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Manual for the implementation of the essential health care program in filipino day care centers

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  • 1. Manual forDay Care Centerson Garantisadong Pambata
  • 2. ContentsImpressumFit for School Inc. DisclaimerProject OfficeMortola-Hayes Streets The inclusion of links and references does not entail recognitionCagayan de Oro, Philippines or endorsement of information given under these links nor can the publisher be held liable for any wrong information. No part of© 2009 of the current edition: Verlagshaus Monsenstein und this publication may be reproduced, stored in a retrieval systemVannerdat OHGMuenster - Germany or transmitted in any form or by any means without the writtenwww.mv-verlag.de permission of the publisher. The publication is distributed free of Foreword 3Design by malzwei, Berlin, Germany charge and commercial reproduction is prohibited. Fit for SchoolPrinted by VJ Graphic Arts, Manila, Philippines Inc. encourages using the manual widely in educational settings; 1. Handwashing 6Text photocopying of the manual or parts of it for personal andBella Monse, Manuel Vallesteros, Lito Benitez, Tara Sering, educational purpose are allowed with recognition of the source.Wim van Palenstein and Roswitha Heinrich Weltzien Requests for reprint and other inquiries should be directed to the 2. Toothbrushing 12Photos Project Office of Fit for School Inc., Mortola-Hayes Streets, 9000Ivan Sarenas, Bella Monse, Jana Gerold and Cagayan de Oro, Philippines, Tel/Fax 0063 (0)88 857 21 46, 3. Footwear 18Roswitha Heinrich-Weltzien info@fitforschool.ph.Acknowledgements 4. Deworming 20Fit for School acknowledges the input of Cromwell Bacareza, Dem- Recommended citation:ocrito Figueroa Jr., Vicente Belizario and Rafael Oclarit Fit for School Inc. (2009) Manual for the implementation of the 5. Roles & Responsibilities 26 essential health care program in day care centers. Fit for School Inc., Cagayan de Oro City. 6. How to Create a Supportive Environment 34 ISBN 978-3-86582-966-5 7. Monitoring 42 Checklist for Day Care Workers 45 Bibliography 46In partnership with
  • 3. Foreword If the wealth of a nation lies in the health of its people, cause of many harmful diseases and their potential then it is wise to make health programs the national lifelong damaging effects. Garantisadong Pambata priority. And if we are to invest our time, resources and works in partnership with local government units and energies on solutions that benefit us in the long term, non-government organizations in implementing policies rather than on quick remedies with fleeting effects, then designed to improve health care for children all over the there is no more effective place to begin than with our country. children. My sincerest congratulations to the local government But infectious diseases, such as worm infections, units, non-government organizations, foreign and local "The Department of Healths Garantisadong Pambata program... diarrhea, the common cold, skin infections, as well as agencies and the Fit for School organization for a supports health programs geared towards reducing childhood tooth decay, continue to afflict millions of Filipino program so vital to national wellbeing. illnesses and deaths" children. The problem is especially glaring in places with little access to proper health care and awareness of Mabuhay! preventive measures that can stop these even before they begin. The Department of Health’s Garantisadong Pambata Francisco T. Duque III,MD, MSc program, a campaign that supports health programs Secretary of Health geared towards reducing childhood illnesses and deaths, Philippines is proud to support Fit for School, a multi-sectoral effort to instill healthy and hygienic habits in our children during their formative years. Teaching our children basic habits — such as daily handwashing with soap, toothbrushing with fluoride, regular deworming and wearing proper footwear as necessary — targets the root2 | Foreword Foreword | 3
  • 4. Foreword The best legacy we can pass on to our children is to The Fit for School manual is a clear and user-friendly supply them with the tools of self-reliance and a sense reference material that is a valuable tool in implementing of responsibility. At its most basic level, this includes this simple yet very effective program. For their efforts teaching them how to take care of themselves and to in producing such an indispensable guide, my sincerest value their health. thanks go to InWent and GTZ, Germany; to the World Health Organization Collaborative Centers in Jena, The Department of Social Welfare and Development Germany and Nijmegen, the Netherlands; and the College (DSWD) believes that the good habits learned in of Public Health in UP Manila for the technical childhood will serve an individual well for the rest of support. "The Department of Social Welfare and Development believes that his or her life. the good habits learned in childhood will serve an individual well To everyone who has seen it fit to invest in the future of for the rest of his or her life." That is why the DSWD fully supports the Fit for School our children — day care workers, health officials, local program, the communitys collective effort to uplift the government officials — congratulations to you. This state of health of our young by teaching them hygienic manual is indeed a valuable tool in ensuring a bright habits, and by helping them understand that their health and healthy future for our children. is in their own hands. The success of Fit for School programs currently in place in a number of provinces is a result of the efforts of the Dr. Esperanza I. Cabral children themselves, the social workers and day care Secretary of Social Welfare and Development workers and local government officials. This model, if Philippines successfully implemented throughout the whole Philippines, will bring unprecedented relief to the country.4 | Foreword Foreword | 5
