MATERNAL, CHILD AND ADOLESCENT HEALTH
SERVICES
CURRENT MATERNAL, NEWBORN, INFANT and
NUTRITION SITUATION
The Department of Health (DOH) issued
Administrative
Order
2008-0029
Entitled.
"Implementing Health Reforms for the Rapid
Reduction of Maternal and Neonatal Mortality As a
response to the slow decline in maternal and child
mortality in the Philippines, far beyond The
Millennium Development Goals in 2015 DOH, 2018).
The MNCHN strategy guides the development,
implementation and monitoring or evaluation of
various government programs aimed at improving the
health of women mothers, and children, to rapidly
reduce maternal and neonatal mortality in the
country.
This goal is to be achieved by using the integrated
Maternal Newborn Child Health and Nutrition
(MNCHN) services for each stage of life-prepregnancy,
pregnancy, delivery, postpartum, newborn, and
childcare--which will ensure the following results:
1. Every pregnancy is wanted, planned, and supported;
2. Every pregnancy is adequately managed throughout
its course;
3. Every delivery is facility-based and managed by
skilled birth attendants or skilled health professionals;
and,
4. Every mother and newborn pair secures proper
postpartum and newborn and childhood care.
Safe Motherhood Program
The Philippines faces unique challenges in aligning its
health system with the needs of its inhabitants,
primarily because of the country's geography and
income distribution. Several communities are in
isolated mountain regions of the country or in coastal
areas which are difficult to reach. Further, there
are wide disparities in the use of health services across
income levels.
the Philippine Department of Health (DOH) launched
the innovative Women's Health and Safe Motherhood
Project 2 (WHSMP2)
funded in part by the World Bank, shifted the
emphasis from identifying and treating high-risk
pregnancies to preparing all women for potential
obstetric complications.
aimed to strengthen the ability of the health system
to deliver a package of interventions, including
maternal care, family planning, control of sexually
transmitted infections, and adolescent health services-with a priority on serving disadvantaged women.
It is a fast-tracked system-wide reform in maternal
health in selected provinces through a set of
interventions:
Sector
governance:
improving
accountability and regulatory oversight; Infrastructure
and essential medical products and equipment;
Human resource development: clinical skill-building
and formation of village-based women's health teams
(composed of a midwife, a pregnant woman, and a
traditional birth attendant (TBA]); Financing: resultsbased financing mechanisms and social health
insurance coverage; • Service delivery: availability,
quantity and quality of essential health services.
Safe motherhood encompasses a series of initiatives,
practices, protocols, and service delivery guidelines
designed to ensure that women receive high-quality
gynecological family planning, prenatal,delivery
andpostpartum care to achieve optimal health for the
mother, fetus, and infant during pregnancy, childbirth,
and postpartum.
The National Safe Motherhood Program
Envisions that Filipino women have full access to
health services to ensure safe pregnancy and delivery.
This program brought about a strategic change in the
design of services provided, which includes the
following:
Shift in handling pregnant clients from a risk approach
to preparing all pregnant women for complications at
childbirth. It follows the rule that there is no such thing
as a low or high-risk pregnant woman. Instead, all
women are considered at risk for pregnancy and
childbirth complications:
Improved quality of Family Planning counseling and
expanded service availability of postpartum family
planning in hospitals and primary birthing centers;
and, The integration of cervical cancer, syphilis,
hepatitis B, and HIV screening among others into the
antenatal care protocols.
Changes in service delivery also involved a shift from
centrally controlled national programs operating
separately and governed independently at various
levels of the health system to an LGU governed system
that delivers an integrated women's health and safe
motherhood service package.
At the ground level, this implies that a woman,
whatever her age and specially if she is disadvantaged,
who seeks care from a public health provider for
reproductive health concerns, could expect to be given
a comprehensive array of services that
Reproductive Maternal Newborn Child Adolescent
Health and Nutrition (RMNCAHN)
has initiated support systems for Maternal-Newborn
service delivery anchored on PhilHealth accreditation
of birthing centers and individual membership or
enrollment into the Sponsored Program. This
mechanism ensures sustainable financing of quality
maternal-newborn services efficiently eliminating outof-pocket expenditures for antenatal, facility delivery,
and postnatal care.
