Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

June 15, 2021

DEPARTMENT MEMORANDUM
No. 2021-

FOR ALL UNDERSECRETARIES, ASSISTANT SECRETARIES,

DIRECTORS OF BUREAUS, SE RVICES AND CENTERS
FOR
HEALTH DEVELOPMENT (CHDs), MINISTER OF
HEALTH —
BANGSAMORO AUTONOMOUS REGION IN MUSLIM
MINDANAO (MOH-BARMM) AND OTHERS CONCERNED

SUBJECT FY 2021 Local Health Systems Maturity Levels

(LHS ML) Annual
Monitoring and Updated LHS ML Monitoring Tool

The Local Health Systems Maturity Levels

(LHS ML) serves as the general framework to
monitor the progress of integration in the Universal
Health Care Integration Sites (UHC IS). In
FY 2020, an assessment was conduct ed
to determine the baseline status of the 58 UHC IS in
terms of the Province- Wide/City-Wi de Health
System (P/CWHS) Characteristics’ Key Result
Areas (KRAs). Pursuant to Admini strative
Order (AO) No. 2020-0037 on Guidelines
Implementation of the Local Health Systems on
Maturity Levels (LHS ML), the monitoring of
integration status shall be performed annually.

This Department Memorandum shall

provide the general guide in the conduct of the FY 202]
LHS ML Annual Monitoring and the updated LHS
ML Monitoring Tool that shall be used by
the UHC IS, DOH-CHDs, and DOH-Central
Office.

A. MAJOR ACTIVITIES DURING THE ANNUAL MONITORING

The following provides the major

steps in conducting the FY 2021 annual monitoring:

ACTIVITY DESCRIPTION EXPECTED OUTPUT/S RESPONSIBLE OFFICE/S

I. ORIENTATION

1. CHD/MOH-BARMM Core Documentation report/Minutes ofthe Core group leader

group team leader to facilitate Meeting including the specific roles and
the conduct of meeting responsibilities of each member ofthe
among
CHD core group members and core group and P/CDOHO during the
the Provincial/City DOH Office assessment, validation, and provision of
(P/CDOHO) of the UHC IS technical assistance
2. CHD/MOH-BARMM Core Documentation Report/Minutes ofthe CHD/ MOH-BARMM
group and P/CDOHO to orient Meeting including the concerns raised by Core Group and
and cascade/ distribute the
updated LHS ML Monitoring
the UHC IS,
if
any, and summary of
agreements and next steps
P/CDOHO
Tool to the UHC IS
II. ASSESSMENT
3. Provincial/City Health Boards I) Accomplished and approved/ signed P/CHB, through
(P/CHB) through the P/CHO to LHS ML Monitoring Tool
Provincial/City Health
conduct self-assessment * One Summary Form Office (P/CHO)
* [0 P/CWHS Characteristic Forms
2) Excel version ofthe accomplished tool

Building 1, San Lazaro

Compound, Rizal Avenue, Sta. Cruz, 1003 Manila ® Trunk Line
Direct Line: 711-9502: 711-9503 Fax: 743-1829 651-7800 local 1108, 1111, 11 12,1113
o URL: htto://www.doh.eov.ph: e-mail:
[email protected]
 ACTIVITY DESCRIPTION EXPECTED OuTPUT/S RESPONSIBLE OFFICE/S
3) MOVs with “Achieved” and “On-
going” status
4. P/CHB, through
submit to CHD/ MOH-
P/CHO. to Google Drive folder shared to CHD/ P/CHB, through P/CHO
MOH BARMM Core Group
containing
BARMM Core Group the the following:
accomplished and signed LHS 1) Accomplished and
approved/ signed
ML Monitoring Tool and the LHS ML Monitoring Tool
corresponding MOVs with 2) Excel version of the accomplished tool
“Achieved” and “On-going” 3) MOVs with “Achieved” and “On-
status going” status
Notes:
One sub-folder containing the
1.
accomplished and approved, signed LHS MIL
Monitoring Tool and excel version of the tool
2. Ten (10) sub-folders,
one per characteristic, for the MOVs with “Achieved”
and “On-going” status
III. REVIEW AND VALIDATION
5. CHD/ MOH-BARMM Core Validated Documents
1)
CHD/ MOH-BARMM
Group and P/CDOHO to review * Signed validated LHS
ML Core Group and
and validate the submitted LHS Monitoring Tool P/CDOHO
ML Monitoring Tool and the * Excel version of
the validated tool
MOV submissions * MOVs with validated “Achieved”
a. CHD core group member status
serving
as
the regional ® Review result for MOVs with
counterpart of the CO lead validated “On-going” status
technical bureau to facilitate
the validation of specific
2) Feedback report to/minutes of meeting
with P/CHB
P/CWHS Characteristic
b. Review of the
appropriateness and
completeness of contents of
MOVs tagged as
“Achieved”, including

¢.
if
signatures required
Review ofthe consistency
with existing policies and
minimum required contents
of MOVs tagged as “On-
going”
6. CHD/ MOH-BARMM Core Google Drive folder shared to BLHSD
Group to submit the validated and FICT with sub-folders, one for each CHD/ MOH-BARMM
Core Group
report with the MOVs for the UHC IS, containing the following:
KRAs with “Achieved” status
Signed validated LHS ML Monitoring
1)
to BLHSD and FICT
Tool
2) Excel version of the validated too]
MOVs with validated “Achieved” status
Notes:
1. The sharing access of the folder should beset to “Anyone with the
and “Viewer”. link"
2. Each UHC IS
sub-folder should contain eleven (11) sub-folders:
* One (1) sub-folder for the signed LHS ML
Monitoring Tool and
accomplished Excel version of the tool (sub-folder name: LHS ML
* Ten (10) sub-folders for the MOVs Tool)
with validated “Achieved” status. Each
characteristic should have one sub-folder which
Tool Code (e.g. LG 1) is labeled based on the
» Each Characteristic sub-folder should contain
sub-folders based on
the number of KRAs for that characteristic
and labeled based on the
KRA No. (e.g. LG 1 KRA 1.1)
 ACTIVITY DESCRIPTION EXPECTED OUTPUT/S RESPONSIBLE OFFICE/S
>»
Each KRA sub-folder should only contain MOVs with
“Achieved”
status that were validated by CHD/ MOH-BARMM and
P/CDOHO
>

7.
1.1_MoV 1) I
Appropriately label each MOV based on the MOV No. (e.g. LG KRA

BLHSD, together with FICT, to Accomplished Tracking Document

1)
BLHSD and FICT
facilitate collection, for LHS Submissions (worksheet
consolidation and endorsement name: Tracking for Validated
of CHD submissions to CO Submissions). See Annex B.A for the
Lead Bureaus description ofthe Tracking Document.
2) Endorsement Memo/ E-Mail to CO
Lead Bureau/s
Note: Only the CO Offices and FICT shall have
a ccess to this shared google
sheet
8.a. Concerned CO Lead Bureau/s Accomplished Consolidated Report.
1)
CO Lead Bureaus:
to review and validate the LHS Please see Annex BL.II for the oLG —-BLHSD 1

ML Monitoring Form specific to description ofthe Consolidated oLG 2 —-BLHSD

their characteristic and Report. oFin BLHSD (with
1
—

corresponding MOVs with 2) Accomplished Tracking Document PHIC)

“Achieved” status for LHS Submissions (worksheet oHW — HHRDB 1

name: Tracking for Vetted olInfo — KMITSI

b. Concerned CO Lead
olInfo 2 — EB
Bureau/s to directly coordinate Submissions). See Annex B.I.B for the
OMPVT | — SCMS and PD
with Regional Counterpart or description of the Tracking Document.
oSD — HFDB and DPCR
1

concerned P/CDOHO for any 3) Google Drive folder shared to BLHSD

oSD 2 - HEMB
clarifications and FICT with one sub-folder per
OSD 3 - HPB
KRA containing the final set of
properly labeled MOVs vetted to have
“Achieved” status (e.g. KRA 1.1 MOV
I_Marikina City)
4) Endorsement Memo/E-Mail to
BLHSD
Note: Only the CO Offices and FICT shall have
a ccess to these documents.
IV. ANALYSIS AND DISSEMINATIO N

9. BLHSD, together with FICT, 1)Regional LHS ML Annual Monitoring BLHSD and FICT
to finalize the national report Results
and facilitate the approval of 2) Department Circular on FY 2021 LHS
the Department Circular ML Annual Report
10. BLHSD, together with I) Documentation Report on meeting BLHSD and FICT
FICT, to
disseminate the with CO Lead Bureaus
approved DC on FY 2021 2) Email sent to CHDs and MOH-
LHS ML Annual Report BARMM

The CHD Core Group member/s who is/are the

regional counterpart/s of the identified CO lead
bureau shall directly coordinate with the lead bureau
for any concerns relating to the
implementation of a particular P/CWHS characteristi ¢. The CO
lead bureau shall directly
coordinate with their regional counte rpart for clarifications
any on the accomplished LHS ML
Monitoring Tool and MOVs with “Achieved” status submitted
by the UH CIs.
To facilitate coordination, each CO lead bureau
had identified technical personnel
characteristic who shall serve as the point person/s per
during the conduct of t he annual monitoring.
Please see Annex A.
 B. TIMELINES

For FY 2021, the following are the indicative

timelines (working days) for the conduct of the
annual monitoring for the LHS ML:

ACTIVITY SCHEDULE RESPONSIBLE OFFICE

1. Conduct of self-assessment and
submission to CHDs and MOH/ November 15 to December 3,2021 P/CHB, through P/CHO
BARMM
2. Data review, validation, and P/CDOHO and CHD/
consolidation December 6 to December 17,2021
MOH-BARMM Core
3. Submission of the validated report Group
and MOVs with “Achieved”
status to BLHSD
December 20, 2021 CHD/ MOH-BARMM
([email protected])
Core Group
copy furnished concerned FICT
Usec and Asec Office
4. Collection, consolidation of CHD
submissions and endorsement to December 21-22, 2021
CO Lead Bureaus BLHSD and FICT

CO Lead Bureaus:
© LG 1-BLHSD
© LG2-BLHSD
5. Review and validation of specific
© Fin BLHSD (with
1
—

PHIC)
monitoring reports and MOVs December 23, 2021 to January 17,
with “Achieved” status and
© HW —-HHRDB 1

2022 © Info — KMITS

1

encoding of validated results in

the Consolidated Report google
Oo
Info2 —-EB

sheet
© MPVT I —SCMS and
PD
© SD I — HFDB and
DPCB
© SD 2-HEMB
© SD 3 -HPB
6. Endorsement
of the validated
report and final set of MOVs with January 21, 2022
“Achieved” status to BLHSD and CO Lead Bureaus
FICT

7. Finalization and approval of

National Report January 24, 2022 to February 25, 2022 BLHSD and FICT

8. Issuance of National Report

February 28, 2022 BLHSD and FICT

C. UppaTED LHS ML MONITORING TOOL

Based on the feedback during the FY 2020 baseline

assessment and consultation with the CO
Lead Bureaus and CHDs, the LHS ML
used for the FY 2021 LHS ML Annual
Monitoring Tool is
hereby updated. This version shall be
Monitoring and succeeding monitoring activities.
D. ATTACHMENTS:

1. Annex A: List of Technical Point Person/s

Per Characteristic
2. Annex B: Guide for CO Lead Bureaus in
Encoding in the Shared Google Sheets
3. Annex C: Updated Summary Form
and ten (10) individual monitoring
Characteristic. The soft copy of the forms, one per
updated monitoring tool (MS Word and MS
formats) can be accessed through this link Excel
http://bit.ly/UpdatedLHSMI Monitoring Tool

For compliance and dissemination

to all concerned.

