Annex H

AOP Form 1. SUMMARY OF INVESTMENT COST BY PILLAR AND FUND SOURCE

REGION: _____________________
PROVINCE/HUC/ICC: _____________________
AOP CY: 2021

Fund Source (PhP)

(2)
Strategic Pillar
(1) DOH LGU
Others
Central Office CHD PLGU C/MLGU BLGU
1. HEALTH SERVICE DELIVERY

Health Facility Development

Human Resource for Health

Commodities

Other TA (for Service Delivery)

2. FINANCING

3. REGULATION

4. GOVERNANCE

Grand Total

As a Percentage of Grand Total

(1) F1 Plus Strategic Pillars of:
§ Service Delivery

§ Governance

§ Regulation

§ Financing

(2) Fund Source – which/what office will be able to fund the investment:

§ DOH – Central Office or Centers for Health Development;

§ LGU – Government funds from Local Government Units: PLGU (province), CLGU (city), MLGU (municipality); BLGU (Barangays)

§ Others - Other Fund Sources: from Official Development Assistance (eg. UN Agencies, development partners); other national agencies; NGOs/CSOs; private and other sectors; and unfund
Grand Total % of Pillar to
REMARKS
(PhP) Grand Total
ivate and other sectors; and unfunded PPAs
Annex H
AOP Form 2. COST ASSUMPTIONS BY PILLAR, PPAS, QUARTER AND FUND SOURCE (AOP MOTHER PLAN)

REGION: _____________
XI
PROVINCE/HUC/ICC: _____________
DAVAO ORIENTAL
AOP CY: 2022

Strategic Pillar: Resource Requirements (PhP)

SERVICE DELIVERY PPA Municipality/ Target (7)
Name of Health (6)
Performance District Component
Program/Project/ Facility
Indicator (3) City/Barangay Items Expense
Activities (PPA) (5) Unit Cost Quantity
(2) (4)
Q1 Q2 Q3 Q4 Total Target Description Category
(1)

NAME OF PROGRAM: LABORATORY SERVICES

GOALS: TO ENSURE ACCESS TO QUALITY AND AFFORDABLE LABORATORY SERVICES TO THE COMMUNITY ESPECIALLY THE
CONSTITUENTS OF MATI CITY.
OBJECTIVE: EXCELLENCE IN LABORATORY PRACTICES AND PROCEDURES;COURTEOUS AND RESPECTFUL TREATMENT TO ALL
CLIENTS

KEY INTERVENTIONS

LABORATORY SERVICES

DILUENT 6500.00 6
# OF CLIENTS
COMPLETE BLOOD COUNT II MATI CITY CHO 500 500 500 500 2000
TESTED

LYSE 7500.00 6

CLEANSER 5500.00 6

CONC. CLEANSER 3500.00 5

CONTROL 12500.00 2
HEMATOLOGY

Page 5 of 54
 Strategic Pillar: Resource Requirements (PhP)
SERVICE DELIVERY PPA Target (7)
Municipality/
Name of Health (6)
Performance District Component
Program/Project/ Indicator Facility
(3) City/Barangay Items Expense
Activities (PPA) (5) Unit Cost Quantity
(2) (4) Q1 Q2 Q3 Q4 Total Target Description Category
(1)
DIL MR36 13205.71 6

LYE MR 36 14617.16 5

70% ALCOHOL 90.00 200

CONTROL MR36 15000.00 2

ANTI D 1500.00 30

2ML EDTA TUBES 950.00 30

0.5 ML EDTA 1200.00 100

MICROCOLLECT

COTTON 50.00 150

MATCH 40.00 30

TOOTHPICK 50.00 30

CLE MR36 2894.68 6

HEMAQUICK 5000.00 1
STAIN

SEALING CLAY 300.00 30

# OF CLIENTS HGB CUVETTE

HEMOGLOBIN II MATI CITY CHO 400 400 400 400 1600 3,000.00 40
TESTED

Page 6 of 54
 Strategic Pillar: Resource Requirements (PhP)
SERVICE DELIVERY PPA Target (7)
Municipality/
Name of Health (6)
Performance District Component
Program/Project/ Indicator Facility
(3) City/Barangay Items Expense
Activities (PPA) (5) Unit Cost Quantity
(2) (4) Q1 Q2 Q3 Q4 Total Target Description Category
(1)
MICROPORE
TAPE 1,500.00 50

LANCET
300.00 100

ANTI SERA
# OF CLIENTS
BLOODTYPING II MATI CITY CHO 400 400 400 400 1600 950.00 70
TESTED

# OF CLIENTS URINE STRIPS

URINALYSIS II MATI CITY CHO 600 600 600 600 2400 700.00 100
TESTED
GRAM STAIN
3,800.00 2

PREGNANCY
KITS 1,200.00 60

SPECIMEN
# OF CLIENTS
FECALYSIS II MATI CITY CHO 500 500 500 500 2000 CONTAINER 10.00 6,000
TESTED
H PYLORI KITS
5,000.00 6

