydration%

o 6ersistent diarrhea%

o )ysentery%

@eeding problems or lo' 'eight%

Baccination status%

-he &ollo'ing constitute additional areas o& relevance during di&&erent implementation phases:

6erinatal/neonatal% Asthma and broncho*obstructive syndrome%

Child development%

#ral health%

Neglect ( child abuse( and accidents %
http://www.paho.org/english/hcp/hcn/vio/trauma.htmhttp://www.paho.org/english/hcp/hcn/vio/trauma.htmhttp://www.paho.org/english/hcp/hcn/vio/violence.htmhttp://www.paho.org/english/hcp/hcn/vio/lesion.htmhttp://www.paho.org/english/hcp/hcn/vio/trauma.htmhttp://www.paho.org/english/hcp/hcn/vio/violence.htmhttp://www.paho.org/english/hcp/hcn/vio/lesion.htm


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)iabetes and obesity%

Components :

1% mproving the per&ormance o& health 'or8ers 'hen tending to children under &ive and their&amilies health*'or8er component$%

3% mproving the organi ation and overall &unctioning o& health*care services so that they o&&ere&&icient( good*,uality care health*service component$%

5% mproving 8no'ledge on best practices &or the care o& boys and girls at home and in thecommunity community component$%

!ith regard to impro ing the performance of health !or"ers ( MC o&&ers a number o& practicaltools( including

Modules &or the evaluation( classi&ication and treatment o& children under &ive( and trainingmaterials on these modules%


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@actors in 4nvironmental >anitation:

!ater sanitation

@ood sanitation

?e&use and garbage disposal

4;creta disposal

nsect vector and rodent control

"ousing

Air pollution

Noise

?adiological protection

nstitutional sanitation

>tream pollution

-he 4nvironmental "ealth >ervices 4">$ o& )#" is responsible &or the promotion o& healthyenvironmental conditions and prevention o& environmental related diseases through appropriatesanitation strategies:

!ater ,uality surveillance

4valuation o& &ood establishments

6roper solid and li,uid 'aste management

>anitation o& public places

>anitation management o& disaster areas

mpact assessment o& environmentally critical pro+ects

4n&orcement o& sanitation la's( rules and regulations%

Ma+or 4nvironmental >anitation 6rograms:

1% "ealth and >anitation 6)% 9 1.7 $ >anitation code o& the 6hils%

3% !ater >upply >anitation 6rogram

5% 6roper e;creta and se'age disposal program

% @ood sanitation program

9% "ospital 'aste management program

% 6rogram on health ris8 minimi ation due to environmental pollution

7% "ealth 4ducation nursing responsibilities and activities


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Control o& Communicable )iseases

1% -= * N-6

3% Leprosy Control 6rogram

5% >chistosomiasis

% @ilariasis

9% Malaria

% )engue "emorrhagic @ever

7% Measles

% Chic8en 6o;

.% Mumps

10% )iphtheria

11% !hooping Cough

13% -etanus neonatorum

15% n&luen a

1 % 6neumonias

19% Cholera

1 % -yphoid &ever

17% Leptospirosis

1 % ?abies

E4isting *o ernment %rograms

-he @ourmula #ne &or "ealth: -he ?oad Map &or "ealth >ector ?e&orms in the 6hilippines 3009 *3010

5hat is FOUR mu!a ONE for #ea!th6

$%&' mula % &or "ealth is the implementation &rame'or8 &or health sector re&orms in the6hilippines &or the medium term covering 3009*3010% t is designed to implement critical healthinterventions as a single pac8age( bac8ed by e&&ective management in&rastructure and &inancing

arrangements%

-his document provides the road map to'ards achieving the strategic health sector re&orm goalsand ob+ectives o& $%&' mula % &or "ealth &rom the national do'n to the local levels%


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effecti e coordination directed at improving the ,uality( e&&iciency( e&&ectiveness and e,uity o& the6hilippine health system in a manner that is &elt and appreciated by @ilipinos( especially the poor%

>peci&ic #b+ectives:

*+ Health $inancing D >ecure more( better and sustained &inancing &or health

2+ Health 'egulation D Assure the ,uality and a&&ordability o& health goods and services

+ Health -er ice .eli ery D 4nsure access to and availability o& essential and basic health pac8ages

