PHC Roadmap Instructions

1. Accomplish the Demographics, PHC Questionnaire, and Annex A

*Check the most appropriate respo

2. In the PHC Performance Guide, put a mark on the peformance indicator in each sub-block based from the responses in th

Put a mark on each

performance indicator
based from PHC
Questionnaire

3. The PHC Roadmap will automatically color.

Red = means non-functional and these gaps need to be prioritized
Yellow = means functional but needs to be strengthened
Green = means strong and functional

4. Updating of responses in the PHC Questionnaire is necessary only for sub-blocks with improvements or those which need
Means of verification must be submitted during baseline, end-line, and whenever there is improvement in the accomplishm
e most appropriate response and take note of questions needing multiple answers

rom the responses in the PHC Questionnaire

Color will change

based from response in
column 2
 nts or those which need to be answered quarterly.
ment in the accomplishment of indicators.
 Municipal Primary Healthcare Roadmap

Municipal Health Profile

Municipality: MacArthur Province: Leyte Region: VIII

Income Class: __________________ GIDA Municipality (Y/N): ________
Name of GIDA Barangays (if applicable): ___________, ____________, __________,
__________________, __________________, __________________, __________________
Name of LCE: ________________________________ Number of Terms: ______________
Name of MHO: _____Milda Closa-Marohom___________________________
LGU Members of Inter-Local Health Zone where you belong: _________, __________,
__________________, __________________, __________________, __________________

YEAR
Demographics
2014 2015 2016
Population (estimated)
Population in Reproductive Age (MAWRA)
(15-49 years old)
Presence of Indigenous People (%)**
Indigenous group Specify (_______________)
Number of Households
Number of NHTS Households
Total number of Barangays
Number of Island Barangays
Number of Upland Barangays
Number of Lowland Barangays
**Estimated Percentage of the Indigenous Population over the Total Population, if applicable
Leading Causes of Mortality # of Deaths Leading Causes of Morbidity # of Cases Latest Year: _________
1) 1)
2) 2)
3) 3)
4) 4)
5) 5)
6) 6)
7) 7)
8) 8)
9) 9)
10) 10)

Primary Health Care Roadmap Questionnaire

Cover Page
 I. HEALTH LEADERSHIP AND GOVERNANCE
Municipal Health Governance
1. Do you have policy on expanding the members of the Local Health Board? YES NO

2. Who are the current members of the LHB? Please check the applicable.
A. Primary Members C. Expanded Members (Other sectors)
Mayor ABC President
Municipal Health Officer BHW President
DOH-Representative Women's Representative
Sangguniang Bayan on Health Workers' Representative
CSO Rep (please specify) __________ Senior Citizens' Representative
Community Leader Youth Representative
B. Expanded Members (Other departments) Urban Poor Representative
Municipal Social Welfare and Development Officer Indigenous People Leader
Municipal Planning and Development Coordinator PWD Representative
Municipal Budget Officer Others (please specify)
Others (please specify) __________
_____________________
3. If YES to Q#1, are the roles and responsibilities of each members of the expanded YES NO
Local Health Board stated in the policy?
4. Is there an orientation on Bridging Leadership or training in 5. How often are LHB meetings conducted?
Municipal Health System Strengthening Program (MHSSP) among Monthly
members of the expanded local health board?
Every other month
Once in a Quarter
YES, they are trained on MHSSP Less than 4 times
YES, they are oriented on Bridging Leadership only None
NO, they are neither oriented on Bridging
Leadership nor trained in MHSSP

6a. Are ALL LHB meetings documented? 6b. Are ALL LHB meeting presided by the mayor?
YES (Please provide supporting documents i.e. minutes of YES (Please provide supporting documents i.e.
the meeting) minutes of the meeting)
NO NO

7. Do you have an updated Municipal Investment Plan for Health (MIPH)? YES NO, go to Q#9
8. If YES to Q#7, kindly check which of the following contents are present in your MIPH:
Executive Summary Overall Health Strategy and Specific Interventions
Introduction Costing of Critical Interventions/ Budget
LGU Profile Plan Management
Health Situationer/Situational Analysis Monitoring and Evaluation
9. In crafting your MIPH, which of the following processes were executed? Please check all applicable.
a. Stakeholder's Consultation
b. Utilizing latest data on health indicators
c. Prioritized intervention based on agreed criteria (e.g. magnitude, urgency, etc.)
d. Inclusion of interventions on priority health needs of barangays

10. Is your MIPH integrated to your Municipal Development Plan? YES NO

11. Do you endorse your MIPH to the the Provincial Health Office (PHO)? YES NO

12. Do you have an updated Annual Operational Plan (AOP) for Health? YES NO, go to Q#14
13. If YES to Q#12, kindly check which of the following contents are present in your AOP:
Cover Letter Adjustments in Proposed Interventions & Investments
Year-end Health Situation Performance Indicators
Local Priorities on Health Planning and Costing Matrices
Major thrusts of the AOP

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 Community Participation
14. How many community consultation activities were conducted in the current year to None 1 2 or more
help address issues that has impact on health?
15. How many community activities or assemblies were conducted in the current year to None 1 2 or more
report/feedback local health data and status of health programs?
16. In the implementation of your health programs, have you organized community YES NO, go to Q#19
volunteers groups (other than the BHWs and BNS)?

YES NO
17. Do the organized community volunteer groups have clear roles and responsibilities?
18. Which of the following sectors are represented in these volunteer groups?
Women Urban Poor Differently-abled Persons
Workers Indigenous People Victims of calamities/disaster
Youth Senior Citizen Others. Please specify
____________________

Barangay Health Governance

19. How many Barangays have a Barangay Health Governance Body managing the health issues at the
barangay level?*
_____________

*list all barangays which has a barangay health governance body, use ANNEX A.
20. Is there a local policy on the strengthening of existing Barangay 21. Is there a local legislation on the creation of Barangay
Health Governance Bodies? Health Governance Bodies?

YES NO YES NO
22. From among the Barangays, how many have a Barangay Policy on strengthening (Refer to ANNEX A)
Brgy. Health Systems or any health policy? ___________________
23. From among the Barangays in your municipality, how many underwent
BHLMP? ___________________
24. How many barangays have a Barangay Investment Plan for Health or Barangay Development Plan
with identified: a. priority health needs, and b. priority health strategies _______________
(Refer to ANNEX A)
25. Are you able to monitor the implementation of these 26. How often are these plans monitored?
barangay health plans? Monthly Semi-annual
YES NO, go to Q#27 Quarterly Annual
Others. Please specify ________________
Health in All Policies
27. Do you have existing executive orders, ordinances , or resolutions to address challenges on the triple burden of disease listed
below?
Kindly check all that is applicable.
a. Communicable Diseases:

HIV
Tuberculosis
Food and waterborne Diseases
Diseases with Endemic potential
b. Non-communicable Diseases:
Hypertension
Diabetes
Chronic Kidney Diseases
c. Mental Health and Substance Abuse
d. Health and Nutrition for all life-stages:
Maternal
Child
Adolescent
Senior Citizens

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For Q#28-32, use existing policies for baseline. For practicum, these will apply to ALL health policies to be issued (new or revised)
after module1
28. Do crafted policies contain local health data? 29. Are crafted policies compliant with national guidelines?

YES NO YES NO
30. In crafting your policies, have you consulted and collaborated 31. Do your policies have monitoring and evaluation plans?
with other relevant sectors?

YES NO YES NO
32. Are ALL policy implementations being monitored? 33. If YES in Q#32, from your monitoring, are ALL policy
executions compliant to their implementing rules and
regulation?
YES NO, go to Q#34
YES NO

LGU support for Building Resilient Health System

YES NO
34. Is your Disaster Risk Reduction Management for Health (DRRM-H) plan integrated to
your Municipal Disaster Risk Reduction and Management Plan?

35. Do you have an existing ordinance adopting the RA 10121 or the Philippine Disaster YES NO
Risk Reduction and Management Act?
YES NO
36. Do you have an established Incident Command System organizational structure?

YES NO
37. Do you have a policy that supports the establishment and integration of Municipal
Health Emergency Management Unit in the Municipal DRRM Council?

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 II. HEALTH FINANCING
Social Insurance
38. Kindly check all applicable PhilHealth packages in which the RHU or LGU-owned facility is accredited.
Primary Care Benefit Package / TSeKaP Animal Bite
Philhealth accredited birthing home (for MCP and NCP) Outpatient Malaria
TB-Directly Observed Treatment Short Course (DOTS) Others (specify):
None, go to Q#47 _______________________________
39. Do you have Information Education Campaign initiative informing 40. Frequency of IEC initiative.
the poor PhilHealth members on their enrolment and the benefits Monthly
they could get from PhilHealth? (Aside from posters and hand-outs)
Quarterly
Annual
YES NO Others, please specify __________________
41. Do you have an LGU-hired or designated YES, indicate name: _______________________ and contact
personnel (other than the PHN, RHM) that acts as a point person for no._____________________
PhilHealth information and concerns?
NO
42. Do you have policies supporting/promoting guidelines on disposition of PCB TB-DOTS
reimbursements for the following PhilHealth Packages?
MCP
43. Do you have an ordinance on the creation of a separate trust fund for YES NO
proceeds from Philhealth reimbursements?

44. Do you submit PhilHealth Claims within the required 60-day 45. Do you submit quarterly reports to PhilHealth or submits
period or in realtime/automatically? them in realtime/automatically?
YES, for all the PhilHealth Packages the RHU is accredited
YES NO
YES, but not for all accredited packages
NO
46. Do you monitor the utilization of approved reimbursed claims of the RHU? YES NO

47. Does the LGU conduct listing of poor families not identified by the YES NO
National Household Targeting System (NHTS)? If NO, Go to Q#50.
48. Does the LGU submit the list of poor families (in Q#47) to your 49. How many poor families not covered by PhilHealth are
Provincial Social Welfare and Development Office (PSWDO) for subsidized by the LGU to cover their premium payments:
evaluation and endorsement to the Philippine Health Insurance
Corporation (PHIC)

a. Total No. of poor families not covered by

YES PhilHealth: ________________
NO b. Total No. of poor families (from a.)
which are sponsored by the LGU: ________________

Local Budget for Health

2014 2015 2016
50. Kindly fill out completely the table below. (Actual amount in PHP)
a. Total Internal Revenue Allotment (IRA)
b. Total Municipal Budget
c. Appropriated Health Budget
d. Actual Health Utilization/Expenditure
51. Do you have other source of health budget other than YES NO, go to Q#53
IRA and Philhealth?

