TOPIC OUTLINE
1) Models of health
2) Health –illness continuum
3) Eco-system factors
4) Types of client in CHN
5) Concepts of CHN
6) Basic
... [Show More] concepts of CHN
MODELS OF HEALTH
HEALTH ACCORDING TO
1. CLINICAL MODEL / BIOMEDICAL MODEL
ABSENCE OF A DISEASE.
ABSENCE OF SIGNS AND SYMPTOMS OF A DISEASE.
NARROWEST INTERPRETATION OF HEALTH.
2. HEALTH ILLNESS -CONTINUUM
HEALTH is an ever changing state.
Being ill and well is never constant.
3. ROLE-PERFORMANCE MODEL
Take note of the word ROLE and PERFORMANCE.
Ability to fulfill societal roles.
So, inability to perform one’s work is known as?
4. ADAPTIVE MODEL
Creative process of adapting.
Disease is the failure in adaptation(maladaptation)
5. ACCORDING TO EUDAMONISTIC MODEL
Health is the actualization and realization of a person’s potential
ILLNESS is the condition that prevents self-actualization
6. ACCORDING TO EPIDEMIOLOGICAL TRIAD
AGENT-HOST-ENVIRONMENT MODEL
ECOLOGICAL MODEL
Balance between AGENT , HOST, ENVIRONMENT (A.H.E.)
Health not in balance = disease occurs
TRIAD OF EPIDEMIOLOGY
1. AGENT
2. HOST
3. ENVIRONMENT
HEALTH –ILLNESS CONTINUUM
7. According TO FLORENCE NIGHTINGALE
HEALTH is the state of well-being and using every power the individual possesses to the fullest extent.
8. According to HIGH- LEVEL WELLNESS MODEL
Health is the ability to reach one’s own POTENTIAL.
9. ACCORDING TO THE MODERN CONCEPT
Health is the optimum level of functioning (OLOF) of individuals, families and communities.
10. HEALTH according to WHO
STATE of COMPLETE PHYSICAL , MENTAL AND SOCIAL WELL BEING AND NOT MERELY THE ABSENCE OF A DISEASE OR INFIRMITY
11. Modern Concept of Health
Refers to the optimum level of individuals , families and communities .
Eco-system factors
1. Political Factors
Safety of the people
Oppression
People empowerment
2. Behavioral Factors
Culture
Habits
Mores
Ethnicity
Customs
3. Heredity
Genetics Materials / endowment
Defects
Strengths
Risk
Fimilial
Ethnic Tribe
Racial
4. Health Care Delivery System
Promotive
Preventive
Curative
Rehabilitative
Primary Health Care (PHC)
Services that are ACCESSIBLE, AVAILABLE ,ACCEPTABLE, SUSTAINABLE and AFFORDABLE.
5. ENVIRONMENTAL FACTORS
AIR
FOOD
WATER SOURCE
URBAN vs RURAL
NOISE
RADIATION
POLLUTION
6. SOCIO-ECONOMIC INFLUENCE
Employment
Education
Housing
DEFINITION OF TERMS
Health is the state of complete physical, mental, and social well-being and it is not merely the absence of disease or infirmity.
Community a group of people who share common interest, who interact with each other, and who function collectively within a defined social structure to address common concern.
Community health the identification of needs and the protection and improvement of collective health within a geographically defined areas.
Community health nursing special field of nursing that combines the skills of nursing, public health and some phrases of social assistance and functions as part of the total public health program for the promotion of health, the improvement of the conditions in the social and physical environment, rehabilitation of illness and disability .
CONCEPT OF HEALTH
Health holistic state of well-being, including soundness of mind, body and, spirit
Wellness health plus the capacity to develop one’s potential, leading to a fulfilling and productive life
Illness state of being relatively unhealthy.
BASIC CONCEPTS OF COMMUNITY HEALTH NURSING
1.The primary focus of CHN is on health promotion , CHN evaluates the health status of people and groups and relating them to practice.
2. CHNurses are GENERALIST- through life’s continuum, full range of health problems and needs
3. CHN is extended to benefit not only the individual but the whole family and community
4. The nature of CHN practice requires that the current knowledge derived from biological and social sciences , ecology, clinical nursing, and community health organizations be utilized.
5. The dynamic process of assessing, planning implementing and intervening ,provide periodic measurements of PROGRESS , evaluation and continuum of the cycle until the termination of nursing is implicit in the practice of community health nursing.
