The Vision, Mission and Core Values of the Institution

EDUCATIONAL INSTITUTION : place where learners of different ages gain education

• Education is based on an age grade system from preschool, primary, intermediate, and
secondary to tertiary level.
• Carry out educational activities that engage students with various learning environment and
spaces.
• Not E.I are structured and formalized, others are spontaneous and no fixed timetables
TWO TYPES
• FORMAL EDUCATION: conventional classroom set-up where structured methods of
learning are administered
o Government offering that predetermines books and materials
o Technical committee set curricula
o Starts at 4 from pre-school to higher education
• INFORMAL EDUCATION: anything learned independently outside the conventional
classroom set-up.
o Not restricted to a certain location
o Involves student's behavioral skills through interaction and exploration on a daily basis
and teacher's traits based on expertise, skills and experience
VISION STATEMENT
• Conveys the desired end of an academic institution
• One-sentence statement w/c describes distinct and motivating long-term desired
transformation resulting from institutional programs.
• Ave. Of 14 words, clear, memorable and concise

HUMAN RIGHTS CAMPAIGN

"Equality for everyone"

MISSION STATEMENT
• One-sentence statement relating the intention of institution existence
• Communicates "What you do or What you do this for?"
• Clear, simple language, 5 to 20 words

TED
"Spreading ideas"
 COMPARISON BET. VISION STATEMENT AND MISSION STATEMENT
VISION STATEMENT MISSION STATEMENT
FUNCTION Inspires to give the best and shapes Defines the key measure of
the understanding and why you are the institution's success
in the institution
DEVELOPING When do we want to reach success? What do we do today?
STATEMENT Where do you want to go forward? For whom do we do it?
How do we want to do it? Why we do what we do?
TIME Talks about future Talks about present leading
to the future
QUESTION Where do we aim to be? What makes you different?
Where you want to be? How will you get where you
want to be?
CORE VALUE/VALUE STATEMENT: list of fundamental doctrines that guides and direct EI
• Sets the moral direction of institution and academic community that guides decision-
making and provides yardstick against any action
o What values are distinct to our educational institution?
o What value should direct our institution?

OBJECTIVES/GOALS (EDUCATIONAL OBJ): short statements that learners should achieve

w/in or the end of course/lesson.
• SMART
o LIST OF E.O. SET BY CHED MEMORANDUM ORDER NO. 14 SERIES OF 2006 on
"Policies, Standards, and Guidelines for Medical Technology Education
▪ Develop the K, A, S in the performance of clinical laboratory procedures
needed to help the physician in the proper diagnosis, treatment, prognosis,
and prevention of diseases
▪ Develop skills in critical and analytical thinking to advance knowledge in
MT/CLS and contribute to the challenges of the profession.
▪ Develop leadership skills and promote competence and excellence, and
▪ Uphold moral and ethical values in the service of society and in the practice
of the profession.
 Health System
HEALTH SYSTEM
• The combination of resources, organization, financing, and management that culminate in the
delivery of health services to the population (Roemer, 1991)
• It refers to all the organizations, institutions, resources, and people whose primary purpose is
to improve health (WHO, 2000)
• A well-performing HS provides direct health-improving activities whether in personal HC, PH
services or intersectoral initiatives, to achieve high health equity

GOALS AND FUNCTIONS OF A HEALTH SYSTEM

1. Improving the health of populations
o Overarching goal of HS
o Population must be protected from existing and emerging health risks
o HS should strive for equity in health by minimizing inequitable disparities w/c are effectively
reduced when recognized and minimization becomes an explicit nat'l goal.

2. Improving the responsiveness of the health system

o RESPONSIVENESS refers to providing satisfactory health services and engaging people as
active partners.
o HS has obligation to respond to legitimate non-health needs and expectations
o Responsive HS maximizes people's autonomy and control allowing them to make choices and
placing them at the center of HS

3. Providing fair health financing

o Ideal HS provides social and financial risk protection in health.
o HS must be adequately funded to provide essential services to all citizens.
o WHO defines a fairly HS as one that does not deter individuals from receiving care due to
payments required at the time of service

• This improves health outcomes

• Attaining the best average level of HC for the entire population by minimizing disparities.
• A more responsive HS that meets the people's expectation and satisfaction
• Equitable HC financing protecting each individual from financial risk

