Republic of the Philippines Department of Health OFFICE OF THE SECRETARY February 4, 2014 DEPARTMENT MEMORANDUM No. 2014-_ 004 TO: ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES, DIRECTORS OF FDA, BOQ, CENTERS FOR HEALTH DEVELOPMENT, CHIEFS OF MEDICAL CENTERS AND HOSPITALS, ATTACHED AGENCIES AND ALL OTHERS CONCERNED. SUBJECT: Harmonizing KP Plans and Monitoring Reports Submissions to Health Policy Development and Planning Bureau from January to December 2014 The Health Policy Development and Planning Bureau is tasked to manage KP monitoring and evaluation as part of the regular tasks and duties in the DOH through standards that can facilitate KP M&E implementation, This Department Memorandum shall guide offices in planning for the KP reports, plans and other requirements for 2014. This shall also minimize late notifications on the deadlines, give ample time for the offices to develop their reports and plans and minimize confusions with the instructions. All offices are requested to refer to the deadlines and templates attached to this Department Memorandum to facilitate the timeliness of submission of data/ reports to HPDPB. Instructions are already incorporated in the templates. Orientation on the templates may be done during the cluster meetings, as needed. The Junior Policy Interns shall assist the cluster heads in the follow-up and in consolidating submissions from all offices within the cluster. ‘The following are the general instructions for all KP plans and reports to be submitted: 1. Submit signed seanned copies of the performance monitoring reports or plans to the email addresses of the eluster head copy furnished the corresponding email address of HPDPB: a. PBB-related documents — dohpbb2013@gmail.com b. BED and BAR, CAS and WFP — dohplanning@gmail.com with As an eco-friendly measure, we shall limit paper submission to those DOH ui intemet connection issues. 2. Follow the correct email subject format [office name_type of report/plan_Qtr/¥r] to facilitate the filing and tracking of submissions on time using the email. 3. All documents should be properly endorsed by the head of offices. 4, Electronic copies of the templates will be available in the DOH intranet. Trak Line 651-7800 Direct Line: 11-9501 I: asecadob.gov.ph ‘Building f, San Lazaro Compound, Rizal Av Fax: 743-1829; 7Deadline Report Remarks Email Subject | Responsible Offices Coding _ January 7, [* Actual 4" quarter | Submit the actual [Office name] | All Central Office 2014 BAR 2013 accomplishments in the 4" BAR 4Q/2013 | Units, CHDs and accomplishments | quarter of 2013 for the BAR hospitals indicators February |° WEP 2014 Use your CAS/PBBIBAR {Officename] [Ali Central Office 10, 2014 accomplishments/ LHSDA WEP Forms 2014 | Units, CHDs and indicators as basis in the hospitals, targeting Submit Forms 1a, 2a, 2b, 3 and 40 HPDPB Forms 1b and Le shall be directly encoded to the ETS Refer to WEP 2014 guidelines for detailed instructions February 4¥ quarter 2013 | Submit the accomplishment | [Office name] | All Execom, Central 14, 2014 CAS from Ist to 4" quarter 2013 CAS, Office Units, CHDs accomplishments Accomplishment | and attached agencies 4Q/2013 February [* MDG-related | See instructions attached [Office name] | NCDPC, NNC, 24, 2014 PAPs Summary MDG Report | Popcom, NCPAM, of Physical and | A copy of the 2013 final 2013, PhilHealth, NEC, Financial Report | submission to NEDA is also NCHP, NCHED, for CY 2013 attached for reference FHO, EPI February | * 2014CAS Ensure that all commitments in| [Office name] | All Execom, Central 28, 2014 planning tool _| Sec. Ona’s CAS 2014 is, CAS Plan 2014 _| Office Units, CHDs cascaded up to director level and attached agencies (and preferably up to the individual PES level). It should | reflect your office's | contribution to the achievement of the Department's performance commitment to the President For CHDs and operation clusters, it should include indicators in the use of “Local Health Systems Development and Assistance” line item Use the revised CAS planning template and refer to the 2014 CAS planning tool of Sec. Ona. April 5, © = I" quarter 2014 | Submit the actual 1% quarter’ [Office name] All Central Office 2014 BAR accomplishments based on BAR 10/2014 _| Units, CHDs and accomplishments | targets set in the 2014 Physical hospitals Plan. Client satisfaction survey questionnaires for MFO I and 2 are attached. - April30, |* PBBFormA | 2013 PBB indicators will be | [OMficename] | All Execom, Central 2014 targets reviewed. A separate guideline | PBB target 2014 | Office Units, CHDs will be issued on PBB hospitals and attached indicators at least one month agencies (exceptFor appropriate action, By