  • 5. Handwashing has been recognized as the most important step in avoiding sickness and spreading germs to others.1. Infectious Diseases Infectious diseases are diseases that spread from one person to another. Worm infections, diarrhea, Handwashing common colds, coughs, even bronchitis and skin infections are the most common infectious diseases. Lack of cleanliness is the root cause for the spread of these diseases. If we all take care to keep ourselves, our home and our day care center clean, and impart healthy and clean habits to children, we can stop most diseases before they start. Fact Scientific research gathered in several studies shows that regular handwashing with soap can reduce the rate of diarrhea by 31% 1 to 47% and respiratory illness by 30%. You should always wash your hands with soap after using the toilet, after handling pets, before handling food and before eating.6 | Handwashing Handwashing | 7
  • 6. Guidelines for Daily Handwashing Proper handwashing is part of the daily routine at day care centers, and should be done by children as a group actitivity. The best time to do this is before eating at recess or at lunch time. With the help of parents, day care workers 1. Wet hands with running water. 2. Apply soap and create lather. 3. Rub palms together and create should organize the line formation of children even more lather. for the handwashing activity. After about a week, children get used to washing hands together so the role of the day care worker will become much easier. Day care workers are to remind children to wash their hands with soap after using the toilet. Children are encouraged to be advocates for 4. Rub fingertips against palms to 5. Intertwine fingers and rub them 6. Grasp thumb and rub with a twisting handwashing with soap and make it a routine in remove dirt under fingernails. against each other. motion. Repeat for other thumb. family life. Towels become a source of infection after the first use. 7. Rub left palm against the back of 8. Rinse hands with running water. 9. Dry hands in the air by shaking off the right hand, and vice versa. excess water.8 | Handwashing Handwashing | 9
  • 7. Frequently Asked Questions | Handwashing ExperiencesWhen washing hands, can I use any kind of soap? If water is scarce, can two or more children use theYes. With proper use, all soaps, even laundry and same water from a basin for handwashing?dishwashing soaps, are effective in cleaning our Children should not use the same water from a basinhands. However, laundry soaps have a stronger when washing hands together as they will also shareformula than other soaps. their germs. Children should rinse their hands individually and it is best to use flowing water.Do we need to use antibacterial soap?No. It is the action of rubbing and not the type of soap Can I participate in the promotion of handwashing Paolo, Day Care Childthat physically removes bacteria from the skin. and how? "I used to be too lazy to wash my hands with Yes, everyone is welcome to join the global movement soap. But after our teacher told us what gets onHow can you implement handwashing with soap in for handwashing with soap. All you have to do is make our hands, millions of super small germs thatschools that have no access to water? it a habit in your own personal and professional life, we dont even see, I always have to wash myAccess to water is essential. Activities can be started talk about it among family members, friends and hands, especially before eating. Im afraid theusing collected rainwater and tippy tap wash stations. colleagues. Encourage your neighbors, your church germs will go to my food and make me sick."It is important to make water an issue and lobby for and your sports mates to join and carry outaccess to water in the barangay council. handwashing activities. It feels good to be part of this important global initiative. Mrs. Abad-Santos, Day Care WorkerCan rainwater be used for handwashing? "In the beginning, some day care workersYes. If water is scarce, water from a well, rainwater Is the promotion of handwashing only being done wanted to know: why do we need to wash ourand even seawater can be used for handwashing, but in the Philippines? hands together? And other parents asked,it is of utmost importance that handwashing is always No, this is part of a global initiative to promote whats the big deal about washing handsdone with soap. handwashing. It is proven that handwashing with anyway? How hard can it be? As part of the Fit soap is the single most effective intervention in for School program, it was my job to explainWhy is it also important to trim fingernails? reducing the spread of infectious diseases and thus to them that proper handwashing prevents allParents must make sure childrens fingernails are well saving lives. Around the world, different stakeholders kinds of diseases, and its a habit kids needtrimmed so that they collect less soil and are easier to such as UNICEF, the World Bank, universities, to think of not as a chore but as somethingkeep clean. industry partners and governments have joined forces thats necessary and good for them. Doing it to promote handwashing with soap on a mass scale. in groups gets everyone involved and makes The Philippine government is now part of this global it more fun. Some days its the kids who movement. actually beat the alarm and say, Its time for handwashing!"10 | Handwashing Handwashing | 11
