A powerpoint presentation about Health Care Programs in the Philippines by Paolo Zabat, RN

1. THE FAMILY HEALTH
PAOLO M. ZABAT, RN

2. PARADIGM OF PHC
Essential
Health
Care
e.g.
Family
health
EPI
Family
planning
Infant
breast
feeding
Community
based
Individuals/
Families
Universally
accessible
Primary
Health
Workers
Social
Development

3. ESSENTIAL HEALTH CARE
PROGRAMS
1.
Family Health Program
2.
Prevention and Control of Noncommunicable Diseases (NDCs)
Prevention and control of
Communicable disease
Environmental Health and Sanitation
Other priority health programs
3.
4.
5.

5. FAMILY HEALTH PROGRAMS


The DOH – Family Health Office is tasked to
operationalized health programs geared
towards the health of the family. It is
responsible for the creation, implementation
and evaluation of health family programs.
The summary of its objective is to improve the
survival, health and well being of each
members of the family as well as the reduction
of morbidity and mortality rates in the family
and community.

6. FAMILY HEALTH PROGRAMS
The following are the family health
programs:
1. Maternal Health Program
2. Family Planning Program
3. Child Health Program
4. Expanded Program Of
Immunization
5. Nutrition Program
6. Oral Health Program
7. Other Health Program


7. MATERNAL
&
CHILD HEALTH
PROGRAM

8. 
WHO Philippines MCH Program works with local
public health departments, community based
organizations, statewide organizations and other
providers to provide and/or assure quality health
services are delivered to mothers, children, and
families in the country.
The primary areas of work focus are:
 Increasing healthy birth outcomes;
 Promoting and assuring comprehensive primary care
for children, from birth to 21 year olds, including
children with special health care needs;
 Promoting healthy lifestyles among school-age youth,
ages 6-21, including children with special health care
needs;
 Promoting access to safe, healthy child care,
including children with special health care needs; and

9. MATERNAL HEALTH PROGRAM
STATISTICS
(Reference: www.doh.gov.ph)

10. MATERNAL HEALTH PROGRAM
OBJECTIVE:
To improve the survival, health and well being of mothers and
unborn child.
MATERNAL HEALTH SERVICES:
1. Antenatal Registration - pregnant women can avail the
free prenatal services at their respective health center.
2. Tetanus Toxoid Immunization - A series of 2 doses of
tetanus toxoid vaccination must be received by a pregnant
women one month before delivery and 3 booster doses after
childbirth
3. Micronutrient Supplementation - Vitamin A and Iron
supplement for the prevention of anemia and Vit. A
deficiency.
4. Treatment of diseases and other conditions - These is
for the women who is diagnosed as under the high risk

11. MATERNAL HEALTH PROGRAM
IDEAL FREQUENCY OF PRENATAL
VISITS DURING THE DURATION OF
PREGNANCY
PRENATAL VISITS
PERIOD OF
PREGNANCY
FIRST VISIT
As early as possible
before 4 months or during
1st trimester
SECOND VISIT
During the second
trimester
During the third trimester
After 8 months until
THIRD VISIT
EVERY 2 WEEKS

12. TETANUS TOXOID
Vaccine
Minimum Age
Interval
Percent
Protected
Duration of Protection
TT1
As early as
possible during
pregnancy
80%
TT2
At least 4 weeks
later
80%
• Gives 3 years protection
for the mothers
TT3
Atleast 6 months
later
90%
• Gives 5 years protection
for the mothers
TT4
Atleast 1 year
later
99%
• Gives 10 years protection
for the mothers
TT5
Atleast 1 year
later
99%
• Gives lifetime protection
for the mothers
When given to women of childbearing age, vaccines that contain tetanus
toxoid not only protect women against tetanus, but also prevent neonatal
tetanus in their newborn infants.