By Authority of the Secretary of Health:

KENNETH G. RON LO, MD, MPHM, CESO III

Assistant Secretary of fealth |

Health Policy and Systems Development Team

 ANNEX A: LIST OF TECHNICAL POINT PERSON/S PER CHARACTERISTIC

R.
To facilitate coordination during the conduct of the annual monitoring, the following table reflects the
list of technical point person/s per characteristic:

Building Block Characteristic Office Name Official Email Address

Unified Governance of the
BLHSD
5 Engr: Raul IR. Alamis
is calthsystemsblhsd@doh. gov
[email protected]
Leadership and Local Health System
; ;

Governa nee Strategic and Investment

i

BLHSD Ms. Teresita Guzman [email protected]

me ee
Planning
.

Financing
.
Financial Management
. .
BLHSD id a
Engr. Raul R. Alami
amis
Ms. Teresita Guzman
[email protected]
>

[email protected]
Human Resource for Health Mr. Hermenegildo Caronan Jr. [email protected]
Health
(HRH) Management and HHRDB Ms. Ma Catherine Arzobal [email protected]
Workforce
Development Ms. Nica Jane Nival [email protected]

A
Ms. Cherrie Esteban [email protected]
"
Information
! Syst KMITS
Mr. John Ulysses Galo [email protected]
wail.com /
lagus. ehdol (@gmail.
Information
Ee ass
:

Ms. Ivy Grace Agus

Epidemiology and [email protected]
EB
Surveillance System [email protected] /
Ms.s-
asy
Daisy Regine
Regine D Lesouza
[email protected]
Medical SCMS Mr. Edison Cervantes edison [email protected]
Products, Procurement and Supply Ms. Sarah Manga [email protected]
Vaccines, and Chain Management PD
Mr. Peter Emmans Palma [email protected]
Technology
Dr. Gabriel Ann T. Dela Paz [email protected]
HEDB
Ar. Katrine Aira Veridiano [email protected]
Referral System [email protected]
Ds. Caamcla Grainds
DPCB [email protected]
Service Ms. Jennilyn Ygana [email protected]
Delivery Disaster Risk Reduction
Dr. Maridith Afuang [email protected]
Management in Health HEMB
(DRRM-H) System Ms. Winselle Joy Manalo [email protected]

Health Promotion Programs Dr. Miguel Angelo Mantaring [email protected]

HPB
and Campaigns Ms. Anne Marie Rey atrey(@doh.gov.ph
ANNEX B: GUIDE FOR CO LEAD BUREAUS IN ENCODING IN THE SHARED GOOGLE SHEETS

Section 41(d) of Republic Act No. 11223, otherwise known as “Universal Health Care Act”, stipulates
that the National Government shall provide technical and financial support to selected LGUs that
commit to province-wide and city-wide integration. Since a “whole-of-DOH” approach is needed in
implementing the reform on integration, Administrative Order No. 2020-0037 identified the DOH
Central Office Bureaus that shall lead the provision of needed technical assistance for the Universal
Health Care Integration Sites (UHC IS) to organize and sustain the functionality of the P/CWHS
characteristics.

For FY 2021 Local Health Systems Maturity Levels (LHS ML) Annual Monitoring, each CO Lead
Bureau shall be responsible for reviewing the means of verification (MOVs) with “Achieved” status
submitted by the UHC IS, through the CHD Core Group on Integration, for their assigned P/CWHS
characteristic. Since the LHS ML Information System is still for development, a Google collaborative
tool (Google sheets) will be used to facilitate the exchange of information among the ten (10) CO Lead
Bureaus and FICT.

This document shall serve as the guide of the CO Lead Bureaus in encoding the needed information in
the shared Google sheets.

I. TRACKING DOCUMENT

This Google spreadsheet has two (2) worksheets reflecting the submission tracking for the validated
LHS ML submissions from the CHD/ MOH-BARMM Core Groups, and vetted LHS ML submissions
from the CO Lead Bureaus.

A. TRACKING FOR VALIDATED SUBMISSIONS

This worksheet shall only be filled out and edited by the BLHSD based on the submissions
from the CHD/ MOH-BARMM Core Group. It is the responsibility of each CO Bureau to
regularly check the submission status for their characteristic. This worksheet contains the
following fields and their corresponding description:

FIELD/ COLUMN DESCRIPTION

HEADER
Region in
List of regions the country
Province/ HUC/ ICC List of provinces, HUCs, and ICCs that expressed commitment to
integrate their local health systems
With Submission Date when BLHSD received the validated submission from the CHD
Core Group for a specific UHC IS
Access Link to Main Link to the Google Drive folder shared by the CHD Core Group to
Folder BLHSD containing all of the submissions from a specific UHC IS
Complete No. of The number of sub-folders in the submission from the CHD Core
Required Sub-Folders Group. Ideally, the folder for each UHC IS shall contain 11 sub-
folders: one (1) sub-folder for the signed LHS ML Monitoring Tool
and accomplished editable excel version of the tool; and ten (10) sub-
folders (one sub-folder for each characteristic)
Access Link to Sub- Direct links to access the signed LHS ML Tool and its editable excel
Folders version, and sub-folder containing the MOVs with “Achieved” status
for a specific characteristic
Remarks Notes from BLHSD for reference/ information of the CO Lead
Bureaus

B. TRACKING FOR VETTED SUBMISSIONS

This worksheet shall be filled out and edited by the concerned CO Lead Bureaus and must
be regularly checked by BLHSD. This worksheet contains the following fields and their
corresponding description:
ANNEX B: GUIDE FOR CO LEAD BUREAUS IN ENCODING IN THE SHARED GOOGLE SHEETS
FIELD/ COLUMN DESCRIPTION
HEADER
List of PPCWHS Characteristics as specified in Section 41.4 of the
Characteristic UHC Act Implementing Rules and Regulations. The names of the
concerned CO Bureaus are also listed in this column.
Name of technical point person, including contact details, from each
Identified Technical Point
CO Lead Bureau. This field was included to facilitate the coordination
Person
among bureaus.
Date of Endorsement to Date when the CO Lead Bureau officially endorsed to BLHSD the
BLHSD
Access Link to MOV
COMPLETE set of vetted LHS ML submissions
Link to the Google Drive folder shared by the CO Lead Bureaus to
Folder with Vetted BLHSD containing all of the MOVs with vetted “Achieved” status
“Achieved” Status
Notes from the CO Lead Bureau/s for reference/ information of the
Remarks
BLHSD and other CO Lead Bureau/s

II. CONSOLIDATED REPORT

To organize the results of the annual monitoring, the shared Google spreadsheet on FY 2021 Annual
Monitoring Consolidated Report shall provide the platform for the encoding and consolidation of the
reviewed and vetted results by the concerned CO Lead Bureaus. This shared Google spreadsheet
includes two (2) worksheets per characteristic for the vetted MOV status and detailed TA needs from
the UHC IS, and summary worksheets for the MOVs, KRAs, level of progress and technical assistance
needs. Each CO Lead Bureau will only be given editing access on their concerned characteristic to
encode the final status per UHC IS.

This spreadsheet specifically contains the following:

WORKSHEET DESCRIPTION AND INSTRUCTIONS

<tool code>_ MOV Encoding sheet for the status of MOVs in a specific characteristic. The
spreadsheet has a total of ten (10) worksheets for this purpose:

LG 1
MOV Unified Governance of the Local Health System
LG 2 MOV Strategic and Investment Planning
Fin 1
MOV Financial Management
HW 1
MOV Human Resource for Health (HRH) Management and
Development
Info 1 MOV Information System
Info 2 MOV Epidemiology and Surveillance System
MPVT 1 MOV Procurement and Supply Chain Management
SD 1
MOV Referral System
SD 2 MOV Disaster Risk Reduction Management for Health
(DRRM-H) System
SD 3 MOV Health Promotion Programs and Campaigns

Only the concerned CO Lead Bureau/s has/have editing access to their

respective worksheets. Each Bureau only has to encode the MOV status per
UHC IS for FY 2021 (column name: FY 2021) since the FY 2020 baseline
status (column name: FY 2020) have already been encoded and the change in
the status between FY 2020 and FY 2021 (column name: Status Change) is
formula-generated.
ANNEX B: GUIDE FOR CO LEAD BUREAUS IN ENCODING IN THE SHARED GOOGLE SHEETS
WORKSHEET DESCRIPTION AND INSTRUCTIONS
<tool code>_TA The encoding sheet for the TA needs identified by the UHC IS. The
Needs spreadsheet has
a
total of ten (10) worksheets for this purpose:

LG 1
TA Needs Unified Governance of the Local Health System
LG 2 TA Needs Strategic and Investment Planning
Fin 1
TA Needs Financial Management
HW TA Needs
1
Human Resource for Health (HRH) Management
and Development
Info TA Needs
1 Information System
Info 2 TA Needs Epidemiology and Surveillance System
MPVT TA Needs 1
Procurement and Supply Chain Management
SD TA Needs
1 Referral System
SD 2 TA Needs Disaster Risk Reduction Management for Health
(DRRM-H) System
SD 3 TA Needs Health Promotion Programs and Campaigns

Only the concerned CO Lead Bureau/s has/have editing access to their

respective worksheets. Each Bureau is expected to encode all of the TA needs
and identified next steps of the UHC IS, any.if
Summary MOV Summary of the vetted status of all MOVs by tool code per UHC IS. This
worksheet is linked to the encoded results on each specific encoding worksheet
(<tool code>_ MOV) using formula, hence, there is no need to encode any data
for this worksheet. Only BLHSD has encoding access for this worksheet.
Summary KRA Summary of the vetted status of all KRAs by tool code per UHC IS. This
worksheet is linked to the Summary MOV worksheet using a formula, hence,
there is no need to encode any data for this worksheet. Only BLHSD has
encoding access for this worksheet.
Summary_Level Summary of the vetted status of all KRAs per maturity level (preparatory,
organizational and functional) by tool code per UHC IS. This worksheet also
includes the maturity level status of a UHC IS per characteristic, per building
block and the overall integration status. This worksheet is linked to the
Summary KRA worksheet using a formula, hence, there is no need to encode
any data for this worksheet. Only BLHSD has encoding access for this
worksheet.
Summary TA Summary of all recommended interventions/ technical assistance needed by
Needs each UHC IS per tool code. This worksheet is linked to the encoded TA needs
on each specific encoding worksheets (<tool/ code> TA Needs) using a
formula, hence, there is no need to encode any data for this worksheet.
ANNEX C
LOCAL HEALTH SYSTEMS MATURITY LEVELS MONITORING TOOL
SUMMARY FORM
Version 2

A. INTRODUCTION:
The Local Health Systems Maturity Levels or LHS ML is the general framework for the monitoring ofthe
progress oflocal
health systems integration as provided by Republic Act No. 11223, otherwise known as "Universal Health Care Act", and
its Implementing Rules and Regulations (IRR). This LHS ML Monitoring Tool shall be used to facilitate the
assessment
and monitoring ofthe progress of integration. It consists of the Summary Form and ten (10) Monitoring Forms, with each
monitoring form representing one (1) Province-Wide/ City-Wide Health System (P/CWHS) characteristic. The monitoring
forms reflect the Key Result Areas (KRAs) and the corresponding Means of Verification
(MOVs) per KRA. The MOVs
have three (3) possible status: Achieved, On-Going, and Not Yet Started.