The system likewise includes systems for safe blood
supply and stakeholder behavior change, through a
combination of advocacy and interpersonal
communication during clinic visits. DOH provides
stewardship and guidance through (1) evidence-based
guidelines and protocols on maternal newborn
services; (2) a system for recognizing providers of
emergency obstetrics and newborn care (BEmONC)
training program; and, (3) monitoring, evaluation and
research on the new maternal-newborn strategies.
RELATED POLICIES
The DOH issued Administrative Order (AO) 2018-0014
entitled, Strategic Framework and Implementing
Guidelines for FOURmula One Plus for Health (F1+). It
aligned health initiatives into four strategic pillars:
Financing, Regulation, Service Delivery, and
Governance. It also added a cross-cutting initiative for
Performance Accountability.
The National Objectives for Health 2017-2022, a
roadmap for the F1+ towards the achievement of
Universal Health Care, was formulated and issued. It
specifies the objectives, strategies, and targets of DOH
F1+ for Health.
Republic Act No. 11148: The "Kalusugan at Nutrisyon
ng Mag-Nanay Act" which scales up the national and
local health nutrition programs for pregnant and
lactating women, adolescent girls, infants, and young
children in the first 1,000 days.
Republic Act No. 11210: The "105-Day Expanded
Maternity Leave Law" which increases the maternity
leave period to 105 days for all female workers; with
an option to extend for an additional 30 days without
pay; and an additional 15 days for solo mothers
Administrative Order 2008-0029: Implementing
Health Reforms to Rapidly Reduce Maternal and
Neonatal Mortality.
Department Order 2009-0084: Guidelines Governing
the Payment of Training Fees Relative to the
Attendance of Health Workers to Basic Emergency
Obstetric and Newborn Care Skills Training Course at
Duly Designated Training Centers
Administrative Order 2011-0011: Establishment of
Basic Emergency Obstetric and Newborn Care Training
Centers in Regional Hospitals and Medical Centers
Administrative Order 2015-0020: Guidelines in the
Administration of Life Saving Drugs During Maternal
Care Emergencies by Nurses and Midwives in Birthing
Centers
Administrative Order 2016-0035: Guidelines on the
Provision of Quality Antenatal Care in All Birthing
Centers and Health Facilities Providing Maternity Care
Services
Administrative Order 2018-0003: National Policy on
the Prevention of Illegal and Unsafe Abortion and
Management of Post-Abortion Complications
Administrative Order (AO) 2016-0035. The National
Policy on the Provision of Quality Antenatal Care in
Birthing Centers and Health Facilities Providing
Maternal Care Services
Republic Act No. 10028:Expanded Breastfeeding
Promotion Act of 2009
The Reproductive Maternal Newborn Child Adolescent
Health and Nutrition (RMNCAHN) core package of
services
The main objective of this core package is to enable all
adolescents to make informed choices on reproductive
health issues, particularly about pregnancy, by
creating awareness and providing access to
information, education, support, services and
necessary treatments in the field of reproductive
health.
refers to a package of services for women, mothers
and children covering the spectrum of (1) known
appropriate clinical case management services
including emergency obstetric and newborn care in
preventing direct causes of maternal and neonatal
deaths which are or will be within the capacity of the
health system to provide routinely; and, (2) known
cost-effective public health measures capable of
reducing exposure to and the severity of risks for
maternal and newborn deaths that are routinely being
provided by LGUs.
MNCHN Service Delivery Network
refers to the network of facilities and providers within
the province-wide or city-wide health system offering
the MNCHN core package of services in an integrated
and coordinated manner. It includes the
communication and transportation system supporting
this network.
The following providers are part of the MNCHN Service
Delivery Network:
1. Community-level service providers Or Community
Health Teams (CHT) comprise of out-patient
departments, Barangay Health Stations, Rural Health
Units, and private clinics which are manned by
community health volunteers and led by a midwife. Its
primary functions are to conduct health risks and
needs assessment and provide basic service delivery
functions such as birth spacing and counseling.
2. BEmONC-capable facility may be a Barangay Health
Station, lying-in, or birthing home that provides the
parenteral administration of oxytocin (3-d stage),
loading anticonvulsant, the initial dose of antibiotic;
assisted imminent breech deliveries; removal of
retained products and placenta; and, emergency
newborn interventions such as resuscitation, sepsis,
and oxygen treatment. BEmONC-capable facilities may
also transfuse blood products if needed.