52. If YES to Q#51, what are the other sources of your health budget?

________________________________________________________________________________________

53. Does the LGU have policy on the following:

a. Provision of subsidies YES (specify): ____________________ NO
b. Social protection schemes YES (specify): ____________________ NO

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 III. HEALTH HUMAN RESOURCE
MUNICIPAL HEALTH HUMAN RESOURCE
54. Kindly fill out completely the table below. 2014 2015 2016
Total Number of Health Personnel hired by the LGU
a1. Number of Physicians 1 1 1
a2. Among the Physicians, how many have permanent positions? 1 1 1
b1. Number of Nurses 1 1 1
b2. Among the Nurses, how many have permanent positions? 1 1 1
c1. Number of Rural Health Midwives 5 5 5
c2. Among the Midwives, how many have permanent positions? 5 5 5
c3. Number of Rural Health Midwives assigned to identified GIDA
Barangay and/or IP community
d. Number of Medical Technologists 1 1 1
e. Number of Municipal Nutrition Action Officer 1 1 1
f. Number of Rural Sanitary Inspectors 1 1 1
g. Number of Pharmacists 0 0 0
Total Number of Mixed Health Personnel hired or not by the LGU
h. Physicians + Nurses + Midwives
55. How many of your LGU-hired Physicians are accredited to 1 1
PhilHealth?
56. How many of your LGU-hired Midwives are accredited to
PhilHealth? 0 0

57. Does the Local Health Board have a policy on the creation of YES NO
BHW Registration and Accreditation Committee?

Competency of Municipal Health Workers

58. Kindly check all the applicable trainings attained by the specific RHU personnel.
Only those trainings which are attended by ALL of the LGU-hired RHU personnel should be checked.
A. ALL LGU-hired Physician
Family Planning (FPCBT 1 and 2, ICV, PPIUD insertion, NSV, SDI)
Antenatal Care and BEmONC
Essential Newborn Care
Expanded Program for Immunization
First 1,000 days for nutrition
Adolescent Sexual and Reproductive Health
TB DOTS
HIV/ AIDS prevention, detection, and treatment/referral
Endemic disease prevention & treatment(e.g. Schistosomiasis, Filariasis, Dengue, Soil helminths, etc.)
Prevention, Control and Treatment of Non-communicable diseases (e.g. for Hypertension, Diabetes, Stroke, Kidney diseases, etc.)
Mental Health Services (Detection, referral/treatment, rehabilitation for mental health, etc.)
Drugs and Substance Abuse Services (Screening, counselling, and referral/rehabilitation for drug and substance abuse)
Environmental Health and Sanitation
Gender and Culture Sensitivity Training
Health Emergency and Disaster Services including Basic Life Support
Medicines Management
Management/ Supervisory Training

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B. ALL LGU-hired Public Health Nurses
Family Planning (FPCBT 1 and 2, ICV)
Antenatal Care and BEmONC
Essential Newborn Care
Expanded Program for Immunization
First 1,000 days for nutrition
Adolescent Sexual and Reproductive Health (AJA)
TB DOTS
HIV/ AIDS prevention, detection, and treatment/referral
Endemic disease prevention and treatment (e.g. Schistosomiasis, Filariasis, Dengue, Soil helminths, etc.)

Prevention, Control and Treatment of Non-communicable diseases (e.g. for Hypertension, Diabetes, Stroke, Kidney diseases, etc.)
Mental Health Services (Detection, referral/treatment, rehabilitation for mental health, etc.)

Drugs and Substance Abuse Services (Screening, counselling, and referral/rehabilitation for drug and substance abuse)

Gender and Culture Sensitivity Training

Health Emergency and Disaster Services including Basic Life Support
Medicines Management
Management/ Supervisory Training
C. Indicate number of LGU-hired Rural Health Midwives trained on the following:
1 Family Planning (FPCBT 1, ICV) 5
2 Antenatal Care and BEmONC 5
3 Essential Newborn Care 5
4 Expanded Program for Immunization 5
5 First 1,000 days for nutrition 0
6 Adolescent Sexual and Reproductive Health 2
Number of LGU-hired Midwives who completed items 1-6
* Total number of LGU-hired Rural Midwives:
Competency of Barangay Health Workers 2014 2015 2016
59. How many Barangay Health Workers are trained on the Basic Course
for Barangay Health Workers? 64 64 64
60. How many Barangay Nutrition Scholars are trained on the Basic
Course for Barangay Nutrition Scholars? 0 0 3
61. Does the LGU have a defined job descriptions of Rural Health
YES NO
Unit (RHU) Staff?

62. Does the LGU conduct competency-based evaluation for RHU YES NO, go to Q#64
Staff?
63. If YES to Q#62, how often d the LGU conducts competency-based Monthly Semi-Annual
evaluation for RHU Staff? Quarterly Annual
Others, please specify _________________
64. How often does the MHO conduct technical coaching for RHU Monthly Semi-Annual
Staff? Quarterly Annual
Others, please specify _________________
None
65. Does the LGU have a local policy on awards and recognition YES NO
system that covers RHU Staff?

66. How often does the LGU conducts competency-based evaluation Monthly Semi-Annual
for BHWs? Quarterly Annual
Others, please specify _________________
None
67. How often does the LGU conduct competency-based evaluation Monthly Semi-Annual
for BNS? Quarterly Annual
Others, please specify _________________
None
68. Does the LGU conduct technical coaching for Barangay Health YES for BHWs and BNS NO
Workers at least quarterly (i.e. Midwives to BHWs, and MNAO to YES for BHWs only
BNS)? YES for BNS only

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 Barangay Health Human Resource
69. Kindly fill out completely the table below. 2014 2015 2016
a. Number of Barangay Health Workers 64 64 64
b. Number of Barangay Nutrition Scholars 27 27 27

Health Human Resource for Emergency

70. Does the LGU have a hired/designated Health Emergency Management System Yes No
Coordinator or DRRM-H plan Manager?
71. Does the LGU have an organized emergency response team? Yes No
72. Does the LGU have a system for recall of Health Human Resource during emergency Yes No
response?

Compensation and Magna Carta for Public Health Workers

73. Kindly fill out completely the table below.
Hazard Laundry Allowance
Allowance (y/n) (y/n) Subsistence
Allowance (y/n)
Health Workers No. of Staf Salary Grade
At least 25% for SG 19 & At least P150.00/month Not less than P50.00/day
below; 5% for SG 20 & or P1,500.00/month
above given
monthly/quarterly or
annually

a. Municipal Health Officer

b. Rural Health Physician
c. Public Health Nurse
PHN 1
PHN 2
PHN 3
d. Rural Health Midwives
MDWF1
MDWF2
MDWF3
MDWF4
MDWF5
MDWF6

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 IV. ACCESS TO MEDICINE AND TECHNOLOGY
74. List all RHU procured medications as of the latest quarter; identify which are listed in the Philippine National Formulary:

Procured meds that are listed in the PNF Procured meds that are not listed in the PNF

75. For the current year, did you forecast the quantity of needed YES NO
medicine supply based on consumption and morbidity data?

76. For the current year, did you conduct monitoring/reporting on YES NO
procurement performance?

77. Kindly check all applicable characteristics present in your MAIN medicine and supply storage.
Uncrowded space
Adequate lighting
Adequate ventilation
Presence of room thermometer
Presence of cold chain for vaccines
Presence of shelves and pallets.

78. Do you conduct physical count (inventory management) and YES NO

reporting of ALL medicines and other health products during the
previous month?
79. Does the RHU adopt the Daily Drug Use Record or Drug YES
NO
Utilization Report?
80. Does the LGU have guidelines in accepting foreign and local drug YES NO
donations?

81. Does the RHU adopted the guidelines for disposal of unwanted or YES NO
expired medicines?

82. Does the LGU have a policy on establishing drugs and 83. Does the LGU have a policy on formalizing LGU protocols
therapeutics committee governing LGU pharmaceutical related on pharmaceutical supply chain management?
activities?
YES NO YES NO
84. Does the LGU have a policy adopting the national guidelines on the implementation of rules
and regulations on licensing of Retail Outlet for Non-prescription drugs? YES NO
85. Does the LGU have a policy on emergency procurement, prepositioning, and immediate
replacement of essential medicines and basic health emergency supplies? YES NO
a. EPI Vaccines: __________________
b. Supplements: __________________
86. Insufficient Supply of Medicines: List all medications that have
less than 1 month supply of stock in the RHU c. Contraceptives: __________________
d. 4 molecules: __________________
e. TB Drugs: __________________

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 V. HEALTH INFORMATION SYSTEM
YES NO, go to Q#89
87. Does the RHU have electronic medical records (EMR) system?

88. What is the EMR being used?

89. Does the RHU have an electronic health data reporting system? YES NO, go to Q#92
90. Is the electronic health data reporting system interoperable (can generate YES NO
and submit) with FHSIS?
91. Does the RHU have a back-up electronic system during YES NO
emergency situation?
Maternal Health Services
Expanded Program for Immunization
Under Five Nutrition
TB Control
92. The LGU has a registry system of patients for the following
services: Notifiable Diseases
Non-communicable Diseases
Drugs and Substance Abuse
Mental Health
Persons with Disabilities
93. For the previous year, do you submit 94. When do you submit your QUARTERLY FHSIS? (refer to latest submitted
QUARTERLY FHSIS data to the Provincial or City data) Realtime/Automatic submission
Health Office?
Month of the succeeding Quarter: Week:
YES NO First month First week
Second month Second week
Third month Third week
Others Fourth week
95. Do you submit ANNUAL FHSIS data (including 96. When do you submit your ANNUAL FHSIS? (refer to latest submitted data)
the list of leading causes of Morbidity and Realtime/Automatic submission
Mortality) to the Provincial or City Health Office?
Month of the succeeding Year: Week:
First month First week
Second month Second week
YES NO Third month Third week
Others Fourth week
97. For the previous year, do you submit 98. When do you submit your QUARTERLY NTP report and data? (refer to
QUARTERLY National Tuberculosis Control and latest submitted data) Realtime/Automatic submission
Prevention Program (NTP) reports and data to the
Provincial or City Health Office? Month of the succeeding Quarter: Week:
First month First week
Second month Second week
YES NO Third month Third week
Others Fourth week
99 Do you submit ANNUAL data on Operation Timbang Plus (OPT Plus) to the 100. When do you submit your ANNUAL OPT Plus
Provincial Nutrition Council or Health Office? data? (refer to latest submitted data)
YES NO, go to Q#101 Kindly specify the date: ______________
101. The RHU have an updated annual list of the following: Leading Causes of Morbidity
Leading Causes of Mortality
Leading Causes of Consults

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102. Do all maternal mortalities in the previous quarter have community-
based mortality investigation report? YES NO No Deaths

103. Do all infant mortalities in the previous quarter have community-based YES NO No Deaths
mortality investigation report?
104 Does the LGU regularly collect the following data?
Male and Female Population by Age group Housing facilities and utilities situation
Population and Residential Density by Barangay Hazard mapping
Population by religious affiliation
Current and Projected Labor force and employment
Elementary and secondary school participation and completion rates
105. Does the LGU have an annual updated list (with at least name, age, gender, address, household head) of the following groups?

FOR ALL: IF APPLICBLE:

Pregnant and lactating women Households with Indigenous People
Under five children Households in remote areas (i.e. GIDA)
Persons with Disabilities
Elderly
Out of school youth

106. Does the LGU have an established early warning system? IF No, Go to Q#108 Yes No
107. Does the LGU have mechanisms to disseminate early warning system information?
Yes No

108. Does the LGU have an established system for Surveillance in Post Extreme
Emergencies and Disasters (SPEED)? Yes No

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 VI. HEALTH SERVICE DELIVERY
Municipal Health Services
109. Kindly fill out completely the table below.
A. The Rural Health Unit is operational for: Check all that is B. Operating Hours C. Operating Days
applicable.
Outpatient Services 8:00 - 5:00 PM Monday- Friday
Emergency and Birthing Services 24hours Monday- Sunday
110. Does the LGU have waiting homes/ half-way houses with water and power supply and a caretaker?
YES NO

111a. Kindly check all the characteristics that are applicable to the RHU 1:
a. With 24/7 WATER supply
b. With 24/7 POWER supply
c. With 24/7 Emergency Transport Vehicle
111b. Kindly check all the characteristics that are applicable to the RHU 2: (if applicable)
a. With 24/7 WATER supply
b. With 24/7 POWER supply
c. With 24/7 Emergency Transport Vehicle
111c. Kindly check all the characteristics that are applicable to the accredited LGU owned birthing facilities:
a. With 24/7 WATER supply
b. With 24/7 POWER supply
c. With 24/7 Emergency Transport Vehicle
112. Does the LGU map the referral facilities as well as the blood service facilities within and outside the municipality?

