1. Manual for
Day Care Centers
on Garantisadong Pambata

2. Contents
Impressum
Fit for School Inc. Disclaimer
Project Office
Mortola-Hayes Streets The inclusion of links and references does not entail recognition
Cagayan de Oro, Philippines or endorsement of information given under these links nor can
the publisher be held liable for any wrong information. No part of
© 2009 of the current edition: Verlagshaus Monsenstein und
this publication may be reproduced, stored in a retrieval system
Vannerdat OHG
Muenster - Germany or transmitted in any form or by any means without the written
www.mv-verlag.de permission of the publisher. The publication is distributed free of Foreword 3
Design by malzwei, Berlin, Germany
charge and commercial reproduction is prohibited. Fit for School
Printed by VJ Graphic Arts, Manila, Philippines
Inc. encourages using the manual widely in educational settings;
1. Handwashing 6
Text photocopying of the manual or parts of it for personal and
Bella Monse, Manuel Vallesteros, Lito Benitez, Tara Sering,
educational purpose are allowed with recognition of the source.
Wim van Palenstein and Roswitha Heinrich Weltzien
Requests for reprint and other inquiries should be directed to the
2. Toothbrushing 12
Photos Project Office of Fit for School Inc., Mortola-Hayes Streets, 9000
Ivan Sarenas, Bella Monse, Jana Gerold and Cagayan de Oro, Philippines, Tel/Fax 0063 (0)88 857 21 46, 3. Footwear 18
Roswitha Heinrich-Weltzien
info@fitforschool.ph.
Acknowledgements 4. Deworming 20
Fit for School acknowledges the input of Cromwell Bacareza, Dem- Recommended citation:
ocrito Figueroa Jr., Vicente Belizario and Rafael Oclarit
Fit for School Inc. (2009) Manual for the implementation of the
5. Roles & Responsibilities 26
essential health care program in day care centers. Fit
for School Inc., Cagayan de Oro City.
6. How to Create a Supportive Environment 34
ISBN 978-3-86582-966-5
7. Monitoring 42
Checklist for Day Care Workers 45
Bibliography 46
In partnership with

3. Foreword
If the wealth of a nation lies in the health of its people, cause of many harmful diseases and their potential
then it is wise to make health programs the national lifelong damaging effects. Garantisadong Pambata
priority. And if we are to invest our time, resources and works in partnership with local government units and
energies on solutions that benefit us in the long term, non-government organizations in implementing policies
rather than on quick remedies with fleeting effects, then designed to improve health care for children all over the
there is no more effective place to begin than with our country.
children.
My sincerest congratulations to the local government
But infectious diseases, such as worm infections, units, non-government organizations, foreign and local
"The Department of Health's Garantisadong Pambata program... diarrhea, the common cold, skin infections, as well as agencies and the Fit for School organization for a
supports health programs geared towards reducing childhood tooth decay, continue to afflict millions of Filipino program so vital to national wellbeing.
illnesses and deaths" children. The problem is especially glaring in places with
little access to proper health care and awareness of Mabuhay!
preventive measures that can stop these even before
they begin.
The Department of Health’s Garantisadong Pambata Francisco T. Duque III,MD, MSc
program, a campaign that supports health programs Secretary of Health
geared towards reducing childhood illnesses and deaths, Philippines
is proud to support Fit for School, a multi-sectoral effort
to instill healthy and hygienic habits in our children
during their formative years. Teaching our children basic
habits — such as daily handwashing with soap,
toothbrushing with fluoride, regular deworming and
wearing proper footwear as necessary — targets the root
2 | Foreword Foreword | 3

4. Foreword
The best legacy we can pass on to our children is to The Fit for School manual is a clear and user-friendly
supply them with the tools of self-reliance and a sense reference material that is a valuable tool in implementing
of responsibility. At its most basic level, this includes this simple yet very effective program. For their efforts
teaching them how to take care of themselves and to in producing such an indispensable guide, my sincerest
value their health. thanks go to InWent and GTZ, Germany; to the World
Health Organization Collaborative Centers in Jena,
The Department of Social Welfare and Development Germany and Nijmegen, the Netherlands; and the College
(DSWD) believes that the good habits learned in of Public Health in UP Manila for the technical
childhood will serve an individual well for the rest of support.
"The Department of Social Welfare and Development believes that his or her life.
the good habits learned in childhood will serve an individual well To everyone who has seen it fit to invest in the future of
for the rest of his or her life." That is why the DSWD fully supports the Fit for School our children — day care workers, health officials, local
program, the community's collective effort to uplift the government officials — congratulations to you. This
state of health of our young by teaching them hygienic manual is indeed a valuable tool in ensuring a bright
habits, and by helping them understand that their health and healthy future for our children.
is in their own hands.
The success of Fit for School programs currently in place
in a number of provinces is a result of the efforts of the Dr. Esperanza I. Cabral
children themselves, the social workers and day care Secretary of Social Welfare and Development
workers and local government officials. This model, if Philippines
successfully implemented throughout the whole
Philippines, will bring unprecedented relief to the
country.
4 | Foreword Foreword | 5

