1. Basic Course for Co-op Health Promoters
With support from:

2. Purpose
Develop a corps of confident,
competent and committed
coop-based health
promoters to assist coop
members address their health
needs by accessing and utilizing
the services/products offered by
the coop social health enterprise
and other healthcare providers.

3. Objectives
1. Discuss the purpose and objectives of the
EVAcoh Project and the SHEs in relation to the
government’s Universal Health Access Agenda;
2. Discuss the coop health promotion process and
their role, functions and responsibilities as coop
health promoters (CHPs);
3. Discuss and demonstrate the key attributes and
the essential skills of a CHP;
4. Discuss basic maternal and family health
messages intended for target clients;
5. Prepare a re-entry action plan.

4. Outputs
1. Validated profile of specific client
groups
2. Validated client targeting,
monitoring and reporting forms
3. Re-entry plans

5. Content
Module 1 Universal Health Access
and the EVAcoh Project
Module 2 Co-op Health Promoters –
Caring for Co-op Members
Module 3 Health for Mothers and
Their Families
Module 4 Let’s Make It Happen

6. Molding the 3C Coop Health Promoter (CHP)

7. --- end of training overview ---

8. Module 1:
UNIVERSAL
HEALTH ACCESS
AND THE
EVAcoh
PROJECT

9. In this module, we will learn...
1. Health is a BASIC human
right!
2. Community health =
individual health =
community health
3. EVAcoh social health
enterprises (SHEs) 
community health system 
UHA  MDGs

10. Health as HUMAN RIGHT
Article 25 (of 30 articles)
• (1) Everyone has the right to a standard of living
adequate for the health and well-being of himself and
of his family, including food, clothing, housing and
medical care and necessary social services, and the
right to security in the event of unemployment,
sickness, disability, widowhood, old age or other lack of
livelihood in circumstances beyond his control.
• (2) Motherhood and childhood are entitled to special
care and assistance. All children, whether born in or
out of wedlock, shall enjoy the same social protection

11. Health?
• “Health is a right of every Filipino citizen
and the State is duty-bound to ensure
that all Filipinos have equitable access
to effective health care services”
(Philippine 1987 Constitution)

12. Health?
• "a state of complete physical,
mental, and social well-being
and not merely the absence
of disease or infirmity.“
-- WHO

13. MMR = 162 vs 52!

15. Better health Responsive health Equitable health
outcomes system financing
Financial Risk
Protection
Improving
Achieving access to
MDGmax quality health
facilities
Health Service Policy, standards Health Health Governance
Financing Delivery and regulation Human Information for Health
Resource

16. Health System
Strengthening?

17. <HSS: videoclip>
What can cooperatives do?

19. Source: Setting-up Community Health Programs, 3rd ed. Ted Lankester.

20. Demand Supply
Target Groups: women of Health System Strengthening -
reproductive age, infant and - what can coops do???
children, young people, senior
citizens, vulnerable and at-risk
groups, etc
Health Promotion

21. Enhancing Access to
and Utilization of
Maternal and Family
Health Services by
Underserved Sectors
in Eastern Visayas
through the
Cooperative Enterprise
System (a.k.a. Eastern
Visayas Area
Cooperation for Health
or EVAcoh Project)
With support from:

22. Co-operative Code of 2008
• 7th Principle: Concern for Community 
sustainable development of communities...
• Social Audit  social impact and ethical
performance

23. The Challenge ... and Opportunity
• 11 Filipino mothers die every day in the
Philippines
• EV one of the top 5 worst places to be a mother
• EV Maternal Mortality Ratio (Deaths per 100, 000
live births) 229.8 (2004)*
• EV Total Fertility Rate(number of children within
reproductive years) 4.3 (2008) – top 4 regions
* compared with 110 in Thailand, 62 in Malaysia
and 14 in Singapore; only 62% of births are
supervised by skilled personnel
Challenge and opportunity…

24. http://web.evis.net.ph/neda8/index2.php?option=com_content&do_pdf=1&id=131; accessed: 19January2011
• 2nd highest region in terms of teen pregnancy
• HIV infections rising (Cebu outbreak: 1 in 2
IDUs is infected!)
• Worsening poverty in EV: 35.3% in 2003 to
40.7% in 2006
• Under-five mortality is second highest (64
deaths) – ARMM (94 deaths) (NDHS, 2008)
• Prevalence of Underweight Children (0-6 years
old) 18.1 % (2009)
Challenge and opportunity…

25. 1 Objective
To enhance ACCESS to and UTILIZATION of
efficient, effective, quality and affordable
maternal and family health including family
planning and HIV prevention services to
underserved groups in selected communities
in Eastern Visayas.

26. ACCESS (A) = a1 + a2 + a3 + a4
available
affordable access adequate
acceptable

27. 3 Performance Indicators
1. Improved level of KASP of target population
2. Increased percentage of co-op women, girls
and men accessing health services
3. Increased percentage of coverage (by area,
by type of client groups) and reach of health
service/s provided by co-operatives
What we intend to accomplish …

28. Self-reliant, healthy and
prosperous family (and
communities)
Our Response:
The 3rd Leg
Coop Sector-
Government Sector- based
based Healthcare Healthcare
Business Sector-
based Healthcare

29. COOPERATIVE-BASED HEALTH SYSTEM STRENGTHENING FOR MFH
Access to
Coop-operated MFH facilities/programs
efficient and
effective
maternal
and family
Business-operated MFH health
Women, young facilities/programs including
girls and men family
planning
and HIV
Government-operated prevention
MFH facilities/programs services
CLIENTELE GROUPS SERVICE POINTS OBJECTIVE
PRINCIPLES: community ownership; gender equity; continuum of quality care
APPROACHES: primary health care approach; CO/CD approach; social enterprise approach
STRATEGIES: behavior change communication; coop-based service delivery; linkaging & networking

30. --- end of module 1 ---

31. Module 2
CO-OP HEALTH PROMOTERS:
CARING FOR CO-OP MEMBERS

32. In this module, we will learn...
1. Elements of a client-focused coop health
promotion process.
2. Essential qualities and attributes of an
effective coop health promoter.
3. Some techniques, tools and tips for coop
health promoters.

33. Elements of Co-op Health Promotion:
principles, steps, stakeholders
A. Principles: A.C.T.
 adult learning theory and
practice (ALT)
Alt
 community self-reliance
 the continuum of care
Csr
Tcc

34. Adult learning ...

35. Self-reliance?(1)...
“Let’s reflect on it”
1. Describe each frame. 2. What are the key messages of
each? 3. Which one do you prefer? 4. Why?

36. Self-reliance: how?

37. Self-reliance? (2)...
“Let’s reflect on it”

38. Release = Self-reliance
Go to the people
Live among them
Learn from them
Plan with them
Work with them
Start with what they know
Build on what they have
Teach by showing
Learn by doing
Not a showcase
But a pattern
Not odds and ends but a system
Not to conform but to transform
Not relief but release.
-- Dr. James Yen

39. What are the dimensions and importance of the Continuum of Care?
The first dimension of the Continuum of Care is time - from pre-pregnancy, through
pregnancy, childbirth, and the early days and years of life

40. The second dimension of the Continuum of Care is place - linking the various levels of home, community,
and health facilities (Figure 2. Connecting care giving between households and health facilities to reduce
maternal, newborn, and child deaths).

41. Continuum of Care 3rd dimension:
Stages of health issue
Prevention
Support Diagnosis
Care Treatment

42. B. Steps:
 How to -- Demand Side = ADPIE:
AD: assess and diagnose
1. understand the client and his/her context or
situation 
PI: plan and implement
2. work with the client in planning and pursuing his/her
health aspirations
E: evaluate
3. assess/evaluate with the client his/her progress
THEN
encourage him/her to move forward or help resolve
issues

43.  How to -- Supply Side:
1. know your SHE  2. map-out other health
care providers  3. set-up linkage/referral
system  4. evaluate and address concerns

44. C. Key Stakeholders:
CHP, Provider & Client

45. CHP’s role = “BRIDGE”
Demand Supply
(mother & families) (SHE ++)
B.R.I.D.G.E. = Bringing-out Responsible Individuals Dedicated to Grassroots Empowerment

46. CHP: Duties – C.P.P.
1. collect, analyze and keep information about
co-op members
2. provide correct, appropriate and timely
health information and referral services to
members
3. promote the services and products offered
by the social health enterprise

47. CHP: Responsibilities – I.P.C.
1. Identify and work with co-op members and
access utilize
their families to &
health services/products
2. Plan, implement, monitor and evaluate
assistance to members
3. Contribute to SHE targets in terms of client
reached and served

48. The Confident, Competent and Committed (3C) CHP
Quality Knowledge Attitude Skill Practice
Confident  Relevant  Positive
(self-esteem) education, outlook, trust self.
“I can learn and
training and
do it.”
experience. “I can make a
Health as positive
human right, contribution.”
MDGs, KP,  “If others can
EVAcoh, coop, do, why can’t I?”
Competent SHE.  Humble --“I  Facilitation,  Apply skills
(essence)  3 elements am willing to Public in specific
of coop health learn more.” speaking, health
promotion, Open-minded. Listening, promotion
role/TOR,  “It’s a shared
Planning, activities such
learning
principles, S.I.R. as reach-out,
process.”
content etc.
(technical, “I am sincere.”
Committed  Continually
(consistency) medical, social,  ‘It is my do volunteer
legal, etc). obligation to help
service ‘rain or
others – am not
doing this for shine’.
something else.”