13. FAMILY PLANNING
PROGRAM

14. FAMILY PLANNING PROGRAM
Brief Description of Program

A national mandated priority public health program
to attain the country's national health development:
a health intervention program and an important tool
for the improvement of the health and welfare of
mothers, children and other members of the family.
It also provides information and services for the
couples of reproductive age to plan their family
according to their beliefs and circumstances
through legally and medically acceptable family
planning methods.

15. FAMILY PLANNING PROGRAM
The program is anchored on the following basic principles.

Responsible Parenthood which means that each family has the
right and duty to determine the desired number of children they
might have and when they might have them. And beyond
responsible parenthood is Responsible Parenting which is the
proper upbringing and education of chidren so that they grow up to
be upright, productive and civic-minded citizens.

Respect for Life. The 1987 Constitution states that the government
protects the sanctity of life. Abortion is NOT a FP method.

Birth Spacing refers to interval between pregnancies (which is
ideally 3 years). It enables women to recover their health improves
women's potential to be more productive and to realize their
personal aspirations and allows more time to care for children and
spouse/husband,.

Informed Choice that is upholding and ensuring the rights of
couples to determine the number and spacing of their children
according to their life's aspirations and reminding couples that
planning size of their families have a direct bearing on the quality of

17. FAMILY PLANNING PROGRAM





In 2003, there are about 84 million Filipinos to
grow annually at 2.36 percent and expected to
double in 29 years.
The total fertility rate is at 3.5 children/ women
The use of contraceptive increases gradually
from 15.4% (1996) to 48.9% (2003)
44% of women got pregnant with their first child
at the age of 20-24.
In 2003, among married women, 48.8% use
any form of contraceptive method and 51.1%
do not use any form of contraceptive method at
all.

18. FAMILY PLANNING PROGRAM
GOAL:
 To provide universal access to family planning
information and services wherever and whenever
these are needed. It aims to contribute to Reduce
neonatal, infant, under-five and maternal deaths.
OBJECTIVES:
 To help couples and individuals achieve their
desired family size within the context of responsible
parenthood and to improve their reproductive
health to attain sustainable growth.
 Ensure that quality FP services are available in
DOH retained hospitals, LGU managed health
facilities and private sector.

19. TYPES OF FAMILY PLANNING
NATURAL
• Standard
Days
Method
• Lactational
Amennorhea Method
• Basal
Body
Temperature
• Billings
Ovulation/Cervical
Mucus Method
• Symptothermal
Method
ARTIFICIAL
•
•
•
•
Condom
Injectables
Oral Contraceptive Pills
Intrauterine Device
PERMANENT
• Vasectomy
• Bilateral Tubal Ligation

20. STANDARD DAYS METHOD
Is the most appropriate for women
who usually have cycles between 26
and 32 days long.
 95% effective
 Uses cycle beads to determine fertile
days.

N
A
T
U
R
A
L

21. STANDARD DAYS METHOD
N
A
T
U
R
A
L
Steps:
1. Count the first day of your menstrual
bleeding as DAY 1.
2. On days 1 to 7, you can have
unprotected intercourse.
3. On days 8 to 19, you should use a
barrier method or avoid intercourse.
4. From day 20 through the end of the
cycle, you can have unprotected
intercourse.

22. CYCLE BEADS
N
A
T
U
R
A
L

23. LACTATIONAL AMENORRHEA
METHOD (LAM)
A temporary postpartum method of
postponing pregnancy based on
the
physiological
infertility
experienced by breast-feeding
mothers.
 The mother may ovulate but not
menstruate while breast-feeding.

N
A
T
U
R
A
L
 Advantage: Easily accomplished by
all postpartum lactating mothers

99.5% effective

24. BASAL BODY TEMPERATURE
It is used to identify the fertile and infertile
period of a woman’s cycle by daily taking and
recording the rise and fall in body
temperature during and after ovulation.
 99% effective
 Based on the fact that:
◦ Before the day of ovulation, a woman’s BBT
falls about half a degree.
◦ At the time of ovulation, her BBT rises a full
degree because of the influence of
progesterone. This is maintained for the
rest of her menstrual cycle.

