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Personal Notes on Preventive Medicine for the Medical Board Exam

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preventive medicine notes

  1. 1. TABLE OF CONTENTS Page Health, Disease and Epidemiology 1 Useful Formula 8 Population 10 National Health Situation and Health Care Delivery System 13 Phil Health 16 Primary Health Care 18 Assessment of Results 21 Environmental Control 23PREVENTIVE MEDICINE NOTES Occupational Health 29 Family and Illness 31 Traditional Medicine Program of the Philippines 36 Philippine National Drug Policy 37 Revised Tuberculosis Control Program 39 Malaria Control Program 41 National Dengue Prevention and Control Program 46 Philippine National AIDS Council 47 Cancer and Cardiovascular Disease 48 Department of Health Comprehensive Nutrition Program 50 Expanded Program of Immunization 51 Integrated Management of Childhood Illness 54 Family Planning 58 Economics in Health Care 62 Research 64 Biostatistics 70
  2. 2. HEALTH, DISEASE AND EPIDEMIOLOGY 3. Environment: sum of all forces that influence the growth and development of an organism o Components: physical, biologic, socio-cultural, economic, politicalHealth o Host Agent Interaction Requirements  Complete physical, mental and social well-being, and not merely the absence of disease (WHO, 1948) a. Favorable conditions in the environment for the agent  Ability to identify and to realize aspirations, to satisfy needs and to change or cope with the environment b. Suitable receivers (WHO, 1986) c. Susceptible host d. Satisfactory portal of entry e. Accessible portal of exitDisease f. Appropriate means of dissemination or transmission  Any deviation or interruption of the normal structure or function of any part of an organ or functional group of organs that is manifested by symptoms or signs  Premises of the Disease Causation 1. Disease results from an imbalance between a disease agent and man  Theories of Disease Causation 2. The nature and extent of the imbalance depends on the nature and characteristics of the host and agent 1. Theory of Supernatural Causation 3. The characteristics of the two are influenced considerably by the conditions of their environment a. Mystical: fate, ominous sensation, retribution b. Animistic: spirit aggression, soul loss  Natural History c. Magical: sorcery, witchcraft o Comprises the body of both quantitative and qualitative knowledge of agent, host and environmental factors 2. Materialistic Theory: health inequities are a consequence of material deprivation o Phases 3. Cultural and Behavioral Theory: health determined by differences in knowledge, attitudes and behaviors 1. Pre-pathogenesis: preliminary interaction of potential agent, host and environmental factors in 4. Theory of General Susceptibility: seeks to explain the vulnerability of some groups to disease using social disease production and psychological variable 2. Pathogenesis: course of disorder in man from the first interaction with disease hence provoking stimuli to the changes in form and function until equilibrium is reached or results in recovery, defect,  Factors of Disease Causation disability or death 1. Agent: substance or force whose presence or absence causes diseases - Incubation Period: from exposure to manifestation o Types: Biologic, Physical, Chemical, Nutrient - Gradient of Infection: sequence of manifestations of illness in the host reflecting his response o Characteristics: Mode of transmission, Source of infection, Virulence, Infectivity, Pathogenicity, to infectious agent which extends from death at one extreme to unapparent infection at the other Antigenicity, Organ of parasitism, Immunity conferred  Interplaying Factors in the Level of Disease in a Population 2. Host: organic body where agent depends for survival 1. Individual Factors o Food, water and vehicles are not host o Age, sex, civil status, social class, state of nutrition, occupation o Resistance/Susceptibility: influenced by age (most important), sex, nutrition, genetics, ethnic group, 2. Spatial Factors physiologic state, prior immunologic experience, behavior o International Variation: related to geographic variations as well as race, ethnicity and culture o Exposure: influenced by behavior, environment, occupation o National Variation: result from difference in socio-economic development as well as cultural and o Immunity geographic differences a. Natural: innate resistance to infection o Local Variation: related to environmental and access to health differences b. Acquired: follows overt or subclinical invasion of body by organisms 3. Temporal Factors - Natural Active: acquired by natural infection with agent which produces either clinical o Secular/Trend: long term fluctuation of disease occurrence over many decades illness or unapparent infection o Cyclic Intrinsic Variation: increase in number of cases more or less regularly every five years due to - Natural Passive: antibodies in the maternal blood are transplacentally transferred to the fetus accumulation of susceptible through births - Artificial Active: induced by administration of vaccines which contain the antigen in a o Sectional Variation: fluctuation of disease occurrence during a year reflecting climatic (seasonal) harmless form changes - Artificial Passive: inoculation of specific protective antibodies from immunized animals or convalescent hyperimmune serum  Community Reactions to Disease 1. Sporadic o Occurrence of a few scattered cases often without relationship to each other o Irregular and unpredictable intermittent presence of the disease 2. Endemic o Constant presence of a disease or infectious agent within a given geographical area o Disease occurs at expected frequency and present in population or region at all times however the level of disease is usually low and predictablePage 1 Page 2