3. CEmONC-capable facilities provide all services
rendered in BEmONC facilities with the addition of
cesarean section, blood banking and transfusion,
highly specialized obstetric intervention, management
of low birth weight and preterm babies, and other
newborn specialized services. Intrauterine device
insertion, vasectomy, and bilateral tubal ligation are
likewise performed in these facilities.
Reproductive health
is the state of complete physical, mental and social
well- being and not merely the absence of in all
matters relating to reproductive system and its
functions and processes. Reproductive health is based
on the right to access appropriate health care services
which enables women to go safely through pregnancy
and childbirth and provides couples with the best
chance of having a healthy infant (WHO, 2008). On the
other hand, reproductive health care refers to the
constellation of methods, techniques, and services
which contribute to reproductive health and wellbeing by preventing and solving reproductive health
problems (WHO, 2008).
The Magna Carta of Women (R.A 9710),
which was enacted in 2009, stipulated that "the State
shall, at all times, provide for comprehensive, culturesensitive, and gender-responsive health services and
programs covering all stages of a woman's life cycle
and which addresses the major causes of woman's
morbidity and mortalityThis law states that in the
provision of comprehensive health services, due
respect shall be accorded to women's religious
convictions, the rights of the spouses to find a family
by their religious conviction, and the demands of
responsible parenthood, and the right of women to
protection
from
hazardous drugs devices,
intervention, and substances. It also stated that the full
range of reproductive health services shall be ensured
by the government (Congress of the Philippines, 2009).
Republic Act 10354, also known as the Responsible
Parenthood and Reproductive Health (RPRH).
It is an act with the declaration that the State
recognizes and guarantees the human rights to
sustainable human development, health, education,
and information, and the right to choose and make
decisions and on one's religious convictions, ethics,
cultural beliefs, and demands of responsible
parenthood.
this law states that local government units shall
endeavor to provide adequate services for maternal
care and skilled birth attendance by hiring additional
personnel to achieve an ideal skilled health
professional to-patient ratio and upgrade facilities to
provide emergency obstetric and newborn care.
It also directs the DOH to procure, distribute to LGUs,
and monitor the usage of family planning supplies for
the whole country (Congress of the Philippines, 2012).
Responsible parenthood refers to the will and ability of
a parent to respond to the needs and aspirations of the
family and children. It is likewise a shared
responsibility between parents to determine and
achieve the desired number of children, spacing, and
timing of their children according to their family life
aspirations, taking into account psychological
preparedness, health status, sociocultural and
economic concerns consistent with their religious
convictions (Congress of the Philippines, 2012).
FOR
COUPLES
TO
PRACTICE
RESPONSIBLE
PARENTHOOD, THEY SHOULD BE AWARE OF THEIR 13
SEXUAL REPRODUCTIVE HEALTH RIGHTS(DOH,2019)
WHICH ARE:
The Right to Life. among other things, that no woman's
life should be put at risk because of pregnancy, gender,
or lack of access to health information and services.
This also includes the right to a safe and satisfying sex
life.
2. The Right to Liberty and Security of the Person. This
recognizes that no woman should be subjected to
forced pregnancy, forced sterilization, or forced
abortion.
3. The Right to Equality, and to be free from all Forms
of Discrimination. freedom from discrimination
because of one's sexuality and reproductive life
choices.
4. The Right to Privacy. all sexual and reproductive
health care services should be confidential in terms of
physical set-up, information given or shared by the
clients, and access to records or reports.
5. The Right to Freedom of Thought. all sexual and
reproductive health care services should be
confidential in terms of physical set-up, information
given or shared by the clients, and access to records or
reports.
6. The Right to Information and Education. access to
full information on the benefits, risks, and
effectiveness of all methods of fertility regulation so
that all decisions taken are made based on full, free,
and informed consent.
7. The Right to Information and Education. access to
full information on the benefits, risks, and
effectiveness of all methods of fertility regulation, so
that all decisions taken are made based on full, free,
and informed consent.
8. The Right to Choose Whether or Not to Marry and
to Find and Plan a Family. right of persons to protect
against a requirement to marry without his/her
consent. It also includes the right of individuals to
choose to remain single without discrimination and
coercion.
9. The Right to Decide Whether or When to Have
Children. right of persons to decide freely and
responsibly the number and spacing of their children
and to have access to related information and
education, to avail of the new reproductive health
technologies that are safe, effective, and acceptable.
10. The Right to Health Care and Health Protection.
The right of clients to the highest possible quality of
health care and the right to be free from harmful
traditional health practices.
