PRIMARY

HEALTH CARE IN
THE
PHILIPPINES
Module III

Regie De Jesus,
College MAN
of Health
COMMUNITY HEALTH NURSING I
PRIMARY HEALTH CARE
(PHC)
• is an essential Health Care based on
practical and socially acceptable
methods and technology
• made universally accessible to
Individual, Family, Community
History of Public Health Care
• WHAT: Alma Ata Conference, first
international conference on PHC
• WHEN: September 6-12, 1978
• WHERE: Alma Ata, USSR/Russia
• WHO: WHO/UNICEF
• WHO: Dr. Dizon/Dr. Villar
• Legal Basis for PHC in the Philippines:
(Letter of Instruction) LOI 949
• Signed by: Pres. Ferdinand Marcos on
October 19, 1979
Goal of Public Health
Care
• HEALTH FOR ALL FILIPINOS in 2000
and HEALTH IN THE HANDS OF THE
PEOPLE by year 2020
• Filipinos are among the healthiest
people in Southeast Asia by 2022, and
Asia by 2040
• An improved state of health & quality
of life for all people attained through
SELF-RELIANCE
• Mission
• Strengthening the health
system wherein people will
manage their own health
care

• Key/Core Strategy
• “PARTNERSHIP with and
EMPOWERMENT of the
people”
PILLARS/CORNERSTONE
OF PUBLIC HEALTH CARE
• Support Mechanism made
available
• Community Participation
Active
• Appropriate technology
• Multi-Sectoral linkages
PILLARS/CORNERSTONE
OF PUBLIC HEALTH CARE
• Support Mechanism made available
• There are 3 major resources:
• People
• Government
• Private Sectors (e.g. NGO, church…)
• Community Participation Active
• Community participation - a process in
which people identify the problems and
needs and assumes responsibilities
themselves to plan, manage, and control.
PILLARS/CORNERSTONE
OF PUBLIC HEALTH CARE
• Appropriate technology
• method used to provide a socially
and environmentally acceptable
level of service or quality product at
the least economic cost.
• Health technology includes tools,
drugs, methods, procedures and
technique, people’s technology, and
indigenous technology
PILLARS/CORNERSTONE
OF PUBLIC HEALTH CARE
• Multi-Sectoral linkages
• Intrasectoral linkages (Two - way
referral sys.) — communication,
cooperation and collaboration
within the health sectors.
• Intersectoral Linkages - between
the health sector and other sectors
like education, agriculture and local
government officials.
KEY PRINCIPLES IN APPROPRIATE
TECHNOLY (Acronym ACCEFS)

• A’s (Four As)

• C ost wise - economical in nature
• C omplex procedures which provide a
simple outcome
• E ffective
• F easibility of use=possibility of use at
all times
• S cope of technology is safe & secure
KEY PRINCIPLES IN APPROPRIATE
TECHNOLY (Acronym ACCEFS)

• A’s (Four As)