/+ Good Go ernance in Health D mprove per&ormance o& the health system

Community "rgani7ing %ro'ess

I8 %RE$ENTRY %#ASE

-he simplest phase in terms o& actual outputs activities and strategies%

A8 Site Se!e'tionCriteria:

)epressed( poor community

naccessibility or inade,uacy o& health services 6oor health status o& community !ith no serious peace and order problem No strong resistance &rom the community &rom the model utili ed No similar agencies or programs currently in the community to avoid duplication o&

activities%

Activities:

Community consultations/dialogues 6reliminary social investigation- initial data gathering

- in&ormal intervie'- net'or8 'ith local government unit &or pro+ect endorsements

.8 Identifi'ation of #ost Fami!ies living 'ith host &amilies ensures round the cloc8 integrationand e;periencing the li&e o& the community residence%

9 A host family should be identified before the actual entry

Criteria:


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"ouse should be strategically located in the barangay to enable communication% "ost &amily should not belong to the rich segment o& the community% -he &amily should be respected by the leaders o& the community% -he &amily should have a house 'here neighbors( especially the poor are not hesitant to

enter%

II 8 ENTRY %#ASE

-he social preparation phase%

Criteria:

#rgani ers should recogni e local authorities through courtesy call to orient pro+ectob+ectives%

-he team member s speech( appearance( behavior and li&estyle should be in 8eeping o&those 'ith the community%

-hey should adopt a lo' 8ey pro&ile and approach%

Activities:

1% ntegration 'ith the community3% Conduct o& in&ormation campaign regarding the program5% Conduct o& deepening social investigation% 6rovision o& health services9% denti&ication o& potential leaders

38 Integration the process o& establishing rapport 'ith the people in a continuing e&&ort toimbibe community li&e%Methods o& ntegration:

1% Living 'ith the community3% 6articipation in direct production activities o& the people li8e planting( harvesting(&ishing( etc%

5% Conducting house to house visit% >ocial activities li8e birthdays( 'eddings( 'a8es( etc%9% Conversing 'here people usually gather such as stores( 'ash area( church yards% )oing household chores%18 Condu't of Information 'ampaign a-out the program + disseminates in&ormation about

the purpose and strategies that 'ould be underta8en &or development:8 Community study and deepening so'ia! in estigation (!ata "athering) 1% 6hysical geographical data3% )emographical data5% 4conomic conditions

% Mortality and morbidity data9% @ood supply and nutrition% Cultural patterns( belie&s and health practices7% "ealth &acilities and services% 4ducation.% Community leaders and organi ation10% )evelopment agencies11% Community problem needs28 %ro ision o f -asi' hea!th s er i'es initiate immediate interventions &or acute health

problems o& the community% 4;% )engue @ever( measles( disasters and calamities%


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;8 Identifi'ation of potentia! !eaders or Core group formation involving &uture organi ersand possible partners% (Community leaders)

III8 "R*ANIetting up the community 'ide organi ation community assembly

Community Diagnosis

A systematic process o& collecting( collating( synthesi ing and analy ing data to dra' a clearpicture o& the community( particularly its problems%

IV8 SUSTENANCE AND STREN*#TENIN* %#ASE

-his occurs 'hen the community health organi ation has already been established and theresidents are already participating in the community 'ide underta8ings%

Strategies(

1% 4ducation and training3% Net'or8ing and lin8ages5% Conduct mobili ation on health and development concerns% mplementation o& livelihood program9% )eveloping secondary leaders

V8 TURN$"VER AND %#ASE "UT %#ASE

-he actual turn*over o& activities( programs that have been previously set to the 8ey person in thecommunity involved in the organi ing process to sustain program/pro+ect continuity anddevelopment%

Leadership -raining( 6rinciples and 6rocess

-he organi ing process must not revolve around the community organi er( but on theindigenous leaders o& the community( 'ho 'ill eventually ta8e over the role o& the communityorgani er% Community #rgani ing promotes collective or shared leadership%

Leadership -raining must be based on the &ollo'ing principles and concepts:


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a% Leadership as service as opposed to a leader as authority% Leadership is directed to'ards the 'el&are o& others%

b% Corporate/collective leadership as opposed to a one*person &orm leadership% t means sharing o&leadership 'ith others%

c% )elegation o& authority in implementing decisions( 'or8 and responsibility are decided bydi&&erent leaders and members%

d% 4liciting participation Leaders encourage/motivate people to +oin the discussions and 'or8to'ards a common goal%

e% 6roblem solving means investigating all aspects o& a situation or a problem% All suggestions areconsidered and integrated into a viable theory that could be put into action%

6rograms and 6ro+ects o& )#"

I8 FA&ILY #EALT# AND NUTRITI"N CLUSTER

-he @amily "ealth and Nutrition 6rogram aims to improve the health and nutritional status o& the&amily( especially that o& the 'omen o& the reproductive age group and that o& the children belo'&ive years o& age( thereby promoting sa&e motherhood( reducing &emale morbidity and mortality(reducing in&ant morbidity and mortality and reducing under*&ive child morbidity and mortality%

%rograms and pro/e'ts under the Fami!y #ea!th and Nutrition C!uster(

1% Maternal and Child "ealth( 2nder*@ive Clinic( 4;panded3% 6romotion o& =reast&eeding and the Mother and =aby @riendly "ospital

5% 4;panded 6rogram on mmuni ation

% >-)/" B/A )> Control 6rogram

9% 6lanning/?eproductive "ealth 6rogram

% Comprehensive Nutrition 6rogram

7% Comprehensive )ental 6rogram

% Control o& Acute ?espiratory n&ection

.% Control o& )iarrheal )iseases


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-he activities o& these di&&erent programs and pro+ects geared to'ards the improvement o& thehealth and nutritional status o& 'omen and children thereby reducing the mortalities andmorbidities o& these groups%

MA#ERNA$ AN! C%I$! CARE&%EA$#% AN! UN!ER'FI E C$INIC

6roviding ,uality health care &or 'omen and children is the utmost concern o& this department% Anintegrated pac8age o& services &or 'omen and children 'as provided( a component o& 'hich is theMaternal and Child Care/"ealth and the 2nder*@ive Clinic%

ts ob+ective is to strengthen the maternal and child health program implementation at the regionaland local levels( particularly by the La&e Motherhood 6ro+ect( the 4arly Child )evelopment6ro+ect( the L


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+#!& AI!+ CON#RO$ RO"RAM

>e;ually -ransmitted )iseases >-)s$( and particularly Ac,uired mmune )e&iciency >yndromeA )>$ are among the ma+or global health concerns% !ith the spread o& these diseases( this 'ould

a&&ect the economy &urther( creating more social problems%

"uman mmunode&iciency Birus " B$ is the virus that causes A )>% Ninety*&ive .9G$ percent o&those in&ected 'ith A )> are not even a'are that they are in&ected%

n 1.. ( it is estimated that about 30(000 have already been in&ected 'ith " B throughout thecountry but ma+ority o& these cases are still undetected and unreported% -hus( " B/A )> isconsidered a priority program o& the )#"%

-he most common mode o& transmission is se;ual transmission( primarily through heterose;ualcontact% #ther modes are through blood and blood products( in+ection drug use( needle pric8in+uries and perinatal during pregnancy%

FAMI$, $ANNIN"&RE RO!UC#I E %EA$#% RO"RAM

-he @amily 6lanning 6rogram aims to assist couples to practice responsible planning anddecision*ma8ing regarding reproductive health% t is geared to'ards promotion o& maternal andchild health through universal access to program in&ormation( education and services% Li8e'ise(the program intends to strengthen the management and &ield implementation o& &amilyplanning/reproductive health initiatives/activities in order to reduce unmet needs( reduce high ris8births( prevent abortions( improve sustainability and e;pand participation o& the private sector%

COM RE%EN+I E NU#RI#ION RO"RAM

#ne in three @ilipino children is malnourished% -his remains a threat to the @ilipino child s survival%

-he ob+ective o& the program is to reduce mortality and morbidity due to avitaminosis and othernutritional de&iciencies among in&ants( preschoolers( pregnant and lactating mothers by improvingthe health and nutrition status o& mothers and children%

Assistance &rom di&&erent pro+ects to the program includes


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-argeted priorities are vulnerable groups such as the 9*13 year old children and pregnant 'omen%>trategies o& the program include social mobili ation through advocacy meetings( partnership 'ithM6%