N
A
T
U
R
A
L

25. BILLINGS OVULATION /
CERVICAL MUCUS METHOD
Abstaining
from
sexual
intercourse during fertile (wet)
days of spinnbarkeit mucus
and 3 days after the peak day.
 97% effective
 Advantage: Can be used by
healthy women with no known
diseases
 Disadvantage: Not so reliable

N
A
T
U
R
A
L

26. BILLINGS OVULATION /
CERVICAL MUCUS METHOD

N
A
T
U
R
A
L

During ovulation, cervical mucus is
copious, thin, watery, transparent, feels
slippery and stretches at least 1 in
before strand breaks. The stretchability
of the mucus is described by its
spinnbarkeit, having the raw egg white
quality that is easier for sperm to
penetrate.
After ovulation, the character of cervical
mucus changes, and under the
influence of progesterone it becomes
thick, scant, and tacky; mucus doesn’t
stretch when pulled between the thumb
and finger. Sperm typically cannot

27. SYMPTOTHERMAL METHOD
It is the combination of Basal Body
Temperature and Billings method.
 98% effective

N
A
T
U
R
A
L

28. RHYTHM METHOD
Calendar method
 It is abstaining from coitus 3 or 4 days
before ovulation until 3 or 4 days after
ovulation.
 The woman determines the number of days
per menstrual cycle for 6 cycles.
Calculation:

N
A
T
U
R
A
L
Subtract 18 from the shortest cycle – first fertile day
 Subtract 11 from the longest cycle – last fertile day
Ex. Range from 25 to 29 days
25
29
- 18
- 11
7th
to
18th day – fertile days (12)
1st to 6th day; 19th to 29th day – non-fertile
days


29. COITUS INTERRUPTUS
Method of contraception where couple
proceeds with coitus until moment of
ejaculation and the man withdraws so
that the spermatozoa are emitted
outside the vagina.
 Disadvantages:

N
A
T
U
R
A
L


Presence of few spermatozoa in preejaculation fluid
Lack of control

30. CONDOM
A thin sheath of latex rubber made to
fit on a man’s erected penis, it prevent
the passage of sperm into the internal
vagina
DISADVANTAGES
 98% effective
ADVANTAGES

A
R
T
I
F
I
C
I
A
L
• Safe and has no
hormonal effect
• Protects against
microorganims
• Easily accessible
• Used in managing
premature ejaculation
• May cause allergy to
latex
• May decrease sensation
• Interrupts the sexual act
• Requires man’s
cooperation

31. INJECTABLES

A
R
T
I
F
I
C
I
A
L

It contains synthetic hormone, progestin
which suppresses ovulation; thickens the
cervical mucus thus making it difficult for
sperm to pass through
Advantages:
 Reversible and no daily intake
 No sexual inference
 No estrogen related effects
 Doesn’t affect breastfeeding

99.95% effective

32. ORAL CONTRACEPTIVE PILLS


A
R
T
I
F
I
C
I
A
L


Pill contains hormones: estrogen and
progesterone, taken daily to prevent
conception.
99.7% effective
Advantages:
 Safe, convenient and easy to use, 3%
failure
 Reduces gynecological symptoms like
painful menstruation and reduce the risk of
ovarian and endometrial cancers
Disadvantages:
 Has side effects like: nausea, dizziness,
breast tenderness, blurring of vision
 Suppresses lactation

33. INTRAUTERINE DEVICE
A long term birth control
method that is a small, Tshaped plastic device that
is wrapped in copper or
contains hormones.
 A plastic string is tied to
the end of the IUD hangs
down through the cervix
into the vagina.
 99.4% effective and can
last up to 10 years.

