Instructions in answering the Basel

1. Open the Roadmap sheet (sheet 2) and input the name of your muni

2. In the succeeding steps, strictly follow the instructions:

2.a. Check each BUILDING BLOCK (sheet 3-8), read and understand t
2.b. Evaluate each building block by assessing using the SUB-BLOCKS
2.c. Read all PERFORMANCE INDICATORS (Column 4) per sub-block.

2.d. Proceed to the next Excel Sheet and answer each sub-block aske
3. Save the file as Roadmap_(Name of your LGU) and email to hlgpdohw

Note:
The SUB-BLOCKS in Sheet 2: Roadmap will be color-filled once you have
Standard of Performance of each block. Kindly double check if your tea
acording to all sub-blocks required. Missed sub-blocks will stay RED if it
 Instructions in answering the Baseline Roadmap Assessment
Open the Roadmap sheet (sheet 2) and input the name of your municipality/city on the top most row

In the succeeding steps, strictly follow the instructions:

2.a. Check each BUILDING BLOCK (sheet 3-8), read and understand their descriptions
2.b. Evaluate each building block by assessing using the SUB-BLOCKS (Column 1)
2.c. Read all PERFORMANCE INDICATORS (Column 4) per sub-block. Read remarks (Column 5) if necessary
2.c.1. Put an "x" mark on the PINK COLUMN corresponding to each indicator if you have met the requirement
being described
2.c.2. Leave BLANK if otherwise
2.c.3. Kindly take note of what is being asked, some require you to input data in %
2.d. Proceed to the next Excel Sheet and answer each sub-block asked until you finish ALL SIX (6) Building blocks
Save the file as Roadmap_(Name of your LGU) and email to hlgpdohwv@gmail.com

ote:
e SUB-BLOCKS in Sheet 2: Roadmap will be color-filled once you have marked all the met indicators according to the
andard of Performance of each block. Kindly double check if your team was able to assess your local health system
ording to all sub-blocks required. Missed sub-blocks will stay RED if it remains unassessed.
 City/Municipality of _____________________________
Primary Health Care Roadmap
Access to Medicine &
Leadership and Governance Health Financing Health Human Resource
Technology
Expanded and Functional Local Accredited Health Complete RHU Staff Complement
Health Board (LHB) Facilities

RHU Human Resource Accreditation

Collaborative, Comprehensive, Barangay Health Worker Registration and

Accreditation
participatory, and evidence- Community IEC on
based Municipal Investment Philhealth Services Trained Medical Doctor
LGU Supply Chain
Planning for Health (MIPH) Management System

Trained Public Health Nurses

Community Engagement Management of

Activities with Inter-sectoral Philhealth Trained Rural Health Midwives
Participation Reimbursements

Trained Barangay Human Resource

Functional Barangay Health Philhealth Coverage Functional Performance Evaluation and

Rewards System for RHU Staff Policy Support on
Governance Body for the Poor
Medicines
Functional Performance Evaluation Management
System for Barangay Health Station (BHS)
Staff

Barangay Investment Plan for LGU Health Budget RHU Health Human Resource Adequacy
Health/Barangay Development Allocation (At least
Plan 15%) Barangay Health Human Resource
Adequacy

Actual Budget
Presence of Health Policies Health Human Resource for Emergency
Utlization

Collaborative and Inter-

sectoral Health Policy Essential Medicines
Adequate Compensation for RHU Staff
Development, Implementation Policy support on
and Monitoring provision of funds
for subsidies and
social protection
LGU support for Building Implementation of Magna Carta for
Resilient Health Systems Public Health Workers
________________
ap
Health Information System Service Delivery

Functional Electronic Functional Health Faciltiies

Health Information
System Established Referral System

Barangay Health Service

Patient Registry System Delivery

Data Reporting and Patient-Centered Care

Utilization

Mortality Reviews
Patient Client Feedback
Mechanism

Data on Social Health Promotion Services

Determinants of Health

Disease Prevention and

Control Services

Profiling of Vulnerable Curative Services

Population
Rehabilitative Services

Early Warning System for Complete Health Service

Emergencies Packages for all Life Courses
 MUN

ANSWER Reference from

SUB-BLOCK put an "x" if applicable, PHC
leave blank if not Questionnaire
Building Block: Leadership and Governance
Description: Involves ensuring strategic policy frameworks exist and are combined with effective oversight,

Q1

Expanded and Functional

Local Health Board (LHB)
Expanded and Functional
Local Health Board (LHB)

Q2

Q3

Q4

Q5-6
 Q7-Q8

Q9

Collaborative,
comprehensive,
participatory, and
evidenced- based Municipal Q9
Investment Planning for
Health (MIPH)
Investment Planning for
Health (MIPH)

Q10

Q11

Q12-Q13

Q14

Q15
Community Engagement
Activities
 Community Engagement
Activities

Q16-Q18

Q19

Q20-Q21

Functional Barangay Health

Governance Body

Q22
 Q23

Q24

Barangay Investment Plan for

Health/ Barangay Development
Plan

Q25-Q26
Presence of Health Policies Q27

Q28-Q30

Collaborative and Inter- sectoral

Health Policy Development, Q31
Implementation and Monitoring
Collaborative and Inter- sectoral
Health Policy Development,
Implementation and Monitoring

Q32-Q33

Q34

Q35

LGU support for Building

Resilient Health Systems Q36
Q37
 MUNICIPAL BASIC HEALTH SYSTEM’S SIX BUILDING BLOCK INDICATORS

PERFORMANCE INDICATORS

s exist and are combined with effective oversight, coalition-building, regulation, attention to system-design, and acco

1. Issued legislation on expanding

the Local Health Board to include
ALL of the following:
a. Municipal Social Welfare and
Development Officer,
b. Municipal Planning and
Development Coordinator
c. Municipal Budget Officer, and
d. other agency representatives
deemed necessary
2. Included individual
representation from the “Basic
sector” (women, workers, senior
citizens, youth, and other members
deemed necessary) in the Local
Health Board

3. Defined functions, roles and

responsibilities of each member of
the Local Health Board

4. Conducted orientation on
Bridging Leadership or training in
Municipal Health System
Strengthening Program (MHSSP)
among members of the expanded
local health board?

5. Documented monthly meetings

presided by mayor or the MHO
1. Reviewed and updated
Municipal Investment Plan for
Health (MIPH) by Local Health
Board

2. Identified health needs through

participatory approach, data, and
prioritization process

3. Integrated Municipal and

Barangay Investment Plan for
Health
4. Integrated Municipal Investment
Plan for Health with Municipal
Development Plan

5. Endorsed Municipal Health Plan

to the Provincial Health Office

6. Reviewed and updated Annual

Operational Plan (AOP)

1. Conducted community
consultation activities once per
quarter

2. Conducted community activities

to report/feedback local health
data and status of health programs
at least twice a year
3. Organized community volunteer
groups which includes sectoral
representatives (e.g. women,
workers, youth, senior citizens,
etc.)

1. Established Barangay Health

Governance Bodies (Barangay
Development Council, Barangay
Health Boards, Barangay Nutrition
Committee) in ALL priority
barangays

2. Issued municipal legislation on

the creation of Barangay Health
Governance Bodies or
strengthening of those existing
already with statement of
functions, roles, and
responsibilities.

3. At least two (2) Resolution on

Barangay Health System
Strengthening or any policy on
health issued by the Sangguniang
Barangay in ALL priority barangays
4. Conducted Barangay Health
Leadership and Management
Program in in ALL priority
barangays

1. Formulated Barangay
Investment Plan for Health/
Barangay Development Plan with
identified priority health needs and
priority health strategies based
from Situational Analysis and
Community Diagnosis in in ALL
priority barangays

2. Monitored implementation of
Barangay Investment Plan for
Health/ Barangay Development
Plan at least in a semi-annual basis

·   Issued legislations (new or

revised) to address focus areas on
the triple burden of disease and
health and nutrition in all life
stages:
1. Communicable Diseases
-HIV
-Tuberculosis
-Food and waterborne Diseases
-Diseases with endemic potential
revised) to address focus areas on
the triple burden of disease and
health and nutrition in all life
stages:
1. Communicable Diseases
-HIV
-Tuberculosis
-Food and waterborne Diseases
-Diseases with endemic potential

2. Non-communicablediseases:
-Hypertension
-Diabetes
-Chronic Kidney Diseases

3. Mental Health and Substance

Abuse

4. Health and Nutrition for all Life-

stage:
-Maternal
-Child
-Adolescent
-Senior Citizen

1. Issued legislations for health

(new or revised) through inter-
sectoral collaboration, participatory
approach, evidence and local
health data

2. Issued/revised legislations for

health with monitoring and
evaluation plans
3. Implemented ALL legislations for
health in line with implementing
rules and regulations

1. Integrated the municipal DRRM-

H plan to the comprehensive
Municipal Disaster Risk Reduction
and Management (MDRRM) Plan

2. Issued an ordinance adopting RA

10121 "Philippine Disaster
Reduction and Management Act"

3. Established an Incident
Command System (ICS)
organizational structure
4. Issued an ordinance establishing
the municipal health emergency
management/disaster risk
reduction and management for
health unit as integrated in the
Municipal Disaster Risk Reduction
and Management Council
 MUNICIPAL BASIC HEALTH SYSTEM’S SIX BUILDING BLOCK INDICATORS

REMARKS

ve oversight, coalition-building, regulation, attention to system-design, and accountability.