CON#RO$ OF ACU#E RE+ IRA#OR, INFEC#ION

6neumonia is consistently one o& the top leading causes o& in&ant and child mortality and morbidity%-he ob+ective o& the program is to reduce in&ant and child mortality &rom pneumonia% -he thrust o&the program is to'ards home management 'herein the child carer is able to recogni e thedisease at an early stage( provide treatment and re&er 'hen needed% Main strategies are trainingo& health personnel health advocacy and promotion particularly among &amily members and childcarers and provision o& logistical support% @or year 3000( 6neumonia is the leading cause o& in&ant

mortality% MC through the 4arly Child )evelopment 6ro+ect and 2N C4@ has been introduced tosupport the CA? program and to integrate its management 'ith other common childhoodillnesses%

CON#RO$ OF !IARR%EA$ !I+EA+E+

-he Control o& )iarrheal )iseases program aims to e&&ectively reduce diarrheal morbidity throughoral rehydration therapy% 4mphasis is on home therapy by continued &eeding and increased inta8eo& &luids rational use and dispensation o& drugs public in&ormation and education on correct andprompt management o& diarrhea at home% >trategies include tri*media campaigns( strengtheningthe essential drug and distribution system( capability building and provision o& #?>% -rainings onMC provides continuous support to the C)) 6rogram

II8 INFECTI"US DISEASE CLUSTER

-he 10 leading causes o& morbidity &or the past 5 years are in&ectious in origin% >i; $ out o& the 10leading causes o& mortality are non*in&ectious/non*communicable but 5 are secondary to in&ectiousor communicable diseases%

-he goal o& the n&ectious )isease Cluster is to reduce mortality and morbidity brought about byin&ectious/communicable diseases% #b+ectives o& the n&ectious )isease Cluster: to signi&icantly

reduce the burden o& priority diseases such as -=( ?abies and Baccine*preventable diseases andsubse,uently eliminate them thru a public health program prevent and control emerging and re*emerging disease%

1% NA- #NAL -= C#N-?#L 6?#


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% L46?#> C#N-?#L 6?#


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places o& Aedes aegypti% #ther initiatives are the dissemination o& 4C materials and tri*mediacoverage%

$E RO+, CON#RO$ RO"RAM

-he Leprosy Control 6rogram envisions to eliminate Leprosy as a human disease by 3030 and iscommitted to eliminate leprosy as a public health problem by attaining a national prevalence rate6?$ o& less than 1 per 10(000 population by year 3000% ts elimination goals are: reduce thenational 6? o& 1 case per 10(000 population by year 1.. and reduce the sub*national 6? to 1case per 10(000 population by year 3000%

6rogram thrust is to'ards &inding hidden cases o& leprosy and put them on Multi*)rug -herapyM)-$( emphasi ing the completion o& treatment 'ithin the !"# prescribed duration%

>trategies are case*&inding( treatment( advocacy( rehabilitation( manpo'er development andevaluation%

RA*IE+ CON#RO$ RO"RAM

?abies( a &atal disease a&&ecting the nervous system( remains a public health problem in thecountry% -he disease is most commonly transmitted through a bite by an in&ected animal( 'ithdogs as the main carriers% -he 6hilippine annual incidence o& rabies &or year 1. 7 to 1..7 ranged&rom 5 to . per million population or appro;imately 500* 00 @ilipinos die o& rabies every year%

-he National ?abies 6revention and Control 6rogram is a program +ointly implemented by the)epartment o& "ealth )#"$ and the )epartment o& Agriculture )A$ in collaboration 'ith the)epartment o& 4ducation( Culture and >ports )4C>$( and the )epartment o& nternal and Local


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%EA$#% RO"RAM FOR O$!ER ER+ON+ (% O )

-he program envisions a healthy productive older population% -his may be done 'ith the &amily(community and government 'or8ing together &or an improved ,uality o& li&e &or older persons% tsgoal is to reduce morbidity and mortality due to chronic diseases among older persons% -hespeci&ic ob+ectives o& the program are: establish a comprehensive cost e&&ective health program &orolder persons advocate a healthy li&estyle prevent/minimi e diseases( disability and handicapsstrengthen the &unctional capacity o& older persons to be productive and sel&*reliant andbuild/enhance the competencies o& health care on the management o& older persons%

6rogram strategies are: advocacy/social mobili ation public in&ormation and health educationhuman resource development/capability building research and monitoring and evaluation%