• Accessibility - distance/travel time required
to get to a health care facility/ services.
• the home must be within 30 min. from the Brgy. Health
Stations
• Affordability - consideration of the
individual, family, community and
government can afford the services
• the out-of-pocket expense determines the affordability of
health care.
• in the Philippines, government insurance is covered through
PhilHealth
KEY PRINCIPLES IN APPROPRIATE
TECHNOLY (Acronym ACCEFS)
• A’s (Four As)
• Acceptability - health care services are
compatible with the culture and traditions of the
population.
• Availability - is a question whether the health
service is offered in health care facilities or is
provided on a regular and organized manner.
• Examples:
• * Botika ng Bayan and Botika ng Bayan - ensures the
availability and accessibility of affordable essential drugs.
It sells low-priced generic home remedies, OTC and
common antibiotics.
• * Ligtas sa Tigdas ang Pinas - mass door-to-door measles
immunization campaign.
- target age: 9 months to below 5 years old
THREE LEVELS OF
DISEASE PREVENTION
• Primary prevention
• Secondary prevention
• Tertiary prevention
Primary Prevention
• most desirable form of
prevention (mostly provided in
BHS/Health Center, Rural health
Unit (RHU))
• Focus is on health promotion
and disease prevention
Behavior Associated
with Primary Prevention
• Quit smoking
• Avoid/limit alcohol intake
• Exercise regularly
• Reduce fat & increase fiber in diet
• Take adequate fluids
• Avoid over exposure to sunlight
• Maintain ideal body weight
• Complete immunization program
• Worksite Wellness (e.g. Wear hazard devices at work site)
• Information Dissemination (e.g. sex education among
youth)
• Environmental Control programs (e.g. clean and green
program)
Secondary Prevention
• curative, prevention of
complications thru screening, early
diagnosis and treatment
• mass screening (e.g. operation
timbang, operation BP)
• case-finding
• contact-tracing
• surveillance
Behavior Associated with
Secondary Prevention
• Have annual physical exam
• Regular Pap smear test for women
• Monthly Breast Self-Exam (BSE) for
women who are 20 years old and above
• Testicular Self-Examination after a warm
bath for men
• Sputum exam for tuberculosis
• Annual rectal examination for clients
over age 50 years
Tertiary Prevention
• rehabilitative, prevention of disability
• Continuing health supervision during
rehabilitation to restore an individual
to an optimal level of functioning
• Minimizing residual disability and
helping the client learn to live
productively with limitations
Behavior Associated
with Tertiary Prevention
• Self-monitoring of blood glucose
among diabetics
• Physical therapy after CVA
• Participate in cardiac rehabilitation
after MI
• Attend self-management education for
diabetes
• Undergo speech therapy after
laryngectomy
REFERRAL SYSTEM IN
PUBLIC HEALTH CARE
• Barangay Health Station (BHS) is
under the management of Rural
Health Midwife (RHM)
• Rural Health Unit (RHU) is under the
management or supervision of PHN
• Public Health Nurse (PHN) caters to
1:10,000 population, acts as
managers in the implementation of
the policies and activities of RHU,
directly under the supervision of MHO
REFERRAL SYSTEM IN
PUBLIC HEALTH CARE
BHS RHU MHO PHO

Specialized National RHO

Agencies Agencies
QUALITY ASSURANCE: SENTRONG
SIGLA MOVEMENT (SSM)

• SSM is a quality improvement

initiative through a
certification/recognition program.
Health facilities are certified based
on a set of standards
• SSM also promotes continuous
quality improvement as a
complementing strategy
• was established by DOH with LGUs
having a logo of a Sun with 8 Rays
Steps in the SSM
Certification Process
• Philippines Department of Health (DOH)
provides copies of quality standards to
local government units (LGUs)
• LGU facility conducts self-assessment
• Mayor/Governor sends letter of intent to
participate
• DOH SS teams conducts assessment
• LGU facility gets certified, receives SS seal
• Certified facility gets monitored twice a
year and tries to strive for higher level
standards
4 Pillars of SSM
• Health Promotion
• Grants and technical assistance
• Quality assurance
• Awards: Cash, plaque, certificate
 SENTRONG SIGLA
MOVEMENT (SSM)
Level Category Description
1 Basic Certification Minimum input, process and output standards for integrated
public health services for 4 core programs (Family Panning,
Expanded Program of Immunization, Maternal Programs, &
TB Program), facility systems, regulatory functions and basic
curative services

2 Specialty Award Second level quality standards for selected public health
programs (includes other health programs in addition to
Level 1 core programs) and facility systems
3 Award of Highest level quality standards for maintaining level
Excellence 2standards for the 4 core public health programs and level
2facility systems for at least 3 consecutive years
FOUR CONTRIBUTIONS OF
PHC to DOH and ECONOMY
• Training of Health Workers
• Creation of Botika sa Baryo & Botika
sa Health Center
• Herbal Plants
• ORESOL
A. TRAINING OF HEALTH WORKERS
(Primary Health Workers)

• 3 Levels of Training
• a. Grassroot/Village Health
Workers
• b. Intermediate
• c. First Line Personnel - the
specialist
a. Grassroot/Village
Health Workers
• Includes Barangay Health Volunteers (BHV)
and Barangay Health Workers (BHW)
• Nonprofessionals, didn’t undergo formal
training, receive no salary but are given
incentive in the form of honorarium from the
local government since 1993 (health
auxiliary volunteer; Traditional Birth
Attendant)
• Initial link, 1st contact of the community
• Work in liaison with the local health service
workers
• Provide elementary curative preventive
health care measures
b. Intermediate
• these are professionals including the 8
members of the PHWs (e.g. General
Medical Practitioners, Public Health
Nurses Midwives)
• 1st source of professional health care
• Attend to health problems beyond the
competence of village health workers
• Provide support to the frontline health
workers in terms of supervision, training,
referral services and supplies thru
linkages with other sectors
First Line Personnel -
the specialist
• Establish close contact with the
village and intermediate level health
workers to promote the continuity of
acre from hospital to community to
home
• Provide back-up health services for
cases requiring hospital or diagnostic
facilities not available in health care
CREATION OF “BOTIKA SA BARYO &
BOTIKA SA HEALTH CENTER” from
Administrative Order (AO) 144 of 2004

