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Guide in Conducting an Implementation Review of the Community Health Service Record System i
ii Guide in Conducting an Implementation Review of the Community Health Service Record System
This Guide was made possible by the generous support of the American People through the United States Agency for
International Development (USAID). The contents of this Guide are the sole responsibility of RTI International and do not
necessarily reflect the views of USAID or the United States Government.
Guide in Conducting an Implementation Review of the Community Health Service Record System iii
iv Guide in Conducting an Implementation Review of the Community Health Service Record System
Guide in Conducting an Implementation Review of the Community Health Service Record System v
Table of Contents
Acknowledgments ..................................................................................................................... vii

List of Acronyms ........................................................................................................................ ix
About This Guide ........................................................................................................................ x
I. Background....................................................................................................................... 1
II. The Community Health Service Record Implementation Review Process and Tool .......... 3
A. Clarifying the Roles and Tasks of Government Agencies and Partner Nongovernment
Organizations/Community Health Volunteer Groups............................................................... 3
B. Conduct of Preparatory Activities ..................................................................................... 4
C. Developing/Modifying the CHSR Implementation Review Tools....................................... 5
D. Actual Conduct of the CHSR Implementation Review Workshop ..................................... 7
III. Next Steps .......................................................................................................................27
References ...............................................................................................................................29
ANNEXES.................................................................................................................................31
Annex A: Sample Activity Design ..............................................................................................33
Annex B: Table of Gaps and Challenges in the CHSR Process and Actions
Taken/Recommendations .........................................................................................................39
Annex C: CHSR Summary Discussion Forum ...........................................................................41
Annex D: CHSR Referral Percentage Contribution Worksheet ..................................................43
Annex E: Good Practice Writing Guide .....................................................................................45
Annex F: Sample Presentation of a Good CHSR Practice - 2016 .............................................47
vi Guide in Conducting an Implementation Review of the Community Health Service Record System
Guide in Conducting an Implementation Review of the Community Health Service Record System vii
Acknowledgments
Sincere gratitude is extended to the following individuals for their invaluable contribution in the
development and review of this Guide in Conducting an Implementation Review of the CHSR
System and all the tools contained therein:
1. , Regional Director, DOH Regional Office III
2. , Regional Director, DOH Regional Office IV
3. , former Regional Director, DOH Regional Office IV
4. , OIC Regional Director, DOH Regional Office V
5. Head, Family Health Cluster, DOH Regional Office V
6. , Regional FP Nurse Coordinator, DOH Regional Office III
7. , Development Management Officer IV, Provincial DOH Office, Albay
8. , Regional MNCHN Coordinator, DOH-Regional Office IV
9. , Provincial Health Officer II, Nueva Ecija
10. , Provincial Health Officer I, Nueva Ecija
11. , Provincial Health Officer, Tarlac
12. , Provincial Health Officer, Bulacan
13. , Provincial Health Officer, Albay
14. , Provincial BHW Coordinator, Provincial Health Office, Tarlac
15. , City Health Officer, Sta. Rosa CHO I, Sta. Rosa City
16. , City Health Officer, San Carlos City
17. , Municipal Health Officer, San Manuel, Pangasinan

viii Guide in Conducting an Implementation Review of the Community Health Service Record System
Guide in Conducting an Implementation Review of the Community Health Service Record System ix
List of Acronyms
ANC Antenatal Care
BHS Barangay Health Station
BHW Barangay Health Worker
CHD City Health Department
CHO City Health Office
CHSR Community Health Service Record
CHT Community Health Team
CHW Community Health Volunteer
CPR Contraceptive Prevalence Rate
CU Current Users
DOH Department of Health
DOHRO Department of Health Regional Office
DSWD Department of Social Welfare and Development
EBF Exclusive Breastfeeding
EPI Expanded Program on Immunization
FAQs Frequently Asked Questions
FBD Facility-Based Delivery
FHSIS Field Health Service Information System
FIC Fully Immunized Child
FP Family Planning
HSP Health Service Provider
HUP Health Use Plan
ICV Informed Choice and Voluntarism
IPC Interpersonal Communication
IPCC Interpersonal Communication and Counseling
KP Kalusugan Pangkalahatan
LCE Local Chief Executive
LuzonHealth Integrated Maternal, Neonatal, Child Health and Nutrition/Family Planning in the
Philippines
MNCHN Maternal, Newborn, Child Health and Nutrition
NA New Acceptors
NDP Nurse Deployment Project
NHTS National Household Targeting System
PHN Public Health Nurse
PHO Provincial Health Office
PIR Program Implementation Review
PDO Provincial DOH Office
RHM Rural Health Midwife
RHU Rural Health Unit
RHU-MHC Rural Health Unit Main Health Center
RPRH Responsible Parenthood and Reproductive Health
SBA Skilled Birth Attendance
TB Tuberculosis
TCL Target Client List
UHC Universal Health Care
USAID United States Agency for International Development
x Guide in Conducting an Implementation Review of the Community Health Service Record System
Guide in Conducting an Implementation Review of the Community Health Service Record System xi
About This Guide

This Guide in Conducting an Implementation Review of the Community Health Service
Record System describes the workshop process and tools used during a review of the
implementation of the Community Health Service Record (CHSR) System. The two-day
implementation review workshop aims to assess the status of the implementation of the CHSR
System in data collection, recording and reporting by the Community Health Team (CHT)
partners/barangay health workers (BWHs). This activity serves as the venue for discussing the
contributions, gaps, and sustainability of CHSR in collecting/gathering data from the National
Household Targeting System (NHTS)/non-NHTS families to provide quality health services to
those found with unmet need for family planning, maternal, newborn, child health and nutrition,
and TB (FP/MNCHN/TB). Through house-to-house profiling of household members, all those
found with unmet need are identified and immediately referred for utilization of appropriate
health services, thus, significantly reducing unmet health needs and resulting in achievement of
higher-level health outcomes.
For FP, this strategic activity continues to be important at this time when the Department of
Health Regional Offices (DOHROs) and Provincial/City Health Offices (P/CHOs) are scaling up
FP strategies and activities in response to Executive Order No. 12 (Attaining and Sustaining
Zero Unmet Need for Modern FP) issued in January 2017; and to DOH Administrative Order
No. 2017-0005 entitled “Achieving the Desired Family Size through Accelerated and Sustained
Reduction in Unmet Need for Modern Family Planning Methods.”
This guide is intended for the use of the BHW coordinators of the DOHROs and P/CHOs in
assessing the use of the CHSR, in coordination with the Regional/Provincial/City/Municipal
Program Managers/Coordinators for FP/MNCHN/TB Programs. For health program managers,
there is a need for them to provide oversight in ensuring continuous quality improvement in the
implementation of health programs; and for the CHSR System, in particular, regular conduct of
an Implementation Review is essential to institutionalize a periodic evaluation system to
determine the status of demand generation, community referral system, and quality of
community-generated data vis-a-vis referral data entries in the Target Client Lists (TCLs) as a
support mechanism for improving the implementation of FP/MNCHN/TB Programs.
The conduct of this CHSR System Implementation Review had been introduced in 2015 and
2016 by the United States Agency for International Development (USAID) LuzonHealth Project
in selected sites that were implementing CHSR, particularly in San Carlos City, San Manuel
Municipality in Pangasinan, Santa Rosa City in Laguna, and in the provinces of Tarlac, Nueva
Ecija, Bulacan and Albay..
In the conduct of the review, the use of the CHSR Summary and Discussion Form and the
CHSR Referral Percentage Contribution Worksheet was introduced. The CHSR Summary and
Discussion Form is used during the review of the CHSR notebooks of the BHWs in a barangay
health station (BHS) catchment area and the Rural Health Midwives’ (RHMs’) Target Client Lists
or Tuberculosis (TB) Registry for the different health conditions (pregnant, postpartum, FP user,
under-one year old, TB patients). For a particular recording and reporting period, the Rural
Health Unit (RHU) Team checks if the referred patients/FP clients listed in the CHSR notebooks
actually went for consultation and received the appropriate services by checking the RHM’s
Field Health Service Information System (FHSIS) TCLs for that recording and reporting period.
xii Guide in Conducting an Implementation Review of the Community Health Service Record System
The CHSR Referral Percentage Contribution Worksheet, on the other hand, is used to check
the percentage contribution of community health volunteer referrals to the accomplishments for
the key FP/MNCHN intermediate indicators – FP current users/new acceptors (CU/NA), ≥4
antenatal care (ANC), skilled birth attendance (SBA), facility-based deliveries (FBD), and fully
immunized child (FIC) – at the barangay level, by counting the aggregated referrals made by the
community health volunteers from the list of patients/FP clients in the corresponding TCLs of the
RHM they refer to.
The Program Implementation Review (PIR) workshop results in the different provinces showed
a range of percentage contribution of CHT referrals in the FP/MNCHN accomplishments. These
two forms were adopted in the conduct of the CHSR Evaluation Study in Tarlac, where all the
18 LGUs (17 municipalities and one city) are implementing the CHSR.
It is hoped that this guide in conducting a CHSR System Implementation Review will be applied
periodically in areas where the BHWs continue to use the CHSR as a recording tool for health
information, as they profile household members, identify those with unmet need for
FP/MNCHN/TB services, and refer and follow them up to access the needed health and FP
services.
Guide in Conducting an Implementation Review of the Community Health Service Record System 1
I. Background
In 2010, the Aquino Administration launched its Health Sector Reform Agenda called Universal
Health Care/Kalusugan Pangkalahatan (UHC/KP) through Department of Health (DOH) Order
No. 2010-0036, with focus on poor families. The UHC/KP had three thrusts: financial risk
protection for the poor through the expansion of National Health Insurance Program (NHIP)
enrollment and benefit delivery; improved access to quality hospitals and health care facilities;
and attainment of the health-related Millennium Development Goals (MDGs).
The Community Health Team (CHT) System was developed as a critical component of the local
implementation of these three UHC/KP thrusts. In each barangay, the CHT was made up of the
Management Group that included the barangay captain and the midwife, and its members
called the CHT Partners. The CHT Partner may be a barangay health worker (BHW) or a parent
leader. In reference to the three UHC/KP three thrusts, the CHTs were expected to: (1) facilitate
enrolment to PhilHealth and availment of its benefits; (2) link families to health providers; and (3)
transform health needs to effective demand.
In 2011, the DOH trained regional teams on the UHC/KP-CHT System. These teams then rolled
out the training in the different provinces down to the municipal level nationwide, where CHTs
were organized and likewise trained. The CHTs were trained to: look for the poorest families as
listed by the Department of Social Welfare and Development (DSWD) through its National
Household Targeting System (NHTS); profile the household members to identify those who
have unmet need for family planning (FP), maternal, newborn, and child health and nutrition
(MNCHN), and TB services; and refer them to nearby health facilities for appropriate health/FP
services.
Part of the training of the CHT Partners was on the use of the Health Use Plans (HUPs) and the
CHT monitoring logbook, for the recording and reporting of health information gathered from the
NHTS household members. However, an assessment of CHT operations by the DOH revealed
some issues regarding the use of the HUP. For example, the HUPs consisted of too many loose
forms that got lost during referrals, and these were costly to reproduce. Also, the key steps
taught during training were oftentimes not done completely, specifically the development of
HUPs and the follow-up of the referred family members if they actually went back for checkup.
In addition, messages were not adequately delivered as taught, the updating of the HUPs and
CHT monitoring logbook was not done in some areas, and CHTs were not closely supervised by
the rural health midwives (RHMs) in some areas.
In 2012, in partnership with the Pangasinan Provincial Health Office, the USAID HealthGov
Project introduced the use of the Columnar Notebook in San Carlos City and the municipality of
San Manuel in Pangasinan. The use of the Columnar Notebook, an alternative recording tool in
place of the HUPs and CHT monitoring logbook, aimed to simplify the recording system for
community health volunteers including the CHT Partners and BHWs. During the training, the
CHT Partners/BHWs were guided in preparing their own Columnar Notebooks. They were
taught how to record health information generated through the profiling of household members
in their respective barangays in the household health profile section of the Columnar Notebook,
and to accomplish/update the Summary Sheets for the different conditions – prenatal,
postpartum, newborn, infant, child, FP current users (CUs), FP non-users, with cough, chronic
disease, elderly, adolescent, and others. The instructions on how to fill up the Columnar
Notebook are described in detail in the USAID HealthGov Project’s manual, Health Profiling,
Recording and Reporting in the CHT System Using the Columnar Notebook: Guide.
2 Guide in Conducting an Implementation Review of the Community Health Service Record System
Starting in 2013, the USAID LuzonHealth Project took over in providing technical assistance on
the use of the Columnar Notebook, per request of selected Department of Health Regional
Offices (DOHROs), particularly DOHROs III, IV-A and V. By this time, the Columnar Notebook
was already called the Community Health Service Record (CHSR). DOHROs III, IV-A and V
provided funding for the CHSR region-wide implementation, which included the LuzonHealth
provincial project sites.
In 2015 and 2016, the provinces of Tarlac, Bulacan and Nueva Ecija in Region III and Albay in
Region V, and later the CaLaBaRZon provinces (Region IV), trained their CHT Partners. By this
time, the CHT Program had ended, so these provinces shifted to training BHWs on the CHSR.
The CHSR has been found to be a useful tool for the BHWs in profiling not only the priority
population of NHTS households, but also non-NHTS households, to identify household
members with unmet need for FP/MNCHN services and refer them to appropriate health
facilities/health service providers for more information, counseling and needed clinical services.
In the Province of Tarlac, right from the start, the Provincial Health Office (PHO) decided that all
households, NHTS and non-NHTS, would be profiled and visited regularly by the BHWs.
From 2015 to 2016, the CHSR became the source of community health information for the
DOH-CHT Reporting using the DOH-prescribed reporting forms for Regions IV and V, but there
were also areas where the CHSR was just used as a recording tool, as in San Carlos City and
San Manuel Municipality in Pangasinan and in Tarlac Province.
After two years of CHSR implementation, LuzonHealth provided technical assistance to the
PHOs of Pangasinan, Tarlac, Bulacan, Nueva Ecija and Albay and to the CHO of Sta. Rosa City
in Laguna in the conduct of a series of CHSR System Implementation Reviews. The activity was
designed to review the health information gathered by the BHWs using the CHSR tool and to
determine its contribution in improving health service coverage. It also aimed to strengthen the
participants’ appreciation of CHSR data and encourage them to utilize the generated
information as basis for future actions in improving health service delivery as well as demand-
generation strategies.
The series of CHSR Implementation reviews conducted surfaced the need for the RHU staff to
continue the regular conduct of supportive supervision and monthly meetings to support the
BHWs in updating family profiles in the CHSR notebooks for easy tracking of patients/FP
clients, including defaulters for the different health services. Also, for the CHSR system to be
sustainable, the LGUs need to include in their annual health plans a budget item for the
procurement of columnar notebooks with printed headings.
During a CHSR Implementation Review conducted for the province of Tarlac in 2016, the
Provincial Health Officer, , shared that the use of the CHSR tool has helped
increase the province’s contraceptive prevalence rate (CPR) from 25 percent to 30 percent and
she attributed this increase to the use of the CHSR in tracking women with unmet need for FP.
II. The Community Health Service Record Implementation