NA#IONA$ A+#%MA E!UCA#ION0 RE EN#ION AN! CON#RO$ RO"RAM (NAE )

-he ob+ective o& the program is to enhance the ,uality o& li&e &or patients 'ith asthma and decreaseasthma related morbidity and mortality% >peci&ically( it aims to: increase a'areness o& patients(health pro&essionals and the public that asthma is a serious chronic disease increase a'arenesson the recognition o& the symptoms o& asthma by patients( &amilies and the public and increase thecapability &or appropriate diagnosis by health pro&essionals and promote e&&ective control o&asthma by encouraging a partnership among patients support groups$( physicians and other

health pro&essionals net'or8ing$ through modern treatment and education programs%

6rogram strategies are &ocused on advocacy/social mobili ation( public in&ormation and healtheducation( and technical assistance to L


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-he Munting )o8tor 6ro+ect is adopted to intensi&y case &inding o& cataract cases% -his is aninnovative approach using


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#utput re&ers to the products or services 'hich an activity is e;pected to produce%

4;% O o& children 'eighed( O o& patients treated( O o& p; 'omen given --

4&&ect re&ers to outcome o& the utili ed pro+ect outputs%

4;% ncidence o& tetanus neonatorum( O o& malnourished children( incidence o&

communicable diseases%

mpact re&ers to the outcome o& program/pro+ect e&&ects% t sho's actual long range

results produced%

mpact 4valuation assesses the impact o& care administered or the impact o& implemented program on

the client by comparing the conditions o& the a&&ected groups be&ore and a&ter program/pro+ectimplementation

Cost e&&ectiveness analysis compares alternative pro+ects/care interventions in terms o& the cost o&producing a given output%

?ecording and ?eporting >ystem

@ield "ealth >ervices and n&ormation >ystem @"> >$

#b+ectives:

-o provide summary data on health service delivery and selected program accomplishedindicators at the barangay( municipality/city( district( provincial( regional( and national levels%

-o provide data 'hich 'hen combined 'ith data &rom other sources( can be used &or programmonitoring and evaluation process%

-o provide a standardi ed( &acility level data base 'hich can be accessed &or more in*depthstudies%

-o ensure that the data reported to the @"> > are use&ul and accurate and are disseminated in atimely and easy to use &ashion%

-o minimi e the recording and reporting burden at the service delivery level in order to allo' moretime &or patient care and promotive activities%

Components:


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@amily -reatment ?ecord

-arget Client List

?eporting @orms

#utput ?eports

1% -reatment ?ecord -he &undamental Pbuilding bloc8Q and &oundation o& the @" >% -his is thedocument( &orm( or piece o& paper upon 'hich recorded the presenting symptoms or complaints o&the patient on consultation and the diagnosis( treatment( and date o& treatment%

4;% 6atient ?ecord

)ate Name Address Complaint ?; )iagnosisi& available$

3% -arget/client lists constitute the second Pbuilding bloc8Q o& the @"> > and are intended to serve&our purposes:

a% -o plan and carry out patient care and services delivery%

b% -o &acilitate the monitoring and supervision o& services

c% -o report service delivered%

d% -o provide a clinic*level database * 'hich can be accessed &or &urther studies

t5% -ally/?eporting @orms it constitute he only mechanism through 'hich data are routinely

transmitted &rom one &acility to another in the revised @"> >% Ma+ority o& the @"> > reports areprepared and submitted either monthly or ,uarterly% @"> > reports are prepared and submitted bythe unit/person responsible &or the service or activity and sent directly to 6rovincial "ealth #&&ice%

% #utput ?eports output reports or tables 'ill be a produced at the 6rovincial "ealth o&&ice oralternate data processing site in the province$ &rom the data reported in @"> > ?eporting @orms%Computer*generated output reports 'ill then be disseminated do'n to the ?"2/M"C and upthrough the )#" system to the ?egional "ealth #&&ice%

Vita! Statisti's

Bital >tatistics re&ers to the systematic study o& vital events such as births( illnesses(marriages( divorces/separations and deaths%

>tatistics o& disease morbidity$ and death mortality$ indicate the health o& a communityand the success or &ailure o& the health 'or8%

6opulation statistics such as age and se; can be obtained &rom N>#


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=irths and deaths are registered in the #&&ice o& the Local Civil ?egistry city or municipality