  • 8. According to the World Health Organization (WHO) and FDI World Dental Federation, toothbrushing using toothpaste with fluoride is the most effective2. way of reducing tooth decay. Tooth Decay Tooth decay is the most common chronic childhood Toothbrushing disease in the whole world. In low-income countries, nearly all tooth decay remains untreated. As it does not heal by itself, untreated tooth decay may last a lifetime and will have profound consequences on a persons quality of life and overall health. Tooth decay is painful and deprives children of a good nights sleep, making it harder for them to pay attention in school or to interact with other children. Ultimately, it may hinder social development. You should brush your teeth at least twice a Fact day: once during the The benefit of fluoride in helping prevent tooth day and always before decay has been firmly established. Research has going to sleep. shown that school-based fluoride toothbrushing programs lead to a 40% to 50% reduction in new tooth decay. 2, 312 | Toothbrushing Toothbrushing | 13
  • 9. Guidelines for Toothbrushing Children should start their day with fresh breath and clean teeth. At the day care center, day care workers are to supervise the daily group toothbrushing activity. 3. Day care workers should get children to form a line for the group activity and dispense fluoride 1. Before using, remove the two Brush all teeth up and down for 4. Feel with your tongue if all toothpaste onto each childs toothbrush. locks from the toothpaste two minutes. teeth are smooth and clean. dispenser and pump the Although children learn quickly and will know plunger until the toothpaste the routine after a week, it is still best for the comes out. Reattach only one day care worker to supervise the whole activity lock onto the dispenser. Now it and make sure there is no spillage of fluoride, is ready for use. and that each child stores his or her toothbrush properly after the activity. After a week of training, the whole activity should not take longer than five minutes each 5. Spit the toothpaste out. Do 6. Wipe your mouth with some day. 4 not rinse your mouth. water using clean hands. Children are encouraged to be champions of clean teeth and fresh breath, and motivate their parents and siblings to brush their teeth, 2. Press the dispenser once to especially before going to bed. apply a drop of toothpaste onto the toothbrush. There is no need to wet the toothbrush with water. If you are using a tube of toothpaste, squeeze only a pea-sized amount onto 7. Rinse your toothbrush 8. Return your toothbrush to the the toothbrush. with water. toothbrush holder.14 | Toothbrushing Toothbrushing | 15
  • 10. Frequently Asked Questions | Toothbrushing ExperiencesWhat can I do to keep my teeth healthy? Is bad breath caused by a lack of oral hygiene? Mrs. Carina Montenegro, MotherEating nutritional snacks and drinking plenty of water If teeth are not cleaned, bad breath will annoy the "I used to think that the baby teeth are not atinstead of softdrinks and sugary drinks are beneficial people around you. Some bacteria produce sulfur all important because they will be replacedfor the teeth and the whole body. compounds and it is helpful to brush the tongue anyway when children grow older. But when an intensively because this is where these bacteria infected upper tooth caused my 2-year-old sonWhy is it important to use fluoride toothpaste? reside. to be hospitalized because of a severelyIn many countries, the levels of tooth decay have swollen face that affected his right eye, I reallyfallen by over 50%. In the last 20 years, leading Is toothpaste safe to swallow? got scared. He was unable to eat because ofexperts around the globe have agreed this is almost Toothpaste is not intended to be eaten and children high fever and too much pain. We spent a lot ofentirely due to the use of fluoride toothpaste. are encouraged to spit out the toothpaste. However, it money for his medicines and hospitalization. is known that children will always swallow some This is the reason why PREVENTION is veryWhy do I see blood when the children spit out the toothpaste. A pea-sized amount of toothpaste is not important. We do not want to compromisetoothpaste after brushing their teeth? harmful as it contains less fluoride than a fluoride nutrition and good health by not teaching themBleeding is a sign of gum infection caused by lack of tablet that many children receive from their dentist good personal hygiene."toothbrushing. It will disappear after one to two for caries prevention.weeks of regular toothbrushing in the day care centerand at home. Is it true that brushing with fluoride toothpaste can cause discoloration and damage to the permanent Ms. Salva, Day Care WorkerWhy is it important to not rinse the mouth after teeth (fluorosis)? "These early formative years play a verytoothbrushing? For as long as a pea-sized amount of fluoride important role in the rest of a persons life. TheRinsing will reduce the positive effect of the fluoride toothpaste is used, the just-spit-no-rinsing method is habits acquired at this time, like goodon your teeth. If you feel a need to rinse the food safe for children and will not cause fluorosis. toothbrushing and handwashing habits, will beparticles, brush and rinse before brushing a second carried over forever — learning them