CFHC

Rossi Sanusi (http://rossisanusi.wordpress.com)

13 September 2014

CFHC• Community & Family Health Care

(Upaya Kesehatan Komunitas & Keluarga).

• HC according to the National Health System(Sistem Kesehatan Nasional/SKN):

Individual Health Care (Upaya Kesehatan Perorangan/UKP) Public Health Care(Upaya Kesehatan Masyarakat/UKM)

Individual HC

Activities:• Case Detection (Dx).• Intervention (Rx) –

Emergency & Standard.

Public HC

Activities:• PH Surveillance (S).• Response (R) –

Rapid & Planned.

Purpose: Disease prevention through management of high risk, sub-clinical & clinical cases.

Purpose: • Disease prevention through management of pathogens & environments.• Indiv HC facilitation.

Natural History of Diseases *

Cured/Death/ Disabled

Clinical onset

Disease Onset

High Risk Onset

Primary Prevention

Dx & Rx High Risk

Cases

Secondary Prevention

Dx & Rx Sub-clinical

Cases

Tertiary Prevention

Dx & Rx Clinical

Cases

Primordial Prevention

Control of Pathogens &

Environments

* NHD = Process of individual case for Indiv HC = Sets of individual cases for Public HC

Rehabilita-tion

Dx & Rx Rehabilita-tion Cases

5

“Case” = disease event = ecological imbalance

Host

Envi-ronmen

t

Pathogen

ClinicalSub-clinicalHigh Risk

Biological (Vectors, Carriers)

Geological,Metereological,

Social

Biological (Bacteria, Viruses, parasites)

Phyisical, Chemical,Psychological

Health Ecology

Branch of science dealing with the relationship of humans (as hosts) dan pathogens (direct causes of diseases) and their environments.

oikos (Gr) = house, dwelling place, habitation = environment.

Source: http://www.etymonline.com/index.php?allowed_in_frame=0&search=ecology&searchmode=none

Individual HC – Public HC Relationship

Case distribution according to place, time & population characteristics

Case rates

Case Dx & Rx

Implementation

Evaluation

(Re-)allocation of Resources &

Techn Guidance, Coordination

Allocation of Resources &

Techn Guidance, Advocation,

PoliciesData

CollectionData

ProcessingData

Interpretation

Planning

Rapid Response

Planned Response

Your Role?

• Use the 3 diagrams to identify Individual & Public HC activities/programs of priority diseases in your assigned community.

• Monitor and evaluate Individual & Public HC programs/activities of priority diseases.

• Use the 3 diagrams (NHD, Ecological Balance & Individual HC – Public HC

Relationship) to identify processes of priority diseases of individual members of the family you are assigned to.

Environments of each Family Member

Family

School---

Priority DiseasesCommunicable

• Immunization preventable diseases

• AFP

• Zoonoses (e.g., malaria, DF & DHF, leptospirosis, filariasis)

• Tuberculosis

• Diarrhoea, typhoid, helminthiasis & other intestinal diseases

• Leprocy• STD• Pneumonia

Noncommunicable

• Hypertension, stroke & CHD

• Diabetes mellitus• Neoplasms• CPOD• Mental disorders• Injuries & accidents• Nutrition disorders• LBW, Obstetric bleeding• Geriatric diseases• Drug & substance

abuse

Emerging Diseases

• New diseases (AIDS, Ebola, SARS, MERS)• Re-emerging diseases (Frambusia)• Increased virulence (Infl H5N1, H1N1)• Drug resistant (Malaria, TB)

Example: Low Birth Weight

LBW a priority disease?

Prevalence: +/- 15%

4. Peningkatan Resiko Penyakit Menahun pada waktu dewasa (penyakit jantung iskemik, hipertensi, stroke, penyakit paru obstruktif, dan diabetes).

Penelusuran lebih lanjut: The foetal origins of disease

hypotheses (The Barker Hypothesis, The Foetal Programming Hypothesis)

Primary Prevention of LBW

• High Risk Cases: Fertile Age Women (FAW).

• Dx & Rx of FAW with Internal Risk Factors - factors that

increases the susceptibility of hosts to pathogens.

External Risk Factors - factors that increases the exposure of

hosts to pathogens.

Internal RFs

Dx

• Nutritional Status: BMI <18.5; micro-nutrients deficiency.

• Anthropometric St: Height <145cm

• Reproduction St: “4 Toos”

• Immunity St: Low

Rx

• Supplementary feeding; micro-nutrients.

• -

• FP

• Immunization

External RFs

Dx

• Biological Env.: Contact persons (TB, STD), Vectors (Malaria).

• Physical Env. (e.g., worms, TB, Malaria).

• Social Env. (life style, income, KAP)

Rx

• Treat contact persons, vector control.

• Hygiene & sanitation

of housing, work place.

• Life style modification, income generating, education.

• Program Evaluation

Output: Number (%) of FAW covered.

Outcome: Distribution of pregnant women with

IUGR (Intra Uterine Growth Retardation).

Mean or Rate of pregnant women with IUGR.

Secondary Prevention of LBW

• Sub-clinical cases: Pregnant women.

• Dx: IUGR.

• Rx: Supplementary feeding, micronutrients, treatment of infections, education.

• Program Evaluation:

Output: Number (%) of pregnant women covered.

Outcome: Distribution of pregnant women giving birth

with LBW babies.Mean or Rate of pregnant women giving

birth with LBW babies.

Tertiary Prevention of LBW

• Clinical cases: Women giving birth and their LBW babies.

• Dx: LBW (BW < 2000gr).

• Rx: LBW case management.

• Program Evaluation:

Output: Number (%) pregnant women with IUGR covered.

Outcome: Distribution of LBW babies who died.

Mean or Rate of LBW babies who died.

• Primordial prevention of LBW?

• Rehabilitation of LBW babies?

HIV/AIDSAre there family members who have the disease or are at

risk?

MARPs (Most at Risk Populations): • Adolescents• IDUs (injection drug users)• MLM (men who like men)• Incarcerated men• Mobile men• Direct CSWs (commercial sex workers)• Indirect CSWs• Transsexuals

If “Yes”1. Use the NHD, Ecological Balance & Individual

HC – Public HC Relationship diagrams to identify processes of HIV/AIDS of those individual family members.

2. Use the 3 diagrams to identify HIV/AIDS Individual & Public HC activities/programs.

3. Monitor and evaluate HIV/AIDS Individual & Public HC programs/activities.