• Refers to a drug outlet managed by a

legitimate community organization
(CO)/non- government organization
(NGO) and/or the Local Government
Unit (LGU), with a trained operator
and a supervising pharmacist.
BOTIKA SA BARYO &
BOTIKA SA HEALTH CENTER
• Goal: To promote equity in health in ensuring
the availability and accessibility of affordable,
safe, and effective quality essential drugs to
all, with priority for marginalized, critical, and
hard to reach areas
• Refers to a drug outlet wherein primary, non-
prescription generic drugs listed in the
Philippine National Drug Formulary (PNDF)
and selected prescription drugs
(Cotrimoxazole, Amoxicillin, Metoprolol,
Captopril, Metformin, Glibenclamide and
Salbutamol) are sold/made available.
BOTIKA SA BARYO &
BOTIKA SA HEALTH CENTER
• The BnBs serves a
total population of
approximately
90,457,200.
• RA 6675: Generics
Act of 1988:
Implementing
• Father of Generics
Act: Dr. Alfredo
Bengzon
Oplan Walang Reseta
Program
• solution to the absence of a
medical officer who prescribed
the medicines so PHN are
given the responsibility to
prescribe generic medicines
Walong Wastong Gamot
Program
• available generics in “Botika sa
Baryo” & Health Center (Acronym
CARIPPON)
• C -otrimoxazole
• A – moxicilllin
• R – ifampicin
• I – soniazid
• P – yrazinamide
• P – aracetamol
• O – resol (Oral Rehydration Solution)
• N – ifedipine
C -otrimoxazole
• it’s a combination of 2 generics
of drugs which is antibacterial
Trimethoprim (TMP)
• Has a bacteriostatic action that
stops/inhibits multiplication of
bacteria
• (TMP combined with SMX)
Sulfamethoxazole (SMX)
• Has bactericidal action that kills
bacteria
• For GUT, GIT, URTI & Skin
Infections
A – moxicilllin
• An antibacterial drug that
comes from the Penicillin
family
• Effect is generally
bacteriostatic (when source
of infection is bacterial)
• These 2 drugs provide the
least sensitivity reaction
(rashes & GI) and the
adverse effect of other
antibiotics is anaphylactic
shock
Tuberculosis Drug
• R – ifampicin – Tuberculosis Drug
• I – soniazid - Tuberculosis Drug
• P – yrazinamide - Tuberculosis Drug
Paracetamol
• Has an analgesic & anti-pyretic
effect
• Acetyl Salicylic Acid (ASA) or
Aspirin is never kept in the
“Botika” because of its effects:
• Anticoagulant-highly dangerous to
Dengue patients that’s why it’s not
available in “Botika” & Health
Center
Oresol (Oral
Rehydration Solution)
•a
management
for diarrhea to
prevent
dehydration
under the
Control of
Diarrheal
Diseases
(CDD)
Program
 Oresol Components
Glucose 20grams 1° Significance:
For re-absorption of Na
Facilitates assimilation of Na
2° Significance:
Provides heat & energy
Sodium Chloride 3.5 For retention of water/fluid
(NaCl) grams
Sodium Bicarbonate 2.5 Buffer content of solution
(NaHCO3) grams Neutralizer content of solution
Potassium Chloride 1.5 Stimulates smooth muscle
(KCl) grams contractility especially the heart &
GIT
 Preparation of Proper
Homemade Oresol
A volume or One-liter Smaller volume or a Glass of
Homemade Oresol Homemade Oresol
Water : 1,000mL or 1Liter 250mL
Sugar: 8 teaspoons 2 teaspoons
Salt: 1 teaspoon ¼ teaspoon or a pinch of salt (i.e.
10 – 12 granules of rock salt; or
for iodized salt = tips of thumb
and index finger are penetrated
with salt
N – ifedipine
• An anti-
hypertensive drug
• According to DOH,
16% of population
belonging to 25
years old & above
in the community
are hypertensive
HERBAL PLANTS
(Acronym LUBBY SANTA)
• RA 8423: Traditional and Alternative
Medicine Act of 1997 (Juan Flavier)
• a program where patient may opt to
use herbal plants especially for drugs
that are not available in dosage form
or patients has no financial means to
buy the drug
• Traditional Medicine:
• Use of herbal plants
HERBAL PLANTS
(Acronym LUBBY SANTA)
• L Lagundi
• U Ulasimang Bato/ Pansit-pansitan
• B Bayabas
• B Bawang
• Y Yerba Buena