· Primary Members of the Local Health Board (LHB) includes the Mayor as
chairman, MHO as vice-chairman, DOH Rep, SB on Health, 1 representative from
the private sector or non-governmental organizations (NGOs) involved in health
services, and a Community Leader.

• Expanding the LHB pertains to addition of ALL of the following:

a. municipal social welfare and development officer,
b. municipal planning and development coordinator,
c. municipal budget officer and
Any of the following
d. President of "Liga ng mga Barangay",
e. Representative/ President of Barangay Health Workers,
f. Representative for Disaster Risk Reduction and Management,
g. Department of Education Representative / School Division or District
superintendent,
h. Hospital Heads (public and private),and
i. Other agency representatives deemed necessary through conduct of
stakeholder analysis.
· This pertains to inclusion of representatives from “Basic sector” which include
ALL of the following: a. women representative, b. workers' representative, c.
senior citizens, d. youth representative, and

any of the following sectors:

a.The urban poor, b. indigenous people/ cultural communities, c. disabled

persons, or d. any other members of the “Basic sector” deemed necessary by
the LHB.

•Basic sector refers to disadvantaged sectors of the Philippine society, which

also includes farmer-peasant, artisanal fisher folk, workers in the formal sector
and migrant workers, workers in the informal sector, indigenous peoples and
cultural communities, women, differently abled persons, senior citizens, victims
of calamities and disasters, youth and students, children, and urban poor;

• Roles and responsibilities of ALL individual members are reflected in the

created/revised ordinance on expanding the Local Health Board

• Municipal Health System Strengthening Program is a ZFF Bridging Leadership

Product which facilitates inter-agency and inter-sectoral collaboration for health
systems strengthening

• Updating of roadmap sub-block should validate if meetings are held and

documented at least monthly for the previous quarter. At least quarterly
meetings should be presided by the mayor
·         Municipal Investment Plan for Health is reviewed and updated with ALL
of the following contents:
a.  Executive Summary,
b. Introduction/Plan Development,
c. LGU Profile,
d. Health Situationer/Situational Analysis,
e. Overall Health Strategy and specific interventions
f. Costing of critical interventions,
g. Plan Management,
h. Monitoring and Evaluation
• Performance indicator will be validated by checking completeness and by
comparing if the old MIPH differs from the new MIPH

·         Executive Summary of MIPH contains identified health needs. Health

Situationer/Situational Analysis contain ALL of the following:

a.  description how it was consulted to stakeholders,

b.  updated health data, and
c.  The method of prioritization used.

The prioritization process should be based from urgency and magnitude, vis-à-
vis organizational capability and effects of inaction. In the preparation of the
MIPH, the LHB

•The Health Situationer/Situational Analysis should include listing of Priority

health needs identified per barangay. The overall health strategy and specific
interventions should highlight or label which were brought up from barangay
health plans
•The Municipal Development Plan should include the priority strategies
identified in the Municipal Investment Plan for Health

•A cover letter must be attached to the accomplished Municipal Health Plan

endorsing the Municipal Health Plan to the Provincial Health Office

·         The Annual Operational Plan is reviewed and updated with ALL of the
following contents:
a. Cover letter,
b. General description (i. Health Situation at the end of the Year, ii. Local
priorities in Health: Adjusting MIPH to the Current Situation, iii. Major thrusts of
the AOP, iv. Adjustments in Proposed Interventions and Investments based from
program implementation review, v. performance indicators),and
c. Planning and Costing Matrices. Minutes of PIR should be annexed to the AOP

• Community engagement is the process of working collaboratively with

community and sectoral groups to address issues that impact the well-being of
those groups. Community consultations could be done through barangay
assemblies, health summits, town hall meetings

• Reporting/feedback activities could be done along with community

consultation activities or through publishing/posting of information in health
data boards
• Performance indicator will be validated through list of volunteers with defined
roles and responsibilities. The volunteers identified are not the barangay health
workers / nutritional scholars but should be sectoral representatives (women,
worker, youth, senior citizens, etc.) or their family members.

•At least one Barangay Health Governance Body in ALL priority barangays as
required based from the policy of the Mayor. The barangay governance bodies
should have documented meetings at least quarterly and have agreed action
points in every meeting.

• Legislation could either be on creation or strengthening of Barangay Health

Board or existing Barangay Health Governance Bodies

• This could also include review of existing resolutions

• At least one new resolution passed.
• Barangay Health Leadership and Management Program (BHLMP) is a ZFF
bridging leadership product which intends to capacitate and empower the
health leaders in the barangay to help them organize and functionalize their
Barangay Health Boards. The barangay health leaders are to improve their
barangay health system making health services available to the community
thereby resulting to improved health outcomes.

• Barangay Investment Plan for Health/ Barangay Development Plan should

indicate the following: a. priority health needs, and b. priority health strategies.
The results of situational analysis and community diagnosis should be annexed
to the Barangay Investment Plan for Health/ Barangay Development Plan
• LGUs should have policies to address ALL diseases/stages listed in each focus
area. Legislations can integrate several diseases/stages in each focus area into a
single policy (e.g. Ordinance on comprehensive maternal and child health and
nutrition, Ordinance on integrated and comprehensive program for non-
communicable diseases)

· Use existing policies for baseline. For practicum, this will apply to ALL health
policies to be issued (new or revised) after module1. All health policies to be
created/revised during practicum phase should have provisions describing
rationale or basis for the policy based on all of the following: a. local health data,
b. national guidelines, and c. consultation/collaborated with other sectors

• All health policies issued during practicum phase should also be signed and
acknowledged by members of the expanded local health board

• All health policies issued during practicum phase should have provisions
describing how the policy is to be monitored and evaluated in terms of
compliance to set rules and regulations
·   Performance indicator will be validated through submission of reports on
status of policy implementation with reference to set rules and regulations.
Implementation reports should indicate the following:

a. description of level of compliance to set implementing rules and regulations,

b. description of actual penalties enacted against non-compliance,
c. key findings and recommendations on improving policy implementation and
monitoring

·  The municipal DRRM-H plan should be acknowledged and signed by the local
health board
• Performance indicator will be validated by reviewing the Municipal Disaster
Risk Reduction and Management Plan and identify if strategies from HEPRRP are
included.

• Created/revised policy should contain Implementing Rules and Regulations on

disaster risk reduction and management

• The Incident Command System (ICS) is a management system designed to

enable effective and efficient domestic incident management by integrating a
combination of facilities, equipment, personnel, procedures, and
communications operating within a common organizational structure.

• ICS organizational structure should contain members, roles and functions, and
implementing rules and regulations
• The established unit will be in charge of institutionalizing a systematic process
of using administrative directives, organizations, and operational skills and
capabilities to implement strategies, polices and improved coping capacities in
order to lessen the adverse impacts of hazards and the possibility of disaster.

• The municipal health emergency management/disaster risk reduction and

management for health unit should contain members, roles and functions, and
implementing rules and regulations
 STANDARD OF MEANS OF VERIFICATION BASIS
PERFORMANCE

untability.