B. GENERAL INSTRUCTIONS:
1. The Provincial/City Health Board (P/CHB), through the Provincial/City Health Office (P/CHO), shall facilitate the
conduct of the self-assessment. The accomplished and signed LHS Monitoring Tool and the MOVs with “Achieved”
and “Ongoing” status shall be submitted by the P/CHB to the concerned Center for Health Development (CHD)
through a shared Google Drive folder.

2. The CHD/ Ministry of Health-Bangsamoro Autonomous Region for Muslim Mindanao (MOH-BARMM) Core Group
and Provincial/City DOH Office (P/CDOHO) shall review, validate and analyze the submissions from the P/CHB, and
provide feedback to the P/CHB on the results of the validation and analysis.

3. The CHD/ MOH-BARMM Core Group and P/CDOHO shall submit the signed validated LHS ML Monitoring Tool
(summary form and 10 monitoring forms), soft copy version of the
results in Excel format and MOVs that have been
validated to have “Achieved” status to the Bureau of Local Health Systems Development (BLHSD) and Field
Implementation and Coordination Team (FICT).

C. GENERAL INFORMATION:
Fiscal Year:
(Indicate the fiscal year)
Province-Wide/ City-Wide Health System of:
of
(Indicate the name the Province/ Highly Urbanized City/
Independent Component City)

Monitoring Period From: To:

(Indicate the specific duration when the self-
assessment/ monitoring started and ended)

Number of Total Number of Barangays:

Municipality/City: (Indicate the number of barangays
(Indicate the number of
municipalities within the HUC/ICC)
and component cities within the
province)

D. SUMMARY OF OVERALL PROGRESS:

(Based on the Summary of Progress table of the individual characteristic monitoring form, indicate the number of KRAsper status: achieved, on-going and not yet
started.)

ildi Status of Key Result Areas

Building Block LeveL OLEROpress TOTAL
Achieved On-Going Not yet Started
Preparatory Level 3
Legdership. and
Organizational Level 6 (5)*
Governance
Functional Level 4

Financing Organizational Level 4 (3)*

Functional Level 1

Preparatory Level 1
Health Workforce
—
Organizational Level 4

Page 1 of 2
ANNEX C
LOCAL HEALTH SYSTEMS MATURITY LEVELS MONITORING TOOL
SUMMARY FORM
Version 2
Functional Level 2

Preparatory Level 2
Information Organizational Level 6
Functional Level 4
Preparatory Level 2
Medical Products,
Vaccines and Organizational Level 4
Lechuolazy
Functional Level 2

Preparatory Level 8
Service Delivery Organizational Level 12

Functional Level 7

TOTAL 72 (70)*
*Entries in parentheses under the TOTAL column refer to the number of KRAs applicable to the C ity-Wide Health System.

E. SUMMARY OF RECOMMENDED INTERVENTIONS AND/ OR TECHNICAL ASSISTANCE NEEDED:

(Consolidated interventions/ strategies and/or assistance needed by the P/CWHSto
achieve the specific KRAs in each characteristic)

Recommended
Person/ Unit
5

Characteristics Interventions/
.
Technical ;
5

Timeframe
:
Expected Output
gn

.
Assistance Needed
.
Responsible

F. SIGNATORIES
(Signature over printed name. Kindly indicate the date)

Approved by:

Provincial/City Health Officer Date:

Validated by:

Provincial/City DOH Officer CHD Core Group Leader

Date: Date:

Noted by:

DOH Regional Director

Date:

Page 2 of 2
 ANNEX C

Local Health Systems Maturity Levels

Monitoring Tool
Building Block:
Leadership and Governance
LG 1 Characteristic: Unified Governance of the
Local Health System
Instructions:
1. Under the Status column, indicate the

~~
status of the means of verification (MOVs):
a. Achieved — with approved document
or target indicated was met
b. On-going — with
an available draft document
¢. Not yet started — no or target was not met but with existing initiatives
existing initiatives yet to achieve the Key Result Areas already
2. Under the Remarks column, (KRAs)
3. Under the Summary of Progress
fill the required fields, as applicable. May also include other
in
table, indicate the status of each KRA based on monitoring notes.
multiple MOVs: the status of its MOV. If a KRA has
a. All MOVs have the same
b. MOVs have different
status - include the KRA in the appropriate column
status - include the KRA under the
4. MOVs tagged as needed shall On-going column
only be provided with a status if applicable.
5. Otherwise, please indicate “not applicable”.
Reports and Lists submitted as MOVs should be
duly signed by the Provincial/ City Health Officer or authorized
representative.
6. In the Recommended Interventions/ Assistance Needed
table, indicate the specific interventions that
carried out and/or technical assistance should be
needed to facilitate the attainment of the
7. Sign thetool and indicate the date. As, KR

Means of Verification Status

(Achieved/ On- Remarks
going/Not vet started)
I. Preparatory Level
KRA 1.1: Commitment to integrate local
health systems (LHS) into Province-Wide/
(P/CWHS) City-Wide Health Systems
1. Signed Sanggunian Panlalawigan/ Panlunsod (SP) SP Resolution/ EO No:
Resolution or Executive Order
(EO) expressing LGUs’
commitment to LHS integration
Signed and notarized Memorandum
of Understanding
(MOU) among the Province/City Government,
DOH. and
PhilHealth describing the specific commitments
to implement LHS integration
of parties
KRA 1.2: Presence of technical
working group/s (or similar group/s) to assist the Provincial
P/CHB) on matters relating to the integration /City Health Board
of LHS
1. Signed EO or Administrative Order (AO) on
the TWG and their functions
the creation of EO or AO No:
relating to the LHS integration
I. Organizational Level
KRA 2.1: Organized Province-Wide Health
Systems (PWHS)
I. Signed and notarized Inter-LGU Memorandum
Agreement (MOA) or Memorandum
of No. of Component LGUs that signed
of Understanding the MOA/ MOU:
(MOU) with the following minimum
provisions:
a. Inter-LGU cooperation through the creation
Care Provider Networks (PCPNs) linked to
of Primary
a secondary
b.
or tertiary care
PHB as the overall
Total No. of Component
Province:
LGUs
in the
manager for the PWHS, and
Technical Management Committee (TMC)
for the Sub-
Provincial Health System (if any)
¢. Resource sharing and coordination mechanisms Percentage of component LGUs that
d. Responsibilities of the province and signed the MOA/ MOU:
component LGUs
(Note: Applies only to PWHS)
KRA 2.2: Expanded Membership and Functions
of the Provincial /City Health Board (P/C HB)
1. Signed EO with the following minimum
Provisions: EO No:
a. Membership
i. Representative/s of municipalities and
component
cities (Note: Applies only to PWHS)
it. Indigenous Cultural Communities/ Indigenous
Peoples (ICC/IP) representative, as applicable No.of representative/s of
b. Functions municipalities and component cities:
Note: This form must be encoded and
signed prior to submission.

Page 1
of 3
 |
BB i. P/CHB having the mandate to
fully manage the
Special Health Fund (SHF) within the P/CWHS
il. Exercise administrative and
technical supervision
over health facilities and health human
within the P/CWHS resources
KRA 2.3: Strengthened Provincial/
City Health Office (P/CHO)
1. Signed Ordinance or EO
reflecting the. following:
a. Creation of Health Service
Delivery Division (HSDD)
and Health Systems Support Division
(HSSD), or any
similar divisions. functioning
b.
as such
Corresponding functions of the two divisions, and
divisions existing in the P/CHO
other Ordinance or EO No:
(if any)
c¢.
Updated organization structure the
of P/CHO
(Note: The LGUs may consider
incorporating already the minimum
required units specified in Info 2 KRA 2.1
(ESU), and SD 3 KRA 2.1
HPU) in this Ordinance or EO)
2. Signed Ordinance on the creation
of positions (if not yet
existing) or EO/Office Order on the
designation of
personnel (if already existing) for:
a. Assistant P/CHO and/ or another
official of equivalent
rank Ordinance/ EQ/ Office Order No:
b. Other personnel in the two divisions (Note:
The LGUs
may consider incorporating already the minimum
personnel specified in Info 1 KRA 24, required
Info 2 KRA 2.1,
MPVT 1 KRA 2.4, SD 2 KRA 2. 1, and SD 3
KRA 2.1 in this
Ordinance/ EQ/ Executive Order)
KRA 2.4: Established Management
Support Unit (MSU)
1. Signed EO establishing an MSU with
personnel
composition and their respective roles and
responsibilities EO No:
(Note: The MSU shall include those
specified in Fin 1 KRA 2.4 to
assist the P/CHB in managing the
SHF)
III. Functional Level
KRA 3.1: Institutionalized P/CWHS
(For Provinces)
la. Signed Provincial Ordinance
providing for the establishment
and operationalization of the PWHS,
including its 4
Ordinance N No:
management support systems
(Note: MOVs on the Sunctionality
of the management support systems
are in the monitoring tool of the concerned
system.)
(For Provinces)
Total no. of Component LGUs with
1b. List of
|
:

component LGUs that committed to the integration

8
i

pared local ordinance ¢ o on integration to

;

—
with signed ordinance on PWHS establishment and
operationalization, including its management
systems support
Total no. of Component LGUs that
(Note: MOVs on the Junctionality committed to integration:
of the management support systems
are in the monitoring tool of the concerned
system.)
Percentage
oS of Com ponent LGUs with
signed local ordinance on integration to
PWHS:
(For HUCs/ICCs)
2. Signed City Ordinance providing for
the establishment and
operationalization of the CWHS, including its
management Ordinance No:
support systems
(Note: MOVs on the Sunctionality
of the management support systems
are in the monitoring tool of the concerned
system.)

KRA 3.2: P/CWHS contracted

by DOH and PhilHealth
1. Signed and notarized Terms of
Partnership (TOP) between
the P/CHB and DOH-Center
for Health Development
Note: This form must be encoded
and signed prior to submission.