FOUR VITAL HEALTH SYSTEM FUNCTIONS

1. Health service provision
o Most visible product of HS: public and private health service program
o Appropriate and cost-effective H delivery
o Best systems includes preventive measures and promotion of a healthy way of living to avoid
illnesses
 2. Health service inputs (managing resources)
o Generating essential physical resources for the delivery of health services (medications, HR,
med. Equipment)
o HS policymakers have to respond and use the available resources to address short-term pop
needs

3. Stewardship
o Overall system oversight which sets the direction, context and policy framework for overall HS
o Main responsibility of the government
o CORE OF STEWARDSHIP FUNCTION
▪ Identifying health priorities for allocation of public resources
▪ Identifying an institutional framework
▪ Coordinating activities with other systems related to external health care
▪ Analyzing health priorities and resource generation trends and their implications
▪ Generating appropriate data for effective decision-making and policymaking on health
matters.

4. Health financing
o Includes raising and pooling resources to pay for health services.

RISK POOLING MODELS

BISMARCK MODEL (Bismarck's Law on Health Insurance of 1883)

• Otto von Bismarck, Prussian Chancellor, invented welfare state (19th century) as part of
unification of Germany
• Uses insurance system where sickness fund finances employer and employee through payroll
deduction
• Multi-payer model w/ tight regulation giving the government the cost-control clout

BEVERIDGE MODEL (Beveridge Report or the Social Insurance and Allied Services of 1942)
• William Beveridge, social reformer, designed Britain's Social Security System and National
Health Service
• HC is provided and funded by the government through tax payments
 • Necessary in strengthening HS and improving the overall health outcomes

Service Delivery : timely delivery of quality and cost-effective personal and

non-personal H services
Leadership & Governance: tasks of ensuring effective stewardship of the entire HS
Financing (HFS): funding for HC services
Health products, vaccines, made accessible, uninterrupted supply, well-managed
technologies: pharmaceutical services and education on proper use of
medication
Health workforce includes individuals and groups working in the achievement
of Health outcomes thru being responsive, fair and
efficient
Information (HIS): analyzes, disseminates, and uses reliable relevant
information on health status, determinants and system
performance.

Philippine Health System

HISTORICAL BACKGROUND
• Health reform initiatives were primarily focused on:
o Health service delivery
o Health regulation
o Health financing
• Health reforms address issues on poor accessibility, inequity, inefficient Phil HS

1979: Adoption of PHC Strategy (LOI Promoted participatory management of local health care
949) system
1982: Reorganization of DOH (EO 851) Integrated the components of health care delivery into its
field operations
1988: The Generics Act (RA 6675) Ushered the writing of prescriptions using the generic
name of the drug
1991: Local Government Code (RA Transferred the responsibility of providing health service
7160) to the local government units
1995: National Health Insurance Act Instituted a national health insurance mechanism for
(RA 7875) financial protection with priority given to the poor
 1999: Health Sector Reform Agenda Ordered major organizational restructuring of the DOH to
improve the way health care is delivered, regulated and
financed.
2005: FOURmula One (F1) for Health Adopted an operational framework to undertake reforms
with speed, precision, and effective coordination and to
improve the Phil HS
2008: Universally Accessible Cheaper Promoted and ensure access to affordable quality drugs
and Quality Medicines Act (RA 9502) and medicines for all
2010: Kalusugang Pangkalahatan or Provided universal health coverage and access to quality
Universal Health Care (AO 2010- health care for all Filipinos
0036)

LEADERSHIP AND GOVERNANCE

• DOH is mandated to provide the appropriate direction for the nation's HC industry.
o Development of plans, guidelines, and standards for the health sector.
o Technical assistance
o Capacity building
o Advisory services for disease prevention
o Control of medical supplies and vaccines
• DOH is duty-bound to:
o Develop policies and programs for the health sector
o Provide technical assistance to its partners
o Encourage performance of the partners in the priority health programs
o Develop and enforce policies and standards
o Design programs for large segments of the population
o Provide specialized and tertiary level care
• DOH coordinates health programs through LGUs
• LGUs take care of their own health services and autonomy under RA 7160
• Provincial government provide health services through provincial and district hospitals
• City and municipal government rely on public health and PHC centers for primary care
 • Before devolution, national HS is consisted of three-tiered system (under DOH):
o Tertiary hospital at national and regional levels
o Provincial and district hospitals and city and municipal health centers
o Barangay (village) health centers
• Under decentralized or devolved structure, state is represented by nat'l offices and LGUs with
provincial, city, municipal, brgy/ village offices.
• Thru LGC of 1991, HS consists of basic health services - health promotion and preventive units

