INTRODUCTION

The devolution of health services to local government units (LGUs) through

the Local Government Code of 1991 brought new challenges to LGUs and
barangays in the management and delivery of public health services. With
devolution, the LGUs became responsible for the general control and
supervision of health personnel and facilities; the operation and maintenance
of local health facilities; the delivery of health services; and regulatory
functions, such as formulation and enforcement of ordinances related to
health, nutrition, sanitation, and all other public health-related matters. The
BHMC is a collaborative effort of the Hermosa Municipal Health Department,
Palihan Barangay Health Office and the USAID funded SIAPS Program in the
Philippines, implemented by Management Sciences for Health. The BHMC
was created to strengthen the delivery of health services, particularly the TB
control program in poor urban communities. The intent was to strengthen
the health system as it works at the community (barangay) level where
patients and health services meet. A strong health system at the barangay
level will improve the quality and delivery of TB control program services
and help reduce the burden of TB in the community in the long term. The
system strengthening approach for the TB program will also benefit other
health programs. The concept uses a team approach to health leadership,
management, and governance that promotes broad stakeholder participation
in setting shared health priorities and objectives. The team comprises
representatives from the community’s health services, barangay officials,
and other stakeholders. The effective engagement, strong commitment, and
cooperation of barangay officials and community stakeholders are critical to
the success of BHMCs. The creation of shared objectives and priorities as
articulated in a BHMC’s work plan manifests stakeholders’ commitment and
desire to work together to improve the TB situation in their community.
Barangay-level planning and decision making for TB control is done by the
BHMC and is guided by evidence from barangay data. The BHMC model
supports the NTP’s strategy to localize the implementation of the NTP as
stated in the Philippines Plan of Action to Control TB (PhilPACT 2010–2016)
and in the recently crafted Philippine Strategic TB Elimination Plan (PhilSTEP-
1 2017–2022). The experiences in the town of Hermosa have demonstrated
the BHMC’s potential to address service delivery problems for TB and other
health programs.
 ESTABLISHING THE BHMC

Pre-Establishment Phase (Preparatory Phase)

The purpose of this phase is to formalize and increase the involvement of

local barangay officials, particularly the Punong Barangay and the Kagawad
for Health in the NTP, as well as other community actors who have a stake in
the demand, delivery, and management of health services in the community.
The main objective is to improve the awareness and understanding of
barangay officials and other stakeholders of the TB problem in the
community. With a better understanding of the TB situation, they can make
better decisions and take positive actions that will contribute to address the
problem. This activity will also benefit health workers and program
managers by giving them a better understanding of the TB problem in the
community.

Review the TB Situation in the Barangay

1. Review the TB situation and the TB control program’s performance in
the barangay, or cluster of barangays, served by the community’s
public health centers (HCs). The HC staff, led by the HC medical officer
with the support of the district health officer (DHO) and supervisors,
should organize activities for the program review.
2. Ensure the involvement of barangay health workers, community health
volunteers, community-based organizations, patients, and others
affected by the disease in this activity to get varied perspectives.
3. Focus the review on the results of case studies and treatment
outcomes based on routine TB program indicators. Identify the factors
that positively or negatively influence the program’s results. Include
epidemiologic, social, political, and economic factors in the analysis to
better understand the context of the community’s problems and health
needs.
4. Analyze the TB program performance in terms of the health system
building blocks, including community leadership and governance,
human resources, financing, medical products and technologies,
service delivery, and information management. Understanding the
systemic problems will play an important role in the effective and
sustainable delivery of TB/health control services.
 5. Prepare a report to be shared and discussed with barangay officials
and other interested individuals or groups. Discussions are an effective
way of sharing findings and should include suggestions or ideas on
what barangay officials and stakeholders can do to help address the
problems.
6. Discuss the findings in a way that lay people will understand.
Remember that the objective is to ensure that stakeholders,
particularly barangay officials, gain a better understanding of the TB
situation and problems in the delivery of effective TB control services.
Therefore, make an effort to keep the findings simple and easy to
understand.