YES NO
113.The RHU have a two-way referral system with the following:
a. All the Barangays in the municipality
b. Any PhilHealth Accredited Higher-level referral facility (thru a MOA/MOU )
c. Any diagnostic facilities for needed laboratory procedure (thru a MOA/MOU )
d. Any blood service unit (thru a MOA/MOU )
e. NONE

Barangay Health Services

114. Kindly fill out completely the table below. 2016
a. Number of Barangays in the municipality 31
b. Number of Barangays with its own Barangay Health Center/Station 5
c. Number of Barangays which do not have their own BHS but belongs to a
catchment area of an existing BHS in other barangays 25
115. From those BHS in 114b., how many have water supply at least during operating
hours?
116. From those BHS in 114-b., how many have power supply at least during operating
hours?
117. Kindly fill out completely the table below. Refer to Previous Month
d. Number of Barangays visited at least once monthly by a nurse or rural health 10
midwife

e. Number of BHWs who conducted monthly visits to their assigned household

f. Number of BNS who conducted monthly Operation Timbang Plus monitoring of
0-23 months old and malnourished children 0-59 months old
118. Does the RHU post their Citizen's Charter? YES NO
119. Does the RHU have protocols in observing patients' rights? YES NO

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120. Kindly check all that is applicable. For the current year, the RHU conducts the following:
a. Assessing the gender-sensitivity of the RHU
b. Strategies to address gender-sensitivity gaps
c. Strategies to increase the access to health services of vulnerable population especially those in GIDA communities, IP
areas, and other sectoral groups
d. Collects feedbacks or satisfaction rating from patients
e. Inclusion of patients' feedbacks in the RHU meeting or LHB agenda
121. Kindly check all the characteristics that are applicable to the RHU:
These services have the following components present:
The RHU ofers the following
health services as of the current
quarter:
a. Maternal and Newborn Health Pregnancy tracking Antenatal Care
Service
Prenatal visits Postpartum Care
Birth preparedness plan and Basic Emergency Obstetric and
referral Newborn Care
Nutrition promotion and Referral services
assessment
Safe labor and delivery
Others (specify): _______________________________________
b. Child Health
Micronutrient supplementation
Growth monitoring for identified
undernourished children

Promotion of infant and young
child feeding
Expanded Program on
Immunization
Integrated Management of
Childhood Illnesses
Others (specify): _______________________________________

c. Family Planning
Family planning promotion
Counselling
Provision of commodities
Referral services
Others (specify): _______________________________________

d. Adolescent Sexual and Youth-friendly services STI Management

Reproductive Health

Promotion of ASRH (inc. HIV, STI, Referral services

Gender Based Violence)
Counselling on prevention of
teenage pregnancies
Counselling for unintended
pregnancies
Others (specify): _______________________________________

e. Oral Health Oral Hygiene Promotion Referral services

Oral prophylaxis

Management of Dental Caries

Tooth Extraction
Others (specify): _______________________________________

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f. Communicable Disease Active case finding for TB Management and control of other
Surveillance and reporting for diseases with endemic potential
notifiable diseases

STI Management Referral services

Management and control of TB
Others (specify): _______________________________________

g. Non-Communicable Disease IEC against NCD risk factors Treatment for Diabetes and
Healthy Lifestyle programs Hypertension

Post-stroke rehabilitation or
Routine screening for risk factor referral
identification
smoking cessation clinic Dialysis or referral
Referral for Diabetes and
Hypertension
Follow-up of cases
Others (specify): _______________________________________

h. Environmental Health and Promoting water quality and food

Sanitation safety

Vector control and waste
management
Others (specify): _______________________________________

i. Mental Health
Promotion of Awareness on Treatment of Mental Illnesses or
Mental Health referral
Referral for long term care of

patients with mental illnesses and
Promote stigma reduction disabilities
Crisis intervention
_______________________________________
Others (specify):
j. Drugs and Substance Abuse Screening and Profiling
Community based drug rehabilitation

Follow-up of cases
Referral services
Others (specify): _______________________________________

k. Health for the elderly Immunization

Referral services
_______________________________________
Others (specify):

l. Health for persons with physical Community based rehabilitation

disability
Referral services
Others (specify): _______________________________________

122. The RHU has complete health service packages (as of the current quarter) for the following Life Stages? (Refer to Question
121a,b,d,k)
Maternal Child Adolescent Senior Citizens
1. Maternal (Pregnancy Tracking, Prenatal visits, Birth preparedness plan and referral, Nutrition promotion and assessment, Safe labor and delivery, Antenatal Care,
Postpartum Care, Basic Emergency Obstetric and Newborn care)
2. Child (Growth monitoring for identified undernourished children, Promotion of infant and young child feeding, Expanded Program on Immunization, Integrated
Management of Childhood Illnesses, Micrnutrient Supplementation)
3. Adolescent (Youth-friendly services, Promotion of ASRH, Counselling for unintended pregnancies, Counselling on prevention of teenage pregnancies, STI management)
4. Senior Citizens (Immunization)

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Page 19 of Page 47
Kindly ensure that all questions are accurately accomplished. Indicate here which questions are intentionally left blank due to
lack of data/information:
________________________________________________________________________________________________

By affixing my signature, I certify that all the health information provided herein is true, accurate, and up to date.
Accomplished by: Verified by:

Signature above Printed Name Signature above Printed Name

Position Position

Date Date

Reviewed by:

Signature above Printed Name

Position

Date

Primary Health Care Roadmap Questionnaire

Page 20 of Page 47
 ANNEX A. BARANGAY HEALTH GOVERNANCE
Name of ALL Priority Brgy? (Yes or No) Q19 B. Does the C. If YES to B, Q22 Q24 Q23
Barangays Provide basis for prioritization A. Type of present Barangay Health are the D. Does the E. Does the Barangay F. Underwent BHLMP?
Based on: ex. Barangay Health Governance meetings Barangay have at have Barangay (Yes/No)
a) health burden Governance Body (e.g. Body meet every documented? least one (1) Investment Plan for
b) GIDA BDC, BHB, CHT-Technical month? (Yes/No) (Yes/No) Resolution on Health or Barangay
c) high poverty incidence Management Committee). If YES, go to C. Barangay Health Development Plan
d) presence of IP
Indicate if NONE then go System incorporating priority
to D. Strengthening or health needs and
any policy in strategies? (Yes/No)
health? (Yes/No)

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Name of Municipality: MacArthur

MUNICIPAL BASIC HEALTH SYSTEMS SIX BUILDING BLOCK INDICATORS:

Building Block: Leadership and Governance
Description: Involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system-design, and accountability.
Reference from PHC
Questionnaire STANDARD OF SCORE
SUB-BLOCK DONE PERFORMANCE INDICATORS REMARKS PERFORMANCE MEANS OF VERIFICATION BASIS Baseline (2016)

Expanded and Functional Q1 1. Issued legislation on expanding the Local Health Primary Members of the Local Health Board (LHB) includes the Mayor as Red: 0-1/5 Copy of legislation Local Government Code (LGC) 0
Local Health Board (LHB) Board to include ALL of the following: chairman, MHO as vice-chairman, DOH Rep, SB on Health, 1 representative from Yellow: 2-4/5 of 1991
a. municipal social welfare and development officer, the private sector or non-governmental organizations (NGOs) involved in health Green: 5/5 Good Practice: Sample
b. municipal planning and development services, and a Community Leader. policies from Gamay Northern
coordinator, Samar and Cotabato City
c. municipal budget officer, and Expanding the LHB pertains to addition of ALL of the following:
d. other agency representatives deemed necessary a. municipal social welfare and development officer,
b. municipal planning and development coordinator,
c. municipal budget officer and
Any of the following
d. President of "Liga ng mga Barangay",
e. Representative/ President of Barangay Health Workers,
0 f. Representative for Disaster Risk Reduction and Management,
g. Department of Education Representative / School Division or District
superintendent,
h. Hospital Heads (public and private), and
i. other agency representatives deemed necessary through conduct of stakeholder
analysis.

Q2 2. Included individual representation from the Copy of legislation ZFF Learning from CHPP
Basic sector (women, workers, senior citizens, Alumni and MLGP
youth, and other members deemed necessary) in
the Local Health Board
This pertains to inclusion of representatives from Basic sector which include
ALL of the following: a. women representative, b. workers' representative, c. senior
citizens, d. youth representative, and
any of the following sectors:
a. the urban poor, b. indigenous people/ cultural communities, c. disabled persons,
or d. any other members of the Basic sector deemed necessary by the LHB.
0
Basic sector refers to disadvantaged sectors of the Philippine society, which also
includes farmer-peasant, artisanal fisherfolk, workers in the formal sector and
migrant workers, workers in the informal sector, indigenous peoples and cultural
communities, women, differently-abled persons, senior citizens, victims of
calamities and disasters, youth and students, children, and urban poor;

Q3 2. Defined functions, roles and responsibilities of Roles and responsibilities of ALL individual members are reflected in the Copy of legislation ZFF Learning from ZFF CHPP
each member of the Local Health Board created/revised ordinance on expanding the Local Health Board Alumni and MLGP
0
 Q4 3.Conducted orientation on Bridging Leadership or Municipal Health System Strengthening Program is a ZFF Bridging Leadership Documentation of Research finding on CHPP
training in Municipal Health System Strengthening Product which facilitates inter-agency and inter-sectoral collaboration for health MHSSP/BL orientation Impact Evaluation
Program (MHSSP) among members of the systems strengthening Activity
expanded local health board?
0

Q5-Q6 4. Documented monthly meetings presided by Updating of roadmap sub-block should validate if meetings are documented, Documentation and Good Practice: ZFF CHPP LGUs
mayor presided by mayor and held at least monthly during the previous quarter. Mayors proceedings of the Local
0 could be excused in presiding meetings during emergency situations. Health Board meetings

Q7-Q8 1. Reviewed and updated Municipal Investment Red: 0-2/6 Copy of old and new Local Investment Planning for 0
Plan for Health (MIPH) by Local Health Board Yellow: 3-5/6 MIPH Health: Handbook on
Green: 6/6 Principles, Guidelines,
Municipal Investment Plan for Health is reviewed and updated with ALL of the Procedures, and Processes.
following contents: Bureau of Local Health Systems
a. Executive Summary, Development (BLHSD)
b. Introduction/Plan Development, Department of Health and
c. LGU profile, United Nations Childrens Fund
d. Health Situationer/Situational Analysis, (UNICEF)
e. Overall Health Strategy and specific interventions,
0
f. Costing of critical interventions,
g. Plan Management,
h. Monitoring and Evaluation
Performance indicator will be validated by checking completeness and by
comparing if the old MIPH differs from the new MIPH

Q9 2. Identified health needs through participatory Executive Summary of MIPH contain identified health needs. Health Copy of new MIPH Local Investment Planning for
approach, data, and prioritization process Situationer/Situational Analysis contain ALL of the following: Health: Handbook on
a. description how it was consulted to stakeholders, Principles, Guidelines,
b. updated health data, and Procedures, and Processes.
c. the method of prioritization used. Bureau of Local Health Systems
The prioritization process should be based from urgency and magnitude, vis--vis Development (BLHSD)
organizational capability and effects of inaction. In the preparation of the MIPH, Department of Health and
0 the LHB should have an agreed criteria and evidence-based rating system (e.g. LGU United Nations Childrens Fund
scorecard) in the prioritization of these identified health needs (UNICEF)