authority of the we Health: LILIBETH C. DAVID, MD, MPH, MPM, CESO IIT OIC, Health Policy Finance and Research Development Cluster ~ [before the deadline. GOCCs) July 5, ¢ 2 quartér 2014 | Submit the actual 2" quarter [Office name] ‘All Central Office | 2014 BAR accomplishments based on BAR 2Q/2014 | Units, CHDs and | accomplishments | targets set in the 2014 Physical hospitals Plan July 14, [* 1 and2"" quarter | Data should include QI and Q2 | [Office name] [All Execom, Central 2014 2014 C. accomplishments CAS Office Units, CHDs ‘accomplishments Accomplishment | and attached agencies s 1929/2014 October 5, |e 3 quarter 2014 | Submit the actual 3" quarter [Office name] All Central Office 2014 BAR accomplishments based on BAR 3Q/2014 | Units, CHDs and accomplishments | targets set in the 2014 Physical hospitals Plan November | * 2015 BED #2 | Submit the current year’s [Office name] | All Central Office 14, 2014 Physical Plan | accomplishments of actual Jan | BED 2015 Units, CHDs and 1- September 30, 2014 and hospitals, estimated October I-December 31, 2014 and the quarterly targets for FY 2015 __ November | Certifications on: | Cut-off for transactions is [Office name} | All CHDs and 30,2014 |e Transparency —_| November 15, 2014 PBB GGC 2014 | hospitals, attached seal agencies (except © PhilGEPs posting | ARTA certification should be GOCCs) * Aging of Cash notarized. ‘Advance Central office — © Citizen's Charter | Ageing of cash advance should transparency seal (ARTA) be verified by the COA (IMS); PhilGEPs © SALN Resident auditor posting (Procurement Service); Cash advance (FS); ARTA (Internal Management Committee); SALN (HHRDB) December |» 2014 PBB Indicate the percent andthe | [Office name] | All Execom, Central 3,2014 accomplishments | absolute values (numerator and | PBB Office Units, CHDs using Form A | denominator) ‘Accomplishment | hospitals and attached 2014 agencies (except - _ : GOCCs) ‘The cluster heads shall ensure the adherence of all concerned offices to the performance report requirements which will be considered in the determination of ranking of offices in the 2014 Performance Based Bonus. Offices will be notified if there are changes in the schedule and/ or templates due to the suance of the new guidelines from the oversight agencies.TEMPLATE 1 QUARTERLY PHYSICAL PERFORMANCE REPORT BUDGET ACCOUNTABILITY REPORT (BAR NO. 1) re jon: 1. This form shall be used by the DOH unit (office/bureaulcenter/hospital) to present their quarterly physical accomplishment report that is targetted monthiy/quarterly in the 2014 Physical Plan. 2. This form shall be shall be signed by the head of office/bureau/centerihospital and submited by the DOH Office to their concerned Cluster Heads and cc HPDPB every Sth day of the month following each quarter. Reason for Under Performance (variance) Name of Office: (Center/Bureau/Service/CHDs/Hospitals) Najr Final OutpuvPertormance indetors o @ a a Prepafed by Approved by: Designate Planning Officer/Program Manager Head of OfficeTEMPLATES ATTACHED TEMPLATE 1. BAR (Physical Report of Operation) TEMPLATE 2. Satisfaction Survey tool for Health Policies (MFO 1 PI 3 of BAR and PBB) TEMPLATE 3. _ Satisfaction Survey tool for Technical Assistance Provided (MFO 2 PI 3 of BAR and PBB) TEMPLATE 4. CAS 2013 Accomplishments a. Cluster heads b. Director TEMPLATE 5. CAS 2014 planning tool targets and. Accomplishments (for cluster heads/ Directors) a. Technical office director b. Technical cluster head c. CHD director d. Operation cluster head TEMPLATE 6. MDG-related PAPs Summary of Physical and Financial Report for 2013 (with instructions on a separate page) TEMPLATE 7. PBB 2014 Form A targets TEMPLATE 8. 2015 BED (Physical Plan) (with instructions on a separate page) TEMPLATE 9. Transparency Seal Certification TEMPLATE 10. Certification of Compliance with PhilGEPs TEMPLATE 11. Report on Ageing of Cash Advance TEMPLATE 12. ARTA Compliance Template TEMPLATE 13. Certification of Compliance with SALN and list of employees (with additional details on a separate page) TEMPLATE 14. PBB 2014 Form A AccomplishmentsFor MFO 1 ‘TEMPLATE 2 SATISFACTION SURVEY ON HEALTH POLICIES CONTROL # Tobe filled up by office staff Good morning/ Good afternoon. The (Office Name) would like to seek your feedback on the health policies issued by this office. All information will be considered “confidential”. Place a check mark (V) on the box for your response. Thank you. BLOCK A,PERSONAL INFORMATION DATE /__/. (MONTH/DAY/YEAR) AGE SEX: POSITION TITLE: 7 OFFICE ae RELEVANCE OF HEALTH POLICIES = aligned with the national] Strongly | Agree | Disagree | Stronaly | REFUSE health agenda, timely and relevant to the needs of the target | agree disagree | TO | bo ANSWER ‘The following health policy/ies are relevant TITLE OF HEALTH POLICY: ‘QUALTTY OF HEALTH POLICIES = eviencobesed, have Cleatly| Svonely | Auree | Disagree] Stronaly_| REISE defined objectives and outcomes, roles and responsibilities are | agree disagree TO clearly defined and easy to understand ANSWER, Tam satisfied with the quality of the folowing health polices TITLE OF HEALTH POLICY ‘COMPREHENSIVENESS OF HEALTH POLICIES — multi-sectoral, | Strongly | Agree | Disagree | Strongly | REFUSE ‘encourages commurity/ stakeholders’ participation, national in | agree disagree | TO AEs ANSWER ‘The following health policies are comprehensive. TITLE OF HEALTH POLICY: BLOCK F. GENERAL ASSESSMENT. Very High | High | Moderate tow REFUSE ‘a 10 o e) ©) _| answer Please rate your over-all satisfaction with the health policies issued by the office: Recommendations/SuggestionsFor MFO 2 TEMPLATE 3 SATISFACTION SURVEY ON TECHNICAL ADVISORY AND SUPPORT CONTROL # To be filled up by office staf Good morning/ Good afternoon. The (Office Name) would like to seek your feedback on the technical assistance provided by this office. All information will be considered “confidential”. Place a check mark (v) on the box for your response. Thank you. BLOCK A.PERSONAL INFORMATION z DATE: I. (MONTH/DAY/YEAR) AGE: ‘SEX: POSITION TITLE: ~ OFFICE: ~ — _ UTILITY OF TECHNICAL ASSISTANCE = technical assistance can be | Strongly [Agree | Disagree | Strongly | REFUSE in the form of commodities/HRH/unds/advisory services and | agree rages | TO training (training evaluation forms can be used for assessing the level of satisfaction for training) “The technical assistance provided is useful. ‘TYPE OF TA PROVIDED: QUALITY” OF TECHNICAL ASSISTANCE — commodities/ HEEP | Strongly | Agree | Disagree | Strongly | REFUSE (functional, in accordance to specs, in good condition, not expired/ | agree disagree | TO damaged, etc); HRH (competent, capable, committed); advisory AWE services (clear and easy to understand; relevant) |Lam satisfied with the quality of the TA provided. ‘TYPE OF TA PROVIDED: TIMELINESS OF TECHNICAL ASSISTANCE = on” or before the |Stronaly | Awee | Disagree | Stronaly | RERSE eadne/ indicated timeline; occurred at a suitable time agree disagree | 70 ANSWER | The technical assistance provided is timely. ‘TYPE OF TA PROVIDED: "BLOCK F. GENERAL ASSESSMENT a Sa, 10. a) 2 1) | answer Please rate your over-all satisfaction with the technical assistance provided by the office: Recommendations/Suggestions:Pao Tu: comes TEMPLATE 4 ‘Action Plan Targets for 2013. ‘Accomplishments for 2013 at Q2 Qs 4 Qt a2 3 COME: ATTA INMENT/OF ‘UNIVERSAL TH] CARE, ae ie — 2. |STRATEGY: la. ACTION: b. |ACTION: |B. OUTCOME: LEADERSHIP, MANAGEMENT AND INNOVATION | Pea la. JACTION: | Ib. [ReTION: | Verified Correct Noted by Brecuive ‘Assistant Cluster head pms/ousecForm 3.8 PLANNING TOOL - ACCOMPLISHMENTS. DIRECTOR LEVEL TEMPLATE 4 ‘Action Plan Targets for 2073 ‘Accomplishments for 2013 at az a3 Rou STRATEGY: E: ATTAINMENT OF UNI HEALTH CARE la. JACTION: |B. OUTCOME: LI 7 |STRATEGY: TION: PAPs: Vorified Correct Noted by: Division Chief/Planning Officer PMs/Ousec® commerrcenein cater sane Sse (8) Tewine “uate OF OPeRATON CUSTER {Linen egos ean fete, rer the CAS fh CHD whch Yue for, You ray we ame target wih Pt fe CHD rou my gv ower fare. Evry ston n cars CAS shoe spp by easton oe CHD ur, The st sb mk se rhe Cb ted Example; One ator: poner Pane lth CHO under chaste arte 321 chon fo pay wii nh starr: The utr may eo we ‘he cane vate 321 ase age fre Iga Set lower gr of 00 con ornate eco, cic oy ua han abe carve’ Do ot cay Ov gecrorpastsfan ecaereen uart he scen mased sy, ae ste een hee quis Ah ui weet con be ior nina area fede at hscan atts capa Row Sb use Penson way ihe pn i rie, 0) rs ith eer rE rN a =a SS Fa = = Hite eer 0 oa i ‘s1:cTIN, Cite Esai Carre@ {CABINET ASSISTANCE SYSTEM (CAS) Template 5 DEPARTMENT OF HEALTH PLANNING AND ACCOMPUSHMENT TOOL | ‘ ‘NAME OF DIRECTOR> GENERAL INSTRUCTIONS: “Tinea the number ard ame of he CHD ana drctr Example: Reson X- North Mindanao 2 Batre leg i he om, per cony oe CAS othe Sct Hea sre a en alin our tart wih eget OOH an 58 3 OUTCOME: Retain ae ows, + Copy sstonies and acon from be Secretary’ CAS which re appicabl to your CHO's oeraten ar past them accrdngy unter the cms hey blog 0 5. You may ad satoges of actions aide om what you wer able o copy Kom the Secretary's CAS. Tho expecod doverabne on th vzateno*"Loal Heath Systm Development rd Assistance” ne tem shoul be nla inthe CAS plnning ta ©. Gn ows or sategy an gon, you may 2a or dt ows depending on what yur CHO can corm. 1 Remember thal ages a accomoishments are