DIRECTIONS OF THE PHILIPPINE HEALTH SECTOR

The Philippine Health Agenda I"All for Health Towards Health for All" as vision for a
2016-2022 Healthy Philippines by 2020
(DOH AO 2016-0038) Expanded the scope of UHC directions
The Philippine Development Plan First of the 4 key medium-term plans to translate vision of a
2017-2022 "matatag, maginhawa, at panatag na buhay" for the Filipinos
and the country
NEDA AmBisyon Natin 2040 Product of PDP 2017-22
Long-term plan w/c envisions better life for the Filipinos and
the country in the nxt 25 yrs
Focuses on four areas:
1. Building a prosperous, predominantly middle-class
society where no one is poor.
2. Promoting a long and healthy life
3. Becoming smarter and more innovative
4. Building a high-trust society
Sustainable Development Goals 2030 Agenda
2030 Compilation of 17 global development goals targets to end
poverty, fight inequality and injustice, confront climate change
issues.
Primary Health Care and the Philippine Health Care Delivery System
HEALTHCARE
• Health is a fundamental human right (Alma-Ata Declaration of 1978)
• The most important global goal for human is to reach the optimal level of their health;
o This requires the action of the health sector and the collaboration among other sectors
such as those in social and economic sectors.
• One of the most common concern of many countries (developed and developing) is the gross
inequality in the people’s health status which is not socially, economically, and politically
acceptable.
• Thus, the government of each country has the duty and responsibility to institute adequate
measures to promote and protect its people’s health and thus achieve a better quality of life.
3 CONCEPTS UNDER HEALTHCARE
1. Health care system
o an organized plan of health services
o defined by Miller and Keane (1987)
2. Health care delivery
o the rendering of health care services to the people
o defined by Williams and Tungpalan (1981)
3. Health care delivery system
o the network of health facilities and personnel which carries out the task of rendering
health care to the people
o defined by Williams and Tungpalan (1981)

PRIMARY HEALTH CARE

As cited by WHO, acc. to Alma-Alta Declaration
• important health care derived from scientifically sound and socially acceptable methods
• it must be universally accessible to all individuals and is based on what the community and
country can provide
• deals with social policy which targets health equity
• has the essential elements and objectives that ensure attainable better health services for
all
• its ultimate goal: better health for all

FIVE KEY ELEMENTS TO ACHIEVE THIS GOAL

1. Universal coverage to reduce exclusion and social disparities in health.
2. Service delivery organized around people’s needs and expectations
3. Public policy that integrates health into all sectors
4. Leadership that enhances collaborative models of policy dialogue
5. Increased stakeholder participation
8 ESSENTIAL ELEMENTS OF PHC 7. Treatment of communicable and non-
1. Education concerning prevailing communicable diseases and
health problems and the methods of promotion of mental health
identifying, preventing, and controlling 8. Safe water and sanitation
them
2. Locally endemic disease prevention
and control 6 Other Elements of Primary
3. Expanded program of immunization Health Care
against major infectious diseases 1. expanded options of immunization
4. Maternal and child health care 2. reproductive health needs
including family planning 3. provision of essential technologies for
5. Essential drug arrangement health
6. Nutritional food supplement, an 4. health promotion
adequate supply of safe and basic 5. prevention and control of non-
nutrition communicable diseases
6. food safety and provision of selected
food supply

PRINCIPLES OF PRIMARY HEALTH CARE

• Primary health care should be integrated and its principles guide the functions of the system
as a whole
• Having a systems perspective bridges the conflict between primary health care as a
distinguished level of care and as a holistic approach to the provision of health services
• Health system should:
o consider the principles of Alma-Alta Declaration and the other intersectoral
approaches
o cover broader health issues of populations while reinforcing public health functions
o come up with programs that provide care and prevent diseases
o come up with programs that provide provision for services especially for the poor and
marginalized groups
o be able to monitor programs for continuous improvement