Q9 3. Integrated Municipal and Barangay Investment The Health Situationer/Situational Analysis should include listing of Priority Copy of new MIPH Department of Budget and
Plan for Health health needs identified per barangay. The overall health strategy and specific Management:
interventions should highlight or label which were brought up from barangay http://www.dbm.gov.ph/wp-
Collaborative, health plans content/uploads/2012/03/BB-
comprehensive, 0 3.pdf
participatory, and >Recommendations from
evidenced-based consultations
Municipal Investment
Planning for Health (MIPH)
Q10 4. Integrated Municipal Investment Plan for Health The Municipal Development Plan should include the priority strategies identified Copy of new MIPH and Department of Budget and
with Municipal Development Plan in the Municipal Investment Plan for Health the Municipal Management:
Development Plan http://www.dbm.gov.ph/wp-
0 content/uploads/2012/03/BB-
3.pdf
Planning for Health (MIPH)

Q11 5. Endorsed Municipal Health Plan to the Provincial A cover letter must be attached to the accomplished Municipal Health Plan Copy of cover letter Local Investment Planning for
Health Office endorsing the Municipal Health Plan to the Provincial Health Office with proof of receipt Health: Handbook on
from the Provincial Principles, Guidelines,
Health Office Procedures, and Processes.
Bureau of Local Health Systems
Development (BLHSD)
0 Department of Health and
United Nations Childrens Fund
(UNICEF)

Q12-Q13 6 Reviewed and updated Annual Operational Plan The Annual Operational Plan is reviewed and updated with ALL of the following Copy of old and new Local Investment Planning for
(AOP) contents: AOP Health: Handbook on
a. cover letter, Principles, Guidelines,
b. general description (i. Health Situation at the end of the Year, ii. Local priorities in Procedures, and Processes.
Health: Adjusting MIPH to the Current Situation, iii. Major thrusts of the AOP, iv. Bureau of Local Health Systems
Adjustments in Proposed Interventions and Investments based from program Development (BLHSD)
implementation review, v. performance indicators), and Department of Health and
0 c. Planning and Costing Matrices. Minutes of PIR should be annexed to the AOP United Nations Childrens Fund
(UNICEF)

Q14 1. Conducted community consultation activities at Community engagement is the process of working collaboratively with Red: 0-1/3 Documentation and Recommendations from 1
least twice a year community and sectoral groups to address issues that impact the well-being of Yellow: 2/3 activity reports consultations
those groups. Community consultations could be done through barangay Green: 3/3
1 assemblies, health summits, town hall meetings, public hearings)

Q15 2. Conducted community activities to Reporting/feedback activities could be done along with community consultation Documentation and Recommendations from
report/feedback local health data and status of activities or through publishing/posting of information in health data boards activity reports consultations
Community Engagement 0 health programs at least twice a year
Activities

Q16-Q18 3. Organized community volunteer groups which Performance indicator will be validated through list of volunteers with defined Directory of volunteers Recommendations from
includes ANY of the sectoral representatives (e.g. roles and responsibilities. The volunteers identified are not the barangay health Documentation of consultations
women, workers, youth, senior citizens, etc.) workers / nutritional scholars but should be sectoral representatives (women, activities participated by
0 worker, youth, senior citizens, etc.) or their family members. volunteers
 Q19 1. Established Barangay Health Governance Bodies At least one Barangay Health Governance Body in ALL priority barangays as Documentation and ZFF Learnings from BHLMP 1
(Barangay Development Council, Barangay Health required based from the policy of the Mayor. The barangay governance bodies proceedings of the
Boards, Barangay Nutrition Committee) in ALL should have documented meetings at least quarterly and have agreed action points Barangay Health Board
priority barangays in every meeting. meetings
0

Q20-Q21 2.Issued municipal legislation on the creation of Legislation could either be on creation or strengthening of Barangay Health Board Red: 0-1/4 Copy of the legislation ZFF Learnings from BHLMP
Barangay Health Governance Bodies OR or existing Barangay Health Governance Bodies Yellow: 2-3/4
strengthening of those existing already with Green: 4/4
1 statement of functions, roles, and responsibilities.

Functional
Barangay Health
Governance Body Q22 3. At least one (1) Resolution on Barangay Health This could also include review of existing resolutions Copy of Resolutions ZFF Learnings from BHLMP
System Strengthening or any policy on health
issued by the Sangguniang Barangay in ALL priority
0 barangays

Q23 4. Conducted Barangay Health Leadership and Barangay Health Leadership and Management Program (BHLMP) is a ZFF bridging BHLMP Activity Report ZFF Learnings from BHLMP
Management Program in in ALL priority barangays leadership product which intends to capacitate and empower the health leaders in with updated Barangay
the barangay to help them organize and functionalize their Barangay Health Boards. Health System
The barangay health leaders are to improve their barangay health system making Scorecards
health services available to the community thereby resulting to improved health
0 outcomes.

Q24 1. Formulated Barangay Investment Plan for Health/ Barangay Investment Plan for Health/ Barangay Development Plan should Red: 0/2 Copy of Barangay Local Investment Planning for 0
Barangay Development Plan with identified priority indicate the following: a. priority health needs, and b. priority health strategies. Yellow: 1/2 Health Plan Health: Handbook on
health needs and priority health strategies based The results of situational analysis and community diagnosis should be annexed to Green: 2/2 Principles, Guidelines,
from Situational Analysis and Community Diagnosis the Barangay Investment Plan for Health/ Barangay Development Plan Work and financial Procedures, and Processes.
in in ALL priority barangays plan of barangay BLHSD-DOH and UNICEF
> Department of Budget and
Management:
http://www.dbm.gov.ph/wp-
0 content/uploads/2012/03/BB- 1
3.pdf
>Recommendations from
consultations
Barangay Investment Plan
for Health/ Barangay
Development Plan

Q25-Q26 2. Monitored implementation of Barangay Report on the progress ZFF Learnings from BHLMP
Investment Plan for Health/ Barangay Development of the status of Barangay
Plan at least in a semi-annual basis Investment Plan for
Health/Barangay
0 Development Plan

None
 Q27 Issued policy (new or revised) to address focus LGUs should have policies to address ALL diseases/stages listed in each focus Red: None or Less Copy of the legislations WHO List of Essential Package 1
None areas on health and nutrition in all life stages and area. Legislations can integrate several diseases/stages in each focus area into a than two focus areas of Health Services
on the triple burden of disease: single policy (e.g. Ordinance on comprehensive maternal and child health and with issued legislations Philippine Health Agenda
nutrition, Ordinance on integrated and comprehensive program for non- in ALL diseases/stages Targets
1 Communicable diseases communicable diseases) Philippine Integrated
-HIV Yellow: 2-3 focus Management of Acute
-Tuberculosis areas with issued Malnutrition policy DOH AO
-Food and waterborne Diseases legislations in ALL 2015-055
0 -Diseases with endemic potential diseases/stages
OR
Less than two focus areas with issueddiseases:
2 Non-communicable legislations in ALL diseases/stages 4 focus areas with
-Hypertension issued legislations in
-Diabetes SOME diseases/stages
-Chronic Kidney Diseases
Green: 4 focus areas
3 Mental Health and Substance Abuse with issued legislations
in ALL diseases/stages
4 Health and Nutrition for all Life-stage:
-Maternal
2-30 focus areas with issued
-Child legislations in ALL diseases/stages
-Adolescent
-Senior Citizen

Presence of Health Policies

4 focus
5 areas with issued legislations in SOME diseases/stages

4 focus
0 areas with issued legislations in ALL diseases/stages
 Q28-Q30 1. Issued legislations for health (new or revised) Use existing policies for baseline. For practicum, this will apply to ALL health Red: 0-1/3 Copy of the legislation ZFF Learning from CHPP 3
through inter-sectoral collaboration, participatory policies to be issued (new or revised) after module1. All health policies to be Yellow: 2/3 Documentation of Alumni and MLGP
approach, evidence and local health data created/revised during practicum phase should have provisions describing rationale Green: 3/3 minutes Recommendations from
or basis for the policy based on all of the following: a. local health data, b. national consultations
guidelines, and c. consultation/collaborated with other sectors
All health policies issued during practicum phase should also be signed and
1 acknowledged by members of the expanded local health board

Collaborative and Inter-

sectoral Health Policy Q31 2. Issued/revised legislations for health with All health policies issued during practicum phase should have provisions Copy of the legislation ZFF Learning from CHPP
Development, monitoring and evaluation plans describing how the policy is to be monitored and evaluated in terms of compliance Alumni and MLGP
Implementation and 1 to set rules and regulations Recommendations from
Monitoring consultations

Q32-Q33 3 Implemented ALL legislations for health in line Performance indicator will be validated through submission of reports on status Copy of reports on ZFF Learning from CHPP
with implementing rules and regulations of policy implementation with reference to set rules and regulations. status of policy Alumni and MLGP
Implementation reports should indicate the following: implementation Recommendations from
a. description of level of compliance to set implementing rules and regulations, consultations
b. description of actual penalties enacted against non-compliance, c. key findings
1 and recommendations on improving policy implementation and monitoring

Q34 1. Integrated the municipal DRRM-H plan to the The municipal DRRM-H plan should be acknowledged and signed by the local Red: 0-1/4 Copy of Copy of ZFF Learnings from Resilient 2
Municipal Disaster Risk Reduction and health board Yellow: 2-3/4 DRRM-H plan Health Systems Program
Management Plan Green: 4/4
1 Performance indicator will be validated by reviewing the Municipal Disaster Risk
Reduction and Management Plan and identify if strategies from HEPRRP are
included.

Q35 2 Issued an ordinance adopting RA 10121 Created/revised policy should contain Implementing Rules and Regulations on Copy of the ordinance Good Practice: sample policy
"Philippine Disaster Reduction and Management disaster risk reduction and management from General Trias, Cavite
Act" Republic Act No. 10121
"Philippine Disaster Reduction
0 and Management Act"

Q36 3. Established an Incident Command System (ICS) Copy of ICS Good Practice: sample policy
organizational structure organizational structure from Jagna, Bohol
The Incident Command System (ICS) is a management system designed to enable ZFF Learnings from Resilient
LGU support for Building Health Systems Program
Resilient Health Systems effective and efficient domestic incident management by integrating a combination
of facilities, equipment, personnel, procedures, and communications operating
0 within a common organizational structure.