ANTIBACTERIAL
SPRAY 500.00 60

DISHWASHING
LIQUID 50.00 50

DISINFECTANT
SOLUTION 1,800.00 10

APPLICATOR
STICK 200.00 60

LIQUID
BLEACH 150.00 40

WORKING
GLOVES 300.00 100

LUGOL'S
IODINE 3,000.00 1

Page 7 of 54
 Strategic Pillar: Resource Requirements (PhP)
SERVICE DELIVERY PPA Target (7)
Municipality/
Name of Health (6)
Performance District Component
Program/Project/ Indicator Facility
(3) City/Barangay Items Expense
Activities (PPA) (5) Unit Cost Quantity
(2) (4) Q1 Q2 Q3 Q4 Total Target Description Category
(1)
GLUCOSE
# OF CLIENTS
BLOOD CHEMISTRY II MATI CITY CHO 150 150 150 150 600 2,950.00 8
TESTED

CHOLESTEROL
3,950.00 8

PIPET TIPS
YELLOW 1,500.00 5

PIPET TIPS
BLUE 1,500.00 5

CREATININE
2,770.00 8

URIC ACID
3,475.00 8

TRIGLYCERIDE
5,795.00 8

CONTROL
1,990.00 12

BUN
3,559.00 1

SYRINGE 3CC
700.00 40

SYRINGE 5CC
700.00 25

HDL
4,730.00 6

HBSAG KITS
2,400.00 50

SGPT
3,500.00 8

Page 8 of 54
 Strategic Pillar: Resource Requirements (PhP)
SERVICE DELIVERY PPA Target (7)
Municipality/
Name of Health (6)
Performance District Component
Program/Project/ Indicator Facility
(3) City/Barangay Items Expense
Activities (PPA) (5) Unit Cost Quantity
(2) (4) Q1 Q2 Q3 Q4 Total Target Description Category
(1)
CRYOVIAL
1,996.00 15

FACE MASK 400.00 80

GARBAGE 700.00 40
BAGS

RED TOP 850.00 50

TUBES

PAPER TOWEL 450.00 40

CAPILLARY 250.00 40
TUBES

SUPPORT INTERVENTIONS

UPDATES ON LABORATORY # OF PERSONNEL MEALS AND

II MATI CITY CHO 1 0 1 0 2 600.00 100
SERVICES ATTENDED SNACKS
TOKEN 100.00 100

# OF SAMPLES 20,000.00 1
NEQAS PARTICIPATION EXAMINATION II MATI CITY CHO 1 1 1 1 4
PARTICIPATED

Sub-total Major PPA1

NOTE: Please use separate sheet for each Strategic Pillar.

(1) Strategic Pillar: Service Delivery, Governance, Regulation, Financing
▪ Projects/Programs/Activities (PPA) - Identified priority strategies/interventions that address health needs and health inequities
▪ Goal – desired outcome for each major PPA

Page 9 of 54
 Strategic Pillar: Resource Requirements (PhP)
SERVICE DELIVERY PPA Target (7)
Municipality/
Name of Health (6)
Performance District Component
Program/Project/ Indicator Facility
(3) City/Barangay Items Expense
Activities (PPA) (5) Unit Cost Quantity
(2) (4) Q1 Q2 Q3 Q4 Total Target Description Category
(1)
(2) PPA Performance Indicator - Measurable value/performance measurement to evaluate the success of a particular strategy/intervention (such as projects, programs, products and other initiatives)
(3) District - the legislative district where the P/P/A will be applied/conducted. In a province, this excludes the legislative districts covered by the HUC/ICC where they will also be reflected in the latter’s respective plans
(4) Municipality/Component City/Barangay - specific area where the P/P/A will be applied/conducted; indicate if area covers GIDA/IP/Urban poor and other vulnerable population
(5) Name of Health Facility - the exact name of the facility where the PPA will be applied/conducted
(6) Target - Should correspond with PPA Performance Indicator; quantity (number) of outputs for the Quarter indicated (eg. # of activity, pax etc)
(7) Resource Requirement – Inputs needed for the PPA to be achieved/conducted
§ Items Description - e.g. meals, accommodation, TEV, venue, kit, etc
§ Expense Category: PS, MOOE, CO-Infrastructure/Equipment
§ Unit Cost: Estimated Cost to produce/conduct the P/P/A
§ Quantity: Total Number of the Targets
§ Total Cost: Unit Cost multiplied by the Quantity
(8) Fund Source – which/what office will be able to fund the investment:
§ DOH – Central Office or Centers for Health Development;
§ LGU – Government funds from Local Government Units: PLGU (province), CLGU (city), MLGU (municipality); BLGU (Barangays)
§ Others - Funds from other Sources: Official Development Assistance (eg. UN Agencies, development partners); other national agencies; NGOs/CSOs; private and other sectors; and unfunded PPAs
(9) Remarks - indicate the specific ODA/NGO/CSO/ Private Sector or if UNFUNDED

Page 10 of 54
 Date: ______________

) Fund Source (PhP)

(8)
DOH LGU Remarks
Total Cost (9)
(Unit Cost x Others
Quantity) CO CHD PLGU C/MLGU BLGU

39000.00 39000.00

45000 45000

33000 33000

17500 17500

25000 25000

Page 11 of 54
) Fund Source (PhP)
(8)
DOH LGU Remarks
Total Cost (9)
(Unit Cost x Others
Quantity) CO CHD PLGU C/MLGU BLGU