  3. 3. 3. Epidemic o Specific Protection: process by which one can avoid having a particular disease o Occurrence in a community or region of cases of an illness clearly in excess of normal expectancy a. Prophylactic Measures and derived from a common or propagated source - Immunization against communicable diseases - Chemoprophylaxis: administration of drugs to prevent occurrence 4. Pandemic - Mechanical prophylaxis: placing mechanical barriers between course of agent and host o Outbreak of an exceptional proportion spreading quickly from one area to another, continental or interaction worldwide proportion b. Control of the Environment c. Occupational Health  Control: to put limit or to hold in check 2. Secondary o Applied in the pathogenesis period and aims to block the progression of disease o Prevention of progression of the disease process by diagnosing the disease early and promptly Prevention initiating treatment:  Interrupts or slow progression of a disease a. Improving utilization of services through health education  Cycle of disease generally may be broken by: b. Screening and case finding activities 1. Increasing host resistance c. Periodic health inventory 2. Destruction of the agent in the environment d. Provision of medical care services 3. Destruction of the agent in the source/reservoir of infection o Limiting disabilities from disease 4. Avoidance of exposure 3. Tertiary o Tries to promote independence by preventing disability or complications as a result of the disease  Strategies towards Sources or Reservoirs o Rehabilitation: restoration of the disabled to useful place in society with maximum use of his 1. Isolation: separation during the period of communicability of infected persons remaining capabilities 2. Quarantine: limitation of movement of well persons who have been exposed to a communicable disease o Basic Health Services 3. Cleaning: removal by scrubbing and washing of infectious agents on surfaces favorable for their growth a. Vital statistics 4. Treatment: specific cure to shorten the period of communicability and/or course of illness b. Medical care c. Environmental sanitation  Strategies towards Susceptible Population d. Control of communicable disease 1. Health education e. Maternal and child health 2. Personal hygiene f. Health education and the public 3. Chemoprophylaxis g. Public health nursing 4. Use of repellants h. Laboratory services 5. Immunization i. Control of chronic disease j. Mental health  Levels of Prevention 1. Primary Measurement of Health and Disease o Tries to prevent the disease before the pathological process has started  Determination of health problems (needs and demands) of the community by use of statistics o Health Promotion: strategies that enable or enhance achievements of optimal health for individuals,  Disease Indices groups and communities 1. Morbidity a. Exercise, posture, rest, relaxation and sleep a. Incidence Rate: risk of developing disease per year b. Nutrition b. Prevalence Rate: proportion of people suffering from disease at a given instant of time - Age: subtract 5% for every 10 years over 25 years - External temperature: subtract or add 3% for every 1 C over 2. Mortality - Physiologic state a. Cause-specific Mortality Rate: risk of dying from a specific disease - Pathologic conditions b. Age-specific Mortality Rate: risk of dying for a specific age group - Weight c. Case Fatality Rate: killing power of a disease c. Personal Cleanliness d. Proportionate Mortality Rate: proportion of total deaths ascribed to a specific disease d. Protection from external forces, injuries, infectious agents e. Maternal Mortality Rate: risk of a woman dying associated with pregnancy, delivery and e. Proper personality development, development of healthy social life and sexual life puerperium f. Stillbirth or Fetal Mortality Rate: risk of losing the product of conception before delivery g. Infant Mortality Rate: risk of dying during first year of life h. Neonatal Mortality Rate: risk of dying during first 28 days of life i. Perinatal Mortality Rate: sum of stillbirth and neonatal death ratesPage 3 Page 4
  4. 4. Determination of Disease Etiology - Advantages  Epidemiology: study of the distribution of a disease or a physiologic condition in human population and of the  Provide correct estimate of risk and with greater accuracy factors that influence this distribution  Less bias of recall of exposure  Types of Epidemiologic Studies  Controls easier to assemble 1. Descriptive Studies: concerned primarily with the determination of distribution of disease in terms of  Change in subjects more easily ascertained variables - Disadvantages o Descriptive of:  More time needed (long follow-up) and resources a. Person: age, sex, civil status, ethnic group  Inefficient if not impossible for rare diseases b. Place: international, local, national, urban, rural  High drop-out rate c. Time: secular, cyclic, instrinsic and extrinsic (seasonal variation), epidemic  Large sample size o Types of Descriptive Studies  