12 Basic Objectives to launch and sustain primary health care as part of the comprehensive
health system
1. Improve the level of health care of the community
2. Promote favorable population growth structure
3. Reduce the morbidity and mortality rates especially among infants and children
4. Reduce prevalence of preventable, communicable, and other diseases
5. Improve basic sanitation
6. Extend essential health services especially to the underserved sectors
7. Develop the capability of the community to become self- reliant
8. Encourage the contribution of other sectors to the social and economic development of the
community
9. Provide equitable distribution of health care
 10. Ensure community participation and monitor adequacy and the distribution of health workers
who are supported locally and at the referral levels
11. Recognize that the formal health sector needs other sectors in the promotion of health
12. Use the appropriate technology which are accessible, feasible, affordable, and culturally
acceptable to the community

MANAGEMENT OF PHC
5 FUNCTIONS IN THE PROCESS OF MANAGEMENT
1. Planning
o setting priorities and determining performance targets
o managers are usually required to set a direction and determine what needs to be
accomplished
2. Organizing
o designing the organization or the specific division, unit, or sector for which the
manager is responsible
o designating reporting relationships and internal patterns of interaction, determining
positions and teamwork assignments, and distributing authority and responsibility
3. Staffing
o acquiring and retaining human resources
o developing and maintaining the workforce through various strategies and tactics
4. Controlling
o monitoring staff activities and performance
o taking the appropriate actions for corrective actions to increase performance
5. Directing
o initiating action in the organization through effective leadership, motivation, and
communication of managers

4 MANAGEMENT PRINCIPLES IN RELATION TO ORGANIZING

• AUTHORITY, RESPONSIBILITY, • TYPES OF AUTHORITY
ACCOUNTABILITY o Line Authority: managers issue
o Authority: formal and legitimate orders to their subordinates and
right of a manager to issue orders, are also responsible for the results
make decisions, and allocate o Functional Authority: for managers
resources that have power only over a
o Responsibility: duty of the specific set of activities
employee to perform the assigned o Staff Authority: given to specialists
tasks and activities in their areas of expertise
o Accountability: reporting and ▪ the staff manager simply
justification of task outcomes to advises, recommends, and
those people with authority counsels
 • CENTRALIZATION, DECENTRALIZATION, AND FORMALIZATION
o Centralization: concentration of planning and decision-making to the top of the
organization
o Decentralization: delegation of planning and decision-making to the lower branches of
the organization
o Formalization: written documentation provided for the direct control of the employees

• STAFFING
4 Functions of a Manager
o Assign individuals to respective positions
o Assess required competencies through:
▪ identification of the key result areas (KRAs) per major activity
▪ determination of the competencies and qualifications
o Recruit qualified personnel
o Improve existing services and programs by:
▪ reviewing and adjusting the requirements accordingly
▪ matching the competency requirements with relation to the responsible
personnel assigned to the activity

THE PHILIPPINE HEALTHCARE SYSTEM

• a complex set of organizations interacting to provide an array of health services - Dizon (1977)
• progressed due to challenges encountered over time
• in 1991, the LGUs took over the management of health service delivery but the issue of
fragmentation has not been absolutely addressed
• health workforce has to deal with the pressing issues of underemployed workers, limited
resources, and unequal distribution
• meanwhile, the private sectors (w/c is said to compromise 50% of the overall health system)
is strongly involved in improving the delivery of health services, but the government’s power
to regulate should be optimized

THE DEPARTMENT OF HEALTH MANDATE

• as specified in E.O No. 119, Sec 3, the MOH (now DOH) has the responsibility to create, plan,
implement, and systematize national health policies, advocacies, and programs
• its primary function is to promote, protect, and preserve or restore people’s health by giving
health services and by monitoring and motivating health service providers
• DOH is also responsible for the issuance of health-related licenses and accreditations and
disseminating information about national health indicators
VISION
• DOH vision by 2030 states
o A global leader for attaining better health outcomes, competitive and responsible
health care system, and equitable health financing
MISSION
• DOH mission states
o To guarantee equitable, sustainable, and quality health for all Filipinos, especially the
poor, and to lead the quest for excellence in health.
LEVELS OF HEALTH CARE FACILITIES
According to William &Tungpalan (as cited in DeDios, n.d.)
1. PRIMARY LEVEL
o units operated by DOH with includes o clinics operated by the Philippine
RHU’s, their respective sub-centers, Medical Association
chest clinics, malaria eradication units, o clinics operated by large industrial firms
and schistosomiasis control units for their employees
o puericulture center operated by the o health centers and community hospitals
League of Puericulture Centers operated by the Philippine Medical Care
o units operated by the Philippine Commission
Tuberculosis Society such as o other health facilities operated by
tuberculosis clinics and hospitals voluntary religious and civic groups