•  Local Government Code (LGC) of

1991
•  Copy of Legislation •  Good Practice: Sample policies from
Gamay Northern Samar and Cotabato
City

Red: 0-1/5 Yellow

2-4/5 Green 5/5
Red: 0-1/5 Yellow
2-4/5 Green 5/5

• ZFF Learning from CHPP Alumni and

•  Copy of Legislation MLGP

•  Copy of Legislation •  ZFF Learning from CHPP Alumni and

MLGP

•  Documentation of MHSSP/BL •  Research finding on CHPP Impact

orientation Activity Evaluation

•  Documentation and
proceedings of the Local Health •  Good Practice: ZFF CHPPLGUs
Board meetings

•  Copy of old and new MIPH
•  Local Investment Planning for Health:
Handbook on Principles, Guidelines,
Procedures, and Processes. Bureau of
Local Health Systems Development
(BLHSD) Department of Health and
United Nations Children’s Fund
(UNICEF)

• Local Investment Planning for Health:

• Copy of new MIPH
Handbook on Principles, Guidelines,
Procedures, and Processes. Bureau of
Local Health Systems Development
(BLHSD) Department of Health and
United Nations Children’s Fund
(UNICEF)

•  Department of Budget and

Red: 0-2/6 Management: http://www.dbm.gov.
Yellow: 3-5/6 • Copy of new MIPH ph/wp- content/uploads/2012/03/BB-
Green: 6/6 3.pdf

Recommendations from consultations

 • Department of Budget and
•  Copy of new MIPH and the Management: http://www.dbm.gov.
Municipal Development Plan ph/wp- content/uploads/2012
/03/BB-3.pdf

•  Local Investment Planning for

•  Copy of cover letter with
proof of receipt from the
Provincial Health Office
Health: Handbook on Principles,
Guidelines, Procedures, and Processes.
Bureau of Local Health Systems
Development (BLHSD) Department of
Health and United Nations Children’s
Fund (UNICEF)

•Local Investment Planning for Health:

•Copy of old and new AOP
Handbook on Principles, Guidelines,
Procedures, and Processes. Bureau of
Local Health Systems Development
(BLHSD) Department of Health and
United Nations Children’s Fund
(UNICEF)

•Documentation and activity

•Recommendations from consultations
reports

•Documentation and activity •Recommendations from consultations

Red: 0-1/3 reports
Yellow: 2/3
Green: 3/3
Red: 0-1/3
Yellow: 2/3
Green: 3/3

• Directory of volunteer
• Documentation of activities •Recommendations from consultations
participated by volunteers

• Documentation and
proceedings of the Barangay
Health Board meetings •ZFF Learnings from BHLMP

•Copy of the legislation •ZFF Learnings from BHLMP

Red: 0-1/4
Yellow: 2-3/4
Green: 4/4

•Copy of the Resolutions •ZFF Learnings from BHLMP

 •BHLMP
Activity Report with updated
Barangay Health System •ZFF Learnings from BHLMP
Scorecards

• Local Investment Planning for Health:

Handbook on Principles, Guidelines,
Procedures, and Processes. BLHSD-
DOH and UNICEF
• Copy of Barangay Health Plan • Department of Budget and
• Work and Financial Plan of Management: http://www.dbm.gov.
Barangay ph/wp- content/uploads/2012
/03/BB-3.pdf
Red: 0/2 Recommendations from consultations
Yellow: 1/2
Green: 2/2

• Report on the progress of the

status of Barangay Investment
Plan for Health/Barangay •ZFF Learnings from BHLMP
Development Plan

Red: Less than two

focus areas with
issued legislations in
ALL diseases/st ages

Yellow: 2-3 focus

Red: Less than two
focus areas with
issued legislations in
ALL diseases/st ages

Yellow: 2-3 focus

areas with issued • WHO List of Essential Package of
legislations in ALL Health Services
diseases/st ages • Philippine Health Agenda Targets
OR
4 focus areas with •Copy of the legislations •Philippine Integrated Management of
issued legislations in Acute Malnutrition Policy DOH AO
SOME 2015-055
diseases/stages

Green: 4
focus areas with
issued legislations in
ALL diseases/st ages

•ZFF Learning from CHPP Alumni and

•Copy of the legislation
•Documentation of minutes MLGP
•Recommendations from consultations

Red: 0-1/3 •ZFF Learning from CHPP Alumni and

Yellow: 2/3 •Copy of the legislation MLGP
Green: 3/3 •Recommendations from consultations
Red: 0-1/3
Yellow: 2/3
Green: 3/3

• Copy of
•ZFF Learning from CHPP Alumni and
reports on status of policy
MLGP
implementation
•Recommendations from consultations

•Copy of DRRM-H plan and • ZFF Learnings from Resilient Health

comprehensive MDRRM plan Systems Program

•Good Practice: Sample policy from

General Trias, Cavite
•Copy of the ordinance •Republic Act No. 10121 "Philippine
Disaster Reduction and Management
Act"

Red: 0-1/4 •Good Practice: Sample policy from

Yellow: 2-3/4 •Copy of ICS organizational Jagna, Bohol
Green: 4/4 structure •ZFF Learnings from Resilient Health
Systems Program
 •Good Practice: Sample policy from
Baler, Aurora
•Municipal Disaster Risk
Reduction and Management •NDRRMC Memorandum Circular
Council Organizational No.04 s.2012
Structure •ZFF Learnings from Resilient Health
Systems Program
\
 M

ANSWER Reference
put an "x" if from PHC
SUB-BLOCK applicable, leave Questionna
blank if not ire
Building Block: Financing
Description: Raises adequate funds for health, in ways that ensure people can use needed services, and are

Accredited Health
Q38
Facilities

Q39-Q40
Community IEC on
Philhealth Services

Q41
 Q42

Management of
Philhealth
Reimbursements

Q43

Q44

Q45
 Q46

Q47

Philhealth Coverage for

the Poor Q48

Q49

Q50

LGU Health Budget

Allocation (At least 15%)

Q51-Q52
 Please input
health budget
utilized in %
Actual Budget
Utilization Q50

Q53
Policy support on
provision of funds for
subsidies and social
protection

Q53
 MUNICIPAL BASIC HEALTH SYSTEM’S SIX BUILDING B

PERFORMANCE INDICATORS

alth, in ways that ensure people can use needed services, and are protected from financial catastrophe or impoverish

1. RHU accredited in Primary Care Benefit (PCB), Anti-

Tuberculosis and Maternal and Care Package (MCP).
Directly Observed Treatment Short-

2. Presence of LGU owned facility accredited as a

birthing home

1. Conducted an information and education campaign

(IEC) initiative on enrolment and benefits (at least
once quarterly)

2. Presence of LGU-hired or designated personnel as

point person for Philhealth information and concerns
1. Issued legislation adopting/promoting guidelines
on disposition of reimbursements for ALL Packages
(PCB, MCP, NBS, TB-DOTS)

2. Issued legislation on creation of separate trust fund

for proceeds from Philhealth reimbursements

3. Submitted reimbursement claims within 60 days after

discharge or treatment for ALL packages (PCB, MCP, NBS, TB-
DOTS)

4. Submitted required quarterly reports to Philhealth

5. Monitored Utilization of Philhealth
reimbursements

1. Conducted listing of poor families not identified by the

National Household Targeting System (NHTS)

2. Submitted list of poor families to Provincial Social Welfare

and Development Office (PSWDO) for evaluation and
endorsement to the Philippine Health Insurance Corporation
(PHIC)

3. LGU sponsorship for low income families who do not qualify

for full subsidy by national government

1. Allocated at least 15% of municipal budget for health

2. Allocated budget for health from internally or externally

sourced income aside from IRA and Philhealth capitation
At least 95% of health budget is utilized

1. Issued legislation on provision of subsidies

2. Issued legislation on provision of Social Protection

Schemes
 MUNICIPAL BASIC HEALTH SYSTEM’S SIX BUILDING BLOCK INDICATORS

REMARKS

es, and are protected from financial catastrophe or impoverishment associated with having to pay for them. It provid

•Birthing home accreditation is required for provision of Maternal Care

Package and Newborn Care Package

·    IEC initiative could be in the form of lectures, caravans and through

counseling. This is aside from the usual giving of hand-outs and setting-up
posters.
• This may include Philhealth’s “ALAGAKA”

• The personnel could be a job-order or designated personnel

• The personnel could also be a member of a municipal Philhealth office.
The description below serves as guide only for LGUs without existing policies or
who desires to revise their policies. For validating the performance indicator,
review if all packages have policy describing percentage breakdown of disposition
of reimbursements.
• Guidelines on allocation of the PCB package payment
§ Professional Fees (10% for physician, 5% for health professional staff, 5% for
non-health staff including volunteers)
§ Medications (40%)
§ Operational costs, Equipment, Information Technology, capacity building, etc.
(40%)
• Guidelines on allocation of the TB DOTS package payment
§ Professional Fees (25%)
§ Facility Fee (40%)
§ Service Staff Fee (35%)

• Guidelines on allocation of the MCP payment

§ Facility Fees (60%)
§ Incentives to mothers/Service Staff Fee(40%)

• Guidelines on allocation of the NCP payment

§ 1750 service fee inclusive of 500 professional fee

• Philhealth guidelines require submission of claims within 60 days after discharge or

treatment.
• Performance indicator will be validated through review of latest transmittal form (whatever
is available for review) submitted to Philhealth for ALL packages (if applicable). ALL individual
patient claims should be within 60 days in ALL reviewed forms.
• Listing could be done through the use of Philhealth’s Family Data Survey
Form, or any method consistent with the means test rule The process for
requesting NHTS list from DSWD could be accessed here:
http://listahanan.dswd.gov.ph/reports/

• This pertains to LGU subsidy or cost- sharing for the premium payment for
members of the informal economy from the lower income segment who do not
qualify for full
subsidy under the means test rule of the DSWD

Numerator = Appropriated Health Budget Denominator = total municipal budget

Denominator = total municipal budget

• Internally sourced income are those locally generated by the LGU and includes the
following:
a. Tax Revenues (e.g. real property tax, tax on business, other taxes)and
b. Non-tax revenues (regulatory fees, service/user charges, receipts from economic
enterprises, toll fees, other receipts).
Externally sourced income includes the following:
a. Share from national tax collection aside from IRA,
b. Foreign and domestic Grants,
c. National Aids,
d. Loans and Borrowings, and
e. Inter-local transfers
• This refers to utilization of the previous year

• Examples of LGU subsidy are medical assistance, transport assistance,

assistance in emergency and crisis situation, etc

• Social Protection constitutes policies and programs that seek to reduce

poverty and vulnerability to risks and enhance the social status and rights of the
marginalized by promoting and protecting livelihood and employment,
protecting against hazards and sudden loss of income, and improving people’s
capacity to manage risks
S

STANDARD OF
PERFORMANCE MEANS OF VERIFICATION BASIS

with having to pay for them. It provides incentives for providers and users to be efficient.

