C F HC

1. CFHC Rossi Sanusi (http://rossisanusi.wordpress.com) 13 September 2014

2. 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)

3. Purpose:Disease prevention through management of high risk, sub-clinical & clinical cases. • Purpose: • Disease prevention through management of pathogens & environments. • Indiv HC facilitation. Individual HC Public HC Activities: PH Surveillance (S). Response (R) – Rapid & Planned. Activities: • Case Detection (Dx). • Intervention (Rx) – Emergency & Standard.

4. Natural History of Diseases * High Risk Onset Disease Onset Clinical onset Cured/Death/ Disabled Primordial Prevention Control of Pathogens& Environments Primary Prevention Dx & Rx High Risk Cases Secondary Prevention Dx & Rx Sub-clinical Cases Tertiary Prevention Dx & Rx Clinical Cases Rehabilita-tion Dx & Rx Rehabilita-tion Cases * NHD= Process of individual case for Indiv HC= Sets of individual cases for Public HC

5. “Case” = disease event = ecological imbalance Clinical Sub-clinical High Risk Biological (Vectors, Carriers) Geological, Metereological, Social Biological (Bacteria, Viruses, parasites) Phyisical, Chemical, Psychological

6. 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

7. Individual HC – Public HC Relationship Case distribution according to place, time & population characteristics (Re-)allocation of Resources & Techn Guidance, Coordination Implementation Rapid Response Case Dx & Rx Evaluation Planned Response Allocation of Resources & Techn Guidance, Advocation, Policies Planning Case rates Data Collection Data Processing Data Interpretation

10. Your Role? • 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. • 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.

11. Environments of each Family Member School ---     Family

12. Communicable 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 Priority Diseases

13. Emerging Diseases • New diseases (AIDS, Ebola, SARS, MERS) • Re-emerging diseases (Frambusia) • Increased virulence (InflH5N1, H1N1) • Drug resistant (Malaria, TB)

14. Example: Low Birth Weight LBW a priority disease? Prevalence: +/- 15%

15. PeningkatanResikoPenyakitMenahunpadawaktudewasa (penyakitjantungiskemik, hipertensi, stroke, penyakitparuobstruktif, dan diabetes). Penelusuranlebihlanjut: The foetal origins of disease hypotheses (The Barker Hypothesis, The Foetal Programming Hypothesis)

16. 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. ExternalRisk Factors - factors that increases the exposureof hosts to pathogens.

17. Internal RFs Dx Rx Supplementary feeding; micro-nutrients. - FP Immunization • Nutritional Status: BMI <18.5; micro-nutrients deficiency. • Anthropometric St: Height<145cm • Reproduction St: “4 Toos” • Immunity St: Low

18. External RFs Dx Rx Treat contact persons, vector control. Hygiene & sanitation of housing, work place. Life style modification, income generating, education. • Biological Env.: Contact persons(TB, STD), Vectors(Malaria). • Physical Env. (e.g., worms, TB, Malaria). • Social Env. (life style, income, KAP)

19. Program Evaluation Output:Number(%) of FAWcovered. Outcome: Distribution of pregnant women withIUGR (Intra Uterine Growth Retardation). MeanorRateof pregnant women with IUGR.

20. Secondary Prevention of LBW • Sub-clinical cases:Pregnant women. • Dx: IUGR. • Rx:Supplementary feeding, micronutrients, treatment of infections, education.

21. 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.

22. Tertiary Prevention of LBW • Clinical cases:Women giving birth and their LBW babies. • Dx:LBW (BW < 2000gr). • Rx:LBW case management.

23. Program Evaluation: Output:Number (%) pregnant women with IUGR covered. Outcome: Distribution of LBW babies who died. MeanorRate of LBW babies who died.

24. Primordial prevention of LBW? • Rehabilitation of LBW babies?

25. HIV/AIDS Are 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

26. If “Yes” • Use the NHD, Ecological Balance & Individual HC – Public HC Relationshipdiagrams to identify processes of HIV/AIDS of those individual family members. • Use the 3 diagrams to identify HIV/AIDS Individual & Public HC activities/programs. • Monitor and evaluate HIV/AIDS Individual & Public HC programs/activities.