Page 2 of 3
 (DOH-CHD) for population-based health services
(Note: Check for the signed and notarized TOP Sor the current
Year) fiscal

2. Signed and notarized contract between the

P/CHB and
PhilHealth for individual-based health services
KRA 3.3: Monitoring of P/CWHS Performance
1. P/CWHS Annual A ccomplishment
Report reflecting:
a. Health service delivery and health
systems
performance
b. Yearly comparative performance analysis
(Note: See related KRAs under HW 1 KRA
3.2, Info 1 KRA 3.1 and
KRA 3.2, MPVT I KRA 3.2,85D1 KRA
3.1, SD 2 KRA 2.2, and SD 3
KRA 3.3)

Summary of Progress

Level of Progress

Preparatory Level
Organizational Level
Functional Level
Total No.

4 (3)*
3
of KRAs
2
(cite
og no.) (cite
as no.) Mobs uy ht )

Total No. of KRAs 9 (8)*

*Entries in parentheses under the TOTAL
No. of KRAs column refer to the number of KRAs applicable to the City- Wide Health System.
Recommended Interventions/ Assistance N eeded

KRA Recommended Interventions/

Technical Assistance Needed Timeframe Expected Output Person/ Unit
KRA 1.1
Responsible

KRA 1.2

KRA 2.1

KRA 2.2

KRA 2.3

KRA 2.4

KRA 3.1

KRA 3.2

KRA 3.3

Assessed by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit
Date:

Validated by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit
Date:

Note: This form must be encoded and

signed prior to submission.

Page 3 of 3
 ANNEX C
Local Health Systems Maturity Levels Monitoring Tool
Building Block: Leadership and Governance
LG 2 Characteristic: Strategic and Investment Planning

Instructions:
1. Under the Status column, indicate the status of the means of verification (MOVs):
a. Achieved — with approved document or target indicated was met
b. On-going — with an available draft document or target was not met but with existing initiatives already
c. Not yet started — no existing initiatives yet to achieve the Key Result Areas (KRAs)
2. Under the Remarks column, fill in the required fields, as applicable. May also include other monitoring notes.
3. Under the Summary of Progress table, indicate the status of each KRA based on the status of its MOV. If a KRA has
multiple MOVs:
a. All MOVs have the same status - include the KRA in the appropriate column
b. MOVs have different status - include the KRA under the On-going column
4. MOVs tagged as needed shall only be provided with
5.
a status if applicable. Otherwise, please indicate “not applicable”.
Reports and Lists submitted as MOVs should be duly signed by the Provincial/ City Health Officer or authorized
representative.
6. Inthe Recommended Interventions/ Assistance Needed table, indicate the specific interventions that should be carried
out and/or technical assistance needed to facilitate the attainment of the KRAs.
7. Sign the tool and indicate the date.

Status
Means of Verification
. .
(Achieved/ On- Remarks
going/Not yet started)
I. Preparatory Level
KRA 1.1: Baseline assessment of LGUs” health systems capacity and corresponding investment needs for the Local |

Health Systems integration |

1. Baseline Assessment Report or Situational Analysis Section of

the Local Investment Plan for Health (LIPH), reflecting the
Jfollowing (but not limited to):

a. Human resources for health, infrastructure, and equipment

b. Service capabilities of health facilities and services
c. Status of licensing (DOH) and accreditation (PhilHealth)
of health facilities and services
d. Management support systems such as human resources for
health management and development, information
management, procurement and supply chain management,
quality assurance/ improvement, referral system, DRRM-H
system, epidemiologic surveillance system, and proactive
and effective health promotion programs/ campaigns
(Note: See related KRAs under HW 1 KRA 1.1, Info 1 KRA 1.1, Info 2
KRA 1.1,MPVTI KRA 1.1, SD 1 KRA 1.1, SD 2 KRA 1.1, and SD 3 KRA
1.1)
II. Organizational Level
KRA 2.1: LIPH as the strategic and investment plan of the Province-Wide/ City-Wide Health Systems (P/CWHS)
1. Signed Provincial/ City Health Board (P/CHB) Resolution or
Executive Order (EO) on the adoption of the LIPH as the P/CHB Resolution or EO No:
strategic and investment plan of the P/CWHS
KRA 2.2: LIPH/ Annual Operational Plan (AOP) concurred by concerned Center for Health Development (CHD)
[. LIPH concurred by the concerned Regional Director as
reflected in the LIPH appraisal checklist
(Notes:
a. For FY 2021 monitoring, check for the 2020-2022 LIPH Appraisal
Checklist
b. For FY 2022 to 2024 monitoring, check for the 2023-2025 LIPH
Appraisal Checklist
¢. For FY 2025 monitoring, check for the 2026-2028 LIPH Appraisal
Checklist)

Note: This form must be encoded and signed prior to submission.

Page 1 of 2
 2. AOP concurred by the concerned Regional Director as reflected
in the AOP appraisal checklist

(Note: Check for the AOP appraisal checklist for the succeeding fiscal
year)
III. Functional Level
KRA 3.1: Analysis of LGU Commitment/Counterpart vis a vis Actual Health Expenditure
1. Report on committed Province/HUC/ICC counterpart fund vs
appropriated budget for health vs actual health expenditures,
prepared by the Provincial/ City Accountant, and noted by
P/CHO
(Notes:
a. To cover PS, MOOE, and CO
b. Province/HUC/ICC Counterpart as reflected in the AOP of the
previous fiscal year
¢. Province/HUC/ICC Appropriated Budget for Health as reflected in
the Appropriation Ordinance/s OR Statement of Appropriation,
Allotment and Obligation (SAAOB) of the previous fiscal year
d. Province/HUC/ICC Actual Health Expenditures as reflected in the
Statement of Receipts and Expenditures (SRE) for the last 3 years

Summary of Progress

a
Achieved On-Going
Total No. of Not yet started
Level of Progress ;
(cite i KR4 en
(cite onify KRA
KRAs pede eife, specific KIA no.)
Preparatory Level 1

Organizational Level 2
Functional Level 1

Total No. of KRAs 4

Recommended Interventions/ Assistance Needed

KRA Recommended Interventions/ Technical Expected

Timeframe
,
Person/ Unit Responsible
5
;
Assistance Noaded Output
KRA 1.1

KRA 2.1

KRA 2.2

KRA 3.1

Assessed by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit

Date:

Validated by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit
Date:

Note: This form must be encoded and signed prior to submission.

Page 2 of 2
 ANNEX C
Local Health Systems Maturity Levels Monitoring Tool
Building Block: Financing
Fin 1 Characteristic: Financial Management

Instructions:
I. Under the Status column, indicate the status of the means of verification (MOVs):
a. Achieved — with approved document or target indicated was met
b. On-going — with an available draft document or target was not met but with existing initiatives already
c. Not yet started — no existing initiatives yet to achieve the Key Result Areas (KRAs)
to Under the Remarks column, fill in the required fields, as applicable. May also include other monitoring notes.
3. Under the Summary of Progress table, indicate the status of each KRA based on the status of its MOV. If a KRA has
multiple MOVs:
a. All MOVs have the same status - include the KRA in the appropriate column
b. MOVs have different status - include the KRA under the On-going column
4. MOVs tagged as needed shall only be provided with status if applicable. Otherwise, please indicate “not applicable”.
5. Reports and Lists submitted as MOVs should be duly signed by the Provincial/ City Health Officer or authorized
representative.
6. Inthe Recommended Interventions/ Assistance Needed table, indicate the specific interventions that should be
carried out and/or technical assistance needed to facilitate the attainment of the KRAs.
7. Sign the tool and indicate the date.

.
Status
Means of Verification
.
(Achieved/ On-going/ Remarks
Not
yet started)
I. Preparatory Level
Note. Preparatory KRAs are subsumed under LG 1 KRA 1.1: Commitment
to
integrate local health systems into Province-Wide/ C ity-Wide
Health Systems (P/CWHS); and LG 1 KRA 2.2: Expanded Membership and Functions of the Provincial/ Ciity Health Board (P/CHB)

II. Organizational Level

KRA 2.1: Opening of Special Health Fund (SHF) Depository Bank Account

1. Signed Provincial/ City Health Board (P/CHB) Resolution on

the opening of an SHF depository bank account in an authorized P/CHB Resolution No:
depository bank based on existing Department of Finance —
Bureau of Local Government Finance (DOF-BLGF) guidelines

2. Signed Sanggunian Panlalawigan/ Panlunsod (SP) Resolution SP Resolution No:

endorsing the P/CHB Resolution on the opening of SHF
depository bank account

3.Bank Certification on the presence of the SHF depository

bank account

KRA 2.2: Presence of Separate SHF Book of Accounts at Provincial/ HUC/ ICC Level
1. Certification from the Provincial/ City Accountant on the
presence of a separate book of accounts for SHF, including
subsidiary ledgers for each fund source

KRA 2.3: Presence of Subsidiary Ledger for SHF in the Trust Fund of Component LGUs
Total no. of Component LGUs with
subsidiary ledger for SHF:
1. List ofcomponent LGUs that have a subsidiary ledger for Total no. of Component LGUs that
SHF in their Trust Fund as
certified by the LGU Accountant committed to integration:
(Note: Applies only to PWHS)
Percentage of Component LGUs with
]

subsidiary ledger for SHF:

Note: This form must be encoded and signed prior to submission.

Page 1 of 2
 KRA 2.4: Presence of Personnel in the Management Support Unit (MSU)
the SHF
to Assist the Board in the management of

1.Copy of
Executive Order (EO) or Office Order designating or
appointment letter hiring the following MSU personnel:
EO/ Office Order No:
a. Accountant (Accountant II)
b. Administrative Officer (Administrative Officer II)
¢. Liaison Officer (Administrative Assistant III)
(Note: See related KRA under LG1 KRA 2.4)
111. Functional Level
KRA 3.1: Exclusive Use of SHF Budget for Health Programs, Projects, and Activities within the P/CWHS

1.P/CHB Resolution on the approval of a budget for priority P/CHB Resolution No:
health programs, projects, and activities within the P/CWHS

2. Approved Work and Financial Plan (WFP)

of the P/CWHS for
the SHF

3. Signed SHF Budget Utilization Report Percentage of SHF Budget Utilization

from previous FY:

Summary of Progress

Level of Progress Total No. of KRAs Achieved On-Going Not yet started
(cite specific KRA no.) (cite specific KRA no.) (cite specific KRA no.)
Preparatory Level 0
Organizational Level 4 (3)*
Functional Level 1

Total No. of KRAs 5 4)*

*Entries in parentheses under the TOTAL No. of KRAs column refer to the number of KRAs applicable to the C ity-Wide Health System.

Recommended Interventions/ Assistance Needed

Recommended Interventions/ ; Person/ Unit

KRA&
Technical Assistance Needed Jameirame Expected Output
Responsible
KRA 2.1

KRA 2.2

KRA 2.3

KRA 2.4

KRA 3.1

Assessed by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit
Date:

Validated by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit

Date:

Note: This form must be encoded and signed prior to submission.