Review Process and Tool
The CHSR Implementation Review process consists of the following:
1. Clarifying the roles and tasks of government agencies, nongovernment organizations and
community health volunteer groups
2. Conduct of preparatory activities
3. Developing/Modifying the CHSR Implementation Review Tools
4. Actual conduct of the CHSR Implementation Review Workshop
 Lecture-presentations
 Workshop proper: Group work using the CHSR Implementation Review Tools
 Action planning
 Synthesis and agreements; next steps for the province/city
A. Clarifying the Roles and Tasks of Government Agencies and Partner

Nongovernment Organizations/Community Health Volunteer Groups
Collaboration and support of government agencies, partner nongovernment organizations

(NGOs), and the community health volunteer groups (composed of the BHWs) are important
factors in the successful implementation of the CHSR System.
The agencies and partners involved, along with their roles, are described below.
Department of Health Regional Offices
The DOHROs provide oversight in the implementation of the DOH health programs, including
the FP/MNCHN Programs. A Regional BHW Coordinator is also assigned to provide regional
oversight in the training and organization of community health volunteers including BHWs. The
DOHROs are mandated to ensure quality of health services in public health facilities down to
the level of the barangay health stations (BHSs), and see to it that BHWs play a vital role in
demand generation for patients/FP clients to access and utilize health services. The DOHROs
continue to provide oversight to the PHOs/CHOs in the conduct of training and organizing of
community health volunteers, including BHWs. The BHW Training Course includes recording
and reporting of the BHW accomplishments, and one of the recording tools being used by the
BHWs in selected provinces is the CHSR.
In 2015 and 2016, DOHROs III, IV and V funded and led the conduct of a Trainers’ Training
Course on CHSR Use for their respective PHOs/CHOs with technical assistance from the
USAID LuzonHealth Project. DOHRO III procured columnar notebooks for the initial use of the
trained CHT Partners/BHWs region-wide. DOHRO IV had the CHSR with its column headings
printed in a bigger notebook (15x13 inches) with bigger spaces for the BHWs to write on for all
the CaLaBaRZon provinces. DOHRO V adopted this CHSR version and likewise printed copies
for all the Bicol provinces. After implementing the use of the CHSR for a few years,
DOHROs/Provincial DOH Offices (PDOs) assisted the PHOs/CHOs in selected provinces/cities
in the conduct of a CHSR Implementation Review in order to assess the health information
gathered by the BHWs using the CHSR tool, and determine its contribution in improving health
service coverage.
Local Government Units: Provincial/City Health Offices and Rural Health Units
The Provincial/City BHW Coordinators provide oversight in the actual training and organization
of BHWs by the RHU staff whom they have trained earlier in CHSR use. These Provincial/City
BHW Coordinators coordinate closely with the FP/MNCHN Coordinators in tracking health
program accomplishments and as a technical team, they conduct monitoring and supportive
supervision of health service providers down to the RHU Main Health Center (MHC)/BHS level.
At the RHU-MHC/BHS level, they assist the Public Health Nurses (PHNs) and RHMs in
identifying and resolving issues and concerns related to demand generation, which include the
profiling and follow-up of household members by the BHWs using the CHSR. Hence it is usually
the technical team from the PHO/CHO that is in the position to identify the need and readiness
of the RHUs to conduct a province-wide or citywide CHSR Implementation Review.
Nongovernment Organizations and Community Health Volunteers
NGOs can also be tapped to provide technical assistance in the conduct of the CHSR System
Implementation Review. On the other hand, the BHW Federation presidents can assist the RHU
staff in ensuring that all the active BHWs participate as community health volunteers in the
CHSR training and in the CHSR System Implementation Review Workshops.
B. Conduct of Preparatory Activities
As mentioned, the PHO/CHO technical staff are the ones who usually determine the need to
conduct a CHSR System Implementation Review, considering that they work closely with the
RHUs in implementing the different health programs.
Once the need to conduct a CHSR Implementation Review has been determined, the
Provincial/City BHW Coordinator, together with the Provincial/City FP/MNCHN Program
Coordinators, then form themselves into a Team of Facilitators to plan out the conduct of the
two-day CHSR Implementation Review Workshop. They can also ask for technical assistance
from the DOHRO/PDO.
During the team’s initial meeting, they can identify the preparatory activities that have to be
done, and spell out the roles and responsibilities or task assignments among themselves, to
include the following:
1. Review the CHSR Implementation Review tools that had been developed by the LuzonHealth
Project as a technical assistance to its LGU partners, and decide if there is a need to make
modifications on the tools based on their needs for such revisions.
2. Identify the FP/MNCHN indicators that they think should be included in the review of CHSR
and Target Client Lists (TCLs) during the CHSR Implementation Review Workshop. The
Senior PHN from each of the RHUs will be requested to prepare and bring with him/her to the
workshop the needed FHSIS data, particularly for the selected BHS/barangay for the current
and previous year, disaggregated by quarter/month. This request should be included in the
invitation letter to the Municipal Mayor/Municipal Health Officer.
3. Identify the participants to the CHSR Implementation Review Workshop. The Team of
Facilitators shall have to decide if they will just invite one team composed of the MHO/Senior
PHN, the FP/MNCHN Nurse Coordinator, one RHM, one Nurse Deployment Program (NDP)
nurse, and two BHWs from one BHS per municipality; or if they will conduct the workshop in
two batches to accommodate more participants from one municipality per batch. It is
important to request the RHM and NDP nurse of the selected BHS to bring with them their
TCLs for FP, prenatal care, postpartum care, and EPI/nutrition, and TB registry for the
current and previous year; while the BHWs should bring with them their CHSR notebooks for
the current and previous years. The RHM will also be requested to bring with her the CHSR
notebooks of the rest of the BHWs in her BHS catchment area for the current and previous
year, for their RHU team to generate the overall CHSR referral contribution for their selected
BHS catchment area.
Because of time constraints during the workshop, the team may decide to just assign the
RHUs by district what to bring with them when they attend the workshop. For example, the
RHUs in District 1 will be assigned to bring TCLs for FP while the RHUs in District 2 will have
to bring TCLs for prenatal care and postpartum care, and so on. All these instructions should
be included in the invitation letters.
4. Prepare the Activity Design and Program for the two-day CHSR Implementation Review
Workshop. (Refer to Annex A for a sample Activity Design.)
5. Compute the needed budget, including sources (DOHRO, P/CHO, Municipal LGU, NGO)
6. Identify the dates of the activity and the workshop venue.
7. Arrange for the venue, accommodations, and meals/snacks.
8. Prepare and send out the invitation letters.
9. Prepare the needed workshop materials.
The Facilitators’ Team should conduct at least two meetings as necessary to work on the
preparatory tasks listed here, starting about a month prior to the workshop, to ensure that the
invited participants are available during the scheduled dates of the activity. The last meeting
should be conducted at least one week prior to the scheduled dates of the workshop, to give the
Facilitators’ Team the opportunity to check if all the preparatory tasks have been accomplished.
By this time the invitation letters with instructions on what to bring to the workshop should have
all been sent out and the participants asked to confirm their participation. The Activity Design,
the CHSR Implementation Review tools, and the slide presentations for the workshop inputs
should have been finalized. Arrangements with the venue and accommodations should have
likewise been completed and workshop materials ready for the activity. The Facilitators’ Team
should then go over the final Program of Activities, for their roles and assignments during the
actual conduct of the workshop.
C. Developing/Modifying the CHSR Implementation Review Tools
The CHSR Implementation Review tools had been developed by LuzonHealth, and were
presented for review and discussion to the PHO/CHO technical team during the Facilitators’
Meeting prior to the conduct of the CHSR Implementation Review Workshops in the provinces
and cities implementing CHSR use. The Team of Facilitators may decide to do modifications on
these tools as they deem necessary when they conduct the activity.
These tools include the following:
1. Table of Gaps and Challenges in the CHSR Process and Actions Taken/
Recommendations – A copy of this table is sent out to the Senior PHN together with the
invitation letter so that he/she can already share it with the RHU team (including the
BHWS) for them to discuss the gaps and challenges that they have encountered in the
implementation of the CHSR, as well as the actions they have taken, or recommendations
that they would like to take up to further improve the CHSR System implementation in their
municipality. Having them discuss these and fill up the table beforehand would cut short
the time spent filling up this table during the actual workshop. (Refer to Annex B for a copy
of this table.)
2. CHSR Summary Discussion Form – This form is used by the RHM and the BHWs
assigned in her catchment area to review the names of referred patients/FP clients in the
CHSR notebooks for the different health conditions (pregnant, postpartum, FP user,
under-one year of age) for a particular reporting period. They will verify if the patients/FP
clients actually went for consultation and received the appropriate services by checking
against the FHSIS Target Client Lists of the RHM for that reporting period, and record the
findings in the appropriate column of the CHSR Summary Discussion Form. The names of
clients needing follow-up are also noted down in the CHSR notebooks of the community
health volunteers. (Refer to Annex C for a copy of the CHSR Summary Discussion Form.)
This process when adopted by the RHU Teams during the monthly meetings among the
RHM, NDP Nurses and BHWs helps ensure that those identified with unmet need for FP
and MNCHN services and were referred to health service providers are actually provided
with the needed services, or are followed up by the BHWs in their homes to remind them
to go back to the health facility for the needed services. This process also helps ensure
that the TCLs of the RHM and the CHSRs of the BHWs are regularly updated. The
process likewise contributes to improving the quality of the reported FHSIS data from the
BHS level.
3. CHSR Referral Percentage Contribution Worksheet – This worksheet is used to check

