Lecture 4

Future changes in the Saudi Health System Strategy Health System in Saudi Arabia Future changes in the Saudi Health System Strategy Proposed Health Reforms 1] Sectoral coordination: (National Health Services Council ) 2] Health manpower 1] Sectoral coordination:1- Coordinating and integrating all health system elements in the kingdom including the private sector. 2- Ensuring optimal utilization of health facilities and available resources in the Kingdom. 3- Selecting adequate alternatives for the operation of hospitals and financing health care services. 4- Developing specific criteria for the establishment of new health facilities. 5- Ensuring regional balance regarding health care services .6- Selecting adequate health insurance alternatives. 7- Conducting health services studies and research at the national level. 2] Health manpower: 1- Encourage private medical and health colleges. 2- Encourage hospitals to establish their own training centers. 3- Enlarge the base of medical postgraduate studies. 4- Strengthen the role of the Saudi Commission for Health Specialties 3] Financing health care: 1- The application of The cooperative health insurance system. 2- Encouragement of the private sector to undertake a greater role in financing, construction and management of health facilities. 3- Better coordination and integration between government health agencies   (Labor Force Council ) 3] Financing health care

Future changes in the Saudi Health System Strategy Health System in Saudi Arabia Future changes in the Saudi Health System Strategy Proposed Health Reforms 4] The function of the Ministry of Health 5] Relevant Data and Statistics 6] Improve the Pharmaceutical Sector 4] The function of the Ministry of Health: 1- Develop and supervise enforcement of regulations and control rules. 2- Continue to provide public health services and primary health care services. 3- Ensure that the disadvantaged categories have continued access to adequate health care. 4- Establish and supervise the implementation of strategies and general plans. 5] Relevant Data and Statistics: All Sectors should: 1- Promote evidence based policy-making. 2- Promote efficient resource allocation by combining/coordinating the multiple public delivery systems and the private sector. 3- Assure quality by developing accreditation and other quality standards for facilities and manpower. 6] Improve the Pharmaceutical Sector: 1- The development of a comprehensive list of essential medicines. 2- Encourage the use of substitute or generic medicine. 3- Offer more training to physicians on logical use of medicines. 4- Develop medicine-pricing system. 5- Effective systems for storage and distribution.  

Future changes in the Saudi Health System Strategy Health System in Saudi Arabia Future changes in the Saudi Health System Strategy Proposed Health Reforms 1] Sectoral coordination: (National Health Services Council ) 1- Coordinating and integrating all health system elements 2- Optimal utilization of facilities and resources 3- Alternatives for the operation and financing services. 4- Specific criteria for new health facilities. 5- Ensuring regional balance 6- Selecting adequate health insurance alternatives. 7- Health services studies and research. 4] The function of the Ministry of Health: 1- Develop and supervise enforcement of regulations and control rules. 2- Continue to provide public health services and primary health care services. 3- Ensure that the disadvantaged categories have continued access to adequate health care. 4- Establish and supervise the implementation of strategies and general plans. 5] Relevant Data and Statistics: All Sectors should: 1- Promote evidence based policy-making. 2- Promote efficient resource allocation by combining/coordinating the multiple public delivery systems and the private sector. 3- Assure quality by developing accreditation and other quality standards for facilities and manpower. 6] Improve the Pharmaceutical Sector: 1- The development of a comprehensive list of essential medicines. 2- Encourage the use of substitute or generic medicine. 3- Offer more training to physicians on logical use of medicines. 4- Develop medicine-pricing system. 5- Effective systems for storage and distribution.  

Future changes in the Saudi Health System Strategy Health System in Saudi Arabia Future changes in the Saudi Health System Strategy Proposed Health Reforms 2] Health manpower (Labor Force Council ) 1- Private colleges. 2- Hospitals own training centers. 3- Expand on the postgraduate 4- Strengthen the role of the SCFHS 3] Financing health care 4] The function of the Ministry of Health: 1- Develop and supervise enforcement of regulations and control rules. 2- Continue to provide public health services and primary health care services. 3- Ensure that the disadvantaged categories have continued access to adequate health care. 4- Establish and supervise the implementation of strategies and general plans. 5] Relevant Data and Statistics: All Sectors should: 1- Promote evidence based policy-making. 2- Promote efficient resource allocation by combining/coordinating the multiple public delivery systems and the private sector. 3- Assure quality by developing accreditation and other quality standards for facilities and manpower. 6] Improve the Pharmaceutical Sector: 1- The development of a comprehensive list of essential medicines. 2- Encourage the use of substitute or generic medicine. 3- Offer more training to physicians on logical use of medicines. 4- Develop medicine-pricing system. 5- Effective systems for storage and distribution.   1- Cooperative HIS. 2- Private sector :financing, construction and management 3- Better coordination and integration between government health agencies