Page 2 of 2
 ANNEX C
Local Health Systems Maturity Levels Monitoring Tool
Building Block: Health Workforce
HW 1 Characteristic: Human Resources for Health Management and Development

Instructions:
I. Under the Status column, indicate the status of the means of verification (MOVs):
a. Achieved — with approved document or target indicated was met
b. On-going — with an available draft document or target was not met but with existing initiatives already
c. Not yet started — no existing initiatives yet to achieve the Key Result Areas (KRAs)
wo
Under the Remarks column, fill in the required fields, as applicable. May also include other monitoring notes.
Under the Summary of Progress table, indicate the status of each KRA based on the status of its MOV. If a KRA has
multiple MOVs:
a. All MOVs have the same status - include the KRA in the appropriate column
b. MOVs have different status - include the KRA under the On-going column
4. MOVs tagged as needed shall only be provided with a status if applicable. Otherwise, please indicate “not applicable”.
5. Reports and Lists submitted as MOVs should be duly signed by the Provincial/ City Health Officer or authorized
representative.
6. Inthe Recommended Interventions/ Assistance Needed table, indicate the specific interventions that should be
carried out and/or technical assistance needed to facilitate the attainment of the KR As.
7. Sign the tool and indicate the date.
.
Status
Means of Verification
.
(Achieved/ On-going/ Remarks
Not yet started)
I. Preparatory Level
KRA 1.1: Baseline Assessment, Gaps Analysis, and Investment Needs for the Development and Strengthening of
the Human Resources for Health Management and Development System
1. Baseline Assessment Report or Situational Analysis Section
of the
Local Investment Plan for Health (LIPH) containing at least the
following:
a. Distribution and staffing pattern (filled and unfilled
positions) within the Province-Wide/City-Wide Health
Systems (disaggregated by hiring authority)
b. HRH gaps/ needs
¢. Learning and development needs based on competency
standards
(Note: The LGUs may consider incorporating this in the Baseline
Assessment Report under LG 2 KRA 1.1)

II. Organizational Level

KRA 2.1: Presence of Province-Wide/ City-Wide Health Systems (P/CWHS) Human Resources for Health (HRH)
Plan
1. HRH plan of the P/CWHS signed by Provincial/ City Health Board
(P/CHB) reflecting the following minimum contents:
a. Strategies on filling up vacant plantilla positions
b. A mechanism on HRH sharing within the health
care provider
network
¢. Creation of plantilla positions for HRH
d. Learning and development plan/intervention
(Note: The programs, projects, and activities should be included in the
LIPH)
KRA 2.2: Updated National Health Workforce Registry (NHWR)
1. Signed NHWR Update Report
(Note: LGUs to present the latest report using the prescribed format of
HHRDB)
KRA 2.3: Presence of Harmonized HRH Management and Development System and HRH Performance
Assessment System
1. Signed Executive Order (EO) EO or P/CHB Resolution No:
or P/CHB Resolution on
harmonized competency-based HRH management and
Note: This form must be encoded and signed prior to submission.
Page 1 of 3
 development system, and HRH performance assessment system,
including grievance redress mechanism

KRA 2.4: Presence of DOH-PRC Certified Primary Care Health Workers

Total number of certified primary
1. List of DOH-PRC Certified primary care health workers in
public primary care facilities care health workers in public
primary care facilities:
III. Functional Level
KRA 3.1: Creation of Permanent Plantilla Positions for HRH
Total number of newly created
HRH plantilla positions, by cadre:

1. Signed Provincial/ Municipal/ City Ordinances on the creation List of Ordinances and concerned
of plantilla positions for HRH based on gaps/needs identified LGUs:
1.

wo

KRA 3.2: Monitoring of PPCWHS Performance on HRH Management and Development

1. Reports on the following:
a. HRH to population ratios
b. Trained HRH based on required competencies per cadre
c. HRH attrition rate
d. Patient satisfaction on HRH performance
e. HRH satisfaction on HRH support provided by P/CWHS
Notes:
1. This report should be included in the P/CWHS Annual
Accomplishment
Report stated in LG 1 KRA 3.3
2. The list provided only reflects the minimum contents of the report. The
P/CWHS may include other HRH-related performance indicators.

Summary of Progress

Level of Progress Total No. of KRAs Achieved On-Going Not yet started
(cite specific KRA no.) (cite specific KRA no.) (cite specific KRA no.)
Preparatory Level
Organizational Level
NB

Functional Level
Total No. of KRAs

Recommended Interventions/ Assistance Needed

Recommended Interventions/ Person/ Unit
KR Technical Assistance Needed
Timefeame
.
Expected Output
Responsible
KRA 1.1

KRA 2.1

KRA 2.2

KRA 23

KRA 2.4

Note: This form must be encoded and signed prior to submission.

Page 2 of 3
 KRA 3.1

KRA 3.2

Assessed by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit

Date:

Validated by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit
Date:

Note: This form must be encoded and signed prior to submission.

Page 3 of 3
 ANNEX C
Local Health Systems Maturity Levels Monitoring Tool
Building Block: Information
Info 1 Characteristic: Information Management System

Instructions:
1. Under the Status column, indicate the status of the means
of
verification (MOVs):
a. Achieved — with approved document or target indicated was met
b. On-going — with an available draft document or target was not met but with
existing initiatives already
¢. Not yet started — no existing initiatives yet to achieve the Key Result Areas (KRAs)
2. Under the Remarks column, fill in the required fields, as applicable. May also include other monitoring notes.
3. Under the Summary of Progress table, indicate the status of each KRA based on the status of its MOV. If a KRA has
multiple MOVs:
a. All MOVs have the same status - include the KRA in the appropriate column
b. MOVs have different status - include the KRA under the On-going column
4. MOVs tagged as needed shall only be provided with a status if applicable. Otherwise, please indicate “not applicable”.
5. Reports and Lists submitted as MOVs should be duly signed by the Provincial/ City Health Officer
or authorized
representative.
6. Inthe Recommended Interventions/ Assistance Needed table, indicate the specific interventions that should be
carried out and/or technical assistance needed to facilitate the attainment of the KRAs.
7. Sign the tool and indicate the date.
Status
Means of Verification (Achieved/ On-going/Not Remarks
yet started)
I. Preparatory Level
KRA 1.1: Baseline Assessment, Gaps Analysis, and Investment Needs for the Development and Strengthening of
the Information Management System
1. Baseline Assessment Report or Situational Analysis Section
of
the Local Investment Plan for Health (LIPH) containing at
least the following:
a. State of ICT governance in the P/CWHS including
strategic and investment planning for health information
management/ICT
Status of EMR implementation
c. Inventory of health facilities with service and ICT
capabilities:
i. Ongoing or currently implemented systems/
applications
ii. Functional/ Serviceable ICT equipment
iii. Internet connectivity
iv. Availability and capacity of dedicated ICT
personnel
v. Cross-cutting ICT issues such as standards
compliance, privacy, and data protection

(Note: The LGUs may consider incorporating this in the Baseline

Assessment Report under LG 2 KRA 1.1)
II. Organizational Level
KRA 2.1: Presence of P/CWHS Health Information Management/ ICT Development Plan
1. Health information management/ ICT development plan of the
P/CWHS signed by P/CHB
(Note: The programs, projects, and activities should be included
LIPH)
in the
KRA 2.2: Functional EMR System among Health Facilities within the P/CWHS
No. of health facilities within the
P/CWHS with functional EMR:
1. Submitted reports to DOH and PhilHealth through EMR

Total no. ofhealth facilities within

the P/CWHS:

Note: This form must be encoded and signed prior to submission.

Page 1 of 3
 Percentage of health facilities
within the P/CWHS with functional
EMR:

KRA 2.3: Engagements with Medical Specialists/ Facilities for the Provision of Telemedicine Services
1. Signed and notarized Memorandum
of Agreement (MOA)/
Service Level Agreements (SLA) between the P/CHB and
medical specialists/ facilities for the provision of telemedicine
services
KRA 2.4: Presence of Dedicated ICT Personnel in the P/CHO
1. Signed office order designating or appointment letter hiring a If with Office Order, indicate the
dedicated ICT personnel in the P/CHO no.:
III. Functional Level
KRA 3.1: Validated EMR System that Links the Members of the PCPN to Secondary and Tertiary Care Providers
within P/CWHS
1. Reports on coordinated referrals using EMR:
a. PCPN to referral facilities (secondary/tertiary)
b. Referral facilities (secondary/tertiary) to Apex hospital/s
¢. Referral facilities or Apex hospital/s to PCPN
Notes:
I. This report should be included in the P/CWHS Annual
Accomplishment Report stated in LG I KRA 3.3
2. Applicability of data disaggregation will depend on the level of health
facilities and services within the P/CWHS
KRA 3.2: Monitoring of PPCWHS Performance on Informati on Management
1. Report on the percent of security incidents and personal data
breaches detected and responded to in a timely manner
(Note: This report should be included in the P/CWHS Annual
Accomplishment Report stated in LG I KRA 3.3)
2. Report on the percent of health facilities providing
telemedicine services
(Note: This report should be included in the P/CWHS Annual
Accomplishment Report stated in LG 1 KRA 3.3)

Summary of Progress

|
Level of Progress Total No. of KRAs Achieved On-Going Not yet started
(cite specific KRA no.) (cite specific KRA no.) (cite specific KRA no.)
Preparatory Level
|=
Organizational Level
Functional Level
NO

Total No. of KRAs

ge
Recommended Interventions/ Assistance Needed

Kn
KRA 1.1
Trane Epctoupu reCa
KRA 2.1

KRA 2.2

KRA 2.3

Note: This form must be encoded and signed prior to submission.

Page 2 of 3
 KRA 2.4

KRA 3.1

KRA 3.2

Assessed by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit

Date:

Validated by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit

Date:

Note: This form must be encoded and signed prior

to submission.
Page 3 of 3
 ANNEX C

Local Health Systems Maturity Levels Monitoring Tool

Za
Building Block: Information
Info 2 Characteristic: Epidemiology and Surveillance System

Instructions:
1. Under the Status column, indicate the status of the means of verification (MOVs):
a. Achieved — with approved document or target indicated was met
b. On-going — with an available draft document
or
target was not met but with existing initiatives already
c. Not yet started — no existing initiatives yet to achieve the Key Result Areas (KRAs)
Under the Remarks column, fill in the required fields,
2.
3.
as applicable. May also include other monitoring notes.
Under the Summary of Progress table, indicate the status of each KRA based on the status of its MOV. If a
KRA has multiple MOVs:
a. All MOVs have the same status
-
include the KRA in the appropriate column
b. MOVs have different status - include the KRA under the On-going column
4. MOVs tagged as needed shall only be provided with a status if applicable. Otherwise, please indicate “not
applicable”.
5. Reports and Lists submitted as MOVs should be duly signed by the Provincial/ City Health Officer or
authorized representative.
6. In theRecommended Interventions/ Assistance Needed table, indicate the specific interventions that should be
carried out and/or technical assistance needed to facilitate the attainment of the KRAs.
7. Sign the tool and indicate the date.