ICS organizational structure should contain members, roles and functions, and
implementing rules and regulations

Q37 4. Issued an ordinance establishing the municipal Municipal Disaster Risk Good Practice: sample policy
health emergency management/disaster risk Reduction and from Baler, Aurora
reduction and management for health unit as The established unit will be in charge of institutionalizing a systematic process of Management Council NDRRMC Memorandum
integrated in the Municipal Disaster Risk Reduction using administrative directives, organizations, and operational skills and capabilities Organizational Structure Circular No.04 s.2012
and Management Council to implement strategies, polices and improved coping capacities in order to lessen ZFF Learnings from Resilient
the adverse impacts of hazards and the possibility of disaster. Health Systems Program
1
The municipal health emergency management/disaster risk reduction and
management for health unit should contain members, roles and functions, and
implementing rules and regulations
Building Block: Financing

Description: Raises adequate funds for health, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverishment associated with having to pay for them. It provides incentives for providers and users to be efficient.
Q38 1. RHU accredited in Primary Care Benefit (PCB) and Red: 0/2 Certificates of The Revised Implementing 2
Anti-Tuberculosis. Directly Observed Treatment Yellow: 1/2 Accreditation Rules and Regulations of the
1 Short-Course (TB-DOTS) Benefit Green: 2/2 National Health Insurance Act 1
of 2013, RA 10606.
http://www.gov.ph/2013/06/19
Accredited Health Facilities /republic-act-no-10606/
Q38 2 Presence of LGU owned facility accredited as a Birthing home accreditation is required for provision of Maternal Care Package and Philhealth Manual on New
birthing home Newborn Care Package Accreditation Process
1

Q39-Q40 1. Conducted an information and education IEC initiative could be in the form of lectures, caravans and through counselling. Red: 0/2 Copy of Recommendations from 1
campaign (IEC) initiative on enrolment and benefits This is aside from the usual giving of hand-outs and setting-up posters. Yellow: 1/2 documentation of the consultations
(at least once quarterly) This may include Philhealths ALAGA KA Green: 2/2 IEC initiatives,
1 Attendance Sheets, or 1
copy of IEC Materials

Community IEC on
Philhealth Services Q41 2. Presence of LGU-hired or designated personnel The personnel could be a job-order or designated personnel Copy of appointment Recommendations from
as point person for Philhealth information and The personnel could also be a member of a municipal philhealth office. or Training certificate of consultations
concerns designated personnel
0
 Q42 1. Issued legislation adopting/promoting guidelines Red: 0-1/5 Copy of legislation Good Practice: Sample policy 1
on disposition of reimbursements for ALL Packages Yellow: 2-4/5 from Tacloban City
(PCB, MCP, TB-DOTS) Green: 5/5 Philhealth circular No. 054,
The description below serves as guide only for LGUs without existing policies or s2012
who desires to revise their policies. For validating the performance indicator, Philhealth circular No. 014,
review if all packages have policy describing percentage breakdown of disposition s2014
of reimbursements.
Guidelines on allocation of the PCB package payment
Professional Fees (10% for physician, 5% for health professional staff, 5% for non-
health staff including volunteers)
Medications (40%)
Operational costs, Equipment, Information Technology, capacity building, etc.
0 (40%)
Guidelines on allocation of the TB DOTS package payment
Professional Fees (25%)
Facility Fee (40%)
Service Staff Fee (35%)

Guidelines on allocation of the MCP payment

Facility Fees (60%)
Incentives to mothers/Service Staff Fee(40%)

Management of Philhealth
Reimbursements Q43 2. Issued legislation on creation of separate trust Copy of legislation Good Practice: Sample policy
0 fund for proceeds from Philhealth reimbursements from San Nicolas, Ilocos Norte

Q44 3. Submitted reimbursement claims within 60 days Philhealth guidelines require submission of claims within 60 days after discharge Transmittal form to The Revised Implementing
after discharge or treatment for ALL packages (PCB, or treatment. PhilHealth from LGU Rules and Regulations of the
MCP, TB-DOTS) or realtime/automatic submission National Health Insurance Act
(e.g. through iclinicsys) Performance indicator will be validated through review of latest transmittal form of 2013, RA 10606.
1 (whatever is available for review) submitted to Philhealth for ALL packages (if http://www.gov.ph/2013/06/19
applicable). ALL individual patient claims should be within 60 days in ALL reviewed /republic-act-no-10606/
forms.

Q45 4. Submitted required quarterly reports to Proof of receiving copy The Revised Implementing
0 Philhealth of report from Philhealth Rules and Regulations of the
National Health Insurance Act
of 2013, RA 10606.
Q46 5. Monitored Utilization of Philhealth Annual Per Family http://www.gov.ph/2013/06/19
reimbursements Payment Rate Utilization /republic-act-no-10606/
Report and
0 Reimbursement Report
submitted by LGU to
PhilHealth

Q47 1. Conducted listing of poor families not identified Listing could be done through the use of Philhealths Family Data Survey Form, or Red: 0-1/3 List of identified non- The Revised Implementing 0
by the National Household Targeting System (NHTS) any method consistent with the means test rule The process for requesting NHTS Yellow: 2/3 NHTS poor and list of Rules and Regulations of the
0 list from DSWD could be accessed here: http://listahanan.dswd.gov.ph/reports/ Green: 3/3 non-NHTS poor enrolled National Health Insurance Act
by LGU of 2013, RA 10606.
LGU policy on http://www.gov.ph/2013/06/19
Q48 2. Submitted list of poor families to Provincial PhilHealth Subsidy or /republic-act-no-10606/
Social Welfare and Development Office (PSWDO) Municipal Budget Report
Philhealth Coverage for for evaluation and endorsement to the Philippine
the Poor 0 Health Insurance Corporation (PHIC)

Q49 3. LGU sponsorship for low income families who do This pertains to LGU subsidy or cost-sharing for the premium payment for
not qualify for full subsidy by national government members of the informal economy from the lower income segment who do not
0 qualify for full subsidy under the means test rule of the DSWD
 Q50 1. Allocated at least 15% of municipal budget for Numerator = Appropriated Health Budget Red: 0/2 DILG scorecard, Annual Local Government Code (LGC) 0
health Denominator = total municipal budget Yellow: 1/2 Municipal Budget Plan, of 1991
Green: 2/2 or Municipal Investment DILG scorecard indicators
0 Planning for Health

Q51-Q52 2. Allocated budget for health from internally or Internally sourced income are those locally generated by the LGU and includes Annual Municipal
externally sourced income aside from IRA and the following: Budget Plan or Municipal
Philhealth capitation a. Tax Revenues (e.g. real property tax, tax on business, other taxes) and Investment Planning for
b. Non-tax revenues (regulatory fees, service/user charges, receipts from economic Health
LGU Health Budget enterprises, toll fees, other receipts).
Allocation (At least 15%) Externally sourced income includes the following:
a. Share from national tax collection aside from IRA,
b. Foreign and domestic Grants,
0 c. National Aids,
d. Loans and Borrowings, and
e. Inter-local transfers

Q50 At least 95% of health budget is utilized This refers to utilization of the previous year. Red: <70% Municipal Financial Recommendations from 0%
Yellow: 70%-94% Statement, Annual consultations
Green: 95%-100% Report of RHU/MHO, or ZFF Learning from CHPP
Summary of Alumni and MLGP
Expenditures from the
Actual Budget office of the Municipal
Utilization 0% Budget Officer
Fund utilization report

Q53 1. Issued policy on provision of subsidies Examples of LGU subsidy are medical assistance, transport assistance, assistance Red: 0/2 Copy of ordinance, Recommendations from 0
in emergency and crisis situation, etc. Yellow: 1/2 executive order or consultations
0 Green: 2/2 resolution 1

Policy support on
provision of funds for Q53 2. Issued policy on provision of Social Protection Social Protection constitutes policies and programs that seek to reduce poverty Copy of ordinance, Social protection handbook
subsidies and social Schemes and vulnerability to risks and enhance the social status and rights of the executive order or for local chief executives
protection marginalized by promoting and protecting livelihood and employment, protecting resolution
0 against hazards and sudden loss of income, and improving peoples capacity to
manage risks.
Building Block: Human Resource

Description: Works in ways that are responsive, fair, and effective to achieve the best health outcomes possible, given available resources and circumstances (i.e. there are sufficient staff, fairly distributed, competent, responsive, and productive.
Q54 The following RHU staff were hired by the LGU: This would include all hired staff whether plantilla, contractual, or job order Red: 0-4/7 RHU organizational Recommendations from 6
1 (permanent or not) positions Yellow: 5-6/7 structure consultations
1. Physician Basis of count is by appointment. If one staff has dual function, he/she should be Green: 7/7
counted based on his/her appointment Copy of appointment
1 2. Public Health Nurse or employment
certificate of designated
Complete RHU Staf 1 3. Registered Midwife personnel
Complement
1 4. Medical Technologist
1 5. Municipal Nutrition Action Officer
1 6. Rural Sanitary Inspector
0 7. Pharmacist
Q55 The following LGU-hired RHU staff were accredited Professional health care providers are accredited to make sure that members get Red: 0/2 Copy of Philhealth Philhealth List of Ac-credited 1
1 by PhilHealth: the highest quality of medical treatment and management from experts in various Yellow: 1/2 Accreditation ID Professionals.
RHU Human 1. Rural Health Physician fields of medical practice Green: 2/2 Proof of registration https://www.philhealth.gov.ph/ 1
Resource partners/providers/professiona
Accreditation Q56 2. All Rural Health Midwives l/accredited/
0

Q57 1. The Local Health Board created/reviewed policy Red: 0/1 Copy of protocol on Good Practice: Sample policy 0
on creation of Barangay Health Worker (BHW) Green: 1/1 BHW registration, from Iligan City and Lal-lo
Registration and Accreditation Committee accreditation and Cagayan
Barangay Health Worker supported by LHB retention Implementing Rules and
Registration and 0 BHW registry Regulations of Magna Carta for
Accreditation Health Workers

Q58 The staff must complete all training per category of service packages and other Red: 0-1/3 Copy of training Recommendations from #VALUE!
training. Put not applicable if Rural Health Physician is not LGU hired Yellow: 2/3 certificates consultations
1. Basic Service Packages Green: 3/3 Personnel data sheet
a. Family Planning (at least FPCBT 1 and 2, ICV, Personnel file folder
PPIUD insertion, NSV, SDI) Training inventory
((FALSE b. Antenatal Care and BEmONC,
c. Essential newborn care,
d. Expanded Program for Immunization
e. First 1000 days for nutrition, and
f. Adolescent Sexual and Reproductive Health (AJA)

Q58

2. Other Service Packages

a. TB DOTS,
b. HIV/AIDS prevention, detection and
treatment/referral,
c. Endemic disease prevention and treatment e.g.
Trained Medical Doctor malaria, schistosomiasis, filariasis, dengue,
0 d. Prevention, control, and treatment of non-
communicable diseases e.g. hypertension, diabetes,
stroke, kidney diseases,
e. Detection, treatment, rehabilitation, or referral
for Mental Health,
f. Screening, counselling, or referral for drugs and
substance abuse,
g. Environmental health and sanitation
 Q58

3. Other Training
a. Gender and Culture Sensitivity Training,
0 b. Health Emergency and Disaster Services,
c. Medicines Management,
d. Management/Supervisory Training

Q58 All staff must complete all training per category of service packages and other Red: 0-1/3 Copy of training Recommendations from 1
training. Yellow: 2/3 certificates consultations
1. Basic Service Packages Green: 3/3 Personnel data sheet
a. Family Planning (FPCBT 1 & 2 and ICV) Personnel file folder
b. Antenatal Care and BEmONC,
1 c. Essential newborn care,
d. Expanded Program for Immunization
e. First 1000 days for nutrition, and
f. Adolescent Sexual and Reproductive Health (AJA)

Q58

2. Other Service Packages

a. TB DOTS,
b. HIV/AIDS prevention, detection and
treatment/referral,
c. Endemic disease prevention and treatment e.g.
Trained Public Health malaria, schistosomiasis, filariasis, dengue,
Nurses 0 d. Prevention, control, and treatment of non-
communicable diseases e.g. hypertension, diabetes,
stroke, kidney diseases,
e. Detection, treatment, rehabilitation, or referral
for Mental Health,
f. Screening, counselling, or referral for drugs and
substance abuse,
g. Environmental health and sanitation

