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

Strategic Pillar: Resource R

SERVICE DELIVERY 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)

NAME OF PROGRAM:

GOALS:

OBJECTIVE:

KEY INTERVENTIONS

Page 5 of 51
 Strategic Pillar: Resource R
SERVICE DELIVERY PPA Target
Municipality/
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)

SUPPORT INTERVENTIONS

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
(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)

Page 6 of 51
 Strategic Pillar: Resource R
SERVICE DELIVERY PPA Target
Municipality/
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)
(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 7 of 51
 Resource Requirements (PhP) Fund Source (PhP)
(7) (8)
DOH LGU
Total Cost
Expense
Unit Cost Quantity (Unit Cost x Others
Category CO CHD PLGU C/MLGU BLGU
Quantity)

Page 8 of 51
 Resource Requirements (PhP) Fund Source (PhP)
(7) (8)
DOH LGU
Total Cost
Expense
Unit Cost Quantity (Unit Cost x Others
Category CO CHD PLGU C/MLGU BLGU
Quantity)

- - - - - - -

ther initiatives)
eflected in the latter’s respective plans

Page 9 of 51
 Resource Requirements (PhP) Fund Source (PhP)
(7) (8)
DOH LGU
Total Cost
Expense
Unit Cost Quantity (Unit Cost x Others
Category CO CHD PLGU C/MLGU BLGU
Quantity)

tors; and unfunded PPAs

Page 10 of 51
Date: ______________

Remarks
(9)

Page 11 of 51
Remarks
(9)

Page 12 of 51
Remarks
(9)

Page 13 of 51
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 14 of 51
 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 15 of 51
 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 16 of 51
 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 17 of 51
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 18 of 51
 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 19 of 51
 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 20 of 51
 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 21 of 51
Date: ______________

Remarks

Page 22 of 51
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 23 of 51
 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 24 of 51
 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 25 of 51
 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 26 of 51
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