Status
Means of Verification (Achieved/ On-going/ Remarks
Not yet started)
I. Preparatory Level
KRA 1.1: Baseline Assessment, Gaps Analysis, and Investment Needs for the Development and Strengthening
of the Epidemiology and Surveillance System
1.Baseline Assessment Report or Situational Analysis Section of
the Local Investment Plan for Health (LIPH) containing at
least the following:
a. Status of Epidemiology and Surveillance Unit (ESU)
and personnel at the provincial, city, and municipal
levels, including hospitals
b. Referral and coordination system among the ESUs
within the Province-Wide/City-Wide Health System
(P/CWHS), including the availability of Information
and Communication Technology (ICT) equipment,
transportation and communication facilities, and
specimen courier/ transport
¢. Compliance with reporting requirements as prescribed
in the Manual of Operations of Disease Surveillance/
Reporting System
(Note: The LGUs may consider incorporating this in the Baseline
Assessment Report under LG 2 KRA 1.1)
IL. Organizational Level
KRA 2.1: Epidemiology and Surveillance Units (ESUs) with Dedicated Personnel Competent on Basic
Epidemiology, Disease Surveillance, and Event-Based Surveillance
1. Signed Ordinance or Executive Order for the creation
of Ordinance or Executive Order No:
Provincial/City ESU (P/CESUs)

2. Signed Executive Order or Office Order designating or Executive Order or Office Order
appointment letter hiring at least the following personnel for No:
the P/CESU:
a. One (1) Disease Surveillance Officer
b. One (1) epidemiology assistant of an allied health
profession

Note: This form must be encoded and signed prior to submission.

Page 1 of 3
 No. of P/CESU staff who
completed the minimum basic
training requirements as
prescribed by EB/ RESU:
3. List of dedicated P/CESUstaff withtraining certificate/s
issued by Epidemiology Bureau (EB) / Regional ESU

—
(RESU) on the following: Total no. of P/CESU staff:
a. Basic Epidemiology

~~
b. Event-Based Surveillance
c. Disease Surveillance Percentage of P/CESU staff who
completed the minimum basic
training requirements as
prescribed by EB/ RESU:

No. of LGU hospitals within the

P/CWHS with established HESU:
List of LGU hospitals within the P/CWHS with signed
Ordinance, Executive Order or Hospital Order on the
establishment of Hospital Epidemiology and Surveillance Total no. of LGU hospitals within
Unit (HESU) and updated hospital organizational structure the P/CWHS:
reflecting the HESU
Percentage of LGU hospitals
within the P/CWHS with
established HESU:
KRA 2.2: Presence of Technical Guidelines/Manual of Operations on Epidemi ology and Surveillance System
1. Provincial/City Health Board-approved technical
guidelines/manual of operations on epidemiology and
surveillance system with the following minimum contents:
a. Case detection, notification, and investigation
b. The flowof case reporting and information feedback
¢. Data management, analysis, report generation
d. Response to health event ofpublic health concern
III. Functional Level
KRA 3.1: Full Implementation of the Epidemiology and Surveillance System Technical Guidelines/Manual of
Operations
1. Budget allocation for the implementation of epidemiology and
surveillance system technical guidelines/manual of Ordinance No:
operations as reflected in an ordinance or work and financial
plan
KRA 3.2: Monitoring of PPCWHS Performance on Epidem iology and Surveillance System
1. Timely and complete submission of Field Health Services
Information System (FHSIS) as prescribed in the FHSIS
Manual of Operations
2. Timely and complete submission of Case-based Surveillance Total number of Weekly
Reports and complete and accurate surveillance databases Notifiable Disease Reports
through Philippine Integrated Disease Surveillance and submitted:
Response (PIDSR) as required in the PIDSR Manual of
Procedures
3. Approved and signednotifiable disease surveillance reports,
specifically:
a. Case-based surveillance reports (PIDSR/ HSS) as
Indicate if the P/CWHS
specified in the PIDSR/ HSS Manual of Procedures
encountered a public health
b. Event-based surveillance reports (ESR) as specified in
the ESR Manual of Procedures, as needed emergency/ disaster within the
FY: (Yes/ No)
4. Epidemiologic/ outbreak reports, as needed

Note: This form must be encoded and signed prior to submission.

Page 2 of 3
 Summary of Progress

Level of Progress

Preparatory Level
Organizational Level
Functional Level
Total No. of KRAs
1

2
2
(cite
ith
:

no.) (cite
Coing
hcB EE no.)
eiop )

Total No. of KRAs 5

Recommended Interventions/ Assistance Needed

Recommended Interventions/
KRA :
Timeframe Expected Output Person/ Unit
: :
Responsible
Technical Assistance Needed
KRA 1.1

KRA 2.1

KRA 2.2

KRA 3.1

KRA 3.2

Assessed by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit
Date:

Validated by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit

Date:

Note: This form must be encoded and signed prior to submission.

Page 3 of 3
 ANNEX C

Local Health Systems Maturity Levels Monitoring Tool

Building Block: Medical Products, Vaccines, and Technology

MPVT 1 Characteristic: Procurement and Supply Chain Management

Instructions:
1. Under the Status column, indicate the status of the means of verification (MOVs):
a. Achieved — with approved document or target in dicated was met
b. On-going — with an available draft document or
target was not met but with existing initiatives already
¢. Not yet started — no existing initiatives yet to achieve the Key Result Areas (KRAs)
2. Under the Remarks column, fill in the required fields, as applicable. May also include other monitoring notes.
3. Under the Summary of Progress table, indicate the status of each KRA based on the status of its MOV. If a KRA has
multiple MOVs:
a. All MOVs have the same status - include the KRA in the appropriate column
b. MOVs have different status - include the KRA under the On-going column
4. MOVs tagged as needed shall only be provided with a status if applicable. Otherwise, please indicate “not applicable”.
5. Reports and Lists submitted as MOVs should be duly signed by the Provincial/ City Health Officer or authorized
representative.
6. Inthe Recommended Interventions/ Assistance Needed table, indicate the specific interventions that should be
carried out and/or technical assistance needed to facilitate the attainment of the KRAs.
7. Sign the tool and indicate the date.
Status
Means of Verification (Achieved/ On-going/ Remarks
Not yet started)
I.
Preparatory Level
KRA 1.1: Baseline Assessment, Gaps Analysis, and Investment Needs for the Development and Strengthening of
the Procurement and Supply Chain Management System
1. Baseline Assessment Report or Situational Analysis Section
of
the Local Investment Plan for Health (LIPH) containing at least
the following:
a. Supply/stock of medicines, vaccines, and other health
commodities
b. Availability of designated areas for proper storage of
supplies, such as warehouses
¢. Trained personnel on procurement and supply chain
management
d. LGU hired licensed pharmacist/ pharmacy assistant vis a
vis list of health facilities
e. Availability of transport network vehicle service

(Note: The LGUs may consider incorporating this in the Baseline

Assessment Report under LG 2 KRA 1.1)

KRA 1.2: Presence of a Pharmacy and Therapeutics Commi ttee (PTC)

1. Signed Provincial/ City Health Board (P/CHB) Resolution or
Executive Order (EO) on the creation of the PTC with clearly P/CHB Resolution or EO No:
defined functions relating to procurement and supply chain
management system of the P/ICWHS
II. Organizational Level
KRA 2.1: Presence of PPCWHS Procurement Plan
1.Signed procurement plan on medicines, vaccines and other
health commodities of the P/ICWHS
(Note: This plan should be based on the approved LIPH/AOP of the
P/CWHS)
KRA 2.2: Presence of Technical
Guidelines/ Manual on Harmonized Supply C hain Management System
I. P/CHB approved technical guidelines/ manual on the
implementation of the harmonized supply chain management
system with the following minimum provisions:

Note: This form must be encoded and signed prior to submission.

Page 1 of 3
 a. Delineation of functions and accountabilities among
member LGUs
b. Warehousing, distribution centers, and consumption
monitoring
c. Inventory management
Transportation strategies
e. Proper storage and disposal of medicines and health
commodities, including expired products
KRA 2.3: Presence of Pharmacist/ Pharmacy Assistant
1. List of existing licensed pharmacist/ pharmacy assistant (LGU-
hired and DOH-deployed) vis-a-vis list of health facilities within
the P/ICWHS

KRA 2.4: Presence of Dedicated Trained Personnel on Supply Chain Management in the P/CHO
1. Signed office order designating or appointment letter hiring If with Office Order, indicate the no.:
dedicated personnel on supply chain management in the P/CHO
No. of dedicated personnel with
certificate/s on supply chain
management:

Total no. of dedicated supply chain

2. List of dedicated supply chain management personnel with
certificate/s on supply chain management management personnel:

Percentage of dedicated personnel with

certificate/s on supply chain
management:

III. Functional Level

KRA 3.1: Interoperable electronic supply chain/ logistics management system within the PPCWHS
1.Report generated through an electronic supply chain/ logistics
management system
KRA 3.2: Monitoring of P/ACWHS Performance on Procurement and Supply Chain Management
Report on the availability of essential medicines in all public
1.
health facilities as represented by % ofpublic health facilities
With no stock-outs
(Note: This report should be included in the P/CWHS Annual
Accomplishment Report stated in LG I KRA 3.3)
2. Report on near-expiry medicines, vaccines, and health
commodities, including the batch number/ lot number, and name
of manufacturer and distributor/ supplier

Summary of Progress

Level of Progress Total No. of KRAs Achieved On-Going Not yet started
(cite specific KRA no.) (cite specific KRA no.) (cite specific KRA no.)
Preparatory Level
Organizational Level [Moro

Functional Level
Total No. of KRAs

Note: This form must be encoded and signedprior to submission.

Page 2 of 3
 Ka
KRA 1.1

KRA 1.2

KRA 2.1

KRA 2.2

KRA 2.3

KRA 24
|
Recommended Interventions/ Assistance Needed

aes Tmtame bectoupn henOo

KRA 3.1

KRA 3.2

Assessed by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit

Date:

Validated by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit

Date:

Note: This form must be encoded and signed prior to submission.

Page 3 of 3
 ANNEX C
Local Health Systems Maturity Levels Monitoring Tool

22
Building Block: Service Delivery
SD 1 Characteristic: Referral System

Instructions:
1. Under the Status column, indicate the status of the means of verification (MOVs):
Achieved — with approved document
a. or target indicated was met
On-going — with an available draft document or target was not met but with existing initiatives already
b.
c. Not yet started — no existing initiatives yet to achieve the Key Result Areas (KRAs)
2. Under the Remarks column, fill in the required fields, as applicable. May also include other monitoring notes.
3. Under the Summary of Progress table, indicate the status of each KRA based on the status of its MOV. If a KRA has
multiple MOVs:
a. All MOVs have the same status - include the KRA in the appropriate column
b. MOVs have different status - include the KRA under the On-going column
4. MOVs tagged as needed shall only be provided with a status if applicable. Otherwise, please indicate “not applicable”.
5. Reports and Lists submitted as MOVs should be duly signed by the Provincial/ City Health Officer or authorized
representative.
6. Inthe Recommended Interventions/ Assistance Needed table, indicate the specific interventions that should be
carried out and/or technical assistance needed to facilitate the attainment of the KRAs.
7. Sign the tool and indicate the date.