>ources o& data:

6opulation Census

?egistration o& vital data

"ealth surveys

>tudies and research

1% Crude =irth ?ate * A measure o& one characteristic o& the natural gro'th or increase o& a population%

C=? -otal no% o& live births registered in a given calendar year J 1(000

4stimated population as o& Ruly 1 o& the same year

3% Crude )eath ?ate A measure o& one mortality &rom all causes 'hich may result in a decrease o&population%

C)? -otal no% o& deaths registered in a given calendar year J 1(000

4stimated population as o& Ruly 1 o& the same year

5% n&ant Mortality ?ate Measures the ris8 o& dying during the 1 st year o& li&e%

M? -otal no% o& deaths under 1 year o& age registered in a given calendar year J 1(000

-otal no% o& registered live births o& same calendar year

% Maternal Mortality ?ate Measures the ris8 o& dying &rom causes related to pregnancy( childbirth andpuerperium%

MM? -otal no% o& deaths &rom maternal causes registered &or a given year J 1(000

-otal no% o& live births registered o& same year


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9% @etal )eath ?ate Measures pregnancy 'astage% )eath o& the product o& conception occurs prior toits complete e;pulsion( irrespective o& duration o& pregnancy%

@)? -otal no% o& &etal deaths registered in a given calendar year J 1(000


+Neonatal )eath ?ate Measures the ris8 o& dying the 1 st month o& li&e%

N)? No% o& deaths under 3 days o& age registered in a given calendar year J 1(000


7+>peci&ic )eath ?ate )escribes more accurately the ris8 o& e;posure o& certain classes or groups to aparticular disease%

>peci&ic )? )eaths in speci&ic class or group registered in a given calendar year J 100(000

4stimated population as o& Ruly 1 in the same speci&ied class or group o& said year

% ncidence ?ate Measures the &re,uency o& occurrence o& the phenomenon during a given period o&

time% )eals only 'ith ne' cases

? No% o& ne' cases o& a particular disease registered during a speci&ied period o& time J 100(000

4stimated population as o& Ruly o& same year

.% 6revalence ?ate Measures the proportion o& the population 'hich e;hibits a particular disease at aparticular time%

6? No% o& ne' and old cases o& a certain disease registered at a given time J 100

-otal no% o& person e;amined at same given time


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10% Attac8 ?ate A more accurate measure o& the ris8 o& e;posure%

A? No% o& persons ac,uiring a disease registered in a given year J 100

No% e;posed to same disease in same year

10% >'aroo& s nde;

> -otal deaths 90 years and above J 100

-otal deaths

Noti&iable )iseases

)iarrheas

6neumonias

=ronchitis/=ronchiolitis

n&luen a

Measles

-= ?espiratory

-= meningitis

-= other &orms )iseases o& the heart

Malignant Neoplasms

Chic8enpo;

)engue @ever

Malaria

Cholera

-yphoid and 6aratyphoid &ever

Biral "epatitis

?abies

)iphtheria

-etanus Neonatorum


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-etanus

6oliomyelitis

!hooping Cough

yphilis

A )>/" B in&ection

Leprosy

>chistosomiasis

@ilariasis

Meningitis/4ncephalitis

Leptospirosis

@ood/chemical 6oisoning

Meningococcemia

"ypertension

Ser i'es %ro ided to Fami!y and Community

C#N pro ides mu!tip!e dire't and indire't '!ient ser i'es8

1% )irect client services:

"ealth teaching

"ands on bedside care

"ealth ris8 appraisal

Counseling

"ealth planning

Clinic services

3% ndirect client services:

?ecord 8eeping

Coordinating 'ith agencies


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>upervising health center sta&&

?e&erences:

1% Community #rgani ing 6articipatory Action ?esearch &or Community "ealth )evelopment by: >r%Carmen 4% Rimene %

3% Nursing 6ractice in the Community by: Araceli >% Maglaya

5% Community "ealth Nursing >ervices in )epartment o& "ealth 6hilippines by: Rean 6% ?eyala% et%al%

% Community 4;posure Community "ealth Management Manual &or Nursing >tudents by: Lydia C%Biet%

9% ntegrated Management o& Childhood llness ?esource Manual and !or8boo8

Com Devt Handouts

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