Future changes in the Saudi Health System Strategy Health System in Saudi Arabia Future changes in the Saudi Health System Strategy Proposed Health Reforms 4] The function of the Ministry of Health 1- Regulations and control rules. 2- Public health services and PHC 3- Disadvantaged access to health care. 4- Strategies and general plans.. 5] Relevant Data and Statistics 4] The function of the Ministry of Health: 1- Develop and supervise enforcement of regulations and control rules. 2- Continue to provide public health services and primary health care services. 3- Ensure that the disadvantaged categories have continued access to adequate health care. 4- Establish and supervise the implementation of strategies and general plans. 5] Relevant Data and Statistics: All Sectors should: 1- Promote evidence based policy-making. 2- Promote efficient resource allocation by combining/coordinating the multiple public delivery systems and the private sector. 3- Assure quality by developing accreditation and other quality standards for facilities and manpower. 6] Improve the Pharmaceutical Sector: 1- The development of a comprehensive list of essential medicines. 2- Encourage the use of substitute or generic medicine. 3- Offer more training to physicians on logical use of medicines. 4- Develop medicine-pricing system. 5- Effective systems for storage and distribution.   All Sectors should: 1- Promote evidence based policy-making. 2- Combining/coordinating the multiple systems and the private. 3- Quality : facilities and manpower.

Future changes in the Saudi Health System Strategy Health System in Saudi Arabia Future changes in the Saudi Health System Strategy Proposed Health Reforms 6] Improve the Pharmaceutical Sector 1- List of essential medicines. 2- Substitute or generic medicine. 3- Training physicians on logical use of medicines 4- Develop medicine-pricing system 5- Storage and distribution. 4] The function of the Ministry of Health: 1- Develop and supervise enforcement of regulations and control rules. 2- Continue to provide public health services and primary health care services. 3- Ensure that the disadvantaged categories have continued access to adequate health care. 4- Establish and supervise the implementation of strategies and general plans. 5] Relevant Data and Statistics: All Sectors should: 1- Promote evidence based policy-making. 2- Promote efficient resource allocation by combining/coordinating the multiple public delivery systems and the private sector. 3- Assure quality by developing accreditation and other quality standards for facilities and manpower. 6] Improve the Pharmaceutical Sector: 1- The development of a comprehensive list of essential medicines. 2- Encourage the use of substitute or generic medicine. 3- Offer more training to physicians on logical use of medicines. 4- Develop medicine-pricing system. 5- Effective systems for storage and distribution.  

Future changes in the Saudi Health System Strategy Health System in Saudi Arabia Future changes in the Saudi Health System Strategy The function of the Ministry of Health Develop and supervise enforcement of regulations and control rules Continue to provide public health services and primary health care services The 10 Essential Public Health Services:1. Monitor health status to identify and solve community health problems. 2. Diagnose and investigate health problems and health hazards in the community. 3. Inform, educate, and empower people about health issues. 4. Mobilize community partnerships and action to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Ensure competent public and personal health care workforces. 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. 10. Research for new insights and innovative solutions to health problems. Ensure that the disadvantaged categories have continued access to adequate health care Establish and supervise the implementation of strategies and general plans.

Health System in Saudi Arabia The 10 Essential Public Health Services: 1. Monitor health status to identify and solve community health problems. 2. Diagnose and investigate health problems and health hazards in the community. 3. Inform, educate, and empower people about health issues. 4. Mobilize community partnerships and action to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Ensure competent public and personal health care workforces. 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. 10. Research for new insights and innovative solutions to health problems. The 10 Essential Public Health Services:1. Monitor health status to identify and solve community health problems. 2. Diagnose and investigate health problems and health hazards in the community. 3. Inform, educate, and empower people about health issues. 4. Mobilize community partnerships and action to identify and solve health problems. 5. Develop policies and plans that support individual and community health efforts. 6. Enforce laws and regulations that protect health and ensure safety. 7. Link people to needed personal health services and assure the provision of health care when otherwise unavailable. 8. Ensure competent public and personal health care workforces. 9. Evaluate effectiveness, accessibility, and quality of personal and population-based health services. 10. Research for new insights and innovative solutions to health problems.