sy set by quae tas not be culate. Oo rot cary ave tratlaccmplshments om one quater othe next quar. heaton s measured enna, plac he targeted gu ne ae uarters {Sr or an quarter) wrere it pan be measoed partial accompa maybe reported inthe cay quarts bl bat eat at sola pari gue. ee 495 chldensrmunaod wih primar vac (paral Ngee as of Augt 30, 2018) ©. Recourcsroguroments ao te nancia oads to ata the acbons enumerate 8. Contino ens may bo ital wih she DOM fly) and exer (agencies and wetions autsise DOH) 10.inreporang seeomgse}nts, you wi use is form a8 wel Usk sure you save a copy fhe la wn eget Ml. 11. ret oret chav i completly signed whchor ou wl strat a harder econ copy ‘Targets irania ae Prepares by: roves by: Panta Dieser Endorsed by,@ CABINET ASSISTANCE SYSTEM (CAS) Template 5 DEPARTMENT OF HEALTH PLANNING AND ACCOMPLISHMENT TOOL, ‘ - 2 Bae igi ts rm seca sap CAS oft Saco ano tr age akg your gl wih heat of DOK an at, 3. Get copies oft 4 The developmen’ of action, ero the CAS of the ofes which you fe rom. You may wits he same target wih that of the aie or you may gue a lower fgue. Every acon in the clusters CAS shuld be supported by at last one othe feat Under Tre star shold make eure that tage wil ot go Dayond what te ofces aged Implement Er, one of te offces under the Custer targated 321 hier or primary vacrinesin the fat quar. The ctr may ao write luo of 221 as her target forthe Tat quarter rset lower igure of 30 ceren according fo tor Custer craton, 4. For actions chosen tat dan bo suppor by more than 1 fico under the cuter, he citer can rive wih he targe by ang he targets ofthe ofc for such parla aeons, ‘5. There sno defined nunfrof sates or acions you shou place in your cisters CAS. Jt mak sur that fey are conse wih fa CAS of he oficws unde your cise. 6. Remember Mat age as accomplishments are stil sat by quarter shoud not be cunuiatve. De not cary oer argetsloecompishments Fam ne quar othe next quart. the action s measured snnusly, pace he targeted igre inthe ter {ares (2 orn quarter where ean be measures paral accomplishments may be feporad the eay quarters able dst fat tis ony paral Agus. ax 486 dren immunized wih primary vacin (paral igure as ot August 9, 2914) 7 Resource reguramants sr the tancial neds atin the actions enumerated. {8 Contbtory erties maybe inl and exema- eer to the CAS of to ofc you led he sctns fom, 9. ereportngaccompihnents, ou wll use this form ae wall Make sure you save o copy ef fo whe ges led up. “0:0 not forme a ave hs comoletely signed whether you wl sub a ardor lector copy oF Tar fr 26 Tesorpiahmeats oczoie FResurce | Combo tin it oF — aes. Injernal | External fe — To utes 0 fe = oTOn ction z cron — - = — eee = as ot a a = = = aE =x a i am =uultt ii Pees a H aE aa ns Approves by ‘Cater Exot Raat ater ReadCABINET ASSISTANCE SYSTEM (CAS) ® conser orheam PLANING AND ACCOMPLIBHMENT TOOL - - Template 5 (GENERAL INSTRUCTIONS: ‘ingot the name ef he fee and rector. 2 Before fling up the frm secure a cony ofthe CAS ofthe Secretary of Heath Yo sere as gue in algning your pets wh the tages of DOH as an agency. 4, OUTCOME: Retain nes rows 4. Copy siateges and actif lam the Secretarfs CAS which are applicable to your ofce and paste them accrsngy unde the euzome they teang to. {nee are no srategies nd actons tom the Secrela’s CAS that ae appeabl to your fice, ndeate your own aatepes snd ations and pace them under he outcme whare they can contrbue 6. When needed, you may $a statepes or action aie rom what you were able fo copy ftom the Secretanys CAS, "Ton roms for strategy andacton, you may 200 odes rows doping on wha your ofce can eam 8: Remember that argels dd accomplishments ae stil set by quartet shoud not be cursdtive. Do not carryover targets‘accomplishments rom one quar tothe next quate. the action is measured annual place the targeted Mgure inthe later qaers (2b of th quater here canbe measured-parl accompishments may be reported in he eal quarters abl ut indicate fal tis only part fgue. e486 cre immunized wh primary vaccine (paral gure as of August 20,2014) 8. Resource requirements re the francia noece to ata e actors enumerated 10: Conirbutery erties may be terra (thin the DOM fay) and extemal (agencies and istuon outside DOH) 11-nreporing secomplennets, you wi! us tn form 2 wal. Make sure you save a copy ot le wit he targets fled vp. 12 Donat gett have Ue completly signed whether you wl subst aha or elecwon copy orgels for 2014 “a ‘Bion CiMILLENNIUM DEVELOPMENT GOALS (4G) TEMPLATE 6 ‘Summary of Physical and Financial Report Departmant/Ageney: Department of Heath (res Top a te oo tyINSTRUCTIONS FOR TEMPLATE 6 Millennium Development Goals-elated Programs/Actvties/Projects, Summary of