Primary Health Care (PHC)

• 1978, WHO & UNICEF sponsored the PHC in Alma Ata, Russia during the Alma Ata Conference (AAC)
• Goal: Health for All for the Year 2000 & beyond to develop self-reliance BQ: PHC conference was held in Alma Ata
• 1979, internationally replicated the conference in Geneva, Switzerland wherein other nations were invited including the Philippines (DOH delegates attended) making the PHC international
• 1984, LOI 949 approves for the legalization of implementation of PHC in the Philippines
• 1993, DOH: Health for All Filipinos was advocated by Dr. Juan Flavier
• 2000, Health for All Filipinos by Dr. Romualdez & up to present
• PHC as defined by WHO is an essential health care made universally accessible to IFC (Individual, Family, Community)

“Sentrong Sigla Movement” (SSM) was established by DOH with LGUs having a logo of a Sun with 8 Rays and composed of 4 Pillars:

1. Health Promotion
2. Granted Facilities
3. Technical Assistance
4. Awards: Cash, plaque, certificate

Characteristics of PHC:

1. Acceptable
2. Affordable
3. Sustainable
4. Accessible
5. Available
6. Attainable

Concepts of Family Health Care:

1. Community Based-community focused & oriented, that’s why the term PHN was changed to CHN
2. Utilizes Multi-Sectoral Approaches-makes referral system
• 2 Modalities of Referral used by PHC:
1. Intra-sectoral=RHCDS=within DOH
2. Inter-sectoral=outside DOH wherein it establishes linkages with other locally based (DSWD, BFAD, DECS) or internationally based (WHO, USAID, ASAID, UNESCO & JAPHIEGO=an international organization based in Japan focused on family planning)
3. Utilizes People Empowerment-population is involved in implementing programs & making decision
1. Community Immersion Program (CIP): imbibing with the community
2. Community Organization Participatory Research (COPAR)
4. Utilizes Appropriate Technologies used by PHC: ACCEFS
• A ffordable, accessible, acceptable, available
• C ost wise=economical in nature
• C omplex procedures which provide a simple outcome
• E ffective
• F easibility of use=possibility of use at all times
• S cope of technology is safe & secure

4 Contributions of PHC to DOH & Economy:

1. Training of Health Workers
2. Creation of Botika sa Baryo & Botika sa Health Center
3. Herbal Plants
4. Oresol

Training of Health Workers 3 Levels of Training:

1. Grassroot/Village
• Includes the Traditional Birth Attendants (TBA) or “Hilots” who attends to delivery, Barangay Health Volunteers (BHV) and Barangay Health Workers (BHW)
• Non professionals, didn’t undergo formal training, receive no salary but are given incentive in the form of honorarium from the local government since 1993
2. Intermediate-these are professionals including the 8 members of the PHWs
3. First Line Personnel-the specialist (Oncologist, cardiologist, nephrologists)

Creation of “Botika sa Baryo & Botika sa Health Center” 21

A. RA 6675: Generics Act of 1988: implementing “Oplan Walang Reseta Program”-solution to the absence of a medical officer who prescribed the medicines so PHN are given the responsibility to prescribe generic medicines and “Walong Wastong Gamot Program”-available generics in “Botika sa Baryo” & Health Center

• Father of Generics Act: Dr. Alfredo Bengzon
• Generic Name-ingredients of drugs expected to provide therapeutic value

Brand Name- name given by the manufacturer 8 Commonly available Generics in “Botika sa Baryo & Health Center”: CARIPPON

1. Co-trimoxazole:
• it’s a combination of 2 generics of drugs which is antibacterial
1. Trimethoprim(TMP)
• Has a bacteriostatic action that stops/inhibits multiplication of bacteria
• For GUT, GIT & URTI (TMP combined with SMX)
2. Sulfamethoxazole (SMX)
• Has bactericidal action that kills bacteria
• For GUT, GIT, URTI & Skin Infections
• The drug of choice of DOH for pneumonia is the combination of TMP & SMX (Co-trimoxazole)
2. Amoxicillin/Ampicillin
• An antibacterial drug that comes from the Penicillin family
• Effect is generally bacteriostatic (when source of infection is bacterial)
• These 2 drugs provide the least sensitivity reaction (rashes & GI) and the adverse effect of other antibiotics is anaphylactic shock
3. Rifampicin (RIF)---------- For TB Program:
4. Isoniazid (INH) → All are antibacterial (bactericidal)
5. Pyrazinamide (PZA)------ All came from Aminoglycoside
• Rifampicin & Isoniazid are the only TB drugs given to children
• Adverse Effect of:
• RIF: Hepatotoxic
• INH: Peripheral neuritis
6. Paracetamol
• Has an analgesic & anti-pyretic effect
• Acetyl Salicylic Acid (ASA) or Aspirin is never kept in the “Botika” because of its effects:
1. Analgesic
2. Anti-pyretic
3. Anti-inflammatory
4. Anticoagulant-highly dangerous to Dengue patients that’s why it’s not available in “Botika” & Health Center
7. Oresol: a management for diarrhea to prevent dehydration under the Control of Diarrheal Diseases (CDD) Program
8. Nifedipine
• An anti-hypertensive drug
• According to DOH, 16% of population belonging to 25 years old & above in the community are hypertensive
• If BP level=150/90, it is normal for 25 years old & above