Lecture 5

Health Promotion or health education Health Promotion is broader than Health Education “Health Promotion is any combination of educational, organizational, economic and environmental support for behaviors and conditions of living conducive to health .”

Health Promotion or health education Health Promotion is used to encompass various activities eg. : Behavior & lifestyle, Preventive health services, Health protection directed at environment, Health related public policy, Economic & regulatory measures. (Health Education is the primary and dominant measure in Health Promotion ).

Principles of health education Interest. Participation. Proceed from known to unknown. Comprehension. Reinforcement by repetition. Motivation Motivation: i.e. awakening the desire to know and learn:- Primary motives, e.g. inborn desires , hunger, sex.- Secondary motives, e.g. desires created by incentives such as praise, love, recognition, competition.

Principles of health education 7. Learning by doing “ If I hear, I forget If I see, I remember If I do, I know”. 8. Good human relations 9. Leaders

Communication Health Education Communicator: the person or the team who give the message (Educator). Message: the contents (materials) of health education Channel: method of carrying the message Audience: the receivers (users or targets) of the message

Good communication technique Health Education Good communication technique Source credibility. Clear message. Good channel: individual, group & mass education. Receiver: ready, interested, not occupied. Feed back. Observe non-verbal cues. Active listing. Establishing good relationship.

Personnel of health services. Medical students, nursing & social work. Health Education Educator Personnel of health services. Medical students, nursing & social work. School personnel. Community leaders & the influential. Requirements: Personality: popular, influential and interested in work. Efficiently trained and prepared . Must show good example.

Message Health Education What information to be communicated. Simple, at the level of understanding. Culturally accepted. Interesting. Meet a felt need. Free of technical jargon. Use audiovisual aids.

Where Does Health Education Happen? Everywhere! Schools Communities Worksites Health Care Sites Homes Consumer Marketplace

Practice Health Education 1-Individual Face to face Education through spoken word. A- Occasions of health appraisal. B- Home visits Nurses Health visitor Social workers

Practice Health Education 2-Group a. Lessons and lectures in schools. Lectures in work places e.g. factories. Demonstration and training 3- Mass media. a. Broadcasting: radio & TV. b. Written word: newspapers, posters, booklets. c. Others e.g. theaters.

Major Variables in Behavior Change Health Education Major Variables in Behavior Change Thoughts and ideas inside a person’s mind have significant influence on an individual’s health behaviors. These variables interact with social and environmental factors and it is the synergy among all these influences that operate on behavior. Knowledge: An intellectual acquaintance with facts, truth, or principles gained by sight, experience, or report.

Major Variables in Behavior Change Health Education Major Variables in Behavior Change Skills : The ability to do something well, arising from talent, training, or practice. Belief : Acceptance of or confidence in an alleged fact or body of facts as true or right without positive knowledge or proof; a perceived truth. Attitude: Manner, disposition, feeling, or position towards a person or thing. Values: Ideas, ideals, customs that arouse an emotional response for or against them.

Lecture 6

Serious Mental Illness MENTAL HEALTH Classification and types of Mental Illness jhjkkjkljlkjljll Serious Mental Illness Schizophrenia Criteria for Schizophrenia Delusions Hallucinations Disorganized Speech Disorganized Behavior jhjkkjkljlkjljll Negative Symptoms Flat Affect Lack of Motivation Social/Occupational Dysfunction

Serious Mental Illness MENTAL HEALTH Classification and types of Mental Illness jhjkkjkljlkjljll Serious Mental Illness Major Depression Criteria for Major Depression Depressed Mood Diminished Interest Weight Loss or Gain Sleep Disturbance Restlessness or Being Slowed Down Fatigue & Loss of Energy Thoughts of Death jhjkkjkljlkjljll

Serious Mental Illness MENTAL HEALTH Classification and types of Mental Illness jhjkkjkljlkjljll Serious Mental Illness Major Depression Criteria for Major Depression Feelings of Worthlessness or Excessive Guilt Difficulty Thinking & Concentrating Symptoms Occur Almost Every Day Significant Distress & Impairment jhjkkjkljlkjljll