Change in exposure after long period of time a. Mortality Studies: official mortality statistics, hospitals, morgues, special studies b. Morbidity Studies b. Case-Control Studies: those in which the study groups are defined or selected in terms of - Case series: hospital, pathologic materials, special group whether they do have the effect or disease - Registers: hospital based, population based - Odds Ratio: the proportion with history of exposure to the suspected factor (prevalence) is 2. Cross-sectional or Survey Studies determined in each group and compared for presence of association o Ad Hoc Survey: special surveys to establish incidence and prevalence Effect (Disease) 3. Analytic Studies: concerned primarily with determining causes of disease occurrence specifically whether Exposure to Factor + - suspected factor is causally associated with disease using observational methods of testing hypothesis or cause + a b a+b o Types of Analytic Studies a. Cohort: those in which the groups to be studied are defined in terms of whether they are not - c d c+d exposed to the suspected factors, are followed for a period of time to determine the frequency (incidence) of the alleged effect (disease) among them (exposed and not exposed a+c b+d a+b+c+d - Types of Analytic Studies i. Concurrent: cohort studies in which the investigator follows up the cohorts from exposure to the occurrence of the effect (disease) - In case control studies, the prevalence of the factor: ii. Non-concurrent: cohort studies in which both exposure and the effect have occurred a prior to the time of investigation Among the cases (diseased group)  ab b Relative Risk Factor Among the non - cases  Attributable Risk + - bd + a b - There is statistical association between the factor and the effect if: a b  - c d ac bd a+c b+d - Advantages  More economical in time and resources - In cohort studies, the incidence/attack rate of the effect (disease)  May be used in rare diseases a Among those exposed to the factor  - Disadvantages ac  Estimate of risk is indirect b  More bias of recall of exposure Among those not exposed  bd  Controls more difficult to assemble - There is statistical association between the suspected causal factor and the alleged effect if: a b  ac bdPage 5 Page 6
  5. 5. c. Experimental Studies: primarily concerned with testing hypothesis of cause - These are essentially cohort studies except that the groups being studied differ from each Useful Formula other only in the presence of characteristics or exposure to some factor that is artificially A. Fertility Rates induced. 1. Crude Birth Rate - Types of Experimental Studies Total no. of live births i. Field/Community Trials: selection of a population and determination of its necessary CBR   1000 Midyear Population size depend on prediction of incidence of the disease e.g. Field Trials of Immunization Agents 2. General Fertility Rate ii. Clinical Trials: the expected incidence of the disease or unfavorable outcome (eg. Total no. of live births death) and estimates of differences in outcome in the different groups is required for the GFR  1000 determination of sizes of the groups Midyear population of women 15 - 44 years old e.g. Therapeutic/Surgical Trials B. Mortality Rates - Other requirements: 1. Crude Death Rate  High incidence of the disease under study number of deaths, all causes  Availability of facilities for observation CBR  1000  Accessibility of subjects of study midyear population  Availability of medical/health resources for precise diagnosis and adequate follow-up 2. Specific Death Rate number of deaths in a specified group GFR  F Preventive Measure midyear population of a specified group Disease + - 3. Cause-specific Death Rate + a b number of deaths due to a specific cause CSDR  F midyear population - c d a+c b+d 4. Proportionate Mortality Rate number of deaths due to a specific cause PMR  100 total deaths - Disease Rate in Experimental Group a 5. Infant Mortality Rate P1  number of deaths below 1 year of age ac IMR  1000 total number of live births - Disease Rate in Control Group b 6. Neonate Mortality Rate P2  number of deaths in a year of children less than 28 days of age bd NMR  1000 total number of live births in same year - Protective Value P P 7. Fetal Death Ratio P 2 1 P2 number of deaths during the year FDRatio  1000 number of live births in same year - Advantage  Strongest evidence for testing hypothesis 8. Perinatal Mortality Rate number of deaths 17 weeks or more - Disadvantage  Ethical issue especially for clinical trials and infant deaths under 7 days of age M ortality Rate   1000 number of live births and fetal deaths 28 weeks or more during the same yearPage 7 Page 8