the percentage contribution of community health volunteer referrals to the
accomplishments for the key FP/MNCHN intermediate indicators – FP current users/new
acceptors (CU/NA), ≥4 antenatal care (ANC), skilled birth attendance (SBA), facility-based
deliveries (FBD), and fully immunized child (FIC) – at the barangay level, by counting the
aggregated referrals made by the community health volunteers from the list of patients/FP
clients in the corresponding TCLs of the RHM they refer to. During the Program
Implementation Review (PIR) Workshop that LuzonHealth conducted in the provinces and
cities using CHSR, trends in the FP/MNCHN accomplishments relative to CHSR referral
contribution were also analyzed. The results in the different provinces showed a range of
percentage contribution of CHT referrals in the FP/MNCHN accomplishments. (Refer to
Annex D for a copy of the CHSR Referral Percentage Contribution Worksheet.)
4. Good Practice Writing Guide – In a group work, the RHU Teams are asked to choose
one of their CHSR good practices and write a brief description on Manila paper, following
the Good Practice Writing Guide. (Refer to Annex E for a copy of the Good Practice
Writing Guide.)
D. Actual Conduct of the CHSR Implementation Review Workshop
The general objective of the activity is to review the health information gathered by the BHWs
using the CHSR tools and how these contributed to improving health service delivery among the
NHTS and non-NHTS population. The activity processes are expected to strengthen the
appreciation of the CHSR data and assist local health implementers in using the health
information generated from the CHSR as the basis for next actions in improving health service
delivery to NHTS and non-NHTS families.
Specifically, the activity aims to:

a. Identify the gaps and challenges at every step of the CHSR process.
b. Review data generated from the CHSR tools.
c. Discuss BHW action points and validate the content of the CHSR records with the TCLs.
d. Present the contributions of BHW deployment and CHSR data in improving health
service delivery to NHTS families; present as well as the contributions of BHWs using
the CHSR in improving health service delivery to non-NHTS families.
e. Identify gains and gaps in the implementation of CHSR.
f. Develop Provincial/City/Municipal Action Plans to strengthen the CHSR implementation.
The following are the expected outputs:

a. List of gaps and challenges, including actions taken and/or recommendations made to
address these.
b. CHSR records and reports validated with the TCLs.
c. List of contributions of BHW participation and CHSR data in improving health service
delivery to NHTS and non-NHTS families.
d. P/CHO and RHU/BHS Action Plans on CHSR based on the identified gains and gaps.
Different methodologies will be employed during the activity, including: workshops, small group
discussion, gallery and plenary presentations.
1. Lecture Presentations
After the preliminary activities on the first day, the participants are oriented on the workshop
activities for them to have an idea of what to expect during the two-day activity. This can be
done through a brief slide presentation and a walk-through the Program of Activities. Other slide
presentations provided during the morning session include the following:
 Presentation of Status of CHSR Implementation in the Province/City – The

Provincial/City BHW Coordinator is usually asked to present and discuss this topic.
 Monitoring and Supportive Supervision for CHSR – This is a discussion of the definitions
of monitoring and supportive supervision, and who are responsible for conducting these
at the RHU-MHC and BHS level, particularly for the BHWs at the community level on the
CHSR System.
 Ensuring Quality Data for the CHSR System at the Barangay Level – This is a
discussion of the desirable attributes of health data – which include completeness,
accuracy, reliability/consistency, and timeliness of recording and reporting of health data
– and how these attributes are applied to health data/information generated by the
BHWs and are recorded in their CHSR notebooks and reported to the RHM.
 Orientation on Informed Choice and Voluntarism (ICV) – Since the BHWs are tasked to
profile and refer women of reproductive age identified to have unmet need for FP, then it
is important that they are also aware of the principles of ICV.
2. Workshop Proper: Group Work Using the CHSR System Implementation