Serious Mental Illness MENTAL HEALTH Classification and types of Mental Illness jhjkkjkljlkjljll Serious Mental Illness Bipolar Disorder Criteria for Bipolar Disorder Manic Episodes Elevated mood Grandiosity Decreased need for sleep Talkativeness Racing thoughts jhjkkjkljlkjljll

Serious Mental Illness MENTAL HEALTH Classification and types of Mental Illness jhjkkjkljlkjljll Serious Mental Illness Bipolar Disorder Criteria for Bipolar Disorder Marked Impairment Occupation Social relationships jhjkkjkljlkjljll May Alternate with Depressive Episodes

Lecture 7

Components of school Environment: SCHOOL HEALTH zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Components of school Environment: zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz 1. Site and area: - easily reached. - Located in quiet area. - 10 – 15 square m. / pupil 2. School building: - Damp, fire and rat proof. - 2 – 3 floors - > 1 stair case. zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz - Governmental design ( E, T, L types ). zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Components of school Environment: zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz SCHOOL HEALTH Components of school Environment: zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz 3. Class rooms: - Rectangular 6x8 = 48 m2 - 1.0-1.5m2 of floor area for primary school pupils, - 1.5-2.0m2 for intermediate & high school students. - Windows on left side - Allow best illumination. - White ceiling. zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Components of school Environment: zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz SCHOOL HEALTH Components of school Environment: zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz 4. School furniture: - Suitably suspended writing board, - Height & slope of desks ( 150 angle ), - Size of seats in relation to students age & built, - Distance between columns of desks ( 60 cm.). zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Components of school Environment: SCHOOL HEALTH zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Components of school Environment: zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz 5. Kitchen and Dining: - Proper illumination & ventilation, - Rat & insect proof, - Washable walls & floors, - Cold & hot water taps, - Refrigerators , zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz - Sanitary refuse baskets , - > one door - Proper control of food handlers. zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Components of school Environment: zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz SCHOOL HEALTH Components of school Environment: zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz 6. Water, Sewage and refuse disposal: zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz - Drinking fountains, - one tap / 40 students, - one toilet / 30 students, - Soap & ? Paper towels zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Health Appraisal Objectives Case-finding, specially of unapparent zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz SCHOOL HEALTH Health Appraisal zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Objectives Case-finding, specially of unapparent disease , Assessment of health status of school children, Baseline for follow-up of health status. Health education and guidance of students, zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Health Appraisal Components 1- comprehensive medical examination zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz SCHOOL HEALTH Health Appraisal zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Components 1- comprehensive medical examination 2- Screening tests, zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz 3- Clinical (curative) service 4- Survey studies. zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Health Appraisal Components 1- comprehensive medical examination SCHOOL HEALTH zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Health Appraisal zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Components 1- comprehensive medical examination zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Beginning of each level Entry Intermediate Secondary zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Health Appraisal Components 2. Screening Tests: zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz SCHOOL HEALTH Health Appraisal zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Components 2. Screening Tests: They are simple tests which can be carried out frequently : - obesity (BMI) - visual acuity, - acuity of hearing, - IQ testing, and - dental examination. zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Health Appraisal Components 3. Clinical Service: School health units, zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz SCHOOL HEALTH Health Appraisal zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Components 3. Clinical Service: School health units, referrals to specialized clinics, referrals to hospitals for diagnosis and treatment . some cases may need specialized diagnosis or/and management. zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Health Appraisal Components 4. Survey Studies: SCHOOL HEALTH zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Health Appraisal zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Components 4. Survey Studies: Occasionally required, specially when precise data are not available zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz nutritional deficiency parasitic diseases handicapping conditions zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