49. CHP: Basic Toolkit
• Records
• BCC materials – maternal and family health
(MFH)
• Reporting forms
• FAQ sheet on MFH
• EVAcoh/SHE infosheets

50. --- end of module 2 ---

51. MODULE 3:
Health-4-MaFa
MaFa = Mother and her Family

52. In this module, we will learn ...
1. Our target individuals
and groups.
2. SHE products and
services
3. Key health promotion
packages and
messages
Note: Most materials in this module were provided by DOH
resource persons and/or downloaded from the internet.

53. Our clients
a. Women of reproductive age (15-49 years old)
b. Infants, children and young people
c. Men

54. PROFILE OF CO-OP HEALTH
PROMOTERS’ CLIENTS

55. Region 8 WRA YOUTH MEN
Age 34 Yrs old 16 Yrs old 41 yrs old
Income 100% below PL 100% below PL 100% below PL
Ave. No. of children 2 1 2
Unemployment 40% (10% national) 0% 16.89%
rate
Literacy rate 100% simple 100% simple 100% simple
literacy literacy literacy
HEALTH PROFILE
Got sick doing self 49.18% 48.72% 41.77%
medication
Submit for lab exam 57.43% 46.26% 65.33%
(annual check-up) (enrollment) (annual check-up)
Access to health 96% 95.3% 84.7%
info
Perceive adequate 33.1% 15.6% 16%
govt health services
Source of info 64.9% (HW) 53.3% (HW) 84.7% (HW)
30% (TV) 40% (TV) 15.3% (TV)

56. Region 8 WRA YOUTH MEN
where buy meds 61.5% (LDS) 46.6% (BnB) 74.7% (BnB)
KASP on MATERNAL & FAMILY HEALTH
TB transmit thru 76.7% 48% 71.3%
utensils
TB can be cured 95.3% 52.7% 85.3%
Ever heard of TB 36.9% 33.1% 16%
DOTS
Knowledge about 86.6% 47.3% 86.7%
hepa
Knowledge that 55.7% 36.5% 80.7%
hepa is transmitted
thru blood
Knows HIV & AIDS 100% 48.6% 100%
Correct attitude 49.7% 43.2% 61.3%
towards person
with HIV

57. Region 8-CVPs WRA YOUTH MEN
Age of 1st sexual 22 yrs. old 18 yrs old 18 years old
relationship
Used condom 5.4% 2.7% 40.7%
during first sex
With other partner 2.0% 2.7% 16.%
Knowledge on FP 77.7% 38.5% 90%
Using FP method 68% 81% (married) 49.6%
Knowledge on 39.2% 3.3% 48.7%
VAWC
VAWC reporting 5.4% 2.7% 0%
practice
Knowledge on 99% 25% 100%
importance of
prenatal
Favorable attitude 99.3% 24.3% 100%
towards prenatal
Favorable attitude 70.9% 0% 0%
towards
postpartum

58. What our SHE offers...
<workshop-discussion>
1. Pharmacy products
2. Clinic services
3. CHP outreach services

59. SHE Health Promotion Packages
1. Package 1: promotion of maternal and child health
and nutrition (MNCHN)
2. Package 2: promotion of adolescent and youth sexual
and reproductive health and rights (AYSRHR) and
prevention, treatment and care of STI and HIV&AIDS
3. Package 3: prevention and treatment of infectious
diseases
4. Package 4: prevention and management of lifestyle
diseases
5. Package 5: promotion of gender equality and equity,
and prevention of violence against women and
children (VAWC)

60. Package 1
promotion of maternal and child health and
nutrition (MNCHN)

61. Home Visit: Scheduling your visit
Prenatal Period:
Make 4 Home Visits to the Pregnant women!!
1st Trimester
1st HOME VISIT
(1-3 months)
2nd Trimester
2nd HOME VISIT
(4-6 months)
3rd Trimester
3rd HOME VISIT
(7-8 months)
3rd Trimester
4th HOME VISIT
(9 months)
You can conduct more visits according to the
necessity!!! 61

62. Home Visit: Scheduling your visit
Postnatal Period: up to 42 days
Make at least 3 Home Visits to the Postpartum women!!
1st Week
1st HOME VISIT (Preferably 2-3 days
after delivery)
2nd HOME VISIT 2 to 3 weeks
3rd HOME VISIT 4 to 6 weeks
You can conduct more visits according to the
necessity!!! 62

63. Warning Signs During Pregnancy
Which symptoms are the warning signs??
Severe Headache & Dizziness, Blurring of Swelling of the legs, hands or
63
Vision face

64. Warning Signs During Pregnancy
Which symptoms are the warning signs??
64

65. Warning Signs During Pregnancy
Which symptoms are the warning signs??
65

66. Warning Signs During Pregnancy
1. Swelling of the legs, hands and/or
face
2. Severe headache, dizziness,
blurring of vision
3. Vaginal bleeding or vaginal spotting
4. Pallor or anemia
5. Fever and chills
6. Vomiting
7. Fast or difficult breathing
66

67. Warning Signs During Pregnancy cont…
8. Severe abdominal pain
9. Vaginal discharge and/or genital sores
10. Painful urination
11. Watery vaginal discharge
12. Convulsions or loss of consciousness
13. Absence of/ reduced fetal
movements
(less than 10 kicks in 12 hours in the second half of
pregnancy)
67

68. 1. Assessing the Postpartum Mother for
Danger Signs:
If mothers has one or more danger signs, REFER
her urgently to the health center:
1.Heavy vaginal bleeding (??5 soaked sanitary
pads??)
2.Fever
3.Severe headache or convulsions
4.Fast or difficult breathing
5.Severe abdominal pain
68

69. Danger Signs of Newborn (1)
Feeding less or not feeding at
all
• Not able to suck at the breast
when the mother tried to put
the baby to the breast several
times over a few hours:
possibility of severe illness
• The baby was feeding well after
birth but has stopped feeding
well now: possibility of infection
69

70. Danger Signs of Newborn (2)
Convulsions
• Convulsion indicates severe illness in the baby
• The baby’s arms and legs may become stiff
• The baby may stop breathing and become blue
• Recurring movement of a part of the body like
twitching of the mouth or blinking of the eyes
70

71. Danger Signs of Newborn (3)
High or very low temperature
• When a baby has a serious infection,
the body can become very cold or
very hot. The temperature should
stay in between 35.5℃ to 37.4℃.
• The baby with higher or lower
temperature of this range must be
referred to the hospital urgently
71

72. Danger Signs of Newborn (4)
Local Infection
Most common infection occurs in:
1. Umbilicus:
- Pus coming out of the umbilical
stump
- The skin where the stump is
attached to is red
2. Skin: Skin boils filled with pus
3. Eyes: Pus coming out from the
eyes
Any local infection needs treatment, therefore, you need to refer
the baby to the health center 72

73. Danger Signs of Newborn (5)
Yellow soles
• Many babies have some jaundice (yellow
eyes and skin) in the first week of life, and
disappears in a few days. This is a normal
condition.
• If the baby develops yellow soles, this means
that jaundice is severe and can be dangerous
⇒Urgently refer to the health center
73

74. Danger Signs of Newborn (6)
No movement or less movement
• Normal baby can move his/her
arms or legs or turn the head
several times in a minute
• If the baby is awake but doesn’t
move on his/her own, gently
stimulate the baby by tapping or
flicking the soles
• If the baby only moves when
stimulated, or doesn’t move at all
with stimulation, this could be a
danger sign, needs to be referred
to the nearest health facility
74