2. SECONDARY LEVEL
o includes smaller and non-departmentalized hospitals
o emergency and regional hospitals (where adequate treatments are offered for
patients with symptomatic stages of diseases)
3. TERTIARY LEVEL
o specialized national hospitals
▪ offer highly technological and sophisticated services
▪ treats patients who are afflicted with life-threatening diseases requiring highly
technical and specialized knowledge, facilities, and personnel

LEVELS OF PRIMARY HEALTH CARE WORKERS

1. GRASSROOT OR VILLAGE HEALTH WORKERS
o the initial links of the community to health care
o they provide preventive health care measures and simple curatives to promote a
healthy environment
o they encourage programs/ activities such as food production programs to improve the
socio-economic level of the community
o they are the volunteers, community health workers, or traditional birth attendants
(komadrona)
2. INTERMEDIATE LEVEL HEALTH WORKERS
o they are the first source of professional health care
o they attend to health problems which are already beyond the competence of the
village workers
 o they provide supervision, training, supplies, and services that provide support to front-
line health workers
o they are medical practitioners, nurses, and midwives

3. FIRST-LINE HOSPITAL PERSONNEL

o when hospitalization is required, they serve as the backup health service providers
o the intermediate level health workers or the village health workers are in close contact
with them
o they are physicians with specialty, nurses, dentist, pharmacists, and other health
professionals

3 FACTORS AFFECTING THE CATEGORIES OF HEALTH WORKERS

1. the availability of the health manpower resources
2. the presence of health care concerns and needs of the locality
3. the issue of financial and political feasibility

Key Points to Remember

• Health is a fundamental human right as cited in
the Alma-Alta Declaration of 1978.
• Reaching the highest possible level of health is
important worldwide.
• Primary Health Care (PHC) is essential health
care made universally accessible through full
participation of health care providers and at a
cost that the community and the country can
afford.
• The ultimate goal of PHC is better health for all.
The principles of PHC should guide the functions
of the system as a whole.
• Management of PHC includes planning,
organizing, staffing, controlling, and directing.
• Health care facilities are categorized into
primary, secondary, and tertiary levels.
• PHC workers are categorized as grassroot or
village health workers, intermediate level health
workers, and first-line hospital personnel.
• The Philippine health care system has
progressed due to many challenges through
time. The private sector has been strongly
engaged but the government regulation should
be optimized.
• The primary function of DOH (then MOH)
indicated in EO no. 119 is to promote, protect,
preserve, or restore people’s health by giving
health services and monitoring health service
providers.
 Overview of Health Informatics
HEALTH INFORMATION TECHNOLOGY
• The area of IT involving the design, development, creation, use, and maintenance of
information systems for HC industries.
• Automated and interoperable HCIS are expected to:
o improve medical care
o lower costs
o increase efficiency
o reduce error
o improve px satisfaction
o optimizing reimbursement for ambulatory and in-patient HC providers
• It vows to provide innovation to HC delivery and connection among users and stakeholders in
the e-health market.
• Systems that are widely deployed worldwide
o Electronic health records
o Decision support systems
o Personal health records

HEALTHCARE SOFTWARE SYSTEMS

3 FUNDAMENTAL COMPONENTS OF HIT

1. Electronic Health Record (EHR)
o Also called Electronic Medical Record
o Digital form of px's official health record shared across multiple HC providers and
agencies.
2. Personal Health Record (PHR)
o A person's self-maintained health record
3. Health Information Exchange (HIE)
o Health data clearinghouse comprise of HC orgs w/ interoperability pact to share data
among their HITS

• Since the implementation of HITECH Act of 2009, the use and implementation of EHR in
the US has increased dramatically.

Two widely used types of HIT:

1. PACS (Picture Archiving and Communications Systems)
2. VNA (Vendor Neutral Archives)
• They help manage and store px's medical images
• They integrate radiology into main hospital workflow
 o Radiology use to be the primary repository for med images
• VNAs can also be used for merging stored imaging data from various depts into a
multi-facility HC system.