  6. 6. POPULATION 9. Fetal Death Rate Demography number of deaths during the year  Is the mathematical and statistical study of the size, composition and spatial distribution of human populations, FDRate  1000 and of changes over time in these aspects, through the operation of the five processes of: number of live births and fetal deaths during the same year 1. Fertility: number of children being born 2. Mortality: deaths 10. Maternal Mortality Rate 3. Marriage: age getting married number of deaths from puerperial causes in a year MMR  1000 4. Migration: in and out migration total number of live births in the same year 5. Social mobility 11. Case Fatality Rate  Sources of Demographic Data number of deaths due to a particular case 1. Census: minimum list of population characteristics about which information is collected CFR  100 a. De jure method: assign individuals to the place of their usual residence regardless of where they were number of case - same cause actually enumerated during the census b. De facto method: people are allocated to the areas where they are physically present at the census date C. Morbidity Rates 2. Sample surveys: collect information from only a subset of the population 1. Period Prevalence Rate number of new and old cases within a period  Uses PR  100 1. To determine the number and distribution of a population in a certain area for planning, priority setting and midyear population for purposes of fund allocation 2. To determine the growth and dispersal of population in the past 2. Point Prevalence Rate 3. To establish a “causal relationship” between population trends and organization total cases (new and old) at fixed point of time PPR  100 4. To predict future developments and their possible consequences total population at that time 3. Cumulative Incidence Demographic Characteristics of Importance to Health number of new cases during a period A. Population Size and Growth CI  F number of individual s free of disease at the beginning of period  Population Size: population at risk  Population Density: number per land area D. Others  Geographic Distribution: migration and urban vs rural distribution 1. Sex Ratio  Population Growth: difference between birth rate and death rate, and is affected by migration Males o Factors in Population Growth SR  100 1. Fecundity Females 2. Coitus rate 3. Death 2. Dependency Ratio 4. Migration Persons aged 0 - 14 and 65 and above DR  100 Persons 15 - 64 years old B. Population Structure  Population Pyramid 3. Swaroop’s Index  Young Population: high fertility rate and high death rate with median age of 15 to 20 years total deaths 50 years old and above  Old Population: low fertility rate and low death rate with a median age of 26 to 30 years SI  100 total death, all causes C. Health Related Characteristics  Overpopulation or Population Explosion: exists when the economy cannot support the population in the face of a rapid population growth economic support is measured in terms of: 1. State of health and nutrition 2. Level of unemployment 3. Level of education 4. State of housingPage 9 Page 10
  7. 7. Population Pyramids B. Types of Estimates and Projections  Graphical representation of the age and sex composition of a population  According to Detail Desired  Types 1. Total population vs Population subgroups 1. Type 1 Pyramid 2. Population by selected characteristics (age and sex) o has a broad base and gently sloping sides o typical of countries with high rates of birth and death  According to Time Reference o population can also be characterized as having a low median age and high 1. Intercensal Estimates: refers to a date intermediate to two census and take the results of these census dependency ratio into account 2. Postcensal Estimates: refers to a past or current date following a census and takes that census and 2. Type 2 Pyramid possibly earlier census into account but not later census o Broader base than type 1 and its sides bow in much more sharply as they slant 3. Projections: refers to dates following the last census for which no current reports are available from the 0-4 age group to the top o Typical of countries that are beginning to grow rapidly because of marked  According to Method of Estimation reduction in infant and child mortality, but are not yet reducing their fertility 1. Component Method: consist of adding natural increase and net migration for the period since the o Median age is decreasing as a consequence of a rapidly increasing population last census to the latest count or the latest previous estimate 2. Mathematical Method: arithmetic, geometric, exponential 3. Type 3 Pyramid o Resembles a beehive o Typical of countries with level of birth and death rates found in Western European countries o Because of low birth rates, the median age is highest and its dependency ratio is lowest compared with other age-sex structures o Dependents are mostly elders 4. Type 4 Pyramid o Bell-shaped o Transitional type of pyramid o Typical of a population which, after years of declining birth and death rates, has reversed the trend in fertility, while maintaining the death rate at low levels 5. Type 5 Pyramid o Represents a population experiencing a marked and rapid decline in fertility o If this decline continues, the absolute loss in numbers will soon become apparent o Represents a population with usually low death rate and had reduced its birth rate very rapidlyPopulation Estimation A. Tools in Describing Change in Population Size 1. Natural Increase NI = number of births – number of deaths 2. Rate of Natural Increase Rate = CBR – CDR 3. Relative Increase in population size o Measure the percent increase or decrease in population count relative to an earlier count 4. Absolute increase in population per year 5. Annual rate of growth o Takes on the assumption that the population is changing at a constant rate per yearPage 11 Page 12