COMMUNITY HEALTH NURSING
A special field of nursing that combines the skills of nursing, public health and some phases of social assistance and functions as part of the total public health and some phases of social
is a learned practice discipline with the ultimate goal of contributing , as individuals and in collaboration with others , to the promotion of the clients optimum level of functioning through teaching and delivery of care.
by WHO Expert Committee of Nursing
LEADERSHIP
- ORGANIZING
- CATALYST OF CHANGE
- MANAGER
- TRANSFORMATION
- EMPORWERMENT
TYPES OF CLIENT IN CHN
1. The INDIVIDUAL PATIENT
The ENTRY POINT OF CARE
Individual who is a member of a family.
INDIVIDUAL which could be classified as MALE or FEMALE , Pediatric or Adult , A father or mother , a child, Pregnant or non-pregnant.
Every individual is UNIQUE.
A problem of one individual is a problem of the FAMILY.
Sick or well and can acquire services of a nurse
Follow ups, consultation,
health teaching ,
counselling, workplace and school place visit ,
case finding and screening
THE HEALTH TASK OF A FAMILY
- Recognize health interruptions
- Seeking health care
- Managing health and non-health crisis
- Providing nursing care to the sick
- Maintains a good home environment
- Reciprocal relatuionship
2. FAMILY (POPULATION GROUP)
The BASIC UNIT of the society
The FUNDAMENTAL UNIT of care in community.
A group of individuals consisting of parents and children living together ( Traditional Type )
Unit of service
- reproduction and socialization
- basic unit of care
- Contributes to wellness and socialization
- Primary Source of Support
Aggregates
Common characteristic
exposure to environmental factors hence with common health problems
3.COMMUNITY (WHOLE CLIENTELE)
A group of people who share common interest , who interact with each other and who function collectively with in a defined social structure to address common concerns.
CLASSIFICATION OF A COMMUNITY
1. RURAL / OPEN LANDS
- Agricultural
- Less dense
- More spacious
2. URBAN / THE CITY
- Non-agricultural
- Dense highly populated
- Highly industrialized
3. RURBAN OR THE CAPITALS
- Mixed
BASIC CINCEPTS OF COMMUNITY HEALTH NURSING
1 PRIMARY GOAL Promotion of OLOF thru health teaching and delivery of care.
CHN must be available to all regardless of race, creed, color or socio economic status
√ The primary focus of CHN is on health promotion, CHN evaluates the health status of people and groups and relating them to practice.
2 PRIMARY DUTY health teaching
There must be provision of for educative supervision in CHN
There should be accurate recording and reporting in CHN.
Health teaching is a basic and primary responsibility of the community health nurse.
Opportunities and continuing staff education program for nurses must be provided by the CHN agency . The CHN is responsible for his own professional growth.
3 PRIMARY PRINCIPLE Health care for the entire community
4 PRIMARY FOCUS Health promotion
5 PRIMARY METHODOLOGY Nursing process
The dynamic process of assessing, planning implementing and intervening ,provide periodic measurements of PROGRESS , evaluation and continuum of the cycle until the termination of nursing is implicit in the practice of community health nursing.
The nature of CHN practice requires that the current knowledge derived from biological and social sciences , ecology, clinical nursing, and community health organizations be utilized.
6 PRIMARY TYPE OF CARE DELIVERY Population focused care (MASS-BASED)
Community Health Nursing (CHN) is a vital part of Public Health and there are 12 principles the govern CHN.
CHN is based on the recognized needs of individuals, families and communities ,groups and individuals.
The CHNurse must understand FULLY the objectives and policies of the agency he represents.
7 PRIMARY BASIS Recognized needs of clients
8 PRIMARY UNIT OF SERVICE Family
CHN considers the family as the unit of service.
9 PRIMARY CLIENT AND SERVICE Community
The Community Health Nurse use available community health resources.
Active participation of the individual, family and community in planning and making decisions for their health care needs, determine, to a large extent, the success of the CHN programs.
The primary focus of CHN is on health promotion , CHN evaluates the health status of people and groups and relating them to practice.