HEALTH INFORMATION ECOSYSTEM

Health Interoperability Ecosystem
• Composition of individuals, systems, and processes that share, exchange, and access all forms
of health information (discrete, narrative, multimedia) - Healthcare Information and
Management Systems Society (2017)
• Potential stakeholders:
o Individuals
o Patients
o Providers
o Hospital/ health systems
o Researchers
o Payors
o Suppliers
o Systems
• An efficient Health Interoperability Ecosystem provides info infrastructure that uses tech
standards, policies, and protocols to enable seamless and secure capture, discovery, exchange
and utilization of health info.
HEALTH INFORMATICS IN THE CLOUD
• 83% of HC orgs are making use of cloud-based apps and its changing landscape of HC
system and health informatics

ADVANTAGES OF CLOUD TECHNOLOGY

1. Integrated and Efficient Patient Care
o It offers access point for patient info w/c allows multiple doctors to review lab
results/ notes on px.
o Allows physicians to have more time for decision making and patient treatment
2. Better management of data
o E-records will allow more meaningful data mining that can better assess the health
of gen public.
o More data = more opportunities in identifying disease trends and crises

DISADVANTAGES OF CLOUD TECHNOLOGY

1. Potential risks to personal information
o It is vulnerable to data breaches and may be subjected to theft or violations of
privacy and confidentiality.
o Safeguards may minimize threats
 1. Cloud setup seems cumbersome
o Transition from traditional to automated system may be difficult for orgs not familiar
w/ cloud tech
o w/ proper education & illustration of its function, advantages can be seen

HEALTH INFORMATICS IN THE PHILIPPINES

• HIT is the application of both technology and systems in a healthcare setting.
• Practiced in the Phil since 1980s.
• Practitioners w/ access to IBM compatible machines used word processors to store px info.

COMMUNITY HEALTH INFORMATION TRACKING SYSTEM (CHITS)

• One of the significant milestones
• An EMR developed through collab of ICT community health and workers designed for use in
Phil health centers in disadvantaged areas.
• Currently utilized in 111 gov't facilities
• Implementation resulted in higher efficiency rate providing more time to be spent in patient
care.

• Despite the development, health informatics in the Phil still suffer from issues of hamper
progress.
o lack of interest in the field
o Many decision-makers do not use the benefits of IT in the health sectors
o Large expenditure for HIS remains a barrier to IT integration in Phil HCS
• H.I is seen more as novelty rather than profession.
• When professional and economic constraints play, priorities shift toward clinical
responsibilities at the expense of HI as a discipline.

KEY POINTS
• HIT involves development and management of health info for improved health service delivery
• EHR is the central component to HIT infrastructure
• PACS and VNAs are two widely use types of HIT helping HC professionals store and manage
px medical images
• An efficient Health Interoperability Ecosystem provides info infrastructure that uses tech
standards, policies, and protocols to enable seamless and secure capture, discovery, exchange
and utilization of health info.
• Advantages of HI in cloud are integrated and efficient patient care and better management
of data
• Despite the development, health informatics in the Phil still suffer from issues of hamper
progress.. One of such is lack of interest in the field. Another is benefits of IT in the health
sectors do not seem apparent to health sector decision makers.
 HMIS: Monitoring and Evaluation
HMIS
• Specially designed to assist the management and planning of health programmes, as
opposed to delivery of care (WHO, 2004)
HEALTH: clinical studies to understand medical terminologies, clinical procedures, and
database processes
MANAGEMENT: principles that help administer the health care enterprise
INFORMATION SYSTEM: ability to analyze and implement applications for efficient and
effective transfer of px info

• One of the six building blocks essential for health system strengthening
• Data collection system specifically designed to support planning, management, and decision-
making in health facilities and orgs.
• It is primarily used at assisting in the planning and management of nat’l health strategy
plans.
o Continuous monitoring and evaluation are necessary for it to be effective.
• The primary aim of HMIS is to have a strong M&E and review system in place for the nat’l
health strategic plan that comprises all major disease programs and health systems.

MONITORING: collection, analysis, and use of information gathered from programs for the
purpose of learning form the acquired experiences, accounting of the resources used
both internal and external, and obtaining results and making decisions.
o PURPOSE CORRESPONDS TO THREE FUNCTIONS
1. Learning:
2. Monitoring:
3. Steering
EVALUATION: systematic assessment of completed programs and policies.
OBJECTIVE: gauge the effectiveness of the program so adjustments can be made
in areas that needs improvement

• Evaluation has both a learning function (lessons learned need to be incorporated into future
proposals) and monitoring function (concerned parties review implementation policies based
on objectives and resources.)