•The Revised Implementing Rules

and Regulations of the National
Health Insurance Act of 2013, RA
Red: 0/2 10606. http://www.gov.ph/2
Yellow: 1/2 •Certificates of Accreditation 013/06/19/republic- act-no-
Green: 2/2 10606/
• Philhealth Manual on New
Accreditation Process

•Copy of documentation of the IEC •Recommendations from

initiatives, Attendance Sheets, or consultations
copy of IEC Materials
Red: 0/2
Yellow: 1/2
Green: 2/2
•Copy of appointment or Training •Recommendations from
certificate of designated personnel consultations
 •Good Practice: Sample policy
from MLGP Alumni Municipality
•Philhealth circular No. 054,s2012
•Copy of Legislation
•Philhealth circular No. 014,s2014

Red: 0-1/5
Yellow: 2-4/5
Green: 5/5

•Good Practice: Sample policy

•Copy of Legislation from MLGP Alumni Municipality.

•The Revised Implementing Rules

•Transmittal form to PhilHealth
from LGU
and Regulations of the National
Health Insurance Act of 2013, RA
10606. http://www.gov.ph/2
013/06/19/republic- act-no-
10606/

•Proof of
receiving copy of report from
Philhealth
•The Revised Implementing Rules
and Regulations of the National
Health Insurance Act of 2013, RA
10606. http://www.gov.ph/2
013/06/19/republic- act-no-
10606/

•Annual Per Family Payment Rate
Utilization Report and
Reimbursement Report submitted
by LGU to PhilHealth
•The Revised Implementing Rules
and Regulations of the National
Health Insurance Act of 2013, RA
10606. http://www.gov.ph/2
013/06/19/republic- act-no-
10606/

•The Revised Implementing Rules

•List of identified non-NHTS poor and Regulations of the National
and list of non-NHTS poor enrolled Health Insurance Act of 2013, RA
Red: 0-1/3 by LGU 10606.
Yellow: 2/3
Green: 3/3 •LGU policy on PhilHealth Subsidy http://www.gov.ph/2
or Municipal Budget Report 013/06/19/republic- act-no-
10606/

•DILG scorecard, Annual Municipal

•Local Government Code (LGC) of
Budget Plan, or Municipal
Investment Planning for Health 1991 DILG scorecard indicators

Red: 0/2
Yellow: 1/2
Green: 2/2
•Annual
Municipal Budget Plan or Municipal
Investment Planning for Health
 •Municipal Financial Statement,
Red: <70% Annual Report of RHU/MHO, or •Recommendations from
Summary of Expenditures from the consultations
Yellow: 70-94%
office of the Municipal •ZFF Learning from CHPP Alumni
Green: 95-100%
BudgetOfficer and MLGP
•Fund utilization report

•Copy of ordinance, executive order •Recommendations from

or resolution consultations

Red: 0/2
Yellow: 1/2
Green: 2/2 •Copy of ordinance, executive order •Social protection handbook for
or resolution local chief executives
 MUNICIPAL BASIC HEALTH SYSTE
Referenc
ANSWER e from
SUB-BLOCK put an "x" if PHC
applicable, leave
blank if not Questio
nnaire
Building Block: Human Resource
Description: Works in ways that are responsive, fair, and effective to achieve the best health outcomes pos
responsive, and productive.

Complete RHU Staff

Complement Q54

Q55

RHU Human Resource

Accreditation
Q56
 Barangay Health
Worker Registration Q57
and Accreditation

Q58

Trained Medical
Doctor

Q58
 Q58

Q58

Trained Public Health

Nurses
Q58

Q58
 Please input
number in %

Trained Rural Health

Q58
Midwives

Q59

Trained Barangay
Human Resource
Q60

Q61

Q62-Q63
Functional
Performance
Evaluation and
Rewards System for
RHU Staff
 Evaluation and
Rewards System for
RHU Staff

Q64

Q65

Q66-Q67

Functional
Performance
Evaluation System for
Barangay Health
Station (BHS) Staff

Q68

Q54

RHU Health Human

Resource Adequacy
Q54
 Q69

Barangay Health
Human Resource
Adequacy
Q69

Q70

Health Human
Resource for Q71
Emergency

Q72

Adequate
Compensation for RHU Q73
Staff
 Implementation of
Magna Carta for Public Q73
Health Workers
 MUNICIPAL BASIC HEALTH SYSTEM’S SIX BUILDING BLOCK INDICATORS

PERFORMANCE INDICATORS

onsive, fair, and effective to achieve the best health outcomes possible, given available resources and circumstances

The following RHU staff were hired by the LGU:

1. Rural Health Physician
2. Public Health Nurse
3. Registered Midwife
4. Medical Technologist
5. Municipal Nutrition Action Officer
6. Rural Sanitary Inspector
7. Pharmacist
8. Dentist

The following LGU-hired RHU staff were accredited

by PhilHealth:
1. Rural Health Physician

2. All Rural Health Midwives and Public Health

Nurses
1. Created/reviewed policy on creation of
Barangay Health Worker (BHW) Registration and
Accreditation Committee supported by LHB

1. Basic Service Packages

a. Family Planning (at least FPCBT 1 and 2, ICV,
PPIUD insertion, NSV,SDI)
b. Antenatal Care and BEmONC,
c. Essential newborn care,
d. Expanded Program for Immunization
e. First 1000 days for nutrition, and
f. Adolescent Sexual and Reproductive Health

2. Other Service Packages

a. TBDOTS,
b. HIV/AIDS prevention, detection and
treatment/referral,
c. Endemic disease prevention and treatment e.g.
malaria, schistosomiasis, filariasis, dengue,
d. Prevention, control, and treatment of non-
communicable diseases e.g. hypertension,
diabetes, stroke, kidneydiseases,
e. Eyecare,
f. Detection, treatment, rehabilitation, or referral
for Mental Health,
g. Screening, counselling, or referral for drugs and
substance abuse,
h. Environmental health and sanitation
3. Other Training
a. Gender and Culture Sensitivity Training,
b. Health Emergency and Disaster Services,
c. Medicines Management,
d. Management/Supervisory Training

1. Basic Service Packages

a. Family Planning (FPCBT 1 & 2 and ICV)
b. Antenatal Care and BEmONC,
c. Essential newborn care,
d. Expanded Program for Immunization
e. First 1000 days for nutrition, and
f. Adolescent Sexual and Reproductive Health

2. Other Service Packages

a. TBDOTS,
b. HIV/AIDS prevention, detection and
treatment/referral,
c. Endemic disease prevention and treatment e.g.
malaria, schistosomiasis, filariasis, dengue,
d. Prevention, control, and treatment of non-
communicable diseases e.g. hypertension,
diabetes, stroke, kidney diseases,
e. Eye care,
f. Detection, treatment, rehabilitation, or referral
for Mental Health,
g. Screening, counseling, or referral for drugs and
substance abuse,
h. Environmental health and sanitation

3. Other Training
a. Gender and Culture Sensitivity Training,
b. Health Emergency and Disaster Services,
c. Medicines Management,
d. Management/Supervisory Training)
ALL Rural Health Midwives trained in the
following:

Basic Service Packages

a. Family Planning (FPCBT 1 and ICV)
b. Antenatal Care and BEmONC,
c. Essential newborn care,
d. Expanded Program for Immunization
e. First 1000 days for nutrition, and
f. Adolescent Sexual and Reproductive Health

1. ALL BHW completed Basic Training Course for

Barangay Health Workers

2. ALL BNS completed Basic Training Course for

Barangay Nutrition Scholars

1. Defined job descriptions of Rural Health Unit

(RHU) Staff

2. Conducted competency-based evaluation for

Rural Health Unit (RHU) Staff at least on a semi-
annual basis
3. Conduct of technical coaching by MHO for Rural
Health Unit (RHU) Staff