May be congenital or acquired. SCHOOL HEALTH zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Health Appraisal zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Components Handicapping conditions: May be congenital or acquired. Children with minor or mild cases of disability can attend regular schools, Severe forms (e.g. the deaf, blind, or mentally retarded) would attend special institutes. zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Some forms in regular school: zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz SCHOOL HEALTH Health Appraisal zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Components Handicapping conditions: Some forms in regular school: Heart disease Musculoskeletal deformities Impaired vision Impaired hearing zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz 1-Heart disease: Rheumatic valvular disease is the most important. 2-Musculoskeletal deformities: mild paralytic poliomyelitis, and healed rickets. 3-Impaired vision: mainly due to errors of refraction, or may be corneal opacity. 4-Impaired hearing: neglected chronic otitis media, ear injury by foreign body, and occasionally ototoxic drugs and complicated meningitis. zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Health Appraisal Components School Health Record zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Health Appraisal zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Components School Health Record Each child should have his own health record Contents of Record: - Personal and social data. - Results of health appraisal. - Immunizations/date/age. - Any morbidity, and management data. zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Health Appraisal Components School Health Record zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz SCHOOL HEALTH Health Appraisal zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Components School Health Record Value of Health Record: For reference whenever health data are needed; (e.g. past medical history to assist diagnosis of existing disease.) Allows follow-up of chronic disease. Collecting statistical data and indices of school children, ( for future planning and evaluation of health services). zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Health Appraisal Role of Teacher: - Spotting suspected cases zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz SCHOOL HEALTH Health Appraisal zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Role of Teacher: - Spotting suspected cases through supervision of the students in the classrooms. Participation in health education program. Supporting mental health promotion. - First aid zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Health Appraisal Role of School Health Physician : Health appraisal. zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz SCHOOL HEALTH Health Appraisal zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz Role of School Health Physician : Health appraisal. First aid and emergency service. Participation in prevention and control of communicable diseases. Inspection of the school environment. Participation in health education. Supervising preparation of statistical indices and health reports. zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

Lecture 7

MCH PERIODS OF MATERNAL CARE: I. Before pregnancy: gy I. Before pregnancy: (> 15 yrs.) for physical and psychological preparation to bear responsibility. A) Nutrition: The nutritional status strongly influences gy Foetal growth Birth weight (newborn) Nutrition during infancy

MCH PERIODS OF MATERNAL CARE: Maternal Abs passive immunization gy I. Before pregnancy: B) Infections: Maternal Abs passive immunization gy Maternal immunization against rubella protects the outcome of pregnancy. Tuberculosis severely affects nutritional status of mothers

MCH PERIODS OF MATERNAL CARE: (Antenatal Care) II. During pregnancy: gy Aims:- gy Promote, protect and maintain health. Detect high risk. Relieve fear and anxiety. Health Education: ( elements of child care, nutrition, hygiene …… etc)

- Affects newborn infant MCH PERIODS OF MATERNAL CARE: gy II. During pregnancy: A) Nutrition: - Well nourished preg. good birth wt. - Anaemia during pregnancy gy - Common - Affects newborn infant - Preventable

MCH PERIODS OF MATERNAL CARE: B) Infection: II. During pregnancy: gy II. During pregnancy: B) Infection: - Rubella Congenital deformities Abortion gy - Syphilis IUFD Stillbirth - Malaria IUFD Low birth wt - UTI Amnionitis IUFD Placentitis Low birth wt

MCH PERIODS OF MATERNAL CARE: II. During pregnancy: gy II. During pregnancy: C) Chronic Diseases Stillbirth Abortion Low birth weight High perinatal mortality gy D) Smoking E) Heavy work and stress in late pregnancy leads to low birth wt F) Psychological stress

MCH PERIODS OF MATERNAL CARE: gy II. During pregnancy: Good ANTENATAL care can provide for all of this and more. gy (key family practices) First visit……… Beyond 16 weeks Second visit….. Between 24 and 28 weeks key family practices: Pregnants should receive the recommended four antenatal visits, recommended doses of tetanus toxoid vaccination, and is supported by family and community in seeking appropriate care, especially at the time of delivery and during the postpartum/breastfeeding period. Third visit……... Between 30 and 32 weeks Fourth visit…… Between 36 and 40 weeks

MCH PERIODS OF MATERNAL CARE: (Intra-natal Care) III. During labour : gy AIMS: Asepsis Minimum injury to mother and newborn. gy Preparedness to deal with complications. (prolonged labor – ante partum hemorrhage – convulsions ) Care of baby at delivery.

MCH PERIODS OF MATERNAL CARE: b) Care during labour gy III. During labour : a) Antenatal Care (Risk assessment) b) Care during labour - Infection ophthalmia neonatorum gy tetanus neonatorum - Bleeding Perinatal asphyxia or neonatal asphyxia is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain. It results most commonly from a drop in maternal blood pressure or some other substantial interference with blood flow to the infant's brain during delivery. - Trauma Mother Newborn - Asphyxia

MCH PERIODS OF MATERNAL CARE: IV. Post-Natal Care Aims: gy Aims: Restoration of health. Check adequacy of breast feeding. Provide basic health education. (Evaluate effect of antenatal Care)?! gy V. Post lactation: spacing?