at a later 4time without rinsing. Do we really need to seriously take care of "baby stage, if at all, might prove too late. We didnt teeth," which will fall off anyway? have such basic information available to usDo I need to change toothbrush every three Baby teeth need to be taken care of for the proper when we were little, so many of us eithermonths? growth and alignment of the permanent teeth. When suffered from bad breath as children or had toNo. Research has shown that there is no difference in they get decayed, nutrition and quality of life are wear dentures by the time we were in our latecleaning effectiveness between an old and a new compromised because the child will not be able to twenties. Such things could have easily been 5toothbrush in the hands of children. chew properly due to pain and infection. Infection prevented by simple habits. So now I take my may be carried from childhood to adulthood, or it may job seriously, making sure the children at the spread to other parts of the face and body, which can day care center are properly taught these be life threatening. things. This will make happier, more confident grownups in the future."16 | Toothbrushing Toothbrushing | 17
  • 11. Injuries, infected wounds and dangerous hookworm infections can be prevented by the simple act of using footwear — slippers, sandals or3. shoes — especially when stepping out of the home. THE DANGERS OF GOING BAREFOOT OUTDOORS Footwear Do not go barefoot or allow children to do so. Hookworms enter the body through the soles of the feet and cause severe anemia. Wearing slippers, sandals or shoes as a protective barrier prevents hookworm infections and injuries. Remember to always Fact put on footwear when Footwear prevents the contracting of worms stepping out of the through the feet and greatly reduces the house or onto unclean risk of injuries, including open wounds and surfaces. gashes.18 || Footwear18 Toothbrushing Footwear | 19
  • 12. Nowadays worm infections can be controlled through biannual deworming with inexpensive, highly effective single-dose drugs.4. Common Worm InfectionS Soil transmitted helminth (STH) infections, also known as worm infections, and schistosomiasis are Deworming very common. School-age children in developing countries are the most heavily infected population. Untreated worm infections cause anaemia and may lead to poor mental development. Anaemic children are always without energy and are generally too tired to participate in social activities. Eventually, they lose all interest in school. Heavily infected children will not grow as expected for their age, and malnourished children will become even more so. In the Philippines, 7 out of 10 elementary school children have worms, with 2 out of 10 being heavily infected. Intestinal worms are harmful parasites Fact that derive food and shelter from their An evaluation of the impact of school- human hosts. Poor environmental based deworming among children in Kenya sanitation and poor personal hygiene revealed that deworming children reduced are major factors that expose humans 6 absenteeism by 25%. to these parasites.20 || Deworming20 Deworming Deworming | 21
  • 13. Guidelines for Mass Deworming Local government unit (LGU) health personnel in collaboration with the local health worker will orient parents and day care workers on mass deworming to address all questions and concerns. The health worker will coordinate with the day care worker to schedule a day for deworming. 1. The health worker orients 2. The day care worker schedules 3. The day care worker calls parents on the deworming a day for deworming. five children at a time. The day care worker will call five children at a process. time and distribute the deworming tablets. These tablets will be chewed by the children immediately under direct observation of the day care worker. A volunteer parent will assist the teacher in documenting the entire activity. Mass deworming will be held every six months. 4. Children receive a tablet from 5. The day care worker inspects 6. A parent helps document the the day care worker, which the mouths of the children. whole activity. they must chew and swallow immediately.22 | Deworming Deworming | 23
  • 14. Frequently Asked Questions | Deworming ExperiencesWhat are the symptoms of worm infection? Why should my child be dewormed again when he Ms. Wilma Galela, Municipal Social WelfareWorms and other parasites live in human intestines was dewormed last year? Development Officerand cause disease. Some worm types can be seen in Children will easily be reinfected. Therefore, "I like the Fit for School program because thethe stool, while some worms lay their eggs outside deworming is needed every six months. It will approach is wholistic. Oral health is integratedthe anus and cause itching, especially at night, which prevent chronic infection and a heavy worm load. with general health. The concept of being cleandisturbs sleep. If the infection is not treated, an in (mass deworming) and out (handwashinginfected person may experience loss of appetite, Can we deworm without a lab result? and toothbrushing) is so simple and yet itsabdominal pain and decline in energy levels resulting The World Health Organization recommends the effects on disease control and prevention arein decreased physical and mental performance. An deworming of all children without prior laboratory staggering. The approach also promotesinfected person will also experience a deficiency in testing if the infection rate in the area is higher than empowerment and the Filipino spirit ofvitamin A, which leads to