11. The Right to Freedom of Assembly and Political
Participation. right of all persons to seek to influence
communities and governments to prioritize sexual and
reproductive health and rights.
12. The Right to be Free from Torture and ILI
treatment. the rights of all women, men and young
people to protection from violence, sexual exploitation
and abuse.
12. The Right to Development. This includes the right
of all individuals to access development opportunities
and benefits, especially in decision-making processes
that affect his/her life.
Family Planning refers to a program that enables
couples and individuals to decide freely and
responsibly the number and spacing of their children
and to have the information and means to do so, and
to have access to a full range of safe, affordable,
effective, non-abortifacient modern natural and
artificial methods of planning pregnancy (Congress of
the Philippines, 2012).
Four Pillars of Family Planning
1. Responsible Parenthood. The couple has the right to
determine the number of children they want to have
provided they can support the needs and provide a
better life for their children.
2. Child Spacing. A birth interval of 3 to 5 years is
encouraged to prepare the mother's uterus for a new
pregnancy and more time for the couple and other
children to establish a strong relationship or bond.
3. Respect for Life. Abortion is considered illegal based
on Philippine Law and culture.
It is mandated that the preservation of life of the fetus
be observed regardless if his or her condition. The
1987 Constitution protects the life of the unborn from
the moment of conception.
4. Informed Choice. The couple has the right to
determine the kind of family planning methods based
on their religious beliefs, culture, and ethical values
subject to conformity with the universally recognized
international human rights. It is the responsibility of
the nurse to discuss full information regarding options,
advantages, and disadvantages of each method.
Benefits of family planning Appropriate family
planning has several benefits not only to the mother
but also to the children and the spouse.
These benefits include the following:
1. Benefits to the mother: Enable to regain her health
after delivery, prevent pregnancy-related health risks,
give enough time and opportunity to love and provide
attention to her husband and children, gives more
time for her family and own personal advancement.
When suffering from illness, gives enough time for
treatment and recovery
2. Benefits to children: Reduces infant mortalit,
healthy mothers produce healthy children, will get the
attention, security, love and care they deserve
3. Benefits to the father: Lightens the burden and
responsibility in supporting his family, enables him to
give his children their basic needs
Methods of family planning
Family planning methods must be widely available and
easily accessible through workers midwives and other
trained health workers to anyone who is sexually
active, including adolescents. Clinicians, nurses,
midwives, community health workers, and other
trained health workers are in the position to promote
family planning among sexually-active individuals by
promoting the use of culturally acceptable birth
control or contraceptive methods (WHO, 2018).
Maternal-newborn health Prepregnancy services
Prepregnancy services include the provision of iron
and folate supplementation, counseling and provision
of Family Planning (FP) methods, and prevention and
management of infection and lifestyle-related
diseases.
Commodities for these services are provided by both
the DOH and Local Government Units LGUs).
Prepregnancy services highlight the provision of
modern FP methods to reduce unplanned pregnancies
and unmet needs of women and adolescents that can
expose them to unnecessary risks from pregnancy and
childbirth. Unplanned pregnancies are also associated
with poorer health outcomes for both mother and
newborn (Yazdkhasti. Pourreza, Pirak, & Abdi, 2015).
Antenatal care services (first 270 days)
Republic Act 11148, known as "Kalusugan at Nutrition
ng Mag-Nanay Act", focuses on scaling up the national
and local nutrition programs through a strengthened
integrated strategy for maternal, and neonatal child
health and nutrition in the first one thousand (1,000)
days of life. The program includes health and nutrition
services provided at different life stages.
Pregnancy Tracking and Enrollment to Antenatal Care
(ANC) Antenatal care (ANC) is care provided by skilled
health professionals to pregnant women and
adolescent girls to ensure the best health conditions
for both mother and baby during pregnancy (World
Health Organization, 2016)
This visit is important because it helps reduce perinatal
morbidity and mortality both directly, through the
detection and treatment of pregnancy-related
complications, and indirectly, through the
identification of women and girls at increased risk of
developing complications during labor and delivery.
In 2016, the WHO recommended eight
ANC visits to achieve a positive pregnancy
experience instead of the four ANC visits
proposed in the WHO Focused Antenatal
Care Model in 2002. It details health system
interventions to improve the utilization and
quality of antenatal care.