79234.26 79234.26

73085.8 73085.8

18000 18000

30000 30000

45000 45000

28500 28500

120000 120000

7500 7500

1200 1200

1500 1500

17368.08 17368.08

5000 5000

9000 9000

120,000.00 120,000.00

Page 12 of 54
) Fund Source (PhP)
(8)
DOH LGU Remarks
Total Cost (9)
(Unit Cost x Others
Quantity) CO CHD PLGU C/MLGU BLGU

75,000.00 75,000.00

30,000.00 30,000.00

66,500.00 66,500.00

70,000.00 70,000.00

7,600.00 7,600.00

72,000.00 72,000.00

60,000.00 60,000.00

30,000.00 30,000.00

30,000.00 30,000.00

2,500.00 2,500.00

18,000.00 18,000.00

12,000.00 12,000.00

6,000.00 6,000.00

30,000.00 30,000.00

3,000.00 3,000.00

Page 13 of 54
) Fund Source (PhP)
(8)
DOH LGU Remarks
Total Cost (9)
(Unit Cost x Others
Quantity) CO CHD PLGU C/MLGU BLGU

23,600.00 23,600.00

31,600.00 31,600.00

7,500.00 7,500.00

7,500.00 7,500.00

22,160.00 22,160.00

27,800.00 27,800.00

46,360.00 46,360.00

23,880.00 23,880.00

3,559.00 3,559.00

28,000.00 28,000.00

17,500.00 17,500.00

28,380.00 28,380.00

120,000.00 120,000.00

28,000.00 28,000.00

Page 14 of 54
) Fund Source (PhP)
(8)
DOH LGU Remarks
Total Cost (9)
(Unit Cost x Others
Quantity) CO CHD PLGU C/MLGU BLGU

29,940.00 29,940.00

32,000.00 32,000.00

28,000.00 28,000.00

42,500.00 42,500.00

18,000.00 18,000.00

10,000.00 10,000.00

60,000.00
60000

10,000.00
10000

20,000.00
20000

1,893,767.14 - - - 1,893,767.14 - - -

Page 15 of 54
) Fund Source (PhP)
(8)
DOH LGU Remarks
Total Cost (9)
(Unit Cost x Others
Quantity) CO CHD PLGU C/MLGU BLGU

Page 16 of 54
Annex H
AOP Form 2. COST ASSUMPTIONS BY PILLAR, PPAS, QUARTER AND FUND SOURCE (AOP MOTHER PLAN)

REGION: _____________
XI
PROVINCE/HUC/ICC: _____________
CITY OF MATI, DAVAO ORIENTAL
AOP CY: 2022

Strategic Pillar: Resource R

GOVERNANCE PPA Municipality/ Target
Name of Health (6)
Performance District Component
Program/Project/ Facility
Indicator (3) City/Barangay Items
Activities (PPA) (5)
(2) (4)
Q1 Q2 Q3 Q4 Total Target Description
(1)

GOAL:

OBJECTIVE:

Page 17 of 54
 Strategic Pillar: Resource R
GOVERNANCE PPA Municipality/ Target
Name of Health (6)
Performance District Component
Program/Project/ Facility
Indicator (3) City/Barangay Items
Activities (PPA) (5)
(2) (4)
Q1 Q2 Q3 Q4 Total Target Description
(1)

Sub-total Major PPA1

TOTAL GOVERNANCE

NOTE: Please use separate sheet for each Strategic Pillar.

(1) Strategic Pillar: Service Delivery, Governance, Regulation, Financing
▪ Projects/Programs/Activities (PPA) - Identified priority strategies/interventions that address health needs and health inequities
▪ Goal – desired outcome for each major PPA

Page 18 of 54
 Date: ______________

Resource Requirements (PhP) Fund Source (PhP)

(7) (8)

Total Cost DOH LGU Remarks

Expense
Unit Cost Quantity (Unit Cost x Others
Category CO CHD PLGU C/MLGU BLGU
Quantity)

Page 19 of 54
 Resource Requirements (PhP) Fund Source (PhP)
(7) (8)

Total Cost DOH LGU Remarks

Expense
Unit Cost Quantity (Unit Cost x Others
Category CO CHD PLGU C/MLGU BLGU
Quantity)

- - -

- - - - -

Page 20 of 54
Annex H
AOP Form 2. COST ASSUMPTIONS BY PILLAR, PPAS, QUARTER AND FUND SOURCE (AOP MOTHER PLAN)

REGION: _____________
XI
PROVINCE/HUC/ICC: _____________
CITY OF MATI, DAVAO ORIENTAL
AOP CY: 2022

Strategic Pillar: Resource

FINANCING PPA Municipality/ Target
Name of Health (6)
Performance District Component
Program/Project/ Facility
Indicator (3) City/Barangay Items
Activities (PPA) (5)
(2) (4)
Q1 Q2 Q3 Q4 Total Target Description
(1)
FINANCIAL RISK PROTECTION
GOAL:

OBJECTIVE:

Sub-total Major PPA1

TOTAL FINANCING

NOTE: Please use separate sheet for each Strategic Pillar.