anemia (for hookworm 50%. The infection rate in the Philippines has been bayanihan: teachers, parents and communitycases only), dry eyes and even blindness. The body of higher than 50% in all areas surveyed. Deworming of leaders all helping one another in building aan infected person cannot absorb food properly, all children is recommended in schools as the drugs healthy environment for the children, the futurewhich then leads to malnutrition and intestinal used are safe even for non-infected children. of our country."obstruction. Why was my child dewormed in school and in theHow can I prevent the children from being community several times last year?infected? In the past, there have been overlapping dewormingThe prevention of worm infection requires programs. Collaboration between the Municipal Social Ms. Teresita Lumen, Mother, Bukidnonimprovement of personal hygiene and sanitation Welfare Development and LGU health offices and "I heard a story once from the next barangayfacilities. First, use a toilet whenever possible. barangay health workers will assure coordination and about a little boy who became deaf and blindSecond, always wash hands with soap after going to mainstreaming of efforts. after deworming because the worms came outthe toilet and before eating. Rubbing hands with soap of his eyes and ears. Another story was thatwill get rid of microscopic worm eggs you or the child Why do children have the highest risk of intestinal hundreds of worms came out of a little girlsmay have picked up. Third, wash vegetables worm infection? anus. Too many horror stories about deworming,thoroughly with clean water. Fourth, keep fingernails Most intestinal worms are so-called "soil transmitted and of course I never want those things toand toenails short. Finally, always wear shoes or helminths," which means that the infection is spread happen to my children! Finally the nurse told meslippers to keep feet from direct contact with the soil. through soil. Soil is easily contaminated with human the stories werent true. She also said being free excreta or waste. Children play on the ground then of worms would make my kids eat better andAre deworming drugs safe? put their fingers in their mouths and get infected. feel livelier, so I agreed. Two worms came out ofDeworming drugs are safe and can also be given to Thus, proper handwashing before eating is very my daughter and three from my little boy. Nownon-infected children. They are safe for all children important. they are much better and healthier."above 1 year of age.24 | Deworming Deworming | 25
  • 15. The Fit for School program identifies different roles to ensure the smooth implementation of daily handwashing with soap and daily fluoride toothbrushing. Children are not only the5. beneficiaries but also the prime actors of day care health programs. Roles & Responsibilities The Role of the Children The Role of the DAY CARE WORKER • participate willingly in each of the activities • ensure the presence and maintenance of facilities • cooperate enthusiastically with the day care worker and supplies: toothbrush holders, toothbrushes, by listening to instructions and following them toothpastes, soaps, spit trays, sinks, water supply • line up in an organized fashion for each of the • orient, facilitate and guide the children in the activities, as directed by the day care worker hygiene routines • behave as directed during each of the activities • organize the parents and community leaders in the • wait for their turn to use the handwashing and improvement of facilities, completion of supplies toothbrushing facilities and implementation of the program • maintain personal cleanliness and the cleanliness • implement the deworming procedure of their surroundings • educate the children and the parents on personal • inform the day care worker of any problems or hygiene questions about the activities26 | Roles & Responsibilities Roles & Responsibilities | 27
  • 16. THE ROLE OF THE SOCIAL WELFARE The Role of the health worker The Role of COMMUNITY LEADERS The Role of ParentsOFFICES • keep open lines of communication with day care (governors, mayors, barangay • cooperate with and assist the day care workers in• monitor the proper implementation of the program workers officials) implementing the program on the provincial and municipal levels • maintain close coordination with the Municipal • extend ample moral support to the network of • build the necessary facilities for properly• integrate the program into the monitoring system of Social Welfare Development Officer, Provincial personnel involved in the program implementation conducting hygienic habits in the day care center day care centers Social Welfare Development Officer and day care • display leadership and be a role model of • ensure the habits are practiced at home• consult with the day care workers on possible areas workers for proper implementation of the program community involvement • monitor the health of their children of improvement or contention • supervise proper dissemination of information on • take ownership of the project • report their children’s special health requirements• discuss tangible solutions to these issues with the health issues throughout the municipality/city • allocate an adequate budget for the program to the day care worker day care workers • orient parents and day care workers on proper • ensure timely procurement of needed materials • report injuries or illnesses immediately to the• lend support to day care workers when necessary hygiene and promote mass deworming • support improvement of washing facilities and health worker• coordinate with other sources of local funds, if • assist parents with special health concerns water supply necessary regarding their children• conduct Fit for School capacity-building seminars for all department heads and day care workers• update the governor about the program and solicit ongoing interest and support• coordinate with the provincial and municipal budget officers for allocation of funds and efficient procurement of materials28 | Roles & Responsibilities Roles & Responsibilities | 29