75. Danger Signs of Newborn (7)
Fast or difficulty in breathing
• “Fast breathing”: if the Breathing rate is 60
per minute or more
• “Chest indrawing”: the lower chest wall goes
in when the child breathes in, and the upper
chest and abdomen move out.
75

76. Reminding of the Mother on Baby Care
Routine
Remind the mother of what was discussed during
the last home visit during the prenatal period.
Kangaroo Care, Hand Washing,
Delay in bathing after birth, Cord
Care, Newborn care,
Breastfeeding a baby
76

77. Care during the first few weeks after birth
Newborn Screening
• A very simple procedural test to see if the baby
has harmful or potentially fatal disorders.
• It is a simple blood test done to the baby from
48 to 72 hours after birth.
CHT-80

78. Newborn Screening cont…
• The disorder can be managed and the child
can grow up healthy if diagnosed early!
• If case was not detected, it could cause mental
retardation or death of the child.
78

79. Follow-up on the status of immunization
and Family Planning
• Check the Immunization Record to see if the
mother and her baby has been receiving
necessary immunization;
• Check the Family Planning Record to see if the
mother has received the consultation on FP. If
not, encourages her to attend the consultation.
79

80. Immunization
Immunization protects the baby
against several infectious diseases.
Check the Immunization record to
see if the mother and her baby
has received necessary
immunizations.
CHT- 86

81. Within 24 6 10 14 9 12-15 16 mos.
hrs weeks weeks weeks mos. mos. & above
(at birth)
BCG
DPT/Hep B-Hib
OPV
HBV
AMV (9mos)
MMR
Other vaccines

82. Feeding Recommendations and Exclusive
Breastfeeding
• A baby should be
given only breastmilk
for the first 6 months
of life.
• Breastmilk is the best
food for the baby and
provides all the food
and fluids that the
baby needs. Exclusive Breastfeeding
CHT- 82

83. Exclusive Breastfeeding cont…
• Breastmilk has antibodies that protect the
baby from illnesses.
• During the exclusive breastfeeding period,
giving other food or fluids, even water, can be
harmful for the baby.
• The mother should breastfeed on demand,
day and night. This will promote milk
production so the baby will be healthy and
grow well.
CHT- 83

84. Proper Attachment:
observing a breastfeed
Good Attachment:
1.More areola is seen above
than below the baby’s
mouth
2.The baby’s mouth is wide
open
3.The baby’s lower lip is
turned outwards
4.The baby’s chin is touching
A the breast B

85. Proper Positioning:
observing a breastfeed
Good Positioning:
1.The baby’s head and
body are in line (the
baby’s neck is not twisted)
2.The baby is held close to
the mother’s body; and
3.The baby’s whole body
is supported
A B

86. Problems Solutions
1. Baby wants to feed all Position the baby properly
the time
2. Bleeding / sore / cracked Proper position and
nipples attachment
3. Thrush (white marks on Oral medication or anti-
sore nipples) fungal cream

87. Problems Solutions
4. Flat nipple or lumpy, Frequent feeding; express milk;
hard and full breasts take warm shower before
(breast engorgement) feeding baby
5. Tender small lump in Improve drainage of milk, look
the breast (blocked for cause & correct
duct) Suggest:
Frequent feeds, gentle massage
towards nipple, warm compress,
start feed on unaffected side,
vary position

88. Problems Solutions
6. Inflamed red areas on Feed the baby, start with the
the breast, along with sore side ; warm and cold
flu symptoms like compress to reduce the
temperature, aches, swelling ; analgesic or
sore breast that is full antibiotic if no improvement
(mastitis)
7. Baby refuses to feed Feed the baby expressed
from the breast breastmilk using a cup; feed
the baby when he is almost
asleep

89. • Birth to 6 months
Exclusive breastfeeding as long as the child wants,
day and night, at least 8 times in 24 hours.
Do not give other foods or fluids including water.

90. • 6 months up to 12 months
Breastfeed as often as the child wants.
In addition to frequent breastfeeding, give the child
who is:
*6 months old, 2-3 tablespoons of thick porridge with
well mashed foods 2x/day.
* 7-8 months old, 2/3 cup of mashed family foods,
3x/day.
* 9-11 months, ¾ cup finely chopped or mashed
family foods in 3 meals + 1 snack.

91. • 12 months up to 2 years
Breastfeed as often as the child wants.
In addition to frequent breastfeeding, give the child a
cupful of family foods , chopped or mashed in 3 meals
and 2 snacks.
Food may include animal food (e.g. meat, fish, egg)
and fruits and vegetables (e.g. banana, papaya, orange,
carrots, squash, beans and nuts).

92. • 2 years and older
Breastfeeding for 2 years of age or longer helps a
child to grow strong and healthy.
A growing child needs 3 meals and 2 snacks.
Give a variety of foods everyday.

93. Milk Code
Sec. 32. It is the primary responsibility of the
health workers to promote, protect and
support breastfeeding and appropriate infant
and young child feeding.
No assistance, support, logistics or training
from milk companies shall be permitted.

94. Package 2
promotion of adolescent and youth sexual and
reproductive health and rights (AYSRHR) and
prevention, treatment and care of STI and
HIV&AIDS

95. Adolescence and Youth Sexual and
Reproductive Health and Rights
(AYSRHR):
Concepts and Realities

96. Adolescence
• is the period in life when an individual is no
longer a child, but not yet an adult.
• is the period when the individual undergoes
enormous physical and psychological changes.

97. Philippine context
• 1 out of 10 Filipina 15-19 years old is already mother
(4,702,400 women)
• 3 in 10 births (33%) by teenage mothers were
unwanted at the time of conception
• 46% of abortion attempts occurred among 20-24 y.o
and 16% among teenagers
• HIV and other STDs
15-24 y.o HIV infection tripled bet. 2007-2008
(from 41-110per year. 29% increase in 2009.
(source NDHS, 2008-2009)

98. Reproductive Rights
These include the rights of couples and
individuals to:
• Make free and informed decisions about their
reproductive lives, including the number,
timing and spacing of children
• Attain the highest standard of sexual and
reproductive health

99. Sexual Rights
These include the rights of all individuals to:
• Make free and informed decisions on all matters
relating to their sexuality
• Be free of discrimination, coercion, or violence in
their sexual lives and decisions
• Expect and demand equality, full consent, mutual
respect and shared responsibility in sexual
relationships

100. 13 Sexual and Reproductive Health
Rights

103. What shall we do?
RESPECT PROTECT FULFILL
Refrain from: -third parties do not -health policy or
-Discriminatory limit people’s access national health plan
practices to information and covering public and
-limiting access to services private sectors
contraceptives and -health professionals -public health
means of maintaining provide care without infrastructure and
sexual and discrimination, having provide sufficient
reproductive health free and informed training for service
-withhold, censor or consent providers
misrepresent -patients should not be
information refused adequate
-infringing on the right medical treatment in
to privacy emergency situation
-information and
counselling

104. HIV and AIDS 101

105. DEFINITION

106. MODES OF TRANSMISSION
A. Unprotected penetrative sex with an HIV infected partner
a.1 Male to female, male to male or female to female
a.2 Anal, Vaginal or Oral
B. Infected blood and blood products
b.1 Blood transfusion
b.2 Organ transplantation
b.3 Sharing of used needles and syringes
b.4 Occupational hazards
C. Infected mother to child
c.1 Delivery
c.2 Breastfeeding

108. 4 REQUIREMENTS FOR TRANSMISSION
• Carrier of the virus (Medium)
– Semen
– Vaginal / Cervical fluid
– Milk
– Blood
• Mode of transmission
– Unprotected Penetrative Sex
– Mother-to-Child
– Blood transfusion / infected blood
• Amount of virus
– Is it enough?
• Entry of virus
– Cuts
– Sores
– Abscess
• Should get into the BLOODSTREAM

109. HIV Progression To AIDS Time when the HIV is introduced into the body and
HIV Infection starts to multiply and spread within the body.
> Approx. 3-6 months after HIV infection
> Individuals are infectious at this stage
> “false negative” even when he/she is positive
Window Period > No symptoms
> Individual will now test positive
> 30 – 50% of people suffer from a flu-like illness (fever,
Seroconversion swollen lymph nodes, night sweats, recurrent headache,
skin rash & cough)
> Test positive but no signs & symptoms
Asymptomatic Phase (10-15 years or more)
> S/he is in high risk of transmission stage
Symptoms:
• Weight loss • Thrush
HIV related illness • Chronic diarrhea • TB
• Prolonged fever
> “Terminal stage” of HIV infection.
> The immune system is severely weakened in PLWA,
and cannot cope with infection
AIDS > Life expectancy is 1-2 yrs if no treatment. CD4 count
less than 200