4. Issued legislation on awards and recognition

system which includes RHU staff

1. Conducted competency-based evaluation for

Barangay Health Workers and Barangay Nutrition
Scholars on a semi-annual basis

2. Conducted technical coaching for Barangay

Health Station (BHS) staff (Registered Midwives to
Barangay Health Workers, Municipal Nutrition
Action Officer to Barangay Nutrition Scholars – if
applicable)

The LGU met the required human resource

recommendations:
1. LGU Hired Doctors to Population Ratio:
1: 20,000
2. LGU Hired Nurses to Population Ratio:
1: 20,000
3. LGU Hired Midwives to Population Ratio:
1: 5,000
All barangays met the human resource
recommendations:

1. BHW to Household Ratio:

1: 20
2 BNS to Barangay Ratio:
1: 1

3. Rural Health Midwife to Identified GIDA

Barangay / IP community (if applicable):
1:1 or 1:1 catchment area

1. LGU Hired/Designated Health Emergency

Management System Coordinator or DRRM-H plan
Manager

2. Presence of an organized emergency response

team

3. Presence of a system for recall of Health Human

Resource during emergency response

The salary of the following staff complied with the

Salary Standardization Law:
1. Rural Health Physician

2. ALL Public Health Nurses

3. ALL Rural Health Midwives

4. Other Health Personnel hired by LGU

The following benefits were given to ALL the
permanent LGU-hired health workers:
1. Hazard Allowance (25%)

2. Laundry Allowance

3. Subsistence Allowance
 HEALTH SYSTEM’S SIX BUILDING BLOCK INDICATORS

STANDARD OF
REMARKS MEANS OF VERIFICATION
PERFORMANCE

h outcomes possible, given available resources and circumstances (i.e. there are sufficient staff, fairly distributed, com

• This would include all hired staff whether • RHU organizational

plantilla, contractual, or job order positions structure
Red: 0-4/8 • Copy of appointment or
• Basis of count is by appointment. If one
Yellow: 5-7/8 employment certificate of
staff has dual function, he/she should be
counted based on his/her appointment Green: 8/8 designated personnel

• Professional health care providers are

accredited to make sure that members get Red: 0/2 • Copy of Philhealth
the highest quality of medical treatment and Yellow: 1/2 • Accreditation ID
management from experts in various fields of Green: 2/2 • Proof of registration
medical practice
 • Copy of
protocol on BHW
Red: 0/1 registration, accreditation
Green: 1/1
and retention
• BHW registry

• Copy of training
• The staff must complete all training per Red: 0-1/3 certificates
category of service packages and “other Yellow: 2/3 • Personnel datasheet
training”. Put not applicable (N/A) if Rural Green: 3/3 • Personnel file folder
Health Physician is not LGU hired •Training inventory
 • Copy of training
certificates
• All staff must complete all training per Red: 0-1/3 • Personnel datasheet
category of service packages and “other Yellow: 2/3 • Personnel file folder
training”. Green: 3/3
 Red: <50% have
complete training
Yellow: 50-99% • Copy of training
have complete certificates
•All staff must complete all training
training • Personnel datasheet
Green: All (100%) • Personnel file folder
have complete
training

• Copy of training
certificates
Red: 0/2
Yellow: 1/2
Green: 2/2

•Copy of Human
Resource Development
• This may only apply to staff with plantilla Plan or document
positions
containing job
descriptions

• Competency-based evaluation refers to •Copy of accomplished

evaluating staff performance based on pre-
defined competencies and their behavioral evaluation forms or
report on summary
indicators
results of competency-
• The Individual Performance Commitment Red: 0-1/4
And Review (IPCR) could be used as template Yellow: 2-3/4 based evaluation
Green: 4/4
 Yellow: 2-3/4
Green: 4/4

• Conduct of coaching would be done at least •Copy of

once per quarter quarterly coaching
• Performance Indicator would be validated
through quarterly submission of documentation from
Municipal Health Officer
documentation summarizing points of
and Public Health Nurses
discussion

•Copy of
• This may only apply to staff with plantilla ordinance, executive
positions order or resolution

•Copy of
accomplished evaluation
forms or report on
• Competency-based evaluation refers to summary results of
evaluating staff performance based on pre- competency- based
defined competencies and their behavioral evaluation
indicators •Copy of
accomplished BNS
Red: 0/2 Evaluation Forms
Yellow: 1/2
Green: 2/2

• Conduct of coaching would be done at least •Copy of

once per quarter quarterly coaching
• Performance Indicator would be validated documentation from
through quarterly submission of midwives and/or
documentation summarizing points of Municipal Nutrition
discussion Action Officer

•RHU organizational
structure
Red: 0-1/3 •Copy of
Yellow: 2/3 appointment or
Green: 3/3
employment certificate of
designated personnel
 •RHU organizational
Red: 0/3
• Exclude #3 for LGUs with no GIDA/IP structure
communities Yellow: 1/3 •List of BHWs and BNS
Green:2-3/3 •Directory of volunteers

•Copy of
appointment
•Copy of
Red: 0-1/3
directory of emergency
Yellow: 2/3
response team
Green: 3/3 •Copy of
protocol on emergency
response

RHP Rural Health Physician 24

PHN1 Public Health Nurse I SG12

PHN2 Public Health Nurse II SG16 •Copy of
PHN3 Public Health Nurse III SG19 Red: 0-1/4 Human Resource
MDWF1 Midwife I SG6 Yellow: 2-3/4 Development Plan, HR
MDWF2 Midwife II SG8 Green: 4/4 policy, pay slips, or
MDWF3 Midwife III SG11 contracts of employment
MDWF4 Midwife IV SG13
MDWF5 Midwife V SG15
MDWF6 Midwife VI SG18
 •Copy of
Human Resource
Red: 0-1/3 Development Plan or HR
Yellow: 2/3
Green: 3/3 policy
•Copy of
payroll
 BASIS

aff, fairly distributed, competent,

•Recommendations from
consultations

• Philhealth List of
Accredited Professionals.
https://www.philhealth.g
ov.ph/partners/providers
/professional/ac
credited/
• Good Practice: Sample
policy from Iligan City
and Lal-lo Cagayan
• Implementing Rules
and Regulations of
Magna Carta for Health
Workers

•Recommendations from
consultations
•Recommendations from
consultations
•Recommendations from
consultations

•Basic Training Course

for Barangay Health
Workers

•Trainer’s Manual on
Basic Course for
Barangay Nutrition
Scholars

•Recommendations from
consultations

•Recommendations from
consultations
•The Individual
Performance
Commitment And Review
(IPCR) Template
•Civil Service
Commission
•Recommendations from
consultations

•Recommendations from
consultations

•Recommendations from
consultations
•NNC Guidelines for BNS
Evaluation

•ZFF Learnings from

Resilient Health Systems
Program
•Magna Carta for Public
Health Workers
•Manual of Operation on
Maternal, Newborn, and
Child Health and
Nutrition
•Indigenous People
Health Strategic Plan
Joint Memorandum
Circular
•ZFF Learnings from
Resilient Health Systems
Program

•Recommendations from
consultations

•Salary Standardization
Law
•DBM Local Budget
Circular No. 108 series
2016
•Magna Carta for Public
Health Workers
 MUNICIPAL BASIC HEALTH SYSTEM’S

ANSWER Reference
put an "x" if from PHC
SUB-BLOCK applicable, leave blank Question
PERFORMANCE INDICATORS
if not naire

Building Block: Access to Medicine & Technology

Description: Ensures equitable access to essential medical products, vaccines and technology of assured qu

1. RHU procured medications are in-line

Q74 with the Philippine National Drug
Formulary

2. Evidence-based quantification of
Q75
supply (consumption or morbidity data)

3. Conducted regular monitoring/

reporting on procurement performance
Q76 (supplier lead times, % of purchases made
through bidding, planned vs actual
purchases

LGU Supply
Chain
Management
System
 Q77 4. Implemented good storage practices
LGU Supply
Chain
Management
System

5. Conducted monthly physical count

Q78 (inventory management) and reporting of
medicines and other health products

6. Adopted the Daily Drug Use Record /

Drug Utilization Report (Name of patient,
Q79 name of medicine, duration of treatment,
when to follow-up)

7. Created/revised guidelines in
Q80 acceptance of foreign and local drug
donations

8. Adopted guidelines for disposal of

Q81
unwanted or expired medicines
 1. Issued legislation on establishing drugs
Q82 and therapeutics committee governing
LGU pharmaceutical related activities

Policy Support
on Medicines
Management

2. Issued legislation formalizing LGU

Q83 protocols on pharmaceutical supply chain
management

3. Issued legislation adopting the National

guidelines on the implementation of rules
Q84 and regulations on licensing of Retail
Outlet for Non-Prescription Drugs