A
R
T
I
F
I
C
I
A
L

34. VASECTOMY
The vas deferens is
blocked or cut, to prevent
the passage of sperm.
 99.9% effective
 Birth control should be
used until two negative
sperm reports have been
examined

P
E
R
M
A
N
E
N
T

35. BILATERAL TUBAL LIGATION
(BTL)


P
E
R
M
A
N
E
N
T

Involves the cutting or
blocking of the 2 fallopian
tubes.
99.5% effective
Advantages:
 Permanent method of
contraception
 No repeated clinic visits
 Does not interfere with sex –
result to increase enjoyment
 No known side effects

36. CHILD HEALTH
PROGRAM

37. CHILD HEALTH PROGRAMS


Newborns, infants and children are vulnerable age
group for common childhood diseases.
To address problems, child health programs have been
created and available in all health facilities which
includes:
 Infant and Young Child Feeding
 Newborn Screening (NBS)
 Expanded Program on Immunization (EPI)
 Management of Childhood Illnesses
 Micronutrient Supplementation
 Dental Health
 Early Child Development
 Child Health Injuries

GOAL: Reduce morbidity and mortality rates for children
0 – 9 years with the strategies necessary for program

38. INFANT AND YOUNG CHILD
FEEDING
There is global evidence that good nutrition in the
early months and years of life plays a very significant
role, affecting not only the health and survival of
infants and children but also their intellectual and
social development, resulting in life-long impact on
school performance and overall productivity.
 Breastfeeding, especially exclusive breastfeeding
during the first half-year of life is an important factor
that can prevent infant and childhood morbidity and
mortality.
 Timely, adequate, safe and proper complementary
feeding will prevent childhood malnutrition.


39. INFANT AND YOUNG CHILD
FEEDING
BREASTFEEDING
Importance of Breast feeding:
 Exclusive breast feeding is giving only breast milk to
infants.
 This is recommended up to 6 months and can be
extended up to 2 years.
BENEFITS FOR THE
BENEFITS FOR THE
MOTHERS
INFANT
• Reduces excessive
• A complete food for the
blood loss after birth
infants
• Natural method of
• Strengthen immune
delaying pregnancies
system thus preventing
• Reduces the risk of
infections
ovarian and breast
• Increases IQ points
cancers

40. INFANT AND YOUNG CHILD
FEEDING
Laws that protects infant and young child feeding:
 Milk code (EO 51)
 Products covered by milk code consist of breast
milk substitute, e.g. infant formula, other milk
products, bottlefed complementary foods
 Rooming-In Breastfeeding Act of 1992 (RA
7600)
 Requires both public and private institution to
promote rooming-in, it encourage and support
the practice of breastfeeding
 Food Fortification Law (RA 8976)
 An act establishing the Philippine food
fortification Program and for other purpose

41. FOOD FORTIFICATION
Food fortification law is vital in the promotion of optimal
health and to compensate for the loss of nutrients
during processing and storage of food.
 The law requires a mandatory food fortification of staple
foods – rice, flour, edible oil, and sugar and voluntary
food fortification of processed food and food products.
(Vitamin A, Iron, Iodine)
 Fortification is “the addition of one or more essential
nutrients to food, whether or not it is normally contained
in the food, for the purpose of preventing or correcting a
demonstrated deficiency of one or more nutrients in the
population or specific population groups”


42. NEWBORN SCREENING
Newborn Screening Act of 2004 (RA 9288).
 Newborn screening (NBS) is a public health
program aimed at the early identification of
infants who are affected by certain genetic/
metabolic/ infectious conditions.
 Early identification and timely intervention can
lead to significant reduction of morbidity,
mortality, and associated disabilities in
affected infants.


43. NEWBORN SCREENING
Newborn screening is ideally done on the 48th
– 72nd hour of life. However, it may also be
done after 24 hours from birth.
 A few drops of blood are taken from the baby’s
heel, blotted on a special absorbent filter card
and then sent to Newborn Screening Center
(NSC).