Review Tools
Workshop Introduction – In the afternoon of the first day of the CHSR System Implementation
Review, the workshop proper is introduced by one of the facilitators through a brief review of the
CHSR implementation process. (See Figure 1 below.)
Figure 1. Improving the BHW Recording System through the CHSR (Adapted from the
2013 LuzonHealth Project CHT process presentation).
The assigned facilitator for Workshop 1 then explains the objective of the workshop, which is the
refinement and enhancement of the pre-workshop output conducted at the
RHU/BHS/community level to identify gaps and challenges as well as
actions/recommendations. It has been mentioned in Part II Section B (Conduct of Preparatory
Activities) above that a copy of this table is sent out to the Senior PHN prior to the workshop so
that the RHU team can already accomplish it before they attend the workshop. (Refer to Annex
B for a copy of this table.)
During the actual workshop, the participants group themselves by RHU Teams, and each group
are tasked to review and enhance their respective table outputs. The results are then written on
Manila paper and presented by the team’s reporter in a gallery setup. The reporters are
requested not to repeat anymore issues and concerns that have already been reported by the
other groups, but they may still present the actions they have taken or recommendations they
have formulated in response to those issues, so that the other groups may consider adopting
them. At the end of the presentations and discussions, the different RHU Teams are advised to
make use of their respective Workshop 1 outputs as their reference when they prepare their
CHSR Action Plans in the afternoon of Day 2.
The Workshop 1 outputs are then summarized by the facilitators, as shown in the sample
accomplished Table 1 below.
Table 1. Sample Accomplished Form: Summary of Gaps and Challenges of CHSR Implementation
in San Carlos City, Pangasinan
Action
CHSR Task Gaps and Challenges Encountered by
Taken/Recommendation
Identification and numbering Group 1  List catchment NHTS
of HHs (sorting) by purok
1. Preparation of Unavailability/lack/delayed 1, 2  Availability, resourcefulness
the CHSR arrival of materials/supplies, and creativity
Notebook e.g. heading, stickers,
scissors, paste, art paper,
plastic cover
Delayed arrival of the tools 1, 2  Shoulder own expenses in
providing necessary supplies
for CHSR tool
Preparation of the headings 3  Printed heading on the
is tedious and time- CHSR
consuming
Labeling 4  Familiarity with the different
labels
Narrow spaces on the 4  Improvement of the
columnar columnar
 Provide bigger and better
CHSR tool
Inadequate supplies (e.g., 5  Provided through Xerox
headings, notebook) copy; hand written
 Provision of columnar for
NHTS and non-NHTS and
key messages
2. Conducting the Profiling
Long walking distance 1  Clustering per purok
NPA 2  Proper endorsement
2.1 Locating NHTS Scattered purok catchment; 2, 3, 5  Team work
HHs Distance from one house to  Assign the CHT to their own
another; purok
The target NHTS are not  Provide fixed schedule, get
located on the same purok contact number and other
as where the CHT partner social network
resides;
Distant from CHT partner
Not familiar with some 4  House to house
catchment facilities
Transferred to another place 5  Communicate with
neighborhood
No person around; 1, 2, 3  Revisit, inform immediate
Action
Availability of family during relatives
2.2 Conducting the HH visit;  Set an appointment with the
Interviews Parents/adult guardians are parent
not present during interview
Respondent not familiar with 1  Validation
birthdays (personal data)
Some mothers are hesitant 2
to answer truthfully
Lack of understanding 4  Further explanation
regarding questions given
Conflict in schedule 5  Set the interview for next
schedule
Computation of age/month 1  Use of calculator
Wrong information on 2, 4, 5  Ask for birth certificates
2.3 Recording of birthdates;  Validation
Information in Inconsistency of data
CHSR gathered;
Incomplete and inaccurate
data
Inadequate space for some 3  Additional paper/notebook
data/information
Difficulty in convincing client 1  Explained the importance of
2.4 Delivering of to seek health services (FP, the health services and
Key Health EPI, prenatal, etc.) programs
Messages Clients are inattentive during 3  Set time when client is
the delivery of key health available and ready to listen
services
Some facilities are doubting 4  Continue on convincing them
the capacity of the CHT in by presenting more
delivering the health information
messages
Lack of knowledge and skills 5  Set up meeting
on some programs
Availability of information 1, 3, 5  Collect sufficient data
needed;  Revisit and validation of
3. Consolidating Inadequate information; information
the different CHT is not available;  Data quality check (TCL)
conditions Incomplete data
Availability of the partner 4  Planning ahead of time
For patients with cough for 1, 4  Reassurance
more than 2 weeks, “social  Accompany them to RHU
4. Referring stigma”;  Assurance of confidentiality
Clients Stereotype
Denial of clients health 2  Proper information
condition dissemination
Embarrassment of client; 2, 5  Build rapport and trust
Hesitation, uncomfortable
Clients referred to a health 3  Accompany clients to the
facility do not go/seek health facility
consultation, giving different  Follow up/revisit
alibis (e.g.,. no time, no  Home visit
money);
No feedback mechanism
Action
5. Following up of Clients
Attitude of clients; 1, 3, 4  Health
5.1 Who have not Hard-headed and lazy education/encouragement
consulted HSP clients (low health seeking  Home visit together with
behavior); midwife and NDP
Attitude towards health  Give extra time and effort
services
Informed clients pero 1  Home visit
nakakalimutan na (attitude
problem)
Availability of time/conflict in 5  Explain to them the
schedule possible untoward signs
and symptoms
Unable to come back on 1, 3, 4  Home visit together with
scheduled visit (e.g., AP, midwife and NDP;
5.2 Given health FP, EPI, NTP, PP);  Follow-up/home visit
services Failure to return on the
scheduled follow-
up/checkup
Depends on their beliefs  Explain the benefits of the
services
6. Reporting to the Midwife
Trans-in/out patients 1  Close monitoring/follow-up
Lack of data of reports; 2, 3, 5  Reported upon schedule
Incomplete data  CART; timely and
accurate;
 Completion of data before
reporting to RHM
 Follow-up
6.1 Validation of Not updated data/CHSR; 3, 4, 5  Early monitoring
CHSR data Inadequate data and  Gather reports through text
inconsistency of reports gathering the reports
during their duty
 Proper validation and
consolidation
Sometimes other CHTs are 4  Constant reminder through
not around during reporting text or during their duty
period
Some data are not updated 1  CART
Late submission of reports 3  Giving early reminder
setting deadline
7. Reporting to
the PHN and
Accuracy and reliability on 4  Setting time for submission
time reporting and checking reports with
P/CHO
CHT’s
Early detection of RHM 5  Close monitoring and
rather than CHTs follow-up
Insufficient data gathered 1  Follow-up
8. Reporting to
the DOH
(some CHT partners not  Validation
around)
(NDPs/DMOs)
Late reporting 3, 5  Setting of early deadline
9. Other tasks
For Workshop 2, the facilitator assigned to handle the session also explains the objective of the
workshop, and the workshop process and steps. This involves the review of health indicators by
condition generated from the CHSR notebook using the CHSR Summary and Discussion Form.
(Refer to Annex C for a copy of the CHSR Summary Discussion Form.)
The facilitator instructs the participants to group themselves again by RHU Teams and presents
the CHSR Summary and Discussion Form when everyone has been given a copy.
The facilitator explains that in the invitation letter to the participants, they had been requested to
bring with them the BHWs’ CHSRs for a barangay or for an entire BHS, along with the RHM’s
TCLs for the assigned health condition (pregnant, postpartum, FP user, under-one year of age,
and suspected TB patient). This means that, due to time constraints, during this workshop, one
RHU Team works on just one assigned health condition instead of conducting the records
review for all the FP/MNCHN indicators. The participants also decide on the time coverage of
the review (e.g., the past four quarters or the past 12 months) depending on the available
updated health data in the CHSRs and TCLs the RHU Teams brought with them.
If an RHU Team has BHW representatives from just one barangay who have with them all the
CHSRs of all the BHWs assigned in their area, then the RHU Team will have to review all the
CHSR notebooks of all the BHWs assigned in this barangay, and the corresponding TCL of the
RHM for this barangay, for the health condition assigned to the RHU Team to review. If the BHS
has two or more barangays represented in the workshop, then the CHSR notebooks of all the
BHWs in these barangays are likewise reviewed along with the RHM’s corresponding TCLs for
these barangays for the condition assigned to them. The CHSRs of the BHWs in the barangay/s
who are not present should be included in the review, for each RHU Team to generate a more
complete CHSR referral picture for their selected barangay/BHS. One can recall that in the
preparation of the invitation letters for this activity, the RHM from the selected BHS was asked
to also bring with her the CHSR notebooks of the BHWs not participating in the workshop.
The next instruction to the participants is on what to review in the CHSRs and TCLs. Using the
CHSR Summary and Discussion Form, the RHU Team reviews the names of referred
patients/FP clients in the CHSR notebooks for the different health conditions (pregnant,
postpartum, FP user, under-one year of age) for a particular reporting period, and verifies if
those referred actually went for consultation and received the appropriate services. This is done
by checking the TCLs of the RHM for that reporting period. The findings are then recorded in the
appropriate column of the CHSR Summary Discussion Form. The number of patients/FP clients
needing follow-up is then recorded in the CHSR Summary Discussion Form, but the names of
these clients are written in the CHSR notebooks of the BHWs for their actual follow-up.
A records review for just one health condition for the past four recording quarters takes just
about 10 to 15 minutes per RHU Team to complete for each health indicator during Workshop 2.
So, the take-home message for the participants is that it is very feasible to conduct such a
records review using the same tool during the monthly meetings among the RHM, NDP Nurse,
and BHWs – such a small amount of time to help ensure that their CHSR notebooks and TCLs
are regularly updated, contributing to improved quality of the reported health data from the BHS
level. More importantly, those identified with unmet need for FP and MNCHN services who were
referred to health service providers are actually provided with the needed services, or are
followed up by the BHWs in their homes to be reminded to go back to the health facility for the
needed services.
The workshop process gives the participants a feel of how feasible it is to conduct the review
process in their respective areas. The RHU Team can refer again to Annex C for a copy of the
CHSR Summary Discussion Form that they can use for the monthly meetings of the RHM, NDP
Nurses and the BHWs to review their records. A sample accomplished CHSR Summary
Discussion Form, consolidated for the participating municipalities of Bulacan, is shown in Table
2. For the one-hour workshop for Bulacan, the CHSR of one BHW from one barangay and the
RHM’s TCL were reviewed for one health condition per municipality.
Table 2. Sample Accomplished CHSR Summary Discussion Form, Consolidated for

Bulacan Province
Community Health Team/Community Health Service Record (CHSR) System
Name of Facility (BHS): Consolidation for Bulacan Province Address: _________________________

Name of RHM: _______________________________ Date of Activity: _________________________
Names of BHWs/Barangay: ______________________________________________________________
_____________________________________________________________________________________
Note: Use 1 form for each type of TCL reviewed.
DISCUSSION RESULTS COMPARING CHSR DATA WITH TCL ENTRIES USING THE CHSR SUMMARY AND DISCUSSION
TOOL:
Number of Patients
Barangay
Listed for Follow-up by
and Type of TCL Reviewed CHSR Notebook
TCL Information BHWs (BHWs note down
(Prenatal, Postpartum, FP, Information
in their CHSR the names
EPI/Nutrition)
of patients for follow-up)
Note: The CHSR of 1 BHW Seen Referred Number of Referred
from 1 barangay and the and Given Services
RHM’s TCL were reviewed and Recorded in TCL
for 1 health condition per of services given
municipality.
1. Angat 2 PP 2 PP 2 in PP TCL 0
(postpartum)
2. Balagtas 2 NB 2 NB 2 in Under-1 TCL 2 for scheduled follow-up
(newborn)
Sept. 2014
3. Bocaue 1 PP 1 PP 1 in PP TCL
Aug. 2015
4. Baliwag 5 suspect TB 5; 2 patients 3 examined, 2 positive; 2 for follow-up for referral
refused now in
consultation TB Registry
5. Bustos 1 infant 1 infant 1 in Under-1 TCL for
EPI
6. Calumpit 1 infant out of 1 1 in Under-1 TCL
13
7. Guguinto 1 infant 1 1 in Under-1 TCL for For scheduled follow-up
EPI
8. Hagonoy (Best RHU) 1 infant for 1 1 in Under-1 TCL for
Penta 3 and EPI
OPV - July
2015
9. Marilao 4 NB for 4 All in TCLs
BCG;
4 infants, 4
4 of 18 4
children for
MMR;
Number of Patients
Barangay
Listed for Follow-up by
and Type of TCL Reviewed CHSR Notebook
TCL Information BHWs (BHWs note down
(Prenatal, Postpartum, FP, Information
in their CHSR the names
EPI/Nutrition)
of patients for follow-up)
2 pregnant 2
1 TB 1
10. Norzagaray 1 infant 1 1 in Under-1 TCL for
EPI
11. Obando 1 infant 1 1 in Under-1 TCL for
EPI
12.Pandi 3 infants Aug. 3 3 in Under-1 TCL for 3 listed for follow-up
2015 EPI
Given immunization
except for Penta - not
available
13. Paombong 1 Infant for 1 1 listed in Under-1 TCL
measles given vaccine
Feb 2015
14. Plaridel 1 infant 1 1 listed in Under-1 TCL
given vaccine
15. Pulilan 2 infants for 2 2 listed in Under-1 TCL
immunization given vaccine
16. San Ildefonso 2 infants – 1 2 2 listed in Under-1 TCL
for BCG, 1 for given vaccine
OPV2/Penta
17. San Miguel 9 WRA 9 9 listed in FP TCL for
pills
18. San Rafael 2 infants for 2 1 listed in Under-1 TCL 1 infant listed for follow-up
Penta 2 and
polio vaccines
19. Sta. Maria 1 pregnant 1 1 listed in prenatal TCL
given FeSO4 and TT
injection
20. Malolos City – team
brought 1 CHSR Notebook
and 1 TCL but not of the
same time period, hence
cannot be analyzed
21. Meycauayan 2 infants 2 1 listed in TCL given 1 already followed up has
immunization transferred to another
barangay
22. SJDM 2 infants for 2 Referred are in Under-1 4 infants listed for follow-
Hepa, TCL and given up for Penta (when
4 infants for 3 immunization except for available)
Penta, Penta
4 infants for 1
measles
For Workshop 3, the assigned facilitator explains the objective and process of the next group
work, using the CHSR Referral Percentage Contribution Worksheet. This worksheet is used to
check the percentage contribution of community health volunteer referrals to the
accomplishments for the key FP/MNCHN intermediate indicators (FP CU/NA, ≥4 ANC, SBA,
FBD and FIC) at the barangay level, by counting the aggregated referrals made by the
community health volunteers from the list of patients/FP clients in the corresponding TCLs of the
RHM they refer to. This can be considered a continuation of Workshop 2. The PIR Workshop
results in the different provinces showed a range of percentage contribution of CHT referrals in
the FP/MNCHN accomplishments. The facilitators may go further by analyzing the trends in the
FP/MNCHN accomplishments relative to CHSR referral contribution. (Refer to Annex D for a

copy of the CHSR Referral Percentage Contribution Worksheet.)
A sample consolidation of the accomplished CHSR Referral Percentage Contribution