• S Sambong
• A Ampalaya
• N Niyug-niyogan
• T Tsaang gubat
• A Akapulko/
 LAGUNDI
Herbal Meds Scientific Indications Parts Preparation
Name used
L Lagundi Vitex Asthma, cough, Leaves Decoction (Tea without bag)
negundo colds, & fever (Chop leaves (2 glasses of
(ASCOF), dysentery, leaves)– then boil in two
Pain and glasses of water for 15
inflammation minutes)
LAGUNDI
 Ulasimang Bato/ Pansit
Pansitan
Herbal Meds Scientific Indications Parts Preparation
Name used
U Ulasimang Peperonia Lowers blood uric Leaves Decoction
Bato/ pellucida acid (rheumatism (Boil 1 ½ glasses of leaves in
Pansit- (arthritis) and gout) two glasses of water for 15
pansitan minutes)
Eaten raw as salad
Ulasimang Bato/ Pansit
Pansitan
 Bayabas
Herbal Meds Scientific Indications Parts used Preparation
Name
B Bayabas Psidium Washing wounds, Leaves Decoction
guajava Diarrhea, gargle to (Two glasses of
relieve toothache leaves into four
glasses of water)
Bayabas
 Bawang
Herbal Meds Scientific Indications Parts Preparation
Name used
B Bawang Allium Hypertension, Clove/ Eaten raw or sauted (eat
sativum lowering Bulb 2 pieces per day)
cholesterol, Boil for minutes
Toothache Apply on affected tooth
 Yerba Buena
Herbal Meds Scientific Indications Parts Preparation
Name used
Y Yerba Mentha Pain (headache, Leaves Decoction
Buena cordifelia toothache, swollen (Chop leaves – then boil in
gums, menstrual two glasses of water for 15
pain), cough, colds, minutes)
fever Poultice (pound the leaves &
apply on affected part)
Yerba Buena
 Sambong
Herbal Meds Scientific Indications Parts Preparation
Name used
S Sambong Blumea antiedema Leaves Decoction
balsamifer (manas), (Chop leaves (2 glasses
a antiurolithiasis, of leaves)– then boil in
diuretic two glasses of water for
15 minutes)
Sambong
 Amplaya
Herbal Meds Scientific Indications Parts Preparation
Name used
A Ampalaya Momordic Diabetes mellitus Leaves Decoction
a (mild non-insulin (Chop leaves (2 cups or 6
charantia dependent) tablespoons of leaves)–
then boil in two glasses
of water for 15 minutes)
Ampalaya
 Niyug - Niyogan
Herbal Meds Scientific Indications Parts Preparation
Name used
N Niyug- Quisqualis Intestinal Seeds Use newly-opened, mature
niyogan indica parasitism/nematodes, and dried seeds (eat the
anti-helminthic seeds 2 hours after dinner)
(Ascariasis) Effectiveness is 3-4 weeks
(Not for children below 4
years old)
Niyog-niyogan
 Tsaang gubat
Herbal Meds Scientific Indications Parts Preparation
Name used
T Tsaang Carmona Diarrhea, or dental Leaves Decoction
gubat retusa caries, (Chop leaves (2 glasses of
stomachache, leaves)– then boil in two
infantile colic glasses of water for 15
(kabag) minutes)
Tsaang Gubat
 Akapulko
Herbal Meds Scientific Indications Parts Preparation
Name used
A Akapulko/ Cassia alata Antifungal/Tinea Leaves Poultice (pound the leaves &
Bayas- infections (buni, apply on affected part)
bayasan alipunga, an-an, Cream (see preparation
hadhad), scabies below)
Akapulko
GUIDELINES IN USING
HERBAL PLANTS
• Be sure that the right kind of plant is used
according to the intended purposes
• Avoid insecticides on plants
• Use a clay pot and remove cover while boiling at
low heat
• Use only the part of the plant being advocated.
Follow accurate dosage suggestions
• Use only one kind of herbal plant for each kind of
symptom
• Stop giving herbal medication if untoward reaction
occurs
• If signs and symptoms are not relieved after 2-3
METHODS OF DRYING
• Air Drying – best method for drying
flowers and leaves
• Sun-Dried – best method for drying
fruits, seeds, bark, branches, and
roots
• Oven dried – used during the rainy