  • 17. THE ROLE OF NON-GOVERNMENT THE ROLE OF GUIDING BODIES AND THE ROLE OF PRIVATE PARTNERS THE ROLE OF THE ACADEMEORGANIZATIONS (NGOS) DONOR AGENCIES (UN, WHO, UNICEF, FDI) • engage in community partnerships • conduct research to strengthen evidence of the• support government agencies in fulfilling their • provide technical assistance to government • encourage community involvement effectivity of the interventions public service mandate agencies • provide funds for capacity development • support government agencies with research• ensure efficient coordination with other partners • take the lead in framework development • provide financial support for pilot projects and • advocate more affordable health care solutions• transfer technology and know-how to local units • promote and strengthen partnerships among support the scale-up process • devise and encourage simple and effective health down the line stakeholders to reach a common goal and prevent • use mass media for health campaigns habits• seek to improve access to clean water program duplication and overlapping • engage in global partnerships for development • disseminate information on scientific developments• support schools and communities in upgrading • promote best practice models and take an active • assist the scientific and academic communities in • transfer technology and know-how to private handwashing and sanitation facilities role in the advocacy process research and development efforts companies, NGOs and local government units• assist in the reproduction of orientation material • promote global partnerships for development • transform new technology into affordable, mass- • work closely with the various development (manuals, films) market health care products agencies, aid agencies and departments in• assist in the financing of capacity development government to promote the general health and workshops welfare of children• motivate schools and divisions by setting • take an active role in the advocacy process incentives, recognizing exemplary work and awarding outstanding performance• join the advocacy process and promote school health locally, nationally and internationally30 | Roles & Responsibilities Roles & Responsibilities | 31
  • 18. Frequently Asked Questions | Roles & Responsibilities Experiences Mrs. Liza Pelayo, Mother "As parents, we feel the need to help ourThe program is taking too much of our time. Can it Are day care workers allowed to perform Ms. Liezl Catapang, Day Care Worker day care worker in the construction of thebe done once or twice a week instead of every day? deworming? "At first, I thought it would be very difficult to handwashing and spit trays and the toothbrushA positive change in personal hygiene habits and The World Health Organization recommends that implement this program with the children. But I holders. We have assigned one parent to gobehavior will occur only if the program is school-based deworming should be done by day care realized that after a few weeks, children easily on duty each day to assist the day care workerimplemented on a daily basis. Doing it once a week or workers. Around the globe, day care workers have perform the daily routine of washing their hands in organizing the children, maintaining theon an irregular basis sends children the wrong signal: been doing this successfully. Day care workers are before eating, then brushing their teeth after cleanliness of the facilities, and providing thethat handwashing and toothbrushing can be done as allowed to perform deworming if parents have signed eating. In fact, they enjoy doing it every day. It water supply by bringing water bottles eachdesired. Personal hygiene must be inculcated as a the informed consent form. Day care workers should is not difficult after all. And I find so much day. Parents also assist with the deworminglifetime daily habit for it to be truly effective as be oriented by health personnel on the deworming fulfillment that, in my own small way, I am procedure every six months. We have alsopreventive health care. procedure. The school nurse and the school principal teaching children a very simple habit that will sought the help of the barangay captain for should involve the community and ask the barangay have a lifetime impact on their health when they funding to improve our facilities. We love doingCan the day care worker instruct children in health worker to be present in the school during the grow older. Health is wealth!" this knowing its for our children."toothbrushing even if he/she is not a dentist? deworming day.Yes. You do not need to be a dentist to teach propertoothbrushing. Parents around the globe familiarize How can civic organizations participate in the Fitchildren in toothbrushing without being dentists for School program?themselves. Toothbrushing is a simple life skill and Civic organizations (church organizations, Rotarychildren need to practice it daily in order to master it. Clubs, Kiwanis) can participate by supporting theDay care workers are well prepared to teach life skills. communities in obtaining