Worksheets for the participating municipalities of Tarlac is presented in Table 3. An RHU Team
was assigned to work on one FP/MNCHN indicator. The numerators are the number of
patients/FP clients who were profiled and referred by the BHWs to the BHS using their CHSR
notebooks, while the denominators represent the total number of patients/FP clients counted
from the TCLs of the RHM. Most of the RHU Teams got a rating of “very significant”, which
means at least 30% of the BHS accomplishments were referrals from the BHWs using the
CHSR.
Table 3. Consolidated CHSR Implementation Review Workshop Results Using the CHSR Referral Percentage Contribution
Worksheet, for 1 Midwife CHSR Team, by City/Municipality for 2015
Tarlac Province
RATING
% Contribution of CHSR Referrals to Service 1. Very Significant (VS)
Documents Reviewed Delivery Accomplishments for Key = 30% or more;
by the Midwife CHSR FP/MNCHN Indicators 2. Significant (S) = 10
City/Municipality/Barangay
Team to 29%
(TCLs and CHSRs) Jan- April- July- Oct-Dec. 3. Needs Improvement
March June Sept. 2015 = <10%
2015 2015 2015
Quarterly FPNA
120 / 132 60 / 143 40 / 158 10 / 170
1. Tarlac City Accomplishments NI / S / VS
(91%) (42%) (25%) (6%)
2015
Quarterly SBA and
2. Pura RHU – Barangays Linao and 9/14 9/9 9/20 9/14
FBD Accomplishments VS
Sinat (64%) (100%) (45%) (64%)
2015
3. La Paz RHU – Barangay San Quarterly FPCU
117 / 263 104 / 232 117 / 261 127 / 276
Roque Accomplishments VS
(44%) (45%) (45%) (46%)
2015
4. Santa Ignacia RHU – Barangays Quarterly FIC
38 / 44 50 / 56 48 / 53 74 / 78
Poblacion East, Poblacion West, Accomplishments VS
(86%) (89%) (90%) (95%)
Pilipili, Nambalan, Diego Cecilio 2015
Quarterly FIC
5. Moncada RHU – Barangays San 7/7 7/7 5/5 5/5
Accomplishments VS
Julian and Sta. Maria (100%) (100%) (100%) (100%)
2015
Quarterly SBA
12 / 12 15 / 16 24 / 26% 19 /21
6. Gerona RHU – Barangay Abagon Accomplishments VS
(100%) (93%) (92%) (90%)
2015
Quarterly SBA and
11/ 14 4/6 12 / 13 7/8
7.Victoria RHU – Barangay Canarem FBD Accomplishments VS
(79%) (66%) (92%) (88%)
2015
Quarterly 4ANC
9/9 8/8 10 / 15 9/9
8. Paniqui RHU – Barangay Aduas Accomplishments VS
(100% (100%) (67%) (100%)
2015
9. Ramos RHU – Barangay Guiteb Quarterly 4ANC 7/9 6/7 21 / 23 16 / 17 VS
Accomplishments (78%) (86%) (91%) (94%)

2015
Quarterly EBF
19 / 25 19 / 25 19 / 25 19 / 25
10. San Jose RHU – Barangay Sula Accomplishments VS
(75%) (75%) (75%) (75%)
2015
Quarterly FIC
46 / 61 46 / 61 46 / 61 46 / 61
Accomplishments VS
(75%) (75%) (75%) (75%)
2015
Quarterly SBA
12. Concepcion RHU – Barangay 28 / 65 0 / 58 7 / 64 28 / 69
Accomplishments S
San Jose (43%) (0%) (11%) (40%)
2015
Quarterly FBD
28 / 58 0 / 53 7 / 58 28 / 63
Accomplishments S
(48%) (0%) (12%) (44%)
2015
Quarterly 4ANC
13. Bamban RHU – Barangay San 8 / 14 8/7 8 / 14 10 / 9
Accomplishments VS
Nicolas (57%) (114%) (57%) (113%)
2015
Quarterly FPCU
15. Capas RHU – Barangay Cristo 76 / 1473 125 / 1623 85 / 1695 121 / 1815
Accomplishments S
Rey (5%) (8%) (5%) (7%)
2015
Quarterly 4ANC
2/2 1/1 1/1
16. Anao RHU – Barangay San Juan Accomplishments 0 VS
(100%) (100%) (100%)
2015
Quarterly EBF
17. San Clemente RHU Accomplishments 31 (9%) 26 (7%) 46 (13%) 48 (14%) S
2015
Quarterly FIC
Accomplishments 59 (17%) 71 (20%) 68 (19) 48 (14%) S
2015
Quarterly SBA and
18. Mayantoc RHU – Mamonit BHS 3/5 6/6 9/9 3/4
FBD Accomplishments VS
and Pedro L. Quines (60% (100%) (100%) (75%)
2015
In Workshop 4, the RHU Teams are asked to choose one of their CHSR good practices on data
generation that facilitates utilization of services at the BHS/barangay level towards improving
program performance. They are further asked to write a brief description of their chosen good
practice on Manila paper, following the Good Practice Guide prepared for this activity. Their
outputs are then presented in plenary so that the other RHU Teams can learn from their
experiences in the use of the CHSR. (Refer to Annex E for a copy of the Good Practice Writing
Guide.)
Table 4 is a sample consolidation of CHSR good practices as reported by the RHU Teams of
Nueva Ecija during the conduct of their province-wide CHSR System Implementation Review in
March 2016. (Refer to Annex F for a Sample Presentation of a Good CHSR Practice in Legazpi
City, Albay that was presented during the conduct of a CHSR Study Tour by the DOHRO IV-A
Team in Albay Province on November 24-25, 2015.)
Table 4. Consolidated CHSR Good Practices by Municipality in Nueva Ecija, March 2016
GOOD PRACTICES IN IMPLEMENTING THE CHSR IN NUEVA ECIJA

CHSR System Implementation Review
March 29-30, 2016
Municipality What is the What steps What are the How will you How do you
intervention/ were results/effects further plan to
good practice undertaken of this good improve on sustain this
in CHSR by the LGU practice in this good good
implementation to implement implementing practice? practice?
? Provide a the good the CHSR?
brief practice?
background. (How it
works)
LICAB Teaming up with  Headings  It was  Establish  Regular
the for the implemented rapport with home visits
NDP/CHT/BHW columnar well that the for us to
for house-to- notebook NHTS community know the
house visits columns families in the people in patients’/cli
funded by community order for us ents’
LGU were given to gain their condition
the services trust. and attend
they needed. to their
needs
immediatel
y
TALUGTUG Weekly  Validation  Accurate  Continue  Provision
evaluation/super of data by reporting implementing of CHSR
vision and NDPs and  Monitoring of CHSR. tool
coaching of the midwives NHTS families  Training of
BHW/CHT on on a made easier BHW/CHT
the first month monthly and handy for on CHSR
of basis to BHWs/CHTs technology
implementation ensure  Continue
for proper correct implementi
encoding of encoding ng CHSR.
data, and then and
monthly updated
monitoring for information
brief practice?
background. (How it
works)
the following
months
SAN Unity among  Time  Improvement  Continue and  Assistance
LEONARDO health providers allowance, of prioritize. from
for a common medical accomplishe  Conduct LuzonHealt
goal mission d CHSR evaluation h, PHO,
and since and PIR. LGU and
community implemented DOH and
assembly dedication
of health
workers
and BHWs
CARRANGL Regular monthly  LGU  Increased  Orient  Regular
AN meetings provided compliance barangay evaluation/
 Implemented venue  Increased council/com monitoring
since 2014 to accomplishm munity on the of the
the present ents benefits. implementa
 Initiated by  Identified  Promote it tion of
the RHU staff unmet needs as CHSR
and NDPs of the target contributing  Sustenanc
 RHU, NDPs clients to good e of the
and BHWs as health: needed
the persons “Health is logistics
responsible Wealth”
 Unique  Stir
feature: everybody’s
Increase interest to
compliance participate.
GENERAL Good  Continuous  Good rapport  Maintain the  To be
MAMERTO relationship with financial made the good patient and
NATIVIDAD the people of support work easier relationship understand
the community from the for the CHT within the ing
and monthly LGU by community.  Always
validation of sustaining update the
CHSR the CHSR
logistics
needed by
the CHT
GUIMBA Regular  Coordinatio  Systematic,  Have good  Using all
updating of n with organized relationship the
CHSR and barangay and accurate with all resources
validation of officials collection of personnel. available
data between  Meeting data
RHM, NDP and and rollout  Time
CHT/BHW of program management
 Meeting and to the
brief practice?
background. (How it
works)
brainstormin CHT/BHW
g of the
RHU staff
and BHWs
to identify
the problem
that might
be
encountered
in profiling
PENARAND Teamwork  Meeting of  CHSR  Cross-  Continuity
A among RHU CHT implementati validate data of services
staff and members on covered through TCL and
BHWs/CHTs once a and and CHSR technical
month monitored review. assistance
 Provision of common from
vehicle diseases like agency
during the HPN and DM concerned
profiling (LuzonHeal
th)
ZARAGOSA Teamwork of  Columnar  Almost 92%  Check the  Dedication
the RHU staff making of the NHTS CHSR and
together with the  Orientation are profiled monthly to commitmen
CHT members and and improve t to work
and NHTS meeting validated good
members of the practice.
 Good RHU staff
communicat , NDP
ion and CHT
 Explaining members
the  Implementa
importance tion of the
of the activity
activity
QUEZON Establishing  Provision of  Unity and  Improve by  Sustain by
good additional teamwork establishing continuing
relationship with support like because we rapport with what was
the people of giving worked as one the people in started
the community, materials team with the the
health team and same goal community.
barangay Be patient
officials; also also because
providing valid we are
data for dealing with
reporting different
kinds of
brief practice?
background. (How it
works)
people.
SCIENCE RHU staff  Once-a-  Increase in  Have good  Good
CITY OF monitoring the week RHU accomplishm teamwork. communica
MUNOZ BHWs’ activities staffs visits ents tion of the
to BHW RHU staff
 Monthly with the
submission BHW
of their
accomplish
ment
 BHW
monthly
meetings
 Coordinat
ion with
the
baranga
y official
using
ambulan
ce for
field
purpose
s
SAN JOSE Support of the  Provision  Fast delivery  Coordinate  Continuing
CITY LGU/Barangay of vehicle of health what was
Council in services/reso workers started
conductin urces needed
g home by the NHTS
visits and families
follow-up especially
those in
hard-to-reach
areas
NAMPICUA Regular meeting  Frequent  Increase in  Maintain  Continuatio
N of the CHTs and meeting of the close n of the
the RHU staff the RHU accomplishm coordination activity
for validation, staff to ents, early of the RHU started
updating and identify the detection and staffs with
evaluation of programs prevention of the
data that need to complications BHWs/CHTs
be , and and NHTS
improved people’s members.
 Quarterly awareness of
PIR and the health
initiating services
brief practice?
background. (How it
works)
new offered at the
programs in RHU
order to
increase
accomplish
ments in
different
indicators
PALAYAN Coordination of  All  All the NHTS  Practice time  Frequent
CITY the barangay barangays families were managemen monitoring
officials and provided provided t for of the
support of the with health health updating. BHWs with
LCE personnel services for  Validate the
who were free. records. supervision
very active of the
in providing RHMs
health
services
Implementation  Monthly  The  Conduct  Regular
LLANERA of CHSR monitoring households monthly monitoring/
of that need updating and updating
households health monitoring of CHSR
that needed services go CHSR by
health directly to RHM and
services health facility NDP.
 Monthly without  Have good
meeting of hesitation. teamwork
BHW with among
RHM BHWs,
RHMs and
NDPs.
3. Action Planning
After the conduct of the workshop proper, the RHU Teams are asked to prepare their respective
Action Plans to address topic areas previously identified for improvement in Workshop 1. Table
5 shows a sample Action Plan for the continuing implementation of CHSR.
Table 5. Sample Action Plan
Municipality/RHU: Zaragosa Date: 03/30/2016
Objective: To address identified gaps and challenges in profiling, identifying those with unmet
need for FP/MNCHN, and referring them to health facilities to access the needed health
services.
Identified Gaps Resource Person