111. HIV Progression To AIDS

112. HIV Testing
voluntary
confidential, anonymous
with pre and post test
counseling
WINDOW PERIOD
 “6 months” from the last exposure with
HIV

113. Process of HIV Testing and Counseling
Results & KNOWING
Pre-test Blood Post Test YOUR
Counseling Sample Counseling STATUS

114. REMINDERS/POINT OF CLARIFICATIONS

119. PREVENTION
Abstain
Be faithful
Correct and consistent
condom use
Don’t share needles
Early detection, early treatment
Follow Universal Blood Precaution

120. The Connection Between
STIs and HIV

121. Three Main Points
• There is a causal link between infection
with STIs and increased transmission of
HIV
• Preventing and treating STIs will reduce
the number of new HIV infections
• You can make a difference by helping
people prevent, identify and treat STIs

122. What is the STI-HIV Connection?
• Similar behaviors put people at risk of
both STIs and HIV
• A current STI can increase risk of getting
HIV by 2-5 times
• People with both HIV infection and
another STI have increased HIV viral loads
and can more easily infect others with
HIV
• People with HIV can have more serious
complications of other STIs

123. STIs
• ulcerative: syphilis, chancroid, genital
herpes
• inflammatory: gonorrhea, chlamydia,
trichomoniasis
• US has highest rates of STIs in
industrialized countries
– especially chlamydia, gonorrhea and genital
herpes

126. Many STIs Have No Symptoms
• In women: over 50% with gonorrhea and
70% with Chlamydia had no symptoms
• In men: 68-92% with gonorrhea and 92%
with Chlamydia reported no symptoms

127. Epidemiologic Evidence
• Researchers have observed a strong
association between having STIs and HIV
in a number of studies.
• The association is termed
“epidemiological synergy”
• 2-5 fold increased risk for HIV infection
among persons who have other STDs.

128. Why the Increased Risk
• Ulcers and inflamed areas provide an
easy portal of entry
• STIs attract T-helper cells to the infected
area
• Even asymptomatic STis can cause
abnormal cellular changes that allow
easier passage of infectious agents.
• STIs increase viral load and shedding of
HIV

129. Conclusions
• There is a direct link between other STIs
and HIV transmission
• Early identification and treatment of STIs
will reduce HIV transmission
• You can make a difference by helping
people know these facts and working
with those at risk to get screened and
treated

130. Package 3
prevention and treatment of
infectious diseases

131. Infectious diseases are caused by pathogenic
microorganisms, such as bacteria, viruses,
parasites or fungi; the diseases can be spread,
directly or indirectly, from one person to
another.

132. Contraction, Transmission, and Stages of
Disease (1)
• Transmission of Infectious Disease
– Interaction of Host, Infectious Agent, and
Environment
– Reservoirs
– Direct vs. Indirect Transmission
• Routes of Exposure
– Bloodborne, airborne, sexual, fecal-oral, and foodborne
• Risk of Infection
– Theoretical vs. measurable

133. Contraction, Transmission, and Stages of
Disease (2)
• Factors Affecting Disease Transmission
– Mode of Entry
– Virulence
– Number of Organisms Transmitted
– Host Resistance
– Other Host Factors

134. Contraction, Transmission, and Stages of
Disease (3)
• Phases of the Infectious Process
– Latent Period
– Communicable Period
– Incubation Period
• Seroconversion and the window phase
– Disease Period

135. Infectious diseases cont’d…
• Hepatitis
– General Signs & Symptoms
• Symptoms are similar regardless of type of infection.
• Headache, fever, weakness, joint pain, anorexia, nausea, vomiting,
and URQ abdominal pain.
• Jaundice, clay-colored stool, and dark urine develop as the disease
progresses.
– Hepatitis A (Infectious or Viral Hepatitis) (HVA)
• Transmitted by fecal-oral route.
• Typically is mild; many patients are asymptomatic.
• Rarely serious and lasts 2–6 weeks.

136. Infectious diseases cont’d…
• Hepatitis (cont.)
– Hepatitis B (Serum Hepatitis) (HBV)
• Virus is transmitted through direct contact with
infected blood, semen, vaginal fluids, or saliva.
• Risk is significantly higher for EMS providers.
– 5-35% of all needlesticks result in infection.
• Vaccination is available and recommended for all EMS
workers.
• 60–80% of infected individuals are asymptomatic.

137. Infectious diseases cont’d…
• Tuberculosis
– General Info
• Most common preventable infectious disease
• Drug-resistant TB
– Skin Testing ??
– Pathogenesis ??
– Clinical Presentation
• Chills, fever, fatigue, chronic cough, weight loss
• Night sweats
• Hemoptysis

138. Infectious diseases cont’d…
• Pneumonia
– History & assessment
• Community-acquired pneumonia.
• Signs include acute onset of chills, fever, dyspnea, pleuritic chest
pain, cough, adventitious breath sounds.
• In geriatric patients, the primary sign may be an altered mental
state.

139. Infectious diseases cont’d…
• Chickenpox
– Varicella Zoster Virus (VCV)
– Clinical Presentation
• Respiratory symptoms, malaise, and low-grade fever
followed by a rash.
• Rash may be the first sign of illness and may be limited
or widespread; often prolific on the trunk.
• Transmission is through airborne droplets and direct
contact with lesions.
• Can be lethal in adult immunocompromised patients.

140. Infectious diseases cont’d…
• Chickenpox (cont.)
– Assessing Immunity
• Past history of chickenpox is sufficient.
– Immunization ??
– Response and Post-exposure
• Observe universal (standard) precautions.
• Get postexposure vaccination.

141. Infectious diseases cont’d…
• Meningitis
– Inflammation of the Meninges
• Caused by a variety of pathogens.
– Transmission Factors
• Host resistance factors, weather
• Contact with oral secretions
• Crowding, close contact, smoking

142. Infectious diseases cont’d…
• Meningitis (cont.)
– Clinical Presentation
• Incubation period of 4–10 days
• Fever, chills, headache, nuchal rigidity, arthralgia, lethargy,
malaise, altered mental status, vomiting, and seizures
– Immunization ??
– Response and Postexposure
• Observe universal (standard) precautions.
• Perform postexposure prophylaxis within 24 hours.

143. Airborne Diseases
• Influenza and the Common Cold
– Viral Infection
• Mutation and virulence
• Epidemics
– Symptoms
• Fever, chills, malaise, muscle aches, nasal discharge,
mild cough
• Secondary infections
– Management ??
– Immunization ??

144. Airborne Diseases
• Measles
– Viral Infection
• Highly communicable, with lifelong immunity after disease.
• Transmitted by airborne droplets and direct contact.
– Symptoms
• Presents similar to severe cold with fever, conjunctivitis,
photophobia, cough, and congestion.
• Rash.
– Management ??
– Immunization ??

145. Airborne Diseases
• Mumps
– Viral Infection
• Transmitted by airborne droplets and direct contact with saliva of
infected patient.
• Occurs primarily in 5- to 15-year-old patients.
– Symptoms
• Painful enlargement of salivary glands
• Symptoms of cold with earache, difficulty chewing, and swallowing
– Management ??
– Immunization ??

146. Airborne Diseases
• Rubella
– Systemic Viral Infection
– Symptoms
• Sore throat, low-grade fever, and fine pink rash
– Management and Immunization
• Respiratory Syncytial Virus (RSV)
– Viral Infection
• Common cause of pneumonias and bronchiolitis
• Commonly associated with lower respiratory infections
during the winter

147. Airborne Diseases
• RSV (cont.)
– Symptoms
• Runny nose and congestion, followed by wheezing, tachypnea, and
signs of respiratory distress
– Management ??
• Pertussis (Whooping Cough)
– Bacterial Infection
– Symptoms
• Catarrhal, paroxysmal, and convalescent phases
– Management and Immunization ??

148. Package 4
prevention and treatment of
lifestyle diseases

149. “The causes of almost all cancers
and diseases are improper diet
and lifestyle! The treatment
should be geared to lifestyle
modification instead of
medications.”