access to water and improving washing facilities. In some areas, civicWhat is the role of health personnel if day care organizations provide the funds for additional healthworkers are deworming and doing handwashing services, like micronutrient supplementation, eyeand toothbrushing with the children? glasses or urgent oral treatment. It is not advisableHealth personnel are the technical experts, they are that NGOs or civic organizations take on the financialtrainers and managers. Their role is crucial! Managers responsibility of LGUs for the needed materialsoversee, support and monitor the program and without ensuring sustainability.support day care workers and administrators. Can parents perform the deworming on their own? It is recommended that parents let their children be dewormed at the day care center. If parents feel that additional deworming is required, they should consult their barangay health worker.32 | Roles & Responsibilities Roles & Responsibilities | 33
  • 19. The implementation of the Fit for School program Fact needs the active participation of the whole According to the World Health Organization, community with the support of the barangay6. 2.4 billion people live without access to council. sanitation services and 1.5 billion people live without access to safe drinking water. Over 5 Water, Sanitation and Health million people, mostly children, die every day in DAY CARE CENTERS How to Create a Access to safe water and sanitation remains a major from water-borne diseases such as diarrhea, dysentery and cholera. Supportive Environment challenge in Philippine day care centers. The Fit for School program can serve as a starting point for making access to water and sanitation in day care centers a priority in every barangay. Parents can judge community leaders commitment to the health of children based on the progress of their lobby for safe water and sanitation facilities. Guidelines for Access to Water Day care centers should provide children in their care with access to water, either from a tap or from water containers (jug, canister or tippy tap). Day care centers without access to water should develop ways and means to ensure availability of water by encouraging parents to bring water to the school. Access to water in the day care center should be a priority of the barangay. Access to water and improvement of washing facilities are the responsibility On the average, at least one liter of water is of the whole community. needed for every child per day.34 | How to Create a Supportive Environment How to Create a Supportive Environment | 35
  • 20. Guidelines for Tippy Tap Wash Stations Tippy taps offer a low-cost solution for day care centers that do not have access to piped water. As a temporary solution, the construction of a tippy tap can be done in each setting, providing sufficient wash stations so that many children 1. 2. can wash their hands simultaneously in an organized manner. Fix a string to the bottle and Make a hole in the cap of each 3. Attach bottles to the wash stand in remove the label. water bottle. such a way that they can be easily Placing the bottles under the sun for at least six turned to an upright position. hours will increase the water quality (http:// www.sodis.ch). The UV light of the sun will desinfect the water. Building tippy taps is a fun activity for children, parents and teachers. 4. Place soap in a stocking or a 5. Wet hands by squeezing the bottle. 6. Rinse hands or toothbrush by fish net near each bottle. Lather your hands using the soap. squeezing the bottle.36 | How to Create a Supportive Environment How to Create a Supportive Environment | 37
  • 21. Guidelines for the Construction of Guidelines for Cleanliness in Handwashing and Toothbrushing Facilities Day Care Centers The entire day care center should be kept clean and well lit. Ensure availability of water, either from a tap or from a jug. The day care worker in charge of the center has to make certain that children bring sufficient water. Daily handwashing and toothbrushing The trough should be slightly inclined so that activities require facilities with enough space water can flow from the source to the drain at Make sure soap is available and placed in a soap for a group of children. the opposite end. dish or a fish net so that the soap stays dry. Day care workers and parents must help maintain cleanliness, and must teach children Ensure the availability of a nail cutter, which is to do the same.Do not use to be used only under the supervision of the daysoapy/dirty care worker.water from abasin. Ensure availability of fluoride toothpaste. Make sure that a toothbrush holder is available. Flowing water is best for handwashing and Hands and toothbrushes may also be rinsed using toothbrushing. clean water from a water jug or pail. The health corner needs a sink so that individual handwashing can be performed after children have used the toilet. Soap must be placed in a soap dish so that it stays dry. No towels are needed. Towels become a source of infection after the first use. Avoid building handwashing facilities that are A simple roof over the outdoor troughs allows too high for little children to reach. handwashing and toothbrushing at all times. 38 | How to Create a Supportive Environment How to Create a Supportive Environment | 39