44. DISORDERS TESTED FOR
NEWBORN SCREENING





CH (Congenital Hypothyroidism)
CAH (Congenital Adrenal Hyperplasia)
GAL (Galactosemia)
PKU (Phenylketonuria)
G6PD (Glucose-6-Phosphate Dehydrogenase)

45. DISORDERS TESTED FOR
NEWBORN SCREENING



CH – results from lack or absence of thyroid hormone
which is essential for the physical and mental
development of a child.
CAH – is an endocrine disorder that causes severe
salt loss, dehydration and abnormally high levels of
male sex hormones in both boys and girls. If not
detected and treated early, babies with CAH may die
within 7-14 days.
GAL – is a condition in which babies are unable to
process
galactose,
the
sugar
present
in
milk. Accumulation of excessive galactose in the body
can cause many problems, including liver damage,
brain damage and cataracts.

46. DISORDERS TESTED FOR
NEWBORN SCREENING


PKU – is a rare condition in which the baby cannot
properly use one of the building blocks of protein
called phenylalanine.
Excessive accumulation of
phenylalanine in the blood causes brain damage.
G6PD – is a condition where the body lacks the
enzyme called G6PD. Babies with this deficiency may
have hemolytic anemia resulting from exposure to
oxidative substances found in drugs, foods and
chemicals.

47. NEWBORN SCREENING
DISORDERS
SCREENED
Effect if NOT
SCREENED
Effect if
SCREENED and
Managed
CH
Severe Mental
Retardation
Normal
CAH
Death
Alive and normal
GAL
Death or Cataracts
Alive and normal
PKU
Severe Mental
Retardation
Normal
G6PD
Deficiency
Severe anemia,
Kernicterus
Normal

48. EXPANDED PROGRAM ON
IMMUNIZATION
The EPI was launched in July 1976 by the
DOH in cooperation with WHO and
UNICEF.
 The original objective was to reduce the
morbidity and mortality among infants and
children caused by the seven childhood
diseases.
 Every
Wednesday is designated as
immunization day in all parts of the country.
 A fully immunized child: receives one dose
of BCG, 3 doses of OPV, DPT, HB and one

st

49. EXPANDED PROGRAM ON
IMMUNIZATION
Republic Act No. 10152
 “Mandatory Infants and Children Health
Immunization Act of 2011 signed by
President Benigno Aquino III in July 26,
2010.
 The
mandatory
includes
basic
immunization for children under 5 including
other types that will be determined by the
Secretary of Health.

50. EXPANDED PROGRAM ON
IMMUNIZATION

Four major strategies:
◦ Sustaining high routine FIC coverage of atleast
90%
◦ Sustaining polio free country for global
certification
◦ Eliminating measles by 2008
◦ Eliminating neonatal tetanus by 2008


Immunization is the process by which
vaccines are introduced into the body before
injection sets in.
Vaccines are administered to induce immunity
thereby causing the recipient’s immune system

51. EXPANDED PROGRAM ON
IMMUNIZATION
GUIDELINES

It is safe and immunologically effective to administer all EPI vaccines
on the same day at different sites of the body.

Moderate fever, malnutrition, mild respiratory infection, cough,
diarrhea and vomiting are not contraindicated to vaccination.

DPT2 and DPT3 are contraindicated to a child who has had
convulsion or shock within 3 days the previous dose.

Live vaccines like BCG must not be given to individuals who are
immunosuppressed due to malignant disease, therapy with
immunosuppressive agents or irradiation.

It is safe and effective with mild side effects after vaccination. (Ex:
Local reaction, fever)

Repeat BCG vaccination if the child does not develop a scar after
the first injection.

BCG immunization shall be given to all school entrants both in
private and public schools regardless of the presence or absence of
BCG scar.

