Republic of the Philippines

DEPARTMENT OF HEALTH
CENTER FOR HEALTH DEVELOPMENT- NORTHERN MINDANAO
J. V. Seriña Street, Carmen, Cagayan de Oro City
PABX (088) 8587123, (088)858 4000/ 727400 / 8587132 / 8582035/ 8550431/ 8550430

RESEARCH, EPIDEMIOLOGY, SURVEILLANCE AND DISASTER RESPONSE UNIT (RESDRU) MONITORING

Name of Health Facility: _____________________________________ :

EPIDEMIOLOGY AND SURVEILLANCE UNIT (ESU)

Legend: - P/M/CESU Only

*Indicators are based on DM 2021-0277 LHS ML KRA 2.1.4, DOH AO 2019-0047, RA 11223 & RA 11332

INDICATOR Means of Verification NEEDED ANSWER

RESPONSE
ESU with Policy Issuance on Presence of Signed Administrative Order for the
(Y/N)
Establishment of ESU Establishment of ESU
LGU Organogram Reflecting the Presence of Organogram Reflecting the ESU
(Y/N)
ESU
Administrative Order designating appointment of ESU
(Y/N)
personnel
● Permanent Health Allied Staff No. of ESU Staff
● Permanent Technical/Admin/Support Staff No. of ESU Staff
ESU Personnel
● Contract of Service Health Allied Staff No. of ESU Staff
● Contract of Service Technical/Admin/Support
Staff No. of ESU Staff

Training Certificates on Basic Epidemiology No. of Trained Staff

Training Certificates on Philippine Integrated Disease
No. of Trained Staff
Surveillance (PIDSR)
Trained ESU Personnel
Training Certificates on Event-based Surveillance
No. of Trained Staff
(ESU)
Training Certificates on Tanod-Kontra Covid (TKC) No. of Trained Staff
Presence of Signed Administrative Order for the
Adoption of National Guidelines
Adoption of National Guidelines on Epidemiology and (Y/N)
on Epidemiology and Surveillance
Surveillance
Presence of designated office space or designated
Designated Office Space (Y/N)
work area for surveillance activities
Presence of the minimum items:
● Computers/Laptops (Y/N)

● Printers (Y/N)

Availability of Supplies and ● Internet Access (Y/N)

Equipment needed for ESU
● Telephone (Y/N)
Operations
● Photocopiers (Y/N)

● Case Report Form/Case Investigation Form (Y/N)

(CRF/CIF)

HESUs with Hospital Order on the establishment of HESU and Updated HESU
Organogram in the jurisdiction of the Local Government Unit
Hospital Epidemiology and ● LGU Hospitals
Surveillance Units (HESU) No. of Hospitals
● Private Hospitals No. of Hospitals
Timely and Complete Surveillance Reports submitted to the next higher-level ESU
Surveillance Reports ● Epidemic-prone Disease Case The No. of Timely
Surveillance(EDCS) Weekly Reports/MDBs Reports Submitted
over the Number of
DOH-CHD10-ORDRESDRU-SOP-03 Form1 Rev 1
 Republic of the Philippines
DEPARTMENT OF HEALTH
CENTER FOR HEALTH DEVELOPMENT- NORTHERN MINDANAO
J. V. Seriña Street, Carmen, Cagayan de Oro City
PABX (088) 8587123, (088)858 4000/ 727400 / 8587132 / 8582035/ 8550431/ 8550430

● COVID-19 Surveillance Reports Deliverable Reports

as of the Previous
● HIV Surveillance Reports Period prior to
Assessment ex.
o LaBBS “10/13”; Annual
Basis for those
o SESS monitored during 1st
Quarter
● FHSIS Surveillance Reports Complete(Y/N) Timely(Y/N)

o Monthly Report M2

o Quarterly Report Q1

o Annual Form A1

● Event-based Surveillance Reports No. of Timely

Reports
STI Services/Testing Offered List of available
HIV/STI Surveillance
(HIV, HepB, HepC, Syphilis, Gonorrhea, Other STI) services
Is the ESU able to generate and disseminate disease
Report Generation (Y/N)
surveillance analysis reports
Name of EMR (if applicable)
MOA between Health Facility and EMR (Y/N)
Able to process Philhealth Claims (Y/N)
Accreditation with Certificate/License
● E-Konsulta (Y/N)
● TB-DOTS (Y/N)
Electronic Medical Record (EMR)
● Maternal Care Package (MCP) (Y/N)
● Animal Bite & Treatment Center (ABTC) (Y/N)
● Others (Specify):
List of other
______________________ accreditations
Completed Household Profiling form % of HH Profiled
Evidence of Online i-ClinicSys encoding (Y/N)
i-ClinicSys Functionality Evidence of regular encoding of FHSIS data (Y/N)
Able to generate FHSIS reports via i-ClinicSys (Y/N)
Health events investigated by ESU with No. of Health
Field Investigations corresponding Event-based Surveillance & Response Events Investigated
Report by ESU
Presence of Epidemic Preparedness and Response
Epidemic Response (Y/N)
Plan
Availability of Laboratory Equipment and Supplies
● Red Top / Yellow Top