151. VIRUS

153. I. HOW SERIOUS IS THE PROBLEM?
• The Global Picture
– CVD and Diabetes are the major causes of
premature deaths
– CVD- approximately 10M of the total 15M CVD
deaths occur each year
– 7M deaths each year from Coronary Artery
Disease (CAD) and 4.5M from Stroke

154. The Regional Picture (Region – 8)
A) CVD – 1st leading cause of death
at 165.73% (2009)
B) COPD – 2nd leading cause of death
at 66.69% (2009)
C) CANCER/NEOPLASM – 3rd leading
cause of dealth at 23.81 %
(2009)
D) DIABETES MILLITUS – 9th leading
cause of death at 11.65%

155. FOUR MAJOR CHRONIC DISEASES
1. CVD (Cardio-Vascular Disease)
2. DIABETES MELLITUS (Type 1 & 2)
3. COPD (Chronic Obstructive
Pulomonary Disease)
4. CANCER

156. The Regional Picture (Region – 8)
A) CVD – 1st leading cause of death
at 165.73% (2009)
B) COPD – 2nd leading cause of death
at 66.69% (2009)
C) CANCER/NEOPLASM – 3rd leading
cause of dealth at 23.81 %
(2009)
D) DIABETES MILLITUS – 9th leading
cause of death at 11.65%

157. CVD (Cardio-Vascular Disease)

158. Heart disease and stroke kill some
17 million people a year, which is
almost one-third of all deaths globally.
In the Philippines, facts show:
CVD - no. 1 killer in the country
Every hour, 9 Filipinos die of CVD
1 out of 4 deaths in the country is due to
CVD
1 out of 10 Filipinos
aged 15 years old and above
has hypertension
and high blood pressure

159. CVD (Cardio-Vascular Disease)
1. HYPERTENSION
2. CORONARY ARTERY DISEASE
3. CEREBROVASCULAR DISEASE

160. II. CAUSES and RISK FACTORS
A. Diseases of the Heart and Blood
Vessels (CVD)
1. HYPERTENSION - sustained systolic BP of
140mmhg or more and sustained diastolic BP of
90mmhg or more based on measurement done
at least 2 visits taken at 1 week apart
“Correct diagnosis of hypertension depends on
correct BP-taking technique!”

161. • Hypertension
- is defined as a sustained elevation in mean
arterial pressure
- it is not a single disease state but
a disorder with many causes, a
variety of symptoms & a range of
responses to therapy.
- hypertension is also risk factor for the
development of other CVD’s like
coronary heart disease & stroke.

162. RISK FACTORS:
1. Older people 35 years old & above
2. Family history of HPN
3. Overweight and Obesity
4. High Salt intake
5. Excess alcohol intake
6. Smoking
7. Diabetics
8. Those on birth control pills
9. Post-menopausal females

163. SYMPTOMS OF HYPERTENSION :
At times, high BP may present when patients have:
• 1. Headache
• 2. Nape pain
• 3. Dizziness
• 4. Epistaxis
• 5. Blurring of vision

164. LIFESTYLE MODIFICATION to MANAGE
HYPERTENSION :
• 1. Weight Reduction.
- maintain normal body weight
(BMI of 18.5 – 24.9)
2. Adopt a balanced eating plan.
- consume a diet risk in fruits,
vegetables & low fat dairy
products with a reduced content
of saturated & total fat.

165. • 3. Dietary sodium reduction
- reduce dietary sodium intake to
no more than 100mEq/L(2.4g. Sodium)
4. Physical Activity
- engage in regular aerobic
physical activity such as brisk walking
(at least 30 min. per day, most days of the
week)

166. • 5. Moderation of alcohol consumption
- limit consumption to no more
than 2 drinks per day (1oz or 30 ml.
ethanol, eg. 24oz beer, 10oz wine, or 3 oz.
go-proof whisky) in most men & no more than
1 drink per day in women & lighter weight
persons.

167. • 6. Stress management
• 7. Regular intake of anti-
hypertensive medicines

168. WHAT WILL HAPPEN IF HYPERTENSION IS NOT
CONTROLLED?
• The HEART
- When the heart pumps blood into a narrow
artery, it has to work harder to meet the body’s
demand for oxygen, nutrients & other essential.
- The heart muscle progressively stretches &
thickens, enlarges & subsequently fails.

169. - When there is total blockage of
one of the arteries supplying blood to the
heart muscle, a myocardial
infarction ensues. This usually
presents as severe chest pain &
is definitely medical emergency.

170. • The ARTERIES
- Arteries are vessels that carry the blood
throughout the body. When the BP is high,
the arteries become scarred, hardened & less
elastic.
- They may not be able to meet the demand
of the tissues, & hence the tissues and organs
cannot function well.

171. • The KIDNEYS
-High BP cause narrowing of the arteries to the
kidneys which in turn can cause kidney failure.
The BRAIN
- Progressive narrowing of the blood vessels to the
brain will decrease blood flow & will cause brain cells
to die.

172. • - Vessels of the brain maybe logged
causing a stroke due to thrombosis &
hemorrhage or rupture.
Like a heart attack, the clogging
of brain vessels is an emergency.

173. Stroke Symptoms:
• 1. Weakness
• 2. Numbness
• 3. Paralysis of a part of the body
• 4. Difficulty in the speech
• 5. Slurred speech
• 6. Dizziness
• 7. Nausea
• 8. Vomiting

174. • The EYES
- Like other parts of the body, the
blood vessels to the eyes may become
narrowed & clogged
leading to impaired vision & even
blindness
• These outcomes can be avoided
by regular intake of medications &
strict blood pressure control

175. II. CAUSES and RISK FACTORS
2. CORONARY ARTERY DISEASE (CAD) heart disease
caused by the impaired coronary blood flow or
known as “Ischemic Heart Disease”.
-Most common is the Atherosclerosis- narrowing
of blood vessels because of the accumulation of
fats and cholesterol.

176. CHEST PAIN
A heart attack occurs when an artery supplying your heart with blood and
oxygen becomes blocked. With each passing minute, more tissue is deprived
of oxygen and deteriorates or dies. Restoring blood flow within the first hour
when most damage occurs is critical to survival of the tissue.

177. CORONARY ARTERY DISEASE(CAD)
• - is heart disease caused by impaired
coronary blood flow. It is also known as
Ischemic Heart Disease.
• - when the coronary arteries become
narrowed or clogged, supply of blood &
oxygen to the heart muscle is affected.

178. • - when there is decreased oxygen supplied
to the heart, muscle, chest pain (called
angina) occurs.
• - CAD can cause M.I. (heart attack),
arrhythmias, heart failure, sudden death.

179. CAUSES:
• The most common cause is ATHEROSCLEROSIS which
is the thickening of the inside walls of arteries or
narrowing of blood vessels because of the
accumulation of cholesterol & fats.
• If the obstruction of blood supply to the heart is
severe & prolonged, this may lead to HEART ATTACK.
If the obstruction in the blood vessels supplying the
brain, this is called STROKE.

180. RISK FACTORS OF CAD:
• Elevated blood lipids & cholesterol level(hyperlipidemia)
• Hypertension
• Smoking
• Diabetes Mellitus
• Overweight & Obesity
• Physical Inactivity/Sedentary Lifestyle
• Stress
• Heredity/family History
• Male Sex
• Increasing Age

181. LIFESTYLE MODIFICATIONS FOR CAD:
• Promote regular physical activity exercises
• Encourage proper nutrition particularly by
limiting intake of saturated fats & increase
LDL, limiting salt intake & increasing intake of
dietary fiber by eating more vegetables, fruits,
unrefined cereals & wheat bread.

182. • Maintain body weight & prevent obesity
through proper nutrition & physical
activity/exercise.
• Advice smoking cessation for active smokers &
prevent exposure to second-hand smoke.
• Early diagnosis, prompt treatment & control of
diabetes & hypertension.

183. II. CAUSES and RISK FACTORS:
3. CEREBROVASCULAR DISEASE or STROKE- loss
or alteration of bodily function that results from
an insufficient supply of blood to some parts of
the brain. If the blood flow is obstructed to any
part of the brain for several minutes, it loses its
energy supply and becomes injured which leads
to paralysis, slurring of speech or disability.

184. CEREBROVASCULAR DISEASE OR STROKE
• It is the loss or alteration of bodily function that
result from an insufficient supply of blood to some
parts of the brain. If the blood flow is obstructed to
any part, the brain loses its energy supply & becomes
injured. If blood is obstructed for more than several
minutes, injury to the brain cells becomes
permanent & tissues dies in the affected region
resulting in cerebral infarction.

185. • Stroke is one of the leading causes of disability. It can
lead to weakness or paralysis usually of one side of
the body. Often, the person has slurring of speech or
even inability to talk.