and Challenges Activities Time Frame Requirement Responsible
Budget for printing Meeting with the LCE April 11, 2016 Columnar MHO
regarding the budget printing/bond RHP
allocation paper, ball pen Nurse
and glue RHM
Some NHTS family Continuous follow-up of April 13-15, Transportation BHW

members not NHTS family members 2016 RHM
cooperative who were not yet profiled
Lack of PHO or LGU to April 13, 2016 Bond paper, Nurse

consolidation forms reproduce/provide ink for the copier
consolidation forms
No money for Coordinate with barangay April 18, 2016 Additional budget MHO
transportation captain for assistance in for gasoline Nurse
expenses of BHWs the transportation of the Barangay
clients captain
Patients do not Lobby with the LCE to April 11, 2016 Gasoline, MHO
have enough request the use of the ambulance Nurses
money going to the ambulance in referring
hospitals for patients to the hospital.
treatment
4. Synthesis and Agreements/Next Steps for the Province/City
The last session is on the presentation of the workshop synthesis and agreements, including the
next steps for the PHO/CHO. This is usually presented by the Provincial Health Officer/City
Health Officer or his/her representative. Table 6 is an example of this output that is presented in
a plenary session.
Table 6. Synthesis, Agreements and Next Steps in the CHSR Implementation

in Tarlac Province
Item / Concern Synthesis, Agreements and Next Steps

1. Development of a CHSR version In 2014, the PHO, , led her technical staff
for the use of BHWs in Tarlac in developing their own version of the CHSR, including the
based on the province’s needs modification of the columnar headings/indicators and the
formatting of the cell entries/codes in the columnar notebook to
come up with a simplified version for the use of the BHWs.
2. Coverage of use of the CHSR The BHW maintains a CHSR for NHTS HHs, and a separate
CHSR for the rest of the population, as prescribed by the DOH-

CHT System. However, Dr. Lazatin is recommending that there
be just one CHSR tool per BHW, and that NHTS family
members listed in the CHSR be simply identified by putting an
asterisk in the remarks column.
3. Supply of Columnar Notebooks Initially the DOHRO III provided columnar notebooks for the use
> Initial supply of the CHT Partners, who were mostly BHWs. The Tarlac
> Concern: Lack of Columnar Provincial Government also procured columnar notebooks
Notebooks for continuing use in (2,800 pieces) for the use of BHWs. The BHWs were asked to
some municipalities as identified in shell out 10 pesos per person to shoulder the cost of the
Workshop 1, especially for the photocopying of the Columnar Headings.
general population Those municipalities which reported lack of columnar logbooks
for continuing use were advised to advocate for support from
the municipal/barangay local chief executives (LCEs) to procure
columnar notebooks.
4. In Workshop 1, some It was emphasized throughout the activity that the use of the
municipalities reported the lack of a CHSR is primarily for BHWs to identify those with unmet needs
reporting form to use from the for FP/MNCHN/TB and refer them to the HSPs/health facilities
barangay level to the PHN. for the appropriate health services. Hence, Dr. Lazatin pointed
out the importance of the conduct of monthly meetings among
the RHM, the NDP assigned in the area, and the BHWs to
verify the CHSR data with the RHM’s TCL entries for the
different health conditions. The names of patients/FP clients
who did not yet seek consultation or need follow-up are then
listed down or marked in the CHSR for the concerned BHW to
follow up. This will help the RHM check and ensure that all
those provided with health services are recorded in her TCLs,
improving the quality of the RHU’s FHSIS data. There is no
need to report the CHSR data to the level of the MHO/PHN.
5. Some RHUs reported in It is important to perform regular monitoring and supportive
Workshop 1 that CHSR tools in supervision through coaching and mentoring by the RHMs and
their areas were not updated or not NDP nurses.
properly filled up. Include in the discussion the need for BHWs to cross out the
names of patients/FP clients listed in one health condition who
were transferred to another section of the CHSR for another
health condition (e.g., pregnant to postpartum, newborn to
infant, dropped from the list of FP current users), using a
highlighter or shading with a pencil.
6. Also in Workshop 1, some RHUs It was explained that it is important to repeatedly write the date
commented on the need to fill up a of birth because the giving of the different vaccines is
column for date of birth repeatedly dependent on the age of the child at a given time.
on the CHSR pages for the The small spaces in the CHSR are meant to be filled up only
Newborn, Infant and Child sections; with a check or a cross mark, or with Y or N, or other letter
and that the CHSR spaces are too codes. The CHSR is meant only to record information on those
small to write on. with unmet needs for FP/MNCHN/TB for referral purposes, and
that detailed information should be collected by the RHM for
recording in her TCLs when the client avails of the needed
services.
Dr. Lazatin also informed the participants that her technical staff
will sit down to update the CHSR, particularly the Expanded
Program on Immunization (EPI) headings.

7. Some BHWs reportedly lack  The BHWs were advised to simply read from the CHSR tool
knowledge and skills in giving key the appropriate messages for their patients/FP clients.
health messages.  Review the key health messages for better understanding of
the BHWs during their monthly meetings with the RHM and
NDP nurse. The BHWs should be advised to just discuss the
health messages applicable/appropriate for the condition of
the patient they are talking to. Additional messages and
explanations can be given by the midwife during consultation.
 PHN and RHMs trained in __________ (IPCC) can provide
inputs/tips on __________ (IPC) skills for the CHT Partners to
make them more confident in giving health messages.
 The RHU staff were advised to recommend for retirement the
quite old BHWs who already have difficulty reading/performing
tasks.
8. The RHUs reported that the DOH  emphasized that health is the responsibility of each
requires the health volunteers to person, and that health education/teaching should be
conduct 100% house-to-house intensified for the community to access available health
visits for NHTS families to profile services that they need, instead of the HSPs/BHWs doing
and identify those with unmet needs house-to-house visits for them.
for FP/MNCHN.
9. Results of Workshop 2 on the The results of Workshop 2 showed that the task of verifying
exercise on verifying CHSR data CHSR data with the TCL entries for a monthly period is very
with the TCL entries using the doable, as it took the participants only about 10 to 15 minutes in
CHSR Summary and Discussion checking the data in the CHSR for a given health program
Tool against the entries in the corresponding TCL. This can easily be
done by the RHM, NDP nurse, and the BHWs during their
monthly meetings.
10. Results of Workshop 3 on the The results of Workshop 3 showed that almost all of the
Accomplishments for Key municipalities (16 of 18) that were able to bring their FHSIS
FP/MNCHN Indicators Relative to data for the key FP/MNCHN got a score in the range of 25% to
CHSR Contribution 100% CHSR contribution in referrals. This means that 30% or
more (very significant) of the accomplishments for their
assigned health program for the municipality/barangay were
seen and referred to the HSPs by the BHWs using the CHSR
for the given reporting periods. The two municipalities also
brought their TCLs and CHSR tools, but these did not belong to
partner RHM and BHW; hence, the data entries cannot be
verified.
It was also shared that the use of the CHSR tool has helped
increase the province’s contraceptive prevalence rate (CPR)
from 25% to 30% for the past year (an increase of 5% points).
Dr. Lazatin attributed this increase to the use of the CHSR in
looking for women with unmet need for FP.
11. Presentation of good practices The different RHUs also shared their good practices in the use
in CHSR of the CHSR in a plenary session. Several municipalities
reported the support they get from the barangay LCEs who
provide columnar notebooks. Some reported that the midwife
and NDPs had been conducting monthly meetings to check the
CHSRs and mentor the BHWs in correctly filling these up.
12. Impressions from the A few participants were asked to share their impressions about

participants the activity. , PHN of Anao Municipality,
shared that only after the introduction of the CHSR Summary
and Discussion tool, a process that they can actually adopt
during the CHSR monthly meetings, did she realize how
important it is for the RHMs to check the CHSR content vis a
vis the TCL entries. Previously this task was often performed by
the NDP.
13. Other matters When the ICV Compliance Lecture was presented to the
participants, a question was raised whether service providers
should ask the parent or guardian of an adolescent to sign a
consent form for the provision of FP services. The response
was yes, whether the FP client has had a previous
pregnancy/abortion or not, a consent form has to be signed,
based on Department Circular 2015-0195 on the Responsible
Parenthood and Reproductive Health (RPRH) Implementation
Frequently Asked Questions (FAQs).
III. Next Steps

The results of the CHSR System Implementation Reviews conducted in the different
participating provinces and cities had been helpful to the P/CHO and RHU program coordinators
in identifying gaps and challenges in the use of the CHSR. This enabled them to address these
issues and improve the use of the CHSR not simply as a recording tool for BHWs, but more
importantly to profile and refer those with unmet need for FP/MNCHN/TB services to health
facilities, so that they can be provided with the needed services.
The following are the common agreements made during the conduct of the CHSR System
Implementation Review in the participating provinces/cities:
1. To expand the use of the CHSR, not only for NHTS households, but also to include non-
NHTS households;
2. For the RHU staff to continue the regular conduct of supportive supervision and monthly
meetings to support the BHWs in updating family profiles in the CHSR notebooks for
easy tracking of patients/FP clients, including defaulters for the different health services;
3. To include in their annual health plans a budget item for the procurement of columnar
notebooks with printed headings;
4. To request the DOHRO and LCEs to provide printed copies of the CHSR; and
5. Some of the provinces and cities have also set the schedule for their next CHSR
Implementation Review, as a periodic assessment of the status of implementation of
CHSR use.
Since this exercise was done for only one program indicator per RHU Team during the conduct
of the CHSR Implementation Reviews, the results are not sufficient to show the real picture of
the referral contribution of community health volunteers in increasing FP/MNCHN service
utilization through the use of the CHSR.
As one of the next steps, therefore, the USAID-LuzonHealth Project collaborated with the Tarlac
PHO to conduct a more focused CHSR Evaluation Study that will cover all the program
indicators. The study will entail conducting the same process of checking the percentage
contribution of referrals of all the community health volunteers to the accomplishments in the
TCLs of the RHM in selected health facilities from the study sites, using the tools developed for
the CHSR Implementation Review. Tarlac Province was selected as the study site because the
community health volunteers in this area, who are all BHWs, cover not only NHTS households,
but all households.
It is hoped that the use of this CHSR System Implementation Review Guide will be helpful for
the provinces and cities that continue to implement the use of the CHSR, as well as for those
areas that will adopt the CHSR use in the future.
References
1. Department of Health. Community Health Team Guidebook for CHT Partners. 2011.
2. Department of Health. Management and Supervision of Community Health Team (CHT)

Operations. August 2014.
3. Global Health Workforce Alliance/World Health Organization. Global Experience of