Physial and Financlal Report for CY2013. Please submit the 02019 physical targets and accomplishments ofthe MOG-related Programs, Aethities and Projects (PAs) inlacing the budge sllcation and expres by fcomplshing the attached mari on MOG Summary of Physical and Fancal Repore tached th 2012 MOGerelatedPAPs Report os submited to the NEDA, or reference List of MDG-rdlated PAPs om health, water and sanitation Family nd Primary HealthCare Program Expanded frogram on Immunastion Malaria Prfvention Tubereulods Control National DS/STi Prevention and Control Program ‘Quaranting services and international health surveillance Epidemiology and Disease Surveillance Enviroameptal and Occupational Health Care ‘Women's Health and Safe Motherhood Project Family Paging initiatives Health Facity Enhancement particularly BEMONC and CEmONC Health rojoton actives (maternal and child health, AIDS, TB, Malaria and other diseases) ! “+Health insane subsidy forindigents + Advacacy dctivites related to responsible parenthood and natural family planning + Afordable drugs program ‘© Water and sanitation services (level and level 2) Capacity bildng activities on gender mainstreaming and gender sensitivity Instructions ‘The matrix shal be accomplished a follows | Column (2) | [MDG Goals, Targets and indicators - indicate the MOG goals, targets and indicators that re relevant tothe DOH. The indieators shall be identified per MOG target as classified by the National Statitcal Coordination Board (NSCB). Other indicators which are deemed important inthe acivepnt ofthe MDG may eine ‘Column (20 and 26) ‘rogroms/Acthities/Projects (MDG-related P/A/Ps) and Major Final Output (MFO) MDG- ‘related (P/A/PS) ~ these are major, centerpiece programs, projec and actives (wide coverage) thf directly address extreme poverty, dietary energy consumption, under 5 rralnutiion, fender equality and women empowerment, child moralty, maternal and reproductive Health, HIV and AIDS, malaria tuberculosis and other major diseases, access to water and sankation, and access to essential drugs. ‘The avoroprale [MFO shall be indicated to be followed by the relevant P/A/Ps. These shall be Indicated und the corresponding MOG, target and indicator presented in Column (1) where ‘the MFO and f/A/Ps are attributed to. A cross-cutting P/A/P which contaibutes to more than one’ nose the goal where ithas the most signfeantcontnbution. Column (3) Source of Fund - indicate the source of fund; ifthe source of fund is the GAA, indicate the ‘description ofthe P/A/P a stated inthe latest GAA; Ifthe fund was funded through continuing appropriations indeate whether its an unobigated allotment or unreleased appropriation. f the source of fndis a loan ora grant, indicate the dover. column (4) Unit of Measure/performance measures - indicate how the indicators shall be measured, Indicators shall be program level indicators and expressed in terms of qualitative ond ‘quantiatve terms of measurement. These may be quantity indicators which measure ofthe volume of outputs and quality indicator which measures the timeliness, cost-efficiency, accuracy, completeness accessibility, and compliance with standards, Columns (56) Physica! Targets ond Accomplishments - shall reflect specific numerical performance measurement of the agency targets and actual accomplishments for the year immediatly preceding the reporting year corresponding to the specific MDG targets and indicators under Column 1. The reason for the variance shall be indicated in the cemarks clure, Columns (7-2) shall reflect clrect (to include MOOE and capital outlay only) cost provision {actual allotment release, tual obligation) fo the year immediately preceding the reporting year corresponding to each P/A/P attiouted to MOG targets/indicators presented under Column (1, Column 9 ‘Remarks ~ OF-budget PAPs may be indicated in this column. Other sources of funds must aso be ditclosed, For more than 10 percent variance on (physical and financial) explanation shall be provided,Republic of the Philippines Department of Health OFFICE OF THE SECRETARY 21 June 2013, HON, ARSENIO M. BALISACAN, Secretary of Socio-Economic Planning National Economic and Development Authority ‘Dear Hon. Secretary Balisacan: May we submit the FY2012 Summary of Physical and Financial Report of the Millennium Development Goals-related Programs and Projects of the Department of Health, for your information and perusal, This is in compliance to the Joint Circular No. 01-2011 dated 3 March 2011 of the Department of Budget and Management and the National Economic and Development Authority on the “Guidelines to institutionalize Reporting of Budget Allocations and Expenditures including Physical Targets and Accomplishments for the Millennium Development Goals.” Thank you. Very truly yours, Up. ENRIQUE T. ONA, MD. Secretary of Health 66 Deparment af Bisdge! and Management ‘Specs! 