  8. 8. NATIONAL HEALTH SITUATION AND HEALTH CARE DELIVERY SYSTEM E. Economic CharacteristicsHealth System Five Community Health Questions  Composed of all activities whose primary purpose is to promote, restore or maintain health (WHO) A. What is the state of the community?  Essential Functions 1. Mortality Rate 1. Service provision  Leading Causes of Mortality (2002) 2. Resource generation a. Heart f. Tuberculosis 3. Financing b. Vascular System g. COPD 4. Stewardship c. Malignant Neoplasms h. Conditions from perinatal  Composition of a Health System d. Pneumonia (M<F) i. Diabetes mellitus (M<F) 1. Health care institutions e. Accidents j. Kidney 2. Supporting human resources 2. Illness or Disease 3. Financing mechanisms  Leading Causes of Morbidity (2004) 4. Information systems a. Acute lower respiratory tract infection and pneumonia 5. Organizational structures b. Bronchitis/Bronchiolitis  Health System Models c. Acute watery diarrhea 1. Private Enterprise Health Care d. Influenza o Purely private enterprise health care systems are comparatively rare e. Hypertension 2. Social Security Health Model f. Tuberculosis o Workers and their families are insured by the state g. Chicken pox o Refers to social welfare service concerned with social protection or protection against socially h. Disease of the heart recognized conditions, including poverty, old age, disability, and unemployment. i. Malaria 3. Publicly Funded Health Care Model j. Dengue fever o Residents of the country are insured by the state 3. Nutritional Status o Health care that is financed entirely or in majority part by citizen’s tax payment  Philippines is one of 42 countries that account for 90% of global deaths among under 5 years old 4. Social Health Insurance o Whole population or most of the population is a member of a sickness insurance company B. What are the factors contributing to this state of health?Major Influences in Health System  Infant Morbidity RateA. Geographic Characteristic 1. Pneumonias  The Philippines is an archipelago of 7107 islands southeast of Asia with a total land area of 300,000 2. Bacterial sepsis square kilometers 3. Disorders related to short gestation (LBW)B. Demographic Characteristic 4. Respiratory distress  Population as of August 2, 2007: 88,574,614 5. Congenital malformation of heart other perinatal conditions  Average annual population growth rate (2000-2007): 2%  Infant Mortality Rate  Population density: 295/square kilometer 1. Pneumonia 2. AccidentsC. Government and Political System 3. Diarrhea  Democratic./Republican  Maternal Mortality Rate  Executive: President/Head of State/Commander in Chief of the Armed Forces 1. Hypertension  Legislative: 2 houses composed of the Senate and Represenatitives 2. Postpartum Hemorrhage  Judicial 3. Complications from abortion  Administrative autonomy enables LGU to raise local revenues to borrow and determine types of local  Economic, Political, Cultural, Environmental Factors expenditure including health care expenditures 1. Poverty: P 5,111 income of family of 5 for minimum basic needs 2. Environmental: Key TransmissionsD. Socio-cultural Characteristics a. Agricultural production or food scarcity  Predominantly Christian (82.0%) b. Water stress or water insecurity  Overall literacy rate: 92.5% c. Rising sea levels or exposure to climate disasters  110 ethno-linguistic groups with 8 major languages d. Ecosystems and biodiversity  Basic unit of society: Family e. Human healthPage 13 Page 14
  9. 9. 3. Socioeconomic inequity: People who live in rural and isolated communities receive less and lower PHILHEALTH quality health services 4. Mass migration: Health care mainly financed thru out of pocket payments Introduction The National Health Insurance Program (formerly Medicare) or NHIP was instituted in 1995 by virtue of RepublicC. What is being done by the health services, community and other sectors? Act 7875 popularly known as the National Health Insurance Act of 1995. Being the country’s largest and premiere  Preventive, Promotive, Curative, Rehabilitative social health insurance program, the NHIP aims to effectively provide accessible, affordable, acceptable and adequate and health care services for all Filipinos from all walks of life.D. What more can be done?  Elements The said law mandates the Philippine Health Insurance Corporation (Phil Health), a government owned and 1. Health Financing (Goal: Foster greater, better sustained investments in health, Philippine Health controlled corporation, to administer and manage a sustainable program that will not only ensure better benefits at Insurance Corporation thru NHIP and DOH) an affordable cost but also extend quality and relevant health care services to a broader membership base that will 2. Health Regulation (Goal: Ensure quality and affordability of health goods and services) led to a universal coverage. 3. Health Service Delivery (Goal: Improve and ensure accessibility and availability of basic and essential Considered as one of the most important social legislation in history, the National insurance Act of 1995, has health care in both public and private facilities and services) institutionalized our ideals and aspiration for a healthy Filipino nation in the new millennium 4. Good Governance (Goal: Enhance health system performance at national and local levels)  Human Development Index [on 2003, Philippines has 0.76] o Longevity: life expectancy at birth Reason for replacement of the Medicare Program o Knowledge: adult literacy rate + enrollment ratio (primary, secondary, tertiary) 1. Accelerate universal coverage: give all Filipinos access to relevant and quality health care services through an o Decent standards of living: GDP per capita affordable health insurance programE. What measures are needed to continue Health Surveillance of the community and to evaluate the effects of what 2. Enhance and expand the benefits to include more outpatient services is being done? 3. Consolidate the Medicare program previously administered separately by the SSS, GSIS and OWWA.  