5. Handwashing has been recognized as the most
important step in avoiding sickness and spreading
germs to others.
1.
Infectious Diseases
Infectious diseases are diseases that spread from one
person to another. Worm infections, diarrhea,
Handwashing
common colds, coughs, even bronchitis and skin
infections are the most common infectious diseases.
Lack of cleanliness is the root cause for the spread of
these diseases. If we all take care to keep ourselves,
our home and our day care center clean, and impart
healthy and clean habits to children, we can stop
most diseases before they start.
Fact
Scientific research gathered in several
studies shows that regular handwashing with
soap can reduce the rate of diarrhea by 31%
1
to 47% and respiratory illness by 30%.
You should always wash your
hands with soap after using
the toilet, after handling
pets, before handling food
and before eating.
6 | Handwashing Handwashing | 7

6. Guidelines for Daily Handwashing
Proper handwashing is part of the daily routine
at day care centers, and should be done by
children as a group actitivity.
The best time to do this is before eating at
recess or at lunch time.
With the help of parents, day care workers 1. Wet hands with running water.
2. Apply soap and create lather.
3. Rub palms together and create
should organize the line formation of children
even more lather.
for the handwashing activity.
After about a week, children get used to washing
hands together so the role of the day care
worker will become much easier.
Day care workers are to remind children to wash
their hands with soap after using the toilet.
Children are encouraged to be advocates for 4. Rub fingertips against palms to
5. Intertwine fingers and rub them
6. Grasp thumb and rub with a twisting
handwashing with soap and make it a routine in
remove dirt under fingernails. against each other. motion. Repeat for other thumb.
family life.
Towels become a
source of infection
after the first use.
7. Rub left palm against the back of 8. Rinse hands with running water. 9. Dry hands in the air by shaking off
the right hand, and vice versa. excess water.
8 | Handwashing Handwashing | 9

7. Frequently Asked Questions | Handwashing Experiences
When washing hands, can I use any kind of soap? If water is scarce, can two or more children use the
Yes. With proper use, all soaps, even laundry and same water from a basin for handwashing?
dishwashing soaps, are effective in cleaning our Children should not use the same water from a basin
hands. However, laundry soaps have a stronger when washing hands together as they will also share
formula than other soaps. their germs. Children should rinse their hands
individually and it is best to use flowing water.
Do we need to use antibacterial soap?
No. It is the action of rubbing and not the type of soap Can I participate in the promotion of handwashing Paolo, Day Care Child
that physically removes bacteria from the skin. and how? "I used to be too lazy to wash my hands with
Yes, everyone is welcome to join the global movement soap. But after our teacher told us what gets on
How can you implement handwashing with soap in for handwashing with soap. All you have to do is make our hands, millions of super small germs that
schools that have no access to water? it a habit in your own personal and professional life, we don't even see, I always have to wash my
Access to water is essential. Activities can be started talk about it among family members, friends and hands, especially before eating. I'm afraid the
using collected rainwater and tippy tap wash stations. colleagues. Encourage your neighbors, your church germs will go to my food and make me sick."
It is important to make water an issue and lobby for and your sports mates to join and carry out
access to water in the barangay council. handwashing activities. It feels good to be part of this
important global initiative. Mrs. Abad-Santos, Day Care Worker
Can rainwater be used for handwashing? "In the beginning, some day care workers
Yes. If water is scarce, water from a well, rainwater Is the promotion of handwashing only being done wanted to know: why do we need to wash our
and even seawater can be used for handwashing, but in the Philippines? hands together? And other parents asked,
it is of utmost importance that handwashing is always No, this is part of a global initiative to promote what's the big deal about washing hands
done with soap. handwashing. It is proven that handwashing with anyway? How hard can it be? As part of the Fit
soap is the single most effective intervention in for School program, it was my job to explain
Why is it also important to trim fingernails? reducing the spread of infectious diseases and thus to them that proper handwashing prevents all
Parents must make sure children's fingernails are well saving lives. Around the world, different stakeholders kinds of diseases, and it's a habit kids need
trimmed so that they collect less soil and are easier to such as UNICEF, the World Bank, universities, to think of not as a chore but as something
keep clean. industry partners and governments have joined forces that's necessary and good for them. Doing it
to promote handwashing with soap on a mass scale. in groups gets everyone involved and makes
The Philippine government is now part of this global it more fun. Some days it's the kids who
movement. actually beat the alarm and say, 'It's time for
handwashing!'"
10 | Handwashing Handwashing | 11