PURPOSE OF M&E
• To assess the effect of an integrated service delivery

M&E FRAMEWORK
• M&E is a core component of current efforts to scale up for better health.
• Global partners and countries have developed a general framework for M&E of health
system strengthening (HSS)
COMPONENTS OF M&E FRAMEWORK (WHO)
1. INDICATOR DOMAINS
o Indicators should be tracked to assess processes and results associated w/
various indicator domains.
o Strengths and weaknesses of implementation are provided and can be used
for system troubleshooting
o OUTCOME AND IMPACT INDICATOR: useful in understanding the current
health status and context within a country
2. DATA COLLECTION
3. ANALYSIS AND SYNTHESIS
4. COMMUNICATION USE

M&E PLAN
• Addresses the component of the framework and establishes the foundation for regular
reviews during the implementation of the plan for nat’l level.
• LOCAL M&E SYSTEMS generate info for global monitoring based on health sector review
processes w/c are considered key factors in monitoring the progress and performance
of the entire system.
M&E AND HMIS INDICATORS
INDICATOR: variable w/c measures the value of the change in units that can be compared
to past and future units.
• HMIS use various indicators to monitor key aspects of health system performance

CATERGORIES OF HMIS KEY INDICATORS (United States Agency for Int’l Development- USAID)
KEY
PERFORMANCE KEY INDICATOR
AREA
Reproductive Health • Family planning acceptance rate
• Antenatal care coverage
• Proportion of deliveries attended by skilled health professionals
• Proportion of deliveries attended by HEWs
Immunization • DPT-3 (Pentevalent-3) coverage (>1 child)
• Measles immunization coverage (>1 child)
Disease Prevention • Malaria case fatality rate among patients under 5 years of age
and Control • New malaria cases per 1,000 population
• New pneumonia cases among children under 5 per 1,000
population <5yrs
• TB case detection rate
• TB cure rate
• Clients receiving VCT services
• PMTCT treatment completion rate
• PLWHA currently on ART
 Resource Utilization • Trace drug availability (in stock)
• OPD attendance per capita
• In-patient admission rate
• Average length of stay (in-patient)
Data Quality • Bed occupancy rate
• Reporting completeness rate
• Reporting timeliness rate

QUANTITATIVE INDICATORS FOR MONITORING FAMILY

PLANNING/IMMUNIZATION INTEGRATION

INDICATOR DATA SOURCE PURPOSE

INPUT
Vaccine stockouts in a single HMIS, Service Statistics Monitor vaccine stockouts
month (YES/NO, by type of
vaccine)
Contraceptive stockouts in a HMIS, Service Statistics Monitor contraceptive
single month (YES/NO, by stockouts
type of contraceptive)
Number of service providers Training records Monitor reach of EPI/FP
trained in provision of integration training as an
EPI/FP integrated services input for effective
integrated service delivery
OUTPUTS
Number of service delivery Service statistics and Coverage of integrated
points offering integrated Supervision service delivery
FP and immunization
services
Number of days per month Service Statistics and Availability of co-located
when both immunization and Supervision (Observation + FP/immunization services
family planning services are Interviews)
offered at the same site
Number/percent of women Supplemental tracking Quality/continuity of
attending routine child column that can be added to implementation of
immunization services who existing immunization integrated service delivery.
received information on register [Monitored for
family planning from a demonstration/ pilot
vaccinator programs only]
Number/percent of women Supplemental tracking Quality/continuity of
(with children column added to FP Ledger implementation of
<12 months) going for family [Monitored for integrated service delivery.
planning who receive demonstration/ pilot
information on immunization programs only]
from
the family planning provider

Number/percent of women Supplemental tracking Acceptance of FP referrals

attending routine child column added to provided by the vaccinator.
immunization services who Immunization Ledger
accept a referral to family [Monitored for
planning services demonstration/ pilot
programs only]
Number /percent of women Comparison of supplemental Follow through on FP
attending routine tracking column added to referrals provided by the
immunization services who immunization ledger, and vaccinator.
follow through on a FP supplemental tracking
referral from a vaccinator column added to FP ledger
[Monitored for
demonstration/ pilot
programs only]

