CLUSTER 7 UPDATEABUNG, CALUBCUB 1, CALUBCUB 2, SUBUKINSEPTEMBER 22-OCTOBER 23, 2009

GARCIA, Gwenalyn; LUCMAN-MOTI, Omairah

Problem tree CLUSTER 7

Abung Calubcub I Calubcub II Subukin

Problem treeHigh Morbidity in Children (0-12) due to infectious disease (ie,

pneumonia, diarrhea, URTI, dental caries)

Malnutrition Poor Environmental SanitationLack in Personal Hygiene

Lack of Sanitary Toilets Limited water resource (access & quality)

Poor Waste mgtPoor dental health

Lack of food access

Improper diet & food intake (?)

Underdeveloped H20 sys

Lack of maintenance of H20 System

Lack of H20 source in some areas

Lack of knowledge

Inaccessibility to healthcare

Poor (unhealthy) practices

Poor attitude

Lack of govt funds

Lack of family income

Lack of livelihood opportunities

Inadequate accessibility to healthcare

Lack of medicines, inefficient referral system

Poor access to the health care system

Objectives tree50% decrease in morbidity in Children (0-12years) due to infectious diseases ( pneumonia, diarrhea, URTI, pediculosis), dental

caries, impacted cerumen, disabilities and malnutrition at the end of 5 years

Improved nutritional status Good Environmental SanitationImproved Personal Hygiene

Access to Sanitary Toilets Sufficient water resource (access & quality)

Good Waste mgtImproved dental health

Better access to food

Proper diet & food intake

Well developed H20 sys

Well maintained H20 System

Sufficient H20 source in all areas

Increase in knowledge on health

Improved Access to health care

Healthy practices

Improved attitude

Increase in govt funds

Increased family income

More livelihood opportunitiesAvailable medicines, efficient referral system

Better access to the health care system

Accessible health services

Objectives for our rotation

At the end of 6 weeks, interns should have properly managed at least 95% of consults in the community

At the end of 6 weeks, BHWs should be able to properly assess & manage at least 75% of patients aged 2mos-5 years presenting with general danger signs, cough, and diarrhea

At the end of 6 weeks, 80% of BHWs should be able to properly assess & manage patients 2mos-5 years presenting with fever

At the end of 6 weeks, interns should be able to establish rapport with foster family, Brgy. Officials, midwives, BHWs of Cluster 7

Calendar of activities

TuesdaySept 22

WednesdaySept 23

ThursdaySept 24

FridaySept 25

SaturdaySept 26

•Arrival in San Juan

•Courtesy call to Municipal Health Officer, Dr. Alidio

•Orientation with Maam Arlene

•Meet the foster parents

•Meet Calubcub II Brgy. Captain, BHWs and midwife, Tita Sabel

•Clinic at Calubcub II

•Market with Mommy Coring

•Meet Calubub I BHWs

•Clinic at Calubcub I

•Familiarizing with the Calubcub – Poblacion transport system

•Preparation for weekly M&M

•Weekly M&M conference

•Return to Manila

Calendar of activities

TuesdayOct 6

WednesdayOct 7

ThursdayOct 8

FridayOct 9

Arrival in San Juan

Fever module briefing

Clinic: Abung

Fever module: Abung

Clinic: Subukin

Fever module: Subukin

Preparing for the M&M

M&M conference

Return to Manila

Calendar of activities

TuesOct 13

WedOct 14

ThursOct 15

FriOct 16

SatOct 17

AM Arrival in San Juan

Fever module: Calubcub 2

Fever module: Calubcub 1

Preceptorial with Dr. Opina-Tan

M&M

Return to Manila

PM Preparation for fever module training

Clinic: Calubcub 2

Clinic: Calubcub 2

Preparation for weekly M&M

Calendar of activities

TuesOct 20

WedOct 21

ThursOct 22

FriOct 23

SatOct 24

AM Arrival in San Juan

Clinic: Calubcub 2

Clinic: Subukin

Preparing for Community Update

Weekly M&M

Return to Manila

PM Clinic: Calubcub 2

Preparing for Community Update

Community Update with Dr. Alidio

OBJECTIVE 1

At the end of 6 wks, interns should have properly managed at least 95% of consults in the community

Patient Census: Sex

Patient Census: Age

Patient Census: Location

Patient Census: Organ System

Problems Recommendations

Few patients seek consult at the health center even if it is conveniently located along the highway.

Determine reasons for low patient consult. (middle class residents? everyone is healthy?)

Busted bulb at health center, no running water in bathroom and kitchen.

Seek support from local government officials for maintenance of health center.

No child cuff, few cotton balls and alcohol, no tongue depressor.

Seek support from local government officials and MHO for procurement of medical equipment.