Q58
3. Other Training
a. Gender and Culture Sensitivity Training,
0 b. Health Emergency and Disaster Services,
c. Medicines Management,
d. Management/Supervisory Training
 Q58 ALL Rural Health Midwives trained in the following: All staff must complete all training Red: less than 50% of Copy of training Recommendations from 0%
Basic Service Packages midwives have certificates consultations
a. Family Planning (FPCBT 1 and ICV) complete training Personnel data sheet
b. Antenatal Care and BEmONC, Yellow: At least 50% Personnel file folder
c. Essential newborn care, (but not all) of
d. Expanded Program for Immunization midwives have
Trained Rural Health e. First 1000 days for nutrition, and complete training
Midwives 0% f. Adolescent Sexual and Reproductive Health Green: all midwives
have complete training

Q59 1. ALL BHW completed Basic Training Course for Red: 0/2 Copy of training Basic Training Course for 1
1 Barangay Health Workers Yellow: 1/2 certificates Barangay Health Workers 1
Green: 2/2 Trainers Manual on Basic
Trained Barangay Human Course for Barangay Nutrition
Resource Q60 2. ALL BNS completed Basic Training Course for Scholars
0 Barangay Nutrition Scholars

Q61 1. Defined job descriptions of Rural Health Unit This may only apply to staff with plantilla positions Red: 0-1/4 Copy of Human Recommendations from 2
(RHU) Staff Yellow: 2-3/4 Resource Development consultations
Green: 4/4 Plan or document
1 containing job
descriptions

Q62-Q63 2. Conducted competency-based evaluation for Competency-based evaluation refers to evaluating staff performance based on Copy of accomplished Recommendations from
Rural Health Unit (RHU) Staff at least on a semi- pre-defined competencies and their behavioral indicators evaluation forms or consultations
annual basis report on summary The Individual Performance
The Individual Performance Commitment And Review (IPCR) could be used as results of competency- Commitment And Review
Functional 0 template based evaluation (IPCR) Template
Performance Civil Service Commission
Evaluation and
Rewards System for RHU
Staf
Q64 3. Conduct of technical coaching by MHO for Rural Conduct of coaching would be done at least once per quarter Copy of quarterly Recommendations from
Health Unit (RHU) Staff coaching documentation consultations
Performance Indicator would be validated through quarterly submission of from Municipal Health
1 documentation summarizing points of discussion Officer and Public Health
Nurses

Q65 4. Issued policy on awards and recognition system This may only apply to staff with plantilla positions Copy of ordinance, Recommendations from
which includes RHU staff executive order or consultations
0 resolution
 Q66-Q67 1. Conducted competency-based evaluation for Competency-based evaluation refers to evaluating staff performance based on Red: 0/2 Copy of accomplished Recommendations from 1
Barangay Health Workers and Barangay Nutrition pre-defined competencies and their behavioral indicators Yellow: 1/2 evaluation forms or consultations
Scholars on a semi-annual basis Green: 2/2 report on summary NNC Guidelines for BNS
results of competency- Evaluation
based evaluation
Copy of accomplished
0 BNS Evaluation Forms 1

Functional Performance
Evaluation System for
Barangay Health Station
(BHS) Staf Q68 2. Conducted technical coaching for Barangay Conduct of coaching would be done at least once per quarter Copy of quarterly
Health Station (BHS) staff (Registered Midwives to coaching documentation
Barangay Health Workers, Municipal Nutrition Performance Indicator would be validated through quarterly submission of from midwives and/or
Action Officer to Barangay Nutrition Scholars - if documentation summarizing points of discussion Municipal Nutrition
1 applicable) Action Officer

Q54 The LGU met the required human resource Formula for #4. Red: 0-1/4 RHU organizational Philippine Health Agenda 0
recommendations: HHR to Populatio Ratio = (#of physicians+#of nurses+#of midwives / Total Yellow: 2-3/4 structure 2016-2022 AO 2017-0004
1. Physician to Population Ratio: (LGU-hired Population) X 10,000 Green: 4/4 Magna Carta for Public
0 permanent position) Copy of appointment Health Workers
1: 20,000 or employment
certificate of designated
personnel
RHU Health Human 2. Nurses to Population Ratio: (LGU-hired
Resource Adequacy permanent position)
0 1: 20,000

3. Midwives to Population Ratio: (LGU-hired

0 permanent position)
1: 5,000

4. Health Human Resource (mixed personnel of

physicians, nurses, midwives) to Population Ratio:
(LGU or Non-LGU hired, permanent or not
0 permenant)
18.8:10,000

Q54, Q69 All barangays met the human resource Exclude #3 for LGUs with no GIDA/IP communities Red: 0/3 RHU organizational Manual of Operation on 0
recommendations: Yellow: 1/3 structure Maternal, Newborn, and Child
1. BHW to Household Ratio: Green: 2-3/3 List of BHWs and BNS Health and Nutrition
0 1: 20 Directory of volunteers Indigenous People Health
Strategic Plan Joint
Memorandum Circular
2 BNS to Barangay Ratio: ZFF Learnings from Resilient
Barangay Health Human 1: 1 Health Systems Program
Resource Adequacy 0

3. Rural Health Midwife to Identified GIDA Barangay

/ IP community (if applicable):
0 1:1 or 1:1 catchment area
 Q70 1. LGU Hired/Designated Health Emergency Red: 0-1/3 Copy of appointment Recommendations from 0
Management System Coordinator or DRRM-H plan Yellow: 2/3 Copy of directory of consultations
0
Manager Green: 3/3 emergency response
team
Q71 2. Presence of an organized emergency response Copy of protocol on
Health Human Resource team emergency response
0
for Emergency

Q72 3. Presence of a system for recall of Health Human

Resource during emergency response
0

Q73 The salary of the following staff complied with the RHP Rural Health Physician 24 Red: 0-1/3 Copy of Human Salary Standardization Law 0
Salary Standardization Law: Yellow: 2/3 Resource Development DBM Local Budget Circular
PHN1 Public Health Nurse I SG12 Green: 3/3 Plan, HR policy, pay slips, No. 108 series 2016
0 1. Rural Health Physician PHN2 Public Health Nurse II SG16 or contracts of
PHN3 Public Health Nurse III SG19 employment
MDWF1 Midwife I 6
Adequate Compensation MDWF2 Midwife II 8
for RHU Staf 2. ALL Public Health Nurses MDWF3 Midwife III 11
MDWF4 Midwife IV 13
0 MDWF5 Midwife V 15
MDWF6 Midwife VI 18
3. ALL Rural Health Midwives
0

Q73 The following benefits are fully given to ALL the Hazard pay - Public health workers shall be compensated hazard allowances Red: 0-1/3 Copy of Human Revised Magna Carta for 0
permanent LGU-hired health workers: equivalent to at least twenty-five (25%) of the monthly basic salary of health Yellow: 2/3 Resource Development Public Health Workers
workers, receiving salary grade 19 and below, and five percent (5%) for health Green: 3/3 Plan or HR policy
0 1 Hazard Allowance workers with salary grade 20 and above. This may be granted on a monthly, Copy of payroll
quarterly or annual basis.

The laundry allowance shall be P150.00 per month. This shall be paid on a monthly
Implementation of Magna 2 Laundry Allowance basis regardless of the actual work rendered by a public health worker.
Carta for Public Health
Workers 0 Subsistence allowance shall be implemented at not less than PhP50.00 per day or
PhP1,500.00 per month as certified by head of agency.
3 Subsistence Allowance

0
Building Block: Access to Medicine & Technology
Description: Ensures equitable access to essential medical products, vaccines and technology of assured quality, safety efficacy and cost-effectiveness, and their scientifically sound and cost-effective use.
Q74 1. RHU procured medications are in-line with the The PNF serves as basis for selection of medicines in a government facility Red: 0-4/8 Validate list of DOH-NCPAMs National Drug 0
Philippine National Formulary including a RHU. The PNF lists the medicines that are considered most essential for Yellow: 5-7/8 purchased medicines if Formulary List
the diseases and conditions encountered in the country. AO No.163 s. 2002 and EO Green: 8/8 they are present in the EO No. 49, 21 January 1993
No. 49 s.1993 mandates that all medicines selected must be only those found in PNF AO No. 163 s.2002
0 the PNF. Copy of purchase
requisition forms
Copy of procurement
plan which reflects
quantification of needed
supplies
Q75 2. Evidence-based quantification of supply Evidence-based quantification of supply pertains to forecasting of needed Copy of Health Facility DOH-NCPAM's Training
(consumption or morbidity data) medicine supplies using consumption and morbidity data Supply Chain Manual on Pharmaceutical
Management Supply Chain Management for
Performance Monitoring Local Government Facilities
Tool
0

Q76 3. Conducted regular monitoring/ reporting on Copy of report on DOH-NCPAM's Training

procurement performance (supplier lead time, % of procurement Manual on Pharmaceutical
purchases made through bidding, planned vs performance Supply Chain Management for
0 actual purchases) Copy of report of Bids Local Government Facilities
and Awards Committee
(BAC)

Q77 4. Implemented good storage practices Check if the MAIN storage of medicines meet ALL of the following good storage Site visit DOH-NCPAM's Training
practices: Copy of Health Facility Manual on Pharmaceutical
LGU Supply Chain a. uncrowded space, Supply Chain Supply Chain Management for
Management b. adequate lighting, Management Local Government Facilities
System
c. adequate ventilation, Performance Monitoring
0 d. presence of room thermometer, Tool
e. cold chain for vaccines,
f. presence of shelves and pallets.

Q78 5 Conducted monthly physical count (inventory Validate using stock card from the previous month Stock Card, RHU Stock DOH-NCPAM's Training
management) and reporting of medicines and Record, Supply or Manual on Pharmaceutical
0 other health products inventory report Supply Chain Management for
Local Government Facilities

Q79 6. Adopted the Daily Drug Use Record / Drug This applies to all medications being dispensed by the RHU Copy of accomplished ZFF Learnings from Resilient
Utilization Report (Name of patient, name of drug utilization reports Health Systems Program
medicine, duration of treatment, when to follow- DOH's Reporting Forms for
up) Monitoring and Evaluating
0 Medicine Access Program

Q80 7. Created/revised guidelines in acceptance of Copy of guidelines DOH-NCPAM's Training

foreign and local drug donations Manual on Pharmaceutical
0 Supply Chain Management for
Local Government Facilities

Q81 8. Adopted guidelines for disposal of unwanted or This could be incorporated in the solid waste management guidelines or in the Copy of guidelines DOH-NCPAM's Training
expired medicines pharmaceutical supply chain management guidelines Manual on Pharmaceutical
0 Supply Chain Management for
Local Government Facilities
 Q82 1. Issued policy on establishing drugs and Examples functions include Red: 0-1/4 Copy of legislation Good Practice: Sample policy 0
therapeutics committee governing LGU a. provision of recommendations to the Local Health Board policies regarding the Yellow: 2-3/4 from Cervantes
pharmaceutical related activities safe, effective, cost-effective prescribing and use of medicines in the treatment of Green: 4/4
patients at the local health facilities; and
b. monitor and review prescribing practices within health facilities in the LGU and
0 provide appropriate guidance or feedback as necessary;

Q83 2. Issued policy formalizing LGU protocols on The local policy should cover the principal phases in medicine management as DOH-NCPAM's Training
pharmaceutical supply chain management stated in the Policy and Legal Framework for Managing Access to Medicines and Manual on Pharmaceutical
Health Technologies. These phases are: Supply Chain Management for
a. Selection, Local Government Facilities
b. Quantification,
0 c. Procurement,
Policy Support on d. Reception and Storage,
Medicines Management e. Distribution, and
f. Use.