Number / percent of women Comparison of supplemental Follow through on

attending family planning tracking column added to FP immunization referrals
services who follow through ledger, and supplemental provided by the family
on referral to immunization tracking column added to planning provider
services from a family immunization ledger
planning provider [Monitored for
demonstration/ pilot
programs only]
OUTCOMES
Number of children Immunization ledger / Use of immunization
receiving DTP 1, DTP 3, HMIS, and population-based services, dropout
measles, and DPT 1-3 survey data
dropout
Immunization coverage for HMIS and population-based Percentage of children
DTP1, DTP3, and measles Survey Data
Number of new family Family Planning ledger / Uptake of family planning
planning acceptors by HMIS services
method type and
demographic/age group
Contraceptive prevalence Population Survey Data Contraceptive use within a
rate given population
 Total financial cost of inputs
required to integrate FP and
immunization services (per
facility, per client exposed,
per new FP acceptor)
Maternal, infant, and child
mortality rates
Program data / Special
costing studies
IMPACT
Studies on maternal and
infant mortality
Cost of inputs required for
integration. This may be
helpful in planning for
decisions related to
sustainability and scale-up
of integrated services.
Measure improvement in
health status.

HMIS INDICATORS AND HEALTH PROGRAMS

• HMIS indicators should be carefully selected to meet the essential info necessary for
monitoring the performance of various health programs and services and to present an
overview of available health resources.

Maternal Survival Interventions

• 5th MDG targets to reduce maternal mortality ratio by 75% and to achieve universal
access to reproductive health
• The following indicators capture data related to pregnancy and are sufficient to give a
broad indication of the performance of the package of maternal interventions.
• It will help prompt future investigations when problems/issues arise.

1. Pregnancy care interventions

o 1st antenatal care attendances
o 4th antenatal care attendances
o Cases of abnormal pregnancies attended at OPD of health facilities
o Institutional cases of maternal morbidity and mortality due to antepartum
hemorrhage (APH), hypertension, and edema reported by IPD of health facility
o Cases of abortion attended at health facilities
o Cases of medical (safe) abortion conducted at health facilities

2. Intrapartum care
o Deliveries by skilled attendants (at HF)
o Deliveries by health extension workers (HEW) (at home of health posts)
o Institutional cases of maternal morbidity and mortality due to obstructed labor

3. Postpartum care
o 1st postnatal care attendance
o Institutional cases of maternal morbidity and mortality due to postpartum
hemorrhage (PPH) and puerperal sepsis

4. Interpartum period
o Family planning method acceptors (new and repeat)
o Family planning methods issued by type of method
Child Mortality and Child Survival Interventions
• PNEUMONIA is the leading cause of <5 child mortality in the Philippines in 2012 (DOH)

• The Phil gov’t through DOH launched various strategies to help ensure good health of
Filipino children by 2025.

1. Child 21 (Phil Nat’l Strategic Framework for Plan Development for Children 2000 to 2025)
o Framework for policymaking and program planning
o Roadmap for interventions aimed at safeguarding the welfare of Fil children
o Part of Phil commitment to UNCRC.
2. Children’s Health 2025
o Subdocument of Child 21 that focuses on development of Fil children and the
protection of their rights by utilizing life cycle approach
3. Integrated Management of Childhood Illness
o Strategy that aims to lower child mortality caused by common illnesses
4. Enhanced Child Growth
o Intervention aimed to improved health and nutrition of Fil children by operating
community-based health and nutrition posts all throughout the country

Stop TB Program
• GOAL: dramatically reduce the global burden of TB by 2015 in line with MDG and Stop TB
Partnership (aim to push TB up the world political agenda).
• One of it main objectives is to achieve universal access to high-quality care for all people
with TB.
• TB case detection and successful completion of the treatment/cure remain at the core of
the Stop TB Strategy.
• By 2050, one of the targets is to reduce the prevalence and deaths due to TB by 50
percent compare w/ 1990 baseline
1. TB px on DOTS (no. of new smear-positive PTB cases enrolled in the cohort)
2. Tb case detection (no. of new smear-positive PTB cases detected, no. of new smear-negative
PTB cases detected, no. of new extra-PTB cases detected)
3. HIV-TB co-infection (proportion of newly diagnosed TB cases tested for HIV)
4. HIV + new TB px enrolled in DOTS
5. TB treatment outcome (tx completed PTB+, Cured PTB+, Defaulted PTB+, Deaths PTB+)