4. Issued legislation on emergency

procurement, prepositioning, and
Q85 immediate replacement of essential
medicines and basic health emergency
supplies.
 RHU properly stocked with All of the
selected essential medicines:
1. Vaccines
2. Supplements: Iron, folic acid, and
Vitamin A
Essential
Medicines 3. Contraceptive
Q86
4. Four (4) molecules: Losartan,
Amlodipine and Metoprolol and
Metformin
5. TB Drugs
CIPAL BASIC HEALTH SYSTEM’S SIX BUILDING BLOCK INDICATORS

STANDARD OF
REMARKS PERFORMANCE MEANS OF VERIFICATION

s and technology of assured quality, safety efficacy and cost-effectiveness, and their scientifically sound and cost-effe

•The PNF serves as basis for selection of

medicines in a government facility including a
RHU. The PNF lists the medicines that are •Validate list of purchased
considered most essential for the diseases medicines if they are present in
and conditions encountered in the country. the PNF
AO No.163 s. 2002 and EO No. 49 s.1993 •Copy of
mandates that all medicines selected must be purchase requisition forms
only those found in the PNF •Copy of
procurement plan which
reflects quantification of
needed supplies
•Copy of Health Facility Supply
Chain Management
•Evidence-based quantification of supply
Performance Monitoring Tool
pertains to forecasting of needed medicine
supplies using consumption and morbidity
data

•Copy of report on
procurement performance
•Copy of report of Bids and
Awards Committee (BAC)

Red: 0-4/8
Yellow: 5-7/8
Green: 8/8
• Check if the MAIN storage of medicines
meet ALL of the following good storage
practices: •Site visit
a. Uncrowded space, •Copy of Health Facility Supply
b. Adequate lighting, Chain Management
c. Adequate ventilation, Performance Monitoring Tool
d. presence of room thermometer, Red: 0-4/8
e. cold chain for vaccines, Yellow: 5-7/8
f. Presence of shelves and pallets. Green: 8/8

• Validate using stock card from the previous •Stock Card, RHU Stock Record,
month Supply or inventory report

• This applies to all medications being •Copy of accomplished drug

dispensed by the RHU utilization reports

•Copy of guidelines

• This could be incorporated in the solid

waste management guidelines or in the
•Copy of guidelines
pharmaceutical supply chain management
guidelines
• Examples functions include
a. provision of recommendations to the Local
Health Board policies regarding the safe,
effective, cost-effective prescribing and use of
medicines in the treatment of patients at the •Copy of legislation
local health facilities; and
b. monitor and review prescribing practices
within health facilities in the LGU and provide
appropriate guidance or feedback as
necessary;

• The legislation should cover the principal

phases in medicine management as stated in
the Policy and Legal Framework for Managing
Access to Medicines and Health Technologies.
These phases are:
a. Selection, Red: 0-1/4
b. Quantification, Yellow: 2-3/4
c. Procurement, Green: 4/4
d. Reception and Storage,
e. Distribution, and
f. Use.

• This should include provisions on planning

of basic health emergency supplies based on
existing community hazards and
vulnerabilities. •Copy of legislation
• Legislation could be incorporated or
separated from the protocols on
pharmaceutical supply chain management
• Properly stocked pertains to availability of
at least 1-month supply. Medicine stock- outs Red: 0-2/5 •Copy of Stock Card, RHU Stock
in health facilities point to weaknesses in the Yellow: 3-4/5 Record, Copy of Supply or
distribution system, and low overall Green: 5/5 inventory report
performance of the supply chain
 BASIS

sound and cost-effective use.

•DOH-NCPAM’s National
Drug Formulary List
•EO No. 49, 21 January 1993
AO No. 163 s.2002

•DOH-NCPAM's Training
Manual on Pharmaceutical
Supply Chain Management
for Local Government
Facilities

•DOH-NCPAM's Training
Manual on Pharmaceutical
Supply Chain Management
for Local Government
Facilities
•DOH-NCPAM's Training
Manual on Pharmaceutical
Supply Chain Management
for Local Government
Facilities

•DOH-NCPAM's Training
Manual on Pharmaceutical
Supply Chain Management
for Local Government
Facilities

•ZFF Learnings from

Resilient Health Systems
Program
•DOH's Reporting Forms for
Monitoring and Evaluating
Medicine Access Program

•DOH-NCPAM's Training
Manual on Pharmaceutical
Supply Chain Management
for Local Government
Facilities

•DOH-NCPAM's Training
Manual on Pharmaceutical
Supply Chain Management
for Local Government
Facilities
•Good Practice: Sample
policy from Cervantes

•DOH-NCPAM's Training
Manual on Pharmaceutical
Supply Chain Management
for Local Government
Facilities

•Administrative Order
No.2014-0034 and FDA
circular no. 2014- 08

•Recommendations from
consultations
•DOH-NCPAM's Training
Manual on Pharmaceutical
Supply Chain Management
for Local Government
Facilities
 MUNICIPAL BASIC HEALTH SYSTEM’S SIX B

ANSWER Reference
put an "x" if from PHC
SUB-BLOCK applicable, leave Questionn PERFORMANCE INDICATORS
blank if not aire

Building Block: Health Information System

Description: Ensures the production, analysis, dissemination and use of reliable and timely information on h

Q87-Q88 1. RHU with electronic medical records

system validated by Philhealth

Functional
Electronic
Health
Information
System

Q89-Q90 2. RHU with electronic health data

reporting system interoperable with the
Field Health Services and Information
System (FHSIS)

Q91
3. RHU with Back-up electronic system
during emergency situations

Established a functional tracking or

registry system of patients for the
following:
1. Maternal Health Services

2. Expanded Program for Immunization

Patient 3. Under Five Nutrition

Registry Q92
System
 Patient
Registry Q92 4. TB Control
System
5. Notifiable Diseases
6. Non-communicable Diseases
7. Drugs and Substance Abuse
8. Mental Health
9. Persons with Disabilities
10. Senior Citizens

1. Timely submitted Municipal

QUARTERLY Field Health Services and
Q93-Q94 Information System (FHSIS) data to
Provincial/City Health Office

2. Timely submitted Municipal ANNUAL

Q95-Q96 Field Health Services and Information
System (FHSIS)

3. Timely submitted Municipal

Data
Reporting and Q97-Q98 QUARTERLY National Tuberculosis
Control Program (NTP) Reporting data to
Utilization Provincial/City Health Office

4. Timely submitted Municipal ANNUAL

Q99-Q100 Operation Timbang Plus data to
Provincial/City Nutrition Council or
Health Office

5. Updated annual list of Leading Causes

Q101 of Morbidity, Mortality, and
Consultations
 Conducted mortality reviews for the
previous quarter:
Q102 1. Maternal Death
-put a check if no maternal death
Mortality occurred-
Reviews

2. Infant (Neonate and Post- neonate)

Q103 Death
-put a check if no infant death occurred-

Presence of the following data on Social

Determinants of Health:
1. Male and Female Population by Age
group (current and projected)
2. Population and Residential Density by
Barangay

3. Current and Projected Labor force and

employment
Data on Social
Determinants
of Health 4. Population be religious affiliation
Q104
5. Elementary and secondary school
participation and completion rates

6. Housing Facilities and utilities situation

7. Hazard Mapping

8. Ethnic Groups

Presence of annually updated profile list

of members of the following:

1. Pregnant and lactating women

2. Under-five children

Profiling of 3. People with disability (PWD)

Vulnerable
Population
Q105
 Profiling of
Vulnerable
Population 4. Elderly
Q105
5. Out of school youth

6. Households with Indigenous Peoples

(for LGUs with IP communities)

7. Households in remote areas (for LGUs

with GIDA communities)

Q106

1. Established early warning system

Early Warning
System for
Emergencies

Q107

2. LGU with mechanisms to disseminate

early warning system information

Q108
3. Established a system for Surveillance
in Post Extreme Emergencies and
Disasters (SPEED)
BASIC HEALTH SYSTEM’S SIX BUILDING BLOCK INDICATORS

STANDARD
OF
REMARKS PERFORMAN MEANS OF VERIFICATION
CE

ble and timely information on health determinants, health system performance and health status.