(1) Strategic Pillar: Service Delivery, Governance, Regulation, Financing

Page 21 of 54
 Strategic Pillar: Resource
FINANCING PPA Municipality/ Target
Name of Health (6)
Performance District Component
Program/Project/ Indicator Facility
(3) City/Barangay Items
Activities (PPA) (5)
(2) (4)
Q1 Q2 Q3 Q4 Total Target Description
(1)
▪ Projects/Programs/Activities (PPA) - Identified priority strategies/interventions that address health needs and health inequities
▪ Goal – desired outcome for each major PPA
(2) PPA Performance Indicator - Measurable value/performance measurement to evaluate the success of a particular strategy/intervention (such as projects, programs, products and other initiatives)
(3) District - the legislative district where the P/P/A will be applied/conducted. In a province, this excludes the legislative districts covered by the HUC/ICC where they will also be reflected in the latter’s
(4) Municipality/Component City/Barangay - specific area where the P/P/A will be applied/conducted; indicate if area covers GIDA/IP/Urban poor and other vulnerable population
(5) Name of Health Facility - the exact name of the facility where the PPA will be applied/conducted
(6) Target - Should correspond with PPA Performance Indicator; quantity (number) of outputs for the Quarter indicated (eg. # of activity, pax etc)
(7) Resource Requirement – Inputs needed for the PPA to be achieved/conducted
§ Items Description - e.g. meals, accommodation, TEV, venue, kit, etc
§ Expense Category: PS, MOOE, CO-Infrastructure/Equipment
§ Unit Cost: Estimated Cost to produce/conduct the P/P/A
§ Quantity: Total Number of the Targets
§ Total Cost: Unit Cost multiplied by the Quantity
(8) Fund Source – which/what office will be able to fund the investment:
§ DOH – Central Office or Centers for Health Development;
§ LGU – Government funds from Local Government Units: PLGU (province), CLGU (city), MLGU (municipality); BLGU (Barangays)
§ Others - Funds from other Sources: Official Development Assistance (eg. UN Agencies, development partners); other national agencies; NGOs/CSOs; private and other sectors; and unfunded P
(9) Remarks - indicate the specific ODA/NGO/CSO/ Private Sector or if UNFUNDED

Page 22 of 54
 Resource Requirements (PhP) Fund Source (PhP)
(7) (8)

Total Cost DOH LGU

Expense
Unit Cost Quantity (Unit Cost x Others
Category CO CHD PLGU C/MLGU BLGU
Quantity)

- -

- -

Page 23 of 54
 Resource Requirements (PhP) Fund Source (PhP)
(7) (8)

Total Cost DOH LGU

Expense
Unit Cost Quantity (Unit Cost x Others
Category CO CHD PLGU C/MLGU BLGU
Quantity)

other initiatives)
reflected in the latter’s respective plans

ctors; and unfunded PPAs

Page 24 of 54
Date: ______________

Remarks

Page 25 of 54
Annex H
AOP Form 2. COST ASSUMPTIONS BY PILLAR, PPAS, QUARTER AND FUND SOURCE (AOP MOTHER PLAN)

REGION: _____________
PROVINCE/HUC/ICC: _____________
AOP CY: 2022

Strategic Pillar: Resource Req

REGULATION PPA Municipality/ Target
Name of Health (6)
Performance District Component
Program/Project/ Facility
Indicator (3) City/Barangay Items
Activities (PPA) (5)
(2) (4) Q1 Q2 Q3 Q4 Total Target Description
(1)
LICENSING & ACCREDITATION
GOAL:
OBJECTIVE:

Sub-total Major PPA1

TOTAL REGULATION
NOTE: Please use separate sheet for each Strategic Pillar.
(1) Strategic Pillar: Service Delivery, Governance, Regulation, Financing

Page 26 of 54
 Strategic Pillar: Resource Req
REGULATION PPA Municipality/ Target
Name of Health (6)
Performance District Component
Program/Project/ Facility
Indicator (3) City/Barangay Items
Activities (PPA) (5)
(2) (4)
Q1 Q2 Q3 Q4 Total Target Description
(1)
▪ Projects/Programs/Activities (PPA) - Identified priority strategies/interventions that address health needs and health inequities
▪ Goal – desired outcome for each major PPA
(2) PPA Performance Indicator - Measurable value/performance measurement to evaluate the success of a particular strategy/intervention (such as projects, programs, products and other initiatives)
(3) District - the legislative district where the P/P/A will be applied/conducted. In a province, this excludes the legislative districts covered by the HUC/ICC where they will also be reflected in the latter’s
(4) Municipality/Component City/Barangay - specific area where the P/P/A will be applied/conducted; indicate if area covers GIDA/IP/Urban poor and other vulnerable population
(5) Name of Health Facility - the exact name of the facility where the PPA will be applied/conducted
(6) Target - Should correspond with PPA Performance Indicator; quantity (number) of outputs for the Quarter indicated (eg. # of activity, pax etc)
(7) Resource Requirement – Inputs needed for the PPA to be achieved/conducted
§ Items Description - e.g. meals, accommodation, TEV, venue, kit, etc
§ Expense Category: PS, MOOE, CO-Infrastructure/Equipment
§ Unit Cost: Estimated Cost to produce/conduct the P/P/A
§ Quantity: Total Number of the Targets
§ Total Cost: Unit Cost multiplied by the Quantity
(8) Fund Source – which/what
office will be able to fund the
investment:
§ DOH – Central Office or Centers for Health Development;
§ LGU – Government funds from Local Government Units: PLGU (province), CLGU (city), MLGU (municipality); BLGU (Barangays)
§ Others - Funds from other Sources: Official Development Assistance (eg. UN Agencies, development partners); other national agencies; NGOs/CSOs; private and other sectors; and unfunded P

Page 27 of 54
 Date: ______________

Resource Requirements (PhP) Fund Source (PhP)

(7) (8)
Total Cost DOH LGU Remarks
Expense
Unit Cost Quantity (Unit Cost x Others
Category CO CHD PLGU C/MLGU BLGU
Quantity)

- - - - -

#REF! #REF! #REF! #REF! #REF! #REF! #REF! #REF!