CHN is extended to benefit not only the individual but the whole family and community
There must provision of periodic evaluation of CHN services
The CHNurse works as a member of the health team
STANDARDS OF CHN PRACTICE
1. Promoting health
Focus on health of the populations
Mediate between environment and people
Recogrnized that health in influence by circumstances , beliefs and the determinant of health
2. Building Relationships
Build the principle of caring and connecting
Positive relationship move initiatives forward within a community
3. Facilitating Access and equity
Embraces the principle of PHC
4. Demonstrate professional responsibility and accountability
Works with autonomy
Ensure knowdlege and eveidence based
Initiate startegies
Explore ethical dilemmas
FIRST LEVEL ASSESMENT
A Typology of Nursing Problems in Family Nursing Practice
NATURE OF THE PROBLEM
1. HEALTH DEFICIT
DEFICIT = GAP / PROBLEM / FAILURE
*** DISEASES
A gap between actual and achievable health status
Instatnces of failure in health maintenance
Possible precursors of health deficit:
o History of repeated infections or miscarriages
o No regular health check-up
Example:
- Illness states, diagnosed or undiagnosed
- Failure to thrive /develop
- Disability
o Transient (aphasia or temporary paralysis after a CVA)
o Permanent (leg amputation secondary to diabetes, blindness from measles, lameness from polio)
2. Presence of Wellness Condition
Stated as potential or Readiness
A clinical or nursing judgment about a wellness or capability to a higher level.
Wellness potential is a nursing judgment on wellness state or condition based on client’s performance, current competencies, or performance, clinical data or explicit expression of desire to achieve a higher level of state or function in a specific area on health promotion and maintenance.
Examples of this are
A. Potential for Enhanced Capability for:
1. Healthy lifestyle-e.g. nutrition/diet, exercise/activity
2. Healthy maintenance/health management
3. Parenting
4. Breastfeeding
B. Readiness for Enhanced Capability for:
1. Healthy lifestyle
2. Health maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being
6. Others. Specify.
3. HEALTH THREAT
Threat=danger / HAZARD
(SAFETY is HEALTHY)
A conditions that are conductive to disease, accident or failure to realize one’s potential
Example:
• Family history of hereditary disease
• Threat of cross infection
• Accident hazards
• Faulty eating habits
• Poor environmental sanitation
• Unhealthy lifestyle / personal habits
4. FORESEEABLE CRISIS
Crisis I urgency I pressure I necessity I Situation
Anticipated periods of unusual demands on the individual or family in terms of adjustment / family resources
Example:
• Marriage
• Pregnancy
• Parenthood
• Divorce of separation
• Loss of job
• Menopause
• Death
Accident hazards specify.
- Broken chairs.
- Pointed /sharp objects, poisons and medicines improperly kept.
- Fire hazards.
- Fall hazards.
Prioritizing health problems
Nature of the problem
categorized into health deficit, health threat and foreseeable crisis
• Health deficit – 3
• Health threat – 2
• Foreseeable crisis – 1
Modifiability of the problem
refers to the probability of success in minimizing, alleviating or totally eradicating the problem through intervention
• Easily modifiable – 2
• Partially modifiable – 1
• Not modifiable – 0
Preventive potential
refers to the nature and magnitude of future problems that can be minimized or totally prevented if intervention is done on the problem under consideration
• High – 3
• Moderate – 2
• Low – 1
Salience
refers to the family’s perception and evaluation of the problem in terms of seriousness and urgency of attention needed
• Serious problem ; immediate attention needed – 2
• Problem ; not needing immediate attention – 1
• Not a felt needed/ problem – 0
Qualities of a health community
(REPAIR ASAP)
1. Resources open & controlled
2. Empowerment active participation
3. People health citizenry
4. Awareness community health status
5. Independence people & leaders
6. Role models parents & guardians
7. Active concerns health threats
8. Sustainability environment and needs
9. Accessibility health services
10. Politics mass-based and respected
WHAT IS A HEALTHY COMMUNITY ?
A healthy community ….
1. Prompts its members to have a degree of awareness that “we are community “. (Sense of belongingness)
2. Uses its natural resources while taking steps while taking steps to conserve them for future generation.
3. Openly recognizes the existence of sub-groups and welcome their participation in the community affairs.
4. Prepared to meet crises ( reactive)
5. Is a problem-solving community (Self-reliance)
identifies , analyses and organizes to meet its own needs
6. Has open channels of communication that allows information to flow to all members of the community.
7. Seeks to make its system’s resources available to all members of the community.
(4 A’s Availability , Affordability , Appropriate, Accessibility of resources /PHC)
8. Has legitimate and effective ways to settle disputes and meet needs of that arise within the community.
9. Encourages maximum citizen participation in decision making. (participatory , democratic)
10. Promotes high level wellness among its members.
ELEMENTS OF A HEALTHY COMMUNITY
1. 1.People are partners in health care
2. People works together to attain goal
3. 3.Physical environment promotes health
4. Safe water and nutritious food
5. Facilities provide members with basic needs
6. Available, affordable health care
Components of a community
The core
People demographics, values beliefs
8 SUBSYSTEMS OF THE COMMUNITY
(CHEER For Public Health)
1. Communication open all channels
2. Housing adequate shelter & security
3. Education health teachings, seminary
4. Economics livelihood projects
5. Fire and safety bldg. house check
6. Politics & gov’t selection of leaders
7. Health health services and programs
COMMUNITY HEALTH WORKER (CHW)
is one who provides basic community health care services for promotion of health , prevention of illness, simple treatment and rehabilitation
This services utilizes the philosophy ,content , method and skills of public health care.