season, 40% of the medicinal value is
lost during the process
FORMS OF
PREPARATION
a. Decoction
• Gather leaves & wash
thoroughly, place in a
container the washed
leaves & add water
• Let it boil without cover
to vaporize/steam to
release toxic substance
& undesirable taste
• Use extracts for
washing
FORMS OF
PREPARATION
b. Poultice
• Done by pounding or chewing
leaves used by herbolaryo
• Example: Akapulko leaves -
when pounded, it releases
extracts coming out from the
leaves contains enzyme
(serves as anti-inflammatory)
then apply on affected skin
or spewed it over skin
• For treatment of skin
diseases
FORMS OF
PREPARATION
c. Infusion (Tsaa)
• To prepare a tea
(use Lipton bag),
keep standing for
15 minutes in a cup
of warm water
where a brown
solution is collected,
pectin which serves
as an adsorbent
and astringent
FORMS OF
PREPARATION
d. Syrup
• To prepare a papaya juice, use ripe
papaya & mechanically mashed then
put inside a blender & add water
• To produce it into a syrup, add sugar
then heat to dissolve sugar & mix it
FORMS OF
PREPARATION
• d. Cream/Ointment (Ungguwento)
• Start with poultice (pound leaves) to
turn it semi-solid
• Add flour to keep preparation pasty &
make it adhere to skin lesions
• To make it into an ointment: add oil
(mineral, baby or any oil- serves as
moisturizer) to the prepared cream to
keep it lubricated while being massage
on the affected area
Cream/Ointment
 Other Alternative Health Care
Alternative
Modalities Definition
Modality
Acupuncture uses special needles to puncture and stimulate
specific part of the body
Aromatherapy combines essential aromatic oils to then applied to
the body
Nutritional therapy “nutritional healing”, this improves health by
enhancing the nutritional value to reduce the risk of
the disease
Reflexology application of pressure on the body’s reflex joints to
enhance body’s natural healing.
Accupressure
• A method of maintaining health,
treating disease, and alleviating pain
by applying pressure or massaging
certain points on the body surfaces.
• Traditional Chinese medicine believes
that life is a result of Qi or life energy,
which has two aspects: the (1) YIN
(negative force) and the (2) YANG
(positive force)
• Imbalance in the two aspects results
Application of
Accupressure
• 1. Posture – Lying down or sitting up, must
be relax.
• 2. Manipulation – thumb pressure must be
bearable, firm but not heavy
• 3. Frequency – as frequent as every 4 hours;
usually once a day; 2-3 times per week
• Room must be warm and well-ventilated
• Use prescribed acupressure points; use
ahshi points (painful spots or modes
which appear when a person has an illness)
Acupressure
Module Requirements
• Design a brochure promoting the use
10 herbal plants advocated by the
DOH

• Prepare an akapulko cream/ointment

for the community people

• Prepare an Oresol for a patient with

diarrhea
My own recipe of
Akapulko Ointment
Materials
• Cooking pot
• Scissors
• Strainer
• Measuring cup
• Medicine containers
• Grater
• 2 cups coconut oil (other oil/s can be used)
• 2 cups Akapulko leaves
• 1 tablespoon of candle was per 3 tablespoon of
Akapulko extract
My own recipe of
Akapulko Ointment
Preparation
• Wash and dry your Akapulko leaves
• Chop/ cut the leaves into smaller pieces
• Warm your coconut oil (or other oil/s)
• Add chopped leaves and cook until leaves are crispy
• Separate the extract
• Grate your candle wax and melt them
• For every three tablespoons of extract, you add one
tablespoon of candle wax
• Mix until ointment consistency is achieved
• Transfer it into medicine container and put label on it.