Engage Barangay Officials

1. Organize one or more meetings to engage barangay officials. The HC
medical officer, the Barangay Operations Center (BOC) coordinator,
and the DHO should initiate the engagement, particularly the Punong
Barangay and the Kagawad for Health. If this is an area with a cluster
of barangays, ensure that all Punong Barangay and Kagawads for
Health in the cluster area are able to attend.
2. The objectives of the meeting should be to inform stakeholders of the
TB situation and to get their support for the BHMC initiative.
3. Work with the barangay secretary to organize the meeting, prepare an
agenda, and invite participants. Barangay officials are busy, and it
may take several attempts to schedule and hold a meeting.
4. Prepare the meeting agenda with a focus on the key meeting
objectives. Do not overload the agenda.
5. During the meeting, give a concise account of the review findings.
Highlight the main issues in the TB situation. This is also the time to
introduce the concept of the BHMC as a key intervention in which
barangay officials and other community members can participate by
leading and managing health services.
6. Communicate messages in a friendly, conversational manner and
encourage participation. Engage barangay officials and other
participants to enhance their involvement in the TB problem.
7. Distribute handouts to help participants remember key messages.
Make the handouts attractive and easy to read. Provide the handouts
to stakeholders who could not attend the meeting.
 8. Follow the agenda and schedule. Take notes, and write minutes after
the meeting.
9. More than one round of meetings and discussions or informal
conversations with barangay officials, stakeholders, and advocates
may be needed to achieve the objectives. Be patient and follow
through.

Secure Barangay Officials’ Commitment to Support the TB program

At this stage, it is important to secure the support and active participation of

barangay officials in in the management of the TB program and other health
services. While there are many instances in which TB is not a priority for
barangay officials, the medical officer and other health workers and
advocates can find ways to convince them to prioritize TB control.

Establishment Phase

Organize the BHMC Core Team and Secretariat

 1. The Punong Barangay, Kagawad for Health, and medical officer should
meet to organize the BHMC core team and the secretariat based on
the provisions of the city ordinance. The Punong Barangay should be
the chair and the Kagawad for Health and the medical officer should
be co-chairs. Figures 1 and 2 show the structure for both types of
BHMCs.
2. The rest of the core team should comprise a representative each from
stakeholder group, such as a government organization that is active in
the barangay, a community-based nongovernmental organization
(NGO), the private sector, a community health workers’ organization,
a TB task force, religious organizations, and public and/or private
schools.
3. The secretariat should comprise the barangay secretary, health center
nurse, and health center midwife. It should be responsible for the
documentation of all activities to be conducted by the BHMC,
coordination of meetings, preparation of reports, and dissemination of
such as approved by the core team.
4. The city health officer, DHOs, and district supervisors should serve as
technical advisors to the BHMC. The city health staff and the BHMC
core team can ask for technical advice or assistance from external
partners when needed.
5. The barangay, or barangays in the cluster BHMC, should create their
respective barangay resolutions, which will serve as their expression of
commitment to support the creation of the BHMC and the
implementation of its planned activities.

BHMC Member Orientation

1. Orient the core team members and secretariat on the content of the
BHMC ordinance and implementing rules and regulations, particularly
the purpose and function of the BHMC. Emphasize the roles and
functions of the BHMC core team and other members and the rules
and procedures within the BHMC.
2. Orient the BHMC core team on the concepts and practices of team
leadership, management, and governance for health at the community
level. This is important because it will provide the BHMC with a new
paradigm for leadership, management, and governance in which
teamwork, cooperation, transparency, equity, and accountability are
 emphasized. The orientation should be carried out by DHOs, district
supervisors, and medical officers.
3. The secretariat should be oriented on the management and use of
information to ensure that relevant reports and accurate information
are generated and provided to the BHMC core team and stakeholders
in a timely manner. The secretariat should also ensure that
achievements, lessons learned, and problems are shared with the
community.

Tip #1. A better way of engaging community partners.

 Inform the partners of the TB situation by talking to barangay officials

and partners.
 Barangay officials and other partners are busy, so make the meetings
short and productive.
 It may take several meetings and informal discussions to achieve the
objectives.
 Be patient and persistent.