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Refer to the set OF FE: occa oe name 2014 DEPARTMENT PERFORMANCE TARGETS. Jour Colm S when necesary. Fikout Jiro inactaf tat are appiesble to your |denomintor ofthe given forma in Coloma 1 andthe actual accompishmant infor 2013, [eta the value in ta submited 2013 Form A lontaine nts oar, which final ane may not be change. Provide the denominator value for ex column wil provide the needed ates. RESPONSUBLE BUREAUS/ | DEPARTMENT FY 2016 ans IMFO: ANOJPERFORMANCEINOICATORS | OFFICEFY 2013 ACTUAL ACCOMPLISHMENT. | OFFICE FY 2016 TARGET cara peel wanes a ey 3 aan ta 8} [rstucans fitout ony Columns Zand. Provide he values Tor the numaatorand [The DOM bercimark wits Only We ndeated oficsin [leave Bis cau Blank, [Filrout when cesar. (a Major Fal Opus POs) Operations [0x Heath sector Poly Serves God auDce! (neste budge) T i 2 Techlel Raveory ad Suppor Series Rose BUDGET (nde de] 5: Mosh Servis PaLe BUDGET tastes aay 0% Wealh sectoe Regulation Sees oie nvoet dndesteboset (Support to Operations (TO) O1e BUDGET. incudedin tne WOE T z (Genaral Administration ad Suppor Servs (GAS) 01s BUDGET: nudedin the FOS Prepared by: Approved by Boaget ew£FY2015 PHYSICAL PLAN (Operating Unt: ‘Organization Code (UACS} Carrent Years Recompinnments Eximate ‘oct | tova | TOTAL bec. 31 z 7 Srna Panelars Actual en. 1 ‘Sept. 30 aro 1 -[oeseraion) Perarmanceindators ua continva down tote ets Ps conve dow to te lst MFO ajo Program/Project ka No.1 Ant Corruption, Transearen Accountable and Panicpaton/ Governance eet? [thr ajo Programe and Projects snd mon tored by tha Present trough PAB continue down tothe eat PAP Continue downto the let Program Bu continue down othe fet RA Prepared Tr coordinate wis Financial Sendees Head/Budget Officer Oat rewpuares ‘BEDNo,2 Yea laviance | Remarks sraawr | ana | ™ aes = Reprod oy ‘Reency Head/Deparement Secretary atTEMPLATE 8 PHYSICAL PLAN (BED No. 2) (*) Instructions The Physical Plan shall contain the performance targets of the department/agency consistent with the targets embodied in the National Expenditure Program (NEP). Column 1. - Part A shall reflect the Cost Structure, Major Final Outputs (MFOs) and the corresponding Performance Indicators (Pls). MFOs are goods/services that a department/agency is mandated to deliver to external clients through the implementation of programs, activities, and projects. Pl is a characteristic of performance (quantity, quality, and timeliness) which will be ‘measured to illustrate the standard of performance by which a department/agency has delivered its MFOs. It is understood that the corresponding MFOs and Pls for Automatic Appropriations (ie., Special Account in the General Fund) are subsumed in MFOs under Operations if applicable. Part B shall highlight the targets of the Major Programs and Projects that are enrolled/attributed to the Program Budgeting Approach per NBM No. 118, and those committed to the President and whose outputs are being closely monitored by the Presidential Management Staff (PMS). These Major Programs and Projects must be duly aligned to any five (5) priority areas of spending of the government, otherwise known as the Key Result Areas (KRAs) pursuant to EO No. 43, follows: (1) Anti-Corruption, Transparent, Accountable and Participatory Governance; (2) Poverty Reduction and Empowerment of the Poor and the Vulnerable; (3) Rapid, (4) Just and Last (5) Integri Inclusive and Sustained Economic Growth; iB Peace and Rule of Law; and ity of the Environment and Climate Change Mitigation and Adaption. For Programs/Projects closely monitored by the Office of the President, targets shall be consistent with Secti ion 4 ~ Performance Information of the NEP and Form 8 of the Performance-Based Bonus (PBB) forms. For other Projects consider those milestones indicated in the approved project profile. Column 2 Column 3-5 Columns 6-10 Column 11 Column 12 ‘Adopt the UACS per COA-DBM-DOF Joint Circular No. 2013-1 dated 6 August 2013. Current year’s accomplishments, composed of actual performance for the period Jan. 1 to Sept. 30 and estimated accomplishments for October 1 to December 31. Refers to the Physical Targets of a department/agency for the entire year with quarterly targets. The difference between columns 6 and 5. As a rule, the target for the budget year should indicate an improving trend over the accomplishments in current year. Any variance that may arise from current year’s accomplishment versus the budget year’s targets