Levels of primary health care worker
1. Village / Barangay health workers
refers to trained community health workers or health auxiliary volunteer or a traditional birth attendant or healer
2. Intermediate Level Health Workers
• general medical practitioner or their assistants
• public health nurse
• rural sanitary inspectors
• midwife
PUBLIC HEALTH WORKES (PHW)
PHW’s members of the health team who are professionals namely:
• Medical officer (MO) – physician
• Public health nurse (PHN) – registered nurse
• Rural health midwife (RHM) – registered midwife
• Dentist
• Nutritioninst
• MEd tech
• Pharmacist
Rural sanitary inspector (FSI) – must be a sanitary engineer
LEGAL BASIS
letter of instruction (LOI) 949 signed on October 19, 1979 by President Ferdinand E. Marcos
The alma-Alta conference defined PHC as
“Essential health care based on practical, scientifically sound, and socially acceptable methods and technology ………”
DEFINITION:
• Primary health care is essential health care
• Made universally accessible to individuals
• And acceptable to them
• Through their full participation and at a
• Cost that the community and country can afford.”
REMEMBER:
1. Essential health care;
2. Universally accessible;
3. Acceptable;
4. Participation;
5. Not costly
REQUIREMENT OF EFFICIENT PHC SERVICES:
EFFICIENT PHCSERVICE MUST BE:
1. Accessible
2. Acceptable
3. Affordable
4. Efficient administrative, professional and technical procedures
5. Community participation
6. Comprehensiveness
7. Continuity
THE BASIC REQUIREMENTS FOR SOUND PHC (THE 8 A’S AND THE 3 C’S)
1) Appropriateness
2) Availability
3) Adequacy
4) Accessibility
5) Acceptability
6) Affordability
7) Assessability
8) Accountability
9) Completeness
10) Comprehensiveness
11) Continuity
ELEMENTS OF PRIMARY HEALTH CARE:
1. Education
2. Locally disease
3. Essential drugs
4. Maternal and Child Health
5. EPI
6. Nutrition
7. Treatment
8. Safe Food
E ducation for health
L ocally Endemic and Communicable Disease Control and Treatment
E xpanded Program on Immunization
M aternal and Child Health and Family Planning
E ssential Drugs
N utrition
T reatment (Medical & Emergency Care)
S anitation of the Environment
PRINCIPLES OF PRIMARY HEALTH CARE:
• A WHO expert committee (1984) recognized and involvefive basic priciples in the definition of primary health care. They are:
1. Equitable distribution
2. Community involvement
3. Appropriate technology
4. Focus on prevention
5. Multi-sectoral approach
1. Education: Education about prevailing health problems and methods of preventing and controlling such problems.
2. Locally disease: Prevention and control of local endemic diseases
3. Essential drugs: Provision of essential drugs.
4. Maternal and Child health: Maternal and child health care and family planning.
5. EPI: (Expanded programme on Immunization) Immunization against major infectious diseases.
6. Nutrition: Promotion of food supply and proper nutrition
7. Treatment: Appropriate treatment of common diseases and injuries
8. Safe water: Adequate supply of safe water and basic sanitation.
PRIMARY HEALTH CARE INCLUDES SERVICES SUCH AS:
1) Immunization
2) Health education
3) MCH care
4) Prevention of illness
5) Prevention & control of endemic diseases
6) Treatment of minor injuries and illness
7) Sanitation
8) Adequate & safe water supply
9) Promotion of mental health
10) Adequate nutrition
11) Providing essential drugs
NEEDLE TYPES
Gauge size Color Outer diameter
14 Olive .072IN(1.83MM)
15 Amber .065IN(1.65MM)
16 Gray .064IN(1.63MM)
18 Green .050IN(1.27MM)
20 Pink .036IN(.91MM)
21 Purple .033IN(.83MM)
22 Blue .027IN(.70MM)
23 Orange .025IN(.63MM)
25 Red .020IN(.53MM)
27 White .016IN(.42MM)
FULLY IMMUNIZED CHILD (REVISED IN 1996)
A child who has received the following vaccines
• 1 BCG, 3 DPT, 3 OPV, 3 Hep B, 1 MV
• At the right intervals
• Before reaching 12 months of age
Dosage, route & site of administration
Vaccine Dose Route of adm. Site of adm.