8. According to the World Health Organization (WHO)
and FDI World Dental Federation, toothbrushing
using toothpaste with fluoride is the most effective
2.
way of reducing tooth decay.
Tooth Decay
Tooth decay is the most common chronic childhood
Toothbrushing
disease in the whole world. In low-income countries,
nearly all tooth decay remains untreated. As it does
not heal by itself, untreated tooth decay may last a
lifetime and will have profound consequences on a
person's quality of life and overall health.
Tooth decay is painful and deprives children of a good
night's sleep, making it harder for them to pay
attention in school or to interact with other children.
Ultimately, it may hinder social development.
You should brush your
teeth at least twice a Fact
day: once during the The benefit of fluoride in helping prevent tooth
day and always before decay has been firmly established. Research has
going to sleep. shown that school-based fluoride toothbrushing
programs lead to a 40% to 50% reduction in
new tooth decay. 2, 3
12 | Toothbrushing Toothbrushing | 13

9. Guidelines for Toothbrushing
Children should start their day with fresh breath
and clean teeth.
At the day care center, day care workers are to
supervise the daily group toothbrushing activity.
3.
Day care workers should get children to form a
line for the group activity and dispense fluoride 1. Before using, remove the two Brush all teeth up and down for
4. Feel with your tongue if all
toothpaste onto each child's toothbrush.
locks from the toothpaste two minutes. teeth are smooth and clean.
dispenser and pump the
Although children learn quickly and will know
plunger until the toothpaste
the routine after a week, it is still best for the
comes out. Reattach only one
day care worker to supervise the whole activity
lock onto the dispenser. Now it
and make sure there is no spillage of fluoride,
is ready for use.
and that each child stores his or her toothbrush
properly after the activity.
After a week of training, the whole activity
should not take longer than five minutes each 5. Spit the toothpaste out. Do
6. Wipe your mouth with some
day. 4
not rinse your mouth. water using clean hands.
Children are encouraged to be champions of
clean teeth and fresh breath, and motivate their
parents and siblings to brush their teeth, 2. Press the dispenser once to
especially before going to bed.
apply a drop of toothpaste
onto the toothbrush. There is
no need to wet the toothbrush
with water. If you are using a
tube of toothpaste, squeeze
only a pea-sized amount onto
7. Rinse your toothbrush 8. Return your toothbrush to the
the toothbrush. with water. toothbrush holder.
14 | Toothbrushing Toothbrushing | 15

10. Frequently Asked Questions | Toothbrushing Experiences
What can I do to keep my teeth healthy? Is bad breath caused by a lack of oral hygiene?
Mrs. Carina Montenegro, Mother
Eating nutritional snacks and drinking plenty of water If teeth are not cleaned, bad breath will annoy the
"I used to think that the 'baby teeth' are not at
instead of softdrinks and sugary drinks are beneficial people around you. Some bacteria produce sulfur
all important because they will be replaced
for the teeth and the whole body. compounds and it is helpful to brush the tongue
anyway when children grow older. But when an
intensively because this is where these bacteria
infected upper tooth caused my 2-year-old son
Why is it important to use fluoride toothpaste? reside.
to be hospitalized because of a severely
In many countries, the levels of tooth decay have
swollen face that affected his right eye, I really
fallen by over 50%. In the last 20 years, leading Is toothpaste safe to swallow?
got scared. He was unable to eat because of
experts around the globe have agreed this is almost Toothpaste is not intended to be eaten and children
high fever and too much pain. We spent a lot of
entirely due to the use of fluoride toothpaste. are encouraged to spit out the toothpaste. However, it
money for his medicines and hospitalization.
is known that children will always swallow some
This is the reason why PREVENTION is very
Why do I see blood when the children spit out the toothpaste. A pea-sized amount of toothpaste is not
important. We do not want to compromise
toothpaste after brushing their teeth? harmful as it contains less fluoride than a fluoride
nutrition and good health by not teaching them
Bleeding is a sign of gum infection caused by lack of tablet that many children receive from their dentist
good personal hygiene."
toothbrushing. It will disappear after one to two for caries prevention.
weeks of regular toothbrushing in the day care center
and at home. Is it true that brushing with fluoride toothpaste can
cause discoloration and damage to the permanent Ms. Salva, Day Care Worker
Why is it important to not rinse the mouth after teeth (fluorosis)? "These early formative years play a very
toothbrushing? For as long as a pea-sized amount of fluoride important role in the rest of a person's life. The
Rinsing will reduce the positive effect of the fluoride toothpaste is used, the just-spit-no-rinsing method is habits acquired at this time, like good
on your teeth. If you feel a need to rinse the food safe for children and will not cause fluorosis. toothbrushing and handwashing habits, will be
particles, brush and rinse before brushing a second carried over forever — learning them at a later
4
time without rinsing. Do we really need to seriously take care of "baby stage, if at all, might prove too late. We didn't
teeth," which will fall off anyway? have such basic information available to us
Do I need to change toothbrush every three Baby teeth need to be taken care of for the proper when we were little, so many of us either
months? growth and alignment of the permanent teeth. When suffered from bad breath as children or had to
No. Research has shown that there is no difference in they get decayed, nutrition and quality of life are wear dentures by the time we were in our late
cleaning effectiveness between an old and a new compromised because the child will not be able to twenties. Such things could have easily been
5
toothbrush in the hands of children. chew properly due to pain and infection. Infection prevented by simple habits. So now I take my
may be carried from childhood to adulthood, or it may job seriously, making sure the children at the
spread to other parts of the face and body, which can day care center are properly taught these
be life threatening. things. This will make happier, more confident
grownups in the future."
16 | Toothbrushing Toothbrushing | 17