• Medical Records System is an electronic

record of health-related information on an
individual that can be created, gathered,
managed, and consulted by the RHU staff
and other national agencies. •Site visit
List of validated EMR systems include
iClinicSys, CHITS, Seg-RHIS, eHatid LGU,
SHINE OS+, WAH – HER
• If LGU has no electronic medical record,
recommend use of Iclinicsys
Red: 0-1/3
Yellow: 2/3
Green: 3/3

• Interoperable means that the electronic

health data reporting system can generate
•Site visit
and submit data needed by FHSIS
• May also include fhsis

• This pertains to copying and archiving

electronic data in another storage to prevent •Site visit
data loss in case of certain events

Red: 0-3/10
Yellow: 4-
• Does not need to be electronic and could 6/10 •Copy of Registry
be paper-based e.g. Target Client List Green: 7-
10/10
 Red: 0-3/10
Yellow: 4-
• Does not need to be electronic and could 6/10 •Copy of Registry
be paper-based e.g. Target Client List
Green: 7-
10/10

• Timely Submission = Every 3RD WEEK of

the FIRST MONTH of the succeeding Quarter •Copy of quarterly FHSIS
or as required by the Provincial/City Health Data with proof of
Office submission

• Timely Submission = Every 3RD WEEK of

•Copy of annual FHSIS
January of the succeeding year or as required
by the Provincial/City Nutrition Council or Data with proof of
Health Office submission

• Timely Submission = Every 2ND WEEK of •Copy of

the FIRST MONTH of the succeeding Quarter Red: 0-1/5 quarterly NTP forms with
or as required by the Provincial/City Health Yellow: 2-4/5
Green: 5/5 proof of submission
Office

• Timely Submission = After 1 week of •Copy of

consolidation but prior May 5 of the Municipal Operation
succeeding year or as required by the Timbang Plus forms with
Provincial/City Health Office proof of submission

•Copy of RHU list of

leading causes of
morbidity, mortality, and
consults
• All mortalities in the previous quarter
should have accomplished death review Red: 0/2
forms Yellow: 1/2 •Death Review Forms
• Leave blank and add remark if LGU has no Green: 2/2 or
maternal or infant death recorded no deaths

•Copy of Municipal
Management Information
Red: 0-3/8
System (Municipal
Yellow: 4-5/8
Planning Development
Green: 6-8/8 Office)

If LGU has IP
communities
or GIDA
• Exclude 6 and 7 for LGUs with no GIDA and areas: •Copies of registries,
no IP communities Profile lists
Red: 0-2/7
Yellow: 3-4/7
Green: 5-7/7
 If LGU has IP
communities
• Exclude 6 and 7 for LGUs with no GIDA and or GIDA •Copies of registries,
no IP communities areas: Profile lists
Red: 0-2/7
Yellow: 3-4/7
Green: 5-7/7

•Site visits

• Early warning system pertains to set of

capacities needed to generate and
disseminate timely and meaningful warning
information to enable individuals, Red: 0-1/3 •Copy of Municipal
communities and organizations threatened Yellow: 2 health emergency
Green: 3/3 preparedness response
by a hazard to prepare and to act
appropriately and in sufficient time to reduce and recovery plan or
the possibility of harm or loss. Municipal disaster risk
reduction and
management plan
•Documentation of early
warning systems

•Copy of
protocol or guidelines in
implementation of SPEED
 BASIS

alth status.

•Philhealth Circular No.

2016-0040
•Philhealth Circular No.
2015-002

•Philippines eHealth
Strategic Framework and
Plan

•Recommendations from
consultations

•Recommendations from
consultations
•Recommendations from
consultations

•DOH FHSIS Manual

•DOH FHSIS Manual

•Implementing
Guidelines for National
Tuberculosis Control
Program

•Implementing
Guidelines for Operation
Timbang Plus

•Recommendations from
consultations
•DOH manual for
Maternal and Neonatal
Death Review System
•Implementing Rules and
Regulations of Republic
Act No. 10354

•Recommendations from
consultations

•ZFF Learnings from

Resilient Health Systems
Program
 •ZFF Learnings from
Resilient Health Systems
Program

•Republic Act No. 10121

"Philippine Disaster
Reduction and
Management Act"
•Good practice: Sample
policies from General
Trias, Cavite and Bacolod
City

•Republic Act No. 10121

"Philippine Disaster
Reduction and
Management Act"
•Good practice: Sample
policies from General
Trias, Cavite and Bacolod
City

•Recommendations from
consultations
•SPEED Manual for
Managers
 MUNICIPAL BASIC HEALTH SYSTEM

ANSWER Reference from

SUB-BLOCK put an "x" if PHC
applicable, leave
blank if not Questionnaire

Building Block:Service Delivery

Description: Deliver effective, safe, quality personal and non-personal health interventions to those that ne

Functional
Health Facilities Q109

Q111

Q112
 Q113

Q113

Established
Referral System

Q113

113
 Q117

Barangay
Health Service Q117
Delivery

Q117

Q118

Q119

Patient-Centered
Care Q120

Q120

Q120
 Q120
Patient and Client
Feedback
Mechanism
Q120

Q121

Health Promotion
Services
Q121
Disease Prevention
and Control
Services

Q121

Disease Prevention
and Control
Services
Q121
Curative Services
Q121

Rehabilitative
Services
Q121
 Complete Health
Service Packages
for all Life Courses
Q121
 MUNICIPAL BASIC HEALTH SYSTEM’S SIX BUILDING BLOCK INDICATORS

PERFORMANCE INDICATORS REMARKS

y personal and non-personal health interventions to those that need them, when and where needed, with minimum

1. Rural Health Unit operational for out- • Operational means with basic resources (HR,
patient services (8 hours, 5 times a week), and
equipment, supplies) to fully operate or
emergency and birthing services (24 hours, 7
perform expected functions
times a week)

2. Operational waiting homes/halfway houses

• Operational means with water source,
if applicable (only for LGUs with GIDA
electricity, and caretaker
communities)

• Available generator or alternative power

3. Rural Health Unit and Birthing facilities have sources are considered for LGUs with no 24/7
24/7 electrical and water supply electrical supply
• Applies to ALL RHUs (if more than1)

4. One (1) operational Barangay Health

Station/Center per barangay or catchment
areas

1. Availability of a 24/7 Emergency Transport

Vehicle

2. Mapping of referral facilities and blood

service facilities within and outside the
municipality
3. Presence of two-way referral system
between barangay and RHU

4. Memorandum of agreement/ understanding

for two-way referral system from RHU to any
Philhealth accredited higher-level referral
facility based from needed services

5. Memorandum of agreement for referral

system from RHU to any diagnostic facility for
needed laboratory procedures

6. Presence of Memorandum of
agreement/understanding for a referral
system to any blood service unit
1. ALL barangays were visited at least once
monthly by a nurse or rural health midwife

• Performance indicator will be validated

2. ALL Barangay Health Workers conducted through complete monthly submission of
monthly visits to their assigned household target client lists of ALL BHWs during the
previous quarter

3. All Barangay Nutrition Scholars conducted • Performance indicator will be validated

monthly Operation Timbang Plus monitoring through each BNS' updated list of
of 0-23 months old and malnourished children malnourished children with monthly
0-59 months old nutritional status during the previous quarter

1. Posting of RHU Citizen’s Charter

2. RHU protocol or guidelines in observing

patient rights

3. Conduct of gender-sensitivity assessment

for RHU (RHU may adopt the USAID Tool to
Assess the Gender-Sensitivity of a Health
Facility, or develop their own tools)

4. Conducted strategies to address gaps in

gender-sensitivity

5. Conducted strategies to increase access to

health services by GIDA, IP communities and
other Basic sector groups
1. RHU with patient/client satisfaction or
feedback mechanism

2. Patient feedback included in RHU staff

meeting/LHB agenda

RHU with Health Promotion Services on the ALL the following services should be included
following: in each program area:

Maternal and Newborn Health - Pregnancy

tracking, Prenatal visits, Birth preparedness
1. Maternal and Newborn Health plan and referral, Nutrition promotion and
assessment

Child Health - Growth monitoring, Promotion

2. Child Health of infant and young child feeding

Family planning - Family planning promotion,

3. Family planning
counseling, and provision of commodities

Adolescent Sexual and Reproductive Health -

Youth-friendly services, Information and
Education Campaign on Adolescent Sexual and
4. Adolescent Sexual and Reproductive Health Reproductive Health, HIV, Sexually
Transmitted Infections, and Gender-Based
Violence, and Counseling on prevention of
teenage pregnancies