MCH THE RIGHTS OF WOMEN ! PRIMARY HEALTH CARE gy SAFE MOTHERHOOD FP ANC SD EOC gy BASIC MATERNITY CARE FP: Family planning, ANC: Antenatal care, SD : Safe delivery, EOC: Emergency obstetrics care PRIMARY HEALTH CARE E Q U I T Y F O R W O M E N

MCH Maternal Mortality Malnutrition Anaemia Pregnancy Infection gy Malnutrition Anaemia Infection Pregnancy gy Bleeding Infection Labour Bleeding Infection Postpartum Lack of awareness Lack of health services Lack of utilization of health services

MCH Child Welfare Infancy and Early Childhood: Rapid growth gy Infancy and Early Childhood: Rapid growth - Period of Development Learning gy Infection - Vulnerability Malnutrition Environmental hazards - Infants: 4% of population: 25% of deaths - “1- 4” years: 13% of pop: 20% of deaths

MCH Child Welfare Child Care Program Objectives of child care: gy Child Care Program Objectives of child care: Safe entry to life Reduction in perinatal and neonatal deaths Reaching a healthy adulthood Promotion, protection and maintenance of health (Overcome genetic factor)? gy

MCH Child Welfare Child Care Program gy Child Care Program 1. Prenatal Care ( Ideally before conception ) Parental guidance and discussion involving: Genetics Family history Feeding plans (Br. F) Home preparation for baby care Answering questions gy

MCH Child Welfare Child Care Program gy Child Care Program 1. Prenatal Care ( Ideally before conception ) Parental guidance and discussion involving: Obstetric gy - Work of mothers - Nutrition - Smoking - Drugs

MCH Child Welfare Child Care Program 2. Infant Care - Early evaluation gy Child Care Program 2. Infant Care - Early evaluation - Encourage breast feeding - Face parents’ concern - Developmental problems - Anxiety - Sleep - Overfeeding - Active immunization - Monitoring of growth and development gy key family practices: 1.Exclusive breastfeeding(six months)2. Starting complementary feeding at about six months. 3. Provide micronutrients. 4. Full course of immunizations (EPI). 5. In malaria-endemic areas(Insecticide-Treated BN). 6. Continue to feed and offer more fluids to children when they are sick. 7. Appropriate home treatment for infections. 8. Seek appropriate health care when needed.

IMCI is an integrated approach to child health that focuses on the well-being of the whole child. IMCI aims to reduce death, illness and disability, and to promote improved growth and development among children under five years of age. IMCI includes both preventive and curative elements that are implemented by families and communities as well as by health facilities.

Mortality in and around infancy VERY IMPORTANT MCH Mortality in and around infancy gy I N F A N T gy N E O N A T E FOETUS PERINATAL PERIOD 28th week of gestation Birth 7 Days 28 Days 1 Year

Mortality in and around infancy MCH Mortality in and around infancy gy Infant Mortality Post-neonatal death Neonatal death Early neo-natal death Late neonatal death gy Perinatal death Still birth 28th week of gestation Birth 7 Days 28 Days 1 Year

MCH Child Welfare Child Care Program 3. Second year of life gy Child Care Program 3. Second year of life - Rapid development - Increased parental concern 4. Pre-school years (< 5 years) - Accident prevention 5. School years gy key family practices: 1. In malaria-endemic areas(Insecticide-Treated BN). 2. Promote appropriate physical and affective interactions. 3. Continue to feed and offer more fluids to children when they are sick. 4. Appropriate home treatment for infections. 5. Seek appropriate health care when needed 6. Prevent and provide treatment for child injuries. 7. Prevent and take action for child abuse. 8. 6. Adolescent Care - Rapid physical growth - Marked emotional changes - Personality development

CONCLUSION gy Antenatal care is the key to modification of outcome to the mother and the newborn Prevention and management of bleeding and infection during and after labour gy Child care starts ideally before conception Integrated Management of Childhood Illness (IMCI) Addressing mortality in and around infancy