Status
Means of Verification (Achieved/ On-going/ Remarks
Not
yet started)
I. Preparatory Level
KRA 1.1: Assessment of Existing Two-Way Referral System
1. Baseline Assessment Report or Situational Analysis Section
of
the Local Investment Plan for Health (LIPH) containing at least
the following:
a. Status of DOH licensing and PhilHealth accreditation of
health facilities within the Province/ City-Wide Health
System (P/CWHS)
b. Communication and transportation arrangements,
including the presence of a licensed ambulance and
medical transport vehicle, and emergency hotline/ call
center
¢. Availability of referral guidelines and case management
protocols

(Note: The LGUs may consider incorporating this in the Baseline

Assessment Report under LG 2 KRA 1.1)

KRA 1.2: Groupings/ Clustering of Health Care Providers and Facilities

1. of grouped/ clustered RHUs/Health Centers and their

List
referral hospitals

KRA 1.3: Identification of Potential Apex Hospital/s

1. List of potential Apex Hospital/s of the P/CWHS

Organizational Level
11.
KRA 2.1: Presence of Technical Guidelines/ Manual on Referral System
L.Provincial/City Health Board (P/CHB)-approved technical
guidelines/ manual on implementation of the referral system with
the following minimum provisions:

Note: This form must be encoded and signed prior to submission.

Page 1 of 4
 a. Directory of health facilities, including service
capabilities, available services, and corresponding
prices, operating hours, and contact details
b. Roles and responsibilities of the referring and referral
facilities, and other identified stakeholders
¢. Communication and transportation arrangements
d. Standard referral forms to be used
KRA 2.2: Adoption and Implementation of Clinical Practices Guidelines (CPGs) and other Case Management
Protocols in the P/CWHS
1. P/CHB-approved compendium of CPGs and other case

management protocols adopted and implemented in the P/CWHS

KRA 2.3: Presence of PPCWHS Health Facility Development Plan

1. P/CHB-approved Health facility development plan of the

P/CWHS
(Note: The programs, projects, and activities should be included in the
LIPH)

KRA 2.4: Presence of Public Health Unit (PHU) in LGU Hospitals

No. of LGU hospitals within the
P/CWHS with PHU:

Total no. of LGU hospitals within the

1.List of LGU hospitals within the P/CWHS with signed
Executive Order (EO) or Hospital Order on the creation P/CWHS:
of PHU
Percentage of LGU hospitals within
the P/CWHS with PHU:

KRA 2.5: Partnership with Apex Hospital/s

Name/s of Apex Hospital/s:
1. Signed Memorandum of Agreement (MOA) with Apex 1.
Hospital/s 2.

KRA 2.6: Registration of Indigents to a Primary Care Provider (PCP) within the P/CWHS
No. of indigents included in NHTS-
PR who are registered to a PCP:
Total no. of indigents included in
1. List ofindigents registered to a PCP NHTS-PR within the P/CWHS:

Percentage of indigents included in

NHTS-PR within the P/CWHS who
are registered to a PCP:
KRA 2.7: Presence of Technical Guidelines on Customer Feedback Mechanism
P/CHB-approved technical guidelines on customer feedback
1.
mechanism, including standard form and data utilization
mechanisms

111. Functional Level

KRA 3.1: Monitoring of PPCWHS Performance on Referral System
1. Reports on the following:
a. Rate (%0) of coordinated referrals:
i. PCPN to referral facilities (secondary/ tertiary)
ii. Referral facilities (secondary/ tertiary) to other
referral facilities (secondary/ tertiary) or Apex
hospital/s
iii. Referral facilities or Apex hospital/s to PCPN
b. Leading causes of referrals
c. Declined referrals
Note: This form must be encoded and signed prior to submission.
Page 2 of 4
 i. Percentage of referrals that were declined
it. Top reasons for declined referrals
e to referral facilities (secondary/ tertiary)
® to Apex hospitals
d. Patient satisfaction rating on service delivery

Notes:
1. This report should be included in the P/CWHS Annual
Accomplishment Report stated in LG 1 KRA 3.3
2. Applicability of data disaggregation will depend on the level of
health facilities and services within the P/CWHS
KRA 3.2: Registration of all Constituents to a PCP within the PPCWHS
No. of constituents who are registered
to a PCP:

Total no. of constituents of the

1. List of constituents registered to a PCP
P/CWHS:
Percentage of constituents who are
registered to a PCP:

Summary of Progress

Level of Progress Total No. of KRAs Achieved On-Going Not yet started
(cite specific KRA4 no.) (cite specific KRA no.) (cite specific KRA no.)
Preparatory Level 3

Organizational Level 7
Functional Level 2
Total No. of KRAs 12

Recommended Interventions/ Assistance Needed

Recommended Interventions/ Person/ Unit

KRA Timeframe Expected Output
Technical Assistance Needed Responsible
KRA 1.1

KRA 1.2

KRA 1.3

KRA 2.1

KRA 2.2

KRA 23

KRA 24

KRA 2.5

KRA 2.6

KRA 2.7

KRA 3.1

Note: This form must be encoded and signedprior to submission.

Page 3 of 4
 Recommended Interventions/
KR
Technical Assistance Needed imine
)
Expected Output
Person/ Unit
Responsible
KRA 3.2

Assessed by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit

Date:

Validated by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit
Date:

Note: This form must be encoded and signed prior to submission.

Page 4 of 4
 ANNEX C

Local Health Systems Maturity Levels

Monitoring Tool
Building Block: Service Delivery
SD 2 Characteristic: Disaster Risk Reduction Management
in Health (DRRM-H) System
Instructions:
1. Under the Status column, indicate the
status of the means of verification (MOVs):
a. Achieved — with approved document
or the target indicated was met
b. On-going — with an available
draft document or target was not met but with
¢. Not yet started — no existing initiatives existing initiatives already
yet to achieve the Key Result Areas
N Under the Remarks column, fill in the (KRAs)
required fields, as applicable. May also include other
3. Under the Summary of Progress table, indicate monitoring notes.
the status of cach KRA based on the status
multiple MOVs: of its MOV. If a KRA has
a. All MOVs have the same status - include
the KRA in the appropriate column
b. MOVs have different
status - include the KRA under the On-going column
4. MOVs tagged as needed shall
5. Reports and Lists submitted
only be provided with
a status if applicable. Otherwise, please indicate “not
as MOVs should be duly signed by the Provincial/
applicable”.
representative. City Health Officer or authorized
6. Inthe Recommended Interventions/ Assistance
Needed table, indicate the specific interventions that
carried out and/or technical assistance needed should be
to facilitate the attainment of the KRAs.
7. Sign the tool and indicate the date.

Status
Means of Verification (Achieved/ On-
going/ Not yet Remarks
I. started)
Preparatory Level
KRA 1.1: Baseline Assessment and Gaps
Analysis on the Implementation of the DRRM-H
1.
System
Accomplished Baseline/ Assessment and Situational
Analysis
(BASA) Report or other similar reports

Notes:
1.Report done by the LGUs, the Center Jor Health
the Central Office not earlier than 2019 Development or
may be presented
2. Any form
of preliminary report that shows the current status and
identified gaps and needs for DRRM-H System institutionalization
II. Organizational Level
KRA 2.1: Organized Province-Wide/ City-Wide DRRM-H
System
I. Ordinance or P/CHB Resolution
on the organization of Ordinance No. or P/CHB Resolution No:
DRRM-H System in P/CWHS

2. Office Order designating or appointing the DRRM-H Office Order No:

Manager
3. P/ICWHS DRRM-H Plan is approved and
disseminated as
evidenced by:
a. Approved and signed DRRM-H Plan
b. Documentation of planning activities and dissemination
activities on the DRRM-H Plan

4. Health Emergency Response Teams

(HERT) organized and
trained on minimum trainings for the P/CWHS
as evidenced by: Office Order No:
a. Office Order organizing the HERT
for Public Health
and Hospital
b. Certificate of Completion/Participation (C OC/COP) of
HERTs on DRRM-H Trainings Training Public Hospital
Note: Health Team
Team Members
1. Threshold on the number of HERT members
required to attend the Members
Jollowing trainings. For the UHC IS to have
an “Achieved” status for
this MOV at this level, ALL
requirements must be met: BLS
_%
Training SFA
Public Health Hospital %
Note: This form must be encoded and
signed prior to submission.

Page 1
of §
 Team Members Team
Member.
embers _%
At least 40%
oy i
At least 15%
At least 5% -
—%
HSFD - %
At least 5% -

- At least 5%

HSFD (Hospital Safe from

- At least 5%
Disaster)
2. Basic
Trainingsrequired of the Public Health and Hospital
HERTs
Public Health and Hospital
*
Training: BLS SFA, Health
|

Emergency Response Operations

* Public Health T, raining: Sub-national
|

PHEMAP
*
Hospital Training: MCIM, HSFD
3. CHD through the
DRRM-H Manager shall only submit
HERT members verified with the list of
COC/COP on Public Health and
Hospital Trainings upon monitoring to the
Central Office.
5. Essential health
emergency commodities (HECs) available
and accessible as evidenced by inventory of HECs and/or
other
supporting documents
Note: The in ventory
may include the Jollowing:
*
Assorted Drugs/Medicine (any medicine
that are anti-
infective, analgesic, antipyretic,
Sluids/electrolytes,
respiratory, and other dietary/nutritional
* First Aid Kit products)
*
Hygiene Kit
* WASH Kit (water drinking
container and disinfectant)
* WASH Equipment (portable
water testing)
*
Nutrition in Emergencies Supplies
*
Medical Supplies and Equipment
*
Personnel Protective E. quipment
*
Emergency Go Bag
*
Dedicated ambulance or patient
transport vehicle Jor mass
casualty incidents and during
emergencies/disasters
*
Generator set/s
*
Handheld radios
* Tents

Indicate if the P/CWHS

encountered an
emergency/disaster (Yes or No):

6. Functional Emergency Operations Center

(EOC) as Within the FY:
evidenced by:
EE
Order on activating an EOC with
a. Office
Raised Code Alert Level (Yes
command and control, coordination
functional or No):
and communication based
on Code Alert level, qs needed
Please specify the Code Alert
Level:

—
Office Order No:

b. Emergency Operations Center Report,

as needed
Note: This form must be encoded
and signed prior to submission.

Page 2 of 5
 7.Local government investment plan
earmarking budget for the
DRRM-H System and its operations
Note: May include Local Development
Investment Plan (LDIP),
Local Investment Plan Sor Health (LIPH),
Annual Operational Plan
(AOP), etc.