11. Injuries, infected wounds and dangerous
hookworm infections can be prevented by the
simple act of using footwear — slippers, sandals or
3.
shoes — especially when stepping out of the home.
THE DANGERS OF GOING BAREFOOT
OUTDOORS
Footwear Do not go barefoot or allow children to do so.
Hookworms enter the body through the soles of the
feet and cause severe anemia. Wearing slippers,
sandals or shoes as a protective barrier prevents
hookworm infections and injuries.
Remember to always Fact
put on footwear when Footwear prevents the contracting of worms
stepping out of the through the feet and greatly reduces the
house or onto unclean risk of injuries, including open wounds and
surfaces. gashes.
18 || Footwear
18 Toothbrushing Footwear | 19

12. Nowadays worm infections can be controlled
through biannual deworming with inexpensive,
highly effective single-dose drugs.
4.
Common Worm InfectionS
Soil transmitted helminth (STH) infections, also
known as worm infections, and schistosomiasis are
Deworming
very common. School-age children in developing
countries are the most heavily infected population.
Untreated worm infections cause anaemia and may
lead to poor mental development. Anaemic children
are always without energy and are generally too tired
to participate in social activities. Eventually, they lose
all interest in school. Heavily infected children will
not grow as expected for their age, and malnourished
children will become even more so.
In the Philippines, 7 out of 10 elementary school
children have worms, with 2 out of 10 being heavily
infected.
Intestinal worms are harmful parasites
Fact that derive food and shelter from their
An evaluation of the impact of school- human hosts. Poor environmental
based deworming among children in Kenya sanitation and poor personal hygiene
revealed that deworming children reduced are major factors that expose humans
6
absenteeism by 25%. to these parasites.
20 || Deworming
20 Deworming Deworming | 21

13. Guidelines for Mass Deworming
Local government unit (LGU) health personnel in
collaboration with the local health worker will
orient parents and day care workers on mass
deworming to address all questions and
concerns.
The health worker will coordinate with the day
care worker to schedule a day for deworming. 1. The health worker orients
2. The day care worker schedules
3. The day care worker calls
parents on the deworming a day for deworming. five children at a time.
The day care worker will call five children at a
process.
time and distribute the deworming tablets.
These tablets will be chewed by the children
immediately under direct observation of the day
care worker.
A volunteer parent will assist the teacher in
documenting the entire activity.
Mass deworming will be held every six months.
4. Children receive a tablet from
5. The day care worker inspects
6. A parent helps document the
the day care worker, which the mouths of the children. whole activity.
they must chew and swallow
immediately.
22 | Deworming Deworming | 23