National Unified Health Research Agenda: joint effort of the PCHRD-DOST, DOH and CHED which 4. Ensure a sustainable National Health Insurance Program for all. provides focus in health research and development efforts in the country, and serves both as template for the country’s research and development efforts for the next 5 years and as plateform to advocate local, national and international support. Program covers the following: 1. Employed sector 2. Individual paying members (include self-employed) 3. Non-paying members 4. Retirees and pensioners 5. Permanent and partial disability pensioners and death pensioners (survivors) 6. Indigent members under the Medicare para sa Masa Coverage that Extends to Family 1. Legitimate spouse not an NHIP member 2. Children (legitimate, illegitimate adopted and step child) below 21 years old unmarried and unemployed Those above 60 years old and not retiree/pensioner members and are wholly dependent on the member for support. Declaring the Dependents  Form needed to enroll the dependents are as follows: 1. M1a or the Member Data Record for employed members 2. M1b or the Member Data Record for Individually Paying MembersPage 15 Page 16
  10. 10. Services Uncompensated in Phil Health PRIMARY HEALTH CARE 1. Non-prescription drugs and medicine 2. Outpatient psychotherapy and counseling for mental disorders Introduction 3. Drugs and alcohol abuses and dependency treatment A. Articulation of Primary Health Care on the Alma Ata 4. Cosmetic surgery  Set of guiding values for health development 5. Home and rehabilitation services  Set of principles for the organization of health services 6. Optometric services  Range of approaches for addressing priority health needs and the fundamental determinants of health 7. Normal obstetric delivery  Not included because it is a natural process of reproduction B. After the Declaration of Alma Ata  Repair of episiotomy or repair of the incision to prevent laceration and facilitate passage of fetus during  Health: not a result of medical intervention but a product of intertwining economic, socio-political, and the first natural vaginal delivery is compensable under the NHIP cultural circumstances 8. Other cost ineffective procedures as defined by Phil Health  Development: not measured by investment on infrastructure but by the quality of the people’s lives  Socio-economic Structure: characterized by inequities and dual economy to one characterized by equality and greater distribution of wealthSingle Period of Confinement  Role of the Community: from passive recipient to actively sharing responsibility for the maintenance of its  Series of successive confinement for the same illness, injury or condition not separated from each other and not own wealth more than 90 days  Member or a beneficiary will not be provided with the single period of confinement except for room and board fees until 45 days allowance is exhausted Primary Health Care  Member can avail of a new set of benefits if succeeding confinements are of different illness or condition A. General Principle  Intents 1. Equal access to health careBenefit entitlement  Key to attain the target  Avail benefits if: 1. Should be part of the development 1. At least 3 monthly contributions within the immediate six months period prior to the month of 2. Should be in the spirit of social justice confinement  Characteristics 2. For OFWs, the payment of the required annual contributions 1. Community-Based 3. Confinement to any accredited hospital for not less than 24 hours due to illness or injury requiring 2. Accessible hospitalization 3. Acceptable  Minor surgical procedures and chemotherapy, radiotherapy, hemodialysis and cataract extraction are also 4. Affordable compensable even on an outpatient basis: 5. Participatory 1. The 45 days allowance for room and board has not been consumed yet  Components 2. Principal members are entitled to 45 days coverage each year while their dependents also have 45 days 1. Education which will be shared among them. Any unused benefit for the given year is not carried over to the 2. Local or Endemic Disease Control succeeding year is not cumulative 3. Expanded Program of Immunization  Confinement in non-accredited hospitals: 4. Maternal and Child Health 1. Phil Health will not pay for confinement except for emergency cases and the hospital or clinic in duly 5. Essential Drugs licensed by the DOH 6. Nutrition  Confinement of less than 24 hours 7. Technology Transfer 1. Phil Health will not pay except for the following: 8. Sanitation a. Case is emergency  Essential health care based on practical, scientifically sound and socially acceptable methods and b. Patient is transferred to another hospital technology made universally accessible to individuals in the community through their full participation c. Patient expires during confinement and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self determination  Forms an integral part both of country’s health system of which is the central function and the main focusIt takes about 60 days to process and adjudicate your claim. Check payments are promptly sent to the of over-all social and economic development of the communitymember/health care provider (depending on who filed the claim) through registered mail.  Brings health care as close as possible to where people live and work  Constitute the first element of a continuing health care processPage 17 Page 18