186. CAUSES :
• Almost all strokes are caused by occlusion of
cerebral vessels by either thrombi or emboli.
1. Thrombus usually occurs in atherosclerotic
blood vessels. This is usually seen in older
people & may occur in a person at rest.

187. • 2. Embolic stroke is caused by a moving blood clot usually
from a thrombus in the left heart that becomes lodged in a
small artery through which it cannot pass. Its onset is usually
sudden.
• 3. Hemorrhagic stroke is the most fatal type of stroke due to
rupture of intracerebral blood vessels. The most common
predisposing factor is hypertension. Other causes of
hemorrhage are aneurysm, trauma, erosion of vessel by
tumors, & blood disorders. It usually occurs suddenly, usually
when the person is active.

188. RISK FACTORS OF STROKE:
• Increasing age
• Sex- more women die than men of stroke
• Heredity
• Hypertension
• Cigarette smoking
• Diabetes mellitus
• Heart disease
• Season & climate
• Excessive alcohol intake
• Certain kinds of drug abuse

189. LIFESTYLE MODIFICATION FOR STROKE:
• Treatment & control of hypertension
• Smoking cessation & promoting a smoke-free environment
• Limit alcohol consumption
• Encourage proper nutrition- low fat, low sodium, high in fiber
foods
• Avoid intravenous drug abuse & cocaine
• Prevent all other risk factors of atherosclerosis
• Stress management

190. CVA Risk Factors are:
1. Increasing age 55
2. Sex- more women than men die of stroke
3. Heredity( family history)
4. Hypertension
5. Cigarette smoking
6. Diabetes mellitus- usually have high
cholesterol and are overweight

191. CVA Risk Factors are:
7. Heart disease
8. High Red Blood Cell (RBC) count- more red blood
cells thicken the blood and make clots more likely.
9. Season and climate- common in periods of extremely
hot or very cold temperatures.
10. Socioeconomic factors- people of lower income and
educational level have a higher risk of stroke.

192. CVA Risk Factors are:
11. Excessive Alcohol Intake- can raise blood
pressure contributing to obesity cancer, cause
heart failure and lead to stroke.
12. Drug abuse – cocaine use may lead to stroke,
heart attack and other CVD complications.

193. B. DIABETES MELLITUS
• Group of metabolic disorder characterized by
glucose intolerance with hyperglycemia
present
- Type I – Insulin Dependent (IDDM)
– Type II – Non-insulin Dependent (NIDDM)
– FBS 109 mg% (normal)
126 mg% (possible DM)

194. TYPES OF DIABETES:
• 1. Type 1 diabetes is insulin-dependent
mellitus(IDDM)
- characterized by absolute lack of insulin due to
damaged pancreas,prone to develop ketosis,
dependent on insulin injections.
- genetic, environment, or maybe acquired due
to viruses (e.g. mumps, congenital rubella) &
chemical toxins (e.g. Nitrosamines)

196. DIABETES MELLITUS
• is one of the leading causes if disability in
person over 4 years old. More than half of
diabetes persons will die of coronary heart
disease. Coronary artery disease tends to
occur at an earlier age & with greater security
in person with diabetes. It also increases the
risk of dying of cardiovascular disease like
heart attack or stroke among women.

197. • Diabetes mellitus is not a single disease. It is a
genetically & clinically heterogenous group of
metabolic disorders characterized by fucose
intolerance, with hyperglycemia present at
time of diagnosis.

198. CAUSES :
• It is easier to think of diabetes as a interaction
between 2 factors :
- GENETIC PREDISPOSITION (diabetogenic genes) +
ENVIRONMENT/LIFESTYLE (obesity, nutrition, lack of
exercise)
• Lifestyle includes obesity, nutrition & lack of physical
activity or exercise.
• Specific causes depend on the type of diabetes.

199. • 2. Type II diabetes is non-insulin
dependent diabetes mellitus(NIDDM)
- characterized by fasting hyperglycemia despite
availability of insulin.
- possible causes include impaired insulin
secretion, peripheral insulin esistance & increased
hepatic glucose production.
- usually occurs in older overweight persons
(about 80%).

200. Signs and Symptoms of
Diabetes Mellitus:
• Abnormal thirst
• Frequent urination
• Extreme hunger
• Drowsiness and fatigue
• Visual disturbances
• Remarkable weight loss
• Itching and infection of the skin
and genitalia

201. RISK FACTORS OF TYPE 2 DM:
• Family history of diabetes
• Overweight (BMI 23kg/m2) & obesity
(BMI>30kg/m2)
• Sedentary lifestyle
• Hypertension
• High density lipoprotein<35mg/dl
(0.90mmol/L)& or triglyceride level>
250mg/dl(2.82mmol/L)
• History of gestational diabetes mellitus (GDM) or
delivery of a baby weighing 9lbs.(4.0kgs.)
• Previously identified to have impaired glucose
tolerance (IGT)

202. COMPLICATION OF DIABETES MELLITUS:
• Acute complications include diabetic ketoacidosis &
hypoglycemia especially in type I diabetes.
• Chronic complications cause most of the disability
associated with the disease. These include renal
disease (nephropathy), blindness (retinopathy),
coronary artery disease & stroke, neuropathies &
foot ulcers.

203. LIFESTYLE MODIFICATIONS FOR DIABETES
MELLITUS:
• Be meticulous about blood sugar control.
• Be meticulous about blood pressure control.
• Maintain body weight & prevent obesity.
• Encourage proper nutrition – eat more DIETARY
FIBER, reduce salt & fat intake, avoid simple sugars
like cakes & pastries; avoid junk foods.

204. • Promote regular physical activity & exercise to
prevent obesity, hypercholesterolemia &
enhance insulin action in the body.
• Advice smoking cessation for active smokers &
prevent exposure to second-hand smoke.

205. COPD
C hronic
O bstructive
P ulmonary
An airway flow disease
D isease A very common problem
224 Tobacco and COPD

206. C. Chronic Obstructive
Pulmonary Disease (COPD)
• Characterized by cough, sputum production
and dyspnea upon exertion

207. CHRONIC OBSTRUCTIONS PULMONARY
DISEASE
• It is a disease characterized by
airflow limitation that is not fully reversible. The
airflow limitation is usually both progressive &
associated with an abnormal inflammatory response
of the lungs to noxious particles or gases.
• The lungs undergo permanent structural change,
which leads to varying degrees of hypoxemia & hyper
apnea. This explains the breathlessness & frequent
cough associated with COPD.

208. CAUSES & RISK FACTORS:
• COPD is usually due to chronic bronchitis &
emphysema, both of which are due to
cigarette smoking.
• Cigarette smoking is the primary cause of
COPD.

209. COPD
• Chronic Bronchitis
• Emphysema
• These two are the most common
diagnoses given to patients
228 Tobacco and COPD

210. COMPLICATIONS:
• Respiratory failure
• Cardiovascular disease – pulmonary
hypertension, which develops late in the
course COPD), is the major cardiovascular
complication of COPD & is associated with the
development of corpulmonale & a poor
prognosis.

211. The wheeze
• Inspiration • widens the airway
 Expiration  narrows the airway
 WHEEZING IS WORSE DURING EXPIRATION AND MAY BE
THE FIRST SIGN OF AIRWAY NARROWING
231 Tobacco and COPD

212. 90%
• 90% of COPD
patients are
current or former
smokers
Tobacco and COPD 232

213. Pathology of COPD
• Small and large airway narrowing caused by
– Epithelial thickening
– Increased mucus cells
– Hyperplasia
– Fibrosis
– Mucus plugs
233 Tobacco and COPD

214. Secondary Effects
• Renal dysfunctions
• Weight loss
• Muscular wasting
• Osteoporosis
all complicating factors in COPD
Tobacco and COPD 234

215. D. Cancer
- not all tumors are cancerous
- Benign tumors grow slowly and do not
spread while malignant tumors grow
more rapidly, metastasize and cause
death.

216. Causes and Risk factors of Cancer
1. Heredity/ family history
2. Carcinogens- maybe a chemical and
environmental agent, radiation and viruses
Many cancers are associated with lifestyle risk
factors like:
• Smoking
• Dietary factors
• Alcohol consumption

217. Other Causes of Cancer
• Radiation - can cause cancer including
ultraviolet rays from sunlight, x-rays,
radioactive chemicals, etc.
• Viruses - found in cervical cancer, liver CA
(hepa B virus), lymphoma and leukemia.