14. Frequently Asked Questions | Deworming Experiences
What are the symptoms of worm infection? Why should my child be dewormed again when he
Ms. Wilma Galela, Municipal Social Welfare
Worms and other parasites live in human intestines was dewormed last year?
Development Officer
and cause disease. Some worm types can be seen in Children will easily be reinfected. Therefore,
"I like the Fit for School program because the
the stool, while some worms lay their eggs outside deworming is needed every six months. It will
approach is wholistic. Oral health is integrated
the anus and cause itching, especially at night, which prevent chronic infection and a heavy worm load.
with general health. The concept of being clean
disturbs sleep. If the infection is not treated, an
in (mass deworming) and out (handwashing
infected person may experience loss of appetite, Can we deworm without a lab result?
and toothbrushing) is so simple and yet its
abdominal pain and decline in energy levels resulting The World Health Organization recommends the
effects on disease control and prevention are
in decreased physical and mental performance. An deworming of all children without prior laboratory
staggering. The approach also promotes
infected person will also experience a deficiency in testing if the infection rate in the area is higher than
empowerment and the Filipino spirit of
vitamin A, which leads to anemia (for hookworm 50%. The infection rate in the Philippines has been
'bayanihan': teachers, parents and community
cases only), dry eyes and even blindness. The body of higher than 50% in all areas surveyed. Deworming of
leaders all helping one another in building a
an infected person cannot absorb food properly, all children is recommended in schools as the drugs
healthy environment for the children, the future
which then leads to malnutrition and intestinal used are safe even for non-infected children.
of our country."
obstruction.
Why was my child dewormed in school and in the
How can I prevent the children from being community several times last year?
infected? In the past, there have been overlapping deworming
The prevention of worm infection requires programs. Collaboration between the Municipal Social Ms. Teresita Lumen, Mother, Bukidnon
improvement of personal hygiene and sanitation Welfare Development and LGU health offices and "I heard a story once from the next barangay
facilities. First, use a toilet whenever possible. barangay health workers will assure coordination and about a little boy who became deaf and blind
Second, always wash hands with soap after going to mainstreaming of efforts. after deworming because the worms came out
the toilet and before eating. Rubbing hands with soap of his eyes and ears. Another story was that
will get rid of microscopic worm eggs you or the child Why do children have the highest risk of intestinal hundreds of worms came out of a little girl's
may have picked up. Third, wash vegetables worm infection? anus. Too many horror stories about deworming,
thoroughly with clean water. Fourth, keep fingernails Most intestinal worms are so-called "soil transmitted and of course I never want those things to
and toenails short. Finally, always wear shoes or helminths," which means that the infection is spread happen to my children! Finally the nurse told me
slippers to keep feet from direct contact with the soil. through soil. Soil is easily contaminated with human the stories weren't true. She also said being free
excreta or waste. Children play on the ground then of worms would make my kids eat better and
Are deworming drugs safe? put their fingers in their mouths and get infected. feel livelier, so I agreed. Two worms came out of
Deworming drugs are safe and can also be given to Thus, proper handwashing before eating is very my daughter and three from my little boy. Now
non-infected children. They are safe for all children important. they are much better and healthier."
above 1 year of age.
24 | Deworming Deworming | 25

15. The Fit for School program identifies different roles
to ensure the smooth implementation of daily
handwashing with soap and daily fluoride
toothbrushing. Children are not only the
5.
beneficiaries but also the prime actors of day care
health programs.
Roles & Responsibilities
The Role of the Children The Role of the DAY CARE WORKER
• participate willingly in each of the activities • ensure the presence and maintenance of facilities
• cooperate enthusiastically with the day care worker and supplies: toothbrush holders, toothbrushes,
by listening to instructions and following them toothpastes, soaps, spit trays, sinks, water supply
• line up in an organized fashion for each of the • orient, facilitate and guide the children in the
activities, as directed by the day care worker hygiene routines
• behave as directed during each of the activities • organize the parents and community leaders in the
• wait for their turn to use the handwashing and improvement of facilities, completion of supplies
toothbrushing facilities and implementation of the program
• maintain personal cleanliness and the cleanliness • implement the deworming procedure
of their surroundings • educate the children and the parents on personal
• inform the day care worker of any problems or hygiene
questions about the activities
26 | Roles & Responsibilities Roles & Responsibilities | 27

16. THE ROLE OF THE SOCIAL WELFARE The Role of the health worker The Role of COMMUNITY LEADERS The Role of Parents
OFFICES • keep open lines of communication with day care (governors, mayors, barangay • cooperate with and assist the day care workers in
• monitor the proper implementation of the program workers officials) implementing the program
on the provincial and municipal levels • maintain close coordination with the Municipal • extend ample moral support to the network of • build the necessary facilities for properly
• integrate the program into the monitoring system of Social Welfare Development Officer, Provincial personnel involved in the program implementation conducting hygienic habits in the day care center
day care centers Social Welfare Development Officer and day care • display leadership and be a role model of • ensure the habits are practiced at home
• consult with the day care workers on possible areas workers for proper implementation of the program community involvement • monitor the health of their children
of improvement or contention • supervise proper dissemination of information on • take ownership of the project • report their children’s special health requirements
• discuss tangible solutions to these issues with the health issues throughout the municipality/city • allocate an adequate budget for the program to the day care worker
day care workers • orient parents and day care workers on proper • ensure timely procurement of needed materials • report injuries or illnesses immediately to the
• lend support to day care workers when necessary hygiene and promote mass deworming • support improvement of washing facilities and health worker
• coordinate with other sources of local funds, if • assist parents with special health concerns water supply
necessary regarding their children
• conduct Fit for School capacity-building seminars
for all department heads and day care workers
• update the governor about the program and solicit
ongoing interest and support
• coordinate with the provincial and municipal
budget officers for allocation of funds and efficient
procurement of materials
28 | Roles & Responsibilities Roles & Responsibilities | 29