shall disclosed/justified under the remarks column. (*) Instructions were culled from the National Budget Circular No. 550, dated 29 October 2013, “Submission of Budget Execution Plans and Targets for 2014 and Subsequent Years”TEMPLATE 9 TRANSPARENCY SEAL CERTIFICATION TEMPLATE Republic of the Philippines Department of Health OFFICE OF THE SECRETARY CERTIFICATION OF COMPLIANCE This is to certify that the name of the office has complied with the Transparency Seal Provision of the General Appropriations Act of 2014, 2013 and 2012 by the Department of Health, as the person in charge, whose signature appears below, have personally prepared, or have personally overseen the preparation of documents containing the following information pertinent to the Department of Health: 9. Agency's mandates and functions, contact information and its officials; ). Statement of allotments and obligations for 2012 and 2013; Financial accountability reports (FARS) for 2014; Approved budget for 2014 and MFO targets; Major programs and projects classified according to the five Key Result Areas; Program/ project beneficiaries as identified in Special Provisions in the Agency Budget; g, Status of implementation of major program/ projects; and h. Annual procurement plan This Certification is being issued to attest to the truth and accuracy of all the information contained therein based on available records and information that can be verified with the Department of Health. This is to further certify that the following documents and information are posted in the website of the Department of Health with this Uniform Resource Locator (URL) under a single Transparency Seal icon, prominently located on the home page of the aforementioned website and that the same shall remain unchanged unless otherwise necessitated by circumstances, such as updates, clerical corrections, and similar causes. IN WITNESS WHEREOF, we have hereunto affixed our signatures this _day of 2014 at (City/ Municipality), Philippines Name Regional Director/ Chief of Hospital/Secretary of Health‘TEMPLATE 10 PhilGEPS CERTIFICATION TEMPLATE Republic of the Philippines Department of Health OFFICE OF THE SECRETARY CERTIFICATION OF COMPLIANCE PhilGEPS Posting This is to certify that the (name of office), for the period beginning (start date, 2014) up to (end date, 2014, has posted the invitation to Bid (TB), Requests for Expression of Interest (REI), Requests for Quotation (RFQ), Notices of Award/ Bid results, the Actual Approved/ Awarded Contracts and Notices to Proceed/ Purchase Orders (P.Qs) for all the projects listed below at the Philippine Government Electronic Procurement System (PhilGEPS), to wit: PHILGEPS | Published | id Notice | Published | Date of Posting | “Bid | Remarks* Reference | Date —of | Title Date of | of P.0,/ | Notice number | Invitation to the Notice | Approved Status” Bid/REI/RFQ of award | Contract/ Notice to Proceed * Indicate current status of the ITB/REI/RFQ ie. “failed”, “cancelled”, “ongoing evaluation”, “ongoing post qualification’, “for signature of the HOPE/BAC’, etc. This is to further certify that the list includes all projects procured by the (name of the office) as of date This Certification is being issued to attest to the truth and accuracy of all the foregoing based on available records and information that can be verified with the PhilGEPS. IN WITNESS WHEREOF, we have hereunto affixed our signatures on the __day of __ 2014 at (city/ municipality), Philippines Chairperson, BAC Director/ Chief/Secretary of HealthTEMPLATE 11 | Report on Aging of Cash Advances Schedule of Advances to Officers and Employees ‘As of NOVEMBER 15, 2014 Book No: Account Title: Advances to Officers & Employees ‘Account Code: 148 THOUNT DUE T NAME Date cA 5 (in alphabetical order) faraxea Particulars Reference | Total Amount | fess than ] Site 60 61-368, on, REMARKS < ‘| sods | “aan | “tye | one la Advances ty Spel — Purposes, | ——— - [ + + — FOREIGN TRAVEL __ = —— | 1 f 3. SPECIAL fpstees/enoseers | all = an L IB. Advances to Regular Disbursing Officers + i-PAYROLE f |2. SEMINAR/ CONFERENCE { | jexrenses | ‘| TOTALS, L Certified Carre: Approved by ead, Accounting Office ena of once Verified by. Approved by (COA Resident Anditor Date SubmittedARTA COMPLIANCE CERTIFICATE TEMPLATE 12 Republic ofthe Philippines Department of Health OFFICE OF THE SECRETARY CERTIFICATION OF COMPLIANCE Pursuant to Republic Act 9485: An Act to Improve Eiciency in the Celery of Government Service tothe Pubic by Reducing Bureaucratic Red Tape, Preventing Graft and Corruption, and Providing Penates Therefor |, {full_ name), Filipino, of legal age, Director/Chief_of the {name of office), being responsible