BCG Infants 0.05 ml Intrademal Deltoid region right arm
OPV 2 drops Oral Mouth
Hep B 0.5 ml Intramuscular Upper outer portion thigh
DPT 0.5 mL Deep IM Upper outer portion thigh
Measles 0.5 ml Subcutaneous Outer part of the upper arm
TT 0.5 ml Intramuscular Deltoid region, upper arm
ROUTINE IMMUNIZATION SCHEDULE FOR INFANTS
Vaccine Min Age, 1st Dose No. of Doses Min Interval Bet. Doses Reason
BCG Birth, anytime 1 - BCG given early protects infants against TB meningitis infection from family members
OPV 6 weeks 3 4 weeks When given early increases of protection against polio
Hep B w/in 24 hrs of birth 3 6 weeks from 1st dose to 2nd dose, and; 8 weeks interval from 2nd dose to 3rd dose - Early start reduces chance of infection & becoming a carrier
- Eliminate HB before 2012( a western regional goal)
DPT 6 weeks 3 4 weeks Early start reduces chance of severe pertussis
Measles 9 months 1 - -At least 86% of measles cases can be prevented by immunizing at this age
-Eliminate measles by 2008
IMMUNIZATION SCHEDULE FOR MOTHERS
Vaccine Minimum interval Percent protection Duration of Protection
TT1 As early as possible during pregnancy
TT2 At least 4 weeks after TT1 80 % Infants protected from neonatal tetanus, 3 years protection for the mother against tetanus
TT3 At least 6 months after TT2 95% Infants protected from neonatal tetanus, 5 years protection for the mother against tetanus
TT4 At least 1 year after TT3 99% Infants protected from neonatal tetanus, 10 years protection for the mother against tetanus
TT5 At least year after TT4 99% Infants protected from neonatal tetanus, lifetime protection for the mother against tetanus
QUESTION:
If a woman received 3 doses of DPT during infancy, what will be her current TT immunization schedule?
A) TT1, previous 3 DPT doses not significant
B) TT2, 3 doses of DPT equals TT1
C) TT3, 3 doses of DPT equals TT1 & TT2
D) TT4, 3 doses of DPT equals 3 TT shots
ANSWER: C
DISCARD POINT OF OPV USING THE VVM
Constant Temperature, Day and Night Length of Time VVM Reaches “Discard Point”
At room temperature + 25C 8 days
At room temperature + 20C 20 days
At room temperature + 4C 180 days
At room temperature + 20C Over 2years
Proper stocking of Vaccines (refrigerator)
• Neatly arrange the vaccines (segregated by type)
• Domestic refrigerator
- Freezer compartment
- OPV, AMV
- Body
- BCG, DPT, Hep B, TT
• Modified refrigerator
- Freezer compartment
- Ice packs
- Body
Top - OPV, AMV
Middle –BCG,DPT, Hep B, TT, Diluent
Lower –Bottles/ ice packs with water
Most Sensitive to Heat
1. Oral Polio Vaccine (live attenuated)
2. Measles Vaccine (freezed dried)
Storage Temperature
-15 to -25 degrees Celsius ( at the freezer)
Least Sensitive to Heat
1. DPT
D- weakened toxin
P- killed bacteria
T- weakened toxin
2. HepBV
3. BCG- freezed dried
4. Tetanus Toxoid
Body of the Refrigerator
+2 to +8 Degrees Celsius
How to Maintain Cold Chain
Stocking of Vaccines in the Transport Box Vaccine Carrier
Make sure you have enough ice packs
Transport box – 24 pcs
Vaccine carrier – 4cs
Place OPV, AMV in contact with frozen ice packs
Wrap DPT, Hep B, TT with paper
Place BCG in between AMV, OPV and wrapped vaccines
WHAT TO DO WITH OPENED VIALS OF VACCINES?
I. Continue to use opened vials in the subsequent sessions if all these conditions are met:
1) Expiry date has not passed
2) Vaccines are stored appropriately (+2 to +8 C)
3) Sterile procedures have been fully observed
4) Opened vials has not been contaminated
NOTE:
Discard opened BCG and MV after 6 hours of reconstitution
Opened vials of DPT, Hep B, TT can still be used for 4 weeks provided condition 1-4 in the previous slide are met.