Intrapartal Services
The DOH advocates facility-based delivery to
ensure safe labor, availability of intrapartum
interventions and to safeguard the welfare of
women and newborns.
The establishment of a network of public and private
healthcare providers of emergency obstetric and
newborn care is integral to safe intrapartum
intervention
Postpartal Services
1.Postpartum Visit 1st visit- within 24 hours and visitwithin one week after delivery Postpartum
Assessment: Breast engorgement, inverted nipples
Uterus-involution, contracted Bladder--within 4-6
hours Bowel may be given laxative especially if with
deep laceration Lochia-Rubra, Serosa and Alba
Episiotomy-MIDAS-diaphoresis Homan's Sign- (+) calf
pain-Deep VeinThrombosis (DVT), emotion Taking-in,
Taking-hold, Letting-go
2. Micronutrient Supplementation Vitamin A-200,000
IU/cap 1 capsule within 4 weeks after delivery Iron and
folate- 60 mg/400 ug/tab 1 tablet for 3 months or 90
days
3. Birth Registration
4. Lactation support and counseling from birth up to
two (2) years and beyond, including those women who
will return to work for women in the informal
economies, and those with breastfeeding difficulties
5. Nutrition assessment and counseling to meet the
demands of lactation in health facilities and
workplaces
6. Identification and management of malnutrition of
chronically energy deficient (CED) and nutritionally-atrisk postpartum and lactating women, including
adolescent mothers, and provision of Ready to Use
Supplementary Food (RUSF) in addition to dietary
supplements, as appropriate
7. Organization of community-based mother support
groups and peer counselors breastfeeding in
cooperation with other health and nutrition workers
8. Lactation breaks for women in workplaces including
micro, small, and medium enterprises
9. Availability of 18 lactation stations in workplaces
both in government and in the private sector, informal
economy workplaces, and in public places and public
means of transportation as stipulated by the
"Expanded Breastfeeding Promotion Act of 2009"' and
it’s implementing rules and regulations
10. Organization of breastfeeding support groups in
workplaces, in cooperation with occupational health
workers and human resource managers trained in
lactation management for the workplace.
11. Provision of micronutrient supplements including
iron, folic acid, Vitamin A and other micronutrients
deemed necessary
12. Promotion of the consumption of iodized salt and
foods fortified with micronutrients deemed necessary
13. Provision of oral health services
14. Counselling on, and utilization of, modern methods
of family planning and access to reproductive health
care services as defined in Republic Act No. 10354
15. Social welfare support to improve access to health
and nutrition services, such as, but not limited to,
dietary supplementation, healthy food products, and
commodities for CD and nutritionally-at-risk
postpartum and/or lactating women belonging to the
poorest of the poor families
16. Assurance of women-friendly and child-friendly
spaces where mothers and their infants will be able to
continue breastfeeding during calamities, disasters,
and other emergencies
17. Provision of support to fathers and caregivers to
ensure their commitment to support the mother and
the child on proper health and nutrition care and
provide necessary counseling and positive parenting
support interventions
18. Counselling and support to parents and caregivers
on parent/caregiver-infant/ child interaction for
responsive care, and early stimulation for early
childhood and development
Birth and newborn services
(twenty-eight days)
Republic Act 8980 also known as the "Early Childhood
Care Development, " refers to the full range of health,
nutrition, education and social services programs that
provide for the holistic needs of young children from
birth to 6 years of age, to promote their optimum
growth and development.
Administrative Order 2005-0014
a. Early initiation of breastfeeding
b. Exclusive breastfeeding for the first 6 months
c. Extended breastfeeding for 2 years and
beyond
d. Appropriate complementary feeding
e. Micronutrient supplementation
f. Universal salt iodization
g. Food fortification
Breastfeeding
Benefits of breastfeeding
Breastmilk contains antibodies that help combat
disease. It is present in colostrum, the yellowish fluid
secreted by the mammary glands in the first few days
after birth. It is rich in Immunoglobulin A (IgA) and
white blood cells to protect the baby against infection.