  • 22. Guidelines for Creating and Maintaining a Common Toothbrush Holder Each child will receive one toothbrush with a cap per year. These are to be stored in a toothbrush holder inside the classroom. The toothbrush holder should be fixed to the wall where children can easily reach it. The toothbrush holder should be made of cloth or plastic or any material that can be easily Using a permanent marker, toothbrushes As an alternative to labeling, have the washed. must be labeled individually according to children personalize their toothbrushes for student name or number. easy identification. There should be enough space between the brushes to avoid cross infection. The slots should be designed in such a way that the head of the brush is exposed to the air. The cap has little holes to prevent molding. Identify each toothbrush and slot with the childs name and picture. The label must be wrapped with tape to prevent Placing transparent polish or varnish over it from being erased over time. the label is another way to protect it. Never let the children bring the brushes home. A second brush is needed at home.40 | How to Create a Supportive Environment How to Create a Supportive Environment | 41
  • 23. Monitoring is necessary for determining the strengths SEARCH FOR THE MOST OUTSTANDING DAY and weaknesses of the implementation process and CARE CENTER identifying room for improvement.7. Criteria for the competition: • Compliance with implementation guidelines • Time needed to perform handwashing/ MONITORING AND EVALUATION toothbrushing Monitor ing is important for evaluating the • Establishment of washing and toothbrush implementation status on the day care center level, as storage facilities Monitoring well as on the municipal and provincial level. Evaluation • Community participation in the program will be done using a score-card system. The scores will • Creative and innovative implementation of serve as the basis for identifying the best day care EHCP center per municipality. These day care centers will go on to compete in the search for the most outstanding day care center in the province. Guidelines for Monitoring Monitoring is carried out in each day care center twice a year. Monitoring requires the use of the standardized monitoring form. Monitoring should be done by a social worker, a health worker, a parent-representative and a barangay official. The monitoring form and competition rules can be downloaded from http://www.fitforschool.ph.42 | Monitoring Monitoring | 43
  • 24. Checklist for Day Care Workers PHASE I: PREPARATION PHASE II: IMPLEMENTATION OOConduct primary assessment. OO Ask the children to line up to wash their OORead the manual and view the video. hands before eating. OOSet a meeting with the parents and the OO Have them wash their hands for at least 20 officers of the parents association. seconds. OOShow the manual and the video to parents. OO Rinse hands using running water, tap water OODiscuss how parents can contribute to the or water jug. construction of handwashing facility, spit OO Ask children to shake their hands in the air to trays or sink and toothbrush holder. dry them. OOSet a meeting with the barangay captain and OO Encourage children to eat healthy snacks and community officials. Encourage their support drink water during meals or recess. and participation. OO Ask the children to line up and and help them OOSet a meeting with LGU health personnel for get their individual toothbrushes from the the implementation of mass deworming. toothbrush holder after they finish eating. OOSupervise the construction of the facilities OO Dispense a pea-sized amount of fluoride together with the parents and barangay toothpaste onto toothbrush bristles. officials. OO Ask the children to form a line beside the OOPosition the toothbrush holder where children water sink or spit trays. can easily reach for their toothbrushes. OO Have the children "dry brush" their teeth OORequest supplies (toothbrushes, toothpastes, (brush without water). Time toothbrushing soaps) from MSWDO. for two minutes. OOLabel or properly identify individual OO Make sure children just spit and do not rinse toothbrushes with the childs name using their mouths after toothbrushing. permanent marker. OO Children should clean their toothbrushes with OOLabel each childs toothbrush slot with his or water. her name and picture. OO Make sure children wipe their mouths with OOPlace toothpaste bottle and soap in the wet but clean hands. health corner. OO Do this activity every day. OO Report problems to MSWDO.44 | Checklist Checklist | 45
  • 25. Bibliography1 Curtis V and Cairncross S (2003). Effect of washing Hands with Soap on Diarrhoea Risk in the Community: A Systematic Review. Lancet Infect Dis 3 pp 275-281.2 Adyatmaka A et. al. School-Based Primary Preventive Programme for Children: Affordable Toothpaste as a Component in Primary Oral Health Care. Experiences from a Field Trial in Kalimantan Barat, Indonesia. <http://www.whocollab.od.mah.se/ searo/indonesia/afford/whoafford.html>3 Curnow M M et al (2002). A Randomised Controlled Trial of the Efficacy of Supervised Toothbrushing in High-Caries-Risk Children. Caries Res vol 36 issue 4 pp 294-300.4 Chestnutt IG, Schafer F, Jacobson AP, Stephen KW. 1998. The influence of toothbrushing frequency and postbrushing rinsing on caries experience in a caries clinical trial. Community Dent Oral Epidemiol. 26(6): 406–411.5 Palenstein Helderman WH van, Kyaing MM, Aung MT et al. Plaque Removal by Young Children Using Old and New Toothbrushes. J Dent Res 2006 85: 1138- 1142.6 Miguel E and Kremer M (2004). Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities. Econometrica Vol 72 No 1 pp 159-217.46 | Bibliography
  • 26. Fit for School, Inc.Project Office4F Mothers House Building www.fitforschool.phMortola-Hayes Streets9000 Cagayan de Oro CityPhone/Fax: +63 88 857 21 46info@fitforschool.ph