17. THE ROLE OF NON-GOVERNMENT THE ROLE OF GUIDING BODIES AND THE ROLE OF PRIVATE PARTNERS THE ROLE OF THE ACADEME
ORGANIZATIONS (NGOS) DONOR AGENCIES (UN, WHO, UNICEF, FDI) • engage in community partnerships • conduct research to strengthen evidence of the
• support government agencies in fulfilling their • provide technical assistance to government • encourage community involvement effectivity of the interventions
public service mandate agencies • provide funds for capacity development • support government agencies with research
• ensure efficient coordination with other partners • take the lead in framework development • provide financial support for pilot projects and • advocate more affordable health care solutions
• transfer technology and know-how to local units • promote and strengthen partnerships among support the scale-up process • devise and encourage simple and effective health
down the line stakeholders to reach a common goal and prevent • use mass media for health campaigns habits
• seek to improve access to clean water program duplication and overlapping • engage in global partnerships for development • disseminate information on scientific developments
• support schools and communities in upgrading • promote best practice models and take an active • assist the scientific and academic communities in • transfer technology and know-how to private
handwashing and sanitation facilities role in the advocacy process research and development efforts companies, NGOs and local government units
• assist in the reproduction of orientation material • promote global partnerships for development • transform new technology into affordable, mass- • work closely with the various development
(manuals, films) market health care products agencies, aid agencies and departments in
• assist in the financing of capacity development government to promote the general health and
workshops welfare of children
• motivate schools and divisions by setting • take an active role in the advocacy process
incentives, recognizing exemplary work and
awarding outstanding performance
• join the advocacy process and promote school
health locally, nationally and internationally
30 | Roles & Responsibilities Roles & Responsibilities | 31

18. Frequently Asked Questions | Roles & Responsibilities Experiences
Mrs. Liza Pelayo, Mother
"As parents, we feel the need to help our
The program is taking too much of our time. Can it Are day care workers allowed to perform Ms. Liezl Catapang, Day Care Worker
day care worker in the construction of the
be done once or twice a week instead of every day? deworming? "At first, I thought it would be very difficult to
handwashing and spit trays and the toothbrush
A positive change in personal hygiene habits and The World Health Organization recommends that implement this program with the children. But I
holders. We have assigned one parent to go
behavior will occur only if the program is school-based deworming should be done by day care realized that after a few weeks, children easily
on duty each day to assist the day care worker
implemented on a daily basis. Doing it once a week or workers. Around the globe, day care workers have perform the daily routine of washing their hands
in organizing the children, maintaining the
on an irregular basis sends children the wrong signal: been doing this successfully. Day care workers are before eating, then brushing their teeth after
cleanliness of the facilities, and providing the
that handwashing and toothbrushing can be done as allowed to perform deworming if parents have signed eating. In fact, they enjoy doing it every day. It
water supply by bringing water bottles each
desired. Personal hygiene must be inculcated as a the informed consent form. Day care workers should is not difficult after all. And I find so much
day. Parents also assist with the deworming
lifetime daily habit for it to be truly effective as be oriented by health personnel on the deworming fulfillment that, in my own small way, I am
procedure every six months. We have also
preventive health care. procedure. The school nurse and the school principal teaching children a very simple habit that will
sought the help of the barangay captain for
should involve the community and ask the barangay have a lifetime impact on their health when they
funding to improve our facilities. We love doing
Can the day care worker instruct children in health worker to be present in the school during the grow older. Health is wealth!"
this knowing it's for our children."
toothbrushing even if he/she is not a dentist? deworming day.
Yes. You do not need to be a dentist to teach proper
toothbrushing. Parents around the globe familiarize How can civic organizations participate in the Fit
children in toothbrushing without being dentists for School program?
themselves. Toothbrushing is a simple life skill and Civic organizations (church organizations, Rotary
children need to practice it daily in order to master it. Clubs, Kiwanis) can participate by supporting the
Day care workers are well prepared to teach life skills. communities in obtaining access to water and
improving washing facilities. In some areas, civic
What is the role of health personnel if day care organizations provide the funds for additional health
workers are deworming and doing handwashing services, like micronutrient supplementation, eye
and toothbrushing with the children? glasses or urgent oral treatment. It is not advisable
Health personnel are the technical experts, they are that NGOs or civic organizations take on the financial
trainers and managers. Their role is crucial! Managers responsibility of LGUs for the needed materials
oversee, support and monitor the program and without ensuring sustainability.
support day care workers and administrators.
Can parents perform the deworming on their own?
It is recommended that parents let their children be
dewormed at the day care center. If parents feel that
additional deworming is required, they should consult
their barangay health worker.
32 | Roles & Responsibilities Roles & Responsibilities | 33