OBJECTIVE 2

At the end of 6 weeks, BHWs should be able to properly assess & manage at least 75% of patients aged 2mos-5 years presenting with general danger signs, cough, and diarrhea

Census of IMCI patients

Patient CC Diagnosis/IMCI Classification

Plan

Padua, Jerich 3/M

Cough Viral URTI/cough/no pneumonia

Paracetamol 250 mg/5 ml 5ml q4o; MVT 5 ml OD; ↑ OFI

Padua, Jerome 4/M

Cough Viral URTI/cough/no pneumonia

Paracetamol 250 mg/5 ml 5ml q4o; MVT 5 ml OD; ↑OFI

Gamboa, Dave 7mo/M

Cough Viral URTI/cough/no pneumonia

↑OFI; continue MVT

Tanyag, Dave 6mo/M

Cough CAP/pneumonia Amoxicillin 100mg/ml 1ml q8o x 7d; Paracetamol 100mg/ml 1ml q4o

Dimaculangan, Jandi 5mo/M

Cough CAP/pneumonia Amoxicillin 100mg/ml 1ml q8o x 7d; Paracetamol 100mg/ml 1ml q4o

Observations

BHWs correctly diagnosed 40% of IMCI patients presenting with cough

BHWs tend to leave management portion of IMCI form blank

No consults for general danger signs or diarrhea

Problem Recommendations

BHWs need to increase their skills at assessing and managing IMCI patients

Institutionalize the intern-BHW feedback system in filling-up IMCI forms during clinic hours.

See patients together with BHWs and explain diagnosis and management.

Encourage BHWs to complete IMCI forms including management even if they are unsure of diagnosis and plan.

Conduct observational study on performance of BHWs in assessing and managing IMCI patients

OBJECTIVE 3

At the end of 6 weeks, 80% of BHWs should be able to properly assess & manage patients 2mos-5 years presenting with fever

Conduction of fever module

43 participants: Abung (10/07): 8 BHWs Subukin (10/08): 8 BHWs Calubcub 1 (10/14): 14

BHWs Calubcub 2 (10/15): 13

BHWs Complete attendance

Test results

Pretest PosttestMean score

6.9 9.3

Range 5-10 7-10Mode 7 10

Item analysis

Classification of

measles

Vitamin A for

measles

Management of severe DHF

Census of IMCI patients

Patient CC Diagnosis/IMCI Classification

Plan

Gunio, Marie 5/F

Fever SVI/fever Paracetamol 250mg/5ml 5ml q4o

MVT 5ml OD

↑ OFI

Observations

BHWs tended to score high on fever training posttest (Mean 9.3 Mode 10)

When seeing an actual case, BHW left fever portion of IMCI form unanswered

BHW was able to identify correct management TSB ↑ OFI

Problems Recommendations

Confusion between tigdas (“chicken pox”) and tuko (“measles”)

Clarify the terms before starting training. Tigdas = tuko/measles.

Difficulty of handling a group of 7-8 BHWs per intern

Assign not more than 4 BHWs per intern/small group

Difficulty of conducting training in an open room along national highway

Conduct training in a quiet, well-lit venue

Preference of BHWs for shorter training session

Make future training sessions more concise

Older BHWs could not read from a small laptop, hence need to refer to handouts

Handouts should have a table of contents and be properly labeled with page numbers for easy reference

Problems Recommendations

BHWs are grade-conscious and tend to focus on pretest and posttest scores

Emphasize goal of training: for BHWs to be able to independently assess & manage patients. Explain pretest and posttest as merely a means of evaluation.

Difficulty in understanding measles and dengue classification and corresponding management

Institutionalize the intern-BHW feedback system in filling-up IMCI forms during clinic hours. See patients together with BHWs and explain diagnosis and management.Encourage BHWs to complete IMCI forms including management even if unsure of diagnosis and plan.Consider providing checklist under assessment portion of IMCI form

OBJECTIVE 4

At the end of 6 weeks, interns should be able to establish rapport with foster family, Brgy. officials, midwives, BHWs of Cluster 7

Alma Ata and San Juan

The CBHP was planned together with the community and is now being implemented in partnership with local officials, health workers, and residents, a concept repeatedly stressed in the Alma Ata declaration.

Alma Ata and San Juan

UP and San Juan identified the root causes of inter-related health, economic, sociocultural, and political problems and characteristics.

a crucial step founded on the Alma Ata principle that primary health care should reflect and evolve from the economic conditions and sociocultural and political characteristics of the community based on results of social, biomedical and health services research and public health experience

Alma Ata and San Juan

5 year plan was conceived which addresses the nutritional status, personal hygiene, accessibility of health services, and good environmental sanitation in order to attain a 50% decrease in childhood morbidity due to infectious diseases, dental caries, impacted cerumen, disabilities and malnutrition.

This is a goal in accordance to the basic ELEMENTS of PHC.

Alma Ata and San Juan

A step to achieving this ultimate goal is empowering the most important health force of the community, the BHWs, who are the key local human resources in making health accessible to even the innermost barangays.

Alma Ata and San Juan

In order to give these BHWs the confidence in providing health service to their community, they need to be equipped with the necessary knowledge and skills.

The IMCI training is the means currently being used to share the knowledge that we have to the BHWs who need it.

Alma Ata and San Juan

In the future, these BHWs will pass this knowledge to the community and help increase their knowledge in health, and hopefully, improve their health attitude and practices, 3 of the objectives of the CBHP.

Alma Ata and San Juan

The Alma Ata teaches that the community should be able to afford to maintain every stage of their development.

Thus, the local government leaders are involved in the CBHP and are encouraged to exercise political will that Alma Ata also necessitates, in order to mobilize their resources rationally.

Governments have a responsibility for the health of their people.

Thank you!