  11. 11. B. Principles of Health Care C. Approach 1. Essential Health Care 1 1. Partnership between government and private  Reflects and evolves from economic conditions, socio-cultural and political characteristics of the 2. Integration of preventive and curative country 3. Linkage with other sectors  Based on the application of the relevant results of social, biomedical and health services research and 4. Use of village health workers public health experience (Appropriate Technology) 5. Cooperation, with traditional medical system 6. Community organizing 2. Essential Health Care 2  Address the main health problems in the community, providing: D. Indicators for Health Development in Primary Health Care a. Promotive 1. Proportion of population with access to basic health services b. Preventive 2. Existence of active community organization for health c. Curative 3. Level of community self-reliance in health d. Rehabilitative Services 4. Reduction of demands for curative care 3. Essential Health Care 3  Elements E. Comparison of Traditional Health Care System and Primary Health Care Approach a. Education concerning prevailing health problems and methods of preventing and controlling Traditional Health Care System Primary Health Care Approach them Health care system separate from other government Functions best through inter-sectoral cooperation b. Promotion of food supply and proper nutrition department c. Adequate supply of safe water and basic sanitation Emphasis on durative medicine using treatment and Emphasis on promotive, preventive care, mainly d. Maternal and child health care including family planning drugs, doctors and hospitals, health centers sanitation, education, immunization and nutrition e. Immunization against the major infectious diseases Emphasis on hi-tech and specialization Emphasis on common technology at risk groups and f. Prevention and control of locally endemic diseases child survival g. Appropriate treatment of common diseases and injuries Auxiliaries are assistant/substitute of doctors Auxiliaries are main agents of health promotion and h. Provision of essential drugs of change Discourage traditional medicine and ignores cultures Encourage traditional medicine and culture 4. Essential Health Care 4: Intersectoral Collaboration Expensive with strong bias towards urban areas and Less expensive, with bias for equal distribution, rural  Involves in addition to the Health Sector, all related sectors and aspects of national and community hospitals areas and urban poor development Often paid for by central government finance Partly supported by community self-reliance  Demands coordinated efforts of all those sectors Causes the patient to be dependent on the doctor, Helps the individuals and community to become 5. Essential Health Care 5: Community Participation nurse and health services more capable of looking after themselves  Requires and promote maximum community and individual self-reliance  Participation in the plan, organization and operation, and control of primary health care  Making fullest use of local, national and other available resources and to this end develops through WHO Key Elements for Better Health for All appropriate education the ability of communities to participate 1. Reducing exclusion and social disparities in health (Universal Coverage Reforms) 2. Organizing health services around people’s needs and expectations (Service Delivery Reforms) 6. Essential Health Care 6: Intrasectoral Collaboration 3. Integrating health into all sectors (Public Policy Reforms)  Sustained by integrated, functional and mutually-supportive referral systems leading to progressive 4. Pursuing collaborative models of policy dialogue (Leadership Reforms) improvement of comprehensive health care for all and giving priority to those most in need 5. Increasing stakeholder participation 7. Essential Health Care 7  Relies at local and referral levels on health workers including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team  Levels of Health Care a. Primary level: barangay health sectors and rural health units b. Secondary level: municipal hospitals, district hospitals, provincial hospitals, private hospitals and clinics c. Tertiary level: regional hospitals, medical centersPage 19 Page 20
  12. 12. ASSESSMENT OF RESULTS - Protective Value Disease Preventive MeasureStatistical Methods + - A. Data Collection  Registration: routine and systemic collection of data as event occurs, usually required by law + a b  Review of hospital, clinic or laboratory records  Census: complete enumeration of individuals or events in a geographic area at a given time - c d  Survey: investigation to determine prevalence of disease or other events in a geographic a+c b+d B. Summarization  Classification: grouping of individuals or events that are similar according to certain descriptive variables Disease Rate in Experimental Group either qualitative or quantitative a P1   Statistical Constants: measures of central tendency and dispersion ac C. Presentation Disease Rate in Control Group  Text, outline form, tabular, graphical b P2  D. Analysis and Interpretation bd  Central