Community Health Workers for Delivery of Health-Related Millennium Development Goals:
A Systematic Review, Country Case Studies, and Recommendations for Integration into
National Health Systems. 2010.
4. USAID-LuzonHealth. CHSR Briefer. July 14, 2014.
5. USAID-LuzonHealth Project. Draft: An Evaluation Study to Determine the Referral

Contribution of Community Health Volunteers Towards Increasing FP/EPI Service Utilization
Through the Use of the Community Health Service Record (CHSR) in Four Municipalities in
Tarlac Province. 2017.
6. USAID-HealthGov Project. Health Profiling, Recording and Reporting in the CHT System
Using the Columnar Notebook: Guide. December 2012.
7. USAID-LuzonHealth Project. Stories from the Field, Volume 1. October 2017.
8. USAID-LuzonHealth Project. Strategy Paper (Collecting, Recording and Reporting

Household-Based Information among NHTS-PR Households Using the Community Health
and Service Record). February 21, 2014.
ANNEXES
Annex A: Sample Activity Design

Activity Design for the Community Health Service Record (CHSR) System
Implementation Review Workshop
Sta. Rosa CHO I, Laguna
Venue:
Dates:
I. RATIONALE AND BACKGROUND
The Province of Laguna is one of the LuzonHealth Project sites implementing the CHSR system
where the BHWs are tasked to collect data from poor households identified through the National
Household Targeting System for Poverty Reduction (NHTS-PR) of the Department of Social
Welfare and Development (DSWD); as well as from non-NHTS households. The generated
information include a basic profile of each household member and health services he/she has
received or has not yet received for specific health conditions particularly focused on maternal,
newborn, child health and nutrition (MNCHN), family planning (FP), and tuberculosis (TB). Using
these information, a health facility can easily identify who among the profiled households have
unmet needs and who should be given services. In order to help the barangay health workers
(BHWs) collect these data efficiently, they were trained in filling up the CHSR tool.
With the support of Department of Health Regional Office (DOHRO) IV, the Provincial Health
Office (PHO), and LuzonHealth, a Training of Trainers’ (TOT) Course on the updated CHSR
was conducted for Laguna PHO Team Leaders and technical staff in July 2015 and
subsequently, an orientation workshop for Laguna Midwife Team Leaders was conducted in
October 2015. The City of Sta. Rosa, specifically the Sta. Rosa City Health Office (CHO) 1
expressed its interest to implement the CHSR as a recording tool for BHWs. Hence, after the
training of a total of 120 BHWs on its use, the CHSR System was implemented in all barangays
of Sta. Rosa CHO 1 in October 2016. Apart from the provision of full funding for this technical
assistance (TA), DOHRO IV also printed 20,000 copies of the CHSR tool which were distributed
to the first few local government units (LGUs) that implemented the system during the 4th year of
the project.
After six months of implementation, the Laguna PHO and Sta. Rosa CHO 1 have agreed to
conduct a CHSR System Implementation Review with technical assistance from LuzonHealth to
determine if the CHSR notebooks are continually being updated and if these are being used to
identify women with FP unmet needs, as well as identify infants, children, and other household
members who need MNCHN/TB health services. More importantly, the CHSR System
Implementation Review will help assess if those identified with unmet needs are provided with
the appropriate FP and MNCHN/TB health services in a timely manner.
II. OBJECTIVES
The general objective of the activity is to review the health information gathered by the BHWs
using the CHSR tool and its contribution to improving health service delivery among the NHTS
and non-NHTS population. The activity processes will strengthen the appreciation of the CHSR
data and assist local health implementers in using the health information generated from the
CHSR as the basis for next actions in improving health service delivery to NHTS and non-NHTS
families.
Specifically, the activity workshops aim to:

1. Identify the gaps and challenges at every step of the CHSR process.
2. Review data generated from the CHSR tool.
3. Discuss BHW action points and validate the content of the CHSR record with the TCL
4. Present the contributions of BHW deployment and CHSR data in improving health
service delivery to NHTS families; present as well as the contributions of BHWs using
the CHSR in improving health service delivery to non-NHTS families.
5. Identify gains and gaps in the implementation of CHSR.
6. Develop Provincial/City/Municipal Action Plans to strengthen the CHSR implementation.
III. EXPECTED OUTPUTS
The following are the expected outputs:

a. List of gaps and challenges identified, including actions taken and/or recommendations
made to address these
b. Validated CHSR records and reports with the TCLs
c. List of contributions of BHW participation and CHSR data in improving health service
delivery to NHTS and non-NHTS families
d. CCHO/BHS Action Plans on CHSR based on the identified gains and gaps
IV. METHODOLOGY
● Workshops
● Small Group Discussion
● Gallery and Plenary Presentation
Workshop I - Introduction: Plenary presentation and review of the CHSR implementation

process to identify the gaps and challenges at every step of the CHSR Process.
Workshop 2 - Workshop Tables: CHSR Summary and Discussion Tool

- Review of health indicators by condition generated from the CHSR tool using the
CHSR Summary and Discussion Tool and discussion of actions taken at the
barangay/midwife level.
Workshop 3:
- Small group discussion and review of monthly program performance (November
2016 to February 2017) relative to CHSR health indicators at the
BHS/barangay/midwife level
Workshop 4:
- Preparation and plenary presentation of good practices in CHSR data generation
and utilization at the BHS/barangay level towards improving program performance.
- Action planning (to address areas identified for improvement)
V. EXPECTED PARTICIPANTS AND ROLES
Participants and Number
Office/Total Pax Roles
LGU: 60 - Participate in the review and provide data from the CHSR
and TCLs.
CHO 2
PHN 6
RHM 13
NDP 6
3 BHWs per
Barangay Health
BHW Station
3 x11 = 33 BHWs
PDO: 2 - Facilitate in the conduct of CHSR System Implementation

Review.
BHW
Coordinator 2 - Assist the participants in identifying the gaps and
and Assistant recommendations for the continuous implementation of CHSR.
PHO: 2 - Monitor CHSR implementation in their respective areas of

assignment.
PHO Staff
(BHW
Coordinator, 3
FP/MNCHN
Coordinators
LuzonHealth/Partner NGO: 3 - Facilitate the conduct of CHSR System Implementation
Review.
1.
2. - Document the CHSR IR activity.
3.
- Assist the DOHRO and PHO in the monitoring of CHSR
implementation.
VI. VENUE & SCHEDULE
The two-day CHSR Implementation Review will be held at the Conference Hall, Sta. Rosa CHO
1, Sta. Rosa City, Laguna on April 25-26 2017.
VII. PROPOSED ACTIVITY DESIGN
Person
Date/Time Activity
Responsible
Day 1
Laguna PHO/Sta. Rosa

8:00 – 9:00AM Registration
CHO1/LuzonHealth
Preliminaries
Laguna PHO/Sta. Rosa
● Opening CHO1
9:00 -9:30AM ● Invocation
● National Anthem
● Welcome message
● Introduction of participants
● Leveling of expectation
SESSION 1
9:30 – 9:50AM
Objectives and Overview of the Activity PDO/PHO
SESSION 2
9:50 – 10:15AM Presentation of Status of CHSR
Sta. Rosa CHO 1
implementation in Sta. Rosa CHO 1
SESSION 3
10:15 – 11:15AM Monitoring and Supportive Supervision for PHO
CHSR
SESSION 4
11:15 – 12:00NN Ensuring Quality Data for the CHSR System
LuzonHealth
at the Barangay Level
12:00 – 1:00PM LUNCH
SESSION 5
1:00 – 2:15PM Workshop Introduction: Plenary LuzonHealth/PHO/PDO/

presentation and review of the CHSR CHO1
implementation process
Workshop 1: Refinement and enhancement

of the pre-workshop output conducted at the
barangay/midwife level to identify gaps and
challenges including
actions/recommendations
SESSION 6 (con’t)
2:15 – 3:15PM
Plenary presentation of Workshop 1 outputs
SESSION 7
3:15 – 3:45PM
The CHSR Summary and Discussion Tool LuzonHealth
SESSION 8
(Using the CHSR Summary and Discussion
3:45 – 4:45PM tool)
Workshop 2: (Activity to be done at the
BHS/Barangay/Midwife level in groups) LuzonHealth/PHO/PDO/
1. Review of health indicators by condition CHO1
generated from the CHSR tool using
workshop tables and discussion of actions
taken at the barangay/midwife level
4:45 – 5:00PM Wrap-up for Day 1 PHO
Day 2
8:00 – 8:30AM Recap Participants
Workshop 2: (con’t)
8:30 – 9:30AM PHO
Plenary presentation of Workshop 2 outputs
SESSION 9
Workshop 3:
Small group discussion and review of
9:30 – 11:00AM program performance relative to CHSR
contribution at the BHS/barangay level using PHO/PDO/CHO1
the CHSR. Selected groups to present in
plenary.
Workshop 4:
PHO/PDO/CHO1
11:00- 12:00NN Group work and plenary presentation of good
practices in CHSR data generation and
utilization at the BHS/barangay level towards
improving program performance
LUNCH
12:00 – 1:00PM
Session 10
1:00 – 3:00PM Action planning (to address areas identified PHO/PDO/CHO1
for improvement)
3:00- 4:00PM Plenary Presentation of Action Plans PHO

4:15 – 4:30PM Synthesis and Next Steps PHO/CHO1
4:30 – 4:45PM Closing Program PHO/CHO1

Annex B: Table of Gaps and Challenges in the CHSR Process

and Actions Taken/Recommendations
Community Health Service Record (CHSR) System Implementation Review Workshop
Name of Province: _________________________________

Name of City/Municipality/RHU: ______________________
Date of Activity: ___________________________________
Workshop 1 – Identify the Gaps and Challenges at every step of the CHSR Process:
CHSR Task Gaps/Challenges Action Taken/Recommendations

1. Preparation of the
CHSR tool/notebook
2. Conducting the Profiling

2.1 Locating the NHTS
HHs
2.2 Conducting the

interviews
2.3 Recording of
information in the CHSR
2.4 Delivering the key

health messages
3. Consolidating the
different conditions
4. Referring Clients
5. Following up Clients:
5.1 Who have not
consulted a HSP
5.2 Given health

services
6. Reporting to the Midwife

6.1 Validation of CHSR
data
6.2 Preparing the

CHSR Report
7. Reporting to the PHN

and P/CHO
8. Reporting to the DOH

(NDPs/DMOs)
9. Other Tasks
Annex C: CHSR Summary Discussion Forum

Community Health Team / Community Health Service Record (CHSR) System
Name of Facility (BHS): ______________________ Address: ________________________________

Name of RHM: ______________________________ Date of Activity: __________________________
Names of BHWs/Barangay: ____________________________________________________________
____________________________________________________________________________________
Note: Use 1 Form for each Type of TCL reviewed.
DISCUSSION RESULTS COMPARING CHSR DATA WITH TCL ENTRIES USING THE CHSR
SUMMARY AND DISCUSSION TOOL:
Barangay CHSR Notebook TCL Information Number of Patients
and Type of TCL Information Listed for Follow-up by
Reviewed (Prenatal, BHWs (BHWs notes
Postpartum, FP, down in her CHSR the
EPI/Nutrition) names of patients for
follow-up)
Example: FP TCL of Seen Referred Number of Referred
RHM for each of 3 Given Services and
barangays in her BHS Recorded in TCL; List
services given
1. Barangay Gana:
BHW1
BHW2
BHW3
TOTAL for Barangay
2. Barangay Las-ud
BHW4
BHW5
TOTAL for Barangay
3. Barangay Sobredillo
BHW6
OVERALL TOTAL for