Breastmilk prevents diarrhea because of reduced risk
for contamination as well as its antibody content. Its
IgA component protects the mucosal membrane in the
baby's gut against pathogens
Breastmilk protects the child against chronic
conditions such as allergies, asthma, obesity, diabetes
and heart disease
Breastmilk promotes intellectual and motor
development. Many studies proved that breastfed
children do better on cognitive and motor
development. The health benefits of breastfeeding to
the mother include: Promoting the release of oxytocin
that keeps the uterus contracted. Thus, it prevents
postpartum hemorrhage, helps in the return of
prepregnancy weight, Delays the return of fertility
Lowers the risk for premenopausal breast and ovarian
cancer Promotes early uterine involution
ADVANTAGES OF BREASTFEEDING ARE AS FOLLOWS:
B- est for baby
R- educe allergy
E- motional bonding
Antibody present--IgA
-tool inoffensive
Temperature always right
F- resh always
E- conomical
E- asy once established
Digested easily
Immediately available
N-utritious
G- astroenteritis is avoided
r
Techniques of breastfeeding Proper positioning during
breastfeeding is important. The nurse teaches the
mother to position herself comfortably for
breastfeeding, holding the infant close to her body,
tummy to tummy, and may assume any of the
following positions:
Cradle Hold (Paduyan or Pahele). The mother sits her
arms supported and, using to back.her arm on the
same side as the nursing breast, cradles the infant in
front of her body
Cross-Cradle Hold. Like cradle hold, except that the
mother cradles her infant with thearm on the opposite
side of the nursing breast.
Football, Clutch or Underarm Hold (Salumkipkip)- the
mother sits, holds theminfant between her flexed arm
and body,positions the infant facing her, and supports
the infant's head with her open hand. Twins maybe fed
at the same time using the double football hold
Side-Lying Hold (Pahigang nakatagilid) the mother lies
on her side with arm supporting her head. The infant
lies beside the mother, facing the breast. The mother
grasps and offers her breast to the infant with the
other hand. Once the infant has latched on, she
supports the infant's body
The number of disorders detected by this test
increased from six (6) to twenty-eight (28) diseases
falling under various types of disorders namely:
hemoglobinopathies, amino acid disorders, organic
acidurias, disorders of fatty acid oxidation, disorders of
carbohydrate metabolism, disorders of biotin
metabolism, cystic fibrosis, and endocrine disorders.
The Comprehensive
Program
Newborn
Screening
(NBS)
Families are given two options either to choose only
the 6 disorders covered by PhilHealth namely:
Congenital Hypothyroidism (CH), Congenital Adrenal
Hyperplasia
(CAH),
Galactosemia
(GAL),
Phenylketonuria (PKU), G6PD Deficiency, and Maple
Syrup Disease (MSUD) or the 28 disorders.
The Department of Health (DOH) acts as the lead
agency in the implementation of the law and
collaborates with other National Government
Agencies (NGA) and key stakeholders to ensure early
detection and management of several congenital
metabolic disorders, which if left untreated, may lead
to mental retardation and/or death. Early diagnosis
and initiation
of treatment, along with appropriate long-term care
help ensure normal growth development of affected
individuals.
This test is not a confirmatory test for these metabolic
disorders but rather, it determines if the baby is at risk
of developing these conditions.
Newborn Screening Procedure
Newborn Screening Test
Screening is done within 48 hours or at least 24 hours
from birth but not later than 3 days after complete
delivery. A newborn placed in intensive care may be
exempted from the 3-day requirement but must be
tested by 7 days of age.
However, positive results should be relayed
immediately within 24 hours by the health facility. A
positive screen means that the newborn should be
referred at once to a specialist for confirmatory testing
and further management.
The specimen for BS is obtained through heel prick
method. A few drops of blood are taken from the
baby's heel, and blotted on a special absorbent filter
card. Blood is dried for four hours and then sent to the
NBS center. Normal results are available by 7-14 days
from the time samples are received at the NBS centers.
The National Immunization Program (NIP)
Immunization is an essential public health service and
is commonly defined as the process of conferring
artificial immunity to population groups
Immunity
is described as resistance
and protection from disease attributed to
the presence of antibodies in the blood.
The National Immunization Program (NIP) is
committed to guaranteeing free immunization
services and ensures that Filipinos,
especially the poor, who have access to routinely
recommended vaccines.
It further guarantees the immunization
of neonates, infants, children, adolescents,
mothers, and the elderly population as part of the
comprehensive strategy for disease prevention
and control following the life stage approach.
The NIP has the following goals:
To immunize all infants against vaccine-preventable
diseases
To sustain a polio-free status of the Philippines
To eliminate measles infections
To eliminate maternal and neonatal tetanus
To control Diphtheria, Pertussis, Hepatitis B infection
and German Measles
TO prevent extra pulmonary tuberculosis among
children Hepatitis B vaccine and BCG are given to
newborns within 24 hours after birth.