19. The implementation of the Fit for School program Fact
needs the active participation of the whole According to the World Health Organization,
community with the support of the barangay
6.
2.4 billion people live without access to
council. sanitation services and 1.5 billion people live
without access to safe drinking water. Over 5
Water, Sanitation and Health million people, mostly children, die every day
in DAY CARE CENTERS
How to Create a Access to safe water and sanitation remains a major
from water-borne diseases such as diarrhea,
dysentery and cholera.
Supportive Environment
challenge in Philippine day care centers. The Fit for
School program can serve as a starting point for
making access to water and sanitation in day care
centers a priority in every barangay. Parents can
judge community leaders' commitment to the health
of children based on the progress of their lobby for
safe water and sanitation facilities.
Guidelines for Access to Water
Day care centers should provide children in their
care with access to water, either from a tap or
from water containers (jug, canister or tippy
tap).
Day care centers without access to water should
develop ways and means to ensure availability
of water by encouraging parents to bring water
to the school. Access to water in the day care
center should be a priority of the barangay. Access to water and improvement of
washing facilities are the responsibility
On the average, at least one liter of water is of the whole community.
needed for every child per day.
34 | How to Create a Supportive Environment How to Create a Supportive Environment | 35

20. Guidelines for Tippy Tap
Wash Stations
Tippy taps offer a low-cost solution for day care
centers that do not have access to piped water.
As a temporary solution, the construction of a
tippy tap can be done in each setting, providing
sufficient wash stations so that many children
1. 2.
can wash their hands simultaneously in an
organized manner.
Fix a string to the bottle and Make a hole in the cap of each 3. Attach bottles to the wash stand in
remove the label. water bottle. such a way that they can be easily
Placing the bottles under the sun for at least six
turned to an upright position.
hours will increase the water quality (http://
www.sodis.ch). The UV light of the sun will
desinfect the water.
Building tippy taps is a fun activity for children,
parents and teachers.
4. Place soap in a stocking or a
5. Wet hands by squeezing the bottle.
6. Rinse hands or toothbrush by
fish net near each bottle. Lather your hands using the soap. squeezing the bottle.
36 | How to Create a Supportive Environment How to Create a Supportive Environment | 37

21. Guidelines for the Construction of Guidelines for Cleanliness in
Handwashing and Toothbrushing Facilities Day Care Centers
The entire day care center should be kept clean
and well lit.
Ensure availability of water, either from a tap or
from a jug. The day care worker in charge of the
center has to make certain that children bring
sufficient water.
Daily handwashing and toothbrushing The trough should be slightly inclined so that
activities require facilities with enough space water can flow from the source to the drain at
Make sure soap is available and placed in a soap
for a group of children. the opposite end.
dish or a fish net so that the soap stays dry. Day care workers and parents must help
maintain cleanliness, and must teach children
Ensure the availability of a nail cutter, which is to do the same.
Do not use to be used only under the supervision of the day
soapy/dirty care worker.
water from a
basin. Ensure availability of fluoride toothpaste.
Make sure that a toothbrush holder is available.
Flowing water is best for handwashing and Hands and toothbrushes may also be rinsed using
toothbrushing. clean water from a water jug or pail.
The health corner needs a sink so that
individual handwashing can be performed after
children have used the toilet. Soap must be placed in a soap dish so that it
stays dry.
No towels are needed.
Towels become a
source of infection
after the first use.
Avoid building handwashing facilities that are A simple roof over the outdoor troughs allows
too high for little children to reach. handwashing and toothbrushing at all times.
38 | How to Create a Supportive Environment How to Create a Supportive Environment | 39

22. Guidelines for Creating and Maintaining
a Common Toothbrush Holder
Each child will receive one toothbrush with a cap
per year. These are to be stored in a toothbrush
holder inside the classroom.
The toothbrush holder should be fixed to the wall
where children can easily reach it.
The toothbrush holder should be made of cloth
or plastic or any material that can be easily Using a permanent marker, toothbrushes As an alternative to labeling, have the
washed. must be labeled individually according to children personalize their toothbrushes for
student name or number. easy identification.
There should be enough space between the
brushes to avoid cross infection.
The slots should be designed in such a way that
the head of the brush is exposed to the air. The
cap has little holes to prevent molding.
Identify each toothbrush and slot with the
child's name and picture.
The label must be wrapped with tape to prevent Placing transparent polish or varnish over
it from being erased over time. the label is another way to protect it.
Never let the children
bring the brushes
home. A second brush
is needed at home.
40 | How to Create a Supportive Environment How to Create a Supportive Environment | 41