ABCD’s or Groups of Drugs for Hypertension (HPN):

A ngiotensin Converting Enzyme (ACE) Inhibitors

• Mechanism: acts as an inhibitor or blocker
• Angiotensin is a constrictor to blood vessels
• Generics ending in -pril
• Example: Captopril (Capoten), Enalapril

B eta Blockers

• Mechanism: a vasodilator
• Generics ending in -olol
• Example: Propranolol, Tinolol, Esmolol, Metropolol, Atenolol

C alcium Channel Blockers

• Calcium stimulates the heart muscle to contract
• Generics ending in -dipine
• Example: Nifedipine (Calcibloc-a gel capsule taken sublingually, commonly used & available in Botika sa Health Center), Adalat, Nicardipine, Amlodipine

D iuretics

• Use to ↑ elimination of fluids from tissue cells→ pressure in blood vessels→ constriction
• Example: Furosemide (Lasix)-a loop diuretic which is commonly used & the safest
1. Site: Loop of Henle
2. Action: It dilates blood vessels→ ↓ BP

S edative (optional)

• Use to keep client calm & relax
• Generics ending in –zepine, -zepam, -zepate
• Example: Benzodiazepines Diazepam (Valium) 2 & 5 mg for HPN 10 mg as hypnotic

B. RA 9165: New Dangerous Drugs Act (old RA 6425): needs S2 license and prescription pad

HERBAL PLANTS

1. RA 8423: Alternative Traditional Medicine Law-a program where patient may opt to use herbal plants especially for drugs that are not available in dosage form or patients has no financial means to buy the drug
2. Traditional Medicine:
1. Use of herbal plants
2. Use of acupressure-allowed only to those who have undergone training

Policies to abide:

1. Know indications
2. Know parts of plants with therapeutic value: roots, fruits, leaves
3. Know official procedure/preparation
• Procedures/Preparations:
1. Decoction
• Gather leaves & wash thoroughly, place in a container the washed leaves & add water
• Let it boil without cover to vaporize/steam to release toxic substance & undesirable taste
• Use extracts for washing
2. Poultice
• Done by pounding or chewing leaves used by herbolaryo
• Example: Akapulko leaves-when pounded, it releases extracts coming out from the leaves contains enzyme (serves as anti-inflammatory) then apply on affected skin or spewed it over skin
• For treatment of skin diseases
3. Infusion
• To prepare a tea (use lipton bag), keep standing for 15 minutes in a cup of warm water where a brown solution is collected, pectin which serves as an adsorbent and astringent
• Used for diarrhea and for pneumonia so PHN discourages to buy commercially prepared cough syrup→ expectorant: Nature of Cough
1. Dry→ mucolytic→ liquefy mucus
2. Example: Carbocisteine, Guafenesin
3. Productive→ expectorant→ irritants to the mucus gland Example: Bromhexine (Bisolvon)
4. Non stop coughing→ antitussive
   Example: Dextromethorpan (Robitussin)→ contains codeine Robitussin AC→ contains atropine & codeine
4. Juice/Syrup
• To prepare a papaya juice, use ripe papaya & mechanically mashed then put inside a blender & add water
• To produce it into a syrup, add sugar then heat to dissolve sugar & mix it
• For problems of constipation
• Example: papaya, mango & caimito
5. Cream/Ointment-for topical use
• Cream is water based & used for wet skin lesions
• Ointment is oil based & used for dry lesions
• Example: Akapulko Leaves
• start with poultice (pound leaves) to turn it semi-solid
• add flour to keep preparation pasty & make it adhere to skin lesions
• to make it into an ointment: add oil (mineral, baby or any oil-serves as moisturizer) to the prepared cream to keep it lubricated while being massage on the affected area