Child Health Services Nutrition Program
The goal of this program is to improve quality
of life through better nutrition, improve
health, and increase productivity.
There are 4 components of this program which
includes
complementary feeding
micronutrient supplementation
food fortification
deworming.
The following laws and policies regulate the nutritional
program of the Philippines:
RA 8172 "Asin Law" - primarily aims to help contribute
to eliminating iodine deficiency in the population
through the use of iodized salt in food preparation. It
also requires manufacturers of food-grade salt to
iodize their salt and for local government units to
monitor salt sold in the market for their compliance to
the iodization of salt.
PD No. 491- declared July as Nutrition Month and
created the National Nutrition Council
EO 382- declared December 7 as National Food
Fortification Day.
Letter of Instruction 441- mandates the integration of
nutrition education in the school curriculum
RA 8976 also known as the Philippine Food
Fortification Act of 2009 provides the mandatory
fortification of the following products: Rice with iron,
Wheat flour with Vitamin A and iron, Refined sugar
with Vitamin A, Cooking oil with Vitamin A
Integrated management of childhood illnesses (IMCI):
The IMCI process can be used by doctors, nurses and
other health care professionals who see sick infants
and children age 1 week up to 5 years.
It is a case management process for a first-level facility
such as clinics, a health center, rural health units or an
outpatient department of the hospital.
The IMCI guidelines describe how to care for a child
who is brought to the clinic with an illness, or for a
scheduled follow-up visit to check the child's progress.
The complete IMCI case management process involves
the following elements:
a. ASSESS. A child must be assessed first for\ danger
signs (or possible bacterial infection in a young infant),
asking questions about common conditions,
examining the child, and checking nutrition and
immunization status. Assessment includes checking
the child for other problems.
b. CLASSIFY. A child's illness is categorized using a
color-coded triage system. Because many children
have more than one condition, each illness is classified
according to whether it requires: Urgent pre-referral
treatment and referral (PINK) Specific medical
treatment and advice (YELLOW) Simple advice on
home management (GREEN).
c. IDENTIFY. After identifying conditions, specific
treatments for the child should be decided. If the child
requires urgent referral give essential treatment
before the patient is transferred. If the child needs
treatment a home, develop an integrated treatment
plan for the child and give the first dose of the
medication in the clinic. If a child should be
immunized, provide immunization.
d. TREATMENT. Provide practical management
instructions, including teaching the mother or
caregiver how to give oral drugs, how to feed and give
fluids during illness, and how to treat local infections
at home. Ask the caregiver to return for a follow-up on
a specific date and teach her how to recognize signs
that indicate the child should return immediately to
the health facility.
e. COUNSEL. Assess feeding, including assessment of
breastfeeding practices, and counsel to solve any
feeding problem found. Then counsel the mother
about her own health.
FOLLOW-UP CARE. When a child is brought back to the
clinic as requested, give follow-up care and, if
necessary, reassess the child for new problems.
The principles of integrated care
The IMCI guidelines are based on the following
principles:
1. All sick children must be examined for "general
danger signs which indicate the need for immediate
referral or admission to the hospital.
a. All sick children must be routinely assessed for major
symptoms:
For children age 2 months up to 5 years: cough,
difficulty breathing, diarrhea, fever, ear problem
For children 1 week up to 2 months: bacterial infection
and diarrhea.
They must also be routinely assessed for nutritional
and immunization status feeding problems and other
potential problems.
b. Only a limited number of carefully selected clinical
signs are used, based on evidence of their sensitivity
and specificity to detect disease. These signs were
selected considering the conditions and realities of
first-level health facilities.
c. A combination of individual signs leads to a child's
classification(s) rather than diagnosis. The
classifications are color- coded.
d. The IMCI guidelines address most, but not all, of the
major reasons a sick child is brought to the clinic.
e. IMCI management procedures use a limited number
of essential drugs and encourage active participation
of caretakers in the treatment of children.