Page 28 of 54
 Resource Requirements (PhP) Fund Source (PhP)
(7) (8)
Total Cost DOH LGU Remarks
Expense
Unit Cost Quantity (Unit Cost x Others
Category CO CHD PLGU C/MLGU BLGU
Quantity)

other initiatives)
reflected in the latter’s respective plans

ectors; and unfunded PPAs

Page 29 of 54
Annex H
AOP Form 3. SUMMARY OF LGU INVESTMENT NEEDS

Region: _________________
Province/HUC/ICC: _________________
AOP Year: 2022

Cost Per Fund Source

Categories of Investment Needs (2)
(1)
DOH CO DOH CHD

1. Health Facility Development

New Construction
a. LGU Hospital
b. RHU
c. BHS
d. Other facilities (please specify)
Repair/Improvement/Upgrading
a. LGU Hospital
b. RHU
c. BHS
d. Other facilities (please specify)
Equipment
a. LGU Hospital
b. RHU
c. BHS
d. Other facilities (please specify)
Motor Vehicle
a. LGU Hospital
b. RHU
 c. BHS
d. Other facilities (please specify)
Information & Communication Technology
a. LGU Hospital
b. RHU
c. BHS
d. Other facilities (please specify)
MOOE
a. LGU Hospital
b. RHU
c. BHS
d. Other facilities (please specify)
Sub-Total

2. Human Resource for Health

Please indicate the quantity and amount per cadre. Qty Qty Qty
Physician (specify) 1 1,000,872.00 4
Nurse 18 6,594,696.00 14
Midwife 16 3,984,768.00 39
Medical Technologist 1 366,372.00 3
Dentist 3
Pharmacist 1 366,372.00 1
Nutritionist-Dietician 1
Physical Therapist 1 366,372.00
Other HRH, please specify - PHA 3 692,380.00
Pharmacist Aide 2 402,192.00
Sanitation Inspector 5
Dental Aide 1
Medical Laboratory Technician 2
Administrative Staff 11
Pest Control Worker II 2
Driver 3
 Fumigator Supervisor 2
Fumigator 8

Sub-Total

3. Commodities (Drugs/Vaccines/Med. Supplies)

Please indicate all the commodities/ drugs/ vaccine under each
program as requested by the LGU. Commodities cited in this
template are EXAMPLES only.
Family Health, Nutrition and Responsible Parenting
Family Planning & Reproductive Health
a. DMPA
b. Pills
c. Condoms
d. Sub-dermal Implant
Oral Health
a. flouride
b. Lidocaine
Nutrition
a. Micronutrient powder
b. Vitamin A
c. Iron
Others
National Immunization
a. IPV
b. OPV
c. DPT-HEPB-HIB
d. MR
Elimination of Infectious Diseases
Malaria Control and Elimination
Schistosomiasis
 Leprosy
Filariasis
Rabies Prevention and Control
Prevention and control of infectious Diseases
TB
Non-communicable Diseases
Hypertension
Diabetes
Mental Health
CVD
Cancer
Dengue Prevention and Control
HIV/STI Prevention and Control
Other Infectious Diseases
Environmental and Occupational Health
Health Emergency Management
Other Commodities
Sub-total

4. Other Technical Assistance

· Governance
· Financing
· Service Delivery (Programs indicated are not exhaustive)
Family Health, Nutrition and Responsible Parenting
National Immunization
Elimination of Infectious Diseases
Rabies Prevention and Control
Prevention and control of infectious Diseases
TB
Dengue Prevention and Control
HIV/STI Prevention and Control
Other Infectious Diseases
 Non-communicable Diseases
Environmental and Occupational Health
Health Emergency Management
Others (specify)
· Regulation

Sub-total

Grand Total
Cost Per Fund Source
(2) REMARKS
LGU Others TOTAL
 Qty
5,653,078.90
9,012,458.80
18,744,863.34
1,905,636.96
2,337,382.80
578,035.08
811,653.96

2,707,489.44
284,102.04
737,996.52
4,314,319.08
627,499.92
829,598.52
 909,750.48
2,242,338.24
Annex H
AOP Form 3.1. LGU INVESTMENT NEEDS FOR HEALTH FACILITY DEVELOPMENT AND INFORMATION & COMMUNICATION TECHNOLOGY

Region: _________________
Province/HUC/ICC: _________________
AOP Year: 2021
Facility Investment Needs (PhP) Cost per Fund Source (PhP)
Municipality/ (6) (7)
Component Name of Project DOH
District Category ICT
City/ Facility Description Medical Total Cost/
(1) (3) Infrastructure Motor Vehicle (Information & LGU
Barangay (4) (5) Equipment Facility
Communication Tech. ) Central Office CHD
(2)
I. Construction/ Completion /Repair/ Upgrading/ Equipping