5. Oral Health Oral Health - Oral Hygiene Promotion

6. Lifestyle-related or Non- Communicable Lifestyle-related or Non-Communicable

Disease Disease - IEC, Healthy Lifestyle programs,
smoking cessation clinic

Environmental Health and Sanitation (IEC,

7. Environmental Health and Sanitation
8. Mental Health
Promoting water quality and food safety,
Promoting vector control and waste
management)
Promotion of Awareness on Mental Health,
Promote stigma reduction
Provision or referral for the following diseases ALL the following services should be included
prevention and control services:
1 Maternal and Newborn Health
2. Child Health
3. Adolescent Sexual and Reproductive Health
4. Oral Health
5. Communicable Disease
6. Lifestyle-related or Non- Communicable
Disease
7. Environmental Health and Sanitation
8. Mental Health
9. Drugs and Substance Abuse
Provision or referral for the following Curative ALL the following services should be included
Services:
1. Maternal and Newborn Health
2. Child Health
in each program area:
Maternal and Newborn Health - Pregnancy
detection, Safe labor and delivery, Antenatal
Care, Postpartum Care
Child Health - Expanded Program on
Immunization
Adolescent Sexual and Reproductive Health -
counseling for unintended pregnancies
Oral Health - Oral prophylaxis
Communicable Disease - Surveillance and
reporting for notifiable diseases, Active case
finding for TB
Lifestyle-related or Non-Communicable
Disease - Routine screening for risk factor
identification
Environmental Health and Sanitation - IEC,
Promoting water quality and food safety,
Promoting vector control and waste
management
Mental Health - IEC, Crisis intervention and
referral
Drugs and Substance Abuse - Screening,
profiling and referral
in each program area:
Maternal and Newborn Health - Basic
Emergency Obstetric and Newborn Care,
Referral services
Child Health - Integrated Management of
Childhood Illnesses, Micronutrient
supplementation
3. Family planning Family planning - Referral services

Adolescent Sexual and Reproductive Health -

4. Adolescent Sexual and Reproductive Health Sexually Transmitted Infection Management
among adolescents, Referral services

Oral Health - Management of Dental Caries,

5. Oral Health Tooth Extraction, Referral services

Communicable Disease - Sexually Transmitted

Infection Management, Management and
6. Communicable Disease control of TB, Management and control of
other diseases with endemic potential,
Referral services

Lifestyle-related or Non-Communicable
7. Lifestyle-related or Non- Communicable Disease - Treatment for Diabetes and
Disease Hypertension, Follow-up of cases, Referral
services

Mental Health - Referral services for

8. Mental Health treatment
Drugs and Substance Abuse - Follow-up on
9. Drugs and Substance Abuse
status of treatment, Referral services

Provision or referral for the following ALL the following services should be included
Rehabilitative Services: in each program area:

1. Lifestyle-related or Non- Communicable
Disease
2. Health for the elderly
Lifestyle-related or Non-Communicable
Disease - Referral for dialysis, post-stroke
rehabilitation
Health for the elderly - community based
long-term care, Referral

Health for persons with physical disability -

3. Health for persons with physical disability community based long-term care, Referral

Mental Health - Referral for long term care of

4. Mental Health patients with mental illnesses and disabilities
 Drugs and Substance Abuse (community
5. Drugs and Substance Abuse
based drug rehabilitation, Referral)

Presence of RHU Service Packages for the ALL the following services should be included
following life stages: in each package:

1. Maternal (Pregnancy Tracking, Prenatal

visits, Birth preparedness plan and referral,
Nutrition promotion and assessment, Safe
1. Maternal labor and delivery, Antenatal Care,
Postpartum Care, Basic Emergency Obstetric
and Newborn care)

2. Child (Growth monitoring, Promotion of

infant and young child feeding, Expanded
2 Child Program on Immunization, Integrated
Management of Childhood Illnesses,
Micronutrient Supplementation)

3. Adolescent (Youth-friendly services,

Promotion of ASTH, Counseling for unintended
3 Adolescent
pregnancies, Counseling on prevention of
teenage pregnancies, STI management)

4. Senior Citizens (Immunization, Community

4 Senior Citizens
based long-term care)
ATORS

STANDARD OF
PERFORMANCE MEANS OF VERIFICATION BASIS

eeded, with minimum waste of resources

•Posted
schedule of RHU operating
•ZFF Learning from
hours
CHPP and MLGP
•RHU Logbook of rendered
services

•Key Informant Interview of

MHO and RHU staff or
facility map or site visits •ZFF Learning from
•Contact CHPP and MLGP
number of designated
caretaker
Red: 0-1/4
Yellow: 2-3/4
Red: 4/4

•Key Informant Interview of

•ZFF Learning from
MHO and RHU staff or site
CHPP and MLGP
visits

•Key Informant Interview of

MHO and RHU staff or
facility map or site visits •Recommendations
•Copy of of from consultations
accomplished Itinerary of
field visits

•Site visits

•Map and list of referral

facilities
 •Copy of
legislations, manual of
operations, memorandum of
agreements /
understanding,
implementing rules and
regulations for referral
system, or Monitoring form
for referrals
•Copy of referral and return
slips
•DOH Guidelines on
establishing Service
Delivery Networks.
Red: 0-2/6 http://www.doh.gov
Yellow: 3-5/6 .ph/sites/default/file
Green: 6/6 s/publications/Guide
•Copy of lines
legislations, manual of %20EstablishingSDN.
operations, memorandum p df
ofagreements/
understanding,
implementing rules and
regulations for referral
system, or Monitoring form
for referrals

•Copy of
policies, manual of
operations, memorandum of
agreements/ understanding,
implementing rules and
regulations for referral
system, or Monitoring form
for referrals
 •Manual of
•Copy of schedule of duties Operation on
and areas of assignment Maternal, Newborn,
•Documentation of visits and Child Health and
Nutrition Program

•Copy of schedule of duties

and areas of assignment •Field Health Service
Red: 0-1/3 •Documentation through
Yellow:2/3 logbooks Information System
Green: 3/3 Manual
•Copy of updated monthly
target client list

•Copy of updated list of

malnourished children,
updated Operation Timbang •Recommendations
from consultations
Plus forms
•OPT Plus Guidelines
•Copy of monthly weighing
report

•Posted Charter •Recommendations

from consultations

•Copy of
protocol/guidelines

Red: 0-1/5 •Patient’s bill of

Yellow: 2-4/5 •Results of assessment tools rights
Green: 5/5 •USAID Tool to
Assess the Gender-
Sensitivity of a
•Documentation of Health Facility
strategies

•Documentation of
strategies
 •Copies of
satisfaction and feedback
Red: 0/2 tools
Yellow: 1/2 •Recommendations
Green: 2/2 from consultations
•LHB/RHU
Minutes of meeting

•Copy of RHU Manual of

operations
•Copy of
implementing rules and
regulations for each
program area
Red: 0-3/8 •Copy of of RHU List of
Yellow: 4-6/8 services acknowledged and
Green: 7-8/8 signed by the LHB
•RHU annual reporting on
status of services
•Other proof of delivery of
services such as
documentations, list of
patients availing services,
etc.
•WHO List of
Essential Package of
Health Services
•Recommendations
from consultations
•Philippine Health
Agenda Targets
•WHO report on
Philippine Health
Service Delivery
Profile
 •Copy of RHU Manual of
operations
•Copy of
implementing rules and
regulations for each
program area
•Copy of of RHU List of
Red: 0-3/9
services acknowledged and
Yellow: 4-6/9
Green: 7-9/9 signed by the LHB
•RHU annual reporting on
status of services
•Other proof of delivery of
services such as
documentations, list of
patients availing services,
etc.
•Copy of RHU Manual of
operations
•Copy of
implementing rules and
regulations for each
•WHO List of
Essential Package of
Health Services
•Recommendations
from consultations
•Philippine Health
Agenda Targets
•WHO report on
Philippine Health
Service Delivery
Profile
•WHO List of
Essential Package of
Health Services
 •Copy of RHU Manual of
operations
•Copy of
implementing rules and
regulations for each
program area
Red: 0-3/9 •Copy of of RHU List of
Yellow: 4-6/9 services acknowledged and
signed by the LHB
Green: 7-9/9 •RHU annual reporting on
status of services
•Other proof of delivery of
services such as
documentations, list of
patients availing services,
etc.
•WHO List of
Essential Package of
Health Services
•Recommendations
from consultations
•Philippine Health
Agenda Targets
•WHO report on
Philippine Health
Service Delivery
Profile

•Copy of RHU Manual of

operations
•Copy of implementing rules •WHO List of
and regulations for each Essential Package of
Health Services
program area
•Recommendations
•Copy of of RHU List of
Red: 0-1/5 services acknowledged and from consultations
Yellow: 2-4/5 signed by the LHB •Philippine Health
Green: 5/5 •RHU annual reporting on Agenda Targets
status of services •WHO report on
•Other proof of delivery of Philippine Health
Service Delivery
services such as
Profile
documentations, list of
patients availing services,
etc.
 Service Delivery
services such as
Profile
documentations, list of
patients availing services,
etc.

•Copy of RHU Manual of

operations
•Copy of implementing rules
and regulations for each
program area
•Copy of of RHU List of •Recommendations
Red: 0-1/4 services acknowledged and from consultations
Yellow: 2-3/4 signed by the LHB •Philippine Health
Green: 4/4 •RHU annual reporting on
Agenda Targets
status of services
•Other proof of delivery of
services such as
documentations, list of
patients availing services,
etc.