2. Timely introduction of safe, appropriate, and
nutrient-dense quality complementary food with
continued sustained breastfeeding for all infants from
six (6) months up to two (2) years of age, with
emphasis on the use of suitable nutrient-rich, homeprepared, and locally available foods that are prepared
and fed safely
3. Provision of nutrition counseling On complementary
food preparation and feeding on mothers and
caregivers
4. Dietary supplementation of age-appropriate and
nutrient-dense quality complementary food
5. Growth and development monitoring and
promotion of children at health facilities and home
6. Provision of routine immunization based on the
latest DOH guidelines
7. Provision of micronutrient supplements deemed
necessary
8. Management of common childhood illnesses based
on WHO and DOH guidelines
9. Management of moderate and severe acute
malnutrition using national guidelines and proper
referral to higher-level health facilities as appropriate,
for treatment and management, especially for those
with serious medical conditions
10. Provision of oral health services including
application of fluoride varnish to prevent
dental caries
11. Provision of anti-helminthic tablets for children
one (1) to two (2) years old as
appropriate
12. Availability of potable source of water, counseling
of
household
members
on
handwashing,
environmental sanitation, personal hygiene, and
support for sanitation needs of households to reduce
food, water, and vector-borne disease
13. Counseling and support to parents and caregivers
for responsive care, early stimulation for early
childhood development, and referral in cases of
developmental delays in children and other disabilities
for early prevention, treatment, and rehabilitation
14. Social welfare support to improve access to health
and nutrition services, such as, but not limited to
dietary supplements, complementary food, other
healthy food products and commodities, assessment
and referral for developmental delays and other
disabilities for early prevention, treatment and
rehabilitation for infants six (6) months and above who
belong to the poorest of the poor families
15. Support for home kitchen gardens wherever
feasible
16. Provision of locally available grown crops,
vegetables and fruits in addition to other agricultural
products to be used
ADOLESCENT SEXUAL AND REPRODUCTIVE HEALTH
The DOH with the technical support of UNICEF,
developed the Adolescent Health and Development
Program (AHDP) Strategic Directions for 2018-2022 to
guide the improvement of the health status of
adolescents, enabling them to enjoy their right to
health through the following strategies: health
education and promotion, life skills building and
medical service provision. Health facilities need to be
provided with capable and adequate human resources
and essential equipment, commodities, drugs and
supplies to ensure delivery of adolescent-friendly
health services. There should also be a strategic
information, education and communication campaign
to encourage the use of adolescent sexual and
reproductive health (ASH) services, and a mechanism
for routine monitoring and evaluation to regularly
track the performance of ASH interventions.
The AHDP aims to improve the health status of
adolescents and enable them to fully enjoy their health
rights. The mission of the AHDP is to ensure that all
adolescents have access to comprehensive health care
and services in an adolescent-friendly environment
The AHDP envisions a country with well-informed,
empowered, responsible and healthy adolescents who
are leaders in society
1. Adolescent Sexual and Reproductive Health. A slight
decline was observed in the following: adolescent
fertility rate, the proportion of women who have had
a birth or are pregnant with the first child the number
of babies born to adolescent parents, and the number
of newly diagnosed HIV-positive cases among the 1524 year age group. Unmet need is still highest among
the youngest age group and the proportion of HIVpositive cases among the 15-24 age group more than
doubled in the past ten years.
2. Human papillomavirus vaccination. To help protect
adolescents from cervical, vaginal and vulvar cancers
associated with human papillomavirus (HPV) infection,
which is sexually transmitted.
3. Elimination of Violence Against Women and
Children. The Philippines continues to narrow the
gender gap between men and women in the country.
4. Weekly iron and folic acid (WIFA) supplementation.
5. Assessment of health and nutrition status and
identification of nutritionally at-risk adolescent girls, as
well as provision of ready-to-use supplementary food
or ready-to-use therapeutic food for nutritionally- atrisk adolescent females, as appropriate
6. Provision of age-appropriate immunization based
on the latest DOH guidelines
7. Provision of oral health including oral health
assessment
8. Provision of anti-helminthic drugs for deworming
9. Counseling on proper hand washing, environmental
sanitation, and personal hygiene
10. Provision of micronutrient supplements according
to the guidelines of the DOH, in partnership with the
Department of Education (DepEd)
11. Promotion of consumption of iodized salt and
foods fortified with micronutrients that may be
deemed necessary
12. Referral to appropriate health facilities to manage
menstruation irregularities or abnormalities that
contribute to anemia and blood loss, and to manage
complicated illnesses including moderate and severe
acute malnutrition
13. Counselling on proper nutrition, mental health,
avoidance of risk-taking behaviors, smoking cessation,
adoption of healthy lifestyle practices, and family
health.