218. Example of Chemicals and Environmental
Agents
• Polycylic hydrocarbons found in cigarette smoke;
industrial agents; found in food as smoked foods (
tinapa)
• Aflatoxin – found in peanuts and peanut butter
• Benzopyrene – found in charcoal broiled or smoked
meat or fish (barbecue)
“Avoid eating burned food and eat smoked food
in moderation.”
• Nitrosamines – used as preservatives in food like
tocino, longganisa, bacon and hotdog

222. Nine Warning Signs of Cancer
C - change in bowel or bladder habits
A - a sore throat that does not heal
U - unusual bleeding or discharge
T - thickening or lump in breast or elsewhere
I - indigestion or difficulty in swallowing
O - obvious change in wart and mole
N - nagging cough or hoarseness
U - unexplained anemia
S - sudden unexplained weight loss
Acronym “CAUTION US” for Cancer

223. Screening Procedures
1. Breast Cancer
Breast self-exam monthly- a week after
onset of menstruation
2. Cervical Cancer
Pap smear over 18 years old in between menses ( 2
weeks after)
At risk are:
- Sexually active
- Multiple partners
- Commercial sex workers

224. Screening Procedures
3. Colon-rectal cancer - digital rectal exam
4. Lung cancer - X-ray and sputum cytology

225. What is Healthy Lifestyle?
• A way of life which promotes and protects one’s
health and well-being
• Practicing good health habits such as eating healthy
diet, regular physical activity, staying smoke free,
abstinence from alcohol or drinking in moderation
• An integrated approach to non-communicable
disease prevention and control and composition of
programs like: CVD, Cancer, Diabetes, Asthma, COPD
including nutrition.

226. PROMOTING PROPER NUTRITION
• Eat 2-3 servings of vegetable each day, one
serving of which is green or yellow leafy
vegetables
– Raw vegetable - 1 cup
– Cooked vegetable - ½ cup
• Eat at least 2 servings of fruit per day
“The Filipino Diet Pyramid Food Guide for
Today’s Lifestyle”

227. Do you know that being
overweight or underweight
increases the risk of health
problems?

228. Hypertension
Heart Diseases
OVERWEIGHT Stroke
Diabetes
Cancer

229. Heart Problems
Chronic Fatigue
UNDERWEIGHT Anemia
Depression
Lowered resistance
to infection

230. A. OVERWEIGHT / OBESITY
- Body fat can best be assessed using BMI.
WEIGHT (kg)
BMI =
HEIGHT (m)2
BMI Result Condition
• Less than 18.5 kg/m2 • Underweight
• 18.6 – 22.9 kg/m2 • Healthy Weight
• Greater than 23.0 kg/m2 • Overweight
• 23.0 - 24.9 kg/m2 • At risk
• 25.0 - 29.9 kg/m2 • Obese I
• Greater than 30.0 kg/m2 • Obese II
“Central OBESITY is a risk factor to HEART DISEASE and STROKE”

231. OVERWEIGHT / OBESITY
WC = WAIST CIRCUMFERENCE
Ideal WC for -
• MEN = Less than 90 cm (35 inches)
• WOMEN = Less than 80 cm (31.5 inches)
“Waist Circumference greater than the above-
mentioned value is not normal and the person is at
risk even if BMI result is normal.”

232. C. Cholesterol in Blood
Philippine Food According to Cholesterol Content:
I. VERY HIGH CHOLESTEROL:
Meat : Carabao’s Brain; Cow’s Brain; Cara Lungs
Eggs : Duck; Chicken; Balut; Salted Duck’s Egg.
II. MODERATE CHOLESTEROL:
Meat : Cow’s Spleen/Lungs/Kidney; Pig Spleen and Lungs
Poultry : Chicken Liver
III. LOW AMOUNT OF CHOLESTEROL:
Meat & Poultry: Cow’s Liver & Small Intestines / Chicken Heart /
Pig’s Liver and Tongue
Fish/Shellfish : Large Crab ; Small Shrimps

233. C. Cholesterol in Blood
Philippine Food According to Cholesterol Content:
IV. LOWEST CHOLESTEROL (99 mgs)
Meat : Cow’s / Carabao’s Tongue & Uterine
Pork Liempo
Lean Beef and Pork
Fish & Shellfish :
Alimasag Lapu-lapu
Salmon Kuhol
Tulya Talaba
Tangigue Tahong
Bangus
Chicken Meat & Egg White

234. C. Cholesterol in Blood
Food High in Sodium Content (400 mg/ serving):
• Soy Sauce • Corned Beef
• Shrimp Paste • Cheese
• Fish Sauces (Patis) • Carbonated Drinks
• Fish Paste (Bagoong isda) • Pickles
• Bacon • Tausi
• Salted Peanuts/Crackers/Chips
“Persons at risk of high blood cholesterol level and heart disease
should limit intake of fatty meat cholesterol-rich food and saturated
fats.”
- Eat egg yolk 2-3 times a week
- Chill meat or poultry broth until fat become solid then spoon-off
the fat “sebo” before using the broth.

235. C. Cholesterol in Blood
Types of Fats/Cholesterol:
1. Saturated fats raise blood cholesterol level
ex: fat in meat, skin of chicken and ducks,
butter, lard cream and milk products
2. Polyunsaturated fats lower total cholesterol
level and LDL or bad cholesterol raise HDL
ex: corn oil, soybean oil, sunflower oil
3. Monounsaturated fat lower LDL HDL
remain unchanged
ex: canola oil, olive oil

236. •Avoid oil or lard that is solid in
room temperature (tumitigas)
•Use iodized salt but avoid
excessive intake of salty foods- to
promote physical and mental
development and prevent iodine
deficiency disorder

237. Finally:
•Manage weight effectively
•Build healthy nutrition
•Choose food wisely or an Acronym:
•A = Aim for ideal body weight
•B = Build healthy nutrition practices
•C = Choose food wisely

238. 2. PROMOTING SMOKE-FREE
ENVIRONMENT
Lung Cancer
• Most significant cause of death from cancer in
the world
• Major cause is tobacco, smoking particularly
cigarette
• Smokers body = 4000 +chemicals present in
cigarette smoke and 43 are carcinogens

239. Cigarette produces 2 kinds of smoke:
Mainstream or active smoker
Sidestream or passive smoker
How does smoking harm us?
•Responsible for 90% of all lung cancer
•75% of chronic bronchitis and emphysema
•25% of ischemic heart disease

240. KEY AREAS FOR PREVENTION ARE:
1. Promote proper nutrition
2. Encourages more physical activity and exercise
3. Promote a Smoke-free Environment and Smoking Cessation
4. Discourages excessive alcohol
5. Manage stress effectively
6. Regular health check-up for early diagnosis and prompt treatment
Factors that influence the increasing trend of lifestyle-
related diseases worldwide:
1. Increasing life expectancy
2. Increasing urbanization
3. Increasing industrialization or globalization

241. PHYSICAL ACTIVITY AND EXERCISE
PHYSICAL ACTIVITY - Is something you do at home, like
washing the dishes, sweeping the
floor and cleaning the house. It is
what you do outside the house like
gardening.
60% – 85% of the adult population lead sedentary life.
EXERCISE - Is a planned, structured and repetitive
movement done to improve or maintain one
or more components of physical fitness.

242. HEALTH BENEFITS OF REGULAR
PHYSICAL ACTIVITY:
• Reduce the risk of dying from coronary heart disease (CAD)
• Reduce the risk of having a 2nd heart attack in people who
have experienced heart attack.
• Lowers bad cholesterol or LDL and increases good
cholesterol or HDL.
• Lowers the risk of developing high blood pressure.
•Lowers the risk of developing Type II Diabetes Melitus.

243. HEALTH BENEFITS OF REGULAR
PHYSICAL ACTIVITY:
• Reduces the risk of developing colon cancer.
• Help achieve and maintain a healthy body weight.
• Reduces feelings of depression and feeling of stress
• Help maintain healthy bones and muscles and joints.
• Helps older adults become stronger and better able to move
without becoming fatigued.

244. • We need to exercise to be physically fit
• We need to exercise to improve our lungs
• We need to exercise to build our muscles.
• Exercise helps control diabetes – helps burn
calories
• Walking is a complete exercise. This is injury-free,
sustaining and effective

245. • Frequency of exercise -
3 – 4 times a week
• Intensity of exercise -
For the older persons aged 50 years and above, the heart
rate ratio is 40-50% of maximal heart rate.
• Exercise time -
For a start, 10 -15 minutes of exercise is good and gradually
increase to 30 minutes.
• For older persons -
Walking, swimming, stretching, dancing, gardening, hiking are
all excellent activities.
Physical activity is a means to control joint swelling and
joint pains in arthritis.