KRA 2.2: Monitoring of Province/ City-Wide Health

System (P/CWHS) Per formance on DRRM-H
1. Program System
Implementation Review (PIR) Reports issued
annually reflecting the recommendations)
concerns raised
during the previous PIR, as well as actions taken
I11. Functional Level
KRA 3.1: Advanced Province-Wide/ City-Wide
DRRM-H System
1. PICWHS DRRM-H Plan is updated and
tested as evidenced
by: Record Revision Year and No:
a. Updated and tested DRRM-H Plan
b. Documentation of drills and exercises
applied in
updating of DRRM-H Plan
2. HERT sustained for the P/CWHS
as evidenced by:
a. Certificate of C ompletion/Participation
of HERTs on
DRRM-H Trainings
Note:
1. Threshold on the number of HERT members
required to attend the
Jollowing trainings. For the UHC IS to have an “Achieved”
status for
this MOV
at
this level, ALL requirements must be met: Publi g

Training Public Health Team Health Team

Hospital Team
Members Members Team Members
Members
BLS At
least 80%
%
SFA —
At least 20%
%
HERO At least 20%
Sub-national At least 20% - | %

PHEMAP Sub-
national
_% _

MCIM PHEMAP
- At least 20%
HSFD MCIM
- At least 20% -
_%
2. Basic Trainings required of the Public Health and HSFD
Hospital HERTs - %
* Public Health and Hospital Training: BLS SFA,
Health
Emergency Response Operations
* Public Health Training: Sub-national PHEMAP
*
Hospital Training: MCIM, HSFD
3. CHD through the DRRM-H
Manager shall only submit the list of
HERT members verified with COC/COP
on Public Health and
Hospital Trainings upon monitoring to the Central Office.
b. Deployment/ Mission Order on HERT mobilization Indicate if the P/ACWHS encountered
including “report from thefield by the HERTs”, an
as emergency/disaster (Yes or No):
needed

Within the FY:

Office Order No:

3. Executive Order/ Office Order on the
organization of the Executive Order No. or Office No:
following Health Clusters with members/
representatives,
identified roles and responsibilities, and rules
of engagements,
including accomplishment reports from each cluster
as needed:
* Public Health! Medical including Minimum
Initial
Service Package for Sexual Reproductive
Health
* Nutrition in Emergencies
®
Water, Sanitation, and Hygiene in
Emergencies; and
Note: This form must be encoded and
signed prior to submission.

Page 3 of §
 Mental Health and Psychosocial Support
*

4. MOA/MOU specifying resource

sharing and/or mobilization
Jor service delivery in emergencies/disasters
Note: Resource sharing and/or mobilization
for Service
Delivery in emergencies/disaster may include the
health services, among others: following
*
pre-hospital care (triage; treatment- first aid &
management of injuries, medical emergencies and
trauma care among others; including packaging
of
patients for transport to health Jacilities);
» field management (arrangements for field
implementation facility);
"
management of victims in temporary shelters or
evacuation centers; and
management of hospital surge
®

Indicate if the P/CWHS encountered an

5. .
Approved final report on major emergencies and disasters, as
; .
;
emergency/disaster
gency. ( (Yes or No):
needed

Within the FY:

6.Office Order authorizing members
of DRRM-H Program
Management Team with defined roles and responsibilities Office Order No:

7. Appropriation ordinance or approved work and

financial
plan reflecting budget allocation Jor the sustainable
implementation of DRRM-H System and its
operations
KRA 3.2: Monitoring of P/CWHS Performance
on DRRM-H System
1. Budget Utilization Reports on the implementation
of the
DRRM-H System and its operations
2. Documentation of lessons learned, best
practices and
innovations on DRRM-H institutionalization

Summary of Progress

Level of Progress Total No. of KRAs Achieved

(cite specific KRA no.)
On-Going Not yet started
(cite specific KRA no.) (cite specific KRA no.)
Preparatory Level 1

Organizational Level 2
Functional Level 2
Total No. of KRAs 5

Recommended Interventions/ Assistance Needed

Rha Recommended Interventions/

Technical Assistance Needed Timeframe
:

Expected Output Person/ Unit

Responsible
KRA 1.1

KRA 1.2

KRA 2.1

KRA 2.2

KRA 3.1

KRA 3.2

Note: This form must be encoded and

signed prior to submission.

Page 4 of 5
 Assessed by: <PRINT NAME AND SIGNATURE>
<Designation> Name of Office/ Unit

Date:

Validated by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit

Date:

Note: This form must be encoded and

signed prior to submission.
Page 5 of 5
 ANNEX C
Local Health Systems Maturity Levels Monitoring Tool
Building Block: Service Delivery
SD 3 Characteristic: Health Promotion Programs or Campaigns

Instructions:
1. Under the Status column, indicate the status of the means of verification (MOVs):
a. Achieved — with approved document or target indicated was met
b. On-going — with an available draft document or target was not met but with existing initiatives already
c. Not yet started — no existing initiatives yet to achieve the Key Result Areas (KRAs)
2. Under the Remarks column, fill in the required fields, as applicable. May also include other monitoring notes.
3. Under the Summary of Progress table, indicate the status of each KRA based on the status of its MOV. If a KRA has
multiple MOVs:
a. All MOVs have the same status - include the KRA in the appropriate column
b. MOVs have different status - include the KRA under the On-going column
4. MOVs tagged as needed shall only be provided with a status if applicable. Otherwise, please indicate “not applicable”.
5. Reports and Lists submitted as MOVs should be duly signed by the Provincial/ City Health Officer or authorized
representative.
6. Inthe Recommended Interventions/ Assistance Needed table, indicate the specific interventions that should be
carried out and/or technical assistance needed to facilitate the attainment of the KRAs.
7. Sign the tool and indicate the date.

Status
Means of Verification (Achieved/ On-going/ Remarks
Not yet started)
I. Preparatory Level
KRA 1.1: Baseline Assessment on Functional Health Literacy
1. Baseline Assessment Report or Situational Analysis Section of
the Local Investment Plan for Health (LIPH) containing the
status offunctional health literacy of
the catchment population
(Note: The LGUs may consider incorporating this in the Baseline
Assessment Report under LG 2 KRA 1.1)

KRA 1. 2: Presence of a Health Promotion Committee (HPC)

1. Signed Executive Order (EO) on the creation of the HPC with
Executive Order No:
clearly defined functions relating to the implementation of
proactive and effective health promotion programs or campaigns
KRA 1. 3: Barangay Health Workers (BHWs) as barangay Health Promotion Officers
1. Signed SP Resolution on the strengthened role of BHWSs as
SP Resolution No:
barangay health promotion officers and members of the P/CWHS’
Primary Care Provider Network
KRA 1.4: Implementation of Population-wide Health Promotion Programs
Self-Appraisal Checklist:
1. Accomplished copy of the self-appraisal checklist (DM 2021-
0068) for at least one (1) HPFS priority area Health Promotion Program #1
® HPFS Priority Area:

(Note: The LHS Health Promotion Playbook may continue to be utilized e Complete Health Promotion Action
as a tool in implementing Population-wide Health Promotion Programs. Areas (“Yes” to all HP action area
Documentation on the implementation of at least one (1) module of the
LHS Health Promotion Playbook shall utilize the self-appraisal items)?
checklist (DM 2021-0068).) oYes oNo
II. Organizational Level
KRA 2.1: Presence of Health Promotion Unit (HPU) in the Provincial/ City Health Office (P/CHO)

1. Signed Ordinance or EO on the creation of the HPU in the Ordinance or HO Ne:

P/CHO

Note: This form must be encoded and signed prior to submission.

Page 1 of 4
 KRA 2.2: Presence of PPCWHS Health Promotion Framework Strategy (HPFS)

1. Signed SP Resolution adopting the HPFS (2021-2030) SP Resolution No:

KRA 2.3: Implementation of Population-wide Health Promotion Programs

1. Accomplished
copy of the self-appraisal checklist (DM 2021- Self-Appraisal Checklist:
0068) for at least three (3) HPFS priority areas
Health Promotion Program #2
© HPFES Priority Area:
(Note: The LHS Health Promotion Playbook may continue to be utilized
as a tool in implementing Population-wide Health Promotion Programs.
Documentation on the implementation of at least three (3) modules of
the LHS Health Promotion Playbook shall utilize the self-appraisal * Complete Heqih SromgHon Aston
checklist (DM 2021-0068). Areas ( Yes” to all HP action area
items)?
oYes oNo
Health Promotion Program #3
® HPFS Priority Area:

e Complete Health Promotion Action

Areas (“Yes” to all HP action area
items)?
oYes oNo

Functional Level
I11.
KRA 3.1: Capacitated to Participate in the Health Impact Assessment (HIA) Review Process

1. List of P/CHB members with a certificate of completion in at

least one (1) learning module on reviewing HIA Reports and
Public Health Management and Mitigation Plan
(Note: “Achieved” status shall be marked as >50% of P/CHB members
having a certificate of completion.)

KRA 3.2: Implementation of Population-wide Health Promotion Programs

1. Accomplished copy of the self-appraisal checklist (DM 2021-
Self-Appraisal Checklist:
0068) for all seven (7) HPFS priority areas
Health Promotion Program #4
(Note: The LHS Health Promotion Playbook may continue to be
utilized as
a tool in implementing Population-wide Health Promotion
® HPFS Priority Area:

yh
Programs. Documentation on the implementation of all seven (7)
modules of the LHS Health Promotion Playbook shall utilize the self-
appraisal checklist (DM 2021-0068).) *
motion Action
items)?
o Yes © No
Health Promotion Program #5
o HPFS Priority Area:

e Complete Health Promotion Action

Areas (“Yes” to all HP action area
items)?
oYes oNo
Health Promotion Program #6
® HPFS Priority Area:

e Complete Health Promotion Action

Areas (“Yes” to all HP action area
items)?
Note: This form must be encoded and signed prior to submission.
Page 2 of 4
 o Yes o No

Health Promotion Program #7

o HPFS Priority Area:

eo
Complete Health Promotion Action
Areas (“Yes” to all HP action area
items)?
o Yes o No

KRA 3.3: Monitoring of Province/ City-Wide Health System (P/CWHS) Performance on the Implementation of
Health Promotion Programs or Campaigns

1. Annual accomplishment report on health promotion program

implementation submitted to DILG and DOH
(Note: This report should be included in the P/CWHS Annual
Accomplishment Report stated in LG 1 KRA 3.3)

2.Compendium of policies, programs, and campaigns

implemented, including documentation of community action and
social mobilization initiatives within the P/CWHS

Summary of Progress

Level of Progress Achieved On-Going Not yet started

Total No. of KRAs
(cite specific KRA no.) (cite specific KRA no.) (cite specific KRA no.)
Preparatory Level 4
Organizational Level 3
Functional Level 3

Total No. of KRAs 10

Recommended Interventions/ Assistance Needed

Recommended Interventions/ Person/ Unit

KRA Timeframe Expected Output
Technical Assistance Needed Responsible
KRA 1.1

KRA 1.2

KRA 1.3

KRA 1.4

KRA 2.1

KRA 2.2

KRA 2.3

KRA 3.1

Note: This form must be encoded and signed prior to submission.

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 KRA 3.2

KRA 3.3 |

Assessed by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit

Date:

Validated by: <PRINT NAME AND SIGNATURE>

<Designation> Name of Office/ Unit

Date:

Note: This form must be encoded and signed prior

to submission.
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