tedency: mean, median, mode  Dispersion: range, standard deviation, variance Protective Value  Rates and Ratio P2  P1   Frequency distribution P2Association Existing Between Suspected Factor and Alleged Effect 2. Temporality: time sequence – exposure antedated the effect  Criteria 3. Dose-Response Relationship: gradient of risk 1. Incidence of the effect among the exposed has equal incidence among those not exposed 4. Specificity: suspected causal factor associated with only one or limited number of disease 2. Prevalence of the factor among the diseases had equal prevalence among the non-diseased 5. Consistency of Findings: risk factor and disease have similar distribution 6. Biologic Plausibility: consistency with existing knowledge 3. Linear correlation in terms of correlation coefficient  Reason for Association o Merely due to chance, hence, chance association or sampling variation o Due to some extraneous or confounding variables, hence, indirect or even spurious or artificial association o Applicable to other populations o A cause and effect relationship or causal association  Handling the Issue o To determine if it is due to chance, do a significance test o To handle extraneous and/or confounding variables - By prevention, appropriate matching of subjects and controls - By specification, analyze by small specific groups - By adjustment or standardization (direct or indirect) o To be certain to which population the association applies, specify from the beginning the population involved o To determine if the association is causal: 1. Strength of Association - Relative Risk: ratio of incidence of effect or disease among exposed to incidence among unexposed - Odds Ratio  a  d bcPage 21 Page 22
  13. 13. ENVIRONMENTAL CONTROL Water Sanitation  single most important preventive measure against diseases  More filtration of water reduces mortality not only of water-borne diseases but mortality from other diseasesEnvironmental Sanitation (Mills-Reineke Phenomenon)  control of all these factors in man’s physical environment which exercise or may exercise a deleterious effect  Examination of Water on his physical development, health and survival 1. Field survey: assess situation of watershed  Types of Pollution 2. Laboratory analysis: for potability of water 1. Air Pollution: release of chemicals/particulates in atmosphere a. Physical: turbidity, color, taste and odor 2. Water Pollution: via surface run off, leaching to ground water, liquid spills, waste water discharges, b. Chemical: pH, alkalinity, total solid, chlorides, hardness and iron eutrophication, littering c. Bacteriological: most important single test (coliform = fecal contamination) 3. Soil Contamination: chemicals released by spill or underground storage tank leakage d. Biological: microorganism responsible for bad odor and taste 4. Radioactive Contamination: alpha-emitters and actinides in environment e. Radiological: done only for water receiving wastes from nuclear installation or radioisotope lab 5. Noise Pollution: roadway noise, aircraft noise, industrial noise  Water Purification 6. Visual Pollution: overhead power lines, billboards, strip mining, open storage trash 7. Light Pollution: over illumination o Household treatment: boiling, filtration, chemical disinfection, storage 8. Thermal Pollution: temperature change in natural water bodies o Public Water Supply 9. Stationary Pollution sources: livestock farms, plastic factories, oil refineries, metal production factories, 1. Basic: coagulation, sedimentation, filtration, disinfection PVC factories 2. Others: aeration, softening, fluoridation o Residual Chlorine: 0.1 ppm to ensure bacteriological safety of waterHousing Sanitation  sanitation of building used for human habitation. Acceptable house must:  Well 1. Satisfy fundamental physiologic needs thru: o Major water supply in rural areas o Should be located higher than and at a distance 100 ft from source of pollution  Adequate space o Should be constructed only in places with sandy loam and not in clay or limestone  Adequate heat and ventilation o Temperature: 20-25 C  Distribution of water o Movement: 15-25 ft/min o Part of the urban water system o Humidity: 50-80% o Must be adequate and well-maintained to avoid water contamination and wastage  Lighting intensity of illumination vary with activity (ie. 100 ft candles for reading)  Pollution and contamination of water: impairment of physical, chemical and bacteriological qualities of water  Noise: not more than 30 decibels  Contamination: presence of deleterious chemicals and/or microorganisms in water  Water/supply: 15-20 gallons per capital per day  Sanitary toilet facility Proper Waste Disposal  Verm in control  Sewage and Excreta should not:  Food storage 1. Contaminated drinking water, water used to culture shellfish and marine life, and water for recreational  Fire protection: proper electric wiring, refuse disposal, two exits purposes  Protection against accidents 2. Contaminated soil to prevent spread of intestinal parasites 2. Satisfy fundamental psychological needs thru: 3. Be accessible to flies, insects, and rodents  Privacy  Qualities of a good toilet  Cleanliness and presence of convenience 1. Sanitary  Provision for normal family life 2. Simple and easy to construct  Provision for normal community life 3. Economical and durable 4. Accessible and acceptable to users 5. Easy to maintain 6. Provide protection and privacyPage 23 Page 24