23. Monitoring is necessary for determining the strengths SEARCH FOR THE MOST OUTSTANDING DAY
and weaknesses of the implementation process and CARE CENTER
identifying room for improvement.
7.
Criteria for the competition:
• Compliance with implementation guidelines
• Time needed to perform handwashing/
MONITORING AND EVALUATION toothbrushing
Monitor ing is important for evaluating the • Establishment of washing and toothbrush
implementation status on the day care center level, as storage facilities
Monitoring
well as on the municipal and provincial level. Evaluation • Community participation in the program
will be done using a score-card system. The scores will • Creative and innovative implementation of
serve as the basis for identifying the best day care EHCP
center per municipality. These day care centers will go
on to compete in the search for the most outstanding
day care center in the province.
Guidelines for Monitoring
Monitoring is carried out in each day care
center twice a year.
Monitoring requires the use of the standardized
monitoring form.
Monitoring should be done by a social worker, a
health worker, a parent-representative and a
barangay official.
The monitoring form and competition rules can
be downloaded from
http://www.fitforschool.ph.
42 | Monitoring Monitoring | 43

24. Checklist for Day Care Workers
PHASE I: PREPARATION PHASE II: IMPLEMENTATION
OOConduct primary assessment. OO Ask the children to line up to wash their
OORead the manual and view the video. hands before eating.
OOSet a meeting with the parents and the OO Have them wash their hands for at least 20
officers of the parents' association. seconds.
OOShow the manual and the video to parents. OO Rinse hands using running water, tap water
OODiscuss how parents can contribute to the or water jug.
construction of handwashing facility, spit OO Ask children to shake their hands in the air to
trays or sink and toothbrush holder. dry them.
OOSet a meeting with the barangay captain and OO Encourage children to eat healthy snacks and
community officials. Encourage their support drink water during meals or recess.
and participation. OO Ask the children to line up and and help them
OOSet a meeting with LGU health personnel for get their individual toothbrushes from the
the implementation of mass deworming. toothbrush holder after they finish eating.
OOSupervise the construction of the facilities OO Dispense a pea-sized amount of fluoride
together with the parents and barangay toothpaste onto toothbrush bristles.
officials. OO Ask the children to form a line beside the
OOPosition the toothbrush holder where children water sink or spit trays.
can easily reach for their toothbrushes. OO Have the children "dry brush" their teeth
OORequest supplies (toothbrushes, toothpastes, (brush without water). Time toothbrushing
soaps) from MSWDO. for two minutes.
OOLabel or properly identify individual OO Make sure children just spit and do not rinse
toothbrushes with the child's name using their mouths after toothbrushing.
permanent marker. OO Children should clean their toothbrushes with
OOLabel each child's toothbrush slot with his or water.
her name and picture. OO Make sure children wipe their mouths with
OOPlace toothpaste bottle and soap in the wet but clean hands.
health corner. OO Do this activity every day.
OO Report problems to MSWDO.
44 | Checklist Checklist | 45

25. Bibliography
1
Curtis V and Cairncross S (2003). Effect of
washing Hands with Soap on Diarrhoea Risk in the
Community: A Systematic Review. Lancet Infect Dis
3 pp 275-281.
2
Adyatmaka A et. al. School-Based Primary
Preventive Programme for Children: Affordable
Toothpaste as a Component in Primary Oral Health
Care. Experiences from a Field Trial in Kalimantan
Barat, Indonesia. <http://www.whocollab.od.mah.se/
searo/indonesia/afford/whoafford.html>
3
Curnow M M et al (2002). A Randomised Controlled
Trial of the Efficacy of Supervised Toothbrushing in
High-Caries-Risk Children. Caries Res vol 36 issue 4
pp 294-300.
4
Chestnutt IG, Schafer F, Jacobson AP, Stephen KW.
1998. The influence of toothbrushing frequency and
postbrushing rinsing on caries experience in a caries
clinical trial. Community Dent Oral Epidemiol. 26(6):
406–411.
5
Palenstein Helderman WH van, Kyaing MM, Aung MT
et al. Plaque Removal by Young Children Using Old
and New Toothbrushes. J Dent Res 2006 85: 1138-
1142.
6
Miguel E and Kremer M (2004). Worms: Identifying
Impacts on Education and Health in the Presence of
Treatment Externalities. Econometrica Vol 72 No 1
pp 159-217.
46 | Bibliography

26. Fit for School, Inc.
Project Office
4F Mother's House Building
www.fitforschool.ph
Mortola-Hayes Streets
9000 Cagayan de Oro City
Phone/Fax: +63 88 857 21 46
info@fitforschool.ph