BHS
Annex D: CHSR Referral Percentage Contribution Worksheet

Community Health Service Record (CHSR) System Implementation Review Workshop
BHS/ Barangay: ___________________________ City/Municipality: ____________________________________________
April-June July-Sept. Oct-Dec. Jan.-March

INDICATOR Remarks
2015 2015 2015 2016
Estimated PROPORTION (%) of the
Accomplishments REFERRED by CHT
Partners/BHWs implementing the CHSR
Formula: Number of Patients/FP Clients

REFERRED by CHT Partners/BHWs divided by
the Total Number of Patients/FP Clients Listed
in the Corresponding TCL of the Midwife for the
same period. This represents the % referral
contribution of CHT Partners/BHWs using the
CHSR in the total accomplishments for a given
period, by health indicator.
1. FP-CU
2. 4ANC
3. SBA
4. FBD
5. EBF
6. FIC
Annex E: Good Practice Writing Guide

GOOD PRACTICE IN IMPLEMENTING THE CHSR
Name of City/Municipality/Barangay: ____________________________________________

____________________________________________________________________________
Office/Unit/Facility: ___________________________________________________________
Start of CHSR Implementation: _____________________
1. What is the Intervention/Good Practice in CHSR implementation? Provide a brief

background, highlighting the following, among others:
 Length of time that the good practice has been in place/implemented
 How the good practice came about (who initiated/conceptualized and what were the
circumstances or problems encountered that led to the adoption of the good practice)
 Person/office primarily responsible for implementing the good practice
 Estimate of resources (time, manpower, financial) required to implement the good
practice
 Unique features of the good practice
2. What steps were undertaken by the LGU to implement the good practice? (How it
works)
 Enumerate and discuss the specific steps involved in implementing the good practice
and identify the specific persons/units involved in each step.
3. What are the results/effects of this good practice in implementing the CHSR?
 Give an account of the observable impact of the good practice on various aspects of
CHSR implementation as well as on the beneficiaries (including client satisfaction) and
program implementers.
 Describe the lessons learned from the introduction of the good practice in CHSR
implementation.
4. How will you further improve on this good practice?
5. How do you plan to sustain this good practice?

Annex F: Sample Presentation of a Good CHSR Practice -

2016
CHSR and the CHT Partners

August,2012 – Pilot training of CHT Partners in Legazpi
City
Year 2013- Columnar Technology was implemented by the
CHT Partners for the following health conditions:
Newborn, Infant, Child, Pregnant, Postpartum, FP
Current User, not using FP, Elderly, PWD and Chronic
Diseases
November and December, 2014- Introduced the CHSR
with additional health conditions: Adolescent, TB Adult,
TB among children, Dengue, Malaria, Rabies, Senior
Citizen and Death Cases
Adapting the CHSR for BHWs of Dita BHC (1)

• The RHM assigned in Dita BHC made a
strategy to facilitate the early submission of
reports from BHWs
• She adopted the idea of CHSR / Columnar
Notebook being used by the CHT partners in
her Barangays and modified it according to
the program implementation needs
• She encouraged the BHWs to adopt the
modified CHSR / Columnar Notebook for the
non – NHTS HH
6
Adapting the CHSR for BHWs of Dita BHC (2)

• New data and information gathered by the
BHWs in the barangays are all entered in the
modified CHSR notebook / Columnar Notebook
• the RHM upon monthly collection of reports,
validates the data in the Columnar Notebooks
of the BHWs with the entries in her Target
Client Lists (TCLs) for patients that she has given
health services, thus facilitating an organized
and easier generation of data from the BHWs
Unique Features of the Good Practice (1)

• Cost of columnar notebook is only ₽ 23.00 per piece
• Columnar notebook may be used for 3 years
• The BHW Columnar Notebook contains the following
Health Conditions as Column Headings:
• Pregnancy tracking
• PostPartum
• Newborn and EPI Schedules ( includes listing of defaulters
and follow-up)
• Mortality and Morbidity
• The RHM and the non-CHT BHWs practice one-on-one
consultation and validation of records and reports every
month based on the Columnar Notebook and TCLs
Steps in Developing the Good Practice (1)

• To address the issue about double reporting and to
ensure efficient masterlisting and record- keeping, the
RHM of Dita BHC adopted a strategy on how to
comprehensively implement the needed health services
in the barangay level
• She proposed to the BHWs during their meeting to
adopt a more systematic way of keeping records by
introducing the modified CHSR/Columnar Notebook
• The health indicators that are needed to be monitored
and followed-up became the headings of the 14-column
BHW Columnar Notebook
Steps in Developing the Good Practice (2)

• Thus, besides the CHT partners, the non-CHT BHWs
assigned in all puroks and sitios in their barangays are
also asked to bring their modified CHSR / Columnar
Notebooks with them during monthly meetings to be
validated by their Supervisor (RHM) with the
assistance of the NDP Nurse
• This way not only NHTS families are thoroughly
monitored for their health conditions but non-NHTS
families will have the same opportunity of being
covered and listed in the modified CHSR / Columnar
Notebook
10
Good results and effects of this practice

Program Implementors Beneficiaries
• The use of too many loose • EPI defaulters are easy to
forms is minimized and the follow-up
BHWs have intact records for
their assigned areas • Maternal Tracking among
pregnant mothers is
• All the data for the needed facilitated especially in
health indicators are in one identifying pregnant
columnar notebook, thus, mothers during their first
reports are easily extracted trimester
• Double reporting is avoided
• The modified CHSR/Columnar
Notebook is handy and light
11
Learnings
• The implementation of the FP/MNCHN/TB Programs
require commitment, passion ,patience and hard
work on the part of the not only of CHT Partners but
also of BHWs who follow-up patients for all programs
in the community
• Some of the BHWs are also members of CHTs that is
why the use of a more comprehensive and organized
system of record keeping like the modified
CHSR/Columnar Notebook is more advantageous on
their part
12
How to further improve this Good Practice

• The Nursing Service of the City Health Office is in the
process of introducing to the other RHMs in Legazpi
City this good practice of encouraging the BHWs to
use the modified CHSR/Columnar Notebook for
recording the information they get from the
households in their areas of assignment
• The CHO staff will monitor the use of this tool and
provide supportive supervision at the barangay level
once its use is implemented
13
How to sustain this good practice

• The Nursing Service Division of Legazpi City Health
Office with the leadership of the City Health Officer
is planning to make a proposal to the City Council
and Barangay Councils for them to fund the
procurement of Columnar Notebooks to be used by
the CHT Partners and BHWs for them to be able to
continue to serve the community better using this
tool
• The NDP Nurses will be requested to facilitate re-
training and re-orientation activities on the
FP/MNCHN Programs for the CHTs/BHWs so that
they will better understand the use of the modified
CHSR / Columnar Notebook
14
CHSR Roll-out Training Nov-Dec., 2014

15
CHTs in action
16
Community Health Service Record

BHW Columnar Record Book
(CHSR)
17
Thank You!

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Guide in Conducting an Implementation Review of the Community Health Service Record System i

Acknowledgments ..................................................................................................................... vii

1. , Regional Director, DOH Regional Office III

2. , Regional Director, DOH Regional Office IV

3. , former Regional Director, DOH Regional Office IV

4. , OIC Regional Director, DOH Regional Office V

5. Head, Family Health Cluster, DOH Regional Office V

6. , Regional FP Nurse Coordinator, DOH Regional Office III

7. , Development Management Officer IV, Provincial DOH Office, Albay

8. , Regional MNCHN Coordinator, DOH-Regional Office IV

9. , Provincial Health Officer II, Nueva Ecija

10. , Provincial Health Officer I, Nueva Ecija

11. , Provincial Health Officer, Tarlac

12. , Provincial Health Officer, Bulacan

13. , Provincial Health Officer, Albay

14. , Provincial BHW Coordinator, Provincial Health Office, Tarlac

16. , City Health Officer, San Carlos City

17. , Municipal Health Officer, San Manuel, Pangasinan

About This Guide

II. The Community Health Service Record Implementation

A. Clarifying the Roles and Tasks of Government Agencies and Partner

Collaboration and support of government agencies, partner nongovernment organizations

Department of Health Regional Offices

Nongovernment Organizations and Community Health Volunteers

B. Conduct of Preparatory Activities

6. Identify the dates of the activity and the workshop venue.

7. Arrange for the venue, accommodations, and meals/snacks.

8. Prepare and send out the invitation letters.

9. Prepare the needed workshop materials.

C. Developing/Modifying the CHSR Implementation Review Tools

These tools include the following:

3. CHSR Referral Percentage Contribution Worksheet – This worksheet is used to check

D. Actual Conduct of the CHSR Implementation Review Workshop

Specifically, the activity aims to:

The following are the expected outputs:

 Presentation of Status of CHSR Implementation in the Province/City – The

2. Workshop Proper: Group Work Using the CHSR System Implementation

Table 2. Sample Accomplished CHSR Summary Discussion Form, Consolidated for

Community Health Team/Community Health Service Record (CHSR) System

Name of Facility (BHS): Consolidation for Bulacan Province Address: _________________________

FP/MNCHN accomplishments relative to CHSR referral contribution. (Refer to Annex D for a

A sample consolidation of the accomplished CHSR Referral Percentage Contribution

Accomplishments (78%) (86%) (91%) (94%)

GOOD PRACTICES IN IMPLEMENTING THE CHSR IN NUEVA ECIJA

Table 5. Sample Action Plan

Municipality/RHU: Zaragosa Date: 03/30/2016

Identified Gaps Resource Person

Some NHTS family Continuous follow-up of April 13-15, Transportation BHW

Lack of PHO or LGU to April 13, 2016 Bond paper, Nurse

4. Synthesis and Agreements/Next Steps for the Province/City

Table 6. Synthesis, Agreements and Next Steps in the CHSR Implementation

Item / Concern Synthesis, Agreements and Next Steps

Item / Concern Synthesis, Agreements and Next Steps

Item / Concern Synthesis, Agreements and Next Steps

Item / Concern Synthesis, Agreements and Next Steps

III. Next Steps

2. Department of Health. Management and Supervision of Community Health Team (CHT)

3. Global Health Workforce Alliance/World Health Organization. Global Experience of

4. USAID-LuzonHealth. CHSR Briefer. July 14, 2014.

5. USAID-LuzonHealth Project. Draft: An Evaluation Study to Determine the Referral

7. USAID-LuzonHealth Project. Stories from the Field, Volume 1. October 2017.

8. USAID-LuzonHealth Project. Strategy Paper (Collecting, Recording and Reporting

Annex A: Sample Activity Design

I. RATIONALE AND BACKGROUND

Name of Facility (BHS): Address: __________