52. EXPANDED PROGRAM ON IMMUNIZATION
Vaccine
Minimum
Age at 1st
Dose
Number of
Doses
Minimum
Interval
Between
Doses
Reason
BCG
Birth or
anytime after
birth
1
DPT
6 weeks
3
4 weeks
Reduces the
chance of
pertussis
OPV
6 weeks
3
4 weeks
Protection
against Polio
Disease
BCG protects
the infant
from
possibility of
TB meningitis
& other TB
infections

53. EXPANDED PROGRAM ON IMMUNIZATION
Vaccine
Minimum
Age at 1st
Dose
Number of
Doses
Minimum
Interval
Between
Doses
Reason
Hepatitis B
At birth
3
6 weeks
interval from
1st dose to
2nd dose; 8
weeks
interval from
2nd to 3rd
dose
Reduces the
chance of
being
infected and
becoming a
carrier
Measles
9 months
1
Prevents
deaths,
malnutrition
and
protection
from measles

54. EXPANDED PROGRAM ON IMMUNIZATION
Type/Form of vaccine
Storage Temperature
Oral Polio (live
attenuated )
-15°C to -25°C ( at the
freezer)
Measles ( Freeze
dried)
-15°C to -25°C ( at the
freezer)
Type/Form of Vaccine
Storage Temperature
Least Sensitive to
Heat
DPT/Hep B
+2 °C to + 8°C ( in the
body of refrigerator)
D” toxoid is a
weakened toxin
“P” killed bacteria
“T” toxoid is a
weakened toxin
Hepatitis B
+2 °C to + 8°C ( in the
body of refrigerator)
BCG (freeze dried)
+2 °C to + 8°C ( in the
body of refrigerator)
Tetanus toxoid
+2 °C to + 8°C ( in the
body of refrigerator)
Most Sensitive to
Heat

55. EXPANDED PROGRAM ON IMMUNIZATION
Vaccine
Dose
Route of
Administration
Site of
Administration
BCG
0.05 ml
Intradermal
Right deltoid
region
DPT
0.5 ml
Intramuscular
Upper outer
portion of the
thigh
OPV
2 drops
Oral
Mouth
Measles
0.5 ml
Subcutaneous
Outer part of the
arm
Hepa B
0.5 ml
Intramuscular
Upper outer
portion of the
thigh
Tetanus
Toxoid
0.5 ml
Intramuscular
Deltoid region

56. NUTRITION PROGRAM




Malnutrition continues to be a public health
concerns in the country.
The common nutritional deficiencies are
Vitamin A, Iron and Iodine.
GOAL: To improve quality of life of Filipinos
through better nutrition, improved health and
increased productivity.
Programs and projects are: Micronutrient
supplementation, food fortification, nutrition
information, communication and education,
home, school and community food production
and food assistance.

57. MICRONUTRIENT
SUPPLEMENTATION


It is one of the interventions to address the
health and nutritional need of infants and
children and improve their growth and survival.
The twice-a-year distribution of Vitamin A
capsules through the “Araw ng Sangkap Pinoy”
(ASAP), known as Garantisadong Pambata or
Child Health Week is the approach adopted to
provide micronutrient supplements to 6-71
months old preschoolers on a nationwide
scale.

58. DENTAL HEALTH



Oral disease continues to be a serious public
health problem in the Philippines. The
prevalence of dental caries on permanent teeth
has generally remained above 90% throughout
the years. About 92.4% of Filipinos have tooth
decay (dental caries) and 78% have gum
diseases (periodontal diseases)
Although preventable, these diseases affect
almost every Filipino at one point or another in
his or her lifetime.
Goal: Attainment of improved quality of life
through promotion of oral health and quality

59. DENTAL HEALTH
Dental Health Objectives:
The prevalence of dental caries is
reduce
 The prevalence of periodontal disease is
reduced
 Dental caries experience is reduced
 The proportion of Orally Fit Children (OFC)
12-71 months old is increased