II. Discard an opened vial immediately if any of the following conditions apply:
2) Sterile procedures have not been fully observed
3) + Suspicion of contamination of the opened vial
4) + Visible evidence of contamination (e.g, change in appearance or presence of floating particles)
1) If the label has come off, or
2) If the VVM has reached discard point
a) The inner square matches, or
b) is darker than the circle
3) Reconstituted vaccines (BCG, AMV) after 6 hours of reconstitution
What is reconstitution?
To restore the original state by adding water; To build up again by putting back together the original pieces.
What is a diluent?
An inert substance that dilutes the strength of a solution or mixture.
What s thermal shock?
It is the process of damage to the vaccine resulting from the use of diluent that is at too high a temperature (above +8C).
It results in the death of some or all of the essential live organisms in the vaccine.
HOW TO READ A VACCINE VIAL MONITOR
Use the vaccine if:
the inner square is lighter than the outer circle. If the expiry date has not passed, use it.
as time passes the inner square is still lighter than outer circle.
Do not use the vaccine:
• Discard point: the color of the inner square matches that of the outer circle
• Beyond the discard point: Inner Square is darker than the out circle.
POINTS TO REMEMBER:
• Only diluent supplied by the manufacture, specific for the vaccine, should be used. No other diluent may be used
• Distilled water for injection should NOT be used as a vaccine diluent.
• Oral vaccine diluents should never be injected
• T ensure the correct quantities are available, diluents must be shipped and distributed together with the vaccine vials that it will be used to reconstitute
DURING RECONSTITUTION PROCESS:
• Only the diluent supplied by the manufacturer should be used to reconstitute a freeze-dried vaccine.
• A sterile needle and sterile syringe must be used for each vial for adding the diluent to the powder in a single vial or ampoule of freeze dried vaccine
• Special caret be taken in opening ampules to avoid loss of the dry vaccine
VACCINATORS AND STORE KEEPER SHOULD ALWAYS:
- Include diluents in stock control and ensure adequate supplies.
- Check that the vaccines have been supplied with the right diluents. If any error is noted, the vaccine should not be used and the supervisor must be notified immediately.
- Use only the diluent that is indicated for each type of vaccine and manufacturer
- Ensure the volume of diluent
- Ensure no other medication
- Reconstituted vaccine should be kept on ice to preserve its potency
- A sterile needle and sterile syringe must be used for each separate dose of reconstituted vaccine drawn from the vial
- The reconstituted vaccine must be kept cool and any remaining liquid must be discarded after 6 hours
SIZES OF SYRINGE AND NEEDLE TO USE DURING VACCINATION
DPT,MV and TT 2-3 ml syringe
25/30 mm
23/25 gauge needle
BCG 1 ml tuberculin syringe
10mm 26 gauge needle
In mixing vaccine 5 or 10 ml syringe w/ 18 gauge needle
PROPER WAYS OF HANDLING SYRINGES AND NEEDLE
Disposal of used syringes and needles
- Immediately after use
- Do not recap the needle
- Place them in a safety collector box
Disposal options:
- Burn in pit, bury
- Collect and incinerate
Absolute contradictions to immunization:
- BCG to baby born from a mother with AIDS
- DPT2 and DPT3 to a child who develops convulsion within 3 days of giving DPT
- Infants and children with active neurologic disease
Relatively contraindication
- Any illness which warrants admission to the hospital
“FIRST EXPIRY AND FIRST OUT’ (FEFO)
- A FEFO vaccine system is practiced to assure that all vaccines are utilized before its expiry date. Proper arrangement of vaccine and / or labeling of expiry dates are done to identify those close to expiring.
- Vaccine temps monitored twice a day (early in the morning and in the afternoon) in all health facilities and plotted to monitor break in the cold chain
Sub centre: Primary health center Community health center
Level of care 1 1 2
Population (plain) 5,000 30,000 1,20,000
population(hill) 3,000 20,000 80,000
Numbers of staff 3 15 30
Maintenance authority Central government State government State government
Population norms:
Population:
1 doctor 3500
1 nurse 5000
1HW /male -female 5000
1 pharmacist 10,000
1 lab technician 10,000
1 train birth assistant 1000
1 ASHA worker 1000
1 village health guide 1000
1 angan – vadi worker 400-800 [Show Less]