● Cryovials

● Sterile Sputum Container

● Sterile Stool Container

Number of Available
Collection and Storage of
● Sterile Urine Container Equipments as of
Surveillance Specimen
the Assessment
● Transport Medias (VTM, Amie, etc…) Period

● Specimen Transport Boxes

● Ice Packs / Cooldogs

● Refrigerators

DOH-CHD10-ORDRESDRU-SOP-03 Form1 Rev 1

 Republic of the Philippines
DEPARTMENT OF HEALTH
CENTER FOR HEALTH DEVELOPMENT- NORTHERN MINDANAO
J. V. Seriña Street, Carmen, Cagayan de Oro City
PABX (088) 8587123, (088)858 4000/ 727400 / 8587132 / 8582035/ 8550431/ 8550430

Proof of Mechanisms for Specimen Transport

Presence of Mechanism for (Procurement of Courier Services or Provision of
(Y/N)
Specimen Transport Resources for Specimen Transport e.g. vehicle, gas
allowance in WFP)
Conduct of Descriptive Study aside from routine No. of Descriptive
Descriptive Studies
surveillance reports Studies Conducted
Monitoring & Evaluation No. of C/M/HESUs monitored and evaluated
● No. of HESUs monitored

● No. of Municipal ESUs(MESUs) monitored

No. monitored over
(for PESU) total (eg. “9/14”)
● No. of City (CESUs) monitored (for PESU)

ISSUES AND CONCERNS

Name & Signature of Interviewee: Assessed by (name and signature):

____________________________________________ _________________________________________________

Designation: __________________________________ Date of Assessment: ________________________________

Contact Number: _______________________________

DISASTER RISK REDUCTION AND MANAGEMENT IN HEALTH (DRRMH) INSTITUTIONALIZATION

Check “YES” if available REMARKS
Check “NO” if not yet
available

YES NO
1. DRRMH PLAN

Updated
· DRRMH Plan for 2022-2025
· Revision log of DRRMH plan updatedness
Approved
· Signed by the Local Chief
Executive/Mayor/MHO
Disseminated- Endorsement of Plan to the LCE or
health council and presented during Local Health
Board meeting and conducted other activities that
involves DRRMH Plan dissemination
(Health/DRRM Budget Review)
· Signed meeting agenda
· Signed meeting agreements
· Meeting attendance
· Meeting documentation (photos)

DOH-CHD10-ORDRESDRU-SOP-03 Form1 Rev 1

 Republic of the Philippines
DEPARTMENT OF HEALTH
CENTER FOR HEALTH DEVELOPMENT- NORTHERN MINDANAO
J. V. Seriña Street, Carmen, Cagayan de Oro City
PABX (088) 8587123, (088)858 4000/ 727400 / 8587132 / 8582035/ 8550431/ 8550430

· Other supporting documents of activities that

involve plan dissemination
Tested
· DRILLS and table top Activity Report/Post
Incident Evaluation
· DRILLS and table top documentation (photos)
· Program Implementation Reviews with
corresponding signed documents

2. HEALTH EMERGENCY RESPONSE TEAM (HERTs)

Organized
(Any of the following or alike documents)

· Official Personnel Order/Executive Order/Local

Ordinance of HERTs
· Team Composition/Organizational Chart
· Incident Command System
Trained - Minimum training requirement: BLS,
SFA, HERO and SubPHEMP
· Training certificates
· Training database
· Official IDs on BLS

3. HEALTH EMERGENCY COMMODITIES (HECs)

Available – Essential commodities are available
such as CAMPOLA Plus, Fluids/Electrolytes,
Respiratory Drugs, Dietary/ Nutritional
products, Hygiene kits and Jerry cans.

(Any of the following or alike documents)

· Logistics inventory
· PR/PO
· Annual Investment Plan/Annual Operational
Plan (for PHO and CHO)
· Memorandum of Agreement/Memorandum of
Understanding
Accessible
· Photos of meds and logistics where it is
stored

4. EMERGENCY OPERATION CENTER

· Executive Order/Office order/Memo of the
identified EOC to be activated during
emergency/disaster
· Floor plan
Command and Control
· Policy establishing an ICS that will be
activated during emergency/disaster
Coordination
(Any of the following or alike documents)

DOH-CHD10-ORDRESDRU-SOP-03 Form1 Rev 1

 Republic of the Philippines
DEPARTMENT OF HEALTH
CENTER FOR HEALTH DEVELOPMENT- NORTHERN MINDANAO
J. V. Seriña Street, Carmen, Cagayan de Oro City
PABX (088) 8587123, (088)858 4000/ 727400 / 8587132 / 8582035/ 8550431/ 8550430

· Documentation of actual conduct of meetings

· Formal agreement or arrangement with
DRRMC or other partner agency (MOA, MOU,
Policy)
Communication
· Inventory of IT and office supplies used in
EOC
· PR/PO/AIP/AOP of supplies for EOC

Name & Signature of Interviewee: Assessed by (name and signature):

_____________________________________________ _________________________________________________

Designation: __________________________________ Date of Assessment: ________________________________

Contact Number: _______________________________

DOH-CHD10-ORDRESDRU-SOP-03 Form1 Rev 1