and accountable in ensuring compliance with Section 6 of the Anti-Red Tape Act of 2007 and Rule IV of its Implementing Rules and Regulations, hereby declare and certify the following truths: 1. The (name of office) has established its service standards known as the Citizen's Charter that enumerates the following: 2. Vision and mission of the agency b. Frontline services offered «. Step-by-step procedure in availing of frontline services 4d. Employee responsible for each step €. Time needed to complete the procedure f. Amount of fees 8; Required documents h, Procedure for filing complaints 2. That the Citizen's Charter is posted as information billboards in all the service offices of (name of office) that deliver frontline services. 3. That the Citizen’s Charter is positioned at the main entrance of the office or at the most conspicuous place of all the said, service offices 4. The Citizen's Charter is published, written either in English, Filipino, or in the local dialect and published as an information ‘material (e.g. booklet or brochure), 5. The Citizen's Charter is uploaded in the agency's website and accessible to the public. 6. The Citizen's Charter was first published on (indicate date) and underwent review and revision on (indicate date/s) as required under Section 4, Rule IV of the IRR: The office or agency shall review the Citizen’s Charter whenever necessary, but not less than once every two years. 7. The Citizen’s Charter already shows the improvements (minimum of three) that resulted from the process review of frontline service delivery, specifically (indicate process improvements made such as streamlining of procedures, shortened turnaround time, reduction in the number of signatories, et.) ‘This Certification is being issued to attest to the accuracy ofall the foregoing based on available records and information that can be verified. IN WITNESS WHEREOF, we have hereunto set my hand this__day of (month) 2014 in (city, province}, Philippines full name) Director/ Chief, (name of agency) ‘SUBSCRIBED AND SWORN to before me this__day of. 2014 in (city, province), Philippines, with affiant exhibiting to me his/her (government issued-ID) issued on (date of issuance) at (place of issuance}. Doc. No. Series of: Fee Paid: OR. No:TEMPLATE 13 CERTIFICATION OF COMPLIANCE WITH SALN TEMPLATE Republic of the Philippines Department of Health OFFICE OF THE SECRETARY CERTIFICATION OF COMPLIANCE SALN Submission/ Filing This is to certify that the name of the office fully satisfies the Statement of Assets, Liabilities and Net Worth (SALN) requirement of the Performance-Based Incentive System for Fiscal Year 2014. This also attests that all submissions of the agency concerned has substantially complied with the minimum requisites for content and formalities prescribed under Republic Act 6713 and its Implementing Rules and Regulations, which are as follows a. Basic information b, Assets (Real Properties and Personal Properties) . Liabilities 4d. Net Worth e. Financial Connections and Business interests f. Relatives in the Government ‘This further certifies that out of __ employees qualified for PBB under the 2014 PBIS Guidelines, ‘employees have completed and filled their SALN as reflected below: OFFICE. NO. OF EMPLOYEES |NO. OF EMPLOYEES | PERCENTAGE OF | wire DULY | COMPLIANCE (36) ACCOMPLISHED AND SUBMITTED SALN The agency has forwarded/ filed all SALNs with the appropriate receiving entity (i.e. Ombudsman in the case of President, Vice President and Constitutional Officials, etc.), in accordance with RA 6713 and its implementing rules and regulations. IN WITNESS WHEREOF, we have hereunto affixed our signatures this __day of 2014 at (City/ Municipality), Philippines Name Regional Director/ Chief of Hospital/Secretary of HealthTemplate 13 - List of Employees Who Submitted Their 2013 SALN Name of Office/Agency: SALARY NO. NAME OF EMPLOYEE POSITION/DESIGNATION GRADE Prepared by: ‘Admin Noted by: Head‘ener nstruion Prod he quested nformato: Offs Nam, 2014 Bet nie nd enalures of concerend perans who prepared ard approve ths rpart and (OFFICE: nde ofc name 2014 DEPARTMENT PERFORMANCE ACCOMPUISHMENTS vempuare 4 MFO: AND PERFORMANCE INDICATORS ey (OFFICE Fy 2013 ACTUAL ‘ACCOMPUSHMENT a a RESPONSIBLE BUREAUS/ ‘OFCES ol DEPARTMENT FY 2014 [ACTUAL ACCOMPLISHMENT 61 Ta Banter HERON SGOT loarencat amo [x Major nat outputs FORT Operations [iro 1: neath sector Poti Services [FO Technica aviary and Suppor Series [nro Hospital Services fzoxesupcerttnciate aaa) [Foe Heath Sector Regulation Seriews [eave super! ciate budget [Suppor to Operations (TOT [Sener Aah statian and Suppor Savin: (GASST [2014 |UDSET;ircudedin the MFOe I ‘Apron Bone