Q84 3. Issued policy adopting the National guidelines on Administrative Order

the implementation of rules and regulations on No.2014-0034 and FDA circular
0 licensing of Retail Outlet for Non-Prescription Drugs no. 2014-08

Q85 4. Issued policy on emergency procurement, This should include provisions on planning of basic health emergency supplies Copy of legislation Recommendations from
prepositioning, and immediate replacement of based on existing community hazards and vulnerabilities. consultations
essential medicines and basic health emergency Policy could be incorporated or separated from the protocols on pharmaceutical
0 supplies. supply chain management

Q86 RHU properly stocked with All of the selected Properly stocked pertains to availability of at least 1-month supply. Medicine Red: 0-2/5 Copy of Stock Card, DOH-NCPAM's Training 0
essential medicines: stock-outs in health facilities point to weaknesses in the distribution system, and Yellow: 3-4/5 RHU Stock Record, Copy Manual on Pharmaceutical
0 low overall performance of the supply chain Green: 5/5 of Supply or inventory Supply Chain Management for 0
report Local Government Facilities

0 1. EPI Vaccines
Essential Medicines 0 2. Supplements: Iron, folic acid, and Vitamin A
0 3. Contraceptive

4. Four (4) molecules: Losartan, Amlodipine and

0 Metoprolol and Metformin
0 5. TB Drugs
Building Block: Health Information System
Description: Ensures the production, analysis, dissemination and use of reliable and timely information on health determinants, health system performance and health status.
Q87-Q88 1. RHU with electronic medical records system Medical Records System is an electronic record of health-related information on Red: 0-1/3 Site visit Philhealth Circular No. 2016- 0
validated by Philhealth an individual that can be created, gathered, managed, and consulted by the RHU Yellow: 2/3 0040
staff and other national agencies. Green: 3/3 Philhealth Circular No. 2015-
List of validated EMR systems include iClinicSys, CHITS, Seg-RHIS, eHatid LGU, 002
0 SHINE OS+, WAH HER
If LGU has no electronic medical record, recommend use of Iclinicsys
Functional
Electronic Health
Information
System Q89-Q90 2. RHU with electronic health data reporting system Interoperable means that the electronic health data reporting system can Site visit Philippines eHealth Strategic
0 interoperable with the Field Health Services and generate and submit data needed by FHSIS Framework and Plan
Information System (FHSIS) May also include efhsis
Q91 3. RHU with Back-up electronic system during This pertains to copying and archiving electronic data in another storage, could Site visit Recommendations from
emergency situations be cloud-based or storage of records via email, to prevent data loss in case of consultations
0 certain events

Q92 Does not need to be electronic and could be paper-based e.g. Target Client List Red: 0-3/9 Copy of Registry Recommendations from 0
Established a functional tracking or registry system Yellow: 4-6/9 consultations
0 of patients for the following: Green: 7-9/9
1. Maternal Health Services

0 2. Expanded Program for Immunization

0 3. Under Five Nutrition
Patient Registry
System 0 4. TB Control
0 5. Notifiable Diseases
0 6. Non-communicable Diseases
0 7. Drugs and Substance Abuse
0 8. Mental Health
0 9. Persons with Disabilities
Q93-Q94 Timely Submission = Every 3RD WEEK of the FIRST MONTH of the succeeding Red: 0-1/5 Copy of quarterly DOH FHSIS Manual 0
1. Timely submitted Municipal QUARTERLY Field Quarter or as required by the Provincial/City Health Office or realtime/automatic Yellow: 2-4/5 FHSIS Data with proof
0 Health Services and Information System (FHSIS) submission electronically Green: 5/5 of submission
data to Provincial/City Health Office

Q95-Q96 Copy of annual FHSIS DOH FHSIS Manual

Timely Submission = Every 3RD WEEK of January of the succeeding year or as Data with proof of
0 2. Timely submitted Municipal ANNUAL Field required by the Provincial/City Nutrition Council or Health Office or submission
Health Services and Information System (FHSIS) realtime/automatic submission electronically

Q97-Q98 Copy of quarterly NTP Implementing Guidelines for

Data Reporting and 3. Timely submitted Municipal QUARTERLY Timely Submission = Every 2ND WEEK of the FIRST MONTH of the succeeding forms with proof of National Tuberculosis Control
Utilization 0 National Tuberculosis Control Program (NTP) Quarter or as required by the Provincial/City Health Office or realtime/automatic submission Program
Reporting data to Provincial/City Health Office submission electronically

Q99-Q100 Copy of Municipal Implementing Guidelines for

4. Timely submitted Municipal ANNUAL Operation Timely Submission = After 1 week of consolidation but prior May 5 of the Operation Timbang Plus Operation Timbang Plus
0 Timbang Plus data to Provincial/City Nutrition succeeding year or as required by the Provincial/CityNutrition Council or Health forms with proof of
Council or Health Office Office submission

Q101 Copy of RHU list of Recommendations from

leading causes of consultations
5. Updated annual list of Leading Causes of morbidity, mortality, and
0 Morbidity, Mortality, and Consultations consults
 Q102 Conducted community-based mortality All mortalities in the previous quarter should have accomplished death review Red: 0/2 Death Review Forms DOH manual for Maternal 0
investigation for the previous quarter: forms Yellow: 1/2 and Neonatal Death Review
1 Maternal Death Leave blank and add remark if LGU has no maternal or infant death recorded Green: 2/2 or no System
0 -put a check if no maternal death occurred- deaths Implementing Rules and 0
Regulations of Republic Act No.
Mortality 10354
Reviews
Q103 2 Infant (Neonate and Post-neonate) Death
-put a check if no infant death occurred-
0

Q104 Presence of the following data on Social Red: 0-3/7 Copy of Municipal Recommendations from 0
0 Determinants of Health: Yellow: 4-5/7 Management consultations
1. Male and Female Population by Age group Green: 6-7/7 Information System
(current and projected) (Municipal Planning
2. Population and Residential Density by Barangay Development Office)
0

3. Current and Projected Labor force and

0 employment
Data on Social
Determinants of Health 4. Population be religious affiliation
0
5. Elementary and secondary school participation
0 and completion rates

6. Housing Facilities and utilities situation

0

0 7. Hazard Mapping

Q105 Exclude 6 and 7 for LGUs with no GIDA and no IP communities If LGU has IP Copies of registries, ZFF Learnings from Resilient 0
Presence of annually updated profile OR list (with communities or with Profile lists Health Systems Program
at least name, age, gender, address, household GIDA areas
0
head) of members of the following:
1. Pregnant and lactating women Red: 0-2/7
Yellow: 3-4/7
Green: 5-7/7
0 2. Under-five children
Profiling of Vulnerable
Population 0 3. People with disability (PWD)
0 4. Elderly
0 5. Out of school youth
6. Households with Indigenous Peoples (for LGUs
0 with IP communities)

0 7. Households in remote areas (for LGUs with GIDA

communities)
 Q106 Early warning system pertains to set of capacities needed to generate and Red: 0-1/3 Site visits Republic Act No. 10121 0
disseminate timely and meaningful warning information to enable individuals, Yellow: 2/3 "Philippine Disaster Reduction
communities and organizations threatened by a hazard to prepare and to act Green: 3/3 and Management Act"
appropriately and in sufficient time to reduce the possibility of harm or loss. Good practice: Sample
0 1.Established early warning system policies from General Trias,
Cavite and Bacolod City

Q107 Copy of Municipal Republic Act No. 10121

health emergency "Philippine Disaster Reduction
preparedness response and Management Act"
Early Warning and recovery plan or Good practice: Sample
System for Municipal disaster risk policies from General Trias,
Emergencies reduction and Cavite and Bacolod City
0 2. LGU with mechanisms to disseminate early
warning system information management plan
Documentation of
early warning systems

Q108 Copy of protocol or Recommendations from

guidelines in consultations
0 3. Established a system for Surveillance in Post implementation of SPEED Manual for Managers
Extreme Emergencies and Disasters (SPEED) SPEED

Building Block: Service Delivery

Description: Deliver effective, safe, quality personal and non-personal health interventions to those that need them, when and where needed, with minimum waste of resources
Q109 1. Rural Health Unit operational for out-patient Operational means with basic resources (HR, equipment, supplies) to fully Red: 0-1/4 Posted schedule of ZFF Learning from CHPP and 0
services (8 hours, 5 times a week), and emergency operate or perform expected functions Yellow: 2-3/4 RHU operating hours MLGP
0 and birthing services (24 hours, 7 times a week) Green: 4/4 RHU Logbook of
rendered services

Q110 2. Operational waiting homes/halfway houses Operational means with water source, electricity, and caretaker Key Informant ZFF Learning from CHPP and
Interview of MHO and MLGP
RHU staff or facility map
0 or site visits
Contact number of
designated caretaker
Functional Health Facilities
Q111 3. Rural Health Unit and Birthing facilities have 24/7 Available generator or alternative power sources are considered for LGUs with no Key Informant ZFF Learning from CHPP and
0 electrical and water supply 24/7 electrical supply Interview of MHO and MLGP
Applies to ALL RHUs (if more than 1) RHU staff or site visits
Q114-116 4. One (1) operational Barangay Health Operational means with electric and water supply at least during operating hours Key Informant Recommendations from
Station/Center per barangay or catchment areas Interview of MHO and consultations
RHU staff or facility map
0 or site visits
Copy of accomplished
Itinerary of field visits
 Q111 1. Availability of a 24/7 Emergency Transport Vehicle Red: 0-2/6 Site visits DOH Guidelines on 0
0 Yellow: 3-5/6 establishing Service Delivery
Green: 6/6 Networks.
Q112 2. Mapping of referral facilities and blood service Map and list of referral http://www.doh.gov.ph/sites/d
0 facilities within and outside the municipality facilities efault/files/publications/Guideli
nes%20EstablishingSDN.pdf
Q113 3. Presence of two-way referral system between Copy of legislations,
barangay and RHU manual of operations,
0 memorandum of
agreements/understandi
ng, implementing rules
Q113 4. Memorandum of agreement/understanding for and regulations for
two-way referral system from RHU to any Philhealth referral system, or
accredited higher-level referral facility based from Monitoring form for
needed services referrals
0 Copy of referral and
return slips

Established Q113 5. Memorandum of agreement for referral system Copy of legislations,

Referral System from RHU to any diagnostic facility for needed manual of operations,
laboratory procedures memorandum of
agreements/understandi
ng, implementing rules
and regulations for
0 referral system, or
Monitoring form for
referrals

Q113 6. Presence of Memorandum of Copy of policies,

agreement/understanding for a referral system to manual of operations,
any blood service unit memorandum of
agreements/understandi
ng, implementing rules
0 and regulations for
referral system, or
Monitoring form for
referrals
 Q117 1. ALL barangays were visited at least once monthly Red: 0-1/3 Copy of schedule of Manual of Operation on 0
by a nurse or rural health midwife Yellow: 2/3 duties and areas of Maternal, Newborn, and Child
Green: 3/3 assignment Health and Nutrition Program
0 Documentation of
visits

Q117 2. ALL Barangay Health Workers conducted monthly Performance indicator will be validated through complete monthly submission of Copy of schedule of Field Health Service
visits to their assigned household target client lists of ALL BHWs during the previous quarter duties and areas of Information System Manual
assignment
Documentation
0 through logbooks
Barangay Health Service Copy of updated
Delivery monthly target client list