Sub-total
II. Maintenance and Other Operating Expenses

Sub-total
Total

(1) District – the legislative district where the facilities are located. In a province, this excludes the legislative districts covered by the HUC/ICC where they will also be reflected in the latter’s respective plans.
(2) Municipality/ Component City/Barangay - specific area where the facilities are located; indicate if area covers GIDA/IP/Urban poor and other vulnerable population
(3) Category – type of facility: Hospital, Rural Health Unit (RHU) and Barangay Health Station (BHS); Others - those which are categorized as hospital, RHU or BHS (eg. CHO, Blood Centers, LGU TRC etc)
(4) Facility – the exact name of the facility
(5) Project Description – describes the specific works/projects to be done per LGU facility, e.g. expansion of OPD, construction of RHU birthing facility, upgrading and equipping
(6) Facility Investment Needs – the specific investment needed for the facility
§ Infrastructure – construction, repair, rehab, upgrading of facilities
§ Medical Equipment –specific equipment needed for the facility
§ Motor Vehicle – ambulance, patient transport
§ ICT equipment - hardware and software for information & commnunication technology
§ Maintenance and other Operating Expenses - equipment below P15,000.00; supplies, utilities etc
§ Total Cost per Facility – total investment for the facility after summation of all required resources
(7) Fund Source – which/what office will be able to fund the investment
§ DOH - from DOH Central Office, Centers for Health Development
§ LGU - Government funds from the Local Government Units: Consolidated from PLGU (province), CLGU (city), MLGU (municipality); BLGU (Barangays)
§ Others - Other Fund Sources: from Official Development Assistance (eg. UN Agencies, development partners); other national agencies; NGOs/CSOs whether local or national; private and other sectors; and unfunded PPAs
hP)

Others
Annex H
AOP Form 3. 2.LGU INVESTMENT NEEDS FOR HUMAN RESOURCE FOR HEALTH

Region: _________________
Province/HUC/ICC: _________________
AOP Year: 2021
Cost per Fund Source (PhP)
Municipality/ Name of Health Salary Salaries and (8)
District HRH/Cadre Number DOH
Component Facility Grade Benefits (PhP)
(1) (4) (5) Central LGU Others
City (2) (3) (6) (7) CHD
Office
I. HRH Deployment

II City of Mati City Health Office 1 24 83,406.00 1,000,872.00

DTTB
Med. Tech 1 15 30,531.00 366,372.00

Pharmacist 1 15 30,531.00 366,372.00

Parmacist Aide 2 8 16,758.00 402,192.00

Nurse 18 15 30,531.00 6,594,696.00

Midwife 16 11 20,754.00 3,984,768.00

Public Health Associate 3 10 19,233.00 692,388.00

Physical Therapists 1 15 30,531.00 366,372.00

Sub-total 13,774,032.00

II. LGU Health Personnel

a. Need for New Items* (summary per facility)
II City of Mati City Health Office; Rural Health Physician
BHS Matiao A,
Taguibo, Tamisan,
Cabuaya and 1 24 114,126.99 1,369,523.88
Libudon, Paanakan
South

Midwife II

6 11 37,906.27 2,729,251.44

Sanitation Inspector VI 1 18 65,628.90 787,546.80

Sanitation Inspector V 1 15 52,056.32 624,675.84

Sub-total 5,510,997.96
b. Existing Plantilla Items* (summary per facility)
II City of Mati City Health Office Phycician - City Health
1 25 128,708.94 1,544,507.28
Officer

Rural Health Physician 1 24 114,126.99 1,369,523.88

Rural Health Physician 1 24 114,126.99 1,369,523.88

Nutritionist Dietician III 1 18 67,637.83 811,653.96

Dentist IV 1 22 91,723.85 1,100,686.20

Dentist II 1 17 61,940.53 743,286.36
Dentist I 1 13 41,117.52 493,410.24
Dental Aide 1 4 23,675.17 284,102.04
Nurse IV 1 19 72,181.18 866,174.16
Nurse III 1 17 54,181.22 650,174.64
Nurse II 12 15 52,056.32 7,496,110.08
Midwife III 14 13 43,886.80 7,372,982.40
Midwife II 19 11 37,906.27 8,642,629.56
Pharmacist II 1 15 48,169.59 578,035.08
Med. Tech III 1 18 62,463.90 749,566.80
Medical Technologist II 2 15 48,169.59 1,156,070.16
Medical Tech Lab. Tech III 1 10 35,353.88 424,246.56
Med. Lab. Tech I 1 6 26,145.83 313,749.96
SAO 1 22 91,723.85 1,100,686.20