Tip #2. A better way of unifying

 Ensure that stakeholders have shared goals and objectives for the
BHMC.
 Ensure that individual barangays in the cluster pass a resolution
supporting the BHMC.
 Share commitments and achievements with BHMC members and
partners.

Tip #3. A new way of moving forward

 Having a BHMC means working as a team for leadership,

management, and governance.
 Success can be achieved when teamwork and cooperation enable the
community to face challenges and overcome obstacles to better
health.
 OPERATIONALIZING THE BHMC

Creating the BHMC Work Plan

A work plan is needed to ensure that a BHMC can implement activities in a

rational and focused manner. The work plan provides a direction for the
BHMC by describing the objectives and activities to be implemented within a
specific period of time. It unifies BHMC members and helps them work
together. The work plan is one of the bases for measuring a BHMC’s
performance and achievements.

Planning is a joint undertaking by core team members, key stakeholders,

and advisers. Ideally, an initial work plan is for a 12-month time frame. This
provides adequate time to implement activities and achieve short-term
tangible results. Achieving results is important to understand a BHMC’s
potential to overcome problems and challenges when members work
together.

Preparing for the Planning Workshop

1. Planning can be carried out through well-structured activities

(workshops) held in suitable facilities in the community, such as
barangay or HC meeting rooms. However, an on-site planning
workshop is ideal to ensure continuous participation by core team
members, particularly during the early stages of the BHMC. The BHMC
core team and secretariat will organize the planning activity with the
support of DHOs and technical advisors.
2. Prepare the schedule and program of activities for the planning
workshop. Ensure that adequate time is allocated for discussions and
decision making. Invite participants well in advance of the event.
Secure the resources and logistics that will be required for the activity
and prepare all planning materials. Idea cards and easel sheets can be
used to help guide the discussion.
3. The BHMC secretariat should prepare all relevant data sets,
information, and reports, including the results of the TB program
review, at least two weeks prior to the planning session (annex A).
The technical advisors, HC medical officers, and other technical staff
 should start the analysis and interpretation of available data and
information prior to the planning workshop.
4. Document the planning session activities and products and store those
documents for future use.

Conducting the Planning Activities

1. The entire BHMC core team must participate in the planning session
with key stakeholders. If needed, resource personnel and facilitators
can be invited to join the planning activity. At the initial stages, it is
suggested that BHMC technical advisors facilitate the discussions and
provide guidance during the workshops.
2. Conduct the sessions in a welcoming atmosphere and encourage all
core team members to participate. Follow the agenda and schedule so
that everyone will be focused on the session’s activities. Assign
leadership roles to barangay officials during the planning session.
3. Manage the discussion so that everyone will be focused on the topic
and encourage everyone to participate. Good time management is
important, as is flexibility. In addition, ensure that barangay officials
participate in all discussions and group activities.
4. During discussions, technical terms (e.g., “program indicators”) should
be simplified and explained to ensure that non-technical participants,
particularly barangay officials, can understand the discussions.
5. Start with an analysis of the situation using the results of the TB
program review, followed by the identification, prioritization, and
analysis of the problems and their root causes. Identify priority
problems and challenges and develop objectives and activities that are
focused on those priorities.
6. The plan should focus on the next 12 months so that short-term
results can be demonstrated to provide a sense of accomplishment
and encouragement at the end of the year. Longer-term plans can be
made based on the needs and the situation.
7. Planners should create the monitoring and evaluation plan based on
the finished set of activities and expected results.
8. Share a copy of the approved work plan and budget with all BHMC
members, key partners, and stakeholders to promote transparency
among stakeholders in the community.
Implementing the Work Plan

1. The BHMC core team is responsible for implementing the work plan,
including securing the budget and funds and mobilizing resources,
including people, tools and equipment, diagnostic supplies, medicines,
office supplies, transportation, and money. These resources are
usually available in the community through residents and other
partners and stakeholders in the barangay.
2. Align community stakeholders and inspire them to support the plan
activities. These stakeholders can include other government entities,
the business sector, faith-based organizations, and schools.

Monitor Work Plan Implementation

1. The BHMC core team, DHOs, supervisors, and BOC coordinators should
monitor the implementation of BHMC plans and activities to ensure
that they are aligned with the objectives and timeframe. The
information gathered from monitoring will inform BHMCs of progress in
plan implementation and achievement of results.
2. Findings should be analyzed by core team members and advisors to
extract lessons learned, identify problems, and formulate solutions.
This information will also feed into the evaluation process.

Evaluation of Results of Plan Implementation

1. At the end of the implementation, DHOs should help the BHMC core
team evaluate the results of its activities. Information gathering and
analysis and reporting of the results should be led by DHOs and
medical officers.
2. The BHMC secretariat and DHOs should ensure that the evaluation
results are reported to the BHMC core team, key stakeholders, and
decision makers at the community, district, and city levels. The
evaluation results can be used to guide the following year’s planning.
 MONITORING AND EVALUATION OF BHMC
ESTABLISHMENT AND PERFORMANCE

1. DHOs, with the support of the city BOC district coordinators, are
tasked with monitoring the performance of BHMCs in their respective
districts. Monitoring the performance of BHMCs gives DHOs the
opportunity to measure and understand implementation problems and
provide technical support to the implementers.
2. DHOs should create and implement a district-level BHMC monitoring
and evaluation plan and budget. This will track the performance of an
established BHMC based on its planned objectives and
accomplishments, as well as the progress of the scale-up in districts.
Annex C shows the list of indicators that DHOs can use to monitor and
evaluate BHMCs. DHOs may solicit support from technical partners to
implement monitoring and evaluation activities.
3. DHOs should conduct meetings to discuss and share findings from
monitoring activities. It is important to highlight the positive aspects of
the implementation. In addition, the lessons learned during the
process should be documented. DHOs should help the BHMC core team
analyze and address identified problems. Part of the monitoring
process is to follow up on the results of the interventions.
4. DHOs should provide a report of the monitoring results and feedback
to the BHMC core team and community stakeholders. The report
should be submitted to the city health officer and shared with major
stakeholders.
5. DHOs should implement evaluation activities by the end of the year
with support from technical partners. They should share the evaluation
results with the BHMC and community stakeholders. The evaluation
report should be submitted to the city health officer, and shared with
the BHMC, partners, and major stakeholders.
 STRATEGIES TO INSTITUTIONALIZE AND SUSTAIN THE
BHMC

Having shown the potential of a BHMC to improve the delivery of TB control

services, it is important to sustain the gains that have been made. It is
worthwhile to institutionalize the existence of BHMCs in the public health and
primary care landscape to enable health program managers and providers to
continue making use of this mechanism to improve health in the community.

1. Pass a local (city) ordinance that supports the establishment and

implementation of BHMCs to institutionalize the initiative. In the
absence of a city-level ordinance, a barangay-level resolution is a
good starting point for institutionalization. Advocacy and support for
the policy development and approval process is recommended to
achieve a barangay resolution or city ordinance.
2. Ensure that regular BHMC meetings are held to discuss progress in
the implementation of activities, emerging problems and challenges,
and ways to address these. Hold annual work planning and team
building sessions to help sustain stakeholders’ commitment to and
interest in the BHMC and its activities.
3. Discussions or forums to share BHMC successes with other people or
organizations within and outside the community, district, or city can
help enhance community spirit, sustain commitment, and improve
camaraderie among the BHMC and other barangays. They can also
inspire new stakeholders to participate.
4. Collaborate with new and existing partners to address gaps and
shortcomings for continuous improvement in BHMC performance.
Adapt initiatives that were effective for other BHMCs.
5. Conduct continuous and innovative learning activities to update the
knowledge and skills of the BHMC core team, community health
workers, and other partners in the community. This will help
stakeholders improve their capacity to adapt to changing situations
and respond effectively to new challenges.
6. Acknowledge good performers, supporters, and partners to inspire
them to continue their work and sustain their commitment to their
BHMC and community.
ANNEX A. BHMC INDICATORS FOR TB CASE FINDING AND
TREATMENT OUTCOMES

The following indicators are based on the NTP’s routine reporting

requirements. They were expanded to allow a more detailed analysis of
program results during planning workshops and program reviews but are not
required for reporting to the NTP.