246. 3. PROMOTING PHYSICAL ACTIVITY AND EXERCISE
Consider the “FIT” Principle :
F- Frequency of exercise = 3 to 4 x a week, spread only
the week
I- Intensity to exercise, the more intense the exercise, the
faster the heart rate.
T- Exercise a minimum of 30 minutes each time. Start
with 10 – 15 minutes then increase gradually to 30
minutes.
To lose fat for weight do the aerobic exercise.
Aerobic Exercises - may be walking, jogging, running,
swimming and biking.
Anaerobic Exercises - may be weightlifting, push-ups or pull-ups.

247. 3. PROMOTING PHYSICAL ACTIVITY AND EXERCISE
Why warm – up?
Prepare the body for exercise
Circulation of the blood needs to be redirected
Protect the articular space and prevent injury
Cooling Down – is just as important as warm-ups. Our body
needs to slow down at its resting level.
5 – 10 minutes cooling down is the minimum.

248. PREVENT ILLNESS...
DO INTESTINAL
CLEANSING
Take virgin coconut oil
and/or papaya everyday!

250. WANNA LIVE LONGER
1. EXERCISE for 30 minutes, most
days of the week.
- this can gain 2.4 yrs. of life.
2. QUIT smoking
- men who smoke a pack a day.
Lose an average of 13 years of
life, while women lose 14
years.

251. • 3. EAT FRUITS & VEGETABLES.
- eat fruits & veggies can lengthen your life by 2-4
years.
• 4. REMEMBER THE FIBER.
- for every 10 gms. Of fiber you can consume per day,
your risk of heart attack goes down by 14% & risk of
death from heart disease drops by 27%.

252. 5. EAT NUTS
- eating one-quarter cup of nuts 5x a week can
add 2.5 years to your life.
6. ONLY the “GOOD” FATS please
- get 20% of total daily calories from healthful fats,
limit saturated fat, to 10% or less.
7. LOSE WEIGHT.
- maintaining IBW for height & age can lengthen your
life by 11 years.

253. Mabuhay!

254. Package 5
Promotion of gender equity and equality, and
prevention of violence against women and
children (VAWC)

255. key health messages
Sex and Gender:
• Sex refers to natural, physical attributes of a
person
• Gender refers to psycho-social identity
Health:
• Sex and gender affects access to health services
 power relations (degree of control) 
outcome (welfare/health status?)
• Our tasks: conscienticize, influence power
relations to empower women

256. VAWC:
• Forms/Types of abuse: rape (sexual), “sampal”
(physical), verbal (emotional), absence of
income (economic/financial)
• If u feel hurt then u are abused
• VAWC leads to: emotional imbalance, physical
impairment, sickness (“makunan”, STI),

257. Pointers...
• Abuser should stop the violence not because of FEAR but because of
LOVE
• Know the provisions of RA 9262
• Isumbong: DSWD, PNP, BLGU (may power ang Punong Barangay to
issue “protection order”  good for 15 days)
• Nothing can be settled at the barangay because issue is complicated 
BLGU and PNP should protect
• Ensure safety inside the house
• Contact the barangay VAWC desk officer aside from the Punong
Barangay
• Provide individual conseling first then as a couple
• Create and operationalize a co-op a gender and woman empowerment
committee (not VAWC committee – negative)
• Inform and advocate: poster (if you experience these… then report
to…)
• Disaggregate survey data and analysis by sex.

258. -- end of module 3 --

259. MODULE 4
Let’s Make It Happen!

260. In this module, we will ...
1. Learn appropriate tools and processes in
determining and knowing our target clients;
2. Learn guidelines and tips in setting targets
and in preparing and action plan; and
3. Prepare a re-entry action plan for the CHP
team.

261. Planning Tools: 1) Targeting Form
PERFORMANCE TOTAL JANUARY-MARCH
INDICATORS SHE TARGET TARGET
1 Number of clients REACHED with
behavior change messages
CLIENT MANAGEMENT TOOLS
 See sub-categories
2 Number of clients SERVED with
medical services/products
 See sub-categories
NOTE: Reached = those who received at Served = those who received consultation
least 2 kinds of health promotion or diagnostic services; or pharmacy
activities such as seminars and products worth at least PHP 50 per
referrals purchase

262. Client Category/Sub-Category Total Target 2012 Target
1 Women of Repro Age (15-49)
1.1  Walang asawa na may-anak
1.2  Live-in
1.3 Legally-married
1.4  Below 14 y-o but with child/ren
2 Youth
2.1  Male
2.2  Female
3 Others
3.1  14 y-o and below including newborn
3.1.1 -- male
3.1.2 -- female
3.2  lalake, 14-49 y-o
3.3  All people 50 y-o and above
3.3.1 -- male
3.3.2 -- female

263. You got to be S.M.A.R.T.
S = Specific
M = Measurable
A = Attainable
R = Relevant
T = Time-bound

264. Reference: Target Per CVP based on
approved SHE business plan
Reached
CVP Served
WRA Youth Others Total
BCCI 5,000 1,000 700 6,700 6,700
AFCCO 4,700 1,000 1,328 7,028 22,680
HFBMPC 2,250 300 2,250 4,800 850
SPPMPC 6,600 1,065 3,750 11,415 4,566
LAMP 3,000 2,400 4,800 10,200 1,618
NSDWCC 4,000 400 800 5,200 9,000
PATECI 1,400 - 953 2,353 3,996
BMPC 2,200 907 668 3,775 9,362
Other CVPs ???

265. Planning Tools: 2) Client Profile Form
<Use DOH-CHT Form>

266. Planning Tools: 3) CHP Report Form 1
Name of Co-op Health Promoter:
Area/s of Coverage:
Month:
1. ACCOMPLISHMENT VS. TARGETS
PERFORMANCE SMART
AREAS TARGETS ACCOMPLISHMENT
1.1 PLANNED WRA MEN CHILDREN TOTAL WRA MEN CHILDREN TOTAL
RESULTS
M F M F
a Number of clients
served
b Number of clients
reached
1.2 PLANNED ACTIVITIES OUTPUTS OF ACTIVITIES
a Outreach - Brgy. 800 300 - - 1,100 Reached 900 individuals with 700 WRA & 200 Men
Assembly (thru health education seminars covering all the 5
coop health promotion packages)
b

267. 2. CHALLENGES AND GOOD PRACTICES
A. CHALLENGES
ITEM BRIEF DESCRIPTION OF ACTIONS RESULTS RECOMMENDATIONS
CHALLENGES TAKEN
YOU ENCOUNTERED
1 Attendance Low turn-out of mothers Set mothers class To be conducted Written communication
due to miscommunication thru BLGU
with the mother-leader
2
3
B. GOOD PRACTICES
ITEM BRIEF DESCRIPTION OF GOOD RESULTS RECOMMENDATIONS
PRACTICES YOU WANT TO
SHARE
1 Hilot involvement Hilots in the area are now Zero Home-based delivery Percentage provision per
member of the CHP and actively endorsement as motivation
promote “Facility Based
Delivery”.
2
3

268. Attachment 1: SUMMARY OF CLIENTS REACHED
KIND/S OF
DATE/S
CATEGORY ITEM FULL NAME ADDRESS AGE SEX SERVICE
reached
PROVIDED
A. WRA 1
2
3
A. MEN 1
2
3
A. CHILDREN 1
2
3

269. Attachment 2: SUMMARY OF CLIENTS SERVED
KIND/S OF
CATEGORY ITEM FULL NAME ADDRESS AGE SEX DATE/S served SERVICE
PROVIDED
A. WRA 1
2
3
A. MEN 1
2
3
A. CHILDREN 1
2
3

270. CHP Team Action Plan (2012)
Item Activity Output Date/s Lead Person
1 Get formal appointment, Formal appointment
terms of reference (TOR) with attached TOR
and budget from and approved budget
BOD/GM
2 Map-out target WRA Directory & profile of
coop members target WRAs
3 Conduct SHE health ??? WRAs reached
education classes per
coop cluster (covering
EVAcoh’s 5 Health
Promotion Packages)
4 Monitoring of WRA ??? WRAs served
family/clients and
submission of reports
5 Year-end evaluation List of gains and
lessons

271. Guide:
1. Group by Coop-SHE.
2. Set CHP targets: refer to targets set in the
SHE bizplan and decide the target to be
accomplished during the period (i.e.,
January-December 2012).
3. Prepare the action plan: identify key
activities to be implemented. Use template.
4. Report back to the plenary.

272. -- end of module 4 --