A.O III 1 14 45,221.14 542,653.68

Admin Assistant II 1 8 31,852.21 382,226.52

A.A VI 2 6 26,307.71 631,385.04

A.A IV 1 4 23,675.17 284,102.04

A.A III 1 3 22,887.76 274,653.12

Cashier I 1 10 35,353.88 424,246.56

Sanitation Inspector IV 1 13 43,886.80 526,641.60

Sanitation Inspector III 1 11 37,906.27 454,875.24

Sanitation Inspector I 1 6 26,145.83 313,749.96

Pest Control Worker II 2 6 26,145.83 627,499.92

Driver II 1 4 23,357.69 280,292.28

Fumigator Supervisor 2 11 37,906.27 909,750.48

CASUAL Fumigator 8 4 23,357.69 2,242,338.24

Admin Aide III 4 3 22,887.76 1,098,612.48

Driver I 2 3 22,887.76 549,306.24

91

Sub-total 46,609,452.84
 BHW/BNS BHWs 500 1,500.00 9,000,000.00

BNS 34 2,000.00 816,000.00

VBSI 34 1,500.00 612,000.00

Sub-total 10,428,000.00

JOB ORDER Nurses 4 12,000.00 576,000.00

Midwife 10 12,000.00 1,440,000.00

Nursing Aide 11 8,000.00 1,056,000.00

Admin Aide 8 8,000.00 768,000.00

Drivers 9 11,000.00 1,188,000.00

Lab. Aide 1 8,000.00 96,000.00

Dental Aide 1 6,000.00 72,000.00

Med Tech 1 12,000.00 144,000.00

Utility Workers 6 7,700.00 554,400.00

Sub-total 770,400.00

Nurse II - PMDT Nurse 1 15 52,056.32 624,675.84

Total
(1) District – the legislative district where the health facility is located. In a province, this excludes the legislative districts 13,774,032.00 63,318,850.80
covered by the HUC/ICC where they 624,675.84
will also be reflected
in the latter’s respective plans.
(2) Municipality/Component City/Barangay - specific area where the health facility is located; indicate if area covers GIDA/IP/Urban poor and other vulnerable population
(3) Health Facility – the exact name of the facility where the HRH will be deployed
(4) HRH/Cadre - the specific HRH needed/requested
a. Physician (specify) f. Pharmacist
b. Nurse g. Nutritionist-Dietician
c. Midwife h. Physical therapists
d. Medical Technologist i. Other HRH Needs
e. Dentist
(5) Number – quantity or number of HRH needed
(6) Salary Grade - predetermined compensation level for a given position or cadre
(7) Salaries and Benefits – actual monetary compensation of the HR to include allowances and other remunerations
(8) Fund Source – which/what office will be able to fund the investment
§ DOH - from DOH Central Office, Centers for Health Development
§ LGU - Government funds from the Local Government Units: Consolidated from PLGU (province), CLGU (city), MLGU (municipality); BLGU (Barangays)
§ Others - Other Fund Sources: from Official Development Assistance (eg. UN Agencies, development partners); other national agencies; NGOs/CSOs whether local or national; private and other
sectors; and unfunded PPAs
 REMARKS
Total

1,000,872.00

366,372.00
366,372.00
402,192.00
6,594,696.00
3,984,768.00
692,388.00
366,372.00

13,774,032.00

1,369,523.88

2,729,251.44

787,546.80
624,675.84

5,510,997.96
 1,544,507.28

1,369,523.88

1,369,523.88

811,653.96

1,100,686.20
743,286.36
493,410.24
284,102.04
866,174.16
650,174.64
7,496,110.08
7,372,982.40
8,642,629.56
578,035.08
749,566.80
1,156,070.16
424,246.56
313,749.96
1,100,686.20
542,653.68
382,226.52
631,385.04
284,102.04
274,653.12
424,246.56
526,641.60
454,875.24
313,749.96
627,499.92
280,292.28
909,750.48
2,242,338.24
1,098,612.48
549,306.24

46,609,452.84
 9,000,000.00
816,000.00
612,000.00
10,428,000.00
576,000.00
1,440,000.00
1,056,000.00
768,000.00
1,188,000.00
96,000.00
72,000.00
144,000.00
554,400.00
770,400.00
624,675.84

77,717,558.64

al; private and other

Annex H
AOP Form 3.3. LGU INVESTMENT NEEDS FOR COMMODITIES

Region: _________________
Province/HUC/ICC: _________________
AOP Year: 2022

Target
Items / Cost pe
Name of Population Estimated
Commodities District Municipality Health (5) Description Quantity Unit Cost Total (PhP)
(1) (2) (3) Facility (6) (7) (PhP) (9)
(# of infants, SC,
(Dosage, Units,
DOH
(4) adolescents, (8)
pregnant, WRA Form) Central
etc) Office
A. National Tuberculosis
Program
1. Specify name of TB Drugs
2. Specify name of TB Drugs
3. Specify name of Commodity

Sub-total TB

B. Family Planning and

RPRH
1. BTL
2. PPIUD
3. POP
4. DMPA
5. IUD TCU
6. Cycle Beads

Sub-total FP

C.Vaccines
1. EPI
a.bOPV
b. DPT-HEPB-HIB
c. MMR
d. IPV
e. PCV 13
 Target
Items / Cost pe
Name of Population Estimated
Commodities District Municipality Health (5) Description Quantity Unit Cost Total (PhP)
(1) (2) (3) Facility (6) (7) (PhP) (9)
(# of infants, SC,
(Dosage, Units,
DOH
(4) adolescents, (8)
pregnant, WRA Form) Central
etc) Office
f. JE
g. MR
h. Td
i. FLU
j. PNEUMO