Q117 3. All Barangay Nutrition Scholars conducted Performance indicator will be validated through each BNS' updated list of Copy of updated list of Recommendations from
monthly Operation Timbang Plus monitoring of 0- malnourished children with monthly nutritional status during the previous quarter malnourished children, consultations
23 months old and malnourished children 0-59 updated Operation OPT Plus Guidelines
months old Timbang Plus forms
0 Copy of monthly
weighing report

0 Q118 1. Posting of RHU Citizens Charter Red: 0-1/5 Posted charter Recommendations from 0
Yellow: 2-4/5 consultations
Q119 2. RHU protocol or guidelines in observing patient Green: 5/5 Copy of Patients bill of rights
0 rights protocol/guidelines the USAID Tool to Assess the
Q120 3. Conduct of gender-sensitivity assessment for Results of assessment Gender-Sensitivity of a Health
RHU (RHU may adopt the USAID Tool to Assess the tools Facility
0 Gender-Sensitivity of a Health Facility, or develop
Patient-Centered Care their own tools)

Q120 4. Conducted strategies to address gaps in gender- Documentation of

0 sensitivity strategies
Q120 5. Conducted strategies to increase access to health Documentation of
0 services by GIDA, IP communities and other Basic strategies
sector groups
 Patient and Q120 1. RHU with patient/client satisfaction or feedback Red: 0/2 Copies of satisfaction Recommendations from 0
0 Yellow: 1/2 and feedback tools consultations 1
Client Feedback mechanism
Mechanism Green: 2/2
Q120 2. Patient feedback included in RHU staff LHB/RHU Minutes of
0 meeting/LHB agenda meeting
Q121 RHU with Health Promotion Services during the Red: 0-3/8 Copy of RHU Manual WHO List of Essential Package 0
current quarter on the following: Yellow: 4-6/8 of operations of Health Services
1. Maternal and Newborn Health ALL the following services should be included in each program area: Green: 7-8/8 Copy of implementing Recommendations from
0 Maternal and Newborn Health - Pregnancy tracking, Prenatal visits, Birth rules and regulations for consultations
preparedness plan and referral, Nutrition promotion and assessment each program area Philippine Health Agenda
Copy of RHU List of Targets
services acknowledged WHO report on Philippine
0 2. Child Health Child Health - Growth monitoring, Promotion of infant and young child feeding and signed by the LHB Health Service Delivery Profile
RHU annual reporting
0 3. Family planning Family planning - Family planning promotion, counselling, and provision of on status of services
commodities Other proof of delivery
of services such as
Health documentations, list of
Adolescent Sexual and Reproductive Health - Youth-friendly services, Information patients availing
Promotion and Education Campaign on Adolescent Sexual and Reproductive Health, HIV,
Services 0 4. Adolescent Sexual and Reproductive Health services, etc.
Sexually Transmitted Infections, and Gender-Based Violence, and Counselling on
prevention of teenage pregnancies

0 5. Oral Health Oral Health - Oral Hygiene Promotion

0 6. Lifestyle-related or Non-Communicable Disease Lifestyle-related or Non-Communicable Disease - IEC, Healthy Lifestyle programs,
smoking cessation clinic
Environmental Health and Sanitation (IEC, Promoting water quality and food safety,
0 7. Environmental Health and Sanitation Promoting vector control and waste management)

0 8. Mental Health Promotion of Awareness on Mental Health, Promote stigma reduction

Q121 Red: 0-3/9 Copy of RHU Manual WHO List of Essential Package 0
Provision (during the current quarter) or referral for Yellow: 4-6/9 of operations of Health Services
the following diseases prevention and control ALL the following services should be included in each program area:
0 Maternal and Newborn Health - Pregnancy detection, Safe labor and delivery, Green: 7-9/9 Copy of implementing Recommendations from
services: Antenatal Care, Postpartum Care rules and regulations for consultations
1 Maternal and Newborn Health each program area Philippine Health Agenda
Copy of RHU List of Targets
0 2. Child Health Child Health - Expanded Program on Immunization services acknowledged WHO report on Philippine
and signed by the LHB Health Service Delivery Profile
Adolescent Sexual and Reproductive Health - counselling for unintended RHU annual reporting
0 3. Adolescent Sexual and Reproductive Health on status of services
Disease pregnancies
Other proof of delivery
Prevention and Control 0 4. Oral Health Oral Health - Oral prophylaxis of services such as
Services documentations, list of
0 5. Communicable Disease Communicable Disease - Surveillance and reporting for notifiable diseases, Active
case finding for TB patients availing
services, etc.
0 6. Lifestyle-related or Non-Communicable Disease Lifestyle-related or Non-Communicable Disease - Routine screening for risk factor
identification
0 7. Environmental Health and Sanitation Environmental Health and Sanitation - Vector control and waste management
0 8. Mental Health Mental Health - IEC, Crisis intervention and referral

0 9. Drugs and Substance Abuse Drugs and Substance Abuse - Screening, profiling and referral
 Q121 Provision (during the current quarter) or referral for ALL the following services should be included in each program area: Red: 0-3/9 Copy of RHU Manual WHO List of Essential Package 0
0 the following Curative Services: Maternal and Newborn Health - Basic Emergency Obstetric and Newborn Care, Yellow: 4-7/9 of operations of Health Services
1 Maternal and Newborn Health Referral services Green: 8-9/9 Copy of implementing Recommendations from
rules and regulations for consultations
Child Health - Integrated Management of Childhood Illnesses, Micronutrient each program area Philippine Health Agenda
0 2. Child Health supplementation Copy of RHU List of Targets
services acknowledged WHO report on Philippine
0 3. Family planning Family planning - Referral services and signed by the LHB Health Service Delivery Profile
RHU annual reporting
Adolescent Sexual and Reproductive Health - Sexually Transmitted Infection on status of services
0 4. Adolescent Sexual and Reproductive Health Other proof of delivery
Management among adolescents, Referral services
of services such as
Curative Services 0 5. Oral Health Oral Health - Management of Dental Caries, Tooth Extraction, Referral services documentations, list of
patients availing
Communicable Disease - Sexually Transmitted Infection Management, services, etc.
0 6. Communicable Disease Management and control of TB, Management and control of other diseases with
endemic potential, Referral services

0 7. Lifestyle-related or Non-Communicable Disease Lifestyle-related or Non-Communicable Disease - Treatment for Diabetes and
Hypertension, Follow-up of cases, Referral services

0 8. Mental Health Mental Health - Referral services for treatment

0 9. Drugs and Substance Abuse Drugs and Substance Abuse - Follow-up on status of treatment, Referral services
Q121 Red: 0-1/4 Copy of RHU Manual WHO List of Essential Package 0
Yellow: 2-3/4 of operations Copy of of Health Services
Provision (during the current quarter) or referral for ALL the following services should be included in each program area: Green: 4/4 implementing rules and Recommendations from
0 the following Rehabilitative Services: Lifestyle-related or Non-Communicable Disease - Referral for dialysis, post-stroke regulations for each consultations
1. Lifestyle-related or Non-Communicable Disease rehabilitation program area Copy of Philippine Health Agenda
RHU List of services Targets
acknowledged and WHO report on Philippine
signed by the LHB RHU Health Service Delivery Profile
Health for persons with physical disability - community based rehabilitation or annual reporting on Executive Order No. 437, s.
Rehabilitative Services 0 2. Health for persons with physical disability status of services 2005 -Implementation of
Referral
Other proof of delivery Community Based
of services such as Rehabilitation
documentations, list of
Mental Health - Referral for long term care of patients with mental illnesses and patients availing
0 3. Mental Health
disabilities services, etc.

0 4. Drugs and Substance Abuse Drugs and Substance Abuse (community based drug rehabilitation, Referral)

Q122 Presence of RHU Service Packages (during the ALL the following services should be included in each package: Red: 0-1/4 Copy of RHU Manual Recommendations from 0
current quarter) for the following life stages: 1. Maternal (Pregnancy Tracking, Prenatal visits, Birth preparedness plan and Yellow: 2-3/4 of operations Copy of consultations
referral, Nutrition promotion and assessment, Safe labor and delivery, Antenatal Green: 4/4 implementing rules and Philippine Health Agenda
0 1. Maternal Care, Postpartum Care, Basic Emergency Obstetric and Newborn care) regulations for each Targets
2. Child (Growth monitoring for identified undernourished children, Promotion of program area
infant and young child feeding, Expanded Program on Immunization, Integrated Copy of RHU List of
Management of Childhood Illnesses, Micrnutrient Supplementation) services acknowledged
3. Adolescent (Youth-friendly services, Promotion of ASRH, Counselling for and signed by the LHB
unintended pregnancies, Counselling on prevention of teenage pregnancies, STI RHU annual reporting
management) on status of services
4. Senior Citizens (Immunization) Other proof of
0 2 Child delivery of services such
Complete
Health Service as documentations, list
Packages for all Life of patients availing
Courses services, etc.

0 3 Adolescent

0 4 Senior Citizens
 Municipal Primary Health Care Roadmap
Access to Medicine &
Leadership & Governance Health Financing Health Human Resource Health information System Health Service Delivery
Complete RHU Staff Technology

Expanded and Complement

Functional Local Health Functional Health
Board (LHB) Accredited Health 2_ Facilities
Functional Electronic
Facilities RHU Human Resource Health Information
Collaborative, Accreditation System Established
1_ Referral
comprehensive, System
1_
participatory, and 3_ 2_
Barangay Health Worker LGU Supply Chain
evidenced-based Registration and Management System 1_
Municipal Investment Community IEC on Accreditation 1_ Barangay Health
Planning for Health Philhealth Services Service Delivery
(MIPH) 1_ Health
Trained#VALUE!
Public Patient Registry
Nurses System 1_
Community 1_ Patient-Centered Care
Engagement Activities 2_ 1_
1_
with Inter-sectoral Trained Rural Health 1_
Data Reporting and 1_
Participation Management of Midwives Utilization Patient and Client
Philhealth Feedback Mechanism
1_ Reimbursements 1_
Trained Barangay Human 1_
Functional Barangay Resource Policy Support on
Health Governance Medicines Mortality Reviews 1_
1_ 2_ Health Promotion
Body Functional Performance Management
Philhealth Coverage Evaluation and Rewards Services
1_ for the Poor System for RHU Staff 1_
Functional Performance 1_
Barangay Investment Evaluation2_System for
Plan for 1_ Barangay Health Station Data on Social
Health/Barangay (BHS) Staff Determinants of Disease Prevention and
Development Plan LGU Health Budget 2_ Health
Allocation (At least Control Services
Presence1_of Health 15%) RHU Health Human 1_
Policies Resource Adequacy
Curative1_
Services
1_ of
Profiling
1_
Barangay Health Human Vulnerable
Collaborative
1_ and Inter- Actual1_
Budget Resource Adequacy Population Rehabilitative Services
sectoral Health Policy Utilization
Health Human 1_
Development, 1_ Resource
Implementation and for Emergency
Adequate Compensation Essential Medicines 1_ 1_
Monitoring
for RHU
1_ Staff
1_
3_ Policy support on Early Warning
LGU support for provision of funds for System for
Building Resilient Implementation
1_ of
subsidies and social Magna Carta for Public Emergencies
Health Systems protection Complete Health
Health Workers
Service Packages for all
1_ Life Courses
1_ 1_
2_ 1_ 1_
 LGU support for provision of funds for System for
Building Resilient Implementation of
subsidies and social Magna Carta for Public Emergencies
Health Systems protection Complete Health
Health Workers
Service Packages for all
1_ Life Courses
1_ 1_
2_ 1_ 1_