2. Anti-Rabies Vaccine
a. Specify name of Vaccine
b. Specify name of Vaccine

Sub-total Vaccines
 Target
Items / Cost pe
Name of Population Estimated
Commodities District Municipality Health (5) Description Quantity Unit Cost Total (PhP)
(1) (2) (3) Facility (6) (7) (PhP) (9)
(# of infants, SC,
(Dosage, Units,
DOH
(4) adolescents, (8)
pregnant, WRA Form) Central
etc) Office

Other Commoditites
D. Syringes
Urine Dip Stick
Glucose Strips
Sub-total

E.
Sub-total

F.
Sub-total

TOTAL

(1) Commodities – various commodities such as drugs, vaccines and their corresponding medical supplies generally categorized into such as:
a. National Tuberculosis Program
b. Family Planning and RPRH
c. Vaccines/EPI
d. Other Major Commodities
(2) District – the legislative district where the health facility is located. In a province, this excludes the legislative districts covered by the HUC/ICC where they will also be reflected in the latter’s respective plans.
(3) Municipality/ Component City/Barangay - specific area where the health facility is located; indicate if area covers GIDA/IP/Urban poor and other vulnerable population
(4) Name of Health facility – the exact name of the health facility where the commodities will be delivered
(5) Target Population – refer to number of infants/ Senior Citizens / adolescents / pregnant / WRA etc who will benefit from the identified commodity
(6) Items / Description – refer to Dosage / Unit / Form of the commodity
(7) Quantity – quantity of the commodity requested
(8) Estimated Unit Cost – standard cost based on latest estimate from DOH program managers
(9) Total – total amount needed for the commodity after considering the estimated unit cost and the quantity
(10) Fund Source – which/what office will be able to fund the investment
§ DOH - from DOH Central Office, Centers for Health Development
§ LGU - Government funds from the Local Government Units: Consolidated from PLGU (province), CLGU (city), MLGU (municipality); BLGU (Barangays)
§ Others - Other Fund Sources: from Official Development Assistance (eg. UN Agencies, development partners); other national agencies; NGOs/CSOs whether local or national; private and o
unfunded PPAs
 Cost per Fund Source (PhP)
(10)

DOH
LGU Others
CHD
 Cost per Fund Source (PhP)
(10)

DOH
LGU Others
CHD
 Cost per Fund Source (PhP)
(10)

DOH
LGU Others
CHD

’s respective plans.

national; private and other sectors; and

Annex H
AOP Form 3.4. LGU INVESTMENT NEEDS FOR OTHER TECHNICAL ASSISTANCE

Region: _________________
Province/HUC/ICC: _________________
AOP Year: 2022

Resource Requirements (PhP)

Cost per Fund Source (PhP)
Municipality/ (4)
Target (3) (5)
Activities Component
DOH REMARKS
(1) City/Barangay Total Cost
(2) Items Description Unit Cost Quantity (Unit Cost x Central LGU Others Total
Q1 Q2 Q3 Q4 Total Target Quantity) CHD
Office
Governance
a.
b.

Sub-total Governance

Financing
a.
b.

Sub-total Financing

Service Delivery
a.
b.

Sub-total Service Delivery

Regulation
a.
b.

Sub-total Regulation

Total

(1) Activities - These include the capacity-building, advocacy and health promotion, workshops, consultations, monitoring and evaluation,
creating and
a. implementing
Governance systems and tools.
- strengthen It is categorized
leadership according
and management to the 4coordination,
capacities, Pillars of the and
F1 Plus.
support mechanisms necessary to ensure
functional, people-centered and participatory health systems
§ GIDA, LIPH/AOP development & M&E, implementation of LGU Scorecard
§ implementation of HLGP
§ improvement of procurement and upgrading of Supply Chain And Logistics Management
§ Response and feedback mechanisms (customer assistance desk/units, hotlines, etc.)
§ Research and health policy development
§ Information System -iClinic Systems (iClinicSys), Rx Box, eHatid and Integrated TB Information System (ITIS), FHSIS, PIDSR
b. Financing -Efficiently mobilizing and equitably distributing more resources for health, rationalizing health spending, and focusing
financial resources towards high impact interventions
c. Service Delivery - ensuring the accessibility of essential quality health products and services at appropriate levels of care e.g.
engaging SDNs to deliver comprehensive package of health services
d. Regulation -ensure high quality and affordable health products, devices, facilities and services
(2) Municipality/Component City/Barangay - specific area where the P/P/A will be applied/conducted; indicate if area covers GIDA/IP/Urban poor and other vulnerable population
(3) Target - Should correspond with PPA Performance Indicator; quantity (number) of outputs for the Quarter indicated (eg. # of activity, pax etc)
(4) Resource Requirement – Inputs needed for the PPA to be achieved/conducted
§ Items Description - e.g. meals, accommodation, TEV, venue, kit, etc
§ Unit Cost: Estimated Cost to produce/conduct the P/P/A
§ Quantity: Total Number of the Targets
§ Total Cost: Unit Cost multiplied by the Quantity
(5) Fund Source – which/what office will be able to fund the investment
§ DOH - from DOH Central Office, Centers for Health Development
§ LGU - Government funds from the Local Government Units: Consolidated from PLGU (province), CLGU (city), MLGU (municipality); BLGU (Barangays)
§ Others - Other Fund Sources: from Official Development Assistance (eg. UN Agencies, development partners); other national agencies;
NGOs/